BMC Geriatrics最新文献

Background: Previous studies have indicated that robotic surgery offers similar safety and efficacy to laparoscopic surgery in older colorectal cancer patients, while its potential advantages remain to be clarified.

Methods: This retrospective study analyzed older colorectal cancer patients undergoing robotic or laparoscopic surgery at Beijing Hospital. Propensity score matching (PSM) and inverse probability weighting (IPTW) to overcome selection bias. Primary outcomes focused on perioperative inflammatory markers (PNI, NLR, LMR, PLR, SII), while secondary endpoints included surgical, pathological, and clinical outcomes. The study evaluated robotic surgery's safety, efficacy, and potential advantages, offering insights into its clinical application for older patients.

Results: A total of 804 patients were initially enrolled in this study, and after screening, 539 cases were included in the final analysis. In the comparison of perioperative inflammatory marker changes, the robotic surgery group consistently demonstrated a lower inflammatory response. Additionally, the robotic surgery group had significantly lower postoperative drainage volumes at both 48 h (148 mL vs. 200 mL, p < 0.05) and 72 h (228 mL vs. 290 mL, p < 0.05). There were no significant differences between the two groups in terms of postoperative complications or length of hospital stay. During a median follow-up of 21.1 months, there were no significant differences in overall survival (OS) or disease-free survival (DFS) between the two groups.

Conclusion: Robotic surgery for older patients with colorectal cancer demonstrates comparable safety and efficacy to laparoscopic surgery, while offering significantly improved control of perioperative inflammatory responses.

Background: Geriatric syndromes (GS) describe complex health challenges in older patients. Understanding the perceptions of geriatric syndromes as age-related vs. disease-related can help to identify different patterns of health-seeking behavior (HSB) for GS among older adults.

Methods: In this explorative, cross-sectional study, we investigate the prevalence and perception of various GS (falls, gait disturbance, pain, urinary incontinence, memory loss, depressive symptoms, loss of social contacts) in a geriatric cohort (n = 94, mean age 82.5 ± 5.29 years, 62.8% female). Variables included the presence of GS, their perceived impact, and whether they were viewed as age-related or disease-related (visual analogue scale). HSB was assessed based on whether patients sought medical consultation, received diagnostics, or underwent therapy for the GS. Additional variables included a comprehensive geriatric assessment, health literacy, locus of control, and views on aging.

Results: The study found significant variations in HSB among different GS. Overall, 94.7% of the patients experienced at least one GS. The most frequently reported GS were falls (59.6%), gait problems (55.3%), and pain (51.1%). Incontinence (39.4%), falls (37.5%), and gait problems (32.7%) were considered the most relevant GS by the patients. Pain (89.6%), incontinence (72.7%), and gait problems (69.2%) were the primary reasons for seeking medical consultation, with therapeutic measures more commonly initiated for pain (70.8%) than for gait disorders (28.8%) and incontinence (33.3%). Symptoms of depression and memory loss received minimal medical attention. Pain was predominantly perceived as disease-related, with corresponding higher HSB, whereas memory loss was often seen as age-related, with corresponding lower HSB. There was no significant association between GS ratings (age or disease-related) and sex, living situation, social support, education level, health literacy, or locus of control. However, a positive view on aging correlated with perceiving depressive symptoms and lack of energy as disease-related.

Conclusion: This explorative study suggests that the individual perceptions of GS may impact the use of medical services. Future confirmatory studies are necessary to develop targeted interventions addressing these perceptions in order to improve the health behavior of older adults.

Background: Self-rated health (SRH) is a widely used global indicator of physical, psychological, and social well-being. In older adults, SRH predicts mortality, morbidity, and functional decline. Although SRH has been linked to psychological, functional, and lifestyle factors, these domains are often examined separately, limiting our understanding of their combined influence. This study examined the multidimensional structure of SRH by assessing mental health, physical function, and activity-related factors among Japanese community-dwelling older adults.

Methods: This cross-sectional study analyzed data from 1,821 older adults (aged ≥ 65 years) in Ayase City, Japan. SRH was assessed using a four-point scale and categorized into high (very/somewhat healthy) and low (not very/unhealthy) groups. Independent variables included age, gender, education, diagnosed conditions, depressive symptoms (Geriatric Depression Scale, GDS), physical fitness (Motor Fitness Scale, MFS), functional capacity (Tokyo Metropolitan Institute of Gerontology Index of Competence for Instrumental Activities of Daily Living, TMIG-IC IADL), and activity frequency. Logistic regression was performed to identify factors associated with SRH.

Results: Participants with higher SRH were younger (median age: 74 vs. 77 years, p < .001), had fewer diagnosed conditions (p < .001), lower GDS scores (median: 0 vs. 2, p < .001), and higher motor fitness scores, including mobility, strength, and balance (p < .001 for all), compared to those with lower SRH. Logistic regression showed that younger age (OR = 0.95, 95% CI: 0.93 to 0.97, p < .001), female sex (OR = 1.68, 95% CI: 1.22 to 2.31, p = .001), and fewer diagnosed conditions (OR = 1.74, 95% CI: 1.56 to 1.93, p < .001) were significant predictors of better SRH. Higher motor fitness scores for mobility, strength, and balance, and lower GDS scores were also significant predictors. Education, TMIG-IC IADL scores, and activity frequency were not significant.

Conclusions: SRH in Japanese older adults is shaped by physical fitness, mental health, and demographic factors. These findings emphasize the importance of holistic health promotion strategies targeting physical activity and mental health. Culturally sensitive interventions and further longitudinal research are warranted to better understand SRH determinants.

Background: Excessive daytime sleepiness (EDS) is common in older adults and may contribute to reduced oral intake, potentially increasing the risk of dehydration, which has been linked to adverse health outcomes. We aimed to investigate whether EDS is associated with elevated plasma osmolarity (Posm) in a geriatric population.

Methods: In this cross-sectional study, 1,335 adults aged ≥ 65 years attending a geriatric outpatient clinic were assessed. Participants were classified as having EDS (Epworth Sleepiness Scale ≥ 11) or non-EDS. Plasma osmolarity was estimated using a validated formula, with thresholds of > 295 mmol/L for dehydration and > 300 mmol/L for overt dehydration. Clinical, laboratory, and demographic data were collected. Associations between EDS and dehydration were analyzed using univariate and multivariate logistic regression, adjusting for age, sex, comorbidities, and medication use.

Results: EDS was present in 24% of participants. Plasma osmolarity exceeded 295 mmol/L in 56% and 300 mmol/L in 23% of participants. Patients with EDS were older and had higher prevalence of chronic kidney disease, dementia, and polypharmacy. In multivariate analysis, independent predictors of Posm > 300 mmol/L included diabetes mellitus (OR 4.41), chronic kidney disease (OR 5.32), serum sodium (OR 1.76), and EDS (OR 1.51, p = 0.027). EDS was not independently associated with Posm > 295 mmol/L.

Conclusions: In older adults, EDS is independently associated with overt dehydration. Routine assessment of daytime sleepiness may serve as a simple, non-invasive marker to identify individuals potentially at risk, enabling timely hydration interventions and potentially improving health outcomes in aging populations.

Background: Dementia in minority ethnic groups is on the rise. South Asian people represent 9.3% of the UK population and are the largest minority ethnic (ME) group. Most dementia care in South Asian communities is provided at home by family carers, yet there is low uptake of care planning and post-diagnostic support services. This review explored factors influencing care planning and post-diagnostic support for South Asian people with dementia.

Methods: Systematic review and thematic synthesis of qualitative studies exploring care planning and post-diagnostic support experiences and views of South Asian people with dementia, family carers, and health and social care professionals (HSCPs). There were no limits on country or date of publication. Six databases were searched (inception - June 2024) and two reviewers independently screened and quality-appraised studies. Reflexive thematic analysis was used to generate themes, which were then mapped to the Socioecological Model. The review protocol was registered on PROSPERO [Registration number: CRD42023404125].

Results: From 3165 studies found, 2069 were screened (after de-duplication) and 24 studies were included for thematic synthesis. Key influential factors were mapped to one of four levels of a modified version of the Socio-ecological Model (SEM): (1) Individual and community level factors - cultural duty for home care, stigma and misinformation, support networks; (2) Interpersonal level factors - language barriers and person- and family-centred care; (3) Organisational and systems level factors - lack of integrated support, cultural competence, system pressures and institutional discrimination; (4) Structural level factors - socioeconomic and policy considerations.

Conclusions: Recommendations to improve dementia care planning and post-diagnostic support for South Asian communities include (1) Reframing narratives around dementia and help-seeking through culturally-tailored community interventions; (2) Culturally competent, person- and family-centred care; (3) Holistic and integrated support beyond clinical care; (4) Equitable partnership working with South Asian communities to co-produce dementia services.