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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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Xu L, Xue C, Yang K, Chen L, Chen X, Xie X, Wang J, Wang X, Wang L. A latent class analysis of community-based rehabilitation needs among Chinese older adults: a mixed study protocol. Front Public Health 2024; 11:1301752. [PMID: 38283286 PMCID: PMC10811259 DOI: 10.3389/fpubh.2023.1301752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Background Geriatric diseases (e.g., chronic diseases and geriatric syndromes) may result in impaired physical performance and a decline in the quality of life. The results of previous studies reported the positive effects of comprehensive community-based rehabilitation (CBR) services on physical and social functioning and psychosocial wellbeing. However, to provide adequate and personalised rehabilitation services, it is essential to understand the needs of the older adults population. There have been no studies on the need for CBR in older adults populations that consider their heterogeneity. Therefore, high-quality studies are required to recognise the heterogeneity and latent classes of CBR needs in older adults population groups. This study aims to identify the heterogeneity of the rehabilitation needs of older adults in the community and explore whether older adults with similar characteristics have similar needs through a cross-sectional survey and latent class analysis (LCA) to provide support for personalised rehabilitation services. Methods The study is structured into four phases. The first phase will focus on constructing a comprehensive questionnaire to assess rehabilitation needs. In the second phase, a pilot study will be conducted to evaluate the reliability and validity of the completed questionnaire. This step ensures the robustness of the instrument for data collection. The third phase will involve cross-sectional surveys using the finalised questionnaires to collect the necessary data from the targeted population. The fourth phase will focus on conducting LCA to determine the CBR needs of the older adult population. Discussion The results of this study will provide novel and critical information for a better understanding of the rehabilitation needs, potential categories, and influencing factors of older adults in the community. The study will be conducted in Guizhou Province in western China, where economic and social development is relatively low, and the results will inform and benefit other regions and developing countries facing similar challenges. However, because of the complete social security and rehabilitation service systems in developed areas, our research results may not fully reflect the situation in these areas. Future studies may need to be conducted in places with different levels of social development. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=191398, ChiCTR2300071478.
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Affiliation(s)
- Lei Xu
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Caixiu Xue
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Ke Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Lingyun Chen
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xidong Chen
- Department of Neurological Rehabilitation, Geriatric Rehabilitation Hospital Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiaohui Xie
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jia Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xueting Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
| | - Lianhong Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing College, Zunyi Medical University, Zunyi, Guizhou, China
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Avendaño-Estrada A, Olarte-Casas MÁ, Ávila-Rodríguez MÁ. Vectorial-based analysis of dual-tracer PET imaging: A proof of concept. Comput Biol Med 2024; 168:107705. [PMID: 37979207 DOI: 10.1016/j.compbiomed.2023.107705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The diagnosis of neurological diseases is complicated since they often share similar symptoms and occur in different severity levels. Imaging techniques such as PET molecular imaging are helpful for an early and accurate diagnosis and, staging allowing a noninvasive evaluation of the disease. The combination of two radioligands in the same patient could be valuable to achieve these diagnostic goals; nevertheless, the imaging data obtained with two radioligands is commonly interpreted independently. This novel approach to combine the PET data of two radiopharmaceuticals, separately acquired in the same subject, is to obtain new quantitative metrics. PET images of patients with Parkinson's disease (PD) and healthy controls (HC) were analyzed. Voxel-by-voxel uptake is compared by combining the imaging data. Dual-tracer PET imaging analysis was tested with [11C]DTBZ-[11C]Raclopride as proof of concept. RESULTS The new proposed metric based on a resultant vector is capable of efficiently discriminating healthy controls from PD patients (p < 0.0001) allowing the detection of slight changes in patients undergoing therapeutic approaches. Significant differences were found between HC and PD patients for the evaluated radiotracers. CONCLUSIONS The resultant vector appears to deliver useful information that could be helpful to evaluate PD patients under treatment and to improve differential diagnoses.
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Affiliation(s)
- Arturo Avendaño-Estrada
- Unidad Radiofarmacia-Ciclotrón, Facultad de Medicina, División de Investigación, Universidad Nacional Autónoma de México, Mexico; Centro de Investigación sobre el Envejecimiento, Centro de Investigación y de Estudios Avanzados Sede Sur, Mexico.
| | - Miguel Ángel Olarte-Casas
- Unidad PET/CT, Facultad de Medicina, División de Investigación, Universidad Nacional Autónoma de México, Mexico
| | - Miguel Ángel Ávila-Rodríguez
- Unidad Radiofarmacia-Ciclotrón, Facultad de Medicina, División de Investigación, Universidad Nacional Autónoma de México, Mexico; Centro de Investigación sobre el Envejecimiento, Centro de Investigación y de Estudios Avanzados Sede Sur, Mexico.
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Sharkiya SH. Impact of healthcare service quality on older people's satisfaction at geriatric medical centers: a rapid review. J Public Health Afr 2023; 14:2685. [PMID: 37859704 PMCID: PMC10583495 DOI: 10.4081/jphia.2023.2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Older adults are concerned about the quality of care as many of them are vulnerable to the co-occurrence of geriatric syndromes and age-related diseases due to accumulated impairments in multiple systems. Literature indicates that though people are living longer, they are not necessarily living healthier, which creates the need for providing quality healthcare services specifically to address the needs of this population. B This rapid review investigates the impact of healthcare service quality on older people's satisfaction at geriatric medical centers. Methods The rapid review includes 11 articles from searches on PubMed, PsycINFO and Google Scholar. Results The reviewed studies indicate that the quality of healthcare services to older adults enhances their satisfaction at senior facilities and produces positive patient outcomes. A thematic analysis of these studies revealed four major themes related to the review topic: perceived quality of healthcare services, patients' quality of life, patient satisfaction, and provider-patient communication. Implications for practice Nurses should provide high-quality care to older adults in geriatric settings to improve patients' and their families' satisfaction. Nurses should target quality leadership, implement quality improvement, and communicate effectively. Nurses should also offer patient-centered care by involving family members in care planning.
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Affiliation(s)
- Samer H. Sharkiya
- Faculty of Graduate Studies, Arab American University, PhD in Nursing, Jenin, Zababdeh, Palestine
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Wu L, Pei H, Zhang Y, Zhang X, Feng M, Yuan L, Guo M, Wei Y, Tang Z, Xiang X. Association between Dried Fruit Intake and DNA Methylation: A Multivariable Mendelian Randomization Analysis. J Nutr Health Aging 2023; 27:1132-1139. [PMID: 37997736 DOI: 10.1007/s12603-023-2030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Observational studies have reported associations between dried fruit intake and DNA methylation(DNAm). However, inherent flaws in observational study designs make them susceptible to confounding and reverse causality bias. Consequently, it is unclear whether a causal association exists. In the present study, we aimed to investigate the causal associations between dried fruit intake and DNAm. METHODS We performed two-sample Mendelian randomization (MR) using the IEU Open GWAS database aggregated data. Forty-three single nucleotide polymorphisms (SNPs) associated with dried fruit intake as instrumental variables (IVs) were selected as exposure. DNAm outcomes include Gran (estimated granulocyte proportions); AgeAccelGrim(GrimAge acceleration); Hannum (Hannum age acceleration); IEAA(Intrinsic epigenetic age acceleration), AgeAccelPheno( PhenoAge acceleration), and DNAmPAIadjAge (DNAm-estimated plasminogen activator inhibitor-1 levels). We used the MR pleiotropy residual sum and outlier test (MRPRESSO) and Radial-MR test to identify any level of multi-effect outliers and assessed the causal effect estimates(after removing outliers). The primary causal effects were estimated using inverse-variance weighted (IVW) method and undertook sensitivity analyses using MR methods robust to horizontal pleiotropy.The direct effects of dried fruit intake on DNAm were estimated using multivariable mendelian randomization (MVMR). RESULTS Leveraging two-sample MR analysis, we observed statistically significant associations between dried fruit intake with a lower AgeAccelGrim(β=-1.365, 95% confidence intervals [CI] -2.266 to -0.464, PIVW=2.985×10-3) and AgeAccelPheno (β= -1.933, 95% CI -3.068 to -0.798, PIVW=8.371×10-4). By contrast, the effects level on Gran (β=0.008, PIVW=0.430), Hannum(β=-0.430, PIVW=0.357), IEAA(β=-0.184, PIVW=0.700), and DNAmPAIadjAge (β=-1.861, PIVW=0.093) were not statistically significant. MVMR results adjusting for the potential effects of confounders showed that the causal relationship between dried fruit intake and AgeAccelGrim(β= -1.315, 95% CI -2.373 to -0.258, PIVW=1.480×10-2) and AgeAccelPheno(β= -1.595, 95% CI -2.987 to -0.202, PIVW=2.483×10-2) persisted. No significant horizontal polymorphism was found in the sensitivity analysis. CONCLUSION Our MR study suggested that increased dried fruit intake is associated with slower AgeAccelGrim and AgeAccelPheno. It can providing a promising avenue for exploring the beneficial effects of dried fruit intake on lifespan extension.
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Affiliation(s)
- L Wu
- Xiqiao Xiang. Department of PET Imaging Center, Shanghai Jiaotong University Affiliated Sixth People Hospital South Campus. Shanghai, 201499, China. E-mail:
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Bellos TC, Tzelves LI, Manolitsis IS, Katsimperis SN, Berdempes MV, Skolarikos A, Karakousis ND. Frailty and benign prostatic hyperplasia: The thrilling underlying impact. Arch Ital Urol Androl 2022; 94:345-349. [DOI: 10.4081/aiua.2022.3.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background: World population is aging. The number of individuals aged over 65 are expected to be 71 million only in the US. 43% of this population will be men. Benign prostatic hyperplasia (BPH), defined as the benign neoplasm of the prostate gland affects 8% of men by their forties, but 90% of men over 90 years old. Lower urinary tract symptoms (LUTS) can be caused by an enlarged prostate, and it seems to be associated more with older and frailer individuals. Methods: The purpose of this study is to review the potential interplay between frailty syndrome and benign prostatic hyperplasia. A thorough MEDLINE/PubMed non-systematic literature review was conducted from 1990 to March of 2022. The terms used for the search were “frailty and benign prostatic hyperplasia” and “low muscle mass and benign prostatic hyperplasia”. Results: It seems that, frailty poses a negative impact on the prognosis of patients with BPH, as it is associated with increased incidence of LUTS. In addition, frailty seems to be a strong predictor concerning surgical procedure failure and mortality following invasive procedures for BPH. Prostatic stent placement on the other hand appears to be the ideal solution for frail patients. Conclusions: BPH has a strong association with frailty and increasing age.
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