Age and ageing最新文献

{"title":"Trajectories of functional decline and predictors in long-term care settings: a retrospective cohort analysis of Canadian nursing home residents","authors":"Bonaventure Amandi Egbujie, Luke Andrew Turcotte, George Heckman, John P Hirdes","doi":"10.1093/ageing/afae264","DOIUrl":"https://doi.org/10.1093/ageing/afae264","url":null,"abstract":"Decline in the ability to perform activities of daily living (ADL) or ‘functional decline’ is a major health concern among aging populations. With intervention, ADL decline may be delayed, prevented or reversed. The capacity to anticipate the trajectory of future functional change can enhance care planning and improve outcome for residents. Methods This is a 36 months’ retrospective longitudinal analysis of LTC residents in five Canadian provinces. Group-based trajectory modelling (GBTM) was performed to identify distinct trajectories and resident attributes associated with membership of the trajectory groups. Results A total of 204 036 LTC residents were included in this study. Their admission mean age was 83.7 years (SD = 8.6), and 63.3% were females. Our model identified four distinct trajectories namely: ‘Catastrophic decline’ (n = 48 441, 22.7%), ‘Rapid decline with some recovery’ (n = 27 620, 18.7%), ‘Progressive decline’ trajectory (n = 30 287, 14.4%), and the ‘No/Minimal decline’ (n = 97 688, 47.9%) Residents’ admission ADL Hierarchy score was the single, strongest predictor of functional decline trajectory that residents followed. Residents with ADLH 5–6 OR 0.03 (0.03–0.04) were least likely to follow a catastrophic decline trajectory, while those with ADLH 5–6 OR 39.05 (36/60–41.88) were most likely to follow a minimal or no decline trajectory. Conclusion Results of this study further highlight the heterogeneity of health trajectory among residents in LTC setting, re-affirming the need for personalized care. The study shows who among residents would be most at risk for different levels of functional decline. The study findings provide useful information that would assist both immediate and advanced care planning as well as to forecast care personnel requirements into the future based on total acuity levels of residents.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"29 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ultra-processed food intake and biological ageing in US adults: findings from National Health and Nutrition Examination Survey (NHANES) 2003–2010","authors":"Barbara Rita Cardoso, Junxiu Liu, Priscila Machado, Dayoon Kwon, Daniel W Belsky, Euridice Martinez Steele","doi":"10.1093/ageing/afae268","DOIUrl":"https://doi.org/10.1093/ageing/afae268","url":null,"abstract":"Background The association between ultra-processed food (UPF) intake and markers of biological ageing has been scarcely investigated, despite the evident adverse health effects associated with UPF. This study aimed to test the association between UPF intake and biological ageing, and evaluate how much of this association is accounted for by overall diet quality. Methods This cross-sectional study assessed 16 055 participants aged 20–79 years (51% women, 46 ± 0.3 years) from the National Health and Nutrition Examination Survey (NHANES) 2003–2010. Dietary UPF intake was assessed using the Nova system. Values were expressed as % of total energy intake and were denominated as a continuous variable and in quintiles. Diet quality was assessed with the American Heart Association 2020 and the Healthy Eating Index 2015. Biological ageing was assessed using the PhenoAge algorithm. Results For each 10% of energy intake accounted for by UPF, participants were 0.21 (95%CI 0.16–0.26) years biologically older in terms of PhenoAge. As compared to participants in the lowest UPF quintile (≤39%), those in the highest UPF quintile (68–100%) were 0.86 (95% CI 0.55, 1.16) years older (P-for-trend across quintiles ≤0.001). Adherence to a healthy diet moderately attenuated the relationship between UPF and PhenoAge (adjusted β = 0.14 per 10% increment of UPF). Conclusions Adults with higher UPF tended to be biologically older. This association is partly independent of diet quality, suggesting that food processing may contribute to biological ageing acceleration. Our findings point to a compelling reason to target UPF consumption to promote healthier ageing.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"23 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated blood pressure variability is associated with an increased risk of negative health outcomes in adults aged 65 and above-a systematic review and meta-analysis.","authors":"Jordy Saren, Aziz Debain, Fien Loosveldt, Mirko Petrovic, Ivan Bautmans","doi":"10.1093/ageing/afae262","DOIUrl":"10.1093/ageing/afae262","url":null,"abstract":"<p><strong>Background: </strong>The clinical relevance of blood pressure variability (BPV) is still unknown, despite increasing evidence associating BPV to negative health outcomes (NHOs). There is currently no gold standard to define high BPV and normal reference values for BPV are lacking.</p><p><strong>Aim: </strong>The primary aim was to examine whether high BPV can predict NHO in adults aged ≥65. The predictive value of BPV was compared to mean BP (mBP) when both parameters were available.</p><p><strong>Methods: </strong>PubMed and Web of Science were systematically screened; 49 articles (12 retrospective, 18 prospective and 19 cross-sectional studies) were included and evaluated for methodological quality. Meta-analyses were conducted to examine the association of BPV (and mBP when available) with NHO.</p><p><strong>Results: </strong>Systolic BPV and systolic mBP seem to indicate at least comparable odds for cardiovascular disease (BPV: odds ratio (OR) = 1.33 (95% CI: 1.19-1.48, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.03-1.09, P = .0002)) and cerebral deterioration (BPV: OR = 1.28 (95% CI: 1.17-1.41, P < .00001) vs mBP: OR = 1.06 (95% CI: 1.04-1.09, P < .00001)). Increased diastolic BPV was associated with higher odds of cerebral deterioration (OR = 1.18 (95% CI: 1.04-1.35), P = .01).</p><p><strong>Conclusion: </strong>High systolic BPV and high systolic mBP are associated with 33% and 6% higher odds of cardiovascular disease in adults aged ≥65, respectively. High BPV is also related to an 18%-28% and 11% increased odds of cerebral deterioration and poor stroke recovery. An overview of cut-off values is provided for the most often reported BPV parameters in literature, which can be used as a guideline to identify elevated BPV in clinical practice.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between delirium and falls in older adults in the community: a systematic review and meta-analysis.","authors":"Charlotte Eost-Telling, Lucy McNally, Yang Yang, Chunhu Shi, Gill Norman, Saima Ahmed, Brenda Poku, Annemarie Money, Helen Hawley-Hague, Chris J Todd, Susan Deborah Shenkin, Emma R L C Vardy","doi":"10.1093/ageing/afae270","DOIUrl":"https://doi.org/10.1093/ageing/afae270","url":null,"abstract":"<p><strong>Objective: </strong>Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.</p><p><strong>Methods: </strong>We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.</p><p><strong>Results: </strong>We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.</p><p><strong>Conclusions: </strong>We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Realising the right to rehabilitation-commentary on 'reablement, rehabilitation, recovery: everyone's business'.","authors":"","doi":"10.1093/ageing/afae281","DOIUrl":"https://doi.org/10.1093/ageing/afae281","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprescribing antihypertensive medication in frail older adults: balancing the complexities of polypharmacy and individualised care.","authors":"Rob J van Marum","doi":"10.1093/ageing/afae267","DOIUrl":"https://doi.org/10.1093/ageing/afae267","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty reduces penumbral volumes and attenuates treatment response in hyperacute ischemic stroke.","authors":"Esmee Dohle, Benjamin Lewis, Smriti Agarwal, Elizabeth A Warburton, Nicholas R Evans","doi":"10.1093/ageing/afae266","DOIUrl":"https://doi.org/10.1093/ageing/afae266","url":null,"abstract":"<p><strong>Background: </strong>Frailty-the loss of physiological reserve to withstand a stressor event-is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke.</p><p><strong>Methods: </strong>Total ischemic lesion volumes (comprising infarct core and penumbral volumes) were measured using computed tomography (CT) perfusion imaging to give the penumbral fraction within the ischemic lesion. Pre-stroke frailty was measured using a validated frailty index. The relationship between frailty and penumbral fraction was adjusted for age, onset-to-CT interval, collateral scores, small vessel disease burden and vascular comorbidities. Stroke severity was measured using the National Institutes of Health Stroke Scale at baseline and after 24 h.</p><p><strong>Results: </strong>In 55 individuals receiving thrombolysis for ischemic stroke, increasing frailty was associated with a reduction in penumbral fraction (rs = -0.36, P < 0.01). This remained significant after adjustment for age, onset-to-imaging time and collateral score (beta = -1.16, P < 0.001). Correspondingly, frailty was independently negatively associated with proportional improvement in stroke severity following treatment (beta = -2.00, P < 0.01). C-reactive protein (CRP) on presentation was associated with frailty index (rs = 0.38, P < 0.01) and penumbral fraction (rs = -0.30, P = 0.02).</p><p><strong>Discussion: </strong>A reduction in salvageable penumbra in frailty may explain the treatment-attenuating effects of frailty on reperfusion therapies. The association with CRP motivates further research into a possible inflammatory component of this relationship.</p><p><strong>Conclusion: </strong>Frailty is independently associated with reduced penumbra and poorer neurological recovery in acute stroke. These findings may explain the attenuated response to stroke reperfusion therapies seen in frailer individuals.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of early-life factors with biological age acceleration and the mediating effect of social environment risks in middle-aged and older adults.","authors":"Xiaojing Liu, Ming Jin, Zeping Yang, Ziyi Zhang, Ninghao Huang, Tao Huang, Nan Li","doi":"10.1093/ageing/afae272","DOIUrl":"https://doi.org/10.1093/ageing/afae272","url":null,"abstract":"<p><strong>Background: </strong>Adverse early-life events influence the health with ageing throughout the life course. However, the effects of combined early-life risks on ageing acceleration in adults and the roles of social environment risks remain unknown.</p><p><strong>Objective: </strong>To investigate associations of maternal smoking, breastfeeding and birth weight with accelerated biological age (BA), and to explore genetic-predicted effect and mediating effect of social environment risks.</p><p><strong>Design: </strong>Population-based prospective cohort.</p><p><strong>Setting: </strong>UK Biobank.</p><p><strong>Subjects: </strong>151 773 participants.</p><p><strong>Methods: </strong>We used Klemera-Doubal BA (KDM-BA), PhenoAge and leukocyte telomere length (LTL) as BA biomarkers. Associations of early-life risk factors and score with BA acceleration were estimated using linear regression models. Genetic risk score (GRS) was calculated based on genetic variations for maternal smoking and birth weight. Polysocial risk scores (PsRS) for each BA were calculated by summing the number of dichotomised social environment factors significantly associated with each of the three BA biomarkers.</p><p><strong>Results: </strong>Maternal smoking, non-breastfeeding and low birth weight were individually associated with BA acceleration. The early-life risk score was significantly associated with accelerated KDM-BA and PhenoAge and shorter LTL. The effects of GRS on accelerated BA were in the same direction. The BA-specific PsRS mediated the accelerated KDM-BA and PhenoAge and shorter LTL by 8.37%, 22.34% and 7.90%, respectively.</p><p><strong>Conclusions: </strong>Our findings demonstrated a dose-dependent association of combined early-life risks with accelerated BA in middle-aged and older adults, partially mediated by social environment risks. The findings highlight the importance of early identification and surveillance of high-risk individuals for ageing acceleration during adulthood.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Uncertainty and advance care planning in older adults living with frailty. A collection and commentary on the theme of advance care planning.","authors":"","doi":"10.1093/ageing/afae273","DOIUrl":"https://doi.org/10.1093/ageing/afae273","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.","authors":"Brandon Stretton, Andrew E C Booth, Joshua Kovoor, Aashray Gupta, Suzanne Edwards, Tom Hugh, John Maddison, Nicholas J Talley, Mark Plummer, Emily Meyer, Michael Horowitz, Savio Barreto, Robert Padbury, Stephen Bacchi, Guy Maddern, Mark Boyd","doi":"10.1093/ageing/afae263","DOIUrl":"https://doi.org/10.1093/ageing/afae263","url":null,"abstract":"<p><strong>Background: </strong>Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.</p><p><strong>Methods: </strong>A multicentre cohort study involving six Australian tertiary hospitals was undertaken. All consecutive surgical patients who underwent an operation were included. Frailty was defined by the Hospital Frailty Risk Score, malnutrition by the Malnutrition Universal Screening Tool (MUST) and low socioeconomic status by the Index of Relative Socioeconomic Disadvantage. Linear mixed-effects and binary logistic generalised estimated equation models were performed for the outcomes: inpatient mortality, length of stay, 30-day readmission and re-operation.</p><p><strong>Results: </strong>A total of 21 976 patients were included. After controlling for confounders, malnutrition and socioeconomic status, patients at high risk of frailty have a mean hospital length of stay 3.46 times longer (mean ratio = 3.46; 95% confidence interval (CI): 3.20, 3.73; P value < .001), odds of 30-day readmission 2.4 times higher (odds ratio = 2.40; 95% CI: 2.19, 2.63; P value < .001) and odds of in-hospital mortality 12.89 times greater than patients with low risk of frailty (odds ratio = 12.89; 95% CI: 4.51, 36.69; P value < .001). Elevated MUST scores were also significantly associated with worse outcomes, but to a lesser extent. Socioeconomic status had no association with outcomes.</p><p><strong>Conclusion: </strong>Perioperative risk evaluation should consider both frailty and malnutrition as separate, significant risk factors. Despite strong causal links with frailty and malnutrition, socioeconomic disadvantage is not associated with worse postoperative outcomes. Additional studies regarding the prospective identification of these patients with implementation of strategies to mitigate frailty and malnutrition and assessment of perioperative risk are required.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 12","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811792","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}