A combined circulating microRNA panel predicts the risk of vascular calcification in community-dwelling older adults with age strata differences.

BACKGROUND: Older adults have a higher risk of developing vascular calcification (VC). Circulating miRNAs can be potential risk indicators. However, prior studies used single miRNA mostly, whereas miRNA panels were rarely evaluated. We aimed to examine whether a miRNA panel outperformed each miRNA alone, and analyzed whether advanced age affected VC risk predictive performance offered by the miRNA panel. METHODS: We prospectively enrolled older adults (age ≥65 years) during their annual health checkup in 2017, and examined their VC severity followed by analyzing sera for VC regulatory miRNAs (miR-125b-5p, miR-125b-3p, and miR-378a-3p). We used multiple regression analyses to determine associations between each miRNA or a 3-combind panel and VC risk, followed by area under the receiver-operating-characteristics curve (AUROC) analysis. Participants were further divided to those of 65-75 and ≥75 years for comparison. RESULTS: From 199 older adults screened, 169 (median age, 73.3 years) with available calcification assessment were analyzed, among whom 74.6 % having VC. Those with VC had significantly lower circulating miR-125b-5p, miR-125b-3p, and miR-378a-3p levels than those without. Regression analyses showed that the 3-combined miRNA panel exhibited significant associations with VC risk, with significantly higher AUROC than those of models based on individual miRNA. Importantly, in those ≥75 years, the miRNA-predicted risk of VC was more prominent than that in the 65-75 years group. CONCLUSION: A miRNA panel for VC risk prediction might outperform individual miRNA alone in older adults, and advanced age modified the association between circulating miRNAs and the risk of VC.

Resilience, activities of daily living, and well-being in patients with chronic kidney disease.

AIM: The aim was to investigate the associations of activities of daily living, resilience and the well-being among patients with chronic kidney disease (CKD) and provide a long-term follow-up study. DESIGN: A longitudinal design was used. METHODS: The instruments included the Instrumental Activities of Daily Living (IADLs) Scale to assess the activities of daily living as well as the Resilience Scale and Well-Being Scale. A regression analysis was used to predict the factors related to well-being. A repeated-measures ANOVA was used for long-term follow-up with regard to IADLs, resilience and well-being. RESULTS: A total of 105 eligible participants were enrolled, of whom 59% were men and 41% were women. Interactions at three time points among IADLs, resilience, and well-being were reported. IADLs were significantly and positively associated with resilience and well-being. Resilience was a significant predictor of well-being. The well-being score increased by 0.24 points for every 1-point increase in the resilience score. CONCLUSION: IADLs, resilience, and well-being are correlated in patients with CKD, and resilience is a predictor of well-being. Higher resilience is associated with higher well-being. Therefore, clinical care providers need to access the resilience level of CKD patients as early as possible and design appropriate interventions to improve mental health and quality of life.

The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study.

Patients with diabetes mellitus (DM) have a higher risk of incident and aggravating frailty over time. Frailty-initiating risk factors have been identified, but modulators of frail severity over time remain poorly defined. We aimed to explore the influences of glucose-lowering drug (GLD) strategy on DM patients' risk of increasing frail severity. We retrospectively identified type 2 DM patients between 2008 and 2016, dividing them into "no GLD", oral GLD (oGLD) monotherapy, oGLD combination, and those receiving insulin without or with oGLD at baseline. Increasing frail severity, defined as ≥1 FRAIL component increase, was the outcome of interest. Cox proportional hazard regression was utilized to analyze the risk of increasing frail severity associated with GLD strategy, accounting for demographic, physical data, comorbidities, medication, and laboratory panel. After screening 82,208 patients with DM, 49,519 (no GLD, 42.7%; monotherapy, 24.0%; combination, 28.5%; and insulin user, 4.8%) were enrolled for analysis. After 4 years, 12,295 (24.8%) had increasing frail severity. After multivariate adjustment, oGLD combination group exhibited a significantly lower risk of increasing frail severity (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.86 - 0.94), while the risk of insulin users increased (HR 1.11, 95% CI 1.02 - 1.21) than no GLD group. Users receiving more oGLD exhibited a trend of less risk reduction relative to others. In conclusion, we discovered that the strategy of oral glucose lowering drugs combination might reduce the risk of frail severity increase. Accordingly, medication reconciliation in frail diabetic older adults should take into account their GLD regimens.

Effects of video-recorded role-play and guided reflection on nursing student empathy, caring behavior and competence: A two-group pretest-posttest study.

AIM: The study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies. BACKGROUND: Educating nursing students in empathy and caring behaviors before entering clinical practice is challenging. DESIGN: We used a two-group pretest and post-test quasi-experimental design. METHODS: First-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale. RESULT: A total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η2 effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (ß = 0.81, 95% CI:0.66-0.97). CONCLUSIONS: Education based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.

The effectiveness of mind-body approaches for enhancing resilience in older adults: A systematic review and network meta-analysis.

BACKGROUND: Resilience in older adults is associated with good well-being and resilience training has been shown to be beneficial. Mind-body approaches (MBAs) combine physical and psychological training in age-appropriate exercise programs.This study aims to evaluate the comparative effectiveness of different modes of MBAs in enhancing resilience in older adults. METHOD: Electronic databases and a manual search were searched to identify randomized controlled trials of different MBA modes. Data from the included studies were extracted for fixed-effect pairwise meta-analyses. Quality and risk were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Cochrane's Risk of Bias tool, respectively. Pooled effect sizes with a standardized mean difference (SMD) and a 95% confidence interval (CI) were used to quantify the impact of MBAs in enhancing resilience in older adults. Network meta-analysis was employed to evaluate the comparative effectiveness of different interventions. The study was registered in PROSPERO (Registration No. CRD42022352269). RESULTS: Nine studies were included in our analysis. Pairwise comparisons indicated that MBAs, regardless of whether they were related to yoga, could significantly enhancing resilience in older adults (SMD: 0.26, 95% CI 0.09-0.44). With strong consistency, a network meta-analysis showed that physical and psychological programs and yoga-related programs were associated with resilience improvement (SMD: 0.44, 95% CI 0.01-0.88 and SMD: 0.42, 95% CI 0.06-0.79, respectively). CONCLUSION: High quality evidence demonstrates that two MBA modes-physical and psychological programs and yoga-related programs-enhance resilience in older adults. However, long-term clinical verification is required to confirm our results.

The Effect of Physical Activity on Body Constitution and Psychological Health in Older Adults: Evidence From an Analysis of a Biobank Research Database.

This study aims to describe the relationship between physical activity, suboptimal health status based on traditional Chinese medicine, and psychological health in older people in Taiwan. A total of 4,497 older individuals were selected from the Taiwan Biobank Research Database. Suboptimal health status was assessed using a body constitution questionnaire to measure yang deficiency, yin deficiency, and stasis. The results showed that older adults involved in physical activity had a lower likelihood of yang/yin deficiency and stasis constitutions than physically inactive people. Participants with yang deficiency or stasis constitutions had a higher likelihood of poor psychological health, whereas those with yin deficiency had a greater likelihood of depression. People involved in physical activity had a lower likelihood of depression than physically inactive people. Compared with male older adults, females had a lower percentage of physical activity habits, poorer body constitutions, and poorer psychological health.

The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units.

Intensive care unit (ICU) patients experience highly complex health problems, such as pain, agitation, delirium, immobility, and sleep disruption (PADIS), and require professional nursing care. The assessment of PADIS is critically important for ICU nurses, and therefore, PADIS education programs need to be conducted for these nurses to update and improve their caring knowledge, attitudes, and skills. The aims of this study are to bridge this gap by evaluating the effects of PADIS education programs on the knowledge, attitudes, and skills of these nurses, and compare the difference between novice and advanced nurses after receiving the PADIS education programs over a short period of time. In this quasi-experimental study, 112 nurses in ICUs were recruited by researchers and participated in the PADIS education programs. The PADIS education intervention was performed in a teaching hospital in Taipei. A demographic and self-developed PADIS care knowledge questionnaire was used. A baseline (T1) was measured before the interventions, followed by post-test (T2) immediately after the programs, and subsequently a follow-up (T3) test one month later. The results indicated that knowledge and skill scores between novice and advanced nurses varied significantly in T1 but not in T2 and T3. Thus, education programs can significantly assist novice ICU nurses to improve their short-term knowledge, attitudes, and skills, and PADIS education programs are strongly suggested for clinical nursing practice.

The frailty risk trajectory associated with kidney and cardiovascular morbidities among patients with incident diabetes: A population-based study.

BACKGROUND AND AIMS: Frailty denotes the increased vulnerability to stressors/insults associated with aging or diseases, and has high incidence in patients with diabetes mellitus (DM). We hypothesized that chronic kidney disease (CKD) and non-kidney morbidities in patients with newly diagnosed DM might modulate their risk of developing incident frailty. METHODS: From the Longitudinal Cohort of Diabetes Patients, we identified 322,109 patients with newly diagnosed DM, and classified them into those without CKD, with CKD before and after DM. We used Kaplan-Meier analyses and Cox proportional hazard regression to analyze associations between CKD or non-kidney morbidities and the risk of incident frailty. We further analyzed the year-to-year trend of frailty risk brought by CKD or non-kidney morbidities. RESULTS: Patients with DM but without CKD (n = 249,752; 77.5%), with CKD prior to (n = 23,829; 7.4%), and after DM (n = 48,528; 15.1%) were enrolled. Those with CKD, regardless of onset timing, had a significantly higher risk of developing frailty than those without (for onset prior to DM, hazard ratio (HR) 1.235, 95% confidence interval (CI) 1.11-1.38; for onset after DM, HR 1.386, 95% CI 1.21-1.59). The risk was more prominent early after the diagnosis of DM was made. Patients with chronic obstructive pulmonary disease, liver, and cardiovascular morbidities all had a significantly higher risk of frailty than those without, with cerebrovascular accident carrying the most prominent risk elevation (HR 4.059, 95% CI 3.73-4.42). CONCLUSIONS: CKD regardless of onset timing relative to DM predicted a higher risk of incident frailty, while non-kidney morbidities including cardiovascular morbidities, similarly increased frailty risk among incident diabetic patients.

Frailty as an Independent Risk Factor for Depression in Patients With End-Stage Renal Disease: A Cross-Sectional Study.

BACKGROUND: Depression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). The presence of depression significantly impairs one's quality of life. Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown. METHODS: We prospectively enrolled patients with end-stage renal disease (ESRD) undergoing hemodialysis for >3 months from National Taiwan University Hospital Yunlin Branch between 2019 and 2021. Clinical, physical, functional, and performance parameters were recorded, followed by frailty/sarcopenia assessment. Depression was screened for using the Geriatric Depression Scale. We analyzed the independent relationship between frailty and depression in these patients, using multiple regression analyses. RESULTS: Totally 151 patients with ESRD were enrolled (mean 61.1 years, 66.9% male), among whom 16.6% had screening-identified depression. ESRD participants with depression did not differ from those without regarding most parameters except serum creatinine, functional indices, and sarcopenia/frailty status. We found that having greater frail severities was independently associated with a higher probability of depression; having FRAIL- (odds ratio [OR] 5.418) and SOF-based (OR 2.858) frailty independently correlated with a higher depression probability. A linear relation exists between a greater frail severity and the probability of depression. Using a more relaxed criterion for detecting depression, higher SOF scores remained significantly associated with an increased depression risk. CONCLUSIONS: In patients with CKD, frailty independently correlated with a higher probability of having depression. Strategies aiming to attenuate frailty may be able to benefit those with depression simultaneously in this population.

Gender-Related Differences in Chronic Kidney Disease-Associated Vascular Calcification Risk and Potential Risk Mediators: A Scoping Review.

Vascular calcification (VC) involves the deposition of calcium apatite in vascular intima or media. Individuals of advanced age, having diabetes mellitus or chronic kidney disease (CKD) are particularly at risk. The pathogenesis of CKD-associated VC evolves considerably. The core driver is the phenotypic change involving vascular wall constituent cells toward manifestations similar to that undergone by osteoblasts. Gender-related differences are observed regarding the expressions of osteogenesis-regulating effectors, and presumably the prevalence/risk of CKD-associated VC exhibits gender-related differences as well. Despite the wealth of data focusing on gender-related differences in the risk of atherosclerosis, few report whether gender modifies the risk of VC, especially CKD-associated cases. We systematically identified studies of CKD-associated VC or its regulators/modifiers reporting data about gender distributions, and extracted results from 167 articles. A significantly higher risk of CKD-associated VC was observed in males among the majority of original investigations. However, substantial heterogeneity exists, since multiple large-scale studies yielded neutral findings. Differences in gender-related VC risk may result from variations in VC assessment methods, the anatomical segments of interest, study sample size, and even the ethnic origins of participants. From a biological perspective, plausible mediators of gender-related VC differences include body composition discrepancies, alterations involving lipid profiles, inflammatory severity, diversities in matrix Gla protein (MGP), soluble Klotho, vitamin D, sclerostin, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and osteoprotegerin levels. Based on our findings, it may be inappropriate to monotonously assume that male patients with CKD are at risk of VC compared to females, and we should consider more background in context before result interpretation.

Muscle relaxant use and the associated risk of incident frailty in patients with diabetic kidney disease: a longitudinal cohort study.

BACKGROUND: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The exposure to muscle relaxants frequently leads to adverse effects despite their modest therapeutic efficacy, but whether muscle relaxants predispose users to frailty remains unclear. METHODS: Patients with DKD from a population-based cohort, the Longitudinal Cohort of Diabetes Patients, were identified between 2004 and 2011 (N = 840,000). Muscle relaxant users were propensity score-matched to never-users in a 1:1 ratio based on demographic features, comorbidities, outcome-relevant medications, and prior major interventions. Incident frailty, the study endpoint, was measured according to a modified FRAIL scale. We used Kaplan-Meier analyses and Cox proportional hazard regression to analyze the association between cumulative muscle relaxant use (⩾ 28 days) and the risk of incident frailty. RESULTS: Totally, 11,637 users and matched never-users were enrolled, without significant differences regarding baseline clinical features. Cox proportional hazard regression showed that patients with DKD and received muscle relaxants had a significantly higher risk of incident frailty than never-users [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.04-1.53]. This increase in frailty risk paralleled that in cumulative muscle relaxant dosages (quartile 1 versus 2 versus 3 versus 4, HR 0.91 versus 1.22 versus 1.38 versus 1.45, p = 0.0013 for trend) and in exposure durations (quartile 1 versus 2 versus 3 versus 4, HR 1.12 versus 1.33 versus 1.23 versus 1.34, p = 0.0145 for trend) of muscle relaxants. CONCLUSION: We found that cumulative muscle relaxant exposure might increase frailty risk. It is prudent to limit muscle relaxant prescription in patients with DKD. PLAIN LANGUAGE SUMMARY: Does cumulative muscle relaxant exposure increase the risk of incident frailty among patients with diabetic kidney disease? Background: Frailty denotes a degenerative feature that adversely influences one's survival and daily function. Patients with diabetes and chronic kidney disease are at a higher risk of developing frailty, but whether concurrent medications, especially muscle relaxants, aggravate this risk remains undefined.Methods: In this population-based study including 11,637 muscle relaxant users and matched never-users with diabetic kidney disease, we used a renowned frailty-assessing tool, FRAIL scale, to assess frailty severity and examined the incidence of frailty brought by muscle relaxant exposure.Results: We found that users exhibited a 26% higher risk of developing incident frailty compared with never-users, and the probability increased further if users were prescribed higher doses or longer durations of muscle relaxants.Conclusion: We concluded that in those with diabetic kidney disease, cumulative muscle relaxant use was associated with a higher risk of incident frailty, suggesting that moderation of muscle relaxant use in this population can be of potential importance.

Corrigendum to 'Tangible dynamic changes in resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia: A longitudinal study' [Archives of Gerontology and Geriatrics AGG, Volume 91, July-August 2021, 104416].

AIM AND OBJECTIVES: The purpose of this study was to explore the inter-relationships among resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia. Besides, the patterns of these three variables over a long-term follow-up was examine. MATERIAL AND METHODS: Quantitative longitudinal study design was used in this study. Sarcopenia is related to aging, lack of physical activity, and malnutrition. Complex inter-relationships exist in patients with regards to their resilience, nutritional status, leisure activities. A generalized estimating equation (GEE) was used for long-term follow-up observations, and data were collected form one month (T1), three months (T2) and six months (T3). A demographic questionnaire and the Chinese versions of the Resilience Scale (CRS), the Mini-Nutritional Assessment (MNA), and the Leisure Time Activities Scale (LTAS), were used to collect data. RESULTS: A total of 267 eligible participants were enrolled in this study, of whom 53% were men and 47% were women. The interactions among resilience, nutrition, and leisure activity were reported. Resilience was positively correlated with nutrition. Higher resilience was developed higher participation in leisure activities was found in older adults with possible sarcopenia. CONCLUSION: Resilience is a key factor for greater participation in leisure activities. Health professionals should develop feasible resilience interventions that would enhance patient's participation in leisure activities. Nutritional consulting and physical activity interventions should be combined in the case of older adults to prevent the occurrence of possible sarcopenia.

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease.

BACKGROUND: Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear. METHODS: A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a  modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty. RESULTS: Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well. CONCLUSIONS: Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.

The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis.

BACKGROUND: Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. METHODS: We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. RESULTS: From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06-1.14), heart failure (HF) (HR 1.282, 95% CI 1.19-1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04-1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08-1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. CONCLUSIONS: The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients.

Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population-based cohort study.

AIMS: Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under-recognized complication of diabetes mellitus. Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear. METHODS: From the longitudinal cohort of diabetes patients (LCDP) (n = 840,000) in Taiwan, we identified adults with DKD, dividing them into those without and with different severities of frailty based on a modified FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty-associated risk of delirium/cognitive impairment, identified using approaches validated by others. RESULTS: Totally 149,145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0% and 1.3% did not have or had 1, 2 and >2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, co-morbidities, medications and interventions, patients with DKD and 1, 2 and >2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2 and >2 items, hazard ratio 1.18, 1.26 and 1.30, 95% confidence interval 1.08-1.28, 1.14-1.39 and 1.10-1.55, respectively). For every FRAIL item increase, the associated risk rose by 9%. CONCLUSIONS: Frailty significantly increased the risk of delirium/cognitive impairment among patients with DKD. Frailty screening in these patients may assist in delirium risk stratification.

Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study.

The prevalence of chronic pain in patients with chronic kidney disease (CKD) and diabetes mellitus is high and correlates with higher frailty risk, but satisfactory pain control frequently fails, necessitating opioid initiation. We aimed to examine whether opioid use affected their outcomes and whether such a relationship was modified by frailty. From the longitudinal cohort of diabetes patients (n = 840,000), we identified opioid users with CKD (n = 26,029) and propensity score-matched them to opioid-naïve patients in a 1:1 ratio. We analyzed the associations between opioid use and long-term mortality according to baseline frailty status, defined by the modified FRAIL scale. Among all, 20.3% did not have any FRAIL items, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items, respectively. After 4.2 years, 16.4% died. Cox proportional hazard regression showed that opioid users exhibited an 18% higher mortality risk (HR 1.183, 95% CI 1.13-1.24) with a dose- and duration-responsive relationship, compared to opioid-naive ones. Furthermore, the mortality risk posed by opioids was observed only in CKD patients without frailty but not in those with frailty. In conclusion, opioid use increased mortality among patients with CKD, while this negative outcome influence was not observed among frail ones.

Vascular Calcification as an Underrecognized Risk Factor for Frailty in 1783 Community-Dwelling Elderly Individuals.

Background Vascular calcification (VC) is associated with high morbidity and mortality among older adults, a population that exhibits a higher tendency for developing frailty at the same time. Whether VC serves as a risk factor for the development of frailty in this population remains unclear. Methods and Results We analyzed a prospectively assembled cohort of community-dwelling older adults between 2014 and 2017 (n=1783). Frailty and prefrailty were determined on the basis of the Study of Osteoporotic Fractures criteria, and VC was measured using semiquantitative aortic arch calcification (AAC) and abdominal aortic calcification scoring. We conducted multiple logistic regression with prefrailty or frailty as the dependent variable, incorporating sociodemographic profiles, comorbidities, medications, laboratory data, AAC status/severity, and other geriatric phenotypes. Among all participants, 327 (18.3%) exhibited either prefrailty (15.3%) or frailty (3.1%), and 648 (36.3%) exhibited AAC. After adjusting for multiple confounders, we found that AAC incidence was associated with a substantially higher probability of prefrailty or frailty (odds ratio [OR], 11.9; 95% CI, 7.9-15.4), with a dose-responsive relationship (OR for older adults with AAC categories 1, 2, and 3 was 9.3, 13.6, and 52.5, respectively). Similar association was observed for older adults with abdominal aortic calcification (OR, 5.0; 95% CI, 1.3-19.5), and might be replicable in another cohort of patients with end-stage renal disease. Conclusions Severity of VC exhibited a linear positive relationship with frailty in older adults. Our findings suggest that a prompt diagnosis and potential management of VC may assist in risk mitigation for patients with frailty.

Resilience among older cardiovascular disease patients with probable sarcopenia.

AIM AND OBJECTIVES: The purpose of this study was to investigate the factors associated with resilience among probable sarcopenia older adults with cardiovascular disease. INTRODUCTION: Resilience has been reported to be positively correlated with the mental health and physical functioning of older adults. Previous research has found that the development of resilience constitutes a form of compensation for loss of physical health. It is important for older adults, especially those with other underlying conditions, such as cardiovascular disease and sarcopenia, to have the ability to overcome adversity during the aging process. Thus, resilience becomes a critical characteristic in achieving a better life. METHODS: A cross-sectional study design was used. A demographic questionnaire and the Chinese version of the Resilience Scale (CRS) were used to collect data. Multiple logistic regression was used to evaluate the predictors of low resilience. RESULTS: A total of 267 participants were recruited, including 126 females and 141 males. Of the participants, 56% of their scores indicated low resilience. Income, education level, exercise time, primary caregiver, and having hypertension were the predictors of resilience. CONCLUSION: The population with sarcopenia is increasing worldwide. Understanding resilience levels among older adults with probable sarcopenia is essential for promoting their mental health. Clinicians can use the results of this study to identify populations at high risk for low resilience and design specific interventions to promote better health outcomes.

Physical Activity and Sarcopenia in the Geriatric Population: A Systematic Review.

INTRODUCTION: Sarcopenia is an aging-related health problem in the geriatric population. Sarcopenia reduces muscle mass, muscle strength, and physical performance. Although physical activity is protective against sarcopenia for older adults, there are limited studies in this area. The purpose of this study was to integrate and analyze research on physical activity and sarcopenia in the geriatric population. METHODS: Studies that assess sarcopenia were searched across electronic databases that included Medline, PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Studies that implemented physical activity-related intervention or research were included. A critical appraisal skills program was used for quality assessment of the selected articles. Study selection and data extraction were counted by 2 independent reviewers. RESULTS: Of the 149 references identified through the database search, 10 studies were included in this systematic review. Seven studies were randomized controlled trials, and 3 were cross-sectional or longitudinal. The results of 8 studies indicated significant improvement in muscle mass, muscle strength, and physical performance through exercise intervention, as determined by long-term observation. CONCLUSIONS: Physical activity is an effective protective strategy for sarcopenia. Most studies of older adults exercise intervention indicated that the participants achieved positive results, but maintenance of muscle strength appeared to depend on continuous implementation of certain types of physical activities. A limitation of these 10 reviewed studies was that there was no consistency in the measurement of sarcopenia. Therefore, sarcopenia measurement needs further investigation.