Advances in Geriatric Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 47790

Special Issue Editor


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Guest Editor
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Interests: cardiovascular aging; cognitive decline; functional decline

Special Issue Information

Dear Colleagues,

Aging is the most impressive demographic phenomenon in human history, bringing changes and challenges in several scientific fields. As physicians, we have to expect a substantial increase of patients with chronic conditions, comorbidities, and polypharmacy. It brings new challenges for physicians and patients, as well as chances for novel minimally invasive treatments, developments for a medicine which is evidence-based and not eminence-based, and eventually shared decision-making and ethical aspects.

Dealing with older patients means also dealing with diseases and with the effect of diseases on functional and cognitive decline. In these cases, the goal might not always be the healing process, but often to maintain a stable situation taking into account maintaining the independence of the individual. Geriatric medicine is challenging, novel, and high risk. To increase knowledge in this field is not an option, it is mandatory.

The aim of this Special Issue is to highlight recent advances in the context of diagnosis, treatment, and the prediction of prognosis in Geriatrics.

Prof. Dr. Francesco Mattace-Raso
Guest Editor

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Keywords

  • older patients
  • comorbidities
  • functional decline
  • dementia
  • frailty
  • mechanisms of aging

Published Papers (23 papers)

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Editorial

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3 pages, 178 KiB  
Editorial
It Is Time for Senescience
by Francesco Mattace-Raso
J. Clin. Med. 2022, 11(15), 4542; https://doi.org/10.3390/jcm11154542 - 04 Aug 2022
Viewed by 899
Abstract
Aging is the most impressive demographic phenomenon in human history [...] Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)

Research

Jump to: Editorial, Review

12 pages, 422 KiB  
Article
Correlates of Restless Legs Syndrome in Older People
by Magdalena Szklarek, Tomasz Kostka and Joanna Kostka
J. Clin. Med. 2024, 13(5), 1364; https://doi.org/10.3390/jcm13051364 - 28 Feb 2024
Viewed by 518
Abstract
Background: We examined the association between restless legs syndrome (RLS) and comprehensive geriatric assessment (CGA) data in two older European populations. The second goal was to evaluate correlates of their quality of life (QoL). Methods: Diagnostic criteria of the International RLS [...] Read more.
Background: We examined the association between restless legs syndrome (RLS) and comprehensive geriatric assessment (CGA) data in two older European populations. The second goal was to evaluate correlates of their quality of life (QoL). Methods: Diagnostic criteria of the International RLS Study Group (IRLSSG) and elements of CGA were used in this study. Results: Among the examined 246 participants, 77 (31.3%) suffered from RLS, more often in the UK (39.4%) than in Poland (25.4%) (p = 0.019). In the multivariate logistic regression model, female sex [OR (CI) = 3.29 (1.51–7.21); p = 0.0014], the number of medications per day [OR (CI) = 1.11 (1.02–1.20); p = 0.011] and alcohol consumption [OR (CI) = 5.41 (2.67–10.95); p < 0.001] increased the probability of RLS. Residing in Poland [OR (CI) = 3.06 (1.36–6.88); p = 0.005], the presence of RLS [OR (CI) = 2.90 (1.36–6.17); p = 0.004], chronic heart failure, [OR (CI) = 3.60 (1.75–7.41); p < 0.001], osteoarthritis [OR (CI) = 2.85 (1.47–5.49); p = 0.0016], and urinary incontinence [OR (CI) = 4.74 (1.87–11.9); p < 0.001] were associated with a higher probability of mobility dimension problems in the QoL. Higher physical activity was related to a lower probability of mobility problems [OR (CI) = 0.85 (0.78–0.92); p < 0.001]. Conclusions: female sex, the number of medications and alcohol consumption are independent correlates of RLS in older adults. RLS together with several chronic medical conditions and a low physical activity level were independent correlates of the mobility dimension of the QoL. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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13 pages, 1080 KiB  
Article
Quality of Life and Kidney Function in Older Adults: Prospective Data of the SCOPE Study
by Rada Artzi-Medvedik, Robert Kob, Mirko Di Rosa, Fabrizia Lattanzio, Andrea Corsonello, Ilan Yehoshua, Regina E. Roller-Wirnsberger, Gerhard H. Wirnsberger, Francesco U. S. Mattace-Raso, Lisanne Tap, Pedro G. Gil, Francesc Formiga, Rafael Moreno-González, Tomasz Kostka, Agnieszka Guligowska, Johan Ärnlöv, Axel C. Carlsson, Ellen Freiberger and Itshak Melzer
J. Clin. Med. 2023, 12(12), 3959; https://doi.org/10.3390/jcm12123959 - 09 Jun 2023
Viewed by 1084
Abstract
A longitudinal alteration in health-related quality of life (HRQoL) over a two-year period and its association with early-stage chronic kidney disease (CKD) progression was investigated among 1748 older adults (>75 years). HRQoL was measured by the Euro-Quality of Life Visual Analog Scale (EQ-VAS) [...] Read more.
A longitudinal alteration in health-related quality of life (HRQoL) over a two-year period and its association with early-stage chronic kidney disease (CKD) progression was investigated among 1748 older adults (>75 years). HRQoL was measured by the Euro-Quality of Life Visual Analog Scale (EQ-VAS) at baseline and at one and two years after recruitment. A full comprehensive geriatric assessment was performed, including sociodemographic and clinical characteristics, the Geriatric Depression Scale-Short Form (GDS-SF), Short Physical Performance Battery (SPPB), and estimated glomerular filtration rate (eGFR). The association between EQ-VAS decline and covariates was investigated by multivariable analyses. A total of 41% of the participants showed EQ-VAS decline, and 16.3% showed kidney function decline over the two-year follow-up period. Participants with EQ-VAS decline showed an increase in GDS-SF scores and a greater decline in SPPB scores. The logistic regression analyses showed no contribution of a decrease in kidney function on EQ-VAS decline in the early stages of CKD. However, older adults with a greater GDS-SF score were more likely to present EQ-VAS decline over time, whereas an increase in the SPPB scores was associated with less EQ-VAS decline. This finding should be considered in clinical practice and when HRQoL is used to evaluate health interventions among older adults. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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11 pages, 1019 KiB  
Article
Better Handgrip Strength Is Related to the Lower Prevalence of Pain and Anxiety in Community-Dwelling Older Adults
by Natalia Sosowska, Agnieszka Guligowska, Bartłomiej Sołtysik, Ewa Borowiak, Tomasz Kostka and Joanna Kostka
J. Clin. Med. 2023, 12(11), 3846; https://doi.org/10.3390/jcm12113846 - 04 Jun 2023
Viewed by 1408
Abstract
Although handgrip strength (HGS) may be treated as a biomarker of many health problems, there is little evidence on the potential role of HGS in the prevention of pain or anxiety in older adults. We investigated the relationship of HGS to the presence [...] Read more.
Although handgrip strength (HGS) may be treated as a biomarker of many health problems, there is little evidence on the potential role of HGS in the prevention of pain or anxiety in older adults. We investigated the relationship of HGS to the presence of pain and anxiety among community-dwelling older adults. The study was performed in 2038 outpatients, aged 60 to 106 years. The Jamar hand-held hydraulic dynamometer was used to measure HGS. The prevalence of pain and anxiety was assessed with the Euroqol 5D questionnaire. Symptoms of depression were recorded with 15-item Geriatric Depression Scale (GDS). In the multivariate logistic regression model taking into account age, sex, BMI and concomitant diseases, the significant influence of HGS on the presence of pain (odds ratio [OR]  =  0.988) in the entire study population and among men (OR  =  0.983) was found. HGS was a significant independent predictor for the presence of anxiety in the entire study population (OR  =  0.987), in women (OR  =  0.985) and in men (OR  =  0.988). In the fully adjusted model with included GDS, 1 kg higher HGS was still associated with 1.2% and 1.3% lower probability of the presence of pain and anxiety, respectively. We conclude that low HGS is associated with the presence of pain and anxiety among older adults, independent of age, sex, depression symptoms and concomitant chronic diseases. Future research should assess whether improvement of HGS would alleviate psychological dysfunction in older adults. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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10 pages, 1538 KiB  
Article
The Effect of Age on Non-Invasive Hemodynamics in Chronic Heart Failure Patients on Left-Ventricular Assist Device Support: A Pilot Study
by Else-Marie van de Vreede, Floor van den Berg, Parsa Jahangiri, Kadir Caliskan and Francesco Mattace-Raso
J. Clin. Med. 2023, 12(1), 29; https://doi.org/10.3390/jcm12010029 - 20 Dec 2022
Viewed by 1105
Abstract
Background: Implantation of continuous flow left ventricular assist devices (LVAD’s) has been increasingly used in patients with advanced heart failure (HF). Little is known about the non-invasive hemodynamics and the relationship with adverse events in this specific group of patients. We aimed to [...] Read more.
Background: Implantation of continuous flow left ventricular assist devices (LVAD’s) has been increasingly used in patients with advanced heart failure (HF). Little is known about the non-invasive hemodynamics and the relationship with adverse events in this specific group of patients. We aimed to identify any differences in non-invasive hemodynamics in patients with an LVAD in different age categories and to investigate if there is an association with major adverse events. Methods: In this observational cross-sectional study, HF patients with a continuous flow LVAD were included. Non-invasive hemodynamic parameters were measured with a validated, automated oscillometric blood pressure monitor. The occurrences of adverse events were registered by reviewing the medical records of the patients. An independent-samples T-test and Chi-square test were used to compare different groups of patients. Results: Forty-seven patients were included; of these, only 12 (25.6%) had a successful measurement. Heart rate, heart rate-adjusted augmentation index, and pulse wave velocity were higher in the ≥55 years of age LVAD group compared to the <55 years of age LVAD group (all p < 0.05). Stroke volume was significantly lower in the ≥55 years of age LVAD group compared to the <55 years of age LVAD group (p = 0.015). Patients with adverse events such as cardiovascular events, GI-bleeding, or admission to a hospital had lower central pulse pressure (cPP) than patients without any adverse event. Conclusion: Older LVAD patients have a significantly higher heart rate, heart rate-adjusted augmentation index, and pulse wave velocity and a significantly lower stroke volume compared to participants aged < 55 years. The pulsatile component of blood pressure was decreased in patients with adverse events. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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10 pages, 843 KiB  
Article
Inflammaging and Blood Pressure Profiles in Late Life: The Screening for CKD among Older People across Europe (SCOPE) Study
by Lisanne Tap, Andrea Corsonello, Mirko Di Rosa, Paolo Fabbietti, Francesc Formiga, Rafael Moreno-González, Johan Ärnlöv, Axel C. Carlsson, Harmke A. Polinder-Bos, Regina E. Roller-Wirnsberger, Gerhard H. Wirnsberger, Tomasz Kostka, Agnieszka Guligowska, Rada Artzi-Medvedik, Ilan Yehoshua, Christian Weingart, Cornel C. Sieber, Pedro Gil, Sara Lainez Martinez, Fabrizia Lattanzio and Francesco U. S. Mattace-Rasoadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(24), 7311; https://doi.org/10.3390/jcm11247311 - 09 Dec 2022
Cited by 2 | Viewed by 1122
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a marker for systemic inflammation. Since inflammation plays a relevant role in vascular aging, the aim of this study was to investigate whether NLR is associated with blood pressure profiles in older adults. This study was performed within [...] Read more.
The neutrophil-to-lymphocyte ratio (NLR) is a marker for systemic inflammation. Since inflammation plays a relevant role in vascular aging, the aim of this study was to investigate whether NLR is associated with blood pressure profiles in older adults. This study was performed within the framework of the SCOPE study including 2461 outpatients aged 75 years and over. Mean blood pressure values, namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were investigated across tertiles of NLR. Change in blood pressure levels in 2 years of follow-up were compared across categories of baseline NLR. Data of 2397 individuals were used, of which 1854 individuals had hypertension. Mean values of blood pressure did not differ across categories of baseline NLR in individuals without hypertension. Individuals with hypertension with a high-range NLR had lower SBP and PP when compared to those in low-range NLR (mean difference SBP −2.94 mmHg, p = 0.032 and PP −2.55 mmHg, p = 0.030). Mean change in blood pressure in 2 years did only slightly differ in non-clinically relevant ranges, when compared across tertiles of baseline NLR. NLR as a marker of inflammaging was not associated with unfavorable blood pressure profiles in older individuals with or without hypertension. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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13 pages, 294 KiB  
Article
Prevalence and Clinical Conditions Related to Sarcopaenia among Older Persons Living in the Community
by Encarnación Blanco-Reina, Ricardo Ocaña-Riola, Gabriel Ariza-Zafra, María Rosa García-Merino, Lorena Aguilar-Cano, Jenifer Valdellós, Claudia Torres-Blanco and Inmaculada Bellido-Estévez
J. Clin. Med. 2022, 11(13), 3814; https://doi.org/10.3390/jcm11133814 - 01 Jul 2022
Cited by 1 | Viewed by 1432
Abstract
(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary [...] Read more.
(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30–5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67–0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
13 pages, 585 KiB  
Article
Assessment of the Management of Patients with Chronic Pain Referred to a Specialized Pain Unit: A Cross-Sectional Multicenter Study (the DUO Project)
by Víctor Mayoral Rojals, Ángeles Canós Verdecho, Begoña Soler López and the Team DUO
J. Clin. Med. 2022, 11(13), 3586; https://doi.org/10.3390/jcm11133586 - 22 Jun 2022
Cited by 1 | Viewed by 2131
Abstract
A multicenter cross-sectional study was designed to assess the quality of treatment of 1190 patients with chronic pain at the time of referral to a specialized pain unit. A total of 119 physicians from 77 pain units throughout Spain collected 23 indicators of [...] Read more.
A multicenter cross-sectional study was designed to assess the quality of treatment of 1190 patients with chronic pain at the time of referral to a specialized pain unit. A total of 119 physicians from 77 pain units throughout Spain collected 23 indicators of the quality of care from 10 consecutive clinical records of chronic pain patients (5 men, 5 women). Degenerative spinal diseases (38.6%) and lumbosciatic pain (29.8%) were the most common etiologies. At the time of referral to the pain unit, 9.8% of patients were not receiving any analgesic treatment. Treatment was modified in 88.1% of the patients by adding adjuvant drugs, adding opioids or increasing the doses of analgesic medications, and using analgesic techniques. Women had higher percentages of osteoarthritis, headache and fibromyalgia as the cause of pain, longer duration of pain and severe pain intensity, and a higher proportion of changes in the diagnosis of the underlying condition with which they had been referred to the pain unit. Improvements should be made in the patient management and referral protocols not only in the clinics prior to patient referral to the pain unit, but also in the pain units themselves. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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9 pages, 846 KiB  
Article
The Multidimensional Prognostic Index Predicts Mortality in Older Outpatients with Cognitive Decline
by Femke C. M. S. Overbeek, Jeannette A. Goudzwaard, Judy van Hemmen, Rozemarijn L. van Bruchem-Visser, Janne M. Papma, Harmke A. Polinder-Bos and Francesco U. S. Mattace-Raso
J. Clin. Med. 2022, 11(9), 2369; https://doi.org/10.3390/jcm11092369 - 23 Apr 2022
Cited by 4 | Viewed by 2189
Abstract
Since the heterogeneity of the growing group of older outpatients with cognitive decline, it is challenging to evaluate survival rates in clinical shared decision making. The primary outcome was to determine whether the Multidimensional Prognostic Index (MPI) predicts mortality, whilst assessing the MPI [...] Read more.
Since the heterogeneity of the growing group of older outpatients with cognitive decline, it is challenging to evaluate survival rates in clinical shared decision making. The primary outcome was to determine whether the Multidimensional Prognostic Index (MPI) predicts mortality, whilst assessing the MPI distribution was considered secondary. This retrospective chart review included 311 outpatients aged ≥65 years and diagnosed with dementia or mild cognitive impairment (MCI). The MPI includes several domains of the comprehensive geriatric assessment (CGA). All characteristics and data to calculate the risk score and mortality data were extracted from administrative information in the database of the Alzheimer’s Center and medical records. The study population (mean age 76.8 years, men = 51.4%) was divided as follows: 34.1% belonged to MPI category 1, 52.1% to MPI category 2 and 13.8% to MPI category 3. Patients with dementia have a higher mean MPI risk score than patients with MCI (0.47 vs. 0.32; p < 0.001). The HRs and corresponding 95% CIs for mortality in patients in MPI categories 2 and 3 were 1.67 (0.81–3.45) and 3.80 (1.56–9.24) compared with MPI category 1, respectively. This study shows that the MPI predicts mortality in outpatients with cognitive decline. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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18 pages, 520 KiB  
Article
Adherence to Medication in Older Adults with Type 2 Diabetes Living in Lubuskie Voivodeship in Poland: Association with Frailty Syndrome
by Iwona Bonikowska, Katarzyna Szwamel and Izabella Uchmanowicz
J. Clin. Med. 2022, 11(6), 1707; https://doi.org/10.3390/jcm11061707 - 19 Mar 2022
Cited by 5 | Viewed by 3084
Abstract
Purpose: Diabetic patients aged 65 years or older are more likely to be frail than non-diabetic older adults. Adherence to therapeutic recommendations in the elderly suffering from diabetes and co-existent frailty syndrome may prevent complications such as micro- or macroangiopathy, as well as [...] Read more.
Purpose: Diabetic patients aged 65 years or older are more likely to be frail than non-diabetic older adults. Adherence to therapeutic recommendations in the elderly suffering from diabetes and co-existent frailty syndrome may prevent complications such as micro- or macroangiopathy, as well as significantly affect prevention and reversibility of frailty. The study aimed at assessing the impact of frailty syndrome (FS) on the level of adherence to medication in elderly patients with type 2 diabetes (DM2). Patients and Methods: The research was carried out among 175 DM2 patients (87; 49.71% women and 88; 50.29% men) whose average age amounted to 70.25 ± 6.7. Standardized research instruments included Tilburg frailty indicator (TFI) to assess FS and adherence in chronic disease scale questionnaire (ACDS) to measure adherence to medications. Results: The group of 101 (57.71%) patients displayed medium, 39 (22.29%)—low, and 35 (20.00%)—high adherence. As many as 140 of them (80.00%) were diagnosed with frailty syndrome. The median of the average result of TFI was significantly higher in the low adherence group (p ˂ 0.001) (Mdn = 9, Q1–Q3; 7–10 pt.) than in the medium (Mdn = 6, Q1–Q3; 5–9 pt.) or high adherence (Mdn = 6.00, Q1–Q3; 4.5–8 pt.) ones. The independent predictors of the chance to be qualified to the non-adherence group included three indicators: TFI (OR 1.558, 95% CI 1.245–1.95), male gender (OR 2.954, 95% CI 1.044–8.353), and the number of all medications taken daily (each extra pill decreased the chance of being qualified to the non-adherence group by 15.3% (95% CI 0.728–0.954). Conclusion: Frailty syndrome in elderly DM2 patients influenced medical adherence in this group. The low adhesion group had higher overall TFI scores and separately higher scores in the physical and psychological domains compared to the medium and high adhesion groups. Full article
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13 pages, 2980 KiB  
Article
Age-Related Alterations of Hyaluronan and Collagen in Extracellular Matrix of the Muscle Spindles
by Chenglei Fan, Carmelo Pirri, Caterina Fede, Diego Guidolin, Carlo Biz, Lucia Petrelli, Andrea Porzionato, Veronica Macchi, Raffaele De Caro and Carla Stecco
J. Clin. Med. 2022, 11(1), 86; https://doi.org/10.3390/jcm11010086 - 24 Dec 2021
Cited by 10 | Viewed by 2849
Abstract
Background: Muscle spindles (MSs) play a crucial role in proprioception and locomotor coordination. Although the elasticity and viscosity of the extracellular matrix (ECM) within which MSs are embedded may play a key role in MS function, the impact of aging on ECM components [...] Read more.
Background: Muscle spindles (MSs) play a crucial role in proprioception and locomotor coordination. Although the elasticity and viscosity of the extracellular matrix (ECM) within which MSs are embedded may play a key role in MS function, the impact of aging on ECM components is unclear. The aim of the current study was to investigate the age-related physiological changes of the ECM and to verify if these could be due to alterations of the environment directly surrounding MSs. Methods: Hematoxylin Eosin and picrosirius-red staining was carried out; collagen types I (COLI) and III (COLIII) were assessed, and biotinylated hyaluronan binding protein (HABP) immunohistochemical analysis was undertaken to evaluate alterations of the ECM in the intramuscular connective tissue (IMCT) of the hindlimbs of C57BL/6J male mice. Assessments were carried out on 6-week-old (Group A), 8-month-old (Group B), and 2-year-old (Group C) laboratory mice. Results: The capsule’s outer layer became progressively thicker with aging (it was 3.02 ± 0.26 μm in Group A, 3.64 ± 0.31 μm in Group B, and 5.81 ± 0.85 μm in Group C). The collagen in IMCT around and within the MSs was significantly higher in Group C, but there were no significant differences between Groups A and B. The MS capsules and continuous IMCT were primarily made up of COLI and COLIII. The average optical density (AOD) values of COLI in IMCT surrounding MS were significantly higher after aging (p < 0.05), but there were no significant differences in COLIII in the three groups (p > 0.05). HA was present in IMCT and filled the MSs capsule. The AOD of HABP of MS showed that there were lower HA levels in Group C with respect to Group A (p = 0.022); no significant differences were noted neither between Groups A and B nor between Groups B and C (p > 0.05). Conclusion: Age-related collagen accumulation and lower HA in the ECM in which the MSs were embedded may probably cause more stiffness in the ECM in vivo, which could help to partly explain the peripheral mechanisms underlying the age-related decline in functional changes related to MSs. Full article
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12 pages, 802 KiB  
Article
The Interplay between Anticholinergic Burden and Anemia in Relation to 1-Year Mortality among Older Patients Discharged from Acute Care Hospitals
by Andrea Corsonello, Luca Soraci, Francesco Corica, Valeria Lago, Clementina Misuraca, Graziano Onder, Stefano Volpato, Carmelinda Ruggiero, Antonio Cherubini and Fabrizia Lattanzio
J. Clin. Med. 2021, 10(20), 4650; https://doi.org/10.3390/jcm10204650 - 11 Oct 2021
Cited by 2 | Viewed by 1912
Abstract
Anticholinergic burden (ACB) and anemia were found associated with an increased risk of death among older patients. Additionally, anticholinergic medications may contribute to the development of anemia. Therefore, we aimed at investigating the prognostic interplay of ACB and anemia among older patients discharged [...] Read more.
Anticholinergic burden (ACB) and anemia were found associated with an increased risk of death among older patients. Additionally, anticholinergic medications may contribute to the development of anemia. Therefore, we aimed at investigating the prognostic interplay of ACB and anemia among older patients discharged from hospital. Our series consisted of 783 patients enrolled in a multicenter observational study. The outcome of the study was 1 year mortality. ACB was assessed by an Anticholinergic Cognitive Burden score. Anemia was defined as hemoglobin < 13 g/dL in men and <12 g/dL in women. The association between study variables and mortality was investigated by Cox regression analysis. After adjusting for several potential confounders, ACB score = 2 or more was significantly associated with the outcome in anemic patients (HR = 1.93, 95%CI = 1.13–3.40), but not non anemic patients (HR = 1.51, 95%CI = 0.65–3.48). An additive prognostic interaction between ACB and anemia was observed (p = 0.02). Anemia may represent a relevant effect modifier in the association between ACB and mortality. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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11 pages, 2074 KiB  
Article
Predictive Model for the Assessment of Preoperative Frailty Risk in the Elderly
by Sang-Wook Lee, Jae-Sik Nam, Ye-Jee Kim, Min-Ju Kim, Jeong-Hyun Choi, Eun-Ho Lee, Kyoung-Woon Joung and In-Cheol Choi
J. Clin. Med. 2021, 10(19), 4612; https://doi.org/10.3390/jcm10194612 - 08 Oct 2021
Cited by 4 | Viewed by 1511
Abstract
Adequate preoperative evaluation of frailty can greatly assist in the efficient allocation of hospital resources and planning treatments. However, most of the previous frailty evaluation methods, which are complicated, time-consuming, and can have inter-evaluator error, are difficult to apply in urgent situations. Thus, [...] Read more.
Adequate preoperative evaluation of frailty can greatly assist in the efficient allocation of hospital resources and planning treatments. However, most of the previous frailty evaluation methods, which are complicated, time-consuming, and can have inter-evaluator error, are difficult to apply in urgent situations. Thus, the authors aimed to develop and validate a predictive model for pre-operative frailty risk of elderly patients by using diagnostic and operation codes, which can be obtained easily and quickly from electronic records. We extracted the development cohort of 1762 people who were hospitalized for emergency operations at a single institution between 1 January 2012 and 31 December 2016. The temporal validation cohort from 1 January 2017 to 31 December 2018 in the same center was set. External validation was conducted on 6432 patients aged 75 years or older from 2012 to 2015 who had emergency surgery in the Korean national health insurance database. We developed the Operation Frailty Risk Score (OFRS) by assessing the association of Operation Group and Hospital Frailty Risk Score with the 90-day mortality through logistic regression analysis. We validated the OFRS in both the temporal validation cohort and two external validation cohorts. In the temporal validation cohort and the external validation cohort I and II, the c-statistics for OFRS to predict 90-day mortality were 0.728, 0.626, and 0.619, respectively. OFRS from these diagnostic codes and operation codes may help evaluate the peri-operative frailty risk before emergency surgery for elderly patients where history-taking and pre-operative testing cannot be performed. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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10 pages, 266 KiB  
Article
Polypharmacy Is Significantly and Positively Associated with the Frailty Status Assessed Using the 5-Item FRAIL Scale, Cardiovascular Health Phenotypic Classification of Frailty Index, and Study of Osteoporotic Fractures Scale
by Chi-Di Hung, Chen-Cheng Yang, Chun-Ying Lee, Stephen Chu-Sung Hu, Szu-Chia Chen, Chih-Hsing Hung, Hung-Yi Chuang, Ching-Yu Chen and Chao-Hung Kuo
J. Clin. Med. 2021, 10(19), 4413; https://doi.org/10.3390/jcm10194413 - 26 Sep 2021
Cited by 4 | Viewed by 2456
Abstract
The aim of this study was to investigate the association between frailty and polypharmacy using three different frailty screening tools. This was a cross-sectional study of people aged ≥65 years. Participants were included and interviewed using questionnaires. Polypharmacy was defined as the daily [...] Read more.
The aim of this study was to investigate the association between frailty and polypharmacy using three different frailty screening tools. This was a cross-sectional study of people aged ≥65 years. Participants were included and interviewed using questionnaires. Polypharmacy was defined as the daily use of eight or more pills. Frailty was assessed using a screening tool, including (1) the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (5-item FRAIL scale), (2) the Cardiovascular Health Phenotypic Classification of Frailty (CHS_PCF) index (Fried’s Frailty Phenotype), and (3) the Study of Osteoporotic Fracture (SOF) scale. A total of 205 participants (mean age: 71.1 years; 53.7% female) fulfilled our inclusion criteria. The proportion of patients with polypharmacy was 14.1%. After adjustments were made for comorbidity or potential confounders, polypharmacy was associated with frailty on the 5-item FRAIL scale (adjusted odds ratio [aOR]: 9.12; 95% confidence interval [CI]: 3.6–23.16), CHS_PCF index (aOR: 8.98; 95% CI: 2.51–32.11), and SOF scale (aOR: 6.10; 95% CI: 1.47–25.3). Polypharmacy was associated with frailty using three frailty screening tools. Future research is required to further enhance our understanding of the risk of frailty among older adults. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
12 pages, 2702 KiB  
Article
Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis
by Salman Hussain, Ambrish Singh, Benny Antony, Rolando Claure-Del Granado, Jitka Klugarová, Radim Líčeník and Miloslav Klugar
J. Clin. Med. 2021, 10(19), 4390; https://doi.org/10.3390/jcm10194390 - 26 Sep 2021
Cited by 4 | Viewed by 2542
Abstract
Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand [...] Read more.
Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle–Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort (n = 3) and case–control (n = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52–2.43), p ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09–1.11), p < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62–3.28), p = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20–3.70), p = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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11 pages, 279 KiB  
Article
Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis
by Encarnación Blanco-Reina, Lorena Aguilar-Cano, María Rosa García-Merino, Ricardo Ocaña-Riola, Jenifer Valdellós, Inmaculada Bellido-Estévez and Gabriel Ariza-Zafra
J. Clin. Med. 2021, 10(16), 3576; https://doi.org/10.3390/jcm10163576 - 14 Aug 2021
Cited by 11 | Viewed by 2499
Abstract
Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the [...] Read more.
Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
10 pages, 559 KiB  
Article
Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest
by Jeannette A. Goudzwaard, Sadhna Chotkan, Marjo J. A. G. De Ronde-Tillmans, Mattie J. Lenzen, Maarten P. H. van Wiechen, Joris F. W. Ooms, Harmke A. Polinder-Bos, Madelon de Beer-Leentfaar, Nicolas M. Van Mieghem, Joost Daemen, Alberto Pilotto, Peter P. T. de Jaegere and Francesco U. S. Mattace-Raso
J. Clin. Med. 2021, 10(16), 3529; https://doi.org/10.3390/jcm10163529 - 11 Aug 2021
Cited by 8 | Viewed by 1695
Abstract
Selecting patients with a high chance of endured benefit from transcatheter aortic valve implantation (TAVI) is becoming relevant with changing indications and increasing number of TAVI being performed. The aim of our study was to investigate the association of the multidimensional prognostic index [...] Read more.
Selecting patients with a high chance of endured benefit from transcatheter aortic valve implantation (TAVI) is becoming relevant with changing indications and increasing number of TAVI being performed. The aim of our study was to investigate the association of the multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) on survival. The TAVI Care & Cure program is a prospective, observational registry of patients referred for TAVI at the Erasmus MC University Medical Center. Consecutive patients who underwent a complete CGA and TAVI were included. CGA components were used to calculate the MPI score. The impact of the MPI score on survival was evaluated using Cox regression. Furthermore, 376 patients were included, 143 (38.0%) patients belonged to the MPI-1 group and 233 (61.9%) patients to the MPI-2–3 group. After 3 years, 14.9% of the patients in the MPI-1 group and 30.5% of the patients in the MPI-2–3 group died (p = 0.001). Patients in MPI-1 had increased chances of overall survival in comparison with patients in MPI group 2–3 Hazard Ratio (HR) 0.57, (95% Confidence Interval (CI) 0.33–0.98)). In this study we found that the MPI tool could be useful to assess frailty and to predict which patient will have a higher chance of enduring benefit from a TAVI procedure. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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12 pages, 1786 KiB  
Article
Interaction between Subjective Memory Decline and Depression Symptom Intensity in Older People. Results of the Second Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS)
by Sławomir Kujawski, Agnieszka Kujawska, Radosław Perkowski, Joanna Androsiuk-Perkowska, Weronika Hajec, Małgorzata Kwiatkowska, Natalia Skierkowska, Jakub Husejko, Daria Bieniek, Julia L. Newton, Paweł Zalewski and Kornelia Kędziora-Kornatowska
J. Clin. Med. 2021, 10(7), 1334; https://doi.org/10.3390/jcm10071334 - 24 Mar 2021
Viewed by 1777
Abstract
Background: Prevalence of subjective memory impairment (SMC), with or without objective memory impairment, and the mediating role of depression symptom intensity was examined in older people. Methods: n = 205 subjects (60 years old and older) were examined and followed up at two [...] Read more.
Background: Prevalence of subjective memory impairment (SMC), with or without objective memory impairment, and the mediating role of depression symptom intensity was examined in older people. Methods: n = 205 subjects (60 years old and older) were examined and followed up at two years. Cognitive function was examined using the Montreal Cognitive Assessment (MoCA) Delayed Recall (DR) subtest. Geriatric Depression Scale (GDS) was used as a screening tool for depression. Statistical analysis was performed using linear mixed models. Results: A total of 144 subjects (70.24%) had SMC. MoCA Delayed Recall scores were not significantly changed in relation to time and SMC. Dynamics of SMC significantly influenced changes in GDS score (p = 0.008). Conclusions: SMC and objective memory impairment do not fully overlap each other. Subjects without SMC for longer than two years noted less intensity of depression symptoms in comparison to subgroup with SMC. However, occurrence of SMC in subjects who were previously free of SMC, was not related to increase in depression symptom intensity. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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12 pages, 1217 KiB  
Article
Age Differences in Motor Recruitment Patterns of the Shoulder in Dynamic and Isometric Contractions. A Cross-Sectional Study
by Cristina Lirio-Romero, Rocío Palomo-Carrión, Helena Romay-Barrero, Asunción Ferri-Morales, Virginia Prieto-Gómez and María Torres-Lacomba
J. Clin. Med. 2021, 10(3), 525; https://doi.org/10.3390/jcm10030525 - 02 Feb 2021
Viewed by 2787
Abstract
Aging processes in the musculoskeletal system lead to functional impairments that restrict participation. Purpose: To assess differences in the force and motor recruitment patterns of shoulder muscles between age groups to understand functional disorders. A cross-sectional study comparing 30 adults (20–64) and 30 [...] Read more.
Aging processes in the musculoskeletal system lead to functional impairments that restrict participation. Purpose: To assess differences in the force and motor recruitment patterns of shoulder muscles between age groups to understand functional disorders. A cross-sectional study comparing 30 adults (20–64) and 30 older adults (>65). Surface electromyography (sEMG) of the middle deltoid, upper and lower trapezius, infraspinatus, and serratus anterior muscles was recorded. Maximum isometric voluntary contraction (MIVC) was determined at 45° glenohumeral abduction. For the sEMG signal registration, concentric and eccentric contraction with and without 1 kg and isometric contraction were requested. Participants abducted the arm from 0° up to an abduction angle of 135° for concentric and eccentric contraction, and from 0° to 45°, and remained there at 80% of the MIVC level while isometrically pushing against a handheld dynamometer. Differences in sEMG amplitudes (root mean square, RMS) of all contractions, but also onset latencies during concentric contraction of each muscle between age groups, were analyzed. Statistical differences in strength (Adults > Older adults; 0.05) existed between groups. No significant differences in RMS values of dynamic contractions were detected, except for the serratus anterior, but there were for isometric contractions of all muscles analyzed (Adults > Older adults; 0.05). The recruitment order varied between age groups, showing a general tendency towards delayed onset times in older adults, except for the upper trapezius muscle. Age differences in muscle recruitment patterns were found, which underscores the importance of developing musculoskeletal data to prevent and guide geriatric shoulder pathologies. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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Review

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22 pages, 1548 KiB  
Review
Anemia and Its Connections to Inflammation in Older Adults: A Review
by Eryk Wacka, Jan Nicikowski, Pawel Jarmuzek and Agnieszka Zembron-Lacny
J. Clin. Med. 2024, 13(7), 2049; https://doi.org/10.3390/jcm13072049 - 02 Apr 2024
Viewed by 813
Abstract
Anemia is a common hematological disorder that affects 12% of the community-dwelling population, 40% of hospitalized patients, and 47% of nursing home residents. Our understanding of the impact of inflammation on iron metabolism and erythropoiesis is still lacking. In older adults, anemia can [...] Read more.
Anemia is a common hematological disorder that affects 12% of the community-dwelling population, 40% of hospitalized patients, and 47% of nursing home residents. Our understanding of the impact of inflammation on iron metabolism and erythropoiesis is still lacking. In older adults, anemia can be divided into nutritional deficiency anemia, bleeding anemia, and unexplained anemia. The last type of anemia might be caused by reduced erythropoietin (EPO) activity, progressive EPO resistance of bone marrow erythroid progenitors, and the chronic subclinical pro-inflammatory state. Overall, one-third of older patients with anemia demonstrate a nutritional deficiency, one-third have a chronic subclinical pro-inflammatory state and chronic kidney disease, and one-third suffer from anemia of unknown etiology. Understanding anemia’s pathophysiology in people aged 65 and over is crucial because it contributes to frailty, falls, cognitive decline, decreased functional ability, and higher mortality risk. Inflammation produces adverse effects on the cells of the hematological system. These effects include iron deficiency (hypoferremia), reduced EPO production, and the elevated phagocytosis of erythrocytes by hepatic and splenic macrophages. Additionally, inflammation causes enhanced eryptosis due to oxidative stress in the circulation. Identifying mechanisms behind age-related inflammation is essential for a better understanding and preventing anemia in older adults. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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18 pages, 496 KiB  
Review
Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review
by Mohammed S. Salahudeen, Adel Alfahmi, Anam Farooq, Mehnaz Akhtar, Sana Ajaz, Saud Alotaibi, Manal Faiz and Sheraz Ali
J. Clin. Med. 2022, 11(3), 714; https://doi.org/10.3390/jcm11030714 - 28 Jan 2022
Cited by 7 | Viewed by 3555
Abstract
Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and [...] Read more.
Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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35 pages, 4298 KiB  
Review
Hematopoiesis, Inflammation and Aging—The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals
by Øystein Bruserud, Anh Khoi Vo and Håkon Rekvam
J. Clin. Med. 2022, 11(3), 706; https://doi.org/10.3390/jcm11030706 - 28 Jan 2022
Cited by 10 | Viewed by 3188
Abstract
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient [...] Read more.
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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16 pages, 1364 KiB  
Review
Acupuncture for Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis
by Chan-Young Kwon and Boram Lee
J. Clin. Med. 2021, 10(14), 3087; https://doi.org/10.3390/jcm10143087 - 13 Jul 2021
Cited by 7 | Viewed by 2950
Abstract
Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched [...] Read more.
Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched to find clinical studies using acupuncture on BPSD, published up to December 2020. Five randomized controlled clinical trials and two before-after studies, mainly on Alzheimer’s disease (AD), were included. Meta-analysis suggested that the total effective rate based on BPSD symptoms in the acupuncture combined with psychotropic drugs group was significantly higher than that in the psychotropic drugs group (risk ratio, 1.27; 95% confidence interval, 1.11 to 1.45; I2 = 51%). In terms of other outcomes related to BPSD, acupuncture as an adjunctive therapy, but not as monotherapy, was associated with significant benefits in most included studies. However, the included studies did not have optimal methodological quality. Our review highlights the limited evidence proving the effectiveness and safety of acupuncture for BPSD in patients with AD. Although some clinical studies have reported the potential benefits of adjuvant acupuncture in managing BPSD, the evidence is not robust and is based on small studies. Therefore, high-quality research in this field is needed. Full article
(This article belongs to the Special Issue Advances in Geriatric Diseases)
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