Age and ageing最新文献

{"title":"Ambulance responses to older adults who have fallen: a systematic review.","authors":"Imogen M Gunson, Chloé Barley, Andy Rosser, Laurna Bullock, Adam Lee Gordon, Tom Kingstone, Milica Bucknall","doi":"10.1093/ageing/afaf228","DOIUrl":"10.1093/ageing/afaf228","url":null,"abstract":"<p><strong>Background: </strong>Approximately 10% of emergency ambulance calls are for adults, 65 years and older, who have fallen. Structured management of this group could improve outcomes and cost-effectiveness. This review sought to synthesise evidence for ambulance-based care of older adults who had fallen and the associated impact on patient outcomes.</p><p><strong>Methods: </strong>Eligibility. Peer-reviewed primary evidence, assessing older adults (aged ≥ 65) who had fallen and received an ambulance response. Information sources. CINAHL (EBSCO), MEDLINE (Ovid), Embase (Ovid), HMIC (Ovid), Web of Science and AMBER were searched on 20 February 2025 with no date limit. Quality appraisal. Joanna Briggs Institute's critical appraisal tools. Synthesis. PRISMA reporting, with narrative synthesis using Synthesis Without Meta-analysis guidelines.</p><p><strong>Results: </strong>Three thousand and forty-nine unique studies were identified. Nine studies were included, ranging from low- to high-quality randomised cluster trials and mixed-methods, prospective and retrospective cohort studies.Patients whose care included fall-specific decision-making tools or referral pathways, were less likely to be conveyed to hospital and more likely to access alternative community healthcare. However, poor uptake of participating paramedics limits the impact on practice.Few fall response or referral schemes were reported in the literature; those that exist have improved outcomes for patients. Where national practice guidelines exist, these were generally adhered to. Patient social characteristics, such as living alone, were the main reason for guideline deviation.</p><p><strong>Discussion: </strong>Where fall pathways were implemented, outcomes improved, though implementation is contextual. Ambulance staff adhere to guidelines, but whether the guidelines reflect current presentations and treatment opportunities is unclear. Further research is required to establish generalisable approaches.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862012","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":"Time to routinely perform 4AT at the 'front door'; evidence informing policy and practice.","authors":"Judith S L Partridge,Jugdeep K Dhesi","doi":"10.1093/ageing/afaf213","DOIUrl":"https://doi.org/10.1093/ageing/afaf213","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"62 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766078","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":"Frailty assessed by a wrist-worn device can predict hospitalisation and mortality in middle-aged and older adults: a UK Biobank study","authors":"Yosuke Osuka, Lloyd L Y Chan, Matthew Brodie, Yoshiro Okubo, Stephen R Lord","doi":"10.1093/ageing/afaf210","DOIUrl":"https://doi.org/10.1093/ageing/afaf210","url":null,"abstract":"Background Digital gait biomarkers (DGBs) from wrist-worn devices may offer a simple, convenient method for assessing frailty; however, their clinical validity has not been sufficiently verified. This study aimed to determine whether frailty assessed using DGBs is not inferior to the Fried frailty phenotype for predicting hospitalisation and mortality. Methods This longitudinal study included 10 156 adults (aged 43–81 years) with complete Fried frailty phenotype and DGB data from the UK Biobank. DGBs were extracted using validated algorithms on raw data from wrist-worn accelerometers over 7 days. DGB frailty was derived from DGBs and the Fried frailty phenotype. Results First hospitalisations and deaths were followed for 4.4 ± 2.7 and 7.2 ± 0.7 years, respectively. In these periods, 6148 (60.5%) were hospitalised (44 277 person-years follow-up) and 270 (2.7%) died (73 312 person-years follow-up). Cox proportional hazards models, adjusting for confounders, showed that both Fried and DGB frailties were predictive of hospitalisation (hazard ratios and 95% confidence intervals [CIs]: 1.29 [1.13–1.47] versus 1.33 [1.17–1.52]) and mortality (1.63 [1.01–2.62] versus 1.77 [1.14–2.74]). The mean differences (DGB frailty–Fried frailty) and 95% CIs in Harrell’s C-index for hospitalisation and mortality were 0.000 [−0.002 to 0.001] and 0.002 [−0.004 to 0.009], respectively, with the lower limit of the 95% CIs exceeding the prespecified noninferiority margin (−0.1). Conclusion DGB-derived frailty predicted hospitalisation and mortality and was not inferior to the Fried frailty phenotype. These findings support the clinical validity and potential utility of wearable devices in the assessment of frailty in clinical practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"719 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755867","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":"Oestrogen replacement combined with resistance exercise in older women with knee osteoarthritis: a randomised, double-blind, placebo-controlled clinical trial.","authors":"Tomohiro Mitoma, Hikaru Ooba, Kasumi Takahashi, Tsunemasa Kondo, Tomohiro Ikeda, Yoko Sakamoto, Toshiharu Mitsuhashi, Jota Maki","doi":"10.1093/ageing/afaf224","DOIUrl":"10.1093/ageing/afaf224","url":null,"abstract":"<p><strong>Background: </strong>Interventions targeting physical function decline in older women with knee osteoarthritis (KOA) are vital for healthy ageing. The additive benefits of combining oestrogen replacement therapy (ERT) with resistance exercise remain unclear.</p><p><strong>Objective: </strong>To evaluate the additive effect of low-dose ERT on physical performance when combined with a muscle resistance exercise programme (MREP) in older women with KOA.</p><p><strong>Design: </strong>This is a placebo-controlled, double-blind, randomised clinical trial.</p><p><strong>Subjects: </strong>The subjects were community-dwelling women aged ≥65 years with chronic knee pain and KOA diagnosis.</p><p><strong>Methods: </strong>Participants completed a 3-month MREP and were randomised to receive daily low-dose transdermal ERT (oestradiol 0.54 mg/day) or placebo. Outcomes were assessed at baseline, postintervention and 12 months later. The primary outcome was change in 30-second chair stand test (CS-30) score. Secondary outcomes included muscle mass, knee extension strength, walking performance, metabolic indicators, knee pain scale and 12-item short-form health survey (SF-12). Between-group differences in CS-30 changes were analysed using a linear regression model based on the intention-to-treat principle.</p><p><strong>Results: </strong>Among 168 individuals screened, 75 participants (mean age 73.8 years, SD 5.8) were enrolled and randomised into an ERT group (n = 37) or a placebo group (n = 38). Baseline CS-30 scores were 14.81 (SD 3.95) in the ERT group and 15.58 (SD 3.48) in the placebo group. At 3 months, mean changes were 2.59 (SD 2.58) and 1.79 (SD 2.28) repetitions, respectively. The primary analysis showed no statistically significant between-group difference [regression coefficient: 0.81 (95% CI: -0.31, 1.92); P = .16]. Post hoc subgroup and sensitivity analyses suggested that benefits may exist among early-stage KOA participants. SF-12 mental health scores also improved significantly in the ERT group. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>ERT did not confer significant additive benefits to resistance exercise overall but may improve outcomes in early-stage KOA and mental health domains. These exploratory findings warrant further investigation.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833746","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":"Day and night nurse staffing levels and hospital-associated disability in older adults in Japan: a retrospective cohort study.","authors":"Noriko Morioka, Mutsuko Moriwaki, Christina Saville, Atsushi Miyawaki, Kiyohide Fushimi, Peter Griffiths","doi":"10.1093/ageing/afaf217","DOIUrl":"10.1093/ageing/afaf217","url":null,"abstract":"<p><strong>Background: </strong>Hospital-associated disability (HAD) in older adults often results from preventable factors. Nurse staffing at the ward level is a key modifiable factor in mitigating HAD.</p><p><strong>Objective: </strong>To investigate the relationship between nurse staffing shortfalls during typical day and night shifts and the risk of HAD in older adults in acute care hospitals.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>General medical or surgical wards in nine acute care hospitals in Japan.</p><p><strong>Subjects: </strong>Hospital admissions of patients aged ≥65 years.</p><p><strong>Methods: </strong>Electronic claims data and daily ward-level nursing rosters were used to measure nurse staffing shortfalls based on the patient-to-nurse ratio relative to the annual mean.</p><p><strong>Results: </strong>Among 57 498 hospital admissions [23 981 (41.7%) female, median age 76 (interquartile range [IQR] 71-76) years], 30 507 (70%) were functionally independent at admission. Functional deterioration occurred in 15 458 (26.9%) admissions. The median (IQR) patient-to-nurse ratio across the whole day was 6.11 (5.54-6.59), 3.70 (3.34-3.90) for the day shift, and 9.38 (8.57-10.37) for the night shift. The median (IQR) deviation from typical ward-level staffing was -0.21 (-0.64 to 0.20) for the whole day, -0.23 (-0.56 to 0.09) for the day shift, and 0.01 (-0.51 to 0.49) for the night shift. For each patient above the mean patient-to-nurse ratio, the risk of HAD increased by 7%.</p><p><strong>Conclusion: </strong>Attention to the deviations from the usual staffing levels for both day and night shifts may be important in efforts to reduce the risk of HAD in older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833741","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":"Moving geriatric medicine to healthy longevity with Integrated Care of Older People.","authors":"Vellas Bruno","doi":"10.1093/ageing/afae257","DOIUrl":"10.1093/ageing/afae257","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858791","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":"Efficiency and equity of community-based falls prevention pathways: a model-based health economic evaluation.","authors":"Joseph Kwon,Hazel Squires,Tracey Young","doi":"10.1093/ageing/afaf212","DOIUrl":"https://doi.org/10.1093/ageing/afaf212","url":null,"abstract":"BACKGROUNDThree pathways exist for community-based falls prevention: reactive (R), after a fall requiring medical attention; proactive (P), after professional referral of high-risk individuals; and self-referred (SR), voluntary intervention enrolment. The UK guidelines recommend scale-up of all three ['recommended care' (RC)], but scale-up of none ['usual care' (UC)], one (R, P, SR) or two (R+P, R+SR, P+SR) are potential options. This study aims to compare the options in terms of efficiency and equity.METHODSCost-utility analysis from the societal perspective over a 40-year horizon identified the optimal strategy based on efficiency alone. Probabilistic sensitivity analysis accounted for parameter uncertainty. Efficiency and equity were jointly evaluated by distributional cost-effectiveness analysis. Alternative scenarios assessed changes in frailty, cognitive impairment, intervention demand and GP access.RESULTSPublic sector cost-effectiveness threshold would need to exceed £30 000 per quality-adjusted life year (QALY) gained for RC to have the highest probability of being cost-effective. R and R+SR were cost-effective, with costs per QALY gained of £2365 (R versus UC) and £5516 (R+SR versus R). RC was cost-ineffective, incurring £34 258 per QALY gained versus R+SR. Other strategies were dominated. However, if decision-makers had the same relative health inequality aversion level as the English general public, RC was optimal in terms of efficiency and equity at threshold of £30 000 per QALY gained. Scenarios of worse geriatric health favoured RC.CONCLUSIONSBoth efficiency and relative health inequality need to be considered for the UK guideline-recommended falls prevention to be optimal versus other permutations of community-based strategies.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"57 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766002","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: Adherence to a Mediterranean diet and leisure-time physical activity are associated with reduced initiation of antidepressant, anxiolytic, antipsychotic and antiseizure drug use in older adults: a cohort study.","authors":"","doi":"10.1093/ageing/afaf240","DOIUrl":"10.1093/ageing/afaf240","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833738","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: 2764 Optimising blood sugar monitoring in frail diabetic inpatients.","authors":"","doi":"10.1093/ageing/afaf234","DOIUrl":"10.1093/ageing/afaf234","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833737","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: delving deeper into physical activity and frailty research.","authors":"Jagadish K Chhetri","doi":"10.1093/ageing/afaf238","DOIUrl":"https://doi.org/10.1093/ageing/afaf238","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 8","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939393","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}