Archives of gerontology and geriatrics最新文献

Objective

Methods

Results

Conclusion

Objective

Materials and Methods

Results

Conclusions

Background

Globally, loneliness is a growing public health concern associated with poor mental and physical health among older adults. Therefore, we performed a meta-analysis to explore the prevalence of loneliness and associated risk factors among older adults across six continents.

Methods

Web of Science, PubMed, Embase, CINAHL, Cochrane Library, and references lists were comprehensively searched until April 2024. Data analysis was performed using Logit Transformation model in R-Software for pooled prevalence and DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis for associated factors of loneliness. Heterogeneity was quantified by $I^2$ and τ² statistics. The funnel plot and Egger's regression test assessed publication bias.

Results

A total of 70 studies with 462,083 older adults were included. The pooled prevalence of loneliness was 26 % (95 %CI, 23 %–30 %) with 38 % for North America, 34 % for Africa, 32 % for Asia and South America, 23 % for Europe, and 13 % for Oceania. Cognitive impairment (2.98; 95 %CI, 1.30–6.81), poor health (2.35; 95 %CI, 1.59–3.45), female (1.92; 95 %CI, 1.53–2.41), depression (1.74; 95 %CI, 1.40–2.16), widowed (1.67; 95 %CI, 1.13–2.48), single (1.51; 95 %CI, 1.06–2.17), institutionalization (2.95; 95 %CI, 1.48–5.88), rural residency (1.18; 95 %CI, 1.04–1.34) were associated with increased risk of loneliness. Being married (0.51; 95 %CI, 0.31–0.82), male (0.55; 95 %CI, 0.43–0.70), and non-institutionalization (0.34; 95 %CI, 0.17–0.68) were associated with lower risk of loneliness.

Conclusion

Approximately, three among ten older adults aged ≥ 60 years are lonely worldwide. Early detection, prevention, and management of loneliness among older adults should consider diverse needs using gender-specific approaches.

Purpose

This study aimed to synthesize and assess evidence on non-pharmacological interventions for older adults, including those with prefrailty and frailty.

Materials and Methods

A comprehensive review of randomized trials and cohort studies on non-pharmacological interventions for individuals aged ≥60 was conducted using MEDLINE, CENTRAL, and Web of Science through April 2023.

Results

Of the 285 papers screened, 13 met the eligibility criteria. Participants aged 62–98 years were studied across 42,917 individuals. Four systematic reviews (SR) focused on healthy older adults, seven on prefrailty, and eleven on frailty. Interventions included exercise therapy (7 articles), nutritional therapy (3 articles), exercise games (1 article), and combined exercise and nutritional therapy (2 articles). Non-pharmacological interventions showed improvement in frailty in 1 out of 1 SR and prevention of frailty progression in 3 out of 4 SRs. Improvements in physical function were noted in 9 out of 12 SRs, muscle strength in 8 out of 11, and muscle mass in 4 out of 6. Exercise interventions enhanced strength, mass, and function in older adults, including those with prefrailty or frailty, whether alone or combined with other components. Combined exercise and nutritional therapy were found to be more effective than monotherapy. Outcomes related to falls, cognitive function, and quality of life were controversial, and no positive effect on mortality was observed.

Conclusions

Exercise therapy, including multicomponent interventions, can prevent frailty and improve physical function, strength, and muscle mass. Nutritional therapy has some advantages, but its combination with exercise therapy is recommended.

Background

Frailty is associated with reduced intrinsic capacity (IC). However, studies evaluating longitudinal transitions between IC and frailty are limited. We conducted longitudinal analyses to investigate the association between intrinsic capacity (IC) and frailty transitions among community-dwelling older adults in Korea.

Methods

A total of 2,345 older adults who completed baseline and two-year follow-up surveys were selected from the Korean Frailty and Aging Cohort Study. IC was measured in five domains: locomotion, vitality, cognition, psychology, and sensory function. Frailty was defined using the Fried frailty phenotype. Transitions in IC and frailty were assessed. Logistic regression analysis was used to analyze the association between baseline IC, IC transitions, and frailty transitions.

Results

During the two-year follow-up, 17.8 % of participants improved, 20.4 % worsened, and 61.8 % maintained the same frailty status. Low IC (odds ratio [OR]=1.93; 95 % confidence interval [CI]=1.42–2.61) significantly predicted remaining frail or worsening frailty. Worsened IC increased the risk of remaining frail or worsening frailty, whereas improved IC decreased this risk. Among the IC domains, the onset of new locomotion (OR=3.33; 95 % CI=2.39–4.64), vitality (OR=2.12; 95 % CI=1.55–2.91), and psychological (OR=3.61; 95 % CI=2.64–4.92) impairment predicted remaining frail or worsening frailty.

Conclusions

Low and worsened IC were associated with an increased risk of remaining frail or worsening frailty over two years. These findings indicate that changes in IC can predict frailty transitions, thereby emphasizing the importance of enhancing IC in preventing frailty progression.

Purpose

There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty.

Methods

Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics.

Results

Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %).

Conclusions

One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.

Objective

This study explored the effectiveness of a newly constructed frailty index (FI) for predicting short-term and long-term mortality in patients with chronic heart failure (HF).

Materials and methods

This retrospective study included inpatients aged ≥60 years diagnosed with chronic HF at a teaching hospital in western China. General data on the patients were collected from the electronic medical record system between January 1, 2017, and July 7, 2022, and death information was obtained from follow-up calls made from July 31, 2022, to August 1, 2022. Receiver operating characteristic (ROC) curves were used to analyze the accuracy of the FI in predicting death in patients with chronic HF. Logistic regression (during hospitalization and within 30 days after discharge) and Cox regression (within 180 days after discharge and one year after discharge) analyses were used to assess associations between frailty and mortality risk in elderly patients with chronic HF.

Results

A total of 432 patients with chronic HF were included in the study. The non-frail group had FI values <0.3, while the FI values in the frail group were ≥0.3. Overall, 130 patients (30.09 %) were diagnosed with frailty, 66 (15.28 %) died during hospitalization or within 30 days after discharge, 55 (12.73 %) died within 180 days after discharge, and 68 (15.74 %) died within one year after discharge. The in-hospital and 30-day mortality rates, the 180-day mortality rates, and the 1-year mortality rates were higher in frail patients than in non-frail patients (in-hospital and 30-day mortality rates, 37.69 % vs. 5.63 %, P < 0.001; within 180 days, 30.61 % vs. 8.45 %, P < 0.001; within 1 year, 34.69 % vs. 11.49 %, P < 0.001). The area under the curve (AUC) values of FI for predicting in-hospital and 30-day mortality after discharge were 0.804, with values of 0.721 for 180-day mortality after discharge and 0.720 for 1-year mortality after discharge. Logistic regression analysis with adjustment for potential confounders indicated that frail HF patients had a higher risk of death during hospitalization and within 30 days than non-frail patients (odds ratio [OR] = 4.98, 95 % confidence interval [CI]: 2.46–10.09). Cox regression analysis with adjustment for potential confounders showed that frail HF patients had a higher risk of death within 180 days (hazard ratio [HR] = 2.63, 95 %CI: 1.47–4.72) and within 1 year (HR = 2.01, 95 %CI: 1.19–3.38).

Conclusion

The results of this study showed that the new FI constructed according to the established construction rules could predict the in-hospital mortality and the risk of death within 30 days after discharge, 180 days after discharge, and 1 year after discharge in patients with chronic HF.

Study Objectives

Against the current backdrop of population ageing, the correlation between cardiovascular diseases and endothelial dysfunction is increasingly important. Exercise, a simple and accessible method of preventing and ameliorating numerous diseases, has been demonstrated to significantly enhance endothelial function. This study aimed to assess the effects of aerobic exercise (AE), resistance exercise (RE), combined exercise (CE) and high-intensity interval training (HIIT) on vascular endothelial function in middle-aged and older adults. Flow-mediated dilation (FMD) is a non-invasive ultrasound technique used to measure endothelial function. Direct and indirect comparisons were used to determine which exercise modality most effectively improved vascular endothelial function in this demographic.

Methods

This comprehensive systematic review and network meta-analysis examined randomised controlled trials (RCTs) comparing the effects of four different exercise interventions (AE, RE, CE and HIIT) to a control intervention on FMD in middle-aged and older adults.

Results

The analysis included 20 RCTs involving 1,123 participants. The surface under the cumulative ranking curve (SUCRA) analysis indicated that AE was the most effective in improving FMD (SUCRA = 68.9 %), followed by HIIT (SUCRA = 62.5 %), RE (SUCRA = 58.8 %), CE (SUCRA = 54.9 %) and CON (SUCRA = 4.9 %).

Conclusions

This network meta-analysis of various interventions for FMD in middle-aged and older adults found that AE was the most effective in improving FMD (SUCRA = 68.9 %). These findings suggest that AE could be a valuable intervention in clinical practice for enhancing vascular health in this population.

Objective

To investigate the interplay between individual nighttime and midday sleep duration and the number of new-onset chronic diseases and determine the optimal sleep duration associated with lowest number of new-onset chronic diseases.

Methods

We used data from the China Health and Retirement Longitudinal Study (CHARLS) covering a decade and involving 10,828 participants. A random intercept cross-lagged model was used to explore the interplay between nighttime/midday sleep durations and new-onset chronic diseases at both the within-individual and between-individual levels, followed by a dose–response analysis at the between-individual level to determine the optimal sleep duration. New-onset chronic diseases include 14 types of self-reported diseases diagnosed by doctors.

Results

Within-individual analysis revealed that increased nighttime/midday sleep duration led to a higher number of new-onset chronic diseases, and an increased number of new-onset chronic diseases resulted in decreased nighttime sleep duration. Between nighttime and midday sleep, one type of sleep duration increase was likely to lead to an increase in another type. Between-individual analysis found a nonlinear relationship between the number of new-onset chronic diseases and nighttime sleep duration, identifying the optimal nighttime sleep duration as 7.46 h.

Conclusions

These findings elucidate the interplay between sleep duration and number of new-onset chronic diseases and underscore the need for public awareness and comprehensive interventions. Future studies should focus on refining sleep monitoring and exploring the sleep–chronic diseases nexus in greater depth.