Archives of gerontology and geriatrics最新文献

Background: While the estimated glomerular filtration rate (eGFR) is a common metric for assessing kidney function, its prognostic value in elderly patients undergoing valvular replacement surgery remains uncertain.

Methods: A total of 4531 elderly patients (aged ≥ 60 years) who underwent valvular replacement surgery at Guangdong Provincial People's Hospital in China were retrospectively included in the study, covering the period from January 2010 to April 2019. The patients were divided into four groups based on the difference between early postoperative and preoperative estimated glomerular filtration rates (eGFR): ΔeGFR ≤ 0, 0 < ΔeGFR ≤ 25, 25 < ΔeGFR < 50, and ΔeGFR ≥ 50. The association between postoperative eGFR changes and both in-hospital and one-year mortality was examined using univariate and multivariate analyses. Kaplan-Meier curves were used to illustrate cumulative hazard rates.

Result: Overall, 204 patients (4.5 %) died during their hospital stay, and 344 patients (7.59 %) patients died within one year. Our analysis revealed significant differences in clinical outcomes between patients with ΔeGFR ≤ 0 and those with ΔeGFR ≥ 50. Patients with ΔeGFR ≥ 50 had higher rates of postoperative dialysis (P < 0.001), acute heart failure (P = 0.037), and in-hospital mortality (P < 0.001). Cumulative survival curves showed a markedly higher one-year mortality rate among patients with ΔeGFR ≥ 50 compared to the other three groups (p < 0.0001). Multivariable analyses demonstrated a significant association between ΔeGFR ≥ 50 and both in-hospital mortality (OR = 2.939, P < 0.001) and one-year all-cause mortality (HR = 2.567, P < 0.001).

Conclusion: Our study identified ΔeGFR ≥ 50 as an independent risk factor for clinical events and in-hospital mortality.

Introduction: Blood-based biomarkers such as plasma neurofilament light chain (pNfL) are crucial biomarkers for Alzheimer's disease (AD). Additionally, neuroimaging techniques such as tensor-based morphometry (TBM), which identify structural changes in the brain, can provide valuable insights into AD pathophysiology. However, the role of genetics in linking the blood based biomarkers and imaging findings has not been well understood. Therefore, we aimed to investigate whether the polygenic hazard score (PHS), affects the association between neurofibrillary tangles and neuritis plaques and brain imaging findings.

Methods: Using the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, we enrolled all participants for whom a complete dataset of pNfL, PHS, and TBM was available. Using Python, we analyzed the associations between pNfL levels and the TBM data of 567 participants incluidng 152 cognitively normal individuals, 309 participants with mild cognitive impairment (MCI), and 106 patients with AD. We used a mediation analysis to identify the effect of PHS in how pNfL is associated with TBM measures.

Results: We found a negative correlation between the accelerated TBM measure and NfL levels in both the MCI and AD groups. The pNfL concentration predicted both accelerated statistical and anatomical TMB measures in patients with MCI. Furthermore, PHS mediatedthe association between statistical TBM measures and NfL levels in AD patients, to the extent that the significant association between NfL and TBM measures disappeared after accounting for PHS.

Conclusion: We showed that although pNfL can predict the cognitiee decline and imaging findings in AD, this effect is mediated by the PHS. Therefore, PHS should be considered when investigating AD biomarkers and their corresponding imaging findings.

Objectives: With dementia prevalence rising globally among older adults, effective and scalable community-based interventions are urgently needed to reduce dementia onset. This study aimed to estimate the association of the going-out program with dementia onset in older adults.

Methods: A 5-year longitudinal observational study was employed. Following a baseline assessment in 2015 and 2017, we observed 2,977 individuals engaging in a community-based going-out program for 12 months in Japan. Participants with continuous data over 12 months were defined as the engaged group, while those without such data were classified as the non-engaged group. After propensity score matching, 1,690 participants were selected. Dementia onset was obtained from the Japanese National Health Insurance and Later-Stage Medical Care System for 48-month follow-up. Incidence of dementia, absolute risk reduction (ARR), and number needed to treat (NNT) were calculated. The Cox proportional hazards model was used to estimate the effect of engagement in the program on dementia onset and to calculate a hazard ratio and 95 % confidential interval (CI).

Results: The incidence of dementia onset was 59 out of 845 (7.0 %) in the non-engagement group and 34 out of 845 (4.0 %) in the engagement group. The ARR rate was 3.0 % (95 % CI 0.8, 5.2), and the NNT was 33 (95 % CI 19, 125). The hazard ratio was 0.57 (95 % CI 0.37, 0.86).

Discussion: Engagement in the going-out program resulted in a 3.0 % reduction in the risk of dementia onset. The going-out program, which can be implemented in communities, holds potential efficacy in preventing dementia onset.

Objective: This study explored the dose-response relationship of exercise prescriptions for improving frailty in older adults, based on the 2024 Older Adult Compendium. It aims to provide evidence-based support for developing frailty intervention programs and their clinical application.

Methods: A comprehensive search was conducted in PubMed, OVID, Cochrane Library, Web of Science, and Scopus from inception to November 5th, 2024. Randomized controlled trials (RCTs) related to exercise interventions in older adults were included. Relevant studies meeting the inclusion criteria were selected, and data were extracted for further analysis. The quality of the included studies was assessed. Meta-analysis was performed using R, and the standardized mean difference (SMD) with 95 % confidence intervals (95 % CI) was used to quantify effect sizes.

Results: A total of 16 eligible RCTs comprising 2,716 older adults were included. The meta-analysis revealed that exercise significantly improved frailty among older adults [SMD = -0.81, 95 % CI (-1.25, -0.38), P < 0.001]. However, high-intensity exercise did not demonstrate a significant effect on frailty improvement [SMD = -0.45, 95 % CI (-0.96, 0.06), P = 0.3]. The analysis indicated a nonlinear dose-response relationship between exercise and frailty improvement. The predicted values for frailty improvement at the minimum and maximum exercise doses recommended by the World Health Organization (600 MET-minutes/week and 1200 MET-minutes/week, respectively) were -0.79 (95 % CI [-1.17, -0.41]) and -1.39 (95 % CI [-2.62, -0.15]), respectively.

Conclusion: Low- to moderate-intensity exercise significantly improves frailty among older adults, while high-intensity exercise programs are not recommended.

Close social ties are important for health but these can decline as people age. Moreover, losses of close social ties may be worse for women, older age and low socioeconomic groups. We characterized alterations in both marital status or living arrangement over 6 years by gender, and assessed patterns by age, country of origin, geographic location, education, wealth, and household income. We used three waves of Canadian Longitudinal Study on Aging data on 25,327 adults (45-85 years at baseline) to construct transition variables and multinomial logistic regressions with post-estimated predicted probabilities. Close social ties were stable over time, with most Canadians remaining partnered (77 % of men and 62 % of women) or co-living (82 % of men and 72 % of women). Adverse close social ties over time were gendered and socially patterned, with women 75+ years and of low socioeconomic status (SES) having the greatest risks. Becoming widowed or remaining non-partnered was relatively more likely for women with oldest age (RRR range: 6.08-15.64) or with low SES (RRRs: 2.29-47.06), and for men with oldest age (RRRs: 1.07-8.77) or low SES (RRRs: 2.03-31.72). Becoming or remaining lone-living was relatively more likely for women of oldest age (RRRs: 5.57-8.72) or low SES (RRRs: 2.16-65.78) and also for men of oldest aged (RRRs: 2.33-2.57) or low SES (RRRs: 2.08-49.62). Tailored healthy aging strategies to foster close social connections of women or men in older and low SES groups seems warranted.

Purpose: To analyze the effect of complex exercise on cognitive ability of the elderly.

Study design: By means of literature screening and quality assessment, high-quality studies were extracted to comprehensively analyze the effects of complex exercise on cognitive ability of the elderly.

Method: By searching databases such as Web of Science and CNKI, we integrated experimental studies on the effects of complex exercise on cognitive ability in the elderly, conducted literature quality assessment according to Cochrane bias risk assessment tool, and conducted meta-analysis using Review Manager 5.3.

Results: 1) A total of 27 articles of high quality literature were included, containing 1072 subjects; 2) Complex exercise had a positive effect on cognitive abilities of older adults (SMD = 0.56; 95 % CI: 0.34, 0.78, P < 0.00001), with differences in the effects on different cognitive abilities, with the best effect on cognitive inhibition (SMD = 0.79; 95 % CI: 0.17, 1.41, P = 0.01), followed by executive function (SMD = 0.76; 95 % CI: 0.41, 1.11, P < 0.0001) and cognitive speed (SMD = 0.48; 95 % CI: 0.13, 0.84, P = 0.008), and a non-significant effect of memory intervention (SMD = 0.07; 95 % CI: -0.2, 0.33, P = 0.62); 3) The literature publication bias detection was more effective.

Conclusion: 1) Complex exercise had a moderate effect in promoting cognitive performance in older adults. 2) By subgroup analysis, the order of intervention effect was cognitive inhibition, executive function, and cognitive speed, in descending order. 3) The intervention effect of complex exercise on memory in older adults was not significant.

Background: The construct of intrinsic capacity (IC) has been recently developed with the aim of assessing and monitoring life-long individuals' functional trajectories. Physical activity (PA) is recognized for its benefits on health but its associations with IC remain less investigated. We explored the cross-sectional and longitudinal associations of PA with IC in non-demented older adults.

Methods: Eight hundred and thirty-seven males and females aged 70 years and over, were included in the present work. IC and its domains (mobility, vitality, cognition, psychology and sensory) were assessed over 2 years and converted to a 0-100 scale. Participants were categorized into 5 PA groups (0-29; 30-499; 500-999; 1000-1999; and 2000+ MET-min/week) using questionnaires. The associations between PA and IC variables (all reflected and square-root-transformed) observed over 2 years were examined using mixed-effect linear regressions.

Findings: Over the 2-year follow-up, ordinal PA was associated with higher scores in IC (B = -0.066, SE = 0.015, p < .001) In addition, compared to the inactive group, most of the active groups had a slower decline in IC (B_{30-499 MET-min/week} = -0.196, SE = 0.078; B_{500-999 MET-min/week} = -0.208, SE = 0.076; B_{1000-1999 MET-min/week} = -0.165, SE = 0.073; B_{2000+MET-min/week} = -0.187, SE = 0.074; all p < .05). Subdomain analyses revealed that these associations were driven by mobility, vitality and psychological domain.

Interpretation: This study suggests that PA may help preventing IC decline, especially mobility, vitality, and psychology in older adults.

Aim: Our aim was to identify multimorbidity clusters and, in particular, to examine their contribution to well-being outcomes among the oldest old in Germany.

Methods: Data were taken from the large nationally representative D80+ study including community-dwelling and institutionalized individuals aged 80 years and over residing in Germany (n = 8,773). The mean age was 85.6 years (SD: 4.1). Based on 21 chronic conditions, latent class analysis was carried out to explore multimorbidity (≥2 chronic conditions) clusters. Widely used tools were applied to quantify well-being outcomes.

Results: Approximately nine out of ten people aged 80 and over living in Germany were multimorbid. Four multimorbidity clusters were identified: relatively healthy class (30.2 %), musculoskeletal class (44.8 %), mental illness class (8.6 %), and high morbidity class (16.4 %). Being part of the mental disorders cluster was consistently linked to reduced well-being (in terms of low life satisfaction, high loneliness and lower odds of meaning in life), followed by membership in the high morbidity cluster.

Conclusions: Four multimorbidity clusters were detected among the oldest old in Germany. Particularly belonging to the mental disorders cluster is consistently associated with low well-being, followed by belonging to the high morbidity cluster. This stresses the need for efforts to target such vulnerable groups, pending future longitudinal research.

Background: Older adults experience chronic inflammation, which is associated with health conditions such as sarcopenia, and resulting in reduced functional capacity. Resistance training (RT) is a beneficial intervention for improving health in the elderly.

Objective: This study aimed to investigate the effect of RT on inflammatory biomarkers, body composition, and functional capacity in healthy adults aged 60 years and over. Additionally, this study conducted a meta-regression to investigate the moderating effect of exercise variables on inflammatory markers.

Method: Medline, PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar were searched systematically until December 2023. Randomized controlled trials (RCTs) assessing the impact of RT on C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), body weight, BMI, fat percentage, fat mass, lean mass, leg extension strength and six-minute walk test (6-MWT) were included. Effect size was estimated by using the mean difference (MD) with 95 % confidence interval (CI).

Results: Nineteen RTCs involving 728 participants were included. The results revealed that CRP levels significantly decreased following RT programs (MD:0.74, p= 0.008), while TNF-α (MD: 0.1, p= 0.95) and IL-6 (MD:0.27, p= 0.12) did not show significant changes. Additionally, RT enhanced leg extension strength and 6-MWT performance.

Conclusion: RT effectively reduces CRP concentrations and enhances functional capacity in healthy older adults. However, it does not have a significant impact on TNF-α and IL-6 levels. Future researches are needed to make a clear conclusion and understand the mechanisms underlying the effects of RT in healthy older adults.

Registration: The original protocol was registered (CRD42023487573) in PROSPERO database.