Hasil untuk "Geriatrics"

Ahmet Yilmaz, Orhan Çiçek

BackgroundThe triglyceride-glucose (TyG) index, a simple surrogate marker of insulin resistance, has been associated with adverse cardiovascular outcomes. However, data on its prognostic value in elderly patients with acute decompensated heart failure (ADHF) are limited. This study aimed to evaluate the predictive role of the TyG index for one-year all-cause mortality in geriatric ADHF patients.MethodsThis retrospective single-center study included 149 patients aged ≥65 years who were hospitalized with ADHF between January 2023 and December 2024. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Patients were stratified into quartiles based on TyG levels, and outcomes were compared across groups. Receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and multivariate Cox regression were applied to evaluate the prognostic performance of the TyG index.ResultsHigher TyG quartiles were significantly associated with increased glucose, triglyceride, and inflammatory marker levels (p < 0.05). ROC analysis demonstrated moderate discriminative ability for one-year mortality (AUC = 0.72, 95% CI: 0.61–0.83, p = 0.001), with an optimal cut-off value of 8.70. Kaplan–Meier curves showed significantly reduced survival in the highest TyG quartile (45.9%) compared with the lowest (89.5%) (log-rank p < 0.001). Although TyG was not an independent predictor in multivariate analysis (HR 1.68; 95% CI: 0.70–4.00; p = 0.25), it was significant in the subgroup with left ventricular ejection fraction <40% (HR 1.91; 95% CI: 1.02–3.59; p = 0.04). Adding the TyG index to a conventional risk model including age, sex, left ventricular ejection fraction, hypertension, chronic obstructive pulmonary disease, cardiovascular disease, and chronic kidney disease significantly improved prognostic accuracy (NRI = 0.273, IDI = 0.011, both p < 0.01).ConclusionElevated TyG levels are associated with increased one-year mortality and reduced survival in elderly ADHF patients. The TyG index provides incremental prognostic value beyond conventional risk factors and in daily clinical practice may serve as a simple, low-cost tool for risk stratification in geriatric heart failure management.

McLeod KJ

Kenneth J McLeod Sonostics, Inc, Endicott, NY, USACorrespondence: Kenneth J McLeod, Email kmcleod@sonostics.comAbstract: The World Health Organization recommends that older adults undertake at least 150 minutes of moderate intensity physical activity over the course of each week in order to maintain physical, mental, and social health. This goal turns out to be very difficult for most community dwelling older adults to achieve, due to both actual and perceived barriers. These barriers include personal health limitations, confinement issues, and self-imposed restrictions such as fear of injury. Climate change exacerbates the confinement issues and injury fears among the elderly. To assist older adults in obtaining the benefits of increased physical activity under increasingly challenging climate conditions, we propose a targeted non-volitional intervention which could serve as a complement to volitional physical activity. Exogenous neuro-muscular stimulation of the soleus muscles is a non-invasive intervention capable of significantly increasing cardiac output in sedentary individuals. Long-term daily use has been shown to improve sleep, reduce bone loss, and reverse age-related cognitive decline, all of which are significant health concerns for older adults. These outcomes support the potential benefit of exogenous neuro-muscular stimulation as a complementary form of physical activity which older adults may find convenient to incorporate into their daily life when traditional forms of exercise are difficult to achieve due to barriers to completing traditional physical activities as a result of in-home or in-bed confinement, perceptual risks, or real environmental risks such as those arising from climate change.Keywords: cardiac output, neuro-muscular stimulation, resting metabolic rate, osteoporosis, cognitive aging

Jaclyn Jordan, Katherine Selman, Richard Byrne

Introduction: Atraumatic corneal melting and perforation is a rare etiology of eye pain and visual loss in the Emergency Department (ED), and xerophthalmia from vitamin A deficiency is primarily described as a cause of blindness in pediatric patients. Case: A 68-year-old female presented to the ED with worsening eye pain and months of clouding and vision loss. History was limited by cognitive impairment and was provided by spouse. On exam, she was found to have a body mass index of 13.7 kg/m 2, dry mucous membranes, purulent discharge from both eyes, and opacification and erosion of both corneas. She was diagnosed with bilateral corneal perforations due to xerophthalmia with superimposed bacterial keratitis. Her vitamin A levels were found to be undetectable. Conclusion:: This presentation was highly concerning for elder neglect due to delay in presentation, poor outpatient follow-up, and presence of severe malnutrition. This case exemplifies the intersection of an acute medical presentation with a syndrome of neglect and demonstrates the importance of ED clinician evaluation for elder abuse and neglect.

A. V. Luzina, A. Yu. Mozgovykh, N. K. Runikhina et al.

With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness.Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty).Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An  individual plan of  perioperative management was drawn up.Results. A  comparative analysis demonstrated statistically significant improvements in  functional status (based on  the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group.Conclusion: the management of  patients with frailty in  the perioperative period with the use of  CGA allows for preventive measures aimed at  maintaining functional, psycho-emotional status. Individual characteristics of  the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.

Feng Peng, Jianping Yi, Min Yang et al.

Objective To explore the influencing factors of incision infection in elderly patients with traumatic limb fracture after surgery, and to construct a nomographic model. Methods A total of 360 elderly patients with traumatic limb fracture who received surgical treatment in the First Affiliated Hospital of Chengdu Medical College from May 2021 to September 2023 were selected as the study subjects and divided into the modeling group (n = 252) and the verification group (n = 108) by the computer random number table. LASSO regression and logistic regression were used to analyze the influencing factors of postoperative incision infection, and column line diagrams were constructed according to the influencing factors, and the predictive performance and effect of the risk prediction model were evaluated by ROC curve and calibration curve. Results Twenty-seven research variables were included in the LASSO regression model for screening, and two models were constructed based on minimum values and standardization. Model 1 included 12 variables, including body mass index (BMI), use of steel plate, diabetes, drainage tube placement time, incision type, operation time, incision length, the ratio of peripheral blood C-reactive protein to albumin (CAR), serum procalcitonin (PCT)/albumin (ALB), interleukin-6 (IL-6), neutrophil to lymphocyte ratio (NLR), and serum erythrocyte sedimentation rate (ESR) three days after operation. Seven variables were included in model 2, including diabetes, drainage tube placement time, and peripheral blood CAR, PCT/ ALB, IL-6, NLR, ESR 3 days after surgery. The logistic regression analysis models were constructed with the dependent variable of whether the incision infection occurred after surgery, and the variables screened by LASSO regression in model 1 and model 2 as independent variables. The results of model 1 showed that BMI ≥28 kg/ m2, combined with diabetes, incision type Ⅲ, operation time, incision length, use of steel plate, placement time of drainage tube ≥ 6 days, and peripheral blood CAR, PCT/ ALB, IL-6, NLR, ESR 3 days after surgery were independent risk factors for postoperative incision infection in elderly patients with traumatic limb fracture (P < 0.05) . The results of model 2 showed that the combination of diabetes, the placement time of drainage tube ≥6 days and the peripheral blood CAR, PCT/ ALB, IL-6, NLR, ESR 3 days after operation were independent risk factors for postoperative incision infection in elderly patients with traumatic limb fracture (P < 0.05) . The area under the ROC curve of Model 1 in the modeling and validation groups was respectively 0.949 (95% CI: 0.898 - 1.000) and 0.981 (95% CI: 0.956 - 1.000), respectively. The results of the Hosmer Lemeshow test for Model 1 in the modeling and validation groups showed that the model did not deviate from a perfect fit, and the consistency of the calibration curve was good. The area under the ROC curve of Model 2 in the modeling and validation groups was respectively 0.882 (95% CI: 0.787 - 0.977) and 0.921 (95% CI: 0.843 - 1.000), respectively. Furthermore, the Hosmer Lemeshow test of Model 2 in the modeling and validation groups showed that the model deviated from a perfect fit and the consistency of the calibration curve was poor. Conclusion BMI, combined diabetes, incision type, operation time, incision length, use of steel plate, placement time of drainage tube, CAR, PCT/ ALB, IL-6, NLR and ESR of peripheral blood 3 days after operation are the influencing factors of postoperative incision infection in elderly patients with traumatic limb fracture.

Qingyue Zeng, Qian Zhong, Lijun Zhao et al.

Abstract The triglyceride-glucose (TyG) index and the Atherogenic Index of Plasma (AIP) are both predictors of cardiovascular diseases (CVD). However, their combined and individual contributions to CVD risk are not well understood. This study evaluate the joint and individual associations of the TyG index and AIP with CVD events in middle-aged and older Chinese adults. This nationwide, retrospective cohort study utilized data from CHARLS. The diagnosis of CVD in this study was determined based on self-reported information provided by participants regarding their medical history( heart disease and/or stroke). Cross-sectional analyses in 2011 and longitudinal analyses over a 9-year follow-up were conducted to assess these associations. In the cross-sectional analysis, 8,531 participants were included at baseline. The odds ratio (OR) for TyG alone was 1.06 (95% CI 0.96–1.22) for CVD, while the OR for AIP alone was 1.16 (95% CI 1.02–1.33). Combined analysis showed that compared to the low TyG & low AIP group, the OR for the high TyG & high AIP group was 1.23 (95% CI 1.07–1.42) for CVD. In the survival Analysis, the hazard ratio (HR) for TyG alone was 1.19 (95% CI 1.04–1.35) for CVD, while the HR for AIP alone was 1.25 (95% CI 1.09–1.43). Combined analysis showed that compared to the low TyG & low AIP group, the HR for the high TyG & high AIP group was 1.27 (95% CI 1.10–1.43) for CVD. The findings underscore the significant coexposure effects of the TyG index and AIP on CVD, particularly in middle-aged adults.

Beomman Ha, Mijin Han, Wi-Young So et al.

Abstract Background Frailty is a pervasive clinical syndrome among the older population. It is associated with an increased risk of diverse adverse health outcomes including death. The association between sleep duration and frailty remains unclear. Therefore, the aim of this study was to investigate the relationship between sleep duration and frailty in community-dwelling Korean older adults and to determine whether this relationship is sex-dependent. Methods Data on 3,953 older adults aged ≥ 65 years were obtained from the 7th (2016–2018) Korea National Health and Nutrition Examination Survey (KNHANES). Frailty was defined using the Fried phenotype with criteria customized for the KNHANES dataset. Self-reported sleep duration was classified as short sleep duration (≤ 6 h), middle sleep duration (6.1–8.9 h), and long sleep duration (≥ 9 h). Complex samples multivariate logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results The percentage of male participants with short, middle, and long sleep durations was 34.9%, 62.1%, and 16.8%, respectively, while that of female participants was 26.1%, 59.2%, and 14.7%. The prevalence of frailty in the middle sleep duration group was lower than that in the short and long sleep duration groups in both men (short, 14.7%; middle, 14.2%; long, 24.5%; p < 0.001) and women (short, 42.9%; middle, 27.6%; long, 48.6%; p < 0.001). Both short (OR = 2.61, 95% CI = 1.91 − 4.83) and long (OR = 2.57, 95% CI = 1.36 − 3.88) sleep duration groups had a significantly higher OR for frailty than the middle sleep duration group even after adjusting for confounding variables among women, but not among men. Conclusion Short and long sleep durations were independently associated with frailty in community-dwelling Korean older adult women. Managing sleep problems among women should be prioritized, and effective interventions to prevent frailty should be developed accordingly.

Qiyuan Huang, Xiaojuan Jiang, Guo Chen et al.

Cesare Mantini, Francesco Corradi, Fabrizio Ricci et al.

The left atrial auricle (LAA) is the main source of intracardiac thrombi, which contribute significantly to the total number of stroke cases. It is also considered a major site of origin for atrial fibrillation in patients undergoing ablation procedures. The LAA is known to have a high degree of morphological variability, with shape and structure identified as important contributors to thrombus formation. A detailed understanding of LAA form, dimension, and function is crucial for radiologists, cardiologists, and cardiac surgeons.This review describes the normal anatomy of the LAA as visualized through multiple imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography. Special emphasis is devoted to a discussion on how the morphological characteristics of the LAA are closely related to the likelihood of developing LAA thrombi, including insights into LAA embryology.

Yoshitatsu Fukuta, Shinichi Arizono, Shinichiro Tanaka et al.

Abstract Background The impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline. Methods Patients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed. Results Sixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β =  − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01). Conclusions Remote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals. Trial registration This interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564 ; registration date: 2020/09/09).

Mengqian Liu, Chen Gong, Xiaozhu Shen et al.

Abstract Background and aim DRP1 and OPA1 play important roles in mitochondrial fusion and fission. However, the role of DRP1 and OPA1 amplification in mitochondrial cognitive impairment has not been reported. This study aimed to investigate the relationship between DRP1 and OPA1 and the risk of cognitive impairment. Methods In this study, 45 elderly patients with diabetes admitted to the Lianyungang Second People’s Hospital from September 2020 to January 2021 were included. The patients were divided into normal group, mild cognitive impairment group and dementia group by using MMSE score, and the clinical characteristics of the three groups were compared. The amplification multiples of the two genes’ DNA were calculated by ΔΔCT and defined as 2− K. Spearman rank correlation was used to analyze the correlation between the DNA amplification multiples of patients’ DRP1 and OPA1 and AD8 and MoCA scores. The sensitivity and specificity of DNA amplification multiples of DRP1 and OPA1 to predict clinical outcomes of diabetic cognitive impairment were evaluated using Receiver operator characteristic (ROC) curves. Multiple logistic regression was used to evaluate the relationship between DNA amplification factor of DRP1 and OPA1 and cognitive function. Results DRP1(2− K) and OPA1(2− K) significantly increased and decreased in dementia and MCI groups compared with the normal group (P ≤ 0.001). The DNA amplification factor of DRP1 was positively correlated with AD8 score and negatively correlated with MoCA score (P < 0.001). The DNA amplification factor of OPA1 was positively correlated with the MoCA score (P = 0.0002). Analysis of ROCs showed that the DNA amplification factor of OPA1 had a higher predictive value for dementia (P < 0.0001), and that it had a higher predictive value when used in combination with DRP1. Multiple logistic regression results showed that increased DNA amplification in DRP1 was associated with increased risk of dementia (OR 1.149;95%CI,1.035–1.275), and increased DNA amplification in OPA1 was associated with decreased risk of MCI (OR 0.004;95%CI,0.000-0.251) and dementia (OR 0.000;95%CI,0.000-0.134). Conclusion DNA amplification multiples of DRP1 and OPA1 are associated with the risk of dementia in elderly patients and may serve as potential biomarkers.

Tasha Woodall, Ashley Pokallus, Shannon Rice et al.

INTRODUCTION Concerns exist that the current health care workforce is underprepared to meet the needs of the aging American population. This study evaluated the current emphasis on geriatrics in doctor of pharmacy curricula. METHODS A 61-item web-based survey was distributed to associate deans with oversight of pharmacy curricula at all United States (US) schools and colleges of pharmacy (S/COP). Information collected included school demographics, employment of geriatrics faculty, geriatric education (required, elective, and experiential courses), co-curricular geriatric experiences, postgraduate residency training in geriatrics, student interest in geriatrics, and perception of preparedness of the profession to care for older adults. RESULTS Of responding S/COP, 35% required a course in geriatrics while 63% offered a geriatrics elective. An advanced pharmacy practice experience (APPE) in geriatrics was required by 14%, and 79% offered an elective APPE. Insufficient curricular emphasis on geriatrics was noted by 44% of responding schools, and 33% lacked confidence that the profession of pharmacy is adequately prepared to care for the aging population. CONCLUSIONS According to the survey respondents, most pharmacy schools do not have a required didactic course or APPE in geriatrics. Additional emphasis on foundational principles of medication management for older adults in pharmacy curricula is warranted to meet the health care needs of the rapidly aging US population.

Vasiliki Papastefanopoulou, Evangelia Stanitsa, Christos Koros et al.

Background: the apolipoprotein e4 allele (<i>APOE4</i>) constitutes an established genetic risk factor for Alzheimer’s Disease Dementia (ADD). We aimed to explore the frequency of the <i>APOE</i> isoforms in the Greek population of Southern Greece. Methods: peripheral blood from 175 Greek AD patients, 113 with mild cognitive impairment (MCI), and 75 healthy individuals. DNA isolation was performed with a High Pure PCR Template Kit (Roche), followed by amplification with a real-time qPCR kit (TIB MolBiol) in Roche’s Light Cycler PCR platform. Results: <i>APOE4</i> allele frequency was 20.57% in the ADD group, 17.69% in the MCI group, and 6.67% in the control group. <i>APOE3/3</i> homozygosity was the most common genotype, while the frequency of <i>APOE4/4</i> homozygosity was higher in the AD group (8.60%). <i>APOE4</i> carrier status was associated with higher odds for ADD and MCI (OR: 4.49, 95% CI: [1.90–10.61] and OR: 3.82, 95% CI: [1.59–9.17], respectively). Conclusion: this study examines the <i>APOE</i> isoforms and is the first to report a higher <i>APOE</i> frequency in MCI compared with healthy controls in southern Greece. Importantly, we report the occurrence of the <i>APOE4</i> allele, related to ADD, as amongst the lowest globally reported, even within the nation, thus enhancing the theory of ethnicity and latitude contribution.

Ewa Więsik-Szewczyk, Marcin Ziętkiewicz, Agata Będzichowska et al.

Data regarding the willingness of patients affected by inborn errors of immunity to accept vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. Therefore, this study assessed SARS-CoV-2 vaccination coverage and hesitancy in immunodeficient patients by surveying adults with primary immune deficiencies and autoinflammatory and rheumatic diseases on biologic therapy. The study was conducted from September 20, 2021, to January 22, 2022, when the primary coronavirus disease 2019 (COVID-19) vaccinations were available to all adults in Poland. We included 207 participants consecutively recruited from five referral centers (57% female; median age: 42.6 [range: 18–76, standard deviation ± 14.70] years). Overall, 55% (n = 114), 17% (n = 36), and 28% (n = 57) of the patients had primary immune deficiencies, autoinflammatory diseases, and rheumatic diseases, respectively. Among the entire cohort, 168 patients (81%) were vaccinated, and 82% were willing to receive a booster dose. Patients with autoinflammatory diseases had the highest vaccination rate (94.4%). A strong conviction that it was the correct decision (72%), fear of getting COVID-19 (38%), and expert opinions (34%) influenced the decision to vaccinate. Among the unvaccinated patients, 33.3% had primary or vocational education (p &lt;0.001). Furthermore, only 33% believed they were at risk of a severe course of COVID-19 (p = 0.014), and 10% believed in vaccine efficacy (p &lt;0.001). They also doubted the safety of the vaccine (p &lt;0.001) and feared a post-vaccination flare of their disease (p &lt;0.001). Half of the unvaccinated respondents declared that they would consider changing their decision. Vaccination coverage in immunodeficient patients was higher than in the general Polish population. However, the hesitant patients doubted the vaccine’s safety, feared a post-vaccination disease flare, and had primary or vocational education. Therefore, vaccination promotion activities should stress personal safety and the low risk of disease flares due to vaccination. Furthermore, all evidence must be communicated in patient-friendly terms.

R. Burke, Rebecca T Brown, B. Kinosian

Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Geriatrics and Extended Care, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA

Qi Yuan, Gregory Tee Hng Tan, Peizhi Wang et al.

Abstract Background Informal caregivers of persons with dementia often experience elevated levels of caregiving burden. However, existing studies tend to use a variable-centered approach to explore it. This study aims to understand the caregiving burden of informal caregivers of persons with dementia in Singapore through a combination of variable-centered and person-centered analytical approaches, and explore the correlates of identified factors and latent classes of caregiving burden. Methods Zarit Burden Interview was used to gauge the caregiving burden of 282 primary informal caregivers of persons with dementia recruited through convenience sampling in Singapore. Factor analysis and latent class analysis were conducted to identify the latent factors and the latent classes of Zarit Burden Interview, followed by multiple linear regression and multinomial logistic regression to explore their significant correlates. Results The analyses suggested a 17-item 3-factor structure for Zarit burden interview and three mutually exclusive caregiving burden classes. Regression analyses found that caregiving related variables especially care recipients’ memory and behaviour problems were correlated with both the factors and latent classes of caregiving burden. Conclusions The combination of these two approaches suggests that caregivers experiencing higher burden on one domain are likely to experience higher burden on the other two domains. This further supports the point that more attention should be given to caregivers who experience an overall high burden. Future research could explore the generalizability of our findings among caregivers elsewhere and explore the type of support needed by caregivers, especially those experiencing high burden.

Vanoh D, Shahar S, Yahya HM et al.

Divya Vanoh,1 Suzana Shahar,2 Hanis Mastura Yahya,2 Normah Che Din,2 Arimi Fitri Mat Ludin,2 Devinder Kaur Ajit Singh,2 Razinah Sharif,2 Nor Fadilah Rajab2 1Nutrition &amp; Dietetics Programme, School of Health Science, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Center for Healthy Aging and Wellness (H‐Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaCorrespondence: Suzana ShaharCenter for Healthy Aging and Wellness (H‐Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, MalaysiaEmail suzana.shahar@ukm.edu.myPurpose: Use of dietary supplements by older adults has been increasing for improving micronutrient deficiencies, cognitive function, and overall health status. Thus, the objective of this secondary investigation is to explore the longitudinal association of baseline supplement intake in improving cognitive function, biochemical parameters, anthropometric variables and physical fitness among older adults.Methods: Towards Useful Aging (TUA) is a three-year longitudinal study conducted at baseline (2013&ndash; 2014) and at follow-up (2015&ndash; 2017) surveys. The number of participants dropped from 2322 during baseline study to 1787 and 1560 during the 18th and 36th month follow-up, respectively. Data on socio-demography, use of dietary supplement, biochemical indices, anthropometry, cognitive function, physical fitness and depressive symptoms were obtained. Longitudinal associations were done using the linear mixed model analysis among 1285 subjects with complete data.Results: The most common vitamin and mineral supplementations consumed were multivitamin, B-complex, and calcium. Meanwhile, the herbal supplements consumed by participants were Eurycoma longifolia, Morinda citrifolia and Orthosiphon aristatus. Longitudinal analysis adjusted for multiple covariates showed improvement in both supplement users and non-users for global cognitive function, working memory, visual memory, 2-minute step test, chair stand test, chair sit and reach and time up and go test, waist circumference and hip circumference in both the supplement users and non-users.Conclusion: Our findings indicated that dietary supplement intake is not associated with cognitive function, physical fitness, nutritional status, depressive symptoms or biochemical indices since improvement in the parameters was observed among both supplement users and non-users.Keywords: dietary supplement, cognitive function, physical fitness, depressive symptoms, nutritional status, biochemical

M. Polidori, S. Maggi, F. Mattace-Raso et al.

Maria Cristina Polidori,1 Stefania Maggi,2 Francesco Mattace-Raso,3 Alberto Pilotto4 1Professor of Geriatrics and Head Ageing Clinical Research, Department Medicine II, University Hospital of Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Aging-associated Diseases, CECAD, University of Cologne, Germany; 2Director Aging Section, National Research Council (CNR), Padova, Italy; 3Head Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; 4Director Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova; Professor of Geriatrics, Department of Interdisciplinary Medicine, University of Bari, Italy

C. Bowling, Heather E. Whitson, T. Johnson

To address the underrepresentation of older adults in clinical research, the National Institutes of Health will require investigators to include individuals across the lifespan. As investigators from other fields endeavor to recruit participants who are more representative of the patient population, geriatricians may have the opportunity to influence a broad range of research studies in older adults. Our aims were to elicit challenges to inclusion of older adults in clinical research and to develop a preliminary framework for communicating these challenges to non–geriatrics‐trained researchers.

J. Overcash, Nikki Ford, Elizabeth Kress et al.

The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.