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Role of the upper limb in limiting head impact during laboratory-induced falls in at fall-risk older adults. 实验室诱发高危老年人跌倒时,上肢在限制头部冲击力方面的作用。
Lingjun Chen, Tobia Zanotto, James Fang, Ethan Scharf, Nathanael Garcia, Andrew Luzania, Rishav Mukherjee, Neil B Alexander, Jacob J Sosnoff

Background: Fall-related head impact is the leading cause of traumatic brain injury in older adults. There is limited understanding of factors related to fall-related head impact. This investigation examined characteristics of upper limb movements during standing-height falls and examined their association with fall-related head impact in older adults at risk for falls.

Methods: Older adults (n=29) at risk for fall-related injuries underwent experimentally induced falls in multiple directions (backwards and sideways). To characterize the upper limb movements and their association with head impact, a standardized analysis tool was used to analyze a total of 164 video-recorded falls. The association between upper limb movements (and their characteristics) and head impact was analyzed through logistic regression.

Results: Nearly 80% of falls involved upper limb movements. Absence of upper limb movements significantly increased head impact odds by approximately 4-fold. The odds of head impact were reduced in falls with energy absorption at the forearm (0.013-fold) and upper arm (0.018-fold), compared to falls without upper limb energy absorption. Backwards falls showed significantly higher odds of head impact (more than 4-fold).

Conclusion: Upper limb movements are common during fall descent and are associated with lower odds of experiencing head impact. Energy absorption with the upper limb seems to be an important protective mechanism. Future work should explore if these movements can be augmented with targeted training.

背景:与跌倒相关的头部撞击是老年人脑外伤的主要原因。人们对与跌倒相关的头部撞击的相关因素了解有限。这项调查研究了有跌倒风险的老年人在站立高度跌倒时上肢运动的特征,并研究了这些特征与跌倒相关头部撞击的关系:方法:对有跌倒相关伤害风险的老年人(29 人)进行实验诱导,诱导他们从多个方向(后方和侧方)跌倒。为了确定上肢运动的特征及其与头部撞击的关系,我们使用标准化分析工具对总共 164 个跌倒视频进行了分析。通过逻辑回归分析了上肢运动(及其特征)与头部撞击之间的关联:结果:近 80% 的跌倒涉及上肢运动。没有上肢运动会使头部受到撞击的几率明显增加约 4 倍。与没有上肢能量吸收功能的跌倒相比,前臂(0.013 倍)和上臂(0.018 倍)有能量吸收功能的跌倒发生头部撞击的几率降低。向后跌倒时头部受到撞击的几率明显更高(超过4倍):结论:上肢运动在跌倒下落过程中很常见,与较低的头部撞击几率有关。上肢吸收能量似乎是一种重要的保护机制。未来的工作应探索是否可以通过有针对性的训练来增强这些动作。
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引用次数: 0
The Association between Psychotropic Medication Use and Gait and Mobility Impairment in Community-Dwelling Older People. Data from The Irish Longitudinal Study on Ageing (TILDA). 居住在社区的老年人使用精神药物与步态和行动障碍之间的关系。来自爱尔兰老龄化纵向研究(TILDA)的数据。
Desmond O' Donnell, Frank Moriarty, Amanda Lavan, Rose Anne Kenny, Robert Briggs

Background: Little work to date has quantified the effect of psychotropic medications (antidepressants, benzodiazepines, 'Z' drugs, antipsychotics, anticholinergics) on mobility and gait in later life. The aim of this study is to examine the relationship between these medications and mobility/gait parameters in a large cohort of community-dwelling older people.

Methods: Participants were included if they were ≥60 years at TILDA Wave 1 and underwent gait and mobility assessment (Gaitrite system), with follow-up at Wave 3 (4 years). Medication lists were examined for psychotropic medications. Regression models assessed the relationship between psychotropic medications and mobility, using the following parameters: Timed Up and Go (TUG), gait speed, step length / width, double support phase. Multilevel modelling assessed trajectories of mobility/gait variables over time by psychotropic use.

Results: Of 2620 patients, 12% were prescribed ≥1 psychotropic medication, 3% prescribed ≥2 psychotropics. Cross-sectionally, psychotropic medication was independently associated with prolonged TUG (β=0.50 (95% CI 0.27-0.73); p<0.001), slower gait speed (β=-5.65 (95% CI -7.92 - -3.38); p<0.001), shorter step length (β=-2.03 (95% CI -2.93 - -1.42); p<0.001) and increased double support phase (β=0.47 (95% CI 0.19-0.75); p=0.001).Longitudinally, psychotropic use was independently associated with transition to abnormal TUG (OR 2.68 (95% CI 1.55-4.64), p<0.001), while using ≥2 psychotropics was associated with transition to slower gait speed (OR 2.59 (95% CI 1.01-6.68); p=0.048).

Conclusions: Psychotropic use was associated with significantly poorer mobility and gait performance, both cross-sectionally and longitudinally. It is imperative that psychotropic medication use is reviewed as part of comprehensive geriatric assessment.

背景:迄今为止,很少有研究对精神药物(抗抑郁药、苯二氮卓类药物、"Z "类药物、抗精神病药物、抗胆碱能药物)对老年人行动能力和步态的影响进行量化研究。本研究的目的是在一大批居住在社区的老年人中研究这些药物与行动能力/步态参数之间的关系:方法:在 TILDA 第 1 波时年龄≥60 岁并接受步态和行动能力评估(Gaitrite 系统)的参与者均被纳入研究范围,并在第 3 波(4 年)进行随访。对药物清单中的精神药物进行了检查。回归模型使用以下参数评估了精神药物与行动能力之间的关系:定时起立行走(TUG)、步速、步长/步宽、双支撑阶段。多层次模型根据精神药物的使用情况评估了随时间变化的活动能力/步态变量的轨迹:在2620名患者中,12%的患者服用了≥1种精神药物,3%的患者服用了≥2种精神药物。从横截面来看,精神药物与 TUG 的延长独立相关(β=0.50 (95% CI 0.27-0.73); p结论:精神药物的使用与 TUG 的延长密切相关:无论从横向还是纵向来看,精神药物的使用都与较差的活动能力和步态表现密切相关。作为老年病综合评估的一部分,必须对精神药物的使用情况进行审查。
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引用次数: 0
Gerontologic Biostatistics and Data Science: Aging Research in the Era of Big Data. 老年生物统计学和数据科学:大数据时代的老年研究。
Chixiang Chen, Terrence E Murphy, Jaime Lynn Speiser, Karen Bandeen-Roche, Heather Allore, Thomas G Travison, Michael Griswold, Michelle Shardell

Introduced in 2010, the sub-discipline of gerontologic biostatistics was conceptualized to address the specific challenges of analyzing data from clinical research studies involving older adults. Since then, the evolving technological landscape has led to a proliferation of advancements in biostatistics and other data sciences that have significantly influenced the practice of gerontologic research, including studies beyond the clinic. Data science is the field at the intersection of statistics and computer science, and although the term "data science" was not widely used in 2010, the field has quickly made palpable impacts on gerontologic research. In this Review in Depth, we describe multiple advancements of biostatistics and data science that have been particularly impactful. Moreover, we propose the sub-discipline of "gerontologic biostatistics and data science", or GBDS, which subsumes gerontologic biostatistics into a more encompassing practice. Prominent GBDS advancements that we discuss herein include cutting-edge methods in experimental design and causal inference, adaptations of machine learning, the rigorous quantification of deep phenotypic measurement, and analysis of high-dimensional -omics data. We additionally describe the need for integration of information from multiple studies and propose strategies to foster reproducibility, replicability, and open science. Lastly, we provide information on software resources for GBDS practitioners to apply these approaches to their own work and propose areas where further advancement is needed. The methodological topics reviewed here aim to enhance data-rich research on aging and foster the next generation of gerontologic researchers.

老年生物统计学这一分支学科于 2010 年提出,旨在解决分析老年人临床研究数据所面临的特殊挑战。从那时起,不断发展的技术环境推动了生物统计学和其他数据科学的进步,极大地影响了老年学研究的实践,包括临床以外的研究。数据科学是统计学和计算机科学的交叉领域,虽然 "数据科学 "一词在 2010 年还未被广泛使用,但该领域已迅速对老年学研究产生了明显的影响。在这篇《深度回顾》中,我们将介绍生物统计学和数据科学的多项进展,这些进展尤其具有影响力。此外,我们还提出了 "老年生物统计与数据科学"(gerontologic biostatistics and data science,简称 GBDS)这一分支学科,它将老年生物统计归纳为一种更全面的实践。我们在此讨论的 GBDS 的突出进展包括实验设计和因果推断的前沿方法、机器学习的调整、深度表型测量的严格量化以及高维组学数据的分析。此外,我们还介绍了整合多项研究信息的必要性,并提出了促进可重复性、可复制性和开放科学的策略。最后,我们提供了有关软件资源的信息,供 GBDS 从业人员将这些方法应用到自己的工作中,并提出了需要进一步推进的领域。本文回顾的方法论主题旨在加强数据丰富的老龄化研究,培养下一代老年学研究人员。
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引用次数: 0
Short-term frailty index fluctuations in older adults: Noise or signal? 老年人的短期虚弱指数波动:噪音还是信号?
Erwin Stolz, Anna Schultz, Emiel O Hoogendijk, Olga Theou, Kenneth Rockwood

Background: Reversible short-term fluctuations in the frailty index (FI) are often thought of as representing only noise or error. Here, we assess (1) size and source of short-term FI fluctuations, (2) variation across socio-demographics, (3) association with chronic diseases, (4) correlation with age, frailty level, frailty change, and mortality, and (5) whether fluctuations reflect discrete health transitions.

Methods: Nationwide, biweekly longitudinal data from 426 community-dwelling older adults (70+) were collected in the FRequent health Assessment In Later life (FRAIL70+) study using a measurement burst design (5,122 repeated observations, median of 13 repeated observations per person). We calculated the intraindividual standard deviation (iSD) of the FI and used location-scale mixed regression models.

Results: Mean iSD was 0.04 (SD=0.03). Fluctuations were driven foremost by cognitive problems, somatic symptoms, and limitations in instrumental and mobility-related activities of daily living. Short-term fluctuations correlated with higher FI levels (r=0.62), one-year FI change (r=0.26), and older age (+3% per year). Older adults who took to bed due to a health problem (+50%), those who had an overnight hospital stay (+50%), and those who died during follow-up (+44%) exhibited more FI fluctuations.

Conclusions: Short-term FI fluctuations were neither small nor random. Instead, as older adults become frailer, their measured health also becomes more unstable; hence short-term fluctuations in overall health status can be seen as a concomitant phenomenon of the aging process. Researchers and clinicians should be aware of existence of reversible fluctuations in the FI over weeks and months and its consequences for frailty monitoring.

背景:人们通常认为虚弱指数(FI)的可逆短期波动仅代表噪音或误差。在此,我们将评估:(1) 短期虚弱指数波动的大小和来源;(2) 不同社会人口统计学之间的差异;(3) 与慢性疾病的关联;(4) 与年龄、虚弱程度、虚弱变化和死亡率的相关性;(5) 波动是否反映了离散的健康转变:晚年健康评估(FRAIL70+)研究采用测量突发设计(5122 次重复观察,中位数为每人 13 次重复观察),收集了来自 426 名社区老年人(70 岁以上)的全国性双周纵向数据。我们计算了 FI 的个体内标准偏差 (iSD),并使用了位置尺度混合回归模型:平均 iSD 为 0.04(SD=0.03)。波动的主要原因是认知问题、躯体症状以及工具性和活动性日常生活活动的限制。短期波动与较高的 FI 水平(r=0.62)、一年的 FI 变化(r=0.26)和年龄(每年 +3%)相关。因健康问题而卧床的老年人(+50%)、住院过夜的老年人(+50%)以及在随访期间死亡的老年人(+44%)的FI波动更大:短期 FI 波动既不小,也不是随机的。因此,整体健康状态的短期波动可被视为衰老过程中的一种伴随现象。研究人员和临床医生应该意识到 FI 在数周或数月内的可逆波动及其对虚弱监测的影响。
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引用次数: 0
FOXO3 Longevity Genotype Mitigates Risk Posed by Hypertension on Incident Coronary Artery Disease in Middle-aged Men: Kuakini Honolulu Heart Program. FOXO3 长寿基因型可降低高血压对中年男性冠心病发病率造成的风险:Kuakini檀香山心脏计划
Randi Chen, Brian J Morris, Timothy A Donlon, Kazuma Nakagawa, Richard C Allsopp, Bradley J Willcox, Kamal H Masaki

This study tested whether carriage of the longevity-associated G-allele of FOXO3 SNP rs2802292 (TG/GG) protects against incident coronary artery disease (CAD) in men with hypertension. Subjects were American men residing on Oahu having Japanese (n=5415) or Okinawan (n=897) ancestry and free of CAD at baseline (1965-1968) when aged 45-68 years. During follow-up there were 1,629 incident CAD cases. Adjusting for age and cardiovascular disease risk factors, the main effect Cox model showed that in men of Japanese ancestry, hypertension was a strong predictor of CAD (HR 1.61; 95% CI 1.44-1.80), P<0.0001), but TG/GG genotype was not associated with CAD (HR 0.92; 95% CI = 0.82-1.02; p=0.11). A full Cox model showed the interaction of TG/GG with hypertension was significant (β = -0.23, p=0.038). Stratified by hypertension status, TG/GG genotype TG/GG had a protective effect against CAD in each group (HR 0.83; 95% CI 0.71-0.96; p=0.021 in men of Japanese heritage, and HR 0.66; 95% CI 0.43-1.01; p=0.054 in men of Okinawan heritage). No association with CAD was seen in normotensive men having either Japanese (HR 1.04; 95% CI 0.89-1.22; p=0.61) or Okinawan (HR 0.95; 95% CI 0.66-1.38; p=0.79) heritage. The present prospective study found longevity associated FOXO3 genotype did not independently affect risk of CAD in all men. Rather, it was associated with protection against incident CAD in men with hypertension. Hypertensive middle-aged men with FOXO3 TT genotype may merit particular attention in CAD prevention programs.

本研究测试了 FOXO3 SNP rs2802292 (TG/GG)的长寿相关 G-等位基因携带者是否能预防男性高血压患者发生冠状动脉疾病(CAD)。研究对象是居住在欧胡岛的美国男性,他们有日本血统(5415 人)或冲绳血统(897 人),基线年龄为 45-68 岁(1965-1968 年),无冠状动脉疾病。在随访期间,共发现 1629 例冠状动脉粥样硬化病例。在对年龄和心血管疾病风险因素进行调整后,主效应 Cox 模型显示,在日本血统的男性中,高血压是预测 CAD 的有力因素(HR 1.61;95% CI 1.44-1.80),P<0.05。
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引用次数: 0
Current Challenges, Solutions, and Novel Directions in Research and Clinical Care: Proceedings from the 14th Annual International Workshop on HIV and Aging. 当前的挑战、解决方案以及研究和临床护理的新方向:第 14 届艾滋病与老龄化国际研讨会论文集》。
Abigail Baim-Lance, Sarah Cooley, Moka Yoo-Jeong, Beau Ances, Gustavo Duque, Ronald J Ellis, Charles Flexner, Brian W Pence, Michael Plankey, John David Mullins, Jing Sun, April D Thames, Joseph B Margolick, David J Moore, Kristine M Erlandson

Integrating antiretroviral therapy (ART) into HIV care dramatically extended the lifespan for people living with HIV (PWH). Improving the health span requires understanding aging, HIV, associated comorbid conditions, and concurrent treatments. The 14th annual International Workshop on HIV and Aging on October 26-27, 2023 included podium presentations on: Sarcopenia Biology, Pathophysiology, Prevention and Treatment; Long-acting ART; Central Nervous System (CNS) Complications; Asymptomatic Neurocognitive Impairment (ANI); Mental Health; Loneliness; and Resilience. Presentations highlighted persistent concerns for PWH including sarcopenia and frailty, mental health, loneliness, and cognition. Presenters encouraged prioritizing mental health treatment, reducing social isolation, and research on resiliency.

将抗逆转录病毒疗法(ART)纳入艾滋病护理,大大延长了艾滋病病毒感染者(PWH)的寿命。改善健康寿命需要了解老龄化、艾滋病、相关合并症和并发症治疗。2023 年 10 月 26 日至 27 日举行的第 14 届艾滋病与老龄化国际研讨会包括以下方面的讲台演讲:Sarcopenia 生物学、病理生理学、预防和治疗;长效抗逆转录病毒疗法;中枢神经系统 (CNS) 并发症;无症状神经认知功能障碍 (ANI);心理健康;孤独;以及复原力。发言强调了 PWH 持续关注的问题,包括肌肉疏松症和虚弱、心理健康、孤独和认知能力。演讲者鼓励将心理健康治疗、减少社会隔离和复原力研究列为优先事项。
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引用次数: 0
LPS-induced delirium-like behavior and microglial activation in mice correlate with bispectral electroencephalography (BSEEG). LPS 诱导的小鼠谵妄样行为和小胶质细胞活化与双谱脑电图 (BSEEG) 相关。
Tsuyoshi Nishiguchi, Kyosuke Yamanishi, Nipun Gorantla, Akiyoshi Shimura, Tomoteru Seki, Takaya Ishii, Bun Aoyama, Johnny R Malicoat, Nathan James Phuong, Nicole Jade Dye, Takehiko Yamanashi, Masaaki Iwata, Gen Shinozaki

Delirium is a multifactorial medical condition characterized by impairment across various mental functions and is one of the greatest risk factors for prolonged hospitalization, morbidity, and mortality. Research focused on delirium has proven to be challenging due to a lack of objective measures for diagnosing patients, and few laboratory models have been validated. Our recent studies report the efficacy of bispectral electroencephalography (BSEEG) in diagnosing delirium in patients and predicting patient outcomes. We applied BSEEG to validate a lipopolysaccharide (LPS)-induced mouse model of delirium. Moreover, we investigated the relationship between BSEEG score, delirium-like behaviors, and microglia activation in hippocampal dentate gyrus and cortex regions in young and aged mice. There was a significant correlation between BSEEG score and impairment of attention in young mice. Additionally, there was a significant correlation between BSEEG score and microglial activation in hippocampal dentate gyrus and cortex regions in young and aged mice. We have successfully validated the BSEEG method by showing its associations with a level of behavioral change and microglial activation in an LPS-induced mouse model of delirium. In addition, the BSEEG method was able to sensitively capture an LPS-induced delirium-like condition that behavioral tests could not capture because of a hypoactive state.

谵妄是一种多因素疾病,其特点是各种精神功能受损,是导致长期住院、发病和死亡的最大风险因素之一。由于缺乏对患者进行诊断的客观测量方法,而且很少有实验室模型经过验证,因此以谵妄为重点的研究已被证明具有挑战性。我们最近的研究报告显示,双谱脑电图(BSEEG)在诊断患者谵妄和预测患者预后方面具有疗效。我们应用 BSEEG 验证了脂多糖(LPS)诱导的小鼠谵妄模型。此外,我们还研究了 BSEEG 评分、谵妄样行为以及年轻小鼠和老年小鼠海马齿状回和皮层区域小胶质细胞活化之间的关系。在年轻小鼠中,BSEEG 评分与注意力受损之间存在明显的相关性。此外,年轻小鼠和老年小鼠的 BSEEG 评分与海马齿状回和皮层区域的小胶质细胞活化之间存在显著相关性。在 LPS 诱导的小鼠谵妄模型中,我们成功验证了 BSEEG 方法与行为变化和小胶质细胞活化水平的相关性。此外,BSEEG 方法还能灵敏地捕捉到 LPS 诱导的类似谵妄的状态,而行为测试由于低活性状态而无法捕捉到这种状态。
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引用次数: 0
Sex Differences in Response to Diet Enriched with Glutathione Precursors in the Aging Heart. 衰老心脏对富含谷胱甘肽前体饮食的反应存在性别差异
Aude Angelini, Grecia Garcia Marquez, Anna Malovannaya, Marta L Fiorotto, Alexander Saltzman, Antrix Jain, Jo Ann Trial, George E Taffet, Katarzyna A Cieslik

Common features of the aging heart are dysregulated metabolism, inflammation, and fibrosis. Elevated oxidative stress is another hallmark of cardiac aging that can exacerbate each of these conditions. We hypothesize that by increasing natural antioxidant levels (glutathione), we will improve cardiac function. Twenty-one-month-old mice were fed Glycine and N-Acetyl Cysteine (GlyNAC) (glutathione precursors)-supplemented or control diets for 12 weeks. Heart function was monitored longitudinally, and the exercise performance was determined at the end of the study. We found that the GlyNAC diet was beneficial for old male but not old female mice, leading to an increase of Ndufb8 expression (a subunit of the mitochondrial respiratory chain complex), and higher enzymatic activity for CPT1b and CrAT, two carnitine acyltransferases that are critical to cardiomyocyte metabolism. Although no quantifiable change of collagen turnover was detected, hearts from GlyNAC-fed old males exhibited a slight but significant enrichment in Fmod, a protein that can inhibit collagen fibril formation, possibly reducing extracellular matrix (ECM) stiffness and thus improving diastolic function. Cardiac diastolic function was modestly improved in males but not females, and surprisingly GlyNAC-fed female mice showed a decline in exercise performance. In summary, our work supports the concept that aged male and female hearts are phenotypically different. These basic differences may affect the response to pharmacological and diet interventions, including antioxidants.

心脏衰老的共同特征是新陈代谢失调、炎症和纤维化。氧化应激升高是心脏衰老的另一个标志,会加剧上述每一种情况。我们假设,通过提高天然抗氧化剂(谷胱甘肽)的水平,可以改善心脏功能。给 21 个月大的小鼠喂食添加甘氨酸和 N-乙酰半胱氨酸(GlyNAC)(谷胱甘肽前体)的食物或对照组食物 12 周。对小鼠的心脏功能进行纵向监测,并在研究结束时测定其运动表现。我们发现 GlyNAC 膳食对老年雄性小鼠有益,但对老年雌性小鼠无益,它能增加 Ndufb8(线粒体呼吸链复合物的一个亚基)的表达,并提高 CPT1b 和 CrAT(对心肌细胞代谢至关重要的两种肉碱酰基转移酶)的酶活性。虽然没有检测到可量化的胶原翻转变化,但喂食 GlyNAC 的老年男性心脏显示出 Fmod 的轻微但显著的富集,Fmod 是一种能抑制胶原纤维形成的蛋白质,可能会降低细胞外基质(ECM)的硬度,从而改善心脏舒张功能。雄性小鼠的心脏舒张功能略有改善,而雌性小鼠则没有,而且令人惊讶的是,喂食 GlyNAC 的雌性小鼠的运动表现有所下降。总之,我们的工作支持了这样一个概念,即老年雄性和雌性心脏在表型上是不同的。这些基本差异可能会影响对药物和饮食干预(包括抗氧化剂)的反应。
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引用次数: 0
The Neighborhood Environment and Handgrip Strength: Longitudinal Findings From the Health and Retirement Study. 邻里环境与握力:健康与退休研究的纵向发现。
Kate A Duchowny, L Grisell Diaz-Ramirez, W John Boscardin, Rohini Perera, Scarlett Lin-Gomez, Peggy M Cawthon, Grace A Noppert, Philippa J Clarke

Background: Muscle strength, as measured by handgrip strength (HGS), is associated with physical function and mortality. Yet the environmental context that influences muscle strength is poorly understood. We evaluated built and social neighborhood characteristics and their association with muscle strength over time.

Methods: Using data from the Health and Retirement Study (2006-2018), linear mixed models assessed how 11 built and social neighborhood variables were associated with baseline levels and changes in HGS over time.

Results: Among the 20 045 respondents (mean age = 63 years, standard deviation = 9.7) with up to 4 HGS measures, 8 455 were men and 11 590 were women. Among men, residing in a neighborhood with a 10% increment higher score on neighborhood disadvantage was associated with a ~1 kg lower HGS at baseline (B = -0.96 kg, 95% confidence interval [CI] = -1.39 to -0.53). Similarly, each 1-point increment on the physical disorder scale was associated with a -0.39 kg lower (95% CI = -0.65 to -0.12) baseline HGS value. Among women, each 10% increment in neighborhood disadvantage was associated with a 0.29 kg lower HGS at baseline (B = -0.29 kg for each 10% increment, 95% CI = -0.46, -0.13). Each 1-unit increment in the number of neighborhood gyms at baseline was associated with a 0.50 kg lower HGS (B = -0.50, 95% CI = -0.76 to -0.23). Each 1-point increment in physical disorder was associated with a -0.12 kg lower (95% CI = -0.24 to -0.00) baseline HGS value. None of the neighborhood features were associated with the HGS rate of change.

Conclusions: Findings suggest that residing in neighborhoods with greater disadvantages and physical disorders may pose challenges for HGS among middle-aged adults as they enter into older adulthood.

背景:以手握强度(HGS)衡量的肌肉力量与身体功能和死亡率有关。然而,人们对影响肌肉力量的环境背景知之甚少。我们评估了建筑和社会邻里特征及其与肌肉力量的长期关联:利用健康与退休研究(2006-2018 年)的数据,通过线性混合模型评估了 11 个建筑和社会邻里变量与 HGS 基线水平和随时间变化的关系:在多达 4 项 HGS 测量的 20,045 名受访者(平均年龄 = 63 岁,SD = 9.7)中,男性为 8,455 人,女性为 11,590 人。在男性中,居住在邻里劣势得分每增加 10%,基线时的 HGS 就会降低约 1 千克(B = -0.96 千克,95% CI = -1.39, -0.53)。同样,身体失调量表每增加 1 分,基线 HGS 值就会降低-0.39 千克(95% CI = -0.65,-0.12)。在女性中,邻里劣势每增加 10%,基线 HGS 值就会降低 0.29 千克(每增加 10%,B = -0.29 千克,95% CI = -0.46,-0.13)。基线时社区健身房数量每增加 1 个单位,HGS 就会降低 0.50 千克(B = -0.50,95% CI = -0.76,-0.23)。身体失调每增加 1 个点,基线 HGS 值就会降低-0.12 千克(95% CI = -0.24,-0.00)。没有一个社区特征与 HGS 变化率相关:研究结果表明,居住在较为贫困和身体机能失调的社区可能会对进入老年期的中年人的 HGS 带来挑战。
{"title":"The Neighborhood Environment and Handgrip Strength: Longitudinal Findings From the Health and Retirement Study.","authors":"Kate A Duchowny, L Grisell Diaz-Ramirez, W John Boscardin, Rohini Perera, Scarlett Lin-Gomez, Peggy M Cawthon, Grace A Noppert, Philippa J Clarke","doi":"10.1093/gerona/glae242","DOIUrl":"10.1093/gerona/glae242","url":null,"abstract":"<p><strong>Background: </strong>Muscle strength, as measured by handgrip strength (HGS), is associated with physical function and mortality. Yet the environmental context that influences muscle strength is poorly understood. We evaluated built and social neighborhood characteristics and their association with muscle strength over time.</p><p><strong>Methods: </strong>Using data from the Health and Retirement Study (2006-2018), linear mixed models assessed how 11 built and social neighborhood variables were associated with baseline levels and changes in HGS over time.</p><p><strong>Results: </strong>Among the 20 045 respondents (mean age = 63 years, standard deviation = 9.7) with up to 4 HGS measures, 8 455 were men and 11 590 were women. Among men, residing in a neighborhood with a 10% increment higher score on neighborhood disadvantage was associated with a ~1 kg lower HGS at baseline (B = -0.96 kg, 95% confidence interval [CI] = -1.39 to -0.53). Similarly, each 1-point increment on the physical disorder scale was associated with a -0.39 kg lower (95% CI = -0.65 to -0.12) baseline HGS value. Among women, each 10% increment in neighborhood disadvantage was associated with a 0.29 kg lower HGS at baseline (B = -0.29 kg for each 10% increment, 95% CI = -0.46, -0.13). Each 1-unit increment in the number of neighborhood gyms at baseline was associated with a 0.50 kg lower HGS (B = -0.50, 95% CI = -0.76 to -0.23). Each 1-point increment in physical disorder was associated with a -0.12 kg lower (95% CI = -0.24 to -0.00) baseline HGS value. None of the neighborhood features were associated with the HGS rate of change.</p><p><strong>Conclusions: </strong>Findings suggest that residing in neighborhoods with greater disadvantages and physical disorders may pose challenges for HGS among middle-aged adults as they enter into older adulthood.</p>","PeriodicalId":94243,"journal":{"name":"The journals of gerontology. Series A, Biological sciences and medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults. 老年人的功能障碍、表型虚弱和特定部门的医疗成本递增。
Kristine E Ensrud, John T Schousboe, Allyson M Kats, Brent C Taylor, Wei Duan-Porter, Kerry M Sheets, Cynthia M Boyd, Peggy M Cawthon, Lisa Langsetmo

Background: This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors.

Methods: Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4 318 women and 3 847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims.

Results: Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2 838 ($5 516) in inpatient, $1 572 ($1 446) in SNF, and $1 349 ($1 060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4 100 (not significant for men) in inpatient, $1 579 ($1 254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs.

Conclusions: In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

背景:本研究量化了特定医疗行业中功能障碍和表型虚弱的医疗支出增量:本研究量化了特定医疗保健部门因功能障碍和表型虚弱而增加的医疗保健支出:方法:对与医疗保险理赔相关联的 4 项前瞻性队列研究进行 2023 年汇总分析,其中包括参加指数检查的 4318 名女性和 3847 名男性(2002-2011 年)。确定指标检查后 36 个月内的住院、专业护理机构 (SNF)、家庭保健 (HHC) 和门诊年化费用(2023 年美元)。从队列数据中得出功能障碍(进行 4 项日常生活活动有困难)和虚弱表型(使用 5 个组件进行操作)。加权多病指数包括从索赔中获得的人口统计数据:指标检查时的平均年龄为 79.2 岁。在考虑了多病症和其他因素后,女性(男性)3-4 种功能障碍与无障碍的平均年化增量成本分别为:住院 2838 美元(5516 美元)、SNF 1572 美元(1446 美元)和 HHC 1349 美元(1060 美元);女性(男性)表型虚弱与体格健壮的平均增量成本分别为:住院 4100 美元(男性不显著)、SNF 1579 美元(1254 美元)和 HHC 645 美元(526 美元)。住院病人费用的增加主要是由于住院风险的增加,而非住院医疗机构和 HHC 费用的增加则与使用风险的增加和使用个人费用的增加有关。两个老年医学领域都与门诊费用无关:在这项针对居住在社区的受益人进行的研究中,男女受益人的功能障碍均与住院、社区护理机构和高等保健机构的后续支出较高有关。表型虚弱与女性后续住院费用的增加以及男女性SNF和HHC费用的增加密切相关。
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The journals of gerontology. Series A, Biological sciences and medical sciences
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