Hasil untuk "Geriatrics"

XinQi Dong

Grace O. Allison, Sydney McCage, Stephan Brandt et al.

Abstract Background and Objectives Alzheimer’s disease and related dementias (ADRDs) are prevalent conditions that are stressful and elevate emotional distress in couples after diagnosis. Without treatment, emotional distress may become chronic and negatively affect couples’ quality of life. We report results from an NIH Stage 1A open pilot of Resilient Together for Dementia (RT-ADRD), a novel, dyadic, skills-based intervention aimed at preventing chronic emotional distress in couples early after diagnosis. We describe results from our mixed-methods single arm feasibility study, including preliminary feasibility and acceptability of the intervention, and qualitative feedback from exit interviews. We also present exploratory analyses for change in outcomes and mechanisms of action. Methods Six couples (N = 12 individuals) were recruited within six months of ADRD diagnosis by their diagnosing providers. Participants completed baseline assessments, participated in weekly RT-ADRD sessions together, then completed post-intervention assessments and one 60-min exit interview together. Results RT-ADRD exceeded all a-priori feasibility and acceptability benchmarks (> 70%). Feedback from exit interviews suggested that participants had favorable impressions of the program and found the skills useful and relevant. Participants also offered perspectives on barriers and facilitators of engagement and program enhancement. In exploratory analyses, persons living with dementia exhibited significant reductions in perceived stress at post-intervention (p < .05; Cohens d > 0.8). Both persons living with dementia and their care partners exhibited statistically significant improvements in positive dyadic interactions measured by the Dyadic Relationship Scale (ps < .05); Cohens ds > 0.8). Conclusions RT-ADRD shows promise as a feasible and acceptable dyadic intervention delivered early after diagnosis. Results support a future NIH Stage 1B trial of RT-ADRD to establish definitive feasibility markers of both intervention and control before formal efficacy testing. Trial registration This open pilot was registered on ClinicalTrials.gov (NCT06421545) on 05/20/2024.

Enver İpek, Fatma Doğan İpek, Feyza Yener Öztürk et al.

Abstract Purpose This study aimed to determine the prevalence of osteoporosis (OP) in patients aged ≥ 75 years using quantitative computed tomography (QCT) and to evaluate the scientific rationale for the approach of “initiating OP treatment without measurement in patients aged 75 and older” as stated in the Turkish Health Practice Bulletin. Methods This retrospective cross-sectional study included 1,531 patients aged ≥ 75 years (mean age 79.2 ± 4.2 years; 91.9% Women) who underwent QCT measurements at a tertiary hospital between January 2023 and August 2025. Lumbar trabecular volumetric bone mineral density (vBMD) and hip areal BMD (aBMD) were assessed. OP classification was performed using American College of Radiology (ACR) standardized BMD thresholds (< 80 mg/cm³) for lumbar spine and T-scores for hip regions. We conducted a study using routinely collected electronic health records (EHR) and Picture Archiving and Communication System (PACS) data at a tertiary hospital in Istanbul. Results Mean lumbar QCT vBMD was 77.9 ± 28.6 mg/cm³. OP prevalence in the lumbar spine was 85.0% based on T-score but 58.5% based on ACR BMD criteria, revealing a 26.5% discrepancy (Cohen’s κ = 0.317, p < 0.001). Among 1,301 patients classified as osteoporotic by T-score, 31.5% (n = 410) were in the osteopenia range according to QCT BMD criteria. At least one region showed OP in 66.2% of patients. OP prevalence increased significantly with age (75–79 years: 50.7%; 80–84 years: 69.7%; ≥85 years: 74.1%; p < 0.001). Women had significantly higher OP prevalence than men (59.6% vs. 46.0%, p < 0.001). Substantial regional discordance was observed between lumbar and hip measurements (54.5% for total hip, 56.6% for femoral neck; p < 0.001), with nearly half of lumbar osteoporotic patients (48.4%) showing only osteopenia in the hip. Conclusion OP prevalence is very high in individuals aged ≥ 75 years, supporting the rationale for empirical treatment without mandatory measurement. QCT evaluation should be based on volumetric BMD values rather than T-scores to avoid false-positive diagnoses. The substantial regional discordance emphasizes the importance of multi-site assessment when measurements are performed.

American Geriatrics Society Beers Criteria® Alternatives Panel, Michael A. Steinman

ABSTRACTThe American Geriatrics Society (AGS) Beers Criteria® serve to identify medications whose potential for harm outweighs their intended benefit in older adults. This highlights the need for guidance not only on what therapies to avoid but also on readily available alternative treatment strategies. AGS thus convened a multidisciplinary, interprofessional panel to develop a list of these alternative treatment strategies for older adults based on guidelines and evidence, updating an earlier effort published in 2015. This report presents these in a manner intended to be easily usable by front‐line clinicians facing common clinical scenarios. The list includes pharmacologic alternatives to medications on the AGS Beers Criteria® as well as non‐pharmacologic management strategies that are often safer and equally or more effective than the potentially inappropriate medications they are replacing. Clinician, patient, and caregiver resources are also provided to support the implementation of alternative treatment strategies in clinical practice.

Sankha Shubhra Chakrabarti

Bartłomiej K. Sołtysik, Anna Cieślak-Skubel, Agnieszka Gutowska et al.

Abstract Introduction Global ageing, the rising prevalence of cardiometabolic diseases and dementia becomes increasingly important public health topic. This relation has evoked extensive research efforts aimed at finding the link between cardiovascular health and cognitive decline. Cardiometabolic medications, widely prescribed for their beneficial effects on vascular health, are being closely examined for their potential influence on cognitive health and their capacity to modify the risk of dementia. Methods In this cross-sectional study, 1735 individuals from Central Poland were investigated on cardiometabolic diseases, treatments, and cognitive function. Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE) dichotomized to ≥ 24 points and < 24 points. Results The logistic regression revealed a strong association between age (OR:1.07, 95% CI 1.05–1.08, p < 0.001) and stroke (OR:1.43, 95% CI 1.30–1.84, p < 0.001) with worse MMSE dichotomized score. Similarly, insulin usage was linked to an increased risk of low MMSE (OR:1.33, 95%CI: 1.06–1.73, p = 0.008). In contrast, BMI (OR:0.96, 95%CI 0.94–0.98, p = 0.001), lipid disorders (OR:0.69, 95% CI 0.48–0.92, p = 0.01), use of calcium channels blockers (OR:0.71, 95% CI 0.48–0.94, p = 0.04), alpha-blockers (OR:0.54, 95% CI 0.23–0.86, p = 0.004) and angiotensin II receptor antagonists (OR 0.56, 95% CI 0.29–0.83, p = 0.001), were associated with normal cognitive functions (R2 = 0.08, p < 0.001). Conclusions The results present the complex connection between cardiometabolic disorders, their treatment and cognitive functioning. The research highlights the necessity for a tailored approach in prescribing cardiovascular medications, considering their potential link with cognitive health. Especially the role of angiotensin II receptor antagonists merits further studies.

Xie Jia, Ma Qing, Fang Ronghua

As the aging trend intensifies, the incidence of chronic diseases among the elderly is increasing. Oral dysfunction and depression are becoming increasingly common health concerns in this demographic. Particularly, factors like as edentulism, compromised mastication, decreased lingual pressure, poor oral motor skills, and dysphagia elevate the incidence of depression among the senior demographic. Conversely, depression increases the probability of developing oral dysfunction. Moreover, oral frailty and depression are associated with comorbidities linked to malnutrition, several chronic illnesses, and periodontitis. This review examines the relationship between oral dysfunction and depression, intending to serve as a reference for their prevention and treatment in the elderly.

Kanglin Cai, Xinyu Chen, Yongkai Cao et al.

Abstract Objective Depression is a serious mental disorder, and its incidence rate has increased rapidly. Radix Bupleuri (root of Bupleurum chinensis DC. BR)-Radix Paeoniae Alba (root of Paeonia lactiflora Pall. PRA) herb pair has been historically used for treating depression in Traditional Chinese Medicine (TCM) while the mechanisms need to be fully revealed. Methods The effects of the BR-PRA herb pair were investigated using a rat model of chronic unpredictable mild stress (CUMS). First, the depressive-like behavior of rats was evaluated by open field test (OFT), elevated plus-maze test (EMP), and forced swimming test (FST). Secondly, histomorphological changes in the CA1 and CA3 regions of the hippocampus were analyzed by hematoxylin-eosin, nissl, and Golgi staining. Ultra high-performance liquid chromatograph tandem quadrupole mass spectrometry (UHPLC-QTRAP-MS/MS) was performed to reveal potential antidepressant mechanisms. Results Following CUMS exposure, rats displayed depressive-like behavior, and neuronal death in the hippocampal region was observed. Consequently, these abnormal changes were reversed by BR-PRA herb-pair intervention. A total of 26 different metabolites related to depression were identified by metabolomics, mainly involving eleven metabolic pathways of pentose phosphate pathway, purine metabolism, and amino sugar and nucleotide sugar metabolism. BR-PRA herb-pair improved four metabolites, including homocitrulline, N-acetyllysine, corticosterone, and N-acetylglutamate. It also may affect the development of depression by interfering with the hypothalamus-pituitary-adrenal axis (HPA axis), amino acid metabolism related to lysine and glutamate, and modulation of oxidative stress. Conclusion BR-PRA herb-pair alleviated depressive-like behavior in CUMS rats, recovered hippocampus damage, and regulated cerebral cortex metabolism, which may be related to the HPA axis, amino acid metabolism related to lysine and glutamate, and modulation of oxidative stress. Clinical trial number Not applicable.

Hao Peng, Hanlin Zhang, Sheng Xin et al.

Purpose: Erectile dysfunction (ED) is associated with several vascular disorders, but the associations between ED and vascular parameters are still unclear. Materials and Methods: We analyzed and synthesized a comprehensive range of studies from PubMed, Web of Science, and Scopus regarding the associations between ED and the following measures: ankle-brachial index (ABI), pulse wave velocity (PWV), intima-media thickness (IMT), nitrate-mediated dilation (NMD), flow-mediated dilation (FMD), augmentation index (AI), endothelial progenitor cells (EPCs) and other vascular parameters. Subgroup analysis was conducted according to specific types of parameters. Study quality was assessed by using the Newcastle–Ottawa Scale. Sensitivity analysis was conducted to confirm the robustness of the pooled results. Results: Fifty-seven studies with 7,312 individuals were included. Twenty-eight studies were considered to be high-quality. ED patients had a 0.11 mm higher IMT (95% confidence interval [CI]: 0.07, 0.15), a 2.86% lower FMD (95% CI: -3.56, -2.17), a 2.34% lower NMD (95% CI: -3.37, -1.31), a 2.83% higher AI (95% CI: 0.02, 5.63), a 1.11 m/s higher PWV (95% CI: 0.01, 2.21), and a 0.72% lower percentage of EPCs (95% CI: -1.19, -0.24) compared to those without ED. However, ABI was similar between ED patients and non-ED individuals. According to sensitivity analysis, the pooled results were robust. Conclusions: Our study confirmed the associations between ED and several vascular parameters and highlighted the importance of prevention and management of vascular and endothelial dysfunction in ED patients.

Caleb C.Y. Wong, Lucy Y. Gao, Yuesong Xu et al.

IntroductionCD44 is a transmembrane glycoprotein implicated in tissue inflammation and fibrosis. We investigated its role in kidney inflammation and fibrosis in a murine model of lupus nephritis (LN), and the clinico-pathological association of serum CD44 level in patients with biopsy-proven Class III/IV ± V LN.MethodsNZB/W F1 mice were treated with control IgG or anti-CD44 monoclonal antibody for 4 weeks and disease parameters assessed. Serum CD44 level in LN patients was determined by ELISA. Control groups included healthy subjects and patients with non-renal SLE or non-lupus renal disease.ResultsCD44 expression was absent in the normal kidney, but it was expressed in proximal and distal tubular epithelial cells and infiltrating cells in renal biopsies from patients with active proliferative LN. ScRNA-Seq datasets confirmed that CD44 was predominantly expressed in tubular cells and all immune cells identified in LN patients including tissue resident, inflammatory and phagocytic macrophages, Treg cells, effector and central memory CD4+ T cells, resident memory CD8+ T cells and naïve and activated B cells. Treatment of NZB/W F1 mice with anti-CD44 antibody preserved kidney histology and reduced proteinuria, tubulo-interstitial infiltration of CD3+, CD4+ and CD19+ immune cells, and mediators of kidney fibrosis compared to Control mice. Longitudinal studies showed that serum CD44 level increased prior to clinical renal flare by 4.5 months and the level decreased after treatment. ROC curve analysis showed that CD44 level distinguished patients with active LN from healthy subjects and patients with quiescent LN, active non-renal lupus, and non-lupus CKD (ROC AUC of 0.99, 0.96, 0.99 and 0.99 respectively). CD44 level correlated with leukocyte infiltration and interstitial inflammation scores in active LN kidney biopsies.DiscussionOur findings suggest that CD44 plays a pathogenic role in renal parenchymal inflammation and fibrosis in active LN and monitoring CD44 may facilitate early diagnosis of flare.

Yue Lu, Yue Lu, Yue Lu et al.

It has been proven that robot-assisted rehabilitation training can effectively promote the recovery of upper-limb motor function in post-stroke patients. Increasing patients’ active participation by providing assist-as-needed (AAN) control strategies is key to the effectiveness of robot-assisted rehabilitation training. In this paper, a greedy assist-as-needed (GAAN) controller based on radial basis function (RBF) network combined with 3 degrees of freedom (3-DOF) potential constraints was proposed to provide AAN interactive forces of an end-effect upper limb rehabilitation robot. The proposed 3-DOF potential fields were adopted to constrain the tangential motions of three kinds of typical target trajectories (one-dimensional (1D) lines, two-dimensional (2D) curves and three-dimensional (3D) spirals) while the GAAN controller was designed to estimate the motor capability of a subject and provide appropriate robot-assisted forces. The co-simulation (Adams-Matlab/Simulink) experiments and behavioral experiments on 10 healthy volunteers were conducted to validate the utility of the GAAN controller. The experimental results demonstrated that the GAAN controller combined with 3-DOF potential field constraints enabled the subjects to actively participate in kinds of tracking tasks while keeping acceptable tracking accuracies. 3D spirals could be better in stimulating subjects’ active participation when compared to 1D and 2D target trajectories. The current GAAN controller has the potential to be applied to existing commercial upper limb rehabilitation robots.

Andréa Negrão Costa, Carla Mércia Souza Dacier Lobato, Karlo Edson Carneiro Santana Moreira et al.

Objetivo: Correlacionar achados de neuroimagem de pacientes idosos com fatores de risco para demência vascular com testes cognitivos e verifi car se esta correlação é compatível com esse tipo de demência. Método: Foram selecionados 31 pacientes acima de sessenta anos, de ambos os sexos, com fator de risco para demência vascular, internados na Fundação Santa Casa de Misericórdia do Pará, no ano de 2011. Foram empregados testes de avaliação cognitiva: miniexame do estado mental, escala de Cerard, teste do relógio e fl uência verbal. Em caráter complementar, foi utilizada ressonância nuclear magnética de crânio, sendo os resultados analisados pelo mesmo radiologista seguindo a classifi cação de Fazekas modifi cada. Foi feita análise estatística dos dados pelo método do qui-quadrado. Resultados: A hipertensão arterial sistêmica (71%), o diabetes mellitus (58,1%), o sedentarismo (58,1%) e o tabagismo (41,9%) foram os fatores de risco mais relacionados à demência vascular. Pela classifi cação da Fazekas, os principais achados foram Fazekas 1 e 2 (64,5%), sendo que destes, 90% apresentaram transtorno cognitivo positivo para demência vascular. Dos testes cognitivos, os de maior sensibilidade para a avaliação de demência foram os testes do miniexame do estado mental e a escala de Cerard. Conclusão: Faz-se necessário o rastreamento de demência vascular em idosos a partir da utilização de pelo menos dois testes cognitivos e uma avaliação de neuroimagem, atentando ao fato de que, por meio do controle e da prevenção dos fatores de risco para doenças cardiovasculares, estar-se-á contribuindo para prevenção desse tipo de demência.

Ilona Moutoussamy, Laurence Taconnat, Lucie Angel et al.

Abstract Aging is marked by a memory decline related to an executive function decline. Physical activity (PA) has beneficial effects on both executive functions and memory, especially in aging. The protective effects of PA on these two cognitive abilities have always been studied separately, despite the well-established relationship between memory and executive functions. Our objective was to explore whether the benefits of PA on memory could be explained by reduced age-related changes in executive functions. Nineteen young adults (27.16 years old) and 25 older adults (69.64 years old) performed a resource-dependent memory task, three executive tasks and completed a PA questionnaire (measuring sports and leisure PA). Age group and PA effects on memory and executive performance were analyzed with generalized linear models. Mediation analyses were calculated using method of causal steps approach with a non-parametric bootstrapping procedure. The results confirmed the effects of age and PA on memory and executive performance. A significant interaction confirmed the protective effect of PA on age-related cognitive performance. PA was positively correlated with performance in both memory and executive tasks, but only in the older adults. Although each predictor alone (age, executive functions and PA) significantly explained memory performance in older adults, only the effect of PA on memory performance remained significant when all the predictors were introduced in the analyses. PA mediates the effects of age and executive functions on memory performance. This suggests that PA protects older adults against memory decline by reducing the decline in executive functioning.

Jussara Meyer Osielski, Décio F. Montresor Jr., Débora Carolina Netz Sanches et al.

Objetivo: Este estudo visa avaliar a prevalência de hiperparatireoidismo secundário à deficiência de vitamina D e sua associação com o declínio de funcionalidade na população de idosos acima de 65 anos de idade, internados na enfermaria de geriatria do Hospital do Servidor Público Estadual. Métodos: Os idosos foram avaliados através de um questionário na forma de entrevista, elaborado com destaque para os fatores mais comuns que levam à hipovitaminose D. Foram analisadas através de escalas apropriadas as perdas funcionais das atividades básicas e instrumentais da vida diária e possível correspondência com o diagnóstico laboratorial de hipovitaminose D e hiperparatireoidismo secundário. Resultados: Foram avaliados, no final do período de verão (março) e no período de outono (meses de abril e maio), 62 pacientes internados na enfermaria de geriatria, dos quais 60 eram considerados válidos. Observou-se associação positiva de hiperparatireoidismo secundário a deficiências de vitamina D em 46,77% dos casos, sendo a média de idade de 84,75 anos. Não foi demonstrada correlação positiva entre o grau de perda funcional com o aumento do hormônio da paratireoide ou deficiência de vitamina D. Conclusão: Os dados evidenciam considerável prevalência de hiperparatireoidismo secundário à deficiência de vitamina D em pacientes internados e a importância de novas investigações, bem como a introdução de estratégias diagnósticas e de tratamentos adequados para a população subdiagnosticada. No entanto, não foi possível associar perda funcional e hiperparatireoidismo à amostra pesquisada.

Eloy F. Ruiz, Oscar J. Ponce, Helen M. Fernandez

ABSTRACT Introduction The COVID‐19 pandemic accelerated the shift from in‐person to virtual recruitment, prompting residency and fellowship programs to adopt innovative strategies, such as leveraging social media platforms to attract applicants and enhance visibility. Our aim was to identify and describe the presence of U.S. geriatric medicine fellowship programs on X. Methods We identified all U.S. geriatric medicine fellowship programs using FREIDA, and then located their X accounts through a stepwise process. Data were collected on account creation, number of followers, posts, and activity level, with an analysis of the last 100 posts from the most active accounts. Descriptive statistics were used to analyze the data. Results Among the 147 geriatric medicine fellowship programs identified, 38 (25.9%) had an X account. The majority of accounts were created after the start of the pandemic, reflecting likely the adaptation to virtual recruitment processes. Only a few accounts generated the majority of posts and followers. The accounts primarily posted or reposted educational content, research highlights, and promotional material. Conclusion The use of X by geriatric medicine programs is still significantly underutilized, with only one‐fourth of them having an account. Half of the accounts were created after the COVID‐19 pandemic began. Programs should focus on building a robust social media presence to increase their visibility, especially as virtual interviews have become a permanent part of recruitment.

Anushruti Aggarwal, Sharang Gupta, Dimple Chopra et al.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign proliferation of blood vessels of uncertain etiology. It primarily affects the head-and-neck region. Histologically, it is characterized by the prominent proliferation of plump endothelial cells, and accompanying eosinophilic and lymphocytic infiltration. Herein, we report the case of ALHE in a 65-year-old male.

Jan Dreyer, Johannes Michael Bergmann, Kerstin Köhler et al.

Abstract Background Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of ‘stability of home-based care arrangements for people living with dementia’ (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. Method This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. Results The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes ‘dementia and care trajectory’ and ‘structure of the dyadic relationship’ best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. Conclusion The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.

En Lin Goh BSc (Hons), MBBS (Dist), MRCS, Swathikan Chidambaram BSc (Hons), MBBS (Dist), MRCS, Suprabha Rai MD et al.

Background In patients with hip fracture on direct oral anti-coagulants (DOACs), timely surgery is important in optimising outcomes but the safety of early surgery is unclear. This study aims to evaluate the timing of surgery on peri- and post-operative outcomes in patients with hip fracture on DOAC therapy. Methods Single-centre, retrospective, population-based cohort study of patients on DOAC therapy compared to standard care with low-molecular-weight heparin (LMWH) undergoing surgery for hip fracture. Data obtained: patient demographics, fracture classification, American Society of Anaesthesiologists (ASA) classification, time to surgery, procedure performed, type of DOAC, timing of last DOAC dose, use of reversal agents or pro-coagulants and length of stay. Outcomes assessed: pre- and post-operative haemoglobin levels, incidence of blood transfusion, major haemorrhage, venous thromboembolism (VTE) and death within 30 days of surgery. Results A total of 755 patients were included. Compared to standard treatment, DOAC use was associated with a similar change in pre- and post-operative haemoglobin levels ( P = .90), risk of blood transfusion (RR: 1.04, 95% CI: .70–1.54, P = .84), haemorrhage (RR: 1.51, 95% CI: .53-4.28, P = .44), VTE (RR: .92, 95% CI: .12–7.20, P = .94) and mortality (RR: 1.85, 95% CI: .89–3.84, P = .10), all of which were independent of the timing of surgery. Conclusion This study builds on growing evidence that surgery for hip fracture in patients on DOAC therapy is not associated with an excessive risk of haemorrhage, irrespective of the timing of surgery. Timely surgical fixation of the hip fracture in this population is indicated in the absence of other risk factors for haemorrhage.

Ryoko Aonuma, Thomas Mayers, Katsuyoshi Mizukami et al.

The purpose of this study was to examine, using a sequential model, factors associated with volunteer participation and sleep efficiency in Japanese older adults receiving treatment for hypertensive disease. A questionnaire survey was conducted to collect data on participant demographics, lifestyle, health status, and depression, and sleep activity monitors were used to objectively measure sleep status and sleep efficacy. Of the 167 respondents, the 59 being treated for hypertension were divided into two groups based on their participation in volunteering. Comparison between the groups showed significant differences in nocturnal awakening, sleep efficiency, and nap frequency. Volunteers had less nocturnal awakening, increased sleep efficiency, fewer naps, and decreased depression. Covariance structure analysis of the survey data and sleep measurements for hypertensive older adults in the volunteer group was performed by modeling the relationships between variables with a path diagram. Our model showed strong goodness of fit (χ² test = 15.636, <i>p</i> = 0.111, GFI = 0.925, AGFI = 0.842, CFI = 0.925, RMSEA = 0.099). The findings of this study suggest that older adults with hypertension who participate in volunteer activities have less nocturnal awakening, improved sleep quality, and reduced risk of depression, and provides evidence to promote social participation in volunteering among older adults with hypertension.

Misun Pak, Masahiko Hara, Shoko Miura et al.

Abstract Background Delirium is associated with high mortality after cardiac surgery. However, evidence on the epidemiology of delirium in patients with acute decompensated heart failure (ADHF) is limited. This study aimed to assess the incidence and prognostic impact of delirium in patients with ADHF. Methods This single-center prospective observational study enrolled 132 consecutive patients with ADHF. We utilized the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and classified the patients into two groups according to the presence or absence of delirium. The primary endpoint was 90-day all-cause mortality. The prognostic impact and risk factors of delirium were evaluated using multivariable Cox and logistic regression analyses, respectively. Results The median patient age was 83 (interquartile range, 75–87) years. Approximately 51.5% were men. Delirium occurred in 36 (27.3%) patients, and hyperactive delirium was the most frequent type (86.1%). The 90-day all-cause mortality was higher in the patients with delirium than in those without (21.6% versus 3.9%, log-rank p = 0.002). Delirium was associated with higher mortality with an adjusted hazard ratio of 6.8 (95% confidence interval, 1.1–42.6, p = 0.042). The risk factors associated with delirium included advanced age, male sex, higher clinical frailty scale score, and dementia. Conclusions Delirium was associated with a higher 90-day all-cause mortality in the older adult patients with ADHF. Hyperactive delirium was the most common subtype.