Estimating the prevalence of chronic kidney disease in the older population using health screening data in Japan.

BACKGROUND: In aging societies, the prevalence of chronic kidney disease (CKD) is expected to increase but may be underestimated because many asymptomatic patients remain undiagnosed. This study aimed to estimate the CKD prevalence among the general older population in Japan. METHODS: This cross-sectional study used health screening data from the Japan Health Insurance Association collected between April 2014 and March 2023. Data from older people aged 65-90 years who underwent renal function screening for estimated glomerular filtration rate (eGFR) and urine protein tests were analyzed. CKD was defined as eGFR < 60 mL/min/1.73 m2 or proteinuria ≥ 1 + . Inverse probability weighting was used to account for the selection bias. The variables used for weighting were age, sex, insurance status, and the number of previous screenings. RESULTS: Among 2.98 million older individuals, 588,809 (19.7%) had undergone screening (median [IQR] age, 69.9 [67.9-76.2] years, 337,862 women [57.4%]). Regarding the weighted CKD prevalence, 25.3% of the individuals aged 65-90 years had CKD; 11.8% of those aged 65-75 years and 34.6% of those aged 75 years and over showed an increase in prevalence with age. Among the patients with CKD, over half exhibited mild renal dysfunction without proteinuria. Hypertension and diabetes were common comorbidities in older patients with CKD. CONCLUSIONS: This cross-sectional study revealed that the weighted prevalence of CKD in the older population aged 65-90 years was high (one in four individuals), indicating that it increases with age. Further studies are required to examine the clinical significance of these findings.

Clinical outcomes of patients from older community hospitalized for heart failure in guideline-directed medical therapy era: Insights from the COMPASS-HF registry.

BACKGROUND: Despite strong recommendations in the latest guidelines for implementing guideline-directed medical therapy (GDMT) before discharge, there is a lack of data on the clinical characteristics and outcomes of older patients with heart failure (HF). Therefore, this study aimed to investigate the clinical characteristics and outcomes of patients with HF in a super-aging society during the GDMT era. METHODS AND RESULTS: In the COMPASS-HF study including 305 consecutive hospitalized patients, 177 with acute HF were identified through a medical record review. The mean age of the enrolled patients was 86.2 years, and 46.3 % were men. The mean simple GDMT score, which is recognized as a useful prognostic tool for Japanese patients with HF, was 5.0. The incidences of all-cause death and HF hospitalization were 46.5 % and 19.4 %, respectively. The incidences of all-cause death and cardiovascular death were significantly lower in the high simple GDMT score group (≥5 points) than in the low simple GDMT score group (≤4 points) (p = 0.049 and p = 0.044, respectively). However, no significant differences were noted in HF hospitalization and composite events (cardiovascular death and HF hospitalization) between the groups (p = 0.564 and p = 0.086, respectively). CONCLUSIONS: While GDMT was well-implemented in the older community, the mortality rate among hospitalized patients with HF remained high. Although GDMT appears to have reduced the HF hospitalization rate, further validation and development of an optimal predictive model for elderly patients with HF are essential. X (FORMERLY TWITTER): In the older community, although the short- and long-term mortality of hospitalized patients with HF is still high even in the GDMT era, the HF hospitalization rate is suppressed, probably due to GDMT. A simple GDMT score may also be useful for stratifying the prognosis of older patients with HF. #HeartFailure#Mortality#GDMT#Fantastic4.

The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review.

BACKGROUND: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. OBJECTIVE: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. METHODS: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. RESULTS: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. CONCLUSIONS: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59900.

Plant-based index linked to fall risk in older Chinese adults: cross-sectional evidence from a national cohort.

OBJECTIVES: Epidemiology showed that the falling incidences increased with advanced age, and recent findings found link between nutritional intake and risk of falls. Nevertheless, the relationship between different plant-based diets and the risk of falls in older adults remains unclear. Our investigation aimed to evaluate the correlation between various plant-based diet indices and the occurrence of falls. DESIGN: This study is a cross-sectional and post-hoc analysis from a national cohort study. SETTING AND PARTICIPANTS: We included individuals over 65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) recruited in 2018 with information on falls and dietary assessments, finally 11,044 participants were eligible. MEASUREMENTS: Using food frequency questionnaire (FFQ), we calculated plant-based index scores categorized as unhealthy plant-based index (uPDI) and healthy plant-based index (hPDI). The primary outcome was falls obtained from questionnaire. Statistical analysis was performed utilizing logistic regression model to investigate the relationship between the plant-based diet indices and falls. We also used the subgroup analysis to investigate the interaction of falls and plant-based diet index (PDI) among different status and used the restricted cubic spline (RCS) curves to investigate the connection between the PDI scores and falls risk. RESULTS: Among 11,044 participants included in our study, a total of 2493 fall cases were observed. The logistic regression analysis revealed that the plant-based index related to falls. In the adjusted model, per 10-unit increment of hPDI has a significant decreased risk of falls (odd ratio [OR]: 0.85, 95% confidence interval [CI]: 0.79-0.91, P for trend < 0.001) and per 10-unit increment in uPDI increased the risk of falls (OR: 1.21, 95% CI: 1.13-1.30, P for trend < 0.001). We also revealed an interaction between smoking status and falls among the uPDI group (Pinteraction = 0.012). Finally, we found that with plant-based index scores increased, the odds of falls among hPDI decreased (P for overall < 0.001, P nonlinear = 0.0239), and the odds of falls among uPDI increased (P for overall < 0.001, P nonlinear = 0.0332). CONCLUSION AND IMPLICATIONS: We found significant association between the Plant-based diet index and the risk of falls, highlighting the key role of the consumption of nutritious plant-based foods on the risk of falls, which needed take into account in developing intervention and prevention strategies to decrease falls among older Chinese adults.

Association between abdominal obesity indices and falls among older community-dwellers in Guangzhou, China: a prospective cohort study.

BACKGROUND: Central obesity was considered as a risk factor for falls among the older population. Waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI), and the Chinese visceral adiposity index (CVAI) are considered as surrogate markers for abdominal fat deposition in increasing studies. Nevertheless, the longitudinal relationship between these indices and falls among the older population remains indistinct. This study aimed to explore the association between abdominal obesity indices and falls among older community-dwellers. METHODS: Our study included 3501 individuals aged ≥ 65 years from the Guangzhou Falls and Health Status Tracking Cohort at baseline in 2021 and then prospectively followed up in 2022. The outcome of interest was the occurrence of falls. The Kaplan-Meier curves and multivariable Cox regression analysis were used to explore the associations between abdominal obesity indices and falls. Moreover, the restricted cubic spline analysis (RCS) was conducted to test the non-linear relationships between abdominal obesity indices and hazards of falls incident. RESULTS: After a median follow-up period of 551 days, a total of 1022 participants experienced falls. The cumulative incidence rate of falls was observed to be higher among individuals with central obesity and those falling within the fourth quartile (Q4) of LAP, VAI, and CVAI. Participants with central obesity and those in Q4 of LAP, VAI, and CVAI were associated with higher risk of falls, with hazard ratios (HRs) of 1.422 (HR 95%CI: 1.255-1.611), 1.346 (1.176-1.541), 1.270 (1.108-1.457), 1.322 (1.154-1.514), respectively. Each 1-SD increment in WC, LAP, VAI, and CVAI was a significant increased risk of falls among participants. Subgroup analysis further revealed these results were basically stable and appeared to be significantly stronger among those females, aged 65-69 years, and with body mass index (BMI) ≥ 28 kg/m2. Additionally, RCS curves showed an overall upward trend in the risk of falls as the abdominal indices increased. CONCLUSIONS: Abdominal obesity indices, as WC, LAP, VAI, and CVAI were significantly associated with falls among older community-dwellers. Reduction of abdominal obesity indices might be suggested as the strategy of falls prevention.

Warfarin Adherence and Its Associated Factors in Thai Older Adults with Atrial Fibrillation.

Introduction: Older people mostly found unable to adhere with warfarin treatment guidelines. The health service system is challenged in order to improve medication adherence in older population under limited health resources. The purpose of this study was to explore health systems factors on warfarin adherence in older population, particularly in resources constraint setting. Methods: This study was a cross-sectional predictive study that enrolled older people who experienced atrial fibrillation (AF) and treated by warfarin, aged 60 years and over, and followed up at the warfarin clinic. Results: A total of 197 participants with the mean age of 72.03 years (SD = 8.84) was recruited. Almost of them (85.8%) reported adhered to warfarin prescription. More than a half (60.5%) were able to report their targeted INR. Participants who stayed with the family had 5.54 times (95% CI 1.79-19.33), took regular daily dose warfarin had 5.07 times (95% CI 1.05-24.49), perceived targeted INR had 2.94 times (95% CI 1.04-8.29), and received family support had 1.33 times (95% CI 1.11-1.60) increased odds of warfarin adherence than those who did not. Participants who perceived a barrier to taking medication had 0.93 times decreased odds of warfarin adherence than those who did not (95% CI 0.86-0.99). Conclusion: Healthcare system should encourage family to support the older population with AF in order to increase warfarin adherence. Future research should develop intervention combining family support to promote warfarin adherence.

Markerless three-dimensional gait analysis in healthy older adults: test-retest reliability and measurement error.

In older adults, gait analysis may detect changes that signal early disease states, yet challenges in biomechanical screening limit widespread use in clinical or community settings. Recently, a markerless method from multi-camera video data has become accessible, making screenings less challenging. This study evaluated the test-retest reliability and measurement error of markerless gait kinematics and kinetics in healthy older adults. Twenty-nine healthy older adults performed gait analysis on two occasions, at preferred walking speed, using their everyday clothes. Lower limb angles and moments were averaged from 8 gait cycles. Integrated pointwise indices [Intraclass Correlation Coefficient (ICCA,K) and Standard Error of Measurement (SEM)] were calculated for curve data, as well as ICCA,K, and SEM [95 % confidence intervals] for selected peaks. Generally, kinematic ICCs were good (>0.75) and reasonably stable throughout the gait cycle, except for the hip kinematics during the swing phase in the sagittal plane and pelvis tilt and rotation. The integrated and peaks SEM were <2.4°. The reliability of kinetics was similar (ICC>0.75), except for the transverse hip moment and abduction peak, fluctuating more during the swing than through the stance phase. SEM were < 0.07Nm/Kg. In conclusion, these results showed good overall test-retest reliability for markerless gait kinematics and kinetics for the hip, knee, and ankle joints, moderate for the pelvis angles, and error levels of ≤5°, and SEM%≤5% for the sagittal plane. This supports this method's use in assessing gait in healthy older adults, including kinetics, for which reliability data from markerless systems is difficult to find reported.

Body Mass Index as a Determinant of Lower Limb Function and Community Well-Being in Older Adults: Analysis of 2020 National Older Korean Survey Data.

This epidemiological research investigated the relationship between body mass index (BMI) and lower limb function and community well-being among the older population (≥65 years old) in South Korea. Using the 2020 National Survey of Older Koreans (N = 10 097; Mage = 73.6 ± 6.63; MBMI = 23.6 ± 2.61), the study identified underweight (2.3%), normal (72.8%), and obese (24.9%) groups. Findings revealed significant associations between BMI and lower limb function, with underweight individuals facing greater physical challenges (P < .05-.01). Underweight participants were also found to live farther from key community locations, possibly reflecting social and environmental factors (P < .01) and expressed higher dissatisfaction with community environments (Ps < .05-.01). The study emphasizes the need for tailored community planning and health care strategies, focusing on the unique needs of the underweight older adults, considering South Korea's rapidly increasing older population.

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities.

OBJECTIVE: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. METHODS: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. RESULTS: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. CONCLUSION: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

Neglect of older adults living with dementia in family caregiving: A dimensional concept analysis.

OBJECTIVE: To present a concept analysis of neglect, specifically examining its occurrence and implications in the context of family caregiving for older adults living with dementia. METHODS: A literature search was conducted in Medline, CINAHL, Scopus, and Embase databases in February 2023. Inclusion criteria targeted articles focusing on neglect in dementia family caregiving, leading to the identification of 11 articles for thorough review. Employing Caron and Bowers' dimensional analysis approach, the concept analysis aimed to elucidate neglect as a social construct shaped by diverse contexts, perspectives, and underlying assumptions. RESULTS: Neglect in this context emerged as a multidimensional phenomenon, influenced by contextual elements such as activities of daily living and behavioral symptoms of dementia. It encompasses dimensions including "expectations of unmet needs", "maladaptive behaviors", and "feelings of guilt", considering the perspectives of both caregivers and individuals living with dementia. Recognizing neglect as a dyadic phenomenon emphasizes the significance of interactions between caregivers and individuals living with dementia. CONCLUSION: A comprehensive understanding of neglect in dementia family caregiving is crucial for effective interventions and support systems. The dyadic perspective is vital for accurate assessment. Primary care physicians, mental health, nurses, and other health professionals play a key role in prevention and supporting family caregivers. Further research is needed to explore the dynamics of dementia caregiving settings strengthening prevention strategies against elder neglect.

Informal Employment and High Burden of Out-of-Pocket Healthcare Payments among Older Workers: Evidence from Longitudinal Ageing Study in India.

India's economy is among the fastest growing in the world. However, a large share of informal workforce is a common characteristic of country's economy, comprises a significant portion of most of its labour markets. This workforce often receives low wages and lacks benefits such as strong social security and health coverage for all. The majority of healthcare spending in India is private. As India's population ages and the informal sector expands, it is expected that many of these workers will continue to work beyond the retirement age to bear their own healthcare costs due to lack of savings, pensions and the precarious nature of their employment. In this context, this study estimates the burden of Out-of-Pocket (OOP) payments on India's informal older workers compared to their formal counterparts, using data from the first wave of the nationally representative Longitudinal Ageing Study in India. According to estimates from the Two-part regression model, informal older workers pay, on an average, INR 1113 (p<0.01) and INR 55 (p<0.05) less than their formal counterparts for inpatient and outpatient care, respectively. However, probit regression models revealed that the burden of combined (both inpatient and outpatient) OOP payments exceeding (by 40%, 20%, and 10%) of their income is significantly higher among informal older workers compared to formal older workers. The study underscores the need for strengthening of universal health insurance schemes to ensure everyone has access to medical services without experiencing financial hardship. It also advocates for policies specifically tailored towards informal workers, considering their unique challenges with regard to livelihoods and healthcare security. In particular, this encompasses bolstering the existing social security and healthcare system, and related policies for ensuring financial security against OOP payments, especially for informal workers and all the population in general.

Association of Age, Frailty, and Strategy for Initiation of Renal-Replacement Therapy: A Post Hoc analysis of the STARRT-Acute Kidney Injury Trial.

INTRODUCTION: This study was designed to assess the association of age and frailty with clinical outcomes in patients with severe acute kidney injury (AKI), according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial. METHODS: This was a secondary analysis of an international randomized trial. Older age was defined as ≥65 years. Frailty was assessed using the clinical frailty scale (CFS) score and defined as a score ≥5. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the impact of age and frailty on clinical outcomes. RESULTS: Of 2,927 patients randomized in the STARRT-AKI trial, 1,616 (55.2%) were aged ≥65 years (median [interquartile range] 73.9 [69.4-78.9]). Older patients had greater comorbid cardiovascular and chronic kidney disease, were more likely to be surgical admissions and to receive vasopressors at baseline. Older patients had higher 90-day mortality (50.4% vs. 35.6%, adjusted-odds ratio (OR), 1.81 [1.53-2.13], p < 0.001). There was no significant difference in RRT dependence at 90 days between older and younger patients (8.7% vs. 7.8%, adjusted-OR, 1.21 [0.82-1.79], p = 0.325). Patients with frailty had higher mortality; but no difference in RRT dependence at 90 days. There was no significant interaction between age and CFS score in relation to mortality, RRT dependence at 90 days, and other secondary outcomes. There was no significant difference in the proportion of patients who received RRT in the standard-strategy stratified by age groups (adjusted-OR, 0.85 [0.67-1.08], p = 0.180). CONCLUSION: In this secondary analysis of the STARRT-AKI trial, older and frail patients had higher mortality at 90 days; however, there was no difference in RRT dependence. Mortality and RRT dependence were not modified by RRT initiation strategy in older or frail patients.

Association between Number of Teeth and Eating out of Home: A 2019 Statistical Survey of the Japanese Representative Population.

Eating out of home (EOH), with its diverse food options, can benefit those with difficulty preparing their meals, especially older adults. Oral health status may be a determinant of EOH, as food accessibility is influenced by oral health, but this association remains unclear. This cross-sectional study used merged data from two national statistical surveys conducted in 2019. Participants were individuals aged ≥ 65 years who responded to both surveys. The frequency of EOH (

[Promoting active mobility in old age through urban design]. / Förderung aktiver Mobilität im Alter durch Stadtgestaltung.

In an ageing society, maintaining independent mobility into old age is an important objective. Mental and physical wellbeing depends not only on individual health status, but also to a large extent on the spatial conditions. Local politics and municipal administrations can influence this, especially in urban planning. This discussion article brings together perspectives from public health and urban planning on urban development and mobility against the background of health equity.The results of the AFOOT (Securing urban mobility of an ageing population) cross-sectional study on socio-spatial conditions in small- and medium-sized towns in northwestern Germany and walking and cycling by older people show the importance of residential environmental factors such as proximity to everyday destinations, walking and cycling infrastructure, and street connectivity. Preferences for the design of an age-friendly living environment and the quality of public spaces exist in terms of urban design quality, quality of stay, and safety in public spaces.In order to improve spatial conditions, the situation needs to be recorded using defined indicators and monitoring, and the perspectives of older people need to be integrated. Strategies and measures to promote active mobility in old age are aimed at the multifunctional design of public spaces, the prioritization of active mobility on everyday trips, and ensuring the accessibility of everyday destinations through urban development. Cross-sectoral cooperation between urban planning, transport planning, and public health is essential to promote the active mobility and health of older people.

Patterns, outcomes, and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6-year-long observational study in North India.

Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015-2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1-4 drugs. "Avoiding the causative drug," "optimal monitoring of the patient," and "start-low and go-slow" policy together could prevent 85% of DDIs. In conclusion, every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults.

Reliability and Validity of Revised Apathy Evaluation Scale-Self in Community-Dwelling Older Adults.

OBJECTIVES: The questionnaire Apathy Evaluation Scale-Self (AES-S) has been widely adopted globally, demonstrating high reliability and validity. However, direct translation of the AES into Chinese does not fit well into the Chinese cultural setting, so a structured and comprehensive revision is needed to obtain a high reliability and validity version of the scale. METHODS: In this study, 436 adults aged ≥ 60 years from two communities in Beijing were assessed using a modified AES-S. The methodology included item analysis, exploratory factor analysis, and confirmatory factor analysis. The scale's validity was tested using the Temporal Experience of Pleasure Scale (TEPS) and Mini-Mental State Examination (MMSE). Reliability assessment included retest reliability, internal consistency reliability, and split-half reliability. RESULTS: The modified Apathy Evaluation Scale-Self-Assessment (AES-S-C) presented a first-order four-factor structure with higher reliability and validity than the original version within the Chinese older adult community. CONCLUSIONS: The revised AES-S-C is more suitable for the Chinese older adults in community settings. CLINICAL IMPLICATIONS: This self-rated scale is suitable for screening apathy among older adults in community or nursing facilities, aiding in the identification of cognitive impairment and promoting mental health.

Development of a tool measuring various aspects of social detachment: The social detachment questionnaire for older population.

BACKGROUND: Social detachment includes the subjective aspect "loneliness" and the objective aspect "social isolation," but tools to assess both dimensions are limited. This study aims to develop a questionnaire, the Social Detachment Questionnaire for Older Population (SDQO), that considers multiple dimensions of social detachment simultaneously. METHODS: The study collected 600 valid samples from individuals aged 55 and above to examine the psychometric properties of the developed SDQO. Item analysis was conducted to assess the performance of each item, and exploratory factor analysis (EFA) was employed to analyze its initial structure and eliminate less ideal items. Subsequently, confirmatory factor analysis (CFA) was used to examine the model fit of the suggested structure by EFA, using different subsamples. Internal consistency, concurrent validity, and other analyses were also performed. RESULTS: The original 27-item SDQO was reduced to 17 items after removing 4 questions in item analysis and 6 questions in EFA. The Cronbach's alpha for the 17-item version of SDQO was 0.80. Both EFA and CFA supported its 6-factor structure, with factors identified as community activities, loneliness, personal resources, leisure activities, friendship, and family resources. SDQO also demonstrated expected performance in concurrent validity. CONCLUSION: The 17-item version of SDQO exhibited good reliability and validity, measuring various aspects of social detachment behavior, feelings, and resources. It holds value for future research applications.

Bacteremia caused by Desulfovibrio desulfuricans with the intestinal tract as the portal of entry: two case reports and a literature review.

BACKGROUND: Desulfovibrio desulfuricans (D. desulfuricans), a commensal anaerobic gram-negative rod endemic to the soil environment and human gastrointestinal tract, rarely causes bloodstream infections. We report two rare cases of bacteremia caused by D. desulfuricans in which the intestinal tract was the portal of entry. In addition, we summarize findings on D. desulfuricans. CASE PRESENTATION: Case 1: A 51-year-old man presented to the emergency department with the chief complaints of fever and right lower abdominal pain. He was admitted to the hospital with ascending colonic diverticulitis and received empirical antibacterial therapy with piperacillin/tazobactam. Blood culture revealed D. desulfuricans. The patient was discharged after 2 weeks of antimicrobial therapy. Case 2: A 95-year-old woman presented to our hospital with a chief complaint of fever. Owing to an elevated inflammatory response and pyuria, the patient was diagnosed with pyelonephritis and treated with ceftriaxone. Klebsiella pneumoniae was detected in her urine culture, while D. desulfuricans was detected in her blood culture. The patient was then treated with ampicillin/sulbactam for 14 days. The fecal occult blood test result was positive, suggesting a colonic mucosal lesion, such as a malignant tumor, may have been the portal of entry for D. desulfuricans bacteremia. Previous literature reviews indicate that D. desulfuricans bacteremia often results from liver or renal abscesses, intestinal lesions, among others, serving as the portal of entry. Although no specific underlying disease has been reported, it is more common in the older population. We encountered two cases of D. desulfuricans bacteremia and combined them with 15 cases from previous studies to explore the characteristics of the disease. The proportion of patients aged [Formula: see text]60 years was 73.7%; overall, 73.7% had gastrointestinal complications, and 63.2% had abdominal symptoms at the time of presentation. CONCLUSIONS: We encountered two rare cases of D. desulfurican bacteremia. This type of bacteremia is more common in elderly people over 60 years of age and is often associated with hepatobiliary and gastrointestinal diseases.

The yield of genetic workup for middle-aged and elderly patients with neurological disorders in a real-world setting.

Genetic workup is becoming increasingly common in the clinical assessment of neurological disorders. We evaluated its yield among middle-aged and elderly neurological patients, in a real-world context. This retrospective study included 368 consecutive Israeli patients aged 50 years and older (202 [54.9%] males), who were referred to a single neurogenetics clinic between 2017 and mid-2023. All had neurological disorders, without a previous molecular diagnosis. Demographic, clinical and genetic data were collected from medical records. The mean age at first genetic counseling at the clinic was 62.3 ± 7.8 years (range 50-85 years), and the main indications for referral were neuromuscular, movement and cerebrovascular disorders, as well as cognitive impairment and dementia. Out of the 368 patients, 245 (66.6%) underwent genetic testing that included exome sequencing (ES), analysis of nucleotide repeat expansions, detection of specific mutations, targeted gene panel sequencing or chromosomal microarray analysis. Overall, 80 patients (21.7%) received a molecular diagnosis due to 36 conditions, accounting for 32.7% of the patients who performed genetic testing. The diagnostic rates were highest for neuromuscular (58/186 patients [31.2%] in this group, 39.2% of 148 tested individuals) and movement disorders (14/79 [17.7%] patients, 29.2% of 48 tested), but lower for other disorders. Testing of nucleotide repeat expansions and ES provided a diagnosis to 28/73 (38.4%) and 19/132 (14.4%) individuals, respectively. Based on our findings, genetic workup and testing are useful in the diagnostic process of neurological patients aged ≥50 years, in particular for those with neuromuscular and movement disorders.

Takotsubo Syndrome in Older Men　- Clinical Characteristics Differ by Sex and Age.

Background: Takotsubo syndrome (TTS) in male patients is under-studied, particularly in the older population. Methods and Results: From 226 patients with TTS, 44 older male patients (prevalence rate: 19.5%, age: median 77 years) were compared with 182 older female patients (prevalence rate: 80.5%, age: median 80 years). Emotional triggers of TTS were less frequent (2% vs. 19%; P=0.007), whereas physical triggers were more frequent (75% vs. 58%; P=0.040) in older men than in women. Among physical triggers, serious respiratory infection was more common in older men than in women. As initial clues to the diagnosis, ECG T-wave inversion was more frequent (48% vs. 29%; P=0.018) and chest pain and/or dyspnea were less common (23% vs. 38%; P=0.050) in older men than in women. In total, 14 patients (6%) had cardiogenic shock and 41 (18%) had severe heart failure as complications, although there were no significant differences in the frequency of these complications between older men and women. Although cardiac death occurred in 3 female patients (1%) and noncardiac death in 3 male and 5 female patients (4%), there were no significant differences in death rate between older men and women. Conclusions: Emotional triggers of TTS were extremely infrequent whereas physical triggers were common in older men. Although severe heart failure was common, there were no significant differences in the frequency of complications and in-hospital deaths between older men and women.