BMC Geriatrics最新文献

Background: The quality of life (QoL) of long-term care residents with advanced dementia represents a critical concern. However, empirical data on this topic especially within Chinese society remains relatively scarce.

Aims: This study aimed to investigate the QoL in this population and identify the key factors affecting it.

Methods: A cross-sectional study employing cluster sampling methodology was carried out in three long-term care facilities in Macao, involving a sample of 81 residents. The participants were assessed using the Functional Assessment Staging Test (FAST) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Other variables recorded included Behavioral and Psychological Symptoms of Dementia (BPSD), comorbidities, PAINAD scores, and Waterlow scores.

Results: The majority of participants were female (65.4%), and 70.1% were classified at Stage 7 on the FAST scale. The mean score on the QUALID was 23.94 ± 7.58, suggesting a relatively lower QoL in Macao, particularly in items of smiling, interaction, and touch. Multiple linear regression analysis indicated that higher PAINAD scores, presence of BPSD, and higher FAST stage were significantly associated with lower quality of life among long-term care residents with advanced dementia, explaining 65.9% of the total variance (F = 36.639, p < 0.001).

Conclusions: The findings indicated that residents with advanced dementia in Macao experience relatively lower quality of life, particularly in aspects such as smiling, interaction, and touch. Pain, BPSD, and advanced dementia stage are the three major associated factors of QoL among long-term care residents with advanced dementia. Comprehensive and individually tailored care strategies focusing on pain management and interventions targeting BPSD are suggested to enhance QoL in this population.

Background: Over the past few years, the development of telerehabilitation has advanced rapidly. Patients with Parkinson's disease (PwPD) often have difficulty with mobility, making it challenging for them to perform centre-based exercise.This study aims to compare the effectiveness and adherence of home physical therapy (HPT) and telerehabilitation (TR) in mitigating motor symptoms and improving the quality of life in patients with mild to moderate Parkinson's disease.

Methods: This randomized controlled trial included a total of 190 patients who underwent in-person eligibility assessment, with 100 allocated to the HPT group and 90 to the TR group. Both interventions consisted of home-based training sessions lasting 40-60 min and were conducted five times a week for 4 weeks. The primary outcome was the Unified Parkinson's Disease Rating Scale motor section (UPDRS3) score. Secondary outcomes included balance function, assessed using the Berg Balance Scale (BBS); risk of fall, evaluated through the Timed Up-and-Go test (TUG) and the Five Times Sit-to-Stand test (FTSST); gait, measured using the Freezing of Gait Questionnaire (FOGQ) and IDEEA activity monitor; muscle strength, evaluated using the isokinetic dynamometry; motor aspects of experiences of daily living (UPDRS2); and quality of life, assessed by Parkinson's Disease Questionnaire-39 (PDQ-39).

Results: There was a significant difference in the UPDRS3, BBS, TUG, FTSST, FOGQ,step length, step velocity,preswing angle, UPDRS2 and PDQ-39 between baseline and 4 weeks in both groups. The decrease in the UPDRS3 score was significantly greater in the HPT group (-3.38 points) than in the RE group (-1.45 points) in the older age group (P = 0.021), but there was no significant between-group difference in the younger age group (P = 0.416). Similar changes favouring the HPT group were observed in the BBS, TUG, step velocity, and extension average torque. 7 (7%) patients in the HPT group and 12 (13%) patients in the TR group did not complete their daily exercise plan.

Conclusions: Both HPT and TR have demonstrated effectiveness, safety, and feasibility in PwPD. However, the HPT program exhibited greater effectiveness among older patients and higher patient compliance compared to TR.

Trial registration: Chictr.org.cn, ChiCTR2300071648. Registered on 22 May 2023-retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=196313 .

Background: During the COVID-19 pandemic, the provision of quality care for behavioral and psychological symptoms in older adults with dementia may have been impeded due to physical distancing and infection control measures. Of particular concern is whether psychotropic medication use has increased despite its limited efficacy and adverse effects. This systematic review described the trajectory of psychotropic use for older adults with dementia across various settings, from community living to healthcare settings during the pandemic. Also, psychotropic use was explored in relation to patients, caregivers, and environment-related factors along with the occurrence of the pandemic.

Methods: We conducted a comprehensive search across five databases: Embase, PubMed, PsycINFO, CINAHL, and Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal tools. A random-effects model was used to estimate the pooled risk ratios (RRs) of psychotropic use in older adults with dementia, comparing the pandemic period to the pre-pandemic period. Subgroup analyses based on the class of psychotropics and sensitivity analyses also were conducted. A funnel plot and Egger's regression test were used to detect potential publication bias.

Results: Of the 3,123 screened articles, 15 studies were included in this systematic review, with 10 of them being part of the meta-analysis. Our meta-analysis yielded an RR of 1.16 (95% CI = 1.05-1.26) for overall psychotropic medication use. Further subgroup analysis based on the type of psychotropic medication revealed a significantly greater prevalence in the use of antipsychotics (RR = 1.19, 95% CI = 1.08-1.30). However, no significant differences were observed in the use of anxiolytics and/or hypnotics (including benzodiazepines), antidepressants, and mood stabilizers. Among psychotropics, some studies on antipsychotic use additionally explored patients, caregivers, and environmental-related factors during the pandemic.

Conclusions: The review indicates a higher risk of psychotropic use, especially antipsychotics, during the pandemic. Nonetheless, underlying reasons for the increased psychotropic use are not fully available from the reviewed studies. Therefore, further research is needed to identify the factors driving psychotropic use during the pandemic and facilitate the development of quality improvement interventions that can be implemented to minimize inappropriate psychotropic prescribing in future pandemics.

Background: The COVID-19 pandemic has seriously affected older adults' social lives, physical activity, and cognitive functions. Additionally, the lockdowns have disrupted regular healthcare for patients with chronic illnesses or needing acute care. Furthermore, the pandemic has negatively affected different psychosocial influences in each country due to the various cultural characteristics, technology, health system, and financial opportunities. This study aimed to investigate the effects of COVID-19 on mood, social participation, and healthcare use in older adults living in Turkey.

Methods: A cross-sectional study was conducted during the third wave of the COVID-19 pandemic (March-December 2021) in three medical centers in Turkey. Patients aged 60 + years without significant cognitive impairment were recruited by mail or at hospital admissions. Information on demographics, pandemic-related distancing measures, healthcare use, lifestyle, symptoms of anxiety, depression, and social participation were assessed.

Results: A total of 343 participants were included in the study. Women had a higher rate of hypertension, symptoms of anxiety, depression, and fatigue compared to men (p < 0.05). Since the start of the pandemic, only 22.4% of non-acute healthcare appointments were conducted face-to-face. Time spent with family and friends, hope for the future, and physical activity decreased. At the same time, the experience of loneliness, the number of meals and unhealthy snacks, and the use of digital services increased. Women were also more concerned about getting coronavirus infection, transmitting the virus to others, and being discriminated against because of the infection (p < 0.05).

Conclusions: These pandemic days have had a significant psychosocial impact on Turkish older adults, especially women. As a strategy of the health care policy, easy access and follow-up to the health system should be provided, and the necessary support should be procured to minimize the detrimental effects of the pandemic on older people.

Background: Falling is a significant challenge in old age, often leading to isolation, self-imposed limitation, reduced movement, and muscle strength. This study aimed to explore the fear of falling and its related factors in older adults following a fall in Kashan, Iran.

Methods: This cross-sectional study followed 200 older adults who visited medical centers in Kashan from July 2023 to May 2024. Continuous sampling was carried out. Data collection involved a background information questionnaire, the shortened version of the falls efficacy scale-international in older adults, the independence scale of activities of daily living, and the short-form state-trait anxiety inventory. Data were gathered before, one month, and three months after the fall. Data analysis utilized SPSS-24, including t-test, ANOVA, Pearson's correlation coefficient, and repeated measures analysis of variance.

Results: Participants had a mean age of 71.34 ± 8.36 years (ranging from 65 to 96 years). There was a significant increase in fear of falling scores one month and three months after the fall (P < 0.001). Multiple linear regression revealed that factors such as illiteracy, old age, and previous falls were predictors of fear of falling before the fall (P < 0.05). One month after the fall, predictors included illiteracy, hip fracture, and high anxiety scores (P < 0.05). Three months after the fall, predictors encompassed illiteracy, hip fracture, high anxiety score, and internal fixator placement as a treatment intervention (P < 0.05), explaining 15% of the variance in fear of falling.

Conclusions: Identifying predictive factors for fear of falling can assist health policymakers in developing a holistic care plan to enhance the quality of life for older adults post-fall. It is essential to screen for fear of falling levels, particularly after trauma, offer educational counseling services, particularly in mental health, after discharge, and prepare training programs related to fall prevention.

Objective: To investigate the association of serum creatinine-cystatin C ratio (Cr/CysC) with long-term all-cause mortality and cause-specific (cardiovascular and cancer) mortality among US general adults.

Methods: This nationally representative cohort study included adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Participants were linked to National Death Index data from the survey date through December 31, 2019. Weighted Cox proportional hazards regression models were used to calculate hazard ratios and 95% confidence intervals (CIs), and restricted cubic splines and stratified analyses were also performed.

Results: A total of 12,914 participants were included in this study (mean [SD] age, 45.3 [17.3] years; males, 48.9%). During a median follow-up of 17.9 years (maximum follow-up, 20.8 years), 3439 total deaths occurred, including 1098 cardiovascular deaths and 736 cancer deaths. Cumulative incidence curves revealed that increased Cr/CysC ratio had lower risk of all-cause (P < 0.001), cardiovascular (P < 0.001) and cancer (P < 0.001) mortality. Cox regression an Fine-Gray hazards models demonstrated that the multivariable-adjusted hazard ratios comparing the highest vs. lowest quartile of Cr/CysC ratio were 0.40 (95% CI, 0.34-0.47; P < 0.001) for all-cause mortality, 0.68 (95% CI, 0.52-0.88; P < 0.001) for cardiovascular mortality, and 0.51 (95% CI, 0.36-0.71; P < 0.001) for cancer mortality. Nonlinear association was observed for Cr/CysC ratio and all-cause mortality (P = 0.018 for nonlinearity), and linear associations were observed for Cr/CysC ratio and cardiovascular (P = 0.212 for nonlinearity) and cancer (P = 0.550 for nonlinearity) mortality. Besides, a series of sensitivity analyses ensured the robustness of the results.

Conclusions: In this cohort of US adults, Cr/CysC ratio was negatively associated with all-cause, cardiovascular, and cancer mortality. Our study suggests that Cr/CysC ratio may serve as a simple and effective predictor of long-term health outcomes.

Odjectives: To investigate the predictive value of computed tomography (CT)-based transverse diameter (TD) and longitudinal diameter (LD) of the psoas muscle at the level of third lumbar vertebra for 28-day mortality in older patients with sepsis.

Methods: This retrospective single-center cohort study included 115 septic patients aged over 65 years old who were admitted to ICU in Beijing-Chaoyang Hospital between July 2017 and July 2022. The TD and LD of psoas muscle were obtained by measurement on abdominal CT images. Logistic regression analysis was conducted to identify the prognostic factors for 28-day mortality in older patients with sepsis, and their predictive performances were evaluated using the receiver operating characteristic (ROC) curve.

Results: Multivariable logistic analysis indicated that TD (OR: 0.405, 95% CI: 0.190-0.864) was a protective factor for 28-day mortality in older patients with sepsis, whereas LD was not. The areas under the curve (AUCs) of TD, APACHE II, and SOFA were 0.666 (95% CI: 0.565-0.767), 0.660 (95% CI: 0.561-0.760), and 0.679 (95% CI: 0.581-0.777), respectively. Furthermore, the AUCs for the combination of TD with APACHE II or SOFA were 0.766 (95% CI: 0.679-0.853, P < 0.001) and 0.765 (95% CI: 0.679-0.852, P < 0.001).

Conclusions: TD of psoas muscle was a predictor for 28-day mortality in older patients with sepsis. The combination of TD with APACHE II or SOFA scores enhances the early identification of patients at high risk for poor prognosis.

Clinical trial number: not applicable.

Background: Hip fractures in older adults are common and carry a high risk of morbidity and mortality. Preoperative dehydration, a key risk factor for adverse outcomes, is often underdiagnosed at admission. It is important to identify high risk patients and optimize modifiable risk factors to improve the postoperative outcome. The p-POSSUM Score is a useful predictor of postoperative mortality risk. Implementing a defined fluid resuscitation protocol early in high-risk groups has proven effective in reducing both postoperative morbidity and mortality.

Materials and methods: We conducted a single-center, retrospective quality improvement study at a Level 1 trauma center in Switzerland, focusing on geriatric patients over 70 with a p-POSSUM Score > 5% and a proximal femur fracture, undergoing surgery between February 2015 and September 2019. We hypothesized that our institutional goal-directed fluid resuscitation protocol (GDT) would result in lower 30- and 90-day mortality rates and fewer complications for these high-risk patients. Outcome changes over time were analyzed annually.

Results: 312 patients were included in our study. 147 followed our institutional GDT protocol, while 165 patients received standard care and were used as a control group. Initially, the odds ratio (OR) for 30-days mortality favored the GDT group; 2015 0.30 (CI: 0.07-1.18), 2016 0.28 (CI: 0.07-1.07), 2017 0.51 (CI: 0.13-2.04). This shifted toward the Non-GDT group in the year 2018 with a OR of 2.14 (CI: 0.59-7.84) and 2019 with 1.92 (CI 0.47-7.83). The pattern for 90-day mortality results was similar and slightly more pronounced. The estimates for the odds ratios remained consistent even after adjustment for the p-POSSUM score. The relative frequencies of complications showed no remarkable differences between the groups (GDT vs. Non-GDT).

Conclusion: In our study, the treatment according to our GDT protocol was associated with survival advantage in the first three years. However, this trend reversed in 2018, with Non-GDT patients faring better. Although our retrospective study does not provide enough evidence of causality between the protocol and the mortality rates, it revealed that continuous critical evaluation of internal processes is essential in healthcare for quality management. This allows timely identification and adaptation of processes to issues, especially after initially positive results.

Background: It is unclear whether antiparkinsonism anticholinergics (AAs) increase hip fracture (HFx) risk in Parkinson's disease (PD) patients. This study examined associations between AAs, HFx and mortality in PD using Taiwan's National Health Insurance Database.

Methods: Newly diagnosed PD patients ≥ 50yrs were categorized by AAs exposure: PD with AAs (≥ 90 days, n = 16,921), PD without AAs (never-exposed, n = 55,940), and demographically matched non-PD controls (n = 291,444). Competing risk of death was considered in Fine & Gray models analyzing HFx. Mortality was compared using Cox regression models.

Results: Both PD groups were associated with higher HFx risk compared to non-PD controls (adjusted hazard ratio [HR] = 1.51 for PD with AAs; 1.53 without). No significant difference in HFx risk was observed between PD groups with and without AAs exposure. Both groups were associated with increased mortality compared to non-PD (adjusted HR = 2.24 with AAs; 2.44 without AAs). Among PD patients, those with AAs exposure were associated with lower mortality compared to those without AAs (adjusted HR = 0.93).

Conclusions: PD was associated with increased HFx and mortality compared to non-PD, regardless of AAs exposure. AAs use was not associated with increased HFx risk and was associated with lower mortality. AAs use was not associated with increased fracture risk and was associated with lower mortality in PD, however further studies are needed to clarify these associations.