Aging Clinical and Experimental Research最新文献

Background

The self-reported FRAIL scale is suitable for frailty assessment in the busy primary care practice setting.

Aim

To estimate the association between phenotypic frailty assessed by FRAIL and subsequent health care costs in older men and women.

Methods

Prospective study of 7947 community-dwelling adults (mean age 79.2 years, 52.6% female) enrolled in 4 cohort studies of older adults linked to U.S. Medicare claims. The primary predictor was the FRAIL scale categorized into 3 levels (robust, pre-frail, and frail). A multimorbidity index (Hierarchical Conditions Category score) and the Kim frailty indicator (approximating the deficit accumulation index) were derived from U.S. Medicare claims. Annualized total and sector-specific health care costs (U.S. 2023 dollars) for 36 months after the index examination were ascertained from claims. Generalized linear models with gamma variance and log link functions were used to estimate the association of FRAIL category with subsequent health care costs.

Results

After accounting for claims-based indicators of multimorbidity and frailty, estimated annualized mean total health care costs for individuals categorized as robust were $9742 in women and $13,319 in men. Compared with robust individuals, adjusted mean annualized incremental costs for prefrailty were $4104 (95% C.I. 604–5604) in women and $1955 (95% C.I. 102–3808) in men and for frailty were $9028 (95% C.I. 6653–11402) in women and $6604 (95% C.I. 3168–11039) in men.

Discussion and conclusion

Pre-frailty and frailty assessed using the self-reported FRAIL scale are associated with higher subsequent total health care costs, even after accounting for claims-based indicators of multimorbidity and frailty.

Background

Denosumab, a monoclonal antibody targeting RANKL, is widely used for the treatment of osteoporosis. In addition to its skeletal benefits, emerging evidence suggests that denosumab may also exert positive effects on muscle health by modulating inflammation, myostatin expression, and insulin sensitivity through the RANK/RANKL/OPG pathway.

Aims

To systematically review the available literature on the effects of denosumab on muscle-related outcomes, including muscle strength, muscle mass, physical performance, and fall risk.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, and Cochrane Library were searched through May 2025 for studies evaluating the impact of denosumab on muscle health in human subjects. Outcomes of interest included grip strength, lean muscle mass, gait speed, fall incidence, and physical performance tests.

Results

Seven studies met the inclusion criteria, including randomized trials and observational cohorts. Most reported favorable outcomes for denosumab compared to bisphosphonates or placebo, particularly in grip strength and physical performance. Preclinical studies further support the biological role of RANKL in muscle dysfunction. However, one recent randomized controlled trial in older adults residing in long-term care settings found no significant effect on muscle outcomes, highlighting inconsistencies in the evidence.

Discussion

Denosumab shows potential for improving muscle-related outcomes in older adults, particularly those with osteosarcopenia.

Conclusions

Current evidence is heterogeneous and inconclusive. Further high-quality randomized trials are needed to clarify the effects of denosumab on muscle health and its possible role in sarcopenia prevention and management.

Background

With global aging, dementia prevalence is rising, imposing significant burdens. Reminiscence therapy (RT) shows promise for improving cognition in older adults with cognitive impairment or dementia, but evidence remains inconsistent, potentially moderated by factors like age, intervention frequency, and setting.

Aims

This systematic review and network meta-analysis aimed to evaluate RT’s efficacy on cognitive function in older patients with cognitive impairment or dementia and identify moderating factors through subgroup analyses.

Methods

A comprehensive search was conducted across 11 English and Chinese databases from inception until May 1, 2025, to identify eligible randomized controlled trials (RCTs) evaluating RT versus standard care in older adults with cognitive impairment or dementia, utilizing the cognitive outcome. Two independent reviewers screened the studies, extracted data, and assessed risk of bias and evidence quality. Using RevMan 5.4 for meta-analysis and subgroup analysis.

Results

Twenty-four RCTs involving 1,963 patients were included. RT significantly improved cognitive function, with benefits sustained at follow-up. RT also improved memory, reduced depression, and enhanced quality of life, but not executive function. Subgroup analyses revealed significantly greater cognitive improvement in patients aged 60–70 years, with intervention frequencies of 12–16 sessions, and in nursing home settings.

Conclusion

RT is an effective intervention for improving cognition, memory, depression, and quality of life in older adults with cognitive impairment or dementia. Patient age, intervention frequency, and setting are potential moderators of its cognitive efficacy, providing actionable insights for optimizing clinical RT protocols.

Background

Combined creatine monohydrate (CRE) and β-hydroxy-β-methylbutyrate (HMB) supplementation may counteract age-related declines in functional capacity, yet evidence in physically active older adults is scarce.

Objective

To investigate the effects of six weeks of CRE + HMB supplementation integrated with a supervised multicomponent exercise program on functional performance, metabolic efficiency, and physiological health in older adults.

Methods

Thirty physically active adults aged ≥ 60 years (20 men, 10 women) completed a randomized, double-blind, placebo-controlled crossover trial involving two 6-week intervention phases (CRE + HMB or placebo), separated by a 3-week washout. The exercise program (4 sessions/week) combined strength, endurance, and coordination training. Functional tests (4-m gait speed, 5-repetition sit-to-stand, Timed Up and Go, 400-m walk), metabolic indices, and cardiopulmonary and inflammatory markers were assessed pre- and post-intervention.

Results

CRE + HMB significantly improved gait speed, sit-to-stand, TUG, and 400-m walk (p < 0.05), with large effect sizes (η²p = 0.15–0.29). Basal metabolic rate and metabolic rate index increased, while visceral adiposity showed favorable trends. Women exhibited reductions in diastolic blood pressure and higher expiratory strength; men showed a transient rise in endothelial protein C receptor (EPCR). No period, sequence, or carryover effects were detected.

Conclusions

Six weeks of CRE + HMB supplementation integrated with supervised multicomponent training enhanced mobility, metabolic efficiency, and selected physiological outcomes in physically active older adults. This strategy represents a safe, feasible, and practical approach to sustain functional independence and metabolic health with aging.

Background

Older adults with gastric cancer are at high risk of postoperative complications, partly owing to age-related physical function decline. The Short Physical Performance Battery (SPPB) is widely used to assess physical function in older adults; however, its association with postoperative complications following gastrectomy remains unclear.

Aim

To investigate the association between SPPB and postoperative complications in older adults who underwent gastrectomy.

Methods

This retrospective cohort study included patients aged ≥ 75 years who underwent elective gastrectomy for gastric cancer between July 2021 and December 2023. Preoperative physical function was assessed using the SPPB, grip strength, and frailty status. Patients were divided into high (SPPB ≥ 10) and low-SPPB (SPPB ≤ 9) groups. The primary outcome was postoperative complications (Clavien-Dindo Grade ≥ II) within 30 days post-surgery. Multivariate logistic regression was performed to identify factors associated with postoperative complications.

Results

Among 156 patients included, postoperative complications occurred in 21.2% of patients. The low-SPPB group had significantly higher complication rates than the high-SPPB group. Multivariate analysis revealed that a low SPPB score was independently associated with postoperative complications (odds ratio: 2.83, 95% confidence interval: 1.02–7.83, p = 0.045).

Discussion

Grip strength, frailty, and nutritional status showed no significant associations. The low-SPPB group demonstrated significantly worse outcomes in balance, walking speed, chair stand, and higher frailty prevalence. Preoperative physical function was significantly associated with postoperative complications in older adults who undergo gastrectomy.

Conclusions

The SPPB may help identify high-risk patients and guide preoperative interventions to improve physical function and reduce postoperative complications.

Background

Knee osteoarthritis (KOA) is a progressive disease that impairs mobility and quality of life in older adults.

Aims

To compare the effects of Swedish massage (SM) and hip strengthening exercises (HSE) versus control on pain, range of motion (ROM), and function in older adults with KOA.

Methods

Seventy-five adults > 60 years with symptomatic KOA were randomized to SM, HSE, or control for 8 weeks of home-based intervention (3 sessions/week, 30 min each). Outcomes included pain, function, and ROM at baseline and week 8. Intention-to-treat analysis used ANCOVA adjusted for baseline values, with Bonferroni correction for two pre-specified comparisons (α = 0.025).

Results

Seventy participants completed the study (93.3%); adherence exceeded 85%. No serious adverse events occurred. Both active interventions significantly outperformed control across all outcomes. Compared with control, SM reduced VAS pain by an adjusted mean of 0.81 cm (95% CI 0.38–1.24, p < 0.001, d = 0.69) and HSE by 0.77 cm (95% CI 0.34–1.20, p < 0.001, d = 0.65). KOOS-ADL improved by 3.59 points with SM (95% CI 1.62–5.56, p < 0.001, d = 0.71) and 3.40 points with HSE (95% CI 1.43–5.37, p = 0.001, d = 0.67). Active knee flexion ROM increased by 3.42° (SM, p = 0.001, d = 0.73) and 3.69° (HSE, p < 0.001, d = 0.77) vs. control.

Discussion

This study shows SM and HSE as safe, feasible home-based options for pain relief in frail older adults with KOA.

Conclusions

SM and HSE mitigate KOA pain, with SM uniquely enhancing daily function, supporting integration into clinical practice to promote independence and reduce healthcare burdens in aging populations.

Clinical trial registration

IRCT20150519022320N33 (August 12, 2023).

Background and aims

Osteosarcopenia, the coexistence of osteoporosis and sarcopenia, is underdiagnosed due to limited diagnostic methods despite its strong association with fractures and falls in older adults. This study compared calf circumference (CC) with chest-CT for assessing osteosarcopenia and predicting outcomes in patients with osteoporotic vertebral fractures (OVFs), aiming to assess simpler and more accessible tools for osteosarcopenia in resource-limited settings.

Methods

We studied 149 patients with OVFs who underwent percutaneous vertebroplasty (PVP), using chest-CT (T12 skeletal muscle index, T12 SMI) and CC to diagnose sarcopenia, alongside grip strength (GS) and Short Physical Performance Battery (SPPB) tests. We compared outcomes like re-fractures, falls, Activities of Daily Living (ADL), and Oswestry Disability Index (ODI) scores over one year.

Results

Osteosarcopenia prevalence was 47% with chest-CT and 52% with CC, showing moderate agreement (Kappa = 0.60). Osteosarcopenia patients had worse outcomes, including lower ADL, higher ODI, and more re-fractures and falls. CC had high sensitivity (84%) but moderate specificity (76%). Binary logistic regression identified abdominal circumference (AC) as the main factor affecting diagnostic consistency. Osteosarcopenia diagnosed by chest-CT were association with re-fracture in one year.

Conclusion

Chest-CT derived T12 SMI defined osteosarcopenia is associated with re-fractures in OVF, while CC provides a simple and sensitive screening tool for osteosarcopenia patients, particularly in fracture patients without markedly high AC.

Background

Population aging presents major health challenges globally, including in Tamil Nadu. The World Health Organisation’s ICOPE framework emphasizes maintaining intrinsic capacity through detailed, person-centered assessments. However, Step 2 evaluations remain underutilized here, critical for understanding older adults’ functional health.

Objective

This study aims to fill that gap by providing vital data to improve geriatric care and promote healthy aging locally. To evaluate intrinsic capacity across various domains (e.g., cognition, psychological health, mobility, sensory abilities, and nutrition) using Step 2 assessment tools.

Methods

The Chengalpattu region of Tamil Nadu was the site of this descriptive cross-sectional study. Eighty-one participants aged 60 and above were assessed using Step 2 of the ICOPE framework. The study evaluated various domains, including cognition, vision, hearing, physical performance, nutrition, mood, and functional capacity. Data collection was conducted after obtaining ethical approval and informed consent from participants. SPSS Version 30.0 was the software used to perform the statistical evaluation.

Results

A sample of 81 elderly people was assessed with an average age of 70.2 years. Participants aged 75 years and above had significantly reduced physical activity assessments calculated by the Short Physical Performance Battery (p = 0.026), worse state of nutrition as described by the MNA (p = 0.002), with a higher dependency on walking aids (30%) compared to those aged 60–74 years (6.6%), with this difference also being statistically significant (p = 0.006). The older group was also more likely to reside in old age homes (p < 0.001). When comparing elderly individuals living with a partner versus those living alone, those living alone were more likely to reside in old age homes (p < 0.001), had significantly poorer physical performance as per SPPB scores (p = 0.012), and were more likely to have undergone an eye check-up within the last six months (p = 0.001). Elderly individuals living in Old age homes have reduced physical function (p = 0.004), use walking aids more often (p = 0.003), and need more help with daily tasks (p < 0.001) than those living at home.

Conclusion

The study highlights vision, mobility, nutrition, and cognitive challenges in aging. Early detection and integrated care are key to promoting healthy aging and reducing dependency.

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.