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Modifiable dementia risk associated with smaller white matter volume and altered 1/f aperiodic brain activity: cross-sectional insights from the LEISURE study. 可改变的痴呆症风险与较小的白质体积和改变的 1/f 非周期性大脑活动有关:LEISURE 研究的横断面见解。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-04 DOI: 10.1093/ageing/afae243
Thomas Pace, Jacob M Levenstein, Toomas E Anijärv, Alicia J Campbell, Ciara Treacy, Daniel F Hermens, Sophie C Andrews

Background: The rising prevalence of dementia necessitates identifying early neurobiological markers of dementia risk. Reduced cerebral white matter volume and flattening of the slope of the electrophysiological 1/f spectral power distribution provide neurobiological markers of brain ageing alongside cognitive decline. However, their association with modifiable dementia risk remains to be understood.

Methods: A cross-sectional sample of 98 healthy older adults (79 females, mean age = 65.44) underwent structural magnetic resonance imaging (sMRI), resting-state electroencephalography (EEG), cognitive assessments and dementia risk scoring using the CogDrisk framework. Univariate and multivariate linear regression models were conducted to investigate the relationships between modifiable dementia risk and sMRI brain volumes, the exponent of EEG 1/f spectral power, and cognition, whilst controlling for non-modifiable factors.

Results: Smaller global white matter volume (F(1,87) = 6.884, R2 = 0.073, P = .010), and not grey (F(1,87) = 0.540, R2 = 0.006, P = .468) or ventricle volume (F(1,87) = 0.087, R2 = 0.001, P = .769), was associated with higher modifiable dementia risk. A lower exponent, reflecting a flatter 1/f spectral power distribution, was associated with higher dementia risk at frontal (F(1,92) = 4.096, R2 = 0.043, P = .046) but not temporal regions. No significant associations were found between cognitive performance and dementia risk. In multivariate analyses, both white matter volume and the exponent of the 1/f spectral power distribution independently associated with dementia risk.

Conclusions: Structural and functional neurobiological markers of early brain ageing, but not cognitive function, are independently associated with modifiable dementia risk in healthy older adults.

背景:随着痴呆症发病率的上升,有必要确定痴呆症风险的早期神经生物学标志物。脑白质体积缩小和电生理 1/f 频谱功率分布斜率变平提供了伴随认知能力下降的大脑老化的神经生物学标志。然而,它们与可改变的痴呆症风险之间的关系仍有待了解:98名健康老年人(79名女性,平均年龄=65.44岁)接受了结构性磁共振成像(sMRI)、静息态脑电图(EEG)、认知评估,并使用CogDrisk框架进行了痴呆风险评分。通过单变量和多变量线性回归模型研究了可改变的痴呆风险与sMRI脑容量、脑电图1/f频谱功率指数和认知能力之间的关系,同时控制了不可改变的因素:全球白质体积较小(F(1,87) = 6.884, R2 = 0.073, P = .010),而灰质体积(F(1,87) = 0.540, R2 = 0.006, P = .468)或脑室体积(F(1,87) = 0.087, R2 = 0.001, P = .769)较小,则与较高的可改变痴呆风险无关。指数越低,反映出 1/f 频谱功率分布越平坦,与额叶(F(1,92) = 4.096,R2 = 0.043,P = .046)痴呆风险越高有关,但与颞叶区域无关。认知能力与痴呆症风险之间没有发现明显的关联。在多变量分析中,白质体积和1/f频谱功率分布指数都与痴呆症风险有独立关联:结论:在健康的老年人中,大脑早期老化的结构性和功能性神经生物学标志物(而非认知功能)与可改变的痴呆症风险有独立的关联。
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引用次数: 0
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
Nut consumption and disability-free survival in community-dwelling older adults: a prospective cohort study. 社区老年人的坚果摄入量和无残疾存活率:一项前瞻性队列研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae239
Holly Wild, Madina Nurgozhina, Danijela Gasevic, Alison M Coates, Robyn L Woods, Joanne Ryan, Lawrence Beilin, Thara Govindaraju, John J McNeil, Alice J Owen

Objectives: The relationship between nut intake and disability-free survival (healthy lifespan) in later life is unclear. The objective was to evaluate the association between nut intake and disability-free survival in a cohort of adults aged ≥70 years, and whether this varied according to overall diet quality.

Methods: This prospective cohort study involved 9916 participants from the ASPREE Longitudinal Study of Older Persons. Participants completed a 49-item Food Frequency questionnaire from which frequency of nut intake was obtained and were asked to categories usual intake as no/infrequent [never/rarely, 1-2 times/month], weekly [1-2 times/week, often 3-6 times/week] or daily [every day or several times a day]. The outcome measured was a composite of first-event mortality, onset of dementia, or persistent physical disability. Cox proportional hazards regression models, adjusted for socio-demographic factors, health-related and clinical covariates and overall dietary quality were conducted to examine the association between varying levels of nut intake and disability-free survival.

Results: Over a mean of 3.9 years of follow-up, the risk of reaching the DFS endpoint were 23% lower (HR 0.77 [0.61-0.98]) for those who consumed nuts daily, when compared to those with no/infrequent nut consumption. Subgroup analysis demonstrated a significant association between daily nut consumption and healthy lifespan among individuals in the second dietary quality tertile (HR 0.71[0.51-0.98]).

Conclusion: For community-dwelling adults aged 70 years and over with sub-optimal diets, daily nut consumption is associated with the promotion of healthy lifespan (disability-free survival).

目的:坚果摄入量与晚年无残疾存活率(健康寿命)之间的关系尚不清楚。研究目的是评估一组年龄≥70岁的成年人中坚果摄入量与无残疾生存率之间的关系,以及这种关系是否会因总体饮食质量的不同而有所变化:这项前瞻性队列研究涉及 ASPREE 老年人纵向研究的 9916 名参与者。参与者填写了一份包含 49 个项目的食物摄入频率问卷,其中包括坚果的摄入频率,并被要求将通常的摄入量分为 "没有/不经常"[从不/很少,1-2 次/月]、"每周"[1-2 次/周,经常 3-6 次/周]或 "每天"[每天或每天数次]。测量的结果是首次死亡、痴呆症发病或持续肢体残疾的综合结果。在对社会人口学因素、健康相关变量和临床相关变量以及总体饮食质量进行调整后,建立了考克斯比例危险回归模型,以研究不同水平的坚果摄入量与无残疾存活率之间的关系:在平均 3.9 年的随访中,与不食用/不经常食用坚果的人相比,每天食用坚果的人达到 DFS 终点的风险降低了 23% (HR 0.77 [0.61-0.98])。分组分析表明,在膳食质量第二梯度的人群中,每天食用坚果与健康寿命之间存在显著关联(HR 0.71[0.51-0.98]):结论:对于 70 岁及以上居住在社区、膳食不达标的成年人来说,每天食用坚果与促进健康寿命(无残疾生存)有关。
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引用次数: 0
The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment. 意大利痴呆症和轻度认知障碍诊断与治疗指南。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae250
Elisa Fabrizi, Antonio Ancidoni, Nicoletta Locuratolo, Paola Piscopo, Francesco Della Gatta, Simone Salemme, Sara Maria Pani, Domitilla Marconi, Luca Vignatelli, Luciano Sagliocca, Paolo Caffarra, Piero Secreto, Antonio Guaita, Andrea Stracciari, Nicola Vanacore, Eleonora Lacorte
<p><strong>Introduction: </strong>Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers.</p><p><strong>Methods: </strong>The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed.</p><p><strong>Results: </strong>The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models and care coordination; (iii) pharmacological interventions for cognitive symptoms; (iv) non-pharmacological interventions for cognitive symptoms; (v) non-cognitive symptoms, intercurrent illnesses and palliative care. The multidisciplinary panel discussed and approved 167 clinical practice recommendations and 39 research recommendations.</p><p><strong>Commentary: </strong>Italy's first National Guideline on dementia and MCI addresses diagnosis, treatment and care within the National Healthcare System. It includes recommendations on pharmacological and non-pharmacological approaches, and emphasises tailored interventions, comprehensive cognitive assessment, staff training and palliative care. The guideline also underlines the need to involve PwD in decision-making and supporting caregivers throughout the entire course of the disease.</p><p><strong>Conclusions: </strong>Structured strategies for the dissemination and implemen
简介目前,意大利约有 200 万人患有痴呆症或轻度认知障碍 (MCI),400 万人作为家庭成员或护理人员参与其中。考虑到痴呆症的重大影响,意大利卫生部委托意大利国家卫生研究所(Istituto Superiore di Sanità)在意大利国家指南系统(Sistema Nazionale Linee Guida, SNLG)内制定一份关于痴呆症和 MCI 诊断与治疗的指南。主要目的是提供以证据为基础的建议,旨在减少临床实践的可变性,并确保痴呆症(PwD)或 MCI 患者及其家属/护理人员从识别、诊断到生命终结的整个护理过程中的适当性:采用 GRADE-ADOLOPMENT 方法来采纳、调整和更新美国国家健康与护理卓越研究所于 2018 年制定的指南(NG97)。该方法以 SNLG 编制的《方法手册》为基础。由 29 位专家和 4 位家庭成员/照顾者代表组成的多学科小组讨论并批准了 47 个审查问题。其中,34 个问题采用了 NG97 的内容,13 个为新问题,包括 10 个涉及 MCI 的问题。每个问题都进行了系统的文献综述,由方法学和临床专家组成的团队根据 GRADE 方法对纳入研究的结果进行了定性评估和总结。为促进本指南内容的实施和传播,还专门为残疾人或 MCI 患者及其家属/护理人员制定了护理路径和宣传单:本指南的文献综述包括截至 2023 年 11 月发表的研究。其中包括 1000 多篇经同行评审的出版物,涵盖以下领域:(i) 识别、诊断和诊断后支持;(ii) 护理模式和护理协调;(iii) 认知症状的药物干预;(iv) 认知症状的非药物干预;(v) 非认知症状、并发症和姑息治疗。多学科小组讨论并批准了 167 项临床实践建议和 39 项研究建议:意大利首份痴呆症和 MCI 国家指南涉及国家医疗保健系统内的诊断、治疗和护理。它包括药物治疗和非药物治疗方法的建议,并强调量身定制的干预措施、全面的认知评估、员工培训和姑息治疗。该指南还强调有必要让残疾人参与决策,并在整个病程中为照护者提供支持:2024-2026 年意大利阿尔茨海默氏症和其他痴呆症基金将确定传播和实施该指南的结构化战略。互动式护理路径和专门针对残疾人及其护理者的传单已经面世。该指南将于 2027 年 1 月开始更新,但如果有突破性进展,可能会提前更新。
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引用次数: 0
World delirium awareness and quality survey in 2023-a worldwide point prevalence study. 2023 年世界谵妄意识和质量调查--一项全球点流行率研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae248
Heidi Lindroth, Keibun Liu, Laura Szalacha, Shelly Ashkenazy, Giuseppe Bellelli, Mark van den Boogaard, Gideon Caplan, Chi Ryang Chung, Muhammed Elhadi, Mohan Gurjar, Gabriel Heras-La-Calle, Magdalena Hoffman, Marie-Madlen Jeitziner, Karla Krewulak, Tanja Mailhot, Alessandro Morandi, Ricardo Kenji Nawa, Esther S Oh, Marie Oxenboell Collet, Maria Carolina Paulino, Rebecca von Haken, Peter Nydahl

Background: Delirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia.

Objectives: To report on the global prevalence of clinically documented delirium and delirium-related clinical practices in wards caring for paediatric and adult patients in healthcare facilities.

Design: A prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023.

Participants: Clinicians or researchers with access to clinical data.

Main outcome and measure: The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. (4 h) and 8:00 p.m. (±4 h). Secondary outcomes included delirium-related care practices and barriers to use. Descriptive statistics were calculated and multilevel modelling was completed.

Results: 1664 wards submitted surveys from 44 countries, reporting on delirium assessments at 8:00 a.m. (n = 36 048) and 8:00 p.m. (n = 32 867); 61% reported use of validated delirium assessment tools. At 8:00 a.m., 18% (n = 2788/15 458) and at 8:00 p.m., 17.7% (n = 2454/13 860) were delirium positive. Top prevention measures were pain management (86.7%), mobilisation (81.4%) and adequate fluids (80.4%). Frequently reported pharmacologic interventions were benzodiazepines (52.7%) and haloperidol (46.2%). Top barriers included the shortage of staff (54.3%), lack of time to educate staff (48.6%) and missing knowledge about delirium (38%).

Conclusion and relevance: In this study, approximately one out of five patients were reported as delirious. The reported high use of benzodiazepines needs further evaluation as it is not aligned with best-practice recommendations. Findings provide a benchmark for future quality improvement projects and research.

背景:谵妄是一种急性脑功能障碍:谵妄是一种急性脑功能障碍,在临床护理中非常普遍,并被证明会显著增加死亡和痴呆的风险:报告全球医疗机构儿科和成人病房中临床记录的谵妄发生率以及与谵妄相关的临床实践:在 2023 年 3 月 15 日 "世界谵妄意识日 "当天完成一项 39 个问题的前瞻性横断面调查:主要结果和测量:主要结果是上午 8:00(4 小时)和下午 8:00(±4 小时)有临床记录的谵妄发生率。次要结果包括与谵妄相关的护理措施和使用障碍。我们计算了描述性统计数字,并完成了多层次建模:来自44个国家的1664个病房提交了调查问卷,报告了上午8:00(36 048人)和下午8:00(32 867人)的谵妄评估情况;61%的病房报告使用了有效的谵妄评估工具。早上 8:00 和晚上 8:00 的谵妄阳性率分别为 18%(n = 2788/15 458)和 17.7%(n = 2454/13 860)。最主要的预防措施是止痛(86.7%)、活动(81.4%)和充分输液(80.4%)。经常报告的药物干预措施是苯二氮卓(52.7%)和氟哌啶醇(46.2%)。最大的障碍包括人员短缺(54.3%)、没有时间教育员工(48.6%)和缺乏有关谵妄的知识(38%):在这项研究中,约五分之一的患者被报告为神志不清。苯二氮卓类药物的高使用率需要进一步评估,因为这不符合最佳实践建议。研究结果为今后的质量改进项目和研究提供了基准。
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引用次数: 0
Editor's view-adaptive approaches. 编辑观点--适应性方法。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae260
Nathalie van der Velde
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引用次数: 0
Effectiveness of bivalent mRNA booster vaccination and previous infection in older adults during Omicron period: real-world evidence. 二价 mRNA 强化疫苗接种的效果与 Omicron 期间老年人的既往感染情况:真实世界的证据。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae251
Pedro-Pablo España, Idoia Castillo-Sintes, Maria J Legarreta, Amaia Bilbao-González, Nere Larrea, Maria Gascon, Ane Uranga, Amaia Artaraz, Julia Garcia-Asensio, Jose M Quintana

Background: The effectiveness of booster bivalent vaccines against the Omicron variant, particularly amongst older patients, remains uncertain.

Objective: We sought to compare the relative effectiveness of a fourth dose of vaccine using bivalent messenger ribonucleic acid (mRNA), by comparing patients who had and had not received this dose.

Methods: We conducted a matched retrospective cohort study to assess the risk of COVID-19 infection, hospitalization and death of people aged >60 years with four doses as compared to those with only three doses. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). We adjusted by age, sex, nursing-home, comorbidities, primary care setting and previous episodes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We also investigated the impact of prior SARS-CoV-2 infection within each cohort, using the same methodology.

Results: The administration of a fourth bivalent mRNA vaccine dose conferred significant additional protection against COVID-19 infection (HR: 0.479; 95% CI: 0.454-0.506), hospitalization (HR: 0.393; 95% CI: 0.348-0.443) and 30-day mortality (HR: 0.234; 95% CI: 0.171-0.318), as compared to individuals who had received only a third monovalent vaccine dose. In both cohorts, a prior history of COVID-19 infection involves lower risk of COVID-infection, hospitalization and death.

Conclusions: During the period of Omicron predominance, receiving a bivalent booster vaccine as a fourth dose, as compared to receiving only three doses of a monovalent mRNA vaccine, provides significant extra protection against COVID-19 infection, hospitalization and mortality. Antecedents of SARS-CoV-2 prior to vaccination involves a notable reduction in the above COVID-19 outcomes.

背景:针对奥米克龙变异株的二价强化疫苗的效果仍不确定,尤其是在老年患者中:我们试图通过比较接种过和未接种过二价信使核糖核酸(mRNA)疫苗的患者,来比较接种第四剂疫苗的相对效果:我们进行了一项匹配的回顾性队列研究,评估接种四剂与仅接种三剂的 60 岁以上人群感染 COVID-19 病毒、住院和死亡的风险。研究采用 Cox 比例危险回归模型估算调整后的危险比 (HRs),并得出 95% 的置信区间 (CIs)。我们根据年龄、性别、疗养院、合并症、初级医疗机构和既往严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染病例进行了调整。我们还采用相同的方法调查了每个队列中之前感染 SARS-CoV-2 的影响:结果:与只接种过第三剂单价疫苗的人相比,接种第四剂二价 mRNA 疫苗可显著降低 COVID-19 感染(HR:0.479;95% CI:0.454-0.506)、住院(HR:0.393;95% CI:0.348-0.443)和 30 天死亡率(HR:0.234;95% CI:0.171-0.318)。在这两组人群中,既往有COVID-19感染史的人感染COVID、住院和死亡的风险较低:结论:在 Omicron 流行期间,与只接种三剂单价 mRNA 疫苗相比,接种四剂二价强化疫苗可在 COVID-19 感染、住院和死亡方面提供显著的额外保护。接种疫苗前的 SARS-CoV-2 前兆会显著减少 COVID-19 的上述结果。
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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
Clinical biomarker-based biological ageing and the risk of adverse outcomes in patients with chronic kidney disease. 基于临床生物标志物的生物老化与慢性肾病患者不良预后的风险。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1093/ageing/afae245
Hao Xiang, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin

Objective: Patients with chronic kidney disease (CKD) show features of premature ageing. We aimed to evaluate the association between biological ageing and adverse outcomes, including end-stage kidney disease (ESKD), cardiovascular diseases (CVD) and all-cause mortality, in patients with CKD.

Methods: 23 435 participants with CKD and free of related adverse outcomes at baseline from the UK Biobank were included. Leukocyte telomere length (LTL) was measured by quantitative polymerase chain reaction assay. Clinical biomarker-based biological ages were quantified using Klemera-Doubal method biological age (KDM-BA) and PhenoAge algorithms.

Results: During a median follow-up of 12 years, 3417 incident CVD, 383 incident ESKD and 3195 all-cause mortality were recorded. Per SD increment of KDM-BA acceleration was associated with a 56% [95% confidence interval (CI): 41%-73%], 26% (95% CI: 21%-31%) and 39% (95% CI: 34%-44%) increase in the risk of incident ESKD, incident CVD and all-cause mortality, respectively. Similar results were found for PhenoAge acceleration. LTL (per SD increment) was inversely associated with the risk of incident CVD [hazard ratio (HR): 0.96, 95% CI: 0.92-0.99] and all-cause mortality (HR: 0.94, 95% CI: 0.91-0.98) and was not significantly associated with the risk of incident ESKD (HR: 0.96, 95% CI: 0.86-1.06). Adding KDM-BA acceleration or PhenoAge acceleration, but not LTL, to the traditional validated clinical prediction models significantly improved the predictive performance for incident ESKD, all-cause mortality and CVD.

Conclusion: In patients with CKD, both KDM-BA acceleration and PhenoAge acceleration were associated with an increased risk of ESKD, CVD and all-cause mortality, and KDM-BA or PhenoAge may be a better predictor on adverse outcomes than LTL.

目的:慢性肾脏病(CKD)患者表现出提前衰老的特征。我们旨在评估生物老化与慢性肾脏病患者不良预后(包括终末期肾脏病(ESKD)、心血管疾病(CVD)和全因死亡率)之间的关联。白细胞端粒长度(LTL)通过定量聚合酶链反应测定法进行测量。使用Klemera-Doubal法生物年龄(KDM-BA)和PhenoAge算法对基于临床生物标志物的生物年龄进行量化:结果:在中位 12 年的随访期间,共记录了 3417 例心血管疾病、383 例 ESKD 和 3195 例全因死亡率。KDM-BA加速度每增加一个标准差,发生ESKD、心血管疾病和全因死亡的风险分别增加56%[95%置信区间(CI):41%-73%]、26%(95% CI:21%-31%)和39%(95% CI:34%-44%)。PhenoAge 加速也发现了类似的结果。LTL(每标准差增量)与心血管疾病发病风险[危险比(HR):0.96,95% CI:0.92-0.99]和全因死亡率(HR:0.94,95% CI:0.91-0.98)成反比,与ESKD发病风险无显著相关性(HR:0.96,95% CI:0.86-1.06)。将KDM-BA加速度或PhenoAge加速度(而非LTL)添加到传统有效的临床预测模型中,可显著提高对ESKD事件、全因死亡率和心血管疾病的预测性能:结论:在慢性肾脏病患者中,KDM-BA 加速和 PhenoAge 加速都与 ESKD、心血管疾病和全因死亡率风险的增加有关,KDM-BA 或 PhenoAge 可能比 LTL 更能预测不良后果。
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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
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Age and ageing
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