Age and ageing最新文献

Within a week of his 20 January 2025 inauguration, US President Donald J. Trump issued an order that froze all federal grants and loans, creating confusion and anxiety about the future of research and development in US biomedical science. The politicisation of science creates significant challenges not only for the researchers who depend on public funding to undertake their research, but also for the public understanding of why basic research is so important to the health and economic prosperity of the world's ageing populations. In 1944 US President Franklin D. Roosevelt wrote a letter to the director of the Office of Scientific Research and Development, Dr. Vannevar Bush, asking Bush how science and medicine could be best harnessed to win the war of science against disease. Bush's response, in his acclaimed 1945 book entitled Science, The Endless Frontier, detailed how 'scientific capital' determines the pace and shape of technological progress. The war against disease approach to public health and medicine has helped increase life expectancy, by reducing the prevalence of premature death, but it has also contributed to the increasing global healthspan-lifespan gap, which is nearly 10 years. Translational gerontology, and in particular the goal of developing geroprotective drugs that may help fortify the 'biological resilience' needed to increase healthy life expectancy, must become an integral part of a 'wisdom-inquiry' approach to public health and medicine if the aspiration of healthy longevity is to be realised this century.

Background: The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.

Methods: Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.

Results: About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.

Conclusions: Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.

Background: Falls are a leading cause of morbidity and mortality among older adults, often linked to gait and balance impairments.

Objective: To compare gait and balance metrics across fall risk levels in community-dwelling older adults and identify principal components predictive of fall risk.

Design: Retrospective cohort study.

Setting: General community.

Subjects: Three hundred older adults were stratified into low, moderate and high fall risk groups using the STEADI toolkit.

Methods: Gait and balance metrics were compared across groups. Principal component analysis (PCA) reduced dimensionality, and binary logistic regression assessed the predictive value of components.

Results: High-risk individuals showed slower cadence, shorter step length, wider step width, greater gait variability and increased centre of pressure (CoP) and centre of mass (CoM) sway. PCA identified four gait and seven balance components, explaining 71.62% and 75.88% of variance, respectively. Logistic regression revealed Gait_principal component (PC)2 (instability) (OR = 2.545, P < .001), Gait_PC3 (rhythm control) (OR = 1.659, P = .006), Balance_PC1 (CoP sway during single-leg stance) (OR = 1.628, P = .007), Balance_PC2 (CoM sway velocity variability) (OR = 1.450, P = .032) and Balance_PC4 (CoP sway during double-leg stance, eyes closed) (OR = 1.616, P = .004) as significant predictors. The model achieved 77.2% accuracy, with a sensitivity of 73.1% and a specificity of 79.4%.

Conclusions: Gait instability, rhythm control and increased postural sway are key predictors of fall risk. Integrating gait and balance metrics enhances fall risk stratification, supporting clinical decision-making.

Background: Physiological age (PA) derived from clinical indicators including blood-based biomarkers and tests of physiological function can be compared with chronological age to examine disparities in health between older adults of the same age. Though education interacts with sex to lead to inequalities in healthy ageing, their combined influence on longitudinally measured PA has not been explored. We derived PA based on longitudinally measured clinical indicators and examined how sex and education interact to inform PA trajectories.

Methods: Three waves of clinical indicators (2004/05-2012/13) drawn from the English Longitudinal Study of Ageing (ages 50-100 years) were used to estimate PA, which was internally validated by confirming associations with incident chronic conditions, functional limitations and memory impairment after adjustment for chronological age and sex. Joint models were used to construct PA trajectories in 8891 English Longitudinal Study of Ageing participants to examine sex and educational disparities in PA.

Findings: Amongst the least educated participants, there were negligible sex differences in PA until age 60 (sex difference [men-women] age 50 = -0.6 years [95% confidence interval = -2.2 to 0.6]; age 60 = 0.4 [-0.6 to 1.4]); at age 70, women were 1.5 years (0.7-2.2) older than men. Amongst the most educated participants, women were 3.8 years (1.6-6.0) younger than men at age 50 and 2.7 years (0.4-5.0) younger at age 60, with a nonsignificant sex difference at age 70.

Interpretation: Higher education provides a larger midlife buffer to physiological ageing for women than men. Policies to promote gender equity in higher education may contribute to improving women's health across a range of ageing-related outcomes.

Background: Hospitalisation often results in adverse effects in older adults, particularly an increased risk of functional and cognitive decline. Although in-hospital exercise interventions have shown benefits, their impact on intrinsic capacity (IC) remains unknown.

Objective: To assess the effects of multicomponent exercise training on IC in acutely hospitalised older adults.

Design: Pooled analysis of two randomised clinical trials.

Setting: Three Acute Care for Elders units.

Subjects: Hospitalised older adults (≥75 years).

Methods: The control group received standard care, whereas the exercise group participated in an in-hospital multicomponent exercise program. The primary outcome was IC assessed using a composite score (0-100) across five domains: vitality (handgrip strength), cognition (Mini-Mental State Examination), psychological health (Yesavage Geriatric Depression Scale), locomotion (Short Physical Performance Battery) and sensory function (self-reported vision and hearing). Adverse outcomes were evaluated 1 year after discharge, including emergency visits, hospital re-admission and mortality.

Results: A total of 570 patients (age 87.3 ± 4.8 years) were enrolled during acute hospitalisation [median duration 8 (interquartile range = 3) days] and randomised to the exercise (n = 288) or control group (n = 282). The exercise intervention significantly improved IC compared to the control group [7.74 points, 95% confidence interval (CI) 6.45-9.03, P < .001], with benefits observed in all IC domains. IC score at discharge was inversely associated with mortality risk during follow-up (OR = 0.98 per each increase in IC score at discharge, 95% CI = 0.96, 0.99, P = .010), although no association was found with emergency visits (P = .866) or re-admissions (P = .567).

Conclusions: In-hospital exercise is an effective strategy to enhance IC in hospitalised older adults. Additionally, the IC score at discharge was inversely related to the mortality risk within 1 year of discharge.

Personality disorders, characterised by enduring and maladaptive patterns of behaviour, cognition and emotional regulation, affect 1 in 10 older adults. Personality disorders are frequently encountered in geriatric care considering their association with multimorbidity and increased health care utilisation. Patients with personality disorders often receive inadequate somatic health care due to (i) difficulties in expressing their actual symptoms and needs, (ii) challenging interactions with professionals, and (iii) non-compliance with medical treatment and lifestyle advice. Acknowledging personality disorders in geriatric care may improve treatment outcomes of somatic diseases. Since empirical evidence on personality diagnosis and treatment in older adults is scarce, we summarise future endeavours. First, the development of age-inclusive diagnostic tools should be prioritised to ensure comparability across age groups and facilitate longitudinal research over the lifespan. Second, evidence-based treatment approaches should be tailored to older people. Insight-oriented psychotherapies remain effective in later life considering sufficient level of introspection. Supportive and mediative therapies may better suit those with significant cognitive or physical impairments. Geriatric care models should be ideal for managing the complex needs of these patients when a consistent approach can be assured within the geriatric team as well as within the network considering the high level of interdisciplinary exchange needed. Third, considering the dynamic nature of personality disorders older adults should not be excluded from studies using novel technologies for real-time monitoring and personalised care. By addressing these gaps, the field can improve somatic treatment outcomes and uphold the dignity and well-being of older adults with personality disorders.

Background: Recognizing perceived stress as a modifiable risk factor, mindfulness-based programs show promise for stress mitigation in older adults with mild cognitive impairment (MCI).

Objective: To assess the efficacy of a mindfulness-based contextual cognitive defusion training (M-bCCDT) program on perceived stress and other health outcomes, and to examine the reliable and clinically significance of these improvements at individual-level among older adults with MCI.

Design: A two-arm, assessor-blinded randomized controlled trial.

Settings and participants: 102 community-dwelling older adults with MCI.

Methods: Participants were randomly allocated to either a M-bCCDT program (weekly 60-minute sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or health promotion classes. Measures of perceived stress, memory function, global cognitive function, psychomotor speed and mindfulness awareness were collected at baseline (T0), 8-week (T1) and 20-week (T2). Intervention effects were assessed at a group level (Generalized Estimating Equation, GEE) and individual level (Reliable and Clinically Significant Changes, RCSC).

Results: The M-bCCDT program demonstrated significant interaction effects in perceived stress compared to the wait-list control group by GEE analysis (βT1 = -3.686, 95% CI [-5.397, -1.976]; βT2 = -7.608, 95% CI [-9.387, -5.829]). Furthermore, this program also showed significant efficacy in memory function, psychomotor speed and mindfulness awareness. RCSC indicated that 30 participants (59%) in the intervention group showed statistically significant improvement in perceived stress at 8-week, with 7 (14%) clinically significant. This increased to 38 (75%) with 20 (39%) clinically significant at 20-week. Secondary outcomes also showed statistically and clinically significant improvements over time, but no improvement in global cognitive function at the individual level.

Conclusions: The M-bCCDT program positively impacted perceived stress and mindfulness awareness in older adults with MCI, facilitating the improvements in memory and psychomotor speed, with these benefits sustained for 20 weeks. It offers a systematic approach for community healthcare providers in MCI stress management.

Background: The association between changes in physical functions and stroke incidence remains uncertain.

Methods: A total of 7978 participants without stroke from the China Health and Retirement Longitudinal Study (CHARLS) were recruited in 2011-2012 and followed up until 2020. We assessed annual changes in physical functions from 2011 to 2015, including absolute grip strength, relative grip strength, walking speed, chair-rising time and standing balance. The Cox proportional hazards model was applied to assess the longitudinal associations between annual changes in physical functions and stroke. Restricted cubic spline analyses were used to explore the dose-response relationships.

Results: During 71 714 person-years of follow-up, 549 incident stroke cases were reported. For each 1-kg absolute grip strength increment, 0.1-unit relative grip strength increment, or 1-point standing balance test score increment, the hazard of stroke was reduced by 12% [hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.84-0.93], 53% (HR: 0.47; 95% CI: 0.34-0.64), 55% (HR: 0.45; 95% CI: 0.30-0.67), respectively. We found a negative linear dose-response association of the annual change in absolute and relative grip strength with incident stroke, as well as a nonlinear association between the annual change in standing balance and incident stroke. However, neither the annual change in walking speed nor chair-rising time was related to the incident stroke.

Conclusions: A greater improvement in absolute grip strength, relative grip strength or standing balance was suggested to be associated with a lower risk of stroke amongst middle-aged and older people. These objectively measured physical function changes are imperative for high-risk population classification and stroke prevention.