Prevalence Of Older Adults Research Articles

Geriatric Syndromes in Older Adults With and Without Diabetes: A Systematic Review and Meta-Analysis.

Diabetes prevalence is increasing among older adults globally. The current study aimed to compare geriatric syndrome prevalence in older adults with and without diabetes. Primary research (2011 to 2024) in English, French, or Spanish was included. We used multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled log odds ratios (ORs) and prevalence rates were calculated using random-effects models. Sensitivity analysis explored heterogeneity, and publication bias was assessed. Older adults with diabetes exhibited higher prevalence rates of cognitive impairment (9.13% vs. 4.22%, log OR: 0.1884), depression (8.96% vs. 5.44%, log OR: 0.3543), falls (11.5% vs. 4.47%, log OR: 0.4237), functional impairment (14.2% vs. 10.6%, log OR: 1.02), urinary incontinence (9.72% vs. 4.35%, log OR: 1.3668), frailty (22.8% vs. 12.1%, log OR: 1.3443), and polypharmacy (22.9% vs. 5.78%, log OR: 2.5420). Diabetes was also associated with a higher comorbidity burden. Multidisciplinary strategies addressing diabetes and associated conditions are crucial for older adults with diabetes. Future research should delve into underlying mechanisms and optimize care strategies. [Research in Gerontological Nursing, xx(x), xx-xx.].

Detection of Elder Abuse Through Emergency Care Technicians Screening Tool Revision for Home-Based Primary Care (DETECT-RPC): a cluster randomised controlled trial study protocol

IntroductionThe annual prevalence of elder mistreatment (EM) in cognitively intact older adults is estimated to be 11%, yet the annual prevalence in older adults with Alzheimer’s disease and related dementias...

Towards a common definition of hospital-acquired deconditioning in adults: a scoping review

BackgroundHospital-acquired deconditioning is a term used in clinical practice, describing a loss of physical and/or cognitive function associated with hospitalisation. Previous reviews have addressed interventions, its prevalence in older adults...

Treatment of elderly and frail myeloma patients.

Multiple myeloma (MM) is an incurable cancer of older adults. Given the aging population, the prevalence of older adults with MM is expected to further increase over the next decade. Challenges in treating older adults result from the heterogeneity of both aging itself and the disease. Over the past two decades, tremendous progress has been made in improving the outcome in this age group with novel therapeutics, including immunomodulatory drugs, proteasome inhibitors, and more recently anti-CD38 monoclonal antibodies, becoming an integral part of initial treatment. Further improvements are expected over the next decade with novel immunotherapy, including T-cell engagers and chimeric antigen receptor therapies. With additional novel treatments, assessment of patient frailty will become increasingly important in balancing the optimal treatment of patients. In this review, we focus on the treatment of elderly and frail older adults with MM. The first part of our review will focus on pertinent investigations, considerations for treatment initiation and initial risk stratification, including frailty assessment prior to treatment initiation. In the second part, we will focus on the overall goals of treatment and therapeutic options for newly diagnosed and those with relapsed/refractory MM, including novel immunotherapy and supportive care. Lastly, we will end this review by highlighting current knowledge gaps and providing suggestions for future directions to further improve outcomes among older adults with MM.

Training of formal caregivers in geriatric mental health and dementia care: Experiences and challenges from the Indian context

AbstractThe population of older adults in India is projected to increase from the current estimate of 150 million to 350 million by the year 2050. The prevalence of older adults with mental health problems including dementia is also increasing rapidly. The socio‐cultural changes in the joint family system have necessitated the increasing requirement of formal caregivers for supporting the care of older adults in home as well as residential care institutions. Home care services providing caregiver assistance, day care, old age homes, residential care institutions for persons with mental illness or dementia are available predominantly in major cities. However, there is a huge variability in the profile of formal caregivers ranging from those with no training to qualified nurses as caregivers depending on the affordability. The need for training of formal caregivers in geriatric mental health and dementia care is acknowledged by most of the the stakeholders in the care of older adults. However, there are no minimum standards of training for the formal caregivers. The lack of trained caregivers has contributed to the increase of elder abuse, higher stress, and burnout for the caregivers with adverse impact on the quality of care of older adults. This presentation will summarize the experience and challenges related to the implementation of the training of formal caregivers in geriatric mental health and dementia care. The training initiatives for the formal caregivers conducted by the Government and Non‐Governmental organizations ranges from brief sensitization program for half a day to formal certificate course for 3 months. Most of the training programs are focused on the basic aspects of geriatric care with inadequate component of practical training. High rates of discontinuation and change of jobs, poor working conditions, lack of motivation among the caregivers and employers, lack of mandatory requirement of training are some of the important challenges limiting the progress in ensuring trained formal caregivers.

Dance programme for older adults with pre-frailty: A mixed-methods feasibility study

The prevalence of older adults with frailty and pre-frailty is increasing with the rapidly ageing population in Singapore. This study aimed to evaluate the feasibility of a 12-week Dance-Up program and test its effects on the physical and psychosocial well-being of older adults with pre-frailty in the community setting in Singapore. A mixed-method approach was used. Pre-post assessments in physical and mobility functions, fear of falling, pain and goal achievements were statistically analysed to detect any changes. Participants’ attendance, drop-out rate, and perception of the program via semi-structured interviews were gathered post-intervention to determine its feasibility. Thirteen eligible participants (mean age: 78.7 years) with mild frailty (Clinical Frailty Scale scored 3 and 4) enrolled in the program and nine completed the 12-week intervention. The majority (n = 8) were female. The average attendance rate was 83 %. Only some assessment tools (e.g. Dynamic Gait Index, Goal Attainment Scale) were sensitive to detect changes pre-/post-intervention. Thematic analysis of the interviews revealed: 1) the acceptance of the program among participants; 2) both positive factors (e.g. self-belief of the importance of regular dance practice) and negative factors (e.g. functional limitations and other commitments) may have influenced the program's outcomes. Participants provided recommendations for future implementation. The Dance-up programme was well received by participants but requires fine-tuning and other assessment tools should be explored in future studies.

Identification of Predictors of Sarcopenia in Older Adults Using Machine Learning: English Longitudinal Study of Ageing.

Background: After its introduction in the ICD-10-CM in 2016, sarcopenia is a condition widely considered to be a medical disease with important consequences for the elderly. Considering its high prevalence in older adults and its detrimental effects on health, it is essential to identify its risk factors to inform targeted interventions. Methods: Taking data from wave 2 of the ELSA, using ML-based methods, this study investigates which factors are significantly associated with sarcopenia. The Minimum Redundancy Maximum Relevance algorithm has been used to allow for an optimal set of features that could predict the dependent variable. Such a feature is the input of a ML-based prediction model, trained and validated to predict the risk of developing or not developing a disease. Results: The presented methods are suitable to identify the risk of acquired sarcopenia. Age and other relevant features related with dementia and musculoskeletal conditions agree with previous knowledge about sarcopenia. The present classifier has an excellent performance since the "true positive rate" is 0.81 and the low "false positive rate" is 0.26. Conclusions: There is a high prevalence of sarcopenia in elderly people, with age and the presence of dementia and musculoskeletal conditions being strong predictors. The new proposed approach paves the path to test the prediction of the incidence of sarcopenia in older adults.

Association between cardiovascular disease risk and sarcopenia in community-dwelling Japanese older adults.

Sarcopenia's high prevalence in older adults with cardiovascular disease (CVD) suggests that the risk of comorbidity in sarcopenia might also be increased during the at-risk phase of CVD. However, the relationship between CVD risk and sarcopenia has not been elucidated. Therefore, the purpose of this cross-sectional study was to investigate the association between CVD risk and sarcopenia in community-dwelling Japanese older adults. The participants in this cross-sectional study included 14 923 community-dwelling Japanese older adults (mean age 73.2 ± 5.6 years). The present study estimated the CVD risk using the revised World Health Organization risk chart, and classified CVD risk into "low" (<10%) and "mid-high" (≥10%). Assessments of sarcopenia, muscle mass, muscle strength and gait speed were measured based on the clinical definitions. Among the participants, 654 people (4.4%) had sarcopenia, and 4857 (32.6%) had CVD mid-high risk. A multiple logistic model showed that the CVD mid-high risk was associated with sarcopenia (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.28-1.89). In addition, CVD mid-high risk was associated with low muscle mass (OR 1.74, 95% CI 1.50-2.01), low muscle strength (OR 1.25, 95% CI 1.14-1.37) and slow gait speed (OR 1.17, 95% CI 1.07-1.27) in the adjusted model. Among community-dwelling older adults, high or moderate CVD risk was associated with an increased risk of sarcopenia. Our findings could help identify older adults with a future high risk for sarcopenia. Geriatr Gerontol Int 2024; 24: 1328-1334.

Novel BMI cutoff points for obesity diagnosis in older Hispanic adults

Current body mass index (BMI) cutoff points (≥ 30 kg/m2) underestimate obesity prevalence in older adults. The aim of the present study was to propose new BMI cutoff points for identifying obesity in older Hispanic adults. In this study, new internally derived (ID) BMI cutoff point for obesity in older Hispanic adults was developed by analyzing data from the National Health and Nutrition Survey of 2018–2019 from Mexico. To evaluate the performance/validation of this newly proposed cutoff point, data from the "Study of the 1000", conducted in Northern Mexico, was utilized. Sensitivity, and negative predictive value (NPV) were assessed using receiver operating characteristic analysis, with obesity defined by fat mass index (FMI; ≥ 9.0 kg/m2 for men and ≥ 12.0 kg/m2 for women) as the reference method. The newly proposed ID BMI cutoff point was ≥ 27.2 kg/m2 which demonstrated high sensitivity (≥ 99.4%) and NPV (≥ 99.5%) in the total sample. Furthermore, the prevalence of obesity estimated by the new BMI cutoff point was comparable to that estimated by the FMI. The newly proposed BMI cutoff point provides a more accurate identification of obesity in older Hispanic adults. These findings have implications for improving obesity diagnosis and management in this population.

Analysis of Stroke Burden in China from 1990 to 2021 and Projections for the Next Decade

Introduction: This study aimed to describe the temporal trends of stroke burden in different age and sex groups in China from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare these data with global figures. Methods: Using data from the Global Burden of Disease database from 1990 to 2021, we analyzed changes in stroke burden in China and globally. The average annual percentage change (AAPC) was calculated using Joinpoint software to reflect trends. Stroke burden differences across various age groups and sexes were compared, and the ARIMA model was utilized for future projections. Results: Between 1990 and 2021, the age-standardized incidence rate (ASIR) of stroke in China decreased from 226.938 to 204.753 per 100,000, while the global ASIR decreased from 180.973 to 141.553 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 1,167.425 to 1,301.42 per 100,000, whereas the global ASPR decreased from 1,201.111 to 1,099.31 per 100,000. The age-standardized mortality rate (ASMR) in China fell from 242.18 to 138.029 per 100,000, while the global ASMR decreased from 144.313 to 87.454 per 100,000. China’s age-standardized DALY rate (ASDR) declined from 4,834.791 to 2,648.025 per 100,000, whereas the global ASDR decreased from 3,078.952 to 1,886.196 per 100,000. The AAPCs for ASIR, ASPR, ASMR, and ASDR in China were −0.370%, 0.326%, −1.793%, and −1.933%, respectively, compared to −0.291%, −0.807%, −1.601%, and −1.570% globally from 1990 to 2021. Age and sex significantly influenced the stroke burden, with higher incidence and mortality rates in males than in females. Projections for the next decade indicate that stroke incidence in China will remain stable, with an expected rise in ASPR, and declines in ASMR and ASDR. Globally, ASIR is expected to decline, while ASPR will rise, and ASMR and ASDR will continue to decrease. Conclusion: From 1990 to 2021, the incidence, mortality, and DALYs of stroke in China have decreased, while the prevalence has increased. Stroke burden is age-related, with higher prevalence in older adults and higher mortality in the elderly. Males are more susceptible to stroke and have a higher risk of death. Over the next decade, stroke prevalence in China is expected to rise, posing challenges due to population aging, even as mortality and disability rates decline. Sustained public health efforts will be necessary.

The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults.

Falls among older adults are more than mere accidents; they are a silent epidemic, profoundly impacting the health and well-being of millions of older adults worldwide. This study examines the incidence and prevalence of falls among individuals aged 65 and above, focusing on the influence of demographic factors and comorbid conditions such as hypertension, diabetes mellitus, cancer, and obesity. A retrospective cohort study was conducted using data from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) from 2019 to 2023. The study population included 16,400 individuals aged 65 and above who presented with fall-related trauma. Data on demographics, clinical diagnoses, procedures, and comorbid conditions were analyzed using descriptive statistics to evaluate the incidence and prevalence of falls. The mean age of the study population was 77.3 years, with a higher proportion of females (60.97%) compared to males (39.02%). Despite the larger number of female participants, incidence and prevalence of falls were highest among individuals aged 65-69 years, and fall rates were notably higher among males compared to females. This suggests that while fewer in number, males in our study experienced falls more frequently. Patients with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%) among comorbid conditions. Falls among older adults are significantly influenced by demographic factors and comorbid conditions. Hypertension, in particular, is associated with the highest fall risk. These findings highlight the need for targeted interventions to manage comorbidities and reduce fall risks among older adult patients.

Excess prevalence of preexisting chronic conditions in older adults with incident epilepsy.

Prior studies have examined chronic conditions in older adults with prevalent epilepsy, but rarely among those with incident epilepsy. Identifying the chronic conditions with which older adults present at epilepsy incidence assists with the evaluation of disease burden in this patient population and informs coordinated care development. The aim of this study was to identify preexisting chronic conditions with excess prevalence in older adults with incident epilepsy compared to those without. Using a random sample of 4 999 999 fee-for-service Medicare beneficiaries aged >65 years, we conducted a retrospective cohort study of epilepsy incidence in 2019. Non-Hispanic Black and Hispanic beneficiaries were oversampled. We identified preexisting chronic conditions from the 2016-2018 Medicare Beneficiary Summary Files and compared chronic condition prevalence between Medicare beneficiaries with and without incident epilepsy in 2019. We characterized variations in preexisting excess chronic condition prevalence by age, sex, and race/ethnicity, adjusting for the racial/ethnic oversampling. We observed excess prevalence of most preexisting chronic conditions in beneficiaries with incident epilepsy (n = 20 545, weighted n = 19 631). For stroke, for example, the adjusted prevalence rate ratio (APRR) was 4.82 (99% CI:4.60, 5.04), meaning that, compared to those without epilepsy, beneficiaries with incident epilepsy in 2019 had 4.82 times the stroke prevalence. Similarly, beneficiaries with incident epilepsy had a higher prevalence rate for preexisting neurological conditions (APRR = 3.17, 99% CI = 3.08-3.27), substance use disorders (APRR = 3.00, 99% CI = 2.81-3.19), and psychiatric disorders (APRR = 1.98, 99% CI = 1.94-2.01). For most documented chronic conditions, excess prevalence among beneficiaries with incident epilepsy in 2019 was larger for younger age groups compared to older age groups, and for Hispanic beneficiaries compared to both non-Hispanic White and non-Hispanic Black beneficiaries. Compared to epilepsy-free Medicare beneficiaries, those with incident epilepsy in 2019 had a higher prevalence of most preexisting chronic conditions. Our findings highlight the importance of health promotion and prevention, multidisciplinary care, and elucidating shared pathophysiology to identify opportunities for prevention.

Aggrecanopathies: Report of a Spondyloepiphyseal Dysplasia Kimberley type (SEDK) in a family, caused by a previously undescribed likely pathogenic variant of the ACAN gene

The study of patients with short stature is complex and requires diagnostic algorithms in which the evaluation by Genetics is essential, seeking to rule out genetic syndromes that may explain the patient's manifestations. Among these possible causes, skeletal dysplasias should always be considered as a diagnostic possibility. We present the case of a family in which in the proband and in his progenitor a previously undescribed probably pathogenic variant was detected in the ACAN gene which encodes the Aggrecan Proteoglycan (PG), a fundamental component in the endochondral bone growth and in the articular cartilage, and whose alteration in heterozygous state produces Kimberley type Skeletal Spóndyloepiphyseal Dysplasia (SEDK) and other disorders known as aggrecanopathies. Molecular genetic analyses are becoming mandatory studies to achieve an accurate diagnosis in these cases. It is expected that the study of these conditions will shed light for a better understanding of the pathophysiology of osteoarthritis and for the development of new treatments for its management, given its high prevalence in older adults and the fact that aggrecan degeneration plays a central role in it.

Factors associated with the fragmentation and stability of the rest-activity rhythm in adults and older adults

ABSTRACT This cross-sectional study aimed to identify factors related to the fragmentation and stability of the rest-activity rhythm (RAR) in adults and older adults. It is part of a larger research project investigating aspects concerning sleep duration, quality, and disorders in a representative subsample of the population. Sociodemographic data, lifestyle, health habits and subjective sleep variables were obtained; RAR records were collected by means of actigraphy and analyzed using non-parametric variables (IS, IV, M10, L5, RA, sL5, and sM10). Study participants were 313 individuals with complete actigraphy records. There was a prevalence of older adults (50.2%) and females (51.1%). Females, individuals with 4–8 y of education, and those who used alcohol abusively exhibited lower RAR fragmentation. Higher fragmentation was observed in individuals who napped and those reporting poor sleep quality. Greater rhythm stability was evident in females, older adults, those with 4–8 y of education, and those who had a partner. Smokers demonstrated lower RAR stability. These findings may contribute valuable insights for decision-making aimed at preventing and treating issues related to fragmentation and instability of the rhythm and its possible consequences to health.

An undue emphasis on rural older adults in the Chief Medical Officer's annual report 2023?

The Chief Medical Officer's annual report 2023 presents an incomplete and skewed picture of the geography of older people in England. We show that there are higher absolute numbers of older people in urban areas in England and Wales, in contrast to key messages from the CMO report which suggest greater need in rural areas based on relative metrics. The absolute size of the urban–rural difference in the population of older people is projected to grow by 2043. Older adults in urban areas are much more likely to live in deprived areas than older adults in rural areas. The absolute number and prevalence of older adults in poorer health is also higher in urban areas, leading to greater healthcare needs. Policy-makers need to consider both absolute and relative demographic trends as well as making use of direct measures of health when planning how healthcare services for older adults are distributed geographically in England.

Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050. Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution. Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing. Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain. Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.

Post-Stroke Depression in Older Adults: An Overview.

Detailed data on post-stroke depression (PSD) in older adults are limited in spite of the high vulnerability of this population to stroke. In fact, PSD prevalence in older adults ranges from 16.0 to 43.9%; however, timing and instruments of evaluation often differ significantly across all available studies. The etiology, genetic and inflammatory factors, as well as structural brain alterations, are claimed as part of a multifaceted mechanism of action in PSD onset. Thus, the aim of this narrative review was to further elaborate on the prevalence, etiology, diagnosis, consequences and treatment of PSD in older adults. The consequences of PSD in older adults may be devastating, including a poor functional outcome after rehabilitation and lower medication adherence. In addition, lower quality of life and reduced social participation, higher risk of new stroke, rehospitalization, and mortality have been reported. In this scenario, treating PSD represents a crucial step to prevent these complications. Both pharmacological and non-pharmacological therapies are currently available. The pharmacological treatment utilizes antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TAs) and new multimodal antidepressants (NMAs). Non-pharmacological therapies include psychological interventions and non-invasive brain stimulation techniques, while excluding drug administration. In the general population experiencing PSD, SSRIs (sertraline in particular) are the most prescribed, whereas the combination of antidepressants and psychotherapy is underused. Furthermore, about one-third of patients do not receive treatment for PSD. In regard to older adults with PSD, the possibility of more adverse effects or contraindications to antidepressant prescription due to comorbidities may limit the therapeutic window. Although drugs such as citalopram, escitalopram, sertraline, venlafaxine, and vortioxetine are usually well tolerated by older patients with PSD, the few randomized controlled trials (RCTs) specifically considering older adults with PSD have been conducted with fluoxetine, fluvoxamine, reboxetine, citalopram and nortriptyline, often with very small patient samples. Furthermore, data regarding the results of non-pharmacological therapies are scarce. High-quality RCTs recruiting large samples of older adults are needed in order to better manage PSD in this population. In addition, adequate screening and diagnosis instruments, with reliable timing of evaluation, should be applied.

Sports Health in Older Age: Prevalence and Risk Factors - Systematic Review

Exercise prevalence in older adults often shows low levels, with a considerable portion of this demographic being physically inactive. Myriad studies have also depicted gender disparities in exercise prevalence, highlighting that men tend to engage in more physical activity compared to women. The primary objective of this research is to highlight sports health in older age, prevalence, and risk fac-tors through a systematic review. This research employs a systematic review method by searching reputable journal databases such as Science Direct and Pubmed. The inclusion criteria in this study were articles published in the last five years related to exercise in the elderly, addressing topics such as exercise prevalence, risk factors for exercise, physical activity participation, the health of the elderly, and barriers to exercise. The exclusion criteria in this study were articles published in non-reputable journals. The researchers selected and analyzed 16 articles meeting the inclusing criteria for this systematic review. For standard operations, this study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) assessment. The research findings reveal that within the first group, various risk factors significantly impede exercise in older adults, including chronic health conditions such as heart disease and diabetes. In addition, factors such as lack of knowledge about the benefits of exercise, fear of injury, and social isolation contributed to reduced participation in physical activity. Furthermore, the findings with-in the second group underscore the significance of information that various exercises through health sports activities to support body health in old age. The results of the third group show that some treatments of sports health therapy are suitable for the elderly. Understanding these multifaceted factors is paramount to design effective interventions to increase sports participation in the elderly. Therefore, the promotion of active and healthy lifestyles in older adults should consider the social, economic and health factors that influence individuals' decisions. This holistic approach can contribute to improving the quality of life and well-being of older adults, concurrently reducing the burden of age-related diseases. Keywords: active lifestyle, older age, physical activity, Sports Health

Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care

PurposeThis study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person’s Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria.MethodsA retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient.ResultsThe mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0–66.6%), 66.8% (95% CI 64.1–69.5%), and 50.1% (95% CI 47.2–53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6–32.9) and Beers criteria (30.1%, 95% CI 27.6–32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4–11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735).ConclusionThis study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.

Vascular Calcification Heterogeneity from Bench to Bedside: Implications for Manifestations, Pathogenesis, and Treatment Considerations.

Vascular calcification (VC) is the ectopic deposition of calcium-containing apatite within vascular walls, exhibiting a high prevalence in older adults, and those with diabetes or chronic kidney disease. VC is a subclinical cardiovascular risk trait that increases mortality and functional deterioration. However, effective treatments for VC remain largely unavailable despite multiple attempts. Part of this therapeutic nihilism results from the failure to appreciate the diversity of VC as a pathological complex, with unforeseeable variations in morphology, risk associates, and anatomical and molecular pathogenesis, affecting clinical management strategies. VC should not be considered a homogeneous pathology because accumulating evidence refutes its conceptual and content uniformity. Here, we summarize the pathophysiological sources of VC heterogeneity from the intersecting pathways and networks of cellular, subcellular, and molecular crosstalk. Part of these pathological connections are synergistic or mutually antagonistic. We then introduce clinical implications related to the VC heterogeneity concept. Even within the same individual, a specific artery may exhibit the strongest tendency for calcification compared with other arteries. The prognostic value of VC may only be detectable with a detailed characterization of calcification morphology and features. VC heterogeneity is also evident, as VC risk factors vary between different arterial segments and layers. Therefore, diagnostic and screening strategies for VC may be improved based on VC heterogeneity, including the use of radiomics. Finally, pursuing a homogeneous treatment strategy is discouraged and we suggest a more rational approach by diversifying the treatment spectrum. This may greatly benefit subsequent efforts to identify effective VC therapeutics.