Age and ageing最新文献

{"title":"Impact of in-hospital medication changes on clinical outcomes in older inpatients: the journey and destination","authors":"Nashwa Masnoon, Sarita Lo, Danijela Gnjidic, Andrew J McLachlan, Fiona M Blyth, Rosemary Burke, Ana W Capuano, Sarah N Hilmer","doi":"10.1093/ageing/afae282","DOIUrl":"https://doi.org/10.1093/ageing/afae282","url":null,"abstract":"Background Medication review is integral in the pharmacological management of older inpatients. Objective To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes. Methods Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes included the number of increases (medications started or dose-increased) and decreases (medications stopped or dose-decreased) for (i) all medications, (ii) Drug Burden Index (DBI)–contributing medications and (iii) Beers Criteria 2015 medications (potentially inappropriate medications, PIMs). Changes also included differences in (i) the number of medications, (ii) the number of PIMs and (iii) DBI score, at discharge versus admission. Associations with clinical outcomes (28-day ED visit, readmission and mortality) were ascertained using logistic regression, adjusted for age, gender and principal diagnosis. For mortality, sensitivity analysis excluded end-of-life patients due to higher death risk. Patients were stratified into : (i) ≤4, (ii) 5–9 and (iii) ≥10 discharge medications. Results The mean age was 86 years (SD = 5.8), with 59.1% female. Medication changes reduced ED visits and readmission risk for patients prescribed five to nine discharge medications, with no associations in patients prescribed ≤4 and ≥ 10 medications. In the five to nine medications group, decreasing PIMs reduced risks of ED visit (adjusted odds ratio, aOR 0.55, 95% CI 0.34–0.91, P = .02) and readmission (aOR 0.62, 95% CI 0.38–0.99, P = .04). Decreasing DBI-contributing medications reduced readmission risk (aOR 0.71, 95% CI 0.51–0.99, P = .04). Differences in PIMs reduced ED visit risk (aOR 0.65, 95% CI 0.43–0.99, P = .04). There were no associations with mortality in sensitivity analyses in all groups. Discussion Medication changes were associated with reduced ED visits and readmission for patients prescribed five to nine discharge medications.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"50 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077484","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":"Evaluation of claims-based frailty measurements in older patients with cancer: a retrospective cohort study.","authors":"Hirooka Kayo, Kanno Yusuke, Itoh Sakiko, Sagawa Mieko, Sakano Tomomi, Takahashi Kunihiko, Anzai Tatsuhiko, Fukui Sakiko","doi":"10.1093/ageing/afaf015","DOIUrl":"10.1093/ageing/afaf015","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with poor outcomes in older adults with cancer. Several efforts have been made to assess frailty using the administrative claims data based on the number of clinical diagnosis codes, yet the literature reporting on this is scarce. This study aimed to evaluate the impact of frailty measures using administrative databases in Japan.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting and participants: </strong>5176 patients with cancer aged ≥65 years who underwent cancer treatment in hospitals.</p><p><strong>Methods: </strong>The Electronic Frailty Index (eFI) and Veterans Affairs Frailty Index (VA-FI), based on diagnostic codes recorded were calculated. We plotted Kaplan-Meier survival curves and calculated hazard ratios (HR) using Cox regression analyses. The primary outcome was mortality, whereas the composite secondary outcome included a decline in care-need level, admission to a long-term care facility (LTCF) or mortality.</p><p><strong>Results: </strong>The Kaplan-Meier survival curve demonstrated a significant association between the eFI and VA-FI and each research outcome. Compared to the lowest frailty group, the highest frailty group exhibited an HR of 2.59 [95% confidence interval (CI), 1.66-4.06] for eFI and 2.45 (95%CI, 1.02-5.91) for VA-FI in relation to a decline in care-need level, an LTCF admission and mortality. The trend test indicated a significant increase in the rate of each outcome with higher frailty levels.</p><p><strong>Conclusions: </strong>Higher frailty levels are associated with an increased risk of composite outcomes in older adults with cancer. This study suggests the potential application of frailty measurements in oncology care settings.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078361","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":"Understanding polypharmacy for people receiving home care services: a scoping review of the evidence.","authors":"Radin Karimi, Anna Robinson-Barella, Vanessa Davey, David R Sinclair, Barbara Hanratty, Adam Todd","doi":"10.1093/ageing/afaf031","DOIUrl":"10.1093/ageing/afaf031","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy, defined as the concurrent use of five or more medications, is common amongst older adults receiving home care services. The relationship between home care and polypharmacy may be critical to older people's health, but there is little research on this topic.</p><p><strong>Objective: </strong>To understand the extent and type of evidence on individuals receiving home care services and experiencing polypharmacy.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Three databases (MEDLINE, Embase, CINAHL) were systematically searched (December 2023) to identify studies with adult participants experiencing polypharmacy and receiving home care.</p><p><strong>Results: </strong>Twenty-three studies were included. For individuals receiving home care services, the studies reported on the following: (i) prevalence of polypharmacy, (ii) interventions to reduce inappropriate polypharmacy, (iii) perceived role of home care workers, (iv) assessment of health literacy in individuals experiencing polypharmacy, and (v) factors associated with polypharmacy and potentially inappropriate medications (PIMs). Polypharmacy and PIMs were found to be associated with older age, female sex, increased frailty, living alone, poor economic situation and inaccuracies within medical records. Improved appropriateness of prescribing can be achieved through interprofessional interventions, efficient use of home care workers and improved health literacy.</p><p><strong>Conclusion: </strong>This review highlights research on the extent of polypharmacy in home care and ways to address it. Whilst there are suggestions for enhancing medication quality, key gaps remain in research into the experiences of care staff and recipients in managing medications and polypharmacy, which should be addressed.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who came to the rescue? Sources of informal support to older Europeans before, during and after the COVID-19 pandemic.","authors":"Judite Gonçalves, France Weaver","doi":"10.1093/ageing/afaf034","DOIUrl":"10.1093/ageing/afaf034","url":null,"abstract":"<p><strong>Background/objective: </strong>The COVID-19 pandemic disrupted the provision of informal care in major ways. This study documents the prevalences of informal support with (instrumental) activities of daily living (IADL and ADL) before, during and after the pandemic, distinguishing between children, other relatives and friends/neighbours and focusing on individuals 50 years and older across 27 European countries.</p><p><strong>Methods: </strong>This longitudinal analysis relies on the Survey of Health, Ageing and Retirement in Europe (SHARE)'s Wave 8 (2019), two Corona surveys (2020 and 2021) and Wave 9 (2022). Linear probability models adjusted for individual fixed effects and time-varying confounders were used to estimate prevalences of informal support over time.</p><p><strong>Results: </strong>During the pandemic, the prevalences of informal support with both IADL and ADL from all three groups of caregivers increased significantly (P < 0.01), to return to their pre-pandemic levels by 2022. For example, the adjusted likelihood of IADL help from children increased from 18.5% (2019) to 36.6% (2020) and 42.5% (2021), then dropped back to 19.7% in 2022. Friends and neighbours played a critical role, with the adjusted likelihood of IADL help going from 8.8% (2019) to 29.7% (2020), then down to 18% (2021) and 8.9% (2022).</p><p><strong>Conclusions: </strong>Future emergency and disaster preparedness plans should contemplate the various sources of informal care, including support measures to non-relative caregivers, as those helpers may be able to rapidly respond to unexpected crisis.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Use of a trigger tool to describe and screen drug-related hospital admissions in older adults: the TRIGGAge retrospective cohort study.","authors":"","doi":"10.1093/ageing/afaf037","DOIUrl":"10.1093/ageing/afaf037","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373710","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":"Goals of care discussions and treatment limitation decisions in European acute geriatric units: a one-day cross-sectional study.","authors":"Ruth Piers, Sophie Pautex, Lourdes Rexach Cano, Jean-Claude Leners, Marc Vali Ahmed, Isabelle De Brauwer, Fatma Ö Kayhan Koçak, Dana Hrnciarikova, Marcin Cwynar, Mariana Alves, Erwin H Pilgram, Rozemarijn L van Bruchem-Visser","doi":"10.1093/ageing/afaf026","DOIUrl":"10.1093/ageing/afaf026","url":null,"abstract":"<p><strong>Background: </strong>It is important to pursue goal-concordant care and to prevent non-beneficial interventions in older people.</p><p><strong>Aim: </strong>To describe serious illness communication and decision-making practices in hospitalised older people in Europe.</p><p><strong>Setting/participants: </strong>Data on advance directives, goals of care (GOC) discussions and treatment limitation decisions were collected about patients aged 75-years and older admitted to 23 European acute geriatric units (AGUs).</p><p><strong>Results: </strong>In this cohort of 590 older persons [59.5% aged 85 and above, 59.3% female, median premorbid Clinical Frailty Score (CFS) 6], a formal advance directive was recorded in 3.3% and a pre-hospital treatment limitation in 14.0% with significant differences between European regions (respectively P < 0.001 and P = 0.018).Most prevalent GOC was preservation of function (46.8%). GOC were discussed with patients in 64.0%, with families in 73.0%, within the interprofessional hospital team in 67.0% and with primary care in 13.4%. The GOC and the extent to which it was discussed differed between European regions (both P < 0.001). The prevalence of treatment limitation decisions was 53.7% with a large difference within and between countries (P < 0.001). The odds of having a treatment limitation decision were higher for patients with pre-hospital treatment limitation decisions (OR 39.1), residing in Western versus Southern Europe (OR 4.8), belonging to an older age category (OR 3.2), living with a higher number of severe comorbidities (OR 2.2) and higher premorbid CFS (OR 1.3).</p><p><strong>Conclusions: </strong>There is large variability across European AGUs concerning GOC discussions and treatment limitation decisions. Sharing of information between primary and hospital care about patient preferences is noticeably deficient.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related differences in staging, treatment and net survival in relation to frailty in adults with colon cancer in England: an analysis of the COloRECTal cancer data repository (CORECT-R) resource.","authors":"Sophie Pilleron, Rebecca J Birch, John Taylor, Shane O'Hanlon, Eva J A Morris","doi":"10.1093/ageing/afaf025","DOIUrl":"10.1093/ageing/afaf025","url":null,"abstract":"<p><strong>Objective: </strong>To describe the distribution of disease stages, receipt of major surgery, 1-year net survival (NS) and 1-year conditional NS in relation to age and frailty in adults aged ≥50 diagnosed with colon cancer in England.</p><p><strong>Methods: </strong>We obtained data on adults aged 50-99 diagnosed with colon cancer between 2014 and 2019, followed up through December 2021, from the national population-based COloRECTal cancer Repository. Frailty was assessed using the Secondary Care Administrative Records Frailty (SCARF) index categorised into fit, mild, moderate and severe frailty. Data on major resection were obtained through linkage with Hospital Episode Statistics dataset. Major resection rates were calculated in adults with stage I-III cancer. Descriptive statistics were used as appropriate. One-year NS from cancer diagnosis and 1-year conditional NS were estimated using the Pohar-Perme estimator.</p><p><strong>Results: </strong>Out of 130 360 individuals (48% females-50% over 75), 48.9% were fit, ranging from 69% in the 50-64 age group to 31% in the 85-99 age group. Over 80% of adults with stage I-III cancer underwent a major resection. This percentage was 58% amongst fit adults aged over 85. One-year NS decreased as age increased across all frailty levels. Differences in NS between the 50-64 age group and the 85-99 age group were reduced in adults who survived beyond 1 year from diagnosis except for severely frail adults.</p><p><strong>Conclusion: </strong>This population-based study shows that a non-negligible proportion of older adults diagnosed with colon cancer and deemed 'fit' through the SCARF did not receive surgery that may impact their survival.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the psychometric properties of PainChek in older general hospital patients with dementia.","authors":"Elizabeth L Sampson, Nathan Davies, Victoria Vickerstaff","doi":"10.1093/ageing/afaf027","DOIUrl":"10.1093/ageing/afaf027","url":null,"abstract":"<p><strong>Background: </strong>Pain is common in people with dementia in general hospitals. This can be difficult to identify.</p><p><strong>Objectives: </strong>To evaluate the psychometric properties of PainChek electronic pain assessment tool.</p><p><strong>Design: </strong>Cross-sectional psychometric study.</p><p><strong>Setting: </strong>Six medical care of older people wards from two general hospitals in greater London, UK.</p><p><strong>Subjects: </strong>63 people with clinical diagnosis of dementia: mean 84 years (SD 6.7), 59% female, 69% living in their own homes, 64% white British, 77% moderate/severe dementia.</p><p><strong>Method: </strong>Psychometric evaluation of PainChek, a point-of-care electronic pain assessment tool combining artificial intelligence, facial analysis and smartphone technology. From a total of 216 assessments, we tested PainChek's inter-rater reliability (IRR) (Cohen's kappa), internal consistency (Cronbach's alpha) and concurrent validity (Pearson's coefficient) between PainChek and Pain Assessment in Advanced Dementia (PAINAD) scores at rest and post-movement [95% confidence interval (95% CI) where appropriate]. We assessed convergent validity with Symptom Management-End of Life in Dementia scale (SM-EOLD) (Pearson's coefficient) and discriminant validity (rest vs post-movement).</p><p><strong>Results: </strong>IRR was 0.714 (95% CI 0.562 to 0.81) (rest) and 0.817 (95% CI 0.692 to 0.894) (post-movement). Internal consistency was 0.755 (rest) and 0.833 (post-movement). Concurrent validity with PAINAD was 0.528 (95% CI 0.317 to 0.690) (rest) and 0.787 (0.604 to 0.891) (post-movement). Convergent validity with SM-EOLD was -0.555 (95% CI -0.726 to -0.318) (rest) and -0.5644 (95% CI -0.733 to -0.331) (post-movement). Discriminant validity was significant.</p><p><strong>Conclusions: </strong>PainChek is a valid and reliable pain assessment tool for people with dementia in general hospitals. Further consideration will be needed for implementation into this setting.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating dementia-friendly travel: enhancing accessibility and inclusion.","authors":"Sara Solis-Lopez, Dafne Estefania Durón-Reyes, Raquel Gutiérrez-Zuñiga, Joaquin Migeot, Brian Lawlor, Roman Romero-Ortuno","doi":"10.1093/ageing/afaf016","DOIUrl":"10.1093/ageing/afaf016","url":null,"abstract":"<p><p>The growing participation of older adults in travel is reshaping this industry and highlighting the need for inclusive travel experiences, particularly for people living with dementia (PLwD). While travel provides substantial physical, psychological, cognitive and social benefits that promote active and healthy ageing, it also presents significant challenges. Although physical disabilities are generally proactively addressed, more \"hidden\" cognitive difficulties often remain unrecognised and unaddressed. These include navigating complex environments, making timely decisions and relying on working memory-tasks that are further challenged by dynamic settings such as airports, train stations and bus terminals. Although efforts to create dementia-friendly travel experiences are underway, their implementation across travel infrastructure remains inconsistent. There is still much to be done to ensure this activity is accessible and inclusive for this population, and there is a need to advocate for a comprehensive, person-centred approach to dementia-friendly travel environments, emphasising the integration of tailored assessments, innovative technologies and coordinated global policies.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078357","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":"Editor\"s view-Safety first: optimising treatment modalities.","authors":"Nathalie van der Velde","doi":"10.1093/ageing/afaf032","DOIUrl":"https://doi.org/10.1093/ageing/afaf032","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466736","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}