Archives of gerontology and geriatrics最新文献_第5页

Actions to control the fear of falling in older people: An umbrella review 控制老年人跌倒恐惧的行动：概括性回顾。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-20 DOI: 10.1016/j.archger.2025.106087

Ana Rita Capela Oliveira , Carla Maria Pintado Magueja , Armando Manuel Gonçalves de Almeida

Background

Fear of falling in older adults is a multifactorial psychological condition associated with the degree of confidence in performing activities of daily living without falling, leading to reduced physical activity, quality of life, and life satisfaction, and resulting in social isolation.

Purpose

This study aimed to summarize and evaluate effective actions to control fear of falling in older adults.

Method

An umbrella review of interventions that control fear of falling in people aged ≥60 years was conducted, in accordance with JBI and PRISMA guidelines. The search was conducted in six electronic databases: CINAHL, Web of Science, MEDLINE, Scopus, Cochrane Reviews, and JBI Databases, during the period from February to April 2024.

Results

Of a total of 706 references identified, 25 met the eligibility criteria. Of those included, eleven studies are systematic review, three studies are meta-analysis, and eleven studies are systematic review with meta-analysis. Five types of action to control fear of falling with therapeutic potential were identified: Physical and functional therapy; Cognitive Behavioral Therapy; Combined strategies; Multifactorial preventive programs; Technological interventions.

Conclusions

The results of this umbrella review indicate that holistic exercises (Tai Chi, Yoga, Pilates) are the most effective in mitigating fear of falling in older adults. Interventions that incorporate multimodal approaches also appear to be beneficial. The combination of physical and cognitive actions is widely recognized as effective and long-lasting. Longitudinal studies are needed to assess the effectiveness of actions over time.

背景：老年人对跌倒的恐惧是一种多因素的心理状况，与进行日常生活活动而不摔倒的信心程度有关，导致身体活动减少，生活质量下降，生活满意度下降，并导致社会孤立。目的：本研究旨在总结和评估控制老年人跌倒恐惧的有效措施。方法：根据JBI和PRISMA指南，对60岁以上人群中控制跌倒恐惧的干预措施进行综合评价。检索于2024年2月至4月期间在六个电子数据库中进行：CINAHL， Web of Science， MEDLINE, Scopus， Cochrane Reviews和JBI数据库。结果：共纳入706篇文献，其中25篇符合入选标准。其中11项研究为系统评价，3项研究为荟萃分析，11项研究为系统评价加荟萃分析。确定了五种具有治疗潜力的控制跌倒恐惧的行动：物理和功能治疗；认知行为疗法；组合策略;多因素预防方案；技术干预措施。结论：这一综述的结果表明，整体运动（太极、瑜伽、普拉提）在减轻老年人对跌倒的恐惧方面最有效。采用多模式方法的干预措施似乎也是有益的。身体和认知活动的结合被广泛认为是有效和持久的。需要进行纵向研究来评估长期行动的有效性。

{"title":"Actions to control the fear of falling in older people: An umbrella review","authors":"Ana Rita Capela Oliveira , Carla Maria Pintado Magueja , Armando Manuel Gonçalves de Almeida","doi":"10.1016/j.archger.2025.106087","DOIUrl":"10.1016/j.archger.2025.106087","url":null,"abstract":"<div><h3>Background</h3><div>Fear of falling in older adults is a multifactorial psychological condition associated with the degree of confidence in performing activities of daily living without falling, leading to reduced physical activity, quality of life, and life satisfaction, and resulting in social isolation.</div></div><div><h3>Purpose</h3><div>This study aimed to summarize and evaluate effective actions to control fear of falling in older adults.</div></div><div><h3>Method</h3><div>An umbrella review of interventions that control fear of falling in people aged ≥60 years was conducted, in accordance with JBI and PRISMA guidelines. The search was conducted in six electronic databases: CINAHL, Web of Science, MEDLINE, Scopus, Cochrane Reviews, and JBI Databases, during the period from February to April 2024.</div></div><div><h3>Results</h3><div>Of a total of 706 references identified, 25 met the eligibility criteria. Of those included, eleven studies are systematic review, three studies are meta-analysis, and eleven studies are systematic review with meta-analysis. Five types of action to control fear of falling with therapeutic potential were identified: Physical and functional therapy; Cognitive Behavioral Therapy; Combined strategies; Multifactorial preventive programs; Technological interventions.</div></div><div><h3>Conclusions</h3><div>The results of this umbrella review indicate that holistic exercises (Tai Chi, Yoga, Pilates) are the most effective in mitigating fear of falling in older adults. Interventions that incorporate multimodal approaches also appear to be beneficial. The combination of physical and cognitive actions is widely recognized as effective and long-lasting. Longitudinal studies are needed to assess the effectiveness of actions over time.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106087"},"PeriodicalIF":3.8,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cognitive decline before and after incident depression: Evidence from three international prospective cohorts 事件抑郁症前后认知能力下降：来自三个国际前瞻性队列的证据。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-16 DOI: 10.1016/j.archger.2025.106086

Xiaoyu Qian , Congdi Wang , Xueman Zhao , Min Jin , Yonghao Xiao , Ziwang Zhou , Feifei Jia

Background

Depression and cognitive decline frequently co-occur in late life, potentially reflecting shared biological, psychological, or social pathways. However, their temporal relationship remains unclear. Understanding how cognitive deterioration and depression unfold over time may inform prevention and intervention strategies.

Methods

This cohort study analyzed 40,167 older adults without baseline depression from CHARLS, HRS, and SHARE (2010–2021). Depressive symptoms were assessed using validated scales. Cognitive function was assessed across memory, executive function, and orientation, and standardized as z-scores. Linear mixed models estimated cognitive trajectories before, at, and after depression onset.

Results

Across 401,017.8 person-years, 10530 participants developed depression. Compared with non-depressed individuals, those with depression onset showed faster cognitive decline before onset, acute decline at onset, and accelerated decline thereafter across all cognitive domains (P <0.001).

Discussion

Cognitive decline precedes, accompanies, and accelerates after the onset of depression among older adults. These findings suggest that cognitive impairment may be an early signal associated with depression risk, highlighting the importance of routine cognitive monitoring in preventive mental health strategies.

背景：抑郁症和认知能力下降经常在晚年共同发生，潜在地反映了共同的生物、心理或社会途径。然而，它们的时间关系尚不清楚。了解认知退化和抑郁症是如何随着时间的推移而发展的，可以为预防和干预策略提供信息。方法：本队列研究分析了来自CHARLS、HRS和SHARE（2010-2021）的40167名无基线抑郁症的老年人。使用有效的量表评估抑郁症状。认知功能通过记忆、执行功能和定向进行评估，并标准化为z分数。线性混合模型估计了抑郁症发病前、发病时和发病后的认知轨迹。结果：在401,017.8人/年的研究中，10530名参与者患上了抑郁症。与非抑郁症个体相比，抑郁症患者在发病前表现出更快的认知衰退，在发病时表现出急性衰退，在所有认知领域表现出加速衰退（P讨论：认知衰退在老年人中先于、伴随并在发病后加速）。这些发现表明，认知障碍可能是与抑郁风险相关的早期信号，强调了常规认知监测在预防性心理健康策略中的重要性。

{"title":"Cognitive decline before and after incident depression: Evidence from three international prospective cohorts","authors":"Xiaoyu Qian , Congdi Wang , Xueman Zhao , Min Jin , Yonghao Xiao , Ziwang Zhou , Feifei Jia","doi":"10.1016/j.archger.2025.106086","DOIUrl":"10.1016/j.archger.2025.106086","url":null,"abstract":"<div><h3>Background</h3><div>Depression and cognitive decline frequently co-occur in late life, potentially reflecting shared biological, psychological, or social pathways. However, their temporal relationship remains unclear. Understanding how cognitive deterioration and depression unfold over time may inform prevention and intervention strategies.</div></div><div><h3>Methods</h3><div>This cohort study analyzed 40,167 older adults without baseline depression from CHARLS, HRS, and SHARE (2010–2021). Depressive symptoms were assessed using validated scales. Cognitive function was assessed across memory, executive function, and orientation, and standardized as z-scores. Linear mixed models estimated cognitive trajectories before, at, and after depression onset.</div></div><div><h3>Results</h3><div>Across 401,017.8 person-years, 10530 participants developed depression. Compared with non-depressed individuals, those with depression onset showed faster cognitive decline before onset, acute decline at onset, and accelerated decline thereafter across all cognitive domains (P <0.001).</div></div><div><h3>Discussion</h3><div>Cognitive decline precedes, accompanies, and accelerates after the onset of depression among older adults. These findings suggest that cognitive impairment may be an early signal associated with depression risk, highlighting the importance of routine cognitive monitoring in preventive mental health strategies.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106086"},"PeriodicalIF":3.8,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bidirectional transitions of frailty states in middle-aged and older adults: Findings from two longitudinal cohorts studies 中老年人虚弱状态的双向转变：来自两项纵向队列研究的结果。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-15 DOI: 10.1016/j.archger.2025.106085

Sutong Wang , Lin Wang , Yongcheng Wang , Xiaoyu Su , Feihu Zhang , Shuli Zong , Lei Qi , Yuehua Jiang , Jifu He , Xiao Li

Objective

We aimed to characterize frailty dynamics in older adults by applying multi-state Markov models (MSMs) to English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS) data to estimate transition intensities.

Methods

Data from ELSA (2004–2012) and CHARLS (2011–2018) cohorts were analyzed using MSMs. Frailty was assessed using the Frailty Index (FI), and covariates like age, sex, marital status, physical activity, and economic status were included. Transition probabilities between frailty states were estimated, and subgroup analyses were performed to assess the influence of covariates on frailty transitions.

Results

A total of 8 187 participants from ELSA, and 9 171 participants from CHARLS were included in the analysis. In ELSA, the transition intensity from pre-frail to robust (0.226, 95 % CI 0.217–0.234) exceeded that from pre-frail to frail (0.105, 95 % CI 0.099–0.111), whereas in CHARLS a different pattern was observed. In the covariate analysis, we found that age, marital status, loneliness, physical activity, current drinking status, and economic status exerted both common and cohort-specific effects on frailty transitions in ELSA and CHARLS, with age and marital status influencing bidirectional frailty transitions in both cohorts.

Conclusion

Frailty is reversible, especially in the pre-frail stage. Transition intensities and influencing factors vary across older adult cohorts in different countries, and beyond age, marital support, physical activity quality, and economic status significantly shape frailty trajectories and should be incorporated into public health policy design.

目的：通过将多状态马尔可夫模型（msm）应用于英国老龄化纵向研究（ELSA）和中国健康与退休纵向研究（CHARLS）数据来估计过渡强度，以表征老年人的衰弱动态。方法：采用MSMs对ELSA（2004-2012）和CHARLS（2011-2018）队列的数据进行分析。使用虚弱指数（FI）评估虚弱程度，协变量包括年龄、性别、婚姻状况、身体活动和经济状况。估计脆弱状态之间的过渡概率，并进行亚组分析以评估协变量对脆弱状态过渡的影响。结果：ELSA共纳入受试者8 187人，CHARLS共纳入受试者9 171人。在ELSA中，从虚弱前期到强壮的过渡强度（0.226,95% CI 0.217-0.234）超过了从虚弱前期到虚弱的过渡强度（0.105,95% CI 0.099-0.111），而在CHARLS中观察到不同的模式。在协变量分析中，我们发现年龄、婚姻状况、孤独、身体活动、当前饮酒状况和经济状况对ELSA和CHARLS的虚弱转变既有共同的影响，也有特定队列的影响，年龄和婚姻状况影响两个队列的双向虚弱转变。结论：虚弱是可逆的，尤其是在虚弱前期。不同国家老年人群体的过渡强度和影响因素各不相同，年龄之外，婚姻支持、身体活动质量和经济状况在很大程度上决定了脆弱性轨迹，应纳入公共卫生政策设计。

{"title":"Bidirectional transitions of frailty states in middle-aged and older adults: Findings from two longitudinal cohorts studies","authors":"Sutong Wang , Lin Wang , Yongcheng Wang , Xiaoyu Su , Feihu Zhang , Shuli Zong , Lei Qi , Yuehua Jiang , Jifu He , Xiao Li","doi":"10.1016/j.archger.2025.106085","DOIUrl":"10.1016/j.archger.2025.106085","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to characterize frailty dynamics in older adults by applying multi-state Markov models (MSMs) to English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS) data to estimate transition intensities.</div></div><div><h3>Methods</h3><div>Data from ELSA (2004–2012) and CHARLS (2011–2018) cohorts were analyzed using MSMs. Frailty was assessed using the Frailty Index (FI), and covariates like age, sex, marital status, physical activity, and economic status were included. Transition probabilities between frailty states were estimated, and subgroup analyses were performed to assess the influence of covariates on frailty transitions.</div></div><div><h3>Results</h3><div>A total of 8 187 participants from ELSA, and 9 171 participants from CHARLS were included in the analysis. In ELSA, the transition intensity from pre-frail to robust (0.226, 95 % CI 0.217–0.234) exceeded that from pre-frail to frail (0.105, 95 % CI 0.099–0.111), whereas in CHARLS a different pattern was observed. In the covariate analysis, we found that age, marital status, loneliness, physical activity, current drinking status, and economic status exerted both common and cohort-specific effects on frailty transitions in ELSA and CHARLS, with age and marital status influencing bidirectional frailty transitions in both cohorts.</div></div><div><h3>Conclusion</h3><div>Frailty is reversible, especially in the pre-frail stage. Transition intensities and influencing factors vary across older adult cohorts in different countries, and beyond age, marital support, physical activity quality, and economic status significantly shape frailty trajectories and should be incorporated into public health policy design.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106085"},"PeriodicalIF":3.8,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ageism and the feminization of old age: A Systematic review 年龄歧视与老年女性化：系统回顾。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-14 DOI: 10.1016/j.archger.2025.106084

Juan Robles Costa , Angélica Quintero-Flórez , Emilio García-Cabrera , Julia Romero-Barranca , Ángel Vilches-Arenas

Background

Increases in life expectancy and declining birth rates have intensified the demographic weight of older adults, particularly women. This population frequently faces intersecting age and gender-based discrimination, resulting in greater health burdens and lower quality of life compared to men.

Objective

To examine gender-based disparities affecting older adults, particularly older women, intending to uncover underlying mechanisms and contribute to the formulation of more equitable, gender-responsive, and age-sensitive public health policies.

Study design

This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251104219).

Methods

Six databases were searched (2014–2024) for studies in English or Spanish on gender- and age-based health inequalities in older adults. Eligible systematic reviews, observational, and experimental studies were quality-assessed (PRISMA, STROBE, CONSORT), and findings were synthesized qualitatively.

Results

Fourteen studies met the inclusion criteria. Across contexts, older women consistently exhibited higher prevalence of disability, frailty, depression, and poorer self-rated health, frequently linked to lower educational attainment and income. In contrast, older men showed lower prevalence of these conditions but faced higher mortality risks from frailty and suicide. Men also tended to report better subjective quality of life.

Conclusions

While women live longer, they often experience greater illness and functional limitations. Socioeconomic disadvantages explain part of these gaps, but a considerable proportion remains unexplained. These findings highlight the urgent need for gender- and age-sensitive public health strategies to reduce inequities in later life.

背景：预期寿命的延长和出生率的下降加剧了老年人，特别是妇女的人口比重。这一人口经常面临年龄和性别的交叉歧视，与男子相比，造成更大的健康负担和更低的生活质量。目的：研究影响老年人，特别是老年妇女的性别差异，旨在揭示潜在机制，并有助于制定更公平、对性别问题敏感和对年龄敏感的公共卫生政策。研究设计：本系统评价遵循PRISMA指南，在PROSPERO注册（CRD420251104219）。方法：检索了6个数据库（2014-2024年），检索了英语或西班牙语关于老年人基于性别和年龄的健康不平等的研究。对合格的系统评价、观察性和实验性研究进行质量评估（PRISMA、STROBE、CONSORT），并对研究结果进行定性综合。结果：14项研究符合纳入标准。在各种情况下，老年妇女始终表现出更高的残疾、虚弱、抑郁和较差的自我评价健康，这往往与较低的教育程度和收入有关。相比之下，老年男性的患病率较低，但因身体虚弱和自杀而面临更高的死亡风险。男性也倾向于报告更好的主观生活质量。结论：虽然女性寿命更长，但她们往往会经历更大的疾病和功能限制。社会经济劣势解释了这些差距的一部分，但仍有相当大一部分无法解释。这些发现突出表明，迫切需要制定对性别和年龄敏感的公共卫生战略，以减少晚年生活中的不平等现象。

{"title":"Ageism and the feminization of old age: A Systematic review","authors":"Juan Robles Costa , Angélica Quintero-Flórez , Emilio García-Cabrera , Julia Romero-Barranca , Ángel Vilches-Arenas","doi":"10.1016/j.archger.2025.106084","DOIUrl":"10.1016/j.archger.2025.106084","url":null,"abstract":"<div><h3>Background</h3><div>Increases in life expectancy and declining birth rates have intensified the demographic weight of older adults, particularly women. This population frequently faces intersecting age and gender-based discrimination, resulting in greater health burdens and lower quality of life compared to men.</div></div><div><h3>Objective</h3><div>To examine gender-based disparities affecting older adults, particularly older women, intending to uncover underlying mechanisms and contribute to the formulation of more equitable, gender-responsive, and age-sensitive public health policies.</div></div><div><h3>Study design</h3><div>This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251104219).</div></div><div><h3>Methods</h3><div>Six databases were searched (2014–2024) for studies in English or Spanish on gender- and age-based health inequalities in older adults. Eligible systematic reviews, observational, and experimental studies were quality-assessed (PRISMA, STROBE, CONSORT), and findings were synthesized qualitatively.</div></div><div><h3>Results</h3><div>Fourteen studies met the inclusion criteria. Across contexts, older women consistently exhibited higher prevalence of disability, frailty, depression, and poorer self-rated health, frequently linked to lower educational attainment and income. In contrast, older men showed lower prevalence of these conditions but faced higher mortality risks from frailty and suicide. Men also tended to report better subjective quality of life.</div></div><div><h3>Conclusions</h3><div>While women live longer, they often experience greater illness and functional limitations. Socioeconomic disadvantages explain part of these gaps, but a considerable proportion remains unexplained. These findings highlight the urgent need for gender- and age-sensitive public health strategies to reduce inequities in later life.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106084"},"PeriodicalIF":3.8,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An explainable machine learning model for comorbidity risk stratification in patients with fractures admitted to the intensive care unit: a multicenter study 一种可解释的机器学习模型用于重症监护室骨折患者的合并症风险分层：一项多中心研究。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-11 DOI: 10.1016/j.archger.2025.106082

Xuelong Liang , Weijie Zhao , Weigui Liufu , Jiale Qian , Nantian Xiang , Xinzhe Zhang , Jihui Zhou , Hongwang Cui

Background

Among traumatic-fracture patients admitted to intensive care units (ICUs), those with substantial chronic comorbidities recover more slowly and die more often than their counterparts without such conditions. The age-adjusted Charlson Comorbidity Index (aCCI) quantifies this burden, yet clinicians still lack a tool that can identify—at the point of ICU admission—which fracture patients are likely to have a high aCCI. To fill this gap, we used a large electronic health-record repository to develop and externally validate an interpretable machine-learning model that predicts severe comorbidity burden in this population.

Methods

We extracted 3 763 adult fracture cases from MIMIC-IV (2008–2019) and split them 3:1 into training and internal validation sets. High comorbidity (aCCI ≥ 7) was defined as the optimal cut-off derived from one-year survival analysis. Nine key predictors emerged from the intersection of LASSO, SVM-RFE, and random-forest importance. Eleven candidate algorithms underwent grid-search hyperparameter tuning with 10-fold cross-validation, and their performance was compared to identify the optimal model, while SHAP clarified model logic. External validation in two Chinese tertiary centres (n = 558) confirmed generalisability, and the final model was deployed as a bedside Shiny calculator.

Results

XGBoost achieved the best internal discrimination (AUROC = 0.84; AUPRC = 0.76) and exhibited excellent calibration and net benefit across clinically relevant thresholds. In external validation, AUROC values were 0.88 (Hainan) and 0.83 (Guangdong). The interactive calculator delivers patient-specific risk explanations in real time.

Conclusions

An XGBoost-based, SHAP-interpretable model accurately predicts high aCCI in ICU fracture patients and generalises across institutions. The readily accessible web tool can help clinicians identify high-risk individuals early, personalise management, and allocate resources more efficiently.

背景：在入住重症监护室（icu）的创伤性骨折患者中，那些有严重慢性合并症的患者比没有这些疾病的患者恢复得更慢，死亡更频繁。年龄调整的Charlson共病指数（aCCI）量化了这一负担，但临床医生仍然缺乏一种工具，可以在ICU入院时识别哪些骨折患者可能具有高aCCI。为了填补这一空白，我们使用了一个大型电子健康记录存储库来开发和外部验证一个可解释的机器学习模型，该模型可以预测这一人群的严重合并症负担。方法：我们从MIMIC-IV（2008-2019）中提取3 763例成人骨折病例，并将其3:1分为训练集和内部验证集。高合并症（aCCI≥7）定义为一年生存分析得出的最佳截止值。从LASSO、SVM-RFE和随机森林重要性的交叉中出现了9个关键预测因子。11种候选算法进行了网格搜索超参数调优，并进行了10倍交叉验证，并比较了它们的性能以确定最优模型，而SHAP则澄清了模型逻辑。在两家中国三级中心（n = 558）进行的外部验证证实了该模型的通用性，最终模型被部署为床边Shiny计算器。结果：XGBoost获得了最佳的内部判别（AUROC = 0.84; AUPRC = 0.76），并在临床相关阈值上表现出出色的校准和净效益。外部验证AUROC值分别为0.88（海南）和0.83（广东）。交互式计算器实时提供患者特定的风险解释。结论：基于xgboost的shap可解释模型可准确预测ICU骨折患者的高aCCI，并可推广到各个机构。易于访问的网络工具可以帮助临床医生早期识别高危个体，个性化管理，并更有效地分配资源。

{"title":"An explainable machine learning model for comorbidity risk stratification in patients with fractures admitted to the intensive care unit: a multicenter study","authors":"Xuelong Liang , Weijie Zhao , Weigui Liufu , Jiale Qian , Nantian Xiang , Xinzhe Zhang , Jihui Zhou , Hongwang Cui","doi":"10.1016/j.archger.2025.106082","DOIUrl":"10.1016/j.archger.2025.106082","url":null,"abstract":"<div><h3>Background</h3><div>Among traumatic-fracture patients admitted to intensive care units (ICUs), those with substantial chronic comorbidities recover more slowly and die more often than their counterparts without such conditions. The age-adjusted Charlson Comorbidity Index (aCCI) quantifies this burden, yet clinicians still lack a tool that can identify—at the point of ICU admission—which fracture patients are likely to have a high aCCI. To fill this gap, we used a large electronic health-record repository to develop and externally validate an interpretable machine-learning model that predicts severe comorbidity burden in this population.</div></div><div><h3>Methods</h3><div>We extracted 3 763 adult fracture cases from MIMIC-IV (2008–2019) and split them 3:1 into training and internal validation sets. High comorbidity (aCCI ≥ 7) was defined as the optimal cut-off derived from one-year survival analysis. Nine key predictors emerged from the intersection of LASSO, SVM-RFE, and random-forest importance. Eleven candidate algorithms underwent grid-search hyperparameter tuning with 10-fold cross-validation, and their performance was compared to identify the optimal model, while SHAP clarified model logic. External validation in two Chinese tertiary centres (<em>n</em> = 558) confirmed generalisability, and the final model was deployed as a bedside Shiny calculator.</div></div><div><h3>Results</h3><div>XGBoost achieved the best internal discrimination (AUROC = 0.84; AUPRC = 0.76) and exhibited excellent calibration and net benefit across clinically relevant thresholds. In external validation, AUROC values were 0.88 (Hainan) and 0.83 (Guangdong). The interactive calculator delivers patient-specific risk explanations in real time.</div></div><div><h3>Conclusions</h3><div>An XGBoost-based, SHAP-interpretable model accurately predicts high aCCI in ICU fracture patients and generalises across institutions. The readily accessible web tool can help clinicians identify high-risk individuals early, personalise management, and allocate resources more efficiently.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106082"},"PeriodicalIF":3.8,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of Home-Based interventions for older adults with frailty or pre-frailty: a systematic review and meta-analysis 以家庭为基础的干预措施对虚弱或虚弱前期老年人的有效性：系统回顾和荟萃分析。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-10 DOI: 10.1016/j.archger.2025.106083

Gengxin Yao , Fei Li , Xuehan Ma , Xinyu Wan , Yali Yang , Yiran Xu , Lishuang Zheng , Guichen Li , Li Chen

Aim

To systematically summarise the characteristics and effectiveness of home-based interventions on health outcomes in older adults with frailty or pre-frailty.

Design

Systematic review and meta-analysis.

Methods

Seven databases were searched from their inception through 31st October 2024. Two reviewers independently performed study screening, selection, data extraction, and quality appraisal. Pooled effects were quantified using standardised mean differences (SMDs) with 95 % confidence intervals (CIs). Risk of bias and evidence certainty were assessed using RoB2 and GRADE, respectively.

Results

Twenty-four studies (20 RCTs; n = 3, 826 participants) were included. The meta-analysis demonstrated that home-based interventions significantly reduced frailty phenotype scores (SMD = -0.27, 95 % CI:0.39 to -0.15) and depressive symptoms (SMD = -0.11, 95 % CI:0.20 to -0.01), alongside marked increases in grip strength (MD = 0.84, 95 % CI: 0.26 to 1.42) and mental health-related quality of life (SMD = 0.17, 95 % CI: 0.04 to 0.30). Subgroup analyses indicated that significant improvements in physical function were observed only in supervised subgroup. No significant changes were observed for overall quality of life, or physical health-related quality of life.

Conclusions

Home-based interventions are a valuable strategy for improving frailty, grip strength, and mental health outcomes in older adults with frailty or pre-frailty. Improvements in physical function appear to depend on home-based interventions delivered under professional supervision, while the unsupervised mode may pose the risk of potential iatrogenic harm and therefore necessitates caution alongside safety monitoring.

Reporting Method

This review followed PRISMA guidelines (PROSPERO: CRD42024604527).

目的：系统地总结以家庭为基础的干预措施对虚弱或虚弱前期老年人健康结果的特点和有效性。设计：系统回顾和荟萃分析。方法：检索自建库至2024年10月31日的7个数据库。两名审稿人独立进行研究筛选、选择、数据提取和质量评估。采用95%置信区间（ci）的标准化平均差异（SMDs）对合并效应进行量化。分别用RoB2和GRADE评估偏倚风险和证据确定性。结果：共纳入24项研究（20项随机对照试验，n = 3826名受试者）。荟萃分析表明，以家庭为基础的干预显著降低了脆弱表型评分（SMD = -0.27, 95% CI:0.39至-0.15）和抑郁症状（SMD = -0.11, 95% CI:0.20至-0.01），同时握力（MD = 0.84, 95% CI: 0.26至1.42）和精神健康相关生活质量（SMD = 0.17, 95% CI: 0.04至0.30）显著增加。亚组分析表明，仅在监督亚组中观察到身体功能的显著改善。总体生活质量或与身体健康相关的生活质量未观察到显著变化。结论：以家庭为基础的干预措施是一种有价值的策略，可以改善虚弱或虚弱前期老年人的虚弱、握力和心理健康结果。身体功能的改善似乎取决于在专业监督下提供的以家庭为基础的干预措施，而无监督模式可能造成潜在的医源性危害，因此需要在安全监测的同时谨慎行事。报告方法：本综述遵循PRISMA指南（PROSPERO: CRD42024604527）。

{"title":"Effectiveness of Home-Based interventions for older adults with frailty or pre-frailty: a systematic review and meta-analysis","authors":"Gengxin Yao , Fei Li , Xuehan Ma , Xinyu Wan , Yali Yang , Yiran Xu , Lishuang Zheng , Guichen Li , Li Chen","doi":"10.1016/j.archger.2025.106083","DOIUrl":"10.1016/j.archger.2025.106083","url":null,"abstract":"<div><h3>Aim</h3><div>To systematically summarise the characteristics and effectiveness of home-based interventions on health outcomes in older adults with frailty or pre-frailty.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Seven databases were searched from their inception through 31st October 2024. Two reviewers independently performed study screening, selection, data extraction, and quality appraisal. Pooled effects were quantified using standardised mean differences (SMDs) with 95 % confidence intervals (CIs). Risk of bias and evidence certainty were assessed using RoB2 and GRADE, respectively.</div></div><div><h3>Results</h3><div>Twenty-four studies (20 RCTs; <em>n</em> = 3, 826 participants) were included. The meta-analysis demonstrated that home-based interventions significantly reduced frailty phenotype scores (SMD = -0.27, 95 % CI:0.39 to -0.15) and depressive symptoms (SMD = -0.11, 95 % CI:0.20 to -0.01), alongside marked increases in grip strength (MD = 0.84, 95 % CI: 0.26 to 1.42) and mental health-related quality of life (SMD = 0.17, 95 % CI: 0.04 to 0.30). Subgroup analyses indicated that significant improvements in physical function were observed only in supervised subgroup. No significant changes were observed for overall quality of life, or physical health-related quality of life.</div></div><div><h3>Conclusions</h3><div>Home-based interventions are a valuable strategy for improving frailty, grip strength, and mental health outcomes in older adults with frailty or pre-frailty. Improvements in physical function appear to depend on home-based interventions delivered under professional supervision, while the unsupervised mode may pose the risk of potential iatrogenic harm and therefore necessitates caution alongside safety monitoring.</div></div><div><h3>Reporting Method</h3><div>This review followed PRISMA guidelines (PROSPERO: CRD42024604527).</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106083"},"PeriodicalIF":3.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reframing sarcopenia: the AWGS 2025 paradigm shift from disease to muscle health 重塑肌肉减少症：AWGS 2025从疾病到肌肉健康的范式转变。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-07 DOI: 10.1016/j.archger.2025.106081

Liang-Kung Chen

引用次数: 0

Social vulnerability increases the risk of death differently in men and women: longitudinal analysis over 15 years in the Paquid Study 社会脆弱性增加男性和女性死亡风险的方式不同：帕奎德研究15年的纵向分析

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-06 DOI: 10.1016/j.archger.2025.106079

Camille Ouvrard , Ivane Koumetio Jiatsa , Antoine Gbessemehlan , Yvanna Simon , Luc Letenneur , Jean-François Dartigues , Melissa K Andrew , Hélène Amieva , Karine Pérès

Background and objectives

Social vulnerability (SV) is a multidimensional construct associated with adverse health outcomes, including mortality. However, little is known about how SV differentially affects older men and women.

Research design and methods

We analyzed data from 3695 community-dwelling older adults from the Paquid cohort, followed for 15 years. SV was assessed using a 26-item SV Index (SVI), categorized into low, moderate, and high levels. Delayed-entry Cox models stratified by gender were used to estimate mortality risk, adjusting for disability, history of ischemic heart disease, dyspnea, diabetes, and cognitive impairment. Associations between SV subdimensions and mortality were also examined separately by gender.

Results

Women accumulated more social deficits than men (40 % vs. 21 % with high SV). High SV was associated with a 21–25 % increased mortality risk in both genders. However, moderate SV is significantly associated with an increased mortality risk only in men (adjusted Hazard Ratio = 1.25, 95 % CI: 1.09–1.44 vs. aHR = 0.96, 95 % CI: 0.81–1.13 in women). Among subdimensions, low socioeconomic status and poor leisure activity engagement were the strongest mortality predictors in men–even at moderate levels (result marginally significant for leisure activities, p = 0.073). In women, poor engagement in leisure activities and negative psychological experience were the main predictors of mortality; low socioeconomic status (SES) showed a trend-level association (p = 0.045).

Discussion and implications

Despite greater SV, women seem to withstand moderate social deficits better than men. These findings highlight the need for further studies to explain gender differences and develop gender-sensitive public health interventions.

背景和目的社会脆弱性（SV）是一个与不良健康结果（包括死亡率）相关的多维结构。然而，对于SV对老年男性和女性的影响有何不同，人们知之甚少。研究设计和方法我们分析了来自帕奎德队列的3695名社区居住老年人的数据，随访15年。SV采用26项SV指数（SVI）进行评估，分为低、中、高水平。使用按性别分层的延迟进入Cox模型来估计死亡风险，调整残疾、缺血性心脏病史、呼吸困难、糖尿病和认知障碍。SV子维度与死亡率之间的关系也按性别分别进行了研究。结果女性比男性积累了更多的社交缺陷（40% vs. 21%高SV）。高SV与两性死亡风险增加21 - 25%相关。然而，仅在男性中，中度SV与死亡风险增加显著相关（校正危险比= 1.25,95% CI: 1.09-1.44，女性aHR = 0.96, 95% CI: 0.81-1.13）。在子维度中，低社会经济地位和不良休闲活动参与是男性死亡率最强的预测因子-即使在中等水平（休闲活动的结果显着，p = 0.073）。在妇女中，缺乏休闲活动和消极的心理体验是死亡率的主要预测因素；低社会经济地位（SES）呈趋势水平相关（p = 0.045）。讨论和启示尽管SV更大，但女性似乎比男性更能承受适度的社交缺陷。这些发现突出表明，需要进一步研究以解释性别差异，并制定对性别问题敏感的公共卫生干预措施。

{"title":"Social vulnerability increases the risk of death differently in men and women: longitudinal analysis over 15 years in the Paquid Study","authors":"Camille Ouvrard , Ivane Koumetio Jiatsa , Antoine Gbessemehlan , Yvanna Simon , Luc Letenneur , Jean-François Dartigues , Melissa K Andrew , Hélène Amieva , Karine Pérès","doi":"10.1016/j.archger.2025.106079","DOIUrl":"10.1016/j.archger.2025.106079","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Social vulnerability (SV) is a multidimensional construct associated with adverse health outcomes, including mortality. However, little is known about how SV differentially affects older men and women.</div></div><div><h3>Research design and methods</h3><div>We analyzed data from 3695 community-dwelling older adults from the Paquid cohort, followed for 15 years. SV was assessed using a 26-item SV Index (SVI), categorized into low, moderate, and high levels. Delayed-entry Cox models stratified by gender were used to estimate mortality risk, adjusting for disability, history of ischemic heart disease, dyspnea, diabetes, and cognitive impairment. Associations between SV subdimensions and mortality were also examined separately by gender.</div></div><div><h3>Results</h3><div>Women accumulated more social deficits than men (40 % vs. 21 % with high SV). High SV was associated with a 21–25 % increased mortality risk in both genders. However, moderate SV is significantly associated with an increased mortality risk only in men (adjusted Hazard Ratio = 1.25, 95 % CI: 1.09–1.44 vs. aHR = 0.96, 95 % CI: 0.81–1.13 in women). Among subdimensions, low socioeconomic status and poor leisure activity engagement were the strongest mortality predictors in men–even at moderate levels (result marginally significant for leisure activities, <em>p</em> = 0.073). In women, poor engagement in leisure activities and negative psychological experience were the main predictors of mortality; low socioeconomic status (SES) showed a trend-level association (<em>p</em> = 0.045).</div></div><div><h3>Discussion and implications</h3><div>Despite greater SV, women seem to withstand moderate social deficits better than men. These findings highlight the need for further studies to explain gender differences and develop gender-sensitive public health interventions.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106079"},"PeriodicalIF":3.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between changes in social isolation status and frailty among older adults 老年人社会孤立状况的变化与虚弱之间的关系。

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-05 DOI: 10.1016/j.archger.2025.106080

Cho Rong Kim , Jisu Ko , Min Jin Ha , Kui Son Choi , Eun-Cheol Park

Introduction

Considering social isolation in approaches to frailty is important for the early detection of health problems in older adults and the development of appropriate intervention strategies. This study aims to investigate the relationship between changes in social isolation and frailty using the data the Korea Longitudinal Study of Aging (2006–2022).

Methods

A longitudinal study was conducted with 17,932 adults aged ≥65 years. Frailty was assessed using the frailty index, changes in social isolation were categorized into four groups. Associations between changes in social isolation and frailty were examined using generalized estimating equations with logistic regression to account for repeated measures and within-subject correlations.

Results

Compared to participants who remained non-isolated, those whose social isolation status changed from a non-isolated to isolated state had 3.47 times higher odds of frailty (95 % confidence interval [CI]: 3.03–3.96), and those in a consistently isolated state had 3.18 times higher odds (95 % CI: 2.80–3.62). Analysis by frailty type indicated that the transition from non-isolated to isolated status exhibited a stronger association with psychological frailty (odds ratio [OR] 4.38, 95 % CI 4.36–4.39) than physical frailty, and the highest increase was observed in the likelihood of exhibiting both physical and psychological frailty (OR 6.81, 95 % CI 6.77–6.84).

Conclusions

The transition to an isolated state was associated with frailty among older adults. These findings emphasize the need for early identification and active interventions to address social isolation to prevent frailty among older adults.

导言：在处理衰弱问题时考虑到社会孤立对于早期发现老年人的健康问题和制定适当的干预策略很重要。本研究旨在利用韩国老龄化纵向研究（2006-2022）的数据，探讨社会孤立的变化与脆弱性之间的关系。方法：对17932名年龄≥65岁的成年人进行纵向研究。脆弱性是用脆弱性指数来评估的，社会孤立的变化被分为四组。使用广义估计方程和逻辑回归来检验社会隔离变化与脆弱性之间的关联，以解释重复测量和受试者内部相关性。结果：与未隔离的参与者相比，社会隔离状态从非隔离状态变为隔离状态的参与者虚弱的几率高3.47倍（95%置信区间[CI]: 3.03-3.96），持续隔离状态的参与者虚弱的几率高3.18倍（95% CI: 2.80-3.62）。虚弱类型分析表明，与身体虚弱相比，从非孤立状态到孤立状态的转变与心理虚弱的关联更强（比值比[OR] 4.38, 95% CI 4.36-4.39），并且观察到表现出身体和心理虚弱的可能性的最高增加（比值比[OR] 6.81, 95% CI 6.77-6.84）。结论：老年人向孤立状态的转变与虚弱有关。这些发现强调需要及早发现并采取积极干预措施，解决社会孤立问题，以防止老年人虚弱。

{"title":"Association between changes in social isolation status and frailty among older adults","authors":"Cho Rong Kim , Jisu Ko , Min Jin Ha , Kui Son Choi , Eun-Cheol Park","doi":"10.1016/j.archger.2025.106080","DOIUrl":"10.1016/j.archger.2025.106080","url":null,"abstract":"<div><h3>Introduction</h3><div>Considering social isolation in approaches to frailty is important for the early detection of health problems in older adults and the development of appropriate intervention strategies. This study aims to investigate the relationship between changes in social isolation and frailty using the data the Korea Longitudinal Study of Aging (2006–2022).</div></div><div><h3>Methods</h3><div>A longitudinal study was conducted with 17,932 adults aged ≥65 years. Frailty was assessed using the frailty index, changes in social isolation were categorized into four groups. Associations between changes in social isolation and frailty were examined using generalized estimating equations with logistic regression to account for repeated measures and within-subject correlations.</div></div><div><h3>Results</h3><div>Compared to participants who remained non-isolated, those whose social isolation status changed from a non-isolated to isolated state had 3.47 times higher odds of frailty (95 % confidence interval [CI]: 3.03–3.96), and those in a consistently isolated state had 3.18 times higher odds (95 % CI: 2.80–3.62). Analysis by frailty type indicated that the transition from non-isolated to isolated status exhibited a stronger association with psychological frailty (odds ratio [OR] 4.38, 95 % CI 4.36–4.39) than physical frailty, and the highest increase was observed in the likelihood of exhibiting both physical and psychological frailty (OR 6.81, 95 % CI 6.77–6.84).</div></div><div><h3>Conclusions</h3><div>The transition to an isolated state was associated with frailty among older adults. These findings emphasize the need for early identification and active interventions to address social isolation to prevent frailty among older adults.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106080"},"PeriodicalIF":3.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An overview of care coordination elements for older adults with long-term care needs: A narrative review 有长期护理需要的老年人护理协调要素综述：一篇叙述性综述

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2025-11-03 DOI: 10.1016/j.archger.2025.106077

Natasha Grande de França , Philipe de Souto Barreto , Hyobum Jang , Matteo Cesari , Yves Rolland

Aims

Care coordination is crucial in long-term care (LTC) as it contributes to patient-centered, high-value, and high-quality care. This review presents an overview of how care coordination for older adults with long-term needs is described in the literature.

Methods

This narrative review focused on older adults receiving LTC in institutional settings and the community. A comprehensive and structured search was conducted in PubMed in January 2025 using a combination of key and indexed terms related to care coordination, long-term care, and older adults.

Results

We retained 56 articles published between 1988 and 2024. Most of the information was from North American programs designed for community-dwelling older persons. Description of care coordination is lacking in middle and low-income countries, with limited information on institutional settings. Coordination is commonly performed by a designated health or social worker, responsible for assessing, developing, and monitoring the care plan with the support of a multidisciplinary team (not always including a geriatrician) and electronic health records. Care coordination can be challenging to translate into practice, mainly due to limited time availability and a lack of specific training. Communication across care settings and among the staff is frequently fragmented, partial, and unstandardized.

Conclusions

Care systems for older persons living in the community seem to apply fundamental elements of care coordination. However, their implementation in real life is challenging. The current information on care coordination is not well-documented at the global level, especially in LTC facilities, highlighting the need for more attention to this aspect of care.

AimsCare协调在长期护理（LTC）中至关重要，因为它有助于以患者为中心，高价值和高质量的护理。本文综述了文献中对有长期需要的老年人护理协调的描述。方法本综述主要关注在机构和社区接受LTC治疗的老年人。我们于2025年1月在PubMed上进行了一次全面的结构化搜索，使用了与护理协调、长期护理和老年人相关的关键和索引术语的组合。结果保留了1988 ~ 2024年间发表的56篇文献。大部分信息来自北美为居住在社区的老年人设计的项目。中低收入国家缺乏对护理协调的描述，关于机构设置的信息有限。协调工作通常由指定的卫生工作者或社会工作者进行，负责在多学科团队（不总是包括老年病专家）和电子健康记录的支持下评估、制定和监测护理计划。将护理协调转化为实践可能具有挑战性，主要是由于可用时间有限和缺乏具体培训。护理机构之间和工作人员之间的沟通往往是碎片化的、局部的和不标准化的。结论社区老年人护理系统似乎应用了护理协调的基本要素。然而，它们在现实生活中的实现是具有挑战性的。目前关于护理协调的信息在全球范围内，特别是在LTC设施中，没有得到充分的记录，这突出表明需要更多地关注这方面的护理。

{"title":"An overview of care coordination elements for older adults with long-term care needs: A narrative review","authors":"Natasha Grande de França , Philipe de Souto Barreto , Hyobum Jang , Matteo Cesari , Yves Rolland","doi":"10.1016/j.archger.2025.106077","DOIUrl":"10.1016/j.archger.2025.106077","url":null,"abstract":"<div><h3>Aims</h3><div>Care coordination is crucial in long-term care (LTC) as it contributes to patient-centered, high-value, and high-quality care. This review presents an overview of how care coordination for older adults with long-term needs is described in the literature.</div></div><div><h3>Methods</h3><div>This narrative review focused on older adults receiving LTC in institutional settings and the community. A comprehensive and structured search was conducted in PubMed in January 2025 using a combination of key and indexed terms related to care coordination, long-term care, and older adults.</div></div><div><h3>Results</h3><div>We retained 56 articles published between 1988 and 2024. Most of the information was from North American programs designed for community-dwelling older persons. Description of care coordination is lacking in middle and low-income countries, with limited information on institutional settings. Coordination is commonly performed by a designated health or social worker, responsible for assessing, developing, and monitoring the care plan with the support of a multidisciplinary team (not always including a geriatrician) and electronic health records. Care coordination can be challenging to translate into practice, mainly due to limited time availability and a lack of specific training. Communication across care settings and among the staff is frequently fragmented, partial, and unstandardized.</div></div><div><h3>Conclusions</h3><div>Care systems for older persons living in the community seem to apply fundamental elements of care coordination. However, their implementation in real life is challenging. The current information on care coordination is not well-documented at the global level, especially in LTC facilities, highlighting the need for more attention to this aspect of care.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106077"},"PeriodicalIF":3.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0