BMC Geriatrics最新文献

Background: Delirium is a common yet often underdiagnosed neuropsychiatric syndrome among older adults, especially those residing in the home setting or in residential care. It has been associated with elevated risks of morbidity, mortality, and institutionalization. While delirium has been extensively studied in hospital settings, its prevention and risk factors in the home setting and residential care setting remain insufficiently investigated.

Objectives: This review investigates the prevalence, risk factors, and preventive interventions for delirium among older adults residing in the home setting and in residential care, including assisted home care facilities and nursing homes.

Methods: A scoping review was undertaken, including studies of individuals aged ≥ 65 years diagnosed with delirium through validated assessment tools (e.g., DSM, ICD). Eligible studies were to have a primary emphasis on the prevalence, associated risk factors, or preventive strategies related to delirium. Data on study characteristics, methodological approaches, and key findings were extracted and synthesized in a narrative format, supplemented by tables and figures.

Results: Sixty studies fulfilled the inclusion criteria. Reported delirium prevalence ranged from 0.1% to 44.0% in the home setting and from 1.0% to 70.3% in residential care. Key risk factors associated with delirium in the home setting and in residential care included cognitive impairment, the presence of dementia, and level of dependence, while age was generally not found to be significantly associated with delirium and was only investigated in residential care. Although various preventive interventions were identified, most studies examined their feasibility rather than their effectiveness in reducing the incidence of delirium.

Conclusion: Delirium and its risk factors remain insufficiently studied in non-hospital settings. The use of validated diagnostic criteria in community settings is crucial to reduce variation in prevalence estimates, and randomized controlled trials are needed to assess the effectiveness of interventions.

Trial registration: This scoping review was registered in the Open Science Framework on 9 July 2023 (https://doi.org/10.17605/OSF.IO/DVYWC).

Background: Global population aging is reshaping social structures and health demands at an unprecedented pace. Existing research indicates that decision-making power is significantly associated with health outcomes in later life. However, the underlying pathways linking household financial decision-making power to mental health remain underexplored in population-based studies. Elucidating multi-pathway effects will provide pathway-based evidence for identifying vulnerable populations and developing clinical interventions.

Methods: We analyzed five waves (2005-2014) of the Chinese Longitudinal Healthy Longevity Survey(CLHLS), comprising 23,994 observations from 9,055 adults aged 65 years or older. Financial decision-making power was self-reported on a four-point ordinal scale. Mental health was assessed via five indicators: psychological resilience, subjective well-being, life satisfaction, self-rated health, and loneliness. Fixed-effects models were applied to control for time-invariant confounders, and inverse probability weighting was used to address attrition bias. Mediation pathways were tested using a bootstrapping approach (500 repetitions).

Results: A graded dose-response relationship was observed: lower financial decision-making power was associated with poorer mental health across all outcomes. Compared to those with full autonomy, older adults without decision-making power showed significantly lower psychological resilience (β = - 0.31, p < 0.001) and subjective well-being (β = - 0.51, p < 0.001). Mediation analyses revealed that activities of daily living (ADL) accounted for 13.0% to 31.8% of the total effect and leisure activities for 10.0% to 34.2%, with the strongest mediation observed for loneliness. Among the participants who were functionally independent at baseline, functional capacity exhibited dual mediating roles: a positive pathway for self-rated health and a suppression effect for loneliness. Heterogeneity analyses revealed more pronounced benefits among economically disadvantaged, financially dependent, female, and younger-old adults, with protective effects partially offsetting vulnerabilities in these populations.

Conclusions: Financial decision-making power is a significant and potentially modifiable factor associated with mental health among older adults, representing an underexplored pathway for promoting healthy aging, with effects partially mediated through ADL and leisure engagement. Mental health promotion strategies should seek to preserve older adults' household financial decision-making power while supporting functional independence and social engagement.

Background: The growing population of centenarians faces unique health challenges. Of particular interest may be the co-occurrence of depressive symptoms and functional dependence, requiring comprehensive exploration.

Objective: To map and summarize existing literature on depressive symptoms and functional dependence in near-centenarians and centenarians, focusing on prevalence rates, screening instruments, and the relationship between these two conditions.

Inclusion criteria: Studies that explored depressive symptoms and functional dependence among individuals aged ≥ 95 years.

Methods: This review was performed in accordance with the JBI Manual for Scoping Reviews. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards were followed for reporting. The literature search was conducted in August 2023 in the following bibliographic databases: Embase.com, Medline ALL Ovid, CINAHL with Full Text, APA PsycInfo Ovid, Web of Science Core Collection, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials; including a grey literature search and citation tracking strategies.

Results: Fifty-three studies from 1994 to 2023 were included, with 28.3% conducted in the USA. Most studies were quantitative and cross-sectional. Depressive symptom prevalence ranged from 10.5% to 73% among studies reported individually; the GDS-15 was the most commonly used instrument. Total functional dependence ranged from 20.8% to 30.3% (ADLs) and 27.5% to 63% (IADLs); the OARS Multidimensional Functional Assessment Questionnaire and the Katz Index were the most frequently employed instruments. Only 30.2% of studies explored the association between depressive symptoms and functional dependence, with 56.3% finding a significant relationship.

Conclusions: The findings revealed geographical research disparities and underscored the need for diverse research methodologies for deeper insights into the health trajectories of the very old. Additionally, centenarians may not inherently have higher depressive symptoms than 'younger' seniors, suggesting possible resilience mechanisms. The relationship between depressive symptoms and functional dependence highlighted their mutual influence and potential to increase the risk of adverse outcomes.

Implications: Diversifying research methodologies and expanding geographical scope are essential for a holistic understanding and international comparisons. Standardized guidelines for assessment instruments could facilitate consistent conclusions. Development and implementation of multifaceted interventions, such as preventive measures, professional competency enhancement, and caregiver support are central to addressing the needs of this population effectively.

Background: Due to advanced morphological tissue degradation and chemical alterations resulting from putrefaction, challenges arise in identification as well as in histopathological and toxicological examinations. Consequently, it has been debated that autopsies performed on decomposed bodies may have limited diagnostic and forensic value and may not always yield satisfactory results. With this study, we aimed to mitigate concerns and biases in the literature-particularly the view that autopsy has limited value in decomposed geriatric cases-and to delineate the diagnostic yield, contributory value, and limits of applicability of autopsy and histopathological evaluation.

Methods: We examined 88 decomposed bodies cases arising from non-traumatic, in-home deaths among geriatric individuals. Detailed evaluations were conducted of autopsy, histopathological, toxicological, identification, medical history, and scene investigation findings. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 25.0 (Chicago, IL, USA).

Results: 83.0% of the cases were male, and the mean age was 70.9 years. 85.2% lived alone, and 70.5% had a history of chronic disease. On histopathological examination, the coronary arteries were the tissues most resistant to autolysis. Toxicological analysis detected therapeutic-range concentrations of pharmaceutical agents in 56.8% of cases and endogenous ethanol in 21.6%. Identification was achieved via DNA comparison analyses in 29.5% of cases. A cause of death was established in 69.3% of cases; the most common non-traumatic cause of death was cardiovascular diseases (48.9%).

Conclusion: Contrary to common presumptions, forensic autopsy and histopathological examinations of decomposed bodies in our study successfully determined the cause of death in a substantial proportion of cases (69.3%), a finding that is broadly consistent with the literature. In particular, the systematic histopathological evaluation of tissues resistant to autolysis-such as the coronary arteries and myocardium-combined with modern toxicological analyses and the integrated assessment of scene investigation findings and medical history data, enables a forensically satisfactory determination of the cause of death.