BMC Geriatrics最新文献

{"title":"Dying in residential care homes during the early COVID-19 pandemic: a qualitative interview study.","authors":"Nancy Preston, Zoë Cockshott, Siân Russell, Rachel Stocker, Jo Knight, Suzanne Mason, Barbara Hanratty","doi":"10.1186/s12877-025-05779-y","DOIUrl":"10.1186/s12877-025-05779-y","url":null,"abstract":"<p><strong>Background: </strong>Early in the COVID-19 pandemic, care homes (long-term care facilities) globally were severely impacted in many ways, including end-of-life care and death of residents. They experienced significantly elevated mortality rates amongst residents, compounded by restrictions on support from external healthcare and specialist palliative care providers. Family access to dying residents was often severely restricted. This paper explores experiences of deaths, dying and end-of-life care in care homes during the first year of the pandemic (Spring 2020-2021).</p><p><strong>Methods: </strong>As part of a wider study of experiences in care homes in Northern England during the early pandemic, we conducted semi-structured interviews with care home staff (16), residents (3), family members (5) and health service staff (10). Interviews were analysed using reflexive thematic analysis, this secondary analysis focusing on experiences of death and dying over the period.</p><p><strong>Results: </strong>Thematic analysis generated three key themes: (1) Preparing for large scale deaths: Care home staff reported a sense of foreboding at requirements to prepare for large scale resident deaths, sometimes feeling left with minimal external support to manage this, and uneasy about the rapid roll-out of emergency care planning to residents; (2) Balancing support and policing visiting during the terminal phase: The requirement to restrict access for family members when their relatives were dying was experienced as distressing for both family members and care home staff; and, (3) Distress surrounding deaths for staff and families: Care home staff were distressed by the frequency and speed of deaths that they witnessed when their care home had a COVID-19 outbreak. Family separation near time of death was a source of distress for everyone involved, with suggestions that this led to regrets in bereavement for family members, and moral distress in staff.</p><p><strong>Conclusions: </strong>The experience of death and dying in care homes in the early waves of the COVID-19 pandemic was extremely challenging for care home staff and family members. Our analysis suggests that the ramifications of stringent visitation policies and the consequent distress may shape experiences in bereavement. Monitoring for longer term consequences, such as prolonged grief and moral injury, should be a priority.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"126"},"PeriodicalIF":3.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11854402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490737","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":"Comparative clinical frailty scale and hospital frailty risk score in identifying frailty and predicting mid-term outcomes in older patients with acute coronary syndrome: a multicenter cohort study in Vietnam.","authors":"Tan Van Nguyen, Huy Minh Tran, Trinh Kim Thi Ngo","doi":"10.1186/s12877-025-05690-6","DOIUrl":"10.1186/s12877-025-05690-6","url":null,"abstract":"<p><strong>Background: </strong>We aimed to compare the agreement between two common frailty assessment tools, Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), and their ability to predict mid-term adverse outcomes in older patients admitted with acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>We conducted a prospective analysis of patients aged ≥ 60 admitted with ACS at multiple centers in Vietnam between July 2022 and June 2023. A cross-tabulation method was used to describe the correlation between CFS and HFRS. To test the predictive accuracy of HFRS for identifying patients with frailty according to CFS, we evaluated the area under the curves of receiver operating characteristic (ROC) analysis. Youden J index was used to identify a new optimal probability threshold for HFRS. We employed Cox regression models to investigate the association between frailty assessed by CFS, HFRS (using both old and new cut-offs), and 9-month mortality.</p><p><strong>Results: </strong>We included 504 older patients admitted with ACS (median age 72.7 years; male: 59.9%). The correlation between CFS and HFRS was fair (AUC = 0.787, p < 0.010). HFRS had a sensitivity of 39.7% and a specificity of 79.2% to detect frailty based on CFS classification. The new optimal probability threshold of HFRS (≥ 1.15 points) improved the instrument's performance with a significantly higher sensitivity of 90.2%. While frailty categorized by HFRS with the original cut-off did not impact mid-term all-cause and cardiovascular mortality, frailty according to CFS and HFRS with the new threshold was shown to be a predictor of mid-term all-cause and cardiovascular mortality (HR = 4.48, p < 0.001 vs. HR = 2.29, p = 0.001; HR = 5.19, p < 0.001 vs. HR = 1.99, p = 0.020).</p><p><strong>Conclusions: </strong>Although a fair correlation existed between the CFS and the HFRS in older patients with ACS, HFRS demonstrated limited predictive validity for mid-term mortality. We advocate for a revised cutoff (HFRS ≥ 1.15 points) to enhance its sensitivity and predictive accuracy. Future research should prioritize the integration of additional clinical biomarkers and conducting longitudinal studies to assess the efficacy of targeted interventions informed by frailty scores, ultimately striving to improve outcomes in this vulnerable population.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"125"},"PeriodicalIF":3.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490734","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":"Associations of frailty and cognitive impairment with all-cause and cardiovascular mortality in older adults: a prospective cohort study from NHANES 2011-2014.","authors":"An-Bang Liu, Yan-Xia Lin, Guan-Ying Li, Ting-Ting Meng, Peng Tian, Jian-Lin Chen, Xin-He Zhang, Wei-Hong Xu, Yu Zhang, Dan Zhang, Yan Zheng","doi":"10.1186/s12877-025-05752-9","DOIUrl":"10.1186/s12877-025-05752-9","url":null,"abstract":"<p><strong>Background: </strong>The global aging trend exacerbates the challenge of frailty and cognitive impairment in older adults, yet their combined impact on health outcomes remains under-investigated. This study aims to explore how frailty and psychometric mild cognitive impairment (pMCI) jointly affect all-cause and cardiovascular disease (CVD) mortality.</p><p><strong>Methods: </strong>The cohort study we examined 2,442 participants aged ≥ 60, is the secondary analysis from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Frailty was quantified using a 49-item frailty index, while pMCI was determined by three composite cognition scores one standard deviation (SD) below the mean. The associations between frailty, pMCI, comorbidity, and mortality were assessed using weighted Cox proportional hazards models.</p><p><strong>Results: </strong>Of the participants, 31.37% were frail, 17.2% had pMCI, and 8.64% exhibited both conditions. The cohort was stratified into four groups based on frailty and pMCI status. After a median follow-up period of 6.5 years, frail individuals with pMCI had the highest all-cause (75.23 per 1,000 person-years) and CVD (32.97 per 1,000 person-years) mortality rates. Adjusted hazard ratios (HRs) for all-cause (3.06; 95% CI, 2.05-4.56) and CVD (3.8; 95% CI, 2.07-6.96) mortality were highest in frail older adults with pMCI compared to those who were non-frail without pMCI.</p><p><strong>Conclusion: </strong>Our study highlights the ubiquity of frailty and cognitive impairment in older adults and underscores the heightened risk of mortality associated with their coexistence. These findings suggest the critical need for proactive screening and management of frailty and cognitive function in clinical practice to improve outcomes for the older adults.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"124"},"PeriodicalIF":3.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476006","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":"Freedom of movement and health of nursing home residents with dementia: an exploratory cross-sectional study.","authors":"Suzan P van Liempd, Sascha R Bolt, Katrien G Luijkx","doi":"10.1186/s12877-025-05774-3","DOIUrl":"10.1186/s12877-025-05774-3","url":null,"abstract":"<p><strong>Background: </strong>Having more freedom of movement may relate to better health in nursing home (NH) residents with dementia. Research that tests whether residents in NHs with more freedom of movement are healthier compared to residents in closed NHs is scarce. Also, existing research on freedom of movement does not consider the diverse dimensions of health. This study explored health differences between two groups of nursing home residents with dementia with different levels of freedom of movement.</p><p><strong>Methods: </strong>We used a quantitative cross-sectional design to investigate differences in health between two groups of NH residents with dementia. One group lived in closed NHs (i.e., with closed unit doors) and the other group in semi-open NHs (i.e., with closed NH entrance doors). A total of 124 residents with dementia were recruited from five NHs in the Netherlands, of whom 61 residents lived in semi-open NHs and 63 residents lived in closed NHs. Data were collected using questionnaires to cover health dimensions according to the concept of Positive Health, including quality of life and participation, mental functioning and perception, daily functioning and bodily functions. An analysis of covariance, adjusted for age, gender and type of dementia, was used to examine differences in residents' health.</p><p><strong>Results: </strong>Most included residents had Alzheimer's or vascular dementia and 68% were female. No significant demographic differences were observed between the two groups in age, gender, type of dementia, length of stay, length of diagnoses and type of care package (p-values ranged from 0.097 to 0.606). After adjusting for multiple comparisons, there were no significant differences in any of the assessed health dimensions between residents of semi-open nursing homes and those of closed nursing homes, with a significance threshold of p <.004 accounting for the correction for multiple testing (p-values ranged from 0.020 to 0.870).</p><p><strong>Conclusions: </strong>This exploratory study found no significant differences in health between residents with dementia in semi-open and closed NHs. These findings contradict earlier research suggesting that more freedom of movement may enhance overall health in this population. Further research, preferably employing longitudinal designs, is necessary to establish causal pathways and identify the underlying mechanisms.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"123"},"PeriodicalIF":3.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476008","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":"The Arabic Version of the Pittsburgh Fatigability Scale for Older Adults: Translation and Validation.","authors":"Mutasim D Alharbi, Fayaz Khan, Aya Saeb, Nancy W Glynn, Baian A Baattaiah","doi":"10.1186/s12877-025-05759-2","DOIUrl":"10.1186/s12877-025-05759-2","url":null,"abstract":"<p><strong>Background: </strong>The Pittsburgh Fatigability Scale (PFS) was developed to assess perceived physical and mental fatigability in older adults (≥ 60 years). No perceived fatigability questionnaire has been validated to date for use among the Arabic older adult population. The aim of this study was to translate the PFS into Arabic language, and to assess the reliability and validity of the translated version among an Arabic older adult population.</p><p><strong>Methods: </strong>The primary design of this methodological study was cross-sectional. The PFS was translated into Arabic using the forward-backward translation method according to established guidelines. Internal consistency was evaluated by Cronbach's alpha coefficient. The test-retest reliability was evaluated using intraclass correlation coefficients over a two-week interval. Construct validity was evaluated by exploratory and confirmatory factor analyses. The convergent and discriminant validity were measured by calculating Spearman's correlation coefficients between the PFS- Arabic version and the Arabic versions of the Fatigue Severity Scale (FSS), Perceived Stress Scale (PSS), and WHO-5 Well-Being Index.</p><p><strong>Results: </strong>The validity and reliability sample included 277 older adults with a mean age of 66.0 ± 5.3. For the PFS- Arabic version, the intraclass correlation coefficient for test-retest reliability for both the physical and mental subscale was high (0.97). Cronbach's alpha for the PFS- Arabic version was 0.75 for the physical fatigability subscale and 0.71 for the mental fatigability subscale. The results of the factor analyses revealed that a four-factor model of PFS- Arabic version physical and mental subscales was a good model fit in our sample. Both subscales of PFS- Arabic version showed moderate correlation with FSS (r = 0.3, p < 0.0001) and weak correlation with PSS (r = 0.2). The WHO-5 showed a moderate correlation with PFS- Arabic Physical subscale (r = -0.3) and weak correlation with PFS- Arabic Mental subscale (r = -0.2).</p><p><strong>Conclusion: </strong>The PFS- Arabic version showed good psychometric properties and is recommended for use among Arabic-speaking populations to assess perceived fatigability in older adults.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"122"},"PeriodicalIF":3.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476022","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":"Moderating effect of instrumental activities of daily living on the relationship between loneliness and depression in people with cognitive frailty.","authors":"Yafang Zhao, Xiaopeng Huo, Hongdi Du, Xiaoxing Lai, Zhen Li, Zhiyuan Zhang, Longfei Yang","doi":"10.1186/s12877-025-05700-7","DOIUrl":"10.1186/s12877-025-05700-7","url":null,"abstract":"<p><strong>Background: </strong>The identification of depression and loneliness among people with cognitive frailty (CF) could prevent negative psychological and physical health outcomes. Few studies have focused on physical and mental health together, and little is known about the role of daily activity in the association between depression and loneliness among elderly individuals with CF.</p><p><strong>Objectives: </strong>To determine the positive effect of loneliness on depression among community-dwelling older adults with CF as well as the moderating effect of instrumental activities of daily living (IADL) on this association.</p><p><strong>Design, setting, participants, and measurements: </strong>This cross-sectional study included 529 adults aged 65 years and older from a community-dwelling population who were screened for CF and was conducted from July 2023 to December 2023. The participants were assessed via validation instruments for the following main variables: Short-form Geriatric Depression Scale, Loneliness Questionnaire, Athens Insomnia Scale, Instrumental Activities of Daily Living (IADL), Social Support Scale, and sociodemographic characteristics. The participants were classified as having reversable CF (RCF) or potentially reversable CF (PRCF).</p><p><strong>Results: </strong>The IADL, depression, insomnia, and loneliness scores were lower among individuals with RCF than among individuals PRCF. The moderating effect of IADL scores shows that the relationship between loneliness and depression has a steeper and positive slope when lower levels of IADL exist, compared with a straight line when there are higher levels of IADL, for this case, the line is less steep and showed negative association.</p><p><strong>Conclusions: </strong>The integrity of physical and social connections has a protective effect on the mental health of elderly people with CF. It is necessary to pay attention to disability and loneliness among elderly individuals. Targeted interventions for improving physical activity and social participation seem to be practical and feasible solutions to alleviate depressive symptoms.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"121"},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472248","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":"No long-term benefits from resistance training on brain grey matter volumes in active older adults at retirement age.","authors":"Mads Bloch-Ibenfeldt, Naiara Demnitz, Anne Theil Gates, Ellen Garde, Hartwig R Siebner, Michael Kjaer, Carl-Johan Boraxbekk","doi":"10.1186/s12877-025-05778-z","DOIUrl":"10.1186/s12877-025-05778-z","url":null,"abstract":"<p><strong>Background: </strong>Resistance training and other forms of physical exercise are commonly suggested to promote brain health, yet the relationship between resistance training and brain structure in aging is poorly understood. We examined the short- and long-term influence of one year of supervised resistance training at two different loadings on brain structure in aging.</p><p><strong>Methods: </strong>In the LISA (LIve active Successful Ageing) study, well-functioning older adults at retirement age (mean age: 66 ± 2 years) were randomized to one year of heavy resistance training (HRT), moderate intensity training (MIT), or a non-exercising control group (CON). Magnetic resonance imaging (MRI) of the brain was performed at baseline, 1-, 2-, and 4-years follow ups. Trajectories of total grey matter, hippocampus, dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and white matter hyperintensities were analyzed in relation to changes in muscle strength.</p><p><strong>Results: </strong>Individuals (n = 276) with MRI scans at all 4 timepoints were included (HRT, n = 96; MIT, n = 95; CON, n = 85). Total grey matter volume decreased with time across all groups (F_3,819 = 231.549, p < 0.001, <math> <msup><mrow><mi>η</mi></mrow> <mn>2</mn></msup> </math> = 0.46), as did hippocampal (F_3,819 = 310.07, p < 0.001, <math> <msup><mrow><mi>η</mi></mrow> <mn>2</mn></msup> </math> = 0.53), vlPFC (F_3,818 = 74.380, p < 0.001, <math> <msup><mrow><mi>η</mi></mrow> <mn>2</mn></msup> </math> = 0.21), and dlPFC (F_3,818 = 3.640, p = 0.013, <math> <msup><mrow><mi>η</mi></mrow> <mn>2</mn></msup> </math> = 0.01) volumes. White matter hyperintensity volumes increased (F_3,819 = 101.876, p < 0.001, <math> <msup><mrow><mi>η</mi></mrow> <mn>2</mn></msup> </math> = 0.27). There were no significant group x time interactions for any of the brain structures. Additional cortical and subcortical vertex-wise analyses showed no group differences. Change in isometric leg strength was weakly associated with change in white matter hyperintensity volume across all individuals (r² = 0.01, p = 0.048).</p><p><strong>Conclusions: </strong>One year of resistance training in well-functioning older adults at retirement age did not influence volume changes in selected brain regions over a 4-year period.</p><p><strong>Trial registration: </strong>The study was approved by the regional ethics committee and registered on clinicaltrials.gov 2014-04-24 (NCT02123641).</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"120"},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472251","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":"Examining the matching of care preferences and care modalities for older dependents, and its association with satisfaction and wellbeing.","authors":"Albert Julià, Pedro Gallo, Marga Marí-Klose, Sandra Escapa","doi":"10.1186/s12877-025-05749-4","DOIUrl":"10.1186/s12877-025-05749-4","url":null,"abstract":"<p><strong>Background: </strong>As societies age, ensuring the quality of life of dependent individuals has become a pressing concern, affecting an increasing large segment of the population. Understanding whether dependent individuals receive the type of care they prefer is central to their well-being. However, there is limited evidence regarding the alignment between care preferences and the care arrangements received by dependent persons. This article aims to provide new insights into how individual and contextual factors are associated to the match -or mismatch- between care preferences and current care arrangements, as well as its implications for individuals' well-being and satisfaction with care.</p><p><strong>Methods: </strong>We use data from the 2023 Survey of Older People with Functional Dependency, which includes a representative sample (n = 1,600, with 992 self-respondents) of dependent individuals aged 65 and over in Barcelona, Spain. Logistic regression models are used to estimate the associations between dependent individuals' characteristics and their care preferences, as well as the matching between these preferences and their current care arrangements. We further examine how this alignment relates to satisfaction and well-being.</p><p><strong>Results: </strong>Care preferences differ based on sex, household size, level of dependency, and household income. Approximately 70 per cent of older dependents report that their current care arrangements do not match their care preferences. Older dependent women and those over 85 are less likely to have care arrangements aligned with their preferences. Living with others in the household increases the likelihood of alignment between preferences and care provision. While no significant association was found between alignment and well-being indicators, we observed that care match enhances individuals' satisfaction with care they receive.</p><p><strong>Conclusions: </strong>Older dependent individuals' preferences for care provision often do not match their current care arrangements. Both individual and contextual factors could explain this phenomenon. The widespread preference for receiving care at home highlights the need for social policies that promote home-based solutions. As family support for dependent individuals becomes less available, and given the significant burden this may place for family caregivers, there is a growing need to develop flexible, personalized, and sustainable care strategies.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"119"},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472244","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":"The factors determining early mobilization in elderly patients undergoing total knee replacement.","authors":"Li-Ling Hung, Yong-Chuan Chen, Yu-Ting Wang, Shun-Ping Wang","doi":"10.1186/s12877-025-05772-5","DOIUrl":"10.1186/s12877-025-05772-5","url":null,"abstract":"<p><strong>Background: </strong>Postoperative early mobilization after total knee replacement (TKR) is essential for preventing complications and offers numerous benefits. The purpose of this study was to evaluate the factors determining early mobilization (EM) after primary TKR and the effects on risk of falls and length of stay (LOS).</p><p><strong>Methods: </strong>This retrospective study recruited elder participants undergoing primary TKR. All patients were classified as EM(+), early mobilization (EM) within 24 h, or EM(-), delayed mobilization over 24 h. Demographic data, pain Visual Analog Scale (VAS), American Society of Anesthesiologists (ASA) score, perioperative blood pressure, postoperative pain control mode, medical catheters, dizziness or nausea/vomiting (PONV), falls during admission, and the LOS were collected.</p><p><strong>Result: </strong>A total of 1759 elder participants undergoing primary TKR were enrolled. Mean age was 73.00 ± 8.11 years. Among them, there were 1260 EM(-) and 499 EM(+) cases, with no significant differences in sex, BMI, PONV, postoperative Patient Controlled Analgesia (PCA) mode, or the use of medical catheters, but age, higher ASA score, VAS, muscle strength, postoperative nausea, and substantial changes of blood pressure were significantly different between the two groups. A greater reduction in systolic blood pressure, when compared to the preoperative baseline blood pressure, was found in EM(-) patients than EM(+) patients on the operative day (13 vs. 4 mmHg, P < 0.001) and first day post-TKR (20 vs. 17 mmHg, P = 0.005). LOS in EM(-) patients was significant longer than that in EM(+) patients, but risk of falls was not significantly different.</p><p><strong>Conclusions: </strong>Multiple factors influence patients' willingness to mobilize or ambulate earlier. However, more blood pressure reduction impeding early mobilization after TKR should be addressed. Maintaining post-TKR blood pressure without significant decreases is recommended for the successful mobilization after surgery. Early mobilization within 24 h after TKR may be beneficial in reducing the LOS and did not increase risk of falls.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"118"},"PeriodicalIF":3.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466910","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":"Predictive role of gait parameters and MRI markers in assessing cognitive decline in CSVD patients.","authors":"Yushuang Liu, Li Zhang, Shanshan Yang, Ruijia Liu, Lian Yi, Meng Liu, Sihan Liu, Zhongling Zhang","doi":"10.1186/s12877-025-05738-7","DOIUrl":"10.1186/s12877-025-05738-7","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel disease (CSVD) is a major contributor to cognitive decline and gait abnormalities in the elderly population. Understanding the relationship between these impairments can aid in early detection and intervention. This study investigated the association between gait performance and cognitive decline in patients with CSVD, focusing on specific gait parameters as potential clinical markers of cognitive impairment.</p><p><strong>Methods: </strong>This cross-sectional study included 95 elderly patients with confirmed atherosclerotic CSVD at Guangzhou Geriatric Hospital. Participants underwent comprehensive gait assessments using the Timed Up and Go (TUG) test, Berg Balance Scale (BBS), and Short Physical Performance Battery (SPPB). Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Imaging markers, including total magnetic resonance imaging (MRI) CSVD burden and Fazekas scale score, were analyzed.</p><p><strong>Results: </strong>Participants with cognitive decline performed significantly worse on the TUG test, BBS, and SPPB, particularly on the SPPB sit-to-stand component. The total MRI CSVD burden and Fazekas scale scores were significantly higher in the cognitive decline group. Deep cerebral microbleeds and enlarged perivascular spaces in the basal ganglia were more prevalent in individuals with cognitive decline. The association between the SPPB sit-to-stand score and cognitive decline remained significant after adjusting for confounders (OR 0.44; 95% confidence interval (CI) 0.21 to 0.94; p = 0.034).</p><p><strong>Conclusion: </strong>This study highlighted the significant relationship between gait performance and cognitive decline in elderly patients with CSVD. In particular, the sit-to-stand component emerged as a robust predictor of cognitive impairment, suggesting its potential as a valuable clinical marker for early detection. The incorporation of gait assessments into routine clinical evaluations can enhance early intervention efforts, improve patient outcomes, and inform healthcare policies. Further longitudinal and multicenter studies are warranted to validate these findings and to explore the underlying mechanisms.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"116"},"PeriodicalIF":3.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466908","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}