Archives of gerontology and geriatrics最新文献

Background: Social frailty has been increasingly prevalent due to the aging populations. This concept is a relatively new topic in the gerontology. Older adults experiencing social isolation because of social frailty remain in a state of loneliness or depression. Many misconceptions exist regarding the association between social frailty and high levels of loneliness and depression in older adults, which may exacerbate their condition.

Objective: To analyze the concept of social frailty on the basis of method introduced by Rodgers and Knafl.

Design: Rodgers and Knafl' evolutionary concept analysis INFORMATION SOURCES: PubMed, Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase were searched for the terms "Social frailty" and "Elderly" OR "Older adults" OR "Aged."

Results: A total of 65 articles on social frailty were selected from 4 databases and subjected to concept analysis based on Rodgers and Knafl' evolutionary concept. Data extraction and analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The analysis yielded 4 domains (11 subdomains) of antecedents, 3 attributes, and 2 domains (28 subdomains) of consequences.

Conclusion: The study findings contribute to a comprehensive and structured understanding of social frailty for health-care workers and the general public. Emphasizing the concept of social frailty can increase the levels of awareness and vigilance among health-care workers regarding the risks associated with social frailty in older adults.

Background: Evidence on antidementia drugs (ADD) use in developing countries, where accessibility to ADD is challenging, is limited. Our aim was to examine prescribing patterns, factors, and outcomes associated with the early-ADD use (within 3 months from diagnosis) in people with dementia.

Methods: A retrospective cohort study included individuals aged ≥ 60 years with dementia from three hospitals in Thailand between 2015 and 2020. Participants were categorized as non-ADD users, early-ADD users, and delayed users. ADD switching and one-year persistence were analyzed. Multivariable logistic regression was used to identify factors associated with early-ADD prescribing and its impact on clinical outcomes, including in-hospital death and hospitalization.

Results: 3,116 patients were included. The ADD prescription rate was 14.31 %, with 79.82 % of those being early-ADD users. Donepezil was the most prescribed (70.18 %). The one-year persistence rate of any ADD was 24.89 %. Factors associated with early-ADD use included the Civil Servant Medical Benefit Scheme, dyslipidemia, and dementia type. Early-ADD use was associated with reduced in-hospital death (adjusted odds ratio [aOR]=0.46, 95 % CI: 0.22-0.96, p = 0.038) and hospitalization (adjusted OR = 0.70 95 % CI: 0.51-0.97, p = 0.034) after controlling for age, sex, and Charlson Comorbidity Index.

Conclusion: ADD prescription rates were relatively low, with a one-year persistence rate of 25 %. Early-ADD use may improve clinical outcomes by reducing hospitalization and in-hospital mortality. These findings provide clinical features of ADD used in real-world settings and highlight the need for adherence to practice standards and strategies to promote ADD persistence among individuals with dementia.

Background: Understanding the global burden and risk factors of non-rheumatic valvular heart disease (NRVHD) in older adults is important for effective disease control. We wanted to analyze the prevalence, incidence, disability-adjusted life years (DALY) rate, mortality rate, and risk factors of NRVHD in older adults aged 60-89 years.

Methods: Global Burden of Disease Study (GBD) 2019 was used as the data source. Age standardized incidence rate, prevalence, DALY rate, and mortality rate of NRVHD among older adults aged 60-89 years from 1990 to 2019. We analyzed different age groups, genders, regions, sociodemographic index (SDI) across 204 countries/territories. Proportional DALY and mortality attributable to risk factors were calculated.

Results: Globally, age-standardized DALY rate (per 100,000 population) for NRVHD in older adults decreased significantly from 44.46 (95 % confidence interval 39.95 to 49.18) in 1990 to 35.94 (32.32 to 40.19) in 2019 with an average annual percent change (AAPC) of -0.19 % (-0.24 % to -0.14 %), and the mortality rate also decreased significantly from 2.48 (2.21 to 2.64) to 2.25 (1.89 to 2.47) with an AAPC of -0.09 % (-0.16 % to -0.03 %,). However, the age-standardized incidence rate (per 100,000 population) increased from 18.37 (17.41 to 19.35) in 1990 to 19.77(18.62 to 20.95) in 2019 with an AAPC of 0.08 % (0.05 % to 0.10 %), and the age-standardized prevalence rate significantly increased from 391.40 (372.71 to 411.20) to 399.50 (378.31 to 420.75) with an AAPC of 0.02 % (0.00 % to 0.05 %). At the regional level, the greatest burden of NRVHD was seen in parts of high-income North America. At the national level, the highest age standardized incidence rate, age standardized DALY rate, and age standardized mortality rate in 2019 were all from Niger, Philippines and Belarus, making it the region with the greatest burden of NRVHD. The age standardized incidence and DALY rate were higher in women 20.83 (19.68 to 22.02) than in men 18.64 (17.39 to 19.88) globally, while the mortality rate was similar in different genders. The differences between men and women in incidence, DALY and mortality were mainly found in age groups of 80-84 and 85-89 years. A significant negative association was found between estimated annual percentage change (EAPCs) and age standardized rate (q=-0.19, p = 0.00). A significant positive relation was detected between EAPCs and human development index (q = 0.17, p = 0.02). The main attributable risk factor for DALY was high body mass index in all regions by SDI.

Conclusion: There is a substantial global burden of NRVHD in older adults in 2019, which is varied by age, gender, SDI and region. NRVHD in older people should be paid attention to. Risk factors described here should provide more evidence and clues for disease prevention in the future.

Objective: To quantitatively synthesise evidence on the prevalence of and risk factors of frailty in older patients with coronary heart disease.

Methods: Nine electronic databases were searched from the inception to July 20th 2024. Random-effects model was performed to calculate to estimate the prevalence of frailty in older patients with coronary heart disease. Meta-regression analysis and subgroup analysis were conducted to explore the potential sources of heterogeneity. Sensitivity analysis was conducted using a study-by-study exclusion method. Meta-analysis of risk factors was performed using the Mantel-Haenszel or inverse variance method and only on the risk factors that have been reported in a minimum of two studies.

Results: A total of 42 studies from 5 countries met the inclusion criteria, involving 11954 older patients. The pooled prevalence in older adults with coronary heart disease was 36% (95%CI: 31%-40%) for frailty. We found a higher prevalence of frailty among older patients with coronary heart disease in females, ≥80 years, case-control studies, EFS evaluation tool and acute coronary syndrome. Age, female, cardiac classification, malnutrition, fall within 1 year, sleep disorder, hypoproteinemia (albumin<35g/L), low level of literacy, depression, anxiety, low BMI, polypharmacy, comorbidities, CCI, diabetes, hypertension, high level of BNP, ADL disability, gait speed, living alone, low level of 25(OH)D₃ were risk factors of frailty among older patients with coronary heart disease.

Conclusions: Coronary heart disease patients have a significantly higher prevalence of frailty. Early screening and timely prevention of frailty by medical practitioners are needed to provide more targeted measures for CHD patients.

Objective: This study aims to evaluate whether obstructive or restrictive lung disorders are associated with the incidence of dynapenia in individuals aged 50 and over.

Methods: Longitudinal study involving 4,975 participants from the English Longitudinal Study of Aging (ELSA) aged 50 or older, without dynapenia at baseline, followed for eight years. Lung function was assessed by spirometry (predicted percentage) and participants were classified as no pulmonary disorder (FEV₁ ≥ 80 %, FVC ≥ 80 % and FEV₁/FVC ≥ 70 %); with obstructive pulmonary disorder (FEV₁ < 80 %, FEV₁/FVC < 70 % and normal FVC or < 80 %); or with restrictive pulmonary disorder (FVC < 80 %, FEV₁/FVC > 70 % and normal or < 80 % FEV₁). The incidence of dynapenia was defined by handgrip strength < 26 kg for men and < 16 kg for women. Association between obstructive or restrictive pulmonary disorders and the incidence of dynapenia were investigated using Poisson regression models adjusted for sociodemographic, behavioural, and clinical characteristics.

Results: The incidence density of dynapenia was 14.2/1000 person-years (95 %CI 12.6-15.9) in those without pulmonary disorders, 25.1/1000 person-years (95 % CI 21.2-29.7) in those with restrictive pulmonary disorders and 36.6/1000 person-years (95 % CI 23.8-56.1) in those with obstructive pulmonary disorders. Having an obstructive pulmonary disorder increased the risk of developing dynapenia by 62 % (95 % CI 1.09-2.41), while having a restrictive pulmonary disorder increased the risk by 37 % (95 % CI 1.13-1.64).

Conclusion: Obstructive and restrictive pulmonary disorders are risk factors for a higher incidence of dynapenia in individuals aged 50 years or older.

Self-perceptions of aging (SPA) are defined as an evaluation of one's own aging. SPA can be positive (e.g., perceiving no change or improvement with age) or negative (e.g., perceived self-decline with age). We disentangle age, period, and cohort effects (e.g., attributed to a) individual differences associated with the passage of one's chronological age, b) circumstances affecting all in the same way, or c) circumstances differentially affecting groups of people born at a particular time, respectively) associated with changes in SPA over time. We relied on data from the Health and Retirement Survey collected between 2008 and 2020, consisting of 42,346 observations of individuals over the age of 50. We found a decline in the incidence of positive SPA after the age of 65 and an increase in the incidence of negative SPA, starting at 50. The effects of age on the incidence of negative and positive SPA varied somewhat across gender and ethnicity. We identified a strong linear trend suggesting a decline in negative SPA over time for Whites and Latinos. We also found a slight non-linear cohort effect in cohorts of Black men born between 1950 and 1955 and women born after 1955, with a higher relative risk of reporting negative SPA compared to other cohorts. For positive SPA, we did not identify linear or non-linear period or cohort effects. Clinically, the findings point to the susceptibility of older persons to lesser positive SPA and more negative SPA with age, thus highlighting a need for differential interventions.

Background: The growing aging population has resulted in a rise in the prevalence of frailty among senile osteoporosis (SOP) patients, with frailty predisposing SOP patients to a higher risk of adverse health outcomes.

Objective: This study aimed to evaluate the prevalence of frailty in SOP patients through a systematic review and meta-analysis.

Methods: A comprehensive search was performed in nine databases (Cochrane Library, PubMed, Web of Science, Embase, CINAHL, SinoMed, CNKI, VIP, and Wanfang) to identify relevant articles from inception to June 2023. Two investigators independently conducted literature screening and data extraction and evaluated the risk of bias using the cross-sectional study quality assessment scale recommended by the Agency for Healthcare Quality and Research (AHRQ) and the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed using Stata 15.1 software. Lastly, meta-regression, subgroup analysis, and sensitivity analysis were carried out to explore sources of heterogeneity.

Results: Eighteen studies involving 9,664 patients were included in the meta-analysis. The results revealed that the prevalence of frailty in SOP patients was 37.8% [95% CI (25.2%, 50.4%)]. Additionally, subgroup analyses indicated a prevalence of frailty of 47.4% [95% CI (23.7%, 71.1%)] in SOP patients aged 60-74 years and 33.3% [95% CI (17.7%, 48.8%)] in those aged ≥75 years. The prevalence rates of frailty in female and male SOP patients were 27.7% [95% CI (6.4%, 48.9%)] and 12.3% [95% CI (0.8%, 23.9%)], respectively. Meanwhile, the prevalence of frailty in SOP patients in developed and developing countries was 23.2% [95% CI (7%, 39.5%)] and 42.3% [95% CI (27.8%, 56.8%)], respectively. The prevalence of frailty in SOP patients, as measured by the Fried Frailty Phenotype Scale (FP), the J-CHS criteria, and the Frailty Assessment (FRAIL) scale, was 26.3% [95% CI (10.6%, 41.9%)], 38.1% [95% CI (31.5%, 44.6%)], and 47.2% [95% CI (31.0%, 63.5%)], respectively. Finally, the prevalence of frailty in SOP patients surveyed in 2005-2015 and 2016-2020 was 22.9% [95% CI (9.5%, 36.2%)] and 47.4% [95% CI (33.2%, 61.6%)], respectively. Meta-regression did not identify significant sources of heterogeneity.

Conclusion: The prevalence of frailty in SOP patients is high, especially in female patients, in developing countries, post-2015, and using the FRAIL scale assessments. Healthcare professionals are recommended to employ assessment tools with high reliability and validity to improve screening for frailty in SOP patients and implement timely interventions to prevent frailty in SOP patients.

Objective: The aim of this systematic review is to determine which physical tests, particularly those assessing strength, walking abilities and balance stability, can provide the most pertinent information for a preliminary screening of cognitive status, facilitating further cognitive evaluation.

Methods: A systematic search was conducted using the PubMed and Web of Science databases. Studies that assessed both strength or balance stability and cognitive state in community-dwelling adults aged ≥60 years old were selected for inclusion.

Results: The search strategy identified a total of 864 studies. After removing duplicates and applying inclusion and exclusion criteria, ten studies comprising a total of 6868 subjects were included in the review. According to the GRADE system, the studies were classified as low quality. Cognitively healthy individuals exhibited better balance, higher strength levels, greater gait speed and higher instrumental activities of daily living scores compared to those with mild cognitive impairment or cognitive impairment.

Conclusion: The assessment of physical function in older adults may serve as a useful tool in identifying impairments associated with physical frailty, sarcopenia, and cognitive decline. Early screening based on physical performance could assist healthcare professionals in determining the need for further cognitive assessment, potentially aiding in the prevention or early detection of cognitive decline.

Objective: Dysphagia significantly affects older adults, particularly those with heart failure (HF). This scoping review aimed to delineate the development of dysphagia and its contributing factors in patients with HF.

Methods: We systematically searched MEDLINE, EMBASE, CINAHL, and CENTRAL databases up to September 2023, focusing on studies involving HF patients aged 60 and above, particularly those assessing post-hospitalization dysphagia.

Results: Of 1,076 identified studies, nine were relevant. The prevalence of dysphagia at admission was 23.6 % (14.1 - 32.9), with 9.4 % (4.5 - 13.8) persisting until discharge. The evaluation of dysphagia primarily relies on oral intake assessments, highlighting several risk factors, including high inflammation, low energy intake, advanced age, low Barthel Index scores, poor oral health, antipsychotic usage, and low maximum tongue pressure. It is important to note potential author bias and overlap among study populations.

Conclusions: This review highlights the significant development of dysphagia in patients with HF, and the prevalence of newly developed dysphagia was 23.6 % (14.1 - 32.9). Key risk factors include older age, high inflammation, low activities of daily living, and sarcopenia, which is suggested as a pathogenic mechanism in dysphagia. Future research should focus on diverse samples, investigate the impact of sarcopenia and cachexia, and objectively assess swallowing function.

This systematic review aimed to evaluate the independent and joint effects of social exclusion in three specific domains-economic, social relations, and civic participation-on the cognitive health of middle-aged and older adults. Longitudinal studies from January 2000 to October 2023 were identified via Web of Science, Scopus, and PubMed, with sixty-five studies meeting inclusion criteria. The quality of the studies was assessed with Newcastle-Otawa Scale. Analysis revealed a strong association between economic exclusion and cognitive decline, with most studies indicating a significant negative impact. Ten studies found a positive link between volunteering and cognitive health for civic participation, while eight did not, showing mixed evidence. In social relations, most studies connected loneliness, social isolation, smaller social networks, reduced contact with family and friends, lower engagement in activities, and negative social interactions with cognitive decline. Notably, one study found that older adults experiencing social exclusion in multiple domains simultaneously face even greater cognitive decline. In summary, this review shows that social exclusion in economic, social relations, and civic participation and all together domains is associated with greater cognitive decline in older adults.