Age and ageing最新文献

Background: Ward changes during hospital admissions are associated with poorer outcomes, but their impact on people living with dementia is unknown.

Objective: To examine whether individuals with dementia are more adversely affected by ward changes.

Setting: Four hospitals within a UK NHS Trust.

Subjects: Individuals aged ≥65 years.

Methods: This service evaluation included data from 01/2023-02/2024. Generalised estimating equations were used to fit linear and logistic regression models. Associations between ward changes, dementia status and their interaction on three outcomes-length of stay (LOS), inpatient mortality and discharged to a care home-were examined. Fully adjusted models accounted for demographic, socioeconomic factors and hospital site.

Results: 27,140 admissions, 19,392 unique individuals (2760 with dementia) were included. Mean age at first admission 79.0 (SD 8.1). In the fully adjusted LOS model, both ward changes (β = 5.2, P < .001) and the interaction with dementia (β = 1.7, P < .001) were associated with longer LOS. In the fully adjusted mortality model, dementia was associated with increased risk of mortality (OR = 1.4, P = .013) but there was no interaction effect of ward changes and dementia. In the fully adjusted care home admission model, dementia (OR = 4.4, P < .001) and ward changes (OR = 1.3, P < .001) were associated with increased risk, without evidence of interaction.

Conclusions: Our results suggest that ward changes disproportionately affect LOS, but not mortality or discharge destination, in people living with dementia. Minimising ward transfers may improve outcomes for all older adults but is particularly important in dementia care to reduce the risk of extended LOS and potential associated inpatient harm.

Background: The prevalence and role of frailty in preclinical Alzheimer's disease (AD) is unclear.

Methods: Cross-sectional analyses of pre-randomization data from the Anti-Amyloid Treatment in Asymptomatic AD (A4) study were analysed to derive two models of a frailty index (FI)-full [FI-Full] and cognitive variables removed [FI-CVR]. The prevalence of frailty (FI > 0.25) according to amyloid status (Aβ+/-), and the association of frailty and cognition (determined by the Preclinical Alzheimer Cognitive Composite (PACC) score) and whether frailty moderates the relationship between amyloid status and cognition was assessed, adjusting for age, sex and education.

Results: Four thousand four hundred eighty-six participants were included (mean age 71.3 ± 4.7 years, 30% participants Aβ+, 59% female). The prevalence of frailty in preclinical AD was 22% (or 44% when cognitive variables were removed from the FI). Using either FI model, in adjusted analyses, Aβ+ participants were more likely to be frail compared to Aβ- [FI-Full-Odds ratio (OR) 1.43 95% confidence interval (CI) 1.20-1.71, P < .001; FI-CVR-OR 1.21 95% CI 1.05-1.40, P < .008]. Frail participants had lower PACC scores compared to non-frail participants, on average (FI-Full-PACC score -0.58 95% CI -0.76 to -0.40, P < .001; FI-CVR-PACC score -0.26 95% CI -0.40 to -0.12, P < .001). Frailty did not influence the relationship between Aβ status and cognition.

Conclusions: In a cohort screened for a preclinical AD trial, elevated Aβ levels were associated with frailty and frailty was associated with reduced cognitive performance independent of elevated Aβ levels. These associations, and whether or not frailty is associated with longitudinal cognitive decline independent of Aβ status, warrant further study.

Background: People with dementia are at risk of going missing while walking outdoors, which can significantly affect their safety and well-being. However, evidence on their lived experiences during such incidents, as well as on strategies that may improve care remain limited.

Aim: To conduct a narrative synthesis of qualitative studies exploring the lived experiences and preferences of people with dementia, family carers and professionals in relation to strategies for supporting safe walking and preventing missing episodes in both community and residential care settings.

Methods: Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were systematically searched up to April 2025. Studies were appraised using the Critical Appraisal Skills Programme qualitative research checklist. A narrative synthesis framework was adapted to explore themes emerging within and among studies.

Results: Of the 19 207 articles identified, 25 met the inclusion criteria. Four themes emerged: (a) emotional impact of missing episodes, (b) safe walking as a fundamental need for people with dementia, (c) existing strategies for safe walking and responding to missing episodes and (d) experiences of using technological solutions to prevent and manage missing incidents.

Conclusions: Preventive and reactive strategies, including technological devices, can promote safe walking for people with dementia. There is an urgent need to embed safe walking plans within dementia care packages to mitigate harms associated with missing incidents. Initiatives that raise awareness of risk among people with dementia, carers and professionals should form a core component of clinical practice.

Background: Junior doctors provide much of the day-to-day medical care for hospitalised older patients. However, there is little formal training after medical school to prepare them for the complex assessment and management required. This gap in postgraduate education raises concerns about preparedness and confidence, yet little research has examined junior doctors' views on their learning needs, teaching preferences and factors affecting their education. Understanding these perspectives can inform targeted educational strategies to enhance care of older patients.

Objective: To explore junior doctors' perspectives on learning needs in assessing and managing hospitalised older patients, preferred teaching methods and barriers and facilitators to learning.

Methods: A qualitative study was undertaken at two major teaching hospitals in Sydney, Australia. Data were collected through semistructured interviews. Interviews were transcribed verbatim, and data were thematically analysed.

Results: Sixteen participants were recruited, which included 10 (63%) postgraduate Year 1 doctors, five (31%) Postgraduate Year 2 doctors and one final-year medical student. Five key themes on learning needs were identified: (i) assessment and management of delirium and dementia, (ii) polypharmacy and deprescribing, (iii) complexity of geriatric medicine, (iv) communication with older patients and their families and (v) Ward craft. Regarding learning methods, experiential learning and microlearning were preferred due to their practicality and immediate applicability. Barriers and facilitators included personal, workplace-specific and situational factors.

Conclusion: Junior doctors value ongoing education in geriatric medicine. Harnessing their learning needs and preferences offers an important opportunity to improve care for older patients.

Background: Orthostatic hypotension (OH) increases the risk of dementia. Although intensive blood pressure (BP) lowering may have cognitive benefits regardless of baseline OH status, its effects in participants who develop OH during intervention remain unknown.

Methods: Participants of the Systolic Blood Pressure Intervention Trial (SPRINT) were randomised to either intensive treatment (systolic BP target <120 mmHg) or standard treatment (systolic BP target <140 mmHg). This post hoc analysis defined new-onset OH as a systolic BP reduction ≥20 mmHg and/or a diastolic BP reduction ≥10 mmHg from a seated to a standing position at any follow-up visit during intervention. The primary outcome was probable dementia. Other outcomes included mild cognitive impairment (MCI), and a composite of probable dementia or MCI.

Results: Amongst 7911 participants without OH at baseline (representing 84.5% of randomised participants in SPRINT; mean age, 67.7 years; 34.7% women), 1264 (16.0%) developed new-onset OH during intervention. Intensive treatment was associated with a lower risk of probable dementia (HR, 0.76; 95% CI, 0.58 to 0.98) amongst participants without new-onset OH, but with a higher risk (HR, 2.39; 95% CI, 1.33 to 4.32) amongst participants with new-onset OH. No significant association was observed between intensive treatment and MCI, or the composite outcome in participants with new-onset OH.

Conclusions: The occurrence of OH requires close monitoring, with caution for potential cognitive adverse effects during ongoing intensive BP-lowering treatment. Validation of current findings in studies with justified methodological designs is warranted.

Registration: URL: ClinicalTrials.gov; Unique Identifier: NCT01206062.

Background: The cost of medical care associated with hip fracture has been reported but the cost of social care is less well understood. Social care costs include formal residential and home care and home adaptations, but also informal care from family and friends. This study investigated the utilisation and cost of care beyond acute hospital stays following hip fracture.

Methods: A multi-centre, prospective observational study of patients ≥60 years with a hip fracture in the United Kingdom (UK), with 120-day follow-up. Marginal costs were calculated, with scenario analysis projecting the cost to the UK hip fracture population. A two-part model was used to calculate the incremental mean cost attributable to complications following surgery.

Results: Amongst 16 679 patients with a hip fracture, the mean cost of social care was £15 525 (95% CI: 14 991-16 059) per person. Mean cost per person for the change in residential requirements was £1656 (95% CI: 1568-1743); formal and informal home care £12 849 (95% CI: 12 448-13 250); and home adaptations £1021 (95% CI: 976-1067). The projected national cost of social care in the first 120 days following all hip fractures in the UK was £1.25 billion. Incremental mean cost of social care for patients who developed a surgery-specific or general complication were £1264 (95% CI: 58-2469) and £1418 (95% CI: 792-2043) per person, respectively.

Conclusion: Social care represents a substantial and often under-recognised component of the economic burden following hip fracture. Formal and informal care were major cost drivers after discharge from hospital and may rival or exceed the cost of acute hospital care.

In 2022, two reviews were published in Age & Ageing to summarise and discuss falls prevention interventions. One was a narrative review looking at the past, present and future of falls interventions. The second was a systematic review and meta-analysis of research on adult falls in hospital. This commentary discusses the findings and recommendations of these publications in the context of real world practice using the Hierarchy of Controls framework and case studies from 180 Patient Safety Specialists applying three systems tools and approaches; Systems Engineering Initiative for Patient Safety, Hierarchical Task Analysis and AcciMaps. The reflection on research (published reviews) and practice (case studies) offers an insight for interventions in practice, rather than research. We hope that future researchers and funders in falls prevention will embrace safety science tools/approaches when planning and reviewing project proposals.

Introduction: High blood pressure (BP), functional decline, and cognitive decline commonly co-occur in late life. The temporal dynamics between changes in BP and changes in functional or cognitive status remain unclear. The aim of this study is to explore these temporal dynamics in adults aged 85 years and older using dynamic time warping (DTW).

Methods: This study used data from the Leiden 85-plus Study. BP, functional status and cognitive function were measured at baseline (age 85) and annually over 5 years. Participants with at least three measurements were included (n = 429 of 599). Functional status was assessed using the Groningen Activity Restriction Scale for Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Cognitive function was measured with the Mini-Mental State Examination (MMSE). DTW was applied to assess temporal relationships.

Results: The 429 participants were all aged 85 years at baseline, 69% were female and 39% used antihypertensive medication. Increases in BP over time were associated with later IADL decline, while BP decreases were associated with later IADL improvement (P < .05). Similarly, decreases in diastolic BP over time were associated with later decreases in MMSE, while increases in diastolic BP were linked to later improvements in MMSE (P < .05).

Conclusion: BP changes were associated with subsequent inverse IADL changes over time, while changes in diastolic BP preceded concordant changes in cognitive function. These findings highlight the importance of BP changes in old age, as they might indicate later functional or cognitive decline.