Hasil untuk "Geriatrics"

Artigo apresentado ao Programa, A. Lins, Mello et al.

Chen Tianpeng, Xia Qishui, Yang Fo et al.

Osteoporotic non-vertebral fractures are a major clinical burden, with cortical bone impairment being a key pathogenic factor often overlooked in traditional treatments. This review aims to synthesize current evidence on the role of Wnt16 (a non-canonical Wnt ligand) in regulating cortical bone and its potential as a therapeutic target for osteoporotic non-vertebral fractures. We systematically review literature on Wnt16 in senile, postmenopausal, and glucocorticoid-induced osteoporosis, focusing on its mechanisms of action: (1) regulating bone mineral density via genetic associations with GWAS-identified loci; (2) reducing cortical bone porosity and increasing thickness; (3) dual regulation of osteoblasts (via JNK/β-catenin pathways) and osteoclasts (via OPG-dependent/independent NF-κB pathways). Wnt16 has been shown to improve bone density and reduce non-vertebral fracture risk in preclinical models, though conflicting findings exist regarding its full compensation for glucocorticoid-induced bone loss. We conclude that Wnt16 is a promising target for non-vertebral fracture prevention, with Notum inhibitors emerging as potential therapeutic agents. This review provides a comprehensive framework for future clinical and translational research.

Tao Zeng, Xinliang Liao, Jie Wu

Background: Exposure to air pollution and adherence to a healthy lifestyle have been identified to be related to sarcopenia. However, the interactive effects between these two factors remain insufficiently elucidated. The present study was designed to investigate the potential interaction exposure to air pollution with healthy lifestyle on the risk of developing sarcopenia. Methods: In the retrospective cohort study, all data was extracted from China Health and Retirement Longitudinal Study. Household air pollution was assessed based on the utilization of solid fuels for cooking and heating. A lifestyle score was constructed comprising information on physical activity, smoking, drinking and sleeping time. Multivariate logistic regression model was used to assess the effects of household air pollution and healthy lifestyle score on sarcopenia, separately. We further explored the additive interaction between household air pollution and healthy lifestyle score to sarcopenia using the interaction table developed by T Anderson. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI) were used to evaluate the additive interactive effect. Results: 2,114 participants were included in this study. The result indicated that exposed to household air pollution [adjusted relative risk (RR) = 1.80, 95% confidence interval (CI): 1.15–2.94] and unhealthy lifestyle (adjusted RR = 1.46, 95%CI: 1.04–2.03) were both significantly associated with increased risk of sarcopenia. Furthermore, participants exposed to both household air pollution and an unhealthy lifestyle exhibited a significantly higher risk of sarcopenia relative to those without household air pollution exposure and maintaining a healthy lifestyle (adjusted RR = 2.44). But RERI, AP, and SI suggested that there is no statistically significant additive interaction between household air pollution exposure and healthy lifestyle factors in relation to sarcopenia risk. Conclusion: Household air pollution in conjunction with an unhealthy lifestyle confers a significantly higher risk of sarcopenia compared to either factor in isolation, with no evidence of a significant additive interaction between these two risk factors.

Philip D. St John, Scott Nowicki, Robert B. Tate

Background There is a large literature on the prevalence of disability in older men, but less data on the incidence of new disability. Objectives 1. To determine the incidence of moderate-to-severe dis-ability in a prospective cohort study of aging men; and 2. To determine predisposing risk factors for new moderate to severe disability. Design & Setting The Manitoba Follow-up Study is a closed cohort study. In 1948, the initial sample was 3,983 men who qualified for air crew training in the Royal Canadian Air Force. In 2004, there were 796 men who were still alive and responded to the annual questionnaire with no missing data, and who did not have disability. The mean age at that time was 84. Methods We calculated the incidence of new moderate-to-severe dis-ability from 2004 to 2017, calculated the time to disability, and constructed survival analysis models to determine factors which predicted disability. Results The incidence of disability increased with the aging of the cohort and ranged from 4% to 12% per year. In unadjusted models, poor self-rated health (SRH), low life satisfaction, a low score on the Physical Component Score (PCS) of the Short Form–36, and the number of chronic conditions were all associated with new disability. In adjusted models, SRH, the PCS, and the number of chronic conditions were associ-ated with new disability.  Conclusions Global measures of well-being, as well as multimorbidity, predict new disability.

Sillas Oliveira Leonel Júnior, Mateus Dias Antunes, Ramon Gustavo de Moraes Ovando et al.

OBJECTIVE: To analyze the behavior of blood pressure and heart rate in elderly people practicing physical exercises in Maringá, Paraná, Brazil. METHODS: 70 elderly volunteers were evaluated, 41 women and 29 men, with a mean age of 67.2 ± 6.6 and 65.9 ± 12.3 years, respectively. They performed three minutes of exercise on the selected equipment, evaluated by means of a frequency meter and by the auscultatory method, with the aid of a sphygmomanometer. RESULTS: High heart rate values were recorded in the multi-exerciser. In both the heart rate and the blood pressure, there were significant differences in the means of the values found in the initial evaluation, compared to the means of the final evaluation (p < 0.05). CONCLUSIONS: Blood pressure rises within the physiological limits established for the elderly, and these activities may be considered safe for this population.

Manqing Luo, Xiaowei Xie, Jieyu Wu et al.

Background: Long-term ambient particulate matter (PM) exposure exerts detrimental effects on cardiovascular health. Evidence on the relation of chronically exposed ambient PM10 and PM2.5 with coronary stenosis remains lacking. Our aim was to investigate the association of PM10 and PM2.5 with coronary stenosis in patients undergoing coronary angiography. Methods: We performed a retrospective cohort study consisting of 7513 individuals who underwent coronary angiography in Fujian Province, China, from January 2019 to December 2021. We calculated a modified Gensini score (GS) to represent the degree of stenosis in coronary arteries by selective coronary angiography. We fitted linear regressions and logistic models to assess the association of PM10 and PM2.5 with coronary stenosis. We employed restricted cubic splines to describe the exposure-response curves. We performed mediation analyses to assess the potential mediators. Results: Long-term ambient PM10 and PM2.5 (prior three years average) exposure was significantly associated with the GS, with a breakpoint concentration of 47.5 μg/m3 and 25.8 μg/m3 for PM10 and PM2.5, respectively, above which we found a linear positive exposure-response relationship of ambient PM with GS. Each 10 µg /m3 increase in PM10 exposure (β: 4.81, 95 % CI: 0.44–9.19) and PM2.5 exposure [β: 10.50, 95 % CI: 3.14–17.86] were positively related to the GS. The adjusted odds ratio (OR) for each 10 µg/m3 increment in PM10 exposure on severe coronary stenosis was 1.33 (95 % CI: 1.04–1.76). Correspondingly, the adjusted OR for PM2.5 was 1.87 (95 % CI: 1.24–2.99). The mediation analysis indicated that the effect of PM10 on coronary stenosis may be partially mediated through total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, serum creatinine and blood urea nitrogen, and the effect of PM2.5 may be mediated in part by hemoglobin A1c. Conclusion: Our study provides the first evidence that chronic ambient PM10 and PM2.5 exposure was associated with coronary stenosis assessed by GS in patients with suspected coronary artery disease and reveals its potential mediators.

Giovanni Carbone, Immacolata Sepe, Maria Rosaria Fiorentino et al.

Symmetrical peripheral gangrene (SPG) can sometimes occur without definite disseminated intravascular coagulation. The differential diagnosis comprises the exclusion of many non-infectious diseases and the effort to isolate the microbic agent in the case of septic shock. Between bacterial causes, Klebsiella pneumoniae is one of the bacteria that can trigger SPG through hypervirulence and hypercoagulopathy mechanisms. We report a case of SPG associated with septic shock and a multi-drug resistant K. pneumoniae infection.

Shannon J. King, Natasha Reid, Sarah J. Brown et al.

Abstract Background Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality. Methods Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m2 were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records. Results Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI. Conclusions Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.

Alanna C. Cote, Alanna C. Cote, Riley J. Phelps et al.

Yulia Bugaevsky MD, Yochai Levy MD, Avital Hershkovitz MD, MHA et al.

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

Cuiyan Xin, Jiahui Lei, Qian Wang et al.

Summary: Chronic kidney disease (CKD) is associated with substantial morbidity and mortality. We developed a mouse model that mimics human CKD with inflammation, extracellular matrix deposition, tubulointerstitial fibrosis, increased proteinuria, and associated reduction in glomerular filtration rate over time. Using this model, we show that genetic deficiency of SMOC2 or therapeutic silencing of SMOC2 with small interfering RNAs (siRNAs) after disease onset significantly ameliorates inflammation, fibrosis, and kidney function loss. Mechanistically, we found that SMOC2 promotes fibroblast to myofibroblast differentiation by activation of diverse cellular signaling pathways including MAPKs, Smad, and Akt. Thus, targeting SMOC2 therapeutically offers an approach to prevent fibrosis progression and CKD after injury.

Meng Zhang, Ping He, Zhigang Bian

Neurodegenerative diseases (NDDs), including Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD), and amyotrophic lateral sclerosis (ALS), are progressive and ultimately fatal. NDD onset is influenced by several factors including heredity and environmental cues. Long noncoding RNAs (lncRNAs) are a class of noncoding RNA molecules with: (i) lengths greater than 200 nucleotides, (ii) diverse biological functions, and (iii) highly conserved structures. They directly interact with molecules such as proteins and microRNAs and subsequently regulate the expression of their targets at the genetic, transcriptional, and post-transcriptional levels. Emerging studies indicate the important roles of lncRNAs in the progression of neurological diseases including NDDs. Additionally, improvements in detection technologies have enabled quantitative lncRNA detection and application to circulating fluids in clinical settings. Here, we review current research on lncRNAs in animal models and patients with NDDs. We also discuss the potential applicability of circulating lncRNAs as biomarkers in NDD diagnostics and prognostics. In the future, a better understanding of the roles of lncRNAs in NDDs will be essential to exploit these new therapeutic targets and improve noninvasive diagnostic methods for diseases.

Eun-Ji Choi, Bum Joon Kim, Hyung-Ji Kim et al.

Introduction: False memory, observed as intrusion errors or false positives (FPs), is prevalent in patients with Alzheimer’s disease, but has yet to be thoroughly investigated in patients with amnestic mild cognitive impairment (a-MCI) with Alzheimer’s disease pathology (ADP). We analyzed false versus veridical memory in individuals with a-MCI and measured the utility of false memory for ADP discrimination. Methods: Patients with a-MCI who received neuropsychological testing and amyloid PET were included. Patients were categorized into “with” and “without ADP” groups according to PET results. Memory tests assessed veridical and false memory, and the verity of patient responses was analyzed. A logistic regression model was used to evaluate false memory efficiency in discriminating ADP, and the sensitivity and specificity at the optimal level were estimated using the receiver-operating characteristic curve. Results: Thirty-seven ADP and 46 non-ADP patients were enrolled. The ADP group made more FPs in the recognition tests, and their response verity was significantly lower in every delayed memory test. No group difference, however, was observed in the veridical memory. The logistic regression analysis demonstrated that as the FPs increased, the risk of ADP increased 1.31 and 1.36 times in the verbal and visual recognition tests, respectively. The discriminatory accuracy of the FPs was estimated “low” to “moderate” in the visual and verbal recognition, respectively, with an optimal cutoff above 2.5. Conclusion: Increased false memory was the only feature to discriminate ADP from non-ADP in individuals with a-MCI. Further studies regarding false memory and its mechanism are warranted.

Jeffrey Cummings, Justin Bauzon, Garam Lee

Abstract Introduction Despite the increase in Alzheimer's disease (AD) cases in the United States, no new treatments have been approved in the United States since 2003. The costs associated with drug development programs are high and serve as a significant deterrent to AD therapeutic investigations. In this study, we analyze the sponsorship data for AD clinical trials conducted since 2016 to assess the fiscal support for AD clinical trials. Methods We analyzed the funding sources of all AD trials over the past 5 years as reported on ClinicalTrials.gov. Results There were 136 trials being conducted for treatments in the US AD therapeutic pipeline on the index date of this study. Among non‐prevention trials, disease‐modifying therapies (DMT) in Phase 3 were almost entirely sponsored by the biopharmaceutical industry; Phase 2 DMT trials were split between the biopharmaceutical industry and funding from the National Institutes of Health (NIH) to academic medical centers (AMCs). The majority of prevention trials received sponsorship from public–private partnerships (PPP). Trials of symptomatic agents are equally likely to have biopharmaceutical or NIH/AMC sponsorship. Most trials with repurposed agents had NIH/AMC funding (89%). Since 2016, there has been consistent growth in the number of trials sponsored both in part and fully by NIH/AMC sources and in PPP, and there has been a reduction in biopharmaceutical company–sponsored trials. Discussion The number of trials supported by the biopharmaceutical industry has decreased over the past 5 years; trials supported from federal sources and PPP have increased. Repurposed compounds are mostly in Phase 2 trials and provide critical mechanistic information.

Andrea Giacomelli, Massimo Galli, Stefania Maggi et al.

We aimed to assess the reported rate of flu vaccination in the 2019/2020 season for respondents to the Italian nationwide online EPICOVID 19 survey. A national convenience sample of volunteers aged 18 or older was assessed between 13 April and 2 June 2020. Flu vaccine rates were calculated for all classes of age. The association between the independent variables and the flu vaccine was assessed by applying a multivariable binary logistic regression model. Of the 198,822 respondents, 41,818 (21.0%) reported having received a flu vaccination shot during the last influenza season. In particular, 15,009 (53.4%) subjects aged 65 years or older received a flu vaccination shot. Being 65 years aged or older (Adjusted Odds Ratios (aOR) 3.06, 95% Confidence Interval (CI) 2.92–3.20) and having a high education level (aOR 1.34. 95%CI 1.28–1.41) were independently associated to flu vaccination. Heart and lung diseases were the morbidities associated with the higher odds of being vaccinated (aOR 1.97 (95%CI 1.86–2.09) and aOR 1.92 (95%CI 1.84–2.01), respectively). Nursing home residents aged ≥ 65 years showed lower odds of being vaccinated (aOR 0.39 (95%CI 0.28–0.54)). Our data indicate the need for an urgent public heath effort to fill the gap of missed vaccination opportunities reported in the past flu seasons.

Laércio Almeida de Melo, Luciana de Castro Braga, Fabíola Pessôa Pereira Leite et al.

Abstract Objective: The objective of the present study was to identify factors associated with multimorbidity in the elderly through an integrative literature review. Method: The “Cochrane Library”, “MEDLINE”, “Web of Science”, “Scopus” and “LILACS” databases were used, as well as the “SciELO” virtual library and the electronic search engine “Google Academic”. The following search terms were applied: “multimorbidity”; “multi-morbidity”; “comorbidity; “multiple diseases”; “elderly”; “major adults”, “older people”, “older persons”, “aged”, “associated factors”, “correlated factors”, “socioeconomic factors” and “demographic factors.” The inclusion criterion was that the object of the study was the elderly population with multimorbidity. Studies in which multimorbidity was not the dependent variable were excluded. Results: a total of seven articles were included in this review. A prevalence of multimorbidity in the elderly ranging from 30.7% to 57% was found. The associated factors were smoking, alcohol consumption, lived in rural areas, low levels of schooling, the female gender, older elderly persons and not living with children. In the majority of articles a low level of family income was also associated with multimorbidity. Conclusion: The results suggest that multimorbidity in the elderly is a common condition and that it is influenced by socioeconomic and demographic factors, lifestyle and family structure.

Ivanilda Lacerda Pedrosa, Djacyr Magna Cabral Freire, Rodolfo Herberto Schneider

Abstract Objective: To create an instrument for the prognostic evaluation of elderly patients hospitalized in an intensive care unit. Methods: A cohort study, with prospective data collection, which included elderly persons aged 60 years or older, was carried out in the city of João Pessoa, in the state of Paraíba, Brazil. Data collection was performed using an instrument created from a pilot study and the Katz Index. Poisson’s regression was used for data analysis. This technique estimates relative risk, retaining variables with p≤0.10 in the instrument, and ensures biological plausibility. The classification of risk of death was performed using quartile analysis, confirmed by the Receiver Operator Characteristic (ROC) curve. Results: 205 elderly patients with an average age of 74.6 years and a 59% risk of mortality, were included. Of the total sample and based on the scores, 16.6% of elderly persons had a low risk of developing death, 23.9% were at moderate risk, 40% had a high risk, and 19.5% exhibited a very high risk of death. The positive predictive value of the instrument was 77% and the negative value was 67.5%, with a concordance index of 0.78. The cutoff score of the instrument was 9 points or over. The sensitivity was 77.7% and the specificity was 66.7%. Conclusions: The instrument developed may be useful in the identification of elderly people with risk factors who require increased care. The instrument described can therefore be applied in Brazilian intensive care units.

Reza Mottaghi, Ali Kamkar, Alireza Maredpoor

Objectives: Taking into consideration the high prevalence of insomnia disorder in the elderly population, this study aims to examine the effectiveness of cognitive behavioral therapy (CBT) in improving the overall quality of sleep and the subscales of sleep quality in the elderly. Methods & Materials: The present study employs experimental research design including 5000 elderly participants from the Jahandedehgan center in Shiraz, Iran. Based on the inclusion and exclusion criteria, a total of 44 subjects were selected randomly. After losing 7.85 percent of the participants, 39 subjects with the mean age of 68 years who were suffering from primary insomnia disorder were evaluated with Pittsburgh Sleep Quality Index (PSQI) in addition to pretest, posttest, and follow-up tests. The intervention took place twice a week within a period of four weeks employing cognitive behavioral therapy based on the ESPIE commands. The SPSS 21 statistical software and covariance of single and multivariate analysis including (ANCOVA and MANCOVA) were used to analyze the collected data. Results: The mean of the overall quality of sleep before and after the intervention in the experimental and control groups were reported to be 12.95 and 12.7, respectively, that later changed to 10.03 and 13.07 in the post-test, and 9.51 and 13.36 during the follow up after three months. From the statistical point of view, the mean of the overall quality of sleep after the intervention was noted to be significant at P<0.001. Conclusion: The present study showed that the cognitive behavioral therapy can enhance the overall quality of sleep and reduce the symptoms of insomnia disorder in the elderly people.

Wang Q, Zhang Z, Li L et al.

Qiumei Wang,1 Zhenxin Zhang,2 Ling Li,2 Hongbo Wen,2 Qun Xu3,4 1Department of Geriatrics, 2Department of Neurology, 3School of Basic Medicine, Peking Union Medical College Hospital, 4Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, People&#39;s Republic of China Background: Although Parkinson&#39;s disease (PD) is clinically characterized by motor symptoms, cognitive impairment is one of the most disabling non-motor symptoms. Despite it attracting increasing attention worldwide, less is known about its prevalence in the Chinese population. The objective of this study was to assess cognitive impairment and related risk factors in Chinese PD patients. Methods: We collected the demographic, diagnostic, and treatment information of 901 PD patients from 42 centers throughout the People&#39;s Republic of China, then administered a battery of neuropsychological tests, to assess motor, cognitive, and neuropsychiatric symptoms. Results: Overall, 193 of 901 (21.4%) PD patients met the criteria for dementia (PD-D), and 206 (22.8%) met the criteria for mild cognitive impairment (PD-MCI). Visuospatial dysfunction and attention/executive impairment predominated. Increased severity of cognitive impairment was associated with greater motor impairment. Patients with psychiatric symptoms, such as depression and hallucinations, were more likely to have dementia. Potentially, the younger-aged and more educated are shown less cognitive impairment, but age at onset, and levodopa equivalent dose, were not associated with the presence of cognitive dysfunction. Conclusion: The prevalence and profile of cognitive impairment in Chinese PD patients, as well as the risk factors, are similar as those reported for other races, but the frequency of nonamnestic cognitive domains differs. Keywords: cognitive impairment, risk factor, prevalence, Parkinson&#39;s disease

W. Abrams, M. Beers, R. Berkow et al.