BMC Geriatrics最新文献

Background: The care requirements of the elderly who live at home should receive enough attention as the world's population ages. On the basis of this, a questionnaire on the elderly who live at home must be created and validated.

Objective: The objective is to create and validate a tool that will allow caregivers to more accurately measure how well-cared-for elderly people perceive them to be at home.

Methods: This study developed a caring perception questionnaire through literature review and interviews in Wuhan. Fifteen experts from six provinces reviewed the initial 43-item draft. When faulty questionnaires were eliminated, the valid sample size for the exploratory factor analysis of the first survey was 238. For confirmatory factor analysis, the second survey's valid sample size was 260. The final version included 31 items, validated for reliability and validity.

Results: A 52-item questionnaire was created based on interviews, refined to 43 items after expert feedback, with a content validity index of 0.88. The first survey (238 valid responses) showed a Cronbach's α of 0.945, and the second (260 valid responses) confirmed good model fit and consistency. The final version has 31 items.

Conclusions: With good reliability and validity, the caring perception questionnaire of the home-dwelling elderly was developed, which could be used as a tool to evaluate the current situation of humanistic care for the home-dwelling elderly.

Background: Vision impairment affects the accuracy of cognitive test outcomes, emphasizing the need for developing cognitive screening tools designed for visually impaired individuals, especially considering global aging trends. This study aimed to develop a modified, validated version of the Vision-Impairment version of Addenbrooke's Cognitive Examination III (VI-ACE-III) for Arabic-speaking elderly individuals with vision impairment in Egypt. In addition, the study aimed to assess the accuracy of VI-ACE-III in diagnosing dementia and mild cognitive impairment (MCI).

Methods: The VI-ACE-III was developed using large printed formats and verbal substitution of the vision-dependent items. One hundred and eighty participants aged ≥ 60, with varying degrees of vision impairment (including moderate, severe, and blindness), were divided into three equal groups: 60 individuals with MCI, 60 with mild to moderate dementia, and 60 with cognitively intact controls. Receiver operating characteristics (ROC) curves were plotted to assess the accuracy of the test screening.

Results: ROC analysis for dementia established an optimal cut-off point of 84 out of 115, demonstrating 100.0% sensitivity, 98.3% specificity, and an area under the curve (AUC) of 0.983, based on the comparison between the dementia and MCI groups. The analysis for MCI determined an optimal cut-off point of 94 out of 115, with 95.0% sensitivity, 96.7% specificity, and an AUC of 0.983 compared to controls. The VI-ACE-III demonstrated significant Cronbach's alpha values (α = 0.866, α = 0.771), indicating strong internal consistency within the dementia and MCI groups.

Conclusions: The VI-ACE-III showed good sensitivity and specificity for assessing dementia and MCI in Arabic-speaking elderly individuals with visual impairment (VI) in Egypt. Regular screening and interventions are crucial for managing and preventing the deterioration of cognitive dysfunction and vision impairment in the elderly population.

Background: Older adults are vulnerable to adverse drug events given the pharmacokinetic and pharmacodynamic changes that coming with ageing, as well as they often take multiple medications for their chronic health conditions, especially older co-morbidities. ADEs can cause unnecessary emergency department visits and hospitalization, which contribute to financial burden and decreased quality of life. This study aims to investigate the prevalence of adverse drug events in elderly co-morbid patients in Liaoning province and explore its risk factors, in order to ensure medication safety in elderly patients.

Methods: This was a cross-sectional study that enrolled elderly patients with co-morbidities, and the data were collected by nurses using a structured interview method for elderly patients with multimorbidity. Risk factors for patient-reported adverse drug events were identified by univariate and logistic regression analyses.

Results: A total of 329 elderly patients were enrolled, among whom 169 were females, with an age ranging from 61 to 90 years. 205 participants (62.3%) had 462 "possible-probable-certain" adverse drug events, and 156 (47.4%) experienced two or more self-reported adverse drug events concurrently. The logistic regression analysis included four variables: female (OR = 2.194, 95% confidence interval 1.281-3.760, P = 0.004), numbers of daily drugs > 12 (OR = 2.257, 95% confidence interval 1.254-4.061, P = 0.007), history of fall within 1 year (OR = 3.106, 95% confidence interval 1.112-8.674, P = 0.031), and medication noncompliance (OR = 3.768, 95% confidence interval 1.535-9.249, P = 0.004).

Conclusion: Patient-reported adverse drug events are more prevalent in older co-morbid patients in Liaoning province. Female, numbers of daily drugs, fall history with 1 year and poor medication compliance were significantly and independently associated with adverse drug events. These findings may provide informative interventions for the medication management in elderly patients living with multimorbidity.

Background: Technological challenges in accessing medical care services may cause individuals to feel isolated from the medical care system. This study posits that individual's subjective socioeconomic status (SES) contribute to differing levels of technological challenges when seeking medical care services, subsequently impacting their health conditions.

Methods: A questionnaire survey was administered to 1,932 residents in China (1,037 men, 891 women, and 4 missing; M_age: 64.28 ± 11.30 years, range: 45-99 years). Participants included 792 urban (40.99%) and 1,140 rural (59.01%) residents. We measured SES, technological challenges perceptions, health conditions, and other control variables.

Results: Analysis of 10,000 bootstrapped samples revealed that technological challenges partially mediate the association between SES and health conditions. Moreover, rural people with low SES had poorer health because of technological challenges. This effect was not significant for urban people after controlling for sex, age, education level, marital status, and experience accessing medical care services.

Conclusions: SES significantly and negatively impacted individuals' health conditions, especially for rural residents, owing to their technological challenges. This study provides evidence and insights into the nexus of policy formulation, modern technology, and public perceptions regarding shortcomings and risks in public health policies.

Objective: The purpose of this research was to evaluate the prognostic significance of preoperative albumin to fibrinogen (AFR) for postoperative delirium (POD) in older patients with non-neurosurgical and non-cardiac surgery.

Method: The retrospective cohort study included a group of patients aged 65 and above who underwent non-neurosurgical and non-cardiac surgery at the First Medical Center of Chinese PLA General Hospital from January 2014 to December 2021. AFR and POD correlation was evaluated through univariate and multivariable logistic regression analysis, as well as propensity score matching (PSM) and subgroup analysis.

Results: In our study, the occurrence of POD was 2.9% (1566/53,609), with the AFR threshold identified as 10.625 based on the ROC curve. The study identified AFR ≤ 10.625 as a significant predictor of POD in both univariate and multivariable regression analyses, and the odds ratios (OR) were 2.65 (2.40-2.93), 1.98 (1.79-2.21), 1.51 (1.34-1.70), 1.27 (1.13-1.43) and 1.32 (1.14-1.53) in four models and the PSM model.

Conclusion: AFR is a valuable predictor for predicting the development of POD in older patients receiving non-neurosurgical and non-cardiac procedures. This finding highlights the importance of preoperative assessment of AFR in these patients to better predict and manage the risk of POD.

Background: Psychoactive drugs represent a major contributor to falls in older people. This study aims to evaluate the prescribing practice of psychoactive drugs in older people hospitalized for hip fracture (HF) and to explore independent correlates of deprescribing.

Methods: Multicenter prospective observational study including patients with HF admitted to 13 Orthogeriatric wards of the Italian Group of Orthogeriatrics (July 2019-August 2022). Patients underwent a comprehensive geriatric assessment. The use of psychoactive drugs associated with a higher risk of falls was assessed using a dedicated checklist. Deprescribing was defined as any reduction in the number of psychoactive drugs upon discharge, and independent correlates of deprescribing were explored using logistic regression analyses. Cluster analysis by Partitioning around Medoids was also performed in the hypothesis that selected clusters of characteristics could be associated with deprescribing.

Results: One thousand eight hundred fifty-four older individuals (mean age 84 years, 77% females) were studied; 1190 (64%) were not prescribed any psychoactive drug, while 474 (26%), 129 (7%), and 61 (3%) took 1, 2, 3 or more psychoactive drugs, respectively. Among 664 patients on psychoactive drugs on admission, 177 (27%) had fewer prescriptions at discharge, mainly anxiolytics from 89 to 10 (50-6%), antipsychotics from 49 to 12 (28-7%) and antidepressants from 98 to 28 (55-16%). On the other count, 51 (8%) were prescribed more psychoactive drugs, mostly antidepressants from 25 to 45 (49-88%) and antipsychotics from 7 to 17 (14-17%). Functional autonomy (ADL aOR 0.87 [95%CI 0.78-0.97] p < 0.001), polipharmacy (aOR 1.15 [95%CI 1.03-1.29] p < 0.001) and the occurrence of post-operative delirium (aOR 1.71 [95%CI 1.09-2.66] p < 0.017) were independent correlates of deprescribing. More specifically, the clustering procedure could not improve the characterization of deprescribing; conversely, the deprescribing propensity significantly depended upon the center-specific prescriptive practice, not explained by other clinical-epidemiological factors.

Conclusion: Only a small proportion of patients hospitalized for HF undergoes deprescribing of psychoactive drugs, with considerable heterogeneity among centers, suggesting that the physician's attitude rather than patient-related factors affects deprescribing.

Background: Previous research indicates that frailty and loneliness are interrelated. The aim of this study is to analyze their possible reciprocal relationship while disentangling between- and within-person effects. The separation of these sources of variance is vital for a better understanding of potential causal mechanisms.

Methods: Within the FRequent health Assessment In Later life (FRAIL70+) project, participants aged 70 and over completed two measurement bursts spread one year apart with seven biweekly assessments each. The final sample consisted of 426 individuals at baseline (M_age=77.0; SD = 5.4; 64.6% female). A latent curve model with structured residuals was used to examine the potential reciprocal relationship between frailty (37-item deficit accumulation approach) and loneliness (3-item UCLA scale).

Results: No relevant cross-lagged effects over repeated 2-week periods were found between frailty and loneliness at the within-person level, but increases in frailty co-occurred with increases in loneliness. At the between-person level, higher levels of frailty correlated with higher levels of loneliness in each burst.

Conclusion: The findings do not support the assumption that frailty and loneliness share a causal reciprocal relationship over weeks and months. Nonetheless, higher levels of frailty were weakly associated with higher levels of loneliness at the within- and considerably associated at the between-person level, which may indicate a common source of both domains.

Background: Post-stroke myocardial injury is a potentially preventable complication after acute ischemic stroke. Therefore, identifying modifiable variables, such as nutritional status, is crucial for reducing the risk of post-stroke myocardial injury. This study aimed to investigate the association between malnutrition risk on admission, as evaluated by the Geriatric Nutritional Risk Index (GNRI), and post-stroke myocardial injury in elderly patients with first‑ever ischemic stroke.

Methods: We conducted this study using the GNRI score to evaluate the nutritional status of older patients with first‑ever ischemic stroke. The primary outcome of interest was post-stroke myocardial injury. Restricted cubic spline (RCS) was executed to assess the dose-effect relationship between the GNRI score and post-stroke myocardial injury. The correlation of malnutrition risk identified by GNRI score for post-stroke myocardial injury was examined using multivariate logistic regression analysis. To balance the potential confounders and verify the robustness of the results, propensity score matching (PSM) was further conducted.

Results: Based on the GNRI score, 30.8% of patients were at moderate to severe risk of malnutrition. The overall incidence of post-stroke myocardial injury was 33.2%. The adjusted RCS analysis revealed a negative dose-response relationship between the GNRI score and post-stroke myocardial injury (P for non-linearity = 0.536). After adjusting for confounders, moderate to severe malnutrition risk, as evaluated by the GNRI score, was substantially associated with an increased risk of post-stroke myocardial injury (OR: 3.25; 95% CI: 1.93-5.48; P < 0.001). Following PSM adjustment, the association between the GNRI score and post-stroke myocardial injury remained significantly robust (OR: 4.28; 95% CI: 2.34-7.83; P < 0.001).

Conclusion: Malnutrition risk on admission is associated with higher risk of post-stroke myocardial injury among elderly patients with first‑ever ischemic stroke. Early screening for malnutrition risk is crucial in the management of patients with first‑ever ischemic stroke.

Background: Self-rated health (SRH) reflects biological, social, and functional aspects of an individual, incorporating personal and cultural beliefs as well as health behaviours. A deeper understanding of the structure of SRH can help health professionals focus on patients' personal health and functional goals and guide preventive health policies. This study aimed to examine the associations between SRH and independent factors by gender.

Methods: The population-based, cross-sectional cohort study included 2,539 community-dwelling 75-year-old Finns who participated in the Turku Senior Health Clinic study. Data were collected through clinical examinations, questionnaires, and interviews, which included assessments of SRH, sociodemographic factors (living arrangements, education, self-rated financial status), psychosocial factors (sense of life meaningfulness, satisfaction with relationships, loneliness), health-related behaviours (smoking, alcohol use, physical activity), physical functioning (use of a mobility device, self-rated ability to walk 400 m, history of falls), and health conditions (pain, depressive symptoms, central obesity, vision, sleep quality, and number of self-reported diseases). A backward logistic regression analysis with an inclusion criterion of p < 0.001 was used to identify independent variables associated with SRH.

Results: Fifty percent of both men and women reported having a poor SRH. There were no significant interactions between gender and independent variables regarding SRH. Independent variables associated with poor SRH were experiencing difficulties in walking 400 m (odds ratio 7.45, 95% confidence interval 4.91-11.30), being multimorbid (≥ 6 diseases 6.00, 4.11-8.75; 2-5 diseases 2.97, 2.18-4.06), poor self-rated financial status (3.46, 2.82-4.24), lower levels of life meaningfulness (2.53, 2.07-3.11), having poor (2.34, 1.70-3.21) or moderate (1.58, 1.26-1.98) sleep quality, experiencing depressive symptoms (2.08, 1.57-2.77), reporting at least moderate (2.01, 1.59-2.54) or mild (1.31, 1.01-1.70) pain, and vision impairment (1.50, 1.21-1.86). The area under the curve of this model was 0.842.

Conclusions: Our findings support early and proven prevention strategies for the most disabling chronic diseases, as well as promoting self-care management, physical activity, and muscle strength. Additionally, a balanced treatment approach that addresses vision impairments and manages symptoms such as pain, poor sleep, and depression is important for older adults' health.

Trail registration: The study is registered in ClinicalTrials.gov (Identifier: NCT05634239). Retrospectively registered.

Background: Physio-Cognitive Decline Syndrome (PCDs) is characterized by the coexistence of MIND (mobility impairment, no disability) and CIND (cognitive impairment, no dementia), which predicts dementia risk. Deteriorating oral health can contribute to malnutrition, cognitive decline, and physical frailty, all of which may exacerbate PCDs symptoms. This study investigates the association between oral health and PCDs, exploring sex differences in this relationship.

Method: A cross-sectional analysis of the baseline data from the Nanjing Brain Health Cohort included 252 participants aged 60 and older, assessing physical mobility (6-meter walk test, grip strength), cognitive function (MoCA), and oral health (natural teeth count, denture use, tongue and lip motor function, masticatory and swallowing ability, Oral Frailty Index). Logistic regression models were used to examine associations between oral health and PCDs.

Results: Among participants, 15.5% were classified as having PCDs. The odds of having PCDs were lower with a higher number of teeth (OR = 0.939, 95% CI: 0.890-0.991, p = 0.021), while impaired tongue and lip motor function increased the odds of PCDs (OR = 3.811, 95% CI: 1.059-13.717, p = 0.041). In females, the odds of MIND and CIND were lower with a greater number of teeth and denture use. For males, the odds of PCDs were higher with oral frailty (OR = 5.202, 95% CI: 1.429-18.940, p = 0.012).

Conclusions: Findings underscore the significant association between oral health and the odds of PCDs among older adults, with sex-specific effects. For women, maintaining natural teeth and proper denture use are associated with lower odds of MIND and CIND, while for men, oral frailty is linked to higher odds of PCDs. Healthcare providers should consider oral health and incorporate sex-specific strategies.