Geriatrics最新文献

{"title":"Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges.","authors":"Pushpa Raj Joshi","doi":"10.3390/geriatrics9020034","DOIUrl":"10.3390/geriatrics9020034","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informing Dementia Support Programs That Serve Low-Income, Multilingual Communities in a Safety Net Health System: Use of Focus Groups to Identify Specific Needs.","authors":"Andrew Pak, Abriella Demanes, Shirley Wu, Katherine Ward, Mailee Hess","doi":"10.3390/geriatrics9020033","DOIUrl":"10.3390/geriatrics9020033","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Combination of Moderate-to-Vigorous Physical Activity and Sleep Quality with Physical Frailty.","authors":"Tsubasa Yokote, Harukaze Yatsugi, Tianshu Chu, Xin Liu, Lefei Wang, Hiro Kishimoto","doi":"10.3390/geriatrics9020031","DOIUrl":"10.3390/geriatrics9020031","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Subjects and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Community-dwelling older adults who did not meet the MVPA criteria, regardless of sleep quality, had a higher prevalence of physical frailty.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet, Food Intake, and Exercise Mixed Interventions (DEMI) in the Enhancement of Wellbeing among Community-Dwelling Older Adults in Japan: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Takaaki Miyazaki, Toshihiro Futohashi, Hiroki Baba","doi":"10.3390/geriatrics9020032","DOIUrl":"10.3390/geriatrics9020032","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide and Glycemic Control Metrics Using Continuous Glucose Monitoring in Older Patients with Type 2 Diabetes Mellitus: An Observational Pilot Study.","authors":"Takuya Omura, Akemi Inami, Taiki Sugimoto, Shuji Kawashima, Takashi Sakurai, Haruhiko Tokuda","doi":"10.3390/geriatrics9020027","DOIUrl":"10.3390/geriatrics9020027","url":null,"abstract":"<p><p>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% (<i>p</i> = 0.041), 45.8% to 19.7% (<i>p</i> = 0.038), and 1.0% to 1.5% (<i>p</i> = 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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprescribing in Older Poly-Treated Patients Affected with Dementia.","authors":"Pietro Gareri, Luca Gallelli, Ilaria Gareri, Vincenzo Rania, Caterina Palleria, Giovambattista De Sarro","doi":"10.3390/geriatrics9020028","DOIUrl":"10.3390/geriatrics9020028","url":null,"abstract":"<p><p>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 (<i>p</i> = 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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Antibiotics Used for Acute Aspiration Bronchitis on the Prevention of Pneumonia.","authors":"Akihiko Goto, Kosaku Komiya, Kenji Umeki, Kazufumi Hiramatsu, Jun-Ichi Kadota","doi":"10.3390/geriatrics9020026","DOIUrl":"10.3390/geriatrics9020026","url":null,"abstract":"<p><strong>Backgrounds: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%; <i>p</i> = 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Adherence and Cognitive Performance in Older Adults by Nativity Status: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014.","authors":"Md Towfiqul Alam, Elizabeth Vásquez, Jennifer L Etnier, Sandra Echeverria","doi":"10.3390/geriatrics9020025","DOIUrl":"10.3390/geriatrics9020025","url":null,"abstract":"<p><p>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 (<i>n</i> = 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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department.","authors":"Daniele Orso, Giulia Furlanis, Alice Romanelli, Federica Gheller, Marzia Tecchiolli, Franco Cominotto","doi":"10.3390/geriatrics9020023","DOIUrl":"10.3390/geriatrics9020023","url":null,"abstract":"<p><p><b>Purpose</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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; <i>p</i> < 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]; <i>p</i> < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], <i>p</i> < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], <i>p</i> < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], <i>p</i> < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], <i>p</i> < 0.001). Cardiovascular disease (47% vs. 11%; <i>p</i> < 0.001) and cognitive impairment (36% vs. 10%; <i>p</i> < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. <b>Conclusions</b>: 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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts.","authors":"Santos Castañeda, Carmen Navarro Ceballos, Jaqueline Usón Jaeger, Carolina de Miguel Benadiba, Esteban Gómez Martín, Guillermo Martínez Díaz-Guerra, Luis Alvarez-Galovich","doi":"10.3390/geriatrics9020024","DOIUrl":"10.3390/geriatrics9020024","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}