Age and ageing最新文献

{"title":"Editor's view-delirium around the world.","authors":"Roy L Soiza","doi":"10.1093/ageing/afae275","DOIUrl":"https://doi.org/10.1093/ageing/afae275","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":"142851957","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":"From burden to benefits: new promises of glucose-lowering treatments in older adults.","authors":"Antoine Christiaens","doi":"10.1093/ageing/afae265","DOIUrl":"https://doi.org/10.1093/ageing/afae265","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":"142827042","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":"Associations of hearing and visual loss with cognitive decline and dementia risk: a 25-year follow-up of the Maastricht Aging Study.","authors":"Lion M Soons, Kay Deckers, Huibert Tange, Martin P J van Boxtel, Sebastian Köhler","doi":"10.1093/ageing/afae271","DOIUrl":"https://doi.org/10.1093/ageing/afae271","url":null,"abstract":"<p><strong>Background: </strong>Hearing loss (HL) and visual loss (VL) are recently identified as promising dementia risk factors, but long-term studies with adequate control of other modifiable dementia risk factors are lacking. This 25-year follow-up study investigated the association between objectively measured HL and VL with cognitive decline and incident dementia.</p><p><strong>Methods: </strong>1823 participants (age 24-82 years) of the Maastricht Aging Study were assessed at baseline, 6, 12 and 25 years. Baseline HL was defined as pure-tone hearing loss ≥20 dB at frequencies of 1, 2 and 4 kHz and VL as binocular, corrected visual acuity <0.5. Associations with cognitive decline (verbal memory, information processing speed, executive function) and incident dementia were tested using linear mixed models and Cox proportional hazard models, respectively. Analyses were adjusted for demographics and 11 modifiable dementia risk factors (LIfestyle for BRAin health index).</p><p><strong>Results: </strong>Participants with HL (n = 520, 28.7%) showed faster decline in all cognitive domains than participants without HL. No consistent association was found for VL (n = 58, 3.2%), but below-average visual acuity (<1) showed significant associations with information processing speed and executive function. No significant associations with dementia risk were found. Findings were independent of demographics and modifiable dementia risk factors.</p><p><strong>Conclusions: </strong>HL predicts faster cognitive decline but not dementia risk in adults aged 24-82 years. VL shows no consistent associations, though below-average visual acuity is linked to faster cognitive decline. This study supports HL as an independent risk factor for cognitive decline. Future studies should further evaluate the roles of HL and VL in dementia risk reduction.</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":"142845534","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":"Functional dependency and cardiometabolic multimorbidity in older people: pooled analysis of individual-level data from 20 countries.","authors":"Anying Bai, Qiushi Chen, Pascal Geldsetzer, Muir Gray, Zhilan Xie, Daqian Zhang, Till Baernighausen, Yixin Hu, Yu Jiang, Simiao Chen","doi":"10.1093/ageing/afae269","DOIUrl":"https://doi.org/10.1093/ageing/afae269","url":null,"abstract":"<p><strong>Background: </strong>The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored.</p><p><strong>Design: </strong>A multicohort study pooled data from three international cohorts.</p><p><strong>Setting: </strong>Data were sourced from the Health and Retirement Study (USA), the China Health and Retirement Longitudinal Study (China) and the Survey of Health, Ageing and Retirement in 18 European countries.</p><p><strong>Methods: </strong>FD was defined as the inability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs) independently. CMM was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease and stroke. Generalised estimating equation models assessed associations between FD and CMM, with mediation analysis using the Karlson, Holm and Breen method to explore the effects of hypertension and depressive symptoms. Sensitivity analyses ensured robustness.</p><p><strong>Results: </strong>The final cohort included 157 512 and 190 249 individuals for ADL and IADL analyses, respectively. CMM prevalence was 18.97% and 16.65% in these groups. FD was consistently associated with higher CMM risk, with odds ratios ranging from 1.47 (95% confidence interval: 1.33-1.63) to 1.56 (1.42-1.73). Hypertension and depressive symptoms increased CMM risk, particularly at higher FD levels. Mediation analysis showed hypertension and depressive symptoms accounted for 8.01%-16.43% and 12.04%-18.36% of the adverse effect of FD on CMM, respectively, with more pronounced effects among smokers and heavy drinkers.</p><p><strong>Conclusions: </strong>Targeted interventions focusing on hypertension, mental wellness, lifestyle factors, and integrated treatments for FD are crucial to prevent CMM in older adults.</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":"142833530","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":"A scoping review of the measurement and analysis of frailty in randomised controlled trials","authors":"Yanhe Sun, Miles D Witham, Andy Clegg, Rod S Taylor, Grace Dibben, David McAllister, Peter Hanlon","doi":"10.1093/ageing/afae258","DOIUrl":"https://doi.org/10.1093/ageing/afae258","url":null,"abstract":"Background Frailty is of increasing interest in trials, either as a target of intervention, as an outcome or as a potential treatment modifier. However, frailty measurement is often highly variable. This scoping review assessed how frailty is quantified in randomised controlled trials (RCTs), in what context and for what purposes. Methods We searched five electronic databases for RCTs in which frailty was measured among trial participants. We extracted data on intervention type, the frailty measure used and the purpose for which frailty was assessed. We then compared these data according to reasons for frailty assessment. Results We identified 415 RCTs assessing frailty across a range of interventions. Frailty was used to define the target population (166 trials), as an outcome (156 trials), as an effect modifier examining interaction of frailty on treatment effect (61 trials), as a purely descriptive characteristic (42 trials) or as a prognostic marker examining the impact of frailty on future health outcome (78 trials). The trials used 28 different measures of frailty (plus 29 additional trial-specific measures). The frailty phenotype model was the most common overall (164 trials), for defining the target population (90/166 trials) and as an outcome (81/156 trials). The cumulative deficit model frailty index was also frequently used (102 trials) and was most common among trials assessing treatment effect modification (21/61 trials). Conclusion Frailty measurement in RCTs is highly variable. Understanding the properties of respective frailty measures and how these relate to frailty as encountered in clinical practice is a priority to ensure that trial findings can inform healthcare delivery for people living with frailty.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"66 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684430","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 effect of multidomain lifestyle intervention on health care service use and costs - secondary analyses from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): a randomised controlled trial","authors":"Maria Sääskilahti, Jenni Kulmala, Markku Nurhonen, Jenni Lehtisalo, Markku Peltonen, Francesca Mangialasche, Tiina Laatikainen, Timo Strandberg, Riitta Antikainen, Jaakko Tuomilehto, Hilkka Soininen, Miia Kivipelto, Tiia Ngandu","doi":"10.1093/ageing/afae249","DOIUrl":"https://doi.org/10.1093/ageing/afae249","url":null,"abstract":"Background The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown. Objective This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated. Methods Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60–77 years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used. Results There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54–1.00) and emergency services (RR 0.83, 95% CI 0.70–0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68–0.99). Conclusions The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"12 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690536","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 of guideline recommendations for older and frail adults with type 2 diabetes mellitus","authors":"Jennifer Bolt, Valeria Carvalho, Kristine Lin, Sung Ju Lee, Colleen Inglis","doi":"10.1093/ageing/afae259","DOIUrl":"https://doi.org/10.1093/ageing/afae259","url":null,"abstract":"Background The application of clinical practice guidelines (CPGs) across the spectrum of individuals living with diabetes can be challenging, particularly in older adults, where factors such as frailty and multimorbidity exacerbate the complexity of management. Objective This systematic review aimed to explore the guidance provided within diabetes CPGs for management of individuals who are older and/or frail, including recommendations for haemoglobin A1C (HbA1c) target and pharmacotherapeutic management. Methods A systematic search was completed in Medline and Embase to identify national or international type 2 diabetes CPGs published in the last 10 years. Data extracted included recommendations for HbA1c targets and pharmacotherapy in older and frail adults, frailty screening and deprescribing. Quality of included CPGs was appraised with the AGREE II tool. Results Twenty-three CPGs were included, within which older adults and frailty were discussed in 21 and 14 CPGs, respectively. Specific HbA1c targets for older and/or frail adults were provided by 15 CPGs, the majority of which suggested a strict target (&amp;lt;7.0%–7.5%) in healthier older adults and a more relaxed target (&amp;lt;8.0%–8.5%) in those who are frail or medically complex. Ten CPGs provided recommendations for insulin therapy and 16 provided recommendations for non-insulin antihyperglycaemic agents that were specific to older and/or frail populations, which primarily focused on minimising risk of hypoglycaemia. Conclusion Most diabetes CPGs recommend strict HbA1c targets in healthier older adults, with more relaxed targets in those living with frailty or medical complexity. However, significant variability exists in pharmacotherapy recommendations and there were proportionately less recommendations for individuals who are frail.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"61 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684429","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":"Menopause age and type and dementia risk: a pooled analysis of 233 802 women","authors":"Annette J Dobson, Zhiwei XU, Louise F Wilson, Hsin-Fang Chung, Sven Sandin, Yvonne T Van der Schouw, Panayotes Demakakos, Elisabete Weiderpass, Gita D Mishra","doi":"10.1093/ageing/afae254","DOIUrl":"https://doi.org/10.1093/ageing/afae254","url":null,"abstract":"Objectives It is not clear whether the association between younger age at menopause and increased risk of dementia is modified by type of menopause. We examined the association of age at menopause or hysterectomy with dementia risk in three groups of women: those with natural menopause, premenopausal bilateral oophorectomy (surgical menopause) or premenopausal hysterectomy (without bilateral oophorectomy). Study design Individual-level data from 233 802 women in five prospective cohort studies (from four countries) were harmonized and pooled. Cox proportional hazards models were used to assess the associations of age at natural menopause, surgical menopause or premenopausal hysterectomy, with age at dementia, death (where available) or end of follow-up, whichever came first. Results The study followed women to the median age of 72 years (quartiles 67, 76 years). The median follow-up time was 13 years, with 3262 dementia cases during this period. Compared with women with menopause at 50–52 years, women with menopause &amp;lt;40 years had a higher risk of dementia (adjusted hazard ratio (aHR): 1.47, 95% confidence interval (CI): 1.39, 1.56). This level of risk was comparable to that of current smoking and stroke, which are well-established risk factors for dementia. Increased risk of dementia associated with surgical menopause or premenopausal hysterectomy (compared to natural menopause) was not apparent after adjustment for age at menopause (aHR 0.99, 95% CI: 0.93, 1.04 and aHR 0.97, 95% CI: 0.95, 1.00, respectively). Conclusion Women who experience menopause before the age of 40 years have a higher risk of dementia irrespective of type of menopause.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672952","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":"Equality of opportunity for timely dementia diagnosis (EQUATED): a qualitative study of how people from minoritised ethnic groups experience the early symptoms of dementia and seek help","authors":"Christine Carter, Moïse Roche, Elenyd Whitfield, Jessica Budgett, Sarah Morgan-Trimmer, Sedigheh Zabihi, Yvonne Birks, Fiona Walter, Mark Wilberforce, Jessica Jiang, Refah Ahmed, Wesley Dowridge, Charles R Marshall, Claudia Cooper","doi":"10.1093/ageing/afae244","DOIUrl":"https://doi.org/10.1093/ageing/afae244","url":null,"abstract":"Introduction People from minoritised ethnic groups are diagnosed with dementia later in the disease. We explored pathways that may determine the timing of diagnoses in a UK ethnically diverse, urban area. Methods We conducted 61 semi-structured interviews: 10 community-dwelling older people from minoritised ethnic backgrounds with diagnosed and undiagnosed dementia (mean age = 72 years; males = 5/10), 30 family members (51; 10/30), 16 health or social care professionals (42; 3/15), 3 paid carers and 2 interpreters for people with dementia. We used reflexive thematic analysis and the Model of Pathways to Treatment to consider diagnostic delay. Findings We identified three themes: (1) Cultural identity and practices shape responses: gendered expectations that families relieve elders of household roles reduce awareness or concern when functioning declines; expectations that religious practices are maintained mean problems doing so triggers help-seeking. Second-generation family members often held insider and outsider identities, balancing traditional and Western perspectives. (2) Becoming like a tourist: daily experiences became unfamiliar for people developing dementia in an adopted country, sometimes engendering a need to reconnect with a home country. For professionals and interpreters, translating meanings faithfully, and balancing relatives’ and clients’ voices, were challenging. (3) Naming and conceptualising dementia: the term dementia was stigmatised, with cultural nuances in how it was understood; initial presentations often included physical symptoms with cognitive concerns. Conclusion Greater understanding of dilemmas faced by minoritised ethnic communities, closer collaboration with interpreters and workforce diversity could reduce time from symptom appraisal to diagnosis, and support culturally competent diagnostic assessments.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"87 4 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672953","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 discontinuation of implantable cardioverter defibrillator shock therapies towards the end of life: consensus guideline from the British Heart Rhythm Society","authors":"Honey Thomas, Amy Dutton, Miriam J Johnson, Heather Herbert, Jane Wallace, Paul Foley","doi":"10.1093/ageing/afae246","DOIUrl":"https://doi.org/10.1093/ageing/afae246","url":null,"abstract":"Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis. Frequently, they will be cared for by non-cardiac teams who may be less familiar with ICDs. Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD. If the ICD shock therapy is not discontinued, there is an increased risk that, as a person reaches the last days of life, the ICD may deliver multiple, painful shocks that are distressing. There is also a risk that the device may delay the person’s natural death, which the person would not have chosen if they had been given the opportunity to discuss discontinuation. The British Heart Rhythm Society has developed a practical guideline to support all healthcare professionals who are caring for patients who have an ICD. This includes descriptions of different device types, ethical and legal aspects, timing and nature of ICD discussions and practical advice regarding how the devices may be deactivated. It aims to promote awareness and timely discussion between professionals and patients and to encourage best practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"44 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610405","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}