Age and ageing最新文献

{"title":"Advancing integrated care for older adults with multimorbidity and dependency in China.","authors":"Hongmei Jiao, Wenjian Zhou, Jie Li, Yao Yao, Erdan Dong","doi":"10.1093/ageing/afaf146","DOIUrl":"https://doi.org/10.1093/ageing/afaf146","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":"144232989","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":"Long-term clinical outcomes of oral anticoagulation in the older patients with atrial fibrillation aged ≥80 years: a report from the GLORIA-AF registry phase III.","authors":"Hongyu Liu, Yang Chen, Bi Huang, Steven Ho Man Lam, Giulio Francesco Romiti, Yang Liu, Brian Olshansky, Menno Huisman, Kui Hong, Tze-Fan Chao, Gregory Y H Lip","doi":"10.1093/ageing/afaf139","DOIUrl":"10.1093/ageing/afaf139","url":null,"abstract":"<p><strong>Background: </strong>Older age increases the risk of thromboembolism (TE) and major bleeding in atrial fibrillation (AF) patients, but limited evidence exists regarding the older population (age ≥ 80) especially from different global regions. Data on benefits of oral anticoagulants in these very old individuals are also limited.</p><p><strong>Methods: </strong>From the prospective, multicenter Global Registry on Long-Term Antithrombotic Treatment in Patients with Atrial Fibrillation registry, we analysed by age all-cause death, cardiovascular death, major adverse cardiovascular events (MACE), TE, major bleeding, stroke, and myocardial infarction (MI) over 3-years follow-up.</p><p><strong>Results: </strong>Of 7652 patients aged ≥75 years (age 80.1 ± 3.9 years, 47.1% male), 4006 were ≥ 80 years (age 83.4 ± 3.9 years, 43.5% male). After multivariable adjustment, older patients had a higher risk of all-cause death (HR:1.94, 95% CI: 1.67-2.27), cardiovascular death (HR: 2.17, 95% CI: 1.71-2.74), MACE (HR: 1.57, 95% CI: 1.32-1.86), TE (HR: 1.45, 95% CI: 1.14-1.83), major bleeding (HR: 1.30, 95% CI: 1.04-1.63), stroke (HR: 1.38, 95% CI: 1.06-1.80) and MI (HR: 1.59, 95% CI:1.14-2.22). Compared with VKA, NOAC use in patients ≥80 years was associated with lower risks of all-cause death (HR: 0.79, 95% CI: 0.65-0.97), cardiovascular death (HR: 0.70, 95% CI: 0.51-0.96), MACE (HR: 0.72, 95% CI: 0.56-0.92), and major bleeding (HR: 0.66, 95% CI: 0.48-0.92). NOACs were more beneficial than warfarin for mortality, MACE and major bleeding in frail patients. The risk of clinical events associated with older patients was primarily seen in Europe and Asia (p-interaction > 0.05), but the effectiveness and safety of NOACs vs. warfarin was consistent across regions.</p><p><strong>Conclusions: </strong>Older age was independently associated with higher risk of death, major bleeding, TE and MACE. Compared with VKA, NOACs show improved effectiveness and safety in the older and patients with frailty, with similar efficacy across regions and ethnic groups.</p>","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/PMC12133677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214681","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: Editor's view-mental and physical wellbeing.","authors":"","doi":"10.1093/ageing/afaf167","DOIUrl":"https://doi.org/10.1093/ageing/afaf167","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":"144281988","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":"Renin-angiotensin system inhibition and risk of dementia in hypertensive patients. An old dilemma.","authors":"Andrea Ungar, Ester Latini, Giulia Rivasi, Enrico Mossello","doi":"10.1093/ageing/afaf140","DOIUrl":"https://doi.org/10.1093/ageing/afaf140","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":"144207412","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":"Persistence with anti-dementia medications: a systematic review and meta-analysis.","authors":"Mohammad Sistanizad, Gregory M Peterson, Tristan Ling, Mohammed Saji Salahudeen, Vyasa Murthy Akondi, Woldesellassie M Bezabhe","doi":"10.1093/ageing/afaf151","DOIUrl":"10.1093/ageing/afaf151","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal persistence with anti-dementia drugs (ADDs) in patients with dementia is associated with poorer clinical outcomes, including accelerated disease progression, cognitive decline and increased healthcare utilisation. This study aimed to systematically review real-world persistence rates with ADDs and identify factors influencing persistence.</p><p><strong>Methods: </strong>We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched Medline, Embase, PsycINFO and CINAHL from 1 January 1995 to 5 February 2024. Pooled persistence rates were calculated using random-effects Mantel-Haenszel models. Heterogeneity was assessed using I2 statistics, publication bias via funnel plots and Egger's/Begg's tests, and moderators were explored through meta-regression.</p><p><strong>Results: </strong>We included 68 studies involving 684,493 participants aged 50 years and older who received ADD. The mean 12-month persistence rate was 49% (95% CI: 42%-56%). Subgroup analyses revealed higher persistence for studies where a permissible gap for medicine refills was not required based on the methodology (67%, 95% CI: 38%-90%), those examining memantine (61%, 95% CI: 38%-82%), studies published between 2011 and 2015 (54%, 95% CI: 41%-68%) and studies conducted in Europe (57%, 95% CI: 43%-71%). Of these, the permissible gap remained an independent predictor of between-study heterogeneity in persistence (β = 0.36, 95% CI: 0.18-0.54).</p><p><strong>Conclusion: </strong>The meta-analysis demonstrated relatively low persistence to ADDs, which varied according to the evaluation criteria used. Targeted interventions to improve persistence with therapy may lead to better outcomes in patients with dementia. Also, a standardised framework for measuring persistence could improve research reliability.</p>","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/PMC12131239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207411","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":"Bleeding risk scores in atrial fibrillation-how should they influence decision-making for anticoagulants?","authors":"Anneka Mitchell, Anita McGrogan","doi":"10.1093/ageing/afaf158","DOIUrl":"https://doi.org/10.1093/ageing/afaf158","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":"144265048","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: Risk of adverse outcomes associated with mirtazapine compared to sertraline use among older people living in long-term care facilities.","authors":"","doi":"10.1093/ageing/afaf178","DOIUrl":"10.1093/ageing/afaf178","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/PMC12163230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281989","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":"Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions.","authors":"Rose S Penfold, Emily Bowman, Emma R L C Vardy, Elizabeth L Sampson, Atul Anand, Bruce Guthrie, Alasdair M J MacLullich","doi":"10.1093/ageing/afaf144","DOIUrl":"https://doi.org/10.1093/ageing/afaf144","url":null,"abstract":"<p><strong>Introduction: </strong>Overall dementia diagnosis rates are substantially below true rates. Hospital admissions of older people involve cognitive and functional assessments relevant to dementia diagnosis. These assessments could be harnessed to contribute to identifying patients for further assessment. Yet relationships of inpatient cognitive tests with known dementia are unclear. The 4AT (www.the4AT.com) assesses for delirium (Scores 4-12) and also cognitive impairment via embedded cognitive tests (Scores 1-3). We investigated relationships between 4AT scores and clinical dementia diagnoses.</p><p><strong>Methods: </strong>We included participants aged ≥65 years admitted as a medical emergency to three hospitals from 4 January 2016 to 4 January 2020, who had the 4AT performed on admission. Clinical dementia diagnosis was ascertained from linked primary care, hospital discharge and community prescribing data.</p><p><strong>Results: </strong>Of 75 221 admissions, 62 188 (82.7%; 33 625 unique patients; mean age 80.2 years; 55.8% female) had a 4AT on admission. Of these, 9948 (16.0%) had a recorded clinical dementia diagnosis at the time of admission, with a further 1197 (1.9%) receiving a new diagnosis at discharge. Of admissions with dementia, 9669/11 145 (86.8%) had a 4AT score ≥1 on admission, compared to 14 994/51 043 (29.4%) without dementia.4AT ≥1 had a sensitivity of 0.87 (95% CI 0.86-0.87) and a specificity of 0.71 (0.70-0.71) in relation to clinical dementia diagnosis. 4AT ≥4 showed sensitivity of 0.50 (0.50-0.51) and a specificity of 0.88 (0.88-0.88).</p><p><strong>Conclusions: </strong>4AT scores were associated with clinically diagnosed dementia. These results suggest that routinely collected 4AT scores could be leveraged in conjunction with other clinical indicators to identify patients with possible undiagnosed dementia who could undergo further inpatient diagnostic assessment and/or post-discharge specialist follow-up.</p>","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":"144301016","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":"Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled trial of an intervention to involve older people in their care (Your Care Needs You)","authors":"Jenni Murray, Kalpita Baird, Stephen Brealey, Laura Mandefield, Gerry Richardson, Jane O'Hara, Robbie Foy, Laura Sheard, Alison Cracknell, Alfredo Palacios, Simon Walker, Ed Breckin, Lubena Mirza, Ruth Baxter, Catherine Hewitt, Rebecca Lawton","doi":"10.1093/ageing/afaf142","DOIUrl":"https://doi.org/10.1093/ageing/afaf142","url":null,"abstract":"Background Transitions from hospital to home are risky for older people. The role of patient involvement in supporting safe transitions is unclear. Objective To assess the clinical effectiveness of an intervention to improve the safety and experience of care transitions for older people. Trial design Cluster randomised controlled trial. Participants Eleven National Health Service acute hospital trusts and 42 wards (clusters) routinely providing care for older people (aged 75 years and older) planning to transition back home. Intervention Patient involvement ward-level intervention—Your Care Needs You (YCNY). Outcomes Unplanned hospital readmission rates within 30 days of discharge (primary outcome). Secondary outcomes included readmissions at 60 and 90 days post-discharge, experience of transitions and safety events. Randomisation Ward as the unit of randomisation from varying medical specialities randomised to YCNY or care-as-usual on a 1:1 basis. Blinding Ward staff, research nurses and researchers were unblinded. Patients were unaware of treatment allocation. Statisticians were blinded to the primary outcome data until statistical analysis plan sign-off. Results Using a mixed effects logistic regression we saw no significant difference in unplanned 30-day readmission rates (OR 0.93; 95% CI, 0.78 to 1.10; P = .372) between intervention (17%) and control (19%). At all timepoints, rates were lower in the intervention group. The total number of readmissions was lower in the intervention group (all timepoints) reaching statistical significance across 90-days with 13% fewer readmissions (IRR: 0.87; 95% CI 0.76 to 0.99) than the control. At 30-days only, intervention group patients reported better experiences of transitions and significantly fewer safety events. Serious adverse events were similarly observed in both groups [YCNY: 26 (52.0%), Care-as-usual: 24 (48.0%)]. None related to treatment. Conclusions YCNY did not significantly impact on unplanned hospital readmissions at 30 days but in some secondary outcomes we did find evidence of clinical benefit.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"14 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176568","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":"Body mass index changes and trajectories from midlife to late-life: association with subjective cognitive complaints in a 30-year Women’s cohort study","authors":"Ho Kyung Sung, Fen Wu, Yelena Afanasyeva, Karen L Koenig, Tess V Clendenen, Anne Zeleniuch-Jacquotte, Yu Chen","doi":"10.1093/ageing/afaf130","DOIUrl":"https://doi.org/10.1093/ageing/afaf130","url":null,"abstract":"Background The relationship between body mass index (BMI) changes across the lifespan and cognitive health in later life remains unclear. This study evaluated the association between BMI changes from midlife to late-life and subsequent subjective cognitive complaints (SCCs) in women. Methods We analysed data from 5160 women in the New York University Women’s Health Study, a prospective cohort with over 30 years of follow-up. BMI was calculated using self-reported height and weight at baseline and follow-up. SCCs were assessed using a validated questionnaire in 2018–2020. Odds ratios (ORs) for reporting ≥2 SCCs were estimated using unconditional logistic regression. Results BMI at specific life stages was not significantly associated with SCC risk. BMI changes from midlife to late-life were associated with SCC risk. Compared to women with stable BMI (≤5% change), moderate BMI loss (5.1–10% decrease) was associated with higher odds of ≥2 SCCs (OR: 1.23, 95% CI: 1.02–1.48), large BMI gain (&amp;gt;10% increase) was associated with lower odds of ≥2 SCCs (OR: 0.81, 95% CI: 0.67–0.97). These findings were consistent across sensitivity analyses, including varying age cut-offs and excluding BMI changes occurring 5–10 years before late-life. Conclusions Our findings emphasize the importance of considering lifelong weight changes in assessing cognitive health risks. In particular, significant weight loss from midlife to late-life may serve as a potential indicator of cognitive decline in older adults. Further research is needed to elucidate the underlying mechanisms of this association and to explore effective interventions for mitigating cognitive health risks.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"23 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136782","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}