Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae261
Latha Velayudhan, Sara Pisani, Marta Dugonjic, Katie McGoohan, Sagnik Bhattacharyya
{"title":"Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference.","authors":"Latha Velayudhan, Sara Pisani, Marta Dugonjic, Katie McGoohan, Sagnik Bhattacharyya","doi":"10.1093/ageing/afae261","DOIUrl":"10.1093/ageing/afae261","url":null,"abstract":"<p><strong>Background: </strong>Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited.</p><p><strong>Objective: </strong>To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990-12th June 2023).</p><p><strong>Methods: </strong>We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model.</p><p><strong>Results: </strong>Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50-87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47-55.79) and 16.35(95% CI, 1.25-48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24-45.47) and 11.36(95% CI, 2.55-26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.</p><p><strong>Conclusions: </strong>Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738056","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}
Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae253
Bin Hu
{"title":"Unveiling mild behavioural impairment in Parkinson's disease: insights from a systematic review.","authors":"Bin Hu","doi":"10.1093/ageing/afae253","DOIUrl":"https://doi.org/10.1093/ageing/afae253","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715168","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}
Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae260
Nathalie van der Velde
{"title":"Editor's view-adaptive approaches.","authors":"Nathalie van der Velde","doi":"10.1093/ageing/afae260","DOIUrl":"https://doi.org/10.1093/ageing/afae260","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685703","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}
Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae251
Pedro-Pablo España, Idoia Castillo-Sintes, Maria J Legarreta, Amaia Bilbao-González, Nere Larrea, Maria Gascon, Ane Uranga, Amaia Artaraz, Julia Garcia-Asensio, Jose M Quintana
{"title":"Effectiveness of bivalent mRNA booster vaccination and previous infection in older adults during Omicron period: real-world evidence.","authors":"Pedro-Pablo España, Idoia Castillo-Sintes, Maria J Legarreta, Amaia Bilbao-González, Nere Larrea, Maria Gascon, Ane Uranga, Amaia Artaraz, Julia Garcia-Asensio, Jose M Quintana","doi":"10.1093/ageing/afae251","DOIUrl":"https://doi.org/10.1093/ageing/afae251","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of booster bivalent vaccines against the Omicron variant, particularly amongst older patients, remains uncertain.</p><p><strong>Objective: </strong>We sought to compare the relative effectiveness of a fourth dose of vaccine using bivalent messenger ribonucleic acid (mRNA), by comparing patients who had and had not received this dose.</p><p><strong>Methods: </strong>We conducted a matched retrospective cohort study to assess the risk of COVID-19 infection, hospitalization and death of people aged >60 years with four doses as compared to those with only three doses. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). We adjusted by age, sex, nursing-home, comorbidities, primary care setting and previous episodes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We also investigated the impact of prior SARS-CoV-2 infection within each cohort, using the same methodology.</p><p><strong>Results: </strong>The administration of a fourth bivalent mRNA vaccine dose conferred significant additional protection against COVID-19 infection (HR: 0.479; 95% CI: 0.454-0.506), hospitalization (HR: 0.393; 95% CI: 0.348-0.443) and 30-day mortality (HR: 0.234; 95% CI: 0.171-0.318), as compared to individuals who had received only a third monovalent vaccine dose. In both cohorts, a prior history of COVID-19 infection involves lower risk of COVID-infection, hospitalization and death.</p><p><strong>Conclusions: </strong>During the period of Omicron predominance, receiving a bivalent booster vaccine as a fourth dose, as compared to receiving only three doses of a monovalent mRNA vaccine, provides significant extra protection against COVID-19 infection, hospitalization and mortality. Antecedents of SARS-CoV-2 prior to vaccination involves a notable reduction in the above COVID-19 outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685704","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}
Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae241
Carly Welch, Yaohua Chen, Peter Hartley, Corina Naughton, Nicolas Martinez-Velilla, Dan Stein, Roman Romero-Ortuno
{"title":"New horizons in hospital-associated deconditioning: a global condition of body and mind.","authors":"Carly Welch, Yaohua Chen, Peter Hartley, Corina Naughton, Nicolas Martinez-Velilla, Dan Stein, Roman Romero-Ortuno","doi":"10.1093/ageing/afae241","DOIUrl":"10.1093/ageing/afae241","url":null,"abstract":"<p><p>Hospital-associated deconditioning is a broad term, which refers non-specifically to declines in any function of the body secondary to hospitalisation. Older people, particularly those living with frailty, are known to be at greatest risk. It has historically been most commonly used as a term to describe declines in muscle mass and function (i.e. acute sarcopenia). However, declines in physical function do not occur in isolation, and it is recognised that cognitive deconditioning (defined by delayed mental processing as part of a spectrum with fulminant delirium at one end) is commonly encountered by patients in hospital. Whilst the term 'deconditioning' is descriptive, it perhaps leads to under-emphasis on the inherent organ dysfunction that is associated, and also implies some ease of reversibility. Whilst deconditioning may be reversible with early intervention strategies, the long-term effects can be devastating. In this article, we summarise the most recent research on this topic including new promising interventions and describe our recommendations for implementation of tools such as the Frailty Care Bundle.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575172","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}
Age and ageingPub Date : 2024-11-01DOI: 10.1093/ageing/afae245
Hao Xiang, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin
{"title":"Clinical biomarker-based biological ageing and the risk of adverse outcomes in patients with chronic kidney disease.","authors":"Hao Xiang, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin","doi":"10.1093/ageing/afae245","DOIUrl":"10.1093/ageing/afae245","url":null,"abstract":"<p><strong>Objective: </strong>Patients with chronic kidney disease (CKD) show features of premature ageing. We aimed to evaluate the association between biological ageing and adverse outcomes, including end-stage kidney disease (ESKD), cardiovascular diseases (CVD) and all-cause mortality, in patients with CKD.</p><p><strong>Methods: </strong>23 435 participants with CKD and free of related adverse outcomes at baseline from the UK Biobank were included. Leukocyte telomere length (LTL) was measured by quantitative polymerase chain reaction assay. Clinical biomarker-based biological ages were quantified using Klemera-Doubal method biological age (KDM-BA) and PhenoAge algorithms.</p><p><strong>Results: </strong>During a median follow-up of 12 years, 3417 incident CVD, 383 incident ESKD and 3195 all-cause mortality were recorded. Per SD increment of KDM-BA acceleration was associated with a 56% [95% confidence interval (CI): 41%-73%], 26% (95% CI: 21%-31%) and 39% (95% CI: 34%-44%) increase in the risk of incident ESKD, incident CVD and all-cause mortality, respectively. Similar results were found for PhenoAge acceleration. LTL (per SD increment) was inversely associated with the risk of incident CVD [hazard ratio (HR): 0.96, 95% CI: 0.92-0.99] and all-cause mortality (HR: 0.94, 95% CI: 0.91-0.98) and was not significantly associated with the risk of incident ESKD (HR: 0.96, 95% CI: 0.86-1.06). Adding KDM-BA acceleration or PhenoAge acceleration, but not LTL, to the traditional validated clinical prediction models significantly improved the predictive performance for incident ESKD, all-cause mortality and CVD.</p><p><strong>Conclusion: </strong>In patients with CKD, both KDM-BA acceleration and PhenoAge acceleration were associated with an increased risk of ESKD, CVD and all-cause mortality, and KDM-BA or PhenoAge may be a better predictor on adverse outcomes than LTL.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 11","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612399","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}
Age and ageingPub Date : 2024-10-24DOI: 10.1093/ageing/afae233
Chetna Malhotra
{"title":"Reimagining and rebranding advance care planning","authors":"Chetna Malhotra","doi":"10.1093/ageing/afae233","DOIUrl":"https://doi.org/10.1093/ageing/afae233","url":null,"abstract":"Advance care planning (ACP) has traditionally aimed at ensuring that patients’ end-of-life (EOL) wishes are understood and respected. However, recent literature raises concerns about its effectiveness, with many trials indicating that ACP does not significantly improve goal-concordant care, enhance quality of life or reduce healthcare costs. This is because patients’ future decisions are influenced by their transient preferences due to projection bias. To remain relevant, ACP requires a radical shift in perspective, implementation and branding. First, ACP’s mission must be redefined with a focus on: Educate, Share and Prepare. This perspective emphasises ongoing conversations about patient health and illness, sharing of patients’ current values and goals of care and preparation for the future, rather than making definitive future decisions. Second, ACP should be integrated into routine care, normalising these discussions. Simplifying ACP processes and shifting incentives to support shared responsibility among stakeholders can enhance integration. Last, rebranding ACP as ‘Advance Care Preparation’ can clarify its purpose, distinguishing it from EOL planning and increasing its uptake. This rebranding ensures that ACP meets the evolving needs of patients and their families, ultimately enhancing the quality of care and patient satisfaction. These changes in perspective, implementation and branding can transform ACP into a valuable tool for delivering compassionate, patient-centred healthcare, making it relevant to all individuals.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489743","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}
Age and ageingPub Date : 2024-10-24DOI: 10.1093/ageing/afae235
Brittany Nocivelli, Fiona Wood, Kerenza Hood, Carolyn Wallace, Victoria Shepherd
{"title":"“Research happens a lot in other settings—so why not here?” A qualitative interview study of stakeholders’ views about advance planning for care home residents’ research participation","authors":"Brittany Nocivelli, Fiona Wood, Kerenza Hood, Carolyn Wallace, Victoria Shepherd","doi":"10.1093/ageing/afae235","DOIUrl":"https://doi.org/10.1093/ageing/afae235","url":null,"abstract":"Background Underrepresentation of care home residents in research has resulted in a poorer evidence base for health care in care homes. Fewer opportunities to take part in research, as well as assumptions made by others about their interest or wishes, creates challenges for residents’ inclusion in research. Early discussions about research preferences and wishes may be beneficial. This qualitative study aimed to explore stakeholders’ views about how care home residents can be supported to communicate their wishes about research participation. Method Semi-structured interviews were conducted with 25 stakeholders: care home residents (n = 5), relatives (n = 5), care home staff (n = 5), other health and social care professionals who work with care homes (n = 6), and care home researchers (n = 4). Interviews were conducted virtually or face-to-face and data were analysed using thematic analysis. Results Views about resident research participation, the barriers and facilitators to their inclusion, and the role of advance research planning were iteratively organized into three themes: (i) We’re of no value to research; (ii) Research is difficult; and (iii) Advance research planning: good in theory, challenging in practice. Subthemes were also identified, and findings were discussed with a Patient and Public Involvement group for additional reflections. Conclusions Stakeholders identified a number of barriers to including care home residents in research, including knowing their preferences about research. The development of interventions to facilitate communication that can be adapted to individuals’ requirements are needed to support discussions and decision-making with care home residents about wishes and preferences for future research participation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"97 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489744","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}
Age and ageingPub Date : 2024-10-18DOI: 10.1093/ageing/afae229
Bob van de Loo, Martijn W Heymans, Stephanie Medlock, Ameen Abu-Hanna, Nathalie van der Velde, Natasja M van Schoor
{"title":"Retrospective evaluation of the world falls guidelines-algorithm in older adults","authors":"Bob van de Loo, Martijn W Heymans, Stephanie Medlock, Ameen Abu-Hanna, Nathalie van der Velde, Natasja M van Schoor","doi":"10.1093/ageing/afae229","DOIUrl":"https://doi.org/10.1093/ageing/afae229","url":null,"abstract":"Background The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own. Methods We included data from 1509 adults aged ≥65 years from the population-based Longitudinal Aging Study Amsterdam. The outcome was ≥1 fall during 1-year follow-up, which was ascertained using fall calendars. The screening tools’ items were retrospectively operationalized using baseline measures, using proxies where necessary. Results Sensitivity ranged between 30.9–48.0% and specificity ranged between 77.0–88.2%. Operationalizing the algorithm with the 3KQ instead of fall history yielded a higher sensitivity but lower specificity, whereas operationalization with the Clinical Frailty Scale (CFS) classification tree instead of Fried’s frailty criteria did not affect predictive performance. Compared to the WFG algorithm, the AGS/BGS algorithm and fall history on its own yielded similar predictive performance, whereas the 3KQ on their own yielded a higher sensitivity but lower specificity. Conclusion The WFG algorithm can identify patients at risk of a fall, especially when the 3KQ are included in its operationalization. The CFS and Fried’s frailty criteria may be used interchangeably in the algorithm’s operationalization. The algorithm performed similarly compared to other screening tools, except for the 3KQ on their own, which have higher sensitivity but lower specificity and lack clinical recommendations per risk category.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"233 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449495","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}
Age and ageingPub Date : 2024-10-14DOI: 10.1093/ageing/afae228
Hendry Anne
{"title":"Realising the right to rehabilitation—commentary on ‘reablement, rehabilitation, recovery: everyone’s business’","authors":"Hendry Anne","doi":"10.1093/ageing/afae228","DOIUrl":"https://doi.org/10.1093/ageing/afae228","url":null,"abstract":"Rehabilitation is a core component of comprehensive geriatric assessment and should be central to integrated care and support across the whole system. Yet access barriers and ageist practices still prevail within many rehabilitation services. This commentary reflects on a report and recommendations published by the British Geriatrics Society in May 2024. As lead author for the report, I share my personal reflection on the key messages and take this opportunity to thank the multidisciplinary contributors. Reablement, Rehabilitation, Recovery: everyone’s business describes why rehabilitation matters to older people and their caregivers. It provides evidence and examples of practice at different care touchpoints and makes the case that rehabilitation is everyone’s business and knows no boundaries, whether by condition, profession, care setting or taxonomy. The report sets out 12 key actions for health and care systems to deliver effective and integrated rehabilitation as a right for all older people, wherever and whenever they need it. To realise that right, health and care professionals must work together, and with their local community partners, to build capacity and capability for reablement, rehabilitation and recovery across the whole workforce. With population ageing and many more people living with frailty or multimorbidity, there is an urgent need for greater investment in rehabilitation to prevent, delay or reduce disability, caregiver burden and demand for long-term care. This timely BGS report should be essential reading for all who plan, commission, provide or assure health and care services for older people.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"88 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142431374","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}