BMC Geriatrics最新文献

Alzheimer's disease (AD) is a complex, progressive, and irreversible neurodegenerative disorder marked by cognitive decline and memory loss. Early diagnosis is the most effective strategy to slow the disease's progression. Mild Cognitive Impairment (MCI) is frequently viewed as a crucial stage before the onset of AD, making it the ideal period for therapeutic intervention. AD is marked by the buildup of amyloid-beta (Aβ) plaques and tau neurofibrillary tangles (NFTs), which are believed to cause neuronal loss and cognitive decline. Both Aβ plaques and NFTs accumulate for many years before the clinical symptoms become apparent in AD. As a result, in this study, CerebroSpinal Fluid (CSF) biomarker information is combined with hippocampal volumes to differentiate between MCI and AD. For this, a novel two-stage hybrid learning model that leverages 3D CNN and the notion of a Fuzzy and Machine learning model is proposed. A 3D-CNN architecture is employed to segment the hippocampus from the structural brain 3D-MR images and quantify the hippocampus volume. In stage 1, the hippocampus volume is passed through thirteen machine learning models and fuzzy clustering for classifying symptomatic AD and healthy brain (Normal Control - NC). The CSF data is fuzzified to capture the inherent uncertainty and overlap in clinical data. The identified symptomatic AD data in the stage1 are further classified into MCI and AD with the aid of a fuzzified CSF biomarker in stage 2. The experimental work presented in this study utilized the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. The proposed hybrid model achieved an average accuracy of 93.6% for distinguishing between NC and symptomatic AD and 93.7% for discriminating between MCI and AD. This approach enhances diagnostic accuracy and provides a more comprehensive assessment, allowing for earlier and more targeted therapeutic interventions.

Background: To investigate the association between indoor ventilation frequency and symptoms of depression and anxiety in older persons.

Methods: A binary logistic regression model was used to analyze the effects of indoor ventilation frequency on depression and anxiety by using data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS).

Results: A total of 9,690 older persons with an average age of (83.20 ± 11.27) years were included, including 4,458 males (46.0%) and 5,232 females (54.0%). The average score of indoor ventilation frequency was (6.06 ± 1.98) points, including 770 people (7.9%) with low frequency, 3,066 people (31.6%) with medium frequency, and 5,854 people (60.4%) with high frequency. 842 (8.7%) had symptoms of depression and 204 (2.1%) had symptoms of anxiety. Compared with the older persons with low indoor ventilation frequency, the older persons with higher ventilation frequency had a lower incidence of depression (OR(95%CI) = 1.92 (1.50 ∼ 2.46), 1.51 (1.27 ∼ 1.79); P < 0.001). However indoor ventilation frequency was not associated with anxiety symptoms.

Conclusion: Indoor ventilation frequency is related to depressive symptoms in older persons. Communities and families should pay more attention to indoor ventilation and intervene in time to promote and improve the mental health of older persons.

Objectives: Fear of falling is a psychological issue that adversely impacts the health of elderly individuals. The purpose of this study was to investigate the correlation among positive coping styles, psychological resilience, and fear of falling in older adults. The mediating role of psychological resilience was also investigated.

Methods: A cross-sectional study was carried out from July 2023 to December 2023. There are 202 older adults from a tertiary hospital in Beijing, China, participated in this study. The general information questionnaire, the Simplified Coping Style Questionnaire, the Chinese version of the Connor-Davidson Resilience Scale, and the Falls Efficacy Scale-International were utilized. Descriptive statistics, Pearson correlation, and structural equation modeling were used for data analysis.

Results: The prevalence of fear of falling in the elderly was 53.00%. Older individuals with a history of falls or fractures had a significantly higher fear of falling (P < 0.05). Fear of falling was inversely connected with psychological resilience and positive coping styles (P < 0.05). Positive coping styles were positively connected with psychological resilience (r = 0.638, P < 0.01). Structural equation modeling showed that psychological resilience fully mediated the effect of positive coping styles on fear of falling (indirect effect estimate = -0.126, 95% CI -0.036 to-0.225; total effect estimate = -0.121, 95% CI -0.028to -0.005).

Conclusion: Fear of falling was widespread among older adults and psychological resilience fully mediated the relationship between positive coping styles and fear of falling. Future interventions targeting the fear of falling should consider the enhancement of psychological resilience.

Objective: The Simpler Modified Fried Frailty Scale (SMFFS) has recently been developed from the original Fried scale to ease its use in clinical practice, by transforming the items requiring measurements into the self-reported inquiries. Its predictive validity needs to be clarified, especially in populations with a high prevalence of frailty, such as patients with heart failure (HF). Primary aim of this study is to find out the prevalence of frailty in older patients with HF by using SMFFS and show its concordance with other frailty assessment tools. Secondary aim is to reveal whether SMFFS is useful to predict mortality in follow-up.

Method: This is a prospective, follow-up study including older adults (≥ 65 years) with HF. SMFFS was used to assess frailty phenotype and presence of ≥ 3 items was accepted as frailty. FRAIL scale, the Study of Osteoporosis Fractures (SOF) index, and Edmonton Frailty Scale (EFS) were alternatively used to study the correlation of SMFFS with different scales. Cox-regression analysis was performed to identify whether SMFFS-defined frailty could predict mortality in follow-up, with adjusting for a list of clinical characteristics and geriatric syndromes.

Findings: Among 101 patients with HF, 44 (42.8%) were female. Mean age was 75.8 ± 7.6 and frailty prevalence was 63.4% according to SMFFS. SMFFS showed a strong correlation with the other frailty scales. In a median follow-up of 759 days, cardiomegaly, increased pulmonary artery pressure (PAP) and frailty defined by SMFFS were the only predictors of mortality in older adults with HF after adjustments for age, falls in the previous year, undernutrition, probable sarcopenia, functional impairments, and quality of life [HR (95% CI) were 3.88 (1.05-14.3), 1.05 (1.01-1.09), and 10.96 (1.07-112.05) (p = 0.027); for older age, PAP, and frailty, respectively].

Conclusions: As a self-reported screening tool, SMFFS was independently associated with mortality in a median follow-up of two years. Frailty assessment recommended by the guidelines for risk stratification in patients with HF seems to be more effectively integrated into routine HF practice with the use of the easy and practical SMFFS. Further large scale studies are needed to support the predictive validity of SMFFS in older patients with HF.

Background: Alanine aminotransferase (ALT) is an enzyme crucial for energy and protein metabolism in muscle cells. Despite this, its association with sarcopenia remains inadequately explored. This study aims to investigate the correlation between serum levels of ALT-related indicators (ALT activity, ALT1, ALT2, and ALT1/ALT2 ratio) and sarcopenia measures, as well as to develop a diagnostic model for sarcopenia in older individuals.

Methods: This retrospective study assessed 653 older adults (aged ≥ 55 years), 109 of whom were studied for the association of ALT1, ALT2, and ALT1/ALT2 ratio with sarcopenia measures. Muscle mass was measured by dual energy X-ray absorptiometry. Hand grip strength (HGS) was measured with a digital dynamometer, and physical performance was assessed through the 6-meter gait speed and the five-times sit-to-stand test (FTSST). Binary logistic regression analysis was used to evaluate associations between ALT-related indicators (ALT activity and ALT1/ALT2 ratio) and sarcopenia. The diagnostic model was developed using binary logistic regression with backward selection, and the diagnostic performance of the model was evaluated by the receiver operator characteristic curve (ROC) curve.

Results: Older adults with sarcopenia exhibited a lower serum ALT activity and a higher ALT1/ALT2 ratio compared to those without sarcopenia. ALT activity tertiles, but not ALT1 or ALT2 tertiles alone, correlated with HGS, gait speed, FTSST, and appendicular skeletal muscle mass index (ASMI), serving as independent protective factors for low HGS, low physical performance, low ASMI, and sarcopenia. Tertiles of the ALT1/ALT2 ratio were significantly associated with HGS and FTSST, and were proved independent risk factors for low physical performance and sarcopenia by binary logistic regression analysis. An optimal Model A (based on ALT activity) was established for sarcopenia to develop a new Logit_P1 (p < 0.001). Similarly, an optimal Model B (based on ALT1/ALT2 ratio tertiles) was established for sarcopenia to develop a new Logit_P2 (p < 0.001). According to the ROC curve analysis for discriminating sarcopenia, the performance of Logit_P2 (area under the curve = 0.830) seemed better than that of Logit_P1 (area under the curve = 0.789), although the difference was not statistically significant (p = 0.214).

Conclusions: In older adults, a low serum ALT activity level was an independent risk factor for low ASMI, HGS, physical performance, and sarcopenia. The serum ALT1/ALT2 ratio emerged as an independent risk factor for low physical performance and sarcopenia. The new indices, Logit_P1 and Logit_P2, demonstrated diagnostic value for sarcopenia.

Background: Racial and ethnic disparities in sleep quality and cognitive health are increasingly recognized, yet little is understood about their associations among Chinese older adults living in the United States. This study aims to examine the relationships between sleep health and cognitive functioning in this population, utilizing data from the Population Study of Chinese Elderly in Chicago (PINE).

Methods: This observational study utilized a two-wave panel design as part of the PINE, including 2,228 participants aged 65 years or older who self-identified as Chinese. Participants completed interviews at two time points. Cognitive functioning was assessed using a battery of tests, including the Chinese Mini-Mental State Examination (C_MMSE), the immediate and delayed recall of the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Sleep quality was assessed using items from the Pittsburgh Sleep Quality Index (PSQI), covering four aspects: subjective sleep quality, sleep latency, sleep efficiency, and sleep duration. Insomnia was assessed using four items from the Women's Health Initiative Insomnia Rating Scale. Mixed-effects regression models were used to assess the effects of sleep parameters on baseline cognitive functioning and cognitive change over time.

Results: Participants had an average age of 77.42 years (± 7.57) at baseline, with about 39% reporting fairly bad or very bad sleep quality. Poorer overall sleep quality (B = -0.01, SE = 0.01, p < .01), and more insomnia symptoms (B = -0.01, SE = 0.00, p < .001) were associated with lower baseline global cognition. However, these associations diminished over time (sleep quality: B = 0.01, SE = 0.00, p < .05; insomnia: B = 0.00, SE = 0.00, p < .05). Among sleep quality subdomains, all except sleep efficiency had significantly negative relationships with baseline global cognition. The associations between sleep parameters and the four cognitive domains were less consistent.

Conclusions: The findings highlight cross-sectional negative relationships between self-reported sleep parameters and cognition, showing distinct associations between various aspects of sleep quality and cognitive domains. Targeted interventions to improve sleep quality may have the potential to enhance cognitive health outcomes.

Background: Occupational balance is a crucial concept in occupational therapy and is recognized as a vital component of health and well-being. The residential status may have a significant impact on the occupational balance (OB) and quality of life (QoL) of older adults.

Methods: A group of 107 older adults from the urban area (mean age: 69.80 ± 4.78 years), and 93 older adults from the rural area (mean age: 71.24 ± 6.79 years) were examined. OB of the participants was evaluated with the Occupational Balance Questionnaire 11-T (OBQ 11-T) The QoL of older adults assessed by the World Health Organization Quality of Life - OLD module (WHOQOL-OLD).

Results: The median OBQ11-T total score was 21.00 (7.00) in the urban area group and 20.00 (5.00) in the rural area group. Older adults residing in urban areas had higher scores in the OBQ 11-T total score, Item 1 = "Having enough things to do during a regular week", Item 5 = "Have sufficient time for doing mandatory occupations", and Item 11 = "Satisfaction with time spent in rest, recovery, and sleep" (p < .05). This suggests that older adults in urban areas may perceive a better balance in their activities. In contrast, rural residents had lower scores on these items, potentially reflecting fewer perceived opportunities for engaging in activities in a balanced manner. Older adults daily residing in urban areas had higher scores in the WHOQOL-OLD total score, WHOQOL-OLD Sensory Abilities Subtest, and WHOQOL-OLD Autonomy Subtest (p < .05). These findings indicate a higher QoL, particularly in sensory and autonomy-related aspects, for older adults in urban areas. Conversely, rural residents reported lower scores on these QoL subscales, which may be attributed to different environmental and lifestyle factors associated with rural living.

Conclusions: These findings indicated that residency status is an important variable for both OB and QoL of older adults. Occupational therapy interventions should consider special needs of older adults who live in rural areas.

Trial registration: The clinical trial number is not applicable.

Background: Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.

Methods: We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.

Results: Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.

Conclusions: Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.

Trial registration: https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.

Background: Anxiety disorders in older adults have become a prominent public health problem due to their concomitant chronic conditions, reduced quality of life and even death. However, fewer studies have been conducted on differences in anxiety among older individuals in different aged-care models, and the interactive relationship between the influencing factors on anxiety remains unclear. The study aimed to examine the disparities in the prevalence of anxiety between community-dwelling and institutionalized older adults and related influencing factors.

Methods: Data were collected from the Anhui Healthy Longevity Survey (AHLS) and the Anhui Elderly Caring Social Organizations Survey (AECSOS). Data on demographic variables, lifestyle factors and health-related variables in 6968 older adults were used for analysis. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Assessment Scale (GAD-7). Binary logistic regression models and a Classification and Regression Tree model (CART) were utilized to examine the relationship between variables.

Results: The prevalence of anxiety were 24.3% and 16.7% among community-dwelling older adults and institutionalized older adults, respectively. Several factors including age, gender, residence, education, income level, live alone, and number of chronic diseases showed a linkage with anxiety among community-dwelling older adults. For the institutionalized older adults, gender, residence, source of income, and number of chronic diseases exhibited a significant association with anxiety. We noted the interactive effect, suggesting that community-dwelling female older adults with an income level of less than 6500 RMB per year and reported chronic disease comorbidities had the highest likelihood of anxiety, and institutionalized female older adults with income sources such as pension, subsidy, family providing, and resident in rural areas have the greatest risk of experiencing anxiety.

Conclusions: This study has brought to light the higher risk of anxiety among community-dwelling older adults compared to institutionalized older adults. Targeted interventions are, therefore emphasized to address the negative impact of anxiety for populations at higher risk.

Background: There is growing interest in developing sensing solutions for remote health monitoring to support the safety and independence of older adults. To ensure these technologies are practical and relevant, people-centred design is essential. This study aims to explore the involvement of various stakeholders across different developmental stages to inform the design and assess the capabilities of unobtrusive sensing solutions being developed as part of the Advanced Care Research Centre (ACRC), Edinburgh, UK.

Methods: This study was conducted in two phases. In Phase I (Ideation), discussions were held with stakeholders (n = 19), including senior geriatricians (n = 2), healthcare and care home professionals (n = 4), PPI experts (n = 2), researchers (n = 4) and public members aged 65 and above from the ACRC Patient and Public Involvement (PPI) Network (n = 7). The goal was to identify clinically significant health parameters and design preferences. Based on this, prototypes of unobtrusive sensors for monitoring movement, hydration, and respiration were developed. In Phase II (Development and Co-Design), an in-person PPI workshop was conducted with PPI experts (n = 2), researchers (n = 4) and PPI members (n = 8). The developed prototypes were demonstrated, and qualitative feedback was collected through focus group discussions on themes such as acceptability, usability, privacy, data sharing, and functionality enhancement.

Results: Stakeholder input from Phase I emphasized the importance of non-contact sensing technologies that maintain privacy. Movement, hydration, and respiration were identified as critical health parameters. In Phase II, PPI members were optimistic about the prototypes, valuing their unobtrusive design and privacy-preserving features. Key themes identified included (1) the need for user-customized alarms, (2) clear data-sharing protocols, and (3) the importance of embedding sensors into familiar household objects. Suggestions for refining the prototypes included adding functionality for detecting deviations in daily routines and integrating feedback mechanisms for caregivers.

Conclusions: Involving diverse stakeholders from the early stages of technology development enhanced the relevance and acceptability of unobtrusive sensing solutions. This study highlights the importance of integrating public perspectives into the design process. For successful implementation, developers of healthcare technologies should prioritize privacy, usability, and clear communication with end-users and caregivers.