Archives of gerontology and geriatrics最新文献

Prevalence, determinants, and health outcomes of potentially inappropriate medication use according to the 2023 beers criteria among hospitalised older patients 根据 2023 年 Beers 标准，住院老年患者中潜在不当用药的发生率、决定因素和健康结果

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-13 DOI: 10.1016/j.archger.2024.105693

Kittipak Jenghua , Sirayut Phatthanasobhon , Duangkamon Poolpun

Background

This study aims to determine the prevalence, determinants, and rehospitalisation outcomes of potentially inappropriate medication (PIM) use among hospitalised older patients.

Design and participants

This retrospective cohort study analysed older patients admitted to a tertiary care hospital from 2021 to 2023. We evaluated PIM prescriptions using the 2023 Beers criteria, classifying the patients as PIM users or non-users. We assessed the prevalence of PIM use, identified its determinants, and investigated the association between PIM use and rehospitalisation for any reason within one year of discharge, as well as the related length of stay and total medical costs.

Results

The study comprised 20,629 hospitalised older patients with a mean age of 71.17 ± 8.14 years, 50.21% of whom were women. PIM usage was prevalent among 91.32% of the patients. The determinants of PIM use included being female, having a longer hospital stay, an increasing number of prescribed drugs, and three or more chronic conditions. However, the use of PIM did not significantly increase the risk of rehospitalisation (adjusted hazard ratios = 1.02; 95% CI = 0.87–1.19), length of stay (adjusted mean difference [aMD] = 0.35 days; 95% CI = -1.31 to 2.01 days), or cost of medical care (aMD = 2,039 Baht; 95% CI = -9,824 to 13,901 Baht).

Conclusions

The use of PIMs among hospitalised older patients remains alarmingly high and is strongly correlated with the number of prescribed drugs. However, no significant link was found between PIM use and rehospitalisation outcomes within a one-year period.

背景本研究旨在确定住院老年患者中潜在不当用药（PIM）的发生率、决定因素和再住院结果。设计和参与者本回顾性队列研究分析了 2021 年至 2023 年期间一家三级医院收治的老年患者。我们采用 2023 年的 Beers 标准对 PIM 处方进行了评估，并将患者分为 PIM 使用者和非使用者。我们评估了 PIM 的使用率，确定了其决定因素，并调查了 PIM 的使用与出院后一年内因任何原因再次住院之间的关系，以及相关的住院时间和医疗总费用。结果这项研究包括 20629 名住院的老年患者，平均年龄为 71.17 ± 8.14 岁，其中 50.21% 为女性。91.32%的患者普遍使用 PIM。使用 PIM 的决定因素包括女性、住院时间较长、处方药数量增加以及患有三种或三种以上慢性疾病。然而，使用 PIM 并不会显著增加再次住院的风险（调整后危险比 = 1.02；95% CI = 0.87-1.19）、住院时间（调整后平均差 [aMD] = 0.35 天；95% CI = -1.31 至 2.结论住院老年患者使用 PIMs 的比例仍然高得惊人，并且与处方药的数量密切相关。然而，在一年内，PIM 的使用与再住院结果之间并没有发现明显的联系。

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引用次数: 0

The molecular mechanisms of steroid hormone effects on cognitive function 类固醇激素影响认知功能的分子机制。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-12 DOI: 10.1016/j.archger.2024.105684

Hai Duc Nguyen , Giang Huong Vu , Woong-Ki Kim

Objective

There is a lack of information on the molecular mechanisms by which steroid hormones (testosterone, estrogen, and progesterone) regulate cognitive impairment. Thus, we aimed to identify the protective effects of steroid hormones on cognitive function.

Methods

We analyzed the literature on the molecular mechanisms, biological activities, physicochemical properties, and pharmacokinetics of steroid hormones.

Results

Steroid hormones can protect against cognitive impairment by regulating key genes (INS, TNF, STAT3, ESR1). Specific microRNAs, namely hsa-miR-335-5p, hsa-miR-16-5p, and hsa-miR-26b-5p, along with transcription factors NFKB1, PPARG, NR3C1, GATA2, EGR1, ATF3, and CEBPA, play a significant role in this protective mechanism. The involvement in cognitive processes, regulation of phosphorylation, neuronal apoptosis, and signaling pathways related to Alzheimer's disease significantly influence the protein-protein interaction network underlying these effects. Additionally, steroid hormones exhibit anti-hypercholesterolemic properties, anti-inflammatory activity, antitoxic properties, and function as inhibitors of acetylcholine neuromuscular transmission. They also hold promise as therapeutic agents for the treatment of dementia. Promising therapeutic interventions for cognitive impairment include the use of miRNA sponges targeting hsa-miR-16-5p, along with the administration of capsaicin, minocycline, dopamine, sertraline, and minaprine. The gut microbiota species Lactobacillus amylovorus, Paraprevotella clara, Libanicoccus massiliensis, Prevotella oris, Turicibacter sanguinis, and Dubosiella newyorkensis were identified as significant contributors to cognitive impairment and altered levels of steroid hormones.

Conclusion

Steroid hormones are promising compounds for improving cognitive function. Further research is needed to validate these findings through focused investigations into apoptosis, regulation of neuronal cell death, miRNA sponges, interactions with gut microbiota, and the potential efficacy of pharmaceutical agents.

目的：关于类固醇激素（睾酮、雌激素和孕酮）调节认知障碍的分子机制，目前还缺乏相关信息。因此，我们旨在确定类固醇激素对认知功能的保护作用：方法：我们分析了有关类固醇激素的分子机制、生物活性、理化性质和药代动力学的文献：结果：类固醇激素可通过调节关键基因（INS、TNF、STAT3、ESR1）来防止认知功能受损。特定的微RNA，即hsa-miR-335-5p、hsa-miR-16-5p和hsa-miR-26b-5p，以及转录因子NFKB1、PPARG、NR3C1、GATA2、EGR1、ATF3和CEBPA，在这一保护机制中发挥了重要作用。参与认知过程、磷酸化调节、神经元凋亡以及与阿尔茨海默氏症有关的信号通路，都会对这些效应背后的蛋白质-蛋白质相互作用网络产生重大影响。此外，类固醇激素还具有抗高胆固醇血症、抗炎、解毒的特性，并可作为乙酰胆碱神经肌肉传导的抑制剂。它们也有望成为治疗痴呆症的药物。有希望治疗认知障碍的干预措施包括使用针对 hsa-miR-16-5p 的 miRNA 海绵，以及服用辣椒素、米诺环素、多巴胺、舍曲林和米那普林。肠道微生物群物种淀粉乳杆菌（Lactobacillus amylovorus）、克拉拉副杆菌（Paraprevotella clara）、大肠利班尼球菌（Libanicoccus massiliensis）、口腔普雷沃特氏菌（Prevotella oris）、血肠球菌（Turicibacter sanguinis）和纽约杜博氏菌（Dubosiella newyorkensis）被确定为认知障碍和类固醇激素水平改变的重要因素：结论：类固醇激素是有希望改善认知功能的化合物。结论：类固醇激素是一种有望改善认知功能的化合物，需要进一步研究，通过重点调查细胞凋亡、神经元细胞死亡调控、miRNA 海绵、与肠道微生物群的相互作用以及药物的潜在功效来验证这些发现。

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引用次数: 0

Silencing of the Nrf2 pathway in aging promotes a decrease in the anti-inflammatory effect of resveratrol 在衰老过程中抑制 Nrf2 通路会降低白藜芦醇的抗炎作用。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-10 DOI: 10.1016/j.archger.2024.105694

Filipe Nogueira Franco, Brenda Evangelista Peixoto, Glaucy Rodrigues de Araújo, Miriam Martins Chaves

During aging, in addition to increased oxidative stress, inflammation also occurs. A chronic and low-grade inflammation - called “inflammaging” - develops, which contributes to the etiology of diseases related to aging. Resveratrol (Resv.) is a polyphenol well known for its biologically active properties, such as antioxidant and anti-inflammatory properties. This balance can be regulated by Nrf2 - a transcription factor that regulates cellular defense against oxidative agents through the expression or inhibition of certain genes. The objective was to evaluate the effect of Nrf2 on the production of cytokines in leukocytes of different ages treated with resveratrol (5µm). The subjects were divided into three groups: 20–39, 40–59 and 60–80 years old. After separation of the leukocytes, a 24-hour treatment was carried out with and without ML385 inhibitor with the treatments: Control, Resv, Peroxide and Peroxide+Resv. 150 µM peroxide was set to develop an oxidative environment. Cytokines were measured by ELISA (*p < 0.05). In general, there was an increase in TNF and IL-6 in cells stimulated with peroxide compared to controls. A decrease in these two cytokines was also observed in cells treated with resveratrol, both at basal levels and in an oxidizing environment (with peroxide). The polyphenol was able to increase IL-10 only in the youngest age groups. The same profile was observed comparing the same groups when the Nrf2 pathway was inhibited with ML385. It is concluded that resveratrol may have a better effect on preventing oxidation and inflammation present in aging, especially through the antioxidant and anti-inflammatory Nrf2 pathway.

在衰老过程中，除了氧化应激增加外，炎症也会发生。慢性和低水平的炎症--被称为 "炎症老化"--会导致与衰老有关的疾病。白藜芦醇（Resv.）是一种多酚，以其生物活性特性（如抗氧化和抗炎特性）而闻名。Nrf2 是一种转录因子，通过表达或抑制某些基因来调节细胞对氧化剂的防御能力。研究的目的是评估 Nrf2 对白藜芦醇（5 微米）处理不同年龄段白细胞产生细胞因子的影响。实验对象分为三组：20-39 岁、40-59 岁和 60-80 岁。在分离白细胞后，使用或不使用 ML385 抑制剂进行 24 小时处理：对照组、Resv、过氧化物和过氧化物+Resv。设置 150 µM 过氧化物以形成氧化环境。细胞因子通过 ELISA 检测（*p < 0.05）。一般来说，与对照组相比，受过氧化物刺激的细胞中 TNF 和 IL-6 增加。用白藜芦醇处理过的细胞，无论是在基础水平还是在氧化环境（过氧化物）中，这两种细胞因子都有所下降。多酚仅在最年轻的年龄组中能够增加 IL-10。用 ML385 抑制 Nrf2 通路时，在相同组别中也观察到了相同的情况。由此得出结论，白藜芦醇在防止衰老过程中出现的氧化和炎症方面可能有更好的效果，尤其是通过抗氧化和抗炎症的 Nrf2 途径。

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引用次数: 0

Examination of the relationship between participation in salons aimed at care prevention through the promotion of social participation and the subsequent cost of care: A 3-year prospective follow-up study in JAGES 研究参加旨在通过促进社会参与来预防护理的沙龙与后续护理成本之间的关系：JAGES 的一项为期 3 年的前瞻性跟踪研究。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-08 DOI: 10.1016/j.archger.2024.105688

Hiroshi Hirai , Masashige Saito , Tokunori Takeda , Katsunori Kondo

Many previous studies have found that social participation improves the health and functional maintenance of older people. However, to determine whether promoting social participation can prevent functional decline in the elderly, it is necessary not only to compare the prognosis of those who participate in social activities to those who do not but also to demonstrate that the intervention was effective in promoting social participation. Although the effect of social participation in preventing caregiving has been demonstrated, the key question is whether preventing functional decline through social participation can reduce care costs. This study aims to examine the relationship between participation in salons aimed at care prevention through the promotion of social participation and the subsequent cost of care. We use the Japan Gerontological Evaluation Study (JAGES) dataset to conduct longitudinal, individuallevel analysis. We focus on all residents 65 years and older who did not have a without disability in Taketoyo town and ran three regression analyses. First, a generalized linear model (GLM) with Tweedie distribution and log-link function, as well as robust estimation of variance components was used to estimate the dependent variables. Second, we used an inverse probability weighting (IPW) model to minimize selection bias. Finally, we performed the IV analysis. In this study, the GLM with IPW and IV models revealed link between salon participants and lower caregiving costs. The link between participation and caregiving costs was confirmed in a model with reduced selection bias, rather than in a simple GLM model.

以往的许多研究发现，社会参与能改善老年人的健康和功能维持。然而，要确定促进社会参与是否能预防老年人功能衰退，不仅需要比较参与社会活动者与不参与社会活动者的预后，还需要证明干预措施对促进社会参与是有效的。虽然社会参与在预防护理方面的效果已经得到证实，但关键问题是，通过社会参与预防功能衰退能否降低护理成本。本研究旨在探讨通过促进社会参与来预防护理的沙龙活动与后续护理成本之间的关系。我们使用日本老年学评估研究（JAGES）数据集进行纵向、个人层面的分析。我们以武丰町所有 65 岁及以上且无残疾的居民为研究对象，进行了三次回归分析。首先，我们使用了带有 Tweedie 分布和对数连接功能的广义线性模型（GLM）以及对方差成分的稳健估计来估计因变量。其次，我们使用了反概率加权（IPW）模型来减少选择偏差。最后，我们进行了 IV 分析。在本研究中，使用 IPW 和 IV 模型的 GLM 显示了沙龙参与者与较低护理成本之间的联系。在一个减少了选择偏差的模型中，而不是在一个简单的 GLM 模型中，参与与护理成本之间的联系得到了证实。

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引用次数: 0

Limited role of biological aging in unhealthy aging: A cross-sectional analysis of global life expectancy and disability data 生物衰老在不健康老龄化中的作用有限：对全球预期寿命和残疾数据的横断面分析。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.archger.2024.105691

Wenpeng You , Luisa Garcia , Kamal Hezam , Hui Chen (Rita) Chang

Background

Biological aging is known to impact quality of life, but its precise role is debated.

Objective

This study explores how biological aging, measured by life expectancy at birth (e0), affects unhealthy aging as indicated by years lost due to disability (YLD).

Methods

Data from international organizations, including e0, YLD, and confounding factors like income, obesity, and urbanization, were analyzed. Correlations were visualized with scatter plots, and associations were assessed using Pearson's and nonparametric methods. Partial, multilevel modelling and multiple regression analyses were conducted to determine e0′s impact on YLD.

Results

e0 strongly correlated with YLD, explaining about 50 % of its variance. After adjusting for confounders, e0’s contribution fell to 12.18 %. Multiple regression identified e0 and urbanization as significant predictors.

Conclusions

Biological aging influences YLD, but its effect diminishes when accounting for other factors, highlighting the need for a comprehensive approach to healthy aging.

背景众所周知，生物老化会影响生活质量，但其确切作用还存在争议：本研究探讨了以出生时预期寿命（e0）衡量的生物老龄化如何影响以残疾损失年数（YLD）表示的不健康老龄化：分析了来自国际组织的数据，包括 e0、YLD 以及收入、肥胖和城市化等混杂因素。相关性用散点图表示，关联性用皮尔逊法和非参数法评估。为了确定 e0 对 YLD 的影响，进行了局部、多层次建模和多元回归分析。在对混杂因素进行调整后，e0 的贡献降至 12.18%。多元回归确定 e0 和城市化是重要的预测因素：结论：生物老龄化会影响 YLD，但在考虑其他因素后，其影响会减弱，这突出表明需要采取综合方法来实现健康老龄化。

{"title":"Limited role of biological aging in unhealthy aging: A cross-sectional analysis of global life expectancy and disability data","authors":"Wenpeng You , Luisa Garcia , Kamal Hezam , Hui Chen (Rita) Chang","doi":"10.1016/j.archger.2024.105691","DOIUrl":"10.1016/j.archger.2024.105691","url":null,"abstract":"<div><h3>Background</h3><div>Biological aging is known to impact quality of life, but its precise role is debated.</div></div><div><h3>Objective</h3><div>This study explores how biological aging, measured by life expectancy at birth (e0), affects unhealthy aging as indicated by years lost due to disability (YLD).</div></div><div><h3>Methods</h3><div>Data from international organizations, including e0, YLD, and confounding factors like income, obesity, and urbanization, were analyzed. Correlations were visualized with scatter plots, and associations were assessed using Pearson's and nonparametric methods. Partial, multilevel modelling and multiple regression analyses were conducted to determine e0′s impact on YLD.</div></div><div><h3>Results</h3><div>e0 strongly correlated with YLD, explaining about 50 % of its variance. After adjusting for confounders, e0’s contribution fell to 12.18 %. Multiple regression identified e0 and urbanization as significant predictors.</div></div><div><h3>Conclusions</h3><div>Biological aging influences YLD, but its effect diminishes when accounting for other factors, highlighting the need for a comprehensive approach to healthy aging.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"129 ","pages":"Article 105691"},"PeriodicalIF":3.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in senescence markers after a weight loss intervention in older adults with obesity 对肥胖症老年人进行减肥干预后衰老标志物的变化。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.archger.2024.105685

David H. Lynch , Curtis L. Petersen , Delisha Stewart , Jamie N. Justice , Dakota J Batchek , Susan Sumner , Susan McRitchie , John A. Batsis

Background

Understanding how weight loss interventions in older adults with obesity impact aging biology can lay the foundation for targeted, ‘geroscience-based’ interventions. This study examines the association between changes in the senescence-associated secretory phenotypes (SASP) and changes in function in response to a weight loss intervention.

Methods

We conducted a post-hoc biomarker analysis on adults aged ≥ 65 years with body mass index [BMI] ≥30 kg/m² enrolled in a six-month, non-randomized telemedicine-delivered weight loss intervention. We assessed 16 SASP cytokines using serum samples collected pre-and post-intervention. Clinical outcomes include anthropometric and physical function measurements. A weight loss responder was defined as a loss of ≥5 % of body weight.

Results

Mean age was 73.2 ± 3.9 years (73 % female), and BMI was 36.5 ± 5.2 kg/m². Responders lost 7.6 ± 2.5 %, while non-responders lost 2.0 ± 2.3 % of weight (n = 16 per group, p < 0.001). We observed several significant associations between SASP cytokines and physical function and anthropometric measurement outcomes in age- and sex-adjusted linear models. These included grip strength and Interleukin-8 (IL-8) (b = 9.07) and Insulin-like Growth Factor 1 (IGF-1) (b = 2.6); gait speed and Thymus and Activation-Regulated Chemokine (TARC) (b = 0.46) and IL-7(b = 61 0.11); weight IL-6 (b = -6.77) and IL-15 (b = -2.53); BMI and IL-15 (b = -0.95); waist-to-hip ratio and osteopontin (b = -0.07) (p < 0.05 for all).

Conclusions

Our pilot data demonstrated an association between changes in select SASP biomarkers and increased functional ability with intentional weight loss in older adults with obesity. However, findings must be replicated in prospective randomized trials with a control group and additional SASP biomarkers.

背景：了解对患有肥胖症的老年人采取的减肥干预措施如何影响衰老生物学，可为采取有针对性的、"基于科学 "的干预措施奠定基础。本研究探讨了衰老相关分泌表型（SASP）的变化与减肥干预后功能变化之间的关联：我们对体重指数[BMI]≥30 kg/m2、年龄≥65岁的成年人进行了一项事后生物标志物分析，这些成年人参加了为期六个月的非随机远程医疗减肥干预。我们使用干预前后采集的血清样本评估了 16 种 SASP 细胞因子。临床结果包括人体测量和身体功能测量。体重下降≥5%即为减肥反应者：平均年龄为 73.2 ± 3.9 岁（73% 为女性），体重指数为 36.5 ± 5.2 kg/m2。有反应者体重减轻了 7.6 ± 2.5%，无反应者体重减轻了 2.0 ± 2.3%（每组 16 人，P < 0.001）。在年龄和性别调整线性模型中，我们观察到 SASP 细胞因子与身体功能和人体测量结果之间存在几种重要的关联。其中包括握力与白细胞介素-8（IL-8）（b = 9.07）和胰岛素样生长因子 1（IGF-1）（b = 2.6）；步速与胸腺和激活调节的趋化因子（TARC）（b = 0.46）和 IL-7（b = 61 0.11）；体重 IL-6（b = -6.77）和 IL-15（b = -2.53）；体重指数（BMI）和 IL-15（b = -0.95）；腰臀比和骨质素（b = -0.07）（所有数据的 p < 0.05）：我们的试验数据表明，在有意减轻肥胖症老年人体重的情况下，某些 SASP 生物标志物的变化与功能能力的提高之间存在关联。然而，这些研究结果必须在有对照组和其他 SASP 生物标志物的前瞻性随机试验中得到证实。

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引用次数: 0

Ambivalent ageism and the pains and gains of informal caregiving for older adults: Findings from Germany 矛盾的老龄歧视与非正式照顾老年人的苦与乐：德国的研究结果。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.archger.2024.105683

Larissa Zwar, Hans-Helmut König, Emily Delfin, André Hajek

Background and objectives

We analyzed the associations between ambivalent ageism, burden and positive experiences of care among informal caregivers of older adults (aged ≥60 years), to advance understanding of its role as psychosocial risk or resilience factor for informal caregivers.

Design and methods

Data of 433 informal caregivers (≥18 years) of adults with care needs (≥60 years) from the Attitudes towards Informal Caregivers (ATTIC) project was used. The Ambivalent Ageism Scale, Positive Aspects of Care Scale and the Burden Scale for Family Caregivers were used. Linear regression analyses adjusted for context and personal factors were conducted, with age and gender included as moderators in additional tests.

Results

High ageism (total score) was significantly associated with a high level of positive aspects of care and burden. Further analyses showed a significant positive association between benevolent ageism and positive aspects of care, while stronger hostile ageism was associated with less positive aspects of care. Hostile ageism was also significantly associated with more burden, while benevolent ageism and burden were not associated. Additional analyses indicated no moderation by gender, but by age. The association between hostile ageism and burden was weaker with caregivers’ higher age.

Discussion and implications

While hostile ageism and worse caregiver burden were associated, positive care experiences seemed to benefit from benevolent ageism. This highlights the complex associations between ageism and caregivers’ well-being, which need to be taken into account in theory and practice focused on improving the care situation for both caregivers and care recipients.

背景和目的：我们分析了老年人（年龄≥60岁）非正规照顾者的矛盾老年主义、照顾负担和积极经验之间的关联，以促进对其作为非正规照顾者的社会心理风险或复原力因素的理解：使用 "对非正式照顾者的态度"（ATTIC）项目中 433 名有照顾需求的成年人（≥60 岁）的非正式照顾者（≥18 岁）的数据。使用了矛盾老年主义量表、护理积极方面量表和家庭护理者负担量表。对环境和个人因素进行了线性回归分析，并将年龄和性别作为调节因素进行了额外测试：结果：高年龄歧视（总分）与高水平的积极护理和负担显著相关。进一步的分析表明，仁慈型老年主义与护理的积极方面之间存在明显的正相关，而较强的敌意型老年主义则与护理的积极方面较少相关。敌对型老龄歧视也与更多的负担明显相关，而仁慈型老龄歧视与负担没有关系。其他分析表明，性别和年龄之间没有调节作用。年龄越大，敌对型老年歧视与负担之间的关系越弱：虽然敌视性年龄歧视与护理人员负担加重有关，但积极的护理体验似乎得益于善意的年龄歧视。这凸显了老龄歧视与照顾者福祉之间的复杂关系，在理论和实践中需要考虑到这一点，以改善照顾者和被照顾者的照顾状况。

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引用次数: 0

Trajectories of obesity indices and their association with pain in community-dwelling older adults: Findings from the English longitudinal study of ageing 社区老年人的肥胖指数轨迹及其与疼痛的关系：英国老龄化纵向研究的结果。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-07 DOI: 10.1016/j.archger.2024.105690

Shangmin Chen , Mengzhen Min , Lin Du , Yongshan Gao , Lei Xie , Junjie Gao , Liping Li , Zhigang Zhong

Background

The prevalence of pain has increased with the increase of obesity, and finding indicators to predict pain risk has become an urgent need. BMI, WC, and WHtR have the potential to be excellent predictors. However, the association of these obesity indicators with various pains remains unclear.

Methods

This longitudinal cohort study included 2155 pain-free participants (mean age = 68.5 years, standard deviation [SD] = 8.6) from the English Longitudinal Study of Ageing (ELSA). BMI, WC, and WHtR were measured during nurse visits at waves 0, 2, and 4. The Group-Based Trajectory Model (GBTM) was used to identify optimal trajectories for BMI, WC, and WHtR. Self-reported pain at four anatomical sites (lower back, hip, knee and total pain) was assessed at Waves 4 to 9. Cox proportional hazards models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obesity indices and pain risk.

Results

Over a median follow-up period of 7.49 years, we observed 1,059 incident cases of all-cause pain. After adjusting for confounders, participants in the High-Stable WC group had a 30% higher risk of experiencing pain (HR: 1.30, 95 % CI: 1.05–1.60, P = 0.014), while those in the High-Stable WHtR group had a 29% higher risk (HR: 1.29, 95% CI: 1.06–1.56, P = 0.010) compared to the Low-Stable group. High-stable trajectories for BMI, WC, and WHtR were also associated with an elevated risk of back, hip, and knee pain.

Conclusion

This study identifies long-term obesity indices as significant predictors of pain, suggesting the importance of monitoring these measures for effective clinical risk assessments. Further research is needed to explore the underlying mechanisms of these associations.

背景：随着肥胖人数的增加，疼痛的发病率也随之增加，寻找预测疼痛风险的指标已成为当务之急。体重指数（BMI）、腹围（WC）和体重指数（WHtR）有可能成为很好的预测指标。然而，这些肥胖指标与各种疼痛的关系仍不清楚：这项纵向队列研究包括来自英国老龄化纵向研究（ELSA）的 2155 名无痛参与者（平均年龄 = 68.5 岁，标准差 [SD] = 8.6）。在第 0、2 和 4 波的护士访问中测量了 BMI、WC 和 WHtR。基于群体的轨迹模型 (GBTM) 被用来确定 BMI、WC 和 WHtR 的最佳轨迹。在第 4 波至第 9 波期间，对四个解剖部位（下背部、髋部、膝部和全身疼痛）的自我报告疼痛进行了评估。采用 Cox 比例危险模型估算肥胖指数与疼痛风险之间的危险比（HR）和 95% 置信区间（CI）：在 7.49 年的中位随访期内，我们观察到 1,059 例全因疼痛病例。在对混杂因素进行调整后，与低稳定组相比，高稳定 WC 组的参与者发生疼痛的风险高出 30%（HR：1.30，95% CI：1.05-1.60，P = 0.014），而高稳定 WHtR 组的参与者发生疼痛的风险高出 29%（HR：1.29，95% CI：1.06-1.56，P = 0.010）。BMI、WC和WHtR的高稳定轨迹也与背部、髋部和膝部疼痛风险升高有关：本研究发现长期肥胖指数是疼痛的重要预测因素，这表明监测这些指标对有效进行临床风险评估非常重要。还需要进一步的研究来探索这些关联的内在机制。

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引用次数: 0

Roles of social support and strain in predicting older adults’ sleep disturbances 社会支持和压力在预测老年人睡眠障碍中的作用。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-05 DOI: 10.1016/j.archger.2024.105682

Shinae Seo , Meghan K. Mattos , Shannon Reilly , Ishan Williams , Wen You

Sleep disturbances impact the well-being of older adults, but there has been limited research on their longitudinal patterns and how they are affected by the quality of social relationships. This study explored longitudinal sleep disturbance patterns and examined the influence of social support and social strain on sleep disturbances in older adults using data from the Health and Retirement Study (HRS) spanning from 2010 to 2018. Group-based trajectory modeling identified distinct trajectory groups. Multinomial logistic regression and a fixed effects model investigated the relationship between sleep disturbances, social support, social strain, and sociodemographic factors. Three sleep disturbance trajectories were identified: high sleep disturbances, moderate sleep disturbances, and low sleep disturbances. Multinomial logistic regression showed that higher social support decreased the likelihood of classification in the high and moderate sleep disturbance groups. Conversely, higher social strain scores increased the likelihood of belonging to the high and moderate sleep disturbance groups. The fixed effects model confirmed the role of social support in predicting sleep disturbances over time, but social strain was not a significant predictor. These findings suggest the need for tailored interventions addressing social support to reduce sleep disturbances in this population.

睡眠障碍会影响老年人的幸福感，但关于睡眠障碍的纵向模式以及社会关系质量如何影响睡眠障碍的研究却很有限。本研究利用健康与退休研究（HRS）从2010年到2018年的数据，探索了纵向睡眠障碍模式，并研究了社会支持和社会压力对老年人睡眠障碍的影响。基于群体的轨迹建模确定了不同的轨迹群体。多项式逻辑回归和固定效应模型研究了睡眠障碍、社会支持、社会压力和社会人口学因素之间的关系。结果发现了三种睡眠障碍轨迹：高度睡眠障碍、中度睡眠障碍和低度睡眠障碍。多项式逻辑回归显示，较高的社会支持会降低被归入高度和中度睡眠障碍组的可能性。相反，较高的社会压力得分会增加属于高度和中度睡眠障碍组的可能性。固定效应模型证实了社会支持在预测长期睡眠障碍中的作用，但社会压力并不是一个重要的预测因素。这些发现表明，有必要针对社会支持采取有针对性的干预措施，以减少这类人群的睡眠障碍。

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引用次数: 0

Insights into young-onset dementia hospitalizations: An 8-year nationwide study using administrative data 青年痴呆症住院情况透视：一项利用行政数据进行的为期 8 年的全国性研究。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-11-02 DOI: 10.1016/j.archger.2024.105666

Bárbara Ferraz Pinto , Manuel Gonçalves-Pinho , Alberto Freitas , Lia Fernandes , Ana Rita Ferreira

Objective

To characterize all Portuguese public hospitalizations of patients aged < 65 years with a primary or secondary diagnosis of dementia, based on ICD-9-CM coding.

Methods

A retrospective observational study was conducted using a nationwide database encompassing all hospitalizations occurred in Portuguese mainland public hospitals with discharge from 2008 to 2015. Hospitalizations of patients aged 35–64 years with primary or secondary diagnoses of dementia were selected based on ICD-9-CM codes 290.1X-290.4X, 291.2, 292.82, 294.1X, 294.2X, 331.0, 331.1X, 331.82, 333.4 and 046.1, excluding diagnostic codes 317-319, 330.X, 343, 758.0-758.3 and 759.3. Information on age, sex, primary diagnosis, comorbidities (secondary diagnosis), type of admission, length of stay (LoS), in-hospital mortality, suicide attempts, discharge destination, readmissions and dementia etiology was collected.

Results

From 7971 hospitalizations, for 5682 inpatients, the median age was 57.3 years (SD±6.5) and 61.8% were of male patients. Vascular dementia was the most prevalent etiology, followed by Alzheimer's disease. Most admissions were urgent and had a primary diagnosis of ‘Delirium, dementia and other cognitive disorders’, followed by pneumonia and alcohol-related disorders. Dementia, cerebrovascular disease and diabetes were the most common comorbidities. Overall, 55.4% of admissions were first-time admissions during the study period and the median LoS was 10.0 days (Q1;Q3: 5.0;20.0). Suicide attempts were recorded in 0.6% of the episodes. The in-hospital mortality rate was 9.2% and most patients were discharged home (80.2%).

Conclusions

This study describes the complexity and strain of young-onset dementia hospitalizations providing a detailed overview and recommendations for further research and tailored interventions.

摘要根据ICD-9-CM编码，描述葡萄牙公立医院中所有年龄小于65岁、主要或次要诊断为痴呆症的患者的特征：我们利用一个全国性数据库开展了一项回顾性观察研究，该数据库涵盖了 2008 年至 2015 年期间葡萄牙本土公立医院的所有住院和出院病例。根据ICD-9-CM代码290.1X-290.4X、291.2、292.82、294.1X、294.2X、331.0、331.1X、331.82、333.4和046.1（不包括诊断代码317-319、330.X、343、758.0-758.3和759.3），选取了主要或次要诊断为痴呆症的35-64岁住院患者。收集的信息包括年龄、性别、主要诊断、合并症（次要诊断）、入院类型、住院时间（LoS）、院内死亡率、自杀企图、出院目的地、再次入院和痴呆病因：在 7971 例住院病例中，有 5682 例住院患者，中位年龄为 57.3 岁（SD±6.5），61.8% 为男性。血管性痴呆是最常见的病因，其次是阿尔茨海默病。大多数入院患者都是急诊病人，主要诊断为 "谵妄、痴呆和其他认知障碍"，其次是肺炎和酒精相关疾病。痴呆、脑血管疾病和糖尿病是最常见的合并症。总体而言，55.4%的入院患者是在研究期间首次入院，住院时间中位数为 10.0 天（第一季度；第三季度：5.0；20.0）。有 0.6% 的患者有自杀企图。院内死亡率为 9.2%，大多数患者出院回家（80.2%）：这项研究描述了年轻痴呆症患者住院治疗的复杂性和压力，为进一步研究和有针对性的干预措施提供了详细的概述和建议。

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引用次数: 0