Hasil untuk "Geriatrics"

C. Eisdorfer, K. Schaie, G. Maddox et al.

G. Small, P. Rabins, P. Barry et al.

Qiaoli Cui, Zhenming Zhang, Lang Qin et al.

ABSTRACT Aims/Introduction Diabetic foot ulcer (DFU) is a prevalent complication of diabetes characterized by heightened inflammation and impaired wound‐healing processes. Interleukin‐37 (IL‐37) is a natural suppressor of innate inflammation. Here, we aim to investigate the potential of IL‐37 in enhancing the healing process of diabetic wounds. Materials and Methods The skin samples of DFU and non‐diabetic patients during foot and ankle orthopedic surgery were collected. The IL‐37 transgenic mice (IL‐37Tg) were created using CRISPR/Cas‐mediated genome engineering. Mice were administered streptozotocin (STZ, 150 mg/kg) to induce a diabetic model. After 4 weeks, an equidistant full‐thickness excisional wound measuring 8 mm was created on the central back of each mouse and allowed to heal naturally. Body weight and blood glucose levels were measured weekly. The wound area was measured, and skin samples were collected on Day 10 for further Quantitative polymerase chain reaction (qPCR) and WB detection and RNA sequencing analysis. Results The proinflammation cytokines such as TNF‐α and IL‐1β and the MAPK signaling pathway were significantly increased in the wound margin of DFU patients. Compared with diabetic mice, diabetic IL‐37Tg mice showed a significantly accelerated healing process. The enriched signaling pathways in RNA sequencing included cytokine–cytokine receptor interaction, TNF signaling pathway, and NOD‐like receptor signaling pathway. Through QPCR and WB detection, we found that IL‐37 could inhibit the activated MAPK and NOD‐like signaling pathway, reducing TNF‐α, IL‐1β, and NLRP3 expression in the diabetic wound. Conclusions IL‐37 promotes skin wound healing in diabetic mice, providing a new possible target for treating diabetic wounds.

Fanrong Wei, Rui Yan, Yaozhong Zhang et al.

Abstract Objective This study aimed to investigate the relationship between preoperative disability and postoperative outcomes in elderly patients undergoing major abdominal surgery. Methods This retrospective study included elderly patients aged 65 years and older who underwent elective major abdominal surgery in our hospital from September 2023 to November 2024, aiming to explore the predictive value of preoperative disability levels for the main postoperative outcomes in this population. Patients were divided into a non-disability group and a disability group according to WHODAS 2.0 scores under an ethics-approved waiver of consent. Results A total of 436 elderly patients were included, with 87 cases (19.9%) in the non-disability group and 349 cases (80.1%) in the disability group. Baseline characteristics showed significant differences between the two groups in Clavien-Dindo Grade (complications: 2.3% vs. 10.9%, P = 0.013) and age (68.0 vs. 71.0, P = 0.004). Univariable analysis showed that disability (OR = 5.19, 95% CI = 1.23–21.96, P = 0.025), history of radiotherapy (OR = 4.51, 95% CI = 1.12–18.16, P = 0.034), coronary heart disease (OR = 2.21, 95% CI = 1.02–4.78, P = 0.045), preoperative anemia (OR = 3.32, 95% CI = 1.57–6.76, P = 0.002), ASA III + IV grade (OR = 2.14, 95% CI = 1.02–4.50, P = 0.044), and prolonged surgery time (per 30 min: OR = 1.15, 95% CI = 1.04–1.27, P = 0.005) were factors associated with adverse outcomes. Multivariable analysis through three models with stepwise variable adjustment (Model 1: gender, age, BMI, history of radiotherapy, coronary heart disease, preoperative anemia; Model 2: additionally adjusted for surgery time; Model 3: adjusted for ASA classification) consistently showed that preoperative disability was an independent risk factor for adverse outcomes, with adjusted ORs of 4.65 (95% CI = 1.09–19.98, P = 0.038), 4.57 (95% CI = 1.02–19.62, P = 0.041), and 4.54 (95% CI = 1.06–19.52, P = 0.042), respectively. Conclusion Preoperative disability is independently associated with an increased risk of postoperative complications in elderly patients undergoing major abdominal surgery, emphasizing the need to develop personalized perioperative management plans for disabled elderly patients.

The Lancet Healthy Longevity

Silvia Andaloro, Stefano Cacciatore, Maria Anna Nicolazzi et al.

Objective: Li-Fraumeni Syndrome (LFS) is a rare autosomal-dominant syndrome caused by a heterozygous germline mutation of the TP53 gene. It is characterized by early-onset malignancies and high penetrance. Non-bacterial thrombotic endocarditis (NBTE) is an uncommon condition for which cancer is a significant risk factor. Here we present a complex case of LFS unveiled by a NBTE-related ischemic stroke. Case presentation: A 41-year-old woman was admitted following a syncopal episode, preceded by a history of ischemic stroke. She had a notable family history of cancers. Imaging studies revealed ischemic damage and hemorrhagic infarcts, indicating a possible embolic origin or neoplastic involvement. Subsequent examinations revealed a NBTE on the aortic valve as well as multiple primary malignancies including high-grade invasive ductal carcinoma in the breast and primary lung adenocarcinoma. Genetic testing confirmed the presence of a pathogenic variant in TP53. Conclusion: This case underscores the intricate interplay between LFS, oncological manifestations, and thrombotic complications leading to ischemic stroke through NBTE embolization.

Yiyu Sun, Di Chen, Tao Dai et al.

Injuries to axons within the central nervous system (CNS) pose a substantial clinical challenge due to their limited regenerative capacity. This study investigates the therapeutic potential of Cell-free fat extract (CEFFE) in CNS injury. CEFFE was injected intravitreally after the optic nerve was crushed. Two weeks post-injury, quantification of regenerated axons and survival rates of retinal ganglion cells (RGCs) were performed. Subsequently, comprehensive gene ontology (GO) an-notation elucidated the cellular origins and functional attributes of CEFFE components. Molecular mechanisms underlying CEFFE’s therapeutic effects were explored through Western blotting (WB). Additionally, levels of inflammatory factors within CEFFE were determined using enzyme-linked immunosorbent assay (ELISA), and histological staining of microglia was conducted to assess its impact on neuroinflammation. CEFFE demonstrated a significant capacity to promote axon re-generation and enhance RGCs survival. GO annotation revealed the involvement of 146 proteins within CEFFE in axonogenesis and neurogenesis. WB analysis unveiled the multifaceted pathways through which CEFFE exerts its therapeutic effects. Elevated levels of inflammatory factors were detected through ELISA, and CEFFE exhibited a modulatory effect on microglial activation in the retinal tissue following optic nerve crush (ONC). The present study highlights the therapeutic promise of CEFFE in the management of CNS injuries, exemplified by its ability to foster axon regeneration and improve RGCs survival.

Mohadese Sarvari, Sanaz Shanbehzadeh, Yaghoub Shavehei et al.

Abstract Objective Altered Postural control could increase the risk of falling in older adults. Factors such as low back pain and fear of falling can be contributing factors to postural control instability. This study aimed to investigate the effect of chronic low back pain (CLBP) and fear of falling (FOF) on postural control of older adults. Method Forty-one older adults were included (27 LBP and 14 control). Among the participants, 22 people had high FOF, and 19 had low FOF based on Falls efficacy scale cut-off of ≥ 26. For postural control evaluation Center of pressure parameters (COP) of Standard deviation (Sd) of velocity, Sd of amplitude, path length and mean velocity in both Medial–lateral (ML) and Anterior–Posterior (AP) directions were measured. Mixed-model anova with two between group factor (Health status; with and without CLBP, and with high and low FES-I groups) and one within factor postural condition (four conditions with and without vision and Achill tendon vibration) was used. Result No significant interaction between groups (health status and FES-I) and group with condition (health status and condition or FES-I and condition) was observed for all COP parameters in both AP and ML direction. There was main effect of FES-I for all COP parameters in ML direction, with greater Sd of velocity, Sd of amplitude, path length and mean velocity in older adults with high FES-I compared to low FES-I in the ML direction. Conclusion High levels of FOF influenced static postural control in the ML direction. Therefore, paying attention to the lateral stability of older adults is of great importance.

Marcela Plascencia-Cruz, Arturo Plascencia-Hernández, Yaxsier De Armas-Rodríguez et al.

The prevalence of colonization by <i>Pneumocystis jirovecii</i> (<i>P. jirovecii</i>) has not been studied in Mexico. We aimed to determine the prevalence of colonization by <i>P. jirovecii</i> using molecular detection in a population of Mexican patients with chronic obstructive pulmonary disease (COPD) and describe their clinical and sociodemographic profiles. We enrolled patients discharged from our hospital diagnosed with COPD and without pneumonia (<i>n</i> = 15). The primary outcome of this study was <i>P. jirovecii</i> colonization at the time of discharge, as detected by nested polymerase chain reaction (PCR) of oropharyngeal wash samples. The calculated prevalence of colonization for our study group was 26.66%. There were no statistically significant differences between COPD patients with and without colonization in our groups. Colonization of <i>P. jirovecii</i> in patients with COPD is frequent in the Mexican population; the clinical significance, if any, remains to be determined. Oropharyngeal wash and nested PCR are excellent cost-effective options to simplify sample collection and detection in developing countries and can be used for further studies.

Agiimaa Byambaa, Indra Altankhuyag, Otgonbayar Damdinbazar et al.

Background. Hand grip strength (HGS) is a tool for diagnosing sarcopenia. In this study, we examined some anthropometric and body circumference measurements as determinants for HGS. Methods. This cross-sectional study was conducted with participants (Mongolians, n = 1080, aged 18–70, mean age of 41.2 ± 13.9 years, 33.7% of men) from the “Mon-Timeline” cohort study. To measure HGS, a digital grip strength dynamometer was used. Results. Mean HGS in men was 40.1 ± 10.4 kg and in women was 24.5 ± 5.6 kg. Correlation analysis showed that the strongest correlation with HGS was height (r = 0.712, p<0.001). Moreover, HGS was inversely correlated with age (r = −0.239, p<0.001) and thigh circumference (r = −0.070, p<0.01), while it was positively correlated with body weight (r = 0.309, p<0.001), neck circumference (r = 0.427, p<0.001), upper arm circumference (r = 0.108, p<0.0001), lower arm circumference (r = 0.413, p<0.0001), and calf circumference (r = 0.117, p<0.0001). In the multivariate linear regression analysis (unstandardized B coefficient, 95% CI), age (−0.159, −0.188; −0.129), sex (−9.262, −10.459; −8.064), height (0.417, 0.357; 0.478), lower arm circumference (1.003, 0.736; 1.270), and calf circumference (−0.162, −0.309; −0.015) were significantly associated with HGS. Conclusions. When detecting sarcopenia using HGS, it is important to take into account variables such as body height and body circumference.

Cheng Xing, Shicong Zhu, Wenzhe Yan et al.

5-methylcytosine modifications play a significant role in carcinogenesis; however, studies exploring 5-methylcytosine-related genes in diffuse large B-cell lymphoma patients are lacking. In this study, we aimed to understand the potential role and clinical prognostic impact of 5-methylcytosine regulators in diffuse large B-cell lymphoma and identify a prognostic biomarker based on 5-methylcytosine-associated genes. Gene expression profiles and corresponding clinical information of diffuse large B-cell lymphoma patients and normal controls were obtained from The Cancer Genome Atlas, Gene Expression Omnibus, and Genotype-Tissue Expression databases. Diffuse large B-cell lymphoma was divided into three clusters according to the 5-methylcytosine regulators, and differentially expressed genes were screened among the three clusters. Univariate Cox and Lasso-Cox regression analyses were used to screen prognostic genes and construct a prognostic risk model. Kaplan-Meier curve analysis, univariate and multivariate Cox regression analyses, and time-dependent receiver operator characteristic curve analysis were used to evaluate prognostic factors. GSVA was used to enrich potential pathways associated with 5-methylcytosine modification patterns. SsGSEA and CIBERSORT were used to assess immune cell infiltration. Six 5-methylcytosine-related genes (TUBB4A, CD3E, ZNF681, HAP1, IL22RA2, and POSTN) were used to construct a prognostic risk model, which was proved to have a good predictive effect. In addition, univariate and multivariate Cox regression risk scores were independent prognostic factors for diffuse large B-cell lymphoma. Further analysis showed that the 5-methylcytosine risk score was significantly correlated with immune cell infiltration and immune checkpoint of diffuse large B-cell lymphoma. Our study reveals for the first time a potential role for 5-methylcytosine modifications in diffuse large B-cell lymphoma, provides novel insights for future studies on diffuse large B-cell lymphoma, and offers potential prognostic biomarkers and therapeutic targets for patients with diffuse large B-cell lymphoma.

Gerardo Moreno, C. Mangione, Lindsay B. Kimbro et al.

Satyabrata Sahoo, Suhasini Dehury, Kaliprasad Pattnaik et al.

Introduction: Geriatrics is a speciality that focuses on healthcare of elderly people. Geriatric population is defined as people above 60 years of age. Geriatric population constitute 8.14% of total population in India. They have diverse physiological and pathological profiles which have an impact on the pharmacokinetic and pharmacodynamic properties of the administered drug. Very often they are under polypharmacy due to multisystem involvement and thereby subjected to numerous drug interactions and Adverse Drug Reactions (ADRs). There are few studies conducted in India regarding ADRs in Geriatric Patients and none in Odisha, India. Aim: Pharmacovigilance study in Geriatric patients was taken up in a tertiary care hospital to assess the spectrum, cause, severity and preventability of ADRs. Materials and Methods: This prospective, observational study was conducted in Department of Pharmacology in collaboration with Departments of Geriatric Medicine, Medicine and Skin and Venereal Disease (VD) of SCB Medical College and Hospital, Cuttack, Odisha, India. All geriatric patients (aged ≥60 years) diagnosed with ADR, from September 2016 to September 2018, were included. The detailed information of type of ADR and its characteristics were filled up in Suspected ADR Reporting Form. The prevalence and profile of ADRs in geriatric patients were studied. Their causality, severity and preventability were assessed by World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) System, Modified Hartwig’s Severity Scale and Schumock and Thornton Preventability Scale, respectively. Results: A total of 236 geriatric ADRs were reported in two years, out of which, the most common ADRs were cutaneous 100 (42.4%), followed by metabolic 68 (28.8%) and Gastrointestional (GI) involvement 26 (11%). Out of the geriatric ADRs, 128 (54.2%) ADRs were possible, 65% were moderate in intensity and 70.3% ADRs were probably preventable. Conclusion: Cutaneous and metabolic ADRs were most common in geriatric patients in present study. Majority of ADRs were possibly caused due to the drug used, were of moderate intensity and probably preventable.

Anna Louisa Hoffmann, Johannes Michael Bergmann, Anne Fahsold et al.

Abstract Background To ensure the sustainable implementation of dementia-specific person-centred care (PCC) in nursing homes, internal policies are crucial. The preliminary German Dementia Policy Questionnaire, which features 19 dichotomous items, assesses the existence of and evaluates these policies. This article reports the results of an exploration of the construct validity of the preliminary Dementia Policy Questionnaire. Methods This study is a cross-sectional study that references a secondary data set drawn from a national survey study of a randomized, stratified sample of 134 nursing homes in Germany. To explore the construct validity of the preliminary Dementia Policy Questionnaire, we conducted an adjusted multiple correspondence analysis of the pretested 19-item assessment. We included data assessed using the preliminary Dementia Policy Questionnaire from 134 care units associated with 134 nursing homes; these data were collected via telephone interviews with nursing home administrators or their representatives. Results Two items assessing visitor regulations and regulations regarding the inclusion of residents in staff selection were less frequent and were therefore excluded from the adjusted multiple correspondence analysis. In total, nine items were assigned to two dimensions. The items assigned to the first dimension assess existing regulations for PCC as well as existing regulations regarding the involvement of the resident, relatives and the multiprofessional team in the collection of information concerning preferences, case conferences or decision making. The items assigned to the second dimension assess existing regulations regarding the systematic assessment of resident preferences and their requirements. Conclusion The study produces exploratory evidence concerning the preliminary Dementia Policy Questionnaire. Since the dimensions of the items included in this questionnaire cannot be conceptualized clearly, the instrument in its current state requires further development.

Jessica Chan, Yi-Chien Lu, Melissa Min-Szu Yao et al.

Abstract Background Previous research has demonstrated a correlation between hand grip strength (HGS) and muscle strength. This study aims to determine the relationship between HGS and muscle mass in older Asian adults. Methods We retrospectively reviewed the dual-energy X-ray absorptiometry (DXA) records of 907 older adults (239 (26.4%) men and 668 (73.6%) women) at one medical institution in Taipei, Taiwan, from January 2019, to December 2020. Average age was 74.80 ± 9.43 and 72.93 ± 9.09 for the males and females respectively. The inclusion criteria were: 1) aged 60 and older, 2) underwent a full-body DXA scan, and 3) performed hand grip measurements. Patients with duplicate results, incomplete records, stroke history, and other neurological diseases were excluded. Regional skeletal muscle mass was measured using DXA. HGS was measured using a Jamar handheld dynamometer. Results Total lean muscle mass (kg) averaged 43.63 ± 5.81 and 33.16 ± 4.32 for the males and females respectively. Average HGS (kg) was 28.81 ± 9.87 and 19.19 ± 6.17 for the males and females respectively. In both sexes, HGS and regional muscle mass consistently declined after 60 years of age. The rates of decline per decade in upper and lower extremity muscle mass and HGS were 7.06, 4.95, and 12.30%, respectively, for the males, and 3.36, 4.44, and 12.48%, respectively, for the females. In men, HGS significantly correlated with upper (r = 0.576, p < 0.001) and lower extremity muscle mass (r = 0.532, p < 0.001). In women, the correlations between HGS and upper extremity muscle mass (r = 0.262, p < 0.001) and lower extremity muscle mass (r = 0.364, p < 0.001) were less strong, though also statistically significant. Conclusion Muscle mass and HGS decline with advancing age in both sexes, though the correlation is stronger in men. HGS measurements are an accurate proxy for muscle mass in older Asian adults, particularly in males.

Paul Tarteret, Alessio Strazzulla, Maxence Rouyer et al.

Objectives: This study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. Methods: Two nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. Results: During the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11–0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03–0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01–0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00–0.24], p = 0.001). Conclusions: This study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.

Sabbe Kelly, van Der Mast Roos, Dilles Tinne et al.

Abstract Background Delirium is a common geriatric syndrome, but only few studies have been done in nursing home residents. Therefore, the aim of this study was to investigate (point) prevalence of and risk factors for delirium in nursing homes in Belgium. Methods A multisite, cross-sectional study was conducted in six nursing homes in Belgium. Residents of six nursing homes were screened for delirium. Exclusion criteria were coma,‘end-of-life’ status and residing in a dementia ward. Delirium was assessed using the Delirium Observation Screening Scale. Results 338 of the 448 eligible residents were included in this study. Of the 338 residents who were evaluated, 14.2 % (95 %CI:3.94–4.81) screened positive for delirium with the Delirium Observation Screening Scale. The mean age was 84.7 years and 67.5 % were female. Taking antipsychotics (p = 0.009), having dementia (p = 0.005), pneumonia (p = 0.047) or Parkinson’s disease (p = 0.03) were more present in residents with delirium. The residents were more frequently physically restrained (p = 0.001), participated less in activities (p = 0.04), had had more often a fall incident (p = 0.007), had lower levels of cognition (p < 0.001; MoCA ≥ 26, p = 0.04; MoCA ≥ 25, p = 0.008) and a higher “Activities of Daily Living” score (p = 0.001). In multivariable binary logistic regression analysis, a fall incident (2.76; 95 %CI: 1.24–6.14) and cognitive impairment (OR: 0.69; 95 %CI: 0.63–0.77) were significantly associated with delirium. Conclusions Delirium is an important clinical problem affecting almost 15 % of the nursing home residents at a given moment. Screening of nursing home residents for risk factors and presence of delirium is important to prevent delirium if possible and to treat underlying causes when present.

Catherine Henderson, Martin Knapp, Sharon M. Nelis et al.

Abstract Introduction We examined 3‐month service use and costs of care for people with mild‐to‐moderate dementia in Great Britain. Methods We analyzed Improving the experience of Dementia and Enhancing Active Life cohort study baseline data on paid care, out‐of‐pocket expenditure, and unpaid care from participants with dementia (N = 1547) and their carers (N = 1283). In regression analyses, we estimated per‐group mean costs of diagnostic and sociodemographic subgroups. Results Use of services apart from primary and outpatient hospital care was low. Unpaid care accounted for three‐quarters of total costs (mean, £4008 [standard error, £130] per participant). Most participants (87%) received unpaid care equating to 36 hours weekly. Estimated costs for people with Parkinson's dementia were £8609, £4359 for participants with mixed dementia, and £3484 for those with Alzheimer's disease. Total costs were lower for participants with dementia living alone than living with others (£2484 vs. £4360); costs were lower for female than for male participants (£3607 vs. £4272). Discussion Costs varied by dementia subtype, carer status, and living arrangement. Policy makers should recognize the high costs of unpaid care for people with dementia, who do not always get the support that they need or would like to receive.

C. Carpenter, Marilyn Bromley, J. Caterino et al.

Lars Donath, Sebastian Ludyga, Daniel Hammes et al.

Abstract Background Aging is accompanied by a decline of executive function. Aerobic exercise training induces moderate improvements of cognitive domains (i.e., attention, processing, executive function, memory) in seniors. Most conclusive data are obtained from studies with dementia or cognitive impairment. Confident detection of exercise training effects requires adequate between-day reliability and low day-to-day variability obtained from acute studies, respectively. These absolute and relative reliability measures have not yet been examined for a single aerobic training session in seniors. Methods Twenty-two healthy and physically active seniors (age: 69 ± 3 y, BMI: 24.8 ± 2.2, VO2peak: 32 ± 6 mL/kg/bodyweight) were enrolled in this randomized controlled cross-over study. A repeated between-day comparison [i.e., day 1 (habituation) vs. day 2 & day 2 vs. day 3] of executive function testing (Eriksen-Flanker-Test, Stroop-Color-Test, Digit-Span, Five-Point-Test) before and after aerobic cycling exercise at 70% of the heart rate reserve [0.7 × (HRmax – HRrest)] was conducted. Reliability measures were calculated for pre, post and change scores. Results Large between-day differences between day 1 and 2 were found for reaction times (Flanker- and Stroop Color testing) and completed figures (Five-Point test) at pre and post testing (0.002 < p < 0.05, 0.16 < ɳp 2 < 0.38). These differences notably declined when comparing day 2 and 3. Absolute between days variability (CoV) dropped from 10 to 5% when comparing day 2 vs. day 3 instead of day 1 vs. day 2. Also ICC ranges increased from day 1 vs. day 2 (0.65 < ICC < 0.87) to day 2 vs. day 3 (0.40 < ICC < 0.93). Interestingly, reliability measures for pre-post change scores were low (0.02 < ICC < 0.71). These data did not improve when comparing day 2 with day 3. During inhibition tests, reaction times showed excellent reliability values compared to the poor to fair reliability of accuracy. Conclusion Notable habituation to the whole testing procedure should be considered as it increased the reliability of different executive function tests. Change scores of executive function after acute aerobic exercise cannot be detected reliably. Large intra- and inter-individual of responses to acute aerobic exercise in seniors can be presumed.