BMC Geriatrics最新文献

Objective: Constructing a predictive model for the occurrence of heart disease in elderly hypertensive individuals, aiming to provide early risk identification.

Methods: A total of 934 participants aged 60 and above from the China Health and Retirement Longitudinal Study with a 7-year follow-up (2011-2018) were included. Machine learning methods (logistic regression, XGBoost, DNN) were employed to build a model predicting heart disease risk in hypertensive patients. Model performance was comprehensively assessed using discrimination, calibration, and clinical decision curves.

Results: After a 7-year follow-up of 934 older hypertensive patients, 243 individuals (26.03%) developed heart disease. Older hypertensive patients with baseline comorbid dyslipidemia, chronic pulmonary diseases, arthritis or rheumatic diseases faced a higher risk of future heart disease. Feature selection significantly improved predictive performance compared to the original variable set. The ROC-AUC for logistic regression, XGBoost, and DNN were 0.60 (95% CI: 0.53-0.68), 0.64 (95% CI: 0.57-0.71), and 0.67 (95% CI: 0.60-0.73), respectively, with logistic regression achieving optimal calibration. XGBoost demonstrated the most noticeable clinical benefit as the threshold increased.

Conclusion: Machine learning effectively identifies the risk of heart disease in older hypertensive patients based on data from the CHARLS cohort. The results suggest that older hypertensive patients with comorbid dyslipidemia, chronic pulmonary diseases, and arthritis or rheumatic diseases have a higher risk of developing heart disease. This information could facilitate early risk identification for future heart disease in older hypertensive patients.

Background: The global aging population has increased dynapenia prevalence, leading to mobility issues and poor sleep quality among older adults. Despite its impact, research on sleep quality in dynapenic outpatients is limited. This study investigates how physiological status, community participation, and daily activity function influence sleep quality in this group.

Methods: This cross-sectional study employed purposive sampling to collect data from 192 dynapenic older outpatients in October 2022, assessing their basic attributes, physiological status, community participation, daily activity function, and sleep quality. Data were analyzed using SPSS 25.0 for descriptive statistics, independent samples t-tests, chi-square tests, and logistic regression analysis.

Results: Findings indicated significant correlations between sleep quality and gender (X² = 11.340, p < .001), occupational status (X² = 13.378, p < .05), residence (X² = 6.265, p < .05), medication intake (X² = 7.250, p < .05), smoking history (X² = 6.695, p < .01), instrumental activities of daily living (X² = 12.556, p < .01), activities of daily living (t = 2.74, p < .01), instrumental activities of daily living (t = 3.60, p < .001), skeletal muscle mass (t = 2.94, p < .01), skeletal muscle index (t = 2.65, p < .01), grip strength (t = 3.61, p < .001), and walking speed (t = 2.09, p < .05). Furthermore, the type of occupational status (OR = 6.608, 95% CI = 1.124-3.744, p < .05), medication intake (OR = 3.916, 95% CI = 1.682-9.114, p < .05), and grip strength (OR = 0.891, 95% CI = 0.797-0.996, p < .05) were significant predictors of sleep quality in dynapenic older patients.

Conclusion: This cross-sectional study reveals significant correlations between sleep quality and key factors such as physiological status, community participation, and daily functional activities in older adults with dynapenia. These findings underscore the importance of addressing these determinants to enhance sleep quality in this population.

Objective: This study aims to investigate the influence of social determinants of health (SDoH) on cognitive performance.

Methods: This study surveyed a sample of older adults aged 60 years and older from the 2011-2014 cohort of participants in the U.S. National Health and Nutrition Examination Survey (NHANES). Data were collected during each survey cycle on self-reported domains of SDoH, which included eight subscales: employment, family income-to-poverty ratio, food security, education level, health insurance coverage, type of health insurance, home ownership, and marital status. Cognitive performance was evaluated using three tests: the Digit Symbol Substitution Test (DSST) for processing speed, the Animal Fluency Test (AFT) for executive function, and a subtest from the Coalition to Establish an Alzheimer's Disease Registry (CERAD) for memory. Multifactorial linear regression modeling was employed to explore the association between SDoH and cognitive performance.

Results: A total of 2,819 elderly subjects were included in this study for analysis, with a mean age of 69.14 ± 0.19 years, 54.36% female and 45.64% male. The study found a negative association between the accumulation of unfavorable SDoH factors and cognitive performance. Similarly, certain unfavorable SDoH domains were negatively associated with cognitive performance.

Conclusion: The findings suggest that unfavorable SDoH domains, particularly when unfavorable SDoH factors accumulate, are linked to decreased cognitive performance. Actively investigating the relationship between these factors may be a crucial strategy for delaying dementia onset.

Background: This particular case is a world-first with no previous literature reports on patients presenting with both benign acoustic schwannoma and malignant ependymoma.

Case presentation: A 60-year-old woman with unexplained right-sided hearing loss that had worsened progressively over 4 years, along with intermittent dizziness that had begun 3 years prior. Our preliminary diagnosis included: (1) Right acoustic neuroma; (2) Ependymoma of the fourth ventricle; and (3) Hydrocephalus. We employed the right sigmoid sinus posterior approach combined with the posterior median approach, beginning with removal of the fourth ventricle tumor and then proceeding to acoustic schwannomas resection through rotating operation positions.

Conclusions: The case presented significant challenges owing to: The difficulty encountered in arriving at a diagnosis; The difficulty in choosing a suitable surgical approach; The complexity of the surgical sequence; The intricacy of the surgical process. It's rare, complex, and had excellent surgical results.

Objectives: Freezing of Gait (FOG) is one of the disabling symptoms in patients with Parkinson's Disease (PD). While it is difficult to early detect because of the sporadic occurrence of initial freezing events. Whether the characteristic of gait impairments in PD patients with FOG during the 'interictal' period is different from that in non-FOG patients is still unclear.

Methods: The gait parameters were measured by wearable inertial sensors. Exploratory factor analysis was used to investigate the inherent structure of diverse univariate gait parameters, with the aim of identifying shared characteristics among the gait variables.

Results: This cross-sectional study involved 68 controls and 245 PD patients (167 without FOG and 78 with FOG). The analysis yielded six distinct gait domains which were utilized to describe the impaired gait observed during the "interictal" period of FOG. Both PD-nFOG and PD-FOG groups exhibited significant impairments in the pace domain, kinematic domain, gait phase domain, and turning process domain compared to the healthy control. The gait phase domain was different in the PD-FOG group compared to the PD-nFOG group (p corrected = 0.004, Cohen's d = -0.46). And it was identified as independent risk factor for FOG (OR = 1.64, 95% CI = 1.05-2.55, p = 0.030), as well as other risk factors: gender (OR = 2.67, 95% CI = 1.19-5.99, p = 0.017), MDS-UPDRS IV score (OR = 1.23, 95% CI = 1.10-1.37, p < 0.001), and PIGD subscore (OR = 1.50, 95% CI = 1.30-1.73, p < 0.001). The model demonstrated a correct discrimination rate of 0.78 between PD-FOG and PD-nFOG, with an area under the receiver operating characteristic curve (AUC) of 0.87.

Conclusions: FOG was found to be associated with abnormal alterations in the gait phase domain during the interictal period. Models constructed using gait phase domain, PIGD subscore, gender, and severity of motor complications can better differentiate freezers from no-freezers during 'interictal' period.

Background: Older adults with cancer are vulnerable to declines in muscle performance (e.g., strength, speed, duration of muscular contraction), which are associated with worse cancer-related outcomes. Exercise-based interventions can mitigate these declines, but evidence of their effect among older adults with myeloid malignancies receiving outpatient treatment is limited. We explore change in muscle performance among patients in a single arm pilot study of a mobile health (mHealth) exercise intervention.

Methods: Patients ≥ 60 years old with myeloid malignancies receiving outpatient chemotherapy completed a home-based resistance band and walking exercise program [EXercise for Cancer Patients (EXCAP)©^®] delivered via a mobile application with symptom monitoring [(Geriatric Oncology-EXCAP (GO-EXCAP)] lasting 2 cycles of chemotherapy (approximately 8-12 weeks). Clinical exercise physiologists provided instruction and ongoing support. Upper and lower extremity peak torque (maximum force, newton-meters, Nm), total work (force over entire movement, Nm), and average power (speed of force, watts, W) were assessed using the BIODEX System 4 isokinetic dynamometer. Muscle activation (motor recruitment, millivolts, mV) was captured using the BTS FREEEMG 1000. We report descriptive statistics and within-patient differences from baseline to post-intervention using Wilcoxon signed rank tests (α = 0.10) and effect size (ES, Cohen's d, 0.20 ≤ small < 0.50, large ≥ 0.80), and explore differences by exercise level (resistance exercise, daily steps).

Results: A total of 25 patients completed baseline assessments, 23 with muscle performance data at baseline, 16 at post-intervention. Of these, most were male (n = 10, 62.5%) and had acute myeloid leukemia (n = 9, 56.3%). From baseline to post-intervention there were improvements in left shoulder peak torque [mean change = 2.45 (Standard Deviation = 2.41), p = 0.004] and average power [2.29 (3.05), p = 0.033]. Muscle activation increased for left rectus femoris [0.04 (0.04), p = 0.074], right and left biceps brachii [0.03 (0.04), p = 0.012; 0.03 (0.05), p = 0.098, respectively], and left pectoralis major [0.02 (0.03), p = 0.064]. Several measures of peak torque/total work and all measures of muscle activation showed ES ≥ 0.20 for improvement. There were no statistically significant decreases from baseline to post-intervention.

Conclusions: Older adults with myeloid malignancies participating in a mHealth exercise intervention had stable to improved muscle performance. Further research is needed to establish the preliminary efficacy of this intervention for improving physical performance in this population at high risk for decline.

Trial registration: clinicaltrials.gov NCT04035499 (registered July 29th, 2019).

Background: Chronic nonspecific neck pain (CNSNP) is a common musculoskeletal disorder, particularly in the elderly, leading to reduced cervical muscle strength, impaired functional balance, and decreased postural stability. This study investigated the correlation between cervical muscle strength, functional balance, and limits of stability (LOS) in elderly individuals with CNSNP. Additionally, it assessed the moderating effect of pain severity on the relationship between cervical muscle strength and these balance outcomes.

Methods: A prospective study included a total of 186 participants, including 93 with CNSNP and 93 asymptomatic individuals, were recruited. Cervical flexor and extensor muscle strength were assessed using an ergoFET hand-held dynamometer. Functional balance was measured using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test, while LOS were evaluated using the Iso-Free machine.

Results: Individuals with CNSNP exhibited significantly lower cervical flexor strength (32.45 ± 5.67 N vs. 40.75 ± 5.20 N, p < 0.001) and extensor strength (28.30 ± 6.05 N vs. 36.90 ± 5.90 N, p < 0.001) compared to asymptomatic individuals. Functional balance was also poorer in the CNSNP group, with lower BBS scores (47.85 ± 4.20 vs. 53.65 ± 3.85, p < 0.001) and slower TUG times (11.30 ± 2.05 s vs. 8.45 ± 1.80 s, p < 0.001). Cervical muscle strength showed moderate to strong positive correlations with LOS (r = 0.56 to 0.62, p < 0.001) and BBS (r = 0.48 to 0.53, p < 0.001). Pain severity significantly moderated the relationship between cervical muscle strength and functional balance (β = 0.20, p = 0.045) as well as LOS (β = 0.22, p = 0.038), suggesting that higher pain levels diminish the positive effects of muscle strength on balance.

Conclusion: Cervical muscle strength plays a crucial role in maintaining functional balance and postural stability in elderly individuals with CNSNP. Pain severity moderates the relationship between cervical muscle strength and balance outcomes, emphasizing the importance of integrating muscle strengthening and pain management in rehabilitation programs for elderly individuals with CNSNP to optimize postural control and minimize fall risk.

Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) and its recovery have becoming significant public health concerns. Therefore, this study aimed to enhance the limited evidence regarding the relationship between sleep quality on long COVID among the older population aged 60 years or old.

Methods: Our study included 4,781 COVID-19 patients enrolled from April to May 2023, based on the Peking University Health Cohort. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. Long COVID was evaluated by well-trained health professionals through patients' self-reported symptoms. Binary logistic regression models were employed to calculate odds ratios (OR) and 95% confidence intervals (95% CI).

Results: The prevalence of long COVID among older adults was 57.4% (2,743/4,781). Specifically, the prevalence of general symptoms, cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, and neurological and psychiatric symptoms was 47.7% (2,282/4,781), 3.4% (163/4,781), 35.2% (1683/4,781), 8.7% (416/4,781) and 5.8% (279/4,781), respectively. For each one-point increase in PSQI scores, the risk of long COVID, general symptoms, cardiovascular symptoms, gastrointestinal symptoms, and neurological and psychiatric symptoms increased by 3% (95% CI: 1.01, 1.06), 3% (95% CI: 1.01, 1.06), 7% (95% CI: 1.01, 1.13), 11% (95% CI: 1.07, 1.15), and 20% (95% CI: 1.15, 1.25), respectively. In multivariate models, compared with good sleepers, COVID-19 patients with poor sleep quality exhibited an increased risk of general symptoms (aOR = 1.17; 95% CI: 1.03, 1.33), cardiovascular symptoms (aOR = 1.50; 95% CI: 1.06, 2.14), gastrointestinal symptoms (aOR = 2.03; 95% CI: 1.61, 2.54), and neurological and psychiatric symptoms (aOR = 2.57; 95% CI = 1.96, 3.37).

Conclusions: Our findings indicate that poor sleep quality is related to various manifestations of long COVID in older populations. A comprehensive assessment and multidisciplinary management of sleep health and long COVID may be essential to ensure healthy aging in the future.

Background: Hypertension is a common condition among the elderly and is frequently accompanied by frailty syndrome (FS). The coexistence of hypertension and FS poses significant challenges in patient management and negatively impacts the quality of life (QoL). This study aimed to analyze the relationship between FS and QoL in elderly patients with suspected hypertension.

Methods: A cross-sectional study was conducted involving 201 patients aged 65 years or older, referred to a Hypertension Clinic for diagnostic evaluation. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and QoL was evaluated with the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Sociodemographic and clinical data were collected, and statistical analyses were performed to identify correlations between FS and QoL.

Results: The study found that 79.60% of the patients were identified as frail (TFI ≥ 5). FS was significantly negatively correlated with all domains of QoL, including physical health (r = -0.634, p < 0.001), psychological health (r = -0.675, p < 0.001), social relationships (r = -0.528, p < 0.001), and environmental factors (r = -0.626, p < 0.001). Multivariate analysis revealed that physical (β = -0.091, p < 0.001) and psychological components of FS (β = -0.128, p = 0.016), as well as age (β = -0.022, p = 0.004), were significant predictors of lower QoL scores. Loneliness (β = -0.235, p = 0.049) was also a significant predictor of lower QoL.

Conclusions: The study demonstrated a strong association between FS and reduced QoL in elderly hypertensive patients, emphasizing the need for comprehensive assessments and personalized management strategies. Routine evaluation of frailty and the implementation of targeted interventions aimed at improving physical, psychological, and social well-being could substantially enhance QoL in this vulnerable population.

Clinical trial number: Not applicable.

Background: With the aging of society, cognitive impairment in elderly people is becoming increasingly common and has caused major public health problems. The screening of cognitive impairment in elderly people and its related influencing factors can aid in the development of relevant intervention and improvement strategies.

Methods: In this study, stratified random cluster sampling was used to conduct a cross-sectional survey of elderly individuals aged 65 years in Chengdu, Sichuan Province, through an electronic questionnaire from November 2022 to November 2023. Descriptive analysis and logistic regression analysis were used to investigate cognitive impairment and its relevant influencing factors.

Results: Among the 16,609 elderly people, 7524 (45.3%) were males and 9085 (54.7%) were females, with an average age of 73.6 ± 6.5 years (age range 65-101 years). The average years of education was 5.9 ± 6.2 years, and the proportion of individuals with cognitive impairment was 13.1%. With increasing age, the risk of cognitive impairment increased significantly. The risk factors for cognitive impairment in elderly individuals included advanced age, hypertension, heart disease, diabetes, cerebrovascular disease, depressive symptoms, and anxiety symptoms, while the protective factors included higher education level, married status, and greater life satisfaction.

Conclusion: Cognitive impairment in elderly individuals in Chengdu is serious. We can intervene in and improve cognitive impairment in elderly people by controlling blood pressure and blood sugar, treating depressive and anxiety symptoms and developing community colleges for elderly people and increasing satisfaction with life.