Journal of the American Geriatrics Society最新文献

{"title":"Multi-level social determinants of health, inflammation, and postoperative delirium in older adults","authors":"Sarinnapha M. Vasunilashorn PhD, Emily Wolfson MPH, Miles Berger MD, PhD, Jacqueline Leung MD, MPH, Erin B. Ware PhD, MPH, Andrea Baccarelli MD, Richard N. Jones ScD, Long H. Ngo PhD, Edward R. Marcantonio MD, SM, Sharon K. Inouye MD, MPH, Amy J. H. Kind MD, PhD","doi":"10.1111/jgs.19159","DOIUrl":"10.1111/jgs.19159","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"279-282"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician perspectives regarding over-screening for breast, colorectal, and prostate cancers in older adults","authors":"Morgan R. Quinley BS, Cynthia M. Boyd MD, MPH, Craig E. Pollack MD, MHS, Somnath Saha MD, MPH, Nancy L. Schoenborn MD, MHS","doi":"10.1111/jgs.19177","DOIUrl":"10.1111/jgs.19177","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"288-292"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Many studies, but little certainty about the effects of statin discontinuation on outcomes","authors":"Michelle C. Odden PhD, Chintan V. Dave PharmD, PhD","doi":"10.1111/jgs.19157","DOIUrl":"10.1111/jgs.19157","url":null,"abstract":"<p>In this issue of the <i>Journal of the American Geriatrics Society</i>, Piexoto et al. conducted a systematic review of studies of statin discontinuation on clinical outcomes.<span><sup>1</sup></span> They identified only one randomized trial of statin discontinuation, conducted in people near the end of life, which found no difference in 60-day mortality or 1-year cardiovascular mortality among people who discontinued statins compared with those who continued statins. In contrast, among 35 nonrandomized studies among people not near the end of life, statin discontinuation was associated with a higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. However, the authors noted concerns around bias of confounding by indication, along with concerns about imprecision, inconsistency, and heterogeneity. Together, the findings from observational studies were evaluated as having a high degree of uncertainty and bias, leaving providers and their patients with little useful information outside of the end-of-life setting.</p><p>There is discordance among the major Northern American and European guidelines on the evaluation of the benefit of statins in older adults, especially for primary prevention.<span><sup>2</sup></span> This is compounded by the challenge of accurate prediction of cardiovascular events in older adults, as a risk-based prevention strategy is the cornerstone of many of the guideline recommendations. Adding to the complexity, there is also insufficient evidence to capture potential harms of statin use due to the limited representation of older adults in large randomized statin trials. Further, limited evidence on statins and patient-centered outcomes such as frailty or statin-associated physical or cognitive changes exists, although one modestly sized trial demonstrated worsening decline in energy and exertional fatigue among persons randomized to statins.<span><sup>3</sup></span> Taken collectively, these factors have contributed to a growing interest in medication discontinuation or dose reduction, otherwise referred to as deprescribing, of statins in older adults.</p><p>Piexoto aimed to address this evidence gap by synthesizing the evidence for statin discontinuation, but their systematic review only highlights the challenges in estimating medication effects in observational studies.<span><sup>1</sup></span> Despite recent advancements in observational research methodologies, the majority of studies included in the review were assessed to have a serious risk of bias. The primary limitation of observational studies, in contrast to randomized trials, is that of confounding, or which occurs when the populations who discontinue statins are systematically different than those who continue statins. This limitation is especially challenging for studies of medication deprescribing and mortality, as limited life expectancy is a common reason for medication review and deprescribing.<span><sup>4</sup></span> The","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3291-3293"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort","authors":"Pauline Ali MD, MSc,&nbsp;Pauline Renaud MD,&nbsp;Manuel Montero-Odasso MD, FRCPC, PhD, AGSF, FGSA,&nbsp;Jennifer Gautier MS,&nbsp;Mickaël Dinomais MD, PhD,&nbsp;Cédric Annweiler MD, PhD","doi":"10.1111/jgs.19162","DOIUrl":"10.1111/jgs.19162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69–76), and 43% (<i>n</i> = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The naming animals dual-task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3437-3447"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety and aging: A marker of brain changes and potential treatment target to promote brain health","authors":"Jordan F. Karp MD,&nbsp;Eric J. Lenze MD","doi":"10.1111/jgs.19168","DOIUrl":"10.1111/jgs.19168","url":null,"abstract":"&lt;p&gt;Almost 7 million Americans have Alzheimer's dementia. Approximately 20% of middle-aged women and 10% of middle-aged men will eventually develop Alzheimer's dementia in their lifetime, usually occurring after age 65.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Given the aging of the population, absent incident prevention or efforts that slow the course of the illness there will be close to 14 million Americans living with the disease by 2060.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although new treatments exist, there is no currently available scalable cure that is cost-effective (accounting for Quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and costs), nor will one likely be launched within the next decade. Thus, there needs to be a greater focus on modifiable risk factors (12 of which account for 40% of worldwide dementias)&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; to prevent new cases in the United States and across the globe.&lt;/p&gt;&lt;p&gt;Anxiety disorders are common: they have a lifetime prevalence of approximately 34% in the United States&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and are the second most common neuropsychiatric disease after depression.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Anxiety is linked with higher rates of both depression&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and addiction&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;; reflects a state of both psychic and physical stress&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;; and is linked with pro-inflammatory&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; states, cognitive impairment,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; cardiovascular disease,&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; and all-cause mortality.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; It is also treatable. Elucidating the interaction between having anxiety in late-life and rates of incident dementia may add to the list of modifiable risk factors for cognitive decline and neurodegenerative diseases.&lt;/p&gt;&lt;p&gt;This issue of the journal includes a study by Khaing and colleagues entitled “The effect of anxiety on all-cause dementia: a longitudinal analysis from the Hunter Community Study.”&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; Their communication describes the association of chronic versus resolved versus new onset anxiety on subsequent diagnosis of dementia. The investigators hypothesized that both the (1) chronicity of anxiety and (2) age of exposure to anxiety would be linked with all-cause dementia risk. The sample (&lt;i&gt;n&lt;/i&gt; = 2132, mean age = 76) was an existing cohort of community-dwelling Australians who were recruited between 2004 and 2007. Wave 2 and Wave 3 assessments were completed at 5-year intervals after Wave 1. The natural history of anxiety was categorized as (1) Chronic Anxiety (present at Wave 1 and Wave 2); (2) Resolved Anxiety (present only at Wave 1); and (3) New Anxiety (present only at Wave 2). The primary outcome was incident all-cause dementia up to 13 years after Wave 1. Sixty-four participants (3%) were diagnosed with dementia with the average onset at year 10. Chronic Anxiety (HR = 2.80) and New Anxiety (HR = 3.20) at Wave 2 were both associated with increased risk of all-cau","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3294-3295"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in neighborhood disadvantage over the course of 22 years among community-living older persons","authors":"Thomas M. Gill MD,&nbsp;Robert D. Becher MD, MS,&nbsp;Linda Leo-Summers MPH,&nbsp;Evelyne A. Gahbauer MD, MPH","doi":"10.1111/jgs.19172","DOIUrl":"10.1111/jgs.19172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Among older persons, neighborhood disadvantage is a granular and increasingly used social determinant of health and functional well-being. The frequency of transitions into or out of a disadvantaged neighborhood over time is not known. These transitions may occur when a person moves from one location to another or when the Neighborhood Atlas, the data source for the area deprivation index (ADI) that is used to identify disadvantaged neighborhoods at the census-block level, is updated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From a prospective longitudinal study of community-living persons, aged 70 years or older in South Central Connecticut, neighborhood disadvantage was ascertained every 18 months for 22 years (from March 1998 to March 2020). ADI scores higher than the 80th state percentile were used to distinguish neighborhoods that were disadvantaged (81–100) from those that were not (1–80).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 205 (29.3%) of the 699 participants were living in a disadvantaged neighborhood. Changes in neighborhood disadvantage during 14 consecutive 18-month intervals were relatively uncommon, ranging from 1.5% to 11.8%. Nearly 80% of participants had no change in neighborhood disadvantage and less than 4% had more than one change over a median follow-up of more than 9 years. Overall, the rate of transitions into or out of neighborhood disadvantage was only 2.7 per 100 person-years. These transitions were most common when the Neighborhood Atlas was updated (2013, 2015, 2018, and 2020). Comparable results were observed when decile changes in ADI scores during the 18-month intervals were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In longitudinal studies of older persons with extended follow-up, it may not be necessary to update information on disadvantaged neighborhoods in circumstances when it is possible, and the degree of misclassification of neighborhood disadvantage should be relatively low in circumstances when updated information cannot be obtained.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"199-205"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services","authors":"Chanee D. Fabius PhD, MA,&nbsp;Romil Parikh MBBS, MPH,&nbsp;Jack M. Wolf BA,&nbsp;Stephanie Giordano DLP, MEEP,&nbsp;Shekinah Fashaw-Walters PhD,&nbsp;Eric Jutkowitz PhD,&nbsp;Tetyana Shippee PhD, FGSA","doi":"10.1111/jgs.19153","DOIUrl":"10.1111/jgs.19153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the National Core Indicators-Aging and Disability survey data (2015–2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, <i>p</i> value &lt; 0.01; and aOR, 1.25, <i>p</i> &lt; 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, <i>p</i> &lt; 0.001 and aOR, 1.39, <i>p</i> &lt; 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; <i>p</i> &lt; 0.01; and aOR 1.26, <i>p</i> &lt; 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3520-3529"},"PeriodicalIF":4.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Willingness to take less medication for type 2 diabetes among older patients","authors":"Petra Denig PhD,&nbsp;Peter J. C. Stuijt MSc","doi":"10.1111/jgs.19175","DOIUrl":"10.1111/jgs.19175","url":null,"abstract":"&lt;p&gt;When people with type 2 diabetes age and their health status deteriorates, reevaluation of their treatment is needed. Medication de-intensification is recommended for older patients with a poor health status when they have low levels of hemoglobin A1c while taking medication. The recently published study of Haider et al. investigated the willingness of older people with diabetes to de-intensify their medication.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Of particular interest, they examined which patient characteristics were associated with such willingness and whether this aligned with the guideline recommendations. A key finding was that the people who may benefit the most from treatment de-intensification according to the guidelines were less likely to be willing to take less diabetes medication.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As Pilla et al. mentioned in an editorial, the study was limited by its reliance on responses to the question “I would be willing to take less medication for my diabetes” that lacks clinical context.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; An alternative question has been posed by Crutzen et al. in a study among older people on diabetes and/or cardiovascular drugs.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This concerns the question from revised Patients Attitudes Towards Deprescribing (rPATD) questionnaire, “If my doctor said it was possible, I would be willing to stop one or more of my regular medicines.”&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Crutzen et al. observed that 88% of older patients were willing to stop medication if their doctor said it was possible. This is clearly higher than the 51% willing to take less medication in the study of Haider et al. Although this could indicate that the willingness was higher given the context “that the doctor said it was possible,” an alternative explanation is that the willingness depends on the type of medication. Where the question posed by Haider et al. referred to “less medication for my diabetes,” the medication is not specified in the willingness question of the rPATD.&lt;/p&gt;&lt;p&gt;Differences regarding attitudes toward specific medication were further explored by Crutzen et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; In particular, attitudes towards de-intensifying insulin, sulfonylurea, or statins were studied, showing remarkable differences. For example, few of the older people would like their doctor to reduce the dose of their insulin and more than half were reluctant to stop insulin (Table 1). For patients taking sulfonylurea or statins, these percentages were more in favor of de-intensification (Table 1). Furthermore, few people would like to try stopping the insulin or sulfonylurea they were taking to see how they would feel without, whereas more patients would like to try stopping their statin (Table 1). This might be related to experiencing drug-related problems, such as side effects. Very few patients believed they experienced side effects from their insulin or sulfonylurea, but this was clearly different for statins (Table 1). The findin","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3607-3608"},"PeriodicalIF":4.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Difference between kidney function by cystatin C versus creatinine and association with muscle mass and frailty","authors":"Jiawei Du PhD,&nbsp;Jinghua Hou PhD","doi":"10.1111/jgs.19171","DOIUrl":"10.1111/jgs.19171","url":null,"abstract":"&lt;p&gt;We are writing to share some constructive thoughts on the recent study examining estimated glomerular filtration rate (eGFR), muscle mass, and frailty among older adults.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although the study provides valuable insights, I believe there are several methodological considerations that could be addressed to further strengthen the findings.&lt;/p&gt;&lt;p&gt;First, the study employs eGFR formulas based on serum creatinine and cystatin C, both of which have inherent limitations and assumptions that may not hold true across diverse populations. Specifically, the creatinine-based eGFR formula assumes a constant creatinine generation rate, which can vary significantly with muscle mass and dietary intake. Individuals with higher muscle mass typically have elevated creatinine levels, potentially leading to an underestimation of eGFR.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; On the other hand, cystatin C-based eGFR, though less influenced by muscle mass, can be affected by factors such as inflammation, smoking, and corticosteroid use. These variables can introduce variability and potential bias in eGFR estimates. Moreover, discrepancies in calibration standards for cystatin C assays across different laboratories may lead to inconsistent results.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Second, the study does not extensively address the role of comorbidities, which could confound the relationships between kidney function, muscle mass, and frailty. For instance, cardiovascular diseases can lead to reduced renal perfusion and muscle wasting due to chronic inflammation and diminished physical activity.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Similarly, diabetes can cause muscle loss through mechanisms such as insulin resistance and chronic inflammation.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Chronic inflammatory conditions like rheumatoid arthritis or chronic obstructive pulmonary disease (COPD) also impact eGFR and muscle mass through sustained inflammation and reduced physical activity.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Incorporating these comorbidities into the analysis would provide a more comprehensive understanding of the observed associations.&lt;/p&gt;&lt;p&gt;Third, the reliance on single measurements of eGFR and muscle mass is another critical limitation. Kidney function and muscle mass can fluctuate due to various factors such as acute illnesses, hydration status, or temporary changes in diet and physical activity.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Single measurements may not accurately reflect the average or typical status of these parameters. Longitudinal data would be more informative, allowing researchers to observe changes over time and establish more robust causal relationships between muscle mass and kidney function.&lt;/p&gt;&lt;p&gt;Fourth, although the study focuses on frailty and muscle mass, it does not evaluate functional outcomes, which are crucial for understanding the clinical implications of the findings. Functional outcomes such as mobility, balance tests, and activities of daily living (ADLs) provide direct insigh","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3923-3924"},"PeriodicalIF":4.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to “Comment on: Difference between kidney function by cystatin C versus creatinine and association with muscle mass and frailty”","authors":"O. Alison Potok MD,&nbsp;Dena E. Rifkin MD, MS","doi":"10.1111/jgs.19170","DOIUrl":"10.1111/jgs.19170","url":null,"abstract":"<p>We are grateful for the opportunity to reply to Du and Hou's letter to the Editor commenting on our recent study on the difference in estimated glomerular filtration rates (eGFRDiff) by cystatin C versus creatinine and muscle mass and frailty in the MrOS cohort.<span>¹</span></p><p>We fully agree with Du et al. that eGFR formulas<span>²</span> are based on assumptions that may not be honored depending on the population studied. Both creatinine and cystatin C are imperfect markers of kidney function because of all the non-GFR determinants<span>³</span> that are rightfully mentioned by the authors. Inflammation<span>⁴</span> is indeed a relevant confounder as it may affect both creatinine and cystatin C level as well as physical activity. The models in our study were adjusted for diabetes, hypertension, kidney disease, and smoking status.</p><p>It is precisely to highlight these known and unknown confounders that we opted to investigate the difference in eGFR by cystatin C versus creatinine. The eGFR equations only “adjust” for age, sex, and body size but there are many more non-GFR determinants to both creatinine and cystatin C. eGFRDiff can be thought of as a proxy for those non-GFR determinants.</p><p>The main goal of the study was to investigate whether muscle mass, as defined by deuterated creatine (D3Cr) dilution, may explain the relationship between eGFRDiff and frailty. This is why we did not include clinical outcomes such as activities of daily living or disability and falls. However, as those functional measures tend to be affected in people who are frail,<span>⁵</span> we concur with Du et al. that they are clinically relevant and should be evaluated in future research.</p><p>Various conditions may make the kidney function vary, and we recognize that repeated or longitudinal data would be more informative than a single data point. We opted to perform a cross-sectional analysis of eGFRDiff and D3Cr dilution measurements as an initial study, but we agree with the authors that future studies should evaluate changes over time to confirm and strengthen our findings.</p><p>In conclusion, to our knowledge, our study was the first to assess the relationship between eGFRDiff and frailty while accounting for muscle mass as defined by D3Cr dilution. We found that D3Cr at least in part explains the association of eGFRDiff and frailty. These findings would be strengthened by longitudinal data and will need to be repeated and validated in other populations.</p><p>OAP and DER drafted the letter.</p><p>The authors declare no conflicts of interest.</p><p>The funders had no role.</p>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 12","pages":"3925-3926"},"PeriodicalIF":4.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}