ResearchPad - geriatrics https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Pooling individual participant data from randomized controlled trials: Exploring potential loss of information]]> https://www.researchpad.co/article/elastic_article_7838 Pooling individual participant data to enable pooled analyses is often complicated by diversity in variables across available datasets. Therefore, recoding original variables is often necessary to build a pooled dataset. We aimed to quantify how much information is lost in this process and to what extent this jeopardizes validity of analyses results.MethodsData were derived from a platform that was developed to pool data from three randomized controlled trials on the effect of treatment of cardiovascular risk factors on cognitive decline or dementia. We quantified loss of information using the R-squared of linear regression models with pooled variables as a function of their original variable(s). In case the R-squared was below 0.8, we additionally explored the potential impact of loss of information for future analyses. We did this second step by comparing whether the Beta coefficient of the predictor differed more than 10% when adding original or recoded variables as a confounder in a linear regression model. In a simulation we randomly sampled numbers, recoded those < = 1000 to 0 and those >1000 to 1 and varied the range of the continuous variable, the ratio of recoded zeroes to recoded ones, or both, and again extracted the R-squared from linear models to quantify information loss.ResultsThe R-squared was below 0.8 for 8 out of 91 recoded variables. In 4 cases this had a substantial impact on the regression models, particularly when a continuous variable was recoded into a discrete variable. Our simulation showed that the least information is lost when the ratio of recoded zeroes to ones is 1:1.ConclusionsLarge, pooled datasets provide great opportunities, justifying the efforts for data harmonization. Still, caution is warranted when using recoded variables which variance is explained limitedly by their original variables as this may jeopardize the validity of study results. ]]> <![CDATA[Is postural dysfunction related to sarcopenia? A population-based study]]> https://www.researchpad.co/article/elastic_article_7695 Postural dysfunction is one of the most common community health symptoms and frequent chief complaints in hospitals. Sarcopenia is a syndrome characterized by degenerative loss of skeletal muscle mass, muscle quality, and muscle strength, and is the main contributor to musculoskeletal impairment in the elderly. Previous studies reported that loss of muscle mass is associated with a loss of diverse functional abilities. Meanwhile, there have been limited studies concerning postural dysfunction among older adults with sarcopenia. Although sarcopenia is primarily a disease of the elderly, its development may be associated with conditions that are not exclusively seen in older persons. Also, recent studies recognize that sarcopenia may begin to develop earlier in life. The objective of this paper was to investigate the association between the prevalence of sarcopenia and postural dysfunction in a wide age range of adults using data from a nationally representative cohort study in Korea. Korean National Health & Nutrition Exhibition Survey V (KNHANES V, 2010–2012) data from the fifth cross-sectional survey of the South Korean population performed by the Korean Ministry of Health and Welfare were used. Appendicular skeletal muscle mass (ASM)/height (ht)2 was used to define sarcopenia, and the Modified Romberg test using a foam pad (“foam balance test”) was performed to evaluate postural dysfunction. ASM/ht2 was lower in women and significantly decreased with age in men. Subjects with sarcopenia were significantly more likely to fail the foam balance test, regardless of sex and age. Regression analysis showed a significant relationship between sarcopenia and postural dysfunction (OR: 2.544, 95% CI: 1.683–3.846, p<0.001). Multivariate regression analysis revealed that sarcopenia (OR: 1.747, 95% CI: 1.120–2.720, p = 0.014) and age (OR: 1.131, 95% CI: 1.105–1.158, p<0.001) are independent risk factors for postural instability. In middle age subjects, the adjusted OR for sarcopenia was 3.344 (95% CI: 1.350–8.285) (p = 0.009). The prevalence of postural dysfunction is higher in sarcopenia patients, independent of sex and age.

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<![CDATA[Associations of Widowhood and β-Amyloid With Cognitive Decline in Cognitively Unimpaired Older Adults]]> https://www.researchpad.co/article/N18d10566-0787-4579-92f1-f500cd977796

Key Points

Question

Is widowhood a specific risk factor associated with more rapid cognitive decline among cognitively unimpaired older adults with higher levels of brain β-amyloid, the Alzheimer disease biomarker?

Findings

In this cohort study of 257 community-dwelling cognitively unimpaired older adults, widowhood and β-amyloid were additively and interactively associated with cognitive decline. These results were independent of demographic factors, cardiovascular disease risk, depression, health-related behaviors, and social support factors.

Meaning

These findings suggest that widowhood may be an understudied risk factor for cognitive decline associated with Alzheimer disease and highlight the need for increased research and clinical attention to this high-risk group.

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<![CDATA[Evaluation of Hospice Enrollment and Family and Unpaid Caregivers’ Experiences With Health Care Workers in the Care of Older Adults During the Last Month of Life]]> https://www.researchpad.co/article/Nd57db1f6-1bbb-4fa3-8897-1930252abdf8

This survey study assesses end-of-life caregivers’ experiences with health care workers during older adults’ last month of life.

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<![CDATA[Interthalamic adhesion size in aging dogs with presumptive spontaneous brain microhemorrhages: a comparative retrospective MRI study of dogs with and without evidence of canine cognitive dysfunction]]> https://www.researchpad.co/article/N25d1ca62-53f4-4e46-b942-f8495d92ac99

Objective

Spontaneous brain microhemorrhages in elderly people are present to some degree in Alzheimer’s disease patients but have been linked to brain atrophy in the absence of obvious cognitive decline. Brain microhemorrhages have recently been described in older dogs, but it is unclear whether these are associated with brain atrophy. Diminution of interthalamic adhesion size-as measured on MRI or CT-has been shown to be a reliable indicator of brain atrophy in dogs with canine cognitive dysfunction (CCD) in comparison with successfully aging dogs. We hypothesized that aging dogs with brain microhemorrhages presenting for neurologic dysfunction but without obvious features of cognitive decline would have small interthalamic adhesion measurements, like dogs with CCD, compared with control dogs. The objective of this study was to compare interthalamic adhesion size between three groups of aging (>9 years) dogs: (1) neurologically impaired dogs with presumptive spontaneous brain microhemorrhages and no clinical evidence of cognitive dysfunction (2) dogs with CCD (3) dogs without clinical evidence of encephalopathy on neurologic examination (control dogs). MR images from 52 aging dogs were reviewed and measurements were obtained of interthalamic adhesion height (thickness) and mid-sagittal interthalamic adhesion area for all dogs, in addition to total brain volume. Interthalamic adhesion measurements, either absolute or normalized to total brain volume were compared between groups. Signalment (age, breed, sex), body weight, presence and number of SBMs, as well as other abnormal MRI findings were recorded for all dogs.

Results

All interthalamic adhesion measurement parameters were significantly (P < 0.05) different between control dogs and affected dogs. Both dogs with cognitive dysfunction (12/15; 80%) and dogs with isolated brain microhemorrhages had more microhemorrhages than control dogs (3/25; 12%). Affected dogs without cognitive dysfunction had significantly more microhemorrhages than dogs with cognitive dysfunction. In addition to signs of cognitive impairment for the CCD group, main clinical complaints for SBM and CCD dogs were referable to central vestibular dysfunction, recent-onset seizure activity, or both. Geriatric dogs with spontaneous brain microhemorrhages without cognitive dysfunction have similar MRI abnormalities as dogs with cognitive dysfunction but may represent a distinct disease category.

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<![CDATA[Prevalence of Diabetes Medication Intensifications in Older Adults Discharged From US Veterans Health Administration Hospitals]]> https://www.researchpad.co/article/N8e0dae21-d10a-4524-891d-d410293b0b39

Key Points

Question

How often are older adults discharged with changes to their outpatient diabetes medication regimens following hospitalization for common medical conditions?

Findings

In this cohort study of 16 178 older adults hospitalized in the Veterans Health Administration national health system, 1 in 10 patients was discharged with intensified diabetes medications. Nearly half of patients receiving intensifications had already reached outpatient blood glucose goals or had limited life expectancy.

Meaning

During hospitalization, consideration of long-term diabetes control is needed in addition to inpatient blood glucose recordings to reduce potentially nonbeneficial medication changes when older adults are discharged home.

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<![CDATA[Monitoring the training dose and acute fatigue response during elbow flexor resistance training using a custom-made resistance band]]> https://www.researchpad.co/article/N19432758-35dd-4005-8ef7-ff1d97e80206

Background

Home-based resistance training offers an alternative to traditional, hospital-based or rehabilitation center-based resistance training and has attracted much attention recently. However, without the supervision of a therapist or the assistance of an exercise monitoring system, one of the biggest challenges of home-based resistance training is that the therapist may not know if the patient has performed the exercise as prescribed. A lack of objective measurements limits the ability of researchers to evaluate the outcome of exercise interventions and choose suitable training doses.

Objective

To create an automated and objective method for segmenting resistance force data into contraction phase-specific segments and calculate the repetition number and time-under-tension (TUT) during elbow flexor resistance training. A pilot study was conducted to evaluate the performance of the segmentation algorithm and to show the capability of the system in monitoring the compliance of patients to a prescribed training program in a practical resistance training setting.

Methods

Six subjects (three male and three female) volunteered to participate in a fatigue and recovery experiment (5 min intermittent submaximal contraction (ISC); 1 min rest; 2 min ISC). A custom-made resistance band was used to help subjects perform biceps curl resistance exercises and the resistance was recorded through a load cell. The maximum and minimum values of the force-derivative were obtained as distinguishing features and a segmentation algorithm was proposed to divide the biceps curl cycle into concentric, eccentric and isometric contraction, and rest phases. Two assessors, who were unfamiliar with the study, were recruited to manually pick the visually observed cut-off point between two contraction phases and the TUT was calculated and compared to evaluate performance of the segmentation algorithm.

Results

The segmentation algorithm was programmatically implemented and the repetition number and contraction-phase specific TUT were calculated. During isometric, the average TUT (3.75 ± 0.62 s) was longer than the prescribed 3 s, indicating that most subjects did not perform the exercise as prescribed. There was a good TUT agreement and contraction segment agreement between the proposed algorithm and the assessors.

Conclusion

The good agreement in TUT between the proposed algorithm and the assessors indicates that the proposed algorithm can correctly segment the contraction into contraction phase-specific parts, thereby providing clinicians and researchers with an automated and objective method for quantifying home-based elbow flexor resistance training. The instrument is easy to use and cheap, and the segmentation algorithm is programmatically implemented, indicating good application prospect of the method in a practical setting.

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<![CDATA[Prevalence of and related risk factors in oral mucosa diseases among residents in the Baoshan District of Shanghai, China]]> https://www.researchpad.co/article/Nec8566ef-bea1-4fab-8a7d-74e91e330ea0

Background

Oral mucosal diseases (OMDs) encompass a variety of different types of diseases. Our aim was to evaluate the prevalence and related risk factors of OMDs among residents in the Baoshan District of Shanghai, China, and provide a scientific basis for prevention and control strategies.

Methods

A sample of 653 residents aged 17 to 92 years from the Baoshan community was investigated in 2014. Each resident was surveyed by questionnaire to evaluate their oral mucosa and oral mucosa examinations were conducted. We followed up with 607 residents in 2018. All data were statistically analyzed using the SPSS 25.0 software package (Chicago, IL, USA) at the general population, gender and age levels. A X2 test was used to compare rates of risk factors and logistic regression analysis was used to detect the correlation between disease and risk factors.

Results

The prevalence rate of OMDs was found to be 9.19%–9.56% (2014–2018). The most common OMDs were atrophic glossitis (1.84%), recurrent aphthous ulcer (RAU, 1.68%), burning mouth syndrome (BMS, 1.38%), oral lichen planus (OLP, 1.23%) and traumatic ulcers (1.23%). The prevalence of RAU and BMS in different age groups was significantly different. Tobacco and alcohol use and psychological factors in the OMDs group were higher than the no-OMDs group. Systemic diseases including diabetes mellitus (DM) was significantly relevant to OLP.

Conclusion

Age, tobacco and alcohol use, and psychological factor correlated strongly with the occurrence and development of OMDs, and they should be the focus of primary prevention. General epidemiological studies suggested that OLP was closely related to DM.

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<![CDATA[A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients]]> https://www.researchpad.co/article/N8fecd5fe-2073-4d74-805a-6132ddca5eea

Background

Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients.

Methods

This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0–4) and attention task (0–6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden’s index.

Results

A total of 187 patients were recruited, mean age 83.8 (range 67–98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6).

Conclusion

Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.

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<![CDATA[A cross-sectional study on interference control: age affects reactive control but not proactive control]]> https://www.researchpad.co/article/Ne74afc62-df7f-43f1-8993-b7279387d181

Background

Working memory updating (WMU), a controlled process to continuously adapt to the changing task demand and environment, is crucial for cognitive executive function. Although previous studies have shown that the elderly were more susceptible to cognitive interference than the youngsters, the picture of age-related deterioration of WMU is incomplete due to lack of study on people at their middle ages. Thus, the present study investigated the impact of age on the WMU among adults by a cross-sectional design to verify whether inefficiency interference control accounts for the aging of WMU.

Methods

In total, 112 healthy adults were recruited for this study; 28 old adults (21 female) ranging from 60 to 78 years of age; 28 middle-age adults (25 female) ranging from 45 to 59 years of age; 28 adults (11 female) ranging from 26 to 44 years of age; and 28 young adults (26 female) ranging from 18 to 25 years of age. Each participant completed a 1-back task. The inverse efficiency score was calculated in various sequences of three trials in a row to quantify the performance of WMU for adults of various ages.

Results

Inverse efficiency score of both young groups (young adult and adult) were significantly shorter than the old group in both Repeat-Alternate (RA, including □□○ and ○○□) and Alternate-Alternate (AA, including ○□○ and □○□) sequential patterns and they were additionally better than the middle-age group in AA sequential pattern.

Conclusion

With the increase of difficulty in the task, the difference in reactive interference control between young and middle age was gradually revealed, while the difference between young and old remained to apparent. The degradation of WMU aging may begin from middle-age and presents selective impairment in that only reactive interference control, but not proactive interference control, shows pronounced age-related decline. The preliminary results can inform future studies to further explore the whole lifespan trajectories of cognitive functions.

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<![CDATA[Oxidative stress and antioxidants in the trabecular meshwork]]> https://www.researchpad.co/article/N1f838d5e-0330-428b-b302-08758987df4d

Glaucoma is an age-dependent disease closely related to oxidative stress and is regarded as the second leading cause of irreversible blindness worldwide. In recent years, many studies have shown that morphological and functional abnormalities of the trabecular meshwork (TM) are closely related to glaucoma, especially with respect to oxidative stress. In this review, the mechanisms of oxidative stress in the TM and treatment strategies for this condition, including strategies involving antioxidants, noncoding RNAs and exogenous compounds, are discussed. Although many questions remain to be answered, the reviewed findings provide insights for further research on oxidative stress alleviation in glaucoma and suggest new targets for glaucoma prevention.

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<![CDATA[Age-related differences in clinical characteristics of invasive group G streptococcal infection: Comparison with group A and group B streptococcal infections]]> https://www.researchpad.co/article/5c8accd0d5eed0c48499008b

Purpose

Invasive Group G streptococcal infection (iGGS) has increasingly been recognized as a cause of severe disease, mainly among elderly people with chronic illnesses. This study aimed to examine age-related differences in clinical characteristics of iGGS and describe its characteristics among very elderly individuals (≥80 years).

Methods

Fifty-four iGGS patients for whom detailed clinical information was available were identified from 2002 to 2014 in a tertiary care hospital in Japan. iGGS (n = 54) was compared with invasive Group A (iGAS; n = 17) and B streptococcal infection patients (iGBS; n = 52) based on patient age.

Results

The incidence of iGGS in our catchment area significantly increased during the study period. The prevalence of iGGS in the very elderly population was higher than that of iGAS or iGBS (p<0.001). Among iGGS patients, cardiovascular disease, chronic kidney disease, oxygen demand, and bacteremia with unknown focus of infection were more frequent in the very elderly population (p = 0.009, p = 0.02, p = 0.04, and p = 0.04, respectively). Altered mental status was present in half of iGGS patients aged ≥60 years (p = 0.03). In contrast, alcohol drinking and liver cirrhosis were significantly more frequent in patients with iGGS aged <60 years than in other age groups (p<0.001, p = 0.001, respectively). Levofloxacin resistance in GBS isolates was significantly more frequent among very elderly patients than among other age groups (p<0.001).

Conclusions

The burden of iGGS has been increasing in our catchment area. Different iGGS-associated clinical characteristics were found in each age group. Unclear and atypical clinical manifestations and syndromes were likely to be observed in very elderly patients. Alcohol drinking and liver cirrhosis may contribute to iGGS even in patients aged <60 years. Understanding these age-related differences could be helpful for optimal diagnosis and treatment.

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<![CDATA[A prospective, multi-center study of Candida bloodstream infections in Chile]]> https://www.researchpad.co/article/5c8c1960d5eed0c484b4d4f3

Background

Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile.

Methods

We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017.

Results

A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%).

Conclusions

Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.

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<![CDATA[Effects of frontal-executive dysfunction on self-perceived hearing handicap in the elderly with mild cognitive impairment]]> https://www.researchpad.co/article/5c897757d5eed0c4847d2a69

It is increasingly agreed upon that cognitive and audiological factors are associated with self-perceived hearing handicap in old adults. This study aimed to compare self-perceived hearing handicap among mild cognitive impairment (MCI) subgroups and a cognitively normal elderly (CNE) group and determine which factors (i.e., demographic, audiometric, or neuropsychological factors) are correlated with self-perceived hearing handicap in each group. A total of 46 MCI patients and 39 hearing threshold-matched CNE subjects participated in this study, and their age ranged from 55 to 80 years. The MCI patients were reclassified into two groups: 16 with frontal-executive dysfunction (FED) and 30 without FED. All subjects underwent audiometric, neuropsychological, and self-perceived hearing handicap assessments. The Korean version of the Hearing Handicap Inventory for the Elderly (K-HHIE) was administered to obtain the hearing handicap scores for each subject. After controlling for age, years of education, and depression levels, we found no significant differences in the K-HHIE scores between the MCI and the CNE groups. However, after we classified the MCI patients into the MCI with FED and MCI without FED groups, the MCI with FED group scored significantly higher than did both the MCI without FED and the CNE groups. In addition, after controlling for depression levels, significant partial correlations of hearing handicap scores with frontal-executive function scores and speech-in-noise perception performance were found in the MCI groups. In the CNE group, the hearing handicap scores were related to peripheral hearing sensitivity and years of education. In summary, MCI patients with FED are more likely to experience everyday hearing handicap than those without FED and cognitively normal old adults. Although educational level and peripheral hearing function are related to self-perceived hearing handicap in cognitively normal old adults, speech-in-noise perception and frontal-executive function are mainly associated with hearing handicap in patients with MCI.

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<![CDATA[Towards a universal concept of vulnerability: Broadening the evidence from the elderly to perinatal health using a Delphi approach]]> https://www.researchpad.co/article/5c76fe2ed5eed0c484e5b68a

Background

The concept 'vulnerability' is prevalent in the public domain, health care, social institutions and multidisciplinary research. Conceptual heterogeneity is present, hampering the creation of a common evidence-base of research achievements and successful policies. Recently an international expert group combined a specific literature review with a 2-stage Delphi procedure, arriving at a seemingly universal concept of vulnerability for the elderly with applications for research instruments. We replicated and extended this study, to generalize this result to health in general, and perinatal health in particular.

Methods

Two independent expert panels (general health, perinatal health) repeated the Delphi-procedure, using an extended and updated literature review to derive statements on the concept and defining pathways of vulnerability. Additional views were collected on research tools. Consensus-by-design was explicitly avoided. Data collection and processing was independent.

Results

Both panels showed surprising convergence on the pathways of vulnerability to health/ill-health, and their interaction. The agreed conceptual model describes a dynamic relation between health and ill-health and vulnerability. The 2 key pathways that link to vulnerability, are complementary, but not symmetrical as biological processes of maintaining health or obtaining better health are not reciprocal to recovery, so also not in terms of vulnerability impacts. An individual's degree of vulnerability is the net balance of risk effects and protective and healing factors (socially, biologically and in terms of health literacy and health care access). These factors can for measurement purposes (according to the panels: interview for exploration, checklists for population research) be grouped into ‘material resources’, ‘taking responsibility for one’s own health’, ‘risky activities and behaviors’, and ‘social support’.

Supportive and transforming action can thus be undertaken.

Conclusion

A universal concept of vulnerability in the context of health was successfully derived after careful replication and extension of an international Delphi study on vulnerability among the elderly.

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<![CDATA[The association of choroidal structure and its response to anti-VEGF treatment with the short-time outcome in pachychoroid neovasculopathy]]> https://www.researchpad.co/article/5c6f14b7d5eed0c48467a726

Pachychoroid neovasculopathy (PNV) shares some anatomical features with other pachychoroid spectrum diseases, but little is known about the characteristics on the treatment with anti-vascular endothelial growth factor (VEGF). We investigated the effect of choroidal structure and responses to anti-VEGF on the prognosis of pachychoroid neovasculopathy (PNV) and other types of neovascular age-related macular degeneration (non-PNV). Twenty-one eyes with PNV and 34 eyes with non-PNV who had anti-VEGF treatment were retrospectively reviewed. Choroidal neovascularization (CNV) area at baseline was measured with fluorescein angiography (FAG). The luminal and stromal area in the choroid was measured by enhanced-depth-imaging (EDI) OCT at baseline and 1 month. The association between dry macula or LogMAR VA (visual acuity, VA) at 1 month and baseline values or changes in the luminal or stromal area at 1 month, baseline CNV area, or anti-VEGF drugs were analyzed in patients with or without PNV. In non-PNV, change of luminal area (coefficient = 7.0×10−5, p = 0.0001), baseline CNV area (coefficient = 0.18, p = 0.033), and aflibercept vs. ranibizumab (coefficient = 0.29, p = 0.0048) were chosen as predictors for dry macula by the model selection. Similarly, in non-PNV, change of luminal area (coefficient = 6.1×10−6, p = 0.033), baseline CNV area (coefficient = 0.034, p = 0.022), and aflibercept vs. ranibizumab (coefficient = 0.056, p = 0.0020) were chosen as predictors for greater VA improvement. In PNV, however, none of these factors was chosen as predictors for dry macula or VA improvement by the model selection. The result of the present study implied that structural response after anti-VEGF might be different between non-PNV and PNV in the treatment with anti-VEGF agents.

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<![CDATA[The impact of dementia on hospital outcomes for elderly patients with sepsis: A population-based study]]> https://www.researchpad.co/article/5c75abe0d5eed0c484d07df2

Background

Prior studies have suggested that dementia adversely influences clinical outcomes and increases resource utilization in patients hospitalized for acute diseases. However, there is limited population-data information on the impact of dementia among elderly hospitalized patients with sepsis.

Methods

From the 2009–2011 National Hospital Discharge Database we identified hospitalizations in adults aged ≥65 years. Using ICD9-CM codes, we selected sepsis cases, divided them into two cohorts (with and without dementia) and compared both groups with respect to organ dysfunction, in-hospital mortality and the use of hospital resources. We estimated the impact of dementia on these primary endpoints through multivariate regression models.

Results

Of the 148 293 episodes of sepsis identified, 16 829 (11.3%) had diagnoses of dementia. Compared to their dementia-free counterparts, they were more predominantly female and older, had a lower burden of comorbidities and were more frequently admitted due to a principal diagnosis of sepsis. The dementia cohort showed a lower risk of organ dysfunction (adjusted OR: 0.84, 95% Confidence Interval [CI]: 0.81, 0.87) but higher in-hospital mortality (adjusted OR: 1.32, 95% [CI]: 1.27, 1.37). The impact of dementia on mortality was higher in the cases of younger age, without comorbidities and without organ dysfunction. The cases with dementia also had a lower length of stay (-3.87 days, 95% [CI]: -4.21, -3.54) and lower mean hospital costs (-3040€, 95% [CI]: -3279, -2800).

Conclusions

This nationwide population-based study shows that dementia is present in a substantial proportion of adults ≥65s hospitalized with sepsis, and while the condition does seem to come with a lower risk of organ dysfunction, it exerts a negative influence on in-hospital mortality and acts as an independent mortality predictor. Furthermore, it is significantly associated with shorter length of stay and lower hospital costs.

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<![CDATA[Effects of microbiota-driven therapy on inflammatory responses in elderly individuals: A systematic review and meta-analysis]]> https://www.researchpad.co/article/5c648cddd5eed0c484c81990

Current evidence suggests that age-associated inflammation, a strong risk factor for the health status of elderly individuals, is closely associated with gut microbiota. Previous animal studies have demonstrated a benefit of microbiota-driven therapy in decreasing low-grade chronic inflammation in elderly individuals; however, it remains controversial in clinical studies. Therefore, the present systematic review and meta-analysis were designed to assess the effects of microbiota-driven therapy on inflammatory markers in elderly individuals. PubMed, EMBASE, and the Cochrane Library were searched with no language restrictions from the inception of the database to November 11th, 2018 to identify all existing literature. We calculated pooled standard mean difference (SMD) using fixed effect model or random effect model to assess the effects of microbiota-driven therapy on elderly individuals. The methodological quality of the studies was determined according to the Cochrane Handbook. The publication bias was evaluated by funnel plot and Egger regression test. Ten randomized controlled studies, with 689 elderly individuals (347 individuals in the microbiota-driven therapy group and 342 individuals in the placebo group), were included in the analysis. Compared with placebo, microbiota-driven therapy did not decrease the levels of tumor necrosis factor-α (SMD, -0.24; 95% CI, -0.69 to 0.21; p = 0.30; I2 = 82.7%), interleukin-6 (SMD, -0.13; 95% CI, -0.74 to 0.49; p = 0.69; I2 = 90.7%) and interleukin-10 (SMD, 1.00; 95% CI, -0.15 to 2.15; p = 0.09; I2 = 96.3%). In addition, the microbiota-driven therapy also did not decrease the levels of C reactive protein (SMD, -1.28; 95% CI, -2.62 to 0.06; p = 0.06; I2 = 96.2%), interleukin-1β (SMD, -0.22; 95% CI, -0.81 to 0.37; p = 0.46; I2 = 73.8%), interleukin-8 (SMD, -0.03; 95% CI, -0.67 to 0.61; p = 0.93; I2 = 88.0%) and monocyte chemoattractant protein-1 (SMD, -0.11; 95% CI, -0.41 to 0.20; p = 0.49; I2 = 0%) when compared with placebo. No obvious publication bias was observed (p>0.05). In conclusion, the present meta-analysis of available randomized controlled studies did not suggest any significant benefit of microbiota-driven therapy in decreasing the inflammatory responses of elderly individuals.

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<![CDATA[Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil]]> https://www.researchpad.co/article/5c5ca2b2d5eed0c48441e8f3

Hand grip strength (HGS) is recognized as an important health indicator, but validated reference values that can be applied to the evaluation of individuals in different populations are still lacking. This work aimed to identify correlations between HGS and anthropometric variables and to establish HGS reference values for adult and elderly populations. This is a population-based cross-sectional study considering the subsets of individuals with healthy right or left upper limbs from a sample of 1,609 adults and elderly residents in Rio Branco, Acre, Brazil. Descriptive statistics of anthropometric measures and HGS values at maximum performance based on three measurements of the two hands were obtained, and Pearson correlations between these variables were applied. Percentile distributions were estimated for right and left HGS by sex and age group. Men presented, in general, a maximum HGS 57% higher than women (43.4 kg vs. 27.6 kg), and also higher HGS levels in the different age groups. In both sexes, the highest HGS values were observed in the age group of 30 to 39 years (men, 46.9 kg; women, 29.4 kg), with a subsequent decline. HGS presented a negative correlation with age and a weak to moderate positive correlation with anthropometric variables, among men and women. The median HGS of men was reduced by about 46% between the ages of 30 and 39 years and 80 years and over (right hand, 46.4 to 23.7 kg; left hand, 42.2 to 23.5 kg) and by about 44% in women (right hand, 29.0 to 16.4 kg, left hand, 27.3 to 15.2 kg). The values identified are a reference for HGS behavior among healthy adults and seniors, although they do not discriminate individuals with specific health conditions. They can be used in rehabilitation programs and subsidize future studies aimed at exploring their potential application in the evaluation of the health condition of adults and elderly individuals.

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<![CDATA[Effects of Nordic walking training on quality of life, balance and functional mobility in elderly: A randomized clinical trial]]> https://www.researchpad.co/article/5c5b5264d5eed0c4842bc750

Purpose

There is physiological and biomechanical evidence suggesting a possible advantage of using poles in walking training programs. The purpose of this proof-of-concept study was to test the hypothesis that untrained elderly training Nordic walking for eight weeks will show higher improvements on the functional mobility, quality of life and postural balance than that training without poles; more likely to occur in self-selected walking speed (primary outcome), and the locomotor rehabilitation index than the quality of life, the static balance and the dynamic stability. It was a two-arm randomized sample- and load-controlled study.

Methods

Thirty-three untrained older people were randomly assigned into Nordic walking (n = 16, age: 64.6±4.1 years old) and free walking (n = 17, age: 68.6±3.9 years old) training groups.

Results

Improvements in the self-selected walking speed (primary outcome, p = 0.011, ES = 0.42 95%CI -0.31 to 1.16), locomotor rehabilitation index (p = 0.013, ES = 0.36; (95%CI -0.39 to 1.10), quality of life (p<0.05), static balance (p<0.05) and dynamic variability (p<0.05) were found in both groups.

Conclusions

The hypothesis was not supported, our findings indicated that after 8 weeks, the Nordic walking training did not result in greater improvements than free walking training for the primary outcome (self-selected walking speed) and most of the secondary outcomes (including locomotor rehabilitation index, static balance, dynamic stability, and psychological and social participation domains of quality of life).

Trial registration

ClinicalTrials.gov NCT03096964.

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