Aging Clinical and Experimental Research最新文献

Introduction

Pharmacists are among the most available and frequently consulted healthcare providers supporting older adults. They can actively contribute to thorough geriatric assessments and interventions and are often included in geriatric teams across different care settings.

Aim

This narrative review aims to compile current knowledge and practical approaches related to pharmacists’ roles in caring for older adults.

Methods

We searched in three databases and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were randomized clinical trials (RCTs) and systematic reviews, published between the years 2014 and 2024 in any language, reporting on the involvement of pharmacists in geriatric care, their interventions and results.

Results

From 306 identified different records, 32 studies were included in the final synthesis. The majority (22; 68.8%) were systematic reviews, ten were RCTs. The studies reported on the role of pharmacists in geriatric care in diverse settings including home, community, outpatient clinics, hospital, long-term care and residential facilities. While interventions were often multifaceted and complex, they more commonly comprised medication reviews and medication reconciliation. Positive outcomes resulting from pharmacists´ interventions were reported in 71.9% of the studies, mostly focused on medication appropriateness, deprescribing, medication safety and effectiveness.

Conclusion

Our narrative review highlights the growing evidence supporting the integration of pharmacists into geriatric care teams across diverse clinical settings. Despite heterogeneity among studies and limited high-certainty evidence, the findings underscore the potential of pharmacists to contribute meaningfully to person-centred, multidisciplinary care in this vulnerable population.

Background

Common consequences of a stroke include impaired motor and cognitive function, with both being linked to increased falls and frailty. Intra-individual variability (IIV) of cognitive performance, which refers to the within-person trial-to-trial variation in reaction time during cognitive tasks, may be a useful predictor for falls in older adults with chronic stroke.

Objective

To examine whether IIV or “traditional” reaction time (RT) measures of cognitive performance predict falls in older adults with chronic stroke.

Methods

This study is a secondary analysis of a proof-of-concept randomized controlled trial (RCT) among community-dwelling adults with a history of stroke, aged 55 years and older, able to walk 6 m, and without dementia. Residualised intraindividual standard deviation (rISD) was the measure of IIV and mean RT was the “traditional” measure of performance on a computerised Stroop Task. Falls were tracked and adjudicated over six months.

Results

120 participants with a mean (SD) age of 70 (8) years, and 46 (38%) female participants, experienced a mean of 0.61 (SD = 1.15) falls over 6 months. rISD for the congruent Stroop Task condition predicted falls, such that a one-unit increase was associated with 20.5% increase in fall rate.

Conclusion

The findings suggest that IIV metrics may have the potential in fall risk screening post-stroke. Further research is required to evaluate whether IIV in cognitive performance can be improved via interventions such as cognitive training and physical activity.

Background

Evidence and appropriate tools are often lacking to support the decision of driving discontinuation in cognitively impaired older adults by Alzheimer’s disease and related disorders. Maintaining strong driving knowledge as individuals age is crucial for ensuring their fitness to drive. The objectives of this study were to describe the driving knowledge of older drivers > 65 referred for cognitive assessment compared to control subjects. We also analyzed the relationship between neuropsychological tests and driving knowledge assessment.

Methods

Cross-sectional, observational, multicenter study in geriatric day hospitals including older drivers with cognitive complaints who underwent a comprehensive neuropsychological assessment. Their performance on a driving theory test (knowledge of driving laws and road rules) and self-evaluation of driving abilities were assessed via a computer-based exam and compared to those of healthy younger drivers. Regression models were used to examine the relationship between driving knowledge and the neuropsychological examination scores with adjustment for age, gender and cognitive performance.

Results

We included 144 patients (mean age 79.6 ± 4.9) and 249 controls (mean age 28.1 ± 6.6). Performance in the driving theory test was significantly lower in patients than in controls (p < 0.001). We showed a significative association between driving knowledge, the Montreal Cognitive Assessment (MoCA) and the Digit Symbol Substitution Test (DSST) independent from age, gender and cognitive performance.

Conclusion

Our study has raised concerns regarding the overall poor theoretical driving skills in older drivers and their low self-evaluation ability. The MoCA and the DSTT may be useful for guiding driving discontinuation in cognitively impaired older adults.

Background

Measuring hand grip strength (HGS) at admission can indicate probable sarcopenia in acute hip fracture and may help predict adverse post-operative outcomes.

Aims

To assess whether HGS is independently associated with adverse post-operative outcomes and enhances risk prediction when combined with the Nottingham Hip Fracture Score (NHFS).

Methods

Routinely collected National Hip Fracture Database data were combined with HGS at a single, high-volume orthopaedic trauma centre. Sarcopenia status was categorised per 2019 European Working Group thresholds as non-sarcopenic, probable sarcopenia, or unable to complete assessment. Binary logistic regression models and receiver-operating-characteristic (ROC) curves assessed prognostic value of HGS assessment.

Results

We analysed data from 282 patients, mean age 83.2 ± 9.2 years; 200 (71%) were women. In univariate analysis, probable sarcopenia (low HGS) was associated with 120-day mortality, 30- and 120-day residential status, prolonged length of stay and post-operative delirium. In multivariate analysis including the NHFS, probable sarcopenia was associated with 120-day mortality, 120-day residential status and post-operative delirium. Combining NHFS and HGS assessment improved discrimination for 120-day mortality (c-statistic 0.79 [95%CI 0.73–0.86]), 30-day residential status (0.85 [95%CI 0.80–0.90]) 120-day residential status (0.89 [95% CI 0.85–0.94]) and post-operative delirium (0.91 [95%CI 0.87–0.94]). Inability to complete HGS assessment was associated with worse prognostic outcomes than low HGS.

Discussion

Sarcopenia is a useful additional predictor of post-operative outcomes in hip fracture, especially post-operative delirium. Inability to complete HGS assessment may indicate even higher risk.

Conclusion

HGS is an inexpensive, feasible and quick adjunct to the NHFS. Further research is required to validate a combined NHFS-HGS score.

Background

Cognitive impairment may hinder effective self-management of cardiovascular disease and lead to worsening cardiovascular risk.

Aims

This study aimed to describe the rate of uncontrolled blood pressure, blood lipids, and blood glucose across different cognitive levels to identify priority groups for managing risk factors in patients with cardiovascular disease.

Methods

A total of 10,707 patients with cardiovascular disease or individuals at high cardiovascular risk were enrolled from Beijing Anzhen Hospital. Cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) scale, was categorized as normal (MoCA ≥ 26) or impaired (MoCA < 26). Logistic regression was used to explore the association between cognitive function and the rates of uncontrolled blood pressure, lipids, and glucose.

Results

Among diabetic patients, the rate of uncontrolled blood glucose in those with cognitive impairment was significantly higher in patients with cognitive impairment than in those with normal cognition [hemoglobin A1c ≥ 7%, 65.7% vs. 56.6%, adjusted odds ratio (aOR) (95% confidence interval, 95% CI):1.40(1.21–1.62), P < 0.001]. The rate of uncontrolled blood pressure and blood lipids were slightly higher in cognitive impairment than normal cognition, however, the differences were not statistically significant [systolic blood pressure(SBP) ≥ 130mmHg and/or diastolic blood pressure(DBP) ≥ 80mmHg, 74.6% vs. 70.5%, aOR(95% CI):1.07 (0.96–1.20), P = 0.206; SBP ≥ 140mmHg and/or DBP ≥ 90mmHg, 45.4% vs. 40.0%, aOR(95% CI):1.08(0.98–1.91), P = 0.125; poor blood lipids management, 72.2% vs. 70.5%, aOR (95% CI):1.00(0.89–1.13), P = 0.994].

Conclusions

In this cross-sectional study, a significant association was observed between cognitive impairment and an unfavorable cardiovascular risk profile. This may reflect challenges in self-management and underscores the need for proactive care.

Background

The growing population of older adults in China has drawn attention to the significant disparities in health resources and overall health status exist between urban and rural older adults. Intrinsic capacity (IC), a key indicator of comprehensive health levels in older adults, plays a crucial role in achieving healthy aging. This study aimed to systematically evaluate the inequality in IC among Chinese older adults from an urban-rural divide perspective, identify the factors influencing these inequalities, and decompose the sources of inequality.

Methods

On the basis of data from the China Health and Retirement Longitudinal Study (CHARLS), 7,695 adults aged 60 years and above were included. Concentration curves and concentration index (CI) were used to measure economic-related inequality in IC. Using the Dahlgren–Whitehead model of social determinants of health, generalized estimating equations (GEEs) were applied to analyze factors influencing IC among urban and rural older adults. Wagstaff’s decomposition method was further employed to decompose the CI.

Results

A pro-rich inequality in IC (CI > 0) was observed among both urban and rural older adults, with a higher degree of inequality in urban areas that continued to widen over time. In 2013, age was the largest contributor to inequality in rural areas (contribution to CI: 27.55%), while social activity was the main contributor in urban areas (contribution to CI: 26.02%). By 2015, social activity had become the primary contributor in both rural (contribution to CI: 22.69%) and urban (contribution to CI: 28.91%) areas. Multivariate analysis showed that increased age, higher Instrumental Activities of Daily Living (IADL)/Activities of Daily Living (ADL) scores, and the presence of chronic diseases were associated with lower IC, whereas longer sleep duration, more social activities, higher education levels, and improved green coverage in built-up areas were associated with higher IC. Having more children was positively associated with IC only among urban older adults, while being married and engaging in exercise were positively associated with IC only among rural older adults.

Conclusion

Chinese older adults showed inequality in IC, with more pronounced inequality in urban areas. Social activity and age are major contributing factors. Interventions such as promoting social participation, optimizing environmental resources, and implementing tailored urban-rural health policies are recommended to mitigate IC inequality and advance health equity.

Background

The body roundness index (BRI) has emerged as a refined anthropometric indicator that integrates waist circumference and height to quantify body shape characteristics and metabolic risk. However, its longitudinal associations with mortality across diverse chronic diseases remain underexplored. This study aims to investigate these associations and their potential mechanisms.

Methods

This longitudinal study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), covering a 9-year follow-up from baseline (2011–2012) to 2020. The study cohort comprised 11,750 middle-aged and older Chinese adults. BRI was calculated using waist circumference and height. The primary outcome was all-cause mortality. Cox proportional hazards models were used to assess associations, restricted cubic spline (RCS) models explored nonlinear effects, and Kaplan-Meier survival curves provided survival rate estimates.

Results

Higher BRI levels conferred significant protective effects against all-cause mortality in the overall population (HR = 0.94, 95% CI = 0.89–0.98), hypertension (HR = 0.93, 95% CI = 0.87–0.98), lung disease (HR = 0.87, 95% CI = 0.78–0.97), asthma (HR = 0.77, 95% CI = 0.63–0.95), and dyslipidemia (HR = 0.90, 95% CI = 0.84–0.97). Conversely, elevated BRI increased liver disease mortality risk (HR = 1.32, 95% CI = 1.04–1.68). RCS modelling revealed significant non-linear relationships between BRI and mortality risk for hypertension and lung disease (non-linear P < 0.05), whereas the associations with dyslipidemia, asthma and the overall population remained essentially linear (non-linear P > 0.05).

Conclusions

BRI is a multifaceted predictor of chronic disease mortality, with associations varying by disease pathophysiology and population characteristics. It offers a pragmatic tool for refining risk stratification in aging populations and challenges one-size-fits-all approaches to obesity management. Future research should investigate dynamic BRI trajectories and interactions with disease-specific biomarkers.

Background

Deterioration of cognitive function with aging is a significant public health issue, particularly in individuals with diabetes mellitus (DM). Exercise has been shown to enhance cognitive function. However, the threshold effect of physical activity on cognitive function in older adult people with DM remains unclear.

Methods

This study analyzed data from 925 older participants (aged 60 and above) derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2014, representing a total weighted respondent count of 13,824,651. Cognitive function was evaluated with the Animal Fluency test (AFT) and Digit Symbol Substitution test (DSST). To assess the relationship between physical activity and cognitive function, we applied weighted linear regression models coupled with restricted cubic spline analysis. Furthermore, a two-piecewise linear regression model was utilized to detect any potential threshold effect of exercise on cognitive function.

Results

The results indicated a positive correlation between physical activity and cognitive function scores on the AFT and DSST after adjusting for potential confounders. Threshold analyses showed a consistent positive relationship for AFT scores at less than 490 MET-min/week of physical activity [β (95% CI) = 0.45 (0.20, 0.70), p = 0.001] and for DSST scores at less than 1,120 MET-min/week [β (95% CI) = 0.55 (0.20, 0.89), p = 0.004]. However, when the exercise volume reached these two inflection points, a saturation effect occurred.

Conclusion

This study shows a clear inverted U-shaped relationship between physical activity and cognitive function in older adults with DM. Cognitive benefits do not increase with higher exercise volume and approximately 490 MET-minutes/week appears to be the optimal dose for preserving cognitive function in this population. Additional research is necessary to confirm these findings in future studies using objective, precise measures such as pedometers and accelerometers.

Objective

This paper aims to assess the clinical effectiveness of an Enhanced Recovery After Surgery (ERAS)-based care bundle in facilitating early rehabilitation in patients with acute ischemic stroke (AIS).

Methods

A total of 120 AIS patients were randomly assigned to either a control group (n = 60), receiving routine nursing care, or an experimental group (n = 60), which received additional ERAS-guided bundled care. Outcome measures included neurological function [NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS)], limb strength (Lovett scale), language ability [Boston Diagnostic Aphasia Examination (BDAE)], swallowing function [Water Swallow Test (WST)], psychological status [Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA)], and quality of life [Stroke-Specific Quality of Life Scale (SS-QOL)]. Incidence of adverse events was also recorded.

Results

Post-intervention, NIHSS and mRS scores declined more markedly in the experimental group than in the control group (P < 0.05). The experimental group had a higher number of patients with Lovett muscle strength grade 4, BDAE grades 4 and 5, and WST grade 1 compared to the control group (P < 0.05). The HAMD and HAMA scores in the experimental group were lower than those in the control group (P < 0.05). The experimental group also had lower adverse event rate compared to the control group (P < 0.05).

Conclusion

An ERAS-based care bundle can significantly enhance early functional recovery, mitigate psychological distress, and reduce complications in AIS patients, supporting its clinical applicability in stroke rehabilitation.

Growing evidence highlights the potential of multidomain lifestyle-based interventions to reduce the risk of cognitive decline among older adults at higher risk of cognitive impairment. Within these complex and often demanding interventions, adherence has emerged as a key factor influencing both outcomes and impact. Numerous studies have explored adherence from the perspective of researchers which is often defined as the extent to which a person’s behaviour corresponds with agreed recommendations from a healthcare provider. However, less is known about how members of the public understand and experience it. This article presents insights gathered from Advisory Boards established within three European-funded projects, as part of Public Involvement activities led by Alzheimer Europe in collaboration with researchers in the projects. The discussions involved 23 members of the public (lay people with and without dementia) from nine European countries and focused on adherence in the context of research-based multidomain lifestyle interventions to reduce dementia risk. Feedback from Advisory Boards members were grouped in three overarching themes: (1) “Baking your own cake” which highlights the relevance and understandings of adherence from members of the public; (2) “Striking a balance” which refers to the complexity and influencing factors linked to adherence; and (3) “A two-way process” which emphasises the involvement of members of the public and the importance of clear communication and appropriate support throughout the intervention process. Promoting adherence requires recognising participants as active partners in research which may not only improve adherence itself but also enhance the relevance, effectiveness and long-term impact of dementia prevention efforts.