Risk In Older Adults Research Articles

New-Onset Postoperative Atrial Fibrillation and Preoperative Sleep in Cardiac Surgical Patients

BackgroundNew-onset postoperative atrial fibrillation is associated with adverse clinical outcomes in older adults. Poor preoperative sleep quality is a putative modifiable risk factor. The relationships between new-onset postoperative atrial fibrillation and preoperative sleep structure in older adults undergoing elective cardiac surgery were investigated at a single center. MethodsThis was a prespecified substudy within a prospective observational study of perioperative electroencephalographic markers (ClinicalTrials.gov; NCT03291626). We analyzed preoperative sleep recordings from 71 cardiac surgical patients aged ≥60 years without a prior history of atrial fibrillation. Overnight recordings were acquired using a consumer-grade headband and underwent manual sleep staging. Electroencephalographic slow wave activity (power in the 0.5-4 Hz frequency band) was computed in 1-minute intervals for non-rapid eye movement sleep stages. Associations between new-onset postoperative atrial fibrillation incidence and sleep measures were evaluated using univariate logistic regression models and multivariate logistic regression models including age and sex. ResultsNew-onset postoperative atrial fibrillation was present in 22 of 71 (31%) patients. A higher preoperative percentage of total sleep time in non-rapid eye movement stage 1 was associated with new-onset postoperative atrial fibrillation (median difference of 5.4%, P = .0002, Mann-Whitney U-test), independent of age and sex. No associations were observed between new-onset postoperative atrial fibrillation and other sleep metrics, including slow wave activity (all P > .05, Mann-Whitney U-test). ConclusionsExcess preoperative non-rapid eye movement stage 1 sleep, consistent with greater sleep fragmentation, is a potential modifiable target for mitigating new-onset postoperative atrial fibrillation risk in older adults undergoing elective cardiac surgery requiring cardiopulmonary bypass.

Older Adult Self‐Harm: A Descriptive Study

ABSTRACTSelf‐harm is a public health problem and is associated with higher suicidal intent and greater suicidal risk in older adults. This retrospective cross‐sectional study examines psychosocial characteristics, service provision and outcomes in patients attending a mental health liaison service (MHLS) with self‐harm attempt in Lincolnshire. The authors also investigate demographic, psychiatric and clinical factors related to self‐harm and discharge destination.

Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies

Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults. In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482. We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial. Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations. None. For the Spanish and French translations of the abstract see Supplementary Materials section.

Feasibility and effect of cognitive-based board game and multi-component exercise interventions on older adults with dementia.

Taiwan is an aging society, and the number of people with dementia is rapidly increasing. Due to a decline in cognitive and physical function, older adults with dementia not only gradually lose the ability to complete daily living tasks on their own, but are also at a higher risk of falls and injurious falls. It is important to develop interventions that combine cognitive and exercise training for older adults with dementia to promote or maintain their cognitive and physical functions and reduce their risk of falls. This study aimed to investigate the feasibility and effect of cognitive-based board games and multi-component exercise interventions on cognitive function, physical fitness, and fall risk in older adults with dementia. This was a quasi-experimental study with a single-group pretest and post-test design. The study participants were 41 community-dwelling older adults with mild to moderate dementia. They received cognitive-based board games and multi-component exercise interventions once a week for 12 weeks. The interventions included 1 hour of exercise training and 1 hour of cognitive training. Scores for the Taiwan version of the Montreal Cognitive Assessment (MoCA-T), physical fitness, and the St. Thomas Risk Assessment Tool for Falling Elderly Inpatients (STRATIFY) were measured as outcome indicators at baseline and after the 12-week period. The overall MoCA-T score increased significantly (effect size = 0.402), with participants with mild dementia showing a greater increase (effect size = 0.522) than those with moderate dementia (effect size = 0.310). Participants' physical fitness performance improved. Female participants exhibited significant improvements in the 30-second chair stand test (effect size = 0.483) and 8-foot up-and-go test (effect size = 0.437). The fall risk score decreased by 0.05 points, the change was not significant. The cognitive-based board game and multi-component exercise interventions used in this study are beneficial for improving cognitive function and physical fitness in older adults with dementia. These interventions are feasible and suitable for promotion among community-dwelling and institution-dwelling older adults with mild cognitive impairment or dementia to delay the decline in cognitive and physical function.

The effect of virtual reality treadmill training on obstacle crossing parameters in older adults

With increased age, walking without tripping requires greater cognitive demand. Therefore, it may be beneficial for training interventions to address and incorporate aspects of cognitive load. The purpose of this study was to compare a semi-immersive virtual reality treadmill training (VRTT) and conventional treadmill training (CTT) on obstacle clearance and trip hazard in older adults. Obstacle clearance parameters were measured with foot-mounted inertial measurement units (IMUs) and a Zeno pressure walkway. All data were processed and analyzed through custom Matlab scripts. Obstacle step height mean decreased (p = .003) in the lead limb following both training interventions. Additional significant changes were found in pre- and post-obstacle distance mean following both training interventions. Furthermore, significant correlations were found between demographic, cognitive, and functional mobility assessments and changes in dependent measures. The findings suggest that both the VRTT and CTT interventions may provide a reduction in trip risk in older adults, although through different methods.

Climate change effects in older people's health: A scoping review.

Climate change has serious consequences for the morbidity and mortality of older adults. To identify the effects of climate change on older people's health. A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected. Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected. Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group. No patient or public contribution.

Impact of diabetes on mortality and hospitalization after dementia diagnosis: Health insurance claims data analysis.

Japan faces a public health challenge of dementia, further complicated by the increasing complications from diabetes within its rapidly aging population. This study assesses the impact of diabetes on mortality and hospitalization among individuals aged ≥75 years with new dementia diagnoses. We analyzed administrative claims data in Japan from 73 324 individuals aged ≥75 years with dementia, of whom 17% had comorbid diabetes. Dementia and diabetes were identified from the International Classification of Diseases, Tenth Revision codes. We used Kaplan-Meier survival analysis, Cox proportional hazards analysis, and population attributable fractions (PAFs) to evaluate the impact on mortality and hospitalization after dementia diagnosis. One-year mortality and 1-year hospitalization probabilities in individuals with dementia and diabetes (10.3% and 31.7%, respectively) were higher than those without diabetes (8.3% and 25.4%, respectively). The adjusted hazard ratios for individuals with diabetes, as compared to those without, were 1.126 (95% confidence interval [CI], 1.040-1.220) for mortality and 1.191 (95% CI, 1.140-1.245) for hospitalization. The PAFs from the comorbidity of dementia and diabetes were 2.2% for mortality and 3.1% for hospitalization. Subgroup analysis showed that the PAFs were highest in men aged 75-79 years and women aged 80-84 years for mortality and in individuals aged 75-79 for hospitalization. During the early postdiagnosis period, comorbid diabetes increases mortality and hospitalization risks in older adults with dementia. The variation in disease burden across age groups underscores the need for age-specific health care strategies to manage comorbid diabetes in individuals with dementia. Geriatr Gerontol Int 2024; 24: 773-781.

Protocol for a home-based self-delivered prehabilitation intervention to proactively reduce fall risk in older adults: a pilot randomized controlled trial of transcranial direct current stimulation and motor imagery

BackgroundSeveral changes occur in the central nervous system with increasing age that contribute toward declines in mobility. Neurorehabilitation has proven effective in improving motor function though achieving sustained behavioral and neuroplastic adaptations is more challenging. While effective, rehabilitation usually follows adverse health outcomes, such as injurious falls. This reactive intervention approach may be less beneficial than prevention interventions. Therefore, we propose the development of a prehabilitation intervention approach to address mobility problems before they lead to adverse health outcomes. This protocol article describes a pilot study to examine the feasibility and acceptability of a home-based, self-delivered prehabilitation intervention that combines motor imagery (mentally rehearsing motor actions without physical movement) and neuromodulation (transcranial direct current stimulation, tDCS; to the frontal lobes). A secondary objective is to examine preliminary evidence of improved mobility following the intervention.MethodsThis pilot study has a double-blind randomized controlled design. Thirty-four participants aged 70–95 who self-report having experienced a fall within the prior 12 months or have a fear of falling will be recruited. Participants will be randomly assigned to either an active or sham tDCS group for the combined tDCS and motor imagery intervention. The intervention will include six 40-min sessions delivered every other day. Participants will simultaneously practice the motor imagery tasks while receiving tDCS. Those individuals assigned to the active group will receive 20 min of 2.0-mA direct current to frontal lobes, while those in the sham group will receive 30 s of stimulation to the frontal lobes. The motor imagery practice includes six instructional videos presenting different mobility tasks related to activities of daily living. Prior to and following the intervention, participants will undergo laboratory-based mobility and cognitive assessments, questionnaires, and free-living activity monitoring.DiscussionPrevious studies report that home-based, self-delivered tDCS is safe and feasible for various populations, including neurotypical older adults. Additionally, research indicates that motor imagery practice can augment motor learning and performance. By assessing the feasibility (specifically, screening rate (per month), recruitment rate (per month), randomization (screen eligible who enroll), retention rate, and compliance (percent of completed intervention sessions)) and acceptability of the home-based motor imagery and tDCS intervention, this study aims to provide preliminary data for planning larger studies.Trial registrationThis study is registered on ClinicalTrials.gov (NCT05583578). Registered October 13, 2022. https://www.clinicaltrials.gov/study/NCT05583578

Nutrient deficiency patterns and all-cause and cardiovascular mortality in older adults with hypertension: a latent class analysis

BackgroundPrevious researches examining the impact of dietary nutrition on mortality risk have mainly focused on individual nutrients, however the interaction of these nutrients has not been considered. The purpose of this study was to identify of nutrient deficiencies patterns and analyze their potential impact on mortality risk in older adults with hypertension.MethodsWe included participants from the National Health and Nutrition Examination Survey (NHANES) study. The latent class analysis (LCA) was applied to uncover specific malnutrition profiles within the sample. Risk of the end points across the phenogroups was compared using Kaplan–Meier analysis and Cox proportional hazard regression model. Multinomial logistic regression was used to determine the influencing factors of specific malnutrition profiles.ResultsA total of 6924 participants aged 60 years or older with hypertension from NHANES 2003–2014 was followed until December 31, 2019 with a median follow-up of 8.7 years. Various nutrients included vitamin A, vitamin B1, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, fiber, folate, calcium, magnesium, zinc, copper, iron, and selenium, and LCA revealed 4 classes of malnutrition. Regarding all-cause mortality, “Nutrient Deprived” group showed the strongest hazard ratio (1.42 from 1.19 to 1.70) compared with “Adequate Nutrient” group, followed by “Inadequate Nutrient” group (1.29 from 1.10 to 1.50), and “Low Fiber, Magnesium, and Vit E” group (1.17 from 1.02 to 1.35). For cardiovascular mortality, “Nutrient Deprived” group showed the strongest hazard ratio (1.61 from 1.19 to 2.16) compared with “Adequate Nutrient” group, followed by “Low Fiber, Magnesium, and Vit E” group (1.51 from 1.04 to 2.20), and “Inadequate Nutrient” group (1.37 from 1.03 to 1.83).ConclusionsThe study revealed a significant association between nutrients deficiency patterns and the risk of all-cause and cardiovascular mortality in older adults with hypertension. The findings suggested that nutrients deficiency pattern may be an important risk factor for mortality in older adults with hypertension.

Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey

Cognitive impairment and functional limitation are commonly observed in older adults. They have a complex correlation, and both are risk factors for mortality. This prospective cohort study aimed to explore the independent and joint impact of cognitive impairment and functional limitations on all-cause mortality in older adults. A total of 3,759 participants aged ≥ 60 years who had available information on mortality data, cognitive function, physical function, and covariates were enrolled. Cox proportional hazards regression models were employed to assess the independent and joint impacts of cognitive impairment and functional limitation on all-cause mortality. Smoothing curve fitting was used to show the nonlinear relationship between the Digit Symbol Coding (DSC) score and all-cause mortality. An interaction between cognitive impairment and functional limitation was identified when examining their associations with all-cause mortality. Cognitive impairment and functional limitation independently correlated with all-cause mortality risk even after adjusting for covariates and performing mutual adjustments (HR for cognitive impairment: 1.34, 95% CI 1.15–1.56; HR for functional limitation: 1.50, 95% CI 1.32–1.70). When the DSC score was > 18, as the score increased, the risk of death significantly decreased (HR 0.99, 95% CI 0.98–0.99). Participants with both cognitive impairment and functional limitation had the highest hazard ratio for all-cause mortality (HR 1.98, 95%CI 1.63–2.40). In summary, cognitive impairment and functional limitation independently correlated with increased all-cause mortality risk. A higher DSC score was a protective factor reducing the premature mortality risk. Older adults with cognitive impairment and functional limitation demonstrated the highest all-cause mortality risk.

Peripheral vascular dysfunction and the aging brain.

Aging is the greatest non-modifiable risk factor for most diseases, including cardiovascular diseases (CVD), which remain the leading cause of mortality worldwide. Robust evidence indicates that CVD are a strong determinant for reduced brain health and all-cause dementia with advancing age. CVD are also closely linked with peripheral and cerebral vascular dysfunction, common contributors to the development and progression of all types of dementia, that are largely driven by excessive levels of oxidative stress (e.g., reactive oxygen species [ROS]). Emerging evidence suggests that several fundamental aging mechanisms (e.g., "hallmarks" of aging), including chronic low-grade inflammation, mitochondrial dysfunction, cellular senescence and deregulated nutrient sensing contribute to excessive ROS production and are common to both peripheral and cerebral vascular dysfunction. Therefore, targeting these mechanisms to reduce ROS-related oxidative stress and improve peripheral and/or cerebral vascular function may be a promising strategy to reduce dementia risk with aging. Investigating how certain lifestyle strategies (e.g., aerobic exercise and diet modulation) and/or select pharmacological agents (natural and synthetic) intersect with aging "hallmarks" to promote peripheral and/or cerebral vascular health represent a viable option for reducing dementia risk with aging. Therefore, the primary purpose of this review is to explore mechanistic links among peripheral vascular dysfunction, cerebral vascular dysfunction, and reduced brain health with aging. Such insight and assessments of non-invasive measures of peripheral and cerebral vascular health with aging might provide a new approach for assessing dementia risk in older adults.

Association of Egg Intake With Alzheimer’s Dementia Risk in Older Adults: The Rush Memory and Aging Project

BackgroundAlzheimer’s disease (AD) is a neurodegenerative disorder with increasing prevalence due to population aging. Eggs provide many nutrients important for brain health, including choline, omega-3 fatty acids, and lutein. Emerging evidence suggests that frequent egg consumption may improve cognitive performance on verbal tests, but whether consumption influences the risk of Alzheimer’s dementia and AD is unknown. ObjectivesTo examine the association of egg consumption with Alzheimer’s dementia risk among the Rush Memory and Aging Project cohort. MethodsDietary assessment was collected using a modified Harvard semiquantitative food frequency questionnaire. Participants’ first food frequency questionnaire was used as the baseline measure of egg consumption. Multivariable adjusted Cox proportional hazards regression models were used to investigate the associations of baseline egg consumption amount with Alzheimer’s dementia risk, adjusting for potential confounding factors. Subgroup analyses using Cox and logistic regression models were performed to investigate the associations with AD pathology in the brain. Mediation analysis was conducted to examine the mediation effect of dietary choline in the relationship between egg intake and incident Alzheimer’s dementia. ResultsThis study included 1024 older adults {mean [±standard deviation (SD)] age = 81.38 ± 7.20 y}. Over a mean (±SD) follow-up of 6.7 ± 4.8 y, 280 participants (27.3%) were clinically diagnosed with Alzheimer’s dementia. Weekly consumption of >1 egg/wk (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34, 0.83) and ≥2 eggs/wk (HR: 0.53; 95% CI: 0.35, 0.81) was associated with a decreased risk of Alzheimer’s dementia. Subgroup analysis of brain autopsies from 578 deceased participants showed that intakes of >1 egg/wk (HR: 0.51; 95% CI: 0.35, 0.76) and ≥2 eggs/wk (HR: 0.62; 95% CI: 0.44, 0.90) were associated with a lower risk of AD pathology in the brain. Mediation analysis showed that 39% of the total effect of egg intake on incident Alzheimer’s dementia was mediated through dietary choline. ConclusionsThese findings suggest that frequent egg consumption is associated with a lower risk of Alzheimer’s dementia and AD pathology, and the association with Alzheimer’s dementia is partially mediated through dietary choline.

The Effect of Concurrent Use of Opioids and Gabapentin on Fall Risk in Older Adults

Falls pose a significant threat to older adults, resulting in injuries and mortality. Concurrently prescribed opioids and gabapentin for pain management may increase fall risks in older patients. This study aimed to estimate fall risks associated with the concurrent use of gabapentin and opioids, comparing them to opioid monotherapy in older adults. A retrospective case-control study of 1,813 patients aged 65–89 on chronic opioid therapy (2017–2020), excluding those with a fall history, analysis focused on the first fall occurrence. Logistic regression assessed the association between concurrent gabapentin and opioid use and fall events. Out of eligible patients, 122 (6.73%) experienced falls during opioid therapy, with 232 (12.80%) having concurrent gabapentin use. Concurrent use significantly increased fall risk (AOR = 1.73; 95% CI: 1.08-2.78). Being female, aged ≥81, and having more chronic conditions also increased risk. Mitigating fall risk in older adults requires education on prevention, exploring alternative pain management, and careful consideration of prescribing. Further research is crucial to understand adverse events linked to combined opioid and gabapentin use in the geriatric population.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test

BackgroundAs a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults. Research questionHow does sarcopenia increase fall risk by affecting static postural control? MethodsForty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk. ResultsSarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001–0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (β=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (β=10.0, P<0.001). SignificanceSarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

Association of cooking oil and incident of frailty in older adults: a cohort study

BackgroundStudies examining the potential association between cooking oil and frailty risk in older adults have produced conflicting outcomes. Therefore, our objective was to explore the relationship between cooking oil (vegetable and animal fat oils), changes in oil usage, and the risk of frailty in older adults.MethodsWe included 4,838 participants aged ≥ 65 years without frailty (frailty index < 0.25) from the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey. Follow-up occurred in the 2014 and 2018 waves. Cox proportional hazard models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to examine the association between cooking oil and frailty. Additionally, we evaluated the effect of switching cooking oil on frailty during the follow-up period.ResultsDuring a median follow-up of 3.0 (2.8–6.9) years, 1,348 individuals (27.9%) developed frailty. Compared to those using vegetable oil, users of animal fat oil had a lower risk of frailty (HR = 0.72, 95% CI: 0.61–0.85). Participants who switched from vegetable oil to animal fat oil, as well as those consistently using animal fat oil, had lower risks of frailty with HRs of 0.70 (0.52–0.95) and 0.63 (0.51–0.77) respectively, compared to those who consistently used vegetable oil. Conversely, individuals who switched from animal fat oil to vegetable oil experienced an increased risk of frailty (HR: 1.41, 95% CI: 1.01–1.97).ConclusionsThe utilization of animal fat oil in cooking exhibited a reduced frailty risk among older adults. Conversely, transitioning from animal fat oil to vegetable oil may elevate the risk. These findings propose that substituting vegetable oil with animal fat oil in the diet may safeguard against frailty.

Association between Height-Changing Scores and Risk of Sarcopenia Estimated from Anthropometric Measurements in Older Adults: A Cross-Sectional Study.

Anthropometric assessments are commonly used to diagnose sarcopenia in older adults. However, the ongoing exploration of novel approaches aims to improve the early detection of sarcopenia. This study investigated the association between the height-changing score (HCS) and the risk of sarcopenia defined by anthropometric measurements in 340 older adults (mean age: 66.2 years). The HCS derived from the difference in height and demi-span equivalent height (DEH) was used as an indicator of declining height in the older adults. Multivariate logistic regression analysis revealed a significant association between the HCS and the risk of sarcopenia in both male and female older adults (OR = 1.146, 95% CI [1.021, 1.286], p = 0.021). In addition, income, BMI, and nutritional status were significantly associated with the risk of sarcopenia (OR = -1.933, 95% CI [0.271, 0.986], p = 0.045; OR = -2.099, 95% CI [0.386, 0.587], p < 0.001; OR = -1.443, 95% CI [0.555, 0.866], p = 0.001, respectively). The white blood cell count, lymphocyte count, and HDL cholesterol were blood biomarkers significantly correlated with calf circumference. It can be suggested that the HCS acts as an indicator and screening tool for sarcopenia risk in older adults, highlighting the potential impact of decreased height on muscle mass loss. Encouraging nutritional support can help mitigate the risk of sarcopenia.

Physical Activity Fragmentation and Falls in Older Adults: Findings from the National Health and Aging Trends Study.

Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (i.e.: more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults. Participants (n=685, 54.3% female, 61.5% aged 70-79 years) from the National Health and Aging Trends Study (NHATS) with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls. Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR=0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR=1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning. PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life-course.

Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North.

Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach.

Foot Problems in Older Adults Presenting to a Falls and Balance Clinic

Introduction: Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with an increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aimed to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. Methods: Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems, and footwear were assessed in the clinic. Results: One-hundred and two patients were included; median age 79.3 (73–84.3) years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p < 0.001). Conclusion: The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

Association between the Dietary Inflammatory Index and fracture risk in older adults: a systematic review and meta-analysis.

We explored correlations between the Dietary Inflammatory Index (DII) and fracture risk in older adults. We systematically searched MEDLINE, PubMed, Science Direct, Scopus, and CNKI for all relevant epidemiological studies published through October 16, 2023. Because observational studies were included in the meta-analysis, we used a random-effects model to pool the study-specific effect sizes and 95% confidence intervals (CIs). We assessed study quality using the Newcastle-Ottawa scale. This meta-analysis was registered in PROSPERO. Eight studies with 462,986 participants were included, with five cohort studies, two cross-sectional studies, and one case-control study. An analysis of heterogeneity among the eight included studies resulted in I2 = 87.1%, indicating significant between-study heterogeneity; hence, the random-effects model was adopted to generate the combined effect size. We found that the DII was positively associated with fracture (relative risk: 1.188, 95% CI: 1.043-1.354). This result was further confirmed in leave-one-out sensitivity analysis. Our study provides evidence suggesting that diets high in pro-inflammatory components might increase the fracture risk among older people. Decreased consumption of pro-inflammatory foods and increased consumption of anti-inflammatory foods are suggested to prevent adverse fracture outcomes. More prospective studies involving both sexes are warranted to verify the results.