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.

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 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.

Loneliness among older Chinese individuals: the status quo and relationships with activity-related factors.

BACKGROUND: With the rapid population aging, healthy aging has become a concern for society as a whole. In this study, loneliness and its relationships with activity-related individual factors were examined among older Chinese individuals from the perspective of mental health and daily leisure activities. METHODS: The data were from the fourth investigation of the Sample Survey of the Aged Population in Urban and Rural China, which had a total of 220,506 participants. Activity ability was assessed by the Barthel Activity of Daily Living Index, a self-designed activity type questionnaire was used to evaluate activity participation, and loneliness was measured with a single-item question. RESULTS: The prevalence of varying degrees of loneliness among Chinese older individuals was 36.6%. The prevalence of loneliness among the older individuals differed significantly by age gender, age, physical health status, annual household income, education level, marital status, living status, ethnic minority status, religious faith and territory of residence. There were differences in activity participation among older Chinese adults in terms of all the demographic factors mentioned above, while there were no significant differences in living status or religious faith, and significant differences in several other demographic factors in terms of activity ability. Self-care ability, as a form of activity ability, and activity participation significantly predicted loneliness among the older participants. CONCLUSION: The topic of loneliness among Chinese older individuals is complex and requires greater attention. The buffering effect of activity-related factors on loneliness suggests that old people should improve their activity ability and participate more in daily activities.

Trends in the incidence and survival of cancer in individuals aged 55 years and older in the United States, 1975-2019.

BACKGROUND: In ageing societies such as the United States, evaluating the incidence and survival rates of cancer in older adults is essential. This study aimed to analyse the incidence and survival rates of cancer in individuals aged 55 years or older in the United States. METHODS: This retrospective study (1975-2019) was conducted using combined registry data from the Surveillance, Epidemiology, and End Results database. Data from the 9, 12, and 17 Registries (Nov 2021 Sub) datasets were used. RESULTS: In 2019, the incidence of cancer in individuals older than 55 years and the overall population was 1322.8 and 382.1 per 100,000 population, respectively. From 2000 to 2019, the incidence of cancer in individuals older than 55 years showed a decreasing trend, whereas their five-year survival rates showed an increasing trend. The incidence of cancer in the 75-79 and 80-84 year age groups was the highest among all age groups. CONCLUSIONS: The incidence of colon cancer declined significantly, whereas that of intrahepatic bile duct cancer increased considerably. These trends may be due to increased screening for cancers with high incidence rates and improved control of the risk factors for cancer. Rapid development of targeted therapy and immunotherapy combined with early tumour detection may be an important reason for the improved survival rates.

Multimorbidity, healthy lifestyle, and the risk of cognitive impairment in Chinese older adults: a longitudinal cohort study.

BACKGROUND: Evidence on the association between multimorbidity and cognitive impairment in Chinese older population is limited. In addition, whether a healthy lifestyle can protect cognitive function in multimorbid older population remains unknown. METHODS: A total of 6116 participants aged ≥ 65 years from the Chinese Longitudinal Healthy Longevity Survey were followed up repeatedly. The number of coexisting chronic diseases was used for assessing multimorbidity and cardiometabolic multimorbidity. Three lifestyle statuses (unhealthy, intermediate, and healthy) were defined based on a lifestyle score covering smoking, alcohol drinking, body mass index, outdoor activities, and dietary pattern. Cognitive impairment was defined as the Mini-Mental State Examination score < 24. A modified Poisson regression model with robust error variance was used to assess the associations between multimorbidity, healthy lifestyle, and cognitive impairment. RESULTS: During a median follow-up period of 5.8 years, 1621 incident cases of cognitive impairment were identified. The relative risk (RR) of cognitive impairment associated with heavy multimorbidity burden (≥ 3 conditions) was 1.39 (95% confidence interval: 1.22-1.59). This association declined with age, with RRs being 3.08 (1.78-5.31), 1.40 (1.04-1.87), and 1.19 (1.01-1.40) in subjects aged < 70 years, ≥ 70 and < 80 years, and ≥ 80 years, respectively (P for interaction = 0.001). Compared to unhealthy lifestyle, a healthy lifestyle was related to an approximately 40% reduced risk of cognitive impairment regardless of multimorbidity burden. Among the 5 lifestyle factors assessed, daily outdoor activities and a healthy dietary pattern showed convincing protective effects on cognitive function. CONCLUSIONS: The relationship between multimorbidity and cognitive impairment is age-dependent but remains significant in the population aged 80 years or older. A healthy lifestyle may protect cognitive function regardless of the multimorbidity burden. These findings highlight the importance of targeting individuals with heavy multimorbidity burden and promoting a heathy lifestyle to prevent cognitive impairment in Chinese older population.

Volunteering and instrumental support during the first phase of the pandemic in Europe: the significance of COVID-19 exposure and stringent country's COVID-19 policy.

BACKGROUND: The COVID-19 control policies might negatively impact older adults' participation in volunteer work, instrumental support provision, and the likelihood of receiving instrumental support. Studies that quantify changes in these activities and the related factors are limited. The current study aimed to examine the level of volunteering, instrumental support provision and receipt before and during the first phase of the COVID-19 pandemic in Europe and to determine whether older adults' volunteering, instrumental support provision and receipt were associated with individual exposure to COVID-19 and the stringency of country's COVID-19 control policy during the first phase of the COVID-19 pandemic. METHODS: A cross-sectional survey using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey 1 was designed to focus on community-dwelling Europeans aged ≥50 years. History of participation in volunteering work and instrumental support provision or receipt was assessed from the previous SHARE Wave data. The country's COVID-19 control policy stringency index (S-Index) was from the Oxford COVID-19 Government Response Tracker database. A total of 45,669 respondents from 26 European countries were included in the volunteering analysis. Seventeen European countries were included in the analyses of instrumental support provision (N = 36,518) and receipt (N = 36,526). The multilevel logistic regression model was fitted separately to analyse each activity. RESULTS: The level of volunteering and instrumental support provision was lower during the pandemic, but instrumental support receipt was higher. The country S-Index was positively associated with support provision (OR:1.13;95%CI:1.02-1.26) and negatively associated with support receipt (OR:0.69;95%CI:0.54-0.88). Exposure to COVID-19 was positively associated with support receipt (OR:1.64;95%CI:1.38-1.95). COVID-19 exposure on close ones positively associated with volunteering (OR:1.47;95%CI:1.32-1.65), support provision (OR:1.28;95%CI:1.19-1.39), and support receipt (OR:1.25;95%CI:1.15-1.35). CONCLUSIONS: The COVID-19 pandemic impacted older Europeans' volunteering, instrumental support provision, and instrumental support receipt from outside their household. When someone close to them was exposed to COVID-19, older Europeans were likely to receive instrumental support and to volunteer and provide instrumental support. A stricter country's COVID-19 control policy might motivate older adults to provide instrumental support, but it prevents them from receiving instrumental support from outside their households.

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.

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 garden work and risk of incident dementia in an older population in China: a national cohort study.

OBJECTIVES: Evidence on the association between garden work and risk of incident dementia in the older Chinese population is limited. This study aimed to explore the association between the frequency of garden work and risk of incident dementia in an older population in China. STUDY DESIGN: This was a national cohort study. METHODS: This study analysed data from 8676 participants (median age: 86 years) from the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazard models were used to assess the association between the frequency of garden work and risk of incident dementia using hazard ratios (HRs) and 95% confidence intervals (CIs). Multiplicative and additive interaction effects were calculated between the frequency of garden work and age, sex or residence on incident dementia; subgroup analyses of the association were also conducted by age, sex and residence. In addition, sensitivity analyses were performed to assess the robustness of the results. RESULTS: During 4.31 years (median) of follow-up, 633 participants developed dementia. Compared with participants who did not engage in garden work, the adjusted risk of incident dementia for those who regularly or almost daily engaged in garden work decreased by 28% (HR = 0.72, 95% CI: 0.57-0.93). An additive interaction effect between frequency of garden work and age on incident dementia was observed, with subgroup analyses demonstrating similar statistically significant associations among participants aged ≥85 years, women and city or town residents. Sensitivity analyses were consistent with the primary analysis in the present study. CONCLUSIONS: Frequent engagement in garden work may be associated with a reduced risk of dementia and may be an effective measure to prevent incident dementia in the older population in China.

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.

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.

[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.

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.

Acute Myeloid Leukemia Treatment in the Elderly: A Comprehensive Review of the Present and Future.

BACKGROUND: Acute myeloid leukemia (AML) is a disease of the hematopoietic system that remains a therapeutic challenge despite advances in our understanding of the underlying cancer biology in the past decade. It is also an affliction of the elderly that predominantly affects patients over 60 years of age. Standard therapy involves intensive chemotherapy that is often difficult to tolerate in older populations. Fortunately, recent developments in molecular targeting have shown promising results in treating leukemia, paving the way for novel treatment strategies that are easier to tolerate. SUMMARY: Venetoclax, a BCL-2 inhibitor, when combined with a hypomethylating agent, has proven to be a highly effective and well-tolerated drug and established itself as a new standard for treating AML in patients who are unfit for standard intensive therapy. Other targeted therapies include clinically proven and FDA-approved agents, such as IDH1/2 inhibitors, FLT3 inhibitors, and Gemtuzumab, as well as newer and more experimental drugs such as magrolimab, PI-kinase inhibitors, and T-cell engaging therapy. Some of the novel agents such as magrolimab and menin inhibitors are particularly promising, providing therapeutic options to a wider population of patients than ever before. Determining who will benefit from intense or novel low-intense therapy remains a challenge, and it requires careful assessment of individual patient's fitness and disease characteristics. KEY MESSAGES: This article reviews past and current treatment strategies that harness various mechanisms of leukemia-targeting agents and introduces novel therapies on the horizon aimed at exploring therapeutic options for the elderly and unfit patient population. It also provides a strategy to select the best available therapy for elderly patients with both newly diagnosed and relapsed/refractory AML.

Dietary profiling of physical frailty in older age phenotypes using a machine learning approach: the Salus in Apulia Study.

PURPOSE: Growing awareness of the biological and clinical value of nutrition in frailty settings calls for further efforts to investigate dietary gaps to act sooner to achieve focused management of aging populations. We cross-sectionally examined the eating habits of an older Mediterranean population to profile dietary features most associated with physical frailty. METHODS: Clinical and physical examination, routine biomarkers, medical history, and anthropometry were analyzed in 1502 older adults (65 +). CHS criteria were applied to classify physical frailty, and a validated Food Frequency Questionnaire to assess diet. The population was subdivided by physical frailty status (frail or non-frail). Raw and adjusted logistic regression models were applied to three clusters of dietary variables (food groups, macronutrients, and micronutrients), previously selected by a LASSO approach to better predict diet-related frailty determinants. RESULTS: A lower consumption of wine (OR 0.998, 95% CI 0.997-0.999) and coffee (OR 0.994, 95% CI 0.989-0.999), as well as a cluster of macro and micronutrients led by PUFAs (OR 0.939, 95% CI 0.896-0.991), zinc (OR 0.977, 95% CI 0.952-0.998), and coumarins (OR 0.631, 95% CI 0.431-0.971), was predictive of non-frailty, but higher legumes intake (OR 1.005, 95%CI 1.000-1.009) of physical frailty, regardless of age, gender, and education level. CONCLUSIONS: Higher consumption of coffee and wine, as well as PUFAs, zinc, and coumarins, as opposed to legumes, may work well in protecting against a physical frailty profile of aging in a Mediterranean setting. Longitudinal investigations are needed to better understand the causal potential of diet as a modifiable contributor to frailty during aging.

Epilepsy among the older population of sub-Saharan Africa: Analysis of the global burden of disease database.

INTRODUCTION: Epilepsy is considered one of the most burdensome neurologic diseases by the World Health Organization due to the high risk of morbidity and mortality. Few studies have investigated the epidemiology of idiopathic epilepsy in Sub-Saharan Africa (SSA). This study aims to characterize the disease burden of epilepsy among the older population in SSA via a large international database. METHODS: Descriptive epidemiological data from the Global Burden of Disease (GBD) database was collected for idiopathic epilepsy in all regions of SSA. The "older" population was defined as 55 years of age and above. The variables of interest included mortality, incidence, prevalence, and disability-adjusted life years (DALYs) rates per one hundred thousand populations. RESULTS: The average mortality rate was highest in Western SSA (6.34 per 100,000), and all regions were significantly higher than the global average (p < 0.001). DALYs and incidence rates of idiopathic epilepsy in all regions of SSA were significantly higher than the global averages (p < 0.01). Globally, the older population had a significantly higher mortality rate than the younger population (2.78 vs 1.62, respectively; p < 0.01). The older population had a higher mortality rate than the younger population in each region of SSA (p < 0.01). Conversely, for DALYs, the younger population had a higher disease burden than the older population globally and in each region of SSA (p < 0.01). CONCLUSION: This study is the first to examine the epidemiologic profile of idiopathic epilepsy in the older population in SSA. Our results indicate that, when compared with the global population, older adults in SSA suffer a greater disease burden and mortality. This study reports the immense need for increased resources and awareness regarding epilepsy in the elderly population of Africa.

New horizons in Parkinson's disease in older populations.

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. Ageing is considered to be the greatest risk factor for PD, with a complex interplay between genetics and the environment. With population ageing, the prevalence of PD is expected to escalate worldwide; thus, it is of utmost importance to reduce the burden of PD. To date, there are no therapies to cure the disease, and current treatment strategies focus on the management of symptoms. Older adults often have multiple chronic diseases and geriatric syndromes, which further complicates the management of PD. Healthcare systems and care models necessary to address the broad needs of older PD patients are largely unavailable. In this New Horizon article, we discuss various aspects of PD from an ageing perspective, including disease management. We highlight recent advancements in PD therapies and discuss new care models with the potential to improve patient's quality of life.

Measurement properties of the EQ-5D in populations with a mean age of ≥ 75 years: a systematic review.

PURPOSE: Healthcare interventions for middle-old and oldest-old individuals are often (economically) evaluated using the EQ-5D to measure health-related quality of life (HrQoL). This requires sufficient measurement properties of the EQ-5D. Therefore, the current study aimed to systematically review studies assessing the measurement properties of the EQ-5D in this population. METHODS: The databases PubMed, Cochrane library, Web of Science, Embase, and EconLit were searched for studies providing empirical evidence of reliability, validity, and/or responsiveness of the EQ-5D-3L and EQ-5D-5L in samples with a mean age ≥ 75 years. Studies were selected by two independent reviewers, and the methodological quality was assessed using the COSMIN Risk of Bias checklist. Results were rated against updated criteria for good measurement properties (sufficient, insufficient, inconsistent, indeterminate). The evidence was summarized, and the quality of evidence was graded using a modified GRADE approach. RESULTS: For both EQ-5D versions, high-quality evidence for sufficient convergent validity was found. Known-groups validity was sufficient for the EQ-5D-5L (high-quality evidence), whereas the results were inconsistent for the EQ-5D-3L. Results regarding the reliability were inconsistent (EQ-5D-3L) or entirely lacking (EQ-5D-5L). Responsiveness based on correlations of change scores with instruments measuring related/similar constructs was insufficient for the EQ-5D-3L (high-quality evidence). For the EQ-5D-5L, the available evidence on responsiveness to change in (Hr)QoL instruments was limited. CONCLUSION: Since the responsiveness of the EQ-5D in a population of middle-old and oldest-old individuals was questionable, either using additional instruments or considering the use of an alternative, more comprehensive instrument of (Hr)QoL might be advisable, especially for economic evaluations.

Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study.

BACKGROUND: There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population. METHODS: The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms. RESULTS: There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41). CONCLUSION: Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.