Hasil untuk "Geriatrics"

M. Tinetti, M. Speechley

S. Zarit, N. Orr, J. Zarit

W. Hazzard

J. Sorensen, J. Kondrup, J. Prokopowicz et al.

Kai Song, Yu Wei, Peng Jia et al.

Abstract Redox dysregulation is recognized as a key driver in the pathophysiology of numerous refractory diseases, contributing significantly to the progression and poor prognosis. The precise targeting and sophisticated modulation of redox processes within pathological microenvironments thus offer a promising avenue for innovative therapeutic strategies. Layered double hydroxides (LDHs)−based nanozyme lies in the programmable multi−active site architecture, which enables unprecedented functional integration for precise pathological microenvironment remodeling. In this review, the redox modulating mechanisms of LDHs−based nanozyme in these critical disease contexts are systematically explored, with special emphasis on intrinsic enzyme−like activities and structure−activity relationships. At the same time, it highlights how designing LDHs−based nanozyme can manipulate redox homeostasis to precisely reprogram the pathological microenvironment for stimulating effective, context−dependent pro− and anti−inflammatory therapeutic outcomes, which is a crucial requirement in conditions such as tumors and tissue injury. Finally, building upon recent advances, a forward−looking perspective is provided on the current challenges and future research directions in this rapidly progressing field.

Ni An, Hailong Lu, Tian Liu et al.

Abstract Background In recent years, non-traditional lipid indices have emerged as significant predictors for cardiovascular events following emergency percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). However, the relationship of residual lipoprotein-cholesterol (RLP-C) and atherogenic index of plasma (AIP) with in-hospital outcomes, especially their predictive value for major adverse cardiovascular and cerebrovascular events (MACCEs) after PCI in STEMI patients, remains underexplored and warrants further investigation. Methods This retrospective cohort study included 526 STEMI patients who underwent emergency PCI between January 2023 and August 2024. We collected baseline demographic, clinical, and laboratory data. RLP-C and AIP were calculated from lipid profiles obtained before PCI. Independent predictors of in-hospital MACCEs were identified using multivariate logistic regression, and model discrimination was evaluated using receiver operating characteristic (ROC) curve analysis. Results Among 526 STEMI patients receiving PCI, 92 (17.49%) developed in-hospital MACCEs. Multivariate analysis identified RLP-C (OR = 3.97, 95%CI: 1.71–9.21; P = 0.001) and AIP (OR = 2.42, 95%CI: 1.01–5.76; P = 0.047) as independent predictors of MACCEs after adjusting for conventional risk factors. The integrated model with hsTnT, ApoB, RLP-C, and AIP demonstrated superior predictive accuracy (AUC 0.744). Dose-response analysis revealed a borderline nonlinear relationship between AIP and MACCEs risk (P for nonlinearity = 0.050), while RLP-C demonstrated a linear dose-response relationship with MACCEs risk (P for nonlinearity = 0.522). Conclusion RLP-C and AIP are independent predictors of in-hospital MACCEs following PCI in STEMI patients. Combined assessment of these indices improves risk stratification and may facilitate early targeted interventions to improve outcomes.

Daniel Alejandro Román Sánchez, Andrés Santiago Aguilar Caivinagua, Manuel Esteban Maldonado Cornejo et al.

The management of stress in cats during veterinary clinical consultations represents a frequent challenge due to their alert nature and the fear generated by an unfamiliar environment. This condition can interfere with diagnostic accuracy and the performance of clinical procedures, in addition to provoking defensive behaviors that may endanger both the veterinarian and the owner. clipnosis, defined as a behavioral inhibition induced by pressure on the skin of the neck, is proposed as a non-pharmacological alternative to induce temporary immobility and facilitate clinical handling.  The objective of this study was to evaluate the efficacy of clipnosis in domestic cats of different age groups, relating the duration of immobility, stress levels, and compliance during routine clinical procedures. The research was conducted at the Veterinary Clinic of the Catholic University of Cuenca, with a sample of 30 cats evenly distributed into three groups: kittens, adults, and geriatrics. The technique was applied under controlled conditions, recording immobility duration, stress levels using the Cat Stress Score and tolerance to nail trimming, oral drug administration, and trichotomy for blood sampling. The results showed a statistically significant relationship between age and duration of immobility (P = 0.025), with adult and geriatric cats exhibiting a higher proportion of times exceeding three minutes. Regarding stress, significant differences were observed among groups during clipnosis application (P = 0.018), with higher levels in kittens. Cooperation improved notably during the trichotomy procedure, particularly in geriatric cats (P = 0.001), whereas no statistically significant differences were found in nail trimming and oral drug administration (P = 0.329 and P = 0.128, respectively). In conclusion, clipnosis represents an effective tool to facilitate certain invasive procedures in cats, although its application should be selective, considering both the age and the welfare of the feline patient.

H. Shimada, H. Makizako, T. Doi et al.

A. C. Kogan, K. Wilber, L. Mosqueda

Flavia Laffleur, Valérie Keckeis

A new era of science and technology has emerged in pharmaceutical research with focus on developing novel drug delivery systems for oral administration. Conventional dosage forms like tablets and capsules are associated with a low bioavailability, frequent application, side effects and hence patient noncompliance. By developing novel strategies for drug delivery, researchers embraced an alternative to traditional drug delivery systems. Out of those, fast dissolving drug delivery systems are very eminent among pediatrics and geriatrics. Orally disintegrating films are superior over fast dissolving tablets as the latter are assigned with the risk of suffocation. Due to their ability of bypassing the dissolution and the first pass effect after oral administration, self-emulsifying formulations have also become increasingly popular in improving oral bioavailability of hydrophobic drugs. Osmotic devices enable a controlled drug delivery independent upon gastrointestinal conditions using osmosis as driving force. The advances in nanotechnology and the variety of possible materials and formulation factors enable a targeted delivery and triggered release. Vesicular systems can be easily modified as required and provide a controlled and sustained drug delivery to a specific site. This work provides an insight of the novel approaches in drug delivery covering the critical comparison between traditional and novel “advanced-designed” systems.

Yunhyung Choi, Ho Sub Chung, Ji Yeon Lim et al.

Abstract Background The Clinical Frailty Scale (CFS) is widely utilized for risk stratification in emergency departments (EDs); however, its predictive value across various age groups remains unclear. Methods In this retrospective multicenter study, we analyzed 6,310 patients in the ED aged ≥ 65 years, categorized into young-old (65–74 years, n = 2,750), middle-old (75–84 years, n = 2,400), and old-old (≥ 85 years, n = 1,160) groups. According to CFS, patients were categorized as robust (scores 1–3), pre-frail (score 4), or frail (scores 5–9). Multivariable logistic regression analyses were performed to evaluate the independent association between frailty categories and clinical outcomes (ICU admission and in-hospital mortality), adjusting for age, sex, and illness severity. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC). Results The predictive value of CFS varied significantly across age groups. In the young-old group, frail status was independently associated with increased ICU admission (adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 1.076–2.062) and in-hospital mortality (aOR 3.232, 95% CI 1.738–6.009). The middle-old group demonstrated the strongest relationship with mortality for frail patients (aOR 5.361, 95% CI 2.872–10.007), but no significant association with ICU admission after adjustment. In the old-old group, neither pre-frail nor frail status significantly predicted outcomes. AUROC analysis showed the highest discriminative capability for ICU admission in the young-old group (0.616, 95% CI 0.597–0.634) and for mortality in the middle-old group (0.730, 95% CI 0.712–0.748), with reduced predictive value observed in the old-old group. Conclusions The prognostic value of CFS varies significantly by age group, demonstrating the strongest performance in young-old patients and diminishing predictive value in the old-old group. These findings suggest the need for age-specific frailty assessment strategies in emergency care, with additional clinical indicators potentially necessary for risk stratification in the oldest patients. Clinical trial number Not applicable.

Hamideh Mancheri, Gholam Reza Mahmoodi-Shan, Leila Jouybari et al.

Introduction: To identify the strengths and weaknesses of the curriculum and improve the quality of education in the Master of Nursing in Geriatrics, this study aimed to compare the educational program of the Master of Nursing in Geriatrics at Golestan University of Medical Sciences in Iran and Duke University in the United States. Methods: This is a descriptive comparative study. Information on the Master of Nursing in Geriatrics curriculum was extracted through documents available on the electronic pages of the two universities in 2024 and by searching related articles using  following keywords: “Gerontological nursing,” “Master's degree,” “Comparative study,” “Curriculum,”  “Duke University,” and “Iran as well as equivalent of these words in persian.” In this review, the curriculum of the Master of Nursing in Geriatrics was analyzed in terms of history, definition, philosophy, mission and vision, the objective of the educational program, student admission, method of presentation and duration of the educational course, number of course units, position and role of graduates in four stages of description, interpretation, juxtaposition, and comparison using the Bereday method. Results: Duke's Master of Nursing in Geriatrics program has a longer history and duration of study. Duke University offers the Master of Nursing in Geriatrics as two acute and primary care programs; however, it is being offered through one program in Iran. At Duke University, student entry criteria are different and based on the quality of candidates. The vision of Duke University focuses on globalization, while the vision of this field in Iran has a national and regional perspective. In Iran, the course is offered in  person and full- time, whereas at Duke University, it is offered full-time and part-time and online and in person. Conclusion: Considering issues such as the use of a decentralized method and multiple criteria for student admission, the existence of part-time distance learning courses and online classes, the presence of an instructor familiar with the field of geriatrics, and the presence of an appropriate clinical environment can strengthen the curriculum of the master's degree in geriatric nursing in Iran.

Sara Rubio‐Guerra, María Belén Sánchez‐Saudinós, Isabel Sala et al.

Abstract INTRODUCTION Recent research has suggested increased sensitivity of Alzheimer's disease (AD)‐negative neuropsychological norms; concurrently, generalized additive models for location, scale, and shape (GAMLSS) have emerged as a promising alternative to traditional norming approaches. Here, we developed amyloid β‐negative (Aβ−) next‐generation norms (NGN) for a comprehensive neuropsychological battery using GAMLSS. METHODS We included N = 987 cognitively normal (CN) individuals from a Spanish multicenter study with extensive neuropsychological data and cerebrospinal fluid AD biomarker assessment. NGN were developed using GAMLSS based on the performance of n = 774 Aβ− CN individuals aged 30–90 years. RESULTS Age‐, education‐, and sex‐adjusted z‐scores were obtained for 14 measures covering the main cognitive domains (memory, language, attention/executive, and visuospatial functions). A user‐friendly calculator for the z‐scores was made available in an open‐access ShinyApp to facilitate their application. DISCUSSION NGN may improve the detection of objective cognitive impairment in clinical and research settings. Highlights Brain amyloid β (Aβ) is associated with poorer performance in cognitively normal individuals. We provide GAMLSS‐based Aβ‐negative norms for 14 neuropsychological measures. Age, education, and often sex significantly influence cognitive performance. An online calculator for the demographically adjusted z‐scores is freely available.

Tingzhi Deng, Ding Li, Lihui Liang et al.

M. McAdams‐DeMarco, M. McAdams‐DeMarco, Andrew H Law et al.

We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post‐KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single‐center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single‐center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17‐fold (95% CI: 1.01–4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post‐KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.

Timothy W. Farrell, L. Francis, Teneille Brown et al.

Coronavirus disease 2019 (COVID‐19) continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors older adults in resource allocation decisions. This is a companion article to the American Geriatrics Society (AGS) position statement, “Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond.” It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations that should be considered when developing strategies for allocation of scarce resources during an emergency involving older adults. This review presents the legal and ethical background for the position statement and discusses these issues that informed the development of the AGS positions: (1) age as a determining factor, (2) age as a tiebreaker, (3) criteria with a differential impact on older adults, (4) individual choices and advance directives, (5) racial/ethnic disparities and resource allocation, and (6) scoring systems and their impact on older adults. It also considers the role of advance directives as expressions of individual preferences in pandemics. J Am Geriatr Soc 68:1143–1149, 2020.

Timothy W. Farrell, W. Hung, K. Unroe et al.

The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID‐19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID‐19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well‐documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.

C. Carrico, Christine L. McKibbin, Leland Waters et al.

Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration‐funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age‐friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP.

Jae-Young Lim

Chase Irwin, Donna Tjandra, Chengcheng Hu et al.

Abstract INTRODUCTION Identifying mild cognitive impairment (MCI) patients at risk for dementia could facilitate early interventions. Using electronic health records (EHRs), we developed a model to predict MCI to all‐cause dementia (ACD) conversion at 5 years. METHODS Cox proportional hazards model was used to identify predictors of ACD conversion from EHR data in veterans with MCI. Model performance (area under the receiver operating characteristic curve [AUC] and Brier score) was evaluated on a held‐out data subset. RESULTS Of 59,782 MCI patients, 15,420 (25.8%) converted to ACD. The model had good discriminative performance (AUC 0.73 [95% confidence interval (CI) 0.72–0.74]), and calibration (Brier score 0.18 [95% CI 0.17–0.18]). Age, stroke, cerebrovascular disease, myocardial infarction, hypertension, and diabetes were risk factors, while body mass index, alcohol abuse, and sleep apnea were protective factors. DISCUSSION EHR‐based prediction model had good performance in identifying 5‐year MCI to ACD conversion and has potential to assist triaging of at‐risk patients. Highlights Of 59,782 veterans with mild cognitive impairment (MCI), 15,420 (25.8%) converted to all‐cause dementia within 5 years. Electronic health record prediction models demonstrated good performance (area under the receiver operating characteristic curve 0.73; Brier 0.18). Age and vascular‐related morbidities were predictors of dementia conversion. Synthetic data was comparable to real data in modeling MCI to dementia conversion. Key Points An electronic health record–based model using demographic and co‐morbidity data had good performance in identifying veterans who convert from mild cognitive impairment (MCI) to all‐cause dementia (ACD) within 5 years. Increased age, stroke, cerebrovascular disease, myocardial infarction, hypertension, and diabetes were risk factors for 5‐year conversion from MCI to ACD. High body mass index, alcohol abuse, and sleep apnea were protective factors for 5‐year conversion from MCI to ACD. Models using synthetic data, analogs of real patient data that retain the distribution, density, and covariance between variables of real patient data but are not attributable to any specific patient, performed just as well as models using real patient data. This could have significant implications in facilitating widely distributed computing of health‐care data with minimized patient privacy concern that could accelerate scientific discoveries.