Older Population Research Articles

Exercise-induced cortical disinhibition mediates the relationship between fitness and memory in older adults.

Regular exercise benefits learning and memory in older adults, but the neural mechanisms mediating these effects remain unclear. Evidence in young adults indicates that acute exercise creates a favourable environment for synaptic plasticity by enhancing cortical disinhibition. As such, we investigated whether plasticity-related disinhibition mediated the relationship between cardiorespiratory fitness and memory function in healthy older adults (n=16, mean age=66.06). Participants completed a graded maximal exercise test and assessments of visual and verbal memory, followed by two counterbalanced sessions involving 20min of either high-intensity interval training exercise or rest. Disinhibition was measured following intermittent theta burst stimulation via paired-pulse transcranial magnetic stimulation. In line with our hypotheses, we observed a positive correlation between cardiorespiratory fitness and verbal memory, which was mediated by plasticity-related cortical disinhibition. Our novel finding implicates cortical disinhibition as a mechanism through which the effects of acute bouts of exercise may translate to improved memory in older adults. This finding extends current understanding of the physiological mechanisms underlying the positive influence of cardiorespiratory fitness for memory function in older adults, and further highlights the importance of promoting exercise engagement to maintain cognitive health in later life. KEY POINTS: There are well established benefits of regular exercise for memory function in older adults, but the mechanisms are unclear. Cortical disinhibition is important for laying down new memories, and is enhanced following acute exercise in young adults, suggesting it is a potential mechanism underlying these benefits in ageing. Older adults completed a fitness test and assessments of memory, followed by two sessions involving either 20min of exercise or rest. Disinhibition was measured following intermittent theta burst stimulation via paired-pulse transcranial magnetic stimulation. Cardiorespiratory fitness was positively associated with memory performance. Higher fitness was associated with enhanced cortical disinhibition following acute exercise. Cortical disinhibition completely mediated the relationship between fitness and memory. This novel finding provides a mechanistic account for the positive influence of cardiorespiratory fitness on memory in later life, and emphasises the importance of regular exercise for cognitive health in older populations.

The impact of nutrition on psycho-affective status in an older Cretan population: a cross-sectional study.

Cognitive and mood status influence both personal and social daily activities, with great impact on life quality, particularly among the elderly population. This cross-sectional study aimed to investigate the psycho-affective status concerning eating habits within an elderly population of the Chania area in Crete, Greece. Cognitive status was assessed in 101 elderly subjects through the Mini-Mental State Examination (MMSE), and mood was evaluated using the Hospital Anxiety and Depression Scale (HADS). Nutritional status was assessed using a validated food frequency questionnaire. Multivariable statistical analysis, after adjustment for age, marital status, education, and comorbidity, highlighted among males a positive association of the MMSE score with vegetable consumption (RR 1.18; 95%CI 1.03‒1.34) and a negative association with potato consumption (RR 0.83; 95%CI 0.72‒0.95). Conversely, among females, no statistically significant association was observed for any food. Further, among males, a protective effect on affective status was identified for chicken meat (RR 0.45; 95%CI 0.27‒0.77), fish (RR 0.41; 95%CI 0.21‒0.82), fruit (RR 0.70; 95%CI 0.52‒0.94), cereals (RR 0.67; 95%CI 0.53‒0.87), and cheese (RR 0.78; 95%CI 0.63‒0.97) consumption. Among females, the adjusted model showed a significant detrimental effect of vegetable consumption (RR 1.33; 95%CI 1.02‒1.73). A predominantly vegetable-based diet-with the notable exception of fruits and legumes-was associated with better cognitive status in males, albeit not in females. A higher intake of fruit, as well as fish, chicken meat, and cheese among males was associated with a better affective status, indicating that adequate protein supply may play a role in maintaining emotional balance.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations’ residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial.

Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults' quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults' use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977. DERR1-10.2196/53587.

Predictors of functional outcome after stroke: Sex differences in older individuals.

Sex differences in stroke are well documented, with females being older at onset, with more severe strokes and worse outcomes than males. Females receive less comprehensive stroke unit treatment. Similarly, older individuals receive poorer quality care than younger ones. There is limited research on sex differences in factors that impact 3-month poststroke functional outcome in people older than 80 years. This register-based and cross-sectional study analyzed data from two stroke quality registers in Sweden from 2014 through 2019. The study included patients aged ≥80 with a diagnosis of ischemic or hemorrhagic stroke. Sociodemographic features, prestroke condition, stroke severity on admission (National Institutes of Health Stroke Scale [NIHSS]), stroke unit care, rehabilitation plans, and 3-month poststroke functional outcome measured with the modified Rankin Scale were analyzed. Ordinal regression analyses stratified by sex were conducted to assess sex differences in factors that impact poststroke functional outcome 3 months after the stroke. A total of 2245 patients were studied with the majority (59.2%) being females. Females experienced more severe strokes (NIHSS median 4 vs. 3, p = 0.01) and were older at stroke onset than males (87.0 vs. 85.4, p < 0.001). Females were also less independent prestroke (69.9% vs. 77.4%, p < 0.001) and a higher proportion of females lived alone (78.2% vs. 44.2%, p < 0.001). Males received intravenous thrombolysis more often than females (16.3% vs. 12.0%, p = 0.005). Regarding 3-month functional outcome, males benefited more from thrombolysis (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.83), whereas females benefited more from thrombectomy (OR 0.40, 95% CI 0.20-0.71). Stroke care should be adapted to sex disparities in older individuals, while clinicians should be aware of these sex disparities. Further research could clarify the mechanisms behind these disparities and lead to a more personalized approach to stroke care of the older population.

Association of low muscle mass with cognitive function and mortality in USA seniors: results from NHANES 1999–2002

BackgroundSarcopenia and cognitive impairment have been linked in prior research, and both are linked to an increased risk of mortality in the general population. Muscle mass is a key factor in the diagnosis of sarcopenia. The relationship between low muscle mass and cognitive function in the aged population, and their combined impact on the risk of death in older adults, is currently unknown. This study aimed to explore the correlation between low muscle mass and cognitive function in the older population, and the relationship between the two and mortality in older people.MethodsData were from the National Health and Nutrition Examination Survey 1999–2002. A total of 2540 older adults aged 60 and older with body composition measures were included. Specifically, 17–21 years of follow-up were conducted on every participant. Low muscle mass was defined using the Foundation for the National Institute of Health and the Asian Working Group for Sarcopenia definitions: appendicular lean mass (ALM) (< 19.75 kg for males; <15.02 kg for females); or ALM divided by body mass index (BMI) (ALM: BMI, < 0.789 for males; <0.512 for females); or appendicular skeletal muscle mass index (ASMI) (< 7.0 kg/m2 for males; <5.4 kg/m2 for females). Cognitive functioning was assessed by the Digit Symbol Substitution Test (DSST). The follow-up period was calculated from the NHANES interview date to the date of death or censoring (December 31, 2019).ResultsWe identified 2540 subjects. The mean age was 70.43 years (43.3% male). Age-related declines in DSST scores were observed. People with low muscle mass showed lower DSST scores than people with normal muscle mass across all age groups, especially in the group with low muscle mass characterized by ALM: BMI (60–69 years: p < 0.001; 70–79 years: p < 0.001; 80 + years: p = 0.009). Low muscle mass was significantly associated with lower DSST scores after adjusting for covariates (ALM: 43.56 ± 18.36 vs. 47.56 ± 17.44, p < 0.001; ALM: BMI: 39.88 ± 17.51 vs. 47.70 ± 17.51, p < 0.001; ASMI: 41.07 ± 17.89 vs. 47.42 ± 17.55, p < 0.001). At a mean long-term follow-up of 157.8 months, those with low muscle mass were associated with higher all-cause mortality (ALM: OR 1.460, 95% CI 1.456–1.463; ALM: BMI: OR 1.452, 95% CI 1.448–1.457); ASMI: OR 3.075, 95% CI 3.063–3.088). In the ALM: BMI and ASMI-defined low muscle mass groups, participants with low muscle mass and lower DSST scores were more likely to incur all-cause mortality ( ALM: BMI: OR 0.972, 95% CI 0.972–0.972; ASMI: OR 0.957, 95% CI 0.956–0.957).ConclusionsLow muscle mass and cognitive function impairment are significantly correlated in the older population. Additionally, low muscle mass and low DSST score, alone or in combination, could be risk factors for mortality in older adults.

ASSESSMENT OF TREATMENT OUTCOMES AND SOME RISK FACTORS FOR MORTALITY OF COMMUNITY-ACQUIRED PNEUMONIA CAUSED BY STAPHYLOCOCCUS AUREUS IN THE ELDERLY POPULATION

Objectives: Community-acquired pneumonia is a notable contributor to mortality from infectious diseases on a worldwide scale, especially in the older population. Staphylococcus aureus is a prevalent infection known to cause severe pneumonia, often leading to a high incidence of complications and fatality. The study's objective was to assess the treatment outcomes and some factors associated with mortality rates of Staphylococcus aureus pneumonia in older people. Subjects and method: A cross-sectional study was conducted with 93 patients diagnosed with Staphylococcus aureus pneumonia admitted to Can Tho Central General Hospital from April 2021 to May 2023. Results: The research results showed clinical outcomes including 30-day all-cause death rates and pneumonia-related complications were slightly higher in the age group over 60 compared to those aged 60 and under, but the difference was not statistically significant. After performing multivariate analysis, it was found that heart failure (OR = 5.68, 95% CI: 1.01-32.1, p = 0.049) and central nervous system disease (OR = 5.26, 95% CI: 1.32-20.9, p = 0.018) were found to be independent factors that increased the mortality rate in individuals aged over 60. Conclusion: Clinical practitioners should evaluate and manage comorbidities regarding heart failure and central nervous system diseases during treatment of Staphylococcus aureus pneumonia due to its elevated fatality rate, especially in old patients.

Social environment, lifestyle, and genetic predisposition with dementia risk: A long-term longitudinal study among older adults.

The role of social environment, i.e., the aggregate effect of social determinants of health (SDOHs), in determining dementia is unclear. We developed a novel polysocial risk score for dementia based on 19 SDOH among 5,199 participants in the Health and Retirement Study, US, to measure the social environmental risk. We used a survival analysis approach to assess the association between social environment and dementia risk in 2006-2020. We further studied the interaction between social environment and lifestyles, and explored racial disparities. The study participants (mean age=73.4 years, SD=8.3; 58.0% female; 11.6% African American) were followed up for an average of 6.2 years, and 1,089 participants developed dementia. Every one-point increase in the polysocial risk score (ranging from 0-10) was associated with a 21.6% higher risk (aHR=1.21, 95% CI=1.15-1.26) of developing dementia, other things being equal. Among participants with high social environmental risk, regular exercise and moderate drinking were associated with a 43-60% lower risk of developing dementia (p<0.001). In addition, African Americans were 1.3 times (aHR=2.28, 95% CI=1.96-2.66) more likely to develop dementia than European Americans, other things being equal. An adverse social environment is linked to higher dementia risk, but healthy lifestyles can partially offset the increased social environmental risk. The polysocial risk score can complement the existing risk tools to identify high-risk older populations, and guide the design of targeted social environmental interventions, particularly focusing on improving the companionship of the older people, to prevent dementia.

A narrative review: suicide and suicidal behaviour in older adults

Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.

Investigating the antecedents of mHealth adoption by older adults in a lower-middle income country: The PLS-MGA approach

ABSTRACT The adoption of technology and the rising digital divide among the older adult population, predominantly in lower-middle income countries such as Bangladesh, have posed a precarious challenge. Hence, the time has come to navigate this upcoming challenge. Thus, the current research aims to investigate the impact of perceived usefulness (PU), perceived ease of use (PE), and perceived risk (PR) on the behavioral intention to adopt mHealth (BI). Furthermore, multigroup analysis (MGA) is used to examine BI regarding gender and income groups. Data from 140 older adults in Bangladesh were gathered and later analysed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to estimate the measurement and structural model parameters and produce concurrent bootstrap evaluations. The findings revealed that PE and PU substantially affect the intention to adopt mHealth, whereas PR has small effect on mHealth adoption. Furthermore, the MGA depicts that the effect of PR is statistically significant for older adult males and females. Additionally, the effect of PE on behavioral intention to adopt mHealth between income groups (lower income vs. higher income) is significant. Therefore, this research advances our theoretical and empirical understanding by yielding new scholarly evidence in the domain of mHealth adoption by older adults. Finally, the paper concludes with augmented practical considerations concerning the adoption of mHealth as a technology by older adults, which will assist in alleviating the digital divide for any such lower-middle income country across the globe.

"I am adhering to HIV treatment so that I can live to support her": A qualitative study of upward intergenerational support in South Africa.

Intergenerational family care, which was upended by the HIV epidemic in sub-Saharan Africa (SSA), may return to a pre-HIV era arrangement as access to antiretroviral therapy (ART) expands and treated adults can once again provide support for older household members. Empirical research has demonstrated positive 'spillover effects' of ART uptake from treated adults to younger generations, yet much less is known about the nature and breadth of such effects to older generations. This study explores the role and lived experiences among adults who take up ART and those of an older generation with whom they live. We conducted a qualitative study consisting of semi-structured interviews (n = 46) embedded in the Agincourt Health and Demographic Surveillance System (HDSS) in rural South Africa, between July and September 2022. We purposefully sampled two respondent categories: (i) young or middle-aged adults on ART (aged 18-59 years old); and (ii) older adults (aged ≥60 years old) who were affiliated with a young or middle-aged adult on ART. We used thematic content analysis to extract, code, and categorise relevant text by types of upward spillover effects from ART in younger adults to older adults. Quantitative data was extracted from the existing Agincourt HDSS database and matched to qualitative interview data based on Clinic link unique identifiers of study participants. Mean age was 41 years among young or middle-aged adults (n = 29) and 72 years among older adults (n = 17). Among younger adults, time on ART ranged from five months to more than 21 years. Both young or middle-aged adults on ART and older adults reported positive spillover effects for older adults across five main tiers: caregiving, financial support, physical and mental health, living arrangements and household relationships, and stigma and reputation. Spillover challenges included financial costs and caregiving responsibilities following ART initiation of young or middle-aged adults, although these additional caregiving responsibilities were generally not perceived as particularly burdensome. ART is likely to benefit older adults in South Africa whose families are affected by HIV. This study identified a wide range of perceived spillover effects from ART in younger adults to older adults, including improvements to upward intergenerational support. These qualitative findings offer a guide to researchers, policymakers, and donors to capitalise on the broader societal effects of a large-scale health intervention to further support family structures and meet the needs of a growing older population.

Association between hydrometeorological conditions and infectious diarrhea in mainland China: a spatiotemporal modeling study

Infectious diarrhea imposes substantial disease burden in China, with local climate identified as a key risk factor. In this study, we aimed to explore the association between hydrometeorological conditions and the incidence of infectious diarrhea, and investigate the modification effect of urbanization, which remained unclear previously. Monthly data were collected from 1 January 2021 to 31 December 2022 from each city of mainland China on cases of infectious diarrhea other than cholera, dysentery, typhoid and paratyphoid (i.e. other infectious diarrhea, OID), temperature and precipitation. We used Palmer drought severity index (PDSI) to represent local hydrometeorological conditions (dry and wet). A spatiotemporal Bayesian hierarchical model combined with distributed lag nonlinear model was specified to explore the association between PDSI and the relative risk of OID. The effect size of hydrometeorological conditions at different urbanization levels were quantified through a linear interaction term. A total of 1999 947 OID cases were included. There was a N-shaped cumulative association between PDSI and OID incidence over a maximum lag of 4 months. The effect of extreme dry conditions persisted over lag 1–3 months and peaked at the 2-month lag (RR = 2.67, 95%CI: 2.44–2.91). By contrast, the relative risk of OID increased immediately under extreme wet conditions (RR = 1.97, 95%CI: 1.68–2.32 at lag 0 month). Children and the older population were particularly susceptible to extreme dry and wet conditions, respectively. Areas with lower urbanization rate, healthcare resources and economic levels, and higher population density showed a higher risk of OID related to extreme dry conditions. While the modification effects of these urbanization characteristics were limited for extreme wet conditions. There was a nonlinear and lagged association between hydrometeorological conditions and the incidence of OID in mainland China, which may be modified in diverse patterns by urbanization indicators. Our findings will provide valuable reference for better prevention and control of OID.

Progressive overload in cardiorespiratory exercise training for young and old: Is increasing duration or intensity of exercise more important?

People undertake endurance training to improve their health and cardio-respiratory fitness. Subsequent cardio-respiratory and skeletal muscle aerobic metabolic adaptations are gauged by improvements in maximum or peak oxygen uptake (V̇O2peak) and the blood lactate inflection point or threshold during incremental exercise – (LIP). To further improve physiological capability, subsequent homoeostatic disturbances from exercise should be progressively greater in succeeding exercise sessions. Therefore, exercise duration, frequency or intensity should be progressively increased during a training regimen to ensure adaptation potential is realized. A progressive increase in training workload is termed “progressive overload”. Despite the universal acknowledgment of the importance of progressive overload, it is unclear if systematically progressing altering either exercise intensity or duration (or distance covered) affect cardio-respiratory gains differently in young and older populations. As running faster results in higher heart rates and greater skeletal muscle metabolic stress than running the same distance at a lower speed, in this hypothesis we postulate that progressively increasing exercise run intensity will result in greater mean and higher incidence of V̇O2peak and LIP gains in young adults (<50 years). However, the mechanisms that initiate improvements in cardio-respiratory fitness and skeletal muscle aerobic function may be different in older adults due to the inevitable aging decline in cardio-vascular function and mechanical and morphological properties of muscle–tendon units. In older adults (>60 years) we hypothesize progressively increasing run distance while maintaining the same speed will just be as effective as to progressively increasing speed to improve V̇O2peak and LIP. To test these hypotheses, we propose a study that compares progressively increasing run intensity to a treatment of progressive matched run distance where speed remains constant in young and old adults.

Prognosis of type A acute aortic syndrome in elderly patients

Abstract Funding Acknowledgements None. Introduction Type A acute aortic syndrome (AAS-A) is associated with a high mortality. Emergent surgery is the treatment of choice for patients with AAS-A. However, this surgery is a highly complex procedure associated with a significant morbidity. There are uncertainties about the best treatment strategy for elderly patients, which pose a challenge in clinical practice. Purpose The aim of this study is to evaluate the prognosis of elderly patients with AAS-A and to analyse the impact and outcome of surgery in this patient population. Methods Patients with AAS-A were prospectively and consecutively collected from April-2019 to March-2023 in a four-hospital network with a tertiary care referral centre for cardiac surgery. Patients were classified according to age into two groups: ≥75 years and under 75 years. Clinical, diagnostic, treatment and prognostic variables were analysed. Results A total of 113 patients with AAS were included, of whom 82 were AAS-A patients. Of these, 27 were aged 75 years or older. Older patients had more comorbidities: COPD, atrial fibrillation, renal failure and stroke (table). Elderly patients were diagnosed later (symptom-to-diagnosis time: 10 hours (6.2-62) vs. 4 hours (2.2-23), p=0.004). At diagnosis, older patients had more complications: cardiac tamponade (33% vs 23%, p= 0.352), hemopericardium (69% vs 38%, p= 0.01), shock (45% vs 30%, p=0.180) and renal failure (40% vs 20%, p= 0.132). The surgical risk of older patients was higher (table) and they underwent surgery in a lower proportion (59.3% vs. 87.3%, p= 0.004). Once diagnosed, time to surgery was similar between groups (3.2h (1.6-10) vs. 2.7h (2.1-5.7), p= 0.728). Despite the increased risk, surgery was associated with a mortality reduction in both patient groups (figure). In patients who underwent surgery, the incidence of post-surgical atrial fibrillation was higher in the group of older patients, with no significant differences in the remaining complications (table). Conclusion Elderly patients with AAS-A have more comorbidities, are diagnosed later and have a higher mortality than those with younger age. Despite this, surgery is associated with a mortality reduction even in the older population. Age alone should not be a contraindication for surgical treatment of AAS-A.Mortality in SAA by age and treatment

An examination from 1990 to 2019: investigating the burden of knee dislocation on a global scale

BackgroundThe literature on the disease burden of knee dislocation is lacking. The aim of the study is to systematically assess the global burden, trends, causes, and influencing factors of knee dislocation.MethodsThe incidence and years lived with disability (YLDs) of knee dislocation were assessed globally, as well as at the regional and national levels from 1990 to 2019. Subsequent analyses focused on the age and gender distribution related to knee dislocation. An investigation into the main causes of knee dislocation followed. Finally, the Pearson correlation between age-standardized rates and social-demographic index (SDI) was calculated.ResultsAlthough the age-standardized incidence and YLDs rate of knee dislocation decreased over the past 30 years, the incidence and YLDs number increased. The disease burden remained higher in males compared to females. Males and females showed different patterns of incidence rates in each age group, but their YLDs rates were similar. Over the past 30 years, the disease burden of knee dislocation increased in the older population while declining in the younger population. Falls had consistently emerged as the most important cause for both incidence and YLD rates. Additionally, a positive correlation between SDI and the disease burden of knee dislocation was found.ConclusionThe disease burden of knee dislocation remains heavy. It is essential to recognize the evolving epidemiology of knee dislocation. Utilizing data-driven assessments can assist in formulating public health policies and strategies to improve overall well-being.

Pharmacotherapy for Coronary Artery Disease and Acute Coronary Syndrome in the Aging Population.

To provide a comprehensive summary of relevant studies and evidence concerning the utilization of different pharmacotherapeutic and revascularization strategies in managing coronary artery disease and acute coronary syndrome specifically in the older adult population. Approximately 30% to 40% of hospitalized patients with acute coronary syndrome are older adults, among whom the majority of cardiovascular-related deaths occur. When compared to younger patients, these individuals generally experience inferior clinical outcomes. Most clinical trials assessing the efficacy and safety of various therapeutics have primarily enrolled patients under the age of 75, in addition to excluding those with geriatric complexities. In this review, we emphasize the need for a personalized and comprehensive approach to pharmacotherapy for coronary heart disease and acute coronary syndrome in older adults, considering concomitant geriatric syndromes and age-related factors to optimize treatment outcomes while minimizing potential risks and complications. In the realm of clinical practice, cardiovascular and geriatric risks are closely intertwined, with both being significant factors in determining treatments aimed at reducing negative outcomes and attaining health conditions most valued by older adults.

Aging amplifies a gut microbiota immunogenic signature linked to heightened inflammation.

Aging is associated with low-grade inflammation that increases the risk of infection and disease, yet the underlying mechanisms remain unclear. Gut microbiota composition shifts with age, harboring microbes with varied immunogenic capacities. We hypothesized the gut microbiota acts as an active driver of low-grade inflammation during aging. Microbiome patterns in aged mice strongly associated with signs of bacterial-induced barrier disruption and immune infiltration, including marked increased levels of circulating lipopolysaccharide (LPS)-binding protein (LBP) and colonic calprotectin. Exvivo immunogenicity assays revealed that both colonic contents and mucosa of aged mice harbored increased capacity to activate toll-like receptor 4 (TLR4) whereas TLR5 signaling was unchanged. We found patterns of elevated innate inflammatory signaling (colonic Il6, Tnf, and Tlr4) and endotoxemia (circulating LBP) in young germ-free mice after 4 weeks of colonization with intestinal contents from aged mice compared with young counterparts, thus providing a direct link between aging-induced shifts in microbiota immunogenicity and host inflammation. Additionally, we discovered that the gut microbiota of aged mice exhibited unique responses to a broad-spectrum antibiotic challenge (Abx), with sustained elevation in Escherichia (Proteobacteria) and altered TLR5 immunogenicity 7 days post-Abx cessation. Together, these data indicate that old age results in a gut microbiota that differentially acts on TLR signaling pathways of the innate immune system. We found that these age-associated microbiota immunogenic signatures are less resilient to challenge and strongly linked to host inflammatory status. Gut microbiota immunogenic signatures should be thus considered as critical factors in mediating chronic inflammatory diseases disproportionally impacting older populations.

The long-term trend in utilization of traditional Chinese medicine and associated factors among older people in Taiwan.

Both the size of the older population and the use of complementary and alternative medicine are increasing worldwide. This study evaluated the long-term trend in utilization of traditional Chinese medicine (TCM) and associated factors among older people in Taiwan. Using the database of population-based interview surveys, we evaluated the one-month prevalence of TCM use among 13,945 older people aged over 65 years from 2001-2017. The sociodemographic status and medical comorbidities of older people who did and did not use TCM were compared by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multiple logistic regressions. The one-month prevalence of TCM use increased from 5.5% in 2001 to 9.1% in 2017 among older people in Taiwan. Overall, 7.3% of older people had used TCM within the previous month. People with a history of heart disease (OR 1.62, 95% CI 1.24-2.12), use of folk therapy (OR 3.16, 95% CI 2.00-4.99), and purchase of non-prescribed Chinese herbal medicine (OR 2.08, 95% CI 1.48-2.91) were more likely to use TCM than the comparison group. However, age ≥80 years (OR 0.48, 95% CI 0.31-0.72) and previous hospitalization (OR 0.59, 95% CI 0.41-0.85) were associated with the reduced use of TCM. From 2001-2017, the use of TCM increased in the older population in Taiwan. The use of folk medicine and purchase of non-prescribed Chinese herbal medicine were significant predictors for the use of TCM.

Determining the most appropriate socioeconomic status indicator for describing inequalities in dental visits by Japanese older people.

This study examined the association between various socioeconomic status (SES) indicators and dental visits among older Japanese. When examining health inequalities, an adequate indicator of SES should be applied. In older adults, wealth and pensions are considered more appropriate indicators of SES than education and income, but few studies have examined. This cross-sectional study used data from 12 391 individuals aged 65 years or older from the 2016 Japan Gerontological Evaluation Study (JAGES). The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were applied to examine the association of education, income, wealth and pensions with dental visits for treatment and check-up adjusting for covariates. The mean age of the participants was 74.0 ± 6.2 years. In the previous year, 56.3% of participants had visited a dentist for a check-up, and 65.9% had visited for treatment. Inequalities in dental treatment visits were observed for wealth, pensions and income rather than education. Income was not significantly associated with check-up visits. Wealth showed the largest association with dental visits for treatment [(SII 0.09, 95% CI 0.06 to 0.13), (RII 1.14, 95% CI 1.09 to 1.21)] and check-up [(SII 0.08, 95% CI 0.05 to 0.12), (RII 1.16, 95% CI 1.09 to 1.23)]. When measuring inequalities in access to dental care among the older population, wealth and pensions could be important indicators of SES.

Real-world effectiveness of CDK4/6 inhibitors on patients with HR+/HER2– advanced breast cancer in South Korea, focusing on underrepresented patients

Objective We assessed the real-world effectiveness of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors as first-line treatments in postmenopausal patients with HR+/HER2− advanced breast cancer, focusing on younger (<45 years) and older (>78 years) populations not considered in clinical trials. Methods We analyzed nationwide claims data from the Health Insurance Review and Assessment Service between November 2016 and February 2021. In this retrospective cohort study, patients using CDK4/6 inhibitors and aromatase inhibitors were selected and grouped by age as follows: 45–78 years (trial-enrolled), <45 years (younger), and >78 years (older). We estimated the median real-world progression-free survival (rwPFS) and overall survival (OS) using the Kaplan-Meier method. We conducted Cox regression analysis using a sub-distribution hazard model to evaluate risk factors (age, history of prior systemic treatment, presence of metastasis, comorbidity index, and type of provider) and estimated hazard ratios (HR). Results Among the 2,830 patients who received CDK4/6 inhibitors as first-line therapy, we identified 358 (12.65%) younger and 148 (5.23%) older underrepresented patients. The younger patient group (50.84%) had the highest rate of prior systemic therapy, followed by the trial-enrolled (25.39%) and older patient groups (8.11%). The median rwPFS was shorter in the older group (19.30 months) than those in the younger and the trial-enrolled age groups (30.33 and 34.53 months, respectively; p = .002). The HR of older age for death was 1.59 (95% confidence interval (CI) = 1.24–2.03). For rwPFS, the HR of prior systemic therapy was 1.19 (95% CI = 1.04–1.37). Conclusions The younger age group, which was underrepresented in the trial, did not show a significant difference in risk compared with the enrolled age group. However, the older age group, which was also underrepresented in the trial, faces a risk of mortality but not progression. Patients who fall outside the specified age groups for the clinical trial can still expect the same level of effectiveness in terms of progression.