BMC Geriatrics最新文献

Background: Frailty is a common condition in older people, and its prevalence increases with age. With an ageing population, the adverse consequences of frailty cause an increasing appeal to the health care system. The impact of frailty on population level is often assessed using adverse health outcomes, such as mortality and medication use. Use of community nursing services and services offered through the Social Support Act are hardly used in assessing the impact of frailty. However, these services are important types of care use, especially in relation to ageing in place. In this cross-sectional study, we aimed to assess the impact of frailty on use of Social Support Act services, use of community nursing services, medication use, and mortality.

Methods: We used a frailty index, the FI-HM37, that was based on data from the Dutch Public Health Monitor 2016, for which respondents ≥ 65 years of age were included (n = 233,498). The association between frailty, the use of Social Support Act services, community nursing services and medication use was assessed using the Zero Inflated Poisson (ZIP) regression method. Survival analysis using Cox proportional hazards regression was conducted to estimate the hazard ratios for the association between frailty and mortality.

Results: The ZIP regression with a final sample size of 181,350 showed that frailty affected care use even after correcting for several covariates mentioned in the literature. For each unit increase in frailty index (FI) score, the relative probability of using zero Social Support services decreased with 7.7 (p < 0.001). The relative chance of zero community nursing services decreased with 4.0 (p < 0.001) for each unit increase in FI score. Furthermore, for each unit increase in FI score, the likelihood of zero medication use decreased with 2.9 (p < 0.001). Finally, for each unit increase in FI score, the mortality risk was 3.8 times higher (CI = 3.4-4.3; p < 0.001).

Conclusions: We demonstrated that frailty negatively affects the use of Social Support Act services, the use of community nursing services, medication use, and mortality risk. This study is the first to demonstrate the impact of frailty on Social Support Act services and community nursing services in the Netherlands. Findings emphasize the importance of frailty prevention for older people and public health policy.

Objective: Falls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country.

Methods: A cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire.

Results: The Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28-35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10-15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052-4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039-2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160-2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563-5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350-0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442-3.821) compared to slight physical dependency as a risk factor.

Conclusions: Approximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls.

Background: While the benefits of physiotherapy for hospitalized older patients (HOPs) are well established, these patients are often considered demotivated by healthcare team members (HTMs), which is perceived as a hindrance to their rehabilitation. The quantitative data currently available on the lack of involvement of HOPs are mainly measures of mobility. Motivation as such has, to our knowledge, never been measured. Therefore, this study aims to quantify for the first time the motivation levels of HOPs in their participation in activities of daily living (ADLs) and physiotherapy, and to explore the motivating factors behind their participation in physiotherapy.

Methods: The motivation of 60 older patients hospitalized in an acute geriatrics ward was quantified using the Scale of Demotivation Assessment (SDA). Out of these participants, 14 were interrogated through individual semi-structured face-to-face interviews. After transcription, data were analyzed according to Self-Determination Theory, which has been proven effective in the understanding of motivational mechanisms.

Results: The prevalence of demotivation was 47% (95% CI: [0.34;0.6]) for ADLs and 35% (95% CI: [0.23;0.48]) for physiotherapy. The main demotivating factors were the feeling of external control (lack of autonomy) and dependance experienced by HOPs, as well as the limited availability of staff during hospitalization. Conversely, feelings of competence, security, respect for limits, and commitment from the HTMs were important motivating factors.

Conclusion: A large number of relational factors have an impact on the motivation of HOPs regarding their participation in ADLs and in physiotherapy sessions. Appropriate time and space organizing and the provision of suitable equipment, combined with a genuine caring and respectful attitude from the HTMs, could considerably encourage the expression of intrinsic motivation and thus the involvement of HOPs in their own care program.

Background: Gait variables assessed by inertial measurement units (IMUs) show promise as screening tools for aging-related diseases like sarcopenia. The main aims of this systematic review were to analyze and synthesize the scientific evidence for screening sarcopenia based on gait variables assessed by IMUs, and also to review articles that investigated which gait variables assessed by IMUs were related to sarcopenia.

Methods: Six electronic databases (PubMed, SportDiscus, Web of Science, Cochrane Library, Scopus and IEEE Xplore) were searched for journal articles related to gait, IMUs and sarcopenia. The search was conducted until December 5, 2023. Titles, abstracts and full-length texts for studies were screened to be included.

Results: A total of seven articles were finally included in this review. Despite some methodological variability among the included studies, IMUs demonstrated potential as effective tools for detecting sarcopenia when coupled with artificial intelligence (AI) models, which outperformed traditional statistical methods in classification accuracy. The findings suggest that gait variables related to the stance phase such as stance duration, double support time, and variations between feet, are key indicators of sarcopenia.

Conclusions: IMUs could be useful tools for sarcopenia screening based on gait analysis, specifically when artificial intelligence is used to process the recorded data. However, more development and research in this field is needed to provide an effective screening tool for doctors and health systems.

Background: Most people living with dementia live in their own home supported by family carers. One of the most challenging problems they face is managing toilet-use and continence. Carers have repeatedly asked for better advice from healthcare professionals. The purpose of this systematic review was to inform the development of an intervention to support healthcare professionals to provide existing continence management advice to the carers of people living at home with dementia. It aimed to identify and synthesise lessons from the development and evaluation of interventions, involving primary or community healthcare professionals, to support the provision of management advice aimed at supporting people living at home with dementia and their carers with activities of daily living. Due to a lack of relevant continence or toilet-use interventions, this included, but was not limited to, toileting or continence care.

Methods: Literature (February 2009-November 2022) was searched using five databases: MEDLINE (Ovid); PsycINFO (Ovid); EMBASE (Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO); and Cochrane Central Register of Controlled Trials (CENTRAL). Empirical studies using a variety of methodologies were included and thus the quality of papers appraised using the Mixed-Methods Appraisal Tool. No studies were excluded based on quality. A narrative synthesis was undertaken.

Results: Twelve articles reporting on 10 interventions were included. Most comprised the provision of online resources only, although some combined these with online or face-to-face contact with healthcare professionals. A variety of methodologies was utilised including randomised controlled trials. The quality of included studies was variable. Six main themes were identified: mode of delivery; targeted and tailored resources; content, design and navigation; credibility; user involvement in the development and evaluation of information resources; and role of professionals and organisations.

Conclusions: Despite the urgent need to better support people living at home with dementia and their carers, this review highlights the paucity of studies reporting on interventions delivered within primary and community healthcare contexts to provide management advice aimed at supporting this population with activities of daily living. This review has identified important considerations that will potentially aid the development, delivery and evaluation of such interventions.

Systematic review registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022372456.

Background: Sarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care.

Methods: This multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65-85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results.

Discussion: To the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care.

Trial registration: This trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).

Objective: Altered Postural control could increase the risk of falling in older adults. Factors such as low back pain and fear of falling can be contributing factors to postural control instability. This study aimed to investigate the effect of chronic low back pain (CLBP) and fear of falling (FOF) on postural control of older adults.

Method: Forty-one older adults were included (27 LBP and 14 control). Among the participants, 22 people had high FOF, and 19 had low FOF based on Falls efficacy scale cut-off of ≥ 26. For postural control evaluation Center of pressure parameters (COP) of Standard deviation (Sd) of velocity, Sd of amplitude, path length and mean velocity in both Medial-lateral (ML) and Anterior-Posterior (AP) directions were measured. Mixed-model anova with two between group factor (Health status; with and without CLBP, and with high and low FES-I groups) and one within factor postural condition (four conditions with and without vision and Achill tendon vibration) was used.

Result: No significant interaction between groups (health status and FES-I) and group with condition (health status and condition or FES-I and condition) was observed for all COP parameters in both AP and ML direction. There was main effect of FES-I for all COP parameters in ML direction, with greater Sd of velocity, Sd of amplitude, path length and mean velocity in older adults with high FES-I compared to low FES-I in the ML direction.

Conclusion: High levels of FOF influenced static postural control in the ML direction. Therefore, paying attention to the lateral stability of older adults is of great importance.

Background: This prospective cohort study focused on the predictive value of frailty or pre-frailty assessed by Edmonton Frailty Scale (EFS) for postoperative delirium in spinal surgery patients.

Methods: The primary outcome measurement was postoperative delirium (POD) evaluated by Confusion Assessment Method at day 1, day 2, and day 3 after the surgery. Secondary outcomes included severity and duration of POD, severe postoperative pain measured by Faces Pain Scale-Revised. Patients scheduled for elective spinal surgery were enrolled and assessed for frailty by EFS before surgery. Demographic data, preoperative, intraoperative, and postoperative information were collected.

Results: 231 out of 325 patients were enrolled and analyzed in this study at last. The cohort with 36.8% being frail and 28.5% being vulnerable. Postoperative delirium was detected in 41 in 231 patients. Multivariate logistic regression analysis revealed that vulnerable to frailty (OR = 4.681, 95% CI: 1.199 to 18.271, P = 0.026), after adjusted duration of surgery more than 3 h, using flumazenil at the end of surgery, using butorphanol only in postoperative patient-controlled intravenous analgesia, moderate-to-severe pain at day 1 and 2, is a strong predictor of postoperative delirium. Frailty was associated with longer duration (frailty vs. fit, P = 0.364) and stronger severity of postoperative delirium in the first two days (P < 0.001). High EFS score was independent risk factor of severe postoperative pain (Frailty vs. Fit: OR = 5.007, 95% CI: 1.903 to 13.174, P = 0.001; Vulnerable vs. Fit: OR = 2.525, 95% CI: 1.008 to 6.329, P = 0.048). In stratified tests, Sufentanil regimen in intravenous PCA significantly increase the proportion of POD in vulnerable group (P = 0.030), instead of frailty group (P = 0.872) or fit group (P = 0.928).

Conclusions: Frailty can increase the risk, severity, duration of delirium and severe postoperative pain in the first 3 days after surgery of patients.

Trial registration: The protocol of this study has been approved by the Ethic Committee of Shanghai Changzheng Hospital (Approval file number: 2022SL044) and informed consent was obtained from all the patients. The trial was retrospectively registered at chictr.org.cn (ChiCTR2300073306) on 6th July 2023.

Background: Post-stroke stress can trigger instant survival but its influence on long-term ischemic stroke outcomes remains controversial. Thus, we sought to explore the associations of acute post-stroke stress evidenced by endocrine and metabolic changes, with long-term ischemic stroke outcomes.

Methods: Admissions for acute ischemic stroke within seven days of onset were prospectively recruited to determine acute endocrine and metabolic variations measured by thyroid parameters and the stress hyperglycemia ratio (SHR). Long-term ischemic stroke prognoses were followed up for one year, with the primary outcome being a modified Rankin Scale score of 3 to 6.

Results: A total of 887 patients were enrolled, of which 535 reached the final one-year followed up at a poor prognosis rate of 29.3%. Patients with poor outcomes were observed to have lower levels of free triiodothyronine (fT3) and higher levels of SHR on admission. Medium values (fT3, 4.4 mmol/L; SHR, 8 nmol/L) were used to divide patients into four gradient stress degrees. Larger acute endocrine and metabolic variations (fT3 < 4.4 mmol/L and SHR ≥ 8 nmol/L) were independently associated with a poor one-year prognosis (adjusted OR = 4.231, P = 0.001).

Conclusions: High degrees of acute post-stroke stress may aggravate long-term ischemic stroke prognosis and timely stress-reduced interventions may help promote post-stroke living quality is equally important as survival.