Geroscience: Linking Aging to Chronic Disease

The phenomenon of population aging in China has evolved into an irreversible trend. The state places significant emphasis on the health-related initiatives for the elderly and has implemented pertinent policies. This study aims to identify the primary health issues affecting the elderly population in China, ascertain the key risk factors influencing their health, and offer a scientific foundation for the government to develop ongoing policies and strategies, as well as to allocate health resources efficiently. This study was conducted utilizing the nationwide surveillance and survey data collected by the National Center for Chronic and Noncommunicable Disease Control and Prevention, China. Descriptive statistics were employed to delineate the mortality rates, disease burden, prevalence of significant risk factors for chronic illnesses, as well as the incidence of disabilities and impairments among the elderly population in China. In 2019, the mortality rate of chronic non-communicable diseases among the elderly population in China aged 60 years and above was 31,238 per 100,000 individuals, representing 93.9% of all deaths. The disability-adjusted life years for males in the elderly population aged 60 years and above in 2019 totaled 103,850,000 person-years, while females accounted for 86,404,000 person-years. Among the elderly population in China, the top three diseases contributing to the highest Disability-Adjusted Life Years (DALYs) were stroke (19.202 million DALYs, representing 18.5% of the total DALYs), ischemic heart disease (13.895 million DALYs, 13.4%), and chronic obstructive pulmonary disease (COPD; 9.453 million DALYs, 9.1%). The primary risk factors associated with chronic diseases among the elderly population in China include inadequate consumption of fruits and vegetables, excessive intake of red meat, lack of physical activity, smoking, alcohol consumption, and being overweight or obese. There exist variations among genders, urban and rural areas, and regions. In 2015, the disability rate for activities of daily living (ADL) was notably high among the elderly population in China, reaching 19.4%. The prevalence of dysfunctions such as depressive symptoms, sleep disorders, and hearing loss is substantial. The prevalence of osteoporosis among the elderly in China is concerning. While China has achieved some progress in enhancing the health of the elderly, the current scenario of population aging in China is grave, and the health of the elderly continues to encounter numerous challenges. The prevalence of chronic diseases continues to be significant, with chronic conditions being the primary cause of mortality in the elderly population. Secondly, risk factors for chronic diseases persist among the elderly population, with a significant prevalence of smoking, alcohol consumption, and obesity. This issue is particularly serious in rural areas, showing an escalating trend that demands heightened attention. The prevalence of functional disorders among the elderly is notably high, and the issue of disability in this population segment is of significant concern. This study suggests five recommendations aimed at enhancing health-related policies and the health service system for the elderly, in response to the existing health challenges and demographic trends. The recommendations include creating an elderly-friendly environment, increasing government investment in elderly health, and addressing the aging population in China and so on to enhance the health outcomes of the elderly population in the country.

A Decade After the KDOQI CKD Guidelines: Impact on the United States and Global Public Policy

BackgroundThe risk of comorbid chronic diseases in elderly people is an important problem affecting their health and quality of life. We analyzed the incidence of chronic diseases for combinations of chronic diseases analyzed.MethodsWe used the original data to construct hypothetical cohorts of elderly individuals that evolved with age. The complex network was used to reduce the dimensionality of disease. The multistate transition model is used to calculate the incidence of each chronic disease, exploring comorbidity characteristics and rules.Results(1) By using complex network, seven chronic diseases were screened out in men, including hypertension, diabetes, heart disease, stroke, chronic lung disease, arthritis and dyslipidemia; six chronic diseases in women showed significant comorbidity except chronic lung disease. (2) Incidence show differences in age and sex; incidence of chronic diseases generally increased with age. (3) The marginal risk increases with the number of basic chronic diseases associated with comorbidities. (4) When hypertension is present as a basic disease, its impact on the risk of other chronic diseases is much less than that of other chronic diseases. (5) When diseases occur as basic chronic diseases, hypertension–heart disease and diabetes–dyslipidemia are combinations that have the greatest impact on each other in men; hypertension–heart disease in women.ConclusionsThe incidence of chronic diseases in patients who have chronic diseases and will form comorbidities differs from that in healthy states, and the related effects of different chronic diseases also differ. Among these conditions, hypertension is caused by a special mechanism.

Fatigue is a symptom reported by patients with various chronic conditions. A better understanding of its nature may provide important clues regarding the mechanisms underlying fatigue and help in developing more effective therapeutic interventions to reduce fatigue and improve quality of life. Energy conservation management is one form of nursing intervention proposed and recommeded. This study aimed to determine the effectiveness of various energy conservation and fatigue management strategies to reduce fatigue and improve quality of life in five chronic non-infectious conditions: cancer, multiple sclerosis, Systemic Lupus Erythematosus (SLE), Chronic Kidney Disease(CKD), and Chronic Obstruction Pulmonary Disease (COPD) through a literature review. This article is a literature review of research articles selected through searches in four open access electronic databases, namely Google Scholar, ProQuest, ScienceDirect, and PubMed. The keywords used included energy conservation management, fatigue, and chronic disease. Inclusion criteria were articles published within the last five years, focusing on quantitative research, involving energy conservation, relevant full-text articles, and original articles. Exclusion criteria were unpublished editorials, letters, conference abstracts, and dissertations. Twenty articles met the inclusion criteria. The findings showed that there are several energy conservation and fatigue management strategies that can reduce fatigue and improve quality of life in patients with chronic diseases. This study found that energy conservation management can be effective in reducing fatigue in patients with chronic diseases, including energy conservation strategies, physical exercise, psychological therapy, recreation, education, self-management programs, and dietary approaches. Keywords: Energy Conservation, Management, Fatique, Chronic Disease ABSTRAK Kelelahan adalah gejala yang sering dilaporkan oleh pasien dengan berbagai kondisi kronis. Pemahaman yang lebih baik mengenai sifatnya dapat memberikan petunjuk penting mengenai mekanisme yang mendasari kelelahan dan membantu dalam mengembangkan intervensi terapeutik yang lebih efektif untuk mengurangi kelelahan dan meningkatkan kualitas hidup. Manajemen konservasi energi merupakan salah satu bentuk intervensi keperawatan yang direkomendasikan. Penelitian ini bertujuan untuk mengetahui efektifitas berbagai strategi manajemen konservasi energi dan fatigue yang dapat dilakukan untuk menurunkan kelelahan dan meningkatkan kualitas hidup pada lima kondisi non-infeksi kronis: kanker, sklerosis multipel, Systemic Lupus Erythematosus (SLE), Chronic Kidney Disease (CKD), and Chronic Obstruction Pulmonary Disease (COPD melalui tinjauan literatur. Artikel ini merupakan tinjauan literatur dari artikel penelitian yang dipilih melalui pencarian di empat database elektronik dengan akses terbuka, yaitu Google Scholar, ProQuest, ScienceDirect, dan PubMed. Kata kunci yang digunakan termasuk energy conservation, management, fatigue, dan chronic disease. Kriteria inklusi adalah artikel yang diterbitkan dalam lima tahun terakhir, berfokus pada penelitian kuantitatif, melibatkan konservasi energi, artikel teks lengkap yang relevan, dan artikel asli. Kriteria eksklusi adalah editorial, surat, abstrak konferensi, dan disertasi yang tidak dipublikasikan. Terdapat dua puluh artikel yang memenuhi kriteria inklusi. Temuan menunjukkan bahwa terdapat beberapa strategimanajemen energi konservasi dan manajemen kelelahan yang dapat menurunkan kelelahan dan meningkatkan kualitas hidup pada pasien dengan penyakit kronik. Penelitian ini menemukan bahwa manajemen konservasi energi dapat efektif dalam mengurangi kelelahan pada pasien dengan penyakit kronis adalah Strategi konservasi energi, latihan fisik, terapi psikologis, rekreasional, edukasi, program manajemen diri, dan pendekatan diit. Kata Kunci: Konservasi Energi, Manajemen, Kelelahan, Penyakit Kronis

BackgroundCognitive function has been suggested to be correlated with mortality, while studies regarding the association among the very elderly population with chronic kidney disease (CKD) are extremely limited.AimTo explore the association between cognitive function and mortality among the very elderly Chinese population with CKD.MethodsThis prospective study included 163 Chinese participants aged 80 years or older with CKD. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Cognitive function was evaluated using the mini-mental state examination (MMSE) at baseline. Participants were divided into three groups based on the MMSE score. Cox proportional hazard models were used to assess the contribution of cognitive function to mortality.ResultsDuring a median follow-up of 28 months, 24 (14.7%) participants died, and 14 of the events were cardiovascular death. After making adjustment for potential confounders, every 1-point increase of MMSE score was associated with 29% decreased risk of all-cause mortality (adjusted hazards ratio [HR], 0.71; 95% CI, 0.58–0.87) and 39% decreased risk of cardiovascular mortality (adjusted HR, 0.61; 95% CI, 0.44–0.83). Compared with participants with top category of MMSE score, the adjusted HRs for all-cause mortality and cardiovascular mortality among those with bottom category of MMSE score were 8.18 (95% CI, 2.05–32.54) and 14.72 (95% CI, 1.65–131.16).ConclusionCognitive function was associated with all-cause mortality and cardiovascular mortality among the very elderly population with CKD.

Hypertension and Chronic Kidney Disease in the Elderly

Blood Pressure Goals: How Low Is Safe in CKD?

COPD 2020: new directions needed.

BackgroundLife expectancy at birth (LE) is a comprehensive measure that accounts for age-specific death rates in a population. Shanghai has ranked first in LE in China mainland for decades. Understanding the reasons behind its sustained gain in LE provides a good reflection of many other cities in China. The aim of this study is intended to explore temporal trend in age- and cause-specific gains in LE in Shanghai and the probable reasons lay behind.MethodsJoinpoint regression was applied to evaluate temporal trend in LE and the long time span was then divided accordingly. Contributions to change in LE (1973–2015) were decomposed by age and cause at corresponding periods.ResultsLE in Shanghai could be divided into four phases ie., descent (1973–1976), recovery (1976–1998), rapid rise (1998–2004) and slow rise (2004–2015). The growing LE was mainly attributed to reductions in mortality from the elderly populations and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers (stomach, liver and esophageal cancer).ConclusionsThe four-decade sustained gain in LE in Shanghai is due to the reductions in mortality from the elderly and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers. Further growth momentum still comes from the elderly population.

Aging remains the most pervasive risk factor for a wide range of chronic diseases that afflict modern societies. In the United States alone, incidence of age-related diseases (e.g.,cardiovascular disease, stroke, Alzheimer's disease, vascular cognitive impairment and dementia, cancer, hypertension, type-2 diabetes, chronic obstructive pulmonary disease, and osteoarthritis) is on the rise, posing an unsustainable socioeconomic burden even for the most developed countries. Tackling each and every age-related disease alone is proving to be costly and ineffective. The emerging field of geroscience has posed itself as an interdisciplinary approach that aims to understand the relationship between the biology of aging and the pathophysiology of chronic age-related diseases. According to the geroscience concept, aging is the single major risk factor that underlies several age-related chronic diseases, and manipulation of cellular and systemic aging processes can delay the manifestation and/or severity of these age-related chronic pathologies. The goal of this endeavor is to achieve health improvements by preventing/delaying the pathogenesis of several age-related diseases simultaneously in the elderly population by targeting key cellular and molecular processes of aging instead of managing diseases of aging as they arise individually. In this review, we discuss recent advances in the field of geroscience, highlighting their implications for potential future therapeutic targets and the associated scientific challenges and opportunities that lay ahead.

To provide reliable estimates of the prevalence, awareness, and treatment of chronic kidney disease (CKD), and their distribution and related influencing factors in middle-aged and elderly population in China. A cross-sessional survey called the China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2011-2012 in Chinese people aged 45 years or older. This was to evaluate the prevalence of CKD, disease awareness compared to other chronic diseases in the population, and whether they were being treated for their CKD. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m(2) . Multivariable logistic regressions were used to estimate odds ratios (ORs) for the risk factors. The overall prevalence of CKD was 11.5% (95%CI: 10.1% ∼ 12.8%). It was higher in urban than rural population (13.0% vs 10.0%, P < 0.05). Among all patients with CKD, only 8.7% were aware of the diagnosis. 4.9% of the patients were receiving treatment. The proportion of those aware of their condition and those who were treated decreased with age in both sexes. Of those aware (8.9%), 55.9% were treated. 31.4% of the treated patients took Chinese traditional medicine. There is a surprising prevalence of CKD in the Chinese middle-aged and elderly population, with disproportionately low awareness and treatment. A comprehensive strategy toward prevention, screening, treatment and control of CKD is needed to slow the epidemic of CKD.

Rejuvenation of the Aging Heart: Molecular Determinants and Applications

Community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20%, depending on cultural situations. A retrospective study based on analysis of various study reports was conducted, to determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. All the studies that constituted the sample were conducted between 1955 and 2005. Included are only community-based, cross-sectional surveys and some prospective studies that had not excluded depression at baseline. These studies were conducted on a homogenous community of the elderly population in the world, who were selected by a simple random sampling technique. After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 487 275 elderly individuals, in the age group of 60 years and above, residing in various parts of the world, were included for the final analysis. The median prevalence rate and its corresponding interquartile range were calculated. The chi-square test and chi-square for linear trend were applied. A P value of <.05 was considered as statistically significant. The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% (interquartile range [IQR], 4.7%-16.0%). The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% (IQR, 11.6%–31.1%). Although there was a significant decrease in the trend of world prevalence of geriatric depression, it was significantly higher among Indians, in recent years, than the rest of the world.

Association between relative hand-grip strength and chronic cardiometabolic and musculoskeletal diseases in Koreans: A cross-sectional study

Introduction: Chronic kidney disease (CKD) affects approximately 13% of the adult population worldwide and represents a significant health problem. In recent years, the morbidity and mortality associated with kidney diseases have increased significantly, and by 2040 these diseases are expected to become the fifth leading cause of disease burden. Potassium is an important electrolyte that plays an essential role in the proper functioning of the kidneys and must be maintained within reference limits to prevent dyskalemia conditions. Management of dyskalemia is key in CKD and requires the application of appropriate pharmacological and non-pharmacological approaches. Aim: The objective is to review the possibilities of maintaining potassium balance through nutrition, as potassium balance is important for managing dyskalemia and reducing the risk of complications in patients with CKD. Material and Methods: The review included publications related to CKD, potassium, dyskalemia, and dietary approaches to managing the condition, based on evidence from scientific databases. The search was performed using the following keywords in English: chronic kidney disease, potassium, dyskalemia, diet foods, low potassium foods, hyperkalemia, hypokalemia, diet. Results: The review shows that dietary interventions, including the restriction of potassium-containing foods and the selection of appropriate cooking methods, effectively control potassium balance in patients with CKD. Replacing common salt with potassium-fortified substitutes may reduce cardiovascular risks but requires caution in these patients due to the risk of hyperkalemia. Conclusions: Effective management of potassium balance in patients with CKD requires an integrated approach with dietary and medical interventions. Individualized dietary strategies tailored to the stage of the disease are key to preventing complications and improving quality of life.