Hasil untuk "Geriatrics"

Li J, Wei W, Xiao L et al.

Jiaxin Li,1,2,* Wenyan Wei,1,3,* Lu Xiao,4,* Nanbo Luo,5 Yuan Kang,6 Lujun Chen,7 Yuxuan Zeng,6 Liangqing Zhang,2,8 Min Chen1,9 1Faculty of Chinese Medicine and State Key Laboratory of Mechanism and Quality of Chinese Medicine, Macau University of Science and Technology, Macau, Macau SAR, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 3Department of Geriatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 4Department of Basic Medicine, Zhuhai Campus, Zunyi Medical University, Zhuhai, Guangdong, People’s Republic of China; 5Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, People’s Republic of China; 6The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 7Department of Cardiovascular Medicine, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 8Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 9Innovation Technology Research Institute, Macau University of Science and Technology (M.U.S.T.), Zhuhai, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Min Chen, Faculty of Chinese Medicine and State Key Laboratory of Mechanism and Quality of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, Macau SAR, 999078, People’s Republic of China, Email cmtcmky@sina.com Liangqing Zhang, Department of Anesthesiology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524000, People’s Republic of China, Email zhanglq1970@163.comPurpose: This study aimed to investigate the association between the systemic inflammation response index (SIRI) and one-year all-cause mortality, as well as major adverse cardiovascular and cerebrovascular events (MACCE), in elderly patients with acute coronary syndrome (ACS).Patients and Methods: This retrospective cohort study enrolled 963 elderly patients diagnosed with ACS at the Affiliated Hospital of Guangdong Medical University between January 2022 and December 2023, comprising those with unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. The cohort encompassed patients who underwent percutaneous coronary intervention as well as those managed conservatively, with a one-year follow-up. The primary endpoint was one-year all-cause mortality. Cox proportional hazards models were used to evaluate the association of SIRI, treated as both a continuous variable and as a categorical variable stratified by median value, with all-cause mortality and MACCE.Results: Among 963 elderly ACS patients (median age 73; 69.5% male), 132 (13.7%) died within one year. The median SIRI value was 2.89 × 109/L. In continuous analyses, higher SIRI was associated with greater all-cause mortality (adjusted hazard ratio [HR] 1.031 per unit; 95% confidence interval [CI] 1.018– 1.045; P < 0.001). Compared with the low-SIRI group, the high-SIRI group had higher mortality (adjusted HR 1.543; 95% CI 1.060– 2.246; P < 0.05). High SIRI was also associated with MACCE (adjusted HR 1.037 per unit; 95% CI 1.025– 1.050; P < 0.001).Conclusion: Elevated admission SIRI is independently associated with a higher risk of one-year all-cause mortality and MACCE among elderly ACS patients.Keywords: systemic inflammation response index, all-cause mortality, elderly patient, acute coronary syndrome

Yutao Li, Yuxin Tang, Weifeng Pan et al.

Abstract Objectives To investigate sarcopenia state transitions (non-sarcopenia, possible sarcopenia, and sarcopenia) and their determinants among older Chinese adults, emphasizing the roles of physical activity, cognitive status, and other risk factors. Methods A longitudinal study utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011–2015, integrating Multi-State Markov (MSM) models and Transformer-based deep learning approaches. We examined 5,756 participants (including 3,373 for deep learning) across three waves, with a mean age of 67.9 years (SD = 6.5). MSM models estimated transition intensities and probabilities between sarcopenia states. Deep learning with SHAP analysis identified key determinants of transitions and mortality. Covariates included age, sex, BMI, smoking, physical activity, mild cognitive impairment (MCI), and functional disability. Results MSM models indicated a high transition rate from non-sarcopenia to possible sarcopenia (intensity: 0.383, 95% CI: 0.355–0.411) and a 38.6% five-year recovery probability from possible sarcopenia to non-sarcopenia. Physical activity reduced deterioration risk (HR: 0.916, 95% CI: 0.842–0.997) and mortality in possible sarcopenia (HR: 0.565, 95% CI: 0.339–0.944). MCI increased deterioration risk (HR: 1.724, 95% CI: 1.268–2.346). Age > 80 significantly elevated deterioration (HR: 3.007, 95% CI: 1.992–4.538) and mortality risks (HR: 7.400, 95% CI: 2.542–21.544). Sex, BMI, smoking, and functional disability also influenced transitions. Conclusions Sarcopenia exhibits bidirectional progression, with physical activity serving as a key protective factor. MCI attenuates this benefit, highlighting the need for tailored interventions that address cognitive status and other risk factors in older adults.

Stefanie Skudlik , Katharina Lüftl, Regina Thalhammer et al.

Abstract Background The transition from home to a nursing home is an emotionally and organisationally challenging process for the care triad, consisting of older adults in need of care, their informal caregivers, and health professionals. Although this transition is known to occur in three phases, no study has comprehensively examined the experiences of care triad members across all phases, and evidence-based interventions to support informal caregivers and older adults through this highly stressful process are lacking. This study aimed to explore the experiences of care triad members, with a focus on identifying problems, strategies, required support, and suggestions for improvement across all three transition phases. These insights will serve as a basis for developing an intervention to enhance the transition. Methods We conducted a qualitative study using semi-structured interviews with participants representing the care triad in Germany. The interview guides were informed by a transitional model and prior literature. Data were analysed using qualitative content analysis. Results A total of 29 interviews were conducted. Key problems included limited care options, complex and often unsuccessful decision-making processes, transitional gaps, and a reduction in both autonomy and participation for older adults. Healthcare professionals showed limited and inconsistent involvement in decision-making and providing support. Informal caregivers often used indirect communication to avoid the sensitive topic of nursing home admission, aiming to prevent conflicts. Essential support needs were collaborative decision-making, adequate preparation time, and emotional support. Recommendations emphasized the importance of initiating care discussions early in the transition process. Conclusion Transitions from home to nursing homes are often delayed due to postponed decisions, family disagreements, and a lack of support from healthcare professionals. Informal caregivers frequently shoulder the burden, feeling overwhelmed and unsupported. As a result, transitions are often rushed, leading to a loss of autonomy and identity among older adults. Proactive planning and counselling could help prevent these negative outcomes. Interventions should focus on encouraging the early engagement of older adults and informal caregivers in planning their care situation, with consistent professional support throughout the process to ensure their participation and autonomy are maintained.

J. Guralnik, L. Branch, S. Cummings et al.

Zhen Liu, Xiao-Yang Wang, Han-Wei Wang et al.

Background CDK4 is highly expressed and associated with poor prognosis and decreased survival in advanced neuroblastoma (NB). Targeting CDK4 degradation presents a potentially promising therapeutic strategy compared to conventional CDK4 inhibitors. However, the autophagic degradation of the CDK4 protein and its anti-proliferation effect in NB cells has not been mentioned.Results We identified autophagy as a new pathway for the degradation of CDK4. Firstly, autophagic degradation of CDK4 is critical for NVP-BEZ235-induced G0/G1 arrest, as demonstrated by the overexpression of CDK4, autophagy inhibition, and blockade of autophagy-related genes. Secondly, we present the first evidence that p62 binds to CDK4 and then enters the autophagy-lysosome to degrade CDK4 in a CTSB-dependent manner in NVP-BEZ235 treated NB cells. Similar results regarding the interaction between p62 and CDK4 were observed in the NVP-BEZ235 treated NB xenograft mouse model.Conclusions Autophagic degradation of CDK4 plays a pivotal role in G0/G1 cell cycle arrest in NB cells treated with NVP-BEZ235.

Jing Xu, Guangwen Liu, Hexian Li et al.

Abstract Background The number of migrant older adults with children (MOAC) in China has been increasing in recent years, and most of them are women. This study aimed to explore the mediating effect of social support between social integration and loneliness among the female MOAC in Jinan, China. Methods In this study, 418 female MOAC were selected using multi-stage cluster random sampling in Jinan, Shandong Province, China. Loneliness was measured by the eight-item version of the University of California Los Angeles Loneliness Scale (ULS-8), and social support was measured by The Social Support Rating Scale (SSRS). Descriptive analyses, t-tests, ANOVA, and structural equation modeling (SEM) were used to illustrate the relationship between social integration, social support, and loneliness. Results The average scores of ULS-8 and SSRS were 12.9 ± 4.0 and 39.4 ± 5.9 among female MOAC in this study. Social integration and social support were found to be negatively related to loneliness, and the standardized direct effect was -0.20 [95% CI: -0.343 to -0.068] and -0.39 [95% CI: -0.230 to -0.033], respectively. Social support mediated the relationship between social integration and loneliness, and the indirect effect was -0.16 [95% CI: -0.252 to -0.100]. Conclusion The female MOAC’s loneliness was at a relatively lower level in this study. It was found that social integration was negatively associated with loneliness, and social support mediated the relationship between them. Helping female MOAC integrate into the inflow city and improving their social support could be beneficial for alleviating their loneliness.

Hanieh Zare, Zahra Tagharrobi, Mohammad Zare

Abstract Background Social frailty is a holistic concept encompassing various social determinants of health. Considering its importance and impact on health-related outcomes in older adults, the present study was conducted to cross-culturally adapt and psychometrically evaluate the Social Frailty Scale in Iranian older adults in 2023. Methods This was a methodological study. The translation and cross-cultural adaptation of the Social Frailty Scale 8-item (SFS-8) was conducted according to Wild’s guideline. Content and face validity were assessed using qualitative and quantitative methods. Then, 250 older adults covered by comprehensive health centers were selected using multistage random sampling. Participants completed the demographic questionnaire, the Abbreviated Mental Test score, the SFS-8, and the Lubben Social Network Scale. Construct validity was assessed by principal component analysis (PCA) and known-group comparisons. The Mann‒Whitney U test was used to compare social frailty scores between the isolated and non-isolated older adults. Internal consistency, equivalence, and stability were assessed using the Kuder-Richardson method, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the minimum detectable change (MDC). The ceiling and floor effects were also assessed. The data were analyzed using JASP 0.17.3. Results The ratio and index of content validity and the modified kappa coefficient of all the items were 1.00. The impact score of the items was greater than 4.6. PCA identified the scale as a single component by removing two questions that could explain 52.9% of the total variance in the scale score. The Persian version of the Social Frailty Scale could distinguish between isolated and non-isolated older adults (p < 0.001). The Kuder–Richardson coefficient, ICC, SEM, and MDC were 0.606, 0.904, 0.129, and 0.358, respectively. The relative frequencies of the minimum and maximum scores obtained from the scale were 34.8 and 1.2, respectively. Conclusions The Persian version of the Social Frailty Scale (P-SFS) can be used as a valid and reliable scale to assess social frailty in Iranian older adults.

Flavia Loreto, Serena Verdi, Seyed Mostafa Kia et al.

Abstract INTRODUCTION Overlooking the heterogeneity in Alzheimer's disease (AD) may lead to diagnostic delays and failures. Neuroanatomical normative modeling captures individual brain variation and may inform our understanding of individual differences in AD‐related atrophy. METHODS We applied neuroanatomical normative modeling to magnetic resonance imaging from a real‐world clinical cohort with confirmed AD (n = 86). Regional cortical thickness was compared to a healthy reference cohort (n = 33,072) and the number of outlying regions was summed (total outlier count) and mapped at individual‐ and group‐levels. RESULTS The superior temporal sulcus contained the highest proportion of outliers (60%). Elsewhere, overlap between patient atrophy patterns was low. Mean total outlier count was higher in patients who were non‐amnestic, at more advanced disease stages, and without depressive symptoms. Amyloid burden was negatively associated with outlier count. DISCUSSION Brain atrophy in AD is highly heterogeneous and neuroanatomical normative modeling can be used to explore anatomo‐clinical correlations in individual patients.

Ihab Hajjar, Reem Neal, Zhiyi Yang et al.

Abstract INTRODUCTION Recent Alzheimer's disease (AD) clinical trials have used cerebrospinal fluid (CSF) biomarker levels for screening and enrollment. Preliminary evidence suggests that AD risk is related to impaired renal function. The impact of kidney function on commonly used AD biomarkers remains unknown. METHODS Participants in studies conducted at the Goizueta Alzheimer's Disease Research Center (N = 973) had measurements of serum creatinine and CSF AD biomarkers. General linear models and individual data were used to assess the relationships between biomarkers and eGFR. RESULTS Lower estimated glomerular filtration rate (eGFR) was associated with lower amyloid beta (Aβ)42/tau ratio (p < 0.0001) and Aβ42 (p = 0.002) and higher tau (p < 0.0001) and p‐tau (p = 0.0002). The impact of eGFR on AD biomarker levels was more robust in individuals with cognitive impairment (all p‐values were < 0.005). DISCUSSION The association between eGFR and CSF AD biomarkers has a significant impact that varies by cognitive status. Future studies exploring this impact on the pathogenesis of AD and related biomarkers are needed. Highlights There is a significant association between Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers and both estimated glomerular filtration rate (eGFR) and mild cognitive impairment (MCI). Kidney function influences CSF biomarker levels in individuals with normal cognitive function and those with MCI. The impact of kidney function on AD biomarker levels is more pronounced in individuals with cognitive impairment. The variation in CSF tau levels is independent of cardiovascular factors and is likely directly related to kidney function. Tau may have a possible role in both kidney and cognitive function.

A. Garnier-Crussard, E. Forestier, Thomas Gilbert et al.

The authors extend their gratitude to the participating nursing homes. Financial Disclosure: This work was supported by the Agency for Healthcare Research and Quality (grant RO1HS25451). Lona Mody is supported by National Institutes of Health (grant number K24 AG050685); the Michigan Institute for Clinical and Health Research (grant number UL1TR002240); the National Institute on Aging (grant number P30 AG024824); and the Geriatrics Research, Education and Clinical Centers, Veterans Affairs AnnArborHealthcare System. Conflict of Interest: The authors have declared no conflicts of interest for this article. Author Contributions: Study concept and design: All authors. Acquisition of specimens and data: Jones, Mantey, Mody. Analysis and interpretation of data: All authors. Preparation of manuscript: All authors. Sponsor’s Role: None.

J. Michel, F. Ecarnot, H. Arai et al.

The proportion of older people in the world population is growing rapidly. Training and retaining healthcare professionals in sufficient numbers in the field of ageing represents a major challenge for the future, to deal with the healthcare needs of this ageing population. The COVID pandemic has unfortunately compounded shortages of healthcare workers worldwide. There is therefore a pressing need to scale-up the education of healthcare professionals in geriatrics and gerontology. Over the last 30 years, a group of motivated geriatrics physicians from Europe have been striving to educate healthcare professionals in geriatrics and gerontology through various initiatives, and using innovative pedagogic approaches to train physicians, nurses and other healthcare professionals around the world. The COVID-19 pandemic unfortunately put a stop to presence-based training programmes, but prompted the development of the online International Association of Gerontology and Geriatrics (IAGG) eTRIGGER (e-Training In Geriatrics and GERontology) course, a new training course in geriatrics and gerontology for healthcare professionals from a wide range of backgrounds. We outline here the history of the educational initiatives that have culminated in the roll-out of this new programme, and the perspectives for the future.

Konstantinos E. Deligiannidis, P. Boling, G. Taler et al.

Department of Family Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, USA Geriatrics and Senior Services, Medstar Health, Baltimore, Maryland, USA Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

G. Alexopoulos, B. Meyers, R. Young et al.

R. Effros, C. Fletcher, K. Gebo et al.

Iain J. McCullagh, Barbara Salas, Andrew Teodorczuk et al.

Abstract Background Post-operative delirium (POD) is an acute brain failure which may occur following major surgery, with serious implications for participants and caregivers. Evidence regarding optimal anaesthetic management for older participants at higher risk of POD is conflicting. We conducted a feasibility study of our protocol in 5 centres to guide sample size estimation and inform future recruitment strategies for a larger cohort study. Methods Participants aged over 65 and scheduled for major surgery were recruited. They were assessed pre-operatively for delirium, cognitive impairment, depression, comorbidity, activity levels and alcohol use. Details of management during surgery, all medications and complications were recorded by a trainee-led research team. Participants were assessed for delirium in the immediate recovery period and then on post-operative days 1–4 using the 4 question attention test (4AT) with complications assessed at day 4 using the post-operative morbidity survey (POMS). Primary outcomes were the incident rates of POD. Secondary outcomes were number of eligible patients, recruitment rates and retention rates throughout the study, time required for data collection, preoperative risk factors assessment and daily postoperative delirium assessments. Also to assess the added value of employing the regional trainee research network (INCARNNET) to deliver the study. Specifically, what proportion of patient consent, data collection and post-operative testing is performed by anaesthesia trainees from this group, especially the success of weekend delirium assessment by trainees? A survey was completed at the end of the study by the trainees involved regarding their involvement in the study. Results Ninety-five participants were recruited, of whom 93 completed the study. Overall, POD occurred in 9 patients. Of these, three were detected in recovery and six on post-op days 1–4. Median length of stay was 6 days. Recruitment rates were high in all but one site. 59 (62%) participants were consented by trainees and 189 (63%) of post op delirium assessments were performed by trainees. A total of six patients declined the study (in a follow up survey of trainees). Pre-existing cognitive impairment, depression and problem drinking were detected in 4(4.3%), 3(3.2%) and 5(5.37%) participants, respectively. Co-morbidity was common with 55(59%) in class three or four of the geriatric index of morbidity. Overall, from a total of 641 data points, levels of missing data were as follows, site A = 9.3%, B = 13.5%, C = 15.4%, D = 10.9%, E = 11.1% (data could not be completed retrospectively). Conclusions A multi-centre observational cohort study of delirium carried out by UK trainee anaesthetists is feasible. Patients are content to undergo day of surgery consent and multiple short questionnaires pre-operatively. Proposed data, especially pharmacological, should be carefully considered for their relevance to modifiable mechanisms that can lead to POD. Future research to enable prognostic modelling of POD should involve large scale cohort studies of enriched populations to capture a higher POD incidence. POD remains a common complication in older persons undergoing major surgery in the UK and studies of interventions are urgently needed. Trial registration All methods were carried out in accordance with relevant guidelines and regulations. The study was retrospectively registered with ISRCTN94663125 on 07/02/2018.

J. Batsis, K. Daniel, Elizabeth Eckstrom et al.

Older adults have been markedly impacted by the coronavirus disease 19 (COVID‐19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID‐19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID‐19.

B. Swenor, M. J. Lee, V. Varadaraj et al.

There is limited research examining the impact of visual impairment (VI) on older adults while considering the complexities of aging, leaving gaps in our understanding of how health consequences of VI might be averted. We created a framework integrating concepts from disability, geriatrics, and ophthalmology that conceptualizes how VI challenges successful aging. Here, VI influences multiple functional domains, and increases the risk of negative health outcomes. This model acknowledges that common causes, such as risk factors that affect eyes and other systems simultaneously, may also drive the relationship between VI and health outcomes. Finally, the model highlights how the impact of VI on aging outcomes can be addressed at multiple intervention points.

Jay N. Patel, D. S. Klein, Swathy Sreekumar et al.

INTRODUCTION This systematic review analyzes the literature on the treatment of geriatric hip fractures by a multidisciplinary hip fracture service including geriatricians/internists and orthopaedic surgeons and what impact this has on patient outcomes. METHODS A systematic review of several databases was conducted according to PRISMA guidelines. Studies comparing an orthopaedic-led care model versus a coordinated orthogeriatrics care model or a geriatrics-led care model to treat hip fractures with reported outcomes for time to surgery, length of stay, readmission rates, and postoperative mortality were included. RESULTS Seventeen articles fitting the inclusion criteria were included. Differences between the results of an orthopaedic-led care model versus a coordinated orthogeriatrics care model or a geriatrics-led care model were assessed using chi-squared tests. With patients admitted under a coordinated orthogeriatrics care model or a geriatrics-led care model, there is a statistically significant decrease in time to surgery (P = 0.045), length of stay (P = 0.0036), and postoperative mortality rates (P = 0.0034). CONCLUSIONS Although a heterogeneous group of studies, the aggregate data from several studies using an orthogeriatrics care model or a geriatrics-led care model trend toward improvements across several clinical and cost-related outcome measures: decreased time to surgery, shorter length of stay, improved postoperative clinical outcomes, decreased mortality, and lower cost.

M. McAdams‐DeMarco, Andrew H Law, Megan L. Salter et al.

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry‐based recipient, transplant and center‐level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with early KT outcomes, might serve as a novel, independent predictor of EHR in KT recipients of all ages. We measured frailty in 383 KT recipients at Johns Hopkins Hospital. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post‐KT discharge. Frail KT recipients were much more likely to experience EHR (45.8% vs. 28.0%, p = 0.005), regardless of age. After adjusting for previously described registry‐based risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR = 1.61, 95% CI: 1.18–2.19, p = 0.002). In addition, frailty improved EHR risk prediction by improving the area under the receiver operating characteristic curve (p = 0.01) as well as the net reclassification index (p = 0.04). Identifying frail KT recipients for targeted outpatient monitoring and intervention may reduce EHR rates.

Laura I. van Dyck, Kirsten M. Wilkins, J. Ouellet et al.

Highlights • What is the primary question addressed by this study? As a medical student interest group, can we alleviate social isolation suffered by nursing home residents during the COVID-19 pandemic through weekly phone calls?• What is the main finding of this study? The Yale Geriatrics Student Interest Group implemented the Telephone Outreach in the COVID-19 Outbreak Program at three nursing homes with initial success. Nursing home residents report looking forward to their weekly phone calls and gratitude for social connectedness.• What is the meaning of this finding? Social isolation and loneliness in nursing home seniors—a common concern now exacerbated by the COVID-19 pandemic—is partly relieved by our replicable telephone outreach program.