Abstract Background Research on the association between atherosclerosis cardiovascular diseases (ASCVDs) and hearing loss (HL) in older people has yielded mixed findings in recent years. Understanding this relationship is crucial for developing early strategies that address both cardiovascular health and auditory function in older adults. Methods To examine the potential association between common ASCVDs (heart attack, coronary heart disease, and stroke) and HL, assessing the mediating effect of the frailty index (FI) and Life’s essential 8 (LE8) metrics. The degree of HL was measured by pure tone average (PTA). This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2018, including 4,441 adults aged 60 or older with comprehensive cardiovascular and hearing measurement data. Statistical analysis was conducted from February 16, 2024, to July 7, 2024. Results The study identified significant correlations between all three ASCVDs and HL in older participants aged 60 or older, particularly noting that heart attacks were notably associated with HL at higher frequencies (2 and 4 kHz). Older participants, especially those aged 75 and above, were more susceptible to stroke-related HL, with a delayed impact observed in females. FI and LE8 mediated the heart attack-HL association in adults aged 75 and above, with FI demonstrating a stronger role than LE8. Conclusion The findings elucidate a complex interplay between cardiovascular health and auditory function, emphasizing that heart attacks may exacerbate HL through the frailty pathway in certain older populations. These results highlight the need for tailored cardiovascular interventions and proactive measures to mitigate HL risks. Future research should focus on defining these pathophysiological associations more clearly to develop targeted interventions for vulnerable older people. Graphical abstract
Addisu Getie, Melaku Bimerew, Mihretie Gedfew
et al.
Introduction: Cognitive impairment is a medical condition caused by neurodegeneration, marked by a gradual decline in neurological, motor, psychological, and cognitive domain functions, as well as daily activities. It primarily affects individuals with conditions such as Alzheimer's disease, stroke, HIV/AIDS, diabetes mellitus, cancer, epilepsy, dementia, and other chronic illnesses, as well as older adults. While some individual studies have explored the effects of cognitive impairment, there is a lack of nationwide research to provide a comprehensive understanding of its burden among individuals with chronic diseases. Objective: To assess the pooled prevalence of cognitive impairment and its associated factors among individuals with chronic diseases in Ethiopia. Methods: Several databases were examined to find available articles. The data were extracted and sorted in Microsoft Excel before being exported to STATA/MP 17.0 for analysis. A random-effects Der Simonian-Laird model with a 95 % confidence interval was used to pool the data. Cochrane I2 statistics and Egger's test were used to evaluate heterogeneity and publication bias, respectively. To determine the cause of heterogeneity, subgroup analysis was performed. A log-odds ratio was utilized to illustrate the association between cognitive impairment and its associated factors. P-values less than 0.05 were considered statistically significant. Result: This study included 22 individual articles comprising a total of 6818 participants. The overall prevalence of cognitive impairment among individuals with chronic diseases was 44.43 % (95 % CI: 37.76–51.10). Studies conducted in Addis Ababa reported a higher prevalence of 50.89 % (95 % CI: 34.59–67.19). Similarly, research focusing on older adults indicated the highest prevalence, at 57.58 % (95 % CI: 28.78–86.39). Participants who are unable to read and write were 3.82 times more likely to experience cognitive impairment compared to those who had completed primary education (AOR = 3.82; 95 % CI: 2.97–4.91). Conclusion: This review found a high prevalence of cognitive impairment among Ethiopians with chronic diseases, especially in older adults and those in Addis Ababa. Illiteracy significantly increased the risk. These findings highlight the need for targeted cognitive screening and integration of cognitive care into chronic disease management.
Abstract Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease affecting the adult motor system, with no effective treatments available. Despite extensive research efforts, the exact pathological cascade leading to progressive motor neuron degeneration remains elusive. Recent evidence highlights significant modifications in lipid metabolism during ALS progression, even before the onset of motor symptoms. Glycerophospholipids, the primary components of cellular membranes, are frequently altered in ALS patients and models. These lipids not only play a structural role in membranes, but also contribute to cellular metabolism, signaling pathways, and cell type-specific processes such as neuronal transmission and muscle contraction. In this review, we discuss glycerophospholipid physiological functions in the motor system and review recent studies demonstrating their alterations and the possible underlying pathological mechanisms in ALS. Furthermore, we discuss challenges emerging from studying lipid alterations in neurodegeneration and evaluate the therapeutic potential of glycerophospholipids.
Neurology. Diseases of the nervous system, Geriatrics
Abstract Background Sleep quality decreased can result in a major health issue in older people with age. While not all sleep changes are pathological in older people’s life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for careers and increased healthcare costs. Despite the known benefits of exercise for improving sleep quality, it is necessary to identify the optimal exercise type and dose. Objective This systematic review and network meta-analysis (NMA) combined to examine evaluated the existing evidence on the effectiveness of different exercises, and to examine the dose and response relationship between overall and specific types with improving sleep quality in older people. Methods PubMed, Cochrane Central, Web of Science, and Embase were systematically searched for this review, including studies up to April 2025. Only randomized controlled trials were included. Studies involved at least one type of exercise intervention and reported changes in sleep quality assessments. To address the limitations of relying solely on statistical significance, we also calculated the minimal clinically important difference (MCID) to determine the smallest meaningful improvement in sleep quality among older people, both overall and across different exercise doses. Data analysis and visualization were conducted using the “meta”, “netmeta”, “MBNMA”, and “ggplot2” packages in the R environment. Results A total of 62 RCTs involving 5005 older adults were included. Overall, exercise significantly improved sleep quality, with clinically meaningful improvements achieved from as early as 5 weeks of intervention. The optimal exercise type was combined aerobic and resistance training, followed by aerobic exercise, resistance training, walking, and yoga. The estimated optimal exercise dose was around 660 to 990 METs*min/week, with longer durations at 15 weeks producing the greatest benefits. Improvements were more pronounced among participants with poorer baseline sleep quality. Conclusion If older people receive the most appropriate exercise intervention, they can obtain clinically meaningful benefits of improving sleep in the elderly within the WHO guidelines for exercise doses. The results support the WHO recommendation that combine aerobic exercise and resistance training should be an important part of interventions for the older people. Protocol registration PROSPERO registration number: CRD42024566751. Graphical Abstract
Stav Brown, Audree B. Tadros, Giacomo Montagna
et al.
PurposePatients undergoing axillary lymph node dissection (ALND) for breast cancer face a high risk of lymphedema, further increased by high body mass index (BMI) and insulin resistance. GLP-1 receptor agonists (GLP-1RAs) have the potential to reduce these risk factors, but their role in lymphedema has never been investigated. The purpose of this study was to determine if GLP-RAs can reduce the risk of lymphedema in patients undergoing ALND.MethodsAll patients who underwent ALND at a tertiary cancer center between 2010 and 2023 were reviewed. Patients with less than 2 years of follow-up from the time of ALND were excluded. Race, BMI, radiation, chemotherapy history, pre-existing diagnosis of diabetes, lymphedema development after ALND, and the use of GLP-1RAs were analyzed. Multivariate logistic regression analysis was performed to assess if there was a significant reduction in the risk of developing lymphedema after ALND. A sub-group analysis of non-diabetic patients was also performed.Results3,830 patients who underwent ALND were included, 76 of which were treated with. GLP-1 RAs. The incidence of lymphedema in the GLP-1 RA cohort was 6.6% (5 patients). Compared to 28.5% (1,071 patients) in the non-GLP-1 RA cohort. On multivariate regression analysis, patients who were treated with GLP-1 RA were 86% less likely to develop lymphedema compared to the non-GLP-1 RA cohort (OR 0.14, 95% CI 0.04–0.32, p < 0.0001). A BMI of 25 kg/m 2 or greater was a statistically significant risk factor for developing lymphedema with an odds ratio of 1.34 (95% CI 1.16–1.56, p < 0.0001). Diabetes was associated with lymphedema development that closely approached statistical significance (OR 1.32, 95% CI 0.97–1.78, p = 0.06). A subgroup analysis solely on non-diabetic patients showed similar results. The odds of developing lymphedema were 84% lower for patients without diabetes treated with GLP1-RAs compared to those who did not receive GLP-1 RAs (OR 0.16, 95% CI 0.05–0.40, p < 0.0001).ConclusionGLP1-RAs appear to significantly reduce the risk of lymphedema in patientsundergoing ALND. The mechanism of action may be multifactorial and not limited to weight reduction and insulin resistance. Future prospective analysis is warranted to clarify the role of GLP-1RAs in reducing lymphedema risk.
Abstract Background Choosing a field of specialization within the nursing profession is affected by nurses’ personality traits, self-confidence in performing clinical skills, and the field’s prestige. A successful choice of area of expertise may improve nurses’ job satisfaction and reduce job mobility. This study aims to examine the relationship between personality traits, clinical self-efficacy, perceived prestige, adoption of technological changes, and choice of specialty field among nursing students. Methods A cross-sectional study was conducted. One-hundred-twenty-seven undergraduate nursing students in their fourth year of studies at a large university in Israel participated in the study. The questionnaire administered was comprised of six parts: demographic data, personality traits, adoption of technological changes, clinical self-efficacy, perceived prestige, and intention to select a field of specialization. Results Acute disciplines were rated more prestigious than chronic disciplines, with intensive care and emergency medicine considered the most prestigious, while mental health and geriatrics were the least prestigious. Students’ mean perceived confidence in performing nursing clinical skills was high and more than half considered themselves open to technology changes. Positive correlations were found between prestige and intention to choose a field of expertise (r = 0.41, p < 0.001) and the personality trait of openness and the intention to choose an acute care area (r = 0.26, p < 0.01). Conclusions Despite the gradual aging of the population and the increase in chronic morbidity, which demand a greater nursing focus on older adults, and notwithstanding the mental health reforms, nursing students perceive geriatrics and mental health as less prestigious fields. A career development path can be applied by developing a tool for occupational guidance designed to rank students’ suitability for specialty fields and thus help them choose the area that best suits them.
Anita Chary, Elise Brickhouse, Beatrice Torres
et al.
Abstract Objectives Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall‐related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall‐related complaints, specifically regarding perceived value and associated challenges and strategies. Methods We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions to consult PT from the ED, perceived value of PT, and common challenges and strategies in ED PT consultation. Results Twenty‐five participants in 4 focus groups and 3 interviews represented 22 distinct institutions with ED PT consultation available for older adults with falls. About two thirds of EDs represented relied on clinician gestalt to request PT consultation (n = 15, 68%), whereas one third used formal consultation pathways (n = 7, 32%). Participants valued physical therapists’ expertise, time, and facilitation of hospital throughput by developing safe discharge plans and contact with patients to improve outpatient follow‐up. Common challenges included limited ED PT staffing and space for PT evaluations; strategies to promote ED PT consultation included advocating for leadership buy‐in and using ED observation units to monitor patients and avoid admission until PT consultation was available. Conclusion ED PT consultation for older adults with falls may benefit patients, ED staff, and hospital throughput. Uncertainty remains over whether geriatric screening‐triggered consultation versus emergency clinician gestalt successfully identifies patients likeliest to benefit from ED PT evaluation. Leadership buy‐in, designated consultation space, and formalized consultation pathways are strategies to address current challenges in ED PT consultation.
Medical emergencies. Critical care. Intensive care. First aid
Amanda S. Latham, Amanda S. Latham, Julie A. Moreno
et al.
Neuroinflammation is a universal characteristic of brain aging and neurological disorders, irrespective of the disease state. Glial inflammation mediates this signaling, through astrocyte and microglial polarization from neuroprotective to neurotoxic phenotypes. Glial reactivity results in the loss of homeostasis, as these cells no longer provide support to neurons, in addition to the production of chronically toxic pro-inflammatory mediators. These glial changes initiate an inflammatory brain state that injures the central nervous system (CNS) over time. As the brain ages, glia are altered, including increased glial cell numbers, morphological changes, and either a pre-disposition or inability to become reactive. These alterations induce age-related neuropathologies, ultimately leading to neuronal degradation and irreversible damage associated with disorders of the aged brain, including Alzheimer’s Disease (AD) and other related diseases. While the complex interactions of these glial cells and the brain are well studied, the role additional stressors, such as infectious agents, play on age-related neuropathology has not been fully elucidated. Both biological agents in the periphery, such as bacterial infections, or in the CNS, including viral infections like SARS-CoV-2, push glia into neuroinflammatory phenotypes that can exacerbate pathology within the aging brain. These biological agents release pattern associated molecular patterns (PAMPs) that bind to pattern recognition receptors (PRRs) on glial cells, beginning an inflammatory cascade. In this review, we will summarize the evidence that biological agents induce reactive glia, which worsens age-related neuropathology.
Somayeh Khosroazad, Christopher F. Gilbert, Jessica B. Aronis
et al.
Abstract Introduction Sleep disorder is often the first symptom of age-related cognitive decline associated with Alzheimer’s disease (AD) observed in primary care. The relationship between sleep and early AD was examined using a patented sleep mattress designed to record respiration and high frequency movement arousals. A machine learning algorithm was developed to classify sleep features associated with early AD. Method Community-dwelling older adults (N = 95; 62–90 years) were recruited in a 3-h catchment area. Study participants were tested on the mattress device in the home bed for 2 days, wore a wrist actigraph for 7 days, and provided sleep diary and sleep disorder self-reports during the 1-week study period. Neurocognitive testing was completed in the home within 30-days of the sleep study. Participant performance on executive and memory tasks, health history and demographics were reviewed by a geriatric clinical team yielding Normal Cognition (n = 45) and amnestic MCI-Consensus (n = 33) groups. A diagnosed MCI group (n = 17) was recruited from a hospital memory clinic following diagnostic series of neuroimaging biomarker assessment and cognitive criteria for AD. Results In cohort analyses, sleep fragmentation and wake after sleep onset duration predicted poorer executive function, particularly memory performance. Group analyses showed increased sleep fragmentation and total sleep time in the diagnosed MCI group compared to the Normal Cognition group. Machine learning algorithm showed that the time latency between movement arousals and coupled respiratory upregulation could be used as a classifier of diagnosed MCI vs. Normal Cognition cases. ROC diagnostics identified MCI with 87% sensitivity; 89% specificity; and 88% positive predictive value. Discussion AD sleep phenotype was detected with a novel sleep biometric, time latency, associated with the tight gap between sleep movements and respiratory coupling, which is proposed as a corollary of sleep quality/loss that affects the autonomic regulation of respiration during sleep. Diagnosed MCI was associated with sleep fragmentation and arousal intrusion.
Gloria Metzner, Lukas Maximilian Horstmeier, Jürgen Bengel
et al.
Abstract Background In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness. Methods A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants’ evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling. Results We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity. Conclusion Supporting patients’ self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning. Trial registration German Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904
Abstract Mesenchymal stem cell (MSC)-mediated immunomodulation has been harnessed for the treatment of human diseases, but its underlying mechanism has not been fully understood. Dead cells, including apoptotic cells have immunomodulatory properties. It has been repeatedly reported that the proportion of nonviable MSCs in a MSC therapeutic preparation varied from 5~50% in the ongoing clinical trials. It is conceivable that the nonviable cells in a MSC therapeutic preparation may play a role in the therapeutic effects of MSCs. We found that the MSC therapeutic preparation in the present study had about 5% dead MSCs (DMSCs), characterized by apoptotic cells. Namely, 1 × 106 MSCs in the preparation contained about 5 × 104 DMSCs. We found that the treatment with even 5 × 104 DMSCs alone had the equal therapeutic effects as with 1 × 106 MSCs. This protective effect of the dead MSCs alone was confirmed in four mouse models, including concanavalin A (ConA)- and carbon tetrachloride (CCl4)-induced acute liver injury, LPS-induced lung injury and spinal cord injury. We also found that the infused MSCs died by apoptosis in vivo. Furthermore, the therapeutic effect was attributed to the elevated level of phosphatidylserine (PS) upon the injection of MSCs or DMSCs. The direct administration of PS liposomes (PSLs) mimic apoptotic cell fragments also exerted the protective effects as MSCs and DMSCs. The Mer tyrosine kinase (MerTK) deficiency or the knockout of chemokine receptor C–C motif chemokine receptor 2 (CCR2) reversed these protective effects of MSCs or DMSCs. These results revealed that DMSCs alone in the therapeutic stem cell preparation or the apoptotic cells induced in vivo may exert the same immunomodulatory property as the “living MSCs preparation” through releasing PS, which was further recognized by MerTK and participated in modulating immune cells.
Krista L. Donohoe, Tabbitha I Bruck, Fawaz M. Alotaibi
et al.
ABSTRACT To determine if student pharmacists’ confidence in their knowledge and skills, and their attitudes toward older adults improved throughout pharmacy school with an integrated geriatrics didactic curriculum (years 1–3) and a final year of clinical training including a required advanced pharmacy practice experience (APPE) in geriatrics (year 4). A two-part voluntary anonymous survey was administered at three different time points to two large cohorts of student pharmacists. The first part of the survey assessed students’ confidence in attaining geriatrics competencies. The second part of the survey used the UCLA Geriatrics Attitudes Scale to assess students’ attitudes. Of the 286 students who were emailed the survey, 236 student pharmacists completed it at the first assessment. Student pharmacists showed an increase in confidence in achieving geriatrics competencies from their first year to their third year, and further increase after their clinical training. Most students also held a generally positive attitude toward older adults from P1 to P4 year. Integration of geriatrics throughout the didactic and experiential curriculum made an impact on student pharmacists’ confidence in their competency toward caring for older adults, while maintaining a positive attitude toward older adults throughout pharmacy school.
Background/Aims Sarcopenia and erectile dysfunction (ED) are associat ed with poor health and quality of life in older men. We investigate the association between sarcopenia and severe ED in community-dwelling older men. Methods We prospectively assessed sarcopenia and ED in 519, community-dwelling, older men (mean age, 74.0) in Pyeongchang, Korea, in 2016 to 2017. Sarcopenia was based on muscle mass, grip strength, and gait speed according to the Asian Working Group consensus algorithm. Severe ED was defined as 5-item International Index of Erectile Function questionnaire score under 8. Lo gistic regressions were used to study associations between incident severe ED and sarcopenia, after adjusting age, cardiovascular risk factors, depression, and poly pharmacy. Results The prevalence of severe ED was 52.4% and that of sarcopenia was 31.6%. At baseline, the prevalence of severe ED was higher in men with sarcopenia than in those without (73.2% vs. 42.8%; adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.18 to 3.03; p = 0.008). Slow gait speed (aOR, 2.80; 95% CI, 1.18 to 6.62; p = 0.019) and decreased muscle mass (aOR, 2.54; 95% CI, 1.11 to 5.81; p = 0.027) were associated with the incidence of severe ED, while decreased grip strength (aOR, 0.76; 95% CI, 0.30 to 1.91; p = 0.564) was not. Conclusions Sarcopenia was associated with severe ED. Slow gait speed, and decreased muscle mass was independently associated with incident severe ED at 1 year. Further research is warranted to examine whether an intervention targeting these components can prevent severe ED.
Scott W. Rogers, Scott W. Rogers, Elizabeth J. Myers
et al.
Nicotine acts as a potent modulator of normal cellular responses through the nicotinic acetylcholine receptor subtype alpha7. In a mouse genetic model of alpha7 receptor dysfunction, alpha7E260A:G, 85 percent of 18 month-old mice exhibit an age-associated spontaneous loosening or complete loss of 3rd molars that was not present in the control mice. The adjacent soft tissues appeared largely unaffected. Further analysis including micro-CT revealed evidence of bone loss surrounding the 3rd molars with areas of cavitation and/or sponge-like (cancellous) bone remodeling in the mandible. The mandible microbiome was examined using 16S-rRNA sequencing. The results show the alpha7E260A:G oral microbiome included increased landscape complexity indicative of dysbiosis, and a significant increase of some bacteria, particularly Staphylococcus. These results suggest that normal alpha7 function plays a relevant role in maintaining normal gene expression and oral microbiome stasis. Consequently, this mouse model suggests there are consequences to ongoing alpha7 receptor dysfunction and oral health, as can occur from chronic exposure to nicotine as expected from electronic nicotine delivery systems (ENDS or “vaping”), that may not be seen until older age.