Search Results (349)

Background/Objectives: This study aimed to compare the effects of low- and medium-frequency NMES, combined with a standard physical therapy (SPT) program, on functional capacity in critically ill patients. Methods: Fifty-four critically ill patients admitted into Intensive Care Unit (ICU) and on mechanical ventilation participated in this randomized, single-blinded, experimental study. Participants were randomly assigned to a Control group, who received a lower limb SPT program; the Low-frequency NMES group received lower limb SPT + NMES at 100 Hz; and the Medium-frequency NMES group received lower limb SPT + NMES at 100 Hz with a carrier frequency of 2500 Hz. The outcomes, encompassing functional capacity in the hospital, included muscle strength, handgrip strength, functional status, degree of independence for activities of daily living, functional and dynamic mobility, quality of life, and total days hospitalized. Results: Both NMES protocols combined with SPT improved functional capacity compared to the control group. Medium-frequency NMES provided additional benefits on dynamic balance, in the degree of independence to perform activities of daily living and quality of life (all p < 0.001) prior to hospital discharge. It also promoted larger gains on functional status prior to ICU discharge and on knee extension strength (both p < 0.05) prior to intermediate care unit discharge. Medium-frequency NMES also enhanced handgrip strength earlier than low-frequency NMES when compared to the control group. Notably, medium-frequency NMES was the only intervention associated with a significant reduction in total hospital stay duration (p < 0.05). Conclusions: Medium-frequency NMES, along with an SPT program in critically ill patients, showed greater benefits on functional capacity during recovery than low-frequency NMES. (Trial registration: This trial is registered on ClinicalTrials.gov: NCT05287919). Implications for rehabilitation: 1. Medium-frequency NMES may enhance physical functionality and quality of life in critically ill patients with ICU-acquired weakness. 2. Medium-frequency NMES can reduce the number of hospitalization days. 3. NMES combined with SPT represents a feasible and effective option for patients unable to engage in active rehabilitation during critical illness. Full article

Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality. Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality. Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07, p = 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07, p < 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality. Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment. Full article

Pain is a common condition among older adults and a key factor influencing daily functioning. This cross-sectional study examined how pain presence and distribution (no pain, localized pain [LP], and widespread pain [WP]) are related to limitations in Basic and Instrumental Activities of Daily Living (BADLs and IADLs). Data were drawn from the Survey of Health, Aging, and Retirement in Europe (SHARE) Wave 9, including 68,839 participants aged 50 or older. A clear gradient of functional limitation was observed: Individuals with WP reported the highest number of limitations, followed by those with LP, while those with no pain showed minimal impairment. These associations remained significant after adjusting for age, sex, cognitive status, physical health, and psychosocial factors, with adjusted prevalence ratios (aPRs) for WP of 1.77 for BADLs and 1.22 for IADLs (p < 0.001). Notably, depression, perceived loneliness, long-term illness, physical inactivity, and mobility limitations were especially relevant among participants with WP. The findings suggest the clinical value of assessing and implementing interventions not only in the presence but also in the extent of pain to better identify individuals at greater risk of losing independence in daily life. Full article

Background/Objectives: This study aims to investigate the influence of demographic, behavioral, anthropometric, and comorbid factors on brain atrophy in people living with HIV (PLWH). Methods: We conducted a cross-sectional study involving 121 HIV-positive patients, stratified into two groups, those with and without brain atrophy (BA). For each participant, we recorded demographic data, smoking status, physical activity levels, disease and treatment duration, and comorbidities. BA was quantitatively assessed using MRI-derived volumetric measurements of 47 cerebral substructures. Results: Patients with BA exhibited significantly reduced gray matter (GM) and white matter (WM) volumes alongside increased cerebrospinal fluid volumes, both in absolute and percentage measurements. WM atrophy was most pronounced in the frontal, parietal, and temporal lobes, with relative sparing of the occipital lobe. GM atrophy predominantly affected the basal ganglia (notably, the thalamus and putamen) and cortical regions, including the hippocampus, frontal, and parietal lobes. Significant positive correlations were observed between BA and both smoking status (pack–years) and disease duration, while physical activity demonstrated an inverse relationship (higher atrophy risk in those with less than 30 min of daily continuous walking). Non-adherence to antiretroviral therapy (ART) was also associated with BA. Among comorbidities, type 2 diabetes and HIV-associated neurocognitive disorders (HAND) showed the strongest associations with BA. Conclusions: Brain atrophy in PWH is correlated with smoking, physical inactivity, and the duration of HIV infection. Comorbid conditions, such as type II diabetes and HAND, amplify the risk for BA. We consider that early lifestyle interventions and optimized ART may mitigate the neurodegeneration process. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by systemic manifestations, including altered body composition, reduced quality of life, and psychological distress. Despite its significance, the relationship between body composition parameters and symptoms of fatigue, anxiety, and depression in patients with COPD remains underexplored. This study aimed to examine the association between detailed body composition metrics and quality of life, fatigue, and anxiety and depression symptoms in male patients with COPD compared to healthy controls. Methods: This cross-sectional study included 49 men with COPD and 51 age-matched healthy controls aged 50–80 years. Body composition was assessed using bioelectrical impedance analysis (BIA). Pulmonary function, dyspnea, activities of daily living, and psychological status were evaluated using spirometry, the Medical Research Council Dyspnea Scale, the London Chest Activity of Daily Living Scale (LCADL), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Compared to the controls, patients with COPD exhibited significantly lower forced expiratory volume in one second (FEV₁: 1.1 vs. 2.16 L; p < 0.001), lower fat mass (15.0 vs. 24.3 kg; p < 0.001), and higher muscle mass (53.8 vs. 42.0 kg; p < 0.001). They also reported significantly greater fatigue (Borg scale: 4 vs. 0; p < 0.001), higher anxiety (8 vs. 5; p = 0.006), and depression scores (11 vs. 5; p < 0.001), along with more pronounced limitations in their daily activities. Conclusions: COPD is associated with profound impairments in body composition, physical function, and mental health. Detailed body composition analysis using BIA provides valuable clinical insights and may aid in tailoring individualized interventions to improve quality of life and psychological outcomes in COPD management. Full article

Neck pain is a significant global health concern and a leading cause of disability. Conventional clinical neck assessments often rely on maximal Cervical Range of Motion (CROM) measurements, which may not accurately reflect functional limitations experienced during activities of daily living (ADLs). This study introduces a novel approach to evaluate neck functional status by employing a virtual reality (VR) environment to simulate an apple-harvesting task. Three-dimensional head kinematics were continuously recorded in 60 participants (30 with clinically significant neck pain and 30 asymptomatic) as they performed the task. Spectral analysis of the data revealed that individuals with neck pain exhibited slower head rotation speed, particularly in the transverse and frontal planes, compared to the pain-free group, as evidenced by higher spectral power in the low-frequency band [0, 0.1] Hz and lower power in the [0.1, 0.5] Hz band. Furthermore, participants with neck pain required significantly more time to complete the apple-harvesting task. The VR system demonstrated high usability (SUS score = 84.21), and no adverse effects were reported. These findings suggest that VR-based assessment during simulated ADLs can provide valuable information about the functional impact of neck pain beyond traditional CROM measurements, potentially enabling remote evaluation and personalized telerehabilitation strategies. Full article

Although the relationship between grandparent and grandchild is often unique due to the supportive and foundational roles grandparents can have in the lives of young or youthful grandchildren, the extent of grandparent–grandchild coresidence globally is under-researched. We harmonized household roster survey data on grandchild coresidence using population-based data on adults 55+ years across 24 countries. Grandchild coresidence rates ranged from 41.1% in Mexico to 0.1% in Sweden. Across contexts, grandchild coresidence was more common among women (compared to men), non-partnered individuals (compared to partnered individuals), those who reported difficulty with activities of daily living (compared to those without such difficulties), and those with education levels below the median (compared to those above the median). Logit regressions indicated gaps in rates of grandchild coresidence by partner status, ADL status, and education were generally not driven by income or other socio-demographic variables. Coresidence with adult grandchildren was not uncommon in most countries with non-negligible rates of grandchild coresidence. In about 25% of households of middle-aged and older adults coresiding with grandchildren, grandchildren ages 0–5 years were present. Future research should consider the meaning of grandparent–grandchild coresidence for the health outcomes of middle-aged and older adults globally, particularly when grandparents are not caregivers of grandchildren. Full article

Background: The association between high-sensitivity C-reactive protein (hsCRP) and activities of daily living (ADL) disability remains unclear. Our study aimed to comprehensively explore the relationship between hsCRP concentrations and the risk of ADL disability, while also identifying potential modifiers of this association in middle-aged and older adults. Methods: We conducted a prospective study involving 16,342 participants aged 50 years and older (mean age: 64 ± 10 years) from the Health and Retirement Study. To investigate the longitudinal association between hsCRP and the risk of ADL disability, we employed Cox proportional hazard regression models, adjusting for a wide range of potential confounders. Subgroups analyses were further conducted to examine interactions across factors such as gender, age, body mass index, smoking status, and drinking status. Results: This study involved a follow-up of 125,858 person-years (median of 8 years; interquartile range: 4–12 years), revealing a total of 4579 incidents of ADL disability. The highest hsCRP concentration was significantly associated with ADL disability after adjustment for covariates (hazard ratio [HR] = 1.25; confidence interval [CI] = 1.14–1.36). The associations between hsCRP and the risk of ADL disability seemed to be somewhat stronger among individuals aged < 65 years and with a BMI ≥ 30 kg/m² (both p for interaction < 0.05). Conclusions: Our findings indicated that elevated hsCRP concentrations are associated with an increased risk of ADL disability in middle-aged and older adults. HsCRP appears to serve as a biomarker for ADL disability, particularly among individuals with obesity and middle-aged adults. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Background: Patients with myasthenia gravis (MG) are susceptible to fractures due to glucocorticoid (GC) use and disease-related functional impairment affecting activities of daily living (ADL). The Fracture Risk Assessment Tool (FRAX^®) estimates fracture probability but does not incorporate disease-specific functional status. We investigated whether combining FRAX^® with the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale improves fracture risk stratification in MG patients. Methods: This single-center prospective cohort study followed 53 MG patients for 10 years (2012–2022) at Toho University Ohashi Medical Center, Japan. Patients were categorized into four groups based on baseline FRAX^® probability (calculated with bone mineral density [BMD]) and MG-ADL scores using median splits: high FRAX^®/high MG-ADL (HH), high FRAX^®/low MG-ADL (HL), low FRAX^®/high MG-ADL (LH), and low FRAX^®/low MG-ADL (LL). The primary outcome was incident major osteoporotic fracture (MOF). Results: Over 10 years, nine MOFs occurred: seven in the HH group (43.8%), two in the HL group (16.7%), and none in the LH or LL groups. Fracture-free survival differed significantly among the groups (log-rank p < 0.001), with the HH group exhibiting the lowest survival rate. Baseline characteristics, including age, disease duration, MG severity scores, BMD, and FRAX^® scores, differed significantly among groups. Specific MG-ADL items reflecting greater impairment (impairment of ability to arise from a chair, double vision, and ptosis) were significantly more pronounced in the HH group at baseline. Conclusions: Combining baseline FRAX^® scores with the MG-ADL assessment effectively stratifies long-term MOF risk in patients with MG. Individuals with both high FRAX^® and high MG-ADL represent a particularly high-risk subgroup. This dual-assessment approach may improve the identification of patients requiring targeted preventive interventions. Full article

Background: Physical, emotional, psychological, and social factors influence the high level of burden of a caregiver providing care for a patient at home after a stroke. The purpose of this study was to identify and evaluate factors influencing the high level of burden on the caregiver providing care for a post-stroke patient, including factors on the part of the patient and caregiver. Methods: This cross-sectional study was conducted at the Neurological Rehabilitation Department of the Hospital Beskid Treatment and Rehabilitation Complex in Jaworze, Poland, and the Neurological Rehabilitation Department of the Railway Hospital in Wilkowice-Bystra. The study participants comprised post-stroke patients and their family caregivers (during visits to hospital), 110 pairs. The measures for caregivers were such as the following: Beck Depression Inventory, the Polish adaptation of the Perceived Stress Scale, the Polish adaptation of the Mini-COPE questionnaire to measure stress coping strategies, and the WHO Quality of Life Brief Version. The measures for patients were such as the following: the modified Rankin Scale and Abbreviated Mental Test Score to assess functional capacity for simple Activities of Daily Living (ADL). All statistical calculations were performed using the R statistical package version 4.4.2. Results: A high caregiver burden was found in 30 people (27.3%). Logistic regression analysis proved that low quality of life, stress, caregiver-triggered strategies (discharge and cessation of activities), caregiver frustration, psychological burden, financial situation, longer time spent on patient care, functional status (ADL) on the part of the patient, judgment of significant degree of disability judgment, and age of the patient are determinants affecting high caregiver burden levels. Conclusions: Almost 1/3 of caregivers experienced a high burden when taking care of a person after stroke. Analyzing the Gini index, from the model’s point of view, quality of life is the most important characteristics, and caregiver frustration is the least important, which influences the high level of caregiver burden. Full article

Residential green space (RGS), as a frequently visited green space by residents, is the main space for daily activities and interactions, and its quality directly affects residents’ physical and mental health. Although many studies have revealed the impact of green space characteristics on health, research on the relationship between its environmental elements and health is still insufficient. This study selected five types of residential area in the central urban area of Beijing for investigation, collecting people’s green space perception, usage, and self-rated health information, and, using stepwise regression analysis, exploring the impact of RGS environmental factors on residents’ self-rated health under different vegetation cover rates. The results suggest the following: (1) Residents’ perception and usage of RGS characteristics are closely related to their self-rated health status, but the impact of environmental factors varies depending on vegetation coverage. (2) Maximizing natural features and cultural symbols is crucial for residential areas with high greenery. In residential areas with moderate vegetation, priority should be given to enhancing path elements, maintenance and shelter. For residential areas with low greenery cover, efforts should focus on strengthening fitness facilities and improving shelter to promote people’s health. (3) The impact of activity duration on usage behavior is most significant. These findings contribute to a more comprehensive understanding of the significance of RGS quality in urban residential areas. They also provide a reference for the optimization and management of the living environment and support the sustainable development of community environments. Full article

Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status in older populations remain limited for Türkiye. This study aimed to estimate the prevalence of depression among individuals aged 65 years or older, examine its associations with instrumental and basic activities of daily living, and identify key sociodemographic and behavioral correlates. Methods: In this study, data obtained from a population-based survey in 2264 clusters by the Turkish Statistical Institute (TUIK) were used, and weighted data were yielded from 6,036,396 adults aged 65 and over. Depression was measured using the Geriatric Depression Scale (GDS), categorizing participants as “not depressed”, “mildly depressed”, or “severely depressed”. Functional status was evaluated using the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale and the Katz Activities of Daily Living (ADL) Scale. Logistic regression models, adjusted for age and body mass index (BMI), were used to determine the associations of depression with functional impairment and various covariates, including gender, education, marital status, chronic disease, physical activity, smoking, and alcohol use. Results: Overall, the prevalence of depression in this cohort was 49.9% [95% CI = 48.7–51%], with 36.0% [95% CI = 34.8–37.0%] classified as mild and 13.9% [95% CI = 13.1–14.7%] as severe depression. IADL and ADL scores were negatively correlated with GDS scores (r = −0.416 and r = −0.321, respectively; p < 0.001). In logistic models, lower IADL scores were linked to higher odds of mild (OR = 0.797, 95% CI = [0.796–0.798], p < 0.001) and severe depression (OR = 0.689, 95% CI = [0.688–0.690], p < 0.001). Being semi-dependent or dependent in ADL further escalated depression risk. Female gender, lower education, single/divorced status, chronic disease, and inactivity also emerged as strong predictors. Conclusions: The findings of this study suggest that depression is highly prevalent among older adults in Türkiye, with functional impairment, unfavorable health behaviors, and sociodemographic vulnerabilities heightening risk. Integrating depression screening into geriatric care—alongside interventions to maintain functional independence—may help mitigate the burden of late-life depression in similar contexts. Full article

Background/Objectives: Instrumental Activities of Daily Living (IADL) are the key indicators of the autonomy and functional ability in older adults with neurocognitive disorders (NCDs). However, the specific predictors of IADL performance across the NCD spectrum remains insufficiently characterized. This study aimed to identify the cognitive, motor, and caregiver-related determinants of the IADL in individuals with minor and major NCDs. Methods: A cross-sectional study was conducted involving 117 participants referred from a university-based dementia clinic. Standardized tools were administered to evaluate their IADL performance (Lawton IADL Scale), cognition [Addenbrooke’s Cognitive Examination III (ACE-III)], Functional Cognitive Assessment Scale (FUCAS)], motor functions, balance, and mobility [Tinetti Test, Timed Up and Go (TUG)], emotional status [Geriatric Depression Scale (GDS)], neuropsychiatric symptoms [Neuropsychiatric Inventory (NPI)], and caregiver burden [Zarit Burden Interview (ZBI)]. Multiple regression analyses were performed to identify the significant predictors of IADL performance. Results: In the total sample (n = 117), the IADL performance was significantly predicted via ACE-III, FUCAS, and Tinetti-balance (adjusted R² = 0.729). In the minor NCD group (n = 41), the significant predictors included sex, FUCAS, GDS, Tinetti-balance, and TUG (adjusted R² = 0.725). In the major NCD group (n = 76), ACE-III, FUCAS, and Tinetti-balance remained the significant predictors (adjusted R² = 0.634). Female sex and a worse profile on the other variables were associated with lower IADL scores. Conclusions: Global cognitive decline, executive dysfunction in everyday problem-solving situations, and balance impairment are the key determinants of IADL performance across both minor and major NCDs. Female sex and depressive symptoms further predicted the IADL performance in the minor NCD group. These findings highlight the need for multidisciplinary assessment and intervention strategies to promote health and autonomy and preserve the functional independence in older adults with NCDs. Full article

Many females experience physical problems caused by menstruation, such as menstrual cramps and premenstrual syndrome, which disrupt their daily lives and work. Knowing when menstruation begins is essential for managing such physical conditions. However, menstrual periods are not always cyclic and can be extended by physical and mental stress. Currently used menstrual management applications rely on self-reported cycle length and basal body temperature (BBT), which makes it challenging to predict irregular periods. Advances in smart wearables have made continuous, non-invasive health monitoring accessible, such as heart rate variability (HRV). HRV characteristics reflect autonomic nervous system activity and are used as physical and mental health status indices. This study aims to explore the relationship between HRV indices and the menstrual cycle using smart wearables. A total of 13 females aged from 18 to 20 participated in this study and measured their indices using an underwear-type wearable device for six months. The device measured HRV and body acceleration. Participants recorded their BBT every morning and answered questionnaires about their physical and mental status every morning and evening. They also reported the start and end dates of menstruation. The HRV data were split into sleep and wake phases using acceleration and calculated time- and frequency-domain HRV indices. Cross-correlation and regression analysis were conducted to assess the relation between the menstrual cycle and phases, such as follicular and luteal, and the HRV indices. A significant relationship between HRV indices and the menstrual cycle length was found, particularly in the difference between the follicular and luteal phases of HRV indices. This difference showed a relatively high association with menstrual cycle length. Importantly, the regression analysis results suggested that HRV indices can be used to predict the length of the menstrual cycle and potential physical and mental disorders. These findings significantly contributed to menstrual health management and the Femtech industry. Full article