Aging Clinical and Experimental Research

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Online ISSN: 1720-8319
Print ISSN: 1594-0667
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PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only
Resmon pro diary© by Restech S.R.L. 6MWD 6 minutes walking distance, CRQ Chronic respiratory questionnaire, HR-QoL Health-related quality of life, QF quadriceps femoris muscle force
Risk of bias of the included studies
  • Lorenzo Lippi
    Lorenzo Lippi
  • Alessio Turco
    Alessio Turco
  • Arianna Folli
    Arianna Folli
  • [...]
  • Marco Invernizzi
    Marco Invernizzi
Background Several technological advances and digital solutions have been proposed in the recent years to face the emerging need for tele-monitoring older adults with Chronic Obstructive Pulmonary Disease (COPD). However, several challenges have negatively influenced an evidence-based approach to improve Health-Related Quality of Life (HR-QoL) in these patients. Aim To assess the effects of tele-monitoring devices on HR-QoL in older adults with COPD. Methods On November 11, 2022, PubMed, Scopus, Web of Science, and Cochrane were systematically searched for randomized controlled trials (RCTs) consistent with the following PICO model: older people with COPD as participants, tele-monitoring devices as intervention, any comparator, and HR-QoL as the primary outcome. Functional outcomes, sanitary costs, safety, and feasibility were considered secondary outcomes. The quality assessment was performed in accordance with the Jadad scale. Results A total of 1845 records were identified and screened for eligibility. As a result, 5 RCTs assessing 584 patients (423 males and 161 females) were included in the systematic review. Tele-monitoring devices were ASTRI telecare system, WeChat social media, Pedometer, SweetAge monitoring system, and CHROMED monitoring platform. No significant improvements in terms of HR-QoL were reported in the included studies. However, positive effects were shown in terms of the number of respiratory events and hospitalization in patients telemonitored by SweetAge system and CHROMED platform. Discussion Although a little evidence supports the role of tele-monitoring devices in improving HR-QoL in older patients, positive effects were reported in COPD exacerbation consequences and functional outcomes. Conclusion Tele-monitoring solutions might be considered as sustainable strategies to implement HR-QoL in the long-term management of older patients with COPD.
Weighted percentile curves for the LSA scores in males
Weighted percentile curves for the LSA scores in females
Background The Life-Space Assessment (LSA) can compliment traditional physical performance measures of mobility by accounting for the interaction between individuals and their environment. However, there are no studies that have generated percentile curves showing sex-stratified reference values in a large population-based sample of community-dwelling adults, making its interpretation difficult. Therefore, this study aimed to establish sex-stratified reference values for the LSA in middle-aged and older Canadians. Methods Baseline data for participants aged 45–84 years old from the Canadian Longitudinal Study on Aging (CLSA) were used (n = 22,154). Quantile regression was used to estimate specific percentiles, with age as the independent variable and LSA scores as the dependent variable. Models were run for the whole sample, then separately for males and females. The models were cross-validated to assess their reliability. CLSA inflation and analytic weights were applied. Results On average, the sample was 62.5 ± 10.0 y.o. (51.1% males), with a weighted mean LSA score of 89.2 ± 17.0. There was also a decrease in LSA scores with age, where scores were lower for older age groups compared to younger groups, and LSA scores were lower for females relative to males. Discussion and conclusions Reference data will aid in interpreting, comparing, and making inferences related to LSA scores obtained in clinical and research settings for Canadian adults.
Background and aim To inform health promotion interventions, there is a need for large studies focusing specifically on what makes older adults feel good, from their own perspective. The aim was to explore older adults’ views of what makes them feel good in relation to their different characteristics. Methods A qualitative and quantitative study design was used. Independently living people (n = 1212, mean age 78.85) answered the open-ended question, ‘What makes you feel good?’ during preventive home visits. Following inductive and summative content analysis, data was deductively sorted, based on The Canadian model of occupational performance and engagement, into the categories leisure, productivity, and self-care. Group comparisons were made between: men/women; having a partner/being single; and those with bad/good subjective health. Results In total, 3117 notes were reported about what makes older adults feel good. Leisure activities were the most frequently reported (2501 times), for example social participation, physical activities, and cultural activities. Thereafter, productivity activities (565 times) such as gardening activities and activities in relation to one’s home were most frequently reported. Activities relating to self-care (51 times) were seldom reported. There were significant differences between men and women, having a partner and being single, and those in bad and good health, as regards the activities they reported as making them feel good. Discussion and conclusions To enable older adults to feel good, health promotion interventions can create opportunities for social participation and physical activities which suit older adults’ needs. Such interventions should be adapted to different groups.
Prototypical stress response is a modular reaction to both antigens and chemical or physical stimuli challenging integrity of the organism, with an up-regulation of evolutionarily conserved mediators of natural immunity. Thus, there is an equivalence of antigen and other stimuli in evoking this pattern of mediators, which may also account for inflammaging
Vessel dysfunction may depend on the accumulation of senescent endothelial cells: A Virus infects cells which induce inflammatory cytokines (iCyt) and ROS; B Senescent cells (red) enhance the tissue response and increase inflammation
The COVID-19 pandemic is a burden for the worldwide healthcare systems. Whereas a clear age-dependent mortality can be observed, especially multimorbid and frail persons are at an increased risk. As bio-functional rather than calendrical age is in the meanwhile known to play a crucial role for COVID-19-related outcomes, aging-associated risk factors, overall prognosis and physiological age-related changes should be systematically considered for clinical decision-making. In this overview, we focus on cellular senescence as a major factor of biological aging, associated with organ dysfunction and increased inflammation (inflammaging).
Eforto® device. From left to right: Eforto® device; start screen; time indicators for starting a self-test; overview of the test results
Study flow chart. MV Martin Vigorimeter, VUB—UZB Vrije Universiteit Brussel & Universitair Ziekenhuis Brussel, Belgium, Radboud Radboud University Medical Center, The Netherlands, ZGT Ziekenhuis Groep Twente, The Netherlands
Bland–Altman plots for GSmax and muscle fatigability measured with MV and Eforto®. Presented data are derived from the community-dwelling older persons who performed the grip strength tests at the clinical study center twice using the analog (MV) and Eforto® (professional mode) (n = 56). The horizontal dotted lines show the upper and lower limits of agreement. The horizontal plain line represents the mean difference in respectively GSmax, FR and GWestimated between both systems. The other plain line represents the linear regression showing that there is no significantly proportional difference in GSmax, FR and GWestimated measured with both systems (GSmaxR² = 0.027, p = 0.223; FR R² = 0.001, p = 0.786; GWestimatedR² = 0.004, p = 0.633). In the first figure the horizontal axis represents the mean of GSmax and the vertical axis represents the difference between GSmax measured with MV and Eforto® device. In the second figure the horizontal axis represents the mean of FR and the vertical axis represents the difference between FR measured with MV and Eforto® device. In the third figure the horizontal axis represents the mean of GW and the vertical axis represents the difference between GW measured with MV and Eforto® device
Introduction We developed Eforto®, an innovative system for (self-)monitoring of grip strength (GS) and muscle fatigability (Fatigue Resistance (FR = time until GS decreased to 50% of maximum during sustained contraction) and grip work (GW = area under the strength-time curve)). The Eforto® system consists of a rubber bulb that is wirelessly connected to a smartphone-based application, and a telemonitoring platform. The aim was to evaluate the validity and reliability of Eforto® to measure muscle fatigability. Methods Community-dwelling older persons (n = 61), geriatric inpatients (n = 26) and hip fracture patients (n = 25) were evaluated for GS and muscle fatigability. In community dwellers fatigability was tested twice in the clinic (once with Eforto®, once with Martin Vigorimeter (MV), standard analog handgrip system) and for six consecutive days as a self-assessment at home with Eforto®. In hospitalized participants, fatigability was tested twice using Eforto®, once by a researcher and once by a health professional. Results Criterion validity was supported by good to excellent correlations between Eforto® and MV for GS (r = 0.95) and muscle fatigability (FR r = 0.81 and GW r = 0.73), and no significant differences in measurements between both systems. Inter-rater and intra-rater reliability for GW were moderate to excellent (intra-class correlation: 0.59–0.94). The standard error of measurement for GW was small for geriatric inpatients and hip fracture patients (224.5 and 386.5 kPa*s) and higher for community-dwellers (661.5 kPa*s). Discussion/conclusion We established the criterion validity and reliability of Eforto® in older community-dwelling persons and hospitalized patients, supporting the implementation of Eforto® for (self-)monitoring of muscle fatigability.
Functional status (ADL) at baseline (T0) and after 6 (T6) and 12 (T12) months by sex. The figure shows how the ADL score changes at 6 and 12 months after the fracture
Cox regression related to mortality at 12 months after discharge by gender. The figure shows Cox regression and the main risk factors for 1-year mortality in men and women
Background Proximal femur fractures have a negative impact on loss of functional autonomy and mortality. Objective The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12 months after discharge and to determine if gender affected outcome. Methods In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12 months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality. Results We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6 months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6 months (HR 0.68/95%, CI 0.48–0.97/p < 0.05 and HR 1.70/95%, CI 1.17–2.48/p < 0.01, respectively) in women, and new hospitalisations at 6 months and polypharmacy in men (HR 1.65/95%, CI 1.07–2.56/p < 0.05 and HR 1.40/95%, CI 1.00–1.96/p = 0.05, respectively) in Cox's regression model. Discussion and Conclusions Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6 months after discharge, and this increases the risk of death at 1 year. Cumulative mortality at 12 months is higher in men and appears to be related to polypharmacy and new hospital admissions 6 months after discharge.
PRISMA diagram of the study selection process
Background The purpose of this scoping review was to organize and describe the literature on the application of clown care to the elderly population in nursing homes, including intervention time, intervention methods and intervention effects, so as to provide reference ideas for other scholars to explore clown care programs suitable for the elderly population in nursing homes. Methods Employing Arksey and O’Malley’s methodology, we searched for PubMed, Web of Science, Embase, Cochrane, CNKI, WanFang, VIP, and CBM systematically and thoroughly, and the search period was from the establishment of each database to December 12, 2022. Two researchers with evidence-based learning experience independently conducted literature retrieval, information extraction, and cross-checking in strict accordance with the inclusion and exclusion criteria. The review process is reported according to PRISMA. Results 148 literature were initially obtained after searching, of which 18 were finally included. Among them, 17 were in English and 1 was in Chinese. There are 16 quantitative studies and 2 qualitative studies published from 2010 to 2022. It is found that the current clown care intervention program has not established a unified intervention standard and effective evaluation program. Conclusions The results of this scoping review conclude that clown care played a significant role in the nursing home. At first, it can reduce negative emotions, cognitive impairments and physical pain among older adults. In addition, it can improve their quality of life, life satisfaction, etc. It is suggested to learn from the advanced experience of clown care in foreign countries and carry out more clown care among the elderly population in nursing homes in China.
3D right ventricle volume analysis
2D left atrium strain analysis
2D left ventricle strain analysis
Objective This study aims to accurately evaluate the cardiac structure and function of the frail population in elderly patients with normal ejection fraction (EF) using the 3D volume quantification and speckle tracking of echocardiography, to explore the correlation between frailty and cardiac structure and function. Methods A total of 350 elderly aged 65 and above in-patients, excluding those with congenital heart disease, cardiomyopathy, and severe valvular heart disease, were included in the study. Patients were divided into non-frail, pre-frail, and frail group. Echocardiography techniques including speckle tracking and 3D volume quantification, were used to analyze the cardiac structure and function of the study subjects. Comparative analysis was statistically significant if P < 0.05. Results The cardiac structure of the frail group was different compared with non-frail patients, the frail group demonstrated increased left ventricular myocardial mass index (LVMI), but decreased stroke volume. Cardiac function was also impaired in the frail group: reservoir strain and conduit strain of left atrium, strain of right ventricular (RV) free wall, strain of RV septum, 3D EF of RV, and global longitudinal strain of LV were significantly decreased. Frailty was significantly and independently associated with LV hypertrophy (OR 1.889; 95% CI 1.240,2.880; P = 0.003), LV diastolic dysfunction (OR 1.496; 95% CI 1.016,2.203; P = 0.041), left ventricular global longitudinal strain (LVGLS) reduction (OR 1.697; 95% CI 1.192, 2.416; P = 0.003), and reduced RV systolic function (OR 2.200; 95% CI 1.017, 4.759; P = 0.045). Conclusion Frailty is closely associated with several heart structural and functional alterations, which not only manifested as LV hypertrophy and reduced LV systolic function, but also decreased LV diastolic function, RV systolic function, and left atrial systolic function. Frailty is an independent risk factor for LV hypertrophy, LV diastolic dysfunction, LVGLS reduction, and reduced RV systolic function. Trial registration number ChiCTR2000033419. Date of registration: May 31, 2020.
Enrollment Flow Chart
Background Though dementia rates vary by racial or ethnic groups, it is unknown if these disparities remain among those aged 90 or older. Aims To test this hypothesis, we used baseline clinical evaluation of 541 ethnically and racially diverse individuals participating in the LifeAfter90 Study to assess how associations between core demographic characteristics and measures of physical and cognitive performance differ across the racial/ethnic groups. Methods Participants in this study were long-term non-demented members of Kaiser Permanente Northern California. They were clinically evaluated and diagnosed with normal or impaired cognition (mild cognitive impairment and dementia) through an in-person comprehensive clinical assessment consisting of a detailed medical history, physical and neurological examination, functional, and cognitive tests. Results The average age at enrollment was 93.0 ± 2.6 years, 62.4% female and 34.2% non-Hispanic White. At initial evaluation 301 participants had normal cognition and 165 had mild cognitive impairment (MCI) and despite screening, 69 participants were determined to have dementia. Age, education, 3MS, FAQ and CDR scores were significantly associated with cognitive impairment (normal versus MCI and dementia), but not gender. There was a significant univariate association between race/ethnicity and cognitive impairment (p < 0.02) being highest among Black (57.4%) and lowest among Asian (32.7%) individuals. After adjustment for age, gender, and education, however, prevalence of cognitive impairment was not influenced by race or ethnicity. Conclusion Our results confirm the ability to reliably assess clinical diagnosis in a diverse sample of very old individuals.
Recruitment flowchart. A diagram showing the participants’ recruitment in this study
Protocol of intervention. Interventions for both groups with dance video game
Stroop test and block design for fNIRS recording. A Stroop word test. B Stroop color word test. C block design. A (Stroop W) Enables reading the color word written in black ink. B (Stroop CW) Allows answering the ink of color word, which is mismatched between the ink color and word. C is block design alternated between the rest [Stroop W] and task [Stroop CW] in 20 s for seven blocks in total
Change of oxyHb of prefrontal cortex activity. Comparison of OxyHb during task performance for AUC in NCF and MCI group
Background Some patients with minor cognitive impairment can revert to normal cognition if intervention is implemented early. Dance video games as multi-task training have shown beneficial effects on cognitive and physical functions in older adults. Aims This study aimed to elucidate the effects of dance video game training on cognitive functions and prefrontal cortex activity in older adults with and without mild cognitive impairment. Methods A single-arm trial was used for this study. The participants were divided based on the Japanese version of Montreal Cognitive Assessment scores into the mild cognitive impairment (n = 10) and normal cognitive function (n = 11) groups. Dance video game training was performed 60 min/day, 1 day/week, for a total of 12 weeks. Neuropsychological assessments, prefrontal cortex activity using functional near-infrared spectroscopy, and step performance of dance video game were recorded at pre- and post-intervention. Results Dance video game training significantly improved the Japanese version of Montreal Cognitive Assessment score (p < 0.05), and tendency toward improvement was observed in the trail making test in the mild cognitive impairment group. The dorsolateral prefrontal cortex activity in the Stroop color word test was significantly increased in the mild cognitive impairment group (p < 0.05) after dance video game training. Conclusions Dance video game training improved cognitive function and increased prefrontal cortex activity in the mild cognitive impairment group.
Background Older adults living in nursing homes (NH) paid a heavy price to the COVID-19 pandemic, despite early and often drastic prevention measures.AimsTo study the characteristics and the impact of the pandemic on NH residents and professionals over 2 years.Methods Cross-sectional study of COVID-19 clusters among residents and/or professionals in NH, from March 2020 to February 2022, in Normandy, France. We used data from the French mandatory reporting system, and cross-correlation analysis.ResultsThe weekly proportion of NH with clusters was strongly correlated with population incidence (r > 0.70). Attack rates among residents and professionals were significantly lower in period 2 (vaccination rate in residents ≥ 50%) compared with periods 1 (waves 1 and 2) and 3 (Omicron variant ≥ 50%). Among residents, mortality and case fatality rates decreased drastically during periods 2 and 3.Conclusion Our study provides figures on the evolution of the pandemic in NH.
The ROC analysis for the Itaki Fall Tool, Hendrich II Fall Risk, and Morse Fall Tool
Background As a result of falls, older patients experience injury and loss of function, and their length of hospital stay and care costs increase. Aim This study was conducted to determine fall risks and compare the sensitivity and specificity of three fall risk assessment tools. Methods Older patients’ fall risk levels were determined according to the Itaki, Hendrich-II, and Morse tools within 2 h following their admission to the wards. A methodological design was used in the study, which included 388 hospitalized elderly patients. The mean age of the patients was 72.29 ± 5.6 years, and 57.7% were female. Results According to the ROC curve values of Sensitivity and 1-Specificity, the cut-off points for the Hendrich-II, Itaki, and Morse fall tools were accepted as 27.5, 8.5, and 6.5, respectively. According to the analysis results, the ratios of the areas under the ROC curve for the Itaki, Morse, and Hendrich-II fall tools were 0.794, 0.773, and 0.724, respectively, which were found to be statistically significant for all three tools (p ≤ 0.001). Conclusions The Itaki Fall Risk Tool was found to be the most sensitive one among the three instruments in assessing the fall risk of older hospitalized patients. The Itaki Fall Risk Tool was followed by the Morse and Hendrich-II tools, respectively, in terms of sensitivity.
Experimental procedure. SQU squat training group, CON control group
A High-density surface electromyography (HDsEMG) of the vastus lateralis muscle was recorded during submaximal ramp-up contraction. B The signals were decomposed to individual motor unit firing. The individual motor unit recruitment threshold and firing rate were calculated. C Each motor unit was assigned to either of the two groups depending on the recruitment threshold: Low-MUs, defined as motor units recruited at 0–25%MVC; High-MUs, defined as motor units recruited at 25–50%MVC
Firing rate of motor units with relatively low- and high-recruitment thresholds. The left panel shows the motor unit firing rate during 0–25%MVC. The right panel shows the motor unit firing rate during 25–50%MVC. Red box plots represent data from the squat group (SQU) and blue box plots represent data from the control group (CON). Black dots represent individual motor unit data. During 0–25%MVC, there was no significant interaction. During 25–50%MVC, there was a significant three-way interaction and a significant difference between PRE and POST in low-MUs in SQU. The asterisk represents p < 0.05
Background It is important to investigate neural as well as muscle morphological adaptations to evaluate the effects of exercise training on older adults. Aims This study was aimed to investigate the effects of home-based bodyweight squat training on neuromuscular adaptation in older adults. Methods Twenty-five community-dwelling older adults (77.7 ± 5.0 years) were assigned to squat (SQU) or control (CON) groups. Those in the SQU group performed 100 bodyweight squats every day and the others in the CON group only performed daily activities for 4 months. Maximum knee extension torque and high-density surface electromyography during submaximal contraction were assessed. Individual motor units (MUs) were identified and divided into relatively low or high-recruitment threshold MU groups. Firing rates of each MU group were calculated. The muscle thickness and echo intensity of the lateral thigh were assessed using ultrasound. As physical tests, usual gait speed, timed up and go test, grip strength, and five-time chair stand test were performed. Results While no improvements in muscle strength, muscle thickness, echo intensity, or physical tests were noted in either group, the firing rate of relatively low recruitment threshold MUs significantly decreased in the SQU group after intervention. Conclusions These results suggest that low-intensity home-based squat training could not improve markedly muscle strength or physical functions even if high-repetition and high frequency exercise, but could modulate slightly neural activation in community-dwelling older adults.
Consort flow chart of the study
Background: It is challenging to find exercise programs that are safe, effective, attractive, and feasible to reduce the risk of falls and fall-related injuries in older adults. Aims: We compared the effects of SSE (Square-Stepping Exercise) versus TCC (Tai Chi Chuan) on functional fitness and fear of falling in older women aged 60 years and above. Methods: It was a single blind randomized control trial. We purposefully selected 36 older women (aged 65.2 ± 3.82 years). They were then paired based on the criterion of functional reach test and randomly assigned to two groups (18 people) of TTC and SSE. The exercise program included 8 weeks of three 1-h-session training. We measured functional fitness and fear of falling. Functional fitness was assessed using the following tests: Single Leg-Stance-Eyes Open/Closed, Timed Up and Go, Functional Reach Test, Chair Stand, Arm Curl, and Back Scratch. Fear of falling was assessed using the Falls Efficacy Scale-International. Results: We analyzed the data using repeated measure ANOVA. Within-group comparisons revealed significant improvements for both groups in all nine measures of functional tests as well as fear of falling [Formula: see text]. Interaction comparisons revealed that improvements in measures of functional fitness were greater in the TTC group [Formula: see text]. Nevertheless, the groups were not significantly different in fear of falling [Formula: see text]. Conclusion: Our findings showed that both TCC and SSE interventions improved functional fitness and fear of falling. The TCC is more effective than SSE, though the latter is easier to learn and perform.
In the associative inference task, participants learned in the encoding phase overlapping pairs of objects (AB + BC). In the test phase, participants were presented with three objects, the top (here, the mug) one served as the cue and the bottom ones served as two choices. On the direct test trials, participants had to select the areophane as this object was directly associated with the mug in the encoding phase. In the inference trials, participants had to select the hammer, as both the mug and the hammer were paired with the airplane in the encoding phase. Importantly, correct choices are circled here for illustrative purposes only (not shown to participants)
Percentage of correct retrieval of previously learned associations and percentage of correct associative inference in Alzheimer’s disease patients and control participants. Error bars represent intervals of 95% within-subjects confidence
Correlations between associative inference and flexibility in Alzheimer’s disease patients (a) and control participants (b)
Background Associative inference refers to an adaptive ability that allows flexible recombination of information acquired during previous experiences to make new connections that they have not directly experienced. This cognitive ability has been widely associated with the hippocampus. Aims We investigated associative inference in patients with Alzheimer’s disease and control participants. Methods The task has two phases. In the training phase, participants learned to encode overlapping pairs of objects (AB + BC). In the test phase, participants were invited to retrieve previously see associations (i.e., AB, BC) as well as novel associations between the previously exposed objects (i.e., AC). In addition, we test the relationship between associative inference and cognitive flexibility. Results Analysis demonstrated lower associative inference in AD patients than in control participants. Interestingly, performance on the associative inference task was significantly correlated with low performance on a cognitive flexibility task in AD patients. Discussion Our findings demonstrate a compromise of the ability to flexibly combine new representations from prior memories in AD, which is likely related to the hippocampal dysfunction in AD.
Background Physical reserve (PR) refers to one’s ability to maintain physical functioning despite age, illness, or injury. The measurement and predictive utility of PR, however, are not well established. Aims We quantified PR using a residual measurement approach by extracting standardized residuals from gait speed, while accounting for demographic and clinical/disease variables, and used it to predict fall-risk. Methods Participants (n = 510; age ≥ 70ys) were enrolled in a longitudinal study. Falls were assessed annually (in-person) and bimonthly (via structured telephone interview). Results General Estimating Equations (GEE) revealed that higher baseline PR was associated with reduced odds of reporting falls over repeated assessments in the total sample, and incident falls among those without fall’s history. The protective effect of PR against fall risk remained significant when adjusting for multiple demographic and medical confounders. Discussion/Conclusion We propose a novel framework to assessing PR and demonstrate that higher PR is protective against fall-risk in older adults.
A A formative measurement model: The overall intrinsic capacity (IC) represents the composite or aggregate of capacities of different domains and levels of functioning. B A reflective measurement model: IC is a general underlying trait, which causes the variation in the observed indicators across different domains of functioning
Flowchart of the study population. Note: In cohort 1, only persons aged 65 and over were selected for the medical interview, and therefore, younger participants from this cohort were not included in the current analyses
Distribution of the IC score at baseline by age and number of chronic diseases categories (n = 1908)
Background: Intrinsic capacity (IC) defined by the WHO refers to the composite of five domains of capacities. So far, developing and validating a standardized overall score of the concept have been challenging partly because its conceptual framework has been unclear. We consider that a person's IC is determined by its domain-specific indicators suggesting a formative measurement model. Aims: To develop an IC score applying a formative approach and assess its validity. Methods: The study sample (n = 1908) consisted of 57-88-year-old participants from the Longitudinal Aging Study Amsterdam (LASA). We used logistic regression models to select the indicators to the IC score with 6-year functional decline as an outcome. An IC score (range 0-100) was constructed for each participant. We examined the known-groups' validity of the IC score by comparing groups based on age and number of chronic diseases. The criterion validity of the IC score was assessed with 6-year functional decline and 10-year mortality as outcomes. Results: The constructed IC score included seven indicators covering all five domains of the construct. The mean IC score was 66.7 (SD 10.3). The scores were higher among younger participants and those who had lower number of chronic diseases. After adjustment for sociodemographic indicators, chronic diseases, and BMI, a one-point higher IC score was associated with a 7% decreased risk for 6-year functional decline and a 2% decreased risk for 10-year mortality. Conclusions: The developed IC score demonstrated discriminative ability according to age and health status and is associated with subsequent functional decline and mortality.
Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.
Association between BMI and all-cause mortality. Hazard ratios (HRs) are indicated by red solid lines and 95% CIs by shaded areas. Data were adjusted for age, gender, residence, educational, marriage, smoking status, alcohol drinking, exercise, ADL impairment, sleep duration, chronic diseases, WC
Associations of BMI with all-cause mortality in Cox models with penalized splines according to MMSE subcohorts. Hazard ratios (HR) are indicated by red solid lines and 95% CIs by shaded areas. Graphs examine the nonlinear shape of the hazard functions using nonparametric smoothers and identify the BMI at minimum all-cause mortality risk. Data were adjusted for age, gender, residence, educational, marriage, smoking status, alcohol drinking, exercise, ADL impairment, sleep duration, chronic diseases, WC
Kaplan–Meier Survival Curve for hazard of all-cause mortality by BMI in MMSE subcohorts
Background Epidemiological studies have reported that among participants with impaired cognitive, overweight and mild obesity are associated with substantially improved survival, this finding has been termed the “obesity paradox” and has led to uncertainty about secondary prevention. Aims To explore whether the association of BMI with mortality differed in different MMSE score, and whether the obesity paradox in patient with cognitive impairment (CI) is real. Methods The study used data from CLHLS, a representative prospective population-based cohort study in China, which included 8348 participants aged ≥ 60 years between 2011 and 2018. The independent association between BMI and mortality in differed MMSE score by calculating hazard ratios (HRs) in multivariate Cox regression analysis. Results During a median (IQR) follow-up of 41.18 months, a total of 4216 participants died. In the total population, underweight increased the risk of all-cause mortality (HRs, 1.33; 95% CI 1.23–1.44), compared with normal weight, and overweight was associated with a decreased risk of all-cause mortality (HR 0.83; 95% CI 0.74–0.93). However, compared to normal weight, only underweight was associated with increased mortality risk among participants with MMSE scores of 0–23, 24–26, 27–29, and 30, and the fully-adjusted HRs (95% CIs) for mortality were 1.30 (1.18, 1.43), 1.31 (1.07, 1.59), 1.55 (1.34, 1.80) and 1.66 (1.26, 2.20), respectively. The obesity paradox was not found in individuals with CI. Sensitivity analyses carried out had hardly any impact on this result. Conclusion We found no evidence of an obesity paradox in patients with CI, compared with patients of normal weight. But underweight individuals may have increased mortality risk whether in the population with CI or not. And overweight/obese people with CI should continue to aim for normal weight.
Forest plot of gait parameters during usual walk adjusted for age, sex, BMI, MMSE score and presbyvestibulopathy in the untimely ARHL and expected ARHL groups. OR (95% CI): odds ratio with 95% confidence interval
Introduction Falls are associated with hearing loss, which might be explained by the onset of gait disorders. The objective of this study was to examine the association between Age-Related Hearing Loss (ARHL) and gait disorders assessed with GAITrite® walkway in a population of fallers aged 75 and over while accounting for the vestibular function. Methods We examined data from 53 older patients (mean 84.2 ± 5.1 years; 64% women) included after a GAITrite® walkway assessment together with hearing and vestibular tests. People with high-frequency hearing loss, higher than 10% of the age and sex-matched population with the worst hearing, composed untimely ARHL group (n = 30), whereas all others had expected ARHL (n = 23). Presbyvestibulopathy was assessed accordingly to Barany Society criteria. Results After adjustment for age, sex, body mass index, Mini-Mental State Examination score and presbyvestibulopathy, we found an increase in stride length mean in the untimely ARHL group (p = 0.046), but no between-group differences in stride length variability, cadence or velocity. Untimely ARHL was not associated with presbyvestibulopathy. Conclusions Untimely ARHL in older fallers was not associated with gait disorders in the studied population.
CONSORT flow diagram showing the recruitment, screening, testing, and data analyses for the participants
Schematics of a the study design, b the vibration platform used to deliver vibration training, c the protocol of each training session on the vibration platform, and d the ActiveStep treadmill (TM) used to induce slips. This study adopted a two-arm, randomized-controlled, and longitudinal design. Qualified participants were randomized into either the training or control group. The training group underwent 8-week vibration training following the protocol in (c). The control group maintained their regular lifestyle during the 8-week period. Immediately before (baseline test, week 1 or month 0), after (post-training test, week 8 or month 2), and 3 months after (retest, week 20 or month 5) the training session, a group of fall risk factors were assessed for both groups. During the post-training test and retest, both groups were exposed to a standardized slip induced by the TM shown in (d). The retrospective fall history (in the past 12 months prior to the baseline session) and prospective daily-living falls (over the 12 months after the baseline test) were also collected for both groups. Each vibration training session consists of 5 repetitions of one bout of training followed by a 1-min rest. During training, participants stand barefoot on the platform with hands holding the handlebars for balance, knees slightly bent at 20°, and trunk upright. The vibration frequency was 20 Hz, and the peak-to-peak magnitude was 2 mm throughout the training course. Such training was repeated 3 times a week for 8 weeks, leading to 24 sessions in total. A safety harness protected participants during all trials on the treadmill. The force exerted on the human body from the harness was registered by a loadcell
Comparison of the faller rate responding to the standard slip between the training and control groups at a the post-training test and b the retest with the risk ratio (RR) and its 95% confidence interval (CI) in the brackets. Also shown are c the proportion of recurrent fallers for both groups over the 12-month periods before and after the baseline session, d the Kaplan–Meier survival curves of falls during the 12 months following the baseline session, and comparisons of e the proportion of fallers and f the number of falls between groups during the retrospective and prospective periods. The retrospective period was 12 months prior to the baseline evaluation. The prospective periods consist of the first 5 months (or mon), 8.5 months, and 12 months after the baseline session. For the survival analysis, the hazard ratio (HR) and its 95% CI were displayed. The arrow indicates the desired direction of improvement for the respective variable. Due to technical issues, 1 (2) participant in the training group and 4 (3) participants in the control group did not have a valid slip trial during the post-training (retest) slip test. In f, the column height and the error bar length represent the respective variable’s mean and standard deviation. *p = 0.041 vs. retrospective
Comparisons of the change from the baseline (BL) test to the post-training (Post) test and from BL test to retest in a the knee strength, b body balance measured by the Berg Balance Scale test, c foot tactile sensation, d chair-rise test time, and e the cognitive function assessed by the Mini-Mental State Examination. To further show the differences in each fall risk factor between groups, the effect size, represented by Cohen’s d was calculated and reported inside the parentheses. The values (in mean ± standard deviation) of all fall risk factors at each assessment were provided in the supplementary file
Background Although vibration training has been applied in older adults, it remains unclear if it can reduce falls. Aims This pilot randomized-controlled trial aimed to test the effects of an 8-week vibration training program on reducing falls among community-dwelling adults. Methods Forty-eight older adults were randomized to two groups: training and control. The training group received three weekly training sessions over eight weeks while the control group maintained their normal lifestyle over the 8-week period. Immediately before (or baseline), following (post-training), and three months after (retest) the 8-week training course, a group of fall risk factors were assessed for all participants. Each participant was also exposed to an unexpected gait-slip on a treadmill during post-training and retest sessions. Their daily-living fall incidence was collected for 12 months after the baseline test. The slip fall was the primary outcome, prospective all-cause falls were the secondary outcome, and fall risk factors acted as the tertiary ones. Results The vibration training program significantly reduced the risk of slip-falls and improved all fall risk factors immediately after the training course. The training effect may be carried over for three months. The 8-week training program could also lower the number of falls between the baseline test and retest and reduce the recurrent faller rate across the 12 months after the baseline test. Discussion This study indicates that vibration training might have some effects on fall-related measures in older adults. Conclusions An 8-week vibration training program could be effective to reduce falls in older adults. registration number NCT02694666.
Background Little is known about the incidence of haematoma, and clinical correlates among orthogeriatric patients. Aims This study aims to describe the incidence of haematoma after surgical repair of hip fracture and to identify the clinical correlates of haematoma among orthogeriatric patients. Methods Two orthopaedic surgeons and a dedicated operator using ultrasound technique, each other in blindness, evaluated 154 orthogeriatric patients during their hospital stay. All patients received a comprehensive geriatric assessment. We investigated the concordance between clinical diagnosis and ultrasound detection of haematoma, and then we explored the clinical correlates of the onset of post-surgical haematoma. Results Blood effusion at the surgical site was detected in 77 (50%) patients using ultrasound technique; orthopaedic surgeons reached a clinical agreement about post-surgical haematoma in 18 (23%) patients. The sensitivity of clinical evaluation was 0.66, and the specificity was 0.70. Independent of age, clinical, pharmacological, and surgical confounders, proton pump inhibitors (PPIs) were associated with post-surgical haematoma (OR 2.28; 95% CI 1.15–4.49). A tendency towards association was observed between selective serotonin reuptake inhibitors and post-surgical haematoma (OR 2.10; 95% CI 0.97–4.54), Conclusions Half of older patients undergoing surgical repair of proximal femoral fracture develop a post-surgical haematoma. Clinical assessment, even if made by senior orthopaedic surgeons, underestimates the actual occurrence of post-surgical haematoma compared to ultrasound detection. Ultrasound technique may help to detect haematoma larger than 15 mm better than clinical assessment. PPIs’s use is a risk factor for post-surgical haematoma independent of several medical and surgical confounders.
Flowmetry change over time stratified according to the age
PSA change over time stratified according to the age
IPSS change over time stratified according to the age
Background Benign Prostatic Obstruction (BPO) is the most common non-malignant urological condition among men and its incidence rise with age. Among prostate treatments, GreenLight laser seems to reduce bleeding and would be safer in the aging population. Aims We aimed to compare the functional outcomes and safety profile of < 75 years old (Group A) and ≥ 75 years old (Group B) patients. Methods In a multicenter setting, we retrospectively analyzed all the patients treated with GreenLight Laser vaporization of the prostate (PVP). Results 1077 patients were eligible for this study. 757 belonged to Group A (median age 66 years) and 320 to Group B (median age 78 years). No differences were present between the two groups in terms of prostate volume, operative time, hospital stay, PSA decrease over time after surgery, complications and re-intervention rate with a median follow-up period of 18 months (IQR 12–26). Nevertheless, focusing on complications, GreenLight laser PVP demonstrated an excellent safety profile in terms of hospital stay, re-intervention and complications, with an overall 29.6% complication rate in older patients and only two cases of Clavien III. Functional outcomes were similar at 12 month and became in favor of Group A over time. These data are satisfactory with a Qmax improvement of 111.7% and an IPSS reduction of 69.5% in older patients. Discussion and conclusions GreenLight laser photoselective vaporization of the prostate is a safe and efficient procedure for all patients, despite their age, with comparable outcomes and an equal safety profile.
Balance test performance among older adults by sex, LASI wave-1, 2017–18
Background Ageing entails a decline in physical and functional abilities including a reduced body balance due to complex integration and coordination of sensory acuity, motor control, neural and cognitive functions. This study aimed to examine the association between tandem balance test and cognitive impairment among older Indian adults. The study also examined the gender differentials in the associations with an interaction analysis. Methods Data for this study were drawn from the recent release of the Longitudinal Ageing Study in India (2017–18). The total sample size for the present study included 26,539 older adults age 60 years and above. Descriptive statistics and bivariate analysis were used to present the preliminary results. Two sample proportion test was used to evaluate the significance for gender differences. Further, multivariable binary logistic regression analysis was used to evaluate the independent association of balance test performance and cognitive impairment among older adults. Results Nearly 16% of male and 26% of female older adults could not finish full tandem test in this study. There were significant gender differences in cognitive impairment among older adults (male—6.5% and female—18.9%). The likelihood of cognitive impairment was significantly higher among older adults who could not finish the full tandem test compared to those who finished the tandem test [AOR: 1.22; CI: 1.09–1.36]. The interaction model revealed that older females who could not finish the full tandem test were 2.11 times significantly more likely to be cognitively impaired in reference to older males who finished the full tandem test [AOR: 2.11; CI: 1.81,2.45]. Similarly, older females who finished the full tandem test were 2.42 times significantly more likely to be cognitively impaired in reference to older males who finished the full tandem test [AOR: 2.42; CI: 2.02,2.88]. Conclusion The findings of the study suggest that healthcare professionals working with older adults should consider the results of a balance test to screen for their risk of cognitive impairment. Results from the relationship between failing to finish the tandem test and cognitive impairment may be helpful for identifying older men and women who are at higher risk of experiencing mobility decline and their progression to dementia.
Objective To investigate comorbidities among hospitalized patients with dementia. Method Data were extracted from the discharge records in our hospital. Comorbidities based on ICD-10 were selected from the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The distributions of these comorbidities were described in dementia inpatients and age- and sex-matched nondementia controls, as well as in inpatients with Alzheimer’s disease and vascular dementia. A logistic regression model was applied to identify dementia-specific morbid conditions. Results A total of 3355 patients with dementia were included, with a majority of 1503 (44.8%) having Alzheimer's disease, 395 (11.8%) with vascular dementia, and 441 (13.1%) with mixed dementia. The mean number of comorbidities was 3.8 in dementia patients (vs. 2.9 in controls). The most prevalent comorbidities in inpatients with dementia compared with those without dementia were cerebral vascular disease (73.0% vs. 35.9%), hypertension (62.8% vs. 56.2%), and peripheral vascular disease (53.7% vs. 31.2%). Comorbidities associated with dementia included epilepsy (OR 4.8, 95% CI 3.5–6.8), cerebral vascular disease (OR 4.1, 95% CI 3.7–4.5), depression (OR 4.0, 95% CI 3.2–5.0), uncomplicated diabetes (OR 1.5, 95% CI 1.4–1.7), peripheral vascular disease (OR 1.8, 95% CI 1.6–2.0), rheumatoid arthritis collagen vascular disease (OR 1.7, 95% CI 1.3–2.3), and anemia (OR 1.2, 95% CI 1.04–1.3). Some comorbidities suggested a protective effect against dementia. They were hypertension (OR 0.8, 95% CI 0.7–0.9), COPD (OR 0.6, 95% CI 0.5–0.6), and solid tumor without metastasis (OR 0.4, 95% CI 0.3–0.4). Vascular dementia has more cardiovascular and cerebrovascular comorbidities than Alzheimer's disease. Conclusion Patients with dementia coexisted with more comorbidities than those without dementia. Comorbidities (esp. cardio-cerebral vascular risks) in patients with vascular dementia were more than those in patients with AD. Specifically, vascular and circulatory diseases, epilepsy, diabetes and depression increased the risk of dementia.
Comparison of age- and BMI-adjusted ROC curves for men and women at the lumbar spine (LS) and femoral neck (FEM). ROC curves showing sensitivity and specificity of REMS BMD T-score (green), DXA BMD T-score (blue) and Fragility Score (red) adjusted for age and body mass index (BMI), with a grey diagonal line representing the null hypothesis (area under the curve, AUC = 0.5)
Background: Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. Aims: The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. Methods: Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. Results: Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472-0.709. Conclusion: FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.
Objective To explore the risk factors of elderly patients with frozen shoulder. Methods 262 cases of scapulohumeral periarthritis treated in our hospital from January 2020 to December 2020 were analyzed retrospectively. According to the age of patients, patients younger than 60 years old were divided into middle-aged group (101 cases), patients between 60 and 75 years old were divided into old-aged group (91 cases), and patients ≥ 75 years old were divided into old-aged group (70 cases). The general demographic data and clinical data of the three groups were compared. Visual analogue scale (VAS) was used to evaluate the degree of pain. Finally, the dependent variable is set as whether the onset age of scapulohumeral periarthritis patients is advanced. Univariate and multivariate Logistic regression was used to analyze the risk factors of frozen shoulder patients at an advanced age. Results There were no significant differences in general demographic data, fixed position, hypertension history, smoking history, drinking history, supraspinatus muscular atrophy and physical exercise among the three groups (all P > 0.05). The course of disease, diabetes, surgical treatment, pain degree, operation time, cholecystitis, coronary heart disease, pain degree three months after operation and cervical spondylosis in the elderly group were all higher than those in the middle-aged group and the elderly group, and the differences were statistically significant (all P < 0.05). The course of scapulohumeral periarthritis, the degree of pain and the degree of pain 3 months after operation in the elderly group were higher than those in the middle-aged group, with significant differences (all P < 0.05). Univariate Logistic regression analysis showed that the risk factors of scapulohumeral periarthritis in the elderly included diabetes mellitus (OR = 3.067, 95% CI 1.881–4.587, P < 0.001), operative treatment (OR = 3.076, 95% CI 1.365–6.765, P = 0.006), VAS score (OR = 2.267, 95% CI 1.117–3.887, P = 0.013), operation time (OR = 1.537, 95% CI 1.305–2.579, P < 0.001), cholecystitis (OR = 2.143, 95% CI 1.019–4.876, P = 0.023), coronary heart disease(OR = 3.128, 95% CI 1.428–7.019, P = 0.005), VAS at 3 months after operation (OR = 1.537, 95% CI 0.786–2.635, P = 0.002), and cervical spondylosis(OR = 1.162, 95% CI 1.029–1.321, P = 0.012). Multivariate logistic regression analysis showed that the risk factors for the onset of the disease at advanced age included fatty infiltration (OR = 4.021, 95% CI 2.981–9.682, P < 0.001), surgical treatment (OR = 4.109, 95% CI 1.419–7.832, P = 0.008), VAS score (OR = 3.081, 95% CI 1.042–7.931, P = 0.046) and operation time (OR = 1.537, 95% CI 1.305–2.579, P < 0.001). Conclusion Risk factors of frozen shoulder at advanced age include fat infiltration, surgical treatment, VAS score and surgical time. In clinical practice, we should refer to the above indicators to help patients with early medical intervention and prevent their onset.
Background Information on the association between disability and severity of white matter hyperintensities (WMH) among stroke-free individuals is limited. We aimed to assess this association in apparently healthy older adults.Methods Following a population-based cross-sectional design, community-dwelling older adults received a brain MRI to grade WMH severity and the Functional Activities Questionnaire to assess the ability to perform activities of daily living. Demographics, clinical risk factors and other markers of cerebral small vessel disease were taken into consideration for analysis.ResultsUnadjusted analysis showed a significant association between moderate-to-severe WMH and disability (p = 0.003) that was tempered by the effect of age. Causal mediation analysis showed that age took away 65.9% of the effect of WMH severity on disability. An interaction model showed that disability was higher only among subjects with moderate-to-severe WMH above the median age.Conclusions Increasing age mediates the probability of WMH-related disability in stroke-free individuals.
Patient inclusion flow chart
Association of B-vitamins intake with frailty risk in patients with COPD. Crude model adjusted for none; Model I adjusted for age, gender, marital status, family income, and education level; Model II adjusted for total energy intake and total protein intake; Model III adjusted for age, gender, marital status, family income, education level, total energy intake, total protein intake, albumin, smoking status, and CCI. *, < 0.05; **, < 0.01; ***, < 0.001
Unadjusted and Adjusted Logistic Regression Curves. A Unadjusted Logistic Regression Curves; B Adjusted Logistic Regression Curves
Purpose Gain insight into the impact of B vitamins, including vitamin B1, vitamin B2, niacin, vitamin B6, total folate, and vitamin B12 on the risk of frailty in patients with chronic obstructive pulmonary disease (COPD). Methods This study was an American population-based cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES). A total of 1201 COPD patients were included in the analysis. Of these, the intake of B vitamins was determined by the two 24-h recall interviews. We followed the method constructed by Hakeem et al. to calculate the frailty index (FI), which is used as a reliable tool to assess the debilitating status of patients with COPD. Missing data were imputed by the MissForest method based on random forests. Multivariate logistic regression model and inverse probability weighted based on propensity scores were used to correct for confoundings. Results Logistic regression models showed that vitamin B6 intake was negatively correlated with frailty risk in COPD patients, while other B vitamins including B1, B2, niacin (vitamin B3), total folic acid and vitamin B12 were not. After adjusting for covariates, the association between vitamin B6 and frailty risk (adjusted OR = 0.80, 95%CI = 0.66–0.95, P = 0.013) remained significant. At the same time, sensitivity analysis proves the robustness of the results. Conclusion COPD patients with lower vitamin B6 intake have a higher risk of frailty. However, intake of vitamin B1, B2, niacin, total folic acid, and vitamin B12 was not associated with frailty risk in COPD patients.
Flowchart of the studydesign of the feasibility study investigating the time requirements for the performance of the Multidimensional Prognostic Index (MPI)
Time needed to perform MPI (min) in the three geriatric departments (cohorts 1-3) as visited en bloc sequentially
Background Comprehensive Geriatric Assessment (CGA) is decisive in patient-centered medicine of the aged individual, yet it is not systematically used. Aim The aim of this study was to provide precise practice-relevant time expenditure data for the Multidimensional Prognostic Index (MPI), a questionnaire-based frailty assessment tool. Methods MPI was determined in ninety older multimorbid adults in three geriatric departments (cohorts 1, 2 and 3). The time needed to perform the MPI (tnpMPI) was recorded in minutes. Follow-up data were collected after 6 months. Results The median tnpMPI was 15.0 min (IQR 7.0) in the total collective. In the last visited cohort 3, the median was 10.0 min and differed significantly from cohorts 1 and 2 with medians of 15.5 and 15.0 ( p < 0.001). Conclusion These findings indicate, that MPI, as a highly informative frailty tool of individualized medicine, can be performed in an adequately practicable time frame.
Study flow chart. ABB Abbiategrasso brain bank
Bland–Altman plots representing agreement between scores obtained in the remote (phone call or videoconference) and face-to-face modality. X-axis reports average between two scores, y-axis the difference between the two scores. Good agreement is matched if the bias (middle dashed line) is close to 0 (solid black line) and within its limits of agreement (upper and lower dashed lines). Colored areas represent 95% confidence intervals: purple for the Bias, green for its upper limit of agreement, pink for its lower limit of agreement. MoCA Montreal Cognitive Assessment, RAVLT Rey Auditory Verbal Test, RME Reading the Mind in the Eye
Background The SARS-CoV-2 pandemic forced to rethink teleneuropsychology, since neuropsychological assessments started to be performed by phone or videoconference, with personal devices and without direct assistance from the clinician, a practice called “Direct-To-Home NeuroPsychology” (DTH-NP).AimsThe present study, employing a counterbalanced cross-over design, was aimed at evaluating (1) the feasibility and (2) the acceptability of DTH-NP in Italian older adults without previously diagnosed neurocognitive disorder, (3) the comparability between remote and face-to-face administration of selected neuropsychological tests.Methods Fifty-eight community-dwelling older adults (65–85 years) were randomly assigned to one of two groups performing a complete neuropsychological assessment remotely (via phone call and videoconference) and face-to-face, in a counterbalance order, 8 weeks apart. The study recruitment rate was calculated, and the number of uncompleted tests and acceptability questionnaire responses were compared between the two administration modalities. Comparability was defined as good reliability of DTH-NP (intraclass correlation coefficient) and agreement between remote and face-to-face scores (Bland–Altman plots).ResultsRecruitment rate was 81%, with a preference for telephonic contact (79%). The acceptability analysis did not reveal any issues related to the DTH-NP assessment, even if most participants would rather repeat it face-to-face. Tests assessing short-term memory, language, and reasoning showed good comparability.Discussion and conclusionOur results point out to a good recruitment rate in a DTH-NP study in an Italian population of older adults (mean age = 80), satisfying acceptability of DTH-NP and remote–face-to-face comparability of certain verbally mediated tests. Further studies including larger samples in videoconference modality, and outpatients, could better clarify its strengths and limits.
The flowchart of this study
The mean changes of BMD at lumbar (A), femoral neck (B), and total hip (C). ¶p < 0.001, vs. BMD in ALN; &p < 0.001, vs. BMD at baseline in TPTD; ❈p < 0.01, vs. BMD at baseline in ALN; ¤p < 0.05, vs. BMD at baseline in TPTD
The VAS score at baseline and 12 months, n.s. denotes not significant
The biochemical markers of bone turnover. A The curve of PINP changes; B the curve of CTX changes; ¶p < 0.001, vs. ALN; §p < 0.01, vs. PINP value at baseline in TPTD; &p < 0.001, vs. CTX value at baseline in ALN
The comparison of refracture numbers
Background Percutaneous vertebroplasty was the most common strategy for osteoporotic vertebral compression fracture. However, refracture after vertebroplasty also occurred and bone mineral density (BMD) was one of the main factors associated with refracture after percutaneous vertebroplasty. Aims To investigate the efficacy of a short-sequential treatment of teriparatide followed by alendronate on prevention of refracture after percutaneous vertebroplasty in osteoporotic patients, and compare it with the therapy of alendronate alone. Methods From January 2018 to January 2020, we recruited 165 female osteoporosis patients after percutaneous vertebroplasty who were assigned into sequential treatment of teriparatide followed by alendronate group (TPTD + ALN group) and alendronate alone group (ALN group). The vertebral fracture occurred during this process was also recorded in both the groups. A total of 105 participants completed the 1-year follow-up. Furthermore, BMD and serum procollagen type I N-terminal propeptide (PINP) and C-terminal cross-linking telopeptide of type I collagen (CTX) were compared between the two groups during 1-year follow-up. Results The 105 patients were finally included, with 59 in ALN group and 46 in TPTD + ALN group. During 1-year follow-up, the vertebral refracture rate in TPTD + ALN group was much lower than that in ALN group (2.2% vs. 13.6%, p < 0.05). At 12 months, the BMDs at lumbar in TPTD + ALN group were significantly elevated when compared to the ALN group (0.65 ± 0.10 vs. 0.57 ± 0.07, p < 0.001). Discussion and conclusion A short-sequential administration of teriparatide followed by alendronate was more effective in elevating the BMD and decreasing the refracture rate at 12-month follow-up, compared to the counterpart with alendronate alone.
Background Altered serum magnesium (Mg) levels in older persons have been hypothesized to have a role in predicting hospitalization and mortality. Hypomagnesemia and delirium are frequent problems in older patients, but no study has evaluated such an association in acute geriatric setting. Aims We investigated the impact of hypomagnesemia on the incidence of delirium in an acute geriatric setting. Methods This retrospective study was conducted on 209 older hospitalized patients. All subjects underwent a comprehensive geriatric assessment. Mg was measured in serum by routine laboratory methods. The presence of incident delirium was determined by the 4AT screening tool. A logistic regression model was used to assess the association between serum Mg and delirium controlling for multiple covariates. Results 209 patients (77.9% women) were included in the study. The mean age of the participants was 85.7 ± 6.50 years (range 65–100). 27 subjects (12.9%) developed delirium during the hospitalization, with no difference between genders. Subjects with delirium had lower serum magnesium levels than those without (1.88 ± 0.34 versus 2.04 ± 0.28; p = 0.009). Delirium risk was significantly higher in patients with lower serum magnesium levels (OR 5.80 95% CI 1.450–23.222; p = 0.013), independent of multiple covariates. Conclusion Our data show that low serum Mg level is a good predictor of incident delirium in acute geriatric settings. Present findings have relevant implications for clinical management, highlighting the need for analyzing Mg concentration carefully. Whether Mg supplementation in patients with hypomagnesemia could lead to delirium prevention and/or control needs further investigation.
Mean (M) and standard deviations (SD) of the demographic characteristics and screening measures
This study newly investigated the joint contribution of metamemory and personality (traits and facets) in explaining episodic memory (EM) performance in typically aging older adults. Forty-eight participants (age range: 64–75 years) completed a self-paced word list (SPWL) recall task, a metamemory questionnaire assessing perceived control and potential improvement (PCPI) and self-efficacy and satisfaction (SESA) regarding one’s mental abilities (e.g., memory), and the Big-Five Questionnaire. Based on the SPWL encoding strategies reported, participants were then classified as effective ( N = 20) or ineffective ( N = 28) memory strategy users. Hierarchical regression analyses showed that a better SPWL performance was predicted by higher levels of PCPI, Scrupulousness and Dominance personality facets. Effective memory strategy users, then, showed higher SPWL performance and Dominance (Energy facet) than ineffective ones. These findings suggest that both specific metamemory processes and personality facets predict better EM performance in older adults. Moreover, personality dispositions relating to Dominance seem to characterize individuals adopting effective memory strategies to support EM performance. These results represent first evidence of the role of both metamemory and personality—facets—in explaining older adults’ EM performance, which should thus be considered when assessing or training EM in old age.
Schematic of collision avoidance trial. The white smiley face and arrows represent the path of the participant, and the gray smiley face and arrow represents the path of the moving hazard. Point A represents the 10-m mark at which the bystander began walking toward the participant
Acceleration magnitudes by group, environment, and epoch for a mean AP acceleration, b peak AP acceleration, c mean ML acceleration, d peak ML acceleration. The dark boxplots indicate older adults with a fall history, and the light boxplots indicate older adults without a fall history. Asterisks indicate significant differences, *p < 0.05
Background Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance.AimsThis study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings.Methods Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants’ first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments.ResultsIn the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history.Conclusions These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.
Background Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood.AimThe purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals.Methods Included were middle-aged adults (40–64 years) and older adults (≥ 65 years) from the 2003–2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate–vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance.ResultsNo significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006).DiscussionLPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance.ConclusionA significant relationship is found between age and fall risk, which is a major concern in the aging population.
The average comorbidities a Charlson Comorbidity Index and b ASA classification between patients with concomitant fractures and isolated hip fractures. a CCI, b ASA classification
Comparison of length of hospital stay for hip fractures only and concomitant fractures
a Comparison of mortality rate between the two matched groups. b Comparison of complication rate between the two matched groups
Background Impact of concomitant fractures on patients sustaining a proximal femur fracture remains unclear. Rising numbers and patient need for rehab is an important issue. The objective of our study was to investigate the impact of concomitant fractures, including all types of fractures, when treated operatively, for proximal femur fractures on the length of hospital stay, in-house mortality and complication rate. Methods Observational retrospective cohort single-center study including 85 of 1933 patients (4.4%) with a mean age of 80.5 years, who were operatively treated for a proximal femoral and a concomitant fracture between January 2016 and June 2020. A matched pair analysis based on age, sex, fracture type and anticoagulants was performed. Patient data, length of hospital stay, complications and mortality were evaluated. Results The most common fractures were osteoporosis-associated fractures of the distal forearm ( n = 34) and the proximal humerus ( n = 36). The group of concomitant fractures showed a higher CCI than the control group (5.87 vs. 5.7 points; p < 0.67). Patients with a concurrent fracture had a longer hospital stay than patients with an isolated hip fracture (15.68 vs. 13.72 days; p < 0.056). Complications occurred more often in the group treated only for the hip fracture (11.8%, N = 20), whilst only 7.1% of complications were recorded for concomitant fractures ( p < 0.084). The in-house mortality rate was 2.4% and there was no difference between patients with or without a concomitant fracture. Conclusions A concomitant fracture to a hip fracture increases the length of hospital stay significantly but does not increase the complication rate or the in-house mortality. This might be due to the early mobilization, which is possible after early operative treatment of both fractures.
The well-established J-shaped relationship between habitual PA and EI in younger adults (black line), and the proposed distorted J-shaped relationship between habitual PA and EI in older adults (red line)
Poor appetite in later life—termed “anorexia of ageing”—is acknowledged as a key determinant of age-related malnutrition. While physical activity (PA) is often recommended for increasing drive to eat, these recommendations are not well-evidenced in the older population. In this opinion piece we outline limitations to physical activity recommendations in anorexic older adults. We then discuss current evidence for the relationship between physical activity and appetite amongst younger adults and postulate how this relationship may change in later life, with implications regarding future recommendations and research.
Purpose: This study aimed to explore the correlation between nutritional status screening using the MNA-SF and stroke-associated infections (SAI) in older adults. Methods: A retrospective study of patients aged over 70 years with acute stroke was conducted. The patients were divided into normal nutritional status, malnutrition risk, and malnutrition groups depending on their baseline MNA-SF scores. The correlation between nutritional status and SAI was identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to demonstrate the predicted value of MNA-SF. Results: 497 patients were included, 101 (20.32%) developed SAI. 32.29% of patients with malnutrition developed SAI, while 25.14% of those with malnutrition risk developed SAI. Malnutrition (aOR 4.58, 95% CI 2.34-8.96, p < 0.001) and risk of malnutrition (aOR 3.70, 95%CI 2.01-6.85, p < 0.001) were independent risk factors for SAI in older stroke patients. The area under the curve (AUC) value of MNA-SF was 0.713. Conclusion: MNA-SF is a simple and effective nutritional screening tool for predicting the occurrence of SAI in older patients with acute stroke.
An example of an exercise snack delivered and monitored entirely remotely
Enablers and barriers of participating in a home-based pragmatic exercise snacking program
Background ‘Exercise snacking’, which is characterised by shorter and more frequent exercise bouts compared with traditional exercise guidelines, may be an acceptable strategy for increasing physical activity and reducing sedentary behaviour in older adults. Aim The aim of this study was to evaluate the enablers and barriers for older adults associated with participation in a home-based exercise snacking program delivered and monitored using an Amazon Echo Show 5 device (Alexa). Methods This study used an interpretive description qualitative design to conduct semi-structured interviews following a 12-week pilot study in 15 adults aged 60–89 years with at least one chronic condition. All participants were prescribed a home based, individualised, lower limb focussed ‘exercise snacking’ program (involving ≤ 10 min of bodyweight exercises 2–4 times per day) delivered and monitored by an Alexa. Qualitative interview data were analysed using thematic analysis. Results All 15 participants (mean age 70.3 years) attended the semi-structured interview. Themes including time efficiency, flexibility, perceived health benefits, and motivation were enablers for participation in the ‘exercise snacking’ program. A lack of upper body exercises and omission of exercise equipment in the program, as well as a lack of time and motivation for performing exercise snacks three or more times per day, were barriers to participation. Conclusion While ‘exercise snacking’ is acceptable for older adults, future trials should provide equipment (e.g. adjustable dumbbells, exercise bands), prescribe whole-body exercise programs, and establish strategies to support participation in more than three exercise snacks per day.
Overview of the study
Background Recorded and live online physical exercise (PE) interventions are known to provide health benefits. However, the effects of prioritizing the number of live or recorded sessions remain unclear.AimsTo explore which recorded-live sessions ratio leads to the best implementation and benefits in older adults.Methods Forty-six community-dwelling adults (> 60y.o.) were randomized into two groups completing a 12-week online PE intervention. Each group had a different ratio of live-recorded online sessions as follows: Live-Recorded-Live sessions (LRL; n = 22) vs. Recorded-Live-Recorded sessions (RLR; n = 24).ResultsDrop-out rates did not reach significance (LRL:14% vs. RLR: 29%, p = 0.20), and adherence was similar (> 85%) between groups. Both groups reported similar levels of satisfaction (> 70%), enjoyment (> 75%), and perceived exertion (> 60%). Both groups increased physical health and functional capacities, with greater improvements in muscle power (LRL: LRL: + 35 ± 16.1% vs. RLR: + 7 ± 13.9%; p = 0.010) and endurance (LRL: + 34.7 ± 15.4 vs. RLR: + 27.0 ± 26.5, p < 0.001) in the LRL group.DiscussionBoth online PE intervention modalities were adapted to the participants’ capacities and led to a high level of enjoyment and retention. The greater physical improvements observed in the LRL group are likely due to the higher presence of the instructor compared to the RLR group. Indeed, participants received likely more feedback to appropriately adjust postures and movements, increasing the quality of the exercises.Conclusion When creating online PE interventions containing both recorded and live sessions, priority should be given to maximizing the number of live sessions and not the number of recorded sessions.
PRISMA flow diagram of the literature search
estimates of meta-analyses regarding sexual function (desire, arousal, lubrication, orgasm, satisfaction, pain), female coital incontinence, and treatment of UI
estimates of meta-analyses regarding mental health (depression, anxiety, and SF-36 score) and UI
estimates of meta-analyses regarding quality of life and systemic disease and UI
Background and aim We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. Methods We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results and discussion From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10−6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551–2.124), and anxiety (OR = 1.498; 95% CI: 1.273–1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053–2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). Conclusions UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.
The flow of the participants
The estimated prevalence of frailty and pre-frailty in Poland
Components of frailty according to sex and age, the entire population
Components of frailty according to the disease burden. Pre-frail and frail persons
Background The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. Aims To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. Methods From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. Results Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6–17.1%), and of pre-frailty 55.8% (53.3–58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7–60.0%), followed by weakness 26.9% (25.4–28.4%), exhaustion 19.2% (17.6–20.8%), low physical activity 16.5% (14.8–18.3%), and weight loss 9.4% (8.4–10.3%). Conclusions Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty.
The Kaplan–Meier curve for cardiovascular readmission and all-cause mortality
Logistic regression analysis of risk factors for HAFD. HAFD hospital-acquired functional decline; BMI body mass index; NYHA New York Heart Association; DM diabetes mellitus; CKD chronic kidney disease; COPD chronic obstructive pulmonary disease; ICU intensive care unit; OR odds ratio; CI confidence interval. *P < 0.05
Background Hospital-acquired functional decline (HAFD) is a new predictor of poor prognosis in hospitalized older patients. Aims We aimed to assess the impact of HAFD on the prognosis of older cardiac surgical patients 2 years after discharge. Methods This multicenter prospective cohort study assessed 293 patients with cardiac disease aged ≥ 65 years who underwent cardiac surgery at 7 Japanese hospitals between June 2017 and June 2018. The primary endpoint was the composite outcome of cardiovascular-related readmission and all-cause mortality 2 years after discharge. HAFD was assessed using the total Short Physical Performance Battery at hospital discharge. Results The primary outcome was observed in 17.3% of the 254 included patients, and HAFD was significantly associated with the primary outcome. Female sex (hazard ratio [HR], 2.451; 95% confidence interval [CI] 1.232–4.878; P = 0.011), hemoglobin level (HR, 0.839; 95% CI 0.705–0.997; P = 0.046), preoperative frailty (HR, 2.391; 95% CI 1.029–5.556; P = 0.043), and HAFD (HR, 2.589; 95% CI 1.122–5.976; P = 0.026) were independently associated with the primary outcome. The incidence rate of HAFD was 22%, with female sex (odds ratio [OR], 1.912; 95% CI 1.049–3.485; P = 0.034), chronic obstructive pulmonary disease (OR, 3.958; 95% CI 1.413–11.086; P = 0.009), and the time interval (days) between surgery and the start of ambulation (OR, 1.260, 95% CI 1.057–1.502; P = 0.010) identified as significant factors. Discussion HAFD was found to be an independent prognostic determinant of the primary outcome 2 years after discharge. Conclusion HAFD prevention should be prioritized in the hospital care of older cardiac surgery patients.
Scatterplot of the baseline FGF23 (pg/mL) and M12 FGF23 (pg/mL) with the line of identity. Clear circles placebo, Black circles vitamin D
Background Recent meta-analyses report that vitamin D supplementation increases blood fibroblast growth factor-23 (FGF23) level. Objectives To determine the effect of 4000 IU/day of vitamin D3 for 12 months on circulating FGF23 levels. We also examined the association of the achieved 25-hydroxyvitamin D level [25(OH)D] with the FGF23 level at 12 months and with 12-month changes in FGF23. Methods An ancillary analysis among adults 70 years and older with prediabetes who participated in a trial comparing vitamin D3 4000 IU/day with placebo. Plasma intact FGF23 and serum 25(OH)D were measured at baseline and month 12 (M12). Results Characteristics of the 52 participants (vitamin D3n = 28; placebo n = 24) did not differ significantly aside from more women than men in the vitamin D3 group. Mean ± SD age was 73.8 ± 3.7 years, BMI 31.3 ± 4.2 kg/m2, and glomerular filtration rate (GFR) 76.3 ± 11.8 mL/min/1.73m² Baseline serum 25(OH)D level was 33.4 ± 10.8 ng/mL and increased at M12 to 54.9 ± 14.8 ng/mL in the vitamin D3 group versus 33.4 ± 14.9 in the placebo (p < 0.001). At baseline, GFR was inversely associated with FGF23 (r = − 0.349, p = 0.011). Change in FGF23 level at M12 did not differ significantly between vitamin D3 and placebo. In all participants combined, the achieved serum 25(OH)D level at M12 was not significantly associated with the M12 plasma FGF23 or the M12 change in FGF23. Conclusion In obese older adults with sufficient vitamin D status and normal renal function, vitamin D3 4000 IU/day for 12 months did not significantly alter plasma intact FGF23 levels. NCT 01,942,694, registered 9/16/2013.