M. Montero‐Odasso, N. van der Velde, F. Martin
et al.
Abstract Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
Kendra Cooling, Danielle R. Bouchard, Molly Gallibois
et al.
Objective: To examine the effects of a standing intervention on gait speed for older adults living in long term care (LTC) residences. Design: A parallel superiority cluster randomized controlled trial. Setting and participants: LTC residences. A total of 95 LTC residents (n = 47 control; n = 48 intervention) participated in the study. Methods: LTC residences and therefore the residents from the homes were randomized to either the intervention group (standing up to 100 minutes/week) for 22 weeks or the control group (socializing with staff with no encouragement to stand for up to 100 minutes/week) for 22 weeks. The primary outcome is gait speed measured by the 10-meter walking speed test. Results: A total of 95 participants (n= 47 in the control group and n=48 in the intervention group) age 86 ± 8 years completed the trial, averaging 41.9 ± 30.3 min of standing per week in the intervention group and 48.4 ± 22.8 min of time matched activity in the control group. There was no significant difference between groups in changes in gait speed (β=-0.034, 95 % C.I. (-0.097 0.028)). Conclusions and implications: This 22-week standing intervention did not improve gait speed in older adults living in LTC residences.Trial registration: clinicaltrials.gov - NCT03796039
<b>Backgrounds/Objectives:</b> This study aims to comprehensively characterize the prevalence and severity of antiepileptic drug (AED)-induced adverse drug events (ADEs) and to identify predictors strongly associated with serious adverse events (SAEs) in both general and geriatric populations. <b>Methods:</b> This cross-sectional study investigated AED-related ADEs reported to the KIDS KAERS DB from January 2014 to December 2023. Disproportionality analysis was performed to detect the association between reported SAEs, and multiple logistic regression was conducted to identify predictors associated with SAEs. Cox’s proportional hazard model was utilized to assess ADE duration in elderly patients aged 60 years and older. <b>Results:</b> More than 50% of 36,809 AED-related ADEs were reported in elderly patients aged 60 years and older, and the prevalence of SAEs was 3.78%. ADEs associated with endocrine disorders had the highest likelihood of SAEs being reported (ROR 15.30), followed by hematological disorders. The predictors associated with elevated SAE risks in the elderly were male sex (OR 1.91; 95% CI 1.62–2.27), aging (OR 1.17; 95% CI 1.04–1.31), and certain AEDs. However, the concomitant administration of acid-suppressive therapy (AST) and opioids was associated with a lower risk of SAEs in the elderly population. Elderly patients not receiving concomitant AST were less likely to experience prolonged ADE duration (HR 0.28, 95% CI 0.07–1.15); however, no substantial differences in ADE duration were observed with the concomitant use of opioids. <b>Conclusions:</b> This study implies significant variability in the frequency, severity, and duration of ADEs depending on the type of AEDs, patient demographics, and concomitant medication use.
When we complete sequential movements with different intentions, we plan our movements and adjust ahead. Such a phenomenon is called anticipatory planning for prior intentions and is known to decline with age. In daily life activities, we often need to consider and plan for multiple demands in one movement sequence. However, previous studies only considered one dimension of prior intentions, either different types of onward actions or different precisions of fit or placement. Therefore, in this study, we investigated anticipatory planning for both extrinsic (movement direction) and intrinsic (fit precision) target-related properties in a computer-based movement task and analyzed the computer cursor movement kinematics of both young and older adults. We found that older people consider and adjust for different properties step-by-step, with movement direction being considered as a prior intention during reach movement and fit precision as a motor constraint during drop movement. The age-related changes in the completion of onward actions are constrained by one’s general cognitive ability, sensorimotor performance and effective motor planning for prior intentions. Age-related decline in motor planning can manifest as counterproductive movement profiles, resulting in suboptimal performance of intended actions.
Li-Yu Chen,1 Chen-Yu Wang,1,2 Chi-Ying Lin,3 Ming-Jui Tsai,3 Wei-Hsun Shen,1 Pei-Jhih Li,1 Lin-Chu Liao,1 Chih-Fen Huang,4,5 Chien-Chih Wu4 1Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; 2National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; 4Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; 5School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanCorrespondence: Chien-Chih Wu, Department of Pharmacy, National Taiwan University Hospital, 7 Chung Shan S. Road, Taipei, Taiwan, Email 101440@ntuh.gov.tw; r93451011@gmail.comBackground: In the field of postoperative care, infections caused by Gram-positive bacteria pose a major clinical challenge. Vancomycin is a key therapeutic agent whose efficacy is greatly influenced by renal function, particularly by augmented renal clearance (ARC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) is an easy and commonly used method to predict ARC; however, it is not well studied to determine vancomycin dose. In this study, we examined the effectiveness of the CKD-EPI equation in determining ARC and optimizing the dose of vancomycin for surgical ward patients.Methodology: A retrospective observational study was conducted to examine 158 surgical ward patients receiving vancomycin. Data on demographics, medical history, and vancomycin dosing were collected. Renal function was evaluated using the CKD-EPI equation, with ARC defined as eGFR ≥ 96.5 mL/min/1.73 m2. Vancomycin pharmacokinetics were calculated using the ClinCalc tool.Results: ARC was in 54% of the patients. Compared with patients without ARC, those with ARC were younger and had lower serum creatinine levels. They also required higher vancomycin doses but had lower trough concentrations and 24-hour area-under-the-curve values. A significant correlation was observed between eGFR and vancomycin clearance, with eGFR > 96.5 mL/min/1.73 m2 necessitating higher vancomycin doses (> 45 mg/kg/day) to achieve the desired area under the curve to minimum inhibitory concentration ratio.Conclusion: For surgical ward patients with CKD-EPI eGFR ≥ 96.5 mL/min/1.73 m2, a vancomycin dosage of > 45 mg/kg/day may be recommended to reach effective therapeutic levels. Overall, this study emphasizes the importance of tailoring vancomycin therapy depending on renal function to ensure efficacy and mitigate the risk of antimicrobial resistance in surgical ward patients.Keywords: augmented renal clearance, vancomycin, surgery
Siri Aas Smedemark, Christian B. Laursen, Dorte Ejg Jarbøl
et al.
Abstract Background Delayed recognition of acute disease among older adults hinders timely management and increases the risk of hospital admission. Point-of-Care testing, including Focused Lung Ultrasound (FLUS) and in-home analysis of biological material, may support clinical decision-making in suspected acute respiratory disease. The aim of this study was to pilot test the study design for a planned randomised trial, investigate whether in-home extended use of point-of-care testing is feasible, and explore its’ potential clinical impact. Methods A non-randomised pilot and feasibility study was conducted during September–November 2021 in Kolding Municipality, Denmark. A FLUS-trained physician accompanied an acute community nurse on home-visits to citizens aged 65 + y with signs of acute respiratory disease. The acute community nurses did a clinical assessment (vital signs, capillary C-reactive protein and haemoglobin) and gave a presumptive diagnosis. Subsequently, the physician performed FLUS, venipuncture with bedside analysis (electrolytes, creatinine, white blood cell differential count), nasopharyngeal swab (PCR for upper respiratory pathogens), and urine samples (flow-cytometry). Primary outcomes were feasibility of study design and extended point-of-care testing; secondary outcome was the potential clinical impact of extended point-of-care testing. Results One hundred consecutive individuals were included. Average age was 81.6 (SD ± 8.4). Feasibility of study design was acceptable, FLUS 100%, blood-analyses 81%, PCR for upper respiratory pathogens 79%, and urine flow-cytometry 4%. In addition to the acute community nurse’s presumptive diagnosis, extended point-of-care testing identified 34 individuals with a condition in need of further evaluation by a physician. Conclusion Overall, in-home assessments with extended point-of-care testing are feasible and may aid to identify and handle acute diseases in older adults.
Background Nursing home residents engage in lower levels of physical activity, primarily remaining seated or lying down, except for routine activities of daily living (ADLs). Since ADLs, particularly toileting, require effort. This study investigated the relationship between physical activity and toileting activity during the daytime among older nursing home residents. Methods The study involved 30 participants, including a group of healthy community-dwelling older individuals and two groups of nursing home residents with independent and non-independent toileting behavior, respectively. The physical activity of participants was measured with an accelerometer, and estimated metabolic equivalents, duration, and amount of physical activity were calculated. Results The amount of physical activity associated with toileting was significantly higher in the independent and non-independent groups than in the community group. Moreover, the amount of non-sedentary physical activity associated with toileting positively affected the amount of non-sedentary physical activity during the daytime. These findings suggest that toileting activity can contribute significantly to the physical activity of older nursing home residents. Conclusion Interventions focusing on improving toileting behavior among nursing home residents may positively impact overall physical activity and functional abilities.
Raffaele Pagliuca, Mario Virgilio Papa, Pagliuca Mena Ilaria
et al.
The rivastigmine patch is the only existing transdermal delivery system used for the treatment of Alzheimer disease. Among the most common adverse events derived from its use are gastrointestinal events, particularly diarrhea. We report a clinical case of an 81-year-old patient admitted to our hospital under long-standing treatment with rivastigmine transdermal patch who presented with atypical watery diarrhea. Anamnesis showed that the patient presented with a likely infectious gastroenteric event, the diarrheal symptoms of which persisted upon resolution of the event and resolved only upon temporary discontinuation of acetylcholinesterase inhibitors. Failure to rapidly identify the causes of profuse diarrhea in older adults can have lethal consequences. When these symptoms occur, quickly recognizing the causes and providing proper management can be lifesaving.
Herb Howard C. Hernandez, Poh Ling Ong, Philomena Anthony
et al.
Background The coronavirus disease 2019 (COVID-19) pandemic has spurred the rapid adoption of telemedicine. However, the reproducibility of face-to-face (F2F) versus remote videoconference-based cognitive testing remains to be established. We assessed the reliability and agreement between F2F and remote administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (mCMMSE), and Chinese Frontal Assessment Battery (CFAB) in older adults attending a memory clinic. Methods The participants underwent F2F followed by remote videoconference-based assessment by the same assessor within 3 weeks. Reliability was evaluated using intraclass correlation coefficients (ICC; two-way mixed, absolute agreement), the mean difference between remote and F2F-based assessments using paired-sample t-tests, and agreement using Bland-Altman plots. Results Fifty-six subjects (mean age, 76±5.4 years; 74% mild; 19% moderate dementia) completed the AMT and mCMMSE, of which 30 completed the CFAB. Good reliability was noted based on the ICC values—AMT: ICC=0.80, 95% confidence interval [CI] 0.68–0.88; mCMMSE: ICC=0.80, 95% CI 0.63–0.88; CFAB: ICC=0.82, 95% CI 0.66–0.91. However, remote AMT and mCMMSE scores were higher compared to F2F—mean difference (i.e., remote minus F2F): AMT 0.3±1.1, p=0.03; mCMMSE 1.3±2.9, p=0.001. Significant differences were observed in the orientation and recall items of the mCMMSE and the similarities and conflicting instructions of CFAB. Bland–Altman plots indicated wide 95% limits of agreement (AMT -1.9 to 2.6; mCMMSE -4.3 to 6.9; CFAB -3.0 to 3.8), exceeding the a priori-defined levels of error. Conclusion While the remote and F2F cognitive assessments demonstrated good overall reliability, the test scores were higher when performed remotely compared to F2F. The discrepancies in agreement warrant attention to patient selection and environment optimization for the successful adaptation of telemedicine for cognitive assessment.
The editors of <em>OBM Geriatrics</em> would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2021. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers receive a voucher entitling them to a discount on their next LIDSEN publication and can download a certificate of recognition directly from our submission system. Additionally, reviewers can sign up to the service Publons (https://publons.com) to receive recognition. Of course, in these initiatives we are careful not to compromise reviewer confidentiality. Many reviewers see their work as a voluntary and often unseen part of their role as researchers. We are grateful to the time reviewers donate to our journals and the contribution they make.
Abstract Background Population aging will be one of humanity’s major challenges in the decades to come. In addition to focusing on the pathologies causing the greatest mortality and morbidity in this population, such as dementia, health research in elderly people must consider a myriad of other interlinked factors, such as geriatric syndromes, social aspects, and factors related to preserving quality of life and promoting healthy aging. This study aims to identify the main subject areas attracting research attention with regard to very old (≥ 80 years) populations. Methods Documents assigned with the medical subject heading “Aged, 80 and over” were retrieved from MEDLINE and the Web of Science. This dataset was used to determine publication output by disease, geographic region, country, and discipline. A co-word analysis was undertaken to identify thematic research clusters. Results Since the mid-2000s, there has been a boom in scientific output focusing specifically on very old populations, especially in Europe (43.7% of the documents) but also in North America (30.5%) and Asia (26%); other regions made only nominal contributions (0.5 to 4.4%). The USA produced the most research, while the most growth over the study period occurred in Japan, Spain, and China. Four broad thematic clusters were identified: a) geriatric diseases, health services for the aged, and social and psychological issues of aging; b) cardiovascular diseases; c) neoplasms, and d) bacterial infections & anti-bacterial agents. Conclusions Scientific research in very old populations covers a wide variety of interrelated topics. In quantitative terms, the top subject areas have to do with cardiovascular and cerebrovascular diseases (including aortic valve stenosis and stroke), dementia, and neoplasms. However, other degenerative pathologies, geriatric syndromes, and different social and psychosocial aspects also attract considerable interest. It is necessary to promote more equal participation in global research on pathologies and topics related to very elderly populations, as the highest rates of population aging and the largest numbers of elderly people in the next decades will be in low- and middle-income countries.
Abstract Introduction Recent exome sequencing studies have identified three novel risk variants associated with Alzheimer's disease (AD). However, the mechanisms by which these variants confer risk are largely unknown. Methods In the present study, the impact of these rare coding variants (in ABI3, PLCG2, and TREM2) on all subcortical volumes is determined in a large sample of young healthy individuals (N = 756–765; aged 22–35 years). Results After multiple testing correction (PCORRECTED < .05), rare variants were associated with basal ganglia volumes (TREM2 and PLCG2 effects within the putamen and pallidum, respectively). Nominal associations between TREM2 and reduced hippocampal and thalamic volumes were also observed. Discussion Our observations suggest that rare variants in microglia‐mediated immunity pathway may contribute to the subcortical alterations observed in AD cases. These observations provide further evidence that genetic risk for AD may influence the volume of subcortical volumes and increase AD risk in early life processes.
Neurology. Diseases of the nervous system, Geriatrics
Atsushi Kimura,1 Kohei Yamaguchi,2,3 Haruka Tohara,3 Yusuke Sato,4 Naoko Sawada,4 Yasuhide Nakagawa,4 Yukako Matsuda,2,5 Motoharu Inoue,2,5 Kazuhiro Tamaki2,4 1College of Risk Management, Nihon University, Setagaya-ku, Tokyo, Japan; 2Dentistry Nanohana Clinic, Medical Corporation Kanjinkai, Nishitama-gun, Tokyo, Japan; 3Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; 4Geriatric Health Services Facility Nanohana, Medical Corporation Kanjinkai, Nishitama-gun, Tokyo, Japan; 5Department of Dysphasia Rehabilitation, Nihon University of Dentistry, Chiyoda-Ku, Tokyo, JapanCorrespondence: Atsushi KimuraCollege of Risk Management, Nihon University, 3-34-1 Shimouma, Setagaya-ku, Tokyo 154-8513, JapanTel +81 3 6453 1600Fax +81 3 6453 1630Email kimura.atsushi@nihon-u.ac.jpKazuhiro TamakiGeriatric Health Services Facility Nanohana, Medical Corporation Kanjinkai, 454 Tonogaya, Mizuho-machi, Nishitama-gun, Tokyo 190-1212, JapanTel +81 42 568 5111Fax +81 42 568 5127Email tamakikazuhiro@g.kanjinkai.netPurpose: The previous study demonstrated that the addition of a sauce is an effective means of influencing the consumption of finger foods among French elderly people with dementia. However, it is unclear the relative importance of low-level sensory factors such as flavor and a semi-solid nature and high-level cognitive factors such as memory stimulation and familiarity to the effect of the addition of sauce on food intake. The present study investigated whether the addition of sauce affects finger-snack intake among Japanese elderly people with dementia who were not familiar with sauce dipping.Patients And Methods: A total of 21 patients with dementia who were recruited in a nursing home in Tokyo received a plate of cut baumkuchen (a very thinly layered German roll cake), which had pieces of baumkuchen both with and without sauce, at their afternoon snack time. The amount of food intake and the first choice between options were measured for each participant. We used chocolate (in Experiment 1, n = 21) and agave (Experiment 2, n =14) syrups as sauce samples.Results: Results of both experiments demonstrate that snack consumption was greater for the with-sauce options than for the without-sauce options. A 90.5% of the participants in Experiment 1 and 64.3% of participants in Experiment 2 ate more snacks with sauce than without sauce.Conclusion: These findings imply that low-level sensory factors such as flavor and a semi-solid nature contribute relatively more strongly to the enhancement of food consumption with the addition of sauce than do high-level cognitive factors such as memory stimulation and familiarity, because Japanese elderly people are not always familiar with the custom of wiping up the sauce with food.Keywords: food consumption, dementia, under nutrition, food improvement, sauce