Geriatrics

Background: Evidence suggests that lipoprotein subclass particles are critical markers of cardiovascular disease (CVD) risk. Older women have increased CVD risk related to age. The purpose of this study was to determine whether low and moderate doses of exercise influence lipoprotein subclasses. Methods: Women (60–75 years) were randomized into groups for 16 weeks of moderate-intensity exercise training at a low or moderate dose (33.6 and 58.8 kJ/kg body weight weekly, respectively). Lipoprotein subclasses were determined by nuclear magnetic resonance spectroscopy before and after the training. RESULTS: The average weekly exercise duration was 109 and 164 min, for low- and moderate-dose groups, respectively. In the low-dose group, high-density lipoprotein particle (HDL-P) concentration decreased (Δ = −1.9 ± 3.1 µmol/L, mean ± SD, p = 0.002) and mean HDL-P size increased (Δ = 0.1 ± 0.3 nm, p = 0.028). In the moderate-dose group, mean HDL-P size (Δ = 0.1 ± 0.2 nm; p = 0.024) and low-density lipoprotein particle size increased (Δ = 0.4 ± 3.9 nm; p = 0.007). Baseline body mass index, peak oxygen consumption and age were associated with changes in a few lipoprotein subclasses. Conclusions: In this sample of inactive older women, moderate-intensity exercise training at a dose equivalent to or even lower than the minimally recommended level by public health agencies induced changes in lipoprotein subclasses in line with reduced CVD risk. However, higher doses are encouraged for greater health benefits. Full article

Purpose: The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). Methods: A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. Results: A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale—international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. Conclusions: A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury. Full article

Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients. Full article

Social isolation is a growing concern worldwide, particularly within aging populations. This study elucidates the specific attitudes, strategies, and approaches of community social workers (CSWs) in Japan as they work toward alleviating social isolation and building inclusive communities. This qualitative study, conducted in Toyonaka City, Osaka Prefecture, Japan, used six Japanese comics as a unique data source, narrating real-life stories of social isolation and CSWs’ approaches. Thematic analysis was conducted to analyze the content of the comics, including systematic coding, theme generation, and refining, while ensuring rigor and reflexivity. The total number of pages in the comics was 505. The transcripts of the comics as Microsoft Word documents totaled 63 pages. Four themes characterizing CSWs’ strategies were revealed: (1) core values of professionalism and dedication; (2) personalized support oriented toward person-centered suffering; (3) community engagement, transitioning from exclusiveness to inclusiveness; and (4) connecting and reorganizing communities for inclusive societies. In Japan, CSWs employ multifaceted strategies to combat social isolation and foster inclusive communities. Their dedication, personalized support, community engagement, and capacity to reorganize their communities contribute to their pivotal role. This study provides a foundation for understanding CSWs’ work and paves the way for further investigation of their evolving role in creating inclusive societies. Full article

The prevalence of hand injuries increases with age, with elderly patients being more prone to hand lesions due to a combination of factors, such as reduced bone density and muscle strength, impaired sensation, and cognitive impairment. Despite the high incidence of hand injuries in the elderly population, few studies have addressed the management and outcomes of hand lesions in this age group. This study aimed to analyze the characteristics and management of hand lesions in patients over 80 years old. The authors conducted a retrospective analysis of medical records of patients over 80 years old who reached their Emergency Department with hand lesions between 2001 and 2020. Data on demographics, injury characteristics, and management were collected and analyzed. A total of 991 patients with hand lesions were included in the study, with a mean age of 84.9 years. The most common causes of injuries were domestic accidents (32.6%) and traffic accidents (12.8%). The most frequent types of hand lesions were fractures (23.5%) and superficial wounds (20.5%). Overall, 23.4% underwent surgical treatment for their hand issue, and 22.1% had associated injuries, among which, the most common were head trauma and other bone fractures. In conclusion, hand lesions in patients over 80 years old are frequent and pose significant challenges in diagnosis and management. Particular attention should be paid to associated injuries and limit indications to surgery when strictly necessary. Full article

(1) Background: Drug–drug interactions (DDIs) possess the potential to lead to a range of clinically significant consequences in the older population. (2) Aims: To investigate the prevalence and associated factors of DDIs among older patients within an outpatient setting of a university hospital. (3) Methods: This is a descriptive analysis of patients aged ≥65 years, who received a minimum of two medications. The electronic medical records were obtained from the outpatient clinic of a tertiary care hospital between November 2021 and November 2022. The outcomes were analyzed using descriptive and regression analysis. (4) Results: The study enrolled 10,877 patients, with a mean age of 74.3 ± 6.8 years. The prevalence of major DDI was 36.8%. Factors associated with major DDI were age (odds ratio [OR] 1.03), female sex (OR 1.23), polypharmacy (OR 2.27–13.78), metabolic disease (OR 1.89), psychiatric disorder (OR 1.79), cardiovascular disease (OR 1.51), musculoskeletal disease (OR 1.37), central nervous system disease (OR 1.24), and tuberculosis (OR 0.18). There was a significant difference observed in the primary healthcare facilities for emergency medicine (OR 1.72), orthopedics (OR 1.36), internal medicine (OR 1.29), and radiology (OR 0.45). (5) Conclusions: Major DDI was prevalent among older patients receiving care at outpatient settings. Several factors linked to major DDIs were identified. Developing appropriate strategies to improve the prescription process and avoid any missed interactions with geriatric patients is recommended. Full article

An 81-year-old woman undergoing B-cell depletion therapy developed COVID-19 and a hyperglycemic hyperosmotic state. She had a history of multiple vaccinations against coronaviruses but had persistent antigen positivity. Strategies to prevent the development of COVID-19 in immunosuppressed patients have not been established. Moreover, there is no standard treatment for prolonged antigen positivity. In this case, we were able to follow IgG antibodies during the course of treatment. The absence of N-IgG antibody titer elevation despite an effective immune response triggered by the vaccine is of great interest. The impaired humoral response observed in patients with lymphoma after anti-CD20 treatment implies the need for a justified different vaccination strategy for these patients. Furthermore, negative N-IgG titers in the immunosuppressed state may serve as an indicator of resistance to therapy. Full article

This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren–Lawrence classification (KL) and Pearson’s correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA. Full article

Introduction. The purpose of this study is to determine the usefulness of the CTMT (Comprehensive Trail Making Test) in diagnosing mild cognitive impairment in older patients. The test is used to assess executive functions, of which impairment is already observed in the early stages of the neurodegenerative process. Materials and Methods. The study includes 98 patients of a geriatric ward assigned to 2 groups of 49 patients each: patients diagnosed with a mild cognitive impairment and patients without a cognitive impairment, constituting the control group (group K). A set of screening tests was used in the initial study: the MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), and CDT (Clock Drawing Test), GDS (Geriatric Depression Scale). The second study included the performance of the CTMT; the performance indicator was the time of performance. Results. Statistically significant differences are obtained between patients with mild cognitive impairments and those in cognitive normality in the performance of the CTMT test (p < 0.01). Patients with MCIs took longer to complete all trails of the test. To identify cognitive impairment, cutoff points were proposed for the CTMT total score and the other test trails. The CTMT overall score and CTMT 5 scored the highest AUCs (CTMT overall score = 0.77, CTMT Trail 5 = 0.80). Conclusions. The Comprehensive Trail Making Test may be useful in diagnosing mild cognitive impairment as a complementary screening tool. Full article

Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62–90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a “test” after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS. Full article

The growing older population, the increasing prevalence of chronic illnesses, and the pressing need to enhance the quality of end-of-life care have underscored the importance for geriatricians to focus on supportive and palliative measures. Within this context, the emphasis on delivering comprehensive and person-centered care has become crucial, ensuring that individuals not only receive medical treatment but also experience comfort during chronic illness and in their final days. Nevertheless, a significant number of older individuals often find themselves in hospitals during their last moments, sometimes undergoing aggressive medical interventions even when facing terminal conditions. The challenge lies in the early recognition of the end-of-life phase, initiating timely supportive and palliative care in conjunction with conventional treatments, adopting a multidisciplinary approach, and providing crucial support to grieving family members. Despite being a relatively recent field, geriatric palliative care (GPC) still requires further development. With this perspective, I aimed to shed light on the challenges and best practices for enhancing care for individuals facing chronic critical illnesses and frailty. Full article

In an aging society, maintaining healthy aging, preventing death, and enabling a continuation of economic activities are crucial. This study sought to develop a model for predicting survival times among community-dwelling older individuals using a deep learning method, and to identify the level of influence of various risk factors on the survival period, so that older individuals can manage their own health. This study used the Korean National Health Insurance Service claims data. We observed community-dwelling older people, aged 66 years, for 11 years and developed a survival time prediction model. Of the 189,697 individuals enrolled at baseline, 180,235 (95.0%) survived from 2009 to 2019, while 9462 (5.0%) died. Using deep-learning-based models (C statistics = 0.7011), we identified various factors impacting survival: Charlson’s comorbidity index; the frailty index; long-term care benefit grade; disability grade; income level; a combination of diabetes mellitus, hypertension, and dyslipidemia; sex; smoking status; and alcohol consumption habits. In particular, Charlson’s comorbidity index (SHAP value: 0.0445) and frailty index (SHAP value: 0.0443) were strong predictors of survival time. Prediction models may help researchers to identify potentially modifiable risk factors that may affect survival. Full article

Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status. Full article

Background: Orthostatic hypotension (OH) is a common blood pressure abnormality in older adults that makes them prone to balance disorders and falls. The maintenance of balance relies on a complex regulatory system. The use of computerized dynamic posturography (CDP) can provide a quantitative evaluation of balance function. The objective of this study was to utilize CDP to measure balance indicators in older individuals with OH. Methods: A total of 303 older adults were divided into an OH group of 91 and a non-OH group of 212. Various factors, including chronic diseases, medication history, laboratory tests, and balance indicators, were compared between the two groups. Results: ① Participants with OH had more chronic diseases, including coronary heart disease (p = 0.049) and a history of falls (p < 0.001), than those without OH. A history of multiple medications in the OH group was significantly more likely than in the non-OH group (p = 0.006). ② There was a significant reduction in the composite equilibrium score (SOT-COM) (p < 0.001), vision ratio score (VIS) (p < 0.001), vestibular ratio score (VEST) (p < 0.001), and directional control (DCL) (p = 0.028) in the OH group. ③ A logistic regression analysis revealed that SOT-COM was a significant independent factor associated with OH. The area under the curve (AUC) of SOT-COM was 0.833 (95% confidence interval: 0.778–0.887, p < 0.001), with a sensitivity of 0.826 and a specificity of 0.759. Conclusions: This study demonstrates that older individuals with OH are more prone to falls, due to decreased sensory integration for balance. Full article

Sarcopenia and frailty are important conditions that become increasingly prevalent with age. There is partial overlap between the two conditions, especially in terms of the physical aspects of the frailty phenotype: low grip strength, gait speed, and muscle mass. This study examined whether administration of the essential branched-chain amino acid leucine, besides improving sarcopenia, may reduce frailty assessed by frailty index (FI) in older institutionalized people living in nursing homes. We conducted a secondary analysis of a placebo-controlled, randomized, double-blind design study (ClinicalTrials.gov NCT03831399). The study included fifty males and females aged 65 and over who were living in nursing homes and did not have dementia. The participants were randomized to a parallel group intervention of 13 weeks’ duration, with a daily intake of leucine (6 g/day) or placebo (lactose, 6 g/day). The outcome of this study was to evaluate whether there was a change in the level of a 95 item FI compared to the baseline and to compare the effect of the leucine group versus the placebo group. A significant inverse correlation was found between FI and performance of the activities of daily life, cognitive function, gait and balance, muscle function parameters, and nutritional status (p < 0.001 in all cases). There were no statistically significant differences in FI levels at baseline (placebo group FI 0.27 ± 0.08 and leucine group FI 0.27 ± 0.10) and at the 13 week follow-up (placebo group FI 0.28 ± 0.10 and leucine group FI 0.28 ± 0.09). There were also no significant differences between the leucine and placebo groups in the mean FI difference between baseline and follow-up (p = 0.316, Cohen’s d: 0.04). This pilot study showed that a nutritional supplementation with leucine did not significantly modify the frailty index in older nursing home residents. Full article

Background: Due to the presence of numerous problems in osteoarthritis, e.g., the presence of one or more chronic diseases, reduced self-esteem and reduced ability to cope, patients must undertake readaptation activities. In such circumstances, resources that are necessary for optimal adaptation become of particular importance. This cross-sectional study aimed to assess the impact of behavioral resources, namely self-efficacy and optimism, on quality of life perception in early-old-age patients with knee osteoarthritis. Methods: An anonymous survey was conducted using recognized research tools: the Index of Severity for Knee Disease, Life Orientation Test, General Self-Efficacy Scale and World Health Organization Quality of Life BEFF. The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without diagnosed joint and muscular diseases of the lower limbs. Non-parametric tests (e.g., Mann–Whitney U test, Kruskal–Wallis test, Spearman’s correlation coefficient) were used for the statistical analysis of the results, assuming a significance level of p < 0.05. Results: The level of the examined personal resources was significantly lower in the group of people with gonarthrosis (p < 0.001), among whom low self-efficacy and a tendency toward pessimism prevailed. The results in terms of the level of lower limb joints impairment among the respondents correlated significantly and negatively with self-efficacy (r = −0.239; p = 0.003) and dispositional optimism (r = −0.318; p < 0.001). A higher level of the studied psychosocial resources led to a more favorable assessment of quality of life (p < 0.001) and own health (p < 0.001). In addition, a higher sense of self-competence was associated with better quality of life in the psychological (p = 0.044), social (p < 0.001) and environmental (p < 0.001) domains, while a tendency toward optimism was associated with higher quality of life perception in the social domain (p < 0.001). Conclusions: It would seem to be reasonable to introduce a routine diagnosis, assessing the level of personal capabilities of elderly people with knee osteoarthritis, which may have a beneficial effect on their perception of their quality of life and their own health. Full article

Introduction: The goals of this retrospective cohort study of 129,443 persons admitted to Calgary acute care hospitals from 2013 to 2021 were to ascertain correlations of “potentially inappropriate medications” (PIMs), “potential prescribing omissions” (PPOs), and other risk factors with readmissions and mortality. Methods: Processing and analysis codes were built in Oracle Database 19c (PL/SQL), R, and Excel. Results: The percentage of patients dying during their hospital stay rose from 3.03% during the first admission to 7.2% during the sixth admission. The percentage of patients dying within 6 months of discharge rose from 9.4% after the first admission to 24.9% after the sixth admission. Odds ratios were adjusted for age, gender, and comorbidities, and for readmission, they were the post-admission number of medications (1.16; 1.12–1.12), STOPP PIMs (1.16; 1.15–1.16), AGS Beers PIMs (1.11; 1.11–1.11), and START omissions not corrected with a prescription (1.39; 1.35–1.42). The odds ratios for readmissions for the second to thirty-ninth admission were consistently higher if START PPOs were not corrected for the second (1.41; 1.36–1.46), third (1.41;1.35–1.48), fourth (1.35; 1.28–1.44), fifth (1.38; 1.28–1.49), sixth (1.47; 1.34–1.62), and seventh admission to thirty-ninth admission (1.23; 1.14–1.34). The odds ratios for mortality were post-admission number of medications (1.04; 1.04–1.05), STOPP PIMs (0.99; 0.96–1.00), AGS Beers PIMs (1.08; 1.07–1.08), and START omissions not corrected with a prescription (1.56; 1.50–1.63). START omissions for all admissions corrected with a prescription by a hospital physician correlated with a dramatic reduction in mortality (0.51; 0.49–0.53) within six months of discharge. This was also true for the second (0.52; 0.50–0.55), fourth (0.56; 0.52–0.61), fifth (0.63; 0.57–0.68), sixth (0.68; 0.61–0.76), and seventh admission to thirty-ninth admission (0.71; 0.65–0.78). Conclusions: “Potential prescribing omissions” (PPOs) consisted mostly of needed cardiac medications. These omissions occurred before the first admission of this cohort, and many persisted through their readmissions and discharges. Therefore, these omissions should be corrected in the community before admission by family physicians, in the hospital by hospital physicians, and if they continue after discharge by teams of family physicians, pharmacists, and nurses. These community teams should also meet with patients and focus on patients’ understanding of their illnesses, medications, PPOs, and ability for self-care. Full article

Introduction: The measurement of physical frailty in elderly patients with orthopedic impairments remains a challenge due to its subjectivity, unreliability, time-consuming nature, and limited applicability to uninjured individuals. Our study aims to address this gap by developing objective, multifactorial machine models that do not rely on mobility data and subsequently validating their predictive capacity concerning the Timed-up-and-Go test (TUG test) in orthogeriatric patients. Methods: We utilized 67 multifactorial non-mobility parameters in a pre-processing phase, employing six feature selection algorithms. Subsequently, these parameters were used to train four distinct machine learning algorithms, including a generalized linear model, a support vector machine, a random forest algorithm, and an extreme gradient boost algorithm. The primary goal was to predict the time required for the TUG test without relying on mobility data. Results: The random forest algorithm yielded the most accurate estimations of the TUG test time. The best-performing algorithm demonstrated a mean absolute error of 2.7 s, while the worst-performing algorithm exhibited an error of 7.8 s. The methodology used for variable selection appeared to exert minimal influence on the overall performance. It is essential to highlight that all the employed algorithms tended to overestimate the time for quick patients and underestimate it for slower patients. Conclusion: Our findings demonstrate the feasibility of predicting the TUG test time using a machine learning model that does not depend on mobility data. This establishes a basis for identifying patients at risk automatically and objectively assessing the physical capacity of currently immobilized patients. Such advancements could significantly contribute to enhancing patient care and treatment planning in orthogeriatric settings. Full article

Background: Studies that quantify the quality of sit-to-stand-to-sit (STS) motions, particularly in terms of smoothness, are limited. Thus, this study aimed to investigate the possibility and usefulness of quality evaluation during STS motions. Methods: This cross-sectional study enrolled 36 females aged >60 years, including 18 females each in the healthy and hip fracture groups. Measurements were performed at two different speeds: five STS as fast as possible (STSF) and two seconds for each motion (STS2s). Indices of smoothness, including harmonic ratio (HR) and power spectrum entropy (PSE), were calculated and compared from the measured data in each of the three axial directions. Results: HR in the vertical direction was significantly higher in the healthy group (STSF: 3.65 ± 1.74, STS2s: 3.42 ± 1.54) than in the hip fracture group (STSF: 2.67 ± 1.01, STS2s: 2.58 ± 0.83) for STSF and STS2s. Furthermore, PSE for all directions and triaxial composites were significantly lower for STS2s (the healthy group (mediolateral (ML): 7.63 ± 0.31, vertical (VT): 7.46 ± 0.22, anterior–posterior (AP): 7.47 ± 0.15, triaxial: 7.45 ± 0.25), the hip fracture group (ML: 7.82 ± 0.16, VT: 7.63 ± 0.16, AP: 7.61 ± 0.17, triaxial: 7.66 ± 0.17)). Conclusions: This study suggests the usefulness of HR and PSE as quality evaluations for STS motions. Full article