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Xie C, Luo H. Comment on "Cognitive impairment and risks of osteoporosis: A systematic review and meta-analysis". Arch Gerontol Geriatr 2024; 117:105250. [PMID: 37952419 DOI: 10.1016/j.archger.2023.105250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Chengxin Xie
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Department of Endocrinology, Ministry of Education, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hua Luo
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
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Xie C, Wang C, Luo H. Increased risk of osteoporosis in patients with cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2023; 23:797. [PMID: 38049723 PMCID: PMC10694915 DOI: 10.1186/s12877-023-04548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Both osteoporosis and cognitive impairment affect overall health in elderly individuals. This study aimed to investigate the association between cognitive impairment and the risk of osteoporosis. METHODS PubMed, Web of Science, and the Cochrane Library were searched for studies on the association between osteoporosis and cognitive impairment from their inception until August 2023. The random-effects model was used to calculate the pooled risk ratio (RR) of osteoporosis in patients with cognitive impairment. Subgroup analysis was used to detect the sources of heterogeneity. Sensitivity analysis was used to test the robustness of the pooled results. Funnel plots, Egger's test, and Begg's test were used to test publication bias. RESULTS Ten studies involving 9,872 patients were included in this meta-analysis. The pooled results showed that patients with cognitive impairment had an increased risk of osteoporosis (RR = 1.56, 95% confidence interval [CI]: 1.30-1.87, p < 0.001). Subgroup analysis showed that patients with Alzheimer's disease (AD) are at 1.7-fold risk of osteoporosis compared with the control group (RR = 1.70, 95% CI: 1.23-2.37, p = 0.001), and sex, cognitive classification, study region, study design, and study quality might be the sources of heterogeneity. Sensitivity analysis showed robustness of the pooled results. No significant publication bias was found (Begg's test, p = 0.474; Egger's test, p = 0.065). CONCLUSION Current evidence suggests that patients with cognitive impairment are at increased risk of osteoporosis, especially patients with AD.
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Affiliation(s)
- Chengxin Xie
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317099, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Department of Endocrinology, Ministry of Education, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Chenglong Wang
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318001, China
| | - Hua Luo
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317099, China.
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Zhao Y, Chen H, Qiu F, He J, Chen J. Cognitive impairment and risks of osteoporosis: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 106:104879. [PMID: 36462246 DOI: 10.1016/j.archger.2022.104879] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically assess the association between osteoporosis and cognitive impairment, and to provide new light on the prevention of cognitive impairment in patients with osteoporosis. METHOD A comprehensive research of Embase, Cochrane Library, PubMed, Web of Science, CNKI, Wangfang Data and VIP was performed from inception to January 2022, using the search term 'osteoporosis' and 'cognitive impairment'. Literature screening, data extraction and quality evaluation were conducted by two reviewers independently, and meta-analysis was performed by RevMan 5.4 software. RESULTS A total of 8 studies (136222 participants) were included. Meta-analysis showed that patients with osteoporosis had an increased risk of cognitive impairment [OR=2.01, 95% CI(1.63-2.48), P<0.01]. This initial meta-analysis had significant heterogeneity, and subgroup analysis suggested that potential heterogeneity in different study types, age and outcome indicators. CONCLUSION Patients with osteoporosis are at increased risk of cognitive impairment, and osteoporosis intervention could prevent or delay the onset of cognitive impairment for those at risk.
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Affiliation(s)
- Yangyang Zhao
- School of Medicine, Xiamen University, Xiamen, Fujian 361000, China
| | - Heqing Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Fei Qiu
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Jianquan He
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Jian Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China.
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Suryadevara V, Klüppel M, Monte FD, Willis MS. The Unraveling: Cardiac and Musculoskeletal Defects and Their Role in Common Alzheimer Disease Morbidity and Mortality. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1609-1621. [PMID: 32407731 DOI: 10.1016/j.ajpath.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/02/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
Alzheimer disease (AD) is characterized by deterioration of cognitive capabilities with an estimated 44 million individuals worldwide living with it. Beyond memory deficits, the most common AD co-morbidities include swallowing defects (muscle), fractures (bone, muscle), and heart failure. The underlying causes of these co-morbidities and their role in AD pathophysiology are currently unknown. This review is the first to summarize the emerging picture of the cardiac and musculoskeletal deficits in human AD. We present the involvement of the heart, characterized by diastolic heart failure, the presence of amyloid deposits, and electrophysiological changes, compared with age-matched control subjects. The characteristic musculoskeletal defects in AD come from recent clinical studies and include potential underlying mechanisms (bone) in animal models. These studies detail a primary muscle weakness (without a loss of muscle mass) in patients with mild cognitive impairment, with progression of cognitive impairment to AD associating with ongoing muscle weakness and the onset of muscle atrophy. We conclude by reviewing the loss of bone density in patients with AD, paralleling the increase in fracture and fall risk in specific populations. These studies paint AD as a systemic disease in broad strokes, which may help elucidate AD pathophysiology and to allow for new ways of thinking about therapeutic interventions, diagnostic biomarkers, and the pathogenesis of this multidisciplinary disease.
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Affiliation(s)
- Vidyani Suryadevara
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Klüppel
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Federica Del Monte
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Monte S Willis
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana; Section of Cardiology, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Park J, Tolea MI, Sherman D, Rosenfeld A, Arcay V, Lopes Y, Galvin JE. Feasibility of Conducting Nonpharmacological Interventions to Manage Dementia Symptoms in Community-Dwelling Older Adults: A Cluster Randomized Controlled Trial. Am J Alzheimers Dis Other Demen 2020; 35:1533317519872635. [PMID: 31533443 PMCID: PMC10623920 DOI: 10.1177/1533317519872635] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed the feasibility of conducting 3 nonpharmacological interventions with older adults in dementia, exploring the effects of chair yoga (CY), compared to music intervention (MI) and chair-based exercise (CBE) in this population. Using a cluster randomized controlled trial (RCT), 3 community sites were randomly assigned 1:1:1 to CY, MI, or CBE. Participants attended twice-weekly 45-minute sessions for 12 weeks. Thirty-one participants were enrolled; 27 safely completed the interventions and final data collection (retention rate of 87%). Linear mixed modeling was performed to examine baseline and longitudinal group differences. The CY group improved significantly in quality of life compared to the MI group (CY mean = 35.6, standard deviation [SD] = 3.8; MI mean = 29.9, SD = 5.3, P = .010). However, no significant group differences were observed in physical function, behavioral, or psychological symptoms (eg, for mini-PPT: slopetime = 0.01, standard error [SE] = 0.3, P = .984 in the CBE group; slopetime = -0.1, SE = 0.3, P = .869 in the MI group; slopetime = -0.3, SE = 0.3, P = .361 in the CY group) over the 12-week intervention period. Overall, this pilot study is notable as the first cluster RCT of a range of nonpharmacological interventions to examine the feasibility of such interventions in older adults, most with moderate-to-severe dementia. Future clinical trials should be conducted to examine the effects of nonpharmacological interventions for older adults with dementia on health outcomes.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Diane Sherman
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Amie Rosenfeld
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Victoria Arcay
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Yve Lopes
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
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Kim HJ, Jang SN, Lee JK, Ha YC. Fracture Experiences and Long-Term Care Initiation among Older Population: Analysis of Korean National Health Insurance Service-Senior Cohort Study. Ann Geriatr Med Res 2019; 23:115-124. [PMID: 32743299 PMCID: PMC7370766 DOI: 10.4235/agmr.19.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term care is a burden on individuals, families, and society. It is important to find ways to delay the onset of disability to lessen the burden of long-term care in aging societies. Fracture is one of the risk factors that affect physical functions and make older people dependent. This study aimed to examine how much more often older adults who experienced fractures initiated long-term care compared to those who did not, and whether the risk of entering long-term care differed significantly by fracture site. METHODS The analyses included insurants aged 65 years and over from the Korean National Health Insurance Service-senior cohort study (2002-2013). Cox proportional hazard models were used to calculate the hazard ratios of the first certification of initiation of long-term care after fracture, by fracture site, and for multiple recurrent fractures. RESULTS The incidence rate of initial long-term care beneficiaries was approximately 2.5 times higher when older people had experienced fractures; these individuals entered long-term care beneficiary status 3 years earlier compared to those who had no fracture events. Lower extremity fracture and multiple recurrent fractures more than doubled the risk for long-term care. CONCLUSION Additional attention to fracture sites in prevention and rehabilitation settings is warranted to reduce disability and the related long-term care burden.
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Affiliation(s)
- Hye-jin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soong-nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ja-kyung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Peng K, Tian M, Andersen M, Zhang J, Liu Y, Wang Q, Lindley R, Ivers R. Incidence, risk factors and economic burden of fall-related injuries in older Chinese people: a systematic review. Inj Prev 2019; 25:4-12. [PMID: 30670560 DOI: 10.1136/injuryprev-2018-042982] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE China's population is ageing and fall-related injury in older Chinese people is a growing public health concern. This review aims to synthesise existing evidence on the incidence, risk factors and economic burden of fall-related injury among older Chinese people to inform health service planning. METHODS A systematic search of literature on falls and injury among older people living in China was performed in six electronic databases including both English and Chinese databases. Results were combined using narrative synthesis due to the heterogeneity of included studies. RESULTS A total of 93 studies from Mainland China, Taiwan and Hong Kong were included in this review. Most of these studies were descriptive; 82 reported the incidence of fall-related injury among older Chinese people, 7 studies examined the risk factors for fall-related injury and 22 studies described the economic burden of fall-related injury. The incidence of fall-related injury reported among older Chinese people ranged from 0.6% to 19.5%. Risk factors significantly associated with fall-related injury among older Chinese included older age, female sex, walking aid use, living environments, chronic disease, medication usage, visual impairment and a fall direction other than forward. The cost of fall-related injury among older Chinese people ranged from US$16 to US$3812 per person per fall. CONCLUSION Falls-related injuries are a significant public health issue for older Chinese people. Further studies using prospective design to identify risk factors and the economic burden of fall-related injuries are needed.
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Affiliation(s)
- Ke Peng
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia .,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Melanie Andersen
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yishu Liu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Qilong Wang
- Peking University Fourth Clinical Medicine School at Jishuitan Hospital, Beijing, China
| | - Richard Lindley
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Burgon C, Darby J, Pollock K, van der Wardt V, Peach T, Beck L, Logan P, Harwood RH. Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study. BMJ Open 2019; 9:e025702. [PMID: 30755449 PMCID: PMC6377506 DOI: 10.1136/bmjopen-2018-025702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia. DESIGN This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis. SETTING Community-based falls and memory assessment services in the East Midlands, UK. PARTICIPANTS Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1). RESULTS Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients' poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia. CONCLUSIONS Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
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Affiliation(s)
- Clare Burgon
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Janet Darby
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Veronika van der Wardt
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Lyndsay Beck
- Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan H Harwood
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Health Care of Older People, Nottingham, UK
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Möllers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry 2019; 34:8-21. [PMID: 30260050 DOI: 10.1002/gps.4993] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. METHODS A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. RESULTS Fifty-two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was -2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was -2.9 to +12.4 and -11.2 to +21.8 days, respectively. CONCLUSIONS The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Wenjia Wei
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Association between Osteoporosis, Bone Mineral Density Levels and Alzheimer's Disease: A Systematic Review and Meta-analysis. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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