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Combined nutritional status and activities of daily living disability is associated with one-year mortality after hip fracture surgery for geriatric patients: a retrospective cohort study. 老年患者髋部骨折术后一年死亡率与营养状况和日常生活能力障碍的综合关系:一项回顾性队列研究。
IF 4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-06-08 DOI: 10.1007/s40520-024-02786-8
Ying Chen, Ying Guo, Gang Tong, Yu He, Ruihua Zhang, Qi Liu

Objective: We aimed to explore the association combined nutritional status and activities of daily living disability with all-cause mortality of older adults with hip fracture in the first year after hospitalization.

Methods: This is a single-center retrospective cohort study in older adults with hip fracture patients. Clinical data and laboratory results were collected from electronic medical record system of our hospital (2014-2021). The endpoint of this study was all-cause mortality in the first year after hospitalization.

Results: A total of 303 older adults were enrolled and all-cause mortality was 21.8%. The study population was categorized by CONUT score. Patients in CONUT score 5-12 had a higher age, ASA status, CRP and creatinine level, more patients with history of fracture, pneumonia and delirium, meanwhile, lower BMI and ADL score, lower hemoglobin, lymphocyte, total protein, albumin, triglyceride, total cholesterol and one year survival than those in CONUT score 0-4 (all P < 0.05). Multivariable Cox analysis showed that BMI, ADL score and CONUT score were independent risk factors for all-cause mortality of hip fracture in older adults (HR (95% CI):2.808(1.638, 4.814), P < 0.001; 2.862(1.637, 5.003), P < 0.001; 2.322(1.236, 4.359), P = 0.009, respectively). More importantly, the combined index of CONUT and ADL score had the best predictive performance based on ROC curve (AUC 0.785, 95% CI: 0.734-0.830, P < 0.0001). Kaplan-Meier survival curves for all-cause mortality showed that patients with CONUT score increase and ADL score impairment had a higher mortality rate at 1 year compared to CONUT score decrease and ADL score well (Log Rank χ2 = 45.717, P < 0.0001).

Conclusions: Combined CONUT and ADL score is associated with one-year mortality after hip fracture surgery for geriatric patients.

目的我们旨在探讨髋部骨折老年人住院后第一年内营养状况和日常生活活动障碍与全因死亡率之间的关系:这是一项针对老年髋部骨折患者的单中心回顾性队列研究。临床数据和实验室结果来自本院的电子病历系统(2014-2021 年)。研究终点为住院后第一年的全因死亡率:共有 303 名老年人参与研究,全因死亡率为 21.8%。研究对象按 CONUT 评分进行分类。与 CONUT 评分 0-4 的患者相比,CONUT 评分 5-12 的患者年龄、ASA 状况、CRP 和肌酐水平更高,有骨折、肺炎和谵妄病史的患者更多,同时,BMI 和 ADL 评分更低,血红蛋白、淋巴细胞、总蛋白、白蛋白、甘油三酯、总胆固醇和一年存活率更低(均为 P 结论:CONUT 评分 5-12 的患者年龄、ASA 状况、CRP 和肌酐水平更高,有骨折、肺炎和谵妄病史的患者更多,同时,BMI 和 ADL 评分更低:CONUT和ADL综合评分与老年患者髋部骨折术后一年的死亡率有关。
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引用次数: 0
Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts. 肌肉疏松症成分对全因死亡率的预测价值:基于人群的队列研究结果。
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-06-06 DOI: 10.1007/s40520-024-02783-x
Leo D Westbury, Nicholas C Harvey, Charlotte Beaudart, Olivier Bruyère, Jane A Cauley, Peggy Cawthon, Alfonso J Cruz-Jentoft, Elizabeth M Curtis, Kristine Ensrud, Roger A Fielding, Helena Johansson, John A Kanis, Magnus K Karlsson, Nancy E Lane, Laetitia Lengelé, Mattias Lorentzon, Eugene McCloskey, Dan Mellström, Anne B Newman, Claes Ohlsson, Eric Orwoll, Jean-Yves Reginster, Eva Ribom, Björn E Rosengren, John T Schousboe, Elaine M Dennison, Cyrus Cooper

Background: Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited.

Aim: We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors.

Methods: Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index).

Results: Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed.

Conclusions: Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors.

背景:低握力和步速与死亡率有关。目的:我们研究了握力和步速是否比更容易获得的临床风险因素更能提高对死亡率的判别能力:方法:我们对健康、衰老和身体成分研究、男性骨质疏松性骨折研究和赫特福德郡队列研究的参与者进行了分析。使用 DXA 确定关节瘦体重 (ALM);通过握力测定法确定肌肉力量;以及 2.4-6 米的正常步速。使用以队列为随机效应的 Cox 回归法研究了肌肉疏松症各组成部分与死亡率之间的关系;使用 Harrell's Concordance Index (C-index) 评估了判别能力:参与者(n = 8362)的平均(标清)年龄为 73.8(5.1)岁;5231(62.6%)人在 13.3 年的中位随访时间内死亡。握力(每标准差下降的危险比(95% CI):1.14(1.10,1.10,1.10)):在考虑了年龄、性别、体重指数(BMI)、吸烟状况、饮酒量、体力活动、种族、教育程度、骨折和跌倒史、股骨颈骨矿密度(BMD)、自评健康状况、认知功能和合并症数量后,在相互调整的模型中,握力(每 SD 下降的危险比(95% CI):1.14 (1.10,1.19))和步速(1.21 (1.17,1.26))与死亡率相关,而 ALM 指数(1.01 (0.95,1.06))与死亡率无关。然而,仅将年龄和性别作为暴露因子的模型得出的C指数(95% CI)为0.65(0.64,0.66),只有在纳入握力和步速后才增至0.67(0.67,0.68):结论:与其他更容易获得的风险因素相比,握力和步速只能提供适度的死亡率辅助风险信息。
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引用次数: 0
Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults. WE-SURF™的可接受性、可行性和有效性:一项针对老年人的虚拟监督集体预防跌倒锻炼计划。
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-06-05 DOI: 10.1007/s40520-024-02759-x
Janet Bong May Ing, Maw Pin Tan, Julie Whitney, Ing Khieng Tiong, Devinder Kaur Ajit Singh

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls.

Method: A preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall's prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events.

Results: Preliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance.

Conclusion: In conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability. (Registration number: ACTRN 12621001620819).

有监督的集体预防跌倒锻炼计划通过实际操作已证明能有效降低老年人跌倒的风险。在这项研究中,我们旨在评估一项针对有跌倒风险的社区居住老年人的虚拟监督小组预防跌倒锻炼计划(WE-SURF™)的可接受性、可行性和有效性:方法:利用虚拟讨论进行了一项初步研究,以评估该计划在六位老年人中的可接受性。在随机对照的可行性研究设计中对其效果进行了评估,共有 52 名参与者(平均年龄:66.54 岁;标准差:5.16),分为实验组(26 人)和对照组(26 人)。实验组参加为期 6 个月的 WE-SURF™ 计划,对照组则接受标准护理和预防跌倒教育课程。干预措施的可行性通过出勤记录、录制视频的参与率、辍学率、流失原因和不良事件来衡量:初步研究结果表明,WE-SURF™ 是可以接受的,但需要进一步改进。研究显示,干预对定时起立和走动(TUG)有明显效果(η2p:0.08;P 分别为 80% 和 8/10 ),辍学率极低(4%)。WE-SURF™计划在增强肌肉力量和平衡能力的同时,还能有效降低跌倒风险:总之,WE-SURF™ 被证明是一项可接受的、可行的、有效的虚拟督导团体运动计划,可预防有跌倒风险的社区老年人跌倒。WE-SURF™取得了积极的成果,参与者的参与度也很高,因此有望在更大范围内推广。建议进一步开展研究和推广工作,以探索其更广泛的适用性。(注册编号:ACTRN 12621001620819)。
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引用次数: 0
Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis. 因髋部骨折住院的老年患者的合并症、急性肾损伤和长期死亡率:调节分析。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-30 DOI: 10.1007/s40520-024-02771-1
Saulo Lacerda Borges de Sá, Maria Luiza Medeiros Faria, Tiago Lins Oliveira Gonçalves, Alexandre Braga Libório

Introduction: Femoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.

Methodology: This study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson-Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.

Results: The analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.

Conclusion: This study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

导言:老年人股骨骨折给健康带来了巨大挑战,往往导致发病率和死亡率上升。住院期间的急性肾损伤(AKI)会使治疗结果更加复杂,但在这一人群中,AKI 严重程度与合并症(以夏尔森合并症指数(CCI)量化)之间的相互作用仍鲜为人知。本研究旨在评估老年患者的 AKI 严重程度与 CCI 之间的关系,以及 AKI 严重程度与股骨骨折后一年死亡率之间的关系:本研究利用重症监护多参数智能监测(MIMIC-IV)数据库中的数据,重点关注因髋部骨折入院的老年患者(65 岁以上)。根据 KDIGO 标准和 CCI 评分对患者进行 AKI 阶段分类。评估的主要结果是出院一年后的全因死亡率。统计分析包括逻辑回归、Cox比例危险度回归和约翰逊-奈曼技术调节分析,以评估AKI与长期死亡率之间以及CCI与长期死亡率之间的关系:分析包括 1,955 名患者,结果显示,严重的 AKI(2 期和 3 期)与一年死亡率的增加有独立关联。值得注意的是,CCI 显著缓和了这些关联。CCI评分越低,重度AKI患者的死亡率越高。对于 CCI 低至 3 分的患者,严重 AKI 的影响更大,观察到的一年死亡率增加了一倍多。相比之下,CCI 分数越高(≥8 分)对死亡率的影响越小。敏感性分析支持这些发现,强调了观察到的关联的稳健性:本研究阐明了老年髋部骨折患者 AKI 严重程度和合并症与长期死亡率之间复杂的相互作用。这些发现强调了在对这一易感人群进行预后评估和干预策略时同时考虑 AKI 严重程度和合并症负担的重要性。针对个体风险特征的针对性干预措施可能有助于减轻 AKI 对死亡率结果的影响,最终改善患者护理和预后。我们有必要开展进一步的研究,以探索相关的内在机制,并完善针对这一人群的风险分层方法。
{"title":"Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis.","authors":"Saulo Lacerda Borges de Sá, Maria Luiza Medeiros Faria, Tiago Lins Oliveira Gonçalves, Alexandre Braga Libório","doi":"10.1007/s40520-024-02771-1","DOIUrl":"10.1007/s40520-024-02771-1","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.</p><p><strong>Methodology: </strong>This study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson-Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.</p><p><strong>Results: </strong>The analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.</p><p><strong>Conclusion: </strong>This study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.</p>","PeriodicalId":7720,"journal":{"name":"Aging Clinical and Experimental Research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11136753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The current status of health care indices and functional independence among older adults: data from HelpAge international-jordan study. 老年人保健指数和功能独立性的现状:来自国际助老会约旦分会研究的数据。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-30 DOI: 10.1007/s40520-024-02738-2
Mohammad Abufaraj, Lana Alhalaseh, Mohammed Q Al-Sabbagh, Zaid Eyadat, Walid Al Khatib, Osama A Samara, Immanuel Azaad Moonesar, Lee Smith, Raeda Al Qutob

Background: Health services should anticipate the changing pattern of illnesses associated with population aging to promote healthy aging.

Aim: We aimed to evaluate health indices and chronic illnesses and their relationship with functional independence in community Syrian refugees & Jordanian elderly.

Methods: A stratified sample of 1,718 community older adults aged ≥ 60-year-old from four major Jordanian governorates was interviewed in this cross-sectional study. Katz Index of Independence in Activities of Daily Living was utilized to assess functional status. Data were analyzed using STATA 15.

Results: Despite the similarities in baseline function, Syrian refugees had more multimorbidities but less active health insurance, accessibility to healthcare services and availability of medications and medical devices than Jordanians. Two-thirds had multimorbidities; with heart diseases, musculoskeletal conditions, hypertension, and diabetes being the most commonly reported chronic illnesses. Females had significantly more multimorbidities, and functional dependence, yet less education, income and accessibility to healthcare services. The mean Katz Index score was 4.99 ± 1.61. Significant predictors of functional dependence included increasing age, lower level of education, and some chronic illnesses.

Conclusion: National inclusive plans to support vulnerable older adults especially refugees and older women, provide health insurance, enhance access to health care facilities, and manage chronic medical illnesses comprehensively are urgently needed to improve independence of community-living older adults and to promote healthy aging.

背景目的:我们旨在评估叙利亚难民和约旦社区老年人的健康指数和慢性疾病及其与功能独立性的关系:在这项横断面研究中,我们对约旦四个主要省份的1718名年龄≥60岁的社区老年人进行了分层抽样。采用卡茨日常生活活动独立性指数(Katz Index of Independence in Activities of Daily Living)评估功能状况。数据使用 STATA 15 进行分析:尽管基线功能相似,但与约旦人相比,叙利亚难民有更多的多病症,但在主动医疗保险、医疗服务可及性以及药物和医疗设备的可得性方面却不如约旦人。三分之二的叙利亚难民患有多种疾病,其中心脏病、肌肉骨骼疾病、高血压和糖尿病是最常见的慢性病。女性的多病症和功能依赖程度明显更高,但教育程度、收入和医疗服务的可及性却更低。卡茨指数平均得分为 4.99 ± 1.61。预测功能依赖的重要因素包括年龄增长、教育水平较低和一些慢性疾病:结论:为了提高在社区生活的老年人的独立性,促进健康老龄化,迫切需要制定国家包容性计划,为弱势老年人(尤其是难民和老年妇女)提供支持,提供医疗保险,提高医疗设施的可及性,并对慢性病进行综合管理。
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引用次数: 0
The Italian guideline on comprehensive geriatric assessment (CGA) for the older persons. 意大利老年人综合评估(CGA)指南。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-27 DOI: 10.1007/s40520-024-02780-0
Stefania Maggi, Luigi Ferrucci
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引用次数: 0
The Italian guideline on comprehensive geriatric assessment (CGA) for the older persons: a collaborative work of 25 Italian Scientific Societies and the National Institute of Health. 意大利老年人综合评估(CGA)指南:25 个意大利科学协会和国家健康研究所的合作成果。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-27 DOI: 10.1007/s40520-024-02772-0
Alberto Pilotto, Pierangelo Lora Aprile, Nicola Veronese, Eleonora Lacorte, Wanda Morganti, Carlo Custodero, Paola Piscopo, Elisa Fabrizi, Francesco Della Gatta, Andrea Merlo, Nicola Vanacore

Background: The guideline was promoted by the Italian General Practitioners-Primary Care and Geriatrics Hospital-Community Societies and was carried out involving the National Institute of Health and an Expert Panel including representatives from 25 Scientific and Health-Professional Organizations. The aim of the Guideline was to develop evidence-based recommendations on the efficacy of CGA in older people across different clinical settings and the accuracy and utility of CGA-based tools to assess prognosis.

Methods: According to the methodological handbook of the Italian National System of Guidelines and NICE criteria (National Institute for Health and Care Excellence in England), the Guideline was produced based on the Grading of Recommendations Assessment, Development and Evaluation. Over 20,000 records gathered through databases searches were initially selected. Sixteen recommendations on CGA efficacy were defined based on 117 studies that met the inclusion criteria and were performed in general practices and primary care (26 studies included), medical and surgical clinics (16 studies), emergency departments (17 studies), hospital medical and surgical wards (53 studies), long-term care facilities and nursing homes (5 studies), hospices and palliative care networks (no studies). Nine recommendations on CGA-based prognostic tools were issues based on 42 included studies carried out in general practices and primary care (5 studies), medical and surgical clinics (4 studies), and hospital wards (33 studies).

Results: Using CGA can be useful to reduce hospitalization, mortality, institutionalization, the risk of delirium, and improve appropriateness in drug prescription and maintain functional activities in different settings. Further research on the efficacy of CGA in rehabilitative facilities, nursing homes, and hospice and palliative-care settings is recommended. CGA-based tools, particularly the Multidimensional Prognostic Index, should be used to predict some negative outcomes in different settings.

Conclusions: This Guideline may be useful in clinical practice and as a tool to support research on the use of CGA in older people.

背景:该指南由意大利全科医师-初级保健和老年病医院-社区协会共同推动,由国家健康研究所和一个专家小组参与实施,专家小组包括来自 25 个科学和健康专业组织的代表。该指南旨在就不同临床环境下 CGA 对老年人的疗效以及基于 CGA 的预后评估工具的准确性和实用性提出循证建议:方法:根据意大利国家指南系统方法手册和 NICE 标准(英国国家健康与护理卓越研究所),该指南是在建议分级评估、开发和评价的基础上制定的。通过数据库搜索收集的 20,000 多条记录被初步筛选出来。根据符合纳入标准的 117 项研究,确定了 16 项关于 CGA 疗效的建议,这些研究分别在全科实践和基础护理(纳入 26 项研究)、内科和外科诊所(16 项研究)、急诊科(17 项研究)、医院内科和外科病房(53 项研究)、长期护理机构和疗养院(5 项研究)、临终关怀机构和姑息治疗网络(无研究)中进行。根据42项纳入研究,就基于CGA的预后工具提出了9项建议,这些研究分别在普通实践和初级护理(5项研究)、内外科诊所(4项研究)和医院病房(33项研究)中进行:结果:使用 CGA 有助于降低住院率、死亡率、住院率、谵妄风险,提高药物处方的合理性,并在不同环境下保持功能活动。建议进一步研究 CGA 在康复机构、疗养院、临终关怀和姑息治疗环境中的疗效。基于 CGA 的工具,尤其是多维预后指数,应被用于预测不同环境下的一些负面结果:本指南可用于临床实践,也可作为支持研究在老年人中使用 CGA 的工具。
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引用次数: 0
Prevention at home in older persons with (pre-)frailty: analysis of participants' recruitment and characteristics of the randomized controlled PromeTheus trial. 虚弱(前期)老年人的居家预防:随机对照 PromeTheus 试验的参与者招募和特点分析。
IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-05-23 DOI: 10.1007/s40520-024-02775-x
Tim Fleiner, Corinna Nerz, Michael Denkinger, Jürgen M Bauer, Christian Grüneberg, Judith Dams, Martina Schäufele, Gisela Büchele, Kilian Rapp, Christian Werner

Background: The "PromeTheus" trial is evaluating a home-based, multifactorial, interdisciplinary prevention program for community-dwelling (pre-)frail older adults. These individuals often suffer from reduced participation, which can complicate the recruitment and enrollment in a clinical trial.

Aims: The aim of this study was to evaluate different recruitment strategies and differences in participant characteristics in relation to these strategies.

Methods: This cross-sectional study used baseline data from the randomized-controlled PromeTheus trial, in which community-dwelling (pre-)frail older persons (Clinical Frailty Scale [CFS] 4-6 pt., ≥ 70 years) were recruited via general practitioners ("GP recruitment") or flyers, newspaper articles, and personalized letters ("direct recruitment"). Differences in the sociodemographic, clinical, physical, functional, mobility-related, psychological and social characteristics were analyzed in relation to the recruitment strategy.

Results: A total of 385 participants (mean age = 81.2, SD 5.9 years; women: n = 283, 73.5%) were enrolled, of which 60 (16%) were recruited by GPs and 325 (84%) through direct recruitment. Participants recruited via GPs had significantly higher subjective frailty levels (CFS), were more often physically frail (Fried Frailty Phenotype), and showed lower physical capacity (Short Physical Performance Battery), participation (disability component of the short version of the Late-Life Function and Disability Instrument), and life-space mobility (Life-Space Assessment) compared to those recruited via the direct approach (p = 0.002-0.026). Costs per randomized participant were 94€ for the GP recruitment strategy and €213 for the direct recruitment strategy.

Conclusion: Different strategies may be required to successfully recruit (pre-)frail home-living older adults into preventive programs. Direct recruitment strategies, in which potential participants are directly informed about the prevention program, seem to be more promising than GP recruitment but may result in enrolment of persons with less functional impairment and higher recruitment costs.

Trial registration: German Clinical Trials Register, DRKS00024638. Registered on March 11, 2021.

背景PromeTheus "试验正在评估一项以家庭为基础、多因素、跨学科的预防计划,对象是居住在社区的(前期)体弱老年人。目的:本研究旨在评估不同的招募策略以及与这些策略相关的参与者特征差异:这项横断面研究使用了随机对照试验 PromeTheus 的基线数据,通过全科医生("全科医生招募")或传单、报纸文章和个性化信件("直接招募")招募居住在社区的(前期)体弱老年人(临床体弱量表 [CFS] 4-6 pt.,≥ 70 岁)。分析了与招募策略相关的社会人口学、临床、身体、功能、行动相关、心理和社会特征的差异:共招募了 385 名参与者(平均年龄 = 81.2 岁,标准差 5.9 岁;女性:n = 283,73.5%),其中 60 人(16%)通过全科医生招募,325 人(84%)通过直接招募。与直接招募的参与者相比,通过全科医生招募的参与者主观虚弱程度(CFS)明显更高,身体更加虚弱(弗里德虚弱表型),体能(短期体能测试)、参与度(晚年功能和残疾测试短版的残疾部分)和生活空间活动度(生活空间评估)也更低(p = 0.002-0.026)。全科医生招募策略的每位随机参与者的成本为94欧元,直接招募策略的每位随机参与者的成本为213欧元:结论:要成功招募(前期)体弱的居家老年人参与预防计划,可能需要采取不同的策略。直接招募策略,即直接告知潜在参与者有关预防计划的信息,似乎比全科医生招募更有前景,但可能会导致功能障碍程度较低的人被招募,招募成本较高:试验注册:德国临床试验注册中心,DRKS00024638。注册日期:2021 年 3 月 11 日。
{"title":"Prevention at home in older persons with (pre-)frailty: analysis of participants' recruitment and characteristics of the randomized controlled PromeTheus trial.","authors":"Tim Fleiner, Corinna Nerz, Michael Denkinger, Jürgen M Bauer, Christian Grüneberg, Judith Dams, Martina Schäufele, Gisela Büchele, Kilian Rapp, Christian Werner","doi":"10.1007/s40520-024-02775-x","DOIUrl":"10.1007/s40520-024-02775-x","url":null,"abstract":"<p><strong>Background: </strong>The \"PromeTheus\" trial is evaluating a home-based, multifactorial, interdisciplinary prevention program for community-dwelling (pre-)frail older adults. These individuals often suffer from reduced participation, which can complicate the recruitment and enrollment in a clinical trial.</p><p><strong>Aims: </strong>The aim of this study was to evaluate different recruitment strategies and differences in participant characteristics in relation to these strategies.</p><p><strong>Methods: </strong>This cross-sectional study used baseline data from the randomized-controlled PromeTheus trial, in which community-dwelling (pre-)frail older persons (Clinical Frailty Scale [CFS] 4-6 pt., ≥ 70 years) were recruited via general practitioners (\"GP recruitment\") or flyers, newspaper articles, and personalized letters (\"direct recruitment\"). Differences in the sociodemographic, clinical, physical, functional, mobility-related, psychological and social characteristics were analyzed in relation to the recruitment strategy.</p><p><strong>Results: </strong>A total of 385 participants (mean age = 81.2, SD 5.9 years; women: n = 283, 73.5%) were enrolled, of which 60 (16%) were recruited by GPs and 325 (84%) through direct recruitment. Participants recruited via GPs had significantly higher subjective frailty levels (CFS), were more often physically frail (Fried Frailty Phenotype), and showed lower physical capacity (Short Physical Performance Battery), participation (disability component of the short version of the Late-Life Function and Disability Instrument), and life-space mobility (Life-Space Assessment) compared to those recruited via the direct approach (p = 0.002-0.026). Costs per randomized participant were 94€ for the GP recruitment strategy and €213 for the direct recruitment strategy.</p><p><strong>Conclusion: </strong>Different strategies may be required to successfully recruit (pre-)frail home-living older adults into preventive programs. Direct recruitment strategies, in which potential participants are directly informed about the prevention program, seem to be more promising than GP recruitment but may result in enrolment of persons with less functional impairment and higher recruitment costs.</p><p><strong>Trial registration: </strong>German Clinical Trials Register, DRKS00024638. Registered on March 11, 2021.</p>","PeriodicalId":7720,"journal":{"name":"Aging Clinical and Experimental Research","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults. 在社区居住的老年人中,多部位肌肉骨骼疼痛与残疾轨迹之间的关系。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-23 DOI: 10.1007/s40520-024-02764-0
Peiyuan Liu, Hongbo Chen, Beibei Tong, Disha Zhu, Xiaomei Cong, Shaomei Shang

Background: Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.

Objective: To examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.

Design: We used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).

Participants: A total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.

Methods: Group-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.

Results: Persons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.

Conclusions: Persons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.

背景:疼痛与残疾有关,但多部位肌肉骨骼疼痛如何随着时间的推移导致残疾却没有得到很好的阐述:在具有全国代表性的队列中研究多部位肌肉骨骼疼痛与残疾的关联:我们使用了 2015-22 年全国健康与老龄化趋势研究(NHATS)的数据。残疾通过基本日常生活活动(ADL)和工具性日常生活活动(IADL)进行评估:本研究共纳入了 5557 名居住在社区的多部位肌肉骨骼疼痛患者:方法:采用基于群体的轨迹模型来识别 ADL 和 IADL 残疾的不同特征。在对社会人口学、健康状况、行为和心理特征进行调整后,采用基于设计的逻辑回归来检验多部位肌肉骨骼疼痛、残疾和双重轨迹群体成员之间的关联:结果:经历过多部位肌肉骨骼疼痛的人在日常活动能力和综合活动能力方面的残疾风险较高。我们发现了五种不同的残疾轨迹,并根据基线水平和随时间推移的增加率对其进行了命名。在患有多部位肌肉骨骼疼痛的老年人中,约有 52.42% 的人处于 ADL 和 IADL 下降的轨迹中,33.60% 的人经历了快速下降。多部位肌肉骨骼疼痛与不良残疾轨迹的相对风险升高有关,而这种风险一般会随着多部位肌肉骨骼疼痛频率和部位数量的增加而升高:结论:多部位肌肉骨骼疼痛患者的残疾风险较高。采取有效的疼痛管理策略对保持老年人的独立生活能力和实现积极老龄化至关重要。
{"title":"Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults.","authors":"Peiyuan Liu, Hongbo Chen, Beibei Tong, Disha Zhu, Xiaomei Cong, Shaomei Shang","doi":"10.1007/s40520-024-02764-0","DOIUrl":"10.1007/s40520-024-02764-0","url":null,"abstract":"<p><strong>Background: </strong>Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.</p><p><strong>Objective: </strong>To examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.</p><p><strong>Design: </strong>We used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).</p><p><strong>Participants: </strong>A total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.</p><p><strong>Methods: </strong>Group-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.</p><p><strong>Results: </strong>Persons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.</p><p><strong>Conclusions: </strong>Persons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.</p>","PeriodicalId":7720,"journal":{"name":"Aging Clinical and Experimental Research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cognitive trajectories preluding the onset of different dementia entities: a descriptive longitudinal study using the NACC database. 不同痴呆症实体发病前的认知轨迹:利用 NACC 数据库进行的描述性纵向研究。
IF 4 3区 医学 Q1 Medicine Pub Date : 2024-05-23 DOI: 10.1007/s40520-024-02769-9
Ioannis Liampas, Nefeli Dimitriou, Vasileios Siokas, Lambros Messinis, Grigorios Nasios, Efthimios Dardiotis

Objective: To describe the 10-year preclinical cognitive trajectories of older, non-demented individuals towards the onset of the four most prevalent types of dementia, i.e., Alzheimer's disease(AD), Lewy body(LBD), vascular(VD) and frontotemporal dementia(FTD).

Methods: Our analysis focused on data from older (≥ 60years) NACC (National Alzheimer's Coordinating Center) participants. Four distinct presymptomatic dementia groups (AD-LBD-VD-FTD) and a comparison group of cognitively unimpaired(CU) participants were formed. Comprehensive cognitive assessments involving verbal episodic memory, semantic verbal fluency, confrontation naming, mental processing speed - attention and executive function - cognitive flexibility were conducted at baseline and on an approximately yearly basis. Descriptive analyses (adjusted general linear models) were performed to determine and compare the yearly cognitive scores of each group throughout the follow-up. Exploratory analyses were conducted to estimate the rates of cognitive decline.

Results: There were 3343 participants who developed AD, 247 LBD, 108 FTD, 155 VD and 3398 composed the CU group. Participants with AD performed worse on episodic memory than those with VD and LBD for about 3 to 4 years prior to dementia onset (the FTD group documented an intermediate course). Presymptomatic verbal fluency and confrontation naming trajectories differentiated quite well between the FTD group and the remaining dementia entities. Participants with incident LBD and VD performed worse than those with AD on executive functions and mental processing speed-attention since about 5 years prior to the onset of dementia, and worse than those with FTD more proximally to the diagnosis of the disorder.

Conclusions: Heterogeneous cognitive trajectories characterize the presymptomatic courses of the most prevalent dementia entities.

目的描述老年非痴呆个体在四种最常见痴呆类型(即阿尔茨海默病(AD)、路易体痴呆(LBD)、血管性痴呆(VD)和额颞叶痴呆(FTD))发病前的10年临床前认知轨迹:我们的分析重点是老年(≥ 60 岁)NACC(美国国家阿尔茨海默病协调中心)参与者的数据。我们组成了四个不同的无症状痴呆组(AD-LBD-VD-FTD)和一个认知功能未受损者(CU)对比组。在基线期和大约每年进行一次综合认知评估,评估内容包括言语外显记忆、语义言语流畅性、对抗命名、心理处理速度--注意力和执行功能--认知灵活性。我们进行了描述性分析(调整后的一般线性模型),以确定和比较各组在整个随访期间的年度认知得分。此外,还进行了探索性分析,以估算认知能力下降率:共有3343名参与者罹患注意力缺失症,247名参与者罹患轻度注意力缺失症,108名参与者罹患轻度注意力缺失症,155名参与者罹患轻度注意力缺失症,3398名参与者罹患中度注意力缺失症。在痴呆症发病前的约3至4年里,注意力缺失症患者的外显记忆表现比VD和LBD患者差(FTD组记录了中间过程)。症状前言语流畅性和对抗性命名轨迹很好地区分了FTD组和其他痴呆实体。在痴呆症发病前5年左右,LBD和VD患者在执行功能和思维处理速度-注意力方面的表现比AD患者差,而在更接近痴呆症诊断的阶段,则比FTD患者差:结论:不同的认知轨迹是最常见痴呆症的症状前病程的特征。
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引用次数: 0
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Aging Clinical and Experimental Research
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