Aging Clinical and Experimental Research最新文献

Background

Osteosarcopenia, defined as the co-existence of osteopenia/osteoporosis and sarcopenia, may influence frailty risk in older adults. However, the longitudinal association between osteosarcopenia or its components and frailty remain unclear. This study aimed to address this.

Methods

Data from a prospective cohort study of community-dwelling adults in Australia. Frailty was defined by the presence of ≥ 3 components based on Fried criteria: exhaustion, slow gait speed, low grip strength, unintentional weight loss, and low physical activity. Osteosarcopenia was defined by osteopenia/osteoporosis (WHO criteria) and sarcopenia (European Working Group on Sarcopenia in Older People [EWGSOP2] and Sarcopenia Definition and Outcome consortium [SDOC]). Multivariable logistic regression models evaluated the associations between osteosarcopenia, its components and frailty.

Results

Of 300 enrolled, 151 (mean age: 65.1years, 59.6%women) completed follow-up (median: 4.8 years). Among 143 non-frails at baseline, 13 (9.1%) transitioned to frailty. Osteosarcopenia (versus non-osteosarcopenia) was associated with frailty irrespective of the definition used: EWGSOP2: OR = 9.53, 95%CI 2.53–35.92; SDOC: OR = 9.19, 95%CI 2.19–38.56). Grip strength reduction by 1 kg (OR = 0.92, 95%CI 0.84–1.00) and gait speed reduction by 0.1 m/sec (OR = 0.67, 95%CI 0.53–0.85) were associated with 8% and 33% lower odds of frailty, respectively, whereas bone mineral density or lean mass was not. An interaction between bone-muscle function and frailty risk was observed (p < 0.011), whereby higher values of grip strength were associated with lower odds of frailty when bone density was lower.

Conclusion

In this prospective cohort study, osteosarcopenia increased the risk of frailty. Our interaction analysis suggests therapies targeting bone density and grip strength may mitigate frailty.

Background

Osteocalcin is a bone-specific protein involving many physiological processes, primarily bone turnover. Also closely related to the musculoskeletal system is the frailty syndrome.

Aim

To investigate if circulating osteocalcin levels and frailty are associated in the old, and in addition, if the presumed association is mediated through alterations in bone.

Methods

999 community-dwelling women from the OPRA (Osteoporosis Prospective Risk Assessment) cohort, all aged 75 years. Serum total osteocalcin was measured together with bone turnover markers PINP and CTX. An OPRA-adapted frailty index was applied. Association between osteocalcin and frailty was investigated using both logistic regression (osteocalcin quintiles Q_low-Q_high; Q₁-Q₅) and linear regression. Splines model was added. Association between osteocalcin level and individual components of the frailty index were investigated using Kruskal-Wallis or Chi² test.

Results

Low osteocalcin (Q₁) was associated with being frail (frailty prevalence 36% vs. 23% (Q1 vs. Q5); absolute difference 13%) in both unadjusted (OR_unadj 1.82, 95% CI[1.12-3.00]) and adjusted analyses (OR_adj 2.55, 95% CI[1.46–4.44]); even after adjustment for bone turnover markers, s-PINP and s-CTX (2.50, 95% CI[1.11–5.61]). Women with low serum osteocalcin (Q1) had significantly poorer gait function (gait speed (p = 0.001; p for trend < 0.001), more steps taken (p = 0.003; p for trend 0.004)), higher inflammation (p < 0.001; p for trend < 0.001), and a larger proportion had diabetes (p for trend < 0.001) and polypharmacy (p for trend < 0.001), compared to those with highest osteocalcin levels (Q5).

Conclusion

Low osteocalcin in circulation was associated with being frail, also after adjusting for bone turnover markers.

Objectives

To determine whether handgrip strength is associated with the incidence of age-related macular degeneration.

Methods

A prospective cohort study of over 500 thousand UK Biobank participants aged 40–69 years. Individuals ≥ 50 years and without age-related macular degeneration at baseline were included. Exposure was the handgrip strength measured by dynamometer. Primary outcome was the incidence of age-related macular degeneration during 13 years of follow-up. Cox proportional-hazard models were fitted to estimate the risk effect for handgrip strength on age-related macular degeneration, and stratified for sociodemographic and lifestyle factors. Mediation models were regressed to explore underlying mechanisms driven by inflammatory and erythrocyte-related biomarkers.

Results

382174 eligible participants in the UK Biobank were included. After 4680431 person-year, 7987 individuals (2.09%) developed age-related macular degeneration. Individuals in the lowest quintile of handgrip strength had higher risk of age-related macular degeneration incidence (Hazard Ratio, 1.25; 95% CI, 1.16–1.35) compared with those in the highest quintile. Per 5 kg decrement in handgrip strength was associated with increased risk of age-related macular degeneration incidence (Hazard Ratio, 1.06; 95% CI, 1.04–1.08) with similar trend among all subgroups except for sex. Specific inflammatory and erythrocyte-related biomarkers partially (37.5%) mediated the incidence of age-related macular degeneration as substantial biological mechanisms following handgrip strength decrease.

Conclusions

Our findings suggest that handgrip strength is associated with the incidence of age-related macular degeneration under the mediation of systemic proinflammatory factors. The current study holds an outlook for improved visual health over the evaluation and intervention of muscle strength in old-age population.

Objective

To investigate the prevalence and associated factors of inappropriate sexual behaviour (ISB) in psychogeriatric inpatients in a Chinese psychiatric hospital.

Methods

A cross-sectional study was conducted from August to October 2021 among 174 psychiatric inpatients aged 60 years and older at a psychiatric hospital in Huzhou, China. ISB was assessed using the St. Andrews Sexual Behaviour Assessment (SASBA), a structured tool that categorizes behaviors into four domains: verbal, non-contact, exposure, and physical contact. Sociodemographic data, clinical characteristics, activities of daily living (ADL), and serum hormone levels (testosterone, estradiol, progesterone) were collected. Binary logistic regression was used to identify factors associated with ISB.

Results

Among the 178 patients, 54 (30.3%) exhibited inappropriate sexual behavior. The prevalence was higher in male patients (38.2%) than in female patients (19.7%, p = 0.013). Patients exhibiting ISB were younger (67.1 ± 5.4 years, p = 0.028), had a longer length of hospitalization (42.5 (7.9, 79.5) months, p = 0.003), and lower progesterone levels (0.10 (0.10, 0.28) nmol/L, p = 0.012).

Conclusion

Inappropriate sexual behavior is prevalent among psychogeriatric inpatients. It is associated with factors including gender, age, hospitalization length, and hormonal levels, especially progesterone.

The recent publication by Zhang et al. on the burden of malignant neoplasm of bone and articular cartilage in the geriatric population reports age-standardized incidence, prevalence, disability-adjusted life year (DALY), and mortality rates. The authors present age-standardized rates for the 6+ age group based on the Global Burden of Disease (GBD) 2021 study. However, calculating age-standardized measures for a single age group is methodologically inconsistent and may lead to misinterpretation. These measures are designed to compare populations with varying age distributions by applying a uniform age structure. Thus, the GBD 2021 study only offers age-standardized rates for total populations, not specific age groups. Moreover, the 65 + group is not among the predefined age groups in the GBD 2021 study for any health measures. While crude numbers for custom age groups, such as individuals aged 65 years and older, can be derived from the available data, estimating incidence, prevalence, DALY or mortality rates requires complex calculations that cannot be reproduced externally. These limitations raise notable concerns about the reliability of the reported measures and their interpretation.

Background

Anticipating discharge challenges in the elderly population is essential to support effective care planning and reduce risks during care transitions. However, there is a lack of targeted assessment tools specifically designed for use in hospital wards to address this need.

Aims

To evaluate the predictive value of the Geriatric Discharge Complexity Score (GDCS) and Blaylock Risk Assessment Screening Score (BRASS) with respect to discharge difficulties in a population of hospitalized older adults.

Methods

The study was conducted on a sample of 416 subjects (175 females) with mean age of 88.2 ± 5.7 years. All subjects underwent evaluation with GDCS, Barthel scale, BRASS and count of total days of hospitalization and days of hospitalization related to social-welfare problems.

Results

The GDCS showed sensitivity of 97.9% and specificity of 69.8% with an area under the curve (AUC) of 0.936. The BRASS showed sensitivity of 86.3% and specificity of 20.2% with an AUC of 0.518. Total and excess days of hospitalization for social problems were significantly higher in subjects with elevated GDCS.

Conclusion

The GDSC seems more predictive of social care issues that may lead to a prolongation of hospital stay than the BRASS.

Background

Multimorbidity is a leading cause of functional health impairments in older adults, affecting Activities of Daily Living (ADL). Health-literacy enables individuals to access, process, and apply health-related information effectively, serving as a strategy to mitigate these effects. Aims: This study explores the moderating role of health literacy in the relationship between multimorbidity and functional health according to ADL.

Methods

Data were derived from 3069 individuals aged 80 and older from the “Ageing in Germany (D80+)” survey. Multimorbidity was measured using a 22-item index, while health literacy was assessed via a two-item scale evaluating knowledge and compliance. Functional health was determined by ADL performance. Elastic Net regression and moderation analysis were employed to examine the relationships between multimorbidity, health literacy, and functional health, controlling for sociodemographic and mental covariates.

Results

Multimorbidity was significantly associated with functional health (b= -1.668, p < 0.001). Health literacy emerged as a significant moderator, attenuating the impact of multimorbidity on functional health (interaction term: b = 0.243, p = 0.023). Conditional effects analysis revealed that individuals with higher health literacy exhibited better functional health, with the adverse effect of multimorbidity on ADL substantially diminished in this group.

Discussion

This study highlights the critical role of health literacy in mitigating the impact of multimorbidity on functional health. Interventions aimed at enhancing health literacy offer a promising avenue for promoting independence and functional health in older adults.

Conclusion

Future research should focus on longitudinal designs and objective measures to further elucidate the pathways linking multimorbidity, health literacy, and functional health. Fostering the ability to independently obtain, understand and implement health information should be a key goal of clinical practice and policy interventions.

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