Age and ageing最新文献

{"title":"Communicative practices used by health and social care professionals, older adults and informal carers during advance care planning conversations: systematic review of qualitative evidence and narrative synthesis.","authors":"Emily Spencer, Sarah Griffiths, Pushpa Nair, Katie Flanagan, Greta Rait, Fiona Stevenson, Nathan Davies","doi":"10.1093/ageing/afaf253","DOIUrl":"https://doi.org/10.1093/ageing/afaf253","url":null,"abstract":"<p><strong>Background: </strong>While advance care planning (ACP) is linked with clinical and psychosocial benefits for older adults and their informal carers, uptake is low. Inadequate communication skills amongst clinicians has been identified as a key barrier to effective ACP. While existing literature reviews have focussed on hypothetical preferences, barriers and facilitators, none have examined direct experience of ACP communication with this population. The aim of this review was to identify and synthesise qualitative evidence regarding the communicative practices used to support older adults, informal carers and health and social care professionals (HSCPs) have ACP conversations.</p><p><strong>Methods: </strong>A systematic review of qualitative evidence and narrative synthesis were undertaken. Five electronic databases (Medline, CINAHL, Emcare, Embase, PsychInfo) were systematically searched from inception to August 2024 for eligible studies reporting on features of ACP communication between HSCPs, older adults and informal carers. Quality appraisal was completed, with thematic analysis used to synthesise findings from eligible studies.</p><p><strong>Findings: </strong>From 6348 titles identified, 264 full texts were assessed for eligibility. Twenty-eight articles reporting on 25 studies were included in the narrative synthesis. Four analytical themes were generated: (i) Introducing a delicate topic; (ii) Participation within the care triad; (iii) Professional influence in decision-making; (iv) Patient perspectives on planning and care.</p><p><strong>Conclusions: </strong>ACP conversations would benefit from improved, personalised information provision to support informed decision-making, with clear, compassionate communication facilitated by continuity of care. Future research should further examine the role of informal carers, nonverbal communication, and take a broader view of ACP as an interactional process.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111481","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":"Remote assessment of physical function in older people: feasibility, safety and agreement with in-person administration.","authors":"Kimberley S van Schooten, Daniel Steffens, Adam Engeler, Meg Letton, Alicia Brown, Amy Perram, Lillian Miles, Michelle Ngo, Kim Delbaere","doi":"10.1093/ageing/afaf266","DOIUrl":"10.1093/ageing/afaf266","url":null,"abstract":"<p><strong>Background: </strong>Physical function is a key health indicator in older people. Interchangeable remote and in-person assessments could improve monitoring flexibility.</p><p><strong>Objective: </strong>To evaluate feasibility, safety and agreement between remote home and in-person laboratory physical function assessments in community-living older people.</p><p><strong>Methods: </strong>Thirty-seven people aged 60+ completed remote and in-person assessments of the five-times Sit-to-Stand (5STS), Timed Up-and-Go (TUG), standing balance test, 4 m Walk and Short Physical Performance Battery (SPPB) in counter-balanced order, two days apart. Feasibility was assessed as technological and environmental barriers, safety as adverse events, and agreement using intraclass correlation coefficients (ICCs) and smallest detectable differences (SDD), and based on kappa using clinical cutpoints (κ).</p><p><strong>Results: </strong>All participants completed the remote assessments without adverse events; 8% experienced minor connectivity issues. In-person performance was better for 5STS, TUG, 4 m Walk and standing balance; SPPB scores were comparable. Agreement was good for 5STS, TUG and standing balance (ICCs: 0.89 [95% confidence interval: 0.79-0.94], 0.85 [0.54-0.94], 0.77 [0.59-0.88], respectively)) and moderate for 4 m Walk and SPPB (ICCs: 0.64 [0.19-0.84] and 0.68 [0.46-0.82], respectively). SDD values for 5STS, TUG and SPPB fell within clinically acceptable ranges; categorical agreement was substantial (κ: 0.65, 0.77 and 0.65, respectively).</p><p><strong>Conclusions: </strong>Remote 5STS and TUG assessments showed good agreement, supporting their use with existing cut-points. Differences between settings in standing balance and walking speed (affecting SPPB) suggest caution in interpretation. Telehealth offers a feasible, safe option for monitoring physical function, though protocol refinements are needed for walking speed and standing balance.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172314","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":"Impact of pre-existing frailty on all-cause mortality in stroke survivors: a systematic review and dose-response meta-analysis.","authors":"Shouqi Wang, Jie Tan, Kaiyan Song, Qi Zhang, Wenhong Yang, Ying Wu","doi":"10.1093/ageing/afaf273","DOIUrl":"10.1093/ageing/afaf273","url":null,"abstract":"<p><strong>Background: </strong>The association between pre-existing frailty and increased mortality in stroke survivors remains unclear, with prior studies reporting inconsistent findings. This meta-analysis aimed to evaluate the impact of pre-stroke frailty on all-cause mortality in this population.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang, VIP, and SinoMed databases up to November 12, 2024. Study selection and data extraction were independently performed by two investigators. Studies using validated frailty assessment tools and reporting adjusted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were included.</p><p><strong>Results: </strong>Sixteen studies involving 55,897 patients met the inclusion criteria. The prevalence of frailty among stroke survivors ranged from 11.2% to 75.3%. Meta-analysis showed that pre-stroke frailty was significantly associated with increased all-cause mortality (pooled HR = 2.19, 95% CI: 1.44-3.34; pooled OR for continuous frailty scores = 1.26, 95% CI: 1.14-1.38). Dose-response analysis revealed a linear relationship, with each one-point increase in frailty score associated with a 6.4% higher risk of death (HR = 1.064, 95% CI: 1.031-1.098). Subgroup analyses indicated that the association was particularly strong in acute ischemic stroke populations (OR = 3.43, 95% CI: 1.81-6.51). The type of frailty assessment tool and study sample size were identified as potential sources of heterogeneity.</p><p><strong>Conclusion: </strong>Pre-stroke frailty independently predicts all-cause mortality in stroke survivors. Even mild increases in frailty burden are associated with worse outcomes, highlighting the clinical importance of incorporating frailty assessment into prognostic evaluation.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172331","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":"Maintaining independence at home after a fall: a process evaluation of the MAINTAIN multicomponent intervention for people living with dementia.","authors":"Leanne Greene, Louise M Allan, Alison Bingham, Ashima Sharma, Bethany Whale, Robert Barber, Christopher Fox, Victoria A Goodwin, Adam Lee Gordon, Abigail J Hall, Rowan H Harwood, Claire Hulme, Thomas Andrew Jackson, Rachel Litherland, Steve W Parry, Obi Ukoumunne, Sarah Morgan-Trimmer","doi":"10.1093/ageing/afaf245","DOIUrl":"10.1093/ageing/afaf245","url":null,"abstract":"<p><strong>Background: </strong>People with dementia who have a fall can experience both physical and psychological effects, often leading to diminished independence. Falls impose economic costs on the healthcare system. Despite elevated fall risks in dementia populations, evidence supporting effective home-based interventions remains limited.</p><p><strong>Methods: </strong>Multiple-methods process evaluation within a pilot cluster randomised controlled trial informed by a realist approach. Settings included six UK sites/clusters (three intervention, three control). Fidelity checks on routine data collection and fidelity observations of intervention sessions, multidisciplinary team meetings and supervision sessions were undertaken. Semi-structured interviews were conducted with people with dementia, caregivers and intervention therapists.</p><p><strong>Results: </strong>The MAINTAIN intervention demonstrated high fidelity in home assessments and intervention delivery, with participants receiving a mean of 15 of the 22 available sessions with a range of 5-25 sessions. Qualitative findings revealed that regular home visits increased engagement and motivation. Multidisciplinary team support enhanced therapists' confidence, particularly with complex cases. While most participants achieved their functional goals and reported improved confidence, challenges included geographical disparities in service delivery, carer burden and varying effectiveness of referral pathways. Therapists' attitudes towards advanced dementia influenced intervention delivery. The paired approach, involving both the person living with dementia and their carer, supported activity engagement but occasionally added extra responsibilities for caregivers.</p><p><strong>Conclusions: </strong>MAINTAIN was both feasible and acceptable. Future studies should consider standardising multidisciplinary support, incorporating targeted falls-related anxiety support and establishing sustainable post-intervention maintenance strategies. Protocol adaptations, such as video consultations, showed promise in addressing workforce constraints.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028791","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":"Testing a vigorous intermittent lifestyle physical activity intervention in adults transitioning to retirement: a pilot randomised controlled trial.","authors":"Bingyan Pang, Joanna C Moullin, Craig Thompson, Cecilie Thøgersen-Ntoumani, Emmanuel Stamatakis, Matthew Ahmadi, Joanne A McVeigh","doi":"10.1093/ageing/afaf244","DOIUrl":"10.1093/ageing/afaf244","url":null,"abstract":"<p><strong>Background: </strong>Vigorous intermittent lifestyle physical activity (VILPA; short bursts of vigorous-intensity activities in a person's daily life) could be an attractive and feasible option to increase physical activity (PA) in adults transitioning to retirement.</p><p><strong>Design and setting: </strong>Two-arm pilot randomised controlled trial (RCT) to test the feasibility of the intervention and the plausibility of the intervention to increase PA in adults transitioning to retirement in Perth, Western Australia.</p><p><strong>Participants: </strong>Insufficiently physically active adults transitioning to retirement.</p><p><strong>Intervention: </strong>Twelve-week theory-based and evidence-informed VILPA intervention designed to increase PA in adults transitioning to retirement.</p><p><strong>Objectives and measurements: </strong>The feasibility of the pilot was determined by the projected sample size with actual sample size, drop-out rates and reporting rates. The feasibility, acceptability and appropriateness of the intervention were assessed using validated questionnaires. The intervention's plausibility to increase PA was assessed by accelerometer-measured PA, functional fitness test and general health questionnaire.</p><p><strong>Results: </strong>Eighty individuals expressed interest in participating in the trial; 42 (feasibility of recruitment = 52.5%) were recruited and 34 completed the trial (retention = 80%). The preliminary data indicated increases in both total PA and VILPA, with positive impacts in self-reported general health and functional fitness. Participants found the intervention acceptable and intended to continue participation in VILPA and accumulate PA after the intervention.</p><p><strong>Conclusions: </strong>The VILPA intervention appears to be feasible for promoting PA in ageing adults. The findings of this pilot RCT also support a larger trial to seek the effectiveness of VILPA in improving health outcomes in ageing adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084716","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 effect of low-dose aspirin on reversing frailty status in older prefrail and frail adults: a secondary analysis of the ASPREE randomised clinical trial.","authors":"Ananta P Handono, Joanne Ryan, Fajar Setiawan, Sara E Espinoza, Aung Zaw Zaw Phyo, Chao Zhu, Mark R Nelson, Michael E Ernst, Suzanne G Orchard, Rory Wolfe, Robyn Woods, Peng Qiu, Zhen Zhou","doi":"10.1093/ageing/afaf271","DOIUrl":"10.1093/ageing/afaf271","url":null,"abstract":"<p><strong>Background: </strong>Chronic low-grade inflammation is hypothesised as a central driver of frailty. This study aims to evaluate whether low-dose aspirin can reverse frailty status among initially prefrail/frail older adults.</p><p><strong>Methods: </strong>This was a post hoc subgroup analysis of the Aspirin in Reducing Events in the Elderly (ASPREE), a randomised, placebo-controlled trial, involving community-dwelling adults aged ≥65 years. The median (Interquartile range) follow-up was 4.7 (3.6-5.7) years. We included participants who were prefrail or frail at baseline, with frailty assessed using two validated measures: the Fried Frailty Phenotype (FFP) and the Deficit-Accumulation Frailty Index (FI). Frailty reversal was defined as a transition to a less severe state (from frail to prefrail/nonfrail, prefrail to nonfrail). The discrete-time survival model was used for outcome analysis; linear mixed-effects models compared longitudinal frailty trajectories between the treatment arms.</p><p><strong>Results: </strong>Among 6595 and 8766 participants included in the FFP and FI analyses, respectively, there was no significant difference in frailty status reversal between aspirin and placebo groups (FFP-HR: 1.00, 95% CI: 0.92-1.07; FI-HR: 1.00, 95% CI: 0.94-1.07). No significant difference was found in the change of FFP counts (β = 0.014, SE = 0.007, P = .06) and FI score (β = 0.0004, SE = 0.004, P = .37) between the aspirin and placebo groups over time, suggesting that aspirin neither reversed nor worsened frailty severity. Subgroup analyses revealed no effect modification by frailty risk factors such as age, sex, race and medical history.</p><p><strong>Conclusion: </strong>Low-dose aspirin has no effect in reversing frailty among prefrail and frail individuals. The findings highlight the need to explore alternative anti-inflammatory medications for frailty management.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136323","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 association between dual sensory impairment and dementia: a meta-analysis and systematic review of the literature.","authors":"Nina Meret Zumbrunn, Karen Beckett, Johannes Alfons Karl, Fiona N Newell, Louise Hopper, David P McGovern","doi":"10.1093/ageing/afaf267","DOIUrl":"10.1093/ageing/afaf267","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests an association between dual sensory impairment (DSI)-that is, both visual and hearing impairments-and dementia. The aim of this systematic review was to synthesise the literature evaluating the dementia risk of adults >18 years with DSI compared to those without sensory impairment and/or those with a single sensory impairment (SSI).</p><p><strong>Methods: </strong>PubMed, Web of Science and PsycINFO were systematically searched in February 2024 and August 2024 for studies that considered the association between DSI and dementia, and compared individuals with DSI to those with either no sensory impairment or a SSI. A meta-analysis was conducted on studies reporting hazard ratios. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered on the Prospective Register of Systematic Reviews (PROSPERO).</p><p><strong>Results: </strong>A total of 22 papers were included in the narrative review, and 13 were included in the meta-analysis. Overall, findings from the narrative synthesis highlighted a consistent link between dementia prevalence and incidence with DSI. The meta-analysis revealed that individuals with DSI are at an ~50% greater risk of developing dementia compared to those without sensory impairments. Moreover, we identified DSI as a potentially greater risk factor for dementia than isolated hearing and visual impairment, with the risk for dementia in the DSI group exceeding the combined risk of the individual sensory impairments.</p><p><strong>Conclusions: </strong>This review highlights that there is substantial evidence linking DSI to an increased risk of dementia, emphasising the importance of considering the interplay between multiple senses in dementia research. Future research should focus on exploring whether interventions targeting DSI could also improve cognitive outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172277","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":"Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care.","authors":"Richard S Bourne, Laura Alberto, Nathan E Brummel, Bas de Groot, Dylan W De Lange, Paul Elbers, Marielle H Emmelot-Vonk, Hans Flaatten, Yonathan Freund, Alessandro Galazzi, Ana Garcia-Martinez, Bertrand Guidet, Iva Holmerová, Jeremy M Jacobs, Gavin M Joynt, Susannah Leaver, Marc Leone, Bairbre McNicholas, David McWilliams, Victoria Metaxa, Christian H Nickel, Daniele Poole, Chiara Robba, Kevin Roedl, Marc Romain, Anne-Françoise Rousseau, Sviri Sigal, Wojciech Szczeklik, Hélène Vallet, James van Oppen, Christian Jung, Michael Beil","doi":"10.1093/ageing/afaf272","DOIUrl":"https://doi.org/10.1093/ageing/afaf272","url":null,"abstract":"<p><strong>Background: </strong>Recent consensus-based recommendations on the management of people aged ≥80 years in intensive care units (ICUs) were developed to guide the management of quality care.</p><p><strong>Objective: </strong>To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice.</p><p><strong>Methods: </strong>Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged ≥80 years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework.</p><p><strong>Results: </strong>Care statement comments were provided by 99 of the 124 (79.8%) participants completing the Delphi first round; primarily identifying barriers (239/258; 92.6%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6%); predominantly limitations in resources/material resources, with staffing (60, 25.1%), and beds or facilities (30, 12.6%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5%), beliefs about consequences (18, 7.5%), care goals (16, 6.7%) and social/professional role and identity (16, 6.7%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1%).</p><p><strong>Conclusions: </strong>The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147403","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":"Constipation preceding stroke, dementia and Parkinson's disease in middle-aged and older adults: a population-based cohort study.","authors":"Qingping Yun, Shiyu Wang, Bingyu Li, Zhirong Yang, Chang Wei, Jinqiu Yuan, Jun Hu, Ye Li, Zuyao Yang, Feng Sha, Jinling Tang","doi":"10.1093/ageing/afaf257","DOIUrl":"https://doi.org/10.1093/ageing/afaf257","url":null,"abstract":"<p><strong>Background: </strong>Previous research indicates that constipation may be an early symptom of Parkinson's disease (PD). However, it remains uncertain whether constipation is a unique symptom prior to PD or to other major neurological disorders as well. This study aimed to explore the association between premorbid constipation and three major neurological disorders: stroke, dementia and PD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from UK Biobank. Constipation was defined based on diagnosed cases in electronic health records, self-reported instances or regular laxative use. The primary outcome was defined as the first onset of any of three neurological disorders: stroke, dementia and PD. Cox regression was used to adjust for socio-demographic characteristics, lifestyle factors, medical conditions and regular medication use.</p><p><strong>Results: </strong>Out of 462,327 eligible participants, those with constipation were associated with higher incidence of three outcome diseases (1415/20,263 [7.0%]) than those without (18,848/442,064 [4.3%]), with adjusted hazard ratio (HR) being 1.35 [1.27-1.42]. Specifically, those with constipation had a 20%, 50% and 56% higher risk of stroke, dementia and PD, respectively. Both self-reported and diagnosed constipation were associated with a higher risk of these conditions, with HR being 1.31 (1.23-1.40) and 1.44 (1.30-1.59), respectively. Interestingly, the association between constipation and neurological disorders was stronger within the first 2 years from baseline.</p><p><strong>Discussion: </strong>These findings support the biological link between constipation and neurological disorders. Given its potential role as a prodromal symptom for these diseases, both diagnosed and self-reported constipation should be considered in risk prediction models.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102594","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":"Retrospective multi-centre cohort study of polypharmacy, the Drug Burden Index and associations with outcomes in older surgical inpatients.","authors":"Bonnie Mengyuan Liu, Kenji Fujita, Janani Thillainadesan, Danijela Gnjidic, Sarah N Hilmer","doi":"10.1093/ageing/afaf270","DOIUrl":"10.1093/ageing/afaf270","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive medication utilisation and its association with outcomes are not well described in older surgical inpatients.</p><p><strong>Objectives: </strong>Investigate medication utilisation and the associations of the number of medications and exposure to anticholinergic and sedative medications measured using the Drug Burden Index (DBI exposure) with outcomes in older surgical inpatients.</p><p><strong>Methods: </strong>A multi-centre retrospective cohort study of surgical patients ≥65 years at five Australian hospitals admitted for ≥48 hours, from 4 January 2022 to 3 January 2023. The number of regular medications was counted on admission and discharge. DBI exposure throughout admission was calculated using the area under the curve for DBI/days of admission (AUC DBI/days). Multilevel regression was conducted for outcomes on/during admission [falls, adverse drug events (ADEs), delirium, pressure ulcers, Hospital Frailty Risk Score (HFRS), length of stay (LOS)].</p><p><strong>Results: </strong>The 13 815 participants (51.1% male) had a median (IQR) age of 77 (71-84) years. The median number of medications was 5 (2-9) on admission and 9 (6-13) on discharge. The median AUC DBI/days was 0.13 (0-0.5). The number of admission medications was associated with delirium [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04], ADEs (aOR 1.03, 95% CI: 1.01-1.04), pressure ulcers (aOR 1.04, 95% CI:1.02-1.06), HFRS [adjusted rate ratio (aRR) 1.01, 95% CI:1.001-1.02] and increased LOS (aRR 1.011, 95% CI: 1.008-1.014). The AUC DBI/days was associated with falls (aOR 1.29, 95% CI: 1.18-1.41), delirium (aOR 1.63, 95% CI:1.46-1.82), ADEs (aOR 1.26, 95% CI: 1.11-1.43), pressure ulcers (OR 1.60, 95% CI: 1.38-1.86), HFRS (aRR 1.27, 95% CI:1.17-1.37) and increased LOS (aRR 1.36, 95% CI:1.32-1.40).</p><p><strong>Conclusion: </strong>Polypharmacy is common amongst older surgical inpatients, and the number of medications increased from admission to discharge. Increased DBI exposure was associated with adverse outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 9","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129774","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}