Aging Clinical and Experimental Research最新文献

Background

Statins are used for cardiovascular prevention, but their potential impact on muscle health in adults aged ≥ 75 years remains unclear.

Aims

To assess whether statin use is associated with adverse changes in muscle strength, skeletal muscle mass, and physical performance in older adults.

Methods

Data were drawn from the SCOPE study including 2,282 participants aged ≥ 75 years with complete baseline data on statin use and muscle outcomes. Muscle strength was assessed via handgrip strength, muscle mass via skeletal muscle index (SMI), and physical performance via the Short Physical Performance Battery (SPPB). Outcomes were measured at baseline and after two years. Associations with statin use were analysed cross-sectionally and longitudinally, stratified by sex, and adjusted for confounders.

Results

At baseline, 1,107 participants (48.5%) used statins (median age 79 years). Cross-sectional analyses showed no association between statin use and handgrip strength, SMI, or SPPB scores in either sex. Over two years, there were no significant between-group differences in changes over time in handgrip strength (men: − 3.1 vs. − 2.6 kg, p = 0.8; women: − 1.5 vs. − 2.5 kg, p = 0.6), SMI (men: +1.0 vs. − 0.6 kg/m², p = 0.1; women: +0.4 vs. − 0.1 kg/m², p = 0.4), or risk of SPPB decline (men: OR 1.3, 95% CI 0.9–1.8; women: OR 1.0, 95% CI 0.8–1.4).

Discussion

These findings support muscular safety of statins in well-functioning older adults, reducing concerns about potential harm.

Conclusions

In this large cohort of adults aged ≥ 75 years, statin use was not associated with adverse changes in muscle strength, muscle mass, or physical performance over two years.

Background

Early knee osteoarthritis (KOA) is difficult to diagnose due to the limited sensitivity of conventional imaging and the heterogeneous presentation. This exploratory study aimed to characterize patients with early KOA symptoms by integrating arthroscopy, MRI, and synovial histopathology, and to assess the complementary value of these modalities.

Methods

We included 130 adults (> 18 years) with knee pain lasting > 3 months and inconclusive clinical and radiographic findings. Exclusion criteria included advanced radiographic OA (Kellgren–Lawrence grade > 2), previous diagnoses of musculoskeletal, rheumatic disorders or previous knee injury or surgery. MRI was performed before arthroscopy. Isolated minor findings (small focal cartilage defects or mild meniscal changes without structural disruption) were not considered exclusionary. All patients underwent diagnostic arthroscopy, and synovial biopsies were obtained from the medial patella and infrapatellar fat pad.

Results

Based on arthroscopic Outerbridge scoring, 24 patients were classified as early KOA (grades 0–2) and 55 as moderate KOA (grades 3–4). Arthroscopy detected early cartilage lesions in 60% of cases, compared with 35% by MRI. MRI WORMS scores for non-cartilaginous structures did not differ between groups. Synovial fibrosis and macrophage infiltration were higher in moderate KOA and correlated with WOMAC pain.

Conclusion

Arthroscopy was more sensitive than MRI for early cartilage damage, while MRI provided complementary information on non-cartilaginous structures. Synovial inflammation and fibrosis were already present at early stages. An integrated approach combining arthroscopy, MRI, and synovial histopathology enables refined structural and biological characterization of early KOA and may support patient stratification in disease-modifying trials.

Aim

This study aimed to examine the trends and determinants of dietary supplement use and to assess the prevalence and predictors of potential drug-supplement interactions among older adults over a 16-year follow-up.

Methods

This repeated cross-sectional study included adults aged ≥ 50 years who participated in the third (2006–2008; n = 3,484), fourth (2009–2011; n = 4,020), fifth (2012–2014; n = 4,342), sixth (2015–2017; n = 4,598), and seventh (2018–2022; n = 4,750) examinations of the Tehran Lipid and Glucose Study (TLGS). Information on dietary supplement use, including individual vitamin supplements and prescription medication use was collected using standardized questionnaires. Trends in supplement use and participant characteristics were evaluated across study phases. Clinically relevant mild-to-moderate potential drug-supplement interactions were defined as the concurrent use of specific dietary supplements and commonly prescribed medications and were classified according to Stockley’s framework. Multivariable logistic regression models were used to identify factors associated with dietary supplement use and potential drug-supplement interactions in the 2018–2022 examination.

Results

Over 16 years, dietary supplement use increased more than 2-fold from 10.4% to 21.1%, mainly from increases in thiamin (2.2% to 13.4%), cobalamin (1.8% to 9.8%), vitamin C (1.3% to 7.9%), vitamin E (1.8% to 8.7%), and zinc (0.2% to 3.3%). Female sex, higher education, and diabetes were associated with higher likelihood of supplement use. In 2018–2022, 4.8% of participants had potential drug-supplement interactions, most commonly vitamin E with aspirin (2.3%) and magnesium or potassium with antihypertensive medications. The likelihood of potential drug-supplement interactions was higher in women (OR = 2.03, 95%CI = 1.61–2.56), participants with primary education (OR = 1.45, 95% CI = 1.09–1.96), smokers (OR = 1.50, 95%CI = 1.07–2.12), and individuals with diabetes (OR = 2.80, 95%CI = 2.13–3.68), hypertension (OR = 2.20, 95%CI = 1.78–2.73), chronic kidney disease (OR = 2.35, 95%CI = 1.88–2.94), or multimorbidity (OR = 2.46, 95%CI = 1.85–3.26).

Conclusion

Over 16 years, supplement use increased among older adults, especially B-complex vitamins, vitamin C, vitamin E, and zinc, with a low but clinically relevant prevalence of drug-supplement interactions.

Background

Intrinsic capacity (IC) is a core concept of the World Health Organization’s (WHO) Integrated Care for Older People (ICOPE), representing the composite of an individual’s physical and mental reserves. While deficits in IC are associated with reduced health-related quality of life (HRQoL), the functional mechanisms underlying this relationship, particularly the role of functional independence as measured by activities of daily living (ADL) remains underexplored. We investigated whether ADL performance mediates the association between IC and HRQoL among Chinese older adults.

Methods

In this cross-sectional analysis, 468 community-dwelling and institutionalized adults aged 60 years and older were recruited from the WHO ICOPE pilot in Lianyungang, China. Cumulative IC impairment was evaluated across five domains (cognition, locomotion, nutrition, sensory function, and psychology) using the ICOPE screening tool. ADL dependence was quantified by the Modified Barthel Index, and HRQoL was measured using the EQ-5D-3 L instrument. Multivariable logistic regression was employed to estimate the association between IC and HRQoL, adjusting for sociodemographic and clinical covariates. A nonparametric bootstrap mediation analysis (5000 resamples) quantified the indirect effect of IC on HRQoL via ADL.

Results

After adjusting for covariates, each one-point increase in Cumulative IC Impairment Score was associated with 46% higher odds of impaired HRQoL (adjusted OR = 1.46; 95% CI: 1.26–1.69; p < 0.001). ADL dependence mediated approximately 34.1% of this association (indirect effect = 0.028; 95% CI: 0.006–0.050; p = 0.013). Subgroup analyses revealed that the IC-HRQoL association was significantly stronger among urban residents compared to suburban residents (interaction p = 0.004) and among community-dwelling older adults compared to nursing home residents (interaction p = 0.043).

Conclusions

Intrinsic capacity impairment is associated with compromised HRQoL both directly and indirectly by exacerbating functional dependence. Preserving functional independence serves as a key pathway connecting intrinsic capacity to well-being. These findings highlight the imperative for integrated interventions that simultaneously bolster intrinsic capacity and support daily functional ability, tailored to diverse living environments to promote healthy aging.

Background

Frailty assessment in the emergency department (ED) is essential but challenging. The Clinical Frailty Scale (CFS) is widely used, although inter-rater variability has been reported across assessors and assessment methods.

Aims

To assess agreement between ED-assigned and retrospectively assigned CFS scores, and to explore characteristics associated with changes in frailty classification.

Methods

We included 500 patients aged ≥ 65 years admitted with suspected pneumonia to Haukeland University Hospital (2019–2023). CFS was initially scored by nurses in the ED and reassessed retrospectively by a geriatric-trained physician using chart review. The retrospective assessment had access to broader and more objective information, including formal documentation from care services on daily function. CFS scores were categorized as fit (1–3), prefrail (4) and frail (5–9). Agreement was measured by Intraclass Correlation Coefficient (ICC).

Results

CFS scores changed numerically in 252 (50.4%) patients and frailty category in 144 (28.8%). Agreement was moderate to good (ICC 0.73; 95% CI 0.68–0.77; p < 0.001), with retrospective assessment yielding higher scores. Agreement was highest in frail (89.7%) and lowest in prefrail patients (44.8%). Recategorized patients were older, more comorbid, more often community-dwelling with greater care dependency, and had higher 1-year mortality.

Discussion

Real-time frailty assessments in the ED may underestimate frailty, particularly among patients who are community-dwelling, older, or have complex health conditions. Retrospective assessments, informed by objective documentation of functional needs, likely reflect baseline frailty more accurately.

Conclusions

Frailty is often underestimated in the ED. Improved access to collateral information may improve assessment accuracy.

Background

Periprosthetic hip fractures (PPHF) are a serious and increasingly frequent complication of hip arthroplasty, associated with significant morbidity and mortality in older adults.

Aims

To investigate the association between orthogeriatric assessment scores and six-month and one-year postoperative mortality in elderly patients undergoing surgery for PPHF.

Methods

A prospective registry of patients aged ≥ 65 years treated surgically for PPHF at Trieste University Hospital was analysed. Clinical, radiographic, and perioperative data were collected. Orthogeriatric scores, including the Mini Nutritional Assessment – Short Form (MNA-SF), Short Portable Mental Status Questionnaire (SPMSQ), Activities of Daily Living (ADL), Charlson Comorbidity Index (CCI), Parker Mobility Index, and Nottingham Hip Fracture Score (NHFS), were recorded on admission and at follow-up. Univariate analyses were performed to identify predictors of six-month and one-year mortality.

Results

Fifty-two patients (mean age 83.6 ± 8.1 years; 77% women) were included. The six-month and one-year mortality rates were 23.1% (12/52 patients) and 22.5% (9/40 patients), respectively. Higher mortality correlated significantly with poorer nutritional status (MNA-SF, p = 0.033; p = 0.011), lower cognitive performance (SPMSQ, p = 0.004, p = 0.002), reduced functional independence (ADL, p = 0.041, p = 0.026), and higher Nottingham Hip Fracture Scores (NHFS, p = 0.022, p = 0.047).

Conclusions

In conclusion, orthogeriatric scores, particularly MNA-SF, SPMSQ, ADL, and NHFS, are strong predictors of mortality after PPHF.

We read the recent systematic review and meta-analysis on nutrition-based, gut microbiota–targeted interventions for sarcopenia in older adults with great interest. While the evidence suggests that probiotics and fiber-enriched diets may improve surrogate outcomes such as muscle strength and gait speed, we highlight two priorities to strengthen future mechanistic and clinical translation. First, microbiome measurements in existing trials are often limited to genus-level taxonomic shifts, which can be biologically misleading because a single genus may include members with divergent immunomodulatory properties. Even species-level profiling may be insufficient, as strains within the same species can differ markedly in genetic content and metabolic capacity. Moreover, taxonomic composition does not necessarily reflect functional output due to functional redundancy across microbial communities. We therefore recommend transitioning to whole-genome shotgun metagenomics to enable strain-level resolution and functional profiling, allowing investigators to quantify pathways and metabolites relevant to muscle preservation, including short-chain fatty acids and vitamin biosynthesis. Second, we argue that improvements in sarcopenia-defining parameters should be linked to patient-centered clinical benefit. Future randomized controlled trials should be adequately powered to assess hard endpoints, including falls, fractures, hospitalization rates, and functional independence, alongside muscle mass and performance measures, to establish whether microbiota modulation delivers meaningful reductions in healthcare burden.

Background

Provision of vascular imaging results has been investigated to prompt changes towards healthy lifestyle behaviours, but effects on body composition and muscle health are unknown.

Aim

This secondary analysis of a 12-week parallel-group randomised controlled trial (RCT) aims to explore body composition and muscle health effects of providing healthy lifestyle education (Ed) with and without abdominal aortic calcification (AAC) results.

Methods

A total of 240 Australian community-dwelling older men and women (mean ± SD age 68 ± 5 years; 58% female; 57.1% with evidence of AAC) were randomised to AAC + Ed (n = 121) or Control + Ed (n = 119). Linear mixed models were used to compare between-group changes in body composition (dual-energy X-ray absorptiometry), grip strength, and subjective physical function.

Results

In total, 226 (94%) participants completed the trial. Provision of AAC results with lifestyle education provided no benefits to body composition, grip strength or physical function, compared to education alone. Exploratory analyses within the AAC + Ed group showed that those with evidence of AAC at baseline had greater declines in fat mass (net difference in change [95% CI] -0.6 [-1.0, -0.1] kg, p = 0.016) and visceral adipose tissue (-31 [-61, -1] g, p = 0.044) compared to those without evidence of AAC.

Conclusions

Providing AAC results with healthy lifestyle education did not improve body composition or muscle health in older adults, compared to education alone. Provision of AAC results to those with evidence of AAC at baseline did improve total and visceral fat mass compared to those without evidence of AAC, but these findings require further investigation.

Trial registration

Australian New Zealand Clinical Trial Registry (anzctr.org.au); registration number ACTRN12618001087246; registered 28/06/2018.

Background

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

Aims

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

Methods

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

Results

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

Discussion

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

Conclusions

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

Prospero registration

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

Clinical trial number

Not Applicable.