Aging Clinical and Experimental Research最新文献

Background

Physical inactivity is an ongoing problem throughout the lifespan. For older people, inactivity has a negative impact on wellbeing, which worsened during the COVID-19 pandemic. Digital technologies can be employed to encourage uptake of social and physical activity through remotely delivered interventions to improve wellbeing, however, we need to understand older people’s perceptions and experiences of using digital technologies before implementing these interventions.

Aims

To explore the perceptions and experiences of older people on the use of digital technologies during the COVID-19 pandemic.

Methods

Qualitative semi-structured interviews were conducted with 16 community dwelling older people from Hertfordshire, United Kingdom who were all programme participants in a remotely delivered mind-body physical activity programme called Positive Movement. Interviews were conducted before programme participation. The audio recorded interviews were transcribed and analysed using thematic analysis.

Results

Four themes emerged from the data. The perceived impact of COVID-19 on social contact, perceived impact of COVID-19 on mental wellbeing, using digital platforms for health or exercise and using digital platforms for social contact.

Discussion

Participants reported reduced social contact due to COVID-19. Most participants reported using digital technologies for social inclusion rather than health reasons, and there were mixed views on the willingness to use digital technologies for physical activity.

Conclusion

Digital technologies offered a lifeline during COVID-19 to maintain social contact and their use was found acceptable by older people. Digital platforms such as Zoom can be further employed to conduct remotely delivered interventions with the aim to increase uptake of social and physical activity interventions within this population.

Recent methodological developments have contributed to a significant advance in computerised neuropsychological instruments and procedures, including those accessible from remote. In this paper we present Auto-GEMS, a newly developed, web-based, self-administered screening test allowing to quickly estimate an individual’s cognitive state also considering their cognitive reserve. Auto-GEMS measures cognitive functioning on eleven items similarly to the in-person paper-and-pencil version (GEMS) and to the remote (phone or video call) version (Tele-GEMS) of the same screening. We collected normative data on a sample of 1308 Italian-speaking participants (age range 18–93) to verify its psychometric properties and computed regression models on demographic variables to establish clinical cut-offs. The psychometric properties of Auto-GEMS have shown good internal consistency, test-retest reliability and convergent validity. This short and user-friendly tool has a number of potential applications. For instance, it can be useful in clinical practice to monitor the cognitive profile of patients or vulnerable individuals, or even administered in a face-to-face, standard clinical setting. It can also be used in research studies to screen participants. The testing materials and the collected data are freely available in a digital archive along with a web App to visualise the test outcome with reference to its normative data.

Background

The German version of the SarQoL^®, a sarcopenia-specific quality of life (QoL) questionnaire, has not been validated hindering its widespread use. This study aimed to evaluate the psychometric properties of the German SarQoL^®.

Methods

Via a cross-sectional study participants were recruited in two geriatric outpatient facilities and one acute geriatric ward in Munich (Germany). Sarcopenia and probable sarcopenia were diagnosed with the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm. From 185 participants (age 79.8 ± 6.1), 77 had probable sarcopenia, and 51 had sarcopenia. Participants completed the SarQoL^® and the European Quality-of-Life 5-Dimension (EQ-5D) questionnaires. The validation included examination of the discriminative power, construct validity, internal consistency, test-retest reliability, and floor/ceiling effects.

Results

Lower SarQoL^®scores for sarcopenic (p = 0.002) and probable sarcopenic subjects (p < 0.001) compared to controls indicated good discriminative power. Consistent construct validity was found for sarcopenic subjects: moderate to high correlations with domains capturing similar constructs of the EQ-5D: ‘Activities of daily living’ (r = -0.58, p < 0.001), ‘Mobility’ (r = -0.72, p < 0.001) and low correlations with domains related to different constructs like ‘Pain’ (r = -0.32, p < 0.022). Similar correlations were found for probable sarcopenic subjects. The Cronbach’s alpha was 0.8. Test-retest reliability was excellent (intraclass coefficient correlation of = 0.96; 95% CI = 0.91–0.99), and no floor/ceiling effects were observed.

Conclusion

QoL was similarly reduced in both patient cohorts compared to controls. The German SarQoL^® is a valid and reliable instrument for measuring QoL in patients > 65 years of age with sarcopenia and probable sarcopenia and can now be used in epidemiological studies and clinical trials in a German-speaking population.

Trial registration

German Clinical Trials Register (DRKS)-ID: DRKS00020504 (March 12th, 2021) .

Background

The association between the frailty index (FI) and the risk of chronic lung diseases (CLDs) remains unexplored, warranting further research.

Methods and materials

This study investigated the relationship between FI and CLD risk using data from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA), comprising a combined sample of 9642 individuals. Propensity score weighting was used to ensure similar distribution of covariates across FI groups. The Wilcoxon rank-sum test was used to analyze differences in FI scores between groups with and without CLD. Kaplan–Meier curves and Cox regression analysis were employed to explore the association between frailty status and CLD incidence, with sensitivity analyses conducted for validation.

Results

Higher FI scores were significantly associated with increased CLD risk in both cohorts (p < .05). Kaplan–Meier survival and Cox regression analyses indicated that frail individuals have a significantly elevated risk of CLD compared to robust individuals, particularly in certain subgroups (e.g., female) within the CHARLS cohort (p < .05). The ELSA cohort yielded similar results (p < .05), affirming FI as a strong predictor of CLD. Additional risk factors identified included age, smoking, and unmarried status (p < .05). Frail individuals consistently exhibited the highest risk in both cohorts (CHARLS HR = 1.54, p = .003; ELSA HR = 6.64, p < .001). The sensitivity analysis did not substantially alter the significant associations.

Conclusion

These findings emphasize the critical role of frailty in the development of CLD, suggesting that targeted interventions could reduce CLD risk.

Background

Most standardized balance tests cannot detect subtle balance deterioration in middle age, or identify those at higher risk for accelerated balance decline due to a ceiling effect.

Aims

To determine whether the Brief Balance Evaluation Systems Test (Brief-BESTest), partially instrumented with accelerometry, can detect balance deterioration in middle age and identify individuals with poor balance.

Methods

We studied young (25.3 ± 2.3 years), early middle-aged (47.7 ± 2.6 years), and late middle-aged adults (60.6 ± 3.6 years), with 25 participants in each age group. Subjects wore an accelerometer on their lower back while performing the Brief-BESTest. Balance measurements included the Brief-BESTest total and sub-measures scores, and postural sway during the Brief-BESTest standing tasks, calculated by the 95% confidence ellipse trajectory of the center of mass (COM-95% ellipse).

Results

Compared to the two middle-aged groups, young adults had better total Brief-BESTest and sub-measures scores, apart from the Stability-in-Gait sub-measure, and less postural sway during the Sensory-Orientation sub-measure. The total Brief-BESTest scores as well as the Biomechanical-Constraints and Sensory-Orientation sub-measures differed also between early and late middle-aged adults. Both the Brief-BESTest total scores and the Sensory-Orientation postural sway values demonstrated increased variation with age, allowing to identify subjects with poor balance. A moderate negative correlation (r = -0.43) was found between the Brief-BESTest total score and the COM-95% ellipse size, and a moderate agreement (k = 0.56) in identifying subjects with poor performance in the early but not the late middle age group.

Conclusions

The Brief-BESTest test combined with accelerometry could be a suitable screening tool to identify middle-aged people with early balance deterioration and potentially identify those with poor balance and a possible higher risk for falls. Clinicians and policymakers can use our findings to implement balance assessment programs in patients < 65 years, leading to preventive strategies before the risk increases.

Introduction

The general population experiences mortality rates that are related to high levels of high-sensitivity C-reactive protein (hs-CRP). We aim to assess the linkage of longitudinal trajectories in hs-CRP levels with all-cause mortality in Chinese participants.

Methods

We utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The exposures were dynamic changes in the hs-CRP and cumulative hs-CRP from 2012 to 2015, and the outcome was all-cause mortality. All participants were categorized into four trajectories according to hs-CRP levels. Multivariable logistic regression analysis, adjusted for potential confounders, was employed to evaluate the relationship of different trajectories of hs-CRP with mortality risk. A two-sample Mendelian randomization (TSMR) method and SHapley Additive exPlanations (SHAP) for identifying determinants of mortality risk were also employed.

Results

The study included 5,445 participants with 233 deaths observed, yielding a mortality proportion of 4.28%. Compared to individuals maintaining low, stable levels of hs-CRP (Class 1), individuals with sustained elevated levels of hs-CRP (Class 4), those experiencing a progressive rise in hs-CRP levels (Class 2), or those transitioning from elevated to reduced hs-CRP levels (Class 3) all faced a significantly heighted death risk, with adjusted Odds Ratios (ORs) ranging from 2.34 to 2.47 across models. Moreover, a non-linear relationship was found between them. Further TSMR analysis also supported these findings. SHAP showed that hs-CRP was the fifth most important determinant of mortality risk.

Conclusions

Our study shows all-cause mortality increases with dynamic changes in hs-CRP levels among middle-aged and elderly adults in China, and cumulative hs-CRP shows an L-shaped relationship with all-cause mortality.

Background

Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown.

Aims

Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs.

Methods

Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted.

Results

Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability.

Conclusions

DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Aim

Non-communicable diseases (NCDs) in elderly are a significant problem in Ukraine. It is expected that the ongoing war will augment this problem. The study aimed to analyze the trends of disability due to NCDs s in newly-diagnosed elderly patients between 2013 and 2023.

Methods

This retrospective study included data obtained from the official document “Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation” commissioned by the Ministry of Health of Ukraine. The data on disability due to NCDs s were obtained from for 2013–2023.

Results

During the 2013–2021 the average number of disabled elderly patients due to NCDs per 10,000 elderly persons was significantly lower in compare with working-age. During the first year of full-scaled war the average number of disabled elderly patients due to NCDS s per 10,000 elderly persons dramatically increased by 2-fold, and in 2023 – by 2.8-fold against 2013 value (p < 0.05), while in working-age the disability rate increased significantly only in 2023 by 1.4-fold compared to the pre-war level. In 2013–2021 the main causes of disability among those related to NCDs in elderly were cardiovascular diseases, followed by cancer. In 2022 compared to the pre-war level, the indicators of disability of the elderly due to CVD increased by 1.5 times, due to cerebrovascular diseases - by 2.2 times, due to cancer - by 1.7 times, due to musculoskeletal diseases - by 2 times (p < 0.05). The most significant increase in the number of elderly people with disabilities during the full-scale war occurred due to coronary artery disease - by 55.1%, and osteoarthritis - by 83.4% from baseline in 2013. It estemated the differences in indicators of disability of elderly between regions of Ukraine, significantly higher indicators of disability of the elderly due to cardiovascular diseases, cancer, cerebrovascular diseases, musculoskeletal diseases were noted in the frontline regions.

Conclusions

Data on primary disability among elderly Ukrainians indicates a significant increase in NCDs-related disability during the war in compare with working population, especially in frontline regions and regions with a high concentration of displaced persons. In this structure of NCDs-related increasing disability, CVD, oncology and musculoskeletal diseases system prevailed.

Aim

The aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older male patients.

Methods

A total of 223 older males attending one geriatric outpatient clinic were included in this cross-sectional study. Anemia was defined as a hemoglobin level below 13 g/dL. Patients’ demographic characteristics, comorbidities, and comprehensive geriatric assessment parameters were also recorded. Handgrip strength of < 27 kg for males was accepted as dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity.

Results

The mean age (standard deviation) of the participants was 80.17 (7.69) years. The prevalence of patients with anemia was 43.9%. There was differences between anemic and non-anemic groups in terms of presence of diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), malnutrition, dynapenia, geriatric depression, BADL and IADL scores (all p < 0.05). In multivariate analysis, after adjusting for all confounding variables except for dynapenia, patients with anemia were associated with reduced BADL and IADL (all p < 0.05). After adjusting for all confounding variables including dynapenia, deterioration in total BADL and IADL scores did not remain significant in the anemic group compared to the non-anemic group (p > 0.05).

Conclusion

Close to one in two older outpatient men had anemia. Anemic men had a higher incidence of DM, CHF, CKD, malnutrition, geriatric depression and dynapenia. Anemia was associated with dependence in both BADL and IADL in older men. However, comorbidities, nutritional status, depressive mood and, specifically muscle strength, were important contributors to this association.

The link between biological aging and prostate cancer (PCa) risk, particularly as indicated by elevated prostate-specific antigen (PSA) levels, remains uncertain. This study utilized data from the National Health and Nutrition Examination Survey (2001–2010) to explore this association. Biological age was assessed using Klemera-Doubal method age (KDMAge) and phenotypic age (PhenoAge). PCa was identified through self-reported diagnoses, and highly probable PCa was determined by PSA levels. We analyzed the prevalence of PCa and PSA-defined highly probable PCa across quartiles of biological age measures using weighted chi-square and linear trend tests. Associations were evaluated using weighted multiple logistic regression models. Among 7,209 and 6,682 males analyzed, the overall weighted prevalence of PCa was 2.86%, increasing to 9.60% in those aged 65 and above. A significant rise in PCa prevalence was observed with higher quartiles of KDMAge or PhenoAge (P for trend < 0.001), particularly in those under 65. In this younger group, higher PhenoAge acceleration quartiles were linked to increased PCa prevalence and higher risk of PCa (OR = 1.50, P = 0.015) as well as highly probable PCa in those without a diagnosis (OR = 1.28, P = 0.031). These findings suggest that accelerated biological aging is associated with an increased risk of PCa and may indicate early risk as signaled by PSA levels, even in those without a PCa diagnosis.