Aging Clinical and Experimental Research最新文献

Background: Low back pain (LBP) is a global health problem that contributes to disability, psychological distress, and reduced quality of life in older adults. Current treatment guidelines for LBP support the use of conservative therapies such as physical therapy alongside medication management. However, interventional pain management strategies for LBP such as lumbar epidural steroid injection (LESI) are rarely mentioned.

Aims: We conducted this systematic review to characterize and evaluate the use and effectiveness of LESI amongst older adults with LBP.

Methods: We conducted a systematic English-language literature search of Ovid MEDLINE, Ovid EMBASE, and Cochrane Library. We used an iterative approach to identify both keywords and controlled vocabulary related to treatment outcomes of epidural interventions for LBP among older adults. The results were reviewed by three members of the team.

Results: Our search of 3 databases produced a total of 2657 studies and 12 met final inclusion criteria. In all studies, the use of LESI was associated with improvement in pain and/or quality of life.

Discussion: As compared to medication management, LESI was associated with statistically significant improvements in pain and functional status. The addition of physical therapy was not superior to LESI alone.

Conclusions: This systematic review is the first that focuses on the effectiveness of LESI in managing LBP in older adults. This review suggests that LESI may reduce pain and improve functional status in older adults, particularly as compared to medication management.

Prospero registration: The study was prospectively registered on Prospero (ID # 422087).

Clinical trial number: Not Applicable.

Background: Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis (AS) in older patients, including nonagenarians. This study aimed to examine perioperative changes in frailty among nonagenarian patients undergoing TAVI.

Methods and results: In this single-center observational analysis, 38 consecutive nonagenarian patients (7.3% of 523 TAVI cases) were evaluated. Frailty parameters-including grip strength, cognitive function (MMSE), overall physical performance (SPPB), gait speed, and activities of daily living (Katz index)-were measured before and after the procedure. No significant differences were observed between preoperative and postoperative values for grip strength (17.4 ± 7.1 vs. 16.1 ± 7.4 kgf, p = 0.102), MMSE (24.1 ± 3.9 vs. 24.3 ± 4.6, p = 0.923), or overall SPPB scores (8.7 ± 2.8 vs. 7.5 ± 3.0, p = 0.084). In contrast, gait speed decreased significantly from 0.8 ± 0.3 m/s to 0.7 ± 0.3 m/s (p = 0.001), and the Katz index also showed a small but statistically significant decline (p = 0.042). The proportion of patients with a walking speed below 0.9 m/s did not change significantly (67.6% vs. 83.8%, p = 0.146).

Conclusions: In a carefully selected nonagenarian cohort, TAVI did not substantially worsen most frailty indices. However, mild in-hospital declines in gait speed and ADL were observed, underscoring the importance of structured early rehabilitation strategies.

This commentary reviews the cross-sectional study by Denche-Zamorano et al. examining the relationship between pain distribution, physical activity, grip strength, exercise issues, and frailty risk. The commentary acknowledges the study's in-depth analysis of the association between widespread pain and frailty, while proposing three key recommendations: First, replacing grip strength/body weight with grip strength/fat-free mass to more accurately assess muscle strength; second, utilizing longitudinal data in future research to explore the mediating role of exercise phobia between pain and frailty; Third, it advocates for more granular grading of physical activity to reveal dose-response relationships. These recommendations aim to enhance the precision and causal inference capabilities of future research, providing a stronger foundation for developing multimodal intervention strategies integrating exercise and cognitive behavioral therapy.

In their recent study, Zhang et al. (Aging Clin Exp Res, 2025) report an association between a composite unhealthy lifestyle score and the risk of comorbid type 2 diabetes mellitus (T2DM) and arthritis in the CHARLS cohort. While the topic is of significant public health relevance, we have identified several substantive methodological and interpretative limitations that temper the conclusions. Chief among these are the oversimplified and unvalidated definition of lifestyle exposures, particularly "unhealthy diet," and the equal weighting of disparate risk factors without biological justification. Crucially, the analysis fails to adequately control for body mass index, a potent confounder and likely mediator in the T2DM-arthritis pathway. Furthermore, the aggregation of all arthritis subtypes obscures potentially distinct etiologies, and the assertion of "synergy" lacks formal statistical interaction testing. Finally, the study remains purely associational, omitting mechanistic investigation into proposed pathways like inflammation. Future research must address these limitations through precise exposure measurement, rigorous confounding control, disease subtyping, and formal mediation analyses to translate this epidemiological observation into causal insight and actionable prevention strategies.

Objective: To examine the association of changes in loneliness with subsequent cardiometabolic comorbidity (CMM) among middle-aged and older Chinese and South Korean adults.

Methods: We used the harmonized individual-level data from the China Health and Retirement Longitudinal Study (CHARLS, n = 9381) from China and the Korean Longitudinal Study of Aging (KLoSA, n = 5052) from South Korea. In both CHARLS and KLoSA, loneliness was measured using a single item from the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) at baseline and in the second survey. CMM was defined as the presence of two or more cardiometabolic conditions, including diabetes, heart disease, and stroke, based on physician-diagnosed self-report. Within each cohort, we used the multivariable Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of incident CMM according to changes in loneliness (never, initiated, relieved, and persistent) over 7 years (CHARLS) or 6 years (KLoSA) of follow-up.

Results: In CHARLS, initiated (aHR 1.42, 95%CI 1.14-1.78), relieved (aHR 1.40, 95%CI 1.16-1.70), and persistent (aHR 2.03, 95%CI 1.64-2.51) loneliness were associated with an increased likelihood of experiencing CMM. In KLoSA, both relieved (aHR 1.72, 95%CI 1.07-2.76) and persistent (aHR 1.86, 95%CI 1.21-2.88) loneliness were significantly associated with CMM, whereas the initiated loneliness showed no significant association (aHR 1.25, 95%CI 0.76-2.07).

Conclusions: Changes in loneliness were associated with an increased risk of subsequent CMM in both China and South Korea, with the strongest associations observed among individuals experiencing persistent loneliness. These findings indicate that loneliness is a dynamic and potentially modifiable risk factor for cardiometabolic multimorbidity across different sociocultural contexts. Early identification and targeted interventions addressing loneliness may contribute to the prevention of CMM among middle-aged and older adults.

Purpose: The World Health Organization (WHO) defines Intrinsic Capacity (IC) as the integration of an individual's physiological and psychological capacities. Encompassing five dimensions- locomotion, cognitive, vitality, psychological, and sensory function-it plays a central role in the assessment of healthy ageing. This study aimed to evaluate the association between IC and hip fractures among community-dwelling older adults in China.

Patients and methods: This population-based longitudinal study analyzed data from 3102 community-dwelling residents aged ≥ 60 years in the China Health and Retirement Longitudinal Study (CHARLS), with baseline assessments conducted in 2011 and a 4-year follow-up through 2015. IC was assessed across five domains: cognitive, psychology, vitality, locomotion, and sensory function. The outcome measure was self-reported hip fracture, while demographic characteristics and other covariates were analyzed as potential confounders. Multivariable logistic regression models were employed to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CI). The relationship between IC and hip fracture was further evaluated using restricted cubic splines and subgroup analyses.

Results: A total of 3,102 older adults (57.16% male) with a median age of 65.00 years were included. Over the 4-year follow-up, 96 participants (3.09%) experienced hip fractures. Regarding IC, the total IC score for the entire cohort was 1.56 ± 1.07(range 0-5, a total score of ≥ 2 is defined as IC impairment). The hip fracture group exhibited significantly higher IC scores compared to the non-fracture group (2.14 ± 1.06 vs.1.14 ± 1.06, p < 0.001). Baseline IC impairment (observed in 48.42% of participants) was associated with a 2.34-fold higher incidence of hip fracture compared to those without impairment (4.39% vs.1.88%). Analysis revealed that each 1-point increase in IC score among individuals aged ≥ 60 years was associated with a 55% elevated risk of hip fracture (adjusted OR = 1.55, 95% CI 1.25-1.94, p < 0.001). When stratified by IC status, the effect was more pronounced with IC-impaired. Compared to without impaired group, individuals with IC impairment had 87% higher risk of fracture (adjusted OR = 1.87, 95% CI 1.72-2.98, p = 0.009). Additionally, a linear relationship was demonstrated between IC and hip fracture risk.

Conclusion: Among community-dwelling older adults, the composite IC score demonstrated a significant independent association with an elevated risk of hip fracture. Regular monitoring of individual IC scores may serve as an early warning indicator to initiate preventive interventions.

Purpose: Older adults with type 2 diabetes (T2D) face an elevated risk of falls due to combined physical and cognitive impairments. The DiaActive feasibility study evaluated the safety, feasibility, and acceptability of a novel fall-prevention exercise program integrating multitask rhythm-based movement, activities of daily living (ADL) exercises, and a structured social component.

Methods: Eight community-dwelling adults (≥ 65 years) with T2D participated in two 60-minute physiotherapist-led sessions per week for four weeks (total 480 min). The program combined rhythm-based (Rythma) and ADL exercises with structured social interaction. Feasibility outcomes included adherence, safety, satisfaction, and overall acceptability.

Results: Adherence was high, with a median attendance of 88% (range 75-100%) and 100% questionnaire completion. No injuries or adverse events occurred, indicating good safety and tolerability. Participants reported that session difficulty progressed appropriately, shifting from "too easy" early on to "appropriately challenging" by week four. Satisfaction increased over time, with most rating sessions as "satisfactory" or "very satisfactory." Qualitative feedback evolved from exercise-focused comments to broader reflections on body awareness and social connectedness. The positive group atmosphere and structured social elements were key motivators supporting adherence and engagement.

Conclusion: The DiaActive protocol-combining rhythm-based, ADL-focused, and social components-was safe, feasible, and well accepted by older adults with T2D. High adherence, absence of adverse events, and increasing satisfaction support progression to a fully powered randomized controlled trial to assess clinical efficacy and long-term adherence.

The global rise in life expectancy is accompanied by an increase in the prevalence of mental health conditions among older adults, including mild cognitive impairment (MCI), dementia, delirium, depression, anxiety, and other severe mental illness. These conditions significantly impact independence, increase healthcare costs, and increase mortality risk. Mounting evidence underscores the central role of modifiable lifestyle factors-particularly physical activity and diet-in the prevention and management of these conditions. This consensus, developed under the auspices of the European Interdisciplinary Council on Ageing (EICA), synthesizes current evidence and expert perspectives. Regular exercise, ranging from aerobic and resistance training to mind-body practices, improves cognition, mood, and physical resilience, while also mitigating cardiometabolic and functional risks. Similarly, adherence to dietary patterns such as the Mediterranean or MIND diets has been consistently associated with reduced incidence of cognitive decline, Alzheimer's disease, and comorbid chronic illnesses, although much of the evidence is observational. Landmark multidomain trials, including the Finnish FINGER and U.S. POINTER studies, have shown that combined interventions targeting diet, physical activity, cognitive stimulation, and social activity can slow cognitive decline in at-risk populations. Lifestyle strategies that promote brain health may enhance functional outcomes in dementia and, in turn, mitigate the risk of delirium. However, widespread implementation of such strategies faces numerous barriers, including physical frailty, socioeconomic constraints, health system fragmentation, and stigma. To overcome these barriers, caregivers, healthcare and public health professionals, policymakers, and community organizations must collaborate in designing accessible, culturally sensitive, and sustainable interventions at a policy level. Emerging digital tools, group-based programs, and co-designed approaches offer novel opportunities to enhance adherence and impact. Integrating lifestyle interventions into standard healthcare pathways represents an urgent, cost-effective strategy to promote mental health and resilience in ageing populations worldwide. This document provides actionable recommendations to guide policy, research, and clinical implementation across diverse health systems.

Background: Older adults were among the most affected by the COVID-19 pandemic, facing greater vulnerability to infection, hospitalization, and post-infection sequelae. However, evidence on its multidimensional impact on healthy aging remains limited, particularly in Latin America. This study examined the association of COVID-19 infection, hospitalization, and vaccination with healthy aging and functional impairment among older Mexican adults.

Methods: We analyzed longitudinal data from the Mexican Health and Aging Study (MHAS), comparing pre-pandemic (2018) and post-pandemic (2021) waves. Two outcomes were assessed: the Healthy Aging Score (HAS), a composite indicator of physical, mental, and social functioning (mean = 50, SD = 10), and functional impairment, defined as any limitation in basic or multiple instrumental activities of daily living. Random-effects regression models estimated associations with self-reported COVID-19 infection, hospitalization, and vaccination, adjusting for sociodemographic and health covariates.

Results: The sample included 8,239 participants (mean age = 72.5 years; 55.9% women). Those reporting prior infection were younger and had higher BMI. COVID-19-related hospitalization was significantly associated with lower HAS (β = -1.96; 95% CI - 3.65 to - 0.26). Infection and vaccination were not significantly associated with HAS. However, vaccination was linked to a reduced likelihood of functional impairment (OR = 0.75; 95% CI 0.53 to 0.95).

Conclusions: Hospitalization due to COVID-19 was associated with poorer multidimensional aging outcomes, whereas vaccination appeared protective against functional decline. These findings highlight the importance of preventive strategies and sustained vaccination coverage to preserve functionality and promote healthy aging in post-pandemic populations.