BMC Geriatrics最新文献

Background: Hearing impairment is a known risk factor for Alzheimer's disease (AD), although less is known about vision impairment or dual sensory impairment (DSI) as risk factors for AD. We studied the association between diagnosed hearing impairment, visual impairment, or DSI, and the risk of AD.

Method: The Medication use and Alzheimer's disease study (MEDALZ) is a register-based nested case-control study including 70,718 community-dwelling persons diagnosed with incident AD in 2005-2011 in Finland and their 282,845 matched controls. Sensory impairment diagnoses (limited to those that cause irreversible sensory loss designated by medical specialists) at least five years prior to AD diagnosis (or matching date) were obtained from national healthcare registers, including specialized outpatient visits. Associations were studied with cofounder-adjusted conditional logistic regression.

Results: Hearing impairment was associated with an increased risk of AD compared to people without a diagnosed sensory impairment (adjusted odds ratio (aOR) 1.15, 95% confidence interval (CI) 1.11-1.19), while no association was found in people with visual (aOR 1.02, 95% CI 0.99-1.05) or dual sensory impairment (aOR 1.05 (95% CI 0.95-1.15).

Conclusions: Hearing impairment can be a modifiable risk factor for AD, and thus its treatment in the aging population is important. Although we did not observe an association between visual impairment and AD, all sensory impairments decrease functioning and quality of life among older adults. Therefore, they should be treated, also among persons with cognitive decline or cognitive disorder.

Clinical trial number: Not Applicable.

While racial inequities in dementia risk are well-documented in the United States, research has paid less attention to role of US Southern context in shaping dementia risk through life course exposures. In this study, we examine how Southern birth and Southern residence in adulthood are linked to dementia incidence for Black and White older adults in the United States. Using the Health and Retirement Study (N = 15,613), we estimate a series of hazard models to evaluate how life course risk factors such as childhood health and social disadvantage, education, adult socioeconomic status, health behaviors, and cardiometabolic conditions impact the association between Southern life course residency and dementia risk. We find different patterns in how Southern life course context shapes dementia risk among Black and White adults, with dementia risk among Blacks especially sensitive to combinations of Southern life course context. These findings demonstrate the importance of considering potential heterogenous life course pathways to cognitive aging and health that may be shaped by larger socio-historical experiences.

Background: Pre-frailty is a window of opportunity for frailty reversal and can be enhanced by multicomponent exercise. The Lifestyle-integrated Functional Exercise (LiFE) program may be a promising alternative to overcome traditional exercise barriers. The latest advancements in mobile health (mHealth) technology have enabled individuals to retain the advantages of supervised exercise training within group settings while providing exercise programs that can be accessed and completed at home. This study aims to assess the feasibility, acceptability, and primary efficacy of the PF-Life program, which is the Lifestyle-Integrated Functional Exercise program for Pre-Frail supported by an mHealth platform.

Methods: Sixteen pre-frail adults aged ≥ 65 years were recruited from five community health centers in Fuzhou, China. All participants were prescribed the PF-Life program by geriatricians using the mhealth platform (web-based portal). Participants engaged in the customized exercises program following in-app video instructions and feedback on the mhealth platform (smartphone application). Physical activity (PA) and sedentary behavior (SB) were registered daily through wearable devices. Study endpoints were feasibility (retention rate, compliance rate, adverse events), usability (system usability scale), acceptability (qualitative interviews), changes in physical function (timed up and go (TUG), handgrip strength (HGS), and 30-second chair rise tests), PA and SB.

Results: The intervention was feasible, 88% of participants adhered completely to the study protocol, and 95% had completed at least 75% of the prescribed experimental duration. System usability was high (85 out of 100 best imaginable). Changes were observed from baseline to follow-up for total HGS (21.41 ± 6.38 vs. 24.12 ± 6.62 kg, P < 0.05, d = 0.714), TUG (8.23 ± 1.33 vs. 7.48 ± 2.01 s, P < 0.01, d = 1.647) and 30-second chair rise test (17.13 ± 4.3 vs. 20.04 ± 4.54 repetitions, P < 0.01, d = 0.94). In addition, SB decreased by a mean of 33 min/day (P < 0.01), and low physical activity increased by 31 min/day (P < 0.01). No adverse events occurred. The majority of participants found the PF-Life program to be straightforward, adaptable, and easily integrable into their daily routines.

Conclusions: Preliminary studies have demonstrated that the PF-life program exhibits good compliance, safety, and usability for the pre-frail elderly population. Large-scale randomized controlled trials are required to ascertain its long-term effectiveness.

Background: Numerous studies have indicated an obesity paradox in observational research on aging health, where being normal weight or underweight adversely affects cognitive function, while moderate obesity may offer protective benefits. This study aims to investigate the association between body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), abdominal volume index (AVI), and the joint effect of BMI and HC on cognitive impairment in older Chinese people.

Methods: A total of 10,579 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this cross-sectional study. BMI, WC, HC, WHtR, WHR, and AVI were calculated from height, weight, WC, and HC measurements, where weight, WC, and HC were obtained by direct measurement. Mini-Mental State Examination was used to assess cognitive impairment. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using binary logistic regression. Non-linear correlations were investigated using restricted cubic spline curves.

Results: In multivariate logistic regression models fully adjusted for confounding variables, our analyses showed significant negative associations of WC [OR 0.93 (95%CI 0.88-0.98), P = .012], HC [OR 0.92 (95%CI 0.87-0.97), P = .004], lower WHR (Q2) [OR 0.85 (95%CI 0.72-1.00), P = .044], and AVI [OR 0.93 (95%CI 0.88-0.98), P = .011] with cognitive impairment. Nonlinear curve analysis showed that the risk of cognitive impairment was lowest when the BMI was about 25.5 kg/m², suggesting that the optimal BMI for older Chinese people to maintain good cognitive ability may be in the overweight range. In addition, there was a non-linear "N" shaped relationship between HC and cognitive impairment, with HC having the highest risk of cognitive impairment at about 82 cm and the lowest risk at about 101 cm. The joint effects analysis indicated that the lowest risk was observed among those with normal or higher BMI but higher HC compared with participants with normal BMI levels and lower HC levels.

Conclusion: In older Chinese people, a low-waisted and high-hip circumference body figure is favorable for cognitive function in older people. It also found a significant association between AVI and cognitive impairment. The joint analysis of BMI and HC suggests that maintaining a normal or higher BMI with a higher HC may be more conducive to maintaining good cognitive function.

Background: Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index < 60 points).

Methods: This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥ 75, Barthel Index < 60, able to collaborate, expected length of stay ≥ 5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed.

Discussion: This project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients' care, comprising IVR and/or ME dispensed within the patient's room, and including patients who are commonly excluded from research clinical trials.

Trial registration: This study was approved by the Navarra Clinical Research Ethics Committee on May 17th, 2023 (PI_2023/60). The trial is registered at ClinicalTrials.gov, registration number NCT06340282, 24th May 2024.

Background: Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings.

Aims and objectives: This scoping review aimed to establish and describe the level of nutrition care provided to older adults admitted and subsequently discharged from EDs.

Research design: Systematic searches of nine academic and grey literature databases (Medline (Ovid), Pubmed, CINAHL Complete (EBSCOhost), EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and four websites (Google, Google Scholar, NICE and LENUS) for relevant professional and organisational publications of research, policy, practice, and guidelines between January 2011 to 2023 were completed. Eligible studies included a population of older adults (≥ 65 years) with an ED attendance and subsequent community discharge, and where nutrition screening had identified malnutrition. Data were extracted on the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model and summarised descriptively.

Results: Overall, 22 studies were included in the review. Nutrition status was screened on admission to the ED using validated tools: Mini Nutritional Assessment-Short Form (n = 13), Malnutrition Universal Screening Tool (n = 2), Short Nutritional Assessment Questionnaire (n = 2), NRS-2002 (n = 1) and the Mini Nutritional Assessment - Full Form (n = 1). A full nutrition assessment was reported by 5 studies. Only one study referred to documentation of malnutrition in healthcare records. Subsequent nutrition intervention after discharge from the ED for older adults was not described in any study.

Conclusion: While there is evidence to support malnutrition screening is taking place in EDs, there is a lack of information about subsequent nutrition care including assessment and therapy interventions. This points to the need for comprehensive exploration of nutrition care pathways, practice, policy, and research to inform models of integrated care for older persons.

Background: Mild cognitive impairment (MCI) is a major risk factor for delirium. Few studies with mid- to long-term follow-up periods have examined delirium, MCI, and the conversion of MCI to dementia. This prospective, longitudinal cohort study aims to assess the incidence of dementia after delirium onset in patients with MCI and to develop an artificial intelligence algorithm for predicting the conversion of MCI to dementia.

Methods: A 30-day evaluation for delirium will be performed for adults aged ≥ 65 years diagnosed with MCI who score 18-23 on the Korean Mini-Mental State Exam. Individuals exhibiting delirium at least once will be classified into the delirium group and the remainder into the non-delirium group. Over 3 years, patients will undergo follow-ups for survival and conversion to dementia at 30-day intervals to analyze risk factors for delirium and clinical outcomes. Differences between the two groups will be analyzed using the chi-square and independent t-tests. Kaplan-Meier survival and Cox proportional hazard regression will be used to assess the effects on 30-day, 60-day, 12-month, 24-month, and 36-month mortality, whereas linear regression will be used to assess the length of stay at long-term care facilities and medical costs.

Discussion: The results will emphasize the importance of preventing delirium in MCI patients, and preventive interventions can be strengthened.

Trial registration: NCT05113446 (ClinicalTrials.gov). Registered 9 November 2021 - Retrospectively registered.

Introduction: COVID-19 provides an opportunity to examine biological phenotypes (observable morphological, functional and biological characteristics) in individuals who experience the same acute condition, potentially revealing differences in response to acute external stressors. The aim our study was to investigate biological phenotypes in older patients hospitalized for COVID-19, exploiting a panel of aging biomarkers.

Methods: Data were gathered from the FRACOVID Project, an observational multicenter study, aimed to evaluate the impact of frailty on health-related outcomes in patients 60 + with COVID-19 in Northern Italy. A hierarchical cluster analysis was run using log-transformed and scaled values of TNF-a, IL-1 beta, IL-6, PAI-1, GDF-15, NT-proBNP, and Cystatin C evaluated at admission.

Results: Eighty-one participants (mean age 75.3 years; 60.5% male) were evaluated. Frailty was identified in 42% of the sample and 27.2% were unable to ambulate outdoors. The mean hospital stay was 24.7 days, with an in-hospital mortality rate of 18.5%. Three biological phenotypes were found: (1) 'inflammatory', with high inflammatory biomarkers; (2) 'organ dysfunction', characterized by elevated cystatin C and NT-proBNP, and lower inflammatory markers; and (3) 'unspecific', with lower NT-proBNP and GDF-15 levels, and intermediate concentrations of other biomarkers. The 'organ dysfunction' phenotype showed the highest mean age and prevalence of frailty, disability, and chronic diseases. The 'inflammatory' phenotype showed the highest burden of respiratory and systemic signs and symptoms of infection.

Conclusion: Biological phenotypes might be used to identify different clinical and functional phenotypes in individuals affected by COVID-19.

Background: Social networks play a critical role in the mental health of older adults. This pilot study investigates the feasibility of a newly developed intervention to enhance older adults' social networks. This intervention was designed on the Theory of Mind's foundation and aimed to enhance older adults' social interaction motivation through theoretical explanations. Furthermore, the courses fostered more social opportunities for the participants through group-based sessions.

Methods: The feasibility of this intervention was tested using a double-blind, two-arm, non-randomized grouping approach. Older individuals residing in two separate residential buildings (n = 31, mean age = 66.81, 48% women) were divided into an intervention group (n = 15) and a control group (n = 16). They attended daily group sessions at a designated location and completed homework assignments. The primary outcomes of this pilot study were the feasibility of the intervention, and secondary outcomes included Theory of Mind levels and social network indicators. Additional outcomes encompassed levels of global mental health and depression.

Results: All participants completed the pilot intervention and completed assessments. The primary outcomes indicated that the intervention had excellent feasibility, including compliance (attendance and homework completion rates met the standards) and satisfaction (average ratings for all items ranged from 4.47 to 5.00 on a 5-point scale). Interview results revealed that participants in the intervention group found the intervention beneficial for their daily lives and expressed a desire to participate in a formal intervention. Regarding secondary and additional outcomes, compared to the control group, the intervention group exhibited a significant improvement in emotional recognition performance of Theory of Mind. There was a significant increase in the whole network density in the intervention group. There were no significant differences in other social network indicators, global mental health, and depression levels in the intervention group compared to the control group.

Conclusions: The social network enhancement intervention for older adults is feasible. This pilot study has identified several improvements in the courses and tests. It is necessary to carry out a formal course to examine the effectiveness of the intervention on social networks in older adults.

Trial registration: Registration number: ChiCTR2100053779; Reg Date: 29/11/2021.