Objectives: This study aimed to investigate the independent and combined association of serum 25-hydroxyvitamin D [25(OH)D] levels and physical activity on oral care needs in older United States (US) adults.
Methods: A cross-sectional study involving 6509 older adults aged 60 years and above data were included from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). The main data for our study came from Questionnaires Data and Laboratory Data. Oral care needs refer to the different levels of overall care recommendations given by trained interviewers after oral examination of interviewees in the NHANES. The weighted multivariate logistic regression model and restricted cubic spline (RCS) were used to explore the associations between 25(OH)D levels, physical activity, and oral care needs. Additional propensity score matching (PSM) was performed to test the stability and reliability of the results.
Results: The results showed that high serum 25(OH)D levels (OR = 0.99, 95% CI, 0.97-1.00, P = 0.04), and vigorous recreational activity (OR = 0.70, 95% CI, 0.53-0.93, P = 0.01) were independently associated significantly with lower risks of oral care needs. High levels of 25(OH)D combined with adequate physical activity might reduce oral care needs in older adults. The mediation effect analysis also showed a mediating effect of 25(OH)D in the association of vigorous recreational activity and oral care needs.
Conclusion: High serum 25(OH)D levels and vigorous recreational activity have been linked to a reduced risk of oral care need among older adults. 25(OH)D is a potential mediator of the reduced need for oral health care associated with vigorous recreational activity when combined effects are considered. Vitamin D supplementation and increased physical activity may be a potential cost-effective oral public health strategy for older adults.
Background: Little is known about the association between catastrophic health expenditure (CHE) and mental health in elderly population and its potential moderators. This study examined the relationship between CHE and depressive symptoms in Chinese older persons and its difference between groups of different income level and social activity engagement.
Methods: We employed data from the 4 waves (2011, 2013, 2015, and 2018, N = 15,406) of the China Health and Retirement Longitudinal Study (CHARLS). A linear mixed model was used to examine the association between depressive symptoms and CHE, and interaction terms were involved in the model to examine the moderating role of social activity and income levels.
Results: Significant correlations have been shown between CHE and depressive symptoms(coefficient = 0.363, P < 0.05), such association was more pronounced in socially inactive (P = 0.034, Difference = 0.37, interaction terms (social activity*CHE: -1.189) or low-income seniors (P < 0.001, Difference = 0.77, interaction terms (medium income*CHE: -0.594, P < 0.05, high income*CHE: -0.667, P < 0.01), and especially in socially inactive and low-income seniors (P < 0.001, Difference = 0.93, interaction terms (high income*CHE*social acitivity: 1.132, P < 0.05). Even after increasing the threshold of CHE to 20% and 25%, similar pattern was observed.
Conclusions: This study suggest a positive association between CHE event and depressive symptoms, as well as the protective effect of advantaged financial status and engagement of social activity. Our finding provide empirical evidence to call for urgent action for government and public health authorities, to address the high medical expenditure, psychological stress among elderly, especially for low-income households or elderly living alone.
Background: Maintaining skeletal muscle mass and function in older adults is of paramount importance for preserving both quality of life and overall health. Exercise is essential for muscle maintenance; however, for older individuals with comorbidities, engaging in physical exercise may pose challenges due to decreased endurance and the inability to reach optimal exercise intensities. Several studies have investigated the effects of protein supplementation on muscle mass, strength, and physical performance in older adults. However, the results are inconsistent. The objective of this study was to systematically review and synthesize the effects of protein supplementation on muscle mass, muscle strength, and physical performance in physically inactive older adults.
Methods: Four databases (PubMed, EMBASE, Web of Science and the Cochrane Central Registry of Controlled Trials) were systematically searched from inception to 31 January 2025. Two reviewers independently conducted the study screening, data extraction, risk of bias and GRADE assessments. In accordance with the PRISMA guidelines, the outcome data were synthesized using meta-analysis via RevMan5.4 software or a narrative method.
Results: Eight data groups from six randomized controlled trials(RCTs) were included in the analysis, stratifying participants into three physical activity(PA) trajectories: sustained low PA (n= 1), transition to structured training from low PA (n= 4), and a shift from moderate to low PA (n= 3). Protein supplementation had no statistically significant effect on total lean body mass (p> 0.05). Furthermore, secondary muscle mass parameters showed negligible intervention benefits, whereas heterogeneous outcomes were observed across muscle strength and physical performance metrics.
Conclusions: The influence of protein on muscle mass was not significantly efficacious, and mixed results were shown for muscle strength and physical performance. Further well-designed studies are needed to determine the effectiveness of protein supplementation to maximize its potential benefits in older individuals with physical inactivity.
Trial registration: This study was registered at www.crd.york.ac.uk/prospero/(registration no. CRD42024504443).
Background: A poor prognosis within 1 year of discharge is important when making decisions affecting postoperative geriatric inpatients. Comprehensive geriatric assessment (CGA) plays an important role in guiding holistic assessment-based interventions. However, current prognostic models derived from CGA and clinical data are limited and have unsatisfactory performance. We aimed to develop an accurate 1-year mortality prediction model for patients discharged from the geriatric ward using CGA and clinical data.
Methods: This longitudinal cohort study analysed data from 816 consecutively assessed geriatric patients between January 1, 2018 and December 31, 2019. Models were constructed using Cox proportional hazards regression and their validity was assessed by analysing discrimination, calibration, and decision curves. The robustness of the model was determined using sensitivity analysis. A nomogram was developed to predict the 1-year probability of mortality, and the model was validated using C-statistics, Brier scores, and calibration curves.
Results: During 644 patient-years of follow-up, 57 (11·7%) patients died. Clinical variables included in the final prediction model were activities of daily living, serum albumin level, Charlson Comorbidity Index, FRAIL scale, and Mini-Nutrition Assessment-Short Form scores. A C-statistic value of 0·911, a Brier score of 0·058, and a calibration curve validated the model.
Conclusion: Our risk stratification model can accurately predict prospective mortality risk among patients discharged from the geriatric ward. The functionality of this tool facilitates objective palliative care.
Background: The incidence of depression and cognitive dysfunction is high in the elderly population, which incurs serious social burden. In recent years, an increasing number of studies have found that poor sleep quality and impaired daily activities in the elderly are also closely related to these two diseases.To explore the mediating role of sleep quality and daily activity ability in the elderly's cognition and depression. It extends upon existing research and provides evidence for new areas of intervention that may ameliorate and delay cognitive decline in the elderly.
Methods: Data were collected from a representative sample of 5,470 (aged 60 years and above) in Anhui Province from the 2019 Anhui Health and Life Expectancy Survey(AHLS). Cognitive function was assessed by the Mini-Mental State Examination(MMSE), depression symptoms by the Patient Health Questionnaire(PHQ-9), physical function by the Barthel Index for Activities of Daily Living, and sleep quality by the Pittsburgh Sleep Quality Index(PSQI). Descriptive analysis was conducted for the distribution of various covariates and results. Pearson correlation analysis was employed to test the relationship between depression symptoms, cognition, poor sleep quality and daily living ability of the elderly. The structural equation model was used to explore the link between depression and cognition in the older adults, and to test mediating effects of daily activity and sleep disturbance on depression and cognition.
Results: Among all participants, the average cognitive score was 21.51 (SD = 6.10), and the incidence of depression symptoms was 31.6%. Depression symptoms had a significant direct impact on cognition (β= -0.075, 95%CI=-0.099, -0.050). Depression symptoms was related to poor sleep quality and daily living ability (β = 0.420, 95%CI = 0.409, 0.447; β=-0.161, 95%CI=-0.163, -0.113). Cognition was also related to both factors (β=-0.042, 95%CI=-0.070, -0.024; β = 0.143, 95%CI = 0.112, 0.173). The ability of daily living was related to poor sleep quality (β=-0.049, 95%CI=-0.079, -0.027). Poor sleep quality and daily living ability mediated the relationship between depression symptoms and cognition (β=-0.020, 95% CI=-0.025, -0.014; β=-0.020, 95%CI=-0.030, -0.010).
Conclusions: This study found that depression symptoms in the older adults was significantly related to cognitive function. Older adults with depression symptoms are more likely to have cognitive impairment. In addition, poor sleep quality and the ability of daily living can play a mediating role between depression and cognition. In the future, the society should pay attention to the mental health of the elderly to avoid depression. They should also pay attention to the impact of their sleep quality and daily activity ability, so as to better maintain cognitive function.
Background: Benign skin tumors become more common with advanced age. However, little is known about the etiology of these common lesions. Our objectives were to evaluate the risk factors for seborrheic keratosis, lentigo solaris, cherry angiomas and melanocytic nevi in an elderly population. Our candidate predisposing factors were sex, age, Fitzpatrick skin type, history of outdoor work, life style factors and anthropometric measurements and laboratory tests.
Methods: In this retrospective cross-sectional study of a large, well-documented cohort, a total body skin examination (TBSE) was performed by dermatologists. The information gathered was augmented with self-reported data. The associations between benign skin tumors and the risk factors analysed with the Chi square test, Fischer exact test and analysis of variance as appropriate.
Results: The study included 552 participants aged between 70 and 93 years. According to the TBSE, benign skin tumors were present in up to 78.7% in certain subsets of participants. Seborrheic keratosis was the most common lesion type, and 15.6% of all cases had > 50 lesions. Seborrheic keratosis were more common in males (p < 0.05), while lentigo solaris and cherry angiomas were more common in females (p < 0.05). A history of outdoor working associated with higher number of lentigo solaris and seborrheic keratosis lesions (p < 0.05). There was an association between lower glycated haemoglobin levels and the presence of multiple cherry angiomas (p < 0.05). Female subjects with multiple cherry angiomas had higher levels of high-density cholesterol and lower triglyceride values than in those with fewer cherry angiomas (p < 0.05 for both). In males, lower mean haemoglobin levels were associated with multiple cherry angiomas (p < 0.05).
Conclusions: We found sex differences and several new possible etiological factors behind benign skin tumors which, despite being common, remain poorly characterized.
Objective: This study aims to explore the association between deep vein thrombosis (DVT) of the lower limbs at admission and the time from injury to admission (TFITA), providing clinical references for the prevention of DVT at admission.
Patients and methods: Data was collected from patients who were admitted to our hospital for hip fractures between January 2017 and December 2023. Univariable and multivariable logistic regression analyses were conducted to examine the relationship between TFITA and DVT at admission, using both continuous and categorized variables based on thresholds for TFITA. Propensity score matching (PSM) and subanalyses stratified by TFITA and characteristics of DVT at admission were further employed to investigate the relationship. Additionally, restricted cubic splines (RCS) analysis was performed to determine whether a non-linear association exists between TFITA and DVT at admission.
Results: A total of 1230 patients were included in the statistical analysis, comprising 116 patients with DVT at admission and 1114 without. Both Univariable and multivariable logistic regression analyses indicated a positive association between TFITA and DVT at admission before and after matching. Subanalyses revealed significant associations for older age, low-energy injuries, high D-dimer levels, and low platelet counts subgroup with TFITA and DVT at admission. RCS analysis indicated no non-linear relationship between TFITA and DVT at admission.
Conclusion: For patients with hip fractures, longer TFITA is positively correlated with the incidence of DVT at admission. These findings support the potential of TFITA as an intervention strategy for managing DVT at admission.
Background: The use of corticosteroids in older adult patients with severe community-acquired pneumonia (sCAP) remains controversial. This meta-analysis aimed to thoroughly assess the efficacy and safety of corticosteroids in the treatment of older adult patients with sCAP.
Methods: We performed a comprehensive search in Public Medline, Excerpta Medica Database, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and SinoMed, covering records from the earliest available to September 15, 2024. Randomized controlled trials (RCTs) were conducted. The primary outcome was 30-day all-cause mortality, with safety outcomes including gastrointestinal bleeding, secondary infections, and acute kidney injury.
Results: This meta-analysis included data from nine RCTs with 2,034 patients, showing that corticosteroid therapy was associated with lower 30-day all-cause mortality (risk ratio (RR) = 0.67; 95% confidence interval [CI], 0.52-0.86; P = 0.002). Corticosteroid use also shortens hospital and intensive care unit stays, reduces mechanical ventilation requirements, lowers vasopressor dependence, and decreases C-reactive protein levels. Regarding safety, corticosteroids did not significantly increase risks of superinfection (RR = 0.78; 95% CI, 0.54-1.13; P = 0.19), upper gastrointestinal bleeding (RR = 0.71; 95% CI, 0.35-1.44; P = 0.34), or acute kidney injury (RR = 0.71; 95% CI, 0.23-2.21; P = 0.56).
Conclusions: This meta-analysis demonstrated that glucocorticoid use is associated with higher survival in older patients with sCAP; however, the safety outcomes remain uncertain due to variability in study definitions.
Trial registration: PROSPERO CRD 42024591076 was successfully registered on September 30, 2024.
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