Aging Clinical and Experimental Research最新文献

Background

Chronic pain in older adults is highly prevalent, multifactorial, and often associated with greater intensity, multisite involvement, and functional impairment. Despite its burden, it remains frequently underdiagnosed and undertreated. Chronological age alone does not adequately capture biological vulnerability or interindividual variability in pain expression.

Aims

To examine the associations of frailty, an indirect marker of biological age, and chronological age with chronic pain characteristics.

Methods

We conducted a cross-sectional study including 455 adults (≥18 years) recruited from primary care. Thirty-three pain characteristics were assessed through structured interviews. Frailty was quantified using a 31-item Frailty Index based on the deficit accumulation model. Associations of frailty, chronological age, and sex with each pain variable were analyzed using multivariable linear and logistic regression models.

Results

Most pain characteristics were more consistently associated with frailty than with chronological age, although effect sizes were modest (sr² typically 1–5%). Frailty correlated with greater pain intensity (sr 0.23, r² 5.3%), higher frequency (sr 0.10, r² 1.1%), and continuous or mixed-type pain (OR 0.97, 95% CI 0.95–0.99). In contrast, chronological age primarily predicted temporal aspects, including pain duration, diagnostic delay, and time to first analgesic prescription. Age and frailty showed opposite directions of association for certain domains, such as accompanying symptoms and daily pain duration.

Conclusion

Frailty provides complementary information to chronological age in characterizing chronic pain. Integrating frailty assessment into routine pain evaluation may enable more individualized management, enhance pain control, and reduce age-related disparities in clinical care.

The proprioceptive and visual systems play a major role in daily tasks by providing continuous feedback to the central nervous system (CNS) for coordinating movements. However, it remains unclear to what extent alterations in the proprioceptive system and CNS affect vibration-induced illusion of movement (VIM) with age and after a stroke. To address this, 29 young (26 ± 7 years), 30 older (63 ± 8 years), and 26 stroke participants (68 ± 12 years) with left arm impairment, all right-handed, received triceps brachii tendon vibration with or without visual feedback of the vibrated arm (with/without vision), as it can modulate the illusion of movement. Vibrations were applied bilaterally in healthy participants and on the impaired left arm in stroke individuals. The illusion was quantified using the Standardized Kinesthetic Illusion Procedure (SKIP) ordinal scale, which evaluates the clearness and the direction of the movement, resulting in a total score on four. While young and older adults achieved higher scores without vision, acute stroke participants did not (Young_left: µ_{(without/with)} = 2.62/0.86, p < 0.001, Young_right: µ_{(without/with)} = 2.35/0.69, p < 0.001; Older_left: µ_{(without/with)} = 1.52/0.63, p < 0.001, Older_right: µ_{(without/with)} = 1.03/0.50, p < 0.01; Stroke: µ_{(without/with)} = 0.85/0.62, p = 0.23). Moreover, young participants reported a stronger illusion than both older and acute stroke participants, and older participants reported a stronger illusion than acute stroke participants. Altogether, these findings suggest that aging alters VIM response, with acute stroke exacerbating this impairment. Finally, in acute stroke participants, a significant negative correlation between age and SKIP total score without vision was observed, highlighting the considerable impact of aging even within a pathological condition.

Clinical Trial registration: NCT06218563–2024-01-12.

Graphical abstract

Aim

This study aims to investigate the prognostic value of admission lactate level in predicting 28-day mortality among geriatric patients admitted to the intensive care unit (ICU) and to compare its performance with established severity scores, including APACHE II and SOFA.

Materials and methods

In this retrospective cohort study, data of patients aged ≥ 65 years who were admitted to a tertiary ICU between December 2024 and June 2025 were analyzed. Patients with ICU stays < 24 h or incomplete records were excluded. Demographic characteristics, comorbidities, admission lactate, APACHE II, and SOFA scores were recorded. The primary outcome was the association between admission lactate and 28-day mortality. Secondary outcomes included ICU length of stay, mechanical ventilation duration, and comparative prognostic accuracy of lactate versus APACHE II and SOFA.

Results

A total of 241 patients were included. The 28-day mortality rate was 32.8%. Non-survivors had significantly higher admission lactate levels compared to survivors (6.29 ± 5.42 vs. 2.44 ± 1.80 mmol/L, p < 0.001). In multivariable logistic regression, admission lactate remained an independent predictor of mortality after adjustment for age, sex, comorbidity, and APACHE II (OR 1.29, 95% CI 1.09–1.52, p = 0.003). ROC analysis showed that lactate predicted 28-day mortality with an AUC of 0.77, compared to 0.92 for APACHE II and 0.88 for SOFA. Mortality increased across lactate categories: 14.2% (< 2 mmol/L), 27.8% (2–4 mmol/L), and 62.5% (> 4 mmol/L) (p < 0.001).

Conclusion

Admission lactate is a simple and readily obtainable biomarker that independently predicts short-term mortality in geriatric ICU patients. While not outperforming established severity scores, lactate provides immediate risk stratification at the bedside and may aid clinical decision-making in this vulnerable population.

Background

Assessing older adults’ physical function via videoconferencing technology is acceptable and feasible, enabling researchers and practitioners to monitor mobility remotely. However, validity of remote assessment in pre-frail and frail older adults, and its ability to detect change with intervention, has yet to be established.

Aim

To establish the validity of remote physical function assessment in pre-frail and frail older adults compared to in-person assessment, and its reliability in detecting improvements in physical function during a 12-week exercise training intervention.

Methods

Participants aged ≥ 65 years identified as pre-frail or frail based on in-person Short Physical Performance Battery scores ≤ 8 completed remote and in-person assessment of the 5x sit-to-stand, 60-second sit-to-stand, and single leg standing balance four times over 12-weeks (n = 49 at baseline, 40 at follow-up), with one group improving physical function with homebased exercise. Intraclass Correlation Coefficient and Bland Altman plots were used to determine agreement between assessment settings and consistency across the range of observed scores respectively in both Exercise and Control groups over time.

Results

Remote assessment of sit-to-stand tests had good-to-excellent agreement with in-person assessment, and balance tests had moderate-to-good agreement. In the Exercise group, absolute bias in sit-to-stand tests was observed in both remote and in-person assessments at 4, 8, and 12 weeks, though this was not statistically different to the Control group.

Discussion

Remotely assessing physical function in pre-frail and frail older adults is promising when compared to in-person assessments; however, there may be a bias towards better test performance over time when assessed remotely compared to in-person.

Conclusions

Monitoring change in physical function in pre-frail and frail older adults using remote assessment is useful but should consider potential bias in measurement outcomes. Larger and more specific studies are needed to conclusively demonstrate the validity of remote assessment compared to in-person assessment when dealing with pre-frail and frail older people.

Background

Osteosarcopenia is a syndrome associated with aging, characterized by the simultaneous occurrence of two conditions: osteopenia and sarcopenia. The association between various fat mass distributions across the body and osteosarcopenia is not clear.

Methods

Cross-sectional data from the PoCOsteo study, involving 1,897 participants, were used. T-score was used to define osteopenia. Sarcopenia was identified based on the skeletal muscle mass index (SMI), handgrip strength measurements, and/or a walking speed. Body fat distribution was assessed using Dual X-ray absorptiometry.

Results

Regression models, after adjustment for covariates—age, gender, marital status, tobacco use, income, education, occupation, and hypertension—revealed a negative association between various fat deposits—including total, gynoid, trunk, arm, and android fat—as well as indices of body mass index (BMI) and the trunk-to-limb fat mass ratio, with both osteoporosis and sarcopenia. A significant inverse relationship was also observed between osteosarcopenia and total fat (OR = 0.946, 95% CI: 0.918–0.975), android fat (OR = 0.932, 95% CI: 0.911–0.953), trunk fat (OR = 0.927, 95% CI: 0.903–0.952), and BMI (OR = 0.738, 95% CI: 0.703–0.775).

Conclusion

Osteosarcopenia and its components (osteoporosis and sarcopenia) are inversely associated with BMI and fat mass, particularly in the trunk and android regions.

Background

The increasing co-occurrence of sarcopenia and obesity is associated with morbidity. The muscle quality index (MQI), which measures strength per unit of muscle mass, has been described to detect sarcopenic obesity, but associations with cardiac function are unknown.

Methods

Adults without cardiovascular disease (CVD) underwent assessment for appendicular skeletal mass (ASM), handgrip strength (HGS), aerobic capacity (VO₂ max, ml/kg/min), echocardiography (mitral early diastolic inflow velocity to annular tissue velocity [E/e’], early to late diastolic inflow velocity [E/A] ratios). Low MQI (HGS divided by upper body ASM) was defined as males < 5.76 kg/kg, females < 5.475 kg/kg.

Results

Participants (n = 574) were 66.3 ± 13.0 years old; 11.8% had obesity. Low MQI was present in 34.3%. The low MQI group was older than the normal MQI group (69.0 ± 10.4years vs. 64.8 ± 14.0years, p < 0.0001), with higher BMI (25.4 ± 3.8kg/m² vs. 22.7 ± 3.1kg/m², p < 0.0001). The low MQI group had greater left ventricular mass (129 ± 45 g vs 114 ± 44 g, p < 0.0001), left atrial volumes (37 ± 14 ml vs 33 ± 13 ml, p = 0.001), and greater diastolic dysfunction, evidenced by lower E/A (0.89 ± 0.28 vs 1.1 ± 0.49, p < 0.0001) and higher E/e’ (8.63 ± 2.42 vs 8.00 ± 2.58, p = 0.005). Low MQI group had lower VO₂ max than the normal MQI group (33 ± 5.7 vs 36 ± 6.7 ml/kg/min, p < 0.0001). On multiple regression, low MQI was independently associated with lower E/A (β=-0.119, p < 0.0001) and VO₂ max (β=-0.137, p < 0.0001).

Conclusion

Low MQI is associated with diastolic dysfunction (reflected by lower E/A) and poorer aerobic capacity.

Objective

Polypharmacy, the concurrent use of five or more medications, is prevalent among older adults with Diabetes, a population at elevated risk for medication-related complications. Complex treatment regimens for Diabetes and its comorbidities exacerbate challenges such as medication non-adherence, drug interactions, adverse events, and increased hospitalization risk. This review aimed to estimate the prevalence of polypharmacy among older adults with Diabetes.

Method

Following PRISMA 2020 guidelines, we performed a systematic search of PubMed, Embase, and Web of Science. Screened articles using Nested Knowledge software. Eligible studies included those aged 60 years or older with Diabetes, reporting on the prevalence of polypharmacy. Study quality was assessed using a modified Newcastle-Ottawa Scale, and meta-analysis was performed using random-effects models in R software version 4.4.1. Publication bias was indicated by a Doi plot with an LFK index.

Results

The pooled prevalence of polypharmacy was 59% (95% CI, 48%-70%). Subgroup analyses showed a prevalence of 55% in retrospective studies and 62% in cross-sectional studies. Sensitivity analyses confirmed the stability of the results. Significant geographic variability was noted, with lower prevalence in high-income countries compared to regions in Southern Europe and Asia.

Conclusions

Polypharmacy is highly prevalent among older adults with Diabetes, with significant variability across study designs and geographic regions. Targeted interventions and further research are essential to address its associated risks and optimize medication management.

Background

Stroke is a significant public health issue, with its risk influenced by various metabolic factors. The Cholesterol, High-Density Lipoprotein, Glucose (CHG) index has been identified as a valid stroke predictor. However, the impact of glucose-metabolic states on the relationship between CHG index and stroke risk remains unclear.

Aims

This study aimed to investigate how baseline, cumulative, and longitudinal changes in CHG index are associated with incident stroke risk across different glucose-metabolic states: normal glucose regulation (NGR), pre-diabetes (Pre-DM), and diabetes (DM).

Methods

We analyzed data from 8,728 adults aged 45 and older, collected through five waves of the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. We assessed baseline, cumulative, and changes in the CHG index, with incident stroke as the primary outcome. Cox proportional hazards models quantified associations, and restricted cubic splines explored dose-response patterns.

Results

Over follow-up, 9.51% of participants had a stroke. The stroke incidence increased with higher CHG quartiles, except in individuals with DM. The highest CHG quartile (Q4) showed a 1.7-fold increased stroke risk (adjusted HR = 2.21 for NGR, adjusted HR = 2.02 for Pre-DM). No significant association was found in individuals with DM. Cumulative and longitudinal CHG index changes were positively associated with stroke risk, particularly in Pre-DM.

Conclusions

Elevated CHG index is linked to higher stroke risk, especially in individuals with NGR and Pre-DM, highlighting the importance of early monitoring and intervention for metabolic dysregulation-related stroke risk.

The global demographic shift towards an aging population highlights the increasing prevalence of age-related health concerns, such as sarcopenia, predominantly observed in older adults. This study aimed to evaluate the prevalence of muscle strength and physical performance in older Chinese adults and to elucidate the association between handgrip strength (HGS), the Timed ‘Up and Go’ (TUG) test, and various anthropometric indices (i.e., height, weight). Participants were enrolled from the China Action on Spine and Hip Status (CASH) study (NTC 01758770). Data were gathered through handgrip strength assessment, the TUG test, anthropometric measurements, and EQ-5D evaluations. All measurements were repeated after an interval of five years. An adjusted linear regression model was employed to examine the relationship between percentage changes in HGS and TUG and changes in anthropometric variables, including height, weight, body mass index (BMI), and EQ-5D in both sexes. The study included 125 participants, with 75 women (60%) averaging 67.6 years (SD 5.0) and 50 men (40%) averaging 69.0 years (SD 5.4). Over the five-year period of the study, HGS showed significant decrease, while TUG and EQ-5D showed significant increases when comparing the group aged below 70 years (n = 49) (HGS: -1.5 ± 21.0) with those aged 70 years and above (n = 26) (TUG: 33.8 ± 27.2; EQ-5D: 50.7 ± 27.7). In contrast, male participants did not exhibit any significant differences across all variables, including height, weight, BMI, HGS, TUG, and EQ-5D, when comparing the under-70 age group (n = 32) with those aged 70 or over (n = 18). There were no significant associations between the five-year percent changes in height, weight, BMI, and EQ-5D in both women and men, with the five-year percent changes in HGS (p > 0.05). The five-year percent changes in TUG were significantly correlated with changes in weight (β = 1.1, 95% CI: 0.1-2.0, p < 0.05) and BMI (β = 1.1, 95% CI: 0.1–1.9, p < 0.05) only in females. However, the percent changes in TUG for males did not significantly differ in relation to the five-year percent changes in height, weight, BMI, and EQ-5D in men and in height and EQ-5D in women (p > 0.05). In conclusion, our study demonstrated a significant decrease in HGS for individuals aged 70 and above. Notably, while the five-year percent changes in TUG in females were associated with weight and BMI, this may suggest a greater vulnerability of older women to poorer physical performance outcomes compared to men. Future research should focus on identifying key demographic groups and developing tailored intervention strategies to mitigate declines in physical function with age.

Aim

This study aimed to investigate the association between dietary phytate intake and the incidence of bone fractures among adults aged over 50 years.

Methods

Particpants of the third (2006–2008) and fourth (2009–2011) phases of the Tehran Lipid and Glucose Study (n = 1917, mean age 59.1 ± 7.1 years, and 50.1% men) who had completed dietary data were included and followed through March 2018 for the incidence of any fracture requiring inpatient care. Cox proportional hazards models were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident fractures across tertile categories (< 1770, 1770–2598, and > 2598 mg/d) and per each 500 mg/d increase in dietary phytate intake.

Results

During a median follow-up period of 11.5 years (interquartile range: 10.5–12.4 years), 4.4% of participants experienced a new incident fracture. Mean ± standard deviation of dietary phytate intake was 2313 ± 1061 mg/d. In the presence of the potential confounders (i.e., age, sex, use steroids, metabolic syndrome score, energy intake, dietary fiber and calcium, use of calcium and vitamin D3 supplement, smoking, and physical activity), participants in the highest tertile of dietary phytate intake (> 2598 mg/d) had a significantly lower risk of fracture (HR = 0.40, 95% CI = 0.21–0.775, P = 0.006). Each 500 mg/d increase in dietary phytate intake was associated with a 14% reduction in fracture risk (HR = 0.86, 95% CI = 0.75–0.98, P = 0.027).

Conclusion

Higher dietary phytate intake was independently associated with a lower risk of incident fractures, suggesting a potential protective role against fracture in middle-aged and older adults.