Age and ageing最新文献

{"title":"Risk of adverse outcomes associated with mirtazapine compared to sertraline use among older people living in long-term care facilities","authors":"Georgina A Hughes, Maria C Inacio, Debra Rowett, Gillian E Caughey, Tracy Air, Catherine E Lang, Megan Corlis, Janet K Sluggett","doi":"10.1093/ageing/afaf074","DOIUrl":"https://doi.org/10.1093/ageing/afaf074","url":null,"abstract":"Background Antidepressants are used by 60% of residents of long-term care facilities (LTCFs). Mirtazapine and sertraline are the most commonly used antidepressants, despite little safety information for their use in LTCFs. Objective To investigate risk of adverse outcomes (falls, fractures, cardiovascular-, dementia-, and delirium-related hospitalisations, all-cause mortality) associated with mirtazapine compared to sertraline use post-LTCF entry. Design Active new user retrospective cohort study. Subjects Individuals aged 65–105 years entering LTCFs in three Australian states during 1 January 2015 to 31 October 2018, who initiated mirtazapine or sertraline ≤60 days post-LTCF entry, with follow-up to 31 December 2019. Methods The inverse probability of treatment weighting of individuals’ propensity scores was used to adjust Cox and Fine–Gray regression models to estimate the risk of outcomes of interest associated with mirtazapine compared to sertraline use in LTCFs. Weighted (adjusted) hazard ratios (aHRs), subdistribution hazard ratios and 95% confidence intervals (95% CIs) are presented. Results A total of 5409 residents initiated mirtazapine (71%, n = 3837) or sertraline (29%, n = 1572) post-LTCF entry. After weighting, mirtazapine was associated with a higher risk of mortality (aHR 1.16, 95% CI 1.05–1.29) compared to sertraline. The risk of falls and fractures within 90 days was not statistically significantly different between the groups but was lower in mirtazapine users thereafter. No differences in risk of cardiovascular-, dementia- or delirium-related hospitalisations were observed. Conclusions Compared to sertraline, mirtazapine use is associated with a higher risk of mortality and, after 90 days of use, a lower risk of falls and fractures. This risk of harm should be balanced with limited evidence for effectiveness when considering antidepressant therapy in LTCFs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"34 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's view-mental and physical wellbeing.","authors":"Nathalie van der Velde","doi":"10.1093/ageing/afaf110","DOIUrl":"https://doi.org/10.1093/ageing/afaf110","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959645","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":"Wisdom-inquiry science is essential for healthy longevity.","authors":"Colin Farrelly","doi":"10.1093/ageing/afaf073","DOIUrl":"10.1093/ageing/afaf073","url":null,"abstract":"<p><p>Within a week of his 20 January 2025 inauguration, US President Donald J. Trump issued an order that froze all federal grants and loans, creating confusion and anxiety about the future of research and development in US biomedical science. The politicisation of science creates significant challenges not only for the researchers who depend on public funding to undertake their research, but also for the public understanding of why basic research is so important to the health and economic prosperity of the world's ageing populations. In 1944 US President Franklin D. Roosevelt wrote a letter to the director of the Office of Scientific Research and Development, Dr. Vannevar Bush, asking Bush how science and medicine could be best harnessed to win the war of science against disease. Bush's response, in his acclaimed 1945 book entitled Science, The Endless Frontier, detailed how 'scientific capital' determines the pace and shape of technological progress. The war against disease approach to public health and medicine has helped increase life expectancy, by reducing the prevalence of premature death, but it has also contributed to the increasing global healthspan-lifespan gap, which is nearly 10 years. Translational gerontology, and in particular the goal of developing geroprotective drugs that may help fortify the 'biological resilience' needed to increase healthy life expectancy, must become an integral part of a 'wisdom-inquiry' approach to public health and medicine if the aspiration of healthy longevity is to be realised this century.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750724","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":"Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape.","authors":"Jodi P Ventre, Fay Manning, Aseel Mahmoud, Grace Brough, Stephen Timmons, Helen Hawley-Hague, Dawn A Skelton, Victoria A Goodwin, Chris J Todd, Denise Kendrick, Pip Logan, Elizabeth Orton","doi":"10.1093/ageing/afaf083","DOIUrl":"https://doi.org/10.1093/ageing/afaf083","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of falls in adults 65+ years remains a common and costly issue worldwide. There is current evidence to suggest that falls can be prevented using evidence-based strength and balance interventions, such as the six-month Falls Management Exercise (FaME) programme. Perspectives of multiple key partners and providers of the FaME programme could inform future implementation and fall prevention strategies.</p><p><strong>Methods: </strong>Partners and providers involved in local community fall prevention pathways were purposefully recruited from three geographical areas across the UK. Semistructured interviews were conducted to gain a broad understanding of factors affecting the adoption, implementation and spread of FaME. Data were analysed using an inductive thematic approach and mapped to the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Data from 25 participant interviews and document analysis revealed 11 themes organised within five CFIR domains-the innovation (3), outer setting (3), inner setting (1), characteristics of individuals (1) and process (2).</p><p><strong>Conclusion: </strong>The adoption, implementation and spread of FaME into community settings is complex and faces multiple health system challenges. For adoption and implementation to be facilitated, FaME programmes must demonstrate effectiveness and fit the local needs of those receiving the intervention. For spread to occur, influential decision-makers and funders must support wider programme rollout whilst also securing sufficient expert capacity to deliver the programme and ensure monitoring is in place to determine effectiveness of provision for older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952337","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 opportunities and uncertainties of clinic visit recording for older adults.","authors":"Paul J Barr, Kerri L Cavanaugh, Meredith C Masel","doi":"10.1093/ageing/afaf079","DOIUrl":"https://doi.org/10.1093/ageing/afaf079","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802154","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":"Does concern about falling predict future falls in older adults? A systematic review and meta-analysis.","authors":"Toby Jack Ellmers, Jodi P Ventre, Ellen Freiberger, Klaus Hauer, David B Hogan, Mei Ling Lim, Lisa McGarrigle, Samuel Robert Nyman, Chris J Todd, Yuxiao Li, Kim Delbaere","doi":"10.1093/ageing/afaf089","DOIUrl":"10.1093/ageing/afaf089","url":null,"abstract":"<p><strong>Background: </strong>The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.</p><p><strong>Methods: </strong>Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.</p><p><strong>Results: </strong>About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.</p><p><strong>Conclusions: </strong>Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802113","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":"Mirtazapine for chronic insomnia in older adults: weighing the risks and potential benefits.","authors":"Joshua M Inglis, Arduino A Mangoni","doi":"10.1093/ageing/afaf090","DOIUrl":"https://doi.org/10.1093/ageing/afaf090","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966632","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":"Gait and balance metrics comparison among different fall risk groups and principal component analysis for fall prediction in older people.","authors":"Lulu Yin, Hyeri Nam, Yaru Wei, Tianyi Feng, Feifei Li, Yushan Wang, Yu Zhang, Lin Wang","doi":"10.1093/ageing/afaf076","DOIUrl":"10.1093/ageing/afaf076","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of morbidity and mortality among older adults, often linked to gait and balance impairments.</p><p><strong>Objective: </strong>To compare gait and balance metrics across fall risk levels in community-dwelling older adults and identify principal components predictive of fall risk.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>General community.</p><p><strong>Subjects: </strong>Three hundred older adults were stratified into low, moderate and high fall risk groups using the STEADI toolkit.</p><p><strong>Methods: </strong>Gait and balance metrics were compared across groups. Principal component analysis (PCA) reduced dimensionality, and binary logistic regression assessed the predictive value of components.</p><p><strong>Results: </strong>High-risk individuals showed slower cadence, shorter step length, wider step width, greater gait variability and increased centre of pressure (CoP) and centre of mass (CoM) sway. PCA identified four gait and seven balance components, explaining 71.62% and 75.88% of variance, respectively. Logistic regression revealed Gait_principal component (PC)2 (instability) (OR = 2.545, P < .001), Gait_PC3 (rhythm control) (OR = 1.659, P = .006), Balance_PC1 (CoP sway during single-leg stance) (OR = 1.628, P = .007), Balance_PC2 (CoM sway velocity variability) (OR = 1.450, P = .032) and Balance_PC4 (CoP sway during double-leg stance, eyes closed) (OR = 1.616, P = .004) as significant predictors. The model achieved 77.2% accuracy, with a sensitivity of 73.1% and a specificity of 79.4%.</p><p><strong>Conclusions: </strong>Gait instability, rhythm control and increased postural sway are key predictors of fall risk. Integrating gait and balance metrics enhances fall risk stratification, supporting clinical decision-making.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802122","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":"Opportunistic screening for atrial fibrillation among frail older patients, little effort for a high diagnostic yield. Outcomes of the Dutch-GERAF study.","authors":"Lennaert A R Zwart, Jocelyn R Spruit, René W M M Jansen, Robert K Riezebos, Ron Pisters, Leonora Louter, Kerst De Vries, Diana G Taekema, Johan F H Wold, Joris R De Groot, Martin E W Hemels","doi":"10.1093/ageing/afaf105","DOIUrl":"https://doi.org/10.1093/ageing/afaf105","url":null,"abstract":"<p><strong>Background and aims: </strong>Frailty increases the risk of atrial fibrillation (AF) and its complications. This study investigated the feasibility and diagnostic yield of an eHealth screening for the detection of new AF, in frail older patients.</p><p><strong>Methods: </strong>Patients referred to the Geriatric Medicine outpatient clinics were eligible. A Frailty Index (FI) was calculated. Patients were screened for AF with electrocardiograms (ECGs) at baseline and a smartphone photoplethysmography (PPG) application, during 6 months.</p><p><strong>Results: </strong>Nine hundred fifty-two patients (median age 79 years) were included, mean FI of 0.16, 311 were frail (33%) and 751 had sinus rhythm (79%) at baseline. Six hundred forty-one patients (85%) performed PPG recordings (median 2), 295 (39%) at least 3 recordings. Twenty (2.7%) new cases of AF were found, 10 at baseline and 10 during follow-up. Among 16 (2%) patients, additional irregular PPG recordings were acquired, but no confirmatory ECG took place.</p><p><strong>Conclusion: </strong>The screening strategy proved feasible in very old and frail patients. A diagnostic yield of 2.7% was found by ECG, and an additional 0.9% of new AF cases were suspected on PPG recordings. The non-binding approach of the strategy might be disadvantageous for the patient category. Future PPG AF screening programmes for very old and frail patients should strictly organise their means of AF confirmation.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061943","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":"What can we learn from 68 000 clinical frailty scale scores? Evaluating the utility of frailty assessment in emergency departments.","authors":"Hugh Logan Ellis, Liam Dunnell, Ruth Eyres, Julie Whitney, Cara Jennings, Dan Wilson, Jane Tippett, Dan F Stein, James Teo, Zina Ibrahim, Kenneth Rockwood","doi":"10.1093/ageing/afaf093","DOIUrl":"https://doi.org/10.1093/ageing/afaf093","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) in England are under significant strain, with increasing attendances and extended wait times, affecting frail older adults. The clinical frailty scale (CFS) has been implemented as a tool to assess frailty in ED settings, but its reliability and predictive accuracy as a screening tool remain debated.</p><p><strong>Objective: </strong>To evaluate the use and variability of the CFS in EDs and its association with patient outcomes, including discharge rates, length of stay, readmission and mortality.</p><p><strong>Methods: </strong>A retrospective cohort study of ED attendances at two London (UK) hospitals from 2017 to 2021. Data included CFS scores, demographics, clinical observations and outcomes. Comparative statistics, logistic regression, Cox proportional hazards models and competing risk regression were applied to examine CFS predictive validity.</p><p><strong>Results: </strong>In a sample of 123 324 ED visits, CFS scores strongly correlated with adverse outcomes: e.g. for long-term mortality (n = 33 475, events = 8871), each CFS single-point increase was associated with a 25% increase in mortality risk (95% CI 1.23-1.26). CFS scores varied significantly between raters and across visits, median difference two levels (interquartile range 1-3). Intraclass correlation coefficient analysis showed that 33.1% of CFS score differences was attributable to between-patient differences, 15.4% to inter-rater differences, with 51.5% residual variance from non-frailty factors, such as acute illness severity.</p><p><strong>Conclusion: </strong>The CFS is associated with crucial patient outcomes in the ED. Inter-rater variability and potentially confounding factors can limit its consistency. Automation to enhance CFS score reliability should be explored as a means to support proactive management.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952718","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}