Aging Clinical and Experimental Research最新文献

Aim

The study aims to examine the prevalence of functional urinary incontinence (FUI) and its comparative frequency with other types of incontinence. Moreover, this study also aims to explore its relationship with key geriatric assessment parameters in older women.

Methods

Older women over the age of 65 years from one geriatrics outpatient clinic were included in the cross-sectional study. UI subtypes were classified based on participants’ responses to the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form. FUI is the involuntary leakage of urine resulting from physical or cognitive limitations in reaching or using toilet facilities. The relationships between UI subtypes and comprehensive geriatric assessment parameters were determined

Results

The study included 1628 participants (mean age 79.6 ± 8.2 years). Prevalence rates were identified as follows: control group (no continence) (37.2%), Urge UI (31.9%), Stres UI (4.6%), FUI (7.6%), Mixt UI (urge and stress, 12.3%), Urge UI and FUI (4.9%), and Stress UI with FUI (1.5%). In multınominal lojistik regression, Basic Activities of Daily Living scores were low across all types of urinary UI (p<0.05). Patients with FUI exhibited significantly lower Mini Nutritional Assessment scores, Tinetti balance and gait scores, and handgrip strength compared to those with other UI subtypes, whereas their Timed Up and Go times and age were higher (p<0.05).

Conclusion

FUI is associated with several geriatric conditions, including increased functional dependency, nutritional deterioration, reduced muscle strength, and impaired balance and gait functions. Therefore, when approaching an older woman with incontinence, it is essential to be aware of FUI, rather than focusing solely on Urge UI or Stress UI.

Background

With global climate change, heatwaves are intensifying in frequency and duration, adversely affecting human health. How heatwaves (HW) exposure contribute to the decline in muscle strength and sarcopenia progression among middle-aged and older adults remains unclear.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015, low muscle strength and sarcopenia were defined according to the Asian Working Group for Sarcopenia 2019 consensus. HW exposure were defined based on temperature thresholds and durations, quantified by event and day counts. HW exposure was measured over 12 months prior to sarcopenia assessments at baseline (2011) and follow-up (2015). A difference-in-differences (DiD) approach was applied to examine the association between HW exposure and changes in muscle strength and sarcopenia status.

Results

This study included 3,554 middle-aged and older adults, with an average age of 58.7 years, and 47.0% were male. Based on a specific HW definition (HW12: 97.5 percentile, duration ≥ 4 days), DiD analysis showed that each additional HW day exposure was associated with a decrease in muscle strength of 0.097 kg (95%CI: -0.124, -0.069, p < 0.001, in model 3) and each additional HW event was associated with a decrease in muscle strength of 0.66 kg (95%CI: -0.933, -0.386, p < 0.001, in model 3); each additional HW day exposure was associated with a 2.1% risk of sarcopenia status deterioration (OR: 1.021, 95%CI: 1.01, 1.031, p < 0.001, in model 3) and each additional HW event was associated with an 18.7% risk of sarcopenia status deterioration (OR: 1.187, 95%CI: 1.07, 1.316, p = 0.001, in model 3). Subgroup analysis indicated that urban residents and individuals with higher levels of education were particularly susceptible to sarcopenia status deterioration related to HW exposure.

Conclusions

HW exposure increases the risk of Sarcopenia Progression among middle-aged and older adults.

Background

Population-based studies on the association between anticoagulant use and the incidence of hemorrhagic stroke in older adults are limited. We examined the association between anticoagulant prescription and hospitalization for hemorrhagic stroke and whether this association varies between warfarin and direct oral anticoagulants (DOACs).

Methods

This propensity score-matched retrospective cohort study used medical insurance claim data from Hokkaido, Japan. Older adults aged ≥ 75 years receiving medical care between April 2016 and March 2017 (baseline period) were included. The exposure variable was prescription of anticoagulants during the baseline period and outcome variable was hospitalization for hemorrhagic stroke between April 2017 and March 2020. A one-to-one matched design adjusted for covariates (age, sex, copayment rate, comorbidities, annual health check-up, and care needs certification) compared the incidence of hospitalization between patients prescribed and those not prescribed anticoagulants.

Results

Among 717,097 patients, 66,916 (9.3%) were prescribed anticoagulants. After propensity score matching, the incidence of hospitalization for hemorrhagic stroke was higher in patients prescribed anticoagulants (383.2 per million person-month) than in those who were not prescribed anticoagulants (252.2 per million person-month) (hazard ratio [HR] = 1.64; 95% Confidence interval [CI], 1.39–1.93). Moreover, among patients prescribed one anticoagulant (n = 61,556), after matching, the incidence of hospitalization for hemorrhagic stroke was significantly higher in patients prescribed warfarin than in those prescribed DOACs (HR, 1.67; 95% CI, 1.39–2.01).

Conclusions

The findings of this study highlight the need for careful consideration when prescribing anticoagulants, particularly warfarin, to older adults to minimize the risk of hemorrhagic stroke.

Background and objectives

Resistance training is widely recommended for managing sarcopenia, but evidence on optimal prescriptions remains limited. This study aimed to assess the effects of different resistance training prescriptions on strength, function, and muscle mass in older adults with sarcopenia.

Methods

We searched PubMed, Embase, Web of Science, and CENTRAL to June 2025. Eligible studies were RCTs in adults aged ≥ 60 with sarcopenia, comparing resistance training with usual care or no intervention, and reporting outcomes on strength, physical function, or muscle mass. Risk of bias was assessed using RoB 2. Meta-analyses were conducted using the meta package in R, and Bayesian dose–response models were fitted using the brms package.

Results

Twenty-four randomized controlled trials involving 951 participants were included. Random-effects model showed that resistance training significantly improved handgrip strength, gait speed, knee extension strength, timed up and go test (TUG) and and five-times sit-to-stand test (5STS) performance. However, no significant improvements were observed in the short physical performance battery (SPPB), appendicular skeletal muscle mass index and appendicular skeletal muscle mass. Subgroup analyses revealed significant differences across resistance type, frequency, and setting, although meta-regression identified no significant sources of heterogeneity. A nonlinear Bayesian random-effects model suggested an optimal dose of 1220 MET-min/week for improving handgrip strength, while a minimal effective dose of 600 MET-min/week may suffice to achieve clinically meaningful improvements in gait speed.

Conclusion

Resistance training probably improves muscle strength and physical function in older adults with sarcopenia. However, improvements in grip strength, gait speed, TUG, 5STS, and SPPB did not exceed their MID thresholds, indicating little to no clinical benefit. Resistance type and training frequency were key effect modifiers. Individualized resistance programs within the optimal dose range, emphasizing higher frequency and appropriate resistance types, may help optimize outcomes.

Graphical abstract

Background

Sarcopenic obesity (SO) is increasingly recognized as a significant health concern, particularly among older populations. Existing literature indicates that SO elevates the risk for various adverse health outcomes such as cardiovascular diseases, fractures, higher all-cause mortality. However, evidence regarding its impact on the risk of falls remains limited and inconclusive. Our study aimed to investigate the association between SO and fall incidents.

Methods

A total of 10,905 participants were enrolled from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave. Participants were categorized into four groups according to sarcopenia and obesity status, with the neither sarcopenia nor obesity group serving as the reference. Logistic regression was utilized to evaluate the cross-sectional association between SO and falls. Furthermore, we tracked fall incidents reported in follow-up surveys conducted in CHARLS 2018 and 2020 wave. Cox regression analysis was performed to explore how SO affected the risk of falls. Stratified Cox analyses by age (< 60 vs. ≥60 years) were also performed.

Results

In the cross-sectional analysis (2015), the SO group [OR (95% CI): 1.84 (1.42 ~ 2.37), P < 0.01] showed a higher risk of falls compared to the reference group; however, this association was not statistically significant after adjusting for potential confounding factors. In the longitudinal analysis (2015–2020), the SO group [HR (95%CI): 2.78 (2.03 ~ 3.80), P < 0.01] had a significantly increased risk of falls. The results remained similar after adjusting for age, sex [HR (95%CI): 1.44 (1.02 ~ 2.04), P < 0.05], and additional covariates [HR (95%CI): 1.43 (1.00 ~ 2.03), P < 0.05]. Notably, stratified Cox models showed that SO was significantly associated with fall risk in both age groups, with a stronger effect observed in participants under 60 years [HR (95%CI): 2.85 (1.13 ~ 7.17), P < 0.05] than in those aged 60 and above [HR (95%CI): 1.64 (1.08 ~ 2.50), P < 0.05].

Conclusion

Sarcopenic obesity is associated with an increased risk of falls among middle-aged and older adults, especially in longitudinal analyses. Age-stratified results suggest that the impact of SO on falls may be more pronounced in the middle-aged group. Our findings support the need for early identification and targeted interventions for individuals with SO to mitigate fall-related risks in aging populations.

Objective

Currently, the association of sarcopenic obesity (SO) with cognitive dysfunction and dementia remains unclear. This study aims to investigate their potential association.

Materials and methods

PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were systematically searched until 30 December 2024. Observational studies investigating the association of SO with cognitive dysfunction and dementia were included. A random-effects model was applied for meta-analysis.

Results

Seventeen studies with 274,996 participants were included, of which 11 were included in quantitative analyses. The pooled odds ratio for cognitive dysfunction in patients with SO versus non-SO was 1.71 (95% CI: 1.39–2.11, p < 0.001, I² = 90.7%). Subgroup analyses showed consistent associations across study design, geographic region, cognitive dysfunction subtypes, and obesity criteria. Significant results were also observed in males (OR = 1.80, 95% CI: 1.07–3.03, p = 0.028), general populations (OR = 1.95, 95% CI: 1.50–2.54, p < 0.001), sarcopenia defined by muscle function and/or mass (OR = 1.67, 95% CI: 1.35–2.07, p < 0.001) or muscle function alone (OR = 2.31, 95% CI: 1.14–4.69, p = 0.020), and cognitive assessment via clinical records (OR = 1.68, 95% CI: 1.21–2.33, p = 0.002) or scales (OR = 1.74, 95% CI: 1.37–2.21, p < 0.001).

Conclusions

SO appears associated with cognitive dysfunction. However, due to high heterogeneity, very low certainty of evidence, and potential biases, these results should be interpreted cautiously. Future high-quality prospective studies are needed to validate this conclusion.

PROSPERO registration number: CRD420251011745.

Aims

Building upon established short-term benefits, this study aimed to assess Tai Chi’s durability for preserving global and domain-specific cognition in older adults (≥ 60 years) with type 2 diabetes and mild cognitive impairment (T2D-MCI), compared to fitness walking and health education.

Methods

Participants (n = 328) were randomized 1:1:1 to Tai Chi, fitness walking, or health education groups, completing 24-week interventions. Cognitive outcomes—global cognition (Montreal Cognitive Assessment, MoCA), executive function, attention, visuospatial ability, and language fluency—were evaluated at baseline, 24 weeks(post-intervention), 36 weeks, and 2 years. Linear mixed models analyzed group-by-time interactions, while time-dependent Cox regression quantified minimal clinically important difference (MCID) attainment (MoCA improvement ≥ 4 points).

Results

At 2-year follow-up, linear mixed models revealed significant group-by-time interactions for MoCA (p < 0.001). The Tai Chi group showed greater MoCA improvement versus health education (mean difference: 1.8, 95% CI 0.3–3.3, p = 0.016). Crucially, 49.8% of Tai Chi practitioners achieved MCID—nearly double the probability of health education (HR 2.0, 95% CI 1.4–2.8, p < 0.001) and exceeding fitness walking (HR 1.7, 95% CI 1.2–2.4; p = 0.005). Tai Chi selectively enhanced executive function (shorter Stroop reaction times vs. health education, p < 0.05; fewer color-word errors vs. fitness walking, p = 0.049) and visuospatial ability (higher Rey-Osterrieth copy scores vs. health education, p = 0.034).

Conclusions

Tai Chi provides superior long-term preservation of global cognition and executive/visuospatial function in T2D-MCI older adults, with nearly 50% achieving clinically meaningful cognitive improvement. As a scalable mind-body intervention, it warrants integration into geriatric preventive care to mitigate dementia risk.

Introduction

Osteoarthritis (OA) is a chronic, progressive joint disease characterized by the degradation of articular cartilage, subchondral bone remodeling, synovial inflammation, and osteophyte formation. Despite being a leading cause of disability in older people, effective long-term management of OA remains a significant challenge. Current treatment strategies primarily focus on symptom control, with both non-pharmacological and pharmacological interventions.

Materials and methods

A systematic literature review followed by a structured Delphi survey was conducted, involving an international Technical Expert Panel (TEP) of OA specialists. The panel evaluated the efficacy, safety, and clinical utility of combining low dose diclofenac and chondroitin sulfate in OA management.

Results

The analysis of expert consensus indicated that the combination of low dose diclofenac and chondroitin sulfate may be effective in reducing pain and improving joint function in patients with knee OA. Additionally, this combination could reduce the need for higher doses of NSAIDs, thereby minimizing systemic adverse effects.

Conclusion

The combination of low dose diclofenac and chondroitin sulfate represents a promising therapeutic strategy for managing knee OA. Further studies are needed to confirm these findings and optimize therapeutic strategies to improve patient outcomes.

Purpose

To assess the feasibility and acceptability of a multicomponent prehabilitation and perioperative care intervention for older persons with frailty scheduled for elective orthopaedic surgery prior to conducting an RCT.

Methods

A mixed-methods feasibility study assessed reach, dose, data collection procedure, acceptability and adaptation. Data was collected through patient reported outcomes, electronic medical record, and interviews with patients and healthcare professionals. No pre-defined feasibility criteria were applied.

Results

Of those referred for surgery, 30% were screened for frailty, among those eligible, 78% consented to participate. Participants received six of the eight planned phone calls, adherence to nutrition advice and exercise was high, and medication review resulted in at least one drug change for 50% of participants. Qualitative analysis identified key themes including the importance of tailoring care to individual patient needs, strong support from healthcare professionals and family members, and effective interdisciplinary collaboration. The intervention appeared feasible and acceptable to both patients and healthcare professionals. Several adaptations were implemented immediately (refined recruitment procedures, reduced number of health coaching sessions, and modified data collection method), while others were proposed (earlier involvement of geriatrician, focusing on hip and knee surgery, 48-hour follow-up, and improved integration with municipal rehabilitation services and general practitioners).

Conclusion

This study demonstrated the feasibility and acceptability of a prehabilitation and perioperative care intervention for older persons with frailty undergoing elective orthopaedic surgery. The proposed adaptations will inform the implementation strategy prior to conducting an RCT to evaluate effects on clinical outcomes and healthcare costs.