Age and ageing最新文献

{"title":"Change in frailty status in the 12 months following solid organ transplantation: a systematic review and meta-analysis.","authors":"Anna Bevan, Jenny Avery, Hoe Leong Cheah, Ben Carter, Jonathan Hewitt","doi":"10.1093/ageing/afae283","DOIUrl":"10.1093/ageing/afae283","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate if frailty status alters following solid organ transplantation (lung, liver, kidney and heart) without rehabilitation intervention.</p><p><strong>Research design and methods: </strong>Studies published between 1 January 2000 and 30 May 2023 were searched across five databases. Studies measuring frailty, using a validated or established frailty measure, pre- and post-transplant were included. Narrative synthesis was used to describe the included studies according to the time post-transplant and according to solid organ group. Where data allowed a meta-analysis was conducted to compare frailty prevalence pre- and 6-12 months post-transplant across studies.</p><p><strong>Results: </strong>Twelve studies were included in this review (6 kidney transplant, 2 liver transplant, 3 lung transplant and 1 heart transplant), with a total of 3065 transplant recipients with 62% being male. The mean age across studies was 51.35 years old. When narratively synthesised after an initial worsening of frailty immediately post-transplant, there appears to be a significant improvement in frailty by 3 months post-transplant that is sustained by 6 to 12 months following solid organ transplantation. Five studies were included in the meta-analysis which demonstrated an odds ratio = 0.27 (95% CI, 0.12, 0.59, P = .001, ${I}^2$ = 82%) for frailty prevalence post-solid organ transplantation (SOT) compared to frailty prevalence pre-SOT. When the single paper deemed to be of poor quality was removed the remaining four studies demonstrated a reduced odds ratio of being frail at 6-12 months post-transplant (OR 0.45 (95% CI, 0.32, 0.65, P = .001, ${I}^2$ = 13%).</p><p><strong>Conclusions: </strong>Transplant may be associated with a reversal in frailty, although heterogeneity was demonstrated across studies.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942780","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":"Systematic review and meta-analysis of the prevalence of frailty and pre-frailty amongst older hospital inpatients in low- and middle-income countries.","authors":"Sean Lawlor Davidson, Jim Lee, Luke Emmence, Emily Bickerstaff, George Rayers, Elizabeth Davidson, Jenny Richardson, Heather Anderson, Richard Walker, Catherine Dotchin","doi":"10.1093/ageing/afae279","DOIUrl":"https://doi.org/10.1093/ageing/afae279","url":null,"abstract":"<p><strong>Background: </strong>As populations age, low- and middle-income countries (LMICs) are rapidly adapting hospital services to meet the needs of older populations. This systematic review aimed to establish the prevalence of frailty and pre-frailty amongst older people admitted to hospital in LMICs, and to compare levels with existing estimates for high-income settings.</p><p><strong>Methods: </strong>Databases Medline, Embase, CINAHL and PsychInfo were searched, and results were manually screened by two researchers. Included studies were cross-sectional or cohort design and reported data from hospital inpatients, aged ≥60 years, in LMICs, using validated methods for identifying frailty. Risk of bias was assessed by two researchers using the Joanna Briggs Institute checklist. Where possible, results were synthesised using meta-analysis.</p><p><strong>Results: </strong>Twenty-nine studies were included, all reporting data from middle-income countries. Physical frailty tools were the most common, with Fried's phenotype and the FRAIL Scale being the most often used methods of assessment. The pooled estimate of the prevalence of frailty was 39.1% [95% confidence interval (CI) 31.9-46.6%] comprising data from 23 311 older inpatients. For pre-frailty, prevalence was 40.0% (95% CI 25.1-51.4%) from 6954 individuals.</p><p><strong>Discussion: </strong>Due to the paucity of eligible studies and their geographical distribution, these pooled estimates are only representative of the burden of frailty in select middle-income settings (particularly China). Future research should seek to establish the prevalence of frailty in hospitals in low-income countries, and to assess clinical outcomes by frailty status, in order to develop bespoke clinical tools and to aid the planning of future geriatric services.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930560","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-clustering of multiple problems in individual patients.","authors":"Roy L Soiza","doi":"10.1093/ageing/afaf012","DOIUrl":"https://doi.org/10.1093/ageing/afaf012","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035812","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":"Behavioural and psychological symptoms of people with dementia in acute hospital settings: a systematic review and meta-analysis.","authors":"Kanthee Anantapong, Aimorn Jiraphan, Warut Aunjitsakul, Katti Sathaporn, Nisan Werachattawan, Teerapat Teetharatkul, Pakawat Wiwattanaworaset, Nathan Davies, Elizabeth L Sampson","doi":"10.1093/ageing/afaf013","DOIUrl":"10.1093/ageing/afaf013","url":null,"abstract":"<p><strong>Background: </strong>Behavioural and psychological symptoms of dementia (BPSD) can complicate acute hospital care, but evidence on BPSD in this setting is heterogeneous.</p><p><strong>Objective: </strong>To determine the prevalence of BPSD in acute hospitals and explore related risk factors, treatments, and outcomes (PROSPERO: CRD42023406294).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis by searching Cochrane Library, MEDLINE, and PsycINFO for studies on BPSD prevalence among older people with dementia during their acute hospital admissions (up to 5 March 2024). Independent double-review processes were used for study screening, selection, and data extraction. Data on 12 BPSD symptoms were extracted based on the Neuropsychiatric Inventory Questionnaire (NPI) and Behavioural Pathology in Alzheimer's Disease (BEHAVE-ad). Risk factors, treatments, and outcomes were summarised. Meta-analysis was used to synthesise results.</p><p><strong>Results: </strong>Out of 15 101 records, 30 articles from 23 studies were included. Most studies were rated as moderate (n = 12) to poor (n = 17) quality. Meta-analysis revealed a pooled prevalence of overall BPSD (one or more BPSD symptoms) at 60% (95% CI = 43-78%) among older inpatients with dementia in acute hospitals (N = 11 studies). Subgroup analysis showed variations in the overall BPSD prevalence based on assessment tools (BEHAVE-ad = 85%, NPI = 74%, Others = 40%). Common BPSD symptoms included aggression/agitation (39%), sleep problems (38%), eating problems (36%), and irritability (32%). BPSD were linked to delirium, pain, increased use of uncomfortable interventions, psychotropic medication uses and higher caregiver distress. Poor patient-staff interactions and fragmented discharge plans often led to frequent emergency admissions and hospital readmissions.</p><p><strong>Conclusion: </strong>Healthcare systems should implement tailored approaches for managing BPSD in acute hospitals, enhance staff training, improve caregiver communication, and develop integrated discharge plans.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063293","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":"Why is implementing remote monitoring in virtual wards (Hospital at Home) for people living with frailty so hard? Qualitative interview study.","authors":"Rosie Kate Lindsay, Paige Cunnington, Mary Dixon-Woods","doi":"10.1093/ageing/afaf003","DOIUrl":"10.1093/ageing/afaf003","url":null,"abstract":"<p><strong>Background: </strong>There is relatively low uptake of remote monitoring on frailty virtual wards (Hospital at Home) compared to virtual wards caring for people with other medical conditions. However, reasons for low uptake are poorly understood.</p><p><strong>Objectives: </strong>To explore the views and experiences of frailty virtual wards stakeholders involved in implementing remote monitoring.</p><p><strong>Methods: </strong>We conducted qualitative interviews with 42 stakeholders involved in delivery, design or evaluation of frailty virtual wards based in the UK. Analysis was based on the constant comparative method.</p><p><strong>Results: </strong>Many participants perceived that remote monitoring was only useful for a small sub-group of patients with frailty for a range of medical, practical and social reasons. Remote monitoring required new ways of working from patients, staff and carers. The nature of this work was not always sufficiently well understood, designed or supported. Procurement practices were also seen to be misaligned with service needs, resulting in provision of equipment that was not fit for purpose. A further challenge in implementing remote monitoring in frailty virtual wards lay in tensions between national-level standardisation and enabling local flexibility.</p><p><strong>Conclusions: </strong>Implementing remote monitoring in frailty virtual wards is challenged by lack of consensus on its suitability for this population, the extent and nature of change in clinical practices and work systems design required, and issues relating to equipment and standardisation. More co-design effort is needed to inform decision-making on remote monitoring for those with frailty.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998684","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":"Early detection and management of hearing loss to reduce dementia risk in older adults with mild cognitive impairment: findings from the treating auditory impairment and cognition trial (TACT).","authors":"Ruan-Ching Yu, Menelaos Pavlou, Anne G M Schilder, Doris-Eva Bamiou, Glyn Lewis, Frank Robert Lin, Gill Livingston, Danielle Proctor, Rumana Omar, Sergi G Costafreda","doi":"10.1093/ageing/afaf004","DOIUrl":"10.1093/ageing/afaf004","url":null,"abstract":"<p><strong>Background: </strong>Age-related hearing loss and mild cognitive impairment (MCI) independently increase dementia risk. The Ageing and Cognitive Health Evaluation in Elders randomised controlled trial (RCT) found hearing aids reduce cognitive decline in high-risk older adults with poor hearing.</p><p><strong>Methods: </strong>This pilot RCT in London memory clinics randomised people with MCI (aged ≥55, untreated hearing loss defined as Pure Tone Average 0.5-4 KHz between 25-70 dB) into two groups. The intervention group received 4 sessions of hearing aid fitting and support. The control group received healthy ageing education and a GP letter recommending audiological referral. Both were followed for 6 months. Primary outcomes were recruitment (feasibility target: 50%; 95% CI: 39%-61%) and retention (feasibility target: 80%; 95% CI: 71%-89%); intervention completion (≥2 visits) and hearing aid use (acceptability target: 80%; 95% CI: 71%-89%) for the intervention group and 50% difference between arms (95% CI: 31%-69%). Secondary outcomes included hearing aid fitting, cognition and other measures.</p><p><strong>Results: </strong>From October 2018 to March 2020, 58 participants were recruited (29 per group, 95% [86%-99%]). Twenty-four participants were fitted with hearing aids in the intervention arm, and 6 in the control arm (difference: 62% [42%-82%]). At 6 months, retention was 81% [69%-90%]. Hearing intervention completion (≥2 visits) was achieved by 24 (83%). Daily hearing aid use was reported by 18 (75%) intervention versus 5 (22%) control participants, a difference of 53% [29%-77%].</p><p><strong>Conclusion: </strong>Randomisation of people with MCI to a personalised hearing intervention versus control is feasible. These findings support proceeding to a fully-powered multicentre RCT.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998678","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":"Improving care in elderly neurosurgery initiative guideline on management of chronic subdural haematoma in older people-relevance for the geriatrician.","authors":"Frances Rickard, Anthony Cox, Adam Willliams, Alex Mortimer, Crispin Wigfield, David Shipway","doi":"10.1093/ageing/afae280","DOIUrl":"https://doi.org/10.1093/ageing/afae280","url":null,"abstract":"<p><p>Chronic subdural haematoma (cSDH) is a common subtype of traumatic brain injury, typically affecting older people living with frailty and multimorbidity. Until now, no published guideline has existed internationally to guide management, perhaps explaining why the care of the older cSDH patient varies between neurosurgical centres. The Improving Care in Elderly Neurosurgery Initiative guideline is the first guideline dedicated to the care of patients with cSDH across the entire patient pathway, from initial presentation through to rehabilitation and discharge after surgery. It includes specific recommendations for those patients not requiring surgery who, in the UK, are mostly managed in satellite hospitals away from the tertiary neurosurgical centre. It therefore has relevance to clinicians across the entire UK and also potentially to a broader international audience. In this guideline commentary we summarise the key points for geriatricians and those allied specialties such as acute medicine who deliver care to a large proportion of patients with cSDH. We discuss issues and limitations relating to guideline development, in particular in the rapidly evolving field of Middle Meningeal Artery Embolisation. We also comment on factors which may influence guideline implementation and future service development. Finally we call for some form of national registry in older people sustaining SDH, which may need to be supported by financial incentives to drive investment in services for this historically neglected patient group.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063301","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":"Immune-related adverse events in older adults receiving immune checkpoint inhibitors: a comprehensive analysis of the Food and Drug Administration Adverse Event Reporting System.","authors":"Buğra Han Esen, Sevval Nur Bektas, Umur Topcu, Bahadır Köylü, Fadime Buket Bayram Kuvvet, Gulistan Bahat, Fatih Selçukbiricik","doi":"10.1093/ageing/afaf008","DOIUrl":"10.1093/ageing/afaf008","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy, yet they carry a unique spectrum of immune-related adverse events (irAEs). Given the ageing global population and the underrepresentation of older adults in clinical trials for ICIs, we investigated the occurrence and characteristics of irAEs in older versus younger adults as well as among different age subsets within the older adult population.</p><p><strong>Methods: </strong>We analysed the U.S. Food and Drug Administration Adverse Event Reporting System database reports from 2015 to 2023, focusing on ICIs. We categorised irAEs into 11 distinct types and performed descriptive and multivariate analyses to compare the prevalence and clinical characteristics of irAEs across different age groups, adjusting for potential confounding factors.</p><p><strong>Results: </strong>Among 47 513 patients aged 18-100 reporting irAEs, the 65-74 and 75-84 age groups had significantly increased risks compared to 18-64 (OR 1.13, 95% CI [1.09-1.18]; 1.15 [1.1-1.21]). Cardiovascular irAEs rose with age, peaking at 75-84, while endocrine irAEs decreased. Hepatobiliary, gastrointestinal and ocular irAEs decreased with age, but renal and musculoskeletal irAEs increased, showing higher risks in older adults. Serious outcomes slightly decreased in the 85+ group, while the proportion of deaths increased with age.</p><p><strong>Conclusion: </strong>We discuss the potential changes in the immune system contributing to the decreased prevalence of irAEs in the oldest age group. Additionally, conservative treatment approaches and underreporting of irAEs in older patients may influence these findings. Our findings highlight the need for personalised decision-making for ICI therapies, considering performance status and comorbidities rather than age alone.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063297","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":"Piloting a minimum data set for older people living in care homes in England: a developmental study.","authors":"Adam L Gordon, Stacey Rand, Elizabeth Crellin, Stephen Allan, Freya Tracey, Kaat De Corte, Therese Lloyd, Richard Brine, Rachael E Carroll, Ann-Marie Towers, Jennifer Kirsty Burton, Gizdem Akdur, Barbara Hanratty, Lucy Webster, Sinead Palmer, Liz Jones, Julienne Meyer, Karen Spilsbury, Anne Killett, Arne T Wolters, Guy Peryer, Claire Goodman","doi":"10.1093/ageing/afaf001","DOIUrl":"10.1093/ageing/afaf001","url":null,"abstract":"<p><strong>Background: </strong>We developed a prototype minimum data set (MDS) for English care homes, assessing feasibility of extracting data directly from digital care records (DCRs) with linkage to health and social care data.</p><p><strong>Methods: </strong>Through stakeholder development workshops, literature reviews, surveys and public consultation, we developed an aspirational MDS. We identified ways to extract this from existing sources, including DCRs and routine health and social care datasets. To address gaps, we added validated measures of delirium, cognitive impairment, functional independence and quality of life to DCR software. Following routine health and social care data linkage to DCRs, we compared variables recorded across multiple data sources, using a hierarchical approach to reduce missingness where appropriate. We reported proportions of missingness, mean and standard deviation (SD) or frequencies (%) for all variables.</p><p><strong>Results: </strong>We recruited 996 residents from 45 care homes in three English Integrated Care Systems. 727 residents had data included in the MDS. Additional data were well completed (<35% missingness at wave 1). Competition for staff time, staff attrition and software-related implementation issues contributed to missing DCR data. Following data linkage and combining variables where appropriate, missingness was reduced (≤4% where applicable).</p><p><strong>Discussion: </strong>Integration of health and social care is predicated on access to data and interoperability. Despite governance challenges we safely linked care home DCRs to statutory health and social care datasets to create a viable prototype MDS for English care homes. We identified issues around data quality, governance, data plurality and data completion essential to MDS implementation going forward.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982439","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":"Falls risk stratification. One size doesn't fit all.","authors":"Manuel Montero-Odasso, Nathalie van der Velde, Jesper Ryg, Tahir Masud","doi":"10.1093/ageing/afae292","DOIUrl":"https://doi.org/10.1093/ageing/afae292","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969505","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}