Lancet Healthy Longevity最新文献

{"title":"Shared decision making with older people on treatment escalation planning for acute deterioration in the emergency medical setting: a UK-based qualitative study of patient perspectives (STREAMS-P)","authors":"Bronwen E Warner MBChB ,&nbsp;Prof Mary Wells PhD ,&nbsp;Prof Cecilia Vindrola PhD ,&nbsp;Prof Stephen J Brett MD","doi":"10.1016/j.lanhl.2025.100689","DOIUrl":"10.1016/j.lanhl.2025.100689","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision making (SDM) in treatment escalation planning (TEP) involves patients and clinicians determining together a contingency for future health deterioration. Patients’ role in health-care decision making is subject to ongoing debate. This study aimed to understand the perspectives of older patients in the UK on SDM in TEP for the acute hospital setting.</div></div><div><h3>Methods</h3><div>In this qualitative study, we recruited older adults with varying levels of frailty and diverse ethnicity via primary care in an Inner London borough. We excluded individuals who did not have the capacity to make TEP decisions, could not be interviewed in English, or whose main chronic clinical problem was cancer or an established severe single organ failure. We used purposive stratified sampling to capture a variety of age, frailty, and ethnicity. We conducted semistructured interviews from March 31 to Dec 19, 2023, and audiorecorded them. We then performed a reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>We conducted 27 interviews with 32 participants. Participants were aged 63–101 years, clinical frailty ranged from none to severe and was distributed across age groups, and 19 participants were female and 13 participants were male. We identified four themes from the interviews: (1) Focusing on a Natural Life Lived Well, which reflects participants’ ideas around expected life and death trajectory; (2) Making Sense of an Unfamiliar Medical Narrative, where detailed planning for medical intervention was not expected; (3) My Body, My Decision, in which there was emphasis on retaining control over health-care decisions; and (4) Expert, Imperfect Doctors in an Essential, Imperfect System, in which the context of decision making involving health-care professionals in a stretched UK health service was considered.</div></div><div><h3>Interpretation</h3><div>Patients did not immediately perceive the relevance of detailed planning for future treatment, but nonetheless showed determination to be final arbiters on health-care decisions. Viewed in the context of increasing emphasis on patient autonomy, future steps include public education on possibilities and limitations for intensive medical intervention, clinician reflection on approaches to TEP conversations and policy-level deliberation to define expectations for patient involvement in TEP decisions.</div></div><div><h3>Funding</h3><div>HCA International and NIHR Imperial Biomedical Research Centre.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100689"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587460","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":"Understanding ageing with HIV in sub-Saharan Africa to improve care","authors":"Lucette A Cysique","doi":"10.1016/j.lanhl.2025.100701","DOIUrl":"10.1016/j.lanhl.2025.100701","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100701"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738121","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":"Effectiveness and safety of using statin therapy for the primary prevention of cardiovascular diseases in older patients with chronic kidney disease who are hypercholesterolemic: a target trial emulation study","authors":"Wanchun Xu MPhil ,&nbsp;Yuk Kam Yau PhD ,&nbsp;Yanyu Pan MSc ,&nbsp;Emily Tsui Yee Tse MBBS ,&nbsp;Prof Cindy Lo Kuen Lam MD ,&nbsp;Eric Yuk Fai Wan PhD","doi":"10.1016/j.lanhl.2025.100683","DOIUrl":"10.1016/j.lanhl.2025.100683","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;There remains a scarcity of evidence on initiating statin therapy for the primary prevention of cardiovascular diseases among older adults with chronic kidney disease due to the under-representation of this population in randomised controlled trials. This study aimed to evaluate the effectiveness and safety of using statin therapy for the primary prevention of cardiovascular diseases in older adults (aged 75–84 years) and very old adults (aged ≥85 years) with chronic kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using territory-wide public electronic health records in Hong Kong, patients older than 60 years with chronic kidney disease and with hyperlipidaemia (defined as elevated LDL cholesterol of ≥2·6 mmol/L) were identified for inclusion in the analyses and were included on a rolling basis in each calendar month from January, 2008, to December, 2015. Patients were categorised into different age groups (ie, 60–74 years, 75–84 years, and ≥85 years) for analysis, and the 60–74 years age group was used as a benchmark group to test the validity of our emulated trial since the effect of statin therapy is well established in this age group. The framework of target trial emulation was adopted to investigate the association between statin therapy and the risk of overall cardiovascular disease incidence, specific cardiovascular disease subtypes (ie, myocardial infarction, heart failure, and stroke), and all-cause mortality, as well as major adverse events (ie, myopathies and liver dysfunction). The primary outcome was overall cardiovascular disease incidence. The hazard ratios for the outcomes were estimated by pooled logistic models in the intention-to-treat analysis and the per-protocol analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;711 966 person-trials from 96 trials were eligible for inclusion in the study. 19 423 unique individuals with chronic kidney disease aged 60–74 years, 22 565 unique individuals with chronic kidney disease aged 75–84 years, and 8811 unique individuals with chronic kidney disease aged 85 years and older were identified for inclusion in the analyses. In patients aged 75–84 years, a significant risk reduction was observed for overall cardiovascular disease incidence in both the intention-to-treat analysis (hazard ratio [HR] 0·94 [95% CI 0·89–0·99]) and in the per-protocol analysis (0·86 [0·80–0·92]) and for all-cause mortality (0·87 [0·82–0·91] in the intention-to-treat analysis and 0·78 [0·72–0·84] in the per-protocol analysis). This risk reduction was also observed among patients aged 85 years and older for cardiovascular diseases (HR 0·88 [0·79–0·99] in the intention-to-treat analysis and 0·81 [0·71–0·92] in the per-protocol analysis), and for all-cause mortality (0·89 [0·81–0·98] in the intention-to-treat analysis and 0·80 [0·71–0·91] in the per-protocol analysis). Substantial risk reduction for myocardial infarction, heart failure, and stroke were also observed across all age groups. N","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100683"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587478","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":"The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study","authors":"Luicer A Ingasia Olubayo PhD ,&nbsp;Theophilous Mathema MSc ,&nbsp;Chodziwadziwa Kabudula PhD ,&nbsp;Prof Lisa K Micklesfield PhD ,&nbsp;Shukri F Mohamed PhD ,&nbsp;Isaac Kisiangani MSc ,&nbsp;Cairo B Ntimane MSc ,&nbsp;Solomon S Choma MSc ,&nbsp;Prof Brian Houle PhD ,&nbsp;Prof Scott Hazelhurst PhD ,&nbsp;Prof Nigel Crowther PhD ,&nbsp;Stephen Tollman PhD ,&nbsp;Furahini D Tluway PhD ,&nbsp;Prof Michele Ramsay PhD ,&nbsp;Prof F Xavier Gómez-Olivé PhD ,&nbsp;AWI-Gen and H3Africa Consortium","doi":"10.1016/j.lanhl.2025.100690","DOIUrl":"10.1016/j.lanhl.2025.100690","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Sub-Saharan Africa’s ageing population includes a rising number of adults aged 50 years and older living with HIV. Although antiretroviral therapy (ART) has extended life expectancy, data on HIV incidence and treatment outcomes among older adults remain scarce. To inform targeted public health interventions, we aimed to examine the prevalence and incidence of HIV, as well as sociodemographic determinants associated with HIV acquisition and treatment outcomes, among older adults in sub-Saharan Africa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;AWI-Gen is a multicentre, longitudinal cohort study. We assessed data from random community-based samples of adults aged 40–60 years collected between Aug 5, 2013, and Aug 19, 2016 (wave 1) and of adults aged 40 years and older collected between Jan 24, 2019, and Nov 23, 2022 (wave 2) from Nairobi (Kenya) and from Soweto, Agincourt, and Dikgale Mamabolo Mothiba (South Africa). Sociodemographic data were collected through interviewer-administered questionnaires and structured interviews. The primary outcome was HIV status at both wave 1 and wave 2, classified as either HIV-positive or HIV-negative. We evaluated the prevalence and incidence of HIV, ART coverage, and self-reported HIV awareness and used logistic regression to examine risk factors associated with HIV acquisition and treatment outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 7919 participants in wave 1 who were recruited and followed up, 6505 (82·1%) participants were aged 40–60 years, of whom 5730 (88·1%) contributed HIV-related data. 3148 (54·9%) participants were women and 2582 (45·1%) were men. In wave 2, 4520 participants from wave 1 were followed up with an additional 579 participants recruited. 5076 (99·5%) participants were aged 40 years and older, of whom 4931 (97·1%) contributed HIV-related data. 2767 (56·1%) participants were women and 2164 (43·9%) were men. Overall, 1271 (22·2%) of 5730 participants in wave 1 and 1073 (21·8%) of 4931 participants in wave 2 were living with HIV, with regional variability (χ&lt;sup&gt;2&lt;/sup&gt; p&lt;0·0001) and higher prevalence in women than in men (χ&lt;sup&gt;2&lt;/sup&gt; p&lt;0·0001). Prevalence was highest among individuals aged 40–45 years (454 [26·7%] of 1698 participants) in wave 1 and those aged 46–50 years (297 [29·9%] of 994 participants) in wave 2, decreasing significantly in older age groups (χ&lt;sup&gt;2&lt;/sup&gt; p&lt;0·0001). Overall HIV incidence was 0·35 per 100 person-years (95% CI 0·26–0·48), with a reduced risk of seroconversion in participants aged 51–55 years (incidence rate ratio [IRR] 0·42 [95% CI 0·17–0·93]; p=0·039) and 56–60 years (0·19 [0·05–0·52]; p=0·0033). Compared with participants with formal education, incidence among those with no formal education was nearly four times higher (IRR 0·96 [95% CI 0·50–1·85] &lt;em&gt;vs&lt;/em&gt; 0·26 [0·16–0·44]). Women and men residing in rural areas showed consistently higher predicted probabilities of HIV status than their counterparts in urban","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100690"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738122","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":"Evidence on the benefits of statins for CVD prevention in older adults with CKD","authors":"Ariela R Orkaby ,&nbsp;Julie M Paik","doi":"10.1016/j.lanhl.2025.100698","DOIUrl":"10.1016/j.lanhl.2025.100698","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100698"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587481","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":"Adopting a complex systems approach to functional ageing: bridging the gap between gerontological theory and empirical research","authors":"Almar A L Kok PhD ,&nbsp;Prof Martijn Huisman PhD ,&nbsp;Erik J Giltay MD PhD ,&nbsp;Gabriela Lunansky PhD","doi":"10.1016/j.lanhl.2024.100673","DOIUrl":"10.1016/j.lanhl.2024.100673","url":null,"abstract":"<div><div>Functional ageing, related to but distinct from biological and environmental systems, is defined as the changes in physical, psychological, cognitive, and social functioning, as well as behavioural factors of individuals as they age. In this Personal View, we propose that a complex systems perspective to functional ageing can show how outcomes such as quality of life and longevity, and success in prevention and treatment, emerge from dynamic interactions among these domains, rather than from single causes. We support this view in three ways. First, we explain how three key principles of complex systems science—namely, resilience, non-linearity, and heterogeneity—apply to functional ageing. Second, we show how established gerontological theories and geriatric models align with these principles. Third, we illustrate the use of novel methodological tools available from complex systems science for studying functional ageing. Finally, we offer a glossary of key concepts and recommendations for researchers to adopt this perspective in future studies on functional ageing.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100673"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068432","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":"The cost of US funding cuts","authors":"The Lancet Healthy Longevity","doi":"10.1016/j.lanhl.2025.100703","DOIUrl":"10.1016/j.lanhl.2025.100703","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100703"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587464","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":"Metformin and physical performance in older people with probable sarcopenia and physical prefrailty or frailty in England (MET-PREVENT): a double-blind, randomised, placebo-controlled trial","authors":"Prof Miles D Witham PhD ,&nbsp;Claire McDonald PhD ,&nbsp;Nina Wilson PhD ,&nbsp;Katherine J Rennie PhD ,&nbsp;Michelle Bardgett MSc ,&nbsp;Penny Bradley MPharm ,&nbsp;Prof Andrew P Clegg PhD ,&nbsp;Stephen Connolly RN ,&nbsp;Prof Helen Hancock PhD ,&nbsp;Shaun Hiu MSc ,&nbsp;Karen Nicholson PhD ,&nbsp;Laura Robertson ,&nbsp;Laura Simms BA ,&nbsp;Alison J Steel PhD ,&nbsp;Prof Claire J Steves PhD ,&nbsp;Bryony Storey BSc ,&nbsp;Prof James Wason PhD ,&nbsp;Prof Thomas von Zglinicki PhD ,&nbsp;Prof Avan A Sayer PhD","doi":"10.1016/j.lanhl.2025.100695","DOIUrl":"10.1016/j.lanhl.2025.100695","url":null,"abstract":"<div><h3>Background</h3><div>Metformin has effects on multiple biological systems relevant to ageing and has been posited as a candidate therapy for sarcopenia and physical frailty. We aimed to test the efficacy and safety of metformin, a candidate geroprotector, to improve physical performance in older people with probable sarcopenia and physical prefrailty or frailty.</div></div><div><h3>Methods</h3><div>In this double-blind, randomised, parallel-group, placebo-controlled trial (MET-PREVENT), participants aged 65 years and older with a 4-m walk speed of less than 0·8 m/s and probable sarcopenia, characterised by low handgrip strength (&lt;16 kg for women and &lt;27 kg for men) or five times sit-to-stand time of longer than 15 s (or inability to complete five sit-to-stands) were recruited from primary care and hospital clinics in Gateshead and Newcastle, UK. Participants were randomly assigned (1:1), via a web-based system with minimisation to ensure balance by sex and baseline 4-m walk speed, to receive either 500 mg oral metformin or matching placebo three times a day for 4 months. The primary outcome was the adjusted between-group difference in 4-m walk speed at 4 months. The primary outcome was analysed in the intention-to-treat population (ie, all participants randomly assigned to treatment) who had complete data, and safety was assessed in all participants who received at least one dose of study treatment. This study is registered with the ISRCTN registry, ISRCTN29932357, and is now complete.</div></div><div><h3>Findings</h3><div>Between Aug 1, 2021, and Sept 30, 2022, 268 individuals were screened for inclusion in the trial, and 72 participants were randomly assigned to either metformin (n=36) or placebo (n=36; intention-to-treat population). Mean age was 80·4 years (SD 5·7), 42 (58%) of 72 participants were female, 30 (42%) were male, and 70 (97%) were White British. 70 (97%) of 72 participants had complete follow-up data (n=34 in the metformin group and n=36 in the placebo group). Mean 4-m walk speed at 4 months was 0·57 m/s (SD 0·19) in the metformin group and 0·58 m/s (0·24) in the placebo group (adjusted treatment effect 0·001 m/s [95% CI –0·06 to 0·06]; p=0·96). 108 adverse events occurred in 35 (100%) of 35 participants who received metformin and 77 adverse events occurred in 33 (92%) of 36 participants who received placebo, and 12 (34%) of 35 participants had hospital admissions in the metformin group versus three (8%) of 36 participants in the placebo group. One death occurred, in the metformin group (one [3%] of 35), and was judged to be unrelated to study treatment.</div></div><div><h3>Interpretation</h3><div>Metformin did not improve 4-m walk speed and was poorly tolerated in this population.</div></div><div><h3>Funding</h3><div>National Institute for Health and Care Research Newcastle Biomedical Research Centre.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100695"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731933","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":"Shared decision making in the emergency department: how can we better do justice for patients?","authors":"Eva Diehl-Wiesenecker ,&nbsp;Lennert Böhm","doi":"10.1016/j.lanhl.2025.100699","DOIUrl":"10.1016/j.lanhl.2025.100699","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100699"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587485","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 the Sudan conflict on older adults: exacerbating health disparities and threatening longevity","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1016/j.lanhl.2025.100692","DOIUrl":"10.1016/j.lanhl.2025.100692","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 2","pages":"Article 100692"},"PeriodicalIF":13.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433986","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}