Geriatrics, Volume 8, Issue 6 (December 2023) – 19 articles

(1) Background: to examine the psychometric properties of the Portuguese version of the Timed Instrumental Activities of Daily Living (TIADL) in nursing home residents. (2) Methods: Fifty-two participants (85.8 ± 4.2 years) were assessed on two occasions, 10–14 days apart. The same rater administered all assessments. Internal consistency was analysed through Cronbach’s α. The reliability was estimated using the intraclass correlation coefficients (ICCs), and the standard error of the mean (SEM) was used to estimate the minimal detectable change (MDC). Construct validity was determined by Spearman’s correlation coefficients. (3) Results: For internal consistency, Cronbach’s α (0.81) revealed high internal reliability. All of the subtests demonstrated good or excellent reliability and also presented acceptable measurement precision, considering the criterion SEM < SD/2. According to Spearman’s rho, correlations with the Portuguese version of the TIADL, the Useful Field of View test, and semantic and phonemic fluency tests were significant, with moderate positive and negative correlations (0.4 < r_s < 0.69). (4) Conclusions: The Portuguese version of the TIADL had good to excellent test–retest reliability (ICC > 0.90) and acceptable measurement precision. This test could be a valuable clinical tool for assessing actual performance in instrumental activities of daily living in nursing home residents. Full article

Acceleration parameters in sit-to-stand (STS) movements are useful for measuring lower-limb function in older adults. The purpose of this study was to examine the relationship between acceleration in STS movements and physical function and the test-retest reliability of acceleration parameters in older adults. We performed cross-sectional analyses on 244 older adults including 107 men (mean age: 77.4 ± 4.7) and 137 women (mean age: 75.6 ± 5.3). Four acceleration parameters were measured in STS movements: maximum acceleration (MA), maximum velocity (MV), maximum power (MP), and stand-up time (ST). Good intraclass correlation coefficients (ICC > 0.70) were observed for all parameters. For the acceleration parameters, MA, MV, and MP were relatively strongly associated with the 5-time STS test (men: r = −0.36~−0.47; women: r = −0.37~−0.45) and the timed up and go test (men: r = −0.39~0.47, women: r = −0.43~−0.51): MP was also strongly associated with grip strength (men: r = 0.48, women: r = 0.43). All acceleration parameters were poorer in participants reporting mobility limitations than in those reporting no mobility limitations. These findings support the usefulness of sensor-based STS measurement. The system is expected to be useful in various settings where care prevention is addressed. Full article

Introduction: Drug–drug interactions (DDIs) represent an important clinical problem, particularly in older patients, due to polytherapy, comorbidity, and physiological changes in pharmacodynamic and pharmacokinetic pathways. In this study, we investigated the association between drugs prescribed after discharge from the hospital or clinic and the risk of DDIs with drugs used daily by each patient. Methods: We performed an observational, retrospective, multicenter study on the medical records of outpatients referred to general practitioners. DDIs were measured using the drug interaction probability scale. Potential drug interactions were evaluated by clinical pharmacologists (physicians) and neurologists. Collected data were analyzed using the Statistical Package for the Social Sciences. Results: During the study, we evaluated 1772 medical records. We recorded the development of DDIs in 10.3% of patients; 11.6% of these patients required hospitalization. Logistic regression showed an association among DDIs, sex, and the number of drugs used (p = 0.023). Conclusions: This observational real-life study shows that the risk of DDIs is common in older patients. Physicians must pay more attention after hospital discharge, evaluating the treatment to reduce the risk of DDIs. Full article

Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome. Full article

Background: The recommended chronic kidney disease (CKD) first-line diagnostic test is based on the creatinine-derived (estimated) glomerular filtration rate (eGFR). Cystatin C use may provide a better assessment. Methods: We compared creatinine- and cystatin C-derived eGFR determination as the first-line diagnostic test for 112 hospital patients aged > 60 years (median = 76 years). The patients were judged to not have CKD (no-CKD group) according to the first-line diagnostic recommendations (n = 61, eGFR (CKD Epidemiology Collaboration (CKD-EPI)) ≥ 60 mL/min/1.73 m², total urine protein < 150 mg/g creatinine, urinary red/white blood cells not increased) or classified to be at risk for kidney insufficiency due to aortic valve dysfunction (at-risk group; n = 51). The accuracy of the eGFR values was evaluated retrospectively with the final case diagnoses. Results: The eGFR (Caucasian, Asian, pediatric, and adult formula (CAPA)) was found to be linearly correlated to the eGFR (CKD-EPI) (R² = 0.5, slope = 0.69, p < 0.0001). In 93/112 (>80%) cases, the eGFR (CAPA) yielded lower values (on average ≈−20%). In 55/112 (49%) cases, the cystatin C-derived CKD stage was lower. CKD reclassification from no-CKD to a kidney-insufficient state (i.e., CKD1/2 to CKD3a/b or 4) or reclassification to a more severe kidney insufficiency (i.e., CKD3a → 3b/4 or 3b → 4) was found in 41/112 (37%) cases. A worse CKD classification (no-CKD → kidney-insufficient) based on the eGFR (CAPA) was plausible in 30% of cases in light of the final case diagnoses. Conclusion: In elderly patients (>60 years), renal function appears to be systematically overestimated by the creatinine-based eGFR (CKD-EPI), indicating that, for this group, the cystatin C-based eGFR (CAPA) should be used as the first-line diagnostic test. Full article

A growing life expectancy may result in a chronic medical condition and multimorbidity because the aging process leads to a decrease in cognitive and physiological function. These risks may affect the quality of life of geriatrics. The present study aims to determine the correlation between cognitive status (in terms of SIRT1, a nicotinamide adenine dinucleotide (NAD⁺)-dependent class III deacetylase) and metabolic function (in terms of the lipid profile, kidney function, and blood glucose) in geriatric patients. The differences in the parameters of metabolic function in the participants’ cognitive status were determined by using the Indonesian version of the Montreal Cognitive Assessments (MoCA-Ina). The elderly participants (n = 120) were recruited at three sites in Indonesia from March to October 2022. Our study demonstrated a negative correlation between the cognitive status of geriatric patients and their metabolic function, represented by the MoCA-Ina score with a linear regression equation of y = 0.27 − 2.4 ×10⁻³x. Higher levels of LDL-C, cystatin C, and HbA1c were found in the Severe-Moderate Cognitive Impairment group. Determining the SIRT1 levels may be beneficial in predicting both the cognitive and metabolic status of geriatrics because this protein is among numerous metabolic sensors in the hypothalamus. Full article

Age-related loss of lower extremity muscle strength is pronounced in individuals with chronic kidney disease (CKD). In contrast, an increase in intrarenal flow pulsatility results in initial age-related changes in renal hemodynamics, leading to the development of CKD. To date, it remains unclear whether lower extremity muscle strength determines elevated renal flow pulsatility. This study aimed to determine the association of lower extremity muscle strength and function with intrarenal hemodynamics in individuals with and without CKD. One hundred seventy-six individuals without CKD (aged 63 ± 9 years) and 101 individuals with CKD (aged 66 ± 8 years) were included in this study. Using Doppler ultrasound, the renal resistive index (RI) was measured as a parameter of renal hemodynamics. Knee extensor muscle strength (KES), gait speed (GS), and the 30 s chair stand test (30s-CST) were used to measure lower extremity muscle strength and function. Multivariate analyses showed that GS and 30s-CST scores were independent determinants of renal RI, whereas the KES score was not associated with renal RI in individuals with and without CKD. In the two-way analysis of covariance, renal RI was the highest in individuals with CKD who had lower KES, GS, and 30s-CST scores. Reduced lower extremity muscle strength and function are independent determinants of elevated renal flow pulsatility in individuals with and without CKD. Full article

(1) Background: Neglected hip dislocation is an uncommon condition, especially in developed countries because dislocations are considered trauma emergencies and thus are treated early. They are usually treated with methods used in commonly occurring dislocations. The aim of this study is to detail a two-stage strategy for neglected hip dislocations in adults applied in a complicated case. (2) Case presentation: We present a complicated case of neglected hip dislocation in a patient with an associated neurological condition. Two-stage open reduction was performed combined with arthrodiastasis and Ilizarov external fixators. After complications requiring a third intervention, the joint was stabilized, and the patient has presented no more episodes to date. (3) Conclusions: Arthrodiastasis has been used to treat these conditions. Comparing it with the other methods described in the literature, it seems to be a good therapeutic strategy, especially in elderly patients. Because of the limited number of studies, we cannot establish the most efficient therapeutic method, but we believe that the described strategy can be useful for patients with this condition. Full article

Background: Evidence suggests that lipoprotein subclass particles are critical markers of cardiovascular disease (CVD) risk. Older women have increased CVD risk related to age. The purpose of this study was to determine whether low and moderate doses of exercise influence lipoprotein subclasses. Methods: Women (60–75 years) were randomized into groups for 16 weeks of moderate-intensity exercise training at a low or moderate dose (33.6 and 58.8 kJ/kg body weight weekly, respectively). Lipoprotein subclasses were determined by nuclear magnetic resonance spectroscopy before and after the training. RESULTS: The average weekly exercise duration was 109 and 164 min, for low- and moderate-dose groups, respectively. In the low-dose group, high-density lipoprotein particle (HDL-P) concentration decreased (Δ = −1.9 ± 3.1 µmol/L, mean ± SD, p = 0.002) and mean HDL-P size increased (Δ = 0.1 ± 0.3 nm, p = 0.028). In the moderate-dose group, mean HDL-P size (Δ = 0.1 ± 0.2 nm; p = 0.024) and low-density lipoprotein particle size increased (Δ = 0.4 ± 3.9 nm; p = 0.007). Baseline body mass index, peak oxygen consumption and age were associated with changes in a few lipoprotein subclasses. Conclusions: In this sample of inactive older women, moderate-intensity exercise training at a dose equivalent to or even lower than the minimally recommended level by public health agencies induced changes in lipoprotein subclasses in line with reduced CVD risk. However, higher doses are encouraged for greater health benefits. Full article

Purpose: The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). Methods: A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. Results: A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale—international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. Conclusions: A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury. Full article

Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients. Full article

Social isolation is a growing concern worldwide, particularly within aging populations. This study elucidates the specific attitudes, strategies, and approaches of community social workers (CSWs) in Japan as they work toward alleviating social isolation and building inclusive communities. This qualitative study, conducted in Toyonaka City, Osaka Prefecture, Japan, used six Japanese comics as a unique data source, narrating real-life stories of social isolation and CSWs’ approaches. Thematic analysis was conducted to analyze the content of the comics, including systematic coding, theme generation, and refining, while ensuring rigor and reflexivity. The total number of pages in the comics was 505. The transcripts of the comics as Microsoft Word documents totaled 63 pages. Four themes characterizing CSWs’ strategies were revealed: (1) core values of professionalism and dedication; (2) personalized support oriented toward person-centered suffering; (3) community engagement, transitioning from exclusiveness to inclusiveness; and (4) connecting and reorganizing communities for inclusive societies. In Japan, CSWs employ multifaceted strategies to combat social isolation and foster inclusive communities. Their dedication, personalized support, community engagement, and capacity to reorganize their communities contribute to their pivotal role. This study provides a foundation for understanding CSWs’ work and paves the way for further investigation of their evolving role in creating inclusive societies. Full article

The prevalence of hand injuries increases with age, with elderly patients being more prone to hand lesions due to a combination of factors, such as reduced bone density and muscle strength, impaired sensation, and cognitive impairment. Despite the high incidence of hand injuries in the elderly population, few studies have addressed the management and outcomes of hand lesions in this age group. This study aimed to analyze the characteristics and management of hand lesions in patients over 80 years old. The authors conducted a retrospective analysis of medical records of patients over 80 years old who reached their Emergency Department with hand lesions between 2001 and 2020. Data on demographics, injury characteristics, and management were collected and analyzed. A total of 991 patients with hand lesions were included in the study, with a mean age of 84.9 years. The most common causes of injuries were domestic accidents (32.6%) and traffic accidents (12.8%). The most frequent types of hand lesions were fractures (23.5%) and superficial wounds (20.5%). Overall, 23.4% underwent surgical treatment for their hand issue, and 22.1% had associated injuries, among which, the most common were head trauma and other bone fractures. In conclusion, hand lesions in patients over 80 years old are frequent and pose significant challenges in diagnosis and management. Particular attention should be paid to associated injuries and limit indications to surgery when strictly necessary. Full article

(1) Background: Drug–drug interactions (DDIs) possess the potential to lead to a range of clinically significant consequences in the older population. (2) Aims: To investigate the prevalence and associated factors of DDIs among older patients within an outpatient setting of a university hospital. (3) Methods: This is a descriptive analysis of patients aged ≥65 years, who received a minimum of two medications. The electronic medical records were obtained from the outpatient clinic of a tertiary care hospital between November 2021 and November 2022. The outcomes were analyzed using descriptive and regression analysis. (4) Results: The study enrolled 10,877 patients, with a mean age of 74.3 ± 6.8 years. The prevalence of major DDI was 36.8%. Factors associated with major DDI were age (odds ratio [OR] 1.03), female sex (OR 1.23), polypharmacy (OR 2.27–13.78), metabolic disease (OR 1.89), psychiatric disorder (OR 1.79), cardiovascular disease (OR 1.51), musculoskeletal disease (OR 1.37), central nervous system disease (OR 1.24), and tuberculosis (OR 0.18). There was a significant difference observed in the primary healthcare facilities for emergency medicine (OR 1.72), orthopedics (OR 1.36), internal medicine (OR 1.29), and radiology (OR 0.45). (5) Conclusions: Major DDI was prevalent among older patients receiving care at outpatient settings. Several factors linked to major DDIs were identified. Developing appropriate strategies to improve the prescription process and avoid any missed interactions with geriatric patients is recommended. Full article

An 81-year-old woman undergoing B-cell depletion therapy developed COVID-19 and a hyperglycemic hyperosmotic state. She had a history of multiple vaccinations against coronaviruses but had persistent antigen positivity. Strategies to prevent the development of COVID-19 in immunosuppressed patients have not been established. Moreover, there is no standard treatment for prolonged antigen positivity. In this case, we were able to follow IgG antibodies during the course of treatment. The absence of N-IgG antibody titer elevation despite an effective immune response triggered by the vaccine is of great interest. The impaired humoral response observed in patients with lymphoma after anti-CD20 treatment implies the need for a justified different vaccination strategy for these patients. Furthermore, negative N-IgG titers in the immunosuppressed state may serve as an indicator of resistance to therapy. Full article

This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren–Lawrence classification (KL) and Pearson’s correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA. Full article

Introduction. The purpose of this study is to determine the usefulness of the CTMT (Comprehensive Trail Making Test) in diagnosing mild cognitive impairment in older patients. The test is used to assess executive functions, of which impairment is already observed in the early stages of the neurodegenerative process. Materials and Methods. The study includes 98 patients of a geriatric ward assigned to 2 groups of 49 patients each: patients diagnosed with a mild cognitive impairment and patients without a cognitive impairment, constituting the control group (group K). A set of screening tests was used in the initial study: the MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), and CDT (Clock Drawing Test), GDS (Geriatric Depression Scale). The second study included the performance of the CTMT; the performance indicator was the time of performance. Results. Statistically significant differences are obtained between patients with mild cognitive impairments and those in cognitive normality in the performance of the CTMT test (p < 0.01). Patients with MCIs took longer to complete all trails of the test. To identify cognitive impairment, cutoff points were proposed for the CTMT total score and the other test trails. The CTMT overall score and CTMT 5 scored the highest AUCs (CTMT overall score = 0.77, CTMT Trail 5 = 0.80). Conclusions. The Comprehensive Trail Making Test may be useful in diagnosing mild cognitive impairment as a complementary screening tool. Full article

Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62–90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a “test” after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS. Full article

The growing older population, the increasing prevalence of chronic illnesses, and the pressing need to enhance the quality of end-of-life care have underscored the importance for geriatricians to focus on supportive and palliative measures. Within this context, the emphasis on delivering comprehensive and person-centered care has become crucial, ensuring that individuals not only receive medical treatment but also experience comfort during chronic illness and in their final days. Nevertheless, a significant number of older individuals often find themselves in hospitals during their last moments, sometimes undergoing aggressive medical interventions even when facing terminal conditions. The challenge lies in the early recognition of the end-of-life phase, initiating timely supportive and palliative care in conjunction with conventional treatments, adopting a multidisciplinary approach, and providing crucial support to grieving family members. Despite being a relatively recent field, geriatric palliative care (GPC) still requires further development. With this perspective, I aimed to shed light on the challenges and best practices for enhancing care for individuals facing chronic critical illnesses and frailty. Full article