Clinical Interventions in Aging最新文献

{"title":"Association of Admission HbA1c Levels and Clinical Outcomes in Patients with Large Vessel Occlusion Following Endovascular Treatment: A Secondary Analysis of RESCUE BT Trial.","authors":"Fei Gao, Xiaolin Tan, Linyu Li, Chao Zhou, Changwei Guo, Jie Yang, Guojian Liu, Lilan Wang, Xiaolei Shi, Shihai Yang, Jinfu Ma, Xu Xu, Dahong Yang, Wenzhe Sun, Nizhen Yu, Shitao Fan, Rui Xu, Jiaxing Song, Wenjie Zi, Zhenying Shang","doi":"10.2147/CIA.S523638","DOIUrl":"10.2147/CIA.S523638","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyze the association of HbA1c levels and outcomes in patients with large vessel occlusion (LVO) undergoing endovascular treatment (EVT).</p><p><strong>Methods: </strong>Patients with recorded HbA1c values were enrolled from The Endovascular Treatment With vs Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial. We defined the high HbA1c levels as a plasma level of HbA1c > 6.5%. The primary outcome was good outcome (defined as a modified Rankin Scale score (mRS) of 0-2) at 90 days, secondary outcomes included other clinical outcomes (excellent outcome, mRS 0-1) at 90 days, mortality at 90 days, symptomatic intracerebral hemorrhage (sICH) within 48h, and any intracerebral hemorrhage (ICH).</p><p><strong>Results: </strong>Among the 560 patients with HbA1c values, 133 (23.7%) patients were in the HbA1c > 6.5% group, and 427 (76.3%) patients were in the HbA1c ≤ 6.5% group. In multivariable analysis, the HbA1c > 6.5% group showed a significant negative association with good outcomes at 90 days (mRS 0-2; adjusted odds ratio [aOR], 0.57; 95% CI 0.37-0.88; <i>P</i> = 0.01), and the HbA1c > 6.5% group was significantly associated with increased mortality (aOR, 2.06; 95% CI 1.20-3.54; <i>P</i> = 0.009). There were no significant differences in the incidence of sICH between the two groups. Additionally, the subgroup analysis showed an interaction effect between high HbA1c levels and age.</p><p><strong>Conclusion: </strong>Our results demonstrated that elevated HbA1c levels were associated with poor clinical outcomes in LVO patients who underwent EVT.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"727-737"},"PeriodicalIF":3.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplemental Nucleus Pulposus Allograft in Patients with Lumbar Discogenic Pain: Evaluation of Clinical Outcomes and Quality of Life in Medicare Beneficiaries.","authors":"Nomen Azeem, Thomas J Myers, Jordan Lee Tate, Christopher A Gilmore, Austin S Harper, Jon E Block","doi":"10.2147/CIA.S523457","DOIUrl":"10.2147/CIA.S523457","url":null,"abstract":"<p><strong>Background: </strong>The healthy nucleus pulposus (NP) of the intervertebral disc is normally replete with proteoglycans and highly hydrated. With degeneration, the disc loses its capacity to bind water, substantially reducing its ability to cushion physiologic loads. Supplementation of degenerated NP with a commercially available NP allograft represents a promising approach to ameliorating lumbar discogenic pain.</p><p><strong>Methods: </strong>This was a prospective, single arm clinical study involving 21 patients at 5 US sites. The magnitude of improvement in back pain severity, back disability and quality of life was evaluated in Medicare-age (≥65 years) patients with chronic axial low back pain treated with intradiscally delivered NP allograft at up to three lumbar vertebral levels (L1-S1). Followup was at 1, 3 and 6 months. Back pain was determined using an 11-point numeric rating scale (NRS), back function by Oswestry disability index (ODI) and quality of life using the PROMIS-29 questionnaire.</p><p><strong>Results: </strong>There was a 60% reduction in average back pain scores between baseline and 6 months; the difference (4.0, 95% CI [2.9, 5.2]) was statistically significant (p < 0.001). 82% and 71% of participants achieved ≥30% and ≥50% NRS improvement, respectively, at 6 months, and 65% of participants reported a final NRS score ≤3. The 6-month improvement in mean ODI scores was 50% with an average difference of 22.8 (95% CI [14, 31]) (p < 0.001). 68% and 51% realized ≥30% and ≥50% ODI improvements, respectively, at 6 months. All PROMIS-29 domains showed improvements toward the normative mean value of 50 by 6 months. No adverse events related to the NP allograft were reported.</p><p><strong>Conclusion: </strong>These findings show clinically significant pain palliation, functional improvement and quality of life enhancement in older adults following supplementation of the degenerated disc with NP allograft.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"717-726"},"PeriodicalIF":3.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Inclusion Pathways and Influencing Factors Among Older Adults in Outpatient Settings: A Grounded Theory Study.","authors":"Yulu Chen, Qianyu Yin, Tingting Zhou, Sijia Gu, Liling Xie, Mingzhao Xiao, Longqiong Wang, Qinghua Zhao","doi":"10.2147/CIA.S518045","DOIUrl":"10.2147/CIA.S518045","url":null,"abstract":"<p><strong>Purpose: </strong>Smart healthcare services in hospitals play a critical role in enhancing efficiency and quality. However, older adults often face varying degrees of challenges in accessing, adapting to, and using these technologies because of the effects of the Silver Digital Divide, including factors such as physical functioning, smart device access, and digital health literacy. This study aims to investigate the experiences, attitudes, and perceptions of older adults in outpatient regarding smart healthcare service in order to develop an explanatory digital inclusion pathway and construct a comprehensive path model for older adults.</p><p><strong>Patients and methods: </strong>We conducted semi-structured interviews with 27 older adults in outpatients in Chongqing, China to understand their experiences, attitudes, and perceptions of attending smart healthcare services through theoretical sampling. Interviews were recorded, transcribed, and translated to English; content was analyzed based on grounded theory to examine the role of each influencing factor in relation to digital inclusion and modeling digital inclusion pathways. The stimuli-organism-response theoretical framework was used to guide path model construction.</p><p><strong>Results: </strong>Interview data of 27 older adults in outpatient settings were analyzed by exploratory interpretation, obtaining 79 initial concepts, 22 subcategories, seven main categories, and three dimensions, and constructing a theoretical model of the path of digital inclusion of older adults. Physical function, digital health literacy, personal perception, and digital attitudes demonstrated a direct impact on the digital inclusion of older adults. The support of smart devices, service scenario, social environments, and demographic attributes indirectly affect the digital inclusion of older adults.</p><p><strong>Conclusion: </strong>This study identifies five pathways to enhance older adults' digital inclusion in outpatient smart healthcare, offering age-friendly insights for system design, medical service quality, and public health policy. These findings aim to bridge the silver digital divide, advance equitable healthcare transformation, and support the development of smart hospitals.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"701-716"},"PeriodicalIF":3.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervening on Calorie Intake or Eating Timing in Older Adults: Lessons Learned in the Healthy Aging and Late-Life Outcomes Randomized Controlled Pilot Trial.","authors":"Jason Fanning, W Jack Rejeski, Barbara J Nicklas, Stephen B Kritchevsky, Michael E Miller, Denise K Houston, Michael P Walkup, Kimberly Kennedy, Cynthia L Stowe, Sherri Ford, Dixie Yow","doi":"10.2147/CIA.S520273","DOIUrl":"10.2147/CIA.S520273","url":null,"abstract":"<p><strong>Purpose: </strong>The Healthy Aging and Late Life Outcomes Pilot (HALLO-P) trial was designed to pilot in-person and remotely delivered caloric restriction (CR and RCR respectively) and time restricted eating (TRE) in preparation for a long-term multi-site clinical trial. Herein, we describe the development and execution of these behavioral interventions with a focus on lessons learned and post-study questionnaire data.</p><p><strong>Patients and methods: </strong>Participants were community-dwelling older (60+ yrs) adults with obesity or overweight with an indication for weight loss. Participants were randomized to 9 months of group-based CR, RCR, or TRE supported by self-monitoring technologies [ie, a tablet application paired with an activity monitor (all) and wireless scale (CR and RCR)]. Intervention staff recorded attendance at sessions and noted intervention-related lessons learned as they arose. Upon completion of the study period, participants were asked to complete a series of Likert-type and open-ended questions related to their experiences in the trial.</p><p><strong>Results: </strong>Participants (N = 90; 67.19 ± 4.91 years) attended 84.4% of sessions on average, engaged with study technologies 96.4% of days, and provided daily weights on >4 days per week across the study (CR and RCR only). Participants reported high satisfaction with the program, with RCR participants being significantly more likely than TRE participants to report being satisfied with their program overall (100% vs 75%, p < 0.01), intending to continue their dietary change post-intervention (97% vs 63%, p < 0.01), and being willing to sustain their dietary approach and engage with study technologies over a 5-year period (88% vs 61%, p < 0.01). Open-ended feedback underscored the value of the group-based structure of the program and remote delivery to reduce travel burden, the need for reduced burden associated with food logging, and the need to identify methods for enhancing perceived value of TRE among older adults.</p><p><strong>Conclusion: </strong>An intervention designed to promote CR, primarily delivered remotely and supported by self-monitoring technology, is both feasible and acceptable to many older adults.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"685-700"},"PeriodicalIF":3.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploration of Pathogenesis and Cutting-Edge Treatment Strategies of Sarcopenia: A Narrative Review.","authors":"Yin Gao, Di Liu, Qixian Xiao, Shan Huang, Li Li, Baocheng Xie, Limin Zhou, Yi Qi, Yanzhi Liu","doi":"10.2147/CIA.S517833","DOIUrl":"10.2147/CIA.S517833","url":null,"abstract":"<p><p>Sarcopenia a progressive and multifactorial musculoskeletal syndrome characterized by loss of muscle mass and function, poses a significant global health challenge, particularly in aging populations. Epidemiological studies reveal that sarcopenia affects approximately 5-10% of the general population, with prevalence rates escalating dramatically after age 60 to reach 10-27% in older adults. This age-associated increase contributes significantly to healthcare burdens by elevating risks of disability, frailty, and mortality. Despite its profound impact, current clinical approaches to sarcopenia remain limited. While resistance exercise and protein supplementation form the cornerstone of management, their efficacy is often constrained by poor long-term adherence and variable individual responses, highlighting the urgent need for more comprehensive and personalized treatment strategies. The pathogenesis of sarcopenia is complex and influenced by various factors, including aging, inflammation, nutritional deficits, physical inactivity, and mitochondrial dysfunction. However, the precise molecular mechanisms underlying this condition are still not fully understood. Recent research has made significant strides in elucidating the intricate mechanisms contributing to sarcopenia, revealing novel insights into its molecular and cellular underpinnings. Notably, emerging evidence points to the pivotal role of mitochondrial dysfunction, altered myokine profiles, and neuromuscular junction degeneration in sarcopenia progression. Additionally, breakthroughs in stem cell therapy, exosome-based treatments, and precision nutrition offer promising avenues for clinical intervention. This review aims to synthesize the latest advancements in sarcopenia research, focusing on the novel contributions to its pathogenesis and treatment strategies. We explore emerging trends such as the role of cellular senescence, epigenetic regulation, and targeted therapeutic interventions that could reshape future approaches to managing sarcopenia. By highlighting recent breakthroughs and cutting-edge research, we hope to advance the understanding of sarcopenia and foster the translation of these findings into effective clinical therapies.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"659-684"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Nested Case-Control Study of Risk Factors for Postoperative Delirium in Elderly Patients with Colorectal Cancer.","authors":"Xinlong Cui, Naihan Cao, Shouyuan Tian, Yi Liu, Jie Xiang","doi":"10.2147/CIA.S507668","DOIUrl":"10.2147/CIA.S507668","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study is to investigate the risk factors associated with postoperative delirium (POD) in elderly patients diagnosed with colorectal cancer (CRC).</p><p><strong>Patients and methods: </strong>This prospective nested case-control study included elderly patients who underwent CRC surgery at Shanxi Provincial Cancer Hospital between May 2022 and September 2023. A propensity score matching (PSM) method was employed to match patients by age and sex. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for POD among elderly patients with CRC.</p><p><strong>Results: </strong>A total of 443 patients were enrolled, among them, 70 (15.8% of all patients, age: 69.5[64, 73], 55 [78.6%] males) developed POD and 373 did not develop POD (84.2% of all patients, age: 67[62, 71], 234 [62.7%] males). Following PSM at a 1:3 ratio, 70 POD patients and 210 age- and sex-matched non-POD patients were selected for further analysis. The POD group exhibited a significantly higher sleep quality score (9 [6, 15] vs 7.5 [3, 12], P = 0.004), greater intraoperative infusion volume (2041.43±724.37 vs 1814.05±653.83, P = 0.015), and elevated peak pain levels post-surgery (1 [0, 2] vs 1 [0, 1], P = 0.001). Univariate and multivariate logistic regression analyses identified higher education level (OR: 0.503 [0.259-0.977]) as an independent factor associated with lower POD risk, whereas higher sleep quality scores (OR: 1.103 [1.040-1.171]) and increased peak pain levels post-surgery (OR: 1.727 [1.295-2.304]) were identified as independent risk factors.</p><p><strong>Conclusion: </strong>Elevated peak postoperative pain levels, lower education levels, and sleep dysfunction or disturbance are independent risk factors for developing POD.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"639-648"},"PeriodicalIF":3.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting-State Functional MRI Reveals Altered Seed-Based Connectivity in Diabetic Osteoporosis Patients.","authors":"Jiang Li, Min Liu, Jian Qin, Yuxiao An, Xiuzhu Zheng, Noor Shafini Mohamad, Izzad Ramli","doi":"10.2147/CIA.S521686","DOIUrl":"10.2147/CIA.S521686","url":null,"abstract":"<p><strong>Background: </strong>Diabetic osteoporosis (DOP) can cause abnormal brain neural activity, but its mechanism is still unclear. This study aims to further explore the abnormal functional connectivity between different brain regions based on the team's previous research.</p><p><strong>Methods: </strong>Resting-state functional magnetic resonance imaging (rs-fMRI) data were obtained from 14 participants diagnosed with type 2 diabetes mellitus (T2DM) and osteoporosis. For comparison, data from 13 T2DM patients without osteoporosis were analyzed. The seed regions for functional connectivity (FC) analysis were chosen according to brain areas previously reported to exhibit abnormal regional homogeneity (ReHo).</p><p><strong>Results: </strong>DOP patients exhibited significantly decreased BMD, T-scores, MoCA scores, and osteocalcin (OC) levels compared to controls (p<0.05). FC analysis revealed: 1) Reduced connectivity between the left middle temporal gyrus (increased ReHo) and middle occipital gyrus; 2) Enhanced connectivity between the right angular gyrus (increased ReHo) and left Rolandic operculum; 3) Weakened the left precuneus (increased ReHo) and right superior/left middle frontal gyri. These alterations correlated with deficits in visual processing, working memory, and executive function.</p><p><strong>Conclusion: </strong>Distinct FC reorganization in DOP patients reflects synergistic effects of metabolic and skeletal pathologies on neural networks, potentially mediating cognitive decline through visual pathway disruption and prefrontal-default mode network decoupling. The findings highlight neuroimaging biomarkers for metabolic bone disease-related cognitive disorders.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"649-658"},"PeriodicalIF":3.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Habits, Anthropometric Values, and Microvascular Reactivity in Older Persons of Both Sexes Living at Retirement Home in Osijek, Croatia.","authors":"Ines Drenjančević, Ivan Prošić, Lucija Firi, Ana Stupin, Ivana Jukić","doi":"10.2147/CIA.S514573","DOIUrl":"10.2147/CIA.S514573","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the correlation between dietary habits, anthropometric measurements, and microvascular reactivity with respect to sex in older adults (aged > 65 years) residing in organized accommodation within retirement homes.</p><p><strong>Patients and methods: </strong>Sixty-nine older persons who live in a retirement home in Osijek, Croatia volunteered to participate (34 men and 35 women) in this observational cross-sectional study. Study was performed in the period from May 1, 2024 to July 1, 2024. Subjects weight, height, waist circumference, hip circumference, blood pressure and heart rate were measured, and body mass index (BMI) and waist to hip ratio (WHR) were calculated. To assess microvascular endothelium-dependent vasodilation, skin microvascular post-occlusion reactive hyperemia (PORH) was assessed by Laser Doppler Flowmetry. Long-term dietary patterns and dietary habits were evaluated with validated EPIC-Norfolk food frequency questionnaire, in Croatian language. Study was approved by Ethical Committee of Faculty of Medicine Osijek (Class: 641-01/24-01/04, No: 2158-61-46-24-86).</p><p><strong>Results: </strong>Mean age (standard deviation, SD) of 34 older men was 83.8 (5.4) years, and of 34 older women 83.6 (5.5) years. The mean BMI of all subjects was 27.1 kg/m2 classifying them as overweight. Both men (WHR 0.99 (0.07)) and women (WHR 0.90 (0.06) had significantly higher than normal WHR (normal WHR, men <0.90, women <0.80), suggesting the visceral type of obesity. The mean intake of NaCl was higher (NaCl g/day men 6.91 (1.43), women 6.93 (2.51)), and intake of vitamin D lower (vitamin D µg/day men 3.64 (1.35), women 3.47 (2.61)) than recommended values (NaCl g/day <5 g/day, vitamin D 15 µg/day). Men consumed significantly more alcohol (alcohol g/day men 1.48 (3.36) vs women 0.17 (0.39), P = 0.03), while women had higher carotene intake (β-carotene, µg/day men 2603 (1020) vs women 3478 (1580), P = 0.009). Microvascular reactivity was similar in women and men (PORH, R-O% men 85.2 (30.6) vs women 76.2 (31.5), P > 0.05). However, women had a significant negative correlation of waist circumference (R = -0.350, P =0.04) and WHR (R = -0.406, P = 0.02) to PORH.</p><p><strong>Conclusion: </strong>Dietary habits were similar between older men and women, except for higher alcohol intake in men and higher carotene intake in women. In older women, microvascular reactivity was negatively associated with waist circumference and WHR, underscoring central obesity as a key cardiovascular risk factor in this population. Given the increased cardiometabolic vulnerability in postmenopausal women, measures of central adiposity should be routinely monitored in geriatric care.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"625-638"},"PeriodicalIF":3.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Machine Learning-Based Prediction Model for Delirium Risk in Older Patients with Dementia: Risk Factors Identification.","authors":"Qifan Xiao, Shirui Zhou, Bin Tang, Yuqing Zhu","doi":"10.2147/CIA.S519366","DOIUrl":"10.2147/CIA.S519366","url":null,"abstract":"<p><strong>Background: </strong>Delirium superimposed on dementia (DSD) is a severe complication in older adults with dementia, marked by fluctuating cognition, inattention, and altered consciousness. Detection is challenging due to symptom overlap, yet it contributes to cognitive decline, prolonged hospitalization, and increased mortality. Identifying key risk factors and developing an accurate prediction model is crucial for timely intervention. This study aimed to establish a machine learning-based model to predict delirium risk, focusing on significant predictors to aid clinical decision-making.</p><p><strong>Methods: </strong>We prospectively collected clinical data from 636 older dementia patients. Five machine learning algorithms-Extreme Gradient Boosting (XGB), Random Forest (RF), Multilayer Perceptron (MLP), Categorical Boosting (CB), and Logistic Regression (LR)-were used to construct prediction models. Feature importance was analyzed using SHapley Additive exPlanations (SHAP) to identify key risk factors. Data included demographic information, biochemical parameters, comorbidities, medication history, and Visual Analogue Scale (VAS) scores.</p><p><strong>Results: </strong>The final analysis included 636 older dementia patients, with a mean age of 78.2 ± 6.3 years, of whom 187 (29.4%) developed delirium during hospitalization. The XGB model demonstrated the best performance, achieving the highest area under the receiver operating characteristic curve (0.930), accuracy (0.870), F1 score (0.892), and area under the precision-recall curve (0.989). The Brier score for the XGB model was 0.08. The SHAP method identified cerebrovascular disease, sedative drug use, hemoglobin levels, VAS score ≥4, superoxide dismutase, diabetes, hsCRP, hypertension, family presence, and hyperlipidemia as the most significant risk factors for delirium. The top 10 variables were used to construct a compact XGB model, which also exhibited good predictive performance.</p><p><strong>Conclusion: </strong>This study developed a machine learning-based prediction model for delirium risk in older dementia patients, with the XGB model demonstrating the best performance. The identified key risk factors provide insights for early intervention, potentially improving delirium management in clinical practice.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"613-623"},"PeriodicalIF":3.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Anesthetic Management Under Bispectral Index Monitoring on the Early Recovery Quality of Elderly Patients Undergoing Laparoscopic Surgery: A Blinded Randomized Controlled Trial.","authors":"Min Shi, Yufang Long, Zhihu Zhou, Liqiao Huang, Danping Wu, Xu Zhang","doi":"10.2147/CIA.S507758","DOIUrl":"10.2147/CIA.S507758","url":null,"abstract":"<p><strong>Purpose: </strong>To comprehensively evaluate the impact of bispectral index (BIS) monitoring-guided anesthesia depth on the early recovery quality in elderly patients undergoing laparoscopic surgery.</p><p><strong>Methods: </strong>Ninety patients aged ≥60 years scheduled for laparoscopic surgery under general anesthesia were randomized into three groups: Group C (empirically guided anesthesia), Group B1 (BIS-guided, target range 40-60), and Group B2 (BIS-guided, target range 50-60). Blinded researchers evaluated recovery quality (QoR-15), pain (VAS), and sleep (RCSQ) preoperatively and on postoperative days 1, 2, 3, and 7 (POD_1,2,3,7). Postoperative delirium was assessed with CAM (POD₁-POD₃), and cognitive function (MMSE) was measured preoperatively, POD₃, and POD₇. Intraoperative data included vital signs, BIS values, anesthetic dosage, emergence/extubation times, PACU stay, and adverse events within three days post-surgery. Time to first ambulation and hospital stay were also recorded.</p><p><strong>Results: </strong>Compared with Group C, Group B1 and B2 had lower propofol consumption, shorter emergence/extubation times, and higher BIS values (T₂-T₅ and overall mean) (<i>P</i><0.05). QoR-15 scores improved on POD₂ in Group B1 and on both POD₁ and POD₂ in Group B2 (<i>P</i><0.05). The RCSQ scores increased on POD₁ and POD₃ in Group B1 (<i>P</i><0.05) and on POD₁, POD₂ and POD₃ in Group B2 (<i>P</i><0.05). In addition, Group B2 had a shorter PACU stay and time to first postoperative ambulation (<i>P</i><0.05). No differences were found in the incidence of postoperative delirium, POCD, or MMSE scores among the three groups. Compared to Group B1, Group B2 exhibited shorter emergence and extubation times, elevated BIS values at T3 and T5, a higher mean BIS value throughout surgery, and enhanced QoR-15 scores on POD₁ and POD₂ (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>BIS monitoring-guided anesthesia management can enhance early recovery from laparoscopic surgery in elderly patients with BIS values within a safe range, which may be particularly advantageous for this demographic during laparoscopic procedures.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"597-612"},"PeriodicalIF":3.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}