Aging Clinical and Experimental Research最新文献

Aim

This research sought to investigate the possible connection between anemia and various parameters of comprehensive geriatric assessment in elderly individuals diagnosed with Dementia with Lewy Bodies (DLB). To our knowledge, this investigation represents the first attempt to examine how anemia impacts patients suffering from DLB.

Methods

This cross-sectional study encompassed 147 DLB patients from a single geriatric outpatient clinic. The study defined anemia as hemoglobin levels under 12 g/dL for women and 13 g/dL for men. Patients’ demographic information, coexisting medical conditions, and results from comprehensive geriatric evaluations were also recorded.

Results

Participants in the study had an average age of 85.4 ± 7.1 years. Anemia was present in 46.9% of the patients. Significant disparities were noted between individuals with and without anemia regarding the occurrence of congestive heart failure (CHF), polypharmacy, geriatric depression, and insomnia (all p < 0.05). After controlling for age, gender, and CHF in the multivariate analysis, the association between anemia and both the quantity of medications used [OR: 1.15 (95% CI:1.01-1,31)] and Geriatric Depression Scale-15 scores [OR: 0.88, 95% CI: 0.78–0.98] remained statistically significant (p < 0.05) when comparing anemic patients to non-anemic individuals.

Conclusion

In the present study almost one in two older patients with DLB were anemic. Anemia is associated with presence of CHF, higher number of drugs and depressive mood in DLB. It is recommended that healthcare providers should recognize the importance of anemia and its associated effects when treating older adults with DLB. This approach may lead to more effective management and treatment of this complex condition.

Background

The associations between left atrial (LA) size, echocardiographic diastolic parameter (E/A ratio), and incident atrial fibrillation (AF) in older inpatients remain underexplored.

Aims

This study aimed to evaluate the relationship between LA size, E/A ratio, and AF risk in older hospitalized patients.

Methods

Between January 2015 and May 2023, a total of 2,615 older inpatients (aged ≥ 65 years) were enrolled in this retrospective longitudinal study. Left atrial diameter (LAD) and E/A ratio were measured using transthoracic echocardiography.

Results

Over a median follow-up of 844 days (IQR: 331–1355 days), 209 patients (8.0%) experienced at least one incident of AF. After adjusting for covariates, large LA and high E/A ratio were significantly associated with incident AF, with an 11% increase in risk for each 1 mm increase in LAD over 35 mm (adjusted HR: 1.11, 95% CI: 1.10–1.13) and a 30% increased risk per standard deviation increase in E/A ratio when E/A ratio exceeded 0.65 (adjusted HR: 1.30, 95% CI: 1.23–1.37), P < 0.001. The influence of LA size and E/A ratio on incident AF was more pronounced in the younger subgroup of older adults. Incorporating LAD and E/A ratios into the CHA2DS2-VASc score improved its predictive accuracy (AUC _increase = 0.168, P < 0.001).

Discussion

This study shows that LA size and E/A ratio are key predictors of AF in hospitalized older patients, with age influencing their predictive value. Incorporating these factors into the CHA2DS2-VASc score enhances risk stratification and highlights the need for early AF screening in this group.

Conclusions

In hospitalized older patients, large LA and high E/A ratio are associated with incident AF, and these associations are more pronounced in younger individuals. LAD and E/A ratios provide incremental predictive value for AF beyond the CHA2DS2-VASc score.

Graphical Abstract

LA, left atrium; ASE: American Society of Echocardiography; E, mitral inflow velocity in the early diastolic phase; A, mitral inflow velocity in the late diastolic phase; AF: Atrial Fibrillation.

Background

Concern about falling is a significant issue among older adults, affecting their quality of life and functional independence. Culturally adapted and validated assessment tools are essential for accurately evaluating concern about falling. This study aimed to translate, cross-culturally adapt, and validate the Arabic short version of the Iconographical Falls Efficacy Scale (Icon-FES).

Methods

The translation and cultural adaptation process followed established guidelines. Structural validity was assessed using exploratory factor analysis (EFA). Internal consistency reliability, test–retest reliability, convergent validity, and known-groups validity of the scale were evaluated.

Results

A total of 123 community-dwelling older adults (mean age 69.54 ± 3.48 years; 53.7% male) participated. The Arabic short version of Icon-FES demonstrated strong structural validity, with EFA supporting a unidimensional structure accounting for 73.47% of the variance. It exhibited high internal consistency (Cronbach’s α = 0.95) and excellent test–retest reliability (ICC = 0.97). Convergent validity was confirmed through significant correlations with the Arabic Falls Efficacy Scale-International (FES-I; r_s = 0.73, p < 0.001), Single Leg Stance (SLS; r_s =  − 0.34, p < 0.001), and Five Times Sit-to-Stand Test (5TSTS; r_s = 0.44, p < 0.001). Known-groups validity showed higher scores in females, those with lower education, and a history of falls.

Conclusions

The Arabic short version of Icon-FES is a reliable and valid tool for assessing concern about falling among community-dwelling older adults. It offers an innovative approach through culturally adapted visual elements that could enhance applicability, enabling accurate assessment and supporting targeted interventions among Arabic-speaking older adults.

Background

Low physical activity is a major risk for sarcopenia. Whether training according to physical activity guidelines accompanied with cognitive training is effective on sarcopenia, remains unclear.

Aims

We investigated whether the effects of 12-month physical and cognitive training (PTCT) and physical training (PT) on grip and knee extension strength, muscle mass, and walking speed differed between older adults with and without sarcopenia.

Methods

Community-dwelling older adults (N = 314, mean age 74.5 ± 3.8 years, 60% women) who did not meet physical activity guidelines were randomized to PTCT and PT groups. PT for both groups included supervised and home-based multicomponent physical training. Cognitive training (CT) included computer-based exercises for executive functioning. Sarcopenia was determined according to the European Working Group on Sarcopenia in Older People 2019 criteria. Generalized estimation equation analysis were conducted.

Results

Compared to PT, PTCT had no additive effect on strength, muscle mass, or walking speed in participants with or without sarcopenia. In pooled data (PT + PTCT) change in the grip strength was greater in sarcopenia (n = 49) group compared to non-sarcopenia (n = 264) group (interaction, p =.014). Both groups improved knee extension strength, and walking speed, but no statistically significant difference between the groups were observed. Muscle mass did not change in either group.

Conclusion

Physical training according to physical activity recommendations improves muscle strength, walking speed, and maintains muscle mass in sarcopenia. Additional cognitive training had no benefits on these outcomes.

Trial registration number

ISRCTN52388040 and date of registration 20/1/2017.

Background

Falls on stairs are a major cause of severe injuries among older adults, with stair descent posing significantly greater risks than ascent. Variations in stair descent phenotypes may reflect differences in physical function and biomechanical stability, and their identification may prevent falls.

Aims

This study aims to classify stair descent phenotypes in older adults and investigate the biomechanical and physical functional differences between these phenotypes using hierarchical cluster analysis.

Methods

Eighty-two older adults participated in this study. Stair descent was measured using a three-dimensional motion analysis system. Physical function was assessed using measures of muscle strength, walking speed, the Timed Up and Go Test (TUG), and the Community Balance and Mobility Scale (CB&M).

Results

Hierarchical cluster analysis was performed on kinematic data obtained during stair descent. Three phenotypes were identified: neutral (N-type; 24%), extension (E-type; 52%), and rotation (R-type; 23%). There were no significant differences in lower limb muscle strength or walking speed among the different types, and TUG scores showed no differences in terms of mobility or balance abilities. However, CB&M scores were significantly lower for E-type and R-type compared to N-type. Sub-analyses revealed that while there were no differences in the mobility factor of CB&M between E-type and R-type, the strength factors were significantly lower compared to those for N-type.

Discussion

These results suggest that E-type and R-type stair-descent patterns may be influenced by declines in standing balance ability and muscle strength.

Conclusions

These findings may inform fall-prevention training programs related to stair descent among older adults.

Objective

The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery.

Design

A prospective cohort study.

Setting and participants

Patients aged ≥ 65 years from a tertiary level A hospital in China.

Methods

The POD was assessed once daily within the first postoperative 3 days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3 days before surgery and 4–7 days after surgery. Regional cerebral oxygen saturation (rScO₂) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD.

Results

A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07–2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO₂ values during the procedure (P < 0.001). In exploratory analysis, the advanced age (P = 0.005), sex (P = 0.038), and lower preoperative MMSE score (P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery.

Conclusions and implications

Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO₂ during the procedure. These findings could help early identification of high-risk POD patients.

Introduction

Frailty, characterized by decreased resilience due to physiological decline, affects approximately 65% of community-dwelling elderly in Nepal. This study assessed frailty and its factors among hospitalized older adults in a tertiary hospital in Nepal.

Methods

This cross-sectional study included 124 participants aged 60 and above, admitted to a tertiary hospital in Nepal. Frailty was assessed using the Groningen Frailty Index (GFI), a validated self-reported tool. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with frailty, using STATA version 13.0.

Results

Frailty was observed in 58.8% of participants. Adjusted analysis showed that, compared to those who cannot read and write, those with no formal education had 0.14 times lower odds of frailty (p = 0.01, 95% CI 0.03–0.66), while those with formal education had 0.19 times lower odds (p = 0.01, 95% CI = 0.04–0.73). Participants with comorbidities had 3.51 times higher odds of frailty (p = 0.01, 95% CI: 1.22–10.07), and those with a history of falls had 8.10 times higher odds (p = 0.005, 95% CI: 1.89–34.78).

Conclusion

Frailty was prevalent in over half of the respondents. Lower levels of educational achievement, comorbidities, and a history of falls were identified factors of frailty. Targeted interventions addressing multimorbidity and fall prevention may reduce frailty risk among high-risk older adults in Nepal.

Background

Tai Chi (TC) is widely acknowledged for its positive impact on improving motor function in older adults. Nevertheless, limited research has directly compared the effects of different TC styles on older adults with functional impairments.

Objective

This study aimed to assess the impact of different TC styles on motor function in older adults with functional impairments.

Method

We searched five databases—PubMed, Scopus, Chinese National Knowledge Infrastructure (CNKI), Web of Science, and Wiley Online Library—including studies published up to September 2024. The selection of literature adhered to PRISMA guidelines, with quality assessment independently carried out by two researchers.

Results

Fourteen studies met the inclusion criteria for this review. The analysis revealed that TC interventions for functionally impaired older adults primarily employed Yang-style, Sun-style, Chen-style, and simplified-style TC. The populations studied included individuals with mild cognitive impairment (MCI), nonspecific low back pain (NS-LBP), preclinical disabilities, chronic diseases, poor balance, osteoarthritis (OA), Parkinson’s disease (PD), sarcopenia, and those at risk of falls. The findings indicated that motor function in functionally impaired older adults were closely linked to balance, gait, mobility, strength, and fall rates. Among the various TC styles, Yang-style was the most frequently utilised intervention.

Conclusion

This review examined four types of TC interventions and found strong evidence supporting the effectiveness of Yang-style TC in improving motor function in older adults with functional impairments. Additionally, five assessment methods—Single-Leg Stance (SL), Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUGT), Chair Stand Test (CST), and Fall Efficacy Scale (FES)—were identified as suitable for evaluating this population. Based on the findings, it is recommended that individuals with functional impairments engage in Yang-style 24-movement TC, with an intervention duration of 12 weeks, practicing two to five times a week for 60 min each session.

Background

Multimorbidity creates challenges for care and increases health care utilization and costs. People with dementia often have multiple comorbidities, but little is known about the role of these comorbidities in hospitalizations.

Aims

This study examines the frequency of hospitalizations during the last two years of life in older adults with and without dementia, the impact of comorbidities on hospitalizations, and their time trends.

Methods

The data came from national registers and covered all persons 70 and above who died in Finland in 2002–2017. The effect of dementia and comorbidities on hospitalizations in the last two years of life was determined using binary logistic regression and negative binomial regression.

Results

At all levels of comorbidity, people with dementia were less likely to be hospitalized and had a lower number of hospitalizations than people at the same level of comorbidity but no dementia. Hospitalizations were strongly associated with multimorbidity. During the study period, the overall hospitalization rates from home and LTC have declined.

Discussion

The declining trend of hospitalization during the 15-year study period should be interpreted in the context of the health and long-term care system.

Conclusion

Among people with dementia, comorbidities were the main driver for hospitalizations. Regardless of the number of comorbidities, people with dementia were hospitalized less often than people without dementia in last two years of life. It remains unclear whether the lower hospitalization rate is due to the improved ability to care for people with dementia outside the hospital or to the lack of sufficient medical care for them.

Loneliness, social isolation, and living alone are significant risk factors for mortality, particularly in older adults. This systematic review and meta-analysis aimed to quantify their associations with all-cause and cause-specific mortality in older adults, broadening previous research by including more social factors. Comprehensive searches were conducted in PubMed, APA PsycINFO, and CINAHL until December 31, 2023, following PRISMA 2020 and MOOSE guidelines. Studies included were prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses used random-effects models with the Restricted Maximum Likelihood method. Subgroup and meta-regression analyses explored the relationships further. Of 11,964 identified studies, 86 met the inclusion criteria. Loneliness was associated with increased all-cause mortality (HR 1.14, 95% CI 1.10–1.18), with substantial heterogeneity (I² = 84.0%). Similar associations were found for social isolation (HR 1.35, 95% CI 1.27–1.43) and living alone (HR 1.21, 95% CI 1.13–1.30). Subgroup analyses revealed variations based on factors like sex, age, region, chronic diseases, and study quality. Meta-regression identified longer follow-up, female sex, validated social network indices, adjustments for cognitive function, and study quality as significant predictors of mortality risks. These findings highlight the need for public health interventions to address these social factors and improve health outcomes in older adults. However, further research is needed due to variability and heterogeneity across studies. Also studying the cumulative effect of these factors on mortality risks will be of considerable interest.