Archives of gerontology and geriatrics最新文献

Background: Evidence on use of ultrasound to assess muscles in older adults, and its relation to clinically relevant measures is diverse and inconsistent.

Objective: To map and synthesize evidence on use of ultrasound-derived muscle variables and their associations with measures of physical function in older adults.

Methods: A scoping review was conducted in accordance with PRISMA-ScR and JBI guidance. MEDLINE, Cochrane, Embase, Scopus, CINAHL, and grey literature was searched. Eligible studies included adults ≥65 years, including frail cohorts, reporting association between ultrasound-derived muscle variables (muscle thickness (MT), cross-sectional area (CSA), echo intensity (EI), pennation angle (PA), fascicle length (FL), or shear-wave elastography (SWE)) and physical function measures (handgrip strength (HGS), sit-to-stand (STS), gait speed (GS), timed up-and-go (TUG), or short physical performance battery (SPPB)).

Results: Seventy studies met inclusion criteria. Mapping revealed that rectus femoris MT at mid-thigh was most frequently examined, with considerable protocol variation. Most studies used cross-sectional designs, and frail cohorts were underrepresented. MT and CSA showed weak to moderate associations with muscle strength-related measures (HGS and STS) and generally very weak to weak associations with physical performance-related measures (GS, TUG, SPPB). Evidence for EI, SWE, PA, and FL was limited and inconsistent.

Conclusion: Current evidence provides limited support for ultrasound-derived muscle variables as markers of physical function in older adults. Muscle thickness and cross-sectional area capture aspects of muscle strength but insufficiently reflect physical performance. Establishing harmonized protocols and exploring responsiveness in frail populations, in longitudinal studies are critical steps for future research and clinical application.

Objective: Early detection of mild cognitive impairment (MCI) is essential for dementia prevention. We developed the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) using age- and education-adjusted norms with a 1.5 standard deviation (SD) cutoff. This study examined the associations between cognitive domains assessed by the NCGG-FAT and incident dementia using the existing and expanded databases.

Method: A 5-year prospective cohort of 2,441 participants without dementia at baseline was analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) for individual cognitive tests and cognitive states (normal cognition, MCI, and global cognitive impairment) were estimated using Cox proportional hazards models. Competing risk of death was addressed using Fine-Gray models. Predictive models for dementia were also developed and validated.

Results: In the expanded database, declines ≥1.5 SD in word list memory, TMT-B, forward and backward digit span, and SDST were significantly associated with dementia onset (HRs 1.77-3.22). Fine-Gray analyses yielded similar results. For cognitive states, amnestic and non-amnestic MCI, particularly moderate subtypes, and global cognitive impairment showed elevated risks (HRs 1.55-2.92), although some associations lost significance after accounting for competing mortality. The NCGG-FAT composite score demonstrated high discrimination for incident dementia (AUC = 0.96; accuracy = 0.95).

Conclusion: The expanded NCGG-FAT database is a useful auxiliary tool for assessing future dementia risk in community-dwelling older adults.

Objective: This study investigated national trends in fall- and facial fracture-related hospitalisations among Australians aged 65 years and over from 2013 to 14 to 2022-23, and examined the association between hospitalisation of specific facial fracture subtypes and fall rates.

Study design: Ecological study using publicly available national hospitalisation data.

Methods: The dataset included all hospital admissions with a principal diagnosis of fall or facial fracture. Trends in hospitalisation rates were analysed using linear regression, and Pearson correlation was applied to assess associations between fall and facial fracture rates. Indexed trends and scatterplots were used to visualise temporal and population-level relationships.

Results: From 2013-14 to 2022-23, facial fracture hospitalisation rates among Australians aged 65+ increased from 55.7 to 84.4 per 100,000, while fall-related hospitalisations rose from 2891.5 to 3171.8 per 100,000. Although both trends were significant, facial fractures increased disproportionately faster than falls over the decade-long study period overall. Nasal fractures had the highest average rate (40.04 per 100,000) and mandibular fractures the lowest (5.17 per 100,000). Fall-related hospitalisation rates were 9.4 times higher in adults aged 85+ years than in those aged 65-69, while facial fracture rates were 6.6 times higher in the oldest group. Correlation analysis showed a strong positive association between fall-related and overall facial fracture hospitalisation rates across the study period. Reliance on principal diagnosis codes likely underestimated facial fractures.

Conclusions: Facial fracture hospitalisations among older Australians increased disproportionately compared with falls, underscoring the need for integrated prevention strategies in this ageing population.

Objective: There is a need to identify non-invasive, accessible biomarkers of cognitive decline and dementia risk. Frailty, sarcopenia and poor nutritional health are known to increase the risk of cognitive impairment and decreased tongue strength is a key component of all these. It remains unclear, though, if tongue strength holds potential as a non-invasive biomarker of cognitive decline. This scoping review mapped evidence from adults ≥50 years of age to document associations between tongue strength and cognitive decline, as well as the known risk factors of frailty, sarcopenia, and poor nutritional health.

Methods: The JBI scoping review methodology and the PRISMA-ScR guided the review process. Six databases were searched: PubMed, PsycINFO (Ovid), Scopus, Embase (Ovid), CINAHL, and Web of Science.

Results: Of 3409 records identified, 59 studies with 27,073 participants met eligibility criteria; these were published between 2011 and 2024, with 45 studies cross-sectional and 14 longitudinal, including two RCTs. Although measurement methods varied across the studies, there was evidence that decreased tongue strength in older adults was associated with cognitive decline (including Mild Cognitive Impairment and dementia), physical frailty, sarcopenia, and poorer nutritional health.

Conclusions: Tongue strength holds promise as a new biomarker of cognitive decline and dementia risk. Effective interventions exist to strengthen the tongue. This further supports the importance of measuring tongue strength to optimise older adults' health and cognitive function. Further culturally diverse, longitudinal studies are needed to validate the observed associations and establish specific tongue strength cutoff values to determine stages of cognitive decline.

An aging population necessitates strategies for extending healthy lifespan, with physical frailty as a key obstacle. Social activity participation is a potential intervention. However, previous studies examining the association between social activity participation and physical frailty have predominantly employed cross-sectional designs with single-wave surveys or longitudinal designs with two-wave surveys, and studies using multi-wave longitudinal designs are limited. Few studies have systematically evaluated the classification of physical frailty in subsequent follow-up assessments while considering temporal variations in social activity participation. Therefore, we studied the effect of temporal variations in social activity on subsequent physical frailty classifications using a three-wave survey. We found that sustained non-participation in sports-based activities significantly increased the risk of Pre-Frailty or Frailty at follow-up compared to sustained participation. Similarly, transitioning from participation to non-participation in culture-based activities increased this risk. These results suggest that maintaining participation in sports activities and avoiding cessation of cultural activities are crucial for preventing frailty. Individuals who consistently avoided sports or stopped cultural activities were more likely to be classified as pre-frail or frail in subsequent assessments.

Objectives: Poor health at the individual and area level has been shown to be associated with earlier labour market exit. This paper builds on work demonstrating that health in a place is associated with higher chances of work exit for older workers even once their own health is taken into account. This paper looks at an additional risk factor for work exit: industrial mix.

Study design: Data was drawn from the full 2011 Census and an approximately 1.1 % representative sample from England and Wales, the Office for National Statistics Longitudinal Study from 2001 to 2011.

Methods: We analysed people aged 40-64 in paid work in 2001 and measured their employment outcomes in 2011, at ages 50-74. Four industrial landscape clusters were derived by K-means cluster analysis using industry mix for 348 local authorities from 2011 Census. 'Health of a place' was measured using 2001 Census data for the usually resident population aged 50-74 years, the proportion who reported 'fair', 'bad' or 'very bad' self-rated health (as opposed to 'good' or 'very good') was calculated and split into tertiles.

Results: Work exit showed industrial landscape and area health inequalities. Older workers in healthy service sector areas in London had the lowest work exit chances with a gradient to those in unhealthy rural areas having the highest chance of work exit.

Conclusions: More research is required to investigate why, in areas where the same types of industry dominate, the health of the local population was associated with differing odds of work exit.

Objective: This systematic review and meta-analysis examined sex and gender differences in caregiver burden among family caregivers of persons with dementia and explored variations by region and country income level.

Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in four databases (CINAHL, PubMed, EMBASE, and PsycINFO), including studies up to December 2024. Forty-seven studies representing 24 countries were included in the systematic review, with 39 studies (41 effect sizes) included in the meta-analysis. A random-effects model was used to calculate pooled effect sizes (Cohen's d), and subgroup analyses were performed based on region and national income level.

Results: Across the 47 studies, 14,919 family caregivers participated, of whom 70 % were women. Most family caregivers were either spouses (44 %) or adult children (43 %). Care recipients were predominantly diagnosed with Alzheimer's disease. Female caregivers reported significantly greater burden than males (Cohen's d= 0.21, 95 % CI: 0.13-0.29, p< 0.001). Subgroup analyses showed higher burden in Asian countries (d= 0.27) compared to Western countries (d= 0.19), though the difference was not statistically significant. High-income countries showed greater disparities (d= 0.21) than middle-income countries (d= 0.16), with no significant difference. High heterogeneity was observed among Western and high-income countries.

Conclusion: Female family caregivers experience a higher burden than male caregivers across regions and economic settings. Although regional and income-level subgroup differences were not statistically significant, findings underscore the role of cultural and structural contexts in shaping caregiver burden. Gender-sensitive, context specific interventions are essential to address these disparities.