BMC Geriatrics最新文献

Objective: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less.

Methods and deign: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment.

Results: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions.

Conclusions: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.

Background: SARC-F questionnaire is a simple and convenient tool for sarcopenia screening, and SARC-CalF is a modified version of it. The developments of their Chinese versions are warranted for the clinical use for Chinese population. This study aimed to culturally adapt the SARC-F questionnaire into Chinese using standardized methods, validate the reliability and diagnostic accuracy of the Chinese version SARC-F and SARC-CalF against five sarcopenia diagnosis criteria, and determine optimal cut-off values for clinical practice in Chinese population.

Methods: The translation and cross-cultural adaptation of SARC-F into Chinese were conducted following the methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. The Chinese version of SARC-F was validated through a diagnostic test, using diagnostic criteria of sarcopenia recommended by the revised 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, Asian Working Group for Sarcopenia (AWGS2019) consensus, the International Working Group on Sarcopenia (IWGS), the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium and the Sarcopenia Definition and Outcomes Consortium (SDOC). Additional analysis was done against the criteria of severe sarcopenia according to the revised EWGSOP2 and AWGS2019.

Results: The Chinese version of SARC-F was well translated and demonstrated good reliability and acceptability. The diagnostic test included 1859 community-dwelling older individuals from two medical centers. Against five different definitions of sarcopenia, the Chinese version of SARC-F showed reasonable diagnostic accuracy for sarcopenia screening (AUC 0.614-0.821), and was demonstrated low sensitivity (13.7-37.9%) but high specificity (94.8-97.7%) with a cut-off value of ≥ 4. SARC-CalF significantly enhanced the diagnostic accuracy of SARC-F when using definitions of EWGSOP2, AWGS2019 and IWGS (all P ≤ 0.001). A score of ≥ 2 for SARC-F and ≥ 7 for SARC-CalF were established as optimal cut-off points for identifying older individuals as at risk of sarcopenia in Chinese population.

Conclusions: The Chinese version SARC-F is of reasonable reliability and validity for sarcopenia screening. Despite its low sensitivity, it proves to be a useful tool to identify severe cases in community taking advantage of its simplicity. SARC-CalF appears to be a more suitable screening tool for clinical use in detecting sarcopenia.

Background: Medication safety issues occur frequently among older-adult patients with chronic diseases during the transition from the hospital to their homes. Patient participation in medication safety has been found to be an effective measure for improving patient safety. However, few studies have been conducted on the safety of older-adult patients with chronic disease during the hospital to family transition period. This study aimed to understand the experiences and perceptions of such patients regarding participation in medication safety during the hospital to family transition period and to explore the actual situation and obstacles during this period in the Chinese context.

Methods: A descriptive, qualitative research approach was adopted using purposive sampling. Eighteen patients with chronic disease (aged 61-84 years) participated, all of whom were in the period of transition from hospital to home. Data were collected through semi-structured face-to-face interviews and analysed using directed qualitative content analysis.

Results: Four themes and 12 sub-themes were identified in this study. The four themes were participation in medication decision-making, participation in medication self-management, participation support, and barriers to patient participation.

Conclusions: Patient participation is important in ensuring medication safety during the hospital to family transition period. This study highlights that older-adult patients' participation in medication safety includes three aspects: participation in medication decision-making, participation in medication self-management, and participation support. Health literacy, medical communication, and family care support are the key factors affecting patient participation in medication safety. Effective intervention strategies for this patient group during the transition period would target improving patients' cognition, health literacy, doctor-prescription communication, and family care support to encourage patients to be more actively involved in the process of drug treatment.

Background: Sarcopenia represents a constant threat to the health of older adults, and accurate risk perception is essential for disease prevention and control. However, current methodologies lack rigorously validated instruments to assess the perceived risk of sarcopenia among this group. Thus, this study aimed to develop and validate a sarcopenia disease risk perception scale for older adults.

Design: The study was conducted in two phases: development of the initial scale and its psychometric evaluation. A STROBE checklist was employed.

Methods: Based on the two-factor model of risk perception theory and the health belief model, the initial draft of the scale was created through literature review, expert consultations, and a preliminary survey with a small sample. Then, we used a cross-sectional study methodology to conveniently select 438 Chinese older adults. Item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were used to refine and validate the scale items. Internal consistency and external consistency were assessed to confirm the scale's reliability.

Results: These evaluations established the scale's framework: content validity, item analysis, and EFA. The two factors extracted from the initial analysis explained 62.250% of the observation variance. The CFA confirmed a good fit for the model, demonstrating the scale's robust reliability and validity. The finalized scale includes 15 items and two dimensions: perceived susceptibility (eight items) and perceived severity (seven items).

Conclusion: The Sarcopenia Disease Risk Perception Scale for Older Adults is reliable and valid, making it appropriate for assessing the risk perception level in the target population.

Background: Recent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults.

Methods: This study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function.

Results: Participants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition.

Conclusions: The findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults.

Background: Diabetes is a global health problem, and its incidence and complications increase with the duration of the disease and over time. This increase in complications in older patients can lead to disability and a lower quality of life. This study aimed to investigate the rate of diabetes control and complications in older adults.

Method: This was a cross-section of an ongoing cohort of patients with type 2 diabetes mellitus (T2DM) aged 65 years and older. The clinical and laboratory characteristics of older adult patients with T2DM in good and intermediate health conditions were collected between 2010 and 2022.

Results: A total of 2,770 older adult patients with T2DM were enrolled, including 1,530(55.3%) female and 1,240 (44.7%) male participants. Metabolic syndrome, hypertension, and coronary artery disease were the most common comorbidities, affecting 1,889 (71.4%), 1,495 (54.4%), and 786 (29.2%) patients, respectively. Albuminuria was present in 626 (22.6%) patients, while retinopathy was detected in 408 (14.7%) patients, including 6% with proliferative retinopathy. Most patients were treated with oral antidiabetic agents (88.9%), with metformin being the most prescribed medication (85.6%). Statins were prescribed to 71.8% of the patients. The most prescribed antihypertensive medications were angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, prescribed to 54% and 15% of patients, respectively. The hemoglobin A1c (HbA1c) goal (HbA1c < 7.5%) was achieved in 1,350 (56.4%) patients, and the low-density lipoprotein cholesterol (LDL-C) goal (LDL < 100) was achieved in 1,165 (45.6%) patients. Blood pressure control (BP < 140/90) was achieved in 1,755 (65.4%) patients. All three goals were achieved in 278 (10.3%) patients. There were no significant differences in clinical laboratory results and the patients' characteristics based on gender.

Conclusion: The rate of progression of complications in older adult patients is higher than the effectiveness of the treatment, indicating the need for increased social support for this age group.

Background: Locomotive syndrome is a major challenge for older adults, and anthropometric indices can greatly affect the musculoskeletal system. This study aimed to compare the anthropometric indices between older adults with and without locomotive syndrome.

Methods: This descriptive-analytical study was performed on 211 older adults using random cluster sampling from a population of over-60 individuals covered by comprehensive health service centers in Sari in Autumn, 2021. Participants were divided into two groups: with and without locomotive syndrome. Locomotive syndrome was assessed via the 25-item Geriatric Locomotive Function Scale questionnaire, and the level of anthropometric indices was determined through the Bioelectrical Impedance Analysis device. Data were analyzed by independent t-test, Mann-Whitney U, Chi-Square, and Binary logistic regression in SPSS, Version 23 (P < 0.05).

Results: The average age of older adult participants was 78.4 ± 6.6 years. In older adults with locomotive syndrome, the average percentage of fat-free mass (P < 0.001) was significantly lower while the average percentage of fat mass and fat mass index (P < 0.001) was significantly higher. Older adults with locomotive syndrome were shorter in height (P < 0.001) and had a higher body mass index (P < 0.05). Fat-free mass percentage (OR = 0.59) and body mass index (OR = 1.4) predicted the incidence of locomotive syndrome in the subjects. Significant differences such as chronic diseases, chronic pain, falls, age, and gender were observed between the two groups (P < 0.05).

Conclusion: Anthropometric indices can play an important role in the occurrence of locomotive syndrome in older adults. Evaluation of anthropometric indices and management of body composition can help prevent locomotive syndrome and improve the quality of life of older adults.

Background: The process of aging is a phenomenon that occurs universally in all living organisms. It begins during intrauterine life and persists until death. Obsessive-compulsive disorder (OCD) can significantly impact the lives of older adults, especially in their relationships with others, including spouses or partners. These relationships often involve conflicts or may be affected by the individual's OCD symptoms, such as rituals. Hence, the present study aimed to investigate the prevalence of OCD among the older person population.

Methods: The systematic review and meta-analysis were carried out without a time limit until March 2024. To identify articles pertinent to the study's objectives, searches were conducted on Embase, PubMed, Scopus, WOS, and Google Scholar databases using appropriate keywords and validated with MeSH/Emtree. The I² index was utilized to assess heterogeneity among the studies.

Results: Ultimately, 10 articles meeting all the inclusion criteria had a sample size of 54,377. The estimated prevalence of OCD in the older person worldwide is 2.4% (95% confidence interval: 1.8%-3.3). The Asian continent showed the highest prevalence of OCD in the older person at 3.5% (95% confidence interval: 2.4-5.1), while the female population had an estimated prevalence of 2.7% (95% confidence interval: 1.9-3.8). As the publication year increased, there was an upward trend in the quality assessment score and the age of OCD prevalence in the older person (P < 0.05).

Conclusion: The results of the present study indicate a high prevalence of OCD among the older person. Hence, it is advised that greater attention be directed towards this issue by experts, authorities, and health policymakers.

Background: Falls remain a persistent problem in residential aged care (RAC) facilities. Fall screening and assessment tools such as the Peninsula Health Falls Risk Assessment Tool (PHFRAT) are widely used to inform falls risk and guide fall prevention interventions. However, it is unclear how it is used in practice and whether clinicians believe it supports resident care. This study aimed to measure the extent of use of PHFRAT to understand clinicians' perceptions of its value and usefulness.

Methods: This mixed method study involved an analysis of PHFRAT assessment from 25 RAC facilities in New South Wales, Australia, and interviews with seven RAC staff about how PHFRAT information is used in practice. In the quantitative component, descriptive statistics were applied to PHFRAT data to summarise how RAC staff use the PHFRAT including the completeness and content of the three parts. In the qualitative component, thematic analysis techniques were applied to interview data.

Results: The sample included 215 RAC residents with 703 PHFRATs, of which 617 documented fall prevention interventions. Among these 617 PHFRATs, 593 (96.1%) included strategies related to staff assistance and 283 (45.9%) recorded strategies related to device provision. While nearly all residents (96.74%) received at least one PHFRAT assessment over the study period, many PHFRAT assessments were incomplete (part 1: 11.5% of information missing; part 2: 10.8%; part 3: 17.1%). There were few variations in fall interventions prescribed to individual residents by their fall risk level. Interviews with RAC staff indicated that PHFRAT assessments are the responsibility of registered nurses with limited input from other staff or residents. While the structured process was viewed positively in guiding risk assessment and intervention assessment, a lack of input from others prevented strategies from being tailored to residents' specific needs and preferences. A shortage of resources, lack of communication, and limited staff education were identified as the main barriers to PHFRAT guideline implementation.

Conclusion: The PHFRAT provides a useful structure for clinicians to assess falls risk factors and plan falls prevention strategies. In the future, increased multidisciplinary input into fall prevention strategy development may improve the comprehensiveness of fall prevention plans.

Background: Sarcopenia, characterized by the loss of skeletal muscle, is assessed using appendicular skeletal muscle mass indices (ASMI). Various international groups propose different ASMI thresholds for assessing sarcopenia. However, the optimal ASMI that correlates best with physical performance measures in older Turkish adults remains unexplored. This study aims to determine which ASMI is most closely associated with physical performance measures, particularly low handgrip strength (dynapenia), in Turkish older adults.

Methods: The study included 326 individuals aged 60 and above. Comprehensive geriatric assessments were conducted on all participants, along with anthropometric evaluations and body composition analyses. ASMI was calculated by adjusting height squared, weight, and body mass index (BMI). Physical performance was assessed through handgrip strength, gait speed, and the chair stand test.

Results: The mean age of the participants was 74 ± 5.77 years, with 59.8% being women and 37.5% having dynapenia. Height-squared adjusted ASMI was not significantly associated with gait speed or the chair stand test. Weight-adjusted ASMI correlated with handgrip strength and gait speed but not with the chair stand test. Both height and weight-adjusted ASMI did not differ significantly between participants with and without dynapenia (p > 0.05). BMI-adjusted ASMI significantly correlated with all physical performance parameters (p < 0.05). Furthermore, in multivariate regression analysis, BMI-adjusted ASMI (OR = 0.028, 95% CI = 0.01-0.31, p = 0.006) was independently associated with dynapenia.

Conclusion: The study indicates that ASMI adjusted for BMI shows stronger correlations with all physical performance parameters and is independently associated with dynapenia. Utilizing ASMI adjusted for BMI may improve sarcopenia diagnosis in Turkish older adults.