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Standing balance test for fall prediction in older adults: a 6-month longitudinal study. 预测老年人跌倒的站立平衡测试:一项为期 6 个月的纵向研究。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05380-9
Daniela Cristina Carvalho de Abreu, Anne Caroline Lima Bandeira, Paola Errera Magnani, Douglas Augusto de Oliveira Grigoletto, José Roberto de Faria Junior, Vitor Roberto Sanchez Teixeira, Victoria Message Fuentes, Roberta de Matos Brunelli Braghin

Background: A core component of older adult health care assessment includes identifying fall risk, which also includes identifying those with subtle balance deficits.

Objective: To compare body displacement of the Center of Pressure (CoP) and time held during the balance test. Also, to examine whether balance tests at baseline can predict falls after 6 months.

Methods: A longitudinal study with 153 community-dwelling older adults, between 60-89 years old. Anteroposterior (AP) and mediolateral (ML) amplitude and velocity CoP displacements were assessed in four upright positions using a force platform: double-leg, semi-tandem, tandem, and single-leg stances, with a maximum duration of 30 s each. Adjusted repeated measures ANOVA were used to compare the differences among the balance positions. Comparisons between males and females were also conducted. Logistic regression adjusted for confounders was performed to verify whether upright balance tests can predict future falls.

Results: As the base of support narrows, body sway increases. A decrease in stance time was observed across the balance stages, i.e., double-leg/semi-tandem versus tandem versus single-leg stances. The mean duration held in the single-leg stance was 14.8 s and for tandem was 22.2 s. Similar stance durations were observed for double-leg and semi-tandem stances. Males were able to maintain balance positions longer than females even with greater CoP displacement. ML amplitude of CoP displacement and the time held during tandem and single-leg positions were able to predict falls after 6 months (p < 0.05).

Conclusion: In clinical practice in which only stance time is recorded, it is possible to interchangeably use the double-leg or semi-tandem stance. To identify early signs of imbalance, we suggest setting a time limit for the balance test equal to or greater than 23 s, as 10 s appear to be insufficient to detect subtle balance deficits. The time maintenance on tandem and single-leg positions was able to predict future falls.

背景:老年人健康护理评估的核心内容包括识别跌倒风险,其中也包括识别那些存在微妙平衡障碍的老年人:老年人医疗保健评估的核心内容之一是识别跌倒风险,其中也包括识别那些存在细微平衡缺陷的人:目的:比较压力中心(CoP)的身体位移和平衡测试中的保持时间。同时,研究基线平衡测试能否预测 6 个月后的跌倒情况:方法:对 153 名 60-89 岁的社区老年人进行纵向研究。在四种直立姿势下,使用测力平台评估前后(AP)和内外侧(ML)CoP位移的幅度和速度:双腿、半串联、串联和单腿站立,每种姿势的最长持续时间为30秒。调整后的重复测量方差分析用于比较不同平衡姿势之间的差异。此外,还对男性和女性进行了比较。为验证直立平衡测试能否预测未来的跌倒,还对混杂因素进行了逻辑回归调整:结果:随着支撑基点的缩小,身体摇摆增加。在各平衡阶段,即双腿/半串联与串联与单腿站立阶段,观察到站立时间减少。单腿站立的平均持续时间为 14.8 秒,双腿站立的平均持续时间为 22.2 秒。即使CoP位移较大,男性保持平衡姿势的时间也比女性长。CoP位移的ML幅度以及双腿和单腿姿势时的保持时间能够预测6个月后的跌倒情况(P 结论:在临床实践中,仅用站立时间来预测跌倒情况是不准确的:在只记录站立时间的临床实践中,可以交替使用双腿站立或半双腿站立。为了识别失衡的早期迹象,我们建议将平衡测试的时间限制设定为等于或大于 23 秒,因为 10 秒似乎不足以发现细微的平衡缺陷。双腿和单腿姿势的时间维持能够预测未来的跌倒。
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引用次数: 0
Eosinophilic gastrointestinal diseases with overall gastrointestinal tract causing liver abscess in an older patient: a case report and literature review. 一名老年患者因嗜酸性粒细胞性胃肠道疾病引起肝脓肿:病例报告和文献综述。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05541-w
Yifan Ke, Yi Jiang, Yuping Yuan, Yihan Chen, Jianbin Huang, Chunwei Huang

Background: Eosinophilic gastrointestinal diseases are the rare gastrointestinal disorders. To our knowledge, there have been no reports of eosinophilic gastrointestinal diseases with overall gastrointestinal tract involvement causing liver abscess in an older patient.

Case presentation: We report a 68-year-old man with eosinophilic gastrointestinal disease with overall gastrointestinal tract involvement. He was admitted with suspected acute gastroenteritis, and histological examination showed eosinophilic infiltration accompanied by liver abscess. The collected pus was tested for Metagenomics Next-Generation Sequencing and confirmed the presence of Klebsiella pneumoniae.

Conclusions: We conducted a literature review on the complications of eosinophilic gastrointestinal diseases and discussed how eosinophilic gastrointestinal diseases lead to liver abscess caused by Klebsiella pneumoniae.

背景:嗜酸性粒细胞胃肠病是一种罕见的胃肠道疾病。据我们所知,还没有关于嗜酸性粒细胞胃肠病累及整个胃肠道并导致老年患者肝脓肿的报道:我们报告了一名患有嗜酸性粒细胞胃肠病并累及整个胃肠道的 68 岁男性患者。他因疑似急性胃肠炎入院,组织学检查显示嗜酸性粒细胞浸润并伴有肝脓肿。对收集的脓液进行了元基因组学新一代测序,证实了肺炎克雷伯菌的存在:我们对嗜酸性粒细胞性胃肠道疾病的并发症进行了文献综述,并讨论了嗜酸性粒细胞性胃肠道疾病如何导致肺炎克雷伯菌引起肝脓肿。
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引用次数: 0
Factors associated with eating performance in nursing home residents living with dementia and other comorbidities. 与患有痴呆症和其他合并症的养老院住户饮食表现相关的因素。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05540-x
Wen Liu, Kyuri Lee, Elizabeth Galik, Barbara Resnick

Background: Eating performance is the functional ability to get food into the mouth and chew/swallow it. Nursing home residents with dementia commonly experience compromised eating performance and subsequent consequences. Prior work examined the association between resident eating performance and their cognitive and functional ability. Yet, the associations between resident eating performance and behavioral and psychological symptoms, psychotropic medication use, and comorbidities are less studied. This study aimed to examine the association between eating performance and cognition, functional ability, behavioral and psychological symptoms, psychotropic medication use, and comorbidities in nursing home residents with dementia.

Methods: This was a secondary analysis using baseline data from two randomized controlled trials, testing the impact of Function Focused Care on function and behavioral symptoms in 882 residents with moderate-to-severe dementia (mean age 86.55 years, 71% female, 30% non-white, 68.5% severe dementia) from 67 nursing homes in two states between 2014 and 2020. Eating performance (dependent variable) was measured using the single self-feeding item of Barthel Index. Independent variables included cognitive impairment, functional ability (Barthel Index total score excluding the self-feeding item score), behavioral and psychological symptoms (agitation, depression, resistiveness-to-care), psychotropic medication use (anti-depression, sedative, anti-psychotics, anti-seizure, anti-anxiety), and comorbidities.

Results: Nearly 39% of residents were dependent in eating. On average, residents had five documented comorbidities (SD = 3.06, range = 0-12) and were on approximately one psychotropic medication (SD = 1.25, range = 0-5). Eating performance was associated with cognitive impairment (OR = 0.53, 95% CI = 0.35, 0.79, p = .002), functional ability (OR = 1.05, 95% CI = 1.04, 1.06, p < .001), depressive symptoms (OR = 0.94, 95% CI = 0.89, 0.98, p = .007), and anxiolytic use (OR = 0.64, 95% CI = 0.42, 0.99, p = .046).

Conclusions: Findings supported that better eating performance was associated with less cognitive impairment, higher functional ability, fewer depressive symptoms, and less anxiolytic use. Targeted interventions to accommodate to cognitive function, optimize functional ability, minimize anxiolytic use, and manage depressive symptoms are encouraged to support eating performance in residents with dementia.

背景:进食能力是指将食物送入口中并咀嚼/吞咽的功能能力。患有痴呆症的疗养院住户通常会出现进食能力下降的情况,并由此产生后果。先前的研究工作探讨了居民进食表现与其认知和功能能力之间的关系。然而,关于住户进食表现与行为和心理症状、精神药物使用以及合并症之间的关系的研究却较少。本研究旨在探讨老年痴呆症患者的饮食表现与认知、功能、行为和心理症状、精神药物使用以及合并症之间的关系:这是一项二次分析,使用了两项随机对照试验的基线数据,测试了功能聚焦护理对中重度痴呆症患者(平均年龄86.55岁,71%为女性,30%为非白人,68.5%为重度痴呆症患者)的功能和行为症状的影响,这些患者来自两个州的67家养老院,时间跨度为2014年至2020年。进食表现(因变量)采用巴特尔指数(Barthel Index)的单一自我喂养项目进行测量。自变量包括认知障碍、功能能力(Barthel 指数总分,不包括自我进食项目得分)、行为和心理症状(躁动、抑郁、抗拒护理)、精神药物使用(抗抑郁、镇静、抗精神病、抗癫痫、抗焦虑)和合并症:近 39% 的住院患者有进食依赖。住院患者平均有五种有记录的合并症(SD = 3.06,范围 = 0-12),并服用约一种精神药物(SD = 1.25,范围 = 0-5)。饮食表现与认知障碍(OR = 0.53,95% CI = 0.35,0.79,p = .002)、功能能力(OR = 1.05,95% CI = 1.04,1.06,p 结论:饮食表现与认知障碍和功能能力有关:研究结果表明,较好的饮食表现与较少的认知障碍、较高的功能能力、较少的抑郁症状和较少的抗焦虑药使用有关。我们鼓励采取有针对性的干预措施,以适应痴呆症患者的认知功能、优化其功能能力、减少抗焦虑药的使用并控制抑郁症状,从而为其饮食表现提供支持。
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引用次数: 0
Mortality in patients older than 65 years undergoing surgery for degenerative lumbar spine disease: a comparison with the general population. 65 岁以上接受腰椎退行性疾病手术患者的死亡率:与普通人群的比较。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05533-w
Raquel Gutiérrez-González, Marta Macarrón, Ana Royuela, Alberto Vallejo-Plaza, Alvaro Zamarron

Background: The increased life expectancy and prevalence of spondylarthrosis have led to a growing frequency of spinal surgery in older people. This study aims to assess whether there is an excess mortality concerning that expected in the general population associated with surgical procedures performed in patients over 65 years old for a degenerative disease of the lumbar spine.

Methods: All patients aged 65 years or older undergoing surgery at a single center between 2009 and 2019 for lumbar spine degenerative disease were included. Standardized mortality ratios (SMRs) were estimated to compare the mortality risk with the expected in the Spanish population for the same age, gender, and calendar-period. Multivariable Cox analysis was employed to determine risk factors of mortality.

Results: A total of 411 procedures were analyzed. The mean age was 72.6 years old. SMR was 0.67 (CI 95% 0.54-0.84). That benefit was significant in women after gender stratification. Patients operated on between 65-84 years old had a lower mortality rate than that expected for the general population. For patients aged 85 or older, the observed mortality was not different from that expected in the general population. Multivariable Cox analysis observed an association between higher mortality and the variables age, male, and Charlson comorbidity index score.

Conclusions: Compared with the general population, patients over 65 years old who underwent spinal surgery for degenerative disease of the lumbar spine experienced a reduction in mortality. This effect was particularly significant in women and patients aged 65-84 years. Age, male gender, and Charlson comorbidity index score were associated with higher mortality risk.

背景:随着预期寿命的延长和脊柱关节病发病率的增加,老年人接受脊柱手术的频率也越来越高。本研究旨在评估65岁以上患者因腰椎退行性疾病接受手术治疗时,死亡率是否高于普通人群:方法:纳入2009年至2019年期间在一个中心接受腰椎退行性疾病手术的所有65岁或以上患者。通过估算标准化死亡率(SMRs),将死亡率风险与西班牙相同年龄、性别和日历期人群的预期死亡率风险进行比较。采用多变量考克斯分析法确定死亡率的风险因素:结果:共分析了 411 例手术。平均年龄为 72.6 岁。SMR为0.67(CI 95% 0.54-0.84)。在对性别进行分层后,女性患者的获益明显。65-84 岁手术患者的死亡率低于普通人群。对于 85 岁或以上的患者,观察到的死亡率与普通人群的预期死亡率没有差异。多变量考克斯分析发现,死亡率较高与年龄、男性和夏尔森合并症指数评分等变量有关:与普通人群相比,65岁以上接受脊柱手术治疗腰椎退行性疾病的患者死亡率有所下降。这一效果在女性和65-84岁的患者中尤为明显。年龄、男性和夏尔森合并症指数评分与较高的死亡风险有关。
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引用次数: 0
Facilitating the transition from hospital to home after hip fracture surgery: a qualitative study from the HIP HELPER trial. 促进髋部骨折手术后从医院到家庭的过渡:HIP HELPER 试验的定性研究。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05390-7
A Welsh, S Hanson, K Pfeiffer, R Khoury, A Clark, K Grant, P-A Ashford, S Hopewell, P A Logan, M Crotty, M L Costa, S E Lamb, T O Smith

Background: People post-hip fracture have reported experiences of fragmented care and poor discharge planning, therefore improvements in patient flow are required. This study reports the challenges people face during the discharge process and offers potential solutions for improving the transition from hospital to home from the perspectives of patients, carers, and health professionals.

Methods: This was a qualitative study embedded within a multi-centre, feasibility randomised controlled trial (HIP HELPER). We undertook semi-structured interviews with 10 patient-carer dyads (10 people with hip fracture; 10 unpaid carers) and eight health professionals (four physiotherapists, two occupational therapists, one nurse and one physiotherapy researcher) between November 2021 and March 2022. Data were analysed using the principles of Framework Analysis.

Results: Participants identified challenges in the transition from hospital to home post-hip fracture surgery: ineffective communication, disjointed systems, untimely services and 'it's more than just the hip'. Possible solutions and insights to facilitate this transition included the need for reassurance, collaborative planning, and individualisation.

Conclusion: The transition from hospital to home following hip fracture surgery can be a challenging experience for patients, and for friends and family who support them as carers, making them feel vulnerable, frustrated and uncertain. Enabling a coordinated, collaborative approach to discharge planning and early recovery provision is considered a positive approach to improving NHS care.

Trial registration: ISRCTN13270387. Registered 29th October 2020.

背景:据报道,髋部骨折后的患者经历了零散的护理和糟糕的出院规划,因此需要改善患者的就医流程。本研究报告了患者在出院过程中面临的挑战,并从患者、护理人员和医疗专业人员的角度提出了改善从医院到家庭过渡的潜在解决方案:这是一项嵌入多中心可行性随机对照试验(HIP HELPER)的定性研究。我们在 2021 年 11 月至 2022 年 3 月期间对 10 个患者-照护者二人组(10 名髋部骨折患者;10 名无偿照护者)和 8 名医疗专业人员(4 名物理治疗师、2 名职业治疗师、1 名护士和 1 名物理治疗研究员)进行了半结构化访谈。我们采用框架分析法的原则对数据进行了分析:结果:参与者指出了髋部骨折术后从医院到家庭的过渡过程中所面临的挑战:沟通不畅、系统脱节、服务不及时以及 "这不仅仅是髋部的问题"。促进这一过渡的可能解决方案和见解包括需要保证、合作规划和个性化:髋部骨折手术后从医院到家中的过渡对于患者以及作为照顾者支持他们的亲朋好友来说可能是一个具有挑战性的经历,会让他们感到脆弱、沮丧和不确定。采用协调合作的方式制定出院计划和提供早期康复服务被认为是改善国民保健服务的积极方法:试验注册:ISRCTN13270387。注册日期:2020 年 10 月 29 日。
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引用次数: 0
The relationship and heterogeneity of family participation and social participation among older adults: from an intersectionality perspective. 老年人的家庭参与和社会参与之间的关系和异质性:从交叉性的角度。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-15 DOI: 10.1186/s12877-024-05545-6
Yan Liu

Participation in late life has been studied as a component of active aging. To effectively promote late-life participation, the study explored the relationship and heterogeneity between two forms of participation among older adults-familial participation and societal participation. This paper utilizes data from the 2020 China Longitudinal Aging Society Survey (CLASS) to examine the relationship between familial participation and societal participation among older Chinese adults. Linear regression results indicate that familial participation can facilitate societal participation among older adults. The MAIHDA model results suggest variations in familial and societal participation among older adults in different social positions. Specifically, older women with higher socioeconomic status and better health have higher levels of familial and societal participation, whereas older men with lower socioeconomic status and health have the lowest levels of participation. Socioeconomic status is the most significant factor contributing to participation disparities among different groups, and older adults with disadvantaged health status experience a compounding effect of multiple disadvantages. The research findings hold significant implications for formulating policies aimed at enhancing the participation of marginalized older adults, ultimately contributing to the realization of active aging.

晚年参与作为积极老龄化的一个组成部分,一直受到研究。为了有效促进晚年参与,研究探讨了老年人两种参与形式--家庭参与和社会参与之间的关系和异质性。本文利用 2020 年中国老龄社会纵向调查(CLASS)的数据,研究了中国老年人家庭参与和社会参与之间的关系。线性回归结果表明,家庭参与能够促进老年人的社会参与。MAIHDA 模型结果表明,不同社会地位的老年人在家庭和社会参与方面存在差异。具体来说,社会经济地位较高、健康状况较好的老年妇女的家庭和社会参与程度较高,而社会经济地位较低、健康状况较差的老年男性的参与程度最低。社会经济地位是造成不同群体之间参与差异的最重要因素,而健康状况较差的老年人则经历了多重不利因素的复合效应。研究结果对制定旨在提高边缘化老年人参与度的政策具有重要意义,最终有助于实现积极老龄化。
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引用次数: 0
Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial. 为居家老年人提供广泛的综合居家服务(WISH):随机鼓励试验的研究方案。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12877-024-05532-x
Chang-O Kim, Taehoon Lee, Ahreum Choi, Eunhee Choi, Haesong Kim, Jakyung Lee, Jongwon Hong, Daehoon Song, Hyejin Jung, Jiyoung Park, Jonghee Kim, Hyejin Lee, Soong-Nang Jang

Background: Home-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults.

Methods: The study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods.

Discussion: This study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries.

Trial registration: CRIS KCT0007921.

背景:居家初级保健(HBPC)是一种新兴的以患者为中心的跨专业医疗保健服务模式,可以解决居家老年人未得到满足的医疗需求和护理负担。2022 年 12 月,韩国保健福祉部启动了家庭医疗中心示范项目,为医生上门服务提供新的捆绑支付方式。在本研究中,我们试图确定韩国最近推出的 HBPC 服务是否与减少居家老年人入住长期护理(LTC)机构和急性住院有关:该研究是一项基于社区、多中心、双臂、随机鼓励设计的试验,随访期为 12 个月(n = 600)。符合条件的研究参与者是居住在社区的多病和功能衰退的长期护理受助者。研究参与者从位于城市地区(首尔东北部、首尔西部、大田、原州和坡州)的五家 HBPC 中心招募。研究参与者以 1:1 的分配比例被随机分配到 HBPC 组或常规护理组。被分配到 HBPC 组的患者将接受跨专业 HBPC 小组根据广泛家庭综合服务(WISH)干预方案进行的每月至少一次的纵向家访。该方案遵循 "老年人综合护理 "原则,要求在微观、中观和宏观层面进行以人为本的评估,并更广泛地整合医疗和长寿护理服务。试验的主要结果是:1)组间社区存活天数;2)组间可能避免的住院治疗。治疗结果采用修正的意向治疗法和平均因果效应分析法进行估算:本研究旨在调查 HBPC 对减少社区环境中长期护理设施入院率和急性病住院率的实际效果。研究结果可为韩国和其他国家扩大 HBPC 服务的医疗政策决策提供参考:试验注册:CRS KCT0007921。
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引用次数: 0
Predicting persistent back pain causing severe interference with daily activities among community-dwelling older adults: the OPAL cohort study. 社区老年人因持续背痛而严重影响日常活动的预测:OPAL 队列研究。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12877-024-05504-1
Esther Williamson, Maria T Sanchez-Santos, Jeremy Fairbank, Lianne Wood, Sarah E Lamb

Background: Many older adults experience disabling back and leg pain. This study aimed to identify factors associated with back pain causing severe interference with daily activities over 2 years.

Methods: Participants were 2,109 community-dwelling adults (aged 65-100 years; mean age 74.2 (SD 6.3)) enrolled in a prospective cohort study who reported back pain at baseline and provided back pain data at 2 years follow-up. Baseline data included demographics, socio-economic factors, back pain presentation and age-associated adverse health states (e.g. frailty, falls, walking confidence). At 2 years follow-up, we asked if they were currently experiencing back pain and if so, asked participants to rate how much their back pain interfered with their daily activities on a scale of 0-10. Severe back pain interference was defined by a rating of 7 or more. The association between baseline factors and severe back pain interference at two years was assessed using logistic regression models.

Results: At two years, 77% of participants (1,611/2,109) still reported back pain, 25% (544/2,083) also reported leg pain and 14% (227/1,611) reported severe back pain interference with activities. Improvements in symptoms were observed over the two years follow-up in 880/2,109 participants (41.7%), 41.2% (869/2,109) of participants report no change and worsening symptoms was reported by 17.1% (360/2109) of participants. After adjusting for back pain troublesomeness at baseline, factors associated with reporting severe interference were adequacy of income (careful with money [OR 1.91; 95% CI 1.19-3.06]; prefer not to say [OR 2.22; 95% CI 1.11-4.43]), low endorsement of exercise in later life (OR 1.18; 95% CI 1.02-1.37), neurogenic claudication symptoms (OR 1.68 (95% CI 1.15-2.46)], multisite pain (OR 1.13; 95% CI 1.02-1.24) and low walking confidence (OR 1.15; 95% CI 1.08-1.22).

Conclusion: After adjusting for baseline pain severity, we identified five factors that were associated with severe pain limitation at two years follow-up among a cohort of community dwelling older people reporting back and leg pain. These included other pain characteristics, walking confidence and attitude to activity in later life. We also identified a socioeconomic factor (perceived adequacy of income). Future research should focus on whether identifying individuals using these risk factors in order to intervene improves back pain outcomes for older people.

背景:许多老年人都经历过致残性背痛和腿痛。本研究旨在确定导致严重干扰日常活动的背痛的相关因素:参加前瞻性队列研究的 2,109 名居住在社区的成年人(年龄在 65-100 岁之间,平均年龄为 74.2 岁(标准差为 6.3))在基线时报告了背痛,并在随访 2 年时提供了背痛数据。基线数据包括人口统计学、社会经济因素、背痛表现和与年龄相关的不良健康状况(如虚弱、跌倒、行走信心)。在 2 年的随访中,我们询问参与者目前是否有背痛症状,如果有,则要求参与者对背痛对其日常活动的干扰程度进行评分,评分标准为 0-10 分。严重背痛干扰度为 7 分或以上。使用逻辑回归模型评估了基线因素与两年后严重背痛干扰之间的关系:两年后,77% 的参与者(1,611/2,109 人)仍报告背痛,25% 的参与者(544/2,083 人)报告腿痛,14% 的参与者(227/1,611 人)报告背痛严重干扰活动。在两年的随访中,有 880/2,109 名参与者(41.7%)的症状有所改善,41.2% 的参与者(869/2,109)报告症状没有变化,17.1% 的参与者(360/2,109)报告症状恶化。43])、对晚年锻炼认可度低(OR 1.18;95% CI 1.02-1.37)、神经源性跛行症状(OR 1.68(95% CI 1.15-2.46)]、多部位疼痛(OR 1.13;95% CI 1.02-1.24)和行走信心不足(OR 1.15;95% CI 1.08-1.22):在对基线疼痛严重程度进行调整后,我们在一群报告腰腿痛的社区老年人中发现了与两年随访时严重疼痛受限相关的五个因素。这些因素包括其他疼痛特征、行走信心和对晚年生活活动的态度。我们还发现了一个社会经济因素(认为收入充足)。未来的研究应侧重于识别使用这些风险因素的个体,以便进行干预,从而改善老年人背痛的治疗效果。
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引用次数: 0
Development of a machine learning-based risk assessment model for loneliness among elderly Chinese: a cross-sectional study based on Chinese longitudinal healthy longevity survey. 基于机器学习的中国老年人孤独风险评估模型的开发:一项基于中国健康长寿纵向调查的横断面研究。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12877-024-05443-x
Youbei Lin, Chuang Li, Xiuli Wang, Hongyu Li

Background: Loneliness is prevalent among the elderly and has intensified due to global aging trends. It adversely affects both mental and physical health. Traditional scales for measuring loneliness may yield biased results due to varying definitions. The advancements in machine learning offer new opportunities for improving the measurement and assessment of loneliness through the development of risk assessment models.

Methods: Data from the 2018 Chinese Longitudinal Healthy Longevity Survey, involving about 16,000 participants aged ≥ 65 years, were used. The study examined the relationships between loneliness and factors such as functional limitations, living conditions, environmental influences, age-related health issues, and health behaviors. Using R 4.4.1, seven assessment models were developed: logistic regression, ridge regression, support vector machines, K-nearest neighbors, decision trees, random forests, and multi-layer perceptron. Models were evaluated based on ROC curves, accuracy, precision, recall, F1 scores, and AUC.

Results: Loneliness prevalence among elderly Chinese was 23.4%. Analysis identified 15 evaluative factors and evaluated seven models. Multi-layer perceptron stands out for its strong nonlinear mapping capability and adaptability to complex data, making it one of the most effective models for assessing loneliness risk.

Conclusion: The study found a 23.4% prevalence of loneliness among elderly individuals in China. SHAP values indicated that marital status has the strongest evaluative value across all forecasting periods. Specifically, elderly individuals who are never married, widowed, divorced, or separated are more likely to experience loneliness compared to their married counterparts.

背景:孤独感在老年人中十分普遍,并且由于全球老龄化趋势而愈演愈烈。它对身心健康都有不利影响。由于定义不同,传统的孤独感测量量表可能会得出有偏差的结果。机器学习的进步为通过开发风险评估模型来改进孤独感的测量和评估提供了新的机遇:研究使用了2018年中国健康长寿纵向调查的数据,涉及约16000名年龄≥65岁的参与者。研究考察了孤独感与功能限制、生活条件、环境影响、年龄相关健康问题和健康行为等因素之间的关系。使用 R 4.4.1 开发了七个评估模型:逻辑回归、脊回归、支持向量机、K-近邻、决策树、随机森林和多层感知器。根据 ROC 曲线、准确率、精确率、召回率、F1 分数和 AUC 对模型进行了评估:结果:中国老年人的孤独感发生率为 23.4%。分析确定了 15 个评价因素,并对 7 个模型进行了评估。多层感知器因其强大的非线性映射能力和对复杂数据的适应性而脱颖而出,成为评估孤独风险最有效的模型之一:研究发现,中国老年人的孤独感发生率为 23.4%。SHAP值表明,婚姻状况在所有预测期内都具有最强的评估价值。具体而言,与已婚老人相比,从未结婚、丧偶、离婚或分居的老人更容易感到孤独。
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引用次数: 0
Association between life's essential 8 and cognitive impairment in older patients: results from NHANES 2011-2014. 生活必需品 8 与老年患者认知障碍之间的关系:2011-2014 年美国国家健康调查(NHANES)结果。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12877-024-05547-4
Hui Wang, Sensen Wu, Dikang Pan, Yachan Ning, Cong Wang, Jianming Guo, Yongquan Gu

Background: This study aimed to examine the association between the American Heart Association's (AHA) newly revised Life's Essential 8 (LE8) algorithm, designed for assessing cardiovascular health (CVH), and cognitive impairment among older adults in the United States.

Methods: This study employed a cross-sectional design, utilizing data from the 2011-2014 National Health and Nutrition Examination Survey to explore the relationship between CVH and cognitive impairment in older adults. CVH scores are assessed based on the AHA definition of the LE8, categorized into three tiers: low (0-49), medium (50-79), and high (80-100). Cognitive impairment is evaluated using three distinct scoring systems: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The lowest quartile as the cut-off point; below or equal to the lower quartile was considered as low cognitive population, and above the lower quartile was normal population. To analyze the association, multivariable logistic regression and restricted cubic spline (RCS) models were employed.

Results: A significant negative correlation exists between the LE8 and cognitive impairment. After adjusting for multiple variables, the odds ratios (OR) for cognitive impairment, as measured by the CERAD, AFT, and DSST, were compared between patients with high and low CVH. The results indicated OR values of 0.60 (95% CI: 0.36-0.98), 0.72 (95% CI: 0.52-0.97), and 0.29 (95% CI: 0.16-0.53) for the CERAD, AFT, and DSST, respectively. Additionally, the RCS curve demonstrated a significant linear relationship between lifestyle factors encapsulated by the LE8 and cognitive impairment.

Conclusions: The findings indicate higher adherence to LE8 was associated with lower odds of cognitive impairment. Furthermore, maintaining optimal CVH is crucial in preventing cognitive impairment.

研究背景本研究旨在探讨美国心脏协会(AHA)新修订的用于评估心血管健康(CVH)的 "生命必备 8 要素"(LE8)算法与美国老年人认知障碍之间的关系:本研究采用横断面设计,利用 2011-2014 年全国健康与营养调查的数据来探讨老年人心血管健康与认知障碍之间的关系。CVH评分根据美国心脏协会对LE8的定义进行评估,分为三个等级:低(0-49)、中(50-79)和高(80-100)。认知障碍采用三种不同的评分系统进行评估:建立阿尔茨海默病登记联盟(CERAD)、动物流畅性测试(AFT)和数字符号替换测试(DSST)。以最低四分位数为分界点,低于或等于最低四分位数为低认知人群,高于最低四分位数为正常人群。为了分析两者之间的关联,采用了多变量逻辑回归和限制性立方样条(RCS)模型:结果:LE8与认知障碍之间存在明显的负相关。在对多个变量进行调整后,比较了高 CVH 患者和低 CVH 患者的认知功能障碍几率比(OR),CERAD、AFT 和 DSST 均对认知功能障碍进行了测量。结果显示,CERAD、AFT 和 DSST 的 OR 值分别为 0.60(95% CI:0.36-0.98)、0.72(95% CI:0.52-0.97)和 0.29(95% CI:0.16-0.53)。此外,RCS 曲线显示,LE8 所包含的生活方式因素与认知障碍之间存在显著的线性关系:结论:研究结果表明,较高的 LE8 坚持率与较低的认知障碍几率相关。此外,保持最佳的 CVH 对预防认知障碍至关重要。
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引用次数: 0
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BMC Geriatrics
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