BMC Geriatrics最新文献

Background: Sarcopenia, gait disturbance, and intradialytic hypotension are among the various factors that contribute to fall risk. This study aimed to investigate the relationship between risk of sarcopenia, hemodialysis (HD) session, and long-term fall risk in older end-stage kidney disease (ESKD) patients by analyzing their spatiotemporal gait characteristics.

Methods: We recruited 22 non-demented patients aged ≥ 65 years who were undergoing maintenance HD. Participants were divided into two groups based on their SARC-F score (< 4 and ≥ 4) to identify those with higher and lower risk of sarcopenia. Demographics, comorbidities, and renal parameters were compared between groups. Inertial measurement unit-based technology equipped with triaxial accelerometry and gyroscope was used to evaluate gait characteristics. The gait task was assessed both before and after dialysis using the Timed-Up and Go (TUG) test and a 10-meter walking test at a regular pace. Essential gait parameters were thoroughly analyzed, including gait speed, stride time, stride length, double-support phase, stability, and symmetry. We investigated the interaction between the dialysis procedure and gait components. Outcome of interest was any occurrence of injurious fall during follow-up period. Logistic regression models were employed to examine the relationship between baseline gait markers and long-term fall risk.

Results: The SARC-F ≥ 4 group showed various gait abnormalities, including longer TUG time, slower gait speed, longer stride time, shorter stride length, and longer double support time compared to counterpart (SARC-F < 4). After HD sessions, the SARC-F ≥ 4 group showed a 2.0-second decrease in TUG task time, an 8.0 cm/s increase in gait speed, an 11.6% lower stride time, and a 2.4% increase in gait symmetry with significant group-time interactions. Shorter stride length and longer double support time were associated with injurious falls during the two-year follow-up.

Conclusion: Our study demonstrated the utility of triaxial accelerometers in extracting gait characteristics in older HD patients. High-risk sarcopenia (SARC-F ≥ 4) was associated with various gait abnormalities, some of which partially improved after HD sessions. These gait abnormalities were predictive of future falls, highlighting their prognostic significance.

Background: Proximity to parks has been suggested as a factor influencing physical activity in older adults. However, it remains unclear the optimal distance between residences and parks for promoting physical activity and reducing sedentary time and whether these associations vary by the time of day. We examined whether the proximity to neighbourhood parks at varying distances is associated with all-day and time-specific physical activity and sedentary behaviour in older adults.

Methods: Data were collected from 214 older adults receiving hospital services in Taipei, Taiwan. The number of parks within 400m, 800m, and 1,600m of participants' residences. Physical activity and sedentary behaviour, stratified by time of day (morning, afternoon, and evening), were measured using accelerometers. Adjusted linear regression models were used to estimate associations of park proximity with activity and sedentary outcomes.

Results: Parks located within 400m and 800m of participants' residences were more markedly associated with longer time in physical activity and less sedentary time compared to parks located 1,600m away. A greater number of parks within 400m and 800m was positively associated with walking steps and light-intensity physical activity while both distances were negatively associated with sedentary time. The associations between park proximity and behavioural outcomes were mainly attributable to that during the afternoon and evening.

Conclusions: Our findings suggest that favourable access to parks within 800m of older adults' residences is associated with more physical activity and less sedentary time, particularly during the afternoon and evening. Future longitudinal studies are required to corroborate these associations.

Background: As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical.

Objective: To investigate the factors associated with a high level of suicide risk among patients with LLD.

Methods: A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses' Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD.

Results: The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD.

Conclusion: This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization.

Background: As one of the key features of sleep, sleep duration (SD) has been confirmed to be associated with multiple health outcomes. However, the link between SD and cognitive function (CF) is still not well understood.

Methods: We employed a combined approach utilizing data from the National Health and Nutrition Examination Survey (NHANES 2011-2014) and Mendelian Randomization (MR) methods to investigate the relationship between SD and CF. In the NHANES cross-sectional analysis, the association between these variables was primarily examined through multivariate linear regression to explore direct correlations and utilized smoothing curve fitting to assess potential nonlinear relationships. To ensure the robustness of our findings, subgroup analyses were also conducted. MR analysis was used to assess the causal relationship between SD and sleeplessness on CF. After excluding confounding factors, univariate and multivariate MR were performed using inverse variance weighting (IVW) as the main analysis method, and sensitivity analysis was performed.

Results: The results of our cross-sectional study indicate a notable negative association between SD and CF, forming an inverted U-shaped curve with the inflection point occurring at SD = 6 h. This relationship remains consistent and robust across subgroup analyses differentiated by variables such as age, levels of physical activity, and frequency of alcohol intake. In MR analysis, IVW analysis showed no causal relationship between SD and sleeplessness on CF (Both P > 0.05).

Conclusion: Cross-sectional studies suggest the existence of an inverted U-shaped correlation between SD and CF among the elderly. However, MR analysis did not reveal a causal relationship between SD and CF, which the lack of nonlinear MR analysis may limit. These findings provide evidence from a sleep perspective for optimizing cognitive strategies in older adults.

Background: Sarcopenia is typically assessed through hand grip strength, walking speed, and chair stand tests. However, it has been inadequately examined in terms of other physical fitness (PF) components in community-dwelling older adults. Thus, in this study, we explored factors influencing the risk of sarcopenia in community-dwelling older adults. In addition, we analyzed the clinicodemographic characteristics of older adults with or without sarcopenia and investigated the effect of sex on their PF.

Methods: This cross-sectional study included 745 older adults from a community health promotion program in Taiwan. Their clinicodemographic characteristics were recorded. PF was assessed through various tests, such as hand grip strength evaluation, 8-foot up-and-go test (8-UGT), 2-min step test, and 6-m walk test. PF and factors influencing sarcopenia risk were compared between older adults with sarcopenia (sarcopenia group) and those without it (nonsarcopenia group). A logistic regression model was performed to identify key factors associated with sarcopenia. Its predictive performance was evaluated by calculating the area under the receiver operating characteristic curve (ROC) curve.

Results: Regardless of sex, the sarcopenia group performed worse in almost all components of PF-for example, upper and lower limb muscular strength and endurance, cardiopulmonary fitness, and balance-than did the nonsarcopenia group. However, for men, no significant between-group difference was observed in flexibility. The logistic regression model indicated age (odds ratio [OR]: 1.107), sex (OR: 2.881), Mini Nutritional Assessment-Short Form scores (OR: 0.690), and performance in 8-UGT (OR: 1.346) as factors influencing the risk of sarcopenia. The model exhibited excellent discriminative ability in predicting sarcopenia, as indicated by an area under the curve value of 0.867 (95% confidence interval: 0.827-0.906; p < 0.05).

Conclusion: Older adults without sarcopenia tend to outperform those with sarcopenia in almost all PF measures, regardless of sex. Older age, male sex, low Mini Nutritional Assessment-Short Form scores, and poor performance in 8-UGT are associated with a high risk of sarcopenia.

Background: Pericapsular nerve group (PENG) block has emerged as a reliable analgesia technique for hip arthroplasty (HA). However, the effects of PENG block on perioperative neurocognitive disorder (PND) after HA has not yet been assessed. The present study aimed to investigate the effects of PENG block on early postoperative cognitive function in older people undergoing hip arthroplasty.

Methods: Sixty older patients undergoing HA under spinal anesthesia were randomly assigned to group P (n = 30) receiving PENG block with ropivacaine and patient-controlled intravenous analgesia (PCIA) pump with sufentanil after surgery or group C (n = 30) only receiving PCIA pump with sufentanil after surgery. The primary outcome was the Mini-Mental State Examination (MMSE) score at 7 days postoperatively. Secondary outcomes consisted of the incidence of PND 7 days postoperatively, the static VAS pain scores at 6, 12, 24, and 48 h postoperatively; cumulative sufentanil consumption and the requirement of rescue analgesia during the 0-24 h period after surgery; quality of recovery-15 (QoR-15) scale scores at 24 h postoperatively; and the plasma levels of high mobility group box protein 1 (HMGB1) preoperatively and 1 day after surgery, and adverse events.

Results: After surgery, the PENG block group had higher MMSE score than the control group at 7 days postoperatively (27.0 ± 1.8 vs. 26.1 ± 1.7, P = 0.048), with a mean difference of 0.9 (95%CI, 0.1-0.9). The incidence of PND at 7 days postoperatively was 6.7% in group P, lower than that of 30% in group C (P = 0.044). In group P, the static VAS scores at 6, 12, and 24 h postoperatively were significantly lower than those in group C (all P < 0.05). Compared with group C, the cumulative sufentanil consumption and the number of patients required rescue analgesia during the 0-24 h period after surgery were significantly lower in group P (all P < 0.05). The scores of QoR-15 scale were higher in group P at 24 h postoperatively than those in group C (P < 0.05). Patients in group P showed lower plasma levels of HMGB1 than group C at 1 day after surgery (P < 0.05), and the rate of complications didn't differ between both groups.

Conclusions: Older people undergoing HA receiving a PENG block for perioperative analgesia experience improved early postoperative cognitive function, reduced postoperative pain, higher quality of recovery, and less postoperative inflammatory response.

Trial registration: Chictr.org.cn identifier ChiCTR2200061055 (Date of registry: 15/06/2022, prospectively registered).

Background: As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network.

Methods: A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6).

Results: The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC.

Conclusions: Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults.

Background: Although the prevalence of poor oral health among older populations in Australia and the United States is higher, the contribution of ethnicity status is unknown. We aimed to estimate the contribution of social inequalities in oral health among older populations in Australia and the United States.

Methods: Cross-sectional study design using data from Australia's National Survey of Adult Oral Health (NSAOH 2004-06 and 2017-18) and the United States' National Health and Nutrition Examination Survey (NHANES 2003-04 and 2011-16). Participants included in the analysis were aged 65 + years. Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographic (age, sex), socioeconomic position (educational attainment, household income) and dental behaviors (last dental visit) to changes in prevalence of edentulism and non-functional dentition, and mean number of missing teeth by ethnicity status over time in Australia and the United States.

Results: The number of participants aged 65 + years who provided clinical and sociodemographic/dental behaviour data was 1043 and 1269 in NSAOH 2004-06 and 2017-18, and 1372 and 1328 in NHANES 2003-04 and 2011-16 respectively. The prevalence of edentulism was from 13 percent (NHANES 2011-16) to 28 percent (NSAOH 2004-06), while the prevalence of non-functional dentition was from 41 percent (NSAOH 2017-18 and NHANES 2011-16) to 61 percent (NHANES 2003-04). The mean number of missing teeth was from 11 (NSAOH 2017-18) to 18 (NHANES 2003-04). The prevalence of edentulism and non-functional dentition, and the mean number of missing teeth were higher among older Australians identifying as White and the opposite results were observed among older Americans identifying as Non-White. For older adults in Australia, risk factors with the greatest impact on oral health outcomes by ethnicity status were educational attainment and household income. For older adults in the United States, the most dominant risk factor for non-optimal oral health outcomes by ethnicity status was last dental visit.

Conclusions: There are important policy translation implications from our findings, as they indicate that social and structural systems in Australia and the United States operate differently in the context of oral health over time among culturally diverse older citizens. This information will help inform initiatives that both target effective oral health promotion for older, culturally-diverse populations and provide evidence for the distribution of resources in the public dental health setting for this age group and cultural demographic.

Background: Depression is the most common psychiatric disorder in older adults, even though it is commonly misdiagnosed and undertreated, leading to exacerbations of preexisting medical conditions and even a higher mortality rate. In the present systematic review with meta-analysis, we quantify the magnitude of depression and its associated risk factors among the older adult population in Egypt.

Methods: A thorough literature search was performed from 2010 up to October 2023. The results were presented as proportions or risk difference with a 95% confidence interval (CI) calculated using the random effects model. A sensitivity analysis was performed to examine the robustness of the results.

Results: Our study included 14 articles with 5857 older adults published between 2011 and 2023. All the included studies assessed depression in geriatrics using the Geriatric Depression Scale. Of the 14 studies, 5 were for community-dwelling older adults, 3 were for older adults attending primary health care (PHC) centers, 2 were for hospitalized older adults, 3 were for residing in geriatric homes, and one for residing in geriatric homes, hospitalized older adults, and community-dwelling older adults. The overall prevalence of depression among Egyptian geriatrics was 64.6%. The pooled prevalence of depression was 59.6%, 67.0%, 67.0%, and 62.0% for community-dwelling older adults, older adults people attending PHC, hospitalized older adults, and older adults residing in geriatric homes, respectively. Older adults with chronic illness, female sex, and low-income elders and elders who were not employed had a higher risk for depression with pooled risk differences of 34.9%, 17.8%, 23.8%, and 15.1% (P < 0.05), respectively. In contrast, there was no significant difference in risk for depression in the older adults residing in urban areas compared to rural areas, the older adults aged + 70 compared to those less than 70, individuals with low levels of education or who are illiterate compared with those with higher levels of education and the older adults who live alone compared with those living with family.

Conclusion: More than half of the older adults in Egypt suffer from depressive symptoms. Chronic diseases, female sex, unemployment, and low-income inequality are the most significant factors contributing to depression among Egypt's older adults.

Background: The prevalence of hypertension increases with age, and older people with this condition are at increased risk of developing orthostatic hypotension (OH) due to age-related changes in blood pressure regulation mechanisms as well as prescribed medications. OH increases the risk of falls, often with subsequent fractures as well as other morbidity and even mortality. The prevalence and characteristics of OH in older people with hypertension in Low-Income Countries have not been well characterized. This study aims to determine the prevalence of OH and associated factors among older people with hypertension in northern Ethiopia.

Method: A hospital-based cross-sectional study was conducted using a convenience sample of patients aged 60 years and older with hypertension receiving pharmacotherapy and followed up at the University of Gondar Hospital, Ethiopia. Blood pressure (BP) was measured in the supine position, and after 3 min of standing; the level of BP drop (> 20/10) was used to define measured OH. Data regarding symptoms of OH were also collected using the Orthostatic Hypotension Questionnaire (OHQ). The data were entered into Microsoft Excel version 2016 and exported to SPSS version 20 for statistical analysis. Logistic regression analysis was conducted to assess the factors associated with OH.

Results: A total of 240 participants were included, with a mean age of 68.8 ± 7.1 years. The prevalence of OH was 23.8% (CI: 21.5%, 26.1%). Of the medications used, calcium channel blocker (CCBs) treatment was strongly associated with OH (AOR = 2.03[95%CI = 1.08-3.8]). Two-thirds (61.4%) of participants with measured OH experienced relevant symptoms of OH.

Conclusion: There was a high prevalence of OH among older patients with hypertension attending a tertiary care hospital in Gondar, with one in four affected. The use of CCBs was identified as an independent risk factor for OH. Most patients with OH experienced relevant symptoms, so monitoring this condition in this group may help prevent adverse consequences.