medRxiv - Geriatric Medicine最新文献

{"title":"Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach","authors":"Sara Groos, Kelly de Wildt, Bob van de Loo, Annemiek Linn, Stephanie Medlock, Kendrick Shaw, Eric Herman, Lotta Seppala, Kim Ploegmakers, Natasja van Schoor, Julia van Weert, Nathalie van der Velde","doi":"10.1101/2024.02.06.24301229","DOIUrl":"https://doi.org/10.1101/2024.02.06.24301229","url":null,"abstract":"Introduction: Deprescribing fall-risk increasing drugs (FRIDs) is a promising intervention for reducing the risk of falling in older adults. Applying appropriate deprescribing in practice can be difficult due to the outcome uncertainties associated with stopping the use of FRIDs. The ADFICE_IT study addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs through use of a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management. The development process of the CDSS is described in this paper.\u0000Methods: Development followed a user-centered design approach in which users and experts were involved throughout each phase. In phase I, a prototype of the CDSS was developed which involved a scoping and systematic literature review, European survey (n = 581), and semi-structured interviews with physicians (n = 19), as well as the aggregation and testing of deprescribing guidelines and the development of the fall-risk prediction model. In phase II, the feasibility of the CDSS was tested by means of two usability testing rounds with end users (n = 11).\u0000Results: The final CDSS consists of five web pages. A connection between the Electronic Health Record allows for the retrieval of patient data into the CDSS. Key design requirements for the CDSS include easy-to-use features for fast-paced clinical practice environments, actionable deprescribing recommendations, information transparency, and visualization of the patient’s fall-risk estimation. Key elements for the software include a modular architecture, open source, and good security.\u0000Conclusion: The ADFICE_IT CDSS supports physicians in deprescribing FRIDs optimally to prevent falls in older patients. Due to continuous user and expert involvement, each new feedback round led to an improved version of the system. Currently, a multicenter, cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benzodiazepine Initiation and the Risk of Falls or Fall-Related Injuries in Older Adults Following Acute Ischemic Stroke","authors":"Shuo Sun, Victor Lomachinsky, Louisa H. Smith, Joseph P. Newhouse, M. Brandon Westover, Deborah Blacker, Lee Schwamm, Sebastien Haneuse, Lidia M.V.R. Moura","doi":"10.1101/2024.02.06.24302430","DOIUrl":"https://doi.org/10.1101/2024.02.06.24302430","url":null,"abstract":"<strong>Background</strong> Benzodiazepine use in older adults following acute ischemic stroke (AIS) is common, yet short-term safety concerning falls or fall-related injuries remains unexplored.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRE-DIAGNOSTIC MANIFESTATIONS OF ALZHEIMER'S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF LONGITUDINAL STUDIES","authors":"Sedigheh Zabihi, Rosario Isabel Espinoza Jeraldo, Rifah Anjum, Christine Carter, Moïse Roche, Jonathan P Bestwick, Sarah Morgan-Trimmer, Yvonne Birks, Mark Wilberforce, Fiona M Walter, Claudia Cooper, Charles R Marshall","doi":"10.1101/2024.01.31.24301944","DOIUrl":"https://doi.org/10.1101/2024.01.31.24301944","url":null,"abstract":"Alzheimer's disease (AD) is associated with a range of non-cognitive symptoms that can be early or even presenting features. Better recognition of pre-diagnostic symptoms of AD would support improved early detection and diagnosis. To identify possible prodromal symptoms of AD, we systematically searched electronic databases for prospective longitudinal studies to March 2023, that reported the risk of AD diagnosis associated with non-cognitive symptoms. We conducted random-effects meta-analyses to obtain pooled odds of subsequent AD. Thirty studies met eligibility criteria. Most studies (n=18) reported on the association of depression with subsequent AD diagnosis (pooled OR= 1.80; 95% CI: 1.29 to 2.50; I2=95.8%). Hearing loss, weight loss, spondylosis and hypotension also predicted a subsequent AD diagnosis. This evidence suggests that these features that may be recorded during routine healthcare encounters are risk markers for incident AD and could therefore support improved early detection and diagnosis.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"09 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139656129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity and fiber intake beneficial for muscle mass and strength preservation during aging: A Comprehensive Cross-Sectional Study in the UK Biobank cohort","authors":"Jordi Morwani-Mangnani, Mar Rodriguez-Girondo, Cecile Singh-Povel, Sjors Verlaan, Marian Beekman, P. Eline Slagboom","doi":"10.1101/2024.01.22.23300657","DOIUrl":"https://doi.org/10.1101/2024.01.22.23300657","url":null,"abstract":"Background: Aging triggers intricate physiological changes, particularly in muscle mass and strength, affecting overall health and independence. Despite existing research, the broader significance of how muscle health is affected by the intricate interplay of lifestyle factors simultaneously during aging needs more exploration. This study aims to examine how nutrition, exercise, and sleep independently and differentially impact on muscle mass and strength in middle-aged men and women, facilitating future personalized recommendations for preserving muscle health.\u0000Methods: The cross-sectional analysis of the UK Biobank involved 45,984 individuals aged 40-70. Multiple linear regression explored determinants of whole-body fat-free mass and handgrip strength, considering traditional, socio-demographics, medication use and smoking as covariates, with gender and age (younger and older than 55 years) stratifications.\u0000Results: Higher physical activity and fiber intake beneficially affect both muscle mass and strength, especially above 55 years. Other lifestyle factors influence the two muscle parameters differently. Key determinants influencing muscle strength included higher protein intake, lower water intake, higher alcohol intake, and extended sleep duration whereas mainly higher water intake contributes to higher muscle mass. Interpretation: Physical activity and fiber intake associate with increased muscle strength and mass which may connect gut and muscle health. Given the observed complexity of muscle health in the age and gender strata, further longitudinal research is needed to provide personalized lifestyle recommendations.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"242 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding exogenous factors and biological mechanisms for cognitive frailty: a multidisciplinary scoping review","authors":"Carol Holland, Nikolett Dravecz, Lauren Owens, Alexandre Benedetto, Irundika Dias, Alan Gow, Susan Broughton","doi":"10.1101/2024.01.18.24301491","DOIUrl":"https://doi.org/10.1101/2024.01.18.24301491","url":null,"abstract":"Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty, AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included “cognitive frailty” OR ((“cognitive decline” OR “cognitive impairment”) AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as “behavioural” or “cognitive decline” or “senescence”, were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer’s disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139517247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Hypertension: Examining Variable Blood Pressure’s Role in Cognition and Brain Structure","authors":"Cassandra Morrison, Michael D. Oliver, Farooq Kamal, Mahsa Dadar, the Alzheimer’s Disease Neuroimaging Initiative","doi":"10.1101/2024.01.15.24301335","DOIUrl":"https://doi.org/10.1101/2024.01.15.24301335","url":null,"abstract":"<strong>Importance</strong> Hypertension is a known risk factor for cognitive decline and structural brain changes in aging and dementia. In addition to high blood pressure (BP), individuals may also experience variable BP, meaning that their BP fluctuates between normal and high. It is currently unclear what the effects of variable BP are on cognition and brain structure.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139496159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards Clinical Prediction with Transparency: An Explainable AI Approach to Survival Modelling in Residential Aged Care","authors":"Teo Susnjak, Elise Griffin","doi":"10.1101/2024.01.14.24301299","DOIUrl":"https://doi.org/10.1101/2024.01.14.24301299","url":null,"abstract":"<strong>Background</strong> An accurate estimate of expected survival time assists people near the end of life to make informed decisions about their medical care.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139496160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of an Intrinsic Capacity Score in the UK Biobank Study","authors":"Melkamu Bedimo Beyene, Renuka Visvanathan, Muktar Ahmed, Beben Benyamin, John R. Beard, Azmeraw T Amare","doi":"10.1101/2024.01.09.24301076","DOIUrl":"https://doi.org/10.1101/2024.01.09.24301076","url":null,"abstract":"Background: In 2015, the World Health Organization introduced the concept of intrinsic capacity (IC) to define the individual-level characteristics that enable an older person to be and do the things they value. This study developed an IC score for UK Biobank (UKB) study participants and validated its use as a tool for health outcome prediction, understanding healthy aging trajectories, and genetic research.\u0000Methods: Our analysis included data from 45,208 UKB participants who had a complete record of the ten variables included in the analysis. Factor adequacy was tested using Kaiser Meyer Olkin (KMO), Barthelt, and the determinant of matrix tests, and the number of factors was determined by the parallel analysis method. Exploratory and confirmatory factor analyses were employed to determine the structure and dimensionality of indicators. Finally, the IC score was generated, and its construct and predictive validities as well as reliability were assessed.\u0000Results: The factor analysis identified a multidimensional construct comprising, one general factor (IC) and five specific factors (locomotor, vitality, cognitive, psychological, and sensory). The bifactor structure showed a better fit (comparative fit index = 0.995, Tucker Lewis index = 0.976, root mean square error of approximation = 0.025, root mean square residual = 0.009) than the conventional five-factor structure. The IC score, generated using the bifactor confirmatory factor analysis has good construct validity, as demonstrated by an inverse association with age (lower IC in older age; beta = -0.035 (95%CI: -0.036, -0.034)), frailty (lower IC score in prefrail, beta = -0.104 (95%CI: (-0.114, -0.094) and frail, beta = -0.227 (95%CI: -0.267, -0.186) than the robust), and Charlson comorbidity index (CCI) for incident cases (a lower IC score associated with increased CCI, beta, = -0.019 (95%CI: -0.022, -0.015). The IC score also predicted incident CCI (a one-unit increase in baseline IC score led to lower CCI, beta = 0.147 (95%CI: -0.173, -0.121)).\u0000Conclusion: The bifactor structure showed a better fit in all goodness of fit tests. The IC construct has strong structural, construct, and predictive validities and it is a promising tool for monitoring aging trajectories. Keywords: Intrinsic capacity, healthy aging, functional ability, physical functioning, mental functioning","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139422965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in the role of sleep on cognition in older adults","authors":"Yumiko Wiranto, Amber Watts","doi":"10.1101/2024.01.08.24300996","DOIUrl":"https://doi.org/10.1101/2024.01.08.24300996","url":null,"abstract":"Advancing age is associated with decreased sleep quality and cognition. Previous work has shown differences in sleep patterns and perceptions of sleep quality between men and women. However, whether the effects of sleep quality on cognition differ between sexes in older populations remains unclear. We analyzed data from 207 cognitively intact and mildly cognitively impaired participants (89 men and 118 women) aged 60&lt; to estimate the effects of subjective and objective measures of sleep on executive function, verbal memory, and attention using generalized additive models. Objective sleep was measured with the GT9X Link Actigraph, and subjective sleep was measured with the Pittsburgh Sleep Quality Index. We found that women showed optimal executive function with up to about 400 minutes of total sleep time, followed by a decline in performance (<em>p</em> = 0.01). Additionally, a longer total sleep time contributed to lower verbal memory in a linear manner (<em>p</em> = 0.043). In men, there was a marginally significant improvement in executive function with higher sleep efficiency (<em>p</em> = 0.05). Higher self-reported sleep complaints were associated with poorer executive function in cognitively intact women (<em>p</em>= 0.024). Our findings suggest that the effects of sleep quality on cognitive performance differ between older men and women. Furthermore, executive function seems to be the cognitive domain that was most closely related to objective and subjective sleep. This study indicates that interventions focusing on sleep to mitigate the risk of cognitive impairment in older adults may need to be sex-specific.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139409864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between frailty assessed by the Clinical Frailty Scale 2.0 and outcomes of acute stroke in older patients","authors":"Paola Forti, Marianna Ciani, Fabiola Maioli","doi":"10.1101/2023.12.05.23299569","DOIUrl":"https://doi.org/10.1101/2023.12.05.23299569","url":null,"abstract":"Background: Frailty is a geriatric syndrome characterized by an increased vulnerability to stressors and increased risk of adverse clinical outcomes. While older patients with acute stroke are routinely screened for prestroke disability using the modified Rankin Scale (mRS), because of its known association with stroke outcomes, prestroke frailty is still rarely assessed. The Clinical Frailty Scale (CFS) is a popoular tool for retrospective frailty assessment in the acute setting. The study hypothesis was that prestroke frailty measured with CFS was associated with stroke outcome of older patients independent of prestroke disability assessed with mRS. Methods: We recruited 4086 individuals aged ≥65 years consecutively admitted with acute stroke to an Italian hospital. Prestroke disability (mRS ≥3) was assessed at admission. Prestroke CFS was retrospectively assessed using information from the medical records. Logistic models determined the association of CFS with poor functional outcome, prolonged discharge, unfavorable discharge setting, and poor rehabilitation potential. Cox models determined the association of CFS with 30-day and 1-month mortality. All models were adjusted for prestroke disability and other major confounders.\u0000Results: Participants were median age 81 years (25th-75th percentile, 75-87 years), 55.0% female, 82.6% with ischemic stroke, and 26.3% with prestroke disability. Overall prevalence of prestroke frailty (CFS ?4) was 41.6%. Multivariable-adjusted logistic models showed that CFS was associated with increasing risk of all outcomes except prologed discharge. In severe frailty (CFS 7-8), OR (95%CI) was 3.44 (2.33-5.07) for poor functional outcome, 0.53 (0.38-0.75) for prolonged discharge, 1.89 (0.36-263) for unfavourable discharge, and 6.24 (3.80-10.26) for poor rehabilitation potential (reference CFS 1-3). In multivariable adjusted- Cox models, CFS was unrelated to 30-day mortality but HR (95%CI) of 1-year mortality was significant for both CFS 4-6 (1.70, 1.36-2.11) and CFS 7-8 (1.69, 1.25-2.30). Conclusions: Prestroke frailty measured with CFS was associated with higher risk of several adverse outcomes even after adjustment for prestroke disability and other major confounders.","PeriodicalId":501025,"journal":{"name":"medRxiv - Geriatric Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}