Geriatrics doi: 10.3390/geriatrics9020042
Authors: Yu-Tai Lo Jin-Jy Wang Yi-Ching Yang Chiu-Yen Yu Chia-Ming Chang Ya-Ping Yang
Advance care planning (ACP) has the potential to improve the outcomes of end-of-life care for residents in nursing homes. The aim of this study was to determine whether an ACP program was beneficial for nursing home residents by assessing end-of-life indicators. An experimental study with a retrospective chart review was conducted. In total, 37 residents in the intervention group participated in an institutional advance care planning program for 1 year, and their chart data over 1 year were collected following the completion of the program; 33 residents in the control group had died within 1 year before the start date of program, and their chart data were reviewed retrospectively. Chi-square and t tests were used to examine four indicators of the quality of end-of-life care. Compared with the control group, the intervention group had a higher proportion of do-not-resuscitate directives, hospice care before death, and deaths in the nursing home, and fewer hospitalizations and deaths in an emergency department. ACP programs may improve the quality of end-of-life care for nursing home residents in Taiwan. Further research across different long-term care facilities is warranted.
]]>Geriatrics doi: 10.3390/geriatrics9020041
Authors: Elisabeta Ioana Hiriscau Omar Cauli Valer Donca Luminita-Aurelia Marinescu Antonia-Eugenia Macarie Lucretia Avram Oana-Gabriela Cancel Steliana Donca Elena-Cristina Buzdugan Dana-Alina Crisan Constantin Bodolea
This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65–90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one’s own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20–15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37–223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.
]]>Geriatrics doi: 10.3390/geriatrics9020040
Authors: Naoki Sugiyama Yoshihiro Kai Hitoshi Koda Toru Morihara Noriyuki Kida
Postural assessment is one of the indicators of health status in older adults. Since the number of older adults is on the rise, it is essential to assess simpler methods and automated ones in the future. Therefore, we focused on a visual method (imaging method). The purpose of this study is to determine the degree of agreement between the imaging method and the palpation and visual methods (clinical method). In addition, the influence of differences in the information content of the sagittal plane images on the assessment was also investigated. In this experiment, 28 sagittal photographs of older adults whose posture had already been assessed using the clinical method were used. Furthermore, based on these photographs, 28 gray and silhouette images (G and S images) were generated, respectively. The G and S images were assessed by 28 physical therapists (PTs) using the imaging method. The assessment was based on the Kendall classification, with one of four categories selected for each image: ideal, kyphosis lordosis, sway back, and flat back. Cross-tabulation matrices of the assessments using the clinical method and imaging method were created. In this table, four categories and two categories of ideal and non-ideal (KL, SB, and FB) were created. The agreement was evaluated using the prevalence-adjusted bias-adjusted kappa (PABAK). In addition, sensitivity and specificity were calculated to confirm the reliability. When comparing the clinical and imaging methods in the four posture categories, the PABAK values were −0.14 and −0.29 for the S and G images, respectively. In the case of the two categories, the PABAK values were 0.57 and 0.5 for the S and G images, respectively. The sensitivity and specificity were 86% and 57% for the S images and 76% and 71% for the G images, respectively. The four categories show that the imaging method is difficult to assess regardless of the image processing. However, in the case of the two categories, the same assessment of the clinical method applied to the imaging method for both the S and G images. Therefore, no differences in image processing were observed, suggesting that PTs can identify posture using the visual method.
]]>Geriatrics doi: 10.3390/geriatrics9020039
Authors: Matteo Briguglio Thomas W. Wainwright Marialetizia Latella Aurora Ninfa Claudio Cordani Cecilia Colombo Giuseppe Banfi Luca Francetti Stefano Corbella
The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.
]]>Geriatrics doi: 10.3390/geriatrics9020038
Authors: Jocelyn Shealy McGee Edward C. Polson Dennis R. Myers Angela McClellan Rebecca Meraz Weiming Ke Holly Carlson Zhao
The experience of burden among family caregivers of persons with Alzheimer’s disease and other forms of dementia may be deleterious for their health and well-being. Little is known, however, about the degree to which internal positive psychological resources, such as hope, influence burden perceptions in this population. The current study is novel in that it examined how multiple dimensions of hope, hope–agency and hope–pathway, influenced burden in a sample of one-hundred and fifty-five family caregivers of persons with Alzheimer’s disease. The stress process model was used as the theoretical framework for variable specification in this study. Hope was conceptualized using Snyder and colleagues’ hope theory. Supporting our first hypothesis, we found that burden was negatively associated with hope–agency, r = −0.33, p < 0.001 and hope–pathway, r = −0.24, p < 0.01. Multiple regression was used to determine if hope–agency and hope–pathway independently contributed to burden. Analysis revealed that hope–agency but not hope–pathway influenced burden when other key variables were taken into consideration. Findings from mediation analysis affirmed that hope–agency had a small but significant mediation effect between stress and burden in this sample. This study provides evidence for the relevance of assessing multiple dimensions of hope when working with caregivers of persons with Alzheimer’s. Although replication studies are warranted, the current study confirms a need for further development and refinement of hope-bolstering behavioral interventions which may mediate stress and burden in this population. These interventions should be systematically assessed for efficacy and effectiveness via implementation studies in real-world settings.
]]>Geriatrics doi: 10.3390/geriatrics9020037
Authors: Ryan M. Glatt Amylee Amos David A. Merrill John F. Hodes Claudia L. Wong Karen J. Miller Prabha Siddarth
Introduction: Adopting healthy lifestyle behaviors has the potential to slow cognitive decline in older adults by reducing risks associated with dementia. Curriculum-based group health coaching may aid in establishing behavior change centered for dementia risk factors. Methods: In this pilot clinical care patient group study (n = 6), we examined the effects of a six-month online Cognitive Health Program combined with a weekly telehealth support group led by the course creator, and personalized health optimization by a collaborating physician, in older adults with subjective cognitive decline. Cognition was assessed at baseline and post-intervention using a computerized battery. Results: Cognitive changes were estimated with nonparametric tests and effect sizes (Cohen’s d). Results showed significant improvements in global cognition (p < 0.03, d = 1.6), spatial planning (p < 0.01, d = 2.3), and visuospatial processing (p < 0.05, d = 1.1) compared to baseline. Participants reported high levels of satisfaction with the virtual group format and online curriculum. Conclusions: This small pilot study suggests that a virtual six-month personalized health coaching group with self-paced online health education is feasible and potentially efficacious for improving cognition in participants with subjective cognitive complaints. This format may facilitate behavior change to slow cognitive decline. Future studies should include a control group, a larger, more diverse sample as well as assessing mood and other subjective measures.
]]>Geriatrics doi: 10.3390/geriatrics9020036
Authors: Diogo Veiga Miguel Peralta Élvio R. Gouveia Marcelo de Maio Nascimento Laura Carvalho Jorge Encantado Adilson Marques
Background: Depression and cardiovascular diseases are two main health conditions contributing to the global disease burden. Several studies indicate a reciprocal association between them. It is still unclear how changes in overall muscle strength may impact this association. This study aimed to analyse how muscular strength moderates the relationship between cardiovascular events and depressive symptoms among middle-aged and older adults. Methods: Wave 8 of the population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) cross-sectional data, which included 41,666 participants (17,986 men) with a mean age of 70.65 (9.1) years old, was examined. Grip strength was measured twice on each hand using a dynamometer. The 12-item EURO-D scale was employed to gauge depressive symptoms. Results: Grip strength negatively moderates the link between cardiovascular events and depressive symptoms (male: B = −0.03, 95% CI = −0.04, −0.03; female: B = −0.06, 95% CI = −0.06, −0.05). Additionally, the grip strength moderation values in the significant zone for males and females were less than 63.2 kg and 48.3 kg, respectively. Conclusions: Muscular strength modifies depressive symptoms and lessens their correlation with cardiovascular diseases. Muscle-strengthening activities could be incorporated into primary and secondary preventive strategies to reduce the burden of depression in people with CVD.
]]>Geriatrics doi: 10.3390/geriatrics9020035
Authors: Nur Riviati Legiran Legiran Irsan Saleh Taufik Indrajaya Zulkhair Ali Irfannuddin Probosuseno
Sarcopenia, a condition characterized by muscle loss and decreased function in older adults, is a growing public health concern. This study aimed to investigate the effects of Ophiocephalus striatus extract on insulin-like growth factor-1 serum, interleukin-6 serum levels, and sarcopenia-related parameters in older adults with sarcopenia. This double-blind randomized controlled trial included 80 older adults with sarcopenia. Participants were randomly assigned to receive Ophiocephalus striatus extract or a placebo for two weeks. The IGF-1 serum and IL-6 serum levels were assessed as primary outcomes. The Ophiocephalus striatus extract intervention resulted in a significant reduction in serum IL-6 levels. Although the IGF-1 levels did not show significant changes, there was an increase for the intervention group. This study demonstrated that a 2-week intervention with Ophiocephalus striatus extract positively impacted the serum IL-6 levels in older adults with sarcopenia. While the IGF-1 levels did not change significantly in this short intervention period, the observed improvements in IGF-1, calf circumference, muscle mass, and muscle strength are promising. The findings suggest that Ophiocephalus striatus extract may offer a valuable intervention for managing sarcopenia, particularly in regions with abundant Ophiocephalus striatus production, such as South Sumatera. This study was registered with trial number NCT05869383.
]]>Geriatrics doi: 10.3390/geriatrics9020034
Authors: Pushpa Raj Joshi
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
]]>Geriatrics doi: 10.3390/geriatrics9020033
Authors: Andrew Pak Abriella Demanes Shirley Wu Katherine Ward Mailee Hess
The Centers of Medicare and Medicaid Services recently announced a new voluntary nationwide model. This model aims to provide comprehensive, standard care for people living with dementia and their unpaid caregivers and to enhance health equity in dementia care. However, little is known about the needs of older adults with dementia and their caregivers in a multiethnic and multicultural patient population of a safety net health system. The aim of this study is to include their voices. We conducted four focus groups in English and Spanish to investigate the common needs and barriers unique to the care of patients within the Los Angeles County healthcare system. Using qualitative, iterative analyses of the transcripts, we identified four domains of concern from the dyads (persons with dementia and their caregivers): need for education for dyad-centered care, barriers to resources, dyad safety, and caregiver burden and insight. These domains are interconnected, and the way this patient population experiences these domains may differ compared to those in well-resourced or predominantly English-speaking healthcare settings. Therefore, the identified domains serve as potential building blocks for dementia support programs inclusive of underserved, multicultural populations.
]]>Geriatrics doi: 10.3390/geriatrics9020032
Authors: Takaaki Miyazaki Toshihiro Futohashi Hiroki Baba
This systematic review and meta-analysis discusses the available data on the efficacy of diet, food intake, and exercise mixed interventions (DEMI) for community-dwelling older adults in Japan and assesses the evidence level. We searched the literature regarding the research questions using electronic and hand-searching methods. To ensure the reliability and quality of the evidence, we used the Cochrane risk of bias tool and GRADE system. All studies included DEMI; other interventions included group activities, health education, and community participation. All interventions were categorized into three classifications, namely “Diet and food intake”, “Exercise”, and “Other”. Programs included lectures, practical exercises, group activities, consulting, and programs that could be implemented at home. By comparing groups and measuring outcomes at various time points, most studies reported positive results regarding the impact of the interventions. Specifically, usual gait speed, Food Frequency Questionnaire Score, and Diet Variety Score demonstrated significant improvement. Additionally, three studies demonstrated improvement in frailty. This review suggests that DEMI resulted in improvements in some outcome variables. However, the efficacy of all variables was not fully examined. The results of the meta-analysis revealed positive outcomes for some variables, although the evidence level for these outcomes was considered moderate.
]]>Geriatrics doi: 10.3390/geriatrics9020031
Authors: Tsubasa Yokote Harukaze Yatsugi Tianshu Chu Xin Liu Lefei Wang Hiro Kishimoto
Background: The association of the individual and combined effects of moderate-to-vigorous physical activity (MVPA) and sleep quality with physical frailty in community-dwelling older adults is still unknown. Subjects and Methods: A cross-sectional study was conducted with a sample of older adults who had not required nursing care or support services. Physical frailty was assessed using Liu’s definition based on Fried’s concept. MVPA was measured by a triaxial accelerometer, and individuals who met either moderate physical activity (MPA) for ≥300 min/week, vigorous physical activity (VPA) for ≥150 min/week, or both were defined as “MVA+”. “SLP+” was defined as a Pittsburgh Sleep Quality Index score of <5.5 points. Results: A total of 811 participants were included in the final analysis. After adjusting for the multivariable confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) for physical pre-frailty and frailty in the MVA−SLP+ (OR, 2.56; 95%CI, 1.80–3.62) and the MVA−SLP− group (OR, 3.97; 95%CI, 2.33–6.74) were significantly higher compared with the MVA+SLP+ group. Conclusion: Community-dwelling older adults who did not meet the MVPA criteria, regardless of sleep quality, had a higher prevalence of physical frailty.
]]>Geriatrics doi: 10.3390/geriatrics9020030
Authors: Tatsushi Mutoh Yasuyuki Yoshida Yasuko Tatewaki Hongkun Chin Ryota Tochinai Junta Moroi Tatsuya Ishikawa
Background: Intravenous thrombolysis and mechanical thrombectomy are the first-line reperfusion therapies for acute ischemic stroke. Here, we describe the utility of diffusion magnetic resonance imaging (MRI) fiber tractography and 123I-iomazenil benzodiazepine receptor single-photon emission computed tomography to estimate the prognosis of post-stroke aphasia after successful reperfusion therapy. Case report: An 81-year-old man was admitted to the hospital approximately 3.5 h after the onset of symptoms, including decreased consciousness, right hemiparesis, and aphasia. An MRI revealed acute cerebral infarction due to M1 segment occlusion. Intravenous alteplase thrombolysis followed by endovascular thrombectomy resulted in recanalization of the left middle cerebral artery territory. A subsequent MRI showed no new ischemic or hemorrhagic lesions. Although the patient’s motor hemiparesis gradually recovered, motor aphasia persisted. Diffusion MRI fiber tractography performed 2 weeks after admission revealed partial injury to the left arcuate fasciculus, indicated by lower fractional anisotropy values than on the contralateral side. A decreased benzodiazepine receptor density was also detected in the left perisylvian and temporoparietal cortices. The patient showed no clear signs of further improvement in the chronic stage post-stroke and was discharged to a nursing home after 3 months. Conclusions: The application of functional neuroimaging techniques to assess neuronal damage to the primary brain regions 2 weeks after reperfusion therapy for large-vessel occlusion may allow for an accurate prognosis of post-stroke aphasia. This may have a direct clinical implication for navigating subacute-to-chronic phases of rehabilitative care.
]]>Geriatrics doi: 10.3390/geriatrics9020029
Authors: Rodrigo Muñoz-Cofré Ramón Pinochet-Urzúa Mariano del Sol Paul Medina-González Jorge Valenzuela-Vásquez Gerardo Molina-Vergara Rodrigo Lizama-Pérez Máximo Escobar-Cabello
To assess ventilatory evolution through the Ventilatory Workload Kinetic Index (VWKI) in patients with asthma and chronic obstructive pulmonary disease (COPD) during stability and exacerbation. Retrospective analysis. Conducted at the Padre Alberto Hurtado Hospital, Santiago, Chile. Ten patients with asthma and fifty-five with COPD participated. Sixty-five clinical records were reviewed. The VWKI in stability and exacerbation of these patients was extracted. When analyzing the baseline with the peak in both asthma and COPD, there was a significant increase in the VWKI. Similarly, the loads, translations, and supports significantly increased from the baseline to the peak. However, in the loads, there were no changes in airway resistance for asthma or in cough for COPD. Likewise, the supports for asthma and COPD showed no changes in the O2. The VWKI determined ventilatory issues in outpatients and made locating the greatest compromise in loads, translations, or supports possible.
]]>Geriatrics doi: 10.3390/geriatrics9020028
Authors: Pietro Gareri Luca Gallelli Ilaria Gareri Vincenzo Rania Caterina Palleria Giovambattista De Sarro
Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs’. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug–drug and drug–disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called “duplicate” drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.
]]>Geriatrics doi: 10.3390/geriatrics9020027
Authors: Takuya Omura Akemi Inami Taiki Sugimoto Shuji Kawashima Takashi Sakurai Haruhiko Tokuda
This observational pilot study aimed to investigate continuous glucose monitoring (CGM) metrics in older Japanese patients with type 2 diabetes mellitus (T2DM) using a CGM system (FreeStyle Libre Pro) during the first tirzepatide administration and compare the glycemic control measures before and after the initial injection. The four patients had a mean age of 79.5 years (standard deviation [SD]: 5.8), a mean body mass index of 24.6 kg/m2 (SD: 4.7), a mean glycated hemoglobin level of 9.1% (SD: 2.1), and a mean measurement period of 10.5 days (SD: 3.5). After the inclusion of tirzepatide treatment, the mean of time in range, time above range, and time below range changed from 53.2% to 78.9% (p = 0.041), 45.8% to 19.7% (p = 0.038), and 1.0% to 1.5% (p = 0.206), respectively. Improved hyperglycemia reduced the oral hypoglycemic medication in two cases and decreased the frequency of insulin injections in two cases. To elucidate the potential benefits of tirzepatide, future studies should investigate the long-term impact on functional prognosis, safety, and tolerability and distinguish between the use of other weekly agonists, especially in nonobese older Asian patients. However, tirzepatide-associated robust glycemic improvement may simplify diabetes treatment regimens in older patients with T2DM.
]]>Geriatrics doi: 10.3390/geriatrics9020026
Authors: Akihiko Goto Kosaku Komiya Kenji Umeki Kazufumi Hiramatsu Jun-ichi Kadota
Backgrounds: It remains unclear if antibiotics should be used for the treatment of acute aspiration bronchitis to prevent the development of pneumonia. This study aimed to assess the associations between the use of antibiotics and the development of pneumonia among patients with acute aspiration bronchitis. Methods: We retrospectively reviewed consecutive patients with acute aspiration bronchitis aged ≥75 years. Acute aspiration bronchitis was defined as a condition with aspiration risk, high fever (body temperature, ≥37.5 °C), respiratory symptoms, and the absence of evidence of pneumonia. Results: There was no significant difference in the incidence of pneumonia between patients treated with and without antibiotics for acute aspiration bronchitis (6/44, 14% vs. 31/143, 22%; p = 0.242). Lower estimated glomerular filtration rate (adjusted odds ratio, 0.956; 95% confidence interval, 0.920–0.993) was significantly associated with the development of pneumonia. Conclusions: Antibiotic administration should not be routinely recommended to prevent pneumonia following acute aspiration bronchitis, and patients with decreased renal function should be closely monitored. A randomized controlled trial is necessary to validate these results.
]]>Geriatrics doi: 10.3390/geriatrics9020025
Authors: Md Towfiqul Alam Elizabeth Vásquez Jennifer L. Etnier Sandra Echeverria
Although adherence to dietary guidelines is associated with better cognitive performance, there may be differences by nativity status. This study aimed to investigate the association between adherence to the healthy eating index (HEI) and cognitive performance (CP) among United States (US)-born and foreign-born older adults (60+ years). Data were obtained from the 2011–2014 NHANES (n = 3065). Dietary adherence was assessed with HEI quintiles. CP (adequate vs. low) was examined using word listing (CERAD), animal naming (AFT), and the digit symbol substitution test (DSST). Weighted multivariable logistic regressions were used to examine associations. The US-born participants in higher dietary quintiles had adequate CP when compared to foreign-born participants. In adjusted models, the US-born participants in the highest HEI quintile had increased odds of adequate DSST scores (odds ratio: 1.95, 95% confidence interval: 1.15–3.28) compared with those in the lowest quintile. Patterns of association were generally reversed for foreign-born participants and were non-statistically significant. Future research should consider the influence of diets in delaying or preventing decline in cognition and evaluate nutritional factors that contribute to cognitive outcomes for the foreign-born population.
]]>Geriatrics doi: 10.3390/geriatrics9020024
Authors: Santos Castañeda Carmen Navarro Ceballos Jaqueline Usón Jaeger Carolina de Miguel Benadiba Esteban Gómez Martín Guillermo Martínez Díaz-Guerra Luis Alvarez-Galovich
Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.
]]>Geriatrics doi: 10.3390/geriatrics9020023
Authors: Daniele Orso Giulia Furlanis Alice Romanelli Federica Gheller Marzia Tecchiolli Franco Cominotto
Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10−16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16–0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56–8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78–4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13–38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67–3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.
]]>Geriatrics doi: 10.3390/geriatrics9020022
Authors: Valerie K. Jones Changmin Yan Marcia Y. Shade Julie Blaskewicz Boron Zhengxu Yan Hyeon Jung Heselton Kate Johnson Victoria Dube
This study examines the potential of AI-powered personal voice assistants (PVAs) in reducing loneliness and increasing social support among older adults. With the aging population rapidly expanding, innovative solutions are essential. Prior research has indicated the effectiveness of various interactive communication technologies (ICTs) in mitigating loneliness, but studies focusing on PVAs, particularly considering their modality (audio vs. video), are limited. This research aims to fill this gap by evaluating how voice assistants, in both audio and video formats, influence perceived loneliness and social support. This study examined the impact of voice assistant technology (VAT) interventions, both audio-based (A-VAT) and video-based (V-VAT), on perceived loneliness and social support among 34 older adults living alone. Over three months, participants engaged with Amazon Alexa™ PVA through daily routines for at least 30 min. Using a hybrid natural language processing framework, interactions were analyzed. The results showed reductions in loneliness (Z = −2.99, p < 0.01; pre-study loneliness mean = 1.85, SD = 0.61; post-study loneliness mean = 1.65, SD = 0.57), increases in social support post intervention (Z = −2.23, p < 0.05; pre-study social support mean = 5.44, SD = 1.05; post-study loneliness mean = 5.65, SD = 1.20), and a correlation between increased social support and loneliness reduction when the two conditions are combined (ρ = −0.39, p < 0.05). In addition, V-VAT was more effective than A-VAT in reducing loneliness (U = 85.50, p < 0.05) and increasing social support (U = 95, p < 0.05). However, no significant correlation between changes in perceived social support and changes in perceived loneliness was observed in either intervention condition (V-VAT condition: ρ = −0.24, p = 0.37; A-VAT condition: ρ = −0.46, p = 0.06). This study’s findings could significantly contribute to developing targeted interventions for improving the well-being of aging adults, addressing a critical global issue.
]]>Geriatrics doi: 10.3390/geriatrics9010021
Authors: Kenta Tsutsui Shoko Ukita Masahiro Kondo Genta Toshima Naoki Miyazaki Kengo Nagashima Mitsuyo Ohmura Saki Tsuchihashi Yoshitaka Tsuji Makoto Katoh Naomi Aida Yoshiki Kobayashi Yui Ohtsu Yoshihiro Fujita Shukichi Tanaka Hiroki Watanabe Yasushi Naruse Isao Iizuka Hiromi Kato Yumi Mashimo Takaaki Senbonmatsu
Background: The second demonstration experiment of supporting elderly people going out with the Choisoko system was conducted. The first study showed that for women, friends, shopping, convenience, and events are factors that have the potential to be effective motivational factors for encouraging these women to go out. On the other hand, these factors did not lead to any behavioral change in men. Since there are approximately 15 million men over the age of 65 in Japan, behavioral changes in the entire elderly population will not occur without guidance for elderly men to go out. Methods: Sixteen elderly men and forty-seven elderly women participated. Interestingly, men are far more passionate about games than women. Therefore, we hypothesized that a preference for games could be a hint as to how we might encourage older men to go out. Then, a second demonstration experiment was conducted, and we analyzed the relationship between six game preferences and the frequency of going out. Results: Among gaming preferences, men with gaming preferences such as Philanthropists, Achievers, and Free Spirits showed a tendency to go out. Conclusions: These stimuli may have the potential to be factors that may encourage elderly men to go out.
]]>Geriatrics doi: 10.3390/geriatrics9010020
Authors: Yasuhiro Suzuki Yukiyo Shimizu Yuichiro Soma Takaaki Matsuda Yasushi Hada Masao Koda
This study examined whether SUKUBARA®, a remotely managed training system that we developed, could improve skeletal muscle mass and muscle strength in community-dwelling older adults. SUKUBARA® is a composite exercise program that combines lower-load resistance training and balance exercises. Participants were instructed to exercise while watching individually assigned videos on YouTube, such that the research administrators could verify the viewing records of each participant. Fifteen participants (69 ± 4 years) were randomly assigned to the intervention (eight participants; the RT group) or the control group (seven participants; the CO group). The primary endpoint was a change in fat-free mass (FFM; kg), whereas the secondary endpoints included a change in knee extension strength (KES; Nm/kg). Correlation analyses were conducted to examine the relationship between FFM and KES. During the 12-week intervention period, significant differences were observed between the RT and CO groups in the changes in FFM (0.5 ± 0.5 vs. −0.1 ± 0.5) and KES (0.20 ± 0.22 vs. 0.02 ± 0.13), and significant positive correlations were found between the changes. Thus, SUKUBARA®-based interventions have the potential to improve muscle hypertrophy and enhance muscle strength among community-dwelling older adults. Thus, SUKUBARA® -based interventions show promise in improving muscle hypertrophy and enhance muscle strength among community-dwelling older adults. However, appropriately powered future research is needed to replicate these findings.
]]>Geriatrics doi: 10.3390/geriatrics9010019
Authors: Erik Kylén Joel Stenholm Madeleine Johansson Lena Aggestam Ann Svensson
Osteoarthritis (OA) is a condition in the hip or knee joints that develops during a long period of time and sometimes needs hip or knee joint replacement surgery when pain gets too intense for the patient. This paper describes how an animated video for pre- and postoperative instructions for patients with osteoarthritis was designed. The design science research (DSR) approach was followed by creating a web-based animated video. The web-based animated video is used to support surgical departments with education for patients suffering from OA. In the web-based animated video, information about OA surgical treatment and its pre- and post-arrangements was included. The relevance, the rigor, and the design cycles were focused on, with some iterations of and improvements in the animations. Even after implementation, there was a feedback-loop with comments from the surgeons and their patients. Moreover, as more departments will use the web-based animated video, they want to make their special mark on it, so that further changes will be made. This paper presents the design and successful implementation of an animated video for pre- and postoperative instructions for patients with osteoarthritis, tightly linked to the patient journey and the workflow of healthcare professionals. The animated video serves not only as a tool to improve care but also as a basis for further scientific research studies.
]]>Geriatrics doi: 10.3390/geriatrics9010018
Authors: Constantin Ciucurel Mariana Ionela Tudor Manuela Mihaela Ciucurel Ioan-Cosmin Boca Elena Ioana Iconaru
(1) Background: This research aims to compare social networks among institutionalized and aging-in-place (AIP) older adults through the validation of a new questionnaire. (2) Methods: The cross-sectional study included 100 older adults (mean age: 73.53 ± 5.49 years; age range: 65–85 years), with 48 institutionalized subjects and 52 AIP subjects. We developed, validated, and administered a new questionnaire, the Social Network Assessment for Older People Questionnaire (SNAOPQ), to assess older adults’ social networks using descriptive and inferential statistical methods. (3) Results: The SNAOPQ demonstrated excellent internal consistency (Cronbach’s alpha of 0.91 and McDonald’s omega of 0.91). Statistical analysis revealed significant associations between variables, highlighting differences in social networks between institutionalized and AIP individuals (p ≤ 0.001). Sociodemographic factors like age, education, living arrangement status, and number of descendants significantly influenced SNAOPQ scores (p ≤ 0.001). Age and residence type notably impacted participants’ scores, indicating reduced social network size with age. Tertiary education and living in a couple were associated with more extensive social networks, while a higher number of descendants correlated with social network expansion. (4) Conclusions: Our study highlights significant differences in social networks among older adults based on residence type, emphasizing the impact of sociodemographic factors such as age, education, living arrangement, and the number of descendants.
]]>Geriatrics doi: 10.3390/geriatrics9010017
Authors: Diana Morais Carla Faria Lia Fernandes
The aging of parents results in changes in the filial relationship. The increasing vulnerability of parents leads adult children to realize that they have individual needs and cannot fully function as sources of security and protection, as they did before. Simultaneously, the evidence of losses and disability imposes the need for care, which tends to be assumed by adult children. Therefore, there is a progressive change in the volume of support exchanges between parents and children, with more support from adult children to parents. The way adult children adapt to these transitions is influenced by several internal and relational factors. Filial maturity has been associated with filial caregiving towards aging parents. The concept of filial maturity describes a developmental stage in which the adult child overcomes the filial crisis, realizing and accepting that the parent also needs support and comfort and starting to relate to him/her beyond the strictly parental role. Thus, this study aims to explore the role of attachment and mental representation of caregiving in filial maturity. A total of 304 children aged between 35 and 64 years old participated in this study, with at least one of the living parents aged 65 years or older, not institutionalized. Attachment was assessed with the Adult Attachment Scale, mental representation of caregiving with the Mental Representations of Caregiving Scale and filial maturity with the Filial Maturity Measure. The results suggest that attachment, mental representation of caregiving and the interaction between the two explain 24.5% (p < 0.01) of variability in Comprehending and 11.1% (p < 0.05) of variability in Distance, two dimensions of filial maturity. These findings suggest that it is important to consider mental representation of caregiving and attachment when adult children must adapt to changes in the filial relationship and to the need to care for parents.
]]>Geriatrics doi: 10.3390/geriatrics9010016
Authors: Florence M. F. Wong Henry W. H. Shie Enoch Kao Hoi Mei Tsoi Wai Keung Leung
Background: Much attention has been paid to advocate proper oral care/hygiene provision by healthcare providers in long-term care institutions (LTCIs). This study aimed to evaluate the effects of an oral health education (OHE) programme (intervention) on knowledge, attitudes, and practice (KAP) of healthcare providers in providing oral care/hygiene to older residents in LTCIs. Methods: A case control study was conducted at two LTCIs, with one assigned as the intervention group and the other as the control group. A KAP survey was administered before and after the intervention, and oral status was assessed by standardized clinical photographs taken before and after oral hygiene provision on three older residents. Results: A total of 40 healthcare providers (20 in intervention and 20 in control groups) participated, with the attitudes and overall KAP significantly improved in the intervention group after the OHE programme. Interestingly, the knowledge of those in the control LTCI was significantly declined at re-evaluation (mean scores were from 17.25 to 14.30), indicating inadequate oral health and care training despite having more experience in taking care of older people. Significant differences in practice were observed between the two groups after the OHE programme (p = 0.006). The three older residents exhibited poor oral health and multiple oral problems. Conclusions: This study revealed that the OHE programme effectively improved attitudes of the healthcare providers and provided a sustaining effect on attitude towards oral health and oral care. However, there were still inadequacies in oral hygiene provision by some healthcare providers, possibly due to unattended oral diseases and hygiene needs, as well as personal and environmental barriers that merit further investigation. Regular evaluation and enforcement of oral care/hygiene provision in LTCIs are necessary to maintain oral health and prevent dental and gum diseases in older residents. Immediate referral for dental treatment is recommended for older people with signs of dental/oral disease(s).
]]>Geriatrics doi: 10.3390/geriatrics9010015
Authors: Yoshitomo Shimazaki Keiko Kishimoto Joji Ishikawa Rika Iwakiri Atsushi Araki Shinobu Imai
This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29–8.57) and moderate (OR: 2.46, 95% CI: 1.06–5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51–2.95, p < 0.001], 2.42 [95% CI: 1.79–3.27, p < 0.001], and 2.01 [95% CI: 1.46–2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.
]]>Geriatrics doi: 10.3390/geriatrics9010014
Authors: Agnieszka Skubiszewska Katarzyna Broczek Iwona Maruniak-Chudek Gabriela Oledzka Marta Izabela Jonas Monika Puzianowska-Kuznicka Malgorzata Mossakowska
Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94–99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200–0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.
]]>Geriatrics doi: 10.3390/geriatrics9010013
Authors: Takashi Mitsuhashi Kohsuke Teranishi Joji Tokugawa Takumi Mitsuhashi Makoto Hishii Hidenori Oishi
This study investigated prognostic factors in elderly patients (80 years and older) undergoing mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) in acute stroke treatment. Of 59 cases, 47.5% achieved a favorable outcome (mRS ≤ 3) at three months, with a mortality rate of 20.3%. Factors associated with better outcomes included younger age, lower admission National Institute of Health Stroke Scale (NIHSS) scores, lower N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer levels, the presence of the first pass effect (FPE), and successful recanalization. However, logistic regression showed that only lower admission NIHSS scores were significantly correlated with favorable outcomes. In addition, this study suggests that lower admission NT-proBNP and D-dimer levels could potentially serve as prognostic indicators for elderly LVO patients undergoing MT.
]]>Geriatrics doi: 10.3390/geriatrics9010012
Authors: Alice Kit Ying Chan Yiu Cheung Tsang Eddie Hsiang-Hua Lai Chun Hung Chu
Introduction: Tooth wear is a prevalent dental condition among older adults, leading to pain and adversely affecting aesthetics, functionality, and their overall quality of life. This review aims to update the information on tooth wear in older adults from the past five years and to provide guidance on the clinical management of tooth wear in older adults. Methods: A literature search was conducted in three electronic databases, Scopus, Pubmed, and Embase, for English publications from January 2019 to December 2023 on clinical studies with participants aged 65 or above on tooth wear. A total of 307 articles were retrieved and 14 articles were finally included as references for this study. Results: This review highlights the common causes of tooth wear and various risk factors, such as medical conditions, hyposalivation, dietary habits, oral hygiene practices, parafunctional habits, and occlusal factors, associated with tooth wear. It is crucial for oral health care professionals to diagnose and manage tooth wear at an early stage through a risk assessment and a clinical examination to avoid complex restorative procedures. Tooth wear management should prioritize prevention, aiming to control etiological and risk factors while employing non-restorative treatments. Restorative intervention, if indicated, should be simple, minimally invasive, and cost-effective. Tooth wear progression should be monitored regularly to determine if a further intervention is needed. Conclusion: Since the clinical studies on tooth wear in older adults over the past five years are limited and mainly cross-sectional, more interventional clinical studies are warranted to provide more clinical guidance on tooth wear management in older adults.
]]>Geriatrics doi: 10.3390/geriatrics9010011
Authors: Yuki Kikuchi Hideki Nakano Akio Goda Kohei Mori Teppei Abiko Nozomi Mitsumaru Shin Murata
Most older adults wish to maintain independence in their familiar communities. However, many experience pain and pain-related disabilities which reduce their health-related quality of life (HRQOL), leading to increased hospitalizations and mortality. This study aimed to determine the impact of physical, mental, and cognitive factors, particularly central sensitization-related symptoms (CSS), on the HRQOL of community-dwelling older adults. A total of 206 participants were included in the analysis, which measured HRQOL, basic attributes, physical functions and body pain, mental factors, cognitive factors, and CSS severity using validated tools. A correlation analysis was used to examine the association between HRQOL and each measure. Furthermore, multiple regression analysis (forced entry method) was performed to identify the factors influencing the HRQOL. The study found that pain intensity and CSS severity significantly influenced the HRQOL among community-dwelling older adults. The higher the pain intensity and CSS severity, the lower their HRQOL. The participants had mild pain and CSS, demonstrating the need to monitor, address, and treat even non-severe issues in community-dwelling older adults. This association, revealed for the first time in this study, suggests that approaches to reduce pain and CSS are important for maintaining and improving the HRQOL of community-dwelling older adults.
]]>Geriatrics doi: 10.3390/geriatrics9010010
Authors: Leah M. Haverhals Chelsea Manheim Deisy Vega Lujan
On 28 September 2022, Hurricane Ian pummeled parts of south Florida. Disaster and climate change research has shown that disasters exacerbate inequalities, especially amongst older and physically vulnerable people. Florida has a large population of Veterans managing multiple chronic health conditions and receiving long-term care in-home from Veterans Health Administration (VA) programs, including Home Based Primary Care and Medical Foster Home. To describe how VA staff provided high quality care during and after the hurricane, and how Veterans and caregivers accessed needed healthcare and supports post-hurricane, we conducted a site visit to Lee County, Florida area in May 2023, conducting N = 25 interviews with VA staff, Veterans, and caregivers. Findings from qualitative thematic analysis showed that while some Veterans and caregivers experienced significant challenges during and after the hurricane, including displacement and difficulty accessing oxygen, they felt highly supported by VA care teams. Staff efforts post-hurricane focused on improving care coordination in anticipation of future disasters, especially around communicating with Veterans and their caregivers, and a VA workgroup formed to implement changes. As climate change causes more severe hazard events, lessons learned from this project can better support healthcare staff, older adults, and their caregivers before and after major disasters.
]]>Geriatrics doi: 10.3390/geriatrics9010009
Authors: Toshiaki Seko Hiroshi Akasaka Masayuki Koyama Nobuaki Himuro Shigeyuki Saitoh Shunichi Ogawa Sayo Miura Mitsuru Mori Hirofumi Ohnishi
Sarcopenia is the core factor of frailty. This study specifically focused on lower limb muscle strength and examined muscle indices that indicate the risk of frailty or pre-frailty in older adults. The study included 327 community-dwelling individuals aged ≥65 years (43.7% male) who participated in the cohort. Frailty was defined based on five symptoms: weight loss, low activity level, exhaustion, weakness and slowness. Participants were classified into frail (three or more applicable), pre-frail (one to two applicable) and non-frail groups. Muscle strength (knee extension strength, toe grip strength and hand grip strength) were assessed, and appendicular muscle mass was assessed via a bioelectrical impedance analysis. The adjusted odds ratio (OR) of muscle indices for with frailty (frail group vs. pre-frail group) or pre-frailty (pre-frail group vs. non-frail group) were calculated. The prevalence of frail and pre-frail was 7% and 40%, respectively. Adjusted for age, sex, albumin and medical history, knee extension strength was significantly associated with frailty (odds ratio 0.95, 95% CI 0.92–0.98), while hand grip strength was associated with pre-frailty (odds ratio 0.92, 95% CI 0.88–0.97) but not with other muscle indices. This study is significant for identifying knee extension strength as a factor relevant to frailty in older adults considered pre-frailty, emphasizing the importance of this specific muscle measure in predicting and managing frailty.
]]>Geriatrics doi: 10.3390/geriatrics9010008
Authors: Cristina Flores-Bello Elsa Correa-Muñoz Martha A. Sánchez-Rodríguez Víctor Manuel Mendoza-Núñez
Background: The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty. Aim: To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community. Method: A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect. Result: We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05]. Conclusion: Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.
]]>Geriatrics doi: 10.3390/geriatrics9010007
Authors: Tomas Escobar Gil Mohammed A. Quazi Tushita Verma Amir H. Sohail Hafiz Abdullah Ikram Adeel Nasrullah Karthik Gangu Asif Farooq Abu Baker Sheikh
Previous studies have convincingly demonstrated the negative impact of dementia on overall health outcomes. In the context of the COVID-19 pandemic, there is burgeoning evidence suggesting a possible association between dementia and adverse outcomes, however the relationship has not been conclusively established. We conducted a retrospective cohort study involving 816,960 hospitalized COVID-19 patients aged 65 or older from the 2020 national inpatient sample. The cohort was bifurcated into patients with dementia (n = 180,845) and those without (n = 636,115). Multivariate regression and propensity score matched analyses (PSM) assessed in-hospital mortality and complications. We observed that COVID-19 patients with dementia had a notably higher risk of in-hospital mortality (23.1% vs. 18.6%; aOR = 1.2 [95% CI 1.1–1.2]). This elevated risk persisted even after PSM. Interestingly, dementia patients had a reduced risk of several acute in-hospital complications, including liver failure and sudden cardiac arrest. Nevertheless, they had longer hospital stays and lower total hospital charges. Our findings conclusively demonstrate that dementia patients face a heightened risk of mortality when hospitalized with COVID-19 but are less likely to experience certain complications. This complexity underscores the urgent need for individualized care strategies for this vulnerable group.
]]>Geriatrics doi: 10.3390/geriatrics9010006
Authors: Hoa T. M. Tran Cristina Roman Gary Yip Michael Dooley Mohammed S. Salahudeen Biswadev Mitra
Older people in the emergency department (ED) often pose complex medical challenges, with a significant prevalence of polypharmacy and potentially inappropriate medicines (PIMs) in Australia. A retrospective analysis of 200 consecutive patients aged over 65 years admitted to the emergency short stay unit (ESSU) aimed to identify polypharmacy (five or more regular medications), assess PIM prevalence, and explore the link between pre-admission PIMs and ESSU admissions. STOPP/START version 2 criteria were used for the PIM assessment, with an expert panel categorizing associated risks. Polypharmacy was observed in 161 patients (80.5%), who were older (mean age 82 versus 76 years) and took more regular medications (median 9 versus 3). One hundred and eighty-five (92.5%) patients had at least one PIM, 81 patients (40.5%) had STOPP PIMs, and 177 patients (88.5%) had START omissions. Polypharmacy significantly correlated with STOPP PIM (OR 4.8; 95%CI: 1.90–12.1), and for each additional medication the adjusted odds of having a STOPP PIM increased by 1.20 (95%CI: 1.11–1.28). Nineteen admissions (9.5%) were attributed to one or more PIMs (total 21 PIMs). Of these PIMs, the expert panel rated eight (38%) as high risk, five (24%) as moderate risk, and eight (38%) as low risk for causing hospital admission. The most common PIMs were benzodiazepines, accounting for 14 cases (73.6%). Older ESSU-admitted patients commonly presented with polypharmacy and PIMs, potentially contributing to their admission.
]]>Geriatrics doi: 10.3390/geriatrics9010005
Authors: Jacob Wale Mobolaji
The unmet need for assistance in activities of daily living (ADLs) accentuates older persons’ risk of falls, ill health, hospitalisation, and mortality. In Nigeria, the family arrangements through which older persons derive support are changing due to modernisation, migration, and economic challenges. How the family dynamics explain the unmet needs is poorly understood. This study investigates the influence of family and household structures on older persons’ unmet needs in ADLs in southwestern Nigeria. The study analysed the data of 827 older adults aged ≥65 years selected from Oyo State, southwestern Nigeria, using a multi-stage sampling design. Associations were examined using the Poisson–logit hurdle regression model. From the results, 65% of older persons with difficulties had unmet needs in instrumental ADLs and 59% in basic ADLs. Increased unmet needs were associated with older persons living with non-family members (β = 0.19; p < 0.01; 95% C.I. = 0.05–0.32) and widows (β = 0.27; p < 0.01; 95% C.I. = 0.13–0.42). Conversely, unmet needs decreased with higher family size (β = −0.06; p < 0.001; 95% C.I. = −0.08–−0.03), living in rich households (β = −0.29; p < 0.001; 95% C.I. = −0.42–−0.17), not being the household head (β = −0.27; p < 0.001; 95% C.I. = −0.40–−0.15), close family bonds, and proximity to children/caregivers. The study recommends alternative or complementary home-based support mechanisms for seniors with vulnerable family settings in southwestern Nigeria.
]]>Geriatrics doi: 10.3390/geriatrics9010004
Authors: Victoria Ramos de Ascanio Gloria Liaño-Esteso David Roldán Teresa Collazo-Lorduy Sara Martínez-Flores José Ángel Hernández-Rivas Isabel González-Gascón-y-Marín
(1) Background: Gradenigo’s Syndrome (GS) is a rare complication of acute otitis media characterized by the triad of diplopia, otitis, and facial pain. The widespread use of antibiotics has significantly reduced its occurrence. (2) Case summary: We present the case of an elderly patient with T-cell lymphoma who developed neurological deficits resembling GS. The patient was ultimately diagnosed with invasive sinus aspergillosis. The diagnostic process was challenging due to the atypical clinical presentation and the lack of specific imaging findings. A biopsy was the most important test for clarifying the diagnosis. (3) Conclusions: The prognosis for this complication is extremely poor without surgery, and the patient died despite adequate antifungal coverage. Therefore, maintaining high clinical suspicion is paramount to avoid adverse outcomes in similar cases, particularly in the geriatric population, wherein this syndrome’s occurrence may not be expected.
]]>Geriatrics doi: 10.3390/geriatrics9010003
Authors: Efthalia Angelopoulou Dionysia Kontaxopoulou Stella Fragkiadaki Evangelia Stanitsa Dimosthenis Pavlou John Papatriantafyllou Christos Koros Vlado Dimovski Darja Šemrov Sokratis G. Papageorgiou
Background: Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands. Methods: Data were derived from the “Specialized Outpatient Clinic of Memory, Dementia and Parkinson’s disease through the National Telemedicine Network”, March 2021–March 2023. The survey included 10 questions (5-point Likert scale). Results: We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information. Conclusions: The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.
]]>Geriatrics doi: 10.3390/geriatrics9010002
Authors: Satoshi Yamasaki Tomotake Tokunou Toyoki Maeda Takahiko Horiuchi
Hot spring bathing is practiced to help manage hypertension. We retrospectively investigated the effects of hot spring bathing on hypertension with the aim of identifying a novel approach to prevent and manage hypertension. The study cohort comprised 99 patients aged ≥65 years admitted to Kyushu University Beppu Hospital between 1 December 2021 and 30 November 2022 who could walk by themselves and who used hot springs for ≥3 days during their hospital stay. The changes in both systolic and diastolic blood pressure were significantly decreased in the night-time bathing group (n = 21) compared with the noontime (n = 26) and afternoon (n = 52) groups. Night-time hot spring bathing was significantly associated with reduced systolic blood pressure the next morning in older adults. Although prospective randomized controlled trials on night-time hot spring bathing as a hypertension treatment are warranted to investigate whether the practice can prevent hypertension among adults aged ≥65 years, we have initiated a single-center, phase II study on the relationship between sleep quality and quality of life in hypertensive patients after night-time hot spring bathing.
]]>Geriatrics doi: 10.3390/geriatrics9010001
Authors: Lotte P. Brinkhof Sanne de Wit Jaap M. J. Murre K. Richard Ridderinkhof
Frequent exposure to ageism has significant repercussions on the quality of life and mental well-being/health of older adults. Resilience may play a crucial role in mitigating these effects. The current study aimed to investigate the potential buffering roles of two types of coping variables—behavioral coping and a positive appraisal style—in older adults (N = 2000, aged 55–93). Confirming previous findings, higher levels of perceived negative ageism (PNA) were associated with diminished quality of life and mental well-being, increased depression and loneliness. However, individuals that tend to employ behavioral coping strategies when confronted with challenging/stressful situations showed a weaker relationship between PNA and quality of life, mental well-being, and depression. Embracing a positive appraisal style attenuated the negative impact of PNA on feelings of depression and loneliness. Interestingly, younger older adults appeared to benefit the most from these resilience factors. Despite considerable inter-individual variability, encouraging the utilization of behavioral coping strategies and nurturing a positive appraisal style could serve as effective approaches to mitigate the detrimental effects of PNA.
]]>Geriatrics doi: 10.3390/geriatrics8060124
Authors: Luis Galhardas Armando Raimundo José Marmeleira
(1) Background: to examine the psychometric properties of the Portuguese version of the Timed Instrumental Activities of Daily Living (TIADL) in nursing home residents. (2) Methods: Fifty-two participants (85.8 ± 4.2 years) were assessed on two occasions, 10–14 days apart. The same rater administered all assessments. Internal consistency was analysed through Cronbach’s α. The reliability was estimated using the intraclass correlation coefficients (ICCs), and the standard error of the mean (SEM) was used to estimate the minimal detectable change (MDC). Construct validity was determined by Spearman’s correlation coefficients. (3) Results: For internal consistency, Cronbach’s α (0.81) revealed high internal reliability. All of the subtests demonstrated good or excellent reliability and also presented acceptable measurement precision, considering the criterion SEM < SD/2. According to Spearman’s rho, correlations with the Portuguese version of the TIADL, the Useful Field of View test, and semantic and phonemic fluency tests were significant, with moderate positive and negative correlations (0.4 < rs < 0.69). (4) Conclusions: The Portuguese version of the TIADL had good to excellent test–retest reliability (ICC > 0.90) and acceptable measurement precision. This test could be a valuable clinical tool for assessing actual performance in instrumental activities of daily living in nursing home residents.
]]>Geriatrics doi: 10.3390/geriatrics8060123
Authors: Korin Tateoka Taishi Tsuji Takuro Shoji Satoshi Tokunaga Tomohiro Okura
Acceleration parameters in sit-to-stand (STS) movements are useful for measuring lower-limb function in older adults. The purpose of this study was to examine the relationship between acceleration in STS movements and physical function and the test-retest reliability of acceleration parameters in older adults. We performed cross-sectional analyses on 244 older adults including 107 men (mean age: 77.4 ± 4.7) and 137 women (mean age: 75.6 ± 5.3). Four acceleration parameters were measured in STS movements: maximum acceleration (MA), maximum velocity (MV), maximum power (MP), and stand-up time (ST). Good intraclass correlation coefficients (ICC > 0.70) were observed for all parameters. For the acceleration parameters, MA, MV, and MP were relatively strongly associated with the 5-time STS test (men: r = −0.36~−0.47; women: r = −0.37~−0.45) and the timed up and go test (men: r = −0.39~0.47, women: r = −0.43~−0.51): MP was also strongly associated with grip strength (men: r = 0.48, women: r = 0.43). All acceleration parameters were poorer in participants reporting mobility limitations than in those reporting no mobility limitations. These findings support the usefulness of sensor-based STS measurement. The system is expected to be useful in various settings where care prevention is addressed.
]]>Geriatrics doi: 10.3390/geriatrics8060122
Authors: Cristina Vocca Antonio Siniscalchi Vincenzo Rania Cecilia Galati Gianmarco Marcianò Caterina Palleria Luca Catarisano Ilaria Gareri Marco Leuzzi Lucia Muraca Rita Citraro Giacinto Nanci Antonio Scuteri Rosa Candida Bianco Iolanda Fera Antonietta Greco Giacomo Leuzzi Giovambattista De Sarro Bruno D’Agostino Luca Gallelli
Introduction: Drug–drug interactions (DDIs) represent an important clinical problem, particularly in older patients, due to polytherapy, comorbidity, and physiological changes in pharmacodynamic and pharmacokinetic pathways. In this study, we investigated the association between drugs prescribed after discharge from the hospital or clinic and the risk of DDIs with drugs used daily by each patient. Methods: We performed an observational, retrospective, multicenter study on the medical records of outpatients referred to general practitioners. DDIs were measured using the drug interaction probability scale. Potential drug interactions were evaluated by clinical pharmacologists (physicians) and neurologists. Collected data were analyzed using the Statistical Package for the Social Sciences. Results: During the study, we evaluated 1772 medical records. We recorded the development of DDIs in 10.3% of patients; 11.6% of these patients required hospitalization. Logistic regression showed an association among DDIs, sex, and the number of drugs used (p = 0.023). Conclusions: This observational real-life study shows that the risk of DDIs is common in older patients. Physicians must pay more attention after hospital discharge, evaluating the treatment to reduce the risk of DDIs.
]]>Geriatrics doi: 10.3390/geriatrics8060121
Authors: Daisuke Homma Izumi Minato Norio Imai Dai Miyasaka Yoji Horigome Hayato Suzuki Yoichiro Dohmae Naoto Endo
Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome.
]]>Geriatrics doi: 10.3390/geriatrics8060120
Authors: Dario Geißer Lina Hetzel Ralf Westenfeld Fritz Boege
Background: The recommended chronic kidney disease (CKD) first-line diagnostic test is based on the creatinine-derived (estimated) glomerular filtration rate (eGFR). Cystatin C use may provide a better assessment. Methods: We compared creatinine- and cystatin C-derived eGFR determination as the first-line diagnostic test for 112 hospital patients aged > 60 years (median = 76 years). The patients were judged to not have CKD (no-CKD group) according to the first-line diagnostic recommendations (n = 61, eGFR (CKD Epidemiology Collaboration (CKD-EPI)) ≥ 60 mL/min/1.73 m2, total urine protein < 150 mg/g creatinine, urinary red/white blood cells not increased) or classified to be at risk for kidney insufficiency due to aortic valve dysfunction (at-risk group; n = 51). The accuracy of the eGFR values was evaluated retrospectively with the final case diagnoses. Results: The eGFR (Caucasian, Asian, pediatric, and adult formula (CAPA)) was found to be linearly correlated to the eGFR (CKD-EPI) (R2 = 0.5, slope = 0.69, p < 0.0001). In 93/112 (>80%) cases, the eGFR (CAPA) yielded lower values (on average ≈−20%). In 55/112 (49%) cases, the cystatin C-derived CKD stage was lower. CKD reclassification from no-CKD to a kidney-insufficient state (i.e., CKD1/2 to CKD3a/b or 4) or reclassification to a more severe kidney insufficiency (i.e., CKD3a → 3b/4 or 3b → 4) was found in 41/112 (37%) cases. A worse CKD classification (no-CKD → kidney-insufficient) based on the eGFR (CAPA) was plausible in 30% of cases in light of the final case diagnoses. Conclusion: In elderly patients (>60 years), renal function appears to be systematically overestimated by the creatinine-based eGFR (CKD-EPI), indicating that, for this group, the cystatin C-based eGFR (CAPA) should be used as the first-line diagnostic test.
]]>Geriatrics doi: 10.3390/geriatrics8060119
Authors: Made Putra Semadhi Dewi Muliaty Eli Halimah Jutti Levita
A growing life expectancy may result in a chronic medical condition and multimorbidity because the aging process leads to a decrease in cognitive and physiological function. These risks may affect the quality of life of geriatrics. The present study aims to determine the correlation between cognitive status (in terms of SIRT1, a nicotinamide adenine dinucleotide (NAD+)-dependent class III deacetylase) and metabolic function (in terms of the lipid profile, kidney function, and blood glucose) in geriatric patients. The differences in the parameters of metabolic function in the participants’ cognitive status were determined by using the Indonesian version of the Montreal Cognitive Assessments (MoCA-Ina). The elderly participants (n = 120) were recruited at three sites in Indonesia from March to October 2022. Our study demonstrated a negative correlation between the cognitive status of geriatric patients and their metabolic function, represented by the MoCA-Ina score with a linear regression equation of y = 0.27 − 2.4 ×10−3x. Higher levels of LDL-C, cystatin C, and HbA1c were found in the Severe-Moderate Cognitive Impairment group. Determining the SIRT1 levels may be beneficial in predicting both the cognitive and metabolic status of geriatrics because this protein is among numerous metabolic sensors in the hypothalamus.
]]>Geriatrics doi: 10.3390/geriatrics8060118
Authors: Natsumi Nishitani Keisei Kosaki Shoya Mori Masahiro Matsui Takeshi Sugaya Makoto Kuro-o Chie Saito Kunihiro Yamagata Seiji Maeda
Age-related loss of lower extremity muscle strength is pronounced in individuals with chronic kidney disease (CKD). In contrast, an increase in intrarenal flow pulsatility results in initial age-related changes in renal hemodynamics, leading to the development of CKD. To date, it remains unclear whether lower extremity muscle strength determines elevated renal flow pulsatility. This study aimed to determine the association of lower extremity muscle strength and function with intrarenal hemodynamics in individuals with and without CKD. One hundred seventy-six individuals without CKD (aged 63 ± 9 years) and 101 individuals with CKD (aged 66 ± 8 years) were included in this study. Using Doppler ultrasound, the renal resistive index (RI) was measured as a parameter of renal hemodynamics. Knee extensor muscle strength (KES), gait speed (GS), and the 30 s chair stand test (30s-CST) were used to measure lower extremity muscle strength and function. Multivariate analyses showed that GS and 30s-CST scores were independent determinants of renal RI, whereas the KES score was not associated with renal RI in individuals with and without CKD. In the two-way analysis of covariance, renal RI was the highest in individuals with CKD who had lower KES, GS, and 30s-CST scores. Reduced lower extremity muscle strength and function are independent determinants of elevated renal flow pulsatility in individuals with and without CKD.
]]>Geriatrics doi: 10.3390/geriatrics8060117
Authors: Juan Carlos García de la Blanca Javier Cuarental García Gonzalo Luengo Rafael Martí Luis Rafael Ramos
(1) Background: Neglected hip dislocation is an uncommon condition, especially in developed countries because dislocations are considered trauma emergencies and thus are treated early. They are usually treated with methods used in commonly occurring dislocations. The aim of this study is to detail a two-stage strategy for neglected hip dislocations in adults applied in a complicated case. (2) Case presentation: We present a complicated case of neglected hip dislocation in a patient with an associated neurological condition. Two-stage open reduction was performed combined with arthrodiastasis and Ilizarov external fixators. After complications requiring a third intervention, the joint was stabilized, and the patient has presented no more episodes to date. (3) Conclusions: Arthrodiastasis has been used to treat these conditions. Comparing it with the other methods described in the literature, it seems to be a good therapeutic strategy, especially in elderly patients. Because of the limited number of studies, we cannot establish the most efficient therapeutic method, but we believe that the described strategy can be useful for patients with this condition.
]]>Geriatrics doi: 10.3390/geriatrics8060116
Authors: Ryan R. Porter Joshua R. Sparks J. Larry Durstine Sabra S. Custer Raymond W. Thompson Xuewen Wang
Background: Evidence suggests that lipoprotein subclass particles are critical markers of cardiovascular disease (CVD) risk. Older women have increased CVD risk related to age. The purpose of this study was to determine whether low and moderate doses of exercise influence lipoprotein subclasses. Methods: Women (60–75 years) were randomized into groups for 16 weeks of moderate-intensity exercise training at a low or moderate dose (33.6 and 58.8 kJ/kg body weight weekly, respectively). Lipoprotein subclasses were determined by nuclear magnetic resonance spectroscopy before and after the training. RESULTS: The average weekly exercise duration was 109 and 164 min, for low- and moderate-dose groups, respectively. In the low-dose group, high-density lipoprotein particle (HDL-P) concentration decreased (Δ = −1.9 ± 3.1 µmol/L, mean ± SD, p = 0.002) and mean HDL-P size increased (Δ = 0.1 ± 0.3 nm, p = 0.028). In the moderate-dose group, mean HDL-P size (Δ = 0.1 ± 0.2 nm; p = 0.024) and low-density lipoprotein particle size increased (Δ = 0.4 ± 3.9 nm; p = 0.007). Baseline body mass index, peak oxygen consumption and age were associated with changes in a few lipoprotein subclasses. Conclusions: In this sample of inactive older women, moderate-intensity exercise training at a dose equivalent to or even lower than the minimally recommended level by public health agencies induced changes in lipoprotein subclasses in line with reduced CVD risk. However, higher doses are encouraged for greater health benefits.
]]>Geriatrics doi: 10.3390/geriatrics8060115
Authors: Katherine C. Ritchey Amanda Olney Sunny Chen Erica Martinez Michelle R. Paulsen Jennifer Tunoa James S. Powers
Purpose: The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). Methods: A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. Results: A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale—international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. Conclusions: A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury.
]]>Geriatrics doi: 10.3390/geriatrics8060114
Authors: Zenovia Surlari Oana Elena Ciurcanu Dana Gabriela Budala Oana Butnaru Ionut Luchian
Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients.
]]>Geriatrics doi: 10.3390/geriatrics8060113
Authors: Ryuichi Ohta Yumi Naito Chiaki Sano
Social isolation is a growing concern worldwide, particularly within aging populations. This study elucidates the specific attitudes, strategies, and approaches of community social workers (CSWs) in Japan as they work toward alleviating social isolation and building inclusive communities. This qualitative study, conducted in Toyonaka City, Osaka Prefecture, Japan, used six Japanese comics as a unique data source, narrating real-life stories of social isolation and CSWs’ approaches. Thematic analysis was conducted to analyze the content of the comics, including systematic coding, theme generation, and refining, while ensuring rigor and reflexivity. The total number of pages in the comics was 505. The transcripts of the comics as Microsoft Word documents totaled 63 pages. Four themes characterizing CSWs’ strategies were revealed: (1) core values of professionalism and dedication; (2) personalized support oriented toward person-centered suffering; (3) community engagement, transitioning from exclusiveness to inclusiveness; and (4) connecting and reorganizing communities for inclusive societies. In Japan, CSWs employ multifaceted strategies to combat social isolation and foster inclusive communities. Their dedication, personalized support, community engagement, and capacity to reorganize their communities contribute to their pivotal role. This study provides a foundation for understanding CSWs’ work and paves the way for further investigation of their evolving role in creating inclusive societies.
]]>Geriatrics doi: 10.3390/geriatrics8060112
Authors: Camillo Fulchignoni Marcello Covino Silvia Pietramala Ivo Lopez Gianfranco Merendi Andrea De Matthaeis Francesco Franceschi Giulio Maccauro Lorenzo Rocchi
The prevalence of hand injuries increases with age, with elderly patients being more prone to hand lesions due to a combination of factors, such as reduced bone density and muscle strength, impaired sensation, and cognitive impairment. Despite the high incidence of hand injuries in the elderly population, few studies have addressed the management and outcomes of hand lesions in this age group. This study aimed to analyze the characteristics and management of hand lesions in patients over 80 years old. The authors conducted a retrospective analysis of medical records of patients over 80 years old who reached their Emergency Department with hand lesions between 2001 and 2020. Data on demographics, injury characteristics, and management were collected and analyzed. A total of 991 patients with hand lesions were included in the study, with a mean age of 84.9 years. The most common causes of injuries were domestic accidents (32.6%) and traffic accidents (12.8%). The most frequent types of hand lesions were fractures (23.5%) and superficial wounds (20.5%). Overall, 23.4% underwent surgical treatment for their hand issue, and 22.1% had associated injuries, among which, the most common were head trauma and other bone fractures. In conclusion, hand lesions in patients over 80 years old are frequent and pose significant challenges in diagnosis and management. Particular attention should be paid to associated injuries and limit indications to surgery when strictly necessary.
]]>Geriatrics doi: 10.3390/geriatrics8060111
Authors: Tippayavadee Wannawichate Panita Limpawattana
(1) Background: Drug–drug interactions (DDIs) possess the potential to lead to a range of clinically significant consequences in the older population. (2) Aims: To investigate the prevalence and associated factors of DDIs among older patients within an outpatient setting of a university hospital. (3) Methods: This is a descriptive analysis of patients aged ≥65 years, who received a minimum of two medications. The electronic medical records were obtained from the outpatient clinic of a tertiary care hospital between November 2021 and November 2022. The outcomes were analyzed using descriptive and regression analysis. (4) Results: The study enrolled 10,877 patients, with a mean age of 74.3 ± 6.8 years. The prevalence of major DDI was 36.8%. Factors associated with major DDI were age (odds ratio [OR] 1.03), female sex (OR 1.23), polypharmacy (OR 2.27–13.78), metabolic disease (OR 1.89), psychiatric disorder (OR 1.79), cardiovascular disease (OR 1.51), musculoskeletal disease (OR 1.37), central nervous system disease (OR 1.24), and tuberculosis (OR 0.18). There was a significant difference observed in the primary healthcare facilities for emergency medicine (OR 1.72), orthopedics (OR 1.36), internal medicine (OR 1.29), and radiology (OR 0.45). (5) Conclusions: Major DDI was prevalent among older patients receiving care at outpatient settings. Several factors linked to major DDIs were identified. Developing appropriate strategies to improve the prescription process and avoid any missed interactions with geriatric patients is recommended.
]]>Geriatrics doi: 10.3390/geriatrics8060110
Authors: Takuya Omura Akira Katsumi Shuji Kawashima Masahiro Naya Haruhiko Tokuda
An 81-year-old woman undergoing B-cell depletion therapy developed COVID-19 and a hyperglycemic hyperosmotic state. She had a history of multiple vaccinations against coronaviruses but had persistent antigen positivity. Strategies to prevent the development of COVID-19 in immunosuppressed patients have not been established. Moreover, there is no standard treatment for prolonged antigen positivity. In this case, we were able to follow IgG antibodies during the course of treatment. The absence of N-IgG antibody titer elevation despite an effective immune response triggered by the vaccine is of great interest. The impaired humoral response observed in patients with lymphoma after anti-CD20 treatment implies the need for a justified different vaccination strategy for these patients. Furthermore, negative N-IgG titers in the immunosuppressed state may serve as an indicator of resistance to therapy.
]]>Geriatrics doi: 10.3390/geriatrics8060109
Authors: Kensuke Todoriki Yoshihiro Kai Shogo Mukai Shin Murata
This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren–Lawrence classification (KL) and Pearson’s correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA.
]]>Geriatrics doi: 10.3390/geriatrics8060108
Authors: Adam Bednorz Dorota Religa
Introduction. The purpose of this study is to determine the usefulness of the CTMT (Comprehensive Trail Making Test) in diagnosing mild cognitive impairment in older patients. The test is used to assess executive functions, of which impairment is already observed in the early stages of the neurodegenerative process. Materials and Methods. The study includes 98 patients of a geriatric ward assigned to 2 groups of 49 patients each: patients diagnosed with a mild cognitive impairment and patients without a cognitive impairment, constituting the control group (group K). A set of screening tests was used in the initial study: the MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), and CDT (Clock Drawing Test), GDS (Geriatric Depression Scale). The second study included the performance of the CTMT; the performance indicator was the time of performance. Results. Statistically significant differences are obtained between patients with mild cognitive impairments and those in cognitive normality in the performance of the CTMT test (p < 0.01). Patients with MCIs took longer to complete all trails of the test. To identify cognitive impairment, cutoff points were proposed for the CTMT total score and the other test trails. The CTMT overall score and CTMT 5 scored the highest AUCs (CTMT overall score = 0.77, CTMT Trail 5 = 0.80). Conclusions. The Comprehensive Trail Making Test may be useful in diagnosing mild cognitive impairment as a complementary screening tool.
]]>Geriatrics doi: 10.3390/geriatrics8060107
Authors: Shin Yoshinaka Kohei Yamaguchi Ryosuke Yanagida Miki Ishii Kazuharu Nakagawa Kanako Yoshimi Ayako Nakane Yusuke Matsuyama Jun Aida Haruka Tohara
Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62–90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a “test” after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS.
]]>Geriatrics doi: 10.3390/geriatrics8060106
Authors: Virginia Boccardi
The growing older population, the increasing prevalence of chronic illnesses, and the pressing need to enhance the quality of end-of-life care have underscored the importance for geriatricians to focus on supportive and palliative measures. Within this context, the emphasis on delivering comprehensive and person-centered care has become crucial, ensuring that individuals not only receive medical treatment but also experience comfort during chronic illness and in their final days. Nevertheless, a significant number of older individuals often find themselves in hospitals during their last moments, sometimes undergoing aggressive medical interventions even when facing terminal conditions. The challenge lies in the early recognition of the end-of-life phase, initiating timely supportive and palliative care in conjunction with conventional treatments, adopting a multidisciplinary approach, and providing crucial support to grieving family members. Despite being a relatively recent field, geriatric palliative care (GPC) still requires further development. With this perspective, I aimed to shed light on the challenges and best practices for enhancing care for individuals facing chronic critical illnesses and frailty.
]]>Geriatrics doi: 10.3390/geriatrics8050105
Authors: Kyoung Hee Cho Jong-Min Paek Kwang-Man Ko
In an aging society, maintaining healthy aging, preventing death, and enabling a continuation of economic activities are crucial. This study sought to develop a model for predicting survival times among community-dwelling older individuals using a deep learning method, and to identify the level of influence of various risk factors on the survival period, so that older individuals can manage their own health. This study used the Korean National Health Insurance Service claims data. We observed community-dwelling older people, aged 66 years, for 11 years and developed a survival time prediction model. Of the 189,697 individuals enrolled at baseline, 180,235 (95.0%) survived from 2009 to 2019, while 9462 (5.0%) died. Using deep-learning-based models (C statistics = 0.7011), we identified various factors impacting survival: Charlson’s comorbidity index; the frailty index; long-term care benefit grade; disability grade; income level; a combination of diabetes mellitus, hypertension, and dyslipidemia; sex; smoking status; and alcohol consumption habits. In particular, Charlson’s comorbidity index (SHAP value: 0.0445) and frailty index (SHAP value: 0.0443) were strong predictors of survival time. Prediction models may help researchers to identify potentially modifiable risk factors that may affect survival.
]]>Geriatrics doi: 10.3390/geriatrics8050104
Authors: Ryuzo Hara Naoki Todayama Tomohiro Tabata Miki Kuwazawa Tomoko Mukai Yukiko Hatanaka Shouji Hironaka Nobuyuki Kawate Junichi Furuya
Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.
]]>Geriatrics doi: 10.3390/geriatrics8050103
Authors: Yao Cui Bo Liu Jian Zhou Qian Liu Hui Ye
Background: Orthostatic hypotension (OH) is a common blood pressure abnormality in older adults that makes them prone to balance disorders and falls. The maintenance of balance relies on a complex regulatory system. The use of computerized dynamic posturography (CDP) can provide a quantitative evaluation of balance function. The objective of this study was to utilize CDP to measure balance indicators in older individuals with OH. Methods: A total of 303 older adults were divided into an OH group of 91 and a non-OH group of 212. Various factors, including chronic diseases, medication history, laboratory tests, and balance indicators, were compared between the two groups. Results: ① Participants with OH had more chronic diseases, including coronary heart disease (p = 0.049) and a history of falls (p < 0.001), than those without OH. A history of multiple medications in the OH group was significantly more likely than in the non-OH group (p = 0.006). ② There was a significant reduction in the composite equilibrium score (SOT-COM) (p < 0.001), vision ratio score (VIS) (p < 0.001), vestibular ratio score (VEST) (p < 0.001), and directional control (DCL) (p = 0.028) in the OH group. ③ A logistic regression analysis revealed that SOT-COM was a significant independent factor associated with OH. The area under the curve (AUC) of SOT-COM was 0.833 (95% confidence interval: 0.778–0.887, p < 0.001), with a sensitivity of 0.826 and a specificity of 0.759. Conclusions: This study demonstrates that older individuals with OH are more prone to falls, due to decreased sensory integration for balance.
]]>Geriatrics doi: 10.3390/geriatrics8050102
Authors: Cristina Buigues Olga Theou Rosa Fonfría-Vivas Francisco M. Martínez-Arnau Kenneth Rockwood Omar Cauli
Sarcopenia and frailty are important conditions that become increasingly prevalent with age. There is partial overlap between the two conditions, especially in terms of the physical aspects of the frailty phenotype: low grip strength, gait speed, and muscle mass. This study examined whether administration of the essential branched-chain amino acid leucine, besides improving sarcopenia, may reduce frailty assessed by frailty index (FI) in older institutionalized people living in nursing homes. We conducted a secondary analysis of a placebo-controlled, randomized, double-blind design study (ClinicalTrials.gov NCT03831399). The study included fifty males and females aged 65 and over who were living in nursing homes and did not have dementia. The participants were randomized to a parallel group intervention of 13 weeks’ duration, with a daily intake of leucine (6 g/day) or placebo (lactose, 6 g/day). The outcome of this study was to evaluate whether there was a change in the level of a 95 item FI compared to the baseline and to compare the effect of the leucine group versus the placebo group. A significant inverse correlation was found between FI and performance of the activities of daily life, cognitive function, gait and balance, muscle function parameters, and nutritional status (p < 0.001 in all cases). There were no statistically significant differences in FI levels at baseline (placebo group FI 0.27 ± 0.08 and leucine group FI 0.27 ± 0.10) and at the 13 week follow-up (placebo group FI 0.28 ± 0.10 and leucine group FI 0.28 ± 0.09). There were also no significant differences between the leucine and placebo groups in the mean FI difference between baseline and follow-up (p = 0.316, Cohen’s d: 0.04). This pilot study showed that a nutritional supplementation with leucine did not significantly modify the frailty index in older nursing home residents.
]]>Geriatrics doi: 10.3390/geriatrics8050101
Authors: Agata Wojcieszek Anna Kurowska Anna Majda Kinga Kołodziej Henryk Liszka Artur Gądek
Background: Due to the presence of numerous problems in osteoarthritis, e.g., the presence of one or more chronic diseases, reduced self-esteem and reduced ability to cope, patients must undertake readaptation activities. In such circumstances, resources that are necessary for optimal adaptation become of particular importance. This cross-sectional study aimed to assess the impact of behavioral resources, namely self-efficacy and optimism, on quality of life perception in early-old-age patients with knee osteoarthritis. Methods: An anonymous survey was conducted using recognized research tools: the Index of Severity for Knee Disease, Life Orientation Test, General Self-Efficacy Scale and World Health Organization Quality of Life BEFF. The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without diagnosed joint and muscular diseases of the lower limbs. Non-parametric tests (e.g., Mann–Whitney U test, Kruskal–Wallis test, Spearman’s correlation coefficient) were used for the statistical analysis of the results, assuming a significance level of p < 0.05. Results: The level of the examined personal resources was significantly lower in the group of people with gonarthrosis (p < 0.001), among whom low self-efficacy and a tendency toward pessimism prevailed. The results in terms of the level of lower limb joints impairment among the respondents correlated significantly and negatively with self-efficacy (r = −0.239; p = 0.003) and dispositional optimism (r = −0.318; p < 0.001). A higher level of the studied psychosocial resources led to a more favorable assessment of quality of life (p < 0.001) and own health (p < 0.001). In addition, a higher sense of self-competence was associated with better quality of life in the psychological (p = 0.044), social (p < 0.001) and environmental (p < 0.001) domains, while a tendency toward optimism was associated with higher quality of life perception in the social domain (p < 0.001). Conclusions: It would seem to be reasonable to introduce a routine diagnosis, assessing the level of personal capabilities of elderly people with knee osteoarthritis, which may have a beneficial effect on their perception of their quality of life and their own health.
]]>Geriatrics doi: 10.3390/geriatrics8050100
Authors: Roger E. Thomas Robert Azzopardi Mohammad Asad Dactin Tran
Introduction: The goals of this retrospective cohort study of 129,443 persons admitted to Calgary acute care hospitals from 2013 to 2021 were to ascertain correlations of “potentially inappropriate medications” (PIMs), “potential prescribing omissions” (PPOs), and other risk factors with readmissions and mortality. Methods: Processing and analysis codes were built in Oracle Database 19c (PL/SQL), R, and Excel. Results: The percentage of patients dying during their hospital stay rose from 3.03% during the first admission to 7.2% during the sixth admission. The percentage of patients dying within 6 months of discharge rose from 9.4% after the first admission to 24.9% after the sixth admission. Odds ratios were adjusted for age, gender, and comorbidities, and for readmission, they were the post-admission number of medications (1.16; 1.12–1.12), STOPP PIMs (1.16; 1.15–1.16), AGS Beers PIMs (1.11; 1.11–1.11), and START omissions not corrected with a prescription (1.39; 1.35–1.42). The odds ratios for readmissions for the second to thirty-ninth admission were consistently higher if START PPOs were not corrected for the second (1.41; 1.36–1.46), third (1.41;1.35–1.48), fourth (1.35; 1.28–1.44), fifth (1.38; 1.28–1.49), sixth (1.47; 1.34–1.62), and seventh admission to thirty-ninth admission (1.23; 1.14–1.34). The odds ratios for mortality were post-admission number of medications (1.04; 1.04–1.05), STOPP PIMs (0.99; 0.96–1.00), AGS Beers PIMs (1.08; 1.07–1.08), and START omissions not corrected with a prescription (1.56; 1.50–1.63). START omissions for all admissions corrected with a prescription by a hospital physician correlated with a dramatic reduction in mortality (0.51; 0.49–0.53) within six months of discharge. This was also true for the second (0.52; 0.50–0.55), fourth (0.56; 0.52–0.61), fifth (0.63; 0.57–0.68), sixth (0.68; 0.61–0.76), and seventh admission to thirty-ninth admission (0.71; 0.65–0.78). Conclusions: “Potential prescribing omissions” (PPOs) consisted mostly of needed cardiac medications. These omissions occurred before the first admission of this cohort, and many persisted through their readmissions and discharges. Therefore, these omissions should be corrected in the community before admission by family physicians, in the hospital by hospital physicians, and if they continue after discharge by teams of family physicians, pharmacists, and nurses. These community teams should also meet with patients and focus on patients’ understanding of their illnesses, medications, PPOs, and ability for self-care.
]]>Geriatrics doi: 10.3390/geriatrics8050099
Authors: Moritz Kraus Ulla Cordula Stumpf Alexander Martin Keppler Carl Neuerburg Wolfgang Böcker Henning Wackerhage Sebastian Felix Baumbach Maximilian Michael Saller
Introduction: The measurement of physical frailty in elderly patients with orthopedic impairments remains a challenge due to its subjectivity, unreliability, time-consuming nature, and limited applicability to uninjured individuals. Our study aims to address this gap by developing objective, multifactorial machine models that do not rely on mobility data and subsequently validating their predictive capacity concerning the Timed-up-and-Go test (TUG test) in orthogeriatric patients. Methods: We utilized 67 multifactorial non-mobility parameters in a pre-processing phase, employing six feature selection algorithms. Subsequently, these parameters were used to train four distinct machine learning algorithms, including a generalized linear model, a support vector machine, a random forest algorithm, and an extreme gradient boost algorithm. The primary goal was to predict the time required for the TUG test without relying on mobility data. Results: The random forest algorithm yielded the most accurate estimations of the TUG test time. The best-performing algorithm demonstrated a mean absolute error of 2.7 s, while the worst-performing algorithm exhibited an error of 7.8 s. The methodology used for variable selection appeared to exert minimal influence on the overall performance. It is essential to highlight that all the employed algorithms tended to overestimate the time for quick patients and underestimate it for slower patients. Conclusion: Our findings demonstrate the feasibility of predicting the TUG test time using a machine learning model that does not depend on mobility data. This establishes a basis for identifying patients at risk automatically and objectively assessing the physical capacity of currently immobilized patients. Such advancements could significantly contribute to enhancing patient care and treatment planning in orthogeriatric settings.
]]>Geriatrics doi: 10.3390/geriatrics8050098
Authors: Takeshi Shimamura Hitoshi Ishikawa Hiromi Fujii Hiroshi Katoh
Background: Studies that quantify the quality of sit-to-stand-to-sit (STS) motions, particularly in terms of smoothness, are limited. Thus, this study aimed to investigate the possibility and usefulness of quality evaluation during STS motions. Methods: This cross-sectional study enrolled 36 females aged >60 years, including 18 females each in the healthy and hip fracture groups. Measurements were performed at two different speeds: five STS as fast as possible (STSF) and two seconds for each motion (STS2s). Indices of smoothness, including harmonic ratio (HR) and power spectrum entropy (PSE), were calculated and compared from the measured data in each of the three axial directions. Results: HR in the vertical direction was significantly higher in the healthy group (STSF: 3.65 ± 1.74, STS2s: 3.42 ± 1.54) than in the hip fracture group (STSF: 2.67 ± 1.01, STS2s: 2.58 ± 0.83) for STSF and STS2s. Furthermore, PSE for all directions and triaxial composites were significantly lower for STS2s (the healthy group (mediolateral (ML): 7.63 ± 0.31, vertical (VT): 7.46 ± 0.22, anterior–posterior (AP): 7.47 ± 0.15, triaxial: 7.45 ± 0.25), the hip fracture group (ML: 7.82 ± 0.16, VT: 7.63 ± 0.16, AP: 7.61 ± 0.17, triaxial: 7.66 ± 0.17)). Conclusions: This study suggests the usefulness of HR and PSE as quality evaluations for STS motions.
]]>Geriatrics doi: 10.3390/geriatrics8050097
Authors: Pinar Soysal Nicola Veronese Lee Smith Yaohua Chen Burcu Akpinar Soylemez Alessandra Coin Dorota Religa Tarja Välimäki Mariana Alves Susan D. Shenkin
The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on the psychological well-being of caregivers of people with dementia or mild cognitive impairment (PwD/MCI). Electronic databases were searched from inception to August 2022 for observational studies investigating the COVID-19 lockdown and psychological well-being of caregivers of PwD/MCI. Summary estimates of standardized mean differences (SMD) in psychological well-being scores pre- versus during COVID-19 were calculated using a random-effects model. Fifteen studies including 1702 caregivers (65.7% female, mean age 60.40 ± 12.9 years) with PwD/MCI were evaluated. Five studies found no change in psychological well-being parameters, including depression, anxiety, distress, caregiver burden, and quality of life. Ten studies found a worsening in at least one parameter: depression (six studies, n = 1368; SMD = 0.40; 95%CI: 0.09–0.71; p = 0.01, I2 = 86.8%), anxiety (seven studies, n = 1569; SMD = 1.35; 95%CI: 0.05–2.65; I2 = 99.2%), caregiver distress (six studies, n = 1320, SMD = 3.190; 95%CI: 1.42–4.95; p < 0.0001; I2 = 99.4%), and caregiver burden (four studies, n = 852, SMD = 0.34; 95%CI: 0.13–0.56; p = 0.001; I2 = 54.1%) (p < 0.05). There was an increase in depression, anxiety, caregiver burden, and distress in caregivers of PwD/MCI during the lockdown in the COVID pandemic. This could have longer term consequences, and it is essential that caregivers’ psychological well-being is assessed and supported, to benefit both themselves and those for whom they care.
]]>Geriatrics doi: 10.3390/geriatrics8050096
Authors: Kleio Moustaka Chrysanthi Nega Ion N. Beratis
The present study aims to explore the differences in the manifestation of cognitive decline and psychiatric symptoms across the different ages of MCI onset: early onset (EOMCI: <65 years old), middle onset (MOMCI: 65–75 years old), and late onset (LOMCI: >75 years old). It was hypothesized that individuals with EOMCI will preserve their cognitive functions to a greater extent as compared to individuals with LOMCI, even after adjusting the cognitive performance for age and education through the use of published Greek norms. The level of cognitive decline concerning MOMCI was evaluated for extracting more precise conclusions regarding the impact of the age of onset on the patterns of MCI symptomatology. The analyses of data were conducted in a Greek population of individuals with MCI, who were consecutive visitors of the Outpatient Memory Clinic of Nestor Alzheimer’s Centre in Athens, Greece. The sample consisted of 297 participants who fulfilled the following inclusion criteria: MCI diagnosis based on Petersen’s criteria, Greek mother language, and absence of a psychiatric history or chronic and incurable organic disease. The overall results support the presence of a cognitive advantage of the EOMCI group compared to the LOMCI group. In the MOMCI group, cognitive performance displayed a tendency to remain intermediate compared to the other two groups. Nonetheless, significant differences were observed when this group was compared with the LOMCI group. The current findings indicate that the age of onset should be taken under consideration in the neuropsychological assessment of individuals with MCI. The specific parameters could have implications in terms of prognosis as well as the design and implementation of tailored interventions.
]]>Geriatrics doi: 10.3390/geriatrics8050095
Authors: Emily Stover Sarah Andrew Joshua Batesole Maren Berntson Chloe Carling Samantha FitzSimmons Tyler Hoang Joseph Nauer Ryan McGrath
Gait speed is a simple, effective indicator of age-related disease and disability. We sought to examine the prevalence and trends of slow gait speed in older Americans. Our unweighted analytic sample included 12,427 adults aged ≥ 65 years from the 2006–2016 waves of the Health and Retirement Study. Gait speed was measured in participant residences. Persons with gait speed < 0.8 or <0.6 m/s were slow. Sample weights were used to generate nationally representative estimates. The overall estimated prevalence of slow gait speed with the <0.8 m/s cut-point was 48.6% (95% confidence interval (CI): 47.4–49.8) in the 2006–2008 waves yet was 45.7% (CI: 44.3–47.1) in the 2014–2016 waves, but this downward trend was not statistically significant (p = 0.06). The estimated prevalence of slowness with the <0.6 m/s cut-point was 21.3% (CI: 20.4–22.3) for the 2006–2008 waves, 18.5% (CI: 17.5–19.4) for the 2010–2012 waves, and 19.2% (CI: 18.2–20.2) for the 2014–2016 waves, but there were again no significant trends (p = 0.61). Our findings showed that the estimated prevalence of slow gait speed in older Americans is pronounced, and different cut-points largely inform how slowness is categorized. Continued surveillance of slowness over time will help guide screening for disablement and identify sub-populations at greatest risk for targeted interventions.
]]>Geriatrics doi: 10.3390/geriatrics8050094
Authors: João Boavida Hande Ayanoglu Cristóvão Valente Pereira Rodrigo Hernandez-Ramirez
The global population is aging, with the percentage of people over 60 expected to rise from 12% to 22% and 33% residing in developed countries. However, most cities lack the appropriate infrastructure to support aging citizens in active aging and traversing the urban landscape, negatively impacting their quality of life. Studies have shown that public parks and green spaces can contribute to a higher quality of life and wellbeing. Also, smart cities are intended to improve the wellbeing and health of their inhabitants. However, most solutions are typically implemented indoors and tend to overlook the needs of older adults. A smart city should consider the increasing rate of aging and give more importance to outdoor environments as a key aspect of quality of life. The article’s main purpose is to provide a comprehensive background to understand the current knowledge on smart public parks and highlight the significance of new research in the field to promote active aging. The article is expected to inspire new research ideas by identifying gaps in knowledge. Open and challenging issues in emerging smart park solutions are proposed for further work.
]]>Geriatrics doi: 10.3390/geriatrics8050093
Authors: Cheng-Kun Hsu Cheng-Chang Liu Tung Chang Jing-Jing Liao Chi-Min Shu
This aim of this research was to explore the appraisal of the use of smart alert bracelets by older adults diagnosed with dementia. Convenience sampling was adopted to recruit older adults with dementia in Yunlin County, Taiwan. A manual questionnaire survey was conducted, and SPSS 26.0 statistical software was used for analysis. The results of this study showed noticeable positive correlation results in the post-test for the modes “wearing device”, “degree of dementia”, and “field configuration”. Based on the experimental results, the following suggestions are provided: (1) in terms of statistical calculation, the statistical results were affected by changes in some participants; (2) as for the design of equipment, to be more suitable for adult use, the size and color of bracelets need to be optimized; (3) as for the problem of battery charging of the device, because the charging location of the device is not easy to find, it is better to extend device standby time; (4) regarding the selection of equipment, older adults with early-stage dementia could be concerned about the function of the wearable device, so it is recommended to provide a device designed with clear functions, such as a watch, so that older adults are more willing to wear it. Patients diagnosed with moderate and severe dementia should be advised to use concealed non-sensory devices, such as charms and cards, to better facilitate assistance from caregivers in wearing them; and (5) as for the device, in case of a loss event, in addition to mobile phone notifications, other light and sound device notifications can be added, allowing caregivers to pay more attention to information in real time. In summary, the feedback from caregivers and older adults suggests that if the device is to be used without charging, the overall design should be light and small, which is more suitable for service designs.
]]>Geriatrics doi: 10.3390/geriatrics8050092
Authors: Roberto Bonanni Lorenzo Abbondante Ida Cariati Elena Gasbarra Umberto Tarantino
Good musculoskeletal quality dramatically influences the outcome of an arthroplasty operation in geriatric patients, as well as is a key element for optimal osseointegration. In this context, metallosis is a complication associated with the type of prosthesis used, as implants with a chromium–cobalt interface are known to alter the bone microarchitecture and reduce the ratio of muscle to fat, resulting in lipid accumulation. Therefore, the aim of our study was to investigate possible muscle changes by histological, morphometric, and immunohistochemical analyses in a patient undergoing hip replacement revision with elevated blood and urinary concentrations of chromium and cobalt. Interestingly, the muscle tissue showed significant structural changes and a massive infiltration of adipose tissue between muscle fibers in association with an altered expression pattern of important biomarkers of musculoskeletal health and oxidative stress, such as myostatin and NADPH Oxidase 4. Overall, our results confirm the very serious impact of metallosis on musculoskeletal health, suggesting the need for further studies to adopt a diagnostic approach to identify the cause of metallosis early and eliminate it as part of the prosthesis revision surgery.
]]>Geriatrics doi: 10.3390/geriatrics8050091
Authors: Hitomi Matsuda Thomas Mayers Naoki Maki Akihiro Araki Sachie Eto
The purpose of this study was to examine the association between sleep quality, frailty, and human relationships in Japanese older adults (aged 65 years and above, excluding those certified as requiring long-term care). This cross-sectional study used a questionnaire survey to gather demographic information, data on frequency of conversation and conversation partners, and employed the following validated instruments: Kihon Checklist (KCL), a Japanese instrument used to determine the care needs and frailty of older adults; the Dysphagia Risk Assessment for Community-Dwelling Elderly (DRACE) scale; Japanese versions of Pittsburgh Sleep Quality Index (PSQI-J); the Geriatric Depression Scale-15 (GDS-15-J); and the University of California Los Angeles Scale (UCLA-J), an instrument to assess loneliness in older adults. The 500 respondents were divided into two groups based on sleep quality (PSQI-J): low sleep quality group (n = 167, 33.4%) and high sleep quality group (n = 333, 66.6%). Our analyses showed that the low sleep quality group had a KCL score of 5.55 ± 2.47, which indicated frailty. Binomial logistic regression analysis identified age, number of diseases under treatment, DRACE, GDS-15-J, and conversation frequency and discussion partner for important matters as factors (p < 0.05) associated with poor sleep quality. These factors could help enhance the detection of frailty and predictability of caregiving needs.
]]>Geriatrics doi: 10.3390/geriatrics8050090
Authors: Katherine Kortes-Miller Maïa Natale Kimberley Wilson Arne Stinchcombe
Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners’ roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.
]]>Geriatrics doi: 10.3390/geriatrics8050089
Authors: Tünde Szilágyiné Lakatos Balázs Lukács Attila Csaba Nagy Zoltán Jenei Ilona Veres-Balajti
Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients’ fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00–40.00 vs. median 20.00 IQR 16.00–24.00) and THA (median 34.50 IQR 28.00–42.00 vs. median 20.00 IQR 16.00–22.00). A control group with TKA (median 37.50 IQR 30.00–40.00 vs. median 64.50 IQR 54.00–82.00) and THA (median 34.50 IQR 28.00–42.00 vs. median 73.00 IQR 56.00–81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00–10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.
]]>Geriatrics doi: 10.3390/geriatrics8050088
Authors: Fatima Alabdulali Afnan Freije Mariam Al-Mannai Jameela Alsalman Fatima Ahmed Buabbas Mariangela Rondanelli Simone Perna
Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain, was carried out. Various biochemical markers were collected from patients’ medical records, including CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine. A semi-structured questionnaire using a standardized food frequency questionnaire (FFQ) was used, from which total energy and total macronutrients were calculated. Results: The mean BMI of the participants was 27.20 kg/m2, and none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients’ dietary intake of macronutrients and total calorie intake were either within or above the recommended RDA levels. The results also showed that all of the mean values of the nutritional and biochemical markers (CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine) were within the normal reference ranges. A significant positive correlation between CD4+ T cell count, Hb, HCT, and albumin at the <0.05 level was found. There was no significant correlation between CD4+ T cell count and MCV, WBCs, and creatinine. A positive significant correlation was found between BMI, CD4+ T cell count, and WBCs at the <0.01 level. Conclusion: The BMI values were significantly correlated with the biochemical markers of AIDS progression. The dietary patterns of the participants were undiversified, with a high prevalence of obesity and overweight. Malnutrition among this study population was not present.
]]>Geriatrics doi: 10.3390/geriatrics8050087
Authors: Naomi Ito Isamu Amir Hiroaki Saito Nobuaki Moriyama Ayako Furuyama Priya Singh Stephanie Montesino Chika Yamamoto Mika Sato Toshiki Abe Tianchen Zhao Masaharu Tsubokura
After the Fukushima nuclear power plant disaster in 2011, the Japanese government implemented a return policy, lifting most evacuation orders in former evacuation areas. Consequently, the return of residents is currently underway. However, it has become common for a large number of residents to carry out multisite living, a lifestyle involving returning to their hometown while maintaining their house at the evacuation site, or living at more than two sites. This report focuses on one aspect of the secondary effects of the nuclear incident, which forced affected residents to adopt a multisite lifestyle. Disasters always have a strong impact, via displacement, on those who are socially vulnerable, such as older people in an ageing society. They need intense support to resume their daily life as it was before the incident. For this report, we interviewed an elderly lady in her 90s, who is executing “multisite living” at evacuation sites, in order to obtain reassurance from neighbours and the local community. Our findings may provide valuable suggestions on how older people can restart their lives with the local community in an ageing society after disasters, which could apply to any kind of disaster preparedness.
]]>Geriatrics doi: 10.3390/geriatrics8050086
Authors: Flávia Borges-Machado Duarte Barros Paula Silva Pedro Marques Joana Carvalho Oscar Ribeiro
Informal caregivers of people with neurocognitive disorders (NCDs) may play a decisive role in guaranteeing partners’ participation in community-based physical exercise interventions. However, little is still known about their perspective on being involved in such programs that are specifically designed for their partners. This study aimed to explore the views of caregivers of people with NCDs about taking part in a multicomponent physical exercise intervention with their partners and to explore the perceived impact of this program on those caregivers who enrolled in it. An exploratory qualitative study was conducted with 20 caregivers (67.5 ± 13.94 years; seven female) from the “Body & Brain” project. Ten took part in the physical exercise sessions (active-participating caregivers), and the others did not (social-participating caregivers). Data retrieved from semi-structured interviews were analyzed following a thematic analysis approach. Regardless of their participation level, all caregivers reported their inclusion to be important in enhancing their partners’ initiation and engagement in the sessions; also, they all identified personal gains. Active-participating caregivers reported exercise-related benefits on general health, enjoyment, and social connectedness. Social-participating caregivers considered this intervention an opportunity for respite and appreciated being involved only occasionally (i.e., occasional gatherings or telephone contacts). The findings support the inclusion of caregivers in physical exercise interventions designed for partners with NCDs, considering their decisive role in the partners’ adherence and engagement and due to the perceived gains. Future community-based interventions designed for people with NCDs should consider giving caregivers the opportunity to choose whether they want or not to be actively involved in the exercise sessions. Further studies with larger samples are needed to verify these results, comparing caregivers’ point of view at baseline and post-intervention.
]]>Geriatrics doi: 10.3390/geriatrics8050085
Authors: Irene Blackberry Tshepo Rasekaba Debra Morgan Kayla Royals Jennene Greenhill David Perkins Megan O’Connell Mohammad Hamiduzzaman Margaret Winbolt Ainsley Robinson Hilary Davis Clare Wilding
Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers’ perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged <55 years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers’ social support and appeared to ease caregiver demand.
]]>Geriatrics doi: 10.3390/geriatrics8050084
Authors: Mauro Cataldi Camilla Celentano Leonardo Bencivenga Michele Arcopinto Chiara Resnati Annalaura Manes Loreta Dodani Lucia Comnes Robert Vander Stichele Dipak Kalra Giuseppe Rengo Francesco Giallauria Ugo Trama Nicola Ferrara Antonio Cittadini Maurizio Taglialatela
Background: Pharmacogenomic factors affect the susceptibility to drug–drug interactions (DDI). We identified drug interaction perpetrators among the drugs prescribed to a cohort of 290 older adults and analysed the prevalence of gene polymorphisms that can increase their interacting potential. We also pinpointed clinical decision support systems (CDSSs) that incorporate pharmacogenomic factors in DDI risk evaluation. Methods: Perpetrator drugs were identified using the Drug Interactions Flockhart Table, the DRUGBANK website, and the Mayo Clinic Pharmacogenomics Association Table. Allelic variants affecting their activity were identified with the PharmVar, PharmGKB, dbSNP, ensembl and 1000 genome databases. Results: Amiodarone, amlodipine, atorvastatin, digoxin, esomperazole, omeprazole, pantoprazole, simvastatin and rosuvastatin were perpetrator drugs prescribed to >5% of our patients. Few allelic variants affecting their perpetrator activity showed a prevalence >2% in the European population: CYP3A4/5*22, *1G, *3, CYP2C9*2 and *3, CYP2C19*17 and *2, CYP2D6*4, *41, *5, *10 and *9 and SLC1B1*15 and *5. Few commercial CDSS include pharmacogenomic factors in DDI-risk evaluation and none of them was designed for use in older adults. Conclusions: We provided a list of the allelic variants influencing the activity of drug perpetrators in older adults which should be included in pharmacogenomics-oriented CDSSs to be used in geriatric medicine.
]]>Geriatrics doi: 10.3390/geriatrics8050083
Authors: Alan Pantoja-Cardoso Jose Carlos Aragão-Santos Poliana de Jesus Santos Ana Carolina Dos-Santos Salviano Resende Silva Newton Benites Carvalho Lima Alan Bruno Silva Vasconcelos Leonardo de Sousa Fortes Marzo Edir Da Silva-Grigoletto
Functional training (FT) is a type of multicomponent training with emphasis on activities of daily living that stimulate different physical capacities in only one session. Dual-task training (DTT) is a type of training that simultaneously applies cognitive and motor stimuli. We investigated the effects of sixteen weeks of FT and DTT and eight weeks of detraining on older women’s inhibitory control, working memory, and cognitive flexibility. Sixty-two older women (66.9 ± 5.4 years; 27.7 ± 3.9 kg/m2) completed a 16-week intervention program comprising the FT (n = 31) and DTT (n = 31), and 43 returned after the detraining period. We used the Stroop Color Word Color test to evaluate inhibitory control, the Corsi Block Test to assess working memory, and the Trail Making Test to evaluate cognitive flexibility. Only DTT reduced the congruent response time between the pre-test and post-test (d= −0.64; p < 0.001), with no difference between the post-test and the detraining values (d = 1.13; p < 0.001). Both groups reduced the incongruent response time between the pre-test and post-test (FT: d = −0.61; p = 0.002; DTT: d= −0.59; p = 0.002) without a difference between groups. There were no significant differences in working memory and cognitive flexibility. Sixteen weeks of FT and DTT increased the inhibitory control of older women but not the working memory and cognitive flexibility, and these effects persisted after eight weeks of detraining.
]]>Geriatrics doi: 10.3390/geriatrics8040082
Authors: Alessia Verduri Ben Carter Ceara Rice James Laraman Eleanor Barton Enrico Clini Nick A. Maskell Jonathan Hewitt
Background: Frailty is a syndrome characterised by increased vulnerability to negative outcomes. Interstitial lung disease (ILD), asthma, and pleural disease are leading causes of morbidity and mortality. We aimed to investigate the prevalence and impact of frailty in adult patients with these diseases. Methods: We conducted a systematic review and meta-analysis, searching PubMed, Web of Science, The Cochrane Library, and EMBASE for studies reporting on frailty in ILD, asthma, and pleural disease. MeSH terms including interstitial lung disease, Idiopathic Pulmonary Fibrosis, Non-specific Interstitial Pneumonia, Chronic Hypersensitivity Pneumonitis, systemic sclerosis-associated ILD, connective tissue disease-associated ILD, and frailty were used as key words. The primary outcome was prevalence of frailty. Where enough contextually homogeneous studies were included, a pooled random-effects meta-analysis was performed with mortality and hospitalisation as the outcomes. Results: The review found three studies relating to frailty in asthma. No studies relating to pleural disease and frailty were identified. The median prevalence in asthma was 9.5% (IQR, 7.8–11.3). Six relevant studies incorporating 1471 ILD patients (age 68.3 ± SD2.38; 50% male) were identified, which were either cohort or cross-sectional design rated either good or fair. The median prevalence of frailty was 48% (IQR, 25–50). There was a positive association between frail ILD patients and increased risk of long-term mortality (pooled OR, 2.33 95%CI 1.31–4.15, I2 9%). One study reported a hospitalization rate of HR = 1.97(1.32–3.06) within 6 months in frail ILD patients. Conclusions: Frailty is very common and associated with increased mortality in patients with ILD. There are still minimal data regarding the prevalence of frailty and its influence on the risk in this population.
]]>Geriatrics doi: 10.3390/geriatrics8040081
Authors: Kirstyn James Matthew E. Growdon Ariela R. Orkaby Andrea Wershof Schwartz
(1) Background: Mobility assessment is a key component of the assessment of an older adult as a part of the Age-Friendly Health System (AFHS) “geriatric 4Ms” framework. Several validated tools for assessing mobility and estimating fall risk in older adults are available. However, they are often under-utilized in daily practice even in specialty geriatric medicine care settings. We aimed to increase formal mobility assessment with brief gait speed measurement in a geriatric medicine outpatient clinic using phased change interventions. (2) Methods: This quality improvement (QI) initiative was conducted in a single outpatient geriatric medicine clinic. All clinic attendees who could complete a gait speed measurement were eligible for inclusion. The outcome measure was the completion of a 4 m gait speed. Several change interventions were implemented on a phased basis using the Model for Improvement methodology during the period from December 2018 to March 2020. Statistical process control charts were used to record gait speed measurements and detect non-random shifts. (3) Results: During this QI initiative, 80 patients were seen, accounting for 142 clinic visits. In response to change interventions, gait speed measurement at clinic visits increased from a median of 25% of visits to 67% by March 2020. (4) Conclusions: Adopting an AFHS care model is an urgent and challenging task to improve the quality of care for older adults. This initiative details how to effectively incorporate a brief, validated assessment of mobility using gait speed measurement into every geriatric medicine outpatient visit and progresses implementation of the AFHS “geriatric 4Ms”. Mobility assessment can aid in identifying older adults at increased fall risk.
]]>Geriatrics doi: 10.3390/geriatrics8040080
Authors: Masatoshi Koumo Yoshinori Maki Akio Goda Kensaku Uchida Shohei Ogawa Tatsumi Matsui Nozomu Hidemura Tomohiro Adachi
Background: Predictive factors associated with independent ambulation post-stroke are less commonly reported for patients during the acute phase of stroke. This study aimed to identify the clinical variables predicting ambulation independence in the acute phase of stroke and test the superiority of their prediction accuracy. Methods: Sixty-nine patients, hospitalized in the acute phase for an initial unilateral, supratentorial stroke lesion, were divided into independent (n = 24) and dependent ambulation (n = 45) groups, with functional ambulation category scores of 4–5 and ≤ 3, respectively. They were evaluated upon admission using the modified Rankin scale (mRS), Stroke Impairment Assessment Set (SIAS) concerning the motor function of the lower extremities, Ability for Basic Movement Scale modified version 2 (ABMS2), and Functional Independence Measure (FIM). Results: The scores of the four measures were significantly different between the groups. A univariate logistic regression analysis identified these variables as prognostic factors for independent ambulation. A receiver operating characteristic curve analysis identified the cutoff values (area under the curve) for the mRS, SIAS, FIM, and ABMS2 as 3 (0.74), 12 (0.73), 55 (0.85), and 23 (0.84), respectively. Conclusion: In summary, the FIM and ABMS2 may be more accurate in predicting ambulation independence in patients with stroke during the acute phase.
]]>Geriatrics doi: 10.3390/geriatrics8040079
Authors: Ines Augustina Sumbayak Sri Lelyati C. Masulili Fatimah Maria Tadjoedin Benso Sulijaya Arrum Mutiara Diana Khoirowati Yuniarti Soeroso Boy M. Bachtiar
Aging can change the ability to respond to various stimuli and physical conditions. A decreased immune response is a form of deterioration of function in older people, who then become more vulnerable when exposed to pathogens. Periodontitis is an inflammatory disease of the periodontal tissues that often occurs in older people. This study aimed to clinically analyze the periodontal status and cytokine levels of IL-1β, TNF-α, and IL-10 in older people and adults with periodontitis. This clinical study examined 20 persons in a group of older people and 20 persons in a group of adults. The clinical measurements of periodontal status included the Simplified Oral Hygiene Index (OHI-S), Plaque Index (PlI), and Papilla Bleeding Index (PBI). The cytokine levels in gingival crevicular fluid (GCF) were quantified by using ELISA kits. The OHI-S, PlI, and PBI were found to be higher in the older group. The mean values of cytokines were higher in the older group than in adults, although no statistically significant differences were found. A strong correlation was found between the clinical measurements and the cytokine levels in the GCF. There was an increasing tendency of pro-inflammatory and anti-inflammatory cytokines in the older group compared to the adult group.
]]>Geriatrics doi: 10.3390/geriatrics8040078
Authors: Sara C. Murphy Jennifer J. Severance Kathlene Camp Janice A. Knebl Thomas J. Fairchild Isabel Soto
According to the Institute of Medicine, immediate steps must be taken across the United States to educate and train the healthcare workforce to work collaboratively to address the needs of the growing older adult population. The Geriatric Practice Leadership Institute (GPLI) was designed to support professional teams working in acute and post-acute care in transforming their organization into a designated Age-Friendly Health System. The program was built around the Institute for Healthcare Improvement’s Age-Friendly Health Systems 4Ms framework. This framework focuses on What Matters, Medication, Mentation, and Mobility (the 4Ms) in supporting care for older adults. The GPLI program is an online, seven-month team-based program with four to seven participants from one organization per team. Additionally, each team selected, developed, and completed a quality improvement project based on Age-Friendly Health Systems 4Ms. The curriculum also includes organizational culture, leadership, and interprofessional team-building modules. Using a post-completion survey, the experiences of 41 participants in the GPLI program were assessed. All respondents found the information in the program ‘very’ or ‘extremely’ valuable, and their executive sponsor ‘very’ or ‘extremely’ valuable in supporting their team’s involvement and project. The GPLI program has trained over 200 healthcare professionals and teams that have successfully implemented projects across their organizations.
]]>Geriatrics doi: 10.3390/geriatrics8040077
Authors: Abdeljalil Lahiouel Jane Kellett Stephen Isbel Nathan M. D’Cunha
Nutrition knowledge is a primary factor influencing food choices and the ability to identify nutritional risk for carers of people with dementia. Acquiring nutrition knowledge helps carers monitor changes in food intake and micronutrient intake, and whether a healthy and balanced diet is being consumed. This study aimed to assess the nutrition knowledge of carers in the Australian community and their experiences with nutrition education. Using a mixed-methods approach, the nutrition knowledge of informal carers was assessed using the revised General Nutrition Knowledge Questionnaire (AUS-R-NKQ), and interviews of informal carers were used to explore the perspectives in a sub-sample. A total of 57 carers (44 females; mean age of 63.0 ± 13.1) completed the survey, and 11 carers participated in follow-up interviews. The total sample scored 22.9 (±4.57) out of 38 on the AUS-R-NKQ, suggesting basic nutrition knowledge. The interviewed carers acknowledged the importance of healthy nutrition but viewed the provision of a healthy diet for a person with dementia as challenging. In both the survey and interviews, carers reported limited use and availability of dementia-specific nutrition resources. Carers were unsatisfied with the advice and number of referrals provided to improve the nutrition of the person with dementia and desired less confusing nutrition education materials adapted to their level of knowledge. The present study highlights the need for informal carers to be supported to acquire adequate nutrition knowledge.
]]>Geriatrics doi: 10.3390/geriatrics8040076
Authors: Panitan Sonpanao Kajohnkiart Janebodin Niwatchai Namvichaisirikul Supattarayan Thongjit Paiboon Jitprasertwong
Aim: To investigate the prevalence of xerostomia in older people with diabetes mellitus and its impacts on oral functions, as well as to determine potential risk factors for xerostomia. Methods: An analytical cross-sectional study was conducted on 623 older type 2 diabetes mellitus (T2DM) Thai people using valid structural questionnaires. Patients were interviewed, and data were recorded. Xerostomia was assessed using subjective symptom questionnaires. Risk factors for xerostomia were analyzed using bivariate and multiple logistic regression analyses. Results: Among the study participants, 38.4% of the older T2DM people had xerostomia, which is associated with sex, age, type of toothpaste, years of diabetes, hemoglobin A1c level, other systemic diseases, medication, smoking, alcohol consumption, and denture wearing. It was significant that xerostomia was associated with toothpaste containing spicy herbal extracts (OR: 9.32 [3.46 to 15.25]), while toothpaste containing artificial sweeteners tended to lower the risk of xerostomia. In addition, older T2DM adults with xerostomia had greater impaired oral functions, which include difficulties in speaking (OR: 3.31 [1.11 to 9.80]), tasting (OR: 5.12 [3.26 to 8.06]), swallowing (OR: 3.59 [2.32 to 5.53]), and chewing (OR: 3.34 [1.15 to 5.82]). Conclusions: Xerostomia is prevalent in older Thai people with T2DM. The results suggest that toothpaste containing spicy herbal extracts might increase the risk of xerostomia, resulting in various oral function problems. Therefore, greater awareness of xerostomia in this group should be raised to monitor dental health, and professionals should work in parallel with other aspects of oral health promotion.
]]>Geriatrics doi: 10.3390/geriatrics8040075
Authors: Helena Dolphin Adam H. Dyer Cathy McHale Sean O’Dowd Sean P. Kennelly
Apathy is a complex multi-dimensional syndrome that affects up to 70% of individuals with Alzheimer’s disease (AD). Whilst many frameworks to define apathy in AD exist, most include loss of motivation or goal-directed behaviour as the central feature. Apathy is associated with significant impact on persons living with AD and their caregivers and is also associated with accelerated cognitive decline across the AD spectrum. Neuroimaging studies have highlighted a key role of fronto-striatial circuitry including the anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and associated subcortical structures. Importantly, the presence and severity of apathy strongly correlates with AD stage and neuropathological biomarkers of amyloid and tau pathology. Following from neurochemistry studies demonstrating a central role of biogenic amine neurotransmission in apathy syndrome in AD, recent clinical trial data suggest that apathy symptoms may improve following treatment with agents such as methylphenidate—which may have an important role alongside emerging non-pharmacological treatment strategies. Here, we review the diagnostic criteria, rating scales, prevalence, and risk factors for apathy in AD. The underlying neurobiology, neuropsychology and associated neuroimaging findings are reviewed in detail. Finally, we discuss current treatment approaches and strategies aimed at targeting apathy syndrome in AD, highlighting areas for future research and clinical trials in patient cohorts.
]]>Geriatrics doi: 10.3390/geriatrics8040074
Authors: Katherine C. Ritchey Laurence M. Solberg Sandra Wolfe Citty Lea Kiefer Erica Martinez Caroline Gray Aanand D. Naik
Background: Patient priorities care (PPC) is an effective age-friendly health systems (AFHS) approach to aligning care with goals derived from ‘what matters’. The purpose of this quality improvement program was to evaluate the fidelity and feasibility of the health priorities identification (HPI) process in VA Community Living Centers (CLC). Methods: PPC experts worked with local CLC staff to guide the integration of HPI into the CLC and utilized a Plan–Do–Study–Act (PDSA) model for this quality improvement project. PPC experts reviewed health priorities identification (HPI) encounters and interdisciplinary team (IDT) meetings for fidelity to the HPI process of PPC. Qualitative interviews with local CLC staff determined the appropriateness of the health priorities identification process in the CLC. Results: Over 8 months, nine facilitators completed twenty HPI encounters. Development of a Patient Health Priorities note template, staff education and PPC facilitator training improved fidelity and documentation of HPI encounters in the electronic health record. Facilitator interviews suggested that PPC is appropriate in this setting, not burdensome to staff and fostered a person-centered approach to AFHS. Conclusions: The HPI process is an acceptable and feasible approach to ask the ‘what matters’ component of AFHS in a CLC setting.
]]>Geriatrics doi: 10.3390/geriatrics8040073
Authors: Lavinia Maris Timea Claudia Ghitea
Through these epidemiological studies, which are based on statistical and observational calculations, without visual appeal, we tracked the incidence of public health problems. In this study, our research objective was to determine and evaluate the health patterns present in a population, along with identifying the factors that contribute to the risks or provide protection against specific diseases or conditions. The progression of cardiometabolic diseases is closely linked to various chronic conditions, such as diabetes, hypertension, dyslipidemia, and chronic kidney disease. This research study involved 578 patients, who were divided into six-year cohorts ranging from 2017 to 2022. The study examined parameters related to cardiometabolic diseases, including alcoholic hepatopathies, non-alcoholic hepatopathy, chronic kidney disease, hypertension, myocardial infarction, other forms of chronic coronary syndrome, peripheral vascular disease, microvascular diseases, macrovascular diseases, and hypercholesterolemia, while considering age and physical activity levels. The study concluded that individuals in the age group of 41–50 years exhibited the highest propensity for cardiometabolic damage. Additionally, the promotion of a healthy and active lifestyle is increasingly gaining traction among elderly patients.
]]>Geriatrics doi: 10.3390/geriatrics8040072
Authors: Ilias D. Iliopoulos Ioanna Lianou Angelos Kaspiris Dimitrios Ntourantonis Christine Arachoviti Christos P. Zafeiris George I. Lambrou Efstathios Chronopoulos
Since December 2019, the COVID-19 pandemic has had a significant impact on healthcare systems worldwide, prompting policymakers to implement measures of isolation and eventually adopt strict national lockdowns, which affected mobility, healthcare-seeking behavior, and services, in an unprecedented manner. This study aimed to analyze the effects of these lockdowns on hip-fracture epidemiology and care services, compared to nonpandemic periods in previous years. We retrospectively collected data from electronic patient records of two major hospitals in Western Greece and included patients who suffered a fragility hip fracture and were admitted during the two 5-week lockdown periods in 2020, compared to time-matched patients from 2017–2019. The results showed a drop in hip-fracture incidence, which varied among hospitals and lockdown periods, and conflicting impacts on time to surgery, time to discharge after surgery, and total hospitalization time. The study also found that differences between the two differently organized units were exaggerated during the COVID-19 lockdown periods, highlighting the impact of compliance with social-distancing measures and the reallocation of resources on the quality of healthcare services. Further research is needed to fully understand the specific variations and patterns of geriatric hip-fracture care during emergency health crises characterized by limited resources and behavioral changes.
]]>Geriatrics doi: 10.3390/geriatrics8040071
Authors: Tagrid A. Alharbi Alice J. Owen Joanne Ryan Danijela Gasevic John J. McNeil Robyn L. Woods Mark R. Nelson Rosanne Freak-Poli
Objective: To identify the socio-demographic, lifestyle, and clinical characteristics associated with self-reported weight status in early (age 18 years) and late (age ≥ 70 years) adulthood. Methods: The number of participants was 11,288, who were relatively healthy community-dwelling Australian adults aged ≥70 years (mean age 75.1 ± 4.2 years) in the Aspirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons (ALSOP) sub-study. Self-reported weight at the study baseline (age ≥ 70 years) and recalled weight at age 18 years were collected. Height measured at baseline was used to calculate the BMI at both time points. Individuals were categorised into one of five ‘lifetime’ weight status groups: healthy weight (at both age 18 year and ≥70 years), overweight (at either or both times), non-obese (age 18 year) to obesity (age ≥70 years), obesity (age 18 years) to non-obese (age ≥ 70 years), and early and later life obesity (at age 18 years and ≥70 years). Results: Participants who experienced obesity in early and/or late adulthood were at a higher risk of adverse clinical characteristics. Obesity in late adulthood (regardless of early adulthood weight status) was associated with high proportions of hypertension, diabetes, and dyslipidaemia, whereas obesity in early adulthood (regardless of late adulthood weight status) was associated with lower cognitive scores (on all four measures). Discussion/Conclusion: Healthy or overweight weight status in early and later adulthood was associated with more favourable socioeconomic, lifestyle, and clinical measures. Obesity in early adulthood was associated with lower cognitive function in later adulthood, whereas obesity in later adulthood was associated with hypertension, diabetes, and dyslipidaemia.
]]>Geriatrics doi: 10.3390/geriatrics8040070
Authors: Sweta Tewary Nicole Cook Desiree Simon Elizabeth Philippe Oksana Shnayder Naushira Pandya
The Medicare Annual Wellness Visit (AWV), which includes comprehensive preventative assessments and screenings, is associated with improved preventative services, including vaccination and cancer screenings. However, the AWV alone does not promote whole-person care. Integrating the AWV within an Age-Friendly Health System (AFHS) contextualizes AWV services within a comprehensive geriatric care framework that integrates the “4Ms” (mentation, medication, mobility, and what matters). This study describes and evaluates quality improvement initiatives to improve the completion of AWV within two different AFHS-recognized health systems (an academic university clinic and a Federally Qualified Health Center). The results from this evaluation present opportunities that other health systems can consider for leveraging electronic health records (EHRs) and enabling services to complete AWVs within a 4Ms framework. The implementation results also suggest an adaptation of the 4Ms assessment schedule for patients with complex chronic conditions who may suffer from multiple comorbidities and cognitive impairment.
]]>Geriatrics doi: 10.3390/geriatrics8040069
Authors: Hui Liu Gerald Roman Nowak Juwen Wang Zhehui Luo
We provide one of the first nationally representative studies to examine COVID-19 vaccine uptake differences by marital status within the first year after the vaccine was recommended among older Americans. Data were drawn from the National Health and Aging Trends Study (2021). The study sample included 3180 participants aged 65 and older with 1846 women and 1334 men. Results from logistic regression models suggest that divorced/separated older adults were less likely to receive at least one dose of the COVID-19 vaccine in 2021 than their married counterparts, especially among women and individuals with higher education. Widowed and never married respondents were generally not significantly different from married respondents in COVID-19 vaccination status, with only one exception: less-educated never-married respondents were more likely to receive COVID-19 vaccination than their less-educated married counterparts. Our study highlights divorce/separation as a significant social factor associated with COVID-19 vaccine uptake among older adults in the U.S. These findings suggest that divorced/separated older adults are the most vulnerable population segment at risk of low COVID-19 vaccine uptake. Future efforts to improve vaccine equity and uptake should target this group specifically, with tailored interventions to increase their access and uptake of the vaccine.
]]>Geriatrics doi: 10.3390/geriatrics8040068
Authors: Terry Fulmer Kim Dash Jody Shue JiHo Chang Jessica Huang Abby Maglich
(1) Background: With the growth of the age-friendly movement, age-friendly ecosystems (AFE) garnered more attention. The successful development of an AFE is contingent on unified efforts across different stakeholders; however, limited efforts were made to help create a common understanding of the necessary components of an AFE. (2) Methodology: In response, The John A. Hartford Foundation and The Age-Friendly Institute hosted a series of convenings of international experts to identify a working definition of the characteristics composing an AFE. The goal of these convenings was to provide a foundation on which to unite cross-sector age-friendly work. (3) Results: This paper discussed the findings of the convenings and provided a framework from which future age-friendly work must draw upon. (4) Conclusions: This paper presented a necessary change in how we conceive AFEs.
]]>Geriatrics doi: 10.3390/geriatrics8030067
Authors: Moustapha Dramé Alison Volberg Lukshe Kanagaratnam Claire Coutureau Lidvine Godaert
Objective: We aimed to identify risk factors for nursing home (NH) entry 36 months after hospitalization via the emergency department (ED) in a population of patients aged 75 years or older. Methods: This was a prospective multicentre cohort. Patients were recruited from the emergency departments (EDs) of nine hospitals. Subjects had been hospitalised in a medical ward in the same hospital as the ED to which they were initially admitted. Subjects who experienced NH entry prior to ED admission were excluded. NH entry has been defined as the incident admission either into an NH or other long-term care facility within the follow-up period. Variables from a comprehensive geriatric assessment of patients were entered into a Cox model with competing risks to predict NH entry during 3 years of follow-up. Results: Among 1306 patients included in the SAFES cohort, 218 (16.7%) who were already in an NH were excluded. The remaining 1088 patients included in the analysis were aged 84 ± 6 years on average. During 3 years of follow-up, 340 (31.3%) entered an NH. The independent risk factors for NH entry were that they: living alone (Hazard ratio (HR) 2.00, had a 95% confidence interval (CI) 1.59–2.54, p < 0.0001), could not independently perform activities of daily living (HR 1.81, 95% CI 1.24–2.64, p = 0.002), and had balance disorders (HR 1.37, 95% CI 1.09–1.73, p = 0.007), dementia syndrome (HR 1.80, 95% CI 1.42–2.29, p < 0.0001) and a risk of pressure ulcers (HR 1.42, 95% CI 1.10–1.82, p = 0.006). Conclusion: The majority of the risk factors for NH entry within 3 years after emergency hospitalization are amenable to intervention strategies. It is therefore reasonable to imagine that targeting these features of frailty could delay or prevent NH entry and improve the quality of life of these individuals before and after NH entry.
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