BMC Geriatrics最新文献

Introduction: Hypertension is highly prevalent among older people, and the balance of benefit and harm of antihypertensive therapy may shift with age. In certain cases, reducing or discontinuing antihypertensive treatment (deprescribing) may be appropriate. This systematic review and meta-analysis aimed to summarize available evidence on deprescribing antihypertensive medications in older adults aged 65 years and older.

Methods: We searched MEDLINE, Embase, CINAHL, the Cochrane Library, the Web of Science Core Collection, ClinicalTrials.gov, ICTRP and Epistemonikos from inception to July 2024. We included randomized controlled trials (RCTs) and comparative observational studies (OS) comparing deprescribing versus continuation of antihypertensive medications in adults ≥ 65 years. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, heart failure, stroke, major adverse cardiovascular events (MACE), orthostatic hypotension and falls. Where possible, data were synthesized using meta-analysis to estimate odds ratios (ORs) and 95% Confidence Intervals (CI). We assessed the risk of bias in the RCTs in Covidence basing on the Cochrane Risk Of Bias (Rob 2) tool. For the observational studies we used the Newcastle Ottawa Scale for comparative observational studies.

Results: We included 17 studies. Results from the observational studies are only reported as narrative summary. The pooled OR for all-cause mortality was 1.11 (95% CI 0.82-1.50; 6 RCTs). For secondary outcomes, pooled ORs were 1.32 (95% CI 0.30-5.92) for myocardial infarction (3 RCTs), 3.16 (95% CI 1.53-6.55) for heart failure (3 RCTs), and 3.08 (95% CI 0.73-13.00) for stroke (4 RCTs).

Conclusion: The effects of deprescribing antihypertensive medications in older adults remain uncertain. The limited and low-event-rate evidence on key cardiovascular outcomes for older individuals highlights the need for individualized decision-making, especially in frail and multimorbid populations. This review provides a foundation for future research to address gaps and guide safer deprescribing practices in older adults in routine clinical practice.

Background: As the population continues to age, the prevalence of mild cognitive impairment (MCI) has increased steadily. Studies have shown that older adults with chronic diseases are more likely to develop MCI than those without chronic conditions, suggesting that chronic diseases may play a significant role in the onset of MCI. Therefore, this study is designed to develop a predictive model for MCI among older individuals with chronic diseases in China and to identify the major factors influencing the occurrence of MCI.

Method: The training and internal validation data are from the 2018 China Health and Retirement Longitudinal Study (CHARLS), using retrospective data with 4,712 older adults with chronic diseases. The external validation data are from the General Hospital of Southern Theater Command in Guangdong, using prospective data with 1,000 cases. This is an observational study. Univariate logistic regression was used to select statistically significant predictors, and ultimately, a combination of LASSO regression and random forest results identified 9 optimal predictors, which were used to construct the nomogram. The model's discrimination, calibration, clinical applicability, and generalizability were assessed using the receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and internal validation.

Results: Age, education level, child satisfaction, marital status, depressive symptoms, ADL score, income, SCD, and the number of chronic diseases were identified as significant predictors of MCI in older adults with chronic diseases. The AUC values exceeded 0.7 across the training, internal validation, and external validation sets.The calibration curves closely align with the diagonal, and the P values of the Hosmer-Lemeshow test are all greater than 0.05, indicating strong consistency between the predicted and actual outcomes. The DCA further demonstrates that the model has significant clinical utility.

Conclusion: The nomogram prediction model deeloped in this study demonstrated good predictive performance and may serve as a useful tool to help identify older adults with chronic diseases who are at increased risk of MCI. These findings may inform future strategies for individualized risk assessment and early management.

Background: Community-based rehabilitation is critical for functional recovery in older adults after hip fracture, yet the optimal strategy remains uncertain. Previous reviews are limited by the pooling of heterogeneous interventions and an incomplete assessment of evidence quality. This network meta-analysis (NMA) aimed to compare the effectiveness of different community-based rehabilitation programs and, critically, to formally assess the certainty of the evidence.

Methods: We conducted a systematic review and NMA of randomized controlled trials (RCTs) from four electronic databases up to August 1, 2025. We included RCTs comparing community-based rehabilitation programs (Comprehensive Multidisciplinary Care [MDC], Structured Home Exercise [HomeEx], Attention/Active Control [AC]) against each other or Usual Care (UC) in adults aged 60 + after hip fracture surgery. Primary outcomes were Physical Performance and Activities of Daily Living (ADL/IADL). The certainty of evidence was evaluated using the GRADE framework.

Results: Twelve RCTs involving 1,510 participants were included. The NMA revealed substantial and statistically significant inconsistency across the network for both Physical Performance (Q = 48.69, p < 0.0001) and ADL/IADL (Q = 18.75, p = 0.001). While point estimates suggested trends favoring active interventions over UC, no comparison reached statistical significance. Critically, the GRADE assessment rated the certainty of evidence for all primary outcome comparisons as very low, due to serious concerns regarding risk of bias, inconsistency, and imprecision.

Conclusion: The principal finding of this NMA is the profound heterogeneity and very low certainty of the evidence base for community-based rehabilitation after hip fracture. This finding challenges the practice of treating broad rehabilitation categories as uniform interventions and precludes definitive conclusions about the superiority of any single strategy. While our analysis identifies promising trends that can inform future research, its most significant contribution is the formal quantification of a critical evidence gap, providing an essential roadmap for designing future, high-quality trials capable of delivering robust answers.

Background: Health inequality is a global issue, with a particularly significant impact on older adults. In China, differences in the urban administrative hierarchy may lead to uneven allocation of public resources, resulting in the concentration of public resources in cities with higher administrative hierarchies and, consequently, health inequality among older adults. Therefore, this study aims to explore the relationship between urban administrative hierarchies and older adults' subjective physical and mental health, while also analyzing the role of resource allocation mechanisms in shaping this dynamic.

Methods: This study utilizes data from the China Family Panel Studies, the China City Statistical Yearbook, and the China Urban Construction Statistical Yearbook, employing a multi-dimensional fixed effects model, incorporating province, individual, and time variables, to evaluate the impact of the urban administrative hierarchy on the subjective physical and mental health inequality of older adults. The study considers medical and environmental resources as potential mediating variables and explores the moderating role of marketization.

Results: The findings reveal a positive correlation between the urban administrative hierarchy and older adults' subjective physical and mental health, with those in cities with higher administrative hierarchies enjoying higher quality of life and subjective health levels. This is primarily due to cities with higher administrative hierarchies owning medical and environmental resources. Furthermore, the level of marketization has a positive moderating effect on the positive relationship between urban administrative hierarchy and older adults' mental health, but has no significant impact on physical health. Heterogeneity analysis by region and age indicates that the impact of the urban administrative hierarchy on the physical and mental health of older adults is more pronounced in economically less developed regions and among younger elderly individuals.

Conclusion: The study highlights the inequalities in the subjective physical and mental health of older adults across cities with different administrative hierarchies in China. By providing more resources, cities with higher administrative hierarchies can significantly improve older adults' life quality and subjective health. Meanwhile, marketization further strengthens the positive impact of urban administrative hierarchy on mental health. By introducing the urban administrative hierarchy as a macro-level political system into the study of individual health disparities, this research not only expands the analytical perspective on health inequalities among older adults, but also provides empirical support for understanding the current trends in elderly migration for retirement. Moreover, it offers valuable insights for global aging governance and promoting health equity.

Background: Engaging staff in residential care homes in advance care planning (ACP) is an increasingly important area. The train-the-trainer strategy driven by the Capacity Opportunity Motivation-Behavior Change Model is a promising approach but has limited data. The study aims to evaluate a theory-driven train-the-trainer implementation strategy on ACP engagement.

Methods: An explanatory sequential mixed-methods study was conducted to evaluate an implementation strategy, the train-the-trainer ACP program consisting of an ACP workshop and individualized field coaching. Surveys of ACP competency and ACP readiness were measured pre- and post-workshop. Interviews were conducted after individualized field coaching.

Results: Sixteen enrolled nurses, 17 registered nurses, 18 health assistants, and 8 social workers (N = 59) were recruited from 10 care homes. The age of the care home residents ranged from 67 to 108 years old. Upon completion of the ACP workshop, participants had significant increases in their ACP competency scores from 80.44 ± 15.12 to 96.12 ± 10.79 (t = 5.953, p < 0.001), but no change in their readiness for engaging in ACP (Z = - 0.988, p = 0.329). Following individualized field coaching, participants further reported professional growth (communication skills, understanding of relevant practice guidelines, integration of ACP as a clinical communication tool, and additional role as an information provider and coordinator) and personal gains (appreciation of the health-illness trajectory, urgency to reflect on end-of-life planning, and being prepared to address the challenges of an aging population). Mixed methods analysis showed a distinct causal pathway revealing that participants' capacity was mostly impacted by the ACP workshop, while their opportunity and motivation in ACP were impacted by the field coaching.

Conclusion: The ACP training program has successfully engaged staff in care homes by increasing their capacity, opportunity, and motivation.

Trial registration: The protocol (version 1.0, dated 20211201) of the trial was first registered on March 23rd, 2023, at ClinicalTrials.gov (identifier NCT06238063).

Background: Research on the association between atherosclerosis cardiovascular diseases (ASCVDs) and hearing loss (HL) in older people has yielded mixed findings in recent years. Understanding this relationship is crucial for developing early strategies that address both cardiovascular health and auditory function in older adults.

Methods: To examine the potential association between common ASCVDs (heart attack, coronary heart disease, and stroke) and HL, assessing the mediating effect of the frailty index (FI) and Life's essential 8 (LE8) metrics. The degree of HL was measured by pure tone average (PTA). This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2018, including 4,441 adults aged 60 or older with comprehensive cardiovascular and hearing measurement data. Statistical analysis was conducted from February 16, 2024, to July 7, 2024.

Results: The study identified significant correlations between all three ASCVDs and HL in older participants aged 60 or older, particularly noting that heart attacks were notably associated with HL at higher frequencies (2 and 4 kHz). Older participants, especially those aged 75 and above, were more susceptible to stroke-related HL, with a delayed impact observed in females. FI and LE8 mediated the heart attack-HL association in adults aged 75 and above, with FI demonstrating a stronger role than LE8.

Conclusion: The findings elucidate a complex interplay between cardiovascular health and auditory function, emphasizing that heart attacks may exacerbate HL through the frailty pathway in certain older populations. These results highlight the need for tailored cardiovascular interventions and proactive measures to mitigate HL risks. Future research should focus on defining these pathophysiological associations more clearly to develop targeted interventions for vulnerable older people.

Objective: Balance disorders and falls represent significant problems in the elderly population, with underlying causes that include both physical health conditions and psychosocial factors. The present study aimed to examine the relationships of social exclusion and loneliness with balance impairment and falls, and their subsequent impact on quality of life.

Methods: The sample consisted of 432 older adults aged 65-95 years. The Tinetti Balance and Gait Assessment (TBGA), Falls Efficacy Scale International (FES-I), Social Exclusion Scale for the Elderly (SESE), Loneliness Scale for the Elderly (LSE), and WHOQOL-OLD were used as data collection tools.

Results: SESE and LSE were negatively and weakly associated with TBGA (r = -0.205 and -0.328, respectively) and negatively associated with WHOQOL-OLD (r = -0.156 and -0.261, respectively). SESE and LSE were positively and weakly associated with FES-I (r = 0.342 and 0.317, respectively) (p < 0.001 for all). Linear regression analyses showed that TBGA was the strongest predictor of LSE, whereas FES-I was the strongest predictor of SESE (R² = 0.106 and 0.115, respectively). These associations remained largely unchanged after adjustment for age, gender, education level, and alcohol use.

Conclusion: Loneliness and social exclusion have a significant impact on falls, balance problems, and quality of life. These findings highlight the importance of considering psychosocial factors and implementing social support interventions as part of strategies to improve physical health and fall-related outcomes in the elderly.

Background: Sarcopenia, defined as progressive loss of skeletal muscle mass and function, is a major health issue with economic consequences in aging societies. Physical activity is recognized as preventive, but its long-term impact across different life stages is not well established. This study examined the association between lifetime physical activity and sarcopenia prevalence using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: Data from the 2014 CHARLS Life History Survey were matched with 2015 cross-sectional health assessments. After excluding participants younger than 60 years or with missing data, a final sample of 6,696 individuals was analyzed. Physical activity at different life stages was assessed using a self-reported questionnaire in the 2014 Life History Survey. Sarcopenia was classified according to the AWGS 2019 criteria. Multivariate logistic regression was conducted to evaluate the association between physical activity at different life stages and sarcopenia prevalence. A significance level of 0.05 was adopted for hypothesis testing.

Results: Among the study participants, 51.7% were without sarcopenia, 36.0% had possible sarcopenia, and 12.3% had sarcopenia. Across all life stages, individuals with sarcopenia were less likely to have engaged in regular physical activity. After adjusting for all covariates, engaging in physical activity for at least one year at any life stage was associated with a 47% lower odds of sarcopenia (OR = 0.53, 95% CI: 0.40-0.69). The strongest protective effect was observed for physical activity during middle adulthood (41-65 years) (OR = 0.36, 95% CI: 0.19-0.69), whereas physical activity in young adulthood (≤ 40 years) and older adulthood (> 65 years) showed no significant associations.

Conclusion: Our findings highlight that maintaining physical activity, particularly during middle adulthood, is associated with reduced risk of sarcopenia. Because physical activity was self-reported, future research should employ objective measures and longitudinal designs to confirm these associations.