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.
{"title":"Modifiable dementia risk associated with smaller white matter volume and altered 1/f aperiodic brain activity: cross-sectional insights from the LEISURE study.","authors":"Thomas Pace, Jacob M Levenstein, Toomas E Anijärv, Alicia J Campbell, Ciara Treacy, Daniel F Hermens, Sophie C Andrews","doi":"10.1093/ageing/afae243","DOIUrl":"10.1093/ageing/afae243","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Structural and functional neurobiological markers of early brain ageing, but not cognitive function, are independently associated with modifiable dementia risk in healthy older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Association of night shift work and biological ageing: the mediating role of body mass index.","authors":"Wenqi Shen, Lingli Cai, Jiang Li, Ying Sun, Bin Wang, Ningjian Wang, Yingli Lu","doi":"10.1093/ageing/afae242","DOIUrl":"https://doi.org/10.1093/ageing/afae242","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575156","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}
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).
{"title":"Nut consumption and disability-free survival in community-dwelling older adults: a prospective cohort study.","authors":"Holly Wild, Madina Nurgozhina, Danijela Gasevic, Alison M Coates, Robyn L Woods, Joanne Ryan, Lawrence Beilin, Thara Govindaraju, John J McNeil, Alice J Owen","doi":"10.1093/ageing/afae239","DOIUrl":"10.1093/ageing/afae239","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusion: </strong>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).</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment.","authors":"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","doi":"10.1093/ageing/afae250","DOIUrl":"10.1093/ageing/afae250","url":null,"abstract":"<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","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"World delirium awareness and quality survey in 2023-a worldwide point prevalence study.","authors":"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","doi":"10.1093/ageing/afae248","DOIUrl":"10.1093/ageing/afae248","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023.</p><p><strong>Participants: </strong>Clinicians or researchers with access to clinical data.</p><p><strong>Main outcome and measure: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion and relevance: </strong>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.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editor's view-adaptive approaches.","authors":"Nathalie van der Velde","doi":"10.1093/ageing/afae260","DOIUrl":"https://doi.org/10.1093/ageing/afae260","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685703","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}
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.
{"title":"Effectiveness of bivalent mRNA booster vaccination and previous infection in older adults during Omicron period: real-world evidence.","authors":"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","doi":"10.1093/ageing/afae251","DOIUrl":"https://doi.org/10.1093/ageing/afae251","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of booster bivalent vaccines against the Omicron variant, particularly amongst older patients, remains uncertain.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685704","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}
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.
{"title":"New horizons in hospital-associated deconditioning: a global condition of body and mind.","authors":"Carly Welch, Yaohua Chen, Peter Hartley, Corina Naughton, Nicolas Martinez-Velilla, Dan Stein, Roman Romero-Ortuno","doi":"10.1093/ageing/afae241","DOIUrl":"10.1093/ageing/afae241","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Clinical biomarker-based biological ageing and the risk of adverse outcomes in patients with chronic kidney disease.","authors":"Hao Xiang, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin","doi":"10.1093/ageing/afae245","DOIUrl":"10.1093/ageing/afae245","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612399","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}
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.
{"title":"Reimagining and rebranding advance care planning","authors":"Chetna Malhotra","doi":"10.1093/ageing/afae233","DOIUrl":"https://doi.org/10.1093/ageing/afae233","url":null,"abstract":"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.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489743","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}