Hasil untuk "Geriatrics"

M. Mittelmark, S. Sagy, M. Eriksson et al.

Hua Ren, Guohua Wei, Yuejin Li et al.

IntroductionRheumatoid arthritis (RA) is a chronic inflammatory disease characterized by pain, functional disability, and comorbidities. Pain management in RA is complex due to both inflammatory and non-inflammatory mechanisms. The Nursing Science Precision Health (NSPH) model offers a personalized approach to pain management, integrating symptom measurement, phenotypic analysis, and biomarker data to guide tailored interventions.MethodsThe recorded data of 287 RA patients were retrospectively archived and categorized into three pain phenotypes: inflammatory pain, non-inflammatory pain, and mixed pain. Pain was assessed using the Visual Analog Scale (VAS), and biomarkers were measured at baseline. Psychological factors, including anxiety, depression, and sleep quality, were also evaluated. Patients’ phenotype-specific interventions were extracted from clinical records: pharmacological treatment for inflammatory pain, psychological counseling and mindfulness-based stress reduction for non-inflammatory pain, and combined therapies for mixed pain. Follow-up assessments were conducted at 12 weeks.ResultsSignificant improvements were observed across all pain phenotypes. Inflammatory pain patients showed reductions in CRP, ESR, and VAS pain scores. Non-inflammatory pain patients experienced reductions in anxiety, depression, and VAS scores, with improvements in sleep quality. Mixed pain patients benefited from both pharmacological and psychological interventions. Patient-reported outcomes, including quality of life and functional status, improved significantly, with 82.6% expressing satisfaction with their pain management plan.DiscussionThe NSPH model offers an effective framework for personalized RA pain management, demonstrating that phenotype-based interventions improve pain outcomes, reduce psychosocial distress, and enhance quality of life. This approach holds potential for broader application in chronic pain management and warrants further research to optimize its implementation.

Lis de Weerd, Selina Hummel, Stephan A. Müller et al.

Abstract Anti-amyloid β-peptide (Aβ) immunotherapy was developed to reduce amyloid plaque pathology and slow cognitive decline during progression of Alzheimer’s disease. Efficient amyloid clearance has been proven in clinical trials testing anti-Aβ antibodies, by their impact on cognitive endpoints correlating with the extent of amyloid removal. However, treatment is associated with adverse side effects, such as oedema and haemorrhages, which are potentially linked to the induced immune response. To improve the safety profile of these molecules, it is imperative to understand the consequences of anti-Aβ antibody treatment on immune cell function. Here, we investigated the effects of long-term chronic anti-Aβ treatment on amyloid plaque pathology and microglial response in the APP-SAA triple knock-in mouse model with an intervention paradigm early during amyloidogenesis. Long-term treatment with anti-Aβ results in a robust and dose-dependent lowering of amyloid plaque pathology, with a higher efficiency for reducing diffuse over dense-core plaque deposition. Analysis of the CSF proteome indicates a reduction of markers for neurodegeneration including Tau and α-Synuclein, as well as immune-cell-related proteins. Bulk RNA-seq revealed a dose-dependent attenuation of disease-associated microglial (DAM) and glycolytic gene expression, which is supported by a parallel decrease of glucose uptake and protein levels of Triggering Receptor Expressed on Myeloid cells 2 (Trem2) protein, a major immune receptor involved in DAM activation of microglia. In contrast, DAM activation around residual plaques remains high, regardless of treatment dose. In addition, microglia surrounding residual plaques display a dose-dependent increase in microglial clustering and a selective increase in antigen-presenting and immune signalling proteins. These findings demonstrate that chronic early intervention by an anti-amyloid immunotherapy leads to a dose-dependent decrease in plaque formation, which is associated with lower brain-wide microglial DAM activation and neurodegeneration. Microglia at residual plaques still display a combined DAM and antigen-presenting phenotype that suggests a continued treatment response.

Sara Peranovic, Maryam Pourhassan, Bendix Labeit et al.

ObjectiveDiagnosing and treating dysphagia in patients with dementia is challenging and few studies have been performed to characterize dysphagia based on Flexible Endoscopic Evaluation of Swallowing (FEES). Therefore, we aimed to characterize and compare the dysphagia pathologies in various stages and types of dementia.MethodsThis is a retrospective study of 107 hospitalized geriatric patients with dysphagia and Alzheimer’s dementia, Alzheimer’s dementia with moderate to severe cerebral vasculopathy (mixed dementia), and patients with dementia associated with Parkinson’s syndrome who underwent FEES. A standardized FEES protocol was used to characterize the dysphagia pathologies, including premature bolus spillage, delayed swallowing reflex and bolus residue as well as penetration and aspiration and the white-out intensity. The distribution of different dysphagia pathologies was cross-tabulated with χ2 statistics across different types of dementia.ResultsA comparative analysis of dysphagia pathologies across the three dementia types revealed a relatively mixed picture of various dysphagia findings in all dementia types. However, a significantly higher prevalence of bolus penetration and complex dysphagia, which was defined as presence of at least two major findings simultaneously within a patient, was seen in patients with Parkinson’s-related dementia compared to other forms of dementia. In general, residue was the most frequent finding in all types of dementia (78%–100%). In contrast, aspiration was the least prevalent finding with no significant variation between dementia types.ConclusionAlthough participants with Parkinson’s-related dementia exhibited minor specific findings, our study revealed no distinct endoscopic dysphagia pathologies across various types of dementia.

Jaclyn H. Ford, Ryan T. Daley, Ryan T. Daley et al.

The need to continually learn and adjust to new technology can be an arduous demand, particularly for older adults who did not grow up with digital technology (“older digital immigrants” or ODIs). This study tests the efficacy of socioemotional learning strategies (i.e., encoding information in a socially- or emotionally-meaningful way) for ODIs learning a new software application from an instructional video (Experiment 1) or a written manual (Experiment 2). An experiment-by-condition effect was identified, where memory was greatest for participants engaging socioemotional learning strategies while learning from a video, suggesting a synergistic effect of these manipulations. These findings serve as a first step toward identifying and implementing an optimal learning context for ODIs to learn new technologies in everyday life.

Yanting Liang, Yanting Liang, Fengyao Liu et al.

ObjectivesTo examine national trends in unhealthy lifestyle factors among adults with cardiovascular disease (CVD) in the United States (US) between 1999 and 2018.MethodsWe analyzed data from National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of participants with CVD who were aged ≥20 years, which was conducted between 1999 and 2000 and 2017–2018. CVD was defined as a self-report of congestive heart failure, coronary heart disease, angina, heart attack, or stroke. The prevalence rate of each unhealthy lifestyle factor was calculated among adults with CVD for each of the 2-year cycle surveys. Regression analyses were used to assess the impact of sociodemographic characteristics (age, sex, race/ethnicity, family income, education level, marital status, and employment status).ResultsThe final sample included 5610 NHANES respondents with CVD. The prevalence rate of their current smoking status remained stable among respondents with CVD between 1999 and 2000 and 2017–2018. During the same period, there was a decreasing trend in the age-adjusted prevalence rate of poor diet [primary American Heart Association (AHA) score <20; 47.5% (37.9%–57.0%) to 37.5% (25.7%–49.3%), p < 0.01]. Physical inactivity marginally increased before decreasing, with no statistical significance. The prevalence rate of sedentary behavior increased from 2007 to 2014 but subsequently returned to its original level in 2018 with no statistical significance. The age-adjusted prevalence rate of obesity increased from 32% (27.2%–36.8%) in 1999–2000 to 47.9% (39.9%–55.8%) in 2017–2018 (p < 0.001). The age-adjusted prevalence rate of depression increased from 7% (4.2%–9.9%) in 1999–2000 to 13.9% (10.2%–17.6%) in 2017–2018 (p = 0.056). Trends in mean for each unhealthy lifestyle factor were similar after adjustment for age. We found that respondents who had low education and income levels were at a higher risk of being exposed to unhealthy lifestyle factors (i.e., smoking, poor diet, and physical inactivity) than those who had high education and income levels.ConclusionsThere is a significant reduction in the prevalence rate of poor diet among US adults with CVD between 1999 and 2018, while the prevalence rate of obesity showed increasing trends over this period. The prevalence rate of current smoking status, sedentary behavior, and depression was either stable or showed an insignificant increase. These findings suggest that there is an urgent need for health policy interventions targeting unhealthy lifestyles among adults with CVD.

Bo Liu, Honghui Yin, Yaxiong Li et al.

Fatty liver diseases are a spectrum of liver disorders consisting of the benign fatty liver, which could eventually lead to cirrhosis or even hepatocellular cancer (HCC) without timely treatment. Therefore, early diagnosis is crucial for fatty liver diseases. Liver biopsy is regarded as the gold standard in the diagnosis of fatty liver diseases. However, it is not recommended for routine use due to its invasiveness and complicated operation. Thus, it is urgent to diagnose fatty liver diseases with non-invasive and precise methods. In this regard, fluorescence imaging technology has attracted intensive attention and become a robust non-invasive method for fatty liver visualization, and a series of fluorescent probes are being intensively designed to track the biomarkers in fatty liver. In this brief review, the small molecular fluorescent probes employed in fatty liver are summarized, mainly focusing on the last four years. Moreover, current opportunities and challenges in the development of fluorescent probes for fatty liver will be highlighted.

Yun Zhu, Weimin Yan, Shuangyan Xu et al.

Backgroud: Renal fibrosis is the common characteristic of chronic kidney disease. Circular RNA plays an essential role in the occurrence and development of Renal fibrosis, but its regulative mechanism remains elusive.Methods: The animal and cell model of Renal fibrosis was established, and RNA-sequencing and real-time polymerase chain reaction (qRT-PCR) experiments were implemented. Subsequently, experiments for detecting apoptosis and proliferation of cell, were carried out, and the isobaric tags for relative and absolute quantification proteomics analyses were performed accordingly.Results: It was found that a newly discovered Circular RNA (circRNA_0002158), is highly expressed in kidneys or cells with fibrosis, implying that this Circular RNA might be associated with the occurrence and development of Renal fibrosis. Subsequently, the overexpression and knockdown of circRNA_0002158 were conducted in the human kidney epithelial cell line (HK-2) cells, and the results indicated that the circRNA_0002158 could inhibit apoptosis, and promote proliferation of cells. The kidney injury-related factors, including Fibronectin and plasminogen activator inhibitor-1 (PAI-1), were decreased in HK-2 cells with overexpression of circRNA_0002158, while the results were reversed in cells with knockdown of circRNA_0002158. Finally, to explore the regulative mechanism of circRNA_0002158, the iTRAQ proteomics analyses were implemented for the cell samples with OE of circRNA_0002158 and its control, it showed that multiple genes and functional pathways were associated with the occurrence and development of Renal fibrosis.Conclusion: CircRNA_0002158 is associated with regulating Renal fibrosis, and may contribute to ameliorating the progression of Renal fibrosis in the future.

Daniel W. L. Lai, Emma H. S. Liu, Elsie C. W. Yan et al.

Abstract Background The social unrest in the second half of 2019 in Hong Kong came with conflicts, confrontations, and violence which affected almost everyone in the city. The destruction and disruption of the urban facilities have undoubtedly had a significant impact on the lives and mental well-being of the public, and the older people are even more vulnerable. This study examined the impacts of the social unrest on the wellbeing of older people, an area that was seldomly addressed in the public discourse and literature. Methods Narrative interviews were conducted to capture older people’s lived experiences and ways of making sense of the unrest in Hong Kong. A total of 63 participants aged 60 and above was recruited through personal networks of the research team, and referrals by participants who took part in the interviews. Qualitative semi-structure interviews was conducted one on one via telephone. Results Thirty-three male and 30 female participants took part in the interview. The number of participants from different risk zones affected by political unrest was comparable. Three themes were generated. Participants experienced challenges during the social unrest, including disturbance to family and social life, reduced incomes which affect quality of life, and difficulties in socializing with friends and accessing medical services. The social unrest caused emotional disturbance, giving rise to feelings of panic, fear, insomnia, depression, annoyance, and anger. Participants reported different coping strategies, ranging from moving to other places, to avoiding going to risky areas and watching news. Conclusion Social unrest brings emotional distress to older people. In many cases, older people cope with challenges in different ways, whether active or passive. Social workers and other professionals should give more support to older people to encourage them to overcome their difficulties. The stakeholders’ awareness of the problem and mental health promotion is required to alleviate the multiple layers of negative impacts.

Sun Ju Chang, Kyoung-eun Lee, Eunjin Yang et al.

Abstract Background The Internet is considered an important channel for providing health information to older adults. We developed an intervention to improve eHealth literacy in older adults according to the information-motivation-behavioral skills (IMB) theory and Intervention Mapping. This study aimed to analyze the effect of a developed intervention on information, motivation, behavioral skills, and behaviors related to eHealth information in older adults. Methods Forty-six older adults over the age of 65 were recruited from two senior welfare centers in a city in South Korea. We divided the participants into four groups and conducted one intervention per group from March to December 2019. One intervention consisted of 5 sessions and was performed once a week (2 h/1 time) for 5 weeks, culminating in a total lecture time of 10 h. One lecture instructor and two assistant instructors supported the participants in the computer practices. Results Participants’ computer/web knowledge, perceived ease of use, perceived enjoyment, and attitude toward eHealth information showed statistically significant increases. The eHealth literacy efficacy score, searching performance score, and understanding score were also significantly increased. However, there was no significant difference in perceived usefulness. Conclusion The application of the current theory-based methodology can improve the quality of research in eHealth literacy. Additionally, various interventions should be developed and continuously applied to improve eHealth literacy among older adults.

Rayrane Iris Melo da Cunha, Luan Victor Anselmo de Oliveira, Kenio Costa de Lima et al.

Resumo Objetivo caracterizar as denúncias de violência contra pessoas idosas no Disque 100 no Rio Grande do Norte, Brasil, entre dezembro de 2018 e novembro de 2019. Métodos estudo transversal no qual foram analisados descritivamente os dados contidos nos extratos das denúncias de violência efetuadas no Disque 100 e, posteriormente, realizada uma análise espacial exploratória. Foram analisados os municípios de residência das vítimas, tipos de violência, local de ocorrência e os encaminhamentos para a rede de garantia de direitos. Além disso, idade, sexo e raça/cor das vítimas; e idade, sexo, raça/cor dos suspeitos e parentesco com a vítima Resultados No total, 878 denúncias contra 1.014 pessoas idosas foram registradas, a maioria de Natal, RN (46,9%). As denúncias mais prevalentes foram: negligência (77%), violência psicológica (44,9%) e abuso financeiro (19%) e ocorreram predominantemente na residência das vítimas (95,3%), atingindo principalmente as mulheres (66,9%). Os suspeitos das violências foram na maioria os filhos (62,1%) e do sexo feminino (49,3%). Conclusão Os resultados sugerem uma fragilidade do apoio/núcleo familiar e a necessidade da atenção do Estado para o cuidado nesse âmbito. Ademais, o fato de que as principais formas de violência nem sempre deixam marcas físicas alerta a população para a sua contribuição na identificação da violência contra a pessoa idosa. Finalmente, os resultados sugerem o desconhecimento do Disque 100 pelos indivíduos que residem no interior, fazendo-se necessário melhor divulgação dos canais de comunicação de violência para esse público, para uma análise mais realista dessa problemática no estado e um enfrentamento mais efetivo.

Xiaoyan Chen, Yanjiao Shen, Lisha Hou et al.

Abstract Objective To assess the utility of the preoperative Sarcopenia index (SI) as a predictive marker of the risk of postoperative complications following hip fracture surgery in older adults. Study design This observational study enrolled older adults with hip fracture who were hospitalized in the Department of Orthopedics of West China Hospital, Sichuan University, from December 7, 2010 - June 14, 2017, and who underwent hip fracture surgery. Primary outcome and measures Clinical data were collected from medical records and serum creatinine and cystatin C were measured before surgery. Outcomes included postoperative complications such as pneumonia, urinary tract infection, respiratory failure, heart failure, and non-grade A healing. Binary logistic regression analyses were used to analyze association between SI and postoperative complications. Results A total of 897 patients aged 60 years and over were enrolled in this study (age range: 60 – 100 years), of whom 306(34.1%)were male, and 591(65.9%)were female. Postoperative complications included pneumonia (12%), urinary tract infections (1.8%), respiratory failure (1.5%), heart failure (1.6%), and non-A- grade healing (3.6%). In the patient group that received joint replacements, the incidence of pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was independently associated with a lower risk of pneumonia after joint replacement surgery (OR:0.39, 95% CI:0.18-0.89, P<0.05). However, we did not find statistically significant association between SI and the risk of postoperative complications other than pneumonia among patients with two types of hip fracture surgery. Conclusion The SI based on serum creatinine and cystatin C can predict pneumonia rather than other postoperative complications among older patients with hip fracture after joint replacement surgery.

Charlotte Uggerhøj Andersen, Pernille Overgaard Lassen, Hussain Qassim Usman et al.

Abstract Background Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons’ Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.

Andreas Ihle, Élvio R. Gouveia, Bruna R. Gouveia et al.

Aims: We investigated whether the longitudinal relation between memory complaints and subsequent decline in executive functioning over 6 years differed by leisure activity engagement as major contributor to cognitive reserve in old age. Methods: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in two waves 6 years apart. Participants reported information on memory complaints and leisure activity engagement. Results: There was a significant interaction of memory complaints with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with less (but not those with greater) leisure activity engagement, memory complaints significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). Conclusion: The role of memory complaints as an early predictor of decline in executive functioning seems to vary by individuals’ cognitive reserve.

Wenzhe Sun, Guo Li, Ziqiang Liu et al.

Abstract Background Large hemispheric infarction (LHI) is a severe form of stroke with high mortality and disability rates. The purpose of this study was to explore predictive indicators of the in-hospital mortality of LHI patients treated conservatively without decompressive hemicraniectomy. Method We performed a retrospective study of 187 consecutive patients with LHI between January 1, 2016 to May 31, 2019. The receiver operating curves were preformed to evaluate predictive performance of demographics factors, biomarkers and radiologic characteristics. Significant prognostic factors were combined to build a nomogram to predict the risk of in-hospital death of individual patients. Result One hundred fifty-eight patients with LHI were finally enrolled, 58 of which died. Through multivariate logistic regression analysis, we identified that independent prognostic factors for in-hospital death were age (adjusted odds ratio [aOR] = 1.066; 95% confidence interval [CI], 1.025–1.108; P = 0.001), midline shift (MLS, aOR = 1.330, 95% CI, 1.177–1.503; P <  0.001), and neutrophil-to-lymphocyte ratio (NLR, aOR = 3.319, 95% CI, 1.542–7.144; P = 0.002). NLR may serve as a better predictor than white blood count (WBC) and neutrophil counts. Lastly, we used all of the clinical characteristics to establish a nomogram for predicting the prognosis, area under the curve (AUC) of this nomogram was 0.858 (95% CI, 0.794–0.908). Conclusion This study shows that age, MLS, and admission NLR value are independent predictors of in-hospital mortality in patients with LHI. Moreover, nomogram, serve as a precise and convenient tool for the prognosis of LHI patients.

Maki Eto, Shinji Miyauchi

Abstract Background Falls may cause serious health conditions among older population. Fall-related physical factors are thought to be associated with occlusal conditions. However, few studies examined the relationship between occlusal force and falls. To identify the association between occlusal force and falls among community-dwelling elderly individuals in Japan, public health nurses conducted a cross-sectional descriptive study. Methods We performed extensive physical assessments of five items: maximum occlusal force, handgrip strength, maximal knee extensor strength, one-leg standing time with eyes open and body sway. We also conducted a questionnaire survey concerning the participants’ demographic characteristics, health status and fall experience during the past year. Mean scores and standard deviations were calculated for age and the total points of the index of activities of daily living. Associations were examined using Mann-Whitney tests and logistic regression. Results We examined 159 community-dwelling people aged ≥65 years, who were independent and active, including 38 participants (24.5%) with experience of falls in the past year. Maximum occlusal force had significant correlation with handgrip strength, maximal knee extensor strength, and one-leg standing time and body sway (P < .05, respectively). We found weak associations between participants with and without a history of falls in terms of the five physical measurements. Logistic regression analysis showed that fall experience was significantly associated with maximum occlusal force (P = 0.004). Conclusions This is the first study, led by public health nursing researchers, to examine the associations between maximum occlusal force and falls among community-dwelling elderly in Japan. The results showed that maximum occlusal force was significantly related to the other four extensive physical assessments, and might also suggest that maximum occlusal force assessment by public health nurses could contribute to more sophisticated and precise prediction of fall risks among the community-dwelling elderly. The latest occlusal force measurement device is non-invasive and easy to use. Public health nurses can introduce it at periodical community health checkup assembly events, which might contribute to raising awareness among community-dwelling elderly individuals and public health nurses about fall prevention and prediction.

Dong Hoon Lee, Tae Mi Yoon, Joon Kyoo Lee et al.

Background: The aim of this study was to review the epidemiologic characteristics, management and treatment outcome of elderly parotid tumors. Methods: From January 2010 to December 2013, Seventy-eight patients ≥60-year-old with a diagnosis of parotid tumor were identified based on their medical records. Results: The 78 patients comprised 38 males and 40 females. Sixty-seven (85.9%) patients had a benign tumor and 11 (14.1%) patients had a malignant tumor. The most common benign tumor was Warthin tumor (n = 26) and the most common malignant tumor was salivary duct carcinoma (n = 5). Fine needle aspiration cytology had a diagnostic sensitivity of 100%, positive-predictive value of 97.0%, and accuracy of 97.3% for diagnosing benign parotid tumors. Conclusions: Warthin tumor was the most common benign tumor, and salivary duct carcinoma was the most frequent malignant tumor in this study. Surgical treatment is the mainstay treatment for benign and malignant parotid tumors.

Dong Wook Lee, Ju Hee Ha, Jun Ho Kim et al.

Pacemaker implantation-related infective endocarditis is an uncommon, but serious complication. The estimated incidence of infection after permanent endocardial pacemaker implantation varies from 0.2% to 3%. Infective endocarditis shows a mortality rate of 30% to 35%. Conservative medical treatment without removing the pacemaker is prone to failure, and reinfection rates of 51% to 77% have been noted in patients whose pacemaker systems become infected. Therefore, diagnosis of the primary infection is particularly important because surgical removal of the pacemaker system is usually required for its treatment. We describe here an 80-year-old woman who had drug fever that could have been misdiagnosed as infective endocarditis after pacemaker implantation.

Annaert Wim