Age and ageing最新文献

{"title":"Correction to: The effect of perioperative cognitive training on postoperative delirium in older patients undergoing total hip and knee arthroplasty: a prospective randomised trial.","authors":"","doi":"10.1093/ageing/afaf081","DOIUrl":"https://doi.org/10.1093/ageing/afaf081","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Pharmacological treatment of neuropsychiatric symptoms of dementia: a network meta-analysis.","authors":"","doi":"10.1093/ageing/afaf070","DOIUrl":"https://doi.org/10.1093/ageing/afaf070","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690381","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":"A smarter approach to fall prevention: insights for action.","authors":"Kim Delbaere","doi":"10.1093/ageing/afae291","DOIUrl":"https://doi.org/10.1093/ageing/afae291","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655618","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":"Fall risk stratification in older adults: low and not-at-risk status still associated with falls and injuries.","authors":"Manuel Montero-Odasso, Frederico Pieruccini-Faria, Surim Son, Daniela Cristina Carvalho de Abreu, Susan Hunter, Jia Qi Liu, Marissa Moore, Areej Hezam, Nathalie van der Velde, Tahir Masud, Jesper Ryg, Mirko Petrovic, Mark Speechley","doi":"10.1093/ageing/afaf064","DOIUrl":"10.1093/ageing/afaf064","url":null,"abstract":"<p><strong>Background: </strong>Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.</p><p><strong>Objective: </strong>To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Geriatric Medicine Clinics.</p><p><strong>Subjects: </strong>Community-dwelling older adults aged 65 and older.</p><p><strong>Methods: </strong>Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).</p><p><strong>Results: </strong>Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.</p><p><strong>Conclusions: </strong>Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727377","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":"Assessing and managing bone health and fracture risk in Parkinson's disease: the BONE PARK 2 protocol.","authors":"Katie C Naylor, Emma Tenis On, Sarah A Hardcastle, Veronica Lyell, Celia L Gregson, Emily J Henderson","doi":"10.1093/ageing/afaf052","DOIUrl":"10.1093/ageing/afaf052","url":null,"abstract":"<p><strong>Background: </strong>In Parkinson's disease (PD), the propensity to fall and the higher risk of osteoporosis converge yielding a high fracture risk. Updated National Osteoporosis Guideline Group (NOGG) guidance recommends that PD should trigger a risk assessment, for example using the FRAX tool, yet clinical pathways remain sub-optimal. To address this, we generated an algorithm for the assessment and management of bone health specifically in PD.</p><p><strong>Methods: </strong>Within the Proactive and Integrated Management and Empowerment in Parkinson's Disease randomised controlled trial (PRIME-UK RCT), bone-health metrics were collected, and all participants were offered a dual X-ray absorptiometry scan. The FRAX tool was used to obtain the 10-year probability of hip and major osteoporotic fracture (MOF), and the resulting NOGG risk-category recorded. Probabilities were recalculated including femoral-neck bone mineral density (FN-BMD) and/or with numeric adjustment for recurrent falls, and results compared.</p><p><strong>Results: </strong>Among 182 people with parkinsonism (mean age 73.8 years, 65% male, median disease duration 5 years), 28% reported a prior fragility fracture, and 40.7% recurrent falls over the previous year. 28.6% had MOF above NOGG intervention thresholds (IT); whilst 12.1% had a FN-BMD T-Score ≤ -2.5. Recalculation of FRAX with FN-BMD (n = 182) reduced fracture MOF and hip fracture probabilities; 12 (6.6%) deescalated below the IT, and 16 (8.8%) moved above the IT.</p><p><strong>Conclusions: </strong>This 2024 BONE-PARK algorithm is informed by both the latest NOGG Guidelines and novel findings in a 'real-world' population. The algorithm will aid bone health assessment for people with PD.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655583","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":"Oral health matters-guideline commentary for oral health for adults in care homes [NG48].","authors":"Mili Doshi, Daniel Gillway, Gerald McKenna","doi":"10.1093/ageing/afaf063","DOIUrl":"https://doi.org/10.1093/ageing/afaf063","url":null,"abstract":"<p><p>Older people's oral health often deteriorates upon admission to care homes, with a detrimental impact on their quality of life, general health and well-being. There are links between poor oral health, nutrition and hydration, community-acquired aspiration pneumoniae and frailty. In 2016, the National Institute for Health and Care Excellence issued guideline NG48 on oral health for adults in care homes to maintain and improve residents' oral health and ensure their timely access to dental treatment. The guideline was aimed at care home managers, staff caring for residents, dental services and local authorities. Reports undertaken by the Care Quality Commission after the release of NG48 found that implementation and awareness of the guidance were inadequate. Suboptimal oral health standards have been exacerbated further by the coronavirus disease 2019 pandemic, when dental access was further limited, resulting in substantial waiting times for dental care. As the care home population grows with increasing health complexities, further evidence is needed to help ensure that NG48 guidance is implemented to make it standard practice. Outcomes from oral health improvement programmes and high-quality research in care homes are required to support further investment for this underserved population. Geriatricians within the community and multidisciplinary teams should include oral health as part of the comprehensive geriatric assessment for care home residents.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727406","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":"Unconventional exercises for motor function in Parkinson's disease: an umbrella review of meta-analyses.","authors":"Jiongliang Zhang, Minmin Wu, Xinlei Hou, Wenjing Song, Jinting Li, Lili Teng, Xinyue Li, Donghui Yu, Jiguang Pan, Luwen Zhu","doi":"10.1093/ageing/afaf062","DOIUrl":"https://doi.org/10.1093/ageing/afaf062","url":null,"abstract":"<p><strong>Background: </strong>Unconventional exercises were initially used in the clinical treatment of Parkinson's disease (PD). However, clarity regarding their efficacy and credibility in clinical settings is lacking.</p><p><strong>Objectives: </strong>To summarise and evaluate the effectiveness of various unconventional exercises on motor function in people with PD (PwPD).</p><p><strong>Methods: </strong>We searched multiple databases up to 31 July 2024, for relevant randomised controlled trials to identify associations between nontraditional exercise and PD outcome evaluations and meta-analyses. The effect sizes were recalculated as mean difference or standardised mean difference with 95% confidence interval and prediction interval. Systematic review quality was assessed using A MeaSurement Tool to Assess systematic Reviews 2, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessments, Developments, and Evaluations system.</p><p><strong>Results: </strong>We included 39 associations from nine meta-analyses. Outcomes of PD motor function, including motor impairment, balance, walking and endurance, were examined. Of the 39 associations, 25 were statistically significant, and one was supported by high-certainty evidence. Robotic-assisted gait training improved motor function compared with conventional interventions. Nine associations of significance were supported by moderate-certainty evidence. Baduanjin, exergaming rehabilitation and dancing also showed significant improvements in motor function.</p><p><strong>Conclusions: </strong>Unconventional exercises demonstrated advantages for PwPD compared to conventional exercises and passive interventions. However, these results should be cautiously interpreted due to variations across studies and differing certainty levels. More high-quality randomised controlled trials are needed to strengthen the evidence base for these interventions in clinical application.</p><p><strong>Systematic review registration: </strong>PROSPERO; identifier: CRD42024555058.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690538","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":"Process evaluation in a randomised controlled trial of DREAMS-START (dementia related manual for sleep; strategies for relatives) for sleep disturbance in people with dementia and their carers.","authors":"Sarah Amador, Gill Livingston, Mariam Adeleke, Julie Barber, Lucy Webster, Hang Yuan, Sube Banerjee, Ankita Bhojwani, Georgina Charlesworth, Christopher Clarke, Caroline Connell, Colin A Espie, Ruochen Gan, Lina Gonzalez, Rossana Horsley, Rachael M Hunter, Simon D Kyle, Malvika Muralidhar, Liam Pikett, Malgorzata Raczek, Marija Taneska, Zuzana Walker, Zuyu Wang, Penny Rapaport","doi":"10.1093/ageing/afaf053","DOIUrl":"10.1093/ageing/afaf053","url":null,"abstract":"<p><strong>Introduction: </strong>DREAMS-START is a multicomponent intervention targeting sleep disturbance in people with dementia. To enhance understanding of the DREAMS-START randomised controlled trial, which showed improved sleep in the intervention compared to the control arm, we conducted a process evaluation exploring (i) DREAMS-START delivery, (ii) behaviour change mechanisms and (iii) contextual factors impacting outcomes.</p><p><strong>Methods: </strong>Mixed-methods design. We measured intervention adherence, fidelity and additional therapeutic process measures. We interviewed a sub-sample of intervention arm family carers and facilitators delivering DREAMS-START. We analysed data thematically guided by a prespecified theory of change logic model informed by the Theoretical Domains Framework. We measured movement using an actigraph worn by the person with dementia at baseline and at four- and eight-month follow-ups to explore potential mechanisms of action.</p><p><strong>Results: </strong>Attendance was good (82.8% attended ≥4/6 sessions). Mean fidelity score (95.4%; SD 0.08) and median score for all four process measures assessed (5/5; IQR 5-5) were high. We interviewed 43/188 family carers and 9/49 DREAMS-START facilitators. We identified three overarching themes aligned with our model: (i) knowledge and facilitation enable behaviour change, (ii) increasing sleep pressure and developing skills to manage sleep disturbances and (iii) Establishing a routine and sense of control. We were unable to collect sufficient data for pre-specified actigraphy analyses.</p><p><strong>Conclusion: </strong>Despite competing demands, carers attended DREAMS-START. It promoted behaviour change through supportive in-session reflection, increasing carer knowledge and skills. This was embedded between sessions and actions were positively reinforced as carers experienced changes. Results will inform future implementation in clinical services.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673126","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: a randomised double-blind placebo-controlled trial-the MIRAGE study.","authors":"Patrick V-Q Nguyen, Thien T Dang-Vu, Geneviève Forest, Sophie Desjardins, Marie-France Forget, Thien T Vu, Quoc D Nguyen, Edouard Kouassi, Philippe Desmarais","doi":"10.1093/ageing/afaf050","DOIUrl":"https://doi.org/10.1093/ageing/afaf050","url":null,"abstract":"<p><strong>Background: </strong>Mirtazapine promotes sleep by blocking serotonin and histaminergic receptors and is often used off-label to treat chronic insomnia. However, its efficacy remains to be demonstrated in a clinical trial. The MIRAGE study aims to determine the efficacy and safety of mirtazapine in older patients with chronic insomnia.</p><p><strong>Methods: </strong>This was a double-blind, randomised, placebo-controlled trial in a geriatric outpatient clinic of a teaching hospital. Adults aged 65 years and older with chronic insomnia were included. Sixty participants were randomised in a 1:1 ratio to receive mirtazapine 7.5 mg or a matching placebo for 28 days. The primary efficacy endpoint was the mean change in the Insomnia Severity Index (ISI) score from baseline to 28 days post-treatment. The primary safety endpoints included any adverse events reported during the clinical trial and all adverse events leading to premature discontinuation.</p><p><strong>Results: </strong>Mirtazapine was superior to placebo on the primary outcome measure, subjective wake after sleep onset, total sleep time and sleep efficiency. After 28 days, the mean change in ISI score was significantly greater in the mirtazapine group (-6.5 [95%CI; -8.3 to -4.8]) compared to the placebo group (-2.9 [95%CI; -4.4 to -1.4]), with a p-value of 0.003. No participant experienced severe adverse events. A total of 6 participants in the mirtazapine group and 1 participant in the placebo group discontinued their treatment due to adverse events.</p><p><strong>Conclusion: </strong>Mirtazapine reduces chronic insomnia symptoms in older people. However, its use may be limited by mild but clinically relevant adverse events. (clinicaltrials.gov NCT05247697).</p><p><strong>Impact statement: </strong>This is the first randomised, double-blind, placebo-controlled trial on the efficacy and safety of Mirtazapine in older adults with chronic insomnia. Our findings show that a 28-day treatment with mirtazapine, compared to placebo, significantly reduces insomnia severity, as measured by the Insomnia Severity Index. Despite the current lack of robust evidence, mirtazapine is widely prescribed by clinicians to treat insomnia in older adults with chronic insomnia. Publishing our study will facilitate the broad dissemination of this critical information, helping clinicians more effectively treat their older patients.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707917","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":"Monitoring the effects of medications in residential aged care (nursing home) using digital health technologies: insights from the ReMInDAR and ADEPT projects.","authors":"Renly Lim, Monique Boord, Julian Soriano, Rebecca Bilton, Elizabeth E Roughead","doi":"10.1093/ageing/afaf019","DOIUrl":"https://doi.org/10.1093/ageing/afaf019","url":null,"abstract":"<p><p>The adoption of technology, particularly for monitoring the effects of medications in residential aged care (nursing home), has been slow. Ageing populations have led to increased demand for residential aged care globally, resulting in a growing imperative to implement technological solutions to meet the complex healthcare and medication needs of older people in residential aged care. This commentary explores the potential for and the challenges associated with implementing technological interventions within residential aged care to improve monitoring of medication effects. Drawing on insights from two implementation trials, specifically the Reducing Medicine-induced Deterioration and Adverse Reactions and A Digitally Enabled Pharmacist Service to detecT medicine harms in residential aged care, we discuss the unique challenges and opportunities arising from the real-world applications of digital technologies for medication safety in aged care.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584365","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}