Aging Clinical and Experimental Research最新文献

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.

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.