BMC Geriatrics最新文献

{"title":"Meaning in life: bidirectional relationship with depression, anxiety, and loneliness in a longitudinal cohort of older primary care patients with multimorbidity.","authors":"King Wa Tam, Dexing Zhang, Yiqi Li, Zijun Xu, Qiao Li, Yang Zhao, Lu Niu, Samuel Ys Wong","doi":"10.1186/s12877-025-05762-7","DOIUrl":"10.1186/s12877-025-05762-7","url":null,"abstract":"<p><strong>Background: </strong>Depression, anxiety and loneliness are common among older patients. As a potential psychological buffer against these challenges, meaning in life (MIL) remains underexplored in longitudinal studies within this population. This study aims to examine the longitudinal relationship of MIL with depression, anxiety, and loneliness among older adults with multimorbidity in Hong Kong.</p><p><strong>Methods: </strong>In a prospective cohort of 1077 primary care patients aged 60 or above with multimorbidity in Hong Kong, MIL was assessed using an item from the Chinese Purpose in Life test at baseline, the 1st follow-up (median: 1.3 years), and the 2nd follow-up (median: 3.1 years). Depression, anxiety, and loneliness were assessed using the Patient Health Questionnaire, Generalized Anxiety Disorder, and De Jong Gierveld Loneliness scales, respectively, at each time point. Cross-lagged relationships between MIL and these measures were examined using cross-lagged panel models.</p><p><strong>Results: </strong>Participants had an average age of 70.0 years, with 70.1% being female. Higher MIL predicted lower depression (β = -0.15), anxiety (β = -0.13), overall loneliness (β = -0.18), emotional loneliness (β = -0.15), and social loneliness (β = -0.16) at the 1st follow-up. Additionally, higher MIL predicted lower overall loneliness (β = -0.12), emotional loneliness (β = -0.11), and social loneliness (β = -0.10) at the 2nd follow-up. At baseline, higher depression (β = -0.21), overall loneliness (β = -0.15), emotional loneliness (β = -0.11), and social loneliness (β = -0.11), but not anxiety, predicted lower MIL at the 1st follow-up. At the 1st follow-up, depression (β = -0.23), anxiety (β = -0.16), overall loneliness (β = -0.10), and emotional loneliness (β = -0.11), but not social loneliness, predicted lower MIL at the 2nd follow-up.</p><p><strong>Conclusions: </strong>The findings suggest a bidirectional relationship between MIL and mental health outcomes in older patients with multimorbidity in Hong Kong. Emotional loneliness demonstrated a more consistent bidirectional association with MIL than social loneliness. Further research is needed to understand the underlying mechanisms and develop targeted interventions addressing both MIL and mental health problems.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"195"},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699515","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":"Accuracy of tongue strength, endurance, and pressure using Iowa oral performance instrument and predictors of dysphagia in community-dwelling older adults: a cross-sectional study.","authors":"Yen-Fang Chou, Chien-Mei Sung, Yu-Hao Chu, Kai-Jo Chiang, Ruey Chen, Kondwani Joseph Banda, Chiu-Kuei Lee, Melati Fajarini, Kuei-Ru Chou","doi":"10.1186/s12877-025-05859-z","DOIUrl":"10.1186/s12877-025-05859-z","url":null,"abstract":"<p><strong>Background: </strong>Decreased tongue strength, pressure, and endurance are key indicators in determining oropharyngeal dysphagia (OD). This study aimed to examine the accuracy of the Iowa Oral Performance Instrument (IOPI) in assessing tongue strength, endurance, and pressure, and to identify predictors of OD.</p><p><strong>Methods: </strong>In this study, we analyzed data of community-dwelling older adults (age ≥ 65 years) collected between March to December 2022. The accuracy for IOPI was examined with Receiver operating characteristic curve using area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) and optimal cutoff with Youden index (J). Bivariate and multivariate logistic regression analysis for predictors of OD were performed presenting odds ratio (OR) with 95% confidence interval (CI).</p><p><strong>Results: </strong>The cohort consisted of 85 older adults with mean age of 83.25 years (SD 6.76), of which 64 (75.3%) were female. The prevalence of OD using EAT-10 was 8.3%. Tongue strength demonstrated better diagnostic accuracy using anterior tongue strength (ATS): cut-off: 37.5 kPa (AUC: 0.79, Se: 0.86, and Sp: 0.65) and posterior tongue strength: cut-off: 31.5 kPa (AUC: 0.73, Se: 0.71, and Sp: 0.79). Tongue endurance demonstrated better diagnostic accuracy using anterior endurance target second (ATE-Target Sec): cut-off: 2.4 (AUC: 0.96, Se: 0.86, and Sp: 0.90), PTE-Target Sec: cut-off: 1.7 (AUC: 0.93, Se: 0.86, and Sp: 0.83), ATE-Target Max with cut-off: 34.4 kPa (AUC 0.81, Se = 0.86, and Sp = 0.64), and PTE-Target Max with cut-off: 29.5 kPa (AUC: 0.77, Se = 0.86, and Sp = 0.69). Tongue pressure revealed limited diagnostic accuracy using saliva swallowing pressure with cut-off: 23.3 kPa (AUC: 0.60) and effortful swallowing pressure with cut-off: 28.5 kPa (AUC: 0.62). Significant predictors for OD were frailty (3.02, 95%CI: 1.56-5.88), age (1.17, 95%CI: 1.01-1.35), nutritional status (0.72, 95%CI: 0.57-0.92), ATS (0.86, 95%CI: 0.77-0.97), ATE-Target Max (0.90, 95%CI: 0.84-0.97), PTE-Target Max (0.92, 95%CI: 0.86-0.99), ADL (0.91), IADL (0.67), and depression (1.32).</p><p><strong>Conclusions: </strong>The findings suggest that tongue strength and endurance, measured by IOPI, are more effective parameters than tongue pressure, with frailty, age, nutritional status, ATS, ATE-Target Max, PTE-Target Max, ADL, IADL, and depression being essential for early screening of OD in community-dwelling older adults.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"194"},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699501","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":"Relationship between masticatory function and sarcopenic obesity in community-dwelling older adults aged 75 or older: a cross-sectional study.","authors":"Hikaru Shiraki, Satoko Kakuta, Yumi Kimura, Masanori Iwasaki, Chihiro Masaki, Taizo Wada, Kozo Matsubayashi, Yasuko Ishimoto, Michiko Fujisawa, Kiyohito Okumiya, Ryuji Hosokawa, Ryota Sakamoto, Toshihiro Ansai","doi":"10.1186/s12877-025-05842-8","DOIUrl":"10.1186/s12877-025-05842-8","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between sarcopenic obesity and masticatory function is poorly understood. This study aims to explore this association in community-dwelling individuals aged 75 years or older.</p><p><strong>Methods: </strong>This study analyzed data from 236 community-dwelling adults aged 75 years or older. Masticatory function was assessed using spectrophotometric measurement of gum color differences before and after chewing color-changeable gum (ΔE^*ab). Participants were categorized into tertiles of masticatory function based on their ΔE*ab values. The tertiles were defined as low, intermediate, and high. Sarcopenic obesity was assessed using the Consensus statement of the Japanese Working Group on Sarcopenic Obesity. Bayesian multinomial logistic regression was employed to examine the relationship between masticatory function and sarcopenic obesity.</p><p><strong>Results: </strong>The prevalence rates for obesity, sarcopenia, and sarcopenic obesity were 15.3%, 24.2%, and 9.7%, respectively. After adjusting for covariates, participants with high masticatory function had a significantly lower posterior estimate of sarcopenic obesity (posterior estimate: -1.83 [95% credible interval: -3.66, -0.22]) and sarcopenia (posterior estimate: -1.97 [95% credible interval: -3.37, -0.72]) compared with participants with low masticatory function. However, no significant associations were observed between masticatory function and obesity.</p><p><strong>Conclusions: </strong>These findings suggest that high masticatory function is associated with a significantly lower prevalence of sarcopenic obesity in older adults.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"191"},"PeriodicalIF":3.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690984","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":"Network-based predictive models for artificial intelligence: an interpretable application of machine learning techniques in the assessment of depression in stroke patients.","authors":"Wenwei Zuo, Xuelian Yang","doi":"10.1186/s12877-025-05837-5","DOIUrl":"10.1186/s12877-025-05837-5","url":null,"abstract":"<p><strong>Background: </strong>Depression is a common complication after a stroke that may lead to increased disability and decreased quality of life. The objective of this study was to develop and validate an interpretable predictive model to assess the risk of depression in stroke patients using machine learning (ML) methods.</p><p><strong>Methods: </strong>This study included 1143 stroke patients from the NHANES database between 2005 and 2020. First, risk factors for depression in stroke patients were determined by univariate and multivariate logistic regression analysis. Next, five machine learning algorithms were used to construct predictive models, and several evaluation metrics (including area under the curve (AUC)) were used to compare the predictive performance of the models. In addition, the SHAP (Shapley Additive Explanations) method was used to rank the importance of features and to interpret the final model.</p><p><strong>Results: </strong>We screened seven features to construct a predictive model. Among the 5 machine learning models, the XGBoost (extreme gradient boosting) model showed the best discriminative ability, with an AUC of the ROC (receiver operating characteristic curve) in the test set of 0.746 and an accuracy of 0.834. In addition, the prediction results of the XGBoost model were interpreted in detail using the SHAP algorithm. We also developed a web-based calculator that provides a convenient tool for predicting the risk of depression in stroke patients at the following link: https://prediction-model-for-depression.streamlit.app .</p><p><strong>Conclusions: </strong>Our interpretable machine learning model serves as an auxiliary tool for clinical judgment, aimed at early and effective identification of depression risk in stroke patients.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"193"},"PeriodicalIF":3.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690983","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":"Robot-assisted exercise improves gait and physical function in older adults: a usability study.","authors":"Su-Hyun Lee, Eunmi Kim, Jinuk Kim, Hwang-Jae Lee, Yun-Hee Kim","doi":"10.1186/s12877-025-05811-1","DOIUrl":"10.1186/s12877-025-05811-1","url":null,"abstract":"<p><strong>Background: </strong>With increasing age, individuals are more likely to experience physical disabilities, functional declines, and mobility limitations. Wearable robots or exoskeletons are relatively new technologies that can help address these issues, reduce healthcare costs, and support home healthcare, decreasing the burden of chronic disease. The purpose of this study was to investigate the usability of Bot Fit after task-specific physical activities and functional gait training, as well as to examine the effects of a wearable hip exoskeleton, Bot Fit, on gait, physical function, and muscle strength in older adults living in residential care facilities.</p><p><strong>Methods: </strong>A total of 32 older adults living in residential care facilities were included in this uncontrolled study. All participants performed eight weeks of task-specific physical activities and functional gait training using Bot Fit, with three exercise sessions per week (24 sessions in total). They were assessed at three time points: pre-test (baseline, T0), mid-test (after the 12 exercise sessions, T1), and post-test (after the last exercise session, T2). Each assessment evaluated functional outcomes (10-m walk test [10MWT], timed up-and-go [TUG], 6-min walk test [6MWT], Berg balance scale [BBS], four-square step test [FSST], and geriatric depression scale-short form [GDS-SF]), as well as muscle strength of the lower extremities. After the post-test, the participants completed a questionnaire to evaluate Bot Fit usability.</p><p><strong>Results: </strong>A significant improvement was observed in all physical assessments, including the 10MWT, TUG, 6MWT, BBS, and FSST, from T0 to T2. It is noteworthy that 10MWT, TUG, and BBS also changed significantly from T0 to T1 and from T1 to T2. Muscle strength in hip flexion, hip extension, knee flexion, knee extension, ankle dorsiflexion, and ankle plantar flexion all improved significantly from T0 to T2, with knee flexion, knee extension, ankle dorsiflexion, and ankle plantar flexion showing significant improvements at all time points. Additionally, on the usability questionnaire, most participants provided positive feedback about their experience with Bot Fit.</p><p><strong>Conclusion: </strong>The findings of this study suggest that task-specific physical activity and functional gait training with Bot Fit have several key advantages for improving gait, physical function, and muscle strength in older adults living in residential care facilities. The findings support the application of Bot Fit to physical activity and functional gait training to improve age-related declines in physical function and muscle strength and to provide important insights into future robot-assisted exercise devices.</p><p><strong>Trial registration: </strong>URL: https://register.</p><p><strong>Clinicaltrials: </strong>gov/ . Unique identifier: NCT04610190 (10/26/2020).</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"192"},"PeriodicalIF":3.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690999","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: Developing a research agenda on NATure‑based and Animal‑assisted Intervention Strategies (NATAIS) in people with neurodegenerative diseases with a specific focus on social isolation and loneliness: a group concept mapping procedure.","authors":"I J N Declercq, R Leontjevas, M -J Enders-Slegers, M Molog, D L Gerritsen, K Hediger","doi":"10.1186/s12877-025-05835-7","DOIUrl":"10.1186/s12877-025-05835-7","url":null,"abstract":"","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"190"},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668618","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":"Gender differences in the association between elder abuse and pain with depression among older adults in India: insights from a cross-sectional survey.","authors":"Hemant Singh Gurjar, Anjna Kumari","doi":"10.1186/s12877-025-05836-6","DOIUrl":"10.1186/s12877-025-05836-6","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the association between elder abuse, pain with depression among older adults in India, with a focus on the interacting effect of gender. Elder abuse is a growing public health concern globally, and understanding its connection with pain and depression is crucial for prevention and intervention strategies, particularly in vulnerable demographic groups.</p><p><strong>Methods: </strong>Data were drawn from the nationally representative Longitudinal Ageing Study in India (LASI) survey conducted in 2017-18 with the total sample size of 73,396. Study sample based on individuals aged 60 years and above, consisted 31,902 older adults. This study combines two binary variables pain and depression symptoms into a composite binary variable Pain with depression (Yes/No). Pain was assessed by asking question to the participants whether they are often troubled with pain. Depression was evaluated using the Centre for Epidemiological Studies depression Scale known as (CES-D-10), using four categories of scale options. A range from 0 to 10 of composite score is obtained and individual who score more than 4 were taken as depressed. Logistic regression models and Chi-square test of significance were used to analyse the relationship between elder abuse and pain with depression, while controlling for socio-demographic, functional and behavioural factors. Interaction effects of gender were examined to assess differential abuse risk between older male and female.</p><p><strong>Results: </strong>The analysis revealed that 5.2% of older adults reported experiencing abuse, with a higher prevalence among female. Older adults with pain and depression were significantly more likely to face abuse, with female showing consistently higher odds of abuse compared to male. Specific groups, such as those aged 75 and above, unmarried, uneducated and living in rural areas were at greater risk.</p><p><strong>Conclusion: </strong>The study highlights the strong association between elder abuse, pain with depression, especially among older female. These findings underscore the need for targeted public health interventions among vulnerable groups such as older female, and future research to explore cross- national dynamics and underlying risk factors.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"189"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662357","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":"A meta-analysis of the impact of initial hemodialysis access type on mortality in elderly incident hemodialysis population.","authors":"Xinyuan Tian, Nan Hu, Di Song, Li Liu, Yuqing Chen","doi":"10.1186/s12877-025-05696-0","DOIUrl":"10.1186/s12877-025-05696-0","url":null,"abstract":"<p><strong>Background: </strong>Selecting the appropriate vascular access type for elderly patients before initiating hemodialysis presents a challenge, given their limited life expectancy and multiple comorbidities. This systematic review aims to evaluate whether initial arteriovenous access (AVa), including arteriovenous fistulas (AVF) and/or arteriovenous grafts (AVG), offers a benefit in reducing the risk of all-cause mortality compared to central venous catheters (CVC) for patients aged ≥ 65 years.</p><p><strong>Methods: </strong>We conducted searches in PubMed (from 1946 to March 20, 2023), Embase (from 1947 to 20 March 20, 2023), and the Cochrane Library to identify studies comparing the use of CVC with AVa as the initial vascular access in hemodialysis patients aged ≥ 65 years. The primary outcome of interest was all-cause mortality. We pooled the hazard ratio (HR) and 95% confidence intervals (CIs) of the included studies using a random-effect model. The Newcastle-Ottawa Scale was employed to assess the risk of bias for each included study.</p><p><strong>Results: </strong>Ten studies involving over 300,000 patients were included, all of which were retrospective cohort studies. Compared to AVa, the use of CVC as the initial dialysis access is associated with a higher incidence of all-cause mortality in patients aged ≥ 65 years (HR = 1.53, 95%CI = 1.41-1.67, I² = 74.9).</p><p><strong>Conclusion: </strong>In this analysis, we observed an increased risk of death in elderly patients initiating dialysis with CVC compared to those using AVa. However, the retrospective cohort studies included in this analysis are susceptible to selection bias, indicating that further randomized controlled trials are necessary to confirm these findings.</p><p><strong>Funding: </strong>This systematic review and meta-analysis were not funded.</p><p><strong>Registration: </strong>The protocol of this systematic review has been registered in the PROSPERO registry (CRD42023435577; https://www.crd.york.ac.uk/prospero ).</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"186"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662353","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":"Association between exposure to organophosphate esters and cognitive function in older adults in the United States: NHANES 2011-2014.","authors":"Baosheng Jiang, Ruipeng Lin, Tongyan Wang, Weikang Wang, Yuxin Lin, Manling Xie, Zhijian Hu, Qian Zhang","doi":"10.1186/s12877-025-05841-9","DOIUrl":"10.1186/s12877-025-05841-9","url":null,"abstract":"<p><strong>Background: </strong>Organophosphate esters (OPEs) are widely used as an alternative to the brominated flame retardant polybrominated diphenyl ethers. The effects of OPEs on the cognitive abilities of older adults remain unclear.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 2011-2014. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning test, the CERAD word recall test, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). OPE metabolites with detection rates above 50% were included in the study. Weighted multiple linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were used to examine the effects of individual and mixed exposures to OPE metabolites on cognitive function.</p><p><strong>Results: </strong>A total of 762 older adults were included. The weighted linear regression model revealed a positive association between Ln DPHP, Ln BDCPP, and Ln BCPP and the DSST score, while a negative association was observed between Ln DBUP and the DSST score. In the positive WQS model, the index was correlated with DSST score (β = 2.65, 95% CI: 0.40 ~ 4.90, P = 0.02), with DPHP having the highest weight. The results of BKMR analysis indicated a borderline statistical significance in the increase of DSST score when the mixture of OPEs is set to a specific 90th percentile compared to all mixture concentrations set to the median.</p><p><strong>Conclusions: </strong>Overall exposure to OPE metabolites are associated with improved cognitive function in older adults in the United States. Further prospective studies with large sample sizes are needed to confirm these results.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"188"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662355","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":"Key informants' perceptions of telehealth palliative care for people living with dementia in nursing homes.","authors":"Joan G Carpenter, Laura C Hanson, George Demiris, Nancy Hodgson, Mary Ersek","doi":"10.1186/s12877-025-05820-0","DOIUrl":"10.1186/s12877-025-05820-0","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown that palliative care delivered to people living with dementia (PLWD) in nursing homes (NHs) improves care quality and reduces potentially burdensome treatments. However, access to palliative care services in NHs is uncommon. Telehealth may extend the reach of specialty palliative care consultation, yet strategies for feasible and acceptable NH implementation remain unknown. During implementation of an embedded pragmatic pilot clinical trial for PLWD, we aimed to describe key informants' perceptions of a NH telehealth palliative care intervention.</p><p><strong>Methods: </strong>Guided by the Practical Implementation Sustainability Model (PRISM), we engaged key informants in 30-60-minute focus groups and individual semi-structured interviews to understand barriers and facilitators to implementation of a NH telehealth palliative care intervention in one NH. Interview prompts addressed contextual factors that influenced outcomes. Interviews were conducted and recorded via videoconference, transcribed, and analyzed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.</p><p><strong>Results: </strong>Participants (n = 14) included NH administrators and other leaders, palliative care providers, telehealth representatives, dementia advocates, a care partner, and a PLWD. Identified barriers to implementation included stigma surrounding dementia, palliative care, and NHs; multiple logistical pieces required to implement the intervention; inflexibility of palliative care providers to meet NH needs; and inability to assess residents in person. Facilitators included convenient, user-friendly and readily available telehealth equipment, and NH staff presence during visits. Outcomes most relevant to the key informants were increased goals of care conversations, improved symptom management and quality of life, and decreased health care utilization. Suggested adaptations included increased family engagement in the logistics of the intervention and strong NH advocacy.</p><p><strong>Conclusions: </strong>In this study, key informants provided feedback that barriers to implementing NH telehealth palliative care far outweighed the facilitators for uptake. Future work will focus on employing NH staff in user centered design to overcome barriers such as optimal timing for consults and/or scheduled consult days to fit NH workflow, assessing organizational readiness for implementing change, and identifying dementia-specific and palliative care education needs.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"187"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662359","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}