BMC Geriatrics最新文献

Background: The lesions observed in very old populations exhibit a wide spectrum of characteristics. Histopathological evaluation may be necessary for accurate diagnosis in this demographic. There is limited amount of data on the histopathological evaluation of lesions in very old patients. Therefore, the aim of this study was to assess the histopathological features in this population.

Methods: A total of 5376 pathological samples from very old patients (≥ 80 years old) were analyzed. Clinical and pathological data were retrospectively reviewed. Histopathological diagnoses were categorized into three groups: malignant (invasive) lesions (MLs), benign/inflammatory lesions (BLs), and dysplastic-dysmorphic/non-invasive malignant lesions (DLs). Statistical analyses were conducted on the histopathological data. Pearson's chi-square test and the Fisher exact test were used to analyze the data, and statistical significance was considered at a p-value of < 0.05.

Results: The mean age of the patients was 83.6 ± 3.4 years (range: 80-107), with 53% being female. The upper gastrointestinal (GI) tract was the most common site among all materials (28%, n = 1524). Benign/inflammatory lesions (BLs) accounted for the highest proportion of cases (62%, n = 3322) compared to MLs and DLs. BLs were significantly more prevalent in female patients (p < 0.001). MLs were notably more common in biopsies from breast locations (p < 0.001). No patients were diagnosed with DLs in the cytological materials.

Conclusions: Despite the broad spectrum of lesions observed in very old patients, the majority tend to be benign. While the Coronavirus disease 2019 (COVID-19) pandemic has altered healthcare dynamics, the increased frequency of benign lesions among the very old population, as a result of more frequent healthcare facility visits, is noteworthy. However, dysplastic and malignant lesions remain significant in this population and can profoundly impact patients' quality of life. This study contributes to our understanding of histopathological diagnoses in the very old population, shedding light on the current approach to managing their pathological specimens.

Objective: To investigate the efficacy of both multicomponent exercise and nutritional interventions on frailty by conducting a systematic review and meta-analysis to examine changes in frailty incidence.

Design: A systematic review and meta-analysis.

Eligible criteria: The included studies were limited to original controlled trials focused on frailty interventions in older adults aged 65 years and over. The studies involved only participants with specific diseases, and those recovering from surgery or being hospitalized were excluded.

Information sources: A systematic search was performed on three databases: PUBMED, EMBASE, and Cumulative Index to Nursing and Allied Health, with the latest search in October 2024. Three authors independently extracted the data using a standardized data collection form. Relative risks were used as a summary measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis.

Results: After searching three databases, 5327 records were identified. After removing duplicates and screening the titles and abstracts, 19 multicomponent exercise studies and 7 nutritional intervention studies were eligible. In a pooled analysis of 18 multicomponent exercise RCTs, including a total of 3457 older adults, the multicomponent exercises showed a clinically significant reduction in frailty risk by relative change 55% times (95% CI 45% to 67%, p value < 0.001). The subgroup analysis of combinations of macronutrients and micronutrients also demonstrated statistically significant decrease in frailty risk by relative change 28% times (95% CI 11% to 72%, p value = 0.008).

Conclusion: Multicomponent exercises can effectively improve physical frailty, regardless of the duration and types of the activities, whereas the efficacy of nutritional supplements remains unclear. Personalized multicomponent approaches that incorporate both exercises and nutritional supplements have promised to enhance effectiveness in reducing frailty, thus warranting further investigation.

Trial registration: The study was registered on 12 September 2022, under PROSPERO registration number CRD42022357357.

Background: Adverse drug reactions are more prevalent in geriatric patients and are frequently associated with a range of polypharmacy-related issues as well as some physiological aging-related alterations. These affect the pharmacokinetic and pharmacodynamic properties of drugs. This study aimed to assess the magnitude of ADRs and their contributing factors among geriatric patients admitted at Comprehensive Specialized Hospitals of the Amhara Region.

Methods: A multicenter prospective cohort study was carried out from May 2023 to August 2023 on geriatric patients admitted to four randomly selected comprehensive hospitals in the Amhara region. We used logistic regression to find the factors influencing the occurrence of ADRs. A P value of less than 0.05 was deemed statistically significant.

Results: During the study's follow-up period, 373 patients in total were included. An incidence rate of 31.10% (95% CI: 26.38-35.82) was obtained from the identification of 121 ADRs in total. The organ most frequently affected by ADRs was the gastrointestinal tract (28.92%), followed by the cardiovascular system (19.01%), and the drug class most often implicated in ADRs was antibiotics (21.49%), then anticoagulants (12.40%). ADRs were substantially linked to being overweight (P < 0.001), having been hospitalized in the previous six months (P = 0.000), and hyperpolypharmacy (p = 0.047). 93.39% of all ADRs received the interventions. 85.12% of the adverse drug reactions were successfully resolved.

Conclusions: This study found that over one-third of older people and individuals admitted to the hospital experienced ADRs. Overweight, hyperpolypharmacy, and patients who had previously been admitted during the preceding six months were significantly linked with the occurrence of ADRs. Improving the drug safety of elderly patients, particularly those who are admitted, should be a greater priority for healthcare professionals.

Background: Epithelioid Hemangioendothelioma (EHE) is an extremely rare malignancy originating from endothelial cells, with an incidence rate of less than 1/100,000. To date, there have been no documented cases of Diaphragm EHE in the English or Chinese literature. EHE can manifest in various organs throughout the body and lacks distinctive clinical features, often leading to misdiagnosis. Given its rarity, there is currently no standardized treatment protocol, management options include radiotherapy, chemotherapy, and targeted therapy. In this report, we present a case study of a 75-year-old male patient who presented with a 6-month history of cough, sputum production, chest tightness, and pleural effusion. A biopsy of the diaphragm mass and immunohistochemical analysis of the pleural fluid confirmed the diagnosis of EHE. The patient underwent chemotherapy combined with targeted therapy, however, unfortunately experienced disease progression. In March 2023, a 75-year-old male patient was admitted to our hospital with persistent cough for over two months accompanied by sputum production and chest tightness. The patient was diagnosed with Diaphragm EHE accompanied by pleural effusion and received treatment at our institution. We initiated combination chemotherapy using albumin-bound paclitaxel and cisplatin along with intrapleural infusion of bevacizumab as an anti-angiogenic drug. After one cycle of treatment, significant control over the pleural effusion was observed which prompted us to administer systemic treatment through intravenous infusion using albumin-bound paclitaxel, cisplatin, and bevacizumab. Unfortunately, the patient's condition continued to deteriorate.

Conclusion: When accompanied by pleural effusion, EHE often demonstrates rapid disease progression.

Background: Psychotropic medications are frequently utilised in residential aged care facilities (RACFs). Longitudinal medication administration data can offer crucial insights into the potential inappropriate use of psychotropic medicines (PIPMs), guiding future quality improvement initiatives. This study aimed to determine the prevalence and predictors of PIPMs use and assess variation in PIPMs use by facility for residents of RACFs.

Methods: We conducted a retrospective longitudinal cohort study using routinely collected electronic health data (2020-2021) relating to 3064 residents from 23 RACFs in New South Wales, Australia. The study included permanent residents aged ≥ 65 years and median length of stay was 483 days. The prevalence of PIPMs use was estimated using updated Beers criteria 2023. The extent of exposure to PIPMs was measured using two metrics i.e., number of days residents were exposed to PIPMs and the proportion of days covered by PIPMs. We used logistic regression model to determine factors associated with PIPM use. Funnel plots to visualised variation in PIPMs use across facilities.

Results: In total 40% (n = 1224) residents used at least one PIPM and 10% (n = 302) used ≥ 2. The most frequently used PIPMs categories were benzodiazepines and Z-drugs (27.4%), followed by first and second generation antipsychotics (17.2%). Certain diagnoses (dementia, pain, depression, anxiety, and endocrine disorders) were associated with the increased use of PIPMs. For example, residents with dementia were 1.94 times more likely to use ≥ 2 PIPMs (OR 1.94; 95% CI 1.50-2.51). The prevalence of at least one PIPM by residents in each facility ranged from 23.3 to 57.0% across facilities. The overall median number of days residents were exposed to PIPMs were 91 days (IQR 6-320) while the median proportion of days covered by at least one PIPM was 39.3% (IQR 2.6-86.6%).

Conclusions: Residents in aged care facilities showed a high rate of PIPMs use with substantial variation across facilities. Quality improvement initiatives which target inappropriate psychotropic medication use are necessary, particularly considering the link between psychotropic drug use and adverse events such as falls.

Background: Cardiovascular risk factors represent an important health issue in older adults. Previous findings suggest that meditation training could have a positive impact on these risk factors. The objective of this study was to investigate the effects of an 18-month meditation-based intervention on cardiovascular health.

Methods: Age-Well was a randomized, controlled superiority trial with blinded end point assessment, including community-dwelling cognitively unimpaired adults 65 years and older enrolled between November 24, 2016, and March 5, 2018, in France. One hundred and thirty-four participants were included in this secondary analysis. Participants were randomly affected to an intervention group that received an 18-month meditation-based program or to comparison groups (active control group i.e. non-native language training or passive control group i.e. no intervention). The main outcome was change in the Framingham Risk Score (FRS); other outcomes were changes in cardiovascular and metabolic risk factors.

Results: There was no difference in FRS change after 18 months between trial arms (p = .38). When assessing individual cardiovascular or metabolic risk factors, meditation training was associated with a greater reduction in diastolic blood pressure than the comparison group in participants with intermediate to high cardiovascular risk (FRS > 10%) at baseline (p = .03).

Conclusion: An 18-month meditation training was not effective to increase overall cardiovascular health in older adults, but improved diastolic blood pressure in a subgroup analysis including at-risk participants. These results suggest a potential benefit of a long-term meditation intervention in older adults at-risk of cardiovascular diseases, and highlights the need for future research in more targeted populations.

Trial registration: ClinicalTrials.gov Identifier: NCT02977819.

Background: Research to date suggests that frailty is higher in women and is associated with functional difficulty. This study builds on the evidence by examining the association between frailty and functional difficulty between low- and higher-income groups and between older men and women in these income groups.

Methods: This study adopted a cross-sectional design that complied with the STROBE checklist and included steps against confounding and common methods bias. The population was community-dwelling older adults aged 50 years or older in two urban neighbourhoods in Accra, Ghana. Participants were either in the low-income group in a low socioeconomic neighbourhood (n = 704) or the higher-income group in a high socioeconomic neighbourhood (n = 510). The minimum sample necessary was calculated, and the hierarchical linear regression analysis was utilised to analyse the data.

Results: Frailty was positively associated with functional difficulty in the low- and higher-income samples, but this association was stronger in the higher-income sample. Frailty was positively associated with frailty in men and women within the low- and higher-income samples.

Conclusion: The association of frailty with functional difficulty was consistent between low- and higher-income samples, although the strength of the relationship differed between these samples. In both income samples, the foregoing relationship was consistent between men and women, although the strength of the relationship differed between men and women.

Background: Regular dental l check-ups and good oral hygiene are challenging for nursing home residents, resulting in poor oral health. The interRAI instrument for Long-Term Care Facilities (LTCF) enables caregivers to evaluate residents' health, including oral health, and to integrate oral care into general care planning. Because the current oral heal1th section in the interRAI instruments does not accurately identify residents who need help with daily oral care or dental referral, the interRAI Oral Health Section (OHS-interRAI) was developed. The OHS-interRAI differs from the current section by including more items, response options and guidelines, photographs, instruction videos, and Collaborative Action Points to alert caregivers when oral care is needed. This study describes and compares residents' oral health status assessed by caregivers using the current section and the OHS-interRAI.

Methods: This cross-sectional study includes baseline data of adults aged 65 years or older in Flemish and Dutch nursing homes, collected by professional caregivers (e.g., nurses, nurse aids, therapists). Assessments with the current section dated from October 2016 to January 2023, and with the OHS-interRAI from October 2020 to January 2023.

Results: InterRAI assessments of 12,476 residents from 158 nursing homes with the current section were compared with those of 1212 residents from 37 nursing homes with the OHS-interRAI. The OHS-interRAI assessments showed more missing data. A higher proportion of oral health problems was detected with the OHS-interRAI compared to the current section for chewing function (13.7% vs. 6.8%), dry mouth (9.8% vs. 7.6%), teeth (22.1% vs. 16.6% ),and gums (7.8% vs. 3.1%). There was no significant difference in the proportion of residents with discomfort or pain in the mouth.

Conclusions: More missing OHS-interRAI data may be attributed to regulatory decisions on using the interRAI LTCF instrument. Caregivers identified more oral health problems with the OHS-interRAI, which may be due to its additional features, such as photographs and extensive instructions. The Collaborative Action Points included in the OHS-interRAI support continuity of care and enable integration of oral care into general care. Further research is needed to evaluate whether the OHS-interRAI accurately identifies residents who need help with daily oral hygiene or dental referral.

Background: Choline alfoscerate, a cholinergic precursor with limited evidence of efficacy in dementia management, has been used for various cognitive impairments in Korea. Partly due to its insurance coverage, this agent appears to incur significant expense for the insurance system. Thus, we aimed to describe choline alfoscerate prescription patterns and analyze their long-term effects in an older adult cohort with dementia.

Methods: This observational study used the National Health Insurance Service Senior Cohort Dataset. Choline alfoscerate -naïve patients who were diagnosed with dementia between 2003 and 2014 with at least 12 months of follow-up were selected. Time-dependent Cox regression was employed to estimate the association between drug exposure and the risk of treatment failure events.

Results: There were 11,463 eligible participants, of whom approximately 73% were female, and 19% had been exposed to choline alfoscerate. According to the main regression survival analysis, the association between longitudinal choline alfoscerate use and the risk of progression events related to treatment failure was unclear. However, a significant decrease of nearly 20% in the risk of all-cause mortality was associated with choline alfoscerate exposure, and a slight reduction in progression regarding treatment failure was observed with CA use only during the early stages of diagnosis. Age, sex, insurance premiums, several comorbidities and concurrent medications were significantly associated with the probability of the events according to the multivariate models.

Conclusions: Further analyses are needed to confirm the early-stage and long-term effectiveness of choline alfoscerate in specific populations, which will help in considering its reimbursement.