Age and ageing最新文献

New horizons in advancing lifestyle medicine for older adults utilizing a transdisciplinary approach: gaps and opportunities 利用跨学科方法推进老年人生活方式医学的新视野：差距和机会

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-13 DOI: 10.1093/ageing/afaf159

Rebecca K F Lassell, Kevin Pritchard, Laura A Baehr, Mirnova E Ceïde, Sudeshna A Chatterjee, Cristina Colón-Semenza, Oshadi Jayakody, Sarah B Lieber, Julia V Loewenthal, Christopher L Mosher, Elena Myasoedova, Annalisa Na, Una Makris, Andrea Sherman, Anoop Sheshadri, Kamal Wagle, Mariana Wingood, Brian J Andonian

{"title":"New horizons in advancing lifestyle medicine for older adults utilizing a transdisciplinary approach: gaps and opportunities","authors":"Rebecca K F Lassell, Kevin Pritchard, Laura A Baehr, Mirnova E Ceïde, Sudeshna A Chatterjee, Cristina Colón-Semenza, Oshadi Jayakody, Sarah B Lieber, Julia V Loewenthal, Christopher L Mosher, Elena Myasoedova, Annalisa Na, Una Makris, Andrea Sherman, Anoop Sheshadri, Kamal Wagle, Mariana Wingood, Brian J Andonian","doi":"10.1093/ageing/afaf159","DOIUrl":"https://doi.org/10.1093/ageing/afaf159","url":null,"abstract":"Nearly half of premature deaths can be prevented with healthy lifestyle behaviours. However, most older adults do not adhere to established guidelines to promote a healthy lifestyle. We propose a tailored framework of lifestyle medicine that acknowledges the complex contexts and care needs of older adults. The proposed framework of lifestyle medicine for older adults integrates their lived experiences (e.g. social determinants of health, built environment), the 5 M framework of geriatric medicine (i.e. Mind, Mobility, Medications, Multicomplexity, Matters Most) and the six pillars of lifestyle medicine (i.e. nutrition/diet, physical activity/exercise, restorative sleep, stress management, avoidance of risky substances, positive social connections) through a novel transdisciplinary approach. Guided by the updated framework, key gaps and opportunities are presented to advance lifestyle medicine practice, research and policy with the goal of promoting sustained behaviour change and improving the healthspan of older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"602 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278348","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}

引用次数: 0

Should octogenarians and people aged 90 years and over be treated separately in studies of stroke? An evaluation of national audit data 在中风研究中，80多岁的人和90岁及以上的人应该分开对待吗？对国家审计数据的评价

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-11 DOI: 10.1093/ageing/afaf164

Meabh Kelly, Joan McCormack, Olga Brych, Peter J Kelly, Tim Cassidy, Ronan Collins, Joseph A Harbison

{"title":"Should octogenarians and people aged 90 years and over be treated separately in studies of stroke? An evaluation of national audit data","authors":"Meabh Kelly, Joan McCormack, Olga Brych, Peter J Kelly, Tim Cassidy, Ronan Collins, Joseph A Harbison","doi":"10.1093/ageing/afaf164","DOIUrl":"https://doi.org/10.1093/ageing/afaf164","url":null,"abstract":"Introduction Population studies frequently use ≥80 years for defining ‘very old’ but as mean life expectancy frequently exceeds 80 years internationally, this may no longer be appropriate. Those ≥90 years now represent a significant proportion of stroke patients. We examined national data to examine the differences between those 80–89 years and those 90+ years. Methods Data from the Irish National Audit of Stroke (2017–22 inclusive), including demographic, admission and outcome data, including prestroke and discharge modified Rankin Scores (mRS), were analysed. Proportional data were analysed using Chi-square statistics. Results Data on 26 829 individual stroke events were analysed of which 7329 (27.3%) were in people 80–89 years; 52.8% were women. 1708 events occurred in people ≥90 (6.4%); 70.0% were women. 73.7% of those 80–89 years had mRS &lt; 3 prestroke vs 51.3% of those ≥90 (P &lt; .001). In hospital mortality for people ≥90 was higher (26.8% vs 17.4% P &lt; .001) and they were less likely to have mRS &lt; 3 at discharge (17.0% vs 35.8% P &lt; .001). Proportion of haemorrhagic stroke was significantly lower in those ≥90 (15.3% vs 12.9% P = .015). Only one haemorrhage was reported amongst 31 people ≥100 years. The proportion of atrial fibrillation (AF) detected following stroke was not significantly different (≥90 years: 33.9%, 80–89 years, 32.4% P = .38). On logistic regression, nonrecovery to independence (mRS &gt;2) in those ≥90 was associated with prestroke mRS, haemorrhagic stroke, AF and being thrombolysed. Conclusion There are differences in profiles and outcomes between the groups, and it is now more appropriate to consider them separately.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"58 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268642","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}

引用次数: 0

Association between hypoglycaemic drug de-intensification, mortality and hospital admission in older adults with type 2 diabetes: a cohort study emulating a target trial 老年2型糖尿病降糖药去强化、死亡率和住院率之间的关系：一项模拟目标试验的队列研究

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-11 DOI: 10.1093/ageing/afaf160

Antoine Christiaens, Alexis Cochard, Florence Tubach, Wade Thompson, Alan J Sinclair, Séverine Henrard, Benoît Boland, Yannis Slaouti-Jégou, Béranger Lekens, Dominique Bonnet-Zamponi, Noémie Simon-Tillaux, Lorene Zerah

{"title":"Association between hypoglycaemic drug de-intensification, mortality and hospital admission in older adults with type 2 diabetes: a cohort study emulating a target trial","authors":"Antoine Christiaens, Alexis Cochard, Florence Tubach, Wade Thompson, Alan J Sinclair, Séverine Henrard, Benoît Boland, Yannis Slaouti-Jégou, Béranger Lekens, Dominique Bonnet-Zamponi, Noémie Simon-Tillaux, Lorene Zerah","doi":"10.1093/ageing/afaf160","DOIUrl":"https://doi.org/10.1093/ageing/afaf160","url":null,"abstract":"Background Hypoglycaemic drugs (sulfonylureas, glinides or insulins) are commonly prescribed for older adults with type 2 diabetes (T2D) but may carry risks of adverse events. Whether de-intensifying hypoglycaemic drugs is associated with clinical benefit in older adults remains unknown. Objective To evaluate the association between de-intensification of hypoglycaemic drugs and clinical outcomes in older adults with T2D. Methods Cohort study conducted with the target trial emulation approach, using data collected from 2000 French general practises between January 2010 and February 2019 (The Health Improvement Network—THIN database). Eligible participants were ≥75 years old, on stable hypoglycaemic drugs (no change in drug or dose) for at least 6 months, and had an HbA1c value &lt;9%. Hypoglycaemic drug de-intensification (exposure) was defined as cessation or reduction of ≥50% of total dose. The primary outcome was a composite measure of all-cause death or hospital admissions within 3 months, and its association with exposure was assessed using multivariable logistic regression adjusted for potential baseline confounders. Results The study included 14 383 unique individuals corresponding to 177 314 trial emulation participants (mean age 80 years; 44.7% female). Of these, 6480 participants were allocated to de-intensification group, and 170 834 to the control group. At 3 months, the primary outcome occurred in 3.96% of the de-intensification group and 2.99% of controls [adjusted relative risk, 1.33 (95% CI, 1.22–1.43)]. Subgroup analyses showed consistent associations across most participants’ profiles. Conclusions In older adults with T2D, de-intensification of hypoglycaemic drugs was associated with a higher short-term risk of all-cause death or hospitalisation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"44 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268722","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}

引用次数: 0

Impact of disease type and temporal trends on the proximity of palliative care initiation to death in older adults: a population-based study 疾病类型和时间趋势对老年人开始姑息治疗与死亡的接近程度的影响：一项基于人群的研究

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-11 DOI: 10.1093/ageing/afaf163

Yu-Tai Lo, Tzu-Jung Chuang, Yu-Tung Huang, Yi-Lin Wu, Yi-Ching Yang, Chung-Yi Li

{"title":"Impact of disease type and temporal trends on the proximity of palliative care initiation to death in older adults: a population-based study","authors":"Yu-Tai Lo, Tzu-Jung Chuang, Yu-Tung Huang, Yi-Lin Wu, Yi-Ching Yang, Chung-Yi Li","doi":"10.1093/ageing/afaf163","DOIUrl":"https://doi.org/10.1093/ageing/afaf163","url":null,"abstract":"Background Chronic conditions like heart disease and dementia have surpassed cancer as leading causes of death in aging populations. Non-cancer patients, despite similar palliative care needs, often face delayed initiation or limited access. This study investigated the proximity of palliative care initiation to death among older adults with different diagnoses and influencing factors. Methods This cross-sectional study used Taiwan’s National Health Insurance and Multiple Causes of Death databases (2010–2020), including individuals aged ≥65 who received specialist palliative care before death. Multinomial logistic regression analysed the association of cancer status and year of death with the proximity of palliative care initiation to death. Results Among 177 403 decedents, 82.41% had cancer and 17.59% non-cancer diagnoses. While median proximity was similar (cancer: 29 days; non-cancer: 28 days), non-cancer decedents had significantly higher adjusted odds ratios (aORs) for late palliative care initiation, particularly ≤3 days (aOR: 1.45, 95% CI: 1.36–1.54) and 4–7 days before death (aOR: 1.34, 95% CI: 1.27–1.41). Over time, the proportion of decedents who initiated palliative care at least 181 days before death increased. Those who died in 2020 were significantly more likely to receive earlier palliative care than those who died in 2010 (aOR: 7.64, 95% CI: 5.78–10.10). Conclusions Despite a trend towards earlier initiation for both groups, non-cancer patients in Taiwan are more likely to have palliative care initiated in the final days of life. Targeted policies are needed to ensure equitable, needs-based palliative care across diagnoses for improved end-of-life outcomes for older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"258 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268723","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}

引用次数: 0

The efficacy of psychosocial interventions in relieving family caregiver burden in older adults with disabilities: a systematic review and network meta-analysis 社会心理干预减轻残疾老年人家庭照顾者负担的效果：系统回顾和网络荟萃分析

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-11 DOI: 10.1093/ageing/afaf155

Yundie Chen, Sichen Yi, Rong Chen, Qi Zhang

{"title":"The efficacy of psychosocial interventions in relieving family caregiver burden in older adults with disabilities: a systematic review and network meta-analysis","authors":"Yundie Chen, Sichen Yi, Rong Chen, Qi Zhang","doi":"10.1093/ageing/afaf155","DOIUrl":"https://doi.org/10.1093/ageing/afaf155","url":null,"abstract":"Background Caregiver burden is a significant challenge for those caring for older adults with disabilities. This review aims to assess the most effective psychosocial interventions for reducing family caregiver burden, focusing on overall effectiveness, care recipients with cognitive impairment and home-based interventions. Methods Seven major databases (PubMed, Web of Science, Embase, Scopus, Cochrane Library, PsycINFO and CINAHL) were systematically searched until 2 October 2024. Continuous outcomes were assessed using standardised mean differences (SMDs) and 95% confidence intervals (CIs). Intervention rankings relied on surface under the cumulative ranking curve (SUCRA) values. Results In 31 trials with 4687 participants, comparing psychoeducation (n = 14), cognitive behavioural therapy (CBT) (n = 9), reminiscence therapy (n = 2), family caregiver support programmes (n = 2), mindfulness-based interventions (MBIs) (n = 2), progressive muscle relaxation (n = 1) and music therapy (n = 1), MBIs (SMD = −6.67, 95% CI: −12.94, −0.41) significantly reduced caregiver burden and ranked highest (SUCRA, 79.2%; mean rank, 2.4). In studies with care recipients with cognitive impairment, MBIs substantially reduced burden (SMD = −17.06, 95% CI: −25.02, −9.10) and held the top ranking (SUCRA, 98.7%; mean rank, 1.2). In studies conducted in caregivers' homes, CBT remained highly effective (SMD = −5.57, 95% CI: −8.59, −2.90) and ranked highest (SUCRA, 95.7%; mean rank, 1.2). Conclusions This network meta-analysis highlights the effectiveness of psychosocial interventions in reducing caregiver burden. MBIs were most effective, particularly for caregivers of individuals with cognitive impairment, while CBT was highly effective in home-based settings. These findings underscore the importance of context-specific strategies.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"52 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268641","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}

引用次数: 0

Comprehensive geriatric hospital-at-home increases the days at home in older adults compared to bed-based intermediate care: a propensity score matching analysis 与基于床的中间护理相比，综合老年住院在家增加了老年人在家的天数：倾向评分匹配分析

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-10 DOI: 10.1093/ageing/afaf162

Tessa Mazzarone, Laura M Pérez, Lorena Villa, Oriol Planesas-Pérez, Filippo M Verri, Ana de Andrés, Ana Gonzalez-de Luna, Maria F Velarde, Roger Martí-Tarradell, Marco Inzitari, Aida Ribera

{"title":"Comprehensive geriatric hospital-at-home increases the days at home in older adults compared to bed-based intermediate care: a propensity score matching analysis","authors":"Tessa Mazzarone, Laura M Pérez, Lorena Villa, Oriol Planesas-Pérez, Filippo M Verri, Ana de Andrés, Ana Gonzalez-de Luna, Maria F Velarde, Roger Martí-Tarradell, Marco Inzitari, Aida Ribera","doi":"10.1093/ageing/afaf162","DOIUrl":"https://doi.org/10.1093/ageing/afaf162","url":null,"abstract":"Objectives To compare the effectiveness and safety of Hospital-at-Home based on Comprehensive Geriatric Assessment (CGA-HaH) for older adults with bed-based Intermediate Care Unit (BBU). Design Cohort study comparing all consecutive CGA-HaH cases managed between January 2018 and December 2023 with contemporary BBU-matched controls at the largest geriatric care provider in Barcelona. Methods We linked all intermediate care admissions at Parc Sanitari Pere Virgili to the Catalan health information system data to track patients’ trajectories from 6 months before the index episode to June 2024. Patients admitted to CGA-HaH were matched to BBU controls using propensity score matching (PSM) based on their baseline characteristics. We used multivariable linear regression to assess the association of CGA-HaH with the percentage of days spent at home (%DSH) and Cox regression to assess the risk of death and first re-hospitalisation. Results We included 1180 consecutive CGA-HaH and 10,528 BBU episodes. CGA-HaH patients were significantly older and more functionally impaired and had better socioeconomic status. After PSM, we compared 961 CGA-HaH and 961 BBU patients, with a mean follow-up of 705 days (SD 593). CGA-HaH patients had a 7.4 higher %DSH (95% CI: 4.5–10.2, P &lt; 0.001) with similar first re-hospitalisation [HR 1.02 (95% CI: 0.91–1.1)] and mortality risk [HR: 0.93 (95% CI: 0.81–1.06)]. Conclusions Our results suggest that CGA-Hospital-at-Home is a viable alternative to traditional inpatient intermediate care for older adults, offering relevant advantages such as increased time spent at home without a rise in mortality.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"4 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144260118","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}

引用次数: 0

Medications associated with dizziness or hypotension and adverse outcomes: an electronic health record study in older adults with dementia 与头晕或低血压相关的药物和不良后果：老年痴呆患者的电子健康记录研究

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-08 DOI: 10.1093/ageing/afaf154

Harsharon Kaur Sondh, Delia Bishara, Gayan Perera, Hitesh Shetty, Robert Stewart, Christoph Mueller

{"title":"Medications associated with dizziness or hypotension and adverse outcomes: an electronic health record study in older adults with dementia","authors":"Harsharon Kaur Sondh, Delia Bishara, Gayan Perera, Hitesh Shetty, Robert Stewart, Christoph Mueller","doi":"10.1093/ageing/afaf154","DOIUrl":"https://doi.org/10.1093/ageing/afaf154","url":null,"abstract":"Background Comorbidities and polypharmacy are common in people with dementia, leading to a higher risk of adverse outcomes. While the impact of anticholinergic properties has been extensively investigated, less is known about other cross-category properties of medications. Objective To investigate whether medications with dizziness or hypotension as a side effect are associated with adverse outcomes in older adults with dementia. Design Retrospective cohort study. Setting and participants From a South London catchment, 15 210 patients diagnosed with dementia between 2008 and 2017. Methods Medications with dizziness and/or hypotension listed as a side effect were compiled and quantified in the cohort. Multivariable Cox regression models were run to determine the risk of mortality, all-cause emergency hospitalisation and hospitalisation due to falls. Generalised estimating equations were applied to investigate cognitive decline. The final model adjusted for 19 potential confounders, including physical and mental health measures. Results Of the patients, 82.2% were receiving at least one dizziness-associated medication and 71.2% at least one hypotension-associated medication. For each additional medication associated with dizziness or hypotension, there was a 4% increased risk of all-cause emergency hospitalisation. No associations were found with hospitalised falls specifically or with mortality or cognitive decline. Conclusion Medications that potentially cause dizziness or hypotension were associated with an increased risk of hospitalisation, although not specifically hospitalisation caused by falls. More systematic attention should be paid to coprescribing around the time of dementia diagnosis and the potential for rationalising this to minimise adverse drug events.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"10 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237698","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}

引用次数: 0

Impact of spousal caregiving on frailty index: longitudinal evidence from China Health and Retirement Longitudinal Study 配偶照顾对衰弱指数的影响：来自中国健康与退休纵向研究的纵向证据

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-08 DOI: 10.1093/ageing/afaf148

Mingming Liu, Shanshan Wang

{"title":"Impact of spousal caregiving on frailty index: longitudinal evidence from China Health and Retirement Longitudinal Study","authors":"Mingming Liu, Shanshan Wang","doi":"10.1093/ageing/afaf148","DOIUrl":"https://doi.org/10.1093/ageing/afaf148","url":null,"abstract":"Background and objective Research on the impact of spousal caregiving on caregivers’ frailty remains limited. This study aimed to examine this association between spousal caregiving and frailty, explore how this association varies with care intensity, and investigate potential gender differences. Methods This study utilized data from four waves of the China Health and Retirement Longitudinal Study, including 3,987 participants aged 50 and above. Frailty was assessed using a composite mean score based on 41 indicators aligned with Rockwood’s frailty criteria. These indicators included self-reported health, medically diagnosed conditions, medical symptoms, functional activities assessment, activities of daily living and instrumental activities of daily living. Samples were stratified by gender, and a growth curve model with random intercepts was employed to examine the associations between spousal caregiving status, care intensity and frailty trajectories over time. Results Among females, compared to non-caregivers, spousal caregiving was significantly associated with the increased frailty index when adjusted by all covariates, and frailty accelerated at a higher rate for caregivers. Providing care at all three intensity levels was associated with higher frailty, although depression attenuated these associations. Additionally, caregiving at lower intensity showed an accelerating rate of frailty progression over time. Among males, only providing higher-care intensity was associated with higher frailty. Conclusions This study highlights the importance of care intensity as well as the gendered effects of spousal caregiving on frailty—caregiving exacerbates frailty, particularly among females and among higher-intensity male caregivers. Our findings suggest the need for targeted supportive measures to alleviate psychological stress.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"26 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237713","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}

引用次数: 0

Depression and anxiety symptom networks across the lifespan 抑郁和焦虑症状贯穿整个生命周期

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-06 DOI: 10.1093/ageing/afaf153

Daniel Harlev, Aya Vituri, Moni Shahar, Noham Wolpe

{"title":"Depression and anxiety symptom networks across the lifespan","authors":"Daniel Harlev, Aya Vituri, Moni Shahar, Noham Wolpe","doi":"10.1093/ageing/afaf153","DOIUrl":"https://doi.org/10.1093/ageing/afaf153","url":null,"abstract":"Background The relationship between anxiety and depressive symptoms is complex and may vary across the lifespan. Symptom network analyses offer a powerful tool to examine these interactions, but few studies have directly compared symptom networks in younger and older adults. Methods We analysed data from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) study, including 786 participants aged 18 to 88, who reported at least subclinical levels of symptoms on the Hospital Anxiety and Depression Scale (HADS). Network analysis was employed to examine symptom communities (clusters of related symptoms), within- and between-community connectivity (association strength), and centrality (symptom importance) across age groups. Results The overall network structure, separating anxiety and depressive symptoms into two communities, remained stable. However, older adults showed reduced connectivity within depression and between depression and anxiety. While ‘panic’ was a consistently central symptom, ‘rumination’ and ‘restlessness’ were the key bridge symptoms (i.e. linking anxiety and depression) in young and older adults, respectively. Discussion Our findings reveal both stable and dynamic aspects of depression and anxiety symptoms across the lifespan. Reduced within-community connectivity for depressive symptoms suggests greater heterogeneity in how depression manifests in older populations. The shift in bridging symptoms, from cognitive (rumination) in young adults to somatic (restlessness) in older adults, suggests subtle yet clinically important differences in how depression and anxiety are linked across the lifespan. Our findings support age-informed assessment and diagnosis of depressive and anxiety symptoms.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 3 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236984","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}

引用次数: 0

Potentially inappropriate polypharmacy is an important predictor of 30-day emergency hospitalisation in older adults: a machine learning feature validation study 潜在不适当的多种用药是老年人30天紧急住院的重要预测因素：一项机器学习特征验证研究

IF 6.7 2区医学

Age and ageing Pub Date : 2025-06-06 DOI: 10.1093/ageing/afaf156

Robert T Olender, Sandipan Roy, Prasad S Nishtala

{"title":"Potentially inappropriate polypharmacy is an important predictor of 30-day emergency hospitalisation in older adults: a machine learning feature validation study","authors":"Robert T Olender, Sandipan Roy, Prasad S Nishtala","doi":"10.1093/ageing/afaf156","DOIUrl":"https://doi.org/10.1093/ageing/afaf156","url":null,"abstract":"Background Machine learning (ML) models in healthcare are crucial for predicting clinical outcomes, and their effectiveness can be significantly enhanced through improvements in accuracy, generalisability, and interpretability. To achieve widespread adoption in clinical practice, risk factors identified by these models must be validated in diverse populations. Methods In this cohort study, 86 870 community-dwelling older adults ≥65 years from the UK Biobank database were used to train and test three ML models to predict 30-day emergency hospitalisation. The three ML models, Random Forest (RF), XGBoost (XGB), and Logistic Regression (LR), utilised all extracted variables, consisting of demographic and geriatric syndromes, comorbidities, and the Drug Burden Index (DBI), a measure of potentially inappropriate polypharmacy, which quantifies exposure to medications with anticholinergic and sedative properties. 30-day emergency hospitalisation was defined as any hospitalisation related to any clinical event within 30 days of the index date. The model performance metrics included the area under the receiver operating characteristics curve (AUC-ROC) and the F1 score. Results The AUC-ROC for the RF, XGB and LR models was 0.78, 0.86 and 0.61, respectively, signifying good discriminatory power. The DBI, mobility, fractures, falls, hazardous alcohol drinking and smoking were validated as important variables in predicting 30-day emergency hospitalisation. Conclusions This study validated important risk factors for predicting 30-day emergency hospitalisation. The validation of important risk factors will inform the development of future ML studies in geriatrics. Future research should prioritise the development of targeted interventions to address the risk factors validated in this study, ultimately improving patient outcomes and alleviating healthcare burdens.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"68 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237138","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}

引用次数: 0