Hasil untuk "Geriatrics"

L. Fried, J. Guralnik

K. Brockow, A. Romano, M. Blanca et al.

Section for Enhancing Geriatric Understanding, Expertise Among Surgical, Medical Specialists

H. Vlassara, M. Palace

A. Sanford, M. Orrell, D. Tolson et al.

Wenjie Kou, Xiaomin Lu, Zhe Zhang et al.

Osteoporosis is a systemic metabolic bone disorder characterized by reduced bone mass and impaired microarchitecture, with its core pathological mechanism being an imbalance between bone formation and resorption. Traditional therapies targeting osteoblast/osteoclast function have limited efficacy and safety concerns. Recent osteoimmunology advances reveal that the innate immune system regulates bone homeostasis via intercellular interactions, cytokine networks, and metabolic reprogramming. This systematic review examines the roles of innate immune cells (macrophages, neutrophils, NK cells, DCs), complement system, and emerging pathways (trained immunity, mitochondrial symbiosis disruption) in osteoporosis. It summarizes therapeutic strategies (immunometabolic modulators, complement antagonists, cytokine-targeted drugs, TCM components) and outlines challenges (target specificity, clinical translation) and future directions, providing theoretical foundations for novel OP treatments.

Mei Chu Chen, Der-Sheng Han, Ke-Vin Chang et al.

T. Sugimoto, H. Arai, T. Sakurai

Since the concept and operational definition of “cognitive frailty” (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut‐derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2022; 22: 99–109.

W. Applegate, J. Ouslander

The worldwide spread of COVID-19 is alarming to all of us and has created an enormous public health and clinical crisis. Emerging data indicate that COVID-19 is a particular risk for older persons, particularly those with multimorbidity. Recent reports of COVID-19 infections indicate that both community-dwelling older persons as well as those residing in nursing homes, assisted living facilities, and other congregate living settings are at high risk. The editors of the Journal of the American Geriatrics Society (JAGS) want to make sure our readers are aware of resources for clinicians and our patients that provide superb guidance. As this outbreak progresses, JAGS will monitor events and provide periodic updates focused on older persons as needed. William B. Applegate, MD, MPH Sticht Center on Aging, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina Joseph G. Ouslander, MD Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida

Haitao Yuan, Xiaoxian Wang, Xin Sun et al.

Photodynamic immunotherapy is a promising strategy for cancer treatment. However, the dysfunctional tumor vasculature results in tumor hypoxia and the low efficiency of drug delivery, which in turn restricts the anticancer effect of photodynamic immunotherapy. In this study, we designed photosensitive lipid nanoparticles. The synthesized PFBT@Rox Lip nanoparticles could produce type I/II reactive oxygen species (ROS) by electron or energy transfer through PFBT under light irradiation. Moreover, this nanosystem could alleviate tumor hypoxia and promote vascular normalization through Roxadustat. Upon irradiation with white light, the ROS produced by PFBT@Rox Lip nanoparticles in situ dysregulated calcium homeostasis and triggered endoplasmic reticulum stress, which further promoted the release of damage-associated molecular patterns, enhanced antigen presentation, and stimulated an effective adaptive immune response, ultimately priming the tumor microenvironment (TME) together with the hypoxia alleviation and vessel normalization by Roxadustat. Indeed, in vivo results indicated that PFBT@Rox Lip nanoparticles promoted M1 polarization of tumor-associated macrophages, recruited more natural killer cells, and augmented infiltration of T cells, thereby leading to efficient photodynamic immunotherapy and potentiating the anti-primary and metastatic tumor efficacy of PD-1 antibody. Collectively, photodynamic immunotherapy with PFBT@Rox Lip nanoparticles efficiently program TME through the induction of immunogenicity and oxygenation, and effectively suppress tumor growth through immunogenic cell death and enhanced anti-tumor immunity.

Tian Liu, Huimin Lv, Jia Li et al.

Background: Gallstone disease is a widespread condition affecting the gastrointestinal tract, and poor diet is believed to be one of the reasons for its occurrence. Previous studies of dietary fiber intake and gallstones have limitations. The study's goal is to investigate the relationship between dietary fiber intake and gallstone prevalence in US adults. Materials and methods: Data from NHANES 2017 to March 2020 is used for the study. The association between fiber intake and gallstone prevalence was analyzed using multivariate logistic regression. To confirm the results’ robustness, we performed sensitivity analyses also. Results: Among the 6,051 U.S. adults aged over 20 with complete information, the prevalence of gallstones was 10.8 % (651/6051). After adjusting for relevant covariates, an increase in fiber intake of 5 g/day was associated with an 11 % decrease in the prevalence of gallstones (fully adjusted OR = 0.89, 95 % CI: 0.83–0.95). Participants were divided into high (>25 g/d) and low (≤25 g/d) fiber intake groups. Still significant negative association between dietary fiber intake and gallstones (fully adjusted OR = 0.66, 95 % CI: 0.49–0.91). Further dividing dietary fiber intake level into quintiles sustained this negative relationship, particularly showing the lowest gallstone occurrence in the highest dietary fiber group (OR = 0.63, 95 % CI: 0.44–0.91). While the stratified analyses indicated variability in the relationship between dietary fiber intake and the prevalence of gallstones, no interactive effects were identified in this association according to the interaction analysis. Conclusions: This study confirms that dietary fiber intake is negatively associated with the prevalence of gallstones. Sufficient dietary fiber intake might protect from gallstones. In order to formulate dietary recommendations, it is important to carry out prospective studies to validate the observed associations.

Majid Yousefi Afrashteh, Azin Fartash, Kimia Aboutorabi

Abstract Introduction The older people, as one of the vulnerable groups in society, face various challenges. Paying attention to their needs and issues during this period of life can improve their quality of life and mental health. This study aimed to investigate the relationship between death anxiety and spiritual intelligence with the potential mediating role of the search for meaning and resilience among Iranian older people. Methods This descriptive-correlational study was conducted on 348 older people over 60 years old in Zanjan, Iran, in 2024. The participants were selected using the Cochran formula. The instruments used in this study were the Spiritual Intelligence Scale, the Death Anxiety Scale, the Meaning in Life Questionnaire, and the Connor-Davidson Resilience Scale. Data analysis was performed using Pearson correlation coefficient and path analysis. Results The results showed a significant negative correlation between spiritual intelligence and death anxiety. In addition, the two variables of search for meaning and resilience played a potential mediating role in the relationship between spiritual intelligence and death anxiety. The goodness-of-fit indices of the final research model indicated a good fit, confirming the significance of the research hypotheses. Conclusion Based on the results, it is suggested that conducting educational programs for the older people and their families can help control death anxiety and enhance spiritual intelligence. This action can improve the quality of life and reduce psychological distress among the older people.

Alejandro Álvarez-Bustos, Isabel Rodríguez-Sánchez, Walter Sepúlveda-Loyola

Cancer incidence rates are rising in Latin America and the Caribbean, particularly among individuals over the age of 60. While treatment advances have improved patient survival, considerable efforts are still required to enhance other aspects of care following a cancer diagnosis. Despite growing evidence of the benefits of exercise interventions during the post-diagnosis period, older adults remain significantly underrepresented in related research. In fact, we found no studies that specifically examine the effects of exercise exclusively in adults over 60 years of age. Moreover, some studies have used this age threshold as an exclusion criterion. In light of these findings, we underscore the urgent need to include older adults with cancer in exercise interventions in Latin America and the Caribbean. The potential benefits of exercise for this population are supported by evidence from broader age groups and international research on older cancer survivors. These include the development of tailored intervention programs, an approach based on geriatric medicine, strategies to enhance adherence, education for patients and their support networks, and addressing the unique challenges faced by older cancer survivors.

Marta del Campo, Carlos Quesada, Lisa Vermunt et al.

Abstract This preclinical AD CSF proteome study identified a panel of 12-CSF markers detecting amyloid positivity and clinical progression to AD with high accuracy; some of these CSF proteins related to immune function, neurotrophic processes, energy metabolism and endolysosomal functioning (e.g., ITGB2, CLEC5A, IGFBP-1, CST3) changed before amyloid positivity is established.

Veronique Nabelsi, Marie Chantal Leclerc, Véronique Plouffe

BackgroundIn Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (“Centres d’hébergement et de soins de longue durée”; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec’s Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. ObjectiveThis study aims to explore nurses’ and nursing assistants’ experience of integrating teleconsultation during night shifts in rural CHSLDs with ≤50 residents. MethodsThe 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. ResultsParticipants’ experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals’ roles and in supporting effective adaptation to teleconsultation. ConclusionsThis pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents.

Janet L Macneil-Vroomen, Nanon H M Labrie, Carolien Smits et al.

Introduction Ageing in place (AIP) for persons with dementia is encouraged by European governments and societies. Healthcare packages may need reassessment to account for the preferences of care funders, patients and informal caregivers. By providing insight into people’s preferences, discrete choice experiments (DCEs) can help develop consensus between stakeholders. This protocol paper outlines the development of a Dutch national study to cocreate a healthcare package design methodology built on DCEs that is person-centred and helps support informal caregivers and persons with dementia to AIP. A subpopulation analysis of persons with dementia with a migration background is planned due to their high risk for dementia and under-representation in research and care.Methods and analysis The DCE is designed to understand how persons with dementia and informal caregivers choose between different healthcare packages. Qualitative methods are used to identify and prioritise important care components for persons with dementia to AIP. This will provide a list of care components that will be included in the DCE, to quantify the care needs and preferences of persons with dementia and informal caregivers. The DCE will identify individual and joint preferences to AIP. The relative importance of each attribute will be calculated. The DCE data will be analysed with the use of a random parameters logit model.Ethics and dissemination Ethics approval was waived by the Amsterdam University Medical Center (W23_112 #23.137). A study summary will be available on the websites of Alzheimer Nederland, Pharos and Amsterdam Public Health institute. Results are expected to be presented at (inter)national conferences, peer-reviewed papers will be submitted, and a dissemination meeting will be held to bring stakeholders together. The study results will help improve healthcare package design for all stakeholders.

Lingwan Xie, Yinze Han, Yuanzhi Liu et al.

Abstract Owing to the limitations of conventional cancer therapies, including chemotherapy, radiotherapy, and surgery, gene therapy has become a prominent strategy for cancer treatment over the past few decades. Gene therapy is a medical approach for targeting and destroying cancer cells by delivering exogenous genes into the target cancerous cells or surrounding tissues. However, successful delivery of foreign genes into target cells and tissues remains a key issue in such therapy. Efficient gene delivery systems would undoubtedly be important for improving the medical outcomes of gene therapy. With genetic modifications, viral vectors can target specific cells with high gene transduction efficiency, thus, the use of viral vectors is a promising technology for improving foreign gene delivery. Currently, four viral vectors—adenovirus, adeno‐associated virus, herpes simplex virus, and retrovirus—are dominantly being investigated and used in preclinical and clinical trials. In this review, we provide an overview of the mechanisms and latest applications of the four above‐mentioned viral vectors, and summarize the current development of several other viral vectors. In addition, we discuss the challenges and provide insights into future development of viral vectors in cancer treatment.

V Suresh Heijebu, Bhupendra Singh, Shrikant Srivastava et al.

Objectives: Cognitive impairment in the geriatric population often remains undiagnosed until progressed enough to cause interruptions in activities of daily living. Routine tests are time taking, requiring a specialist. Handwriting function reflects the brain's cognitive capacity by involving it's both halves. It is easy to collect and does not strain the participant, and can aid in the faster diagnosis of cognitive impairment. Materials and Methods: To study handwriting parameters collected with Livescribe Echo Smart Pen and compare them with cognitive scores of Montreal Cognitive Assessment-Hindi (MOCA-H) and Addenbrooke's Cognitive Examination-Hindi (ACE-H) in a cross-sectional observational study. Handwritten parameters differentiating both cognitive groups were identified and analyzed. Results: The mean age of the study population was 66.4 (5.3) years. The mean MOCA score in the cognitively impaired (CI) and noncognitively (NCI) group was 22.67 and 27.00, respectively. The mean ACE-H score in CI and NCI group was 80.68 and 93.05, respectively. In all handwriting tasks (T1-T3), higher scores were obtained on all parameters in the CI group except text width (TW), stroke frequency (SF), and writing speed (WS). In handwriting task 3 (single letter repetition), WC (word count) was found to be higher in the NCI group. Handwriting parameters of the whole task (TOT, PSPS, TW, TH, NOL, and WS) and text line (MTOL and MTOSS) were found to be helpful in group differentiation in all three tasks. There was a moderate degree of positive correlation with handwriting parameters (PSPS, WS, and WC) and a negative correlation with handwriting parameters (NOPS, TOT, TH, NOL, MHOL, MTOL, and MTOSS) across the tasks with MOCA and ACE scores. Conclusion: Inclusion of quantitative handwriting analysis in neuropsychological assessment can be one step forward towards a simple, reliable, and faster diagnosis of geriatric cognitive impairment.

Shobhit Srivastava, T. Muhammad

Abstract Introduction The Indian population is rapidly aging with huge proportion of illiterate and socioeconomically disadvantaged people and there is a dearth of research on the relationships between factors of socioeconomic vulnerability and frailty in older people. The present study examined the cross-sectional associations between socioeconomic vulnerability and physical frailty in community-dwelling older individuals in India. Materials and methods The data for the study were obtained from the Longitudinal Aging Study in India (LASI), which was conducted in 2017–18. The effective sample size was 14,652 older males and 15,899 older females aged 60 and over. The outcome variable was physical frailty phenotype measured from exhaustion, unintentional weight loss, weak grip strength, low physical activity, and slow walking time. The main explanatory variable was vulnerability status based on education, wealth and caste. The study carried out bivariate analysis to observe the association between vulnerability status and physical frailty. Further, multivariable binary logistic regression analysis was conducted to fulfil the objective of the study. Results A proportion of 10.5 and 14.4% of older males and females respectively were in the overall vulnerable category. The prevalence of physical frailty was high among older males from vulnerable population (31.4% vs 26.9%; p < 0.001). The adjusted estimates from multivariate analysis revealed that older adults from vulnerable category had 14% significantly higher odds of being frail in comparison to non-vulnerable category [AOR: 1.14; CI: 1.06,1.24]. The adjusted model further revealed that there were no significant gender differentials in physical frailty among older adults. Model-3 (adjusted model) revealed that older males and females from vulnerable population had 18% [AOR: 1.18; CI: 1.04,1.34] and 8% [AOR: 1.08; CI: 1.01,1.21] significantly higher odds of being physically frail in comparison to older males from non-vulnerable population respectively. Conclusions Adverse socioeconomic circumstances such as low education, lower wealth and caste status that are associated with increased prevalence of physical frailty raise urgent questions both for public health practitioners and clinicians. The current findings may help to adapt public policies focusing on screening physical frailty in the clinical settings, especially among vulnerable populations as a marker of a possibly reversible vulnerability to adverse outcomes in old age.

Kristin Taraldsen, Jorunn L. Helbostad, Turid Follestad et al.

Abstract Background The research on associations between gait, physical function, physical activity (PA), and cognitive function is growing. Still, clinical assessments of cognitive function and motor function is often kept separate. In this study, we aimed to look at a broad range of measures of gait, physical function, and PA in three groups of home-dwelling older adults with no or questionable dementia, mild dementia, and moderate/severe dementia. Methods This cross-sectional study included 100 home-dwelling older adults, recruited from an outpatient geriatric memory clinic. Severity of dementia was categorised using the clinical dementia rating scale (CDR), with no or questionable dementia (CDR score 0 and 0.5), mild dementia (CDR score 1) and moderate/severe dementia (CDR score 2 and 3). We used thigh worn accelerometers to measure daily PA, the Short Physical Performance Battery (SPPB) to measure physical function, and an electronic gait mat to evaluate gait characteristics. Associations between severity of dementia and measures of PA, physical function, and gait characteristics were assessed by linear regression. Results Participants’ (mean age 78.9 (SD 6.7) years, 57% women) average gait speed was 0.93 m/sec, and average upright time was 301 min/day. Statistically significant associations were found for the severity of dementia and gait speed (p=0.002), step time (p=0.001), physical function (SPPB, p=0.007), and PA (upright time, p=0.031), after adjusting for age. Overall, having no or questionable dementia was associated with faster gait speed (mean difference 0.163 (95% CI: 0.053 to 0.273)), shorter step time (-0.043 (-0.082 to -0.005)), better SPPB score (1.7 (0.5 to 2.8)), and longer upright time (78.9 (18.9 to 139.0)), compared to those with mild dementia. Furthermore, having no or questionable dementia was also associated with faster gait speed and better SPPB scores, as compared to those with moderate to severe dementia. No evidence of any differences was found between the participants with the mild dementia versus the moderate to severe dementia. Conclusions After adjusting for age, we found that the no or questionable dementia group to be associated with better gait and physical function, and more PA, as compared with the two groups with mild or moderate/severe dementia. Evaluation of gait, physical function, and PA can add clinically important information of everyday functioning in memory clinics meeting geriatric patients, but investigations on how to use these results to guide interventions are still needed.