Scientific Research

Subjective cognitive decline (SCD) is defined by cognitive complaints expressed by the individual, without evidence of cognitive impairment on objective neuropsychological tests. Studies have analyzed SCD among patients with specific groups of diseases. An increased understanding of the association between disease patterns and subjective cognitive decline is essential to develop targeted interventions for these groups. Using data from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), this cross-sectional study included 2,508 participants. Subjective Cognitive Decline (SCD) was assessed using the Subjective Cognitive Decline Initiative Working Group's criteria. Multimorbidity (MM) was defined as the presence of two or more of 14 self-reported health conditions. Clusters of MM were identified based on the most prevalent dyads and triads of diseases within the sample. Robust Poisson regression models were used to estimate adjusted prevalence ratios (PR) for the association between MM clusters and SCD, accounting for potential confounders. The following dyads of chronic conditions were associated with higher prevalence of SCD: ophthalmological problems/osteoporosis (RR: 1.497 p=0.042), heart problems/stroke (RR: 2.33, p<.001), and hypertension />asthma (RR: 3.309, p=0.013). No triads had positive association with SCD, although the triads of ophthalmological problem/hypertension/osteoporosis (RR: 0.367, p<.001) and hypertension />cardiac problems/dyslipidemia (RR: 0.545, p=0.012) were negatively associated with the prevalence of SCD. Our study demonstrated an association between SCD and MM clusters, which is important for developing and managing care for individuals with cognitive decline and/or those multimorbidity patterns. The results could also provide a foundation for future research exploring the causality between these variables.

Background: Worldwide population ageing is motivating how to measure the health of ageing populations. One approach is to compare dynamics of frailty, assessed by the cumulative-deficit frailty index, across different populations. We aim to compare the frailty distribution, mortality risk, and change in frailty over time between 18 countries.

Methods: Using data from five harmonised international surveys (HRS, SHARE, ELSA, CHARLS and MHAS) we assessed frailty with a 40-item frailty index (baseline, 2-, 4- and 6-year follow-up), along with mortality status. We constructed separate regression models for participants with the fewest baseline health deficits (“zero-state” – assessing ambient health of the population) and the rest of the population (“non zero-state”). Using logistic and negative binomial, respectively, we assessed the odds of mortality and the rate of deficit accumulation (i.e. change in frailty index) between countries, adjusted for baseline frailty, age, and sex.

Results: Highest baseline frailty, mortality risk, and the most rapid increases in frailty were observed in Mexico, followed by China. Differences in mortality risk and deficit accumulation were similar regardless of baseline frailty. Lowest mortality risk and the slowest rates of deficit accumulation were observed in Scandinavian countries and in Switzerland. Differences between Central/Southern European countries, USA and UK varied when comparing zero-state with non zero-state models. For example, mortality rates and deficit accumulation were relatively lower among the healthiest subset of the USA (and to a lesser extent UK) population. However, when modelling those with some degree of baseline frailty, mortality and deficit accumulation in the USA were relatively higher compared to European countries.

Conclusion: Dynamics of the frailty index can provide insights into population-level differences in health across different settings. For some, but not all, countries, findings are sensitive to the degree of frailty present at baseline, which may reflect inequalities in healthcare provision or access.

Introduction

Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay.

Methods

Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability. Secondary outcomes included physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy, and PA. Outcomes were measured and compared at baseline, post-intervention, and follow-up (3-months). Interviews were transcribed verbatim and analysed using thematic analysis.

Results

Five volunteers (mean age 16, 3 female) completed training, and 3 (60%) were retained at the end of the study. Twenty-seven older adults (mean age 80 years, 15 female) signed up to the intervention (10 online;13 telephone). Seventeen completed the intervention. Participants attended 75% (IQR 38-92) online sessions, and 80% (IQR 68.5-94.5) telephone support. Self-reported total PA (p = .006), quality of life (p = .04), and appetite (p = .03) improved significantly post-intervention, with a non-significant decrease at follow-up. The intervention was safe and acceptable to volunteers, and older adults with frailty. Key barriers were lack of social support, and exercise discomfort. The online group was a positive vicarious experience, and telephone calls provided reassurance and monitoring to socially isolated older adults.

Conclusion

Volunteers can safely deliver a remote multimodal intervention for frail older adults discharged from hospital with training and support from a health practitioner.

Background: Informal caregivers play a critical role in providing continuous, unpaid care to individuals with dementia, helping to improve their quality of life and reduce the demand on formal care services. The caregiving relationship is a complex, dyadic process that can have profound effects on both the caregiver and the care recipient, underscoring the need to alleviate caregiver burden and support their well-being. Understanding the motivations behind why individuals take on caregiving roles is essential, as it can predict their experiences, perceptions, and the overall impact of caregiving on their lives. A systematic review by Greenwood and Smith identified key motivators for informal caregivers. Additionally, there is substantial evidence that cultural perspectives and social values significantly influence caregiver experiences and motivations.

Methods: This systematic review aimed to update the findings of Greenwood and Smith by examining recent research on the motivations behind caregiving across different demographics, ethnicities, and cultures. Six electronic databases were searched from August 2018 to January 2024. Titles and abstracts were screened using machine learning methods (ASReview), and a subset of full texts underwent duplicate screening. Eligible studies were appraised using the Mixed Methods Appraisal Tool (MMAT), and data were extracted and organized into thematic categories.

Results: The initial search yielded 1,843 articles, of which 37 studies met the inclusion criteria after deduplication and screening. Cultural explanations for caregiving motivations included themes such as familism, ethnic identity, cultural values and beliefs, a sense of obligation, and personal fulfillment.

Discussion: Cultural perceptions and social values play a significant role in shaping caregivers' experiences and perceptions, which in turn influence families’ engagement with and acceptance of formal care and support services. These findings highlight the need for further research to guide the development of culturally sensitive psychosocial support interventions tailored for diverse caregiving populations. Such personalized approaches are essential for reducing caregiver burden and fostering an inclusive caregiving environment that respects the unique motivations and values of caregivers from various cultural backgrounds.

Ethnic variations in frailty lack comprehensive understanding ¹. This systematic review examined ethnic variations in the prevalence, incidence, and trajectories of frailty; associations between frailty and sociodemographic/lifestyle risk factors; and health-related outcomes of frailty.

Methods: MEDLINE, Embase, Web of Science Core Collection, and CINAHL were searched (2000–July 2023). Searches supplemented by forward citation searching and hand-searching reference lists. Inclusion criteria: observational studies (using any frailty measure) in adults (>18 years) assessing frailty prevalence, trajectories, or association with health-related outcomes by ethnicity.

1. Frailty Prevalence

Introduction

Thomas Sydenham, English physician stated, “a man is as old as his arteries”. Chronological age has been noted to correlate strongly with vascular/ biological age. However, little is known about how chronological and vascular parameters of ageing, correlate with frailty. In this study, we sought to study the correlations between frailty, chronological age and parameters of vascular ageing.

Methods

Data from two studies with participants aged ≥ 60years investigating the associations between Cytomegalovirus infection and frailty indices and vascular parameters were included. Two hundred and sixty community dwelling adults were enrolled in both studies. Vascular parameters were measured by cardio-ankle vascular index (CAVI) using VaSera VS-2000® and pulse wave velocity-PWV (carotid-femoral and carotid-radial) using COMPLIOR®. Hand grip strength (HGS) and Charlson co-morbidity index (CCI) were measured for clinical frailty data. Patients were excluded if they had malignancy, were on active treatment for cancer or were unable to give consent.

Results

There were 260 study participants, (mean age ± SD; 72 ± 8years), with gender distribution M:F (50:50). Chronological age strongly correlated positively with vascular ageing parameters such as CAVI (r=0.6, p<0.001) and cf-PWV(r=0.5, p<0.01). Similarly, chronological age correlated positively with CCI (r=0.7, p˂0.001) and negatively with HGS (r= - 0.3, p˂0.001). Vascular ageing as measured by CAVI (estimated CAVI age) correlated positively with CCI (r=0.5, p<0.01) and negatively with HGS (r = -0.2, p=0.01). Other measures of vascular ageing such as cf-PWV positively correlated with CCI (r= 0.4, p<0.01) and negatively with HGS (r=- 0.1, p =0.09).

Conclusion

Clinical frailty parameters correlate strongly with measures of vascular ageing and chronological age. Vascular ageing is a strong independent predictor of frailty.

Background: Newer glucose-lowering agents for type 2 diabetes (sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor analogues (GLP1ra) and dipeptidyl peptidase-4 inhibitors (DPP4i)) improve hyperglycaemia and SGLT2i and GLP1ra reduce the risk of major adverse cardiovascular events (MACE). It is not clear whether the efficacy of these agents varies by age.

Methods: We searched Medline and Embase, plus clinical trial registries, for randomised controlled trials of SGLT2i, GLP1ra and DPP4i, versus placebo or active comparator, in adults with type 2 diabetes.

Outcomes: HbA1c and MACE. Where IPD were available, we modelled age-treatment interactions for each trial. Otherwise, we assessed age distributions along with results from aggregate trial data. IPD and aggregate findings were combined in a Bayesian network meta-analysis to assess whether the efficacy differed by age.

Results: We identified 616 eligible trials (604 reporting HbA1c, 23 reporting MACE) and obtained IPD for 75 trials (6 reporting MACE). Mean age was 59.0 (10.7) years and 64.0 (8.6) in HbA1c and MACE trials, respectively. SGLT2i reduced HbA1c by 0.5-1.0% overall compared to placebo. This reduction versus placebo was attenuated in older participants (change in HbA1c 0.25 percentage-points less for 75-year-olds compared to 45-year-olds). SGLT2i showed greater relative efficacy in MACE risk reduction among older than younger people. This finding was sensitive to the exclusion of one of the IPD MACE trials, however, in all sensitivity analyses, SGLT2i were either as efficacious or more efficacious in older participants. There was no consistent difference in efficacy by age for GLP1ra or DPP4i for HbA1c or MACE.

Conclusion: Newer glucose-lowering drugs are efficacious across age and sex groups. SGLT2i are more cardioprotective in older than younger people despite smaller HbA1c reductions. Age alone should not be a barrier to treatments with proven cardiovascular benefit providing they are well tolerated align with patient priorities.

Introduction

Poor appetite affects 15-20% of community dwelling older adults. Studies link poor appetite with frailty and sarcopenia; however, lack of longitudinal evidence exists to inform potential causality. We aimed to determine if poor appetite predicts frailty or sarcopenia-related factors in community dwelling older adults.

Methods

Secondary data analysis on adults aged >60 years recruited from, syncope, fragility fracture and comprehensive geriatric assessment clinics with 2.5 year follow up. Appetite was assessed by Simplified Nutritional Appetite Questionnaire (SNAQ); a score of <14/20 defining poor appetite. Hand grip strength (HGS) was measured using a dynamometer, low HGS was defined by European criteria (<27kg for males and <16kg for females). Frailty was measured using self-report of Fried phenotype.

Results

86 participants, mean age of 78 years, 62% female. Sixty-two (72%) were followed up, of those 9 had died.

Baseline mean SNAQ score was 15.2 (SD 8.1); 14 (16.3%) scored <14. Mean SNAQ score for the 53 participants at 2.5 year follow up was 14.9, 12 (22%) scored <14. Baseline and follow up SNAQ scores correlated moderately (Pearson’s r=0.5; P=<.001).

Fifteen (28%) individuals had low HGS at follow up, 12 had frailty (22%). Baseline SNAQ score <14 was associated with increased odds of frailty (OR 18.00; 95% CI 2.92-111.00) and low HGS (OR 7.76; 95% CI 1.62-37.30) after 2.5 years. The association of baseline SNAQ <14 with presence of frailty was robust to adjustment for age and comorbidities (OR 13.50; 95% CI 1.14-160.03), while association with low HGS was attenuated (OR 2.29; 95% CI 0.27-19.39).

Conclusion

Poor appetite is predictive of presence of frailty and low HGS after 2 years in community dwelling older adults. This suggests poor appetite as causative in the development of poor health outcomes in older people and so a key intervention target to optimise healthy ageing.

Objectives: Older adults hospitalized with a hip fracture are at risk for adverse health outcomes depending on their level of frailty. This study examined how frailty levels prior to admission impacted length of stay (LOS), requirement for alternative level of care (ALC), returning home post-discharge, and mortality.

Methods: A random sample was generated from all hip fracture patients aged 65 and older admitted to a Level One Trauma Centre in New Brunswick, Canada from 2015-2019. This sample had their frailty level determined retrospectively using the Pictorial Fit-Frail Scale and the patients’ hospital electronic health record.

Results: Our study included 189 patients (mean age: 83.2 ± 8.2, 73.0% female), representing 91 not frail to mildly frail (48.2%; NF-MF), 32 moderately frail (16.9%; ModF), and 66 severely frail (34.9%; SF) patients. The ModF patients had a longer LOS (median: 20.0 days, IQR=22.5) compared to NF-MF patients (median: 11.0 days, IQR=10.0, p=0.039, Kruskal-Wallis test) and SF patients (median: 8 days, IQR=5.5, p<0.0001, Kruskal-Wallis test). More ModF patients (56.3%) required an ALC stay in acute care compared to NF-MF (30.8%) and SF (28.8%) patients (p=0.016, Chi-square test). More SF patients (28.8%) died in hospital or within six months post-discharge compared to NF-MF (8.8%) patients (p=0.005, Chi-square test). Logistic regression revealed that both NF-MF (OR=8.11, 95% CI: [3.12-21.06], p<0.001) and ModF (OR=5.18, 95% CI: [0.85-0.95], p=0.007) patients had greater odds of returning home compared to SF patients when accounting for sex, age, and time to surgery.

Conclusions: A patient’s level of frailty prior to hospital admission impacts various health outcomes following a hip fracture and may provide helpful information for guiding treatment as well as discussions about health care.  

An 85-year-old male presented with a hip fracture following an accidental fall. His medical history included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus.

He underwent intramedullary nail insertion, supplemented with a plate and screws, for a subtrochanteric fracture. Post-operatively, he received four units of red blood cells for low haemoglobin. He was unable to mobilise due to persistent swelling and pain, and recurrent drops in haemoglobin levels despite multiple transfusions, with no evidence of visible bleeding from the wound or other sites.  However, pelvic x-rays showed stable fixation of the hip.

The patient subsequently developed extensive deep vein thrombosis in the contralateral leg and was started on a therapeutic dose of low molecular weight heparin. Further acute drops in his haemoglobin prompted an ultrasound of his hip, which identified an intramuscular hematoma. A CT angiogram confirmed active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The imaging also revealed a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. The patient underwent coil embolisation under radiological guidance, successfully achieving complete haemostasis.

Following the procedure, pain and swelling improved, haemoglobin levels remained stable, and he tolerated full anticoagulation without further drops in haemoglobin. Additionally, his mobility improved, and he transferred to a rehabilitation unit before being discharged home.

CONCLUSION

Pseudoaneurysms following hip fracture surgery are rare. Persistent drops in haemoglobin, along with pain, swelling, and stable fixation of an intramedullary nail, should raise suspicion for a haematoma, warranting further investigation with a CT angiogram.