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Association of night shift work and biological ageing: the mediating role of body mass index. 夜班工作与生物衰老的关系:体重指数的中介作用。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae242
Wenqi Shen, Lingli Cai, Jiang Li, Ying Sun, Bin Wang, Ningjian Wang, Yingli Lu

Background: We aimed to examine whether current and lifetime night shift work is associated with accelerated biological ageing and the potential role of body mass index (BMI) in mediating the association.

Methods: Data were sourced from the UK Biobank cohort. This study included participants who reported detailed information on their current work schedule and had complete data to calculate PhenoAge. The outcome of interest was biological ageing, measured by PhenoAge acceleration. Multivariable linear regression models were conducted to test the relationship between night shift work and biological ageing. Mediation analyses were performed.

Results: Of the 182 064 participants included, the mean age was 52.6 years, and 51.1% were male. After adjustment for chronological age and sex, compared with day workers, shift workers without night shift, irregular night shift workers and permanent night shift workers were associated with 0.59-, 0.87- and 1.30-year increase in biological ageing, respectively (P for trend <.001). Considering the lifetime work schedule, participants who worked night shifts >10 years and participants who worked >8 night shifts each month showed increased biological age acceleration [>10 years: β = 0.54, 95% confidence interval (CI) 0.29-0.79; >8 times/month: β = 0.29, 95% CI 0.07-0.50]. The mediation analysis showed that BMI mediated the associations between night shift work and biological age acceleration by 36%-53%.

Conclusions: We showed that night shift work was associated with accelerated biological ageing. Our findings highlight the interventions on appropriate shift work schedules and weight management in night shift workers, which may slow the biological ageing process and ultimately reduce the burden of age-related diseases.

背景:我们旨在研究当前和终生夜班工作是否与加速生物衰老有关,以及体重指数(BMI)在调节这种关联中的潜在作用:数据来源于英国生物库队列。方法:数据来源于英国生物库队列。这项研究的参与者详细报告了他们目前的工作时间安排,并提供了计算 PhenoAge 的完整数据。研究结果是生物老化,通过 PhenoAge 加速度进行测量。我们建立了多变量线性回归模型,以检验夜班工作与生物衰老之间的关系。还进行了中介分析:在 182 064 名参与者中,平均年龄为 52.6 岁,51.1% 为男性。在对实际年龄和性别进行调整后,与白班工人相比,无夜班的轮班工人、不定时夜班工人和长期夜班工人的生物衰老分别增加了 0.59 年、0.87 年和 1.30 年(P 为 10 年趋势),每月夜班次数大于 8 次的参与者的生物衰老加速度增加[大于 10 年:β = 0.54,95% 置信区间(CI)为 0.29-0.79;大于 8 次/月:β = 0.29,95% 置信区间(CI)为 0.07-0.50]。中介分析表明,体重指数对夜班工作与生物年龄加速度之间的关联有36%-53%的中介作用:我们的研究结果表明,夜班工作与加速生物衰老有关。结论:我们的研究结果表明,夜班工作与生物衰老加速有关。我们的研究结果突出表明,对夜班工人进行适当的轮班工作时间安排和体重管理干预,可延缓生物衰老过程,最终减轻老年相关疾病的负担。
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引用次数: 0
New horizons in hospital-associated deconditioning: a global condition of body and mind. 医院相关失调症的新视野:一种全球性的身心状况。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae241
Carly Welch, Yaohua Chen, Peter Hartley, Corina Naughton, Nicolas Martinez-Velilla, Dan Stein, Roman Romero-Ortuno

Hospital-associated deconditioning is a broad term, which refers non-specifically to declines in any function of the body secondary to hospitalisation. Older people, particularly those living with frailty, are known to be at greatest risk. It has historically been most commonly used as a term to describe declines in muscle mass and function (i.e. acute sarcopenia). However, declines in physical function do not occur in isolation, and it is recognised that cognitive deconditioning (defined by delayed mental processing as part of a spectrum with fulminant delirium at one end) is commonly encountered by patients in hospital. Whilst the term 'deconditioning' is descriptive, it perhaps leads to under-emphasis on the inherent organ dysfunction that is associated, and also implies some ease of reversibility. Whilst deconditioning may be reversible with early intervention strategies, the long-term effects can be devastating. In this article, we summarise the most recent research on this topic including new promising interventions and describe our recommendations for implementation of tools such as the Frailty Care Bundle.

与医院相关的体力衰退是一个广义的术语,非特指因住院而导致的身体任何功能的衰退。众所周知,老年人,尤其是体弱者,面临的风险最大。它历来最常用于描述肌肉质量和功能的下降(即急性肌肉疏松症)。然而,身体机能的衰退并不是孤立发生的,人们认识到,认知功能减退(定义为精神处理延迟,是一个范围的一部分,其一端是急性谵妄)是住院病人经常遇到的情况。虽然 "衰竭 "一词具有描述性,但它可能会导致对与之相关的固有器官功能障碍重视不够,而且还暗示着某种程度上的可逆性。虽然通过早期干预策略可以逆转衰竭,但其长期影响可能是毁灭性的。在这篇文章中,我们总结了有关这一主题的最新研究,包括有前景的新干预措施,并介绍了我们对实施衰弱护理包等工具的建议。
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引用次数: 0
Reimagining and rebranding advance care planning 重新构想和打造预先护理规划
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-24 DOI: 10.1093/ageing/afae233
Chetna Malhotra
Advance care planning (ACP) has traditionally aimed at ensuring that patients’ end-of-life (EOL) wishes are understood and respected. However, recent literature raises concerns about its effectiveness, with many trials indicating that ACP does not significantly improve goal-concordant care, enhance quality of life or reduce healthcare costs. This is because patients’ future decisions are influenced by their transient preferences due to projection bias. To remain relevant, ACP requires a radical shift in perspective, implementation and branding. First, ACP’s mission must be redefined with a focus on: Educate, Share and Prepare. This perspective emphasises ongoing conversations about patient health and illness, sharing of patients’ current values and goals of care and preparation for the future, rather than making definitive future decisions. Second, ACP should be integrated into routine care, normalising these discussions. Simplifying ACP processes and shifting incentives to support shared responsibility among stakeholders can enhance integration. Last, rebranding ACP as ‘Advance Care Preparation’ can clarify its purpose, distinguishing it from EOL planning and increasing its uptake. This rebranding ensures that ACP meets the evolving needs of patients and their families, ultimately enhancing the quality of care and patient satisfaction. These changes in perspective, implementation and branding can transform ACP into a valuable tool for delivering compassionate, patient-centred healthcare, making it relevant to all individuals.
传统上,预先护理计划(ACP)旨在确保患者的临终(EOL)意愿得到理解和尊重。然而,最近的文献引起了人们对其有效性的担忧,许多试验表明,预先护理规划并不能显著改善目标一致的护理、提高生活质量或降低医疗成本。这是因为由于预测偏差,患者未来的决定会受到其短暂偏好的影响。为了保持其相关性,ACP 需要在视角、实施和品牌方面进行彻底转变。首先,必须重新定义 ACP 的使命,将重点放在:教育、分享和准备上:教育、分享和准备。这一观点强调就患者的健康和疾病进行持续对话,分享患者当前的价值观和护理目标,并为未来做好准备,而不是做出明确的未来决定。其次,应将 ACP 纳入常规护理,使这些讨论正常化。简化 ACP 流程并转变激励机制以支持利益相关者共同承担责任,可以加强整合。最后,将 ACP 重新命名为 "预先护理准备 "可以明确其目的,将其与临终关怀规划区分开来并提高其使用率。这一品牌重塑可确保 ACP 满足患者及其家属不断变化的需求,最终提高护理质量和患者满意度。这些观点、实施和品牌方面的改变可以将 ACP 转变为提供富有同情心、以患者为中心的医疗保健服务的重要工具,使其与所有人息息相关。
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引用次数: 0
“Research happens a lot in other settings—so why not here?” A qualitative interview study of stakeholders’ views about advance planning for care home residents’ research participation "研究在其他环境中经常发生,为什么这里没有?一项定性访谈研究,探讨利益相关者对养老院居民参与研究的预先规划的看法
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-24 DOI: 10.1093/ageing/afae235
Brittany Nocivelli, Fiona Wood, Kerenza Hood, Carolyn Wallace, Victoria Shepherd
Background Underrepresentation of care home residents in research has resulted in a poorer evidence base for health care in care homes. Fewer opportunities to take part in research, as well as assumptions made by others about their interest or wishes, creates challenges for residents’ inclusion in research. Early discussions about research preferences and wishes may be beneficial. This qualitative study aimed to explore stakeholders’ views about how care home residents can be supported to communicate their wishes about research participation. Method Semi-structured interviews were conducted with 25 stakeholders: care home residents (n = 5), relatives (n = 5), care home staff (n = 5), other health and social care professionals who work with care homes (n = 6), and care home researchers (n = 4). Interviews were conducted virtually or face-to-face and data were analysed using thematic analysis. Results Views about resident research participation, the barriers and facilitators to their inclusion, and the role of advance research planning were iteratively organized into three themes: (i) We’re of no value to research; (ii) Research is difficult; and (iii) Advance research planning: good in theory, challenging in practice. Subthemes were also identified, and findings were discussed with a Patient and Public Involvement group for additional reflections. Conclusions Stakeholders identified a number of barriers to including care home residents in research, including knowing their preferences about research. The development of interventions to facilitate communication that can be adapted to individuals’ requirements are needed to support discussions and decision-making with care home residents about wishes and preferences for future research participation.
背景 护理院住户在研究中的代表性不足,导致护理院医疗保健的证据基础较差。参与研究的机会较少,以及他人对其兴趣或意愿的假设,都为将院友纳入研究带来了挑战。及早讨论研究偏好和意愿可能会有所裨益。本定性研究旨在探讨利益相关者对如何支持护理院住户表达其参与研究意愿的看法。研究方法 对 25 名利益相关者进行了半结构化访谈,包括:护理院居民(5 人)、亲属(5 人)、护理院员工(5 人)、与护理院合作的其他医疗和社会护理专业人员(6 人)以及护理院研究人员(4 人)。访谈以虚拟或面对面的方式进行,采用主题分析法对数据进行分析。结果 关于居民参与研究的观点、纳入居民的障碍和促进因素以及预先研究规划的作用被反复整理成三个主题:(i) 我们对研究没有价值;(ii) 研究很难;(iii) 预先研究规划:理论上很好,实践中很难。此外,还确定了次主题,并与患者和公众参与小组讨论了研究结果,以便进行更多反思。结论 利益相关者指出了让护理院居民参与研究的一些障碍,包括了解他们对研究的偏好。有必要开发可适应个人需求的干预措施来促进沟通,以支持与护理院居民就未来参与研究的愿望和偏好进行讨论和决策。
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引用次数: 0
Retrospective evaluation of the world falls guidelines-algorithm in older adults 对世界老年人跌倒指南算法的回顾性评估
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-18 DOI: 10.1093/ageing/afae229
Bob van de Loo, Martijn W Heymans, Stephanie Medlock, Ameen Abu-Hanna, Nathalie van der Velde, Natasja M van Schoor
Background The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own. Methods We included data from 1509 adults aged ≥65 years from the population-based Longitudinal Aging Study Amsterdam. The outcome was ≥1 fall during 1-year follow-up, which was ascertained using fall calendars. The screening tools’ items were retrospectively operationalized using baseline measures, using proxies where necessary. Results Sensitivity ranged between 30.9–48.0% and specificity ranged between 77.0–88.2%. Operationalizing the algorithm with the 3KQ instead of fall history yielded a higher sensitivity but lower specificity, whereas operationalization with the Clinical Frailty Scale (CFS) classification tree instead of Fried’s frailty criteria did not affect predictive performance. Compared to the WFG algorithm, the AGS/BGS algorithm and fall history on its own yielded similar predictive performance, whereas the 3KQ on their own yielded a higher sensitivity but lower specificity. Conclusion The WFG algorithm can identify patients at risk of a fall, especially when the 3KQ are included in its operationalization. The CFS and Fried’s frailty criteria may be used interchangeably in the algorithm’s operationalization. The algorithm performed similarly compared to other screening tools, except for the 3KQ on their own, which have higher sensitivity but lower specificity and lack clinical recommendations per risk category.
背景 《世界跌倒指南》(WFG)提出了一种将患者分为低危、中危和高危的算法。我们评估了 WFG 算法的不同操作方法,并将其预测性能与其他跌倒筛查工具进行了比较,这些工具包括:美国老年医学会和英国老年医学会(AGS/BGS)算法、3KQ 本身以及跌倒史本身。方法 我们纳入了阿姆斯特丹人口纵向老龄化研究中 1509 名年龄≥65 岁的成年人的数据。结果是在 1 年的随访中跌倒次数≥1 次,并通过跌倒日历进行确认。筛查工具的项目通过基线测量进行回顾性操作,必要时使用替代物。结果 灵敏度在 30.9-48.0% 之间,特异度在 77.0-88.2% 之间。用 3KQ 代替跌倒史来操作该算法,灵敏度较高,但特异性较低;而用临床虚弱量表(CFS)分类树代替弗里德的虚弱标准来操作该算法,并不会影响预测效果。与 WFG 算法相比,AGS/BGS 算法和跌倒史本身的预测效果相似,而 3KQ 本身的灵敏度较高,但特异性较低。结论 WFG 算法可以识别有跌倒风险的患者,尤其是在将 3KQ 纳入其操作中时。在算法的操作中,CFS 和 Fried 的虚弱标准可以互换使用。与其他筛查工具相比,除了 3KQ 本身的灵敏度较高但特异性较低,而且缺乏对每个风险类别的临床建议外,该算法的表现类似。
{"title":"Retrospective evaluation of the world falls guidelines-algorithm in older adults","authors":"Bob van de Loo, Martijn W Heymans, Stephanie Medlock, Ameen Abu-Hanna, Nathalie van der Velde, Natasja M van Schoor","doi":"10.1093/ageing/afae229","DOIUrl":"https://doi.org/10.1093/ageing/afae229","url":null,"abstract":"Background The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own. Methods We included data from 1509 adults aged ≥65 years from the population-based Longitudinal Aging Study Amsterdam. The outcome was ≥1 fall during 1-year follow-up, which was ascertained using fall calendars. The screening tools’ items were retrospectively operationalized using baseline measures, using proxies where necessary. Results Sensitivity ranged between 30.9–48.0% and specificity ranged between 77.0–88.2%. Operationalizing the algorithm with the 3KQ instead of fall history yielded a higher sensitivity but lower specificity, whereas operationalization with the Clinical Frailty Scale (CFS) classification tree instead of Fried’s frailty criteria did not affect predictive performance. Compared to the WFG algorithm, the AGS/BGS algorithm and fall history on its own yielded similar predictive performance, whereas the 3KQ on their own yielded a higher sensitivity but lower specificity. Conclusion The WFG algorithm can identify patients at risk of a fall, especially when the 3KQ are included in its operationalization. The CFS and Fried’s frailty criteria may be used interchangeably in the algorithm’s operationalization. The algorithm performed similarly compared to other screening tools, except for the 3KQ on their own, which have higher sensitivity but lower specificity and lack clinical recommendations per risk category.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Realising the right to rehabilitation—commentary on ‘reablement, rehabilitation, recovery: everyone’s business’ 实现康复权--关于 "重新适应、康复、恢复:人人有责 "的评论
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-14 DOI: 10.1093/ageing/afae228
Hendry Anne
Rehabilitation is a core component of comprehensive geriatric assessment and should be central to integrated care and support across the whole system. Yet access barriers and ageist practices still prevail within many rehabilitation services. This commentary reflects on a report and recommendations published by the British Geriatrics Society in May 2024. As lead author for the report, I share my personal reflection on the key messages and take this opportunity to thank the multidisciplinary contributors. Reablement, Rehabilitation, Recovery: everyone’s business describes why rehabilitation matters to older people and their caregivers. It provides evidence and examples of practice at different care touchpoints and makes the case that rehabilitation is everyone’s business and knows no boundaries, whether by condition, profession, care setting or taxonomy. The report sets out 12 key actions for health and care systems to deliver effective and integrated rehabilitation as a right for all older people, wherever and whenever they need it. To realise that right, health and care professionals must work together, and with their local community partners, to build capacity and capability for reablement, rehabilitation and recovery across the whole workforce. With population ageing and many more people living with frailty or multimorbidity, there is an urgent need for greater investment in rehabilitation to prevent, delay or reduce disability, caregiver burden and demand for long-term care. This timely BGS report should be essential reading for all who plan, commission, provide or assure health and care services for older people.
康复是老年病综合评估的核心组成部分,应成为整个系统中综合护理和支持的核心。然而,在许多康复服务机构中,获取康复服务的障碍和年龄歧视的做法仍然普遍存在。本评论反映了英国老年医学会于 2024 年 5 月发布的一份报告和建议。作为该报告的主要作者,我与大家分享我个人对其中关键信息的思考,并借此机会向多学科的撰稿人表示感谢。疗养、康复、恢复:每个人的事 "描述了为什么康复对老年人及其照护者很重要。报告提供了不同护理接触点的实践证据和实例,并说明康复是每个人的事,不分病情、职业、护理环境或分类标准。报告为医疗和护理系统提出了 12 项关键行动,以提供有效的综合康复服务,并将其作为所有老年人的一项权利,无论他们何时何地需要康复服务。为了实现这一权利,医疗和护理专业人员必须与当地社区合作伙伴通力合作,在整个工作队伍中建立起重新适应、康复和恢复的能力。随着人口老龄化和越来越多的人体弱多病,我们迫切需要加大对康复的投资,以预防、延缓或减少残疾、护理人员的负担和对长期护理的需求。对于所有为老年人规划、委托、提供或保证医疗和护理服务的人员来说,这份及时的英国医疗服务管理局报告应该是必不可少的读物。
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引用次数: 0
Effects of controlled supramaximal high-intensity interval training on muscle capacities and physical functions for older adults: analysis of secondary outcomes from the Umeå HIT study—a randomised controlled trial 受控超大强度高强度间歇训练对老年人肌肉能力和身体机能的影响:乌默奥 HIT 研究--随机对照试验的次要结果分析
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-14 DOI: 10.1093/ageing/afae226
Erik Frykholm, Mattias Hedlund, Clemens Becker, Henrik Holmberg, Bengt Johansson, Jochen Klenk, Nina Lindelöf, Ulrich Lindemann, Emma Simonsson, Carl-Johan Boraxbekk, Erikx Rosendahl
Objective This study investigated the effectiveness of supramaximal high-intensity interval training (supramaximal HIT) on muscle capacities and physical function compared to moderate-intensity training (MIT) for older adults. Methods Sixty-eight older adults (66–79 years, 56% women), not engaged in regular exercise, were randomised to 3 months of twice-weekly supramaximal HIT (20 minutes including 10 × 6-second intervals) or MIT (40 minutes including 3 × 8-minute intervals). Both groups performed the training on stationary bicycles in a group setting. Target intensity was watt-controlled, with standardised cadence and individualised resistance. Outcomes analysed with linear-mixed models included leg power (Nottingham Power Rig), hand grip strength (Jamar dynamometer), static and dynamic balance (One leg stance, 30-second step test), chair stand (30-second chair stand), and anaerobic cycling performance (modified Borg Cycle Strength Test). Results Baseline values were (supramaximal HIT/MIT, mean ± SD) leg power 198 ± 60/189 ± 53 W, hand grip strength 4.2 ± 1.0/4.3 ± 1.1 N/kg, static balance 64 ± 41/62 ± 41 s, dynamic balance 39 ± 7/38 ± 5 steps, chair stands 22 ± 6/22 ± 6 and anaerobic cycling performance 224 ± 60/217 ± 55 W. At 3-month follow-up, a between-group difference in favour of supramaximal HIT [95% CI] was observed in anaerobic cycling performance of 19[3;35] W. Within-group mean changes for supramaximal HIT/MIT were for leg power 8.4[0.9;15.8]/6.0[−1.3;13.3] W, hand grip strength 0.14[0.00;0.27]/0.13[−0.01;0.26] N/kg, static balance 11[3;20]/10[1;18] s, dynamic balance 1.6[0.3;2.8]/2.3[1.1;3.6] steps, 2.1[1.1;3.1]/1.4[0.4;2.3] chair stands and anaerobic cycling performance 31.3[19.6;43.0]/12.0[0.4;23.5] W. Conclusion Supramaximal HIT showed superior effect on anaerobic cycling performance when compared to MIT. Additionally, the results indicate that supramaximal HIT is comparably beneficial as MIT in terms of effects on muscle capacity and physical function for older adults.
目的 本研究调查了超大强度高强度间歇训练(超大强度 HIT)与中等强度训练(MIT)相比对老年人肌肉能力和身体功能的影响。方法 对 68 名没有定期锻炼的老年人(66-79 岁,56% 为女性)随机进行为期 3 个月的每周两次超大强度 HIT(20 分钟,包括 10 × 6 秒间歇)或 MIT(40 分钟,包括 3 × 8 分钟间歇)训练。两组均在固定自行车上进行集体训练。目标强度由瓦特控制,采用标准化的速度和个性化的阻力。采用线性混合模型分析的结果包括腿部力量(诺丁汉力量仪)、手部握力(贾马测力计)、静态和动态平衡(单腿站立、30 秒台阶测试)、椅子站立(30 秒椅子站立)和无氧骑行成绩(改良博格自行车力量测试)。结果 基线值为(超极限 HIT/MIT,平均值 ± SD)腿部力量 198 ± 60/189 ± 53 W,手部握力 4.2 ± 1.0/4.3 ± 1.1 N/kg,静态平衡 64 ± 41/62 ± 41 秒,动态平衡 39 ± 7/38 ± 5 步,椅子站立 22 ± 6/22 ± 6,无氧骑行成绩 224 ± 60/217 ± 55 W。在 3 个月的随访中,观察到无氧骑车成绩的组间差异为 19[3;35] W,而超大负荷 HIT 的组间差异为[95% CI]。超极限 HIT/MIT 的组内平均变化为:腿部力量 8.4[0.9;15.8]/6.0[-1.3;13.3] W,手部握力 0.14[0.00;0.27]/0.13[-0.01;0.26] N/kg,静态平衡 11[3;20]/10[1;18] s,动态平衡 1.6[0.3;2.8]/2.3[1.1;3.6]步、2.1[1.1;3.1]/1.4[0.4;2.3]椅站立和无氧骑行成绩 31.3[19.6;43.0]/12.0[0.4;23.5] W。此外,研究结果表明,就对老年人肌肉能力和身体机能的影响而言,超极限 HIT 与 MIT 的益处相当。
{"title":"Effects of controlled supramaximal high-intensity interval training on muscle capacities and physical functions for older adults: analysis of secondary outcomes from the Umeå HIT study—a randomised controlled trial","authors":"Erik Frykholm, Mattias Hedlund, Clemens Becker, Henrik Holmberg, Bengt Johansson, Jochen Klenk, Nina Lindelöf, Ulrich Lindemann, Emma Simonsson, Carl-Johan Boraxbekk, Erikx Rosendahl","doi":"10.1093/ageing/afae226","DOIUrl":"https://doi.org/10.1093/ageing/afae226","url":null,"abstract":"Objective This study investigated the effectiveness of supramaximal high-intensity interval training (supramaximal HIT) on muscle capacities and physical function compared to moderate-intensity training (MIT) for older adults. Methods Sixty-eight older adults (66–79 years, 56% women), not engaged in regular exercise, were randomised to 3 months of twice-weekly supramaximal HIT (20 minutes including 10 × 6-second intervals) or MIT (40 minutes including 3 × 8-minute intervals). Both groups performed the training on stationary bicycles in a group setting. Target intensity was watt-controlled, with standardised cadence and individualised resistance. Outcomes analysed with linear-mixed models included leg power (Nottingham Power Rig), hand grip strength (Jamar dynamometer), static and dynamic balance (One leg stance, 30-second step test), chair stand (30-second chair stand), and anaerobic cycling performance (modified Borg Cycle Strength Test). Results Baseline values were (supramaximal HIT/MIT, mean ± SD) leg power 198 ± 60/189 ± 53 W, hand grip strength 4.2 ± 1.0/4.3 ± 1.1 N/kg, static balance 64 ± 41/62 ± 41 s, dynamic balance 39 ± 7/38 ± 5 steps, chair stands 22 ± 6/22 ± 6 and anaerobic cycling performance 224 ± 60/217 ± 55 W. At 3-month follow-up, a between-group difference in favour of supramaximal HIT [95% CI] was observed in anaerobic cycling performance of 19[3;35] W. Within-group mean changes for supramaximal HIT/MIT were for leg power 8.4[0.9;15.8]/6.0[−1.3;13.3] W, hand grip strength 0.14[0.00;0.27]/0.13[−0.01;0.26] N/kg, static balance 11[3;20]/10[1;18] s, dynamic balance 1.6[0.3;2.8]/2.3[1.1;3.6] steps, 2.1[1.1;3.1]/1.4[0.4;2.3] chair stands and anaerobic cycling performance 31.3[19.6;43.0]/12.0[0.4;23.5] W. Conclusion Supramaximal HIT showed superior effect on anaerobic cycling performance when compared to MIT. Additionally, the results indicate that supramaximal HIT is comparably beneficial as MIT in terms of effects on muscle capacity and physical function for older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer: the ELCAPA-EDS cohort study 用医院虚弱风险评分预测癌症老年人的虚弱领域损伤和死亡率:ELCAPA-EDS 队列研究
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-14 DOI: 10.1093/ageing/afae222
Charline Jean, Elena Paillaud, Pascaline Boudou-Rouquette, Claudia Martinez-Tapia, Frédéric Pamoukdjian, Meoïn Hagège, Stéphane Bréant, Claire Hassen-Khodja, Pierre-André Natella, Tristan Cudennec, Marie Laurent, Philippe Caillet, Florence Canouï-Poitrine, Etienne Audureau
Background Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. Methods This retrospective, linkage-based study included patients aged ≥70 years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016–2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6 months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10 days, 30-day readmission, and mortality. Results Among 587 patients included (median age 82 years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS&gt;5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Discussion Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.
背景 医院虚弱风险评分(HFRS)等自动虚弱筛查工具主要针对护理消耗结果进行验证。我们以老年医学 8(G8)筛查工具为临床基准,评估了 HFRS 对老年癌症患者的护理消耗结果、虚弱领域损伤和死亡率的预测能力。方法 这项基于链接的回顾性研究纳入了年龄≥70岁的实体瘤患者,他们都参加了老年癌症患者(ELCAPA)多中心队列研究(2016-2020年),并在大巴黎大学医院接受了急诊住院治疗。HFRS评分包括医院获得性问题和虚弱相关综合征,通过索引入院和之前6个月的数据计算得出。在纳入 ELCAPA 时进行了多领域老年评估 (GA),包括认知、营养、情绪、功能状态、活动能力、合并症、多药治疗、大小便失禁和社会环境,并计算出 G8 分数。逻辑回归和 Cox 回归测量了 G8、HFRS、GA 领域改变、住院时间超过 10 天、30 天再入院和死亡率之间的关系。结果 在纳入的 587 名患者(中位年龄为 82 岁,转移性癌症患者占 47.0%)中,有 237 人(40.4%)的 HFRS(HFRS&gt;5)和 261 人(47.5%)的 G8(G8≤10)存在虚弱风险增加的情况。HFRS 和 G8 均与认知和功能障碍、大小便失禁、合并症、住院时间延长和 30 天死亡率密切相关。G8 与多药、营养和情绪障碍有关。讨论 虽然 HFRS 与短期护理消耗有明显相关性,但它无法识别多重药物、营养、情绪和社会环境损害,而且在所有 GA 领域都显示出较低的判别能力。
{"title":"Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer: the ELCAPA-EDS cohort study","authors":"Charline Jean, Elena Paillaud, Pascaline Boudou-Rouquette, Claudia Martinez-Tapia, Frédéric Pamoukdjian, Meoïn Hagège, Stéphane Bréant, Claire Hassen-Khodja, Pierre-André Natella, Tristan Cudennec, Marie Laurent, Philippe Caillet, Florence Canouï-Poitrine, Etienne Audureau","doi":"10.1093/ageing/afae222","DOIUrl":"https://doi.org/10.1093/ageing/afae222","url":null,"abstract":"Background Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. Methods This retrospective, linkage-based study included patients aged ≥70 years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016–2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6 months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10 days, 30-day readmission, and mortality. Results Among 587 patients included (median age 82 years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS&amp;gt;5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Discussion Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of intergenerational social mobility on brain structure and global cognition: findings from the Whitehall II study across 20 years 代际社会流动对大脑结构和全球认知能力的影响:白厅 II 研究 20 年来的发现
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-12 DOI: 10.1093/ageing/afae221
Yingxu Liu, Benjamin Thyreau, Yuehua Cui, Ye Zhang, Yasuko Tatewaki, Yasuyuki Taki
Background Whether changes in socioeconomic position (SEP) across generations, i.e. intergenerational social mobility, influence brain degeneration and cognition in later life is unclear. Objective To examine the association of social mobility, brain grey matter structure and global cognition. Methods We analysed T1 brain MRI data of 771 old adults (69.8 ± 5.2 years) from the Whitehall II MRI substudy, with MRI data collected between 2012 and 2016. Social mobility was defined by SEP changes from their fathers’ generation to mid-life status. Brain structural outcomes include grey matter (GM) volume and cortical thickness (CT) covering whole brain. Global cognition was measured by the Mini Mental State Examination. We firstly conducted analysis of covariance to identify regional difference of GM volume and cortical thickness across stable high/low and upward/downward mobility groups, followed with diagonal reference models studying the relationship between mobility and brain cognitive outcomes, apart from SEP origin and destination. We additionally conducted linear mixed models to check mobility interaction over time, where global cognition was derived from three phases across 2002 to 2017. Results Social mobility related to 48 out of the 136 GM volume regions and 4 out of the 68 CT regions. Declined volume was particularly seen in response to downward mobility, whereas no independent association of mobility with global cognition was observed. Conclusion Despite no strong evidence supporting direct influence of mobility on global cognition in later life, imaging findings warranted a severe level of neurodegeneration due to downward mobility from their father’s generation.
背景 社会经济地位(SEP)的代际变化,即代际社会流动性,是否会影响晚年的大脑退化和认知能力,目前尚不清楚。目的 研究社会流动性、大脑灰质结构和整体认知能力之间的关系。方法 我们分析了怀特霍尔 II MRI 子研究中 771 名老年人(69.8 ± 5.2 岁)的 T1 脑 MRI 数据,这些 MRI 数据收集于 2012 年至 2016 年。社会流动性是指从父辈到中年的SEP变化。脑结构结果包括覆盖全脑的灰质(GM)体积和皮质厚度(CT)。总体认知能力通过迷你精神状态检查(Mini Mental State Examination)进行测量。我们首先进行了协方差分析,以确定在稳定的高/低流动组和上/下流动组中,大脑灰质体积和皮层厚度的区域差异,然后使用对角参考模型研究除 SEP 来源地和目的地之外的流动与大脑认知结果之间的关系。此外,我们还建立了线性混合模型来检验流动性随时间变化的交互作用,其中全球认知结果来自 2002 年至 2017 年的三个阶段。结果 社会流动性与 136 个 GM 容量区域中的 48 个和 68 个 CT 区域中的 4 个相关。体量的下降尤其与人口向下流动有关,而人口流动与全球认知并无独立关联。结论 尽管没有强有力的证据支持人口流动对晚年整体认知能力的直接影响,但成像结果证明,父辈的人口向下流动导致了严重的神经退化。
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引用次数: 0
The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study 五个欧洲国家居住在社区的老年人孤独与虚弱之间的关系:纵向研究
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-10 DOI: 10.1093/ageing/afae210
Lizhen Ye, Esmee Bally, Sophie A Korenhof, Irene Fierloos, Tamara Alhambra Borrás, Gary Clough, Hein Raat, Amy van Grieken
Background Loneliness is described as the subjective experience of unfulfilled personal and social needs, with emotional and social domains. Frailty is a state of vulnerability to stressors, which is often characterised by impairment in the physical, psychological and/or social domain. Objective This study aims to examine the bidirectional association between loneliness and frailty across the different domains. Methods The study included 1735 older adults from the Urban Health Centres Europe project. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale. Frailty was assessed by the Tilburg Frailty Indicator. Multivariate linear regression and cross-lagged panel models were used to explore the associations between the social and emotional loneliness dimensions and overall, physical, psychological and social frailty. Results A bidirectional association existed between overall loneliness and overall frailty (loneliness to frailty: β = 0.09, 95% CI: 0.03, 0.15; frailty to loneliness: β = 0.05, 95% CI: 0.004, 0.10). Higher levels of overall loneliness at baseline were associated with higher levels of psychological frailty at follow-up (β = 0.05, 95% CI: 0.00, 0.10). The reverse association was not significant. A bidirectional association existed between overall loneliness and social frailty (loneliness to social frailty: β = 0.05, 95% CI: 0.01, 0.10; social frailty to loneliness: β = 0.05, 95% CI: 0.00, 0.09). Conclusion This study confirms the importance of addressing loneliness among older adults. Interventions that increase social support, exercise engagement and promote healthy behaviours may be effective in reducing the risk of frailty among older adults and simultaneously preventing loneliness.
背景 孤独被描述为个人和社会需求得不到满足的主观体验,涉及情感和社会领域。虚弱是一种易受压力影响的状态,通常表现为身体、心理和/或社交方面的损伤。目的 本研究旨在探讨孤独与虚弱之间在不同领域的双向联系。方法 研究对象包括来自欧洲城市健康中心项目的 1735 名老年人。孤独感采用六项目 De Jong Gierveld 孤独感量表进行评估。年老体弱采用蒂尔堡年老体弱指标进行评估。采用多变量线性回归和交叉滞后面板模型来探讨社交孤独和情感孤独维度与总体、身体、心理和社会脆弱性之间的关联。结果 总体孤独感与总体虚弱之间存在双向联系(孤独感与虚弱:β = 0.09,95% CI:0.03,0.15;虚弱与孤独感:β = 0.05,95% CI:0.004,0.10)。基线时总体孤独程度较高与随访时心理虚弱程度较高相关(β = 0.05,95% CI:0.00,0.10)。反向关联并不显著。总体孤独感与社交脆弱之间存在双向关联(孤独感导致社交脆弱:β = 0.05,95% CI:0.01,0.10;社交脆弱导致孤独感:β = 0.05,95% CI:0.00,0.09)。结论 本研究证实了解决老年人孤独问题的重要性。增加社会支持、锻炼参与和促进健康行为的干预措施可有效降低老年人体弱的风险,同时预防孤独。
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Age and ageing
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