BMC Geriatrics最新文献

This systematic review investigates the association between sarcopenia and cognitive impairment among hospitalized older populations across five studies with diverse geographic settings. The review reveals a significant association between these conditions, emphasizing the impact of sarcopenia on cognitive function. Variability in diagnostic criteria and sample demographics across studies underscores the need for standardized methods to enhance comparability. The findings suggest that sarcopenia and cognitive impairment are interlinked through potentially shared pathological processes, highlighting the importance of early detection and integrated management in geriatric care. Future research should focus on elucidating the underlying mechanisms and developing targeted interventions to mitigate these conditions.

Objectives: Worldwide, the elderly population is steadily growing. A new population of very elderly patients is emerging, with specific management requirements, particularly at the end of life. However, data is scarce concerning the end-of-life care in these patients. The territories where this population is growing rapidly, like overseas France, was therefore of the utmost interest, to describe how they are provided end-of-life care and die. The aim of the study was to describe end-of-life care and death in overseas France nonagenarians and over, and to compare them with the rest of the population in these territories.

Methods: A retrospective study of a representative sample of adult patients who died between March 2020 and February 2021 was conducted in overseas France. Physicians who certified the deaths were asked to describe end-of-life care and medical decisions in a questionnaire.

Results: A total of 1815 deaths were analysed over 8730 questionnaires sent, with a total of 1082 questionnaires collecting data on non-sudden informed deaths. The nonagenarians were mostly women (p<0.0001) with cognitive impairment (p<0.0001) and died at home (p < 0.0001). Physicians were mostly experienced (p=0.0022) general practitioners (p<0.0001). Nonagenarians were less provided with palliative care than the rest of the population (64.36% vs 74.83%), with a lower use of deep and continuous sedation maintained until death (2.84% vs 15.19%) and less intensification of treatments to relieve symptoms (23.45% vs 32.56%).

Conclusions: The population of nonagenarians was specific in causes of death and comorbidities. Improving end-of-life care for these patients can include a high access to specialist palliative care and symptoms management.

Background: Adverse childhood experiences (ACEs) are linked to depression in later life; however, the mediating pathways in older Chinese adults remain underexplored. Sleep disorders, highly prevalent in geriatrics, may mediate this pathway through chronic stress mechanisms, yet evidence from Asian cohorts is limited. This study examines the mediating roles of sleep duration, chronic diseases, and other factors in the ACEs-depression associations using a nationally representative sample.

Methods: We conducted a cross-sectional analysis of data from 6,585 adults aged 60 years and older, obtained from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS). ACEs (range 0-12) were assessed via a 12-item scale, and depression via the CES-D-10 (cutoff ≥ 12). Mediators included sleep duration, chronic diseases, and social isolation. Multivariable logistic regression and causal mediation analysis (1,000 bootstraps) were used, adjusting for relevant covariates.

Results: The prevalence of depressive symptoms was 32.1%. Each additional ACE increased depression risk (adjusted OR = 1.17, 95% CI = 1.11-1.24). Sleep duration mediated 9.4% (β=-0.09) and chronic diseases 4.3% (β = 0.09) of the total associations; social isolation showed negligible mediation (0.03%). Stronger ACEs-depression associations occurred in Central China (OR = 1.35 vs. 1.15 in West, p-interaction = 0.029) and higher-educated groups.

Conclusions: ACEs are associated with increased late-life depression risk in older Chinese adults, partially mediated by short sleep duration and chronic diseases. These findings suggest the potential value of ACEs screening and targeted interventions addressing sleep and multimorbidity in geriatric care. Longitudinal studies are needed to confirm these pathways.

Introduction: Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including functional deterioration, hospital readmission, and death. Despite this, there is a paucity of literature exploring patient experience in this group, and little is known about what factors influence recovery. As a result, there is limited information to guide the development of robust post-operative care pathways that support optimal recovery and improve the overall experience.

Methods: Twenty older people, aged ≥ 65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight hospital sites over an eight-month period. Semi-structured interviews were undertaken approximately one month after surgery to explore the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis.

Results: Participants described their experience of undergoing emergency laparotomy over five temporal themes, starting at the experience around the time of surgery, followed by the early recovery period and ending with reflections of the overall experience: feeling out of control in the acute phase, memory and understanding of the surgery, physical and psychological implications, transitional care needs, reflecting on recovery.

Conclusion: Undergoing emergency laparotomy appears to be a significant and potentially life-changing event for older people living with frailty, but one that they expressed gratitude to have experienced to remain alive. Our findings highlight the challenges encountered by this group across the perioperative and early recovery period, indicating that adaptations to service delivery may improve this experience and facilitate recovery.

Introduction: Goals-of-care (GOC) discussions are often delayed or uninitiated for people with dementia, potentially contributing to inappropriate end-of-life treatment. The Serious Illness Conversation Guide (SICG) facilitates structured GOC discussions about patient values and care preferences, but a dementia-specific Guide adapted to the Asian cultural context has yet to be developed. This study aimed to adapt and iteratively revise the SICG-C, and assess its acceptability among caregivers of people with dementia.

Methods: We adapted the SICG for caregivers of people with dementia in Singapore using a three-phase, approach. Phase 1 involved adapting the patient-facing SICG to caregiver-facing language (version 1). In Phase 2, we iteratively tested the guide with 6 and 13 caregivers in 2 rounds of interviews to derive the final version of the Guide. In Phase 3, 50 caregivers rated each SICG-C item from Versions 1 and 3 using a structured questionnaire, with presentation order alternated to minimise order effects.

Results: Sixty-nine caregivers were recruited in this study. Qualitative interviews revealed that caregivers valued professionalism and reassurance from clinicians, while also emphasising their own experiential knowledge as distinct from clinical expertise. Many struggled to articulate their loved ones' priorities due to cognitive decline and the absence of prior discussions, often expressing uncertainty about whether their assumptions reflected what their loved ones would have wanted. Caregivers were sensitive to language implying poor prognosis and preferred phrasing that conveyed continuity of care and partnership. None of the caregivers had been informed by their loved ones of their goals and priorities, reaffirming the value of the SICG-C. In the final survey (n = 50), caregivers showed a strong preference for Version 3 over Version 1, with 21 of 22 items rated significantly higher (all p<0.001). The final SICG-C was rated highly acceptable.

Conclusion: The SICG-C enables clinicians to initiate timely, values-based GOC discussions with caregivers of people with dementia. Its structured, sensitive language addresses caregiver concerns and may be used to support proactive care planning in dementia. Further research is needed to evaluate implementation in routine clinical practice.

Background: The bulk of research focused on family caregiving for persons with Alzheimer's Disease and Related Dementias (ADRD) has been limited to those in close proximity to their care-recipient. The unique needs of the growing number of long-distance caregivers (LDCs) remain understudied and unaddressed. Existing measures of caregiver strain, which were primarily developed for and with geographically proximate caregivers, do not adequately capture the unique challenges faced by LDCs (e.g., difficulties with ensuring and monitoring care from afar). Thus, the current study aims to evaluate the suitability and psychometric properties of a caregiving difficulty index tailored for LDCs.

Methods: Data were from 40 participants enrolled in a pilot feasibility trial of a psycho-educational intervention for burdened LDCs of older adults with ADRD. Participants completed several measures assessing sociodemographic characteristics, caregiver burden, strain (i.e., family and work conflict, role captivity), and the 9-item difficulty index. An exploratory factor analysis (EFA) was conducted to examine the index's underlying factor structure. Pearson's correlations were used to assess the relationship among the final items and other validated measures of burden and strain. Cronbach's alphas were calculated for the total index and each subscale to evaluate internal consistency.

Results: EFA findings revealed that retention of eight out of the original nine items yielded the best model fit, with items loading onto two distinct components capturing general caregiving and distance-specific challenges. Cronbach's alphas were 0.79 for the total measure and between 0.67-0.80 for its subscales. Overall difficulty scores were also significantly positively related to caregiver burden (r = 0.42) and strain (rs = 0.31-0.44). Results provide initial evidence supporting the index's reliability and validity.

Conclusion: Findings provide preliminary support for the potential suitability of the 8-item index for use with LDCs and underscore the importance of tailored assessments to adequately measure the unique challenges associated with the long-distance caregiving experience.

Background: Elder abuse (EA) is a worldwide problem with serious consequences for individuals and society. This study aimed to determine the prevalence of EA and positive predictive value (PPV) of the Dutch Elder Abuse Scale (ERASE), an early warning tool for EA in patients presenting to the emergency department (ED) or geriatric outpatient clinic (GOC) in hospitals in the Netherlands.

Methods: Three general peripheral hospitals in the Netherlands participated. The study population were subsequent patients aged 70 years and older who visited the ED or GOC. Healthcare professionals (nurses/physicians) working at the hospital's ED and GOC administered ERASE. In case of suspected EA, the case was assessed in a standardized manner in the EA multidisciplinary team meeting (EA-MDTM) by independent experts. This assessment was considered the reference test. All data were quantitatively descriptively analyzed. To test ERASE for its performance in clinical practice, the PPV was determined. Also the prevalence of EA in the (acute) hospital setting was determined.

Results: In the inclusion period 22924 patients aged 70 years and older visited the ED or GOC. In almost half of these patients ERASE was administered by healthcare professionals of the three hospitals. In total 202 (1.8% (95% CI: [1.5%; 2.0%]) patients had a positive score on ERASE and were subsequently discussed in the EA-MDTM. In total 54 patients were concluded to have been a victim of EA according to the EA-MDTM. The total prevalence of EA in patients aged 70 years and older, visiting the ED or GOC, based on the conclusion of the EA-MDTM of the hospital working group on domestic violence, was 0.5% (95% CI: [0.35%; 0.62%]. The PPV of ERASE was 28% (95% CI: [0.20%; 0.35%].

Conclusions: Although the PPV of ERASE was not high, the tool may help detect signs of EA in the ED or GOC. Subsequently further investigation is required to substantiate or reject the diagnosis of EA. An EA-MDTM where a case is discussed in a standardized manner can aid in that perspective.