Age and ageing最新文献

{"title":"Exploring clinical reasoning in physical and occupational therapists treating frail older adults in skilled nursing facilities: a Delphi study.","authors":"Thomas Bloch, Kelly Melekis, Mathew Failla, Reuben Escorpizo","doi":"10.1093/ageing/afag293","DOIUrl":"10.1093/ageing/afag293","url":null,"abstract":"<p><p>Frailty is highly prevalent in skilled nursing facilities (SNFs), yet little is known about how physical and occupational therapists (PTs/OTs) apply clinical reasoning (CR) when designing and progressing EPs for frail older adults. This study used a three-round Delphi method (DM) to generate expert consensus on the reasoning strategies therapists employ in SNF practice. Licensed PTs and OTs from the USA and Canada were recruited through professional directories and completed iterative surveys focused on assessment, goal-setting and intervention adaptation. Round 1 consisted of open-ended questions analysed through thematic coding; Rounds 2 and 3 involved Likert-scale ratings of synthesised statements, with consensus defined as ≥75% agreement. Forty-four therapists participated in Round 1, with 39 completing all rounds (89% retention). Participants represented a wide range of experience levels and both professional disciplines. Five core themes reached consensus: (i) engagement in therapy, emphasising meaningful, patient-centred activities to enhance motivation; (ii) mobility and movement confidence, reflecting the importance of addressing fear of falling and psychological readiness; (iii) functional outcomes and endurance, prioritising activities aligned with real-world activities of daily living (ADLs) and stamina; (iv) pain and cognition, recognising daily fluctuations that require dynamic clinical adjustment and (v) task-specific interventions, integrating ADL-focused and dual-task activities to promote carryover and ecological validity. These findings illustrate the complexity and adaptability of therapist decision-making when treating frail older adults in SNFs. The themes highlight how PTs and OTs integrate patient goals, functional demands and fluctuating physical and cognitive status into individualised exercise planning. This study provides a foundation for developing frailty-focused education, clinical pathways and interdisciplinary guidelines to support high-quality rehabilitation in SNFs.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035887","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":"Measuring what matters: evaluating the psychometric properties of goal attainment scaling in a psychosocial dementia trial.","authors":"Jessica Budgett, Harriet Demnitz-King, Andrew Sommerlad, Nuriye Kupeli, Victoria Vickerstaff, Claudia Cooper","doi":"10.1093/ageing/afag260","DOIUrl":"10.1093/ageing/afag260","url":null,"abstract":"<p><strong>Background: </strong>It can be challenging to identify clinically meaningful, responsive primary outcomes for psychosocial intervention trials in people with dementia. Goal Attainment Scaling (GAS), a personalised, patient-generated outcome measure, enables individuals to define and evaluate progress toward meaningful goals. Evidence regarding its psychometric properties in dementia trials, however, remains limited.</p><p><strong>Objective: </strong>To evaluate the feasibility, reliability, and validity of GAS within the randomised controlled trial of NIDUS-Family (New Interventions in Dementia Study), a goal-based psychosocial intervention.</p><p><strong>Methods: </strong>302 people with dementia and family carer dyads collaboratively set baseline goals toward supporting the person with dementia to live well at home. In a psychometric evaluation guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework, we examined follow-up completion (measuring feasibility); rater agreement; intra-rater reliability; construct validity by assessing correlations between change in GAS and quality-of-life (DEMQOL-proxy and CarerQoL); and predictive validity by testing whether GAS change predicted living at home at 12 months.</p><p><strong>Results: </strong>GAS completion rates were 86% at 6 months and 82% at 12 months. GAS demonstrated excellent inter-rater (Intraclass Correlation Coefficient = 0.99) and intra-rater reliability (Cohen's kappa = 0.91). There were significant but weak positive correlations between GAS change and carer and person with dementia quality-of-life (r = 0.14-0.22). GAS change was associated with remaining at home (odds ratio 1.08 per point increase; P <.01).</p><p><strong>Conclusion: </strong>GAS is feasible, valid and reliable, so may be a sensitive and clinically meaningful candidate primary outcome for psychosocial dementia trials. Correlations with global quality of life were significant but modest, consistent with GAS capturing personalised rather than generic outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966205","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":"Existing validated tools for assessing intrinsic capacity and its components within a positive ageing framework: a scoping review and structured appraisal by the Multidisciplinary International Positive Ageing Group.","authors":"Yves Henrotin, Luis Agüera, Giovanni Briganti, Tommy Cederholm, Demirhan Diracoglu, Gianni Franco, Alfonso J Cruz-Jentoft, Karolina Piotrowicz, Virginia Boccardi, Sandrine Vandenput, Sofia Duque","doi":"10.1093/ageing/afag274","DOIUrl":"10.1093/ageing/afag274","url":null,"abstract":"<p><strong>Introduction: </strong>Preserving intrinsic capacity (IC) is central to healthy ageing. However, no consensus exists regarding validated multidimensional instruments suitable for assessing IC across the adult lifespan. This scoping review identified instruments used to assess IC and to evaluate their scientific validity, clinical relevance and usability.</p><p><strong>Methods: </strong>An updated literature search was conducted following the PRISMA-ScR guidelines in five databases for studies published between January 2022 and May 2025. This scoping review updates and expands upon a previously published comprehensive review. Nine experts independently evaluated all identified tools using predefined criteria: scientific validity, clinical relevance, usability in clinical practice, usability for self-assessment and suitability for adults aged <60 years.</p><p><strong>Results: </strong>A total of 61 studies describing 61 distinct IC assessment instruments were included. All five IC domains were represented, although coverage across domains was uneven. Instruments assessing sensory capacity were scarce and generally received lower ratings than those targeting other domains. Only the Generalized Anxiety Disorder-7 and EUROQOL-5D achieved the maximum expert score. Importantly, very few instruments were considered appropriate for assessing IC in adults younger than 60 years, limiting their potential use for early identification of functional decline and preventive interventions.</p><p><strong>Conclusions: </strong>Current IC assessment instruments show substantial heterogeneity in content, validity and usability, with important gaps in the assessment of sensory capacity and younger adults. The gaps identified in this scoping review suggest that the development and validation of a comprehensive, multidimensional IC assessment tool may be warranted.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011807","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: Symptoms provide predictive information on daily functioning beyond signs and diseases in middle-aged and older adults, particularly those with multimorbidity.","authors":"","doi":"10.1093/ageing/afag278","DOIUrl":"10.1093/ageing/afag278","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954638","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":"Emergency department revisits and hospital readmissions following a fall-related emergency department presentation in older adults: a systematic review and meta-analysis.","authors":"Chris Larue, Lotte Jonkman, Bjorn Winkens, Sofie Jansen, Nathalie van der Velde, Gideon H P Latten, Bart Spaetgens","doi":"10.1093/ageing/afag271","DOIUrl":"10.1093/ageing/afag271","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of emergency department (ED) visits in older adults, yet subsequent trajectories of acute care use remain poorly characterised. We aimed to estimate pooled proportions of ED revisits and hospital readmissions at multiple follow-up intervals within 1 year.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis (PROSPERO: CRD420251167449), we searched PubMed, Embase and Scopus from inception to 30 November 2025 for observational studies including adults aged ≥65 years presenting to the ED after an index fall. Eligible studies reported ED revisits and/or hospital readmissions within 1 year. Two reviewers independently screened studies, extracted data and assessed risk of bias using the Newcastle-Ottawa Scale. Random-effects meta-analyses of proportions were conducted for each follow-up interval.</p><p><strong>Results: </strong>Nineteen studies (20 publications) were included, with overall low to moderate risk of bias. The cumulative proportions of patients experiencing an ED revisit increased with longer follow-up, from 3.9% within 3 days to 8.8% within 7 days, 15.0% within 30 days and 21.7% within 90 days (single study), reaching 37.5% at 6 months and 41.3% at 12 months. Hospital readmissions similarly increased from 10.4% at 30 days to 30.4% at 6 months and 31.9% at 12 months (single study). Substantial heterogeneity was observed across several pooled analyses.</p><p><strong>Conclusion: </strong>A fall-related ED presentation is associated with substantial cumulative acute care use over the following year. Falls may represent an important marker of broader vulnerability and ongoing healthcare needs. Future research should identify patients at high risk of recurrent acute care use and determine whether targeted follow-up reduces recurrent ED visits and hospital readmissions.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966167","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":"Frailty index deficit interchangeability: an empirical test using random survival forests in adults with cardiovascular disease.","authors":"Jack Quach, Olga Theou, Kenneth Rockwood, Scott Kehler, Joanna Blodgett","doi":"10.1093/ageing/afag262","DOIUrl":"10.1093/ageing/afag262","url":null,"abstract":"<p><strong>Background: </strong>The frailty index (FI) assumes that deficits are interchangeable; the type of individual items matters less than the total count. Machine learning is increasingly used to create shorter FIs, often motivated by perceived barriers to collecting many items in clinical settings despite availability of electronic health records. We explored whether FI item selection matters when predicting mortality in adults living with cardiovascular disease (CVD).</p><p><strong>Methods: </strong>We analysed 3669 adults living with CVD from the National Health and Nutrition Examination Survey (1999-2018) with a 46-item FI. Cox and random survival forest models predicted all-cause and CVD-specific mortality using individual items or composite FI scores. Items were ranked by permutation importance. At each item count k (1-46), we compared the top k items as individual predictors, the top k items combined into a single FI and 200 FIs each built from randomly selected k items.</p><p><strong>Results: </strong>Models using 46 individual items outperformed composite FI approaches for both outcomes (C-index: 0.71 [0.69-0.74] vs 0.64-0.67). Importance-ranked FI performance peaked at ~10 items then declined. Randomly built FIs improved steadily, converging with the importance-ranked composites by ~35 items (all-cause) and 20 items (CVD). Analyses using imputation produced consistent results.</p><p><strong>Conclusions: </strong>When enough items are included, which specific items make up the FI has negligible influence on prediction. Combining items into a single score discards some prognostic information, but this trade-off maintains the generalisability that makes the FI practical. Short importance-ranked FIs benefit from avoiding dilution rather than capturing an optimal item set, and any such selection is outcome-specific and sample-dependent.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890693","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 the dynamics of crisis situations in care for community-dwelling older individuals-a qualitative study.","authors":"Dolly R E Haselager, Rosalinde K E Poortvliet, Miriam L Haaksma, Yvonne M Drewes, Oumaima Boulahfa, Hedwig M M Vos, Jacobijn Gussekloo","doi":"10.1093/ageing/afag288","DOIUrl":"10.1093/ageing/afag288","url":null,"abstract":"<p><strong>Background: </strong>Crisis situations in care for community-dwelling older individuals, where the capacity of existing care arrangements at home is suddenly and unsustainably exceeded, can lead to adverse outcomes, such as hospitalisation, institutionalisation and death. Understanding how these crisis situations arise and take shape may contribute to their prevention and mitigation.</p><p><strong>Objective: </strong>To investigate the dynamics through which crisis situations in care for community-dwelling older individuals develop and take shape, as reflected in the experiences of older individuals, informal caregivers and healthcare professionals.</p><p><strong>Methods: </strong>This qualitative study consisted of 45 semi-structured interviews about experiences with crisis situations among older individuals, informal caregivers and healthcare professionals from diverse disciplines, with two additional focus groups involving general practitioners. Data were analysed using thematic analysis.</p><p><strong>Results: </strong>The analysis yielded two main themes: 'Tipping points' and 'Progressive instability in care systems'. The first theme captures how tipping points mark the moment when remaining at home becomes untenable because the situation is unsafe, undignified or because an acute event requires medical attention. The second theme shows that older individuals are part of care systems that can become progressively unstable through various processes.</p><p><strong>Conclusion: </strong>Crisis situations in care for community-dwelling older individuals are systemic phenomena, developing through progressive instability in care systems and taking shape at tipping points, when these systems suddenly lose their balance. This systemic understanding of crisis dynamics may help healthcare professionals map key issues, recognise early instability and identify resilience, thereby supporting crisis prevention and management.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 9","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073212","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":"Slowing disease accumulation but persistent complexity: population-level multimorbidity dynamics in old age","authors":"Yuge Zhang,Marcus Ebeling,Katharina Schmidt-Mende,Sven Drefahl,Karin Modig","doi":"10.1093/ageing/afag268","DOIUrl":"https://doi.org/10.1093/ageing/afag268","url":null,"abstract":"Abstract Background Most research on multimorbidity has focused on individual disease trajectories, with less attention to how disease accumulation evolves at the population level as cohorts age. Understanding these dynamics is essential for planning care in ageing populations. This study aimed to characterize population-level trajectories of disease accumulation between ages 70 and 100 and quantify the contributions of survivorship, proximity to death and disease composition. Methods Using nationwide register data from Sweden, we examined disease accumulation between ages 70 and 100 amongst all individuals born in 1920–1922 who survived to age 70, assessing the roles of survivorship, proximity to death, disease composition. Results Multimorbidity increased substantially between ages 70 and 100. Disease accumulation accelerated up to age 80, stabilized between ages 80 and 90, and decelerated thereafter, although both disease burden and complexity continued to increase into extreme old age. By age 90, the mean number of diseases was 3.9 in men and 3.5 in women, and more than half of individuals aged ≥95 had five or more diseases. Most accumulation occurred during non-terminal years of life. Cardiovascular disease was the dominant contributor throughout, whilst musculoskeletal and neurosensorial diseases became increasingly important at advanced ages. Conclusion Multimorbidity continues to accumulate and diversify well into extreme old age. Although the pace of accumulation slows after age 90, disease burden and complexity continue to increase. These findings highlight that multimorbidity in late life is primarily driven during non-terminal years and increasingly characterized by complex, cross-system disease patterns, with important implications for geriatric care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"468 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922898","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":"Beyond single-drug indicators: the power of unsupervised phenotyping in mitigating medication-related harm.","authors":"Richard Woodman","doi":"10.1093/ageing/afag230","DOIUrl":"https://doi.org/10.1093/ageing/afag230","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663384","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":"Real-world effectiveness of SGLT2 inhibitors in adults aged 75 years or older: a target trial emulation.","authors":"Hisashi Noma, Atsushi Goto, Taiki Sugimoto, Hiroshi Sunada, Futoshi Oda, Megumi Maeda, Haruhisa Fukuda","doi":"10.1093/ageing/afag246","DOIUrl":"10.1093/ageing/afag246","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes, but evidence in adults aged ≥75 years remains limited, particularly compared with dipeptidyl peptidase-4 inhibitors (DPP-4i).</p><p><strong>Methods: </strong>We conducted a target trial emulation using linked administrative claims and health examination data in Japan. Individuals aged ≥75 years with type 2 diabetes who newly initiated an SGLT2i or DPP-4i were identified. Intention-to-treat (ITT) effects were estimated using inverse probability weighting, with a 1-month induction period for mortality, cardiovascular and renal outcomes.</p><p><strong>Results: </strong>The study included 8486 individuals (2204 SGLT2i users, 6282 DPP-4i users). After a 1-month induction period, SGLT2i initiation was associated with lower all-cause mortality (hazard ratio [HR] 0.677, 95% confidence interval [CI] 0.500-0.916) and lower risk of end-stage renal disease or dialysis (HR 0.374, 95% CI 0.157-0.890). No clear differences were observed for heart failure hospitalisation (HR 1.103, 95% CI 0.854-1.426) or myocardial infarction (HR 1.015, 95% CI 0.768-1.341) in the ITT analysis. Stroke occurred more frequently among SGLT2i users (HR 1.420, 95% CI 1.165-1.828), although this finding should be interpreted cautiously.</p><p><strong>Conclusions: </strong>Among adults aged ≥75 years with type 2 diabetes, SGLT2i initiation was associated with lower all-cause mortality and renal risk compared with DPP-4i initiation. The higher observed stroke risk requires cautious interpretation because residual confounding, competing mortality and heterogeneity in vulnerable older adults may contribute to this signal.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787054","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}