Age and ageing最新文献

{"title":"Sativex (nabiximols) for the treatment of Agitation & Aggression in Alzheimer’s dementia in UK nursing homes: a randomised, double-blind, placebo-controlled feasibility trial","authors":"Christopher P Albertyn, Ta-Wei Guu, Petrina Chu, Byron Creese, Allan Young, Latha Velayudhan, Sagnik Bhattacharyya, Hassan Jafari, Simrat Kaur, Pooja Kandangwa, Ben Carter, Dag Aarsland","doi":"10.1093/ageing/afaf149","DOIUrl":"https://doi.org/10.1093/ageing/afaf149","url":null,"abstract":"Background Alzheimer’s Disease (ad) patients often experience clinically significant agitation, leading to distress, increased healthcare costs and earlier institutionalisation. Current treatments have limited efficacy and significant side effects. Cannabinoid-based therapies, such as the nabiximols oral spray (Sativex®; 1:1 delta-9-tetrahydrocannabinol and cannabidiol), offer potential alternatives. We aimed to explore the feasibility and safety of nabiximols as a potential treatment for agitation in ad. Methods The ‘Sativex® for Agitation & Aggression in Alzheimer’s Dementia’ (STAND) trial was a randomised, double-blind, placebo-controlled, feasibility study conducted in UK care homes. Participants with probable ad and predefined clinically significant agitation were randomised to receive placebo or nabiximols for 4 weeks on an up-titrated schedule, followed by a 4-week observation period. To be considered feasible, we prespecified the following thresholds that needed to be met: randomising 60 participants within 12 months, achieving a ≥ 75% follow-up rate at 4 weeks, maintaining ≥80% adherence to allocation and estimating a minimum effect size (Cohen’s d ≥ 0.3) on the Cohen–Mansfield Agitation Inventory. This trial is registered with ISRCTN 7163562. Findings Between October 2021 and June 2022, 53 candidates were assessed; 29 met eligibility criteria and were randomised. No participants withdrew, and adherence was high (100%) and was generally feasible to deliver. The intervention was well tolerated (0 adverse reactions), with no safety concerns reported. Interpretation Despite significant COVID-19 pandemic related challenges, administering nabiximols through oral mucosa to advanced ad patients with agitation demonstrated feasibility and safety. These findings support a larger confirmatory efficacy trial to evaluate the potential therapeutic efficacy of nabiximols for agitation in ad.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"21 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236983","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":"Epidemiology of falls in community-dwelling older adults in Europe: a systematic review and meta-analysis","authors":"Ellis Rommers, Robby De Pauw, Mirko Petrovic, Dirk Cambier","doi":"10.1093/ageing/afaf157","DOIUrl":"https://doi.org/10.1093/ageing/afaf157","url":null,"abstract":"Objectives Falls have long been recognised as a frequent problem among older adults and have been cited in literature since the 1950s. Given extensive research on risk factors, prevention, and implementation strategies, one might expect a decline in fallers prevalence. The aim of this review is to explore the epidemiology of falls in Europe, focusing on healthy, community-dwelling individuals aged 65 years or older. Methods Articles for this systematic review and meta-analysis were sourced from PubMed and Web of Science in June 2023, with screening completed by August 2023 and an update in January 2024. Risk of bias assessment used the Standard quality assessment criteria and potential outliers were identified. Publication bias was assessed using Egger’s regression test. Data analysis was performed in R. Results Thirty-eight articles were included, comprising a sample of 71 245 European, community-dwelling older adults. The average fallers prevalence among European older adults was 30% (95% CI 0.26–0.34). Meta-regression analysis showed no significant change in fallers prevalence over the years (P = .66), in contrast with meta-regression for average age (P < .01). In the subgroup analysis, differences in fallers prevalence were seen for gender (P < .01), country (P < .01), and length of follow-up (P = .02). Conclusion Despite decades of evidence supporting effective fall prevention, there is no significant change in the prevalence of fallers among community-dwelling older adults in Europe. Future research should focus on systematically identifying the factors contributing to the persistent fall rates. Additionally, efforts must be made to ensure effective implementation of existing knowledge on fall prevention.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"41 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236985","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":"Detection of early Parkinson’s disease using 5-hydroxymethylcytosine episignatures in blood DNA","authors":"Jian-Yong Wang, Ya-Dan Song, Dao-Lu Zhang, Lei Cui, Qing Guo, Xue-Fei Fan, Bei-Lei Hu, Jie Deng, Hong-Mei Wu, Xiong Zhang, Jian-Hong Zhu","doi":"10.1093/ageing/afaf147","DOIUrl":"https://doi.org/10.1093/ageing/afaf147","url":null,"abstract":"Background Parkinson’s disease (PD) is a common neurodegenerative disorder. However, alterations in the blood hydroxymethylome and the potential of 5-hydroxymethylcytosine episignatures as diagnostic biomarkers for PD remain unclear. Methods We employed APOBEC-coupled epigenetic sequencing (ACE-seq) in a two-phase study design. In the first step, we performed single-base resolution profiling of the hydroxymethylome in a small cohort of drug-naïve PD patients and matched controls. Differentially hydroxymethylated regions (DhmRs) were identified and selected for validation. In the second step, these regions were re-sequenced in a larger cohort to develop and evaluate a diagnostic model. Results Initial genome-wide screening identified 16 candidate DhmRs. Although models based solely on these regions yielded modest diagnostic performance, an alternative analysis focusing on differentially hydroxymethylated cytosines within the 16 regions led to a diagnostic panel with robust performance, particularly for early PD detection. Retrospective analyses further confirmed the panel’s ability to distinguish early PD patients from controls. Conclusions Our study provides the first evidence that blood-based hydroxymethylome profiles are promising biomarkers for the early diagnosis of PD.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"5 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228507","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":"Subjective geriatric complaints as predictors of disability and mortality in community-dwelling older adults: a 5-year cohort study","authors":"Hajime Takechi, Akira Tsuzuki, Hiroshi Yoshino, Takenori Okumura, Yoshikiyo Kanada","doi":"10.1093/ageing/afaf152","DOIUrl":"https://doi.org/10.1093/ageing/afaf152","url":null,"abstract":"Background Various health-related concerns experienced daily by older adults, designated here as subjective geriatric complaints (SGCs), and are suspected to be early signs of the decline in quality of life (QOL). This study aims to test the hypothesis that SGCs are significant predictors of future disability and mortality among older adults. Methods This prospective cohort study was conducted in Japan. A health-related questionnaire was mailed to community-dwelling older adults, and data on the certification of long-term care needs and mortality that occurred over the subsequent 5 years were analysed. The analysis included 10 199 individuals. Thirteen SGCs were classified into six groups. The primary outcome was a composite end point of disability and mortality. Survival time analysis was conducted using Kaplan–Meier analysis and Cox proportional hazard regression models. Results The mean age (standard deviation) of participants (52.4% female) at baseline was 73.7 (6.0) years. Over the 5-year study period, 1793 participants (17.6%) were newly certified as requiring long-term care and 931 (9.1%) died. After adjusting for age, sex, depressive mood, and presence of multimorbidity, the hazard ratios (95% confidence intervals) for SGC 1b (circulatory/respiratory complaints) and SGC 3 (neurological complaints) were 1.558 (1.316–1.884, P < 0.001) and 1.355 (1.14–1.61, P = 0.001), respectively. Conclusion These findings suggest that SGCs are independent risk factors for a decline in QOL. Additionally, risk varied across different symptom groups within SGCs. These differences should be carefully considered in the management of health for older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"2017 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228506","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":"Glymphatic function associates with Alzheimer’s disease—signature region volumes, plasma biomarkers and white matter hyperintensity progression in cognitively unimpaired older adults","authors":"Qian Chen, Danni Ge, Xinru Xu, Futao Chen, Shunshun Du, Yijun Bai, Dongming Liu, Yan Lei, Yajing Zhu, Cong Long, Jiaming Lu, Pin Lv, Xin Zhang, Bing Zhang","doi":"10.1093/ageing/afaf141","DOIUrl":"https://doi.org/10.1093/ageing/afaf141","url":null,"abstract":"Background Brain glymphatic system is thought to play a critical role in the pathogenesis of Alzheimer’s disease (AD). Objective To investigate the relationships between glymphatic function and AD-signature region volumes, plasma biomarkers and disease progression in cognitively unimpaired older adults. Methods Two datasets comprising a total of 229 cognitively unimpaired older adults were enrolled. Brain glymphatic function was assessed using diffusion tensor imaging along the perivascular space (DTI-ALPS). The associations between the DTI-ALPS index and volumes in AD-signature regions, including the basal forebrain, entorhinal cortex and hippocampus, were evaluated, along with white matter hyperintensity (WMH) volumes. In dataset 1 with plasma biomarkers, the mediation effects of DTI-ALPS index on plasma biomarkers and cognition were examined. In dataset 2 with follow-up data, the baseline DTI-ALPS index was correlated with the annual percent change in volumes of AD-signature regions and WMH. Results The DTI-ALPS index showed positive correlations with volumes in the basal forebrain, entorhinal cortex and hippocampus, and negative correlations with WMH volumes in both datasets. The DTI-ALPS index negatively associated with plasma phosphorylated tau (ptau) and mediated the relationship between ptau and cognition. The baseline DTI-ALPS index was negatively associated with WMH progression at follow-up. Conclusion Worse glymphatic system function indicates decreased AD-signature region volumes, severe WMH lesions, elevated plasma ptau, and accelerated WMH progression before the occurrence of objective cognitive impairment. Therapeutic methods targeting the glymphatic system may prevent cognitive decline through the clearance of AD pathological proteins and the deceleration of WMH lesions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"136 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201945","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":"Access to communication support for community-dwelling people with dementia: A mixed methods study exploring local perspectives within the United Kingdom context","authors":"Anna Hockley, Deborah Moll, Jemima Littlejohns, Zoe Collett, Catherine Henshall","doi":"10.1093/ageing/afaf150","DOIUrl":"https://doi.org/10.1093/ageing/afaf150","url":null,"abstract":"Introduction Communication difficulties occur in all dementia subtypes. This can affect individuals’ identity, relationships, and quality-of-life of people with dementia and their relatives. Professional guidelines recommend access to communication intervention, for example through speech and language therapy (SLT) services, but anecdotal evidence suggests that the type and availability of this provision varies. Aims This study aimed to explore the communication needs of people with dementia, their quality-of-life impact, and local and national service provision. Methods This mixed-methods study comprised three phases: Data was analysed using descriptive statistics and thematic analysis. Results Four main themes were identified: dementia-related communication changes; accessing support for communication; identifying communication strategies; and service considerations. The survey identified inconsistent or absent communication input for many people with dementia. Interview and focus group findings highlighted diverse dementia-related communication needs which impacted quality-of-life and support required. Participants suggested service-level considerations for addressing these needs. Conclusion Dementia-related communication impairments are diverse and can considerably impact quality-of-life of people with dementia and their relatives. Communication intervention service-provision varies widely, resulting in unmet needs. These findings add to the growing evidence-base on dementia-related communication difficulties, and highlight a need to develop clinical services.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"176 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201939","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 in older adults admitted to hospital: a six-year dual-centre retrospective study of over 53 000 clinical frailty scale assessments","authors":"Emma Walker, Rebecca Winter, Luke Eliot Hodgson","doi":"10.1093/ageing/afaf137","DOIUrl":"https://doi.org/10.1093/ageing/afaf137","url":null,"abstract":"Aim To examine frailty assessments in older patients admitted to hospital, and explore associations with sex, admission and discharge status. Methodology Worldwide, the prevalence of frailty is increasing. Stratifying frailty can be beneficial at a population level to improve public health and target local services. At an individual level, recognition of frailty can help inform prognosis and advanced planning. The Clinical Frailty Scale (CFS) is validated for predicting outcomes of older hospitalised adults. All patients admitted into two hospitals in the South-East of England between 1 January 2017 and 31 December 2022, aged ≥65 years old with an electronically recorded CFS were included. Results Over the study period there were 100 933 admissions, representing 53 361 individual patients. A single admission was observed in 16 284 (30.5%), whilst 37 077 (69.5%) had more than one admission. The mean CFS was 4.62 (SD 1.66) and 49.5% were living with frailty (CFS ≥5). Across 6 years, before, during and after the Covid-19 pandemic, this percentage remained stable. Females had a higher average CFS than males (4.74 vs 4.46, P < 0.01). Patients with a single admission had a higher mean CFS than patients with subsequent readmissions. Patients who died during admission had a higher average CFS than those who survived to discharge (6.02 vs 4.52, P < 0.01). Conclusion This large cohort study of acutely admitted older adults found half were living with frailty. This highlights the importance of frailty identification to optimise personalised care. There was no significant change in frailty severity between 2018 and 2022.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"11 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201947","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 new bleeding risk score specifically developed for direct oral anticoagulants in a geriatric population","authors":"Matthieu Piccoli, George Pisica-Donose, Abdelhakim Hacil, Galdric Orvoën, Jean Philippe David, Judith Charbit, Rafaëlle Roth, Yara Antakly, Nicolas Boulloche, Ulric Vinsonneau, Stéphane Bouée, Pierre Krolak-Salmon, Laurent Fauchier, Pierre Jouanny, Guillaume Sacco, Fabienne Bellarbre, Joël Belmin, Puisieux François, Matthieu Lilamand, Elena Paillaud, Anne Sophie Boureau, Olivier Hanon, Jean-Sébastien Vidal","doi":"10.1093/ageing/afaf118","DOIUrl":"https://doi.org/10.1093/ageing/afaf118","url":null,"abstract":"Although the use of direct oral anticoagulants increases in parallel with the increase in atrial fibrillation (AF) with age, none of the bleeding risk scores (HAS-BLED, HEMORR2HAGES, ATRIA nor RE-LY) have been developed in a geriatric population. Our study aimed to develop a bleeding risk score adapted to this specific population and this therapeutic class. Multicentre, longitudinal, prospective, observational, pharmacoepidemiologic study conducted in 60 French cardiologic and geriatric centres included consecutive patients aged ≥80 years with AF, treated with rivaroxaban and followed for at least 1 year. All thromboembolic, bleeding and clinical events, including falls, hospitalisations or deaths, were recorded every 3 months for 1 year. A predictive risk score based on the clinical variables most associated with bleeding events was developed from the total sample, randomly divided into a training sample and a validation sample. Among the 839 patients included (mean age = 86 year old, 62% women), there were 78 (9.3%) major haemorrhagic events. Variables associated with bleeding were age, anaemia, low albuminemia, amiodarone use and low creatinine clearance estimated with Cockcroft formula, grouped together as the A4C score. The A4C score better identifies bleeding risk in subjects ≥80 years than the scores already validated in younger populations, as its area under the curve in the training sample and in the validation sample was 0.73 and 0.66, respectively, whereas it was 0.49/0.55 for the HAS-BLED score, 0.53/0.50 for the HEMORR2HAGES score, 0.58/0.61 for the ATRIA score and 0.57/0.54 for the RE-LY score. A threshold of the A4C score ≥ 2 identifies subjects ≥80 years at high risk of bleeding.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201946","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: Assessing and managing bone health and fracture risk in Parkinson's disease: the BONE PARK 2 protocol.","authors":"","doi":"10.1093/ageing/afaf172","DOIUrl":"10.1093/ageing/afaf172","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265049","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":"The importance of integrated care.","authors":"Miriam L Haaksma, Frederiek van den Bos","doi":"10.1093/ageing/afaf145","DOIUrl":"https://doi.org/10.1093/ageing/afaf145","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207413","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}