Impact of intrinsic capacity on predicting future falls and readmission in older patients / 中华老年医学杂志

Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.

The associations of malnutrition, sarcopenia and disability in older hospitalized patients / 中华老年医学杂志

Objective:To explore the associations of malnutrition, sarcopenia and disability in older hospitalized patients.Methods:A retrospective study was conducted on 180 patients who were admitted to the department of geriatrics of our hospital from November 2015 to September 2020 and completed 1-year follow-up.Malnutrition and sarcopenia were diagnosed as the Global Leadership Initiative on Malnutrition(GLIM)criteria and the 2019 sarcopenia criteria issued by the Asian Working Group for Sarcopenia(AWGS2019).Disability was defined as a score of less than or equal to 95 on the Barthel Index(BI).At the end of the 1-year follow-up, a decrease of ≥5 points in the total BI score from baseline was defined as aggravation of the disability.Multivariate Logistic regression models were used to analyze the effects of malnutrition and sarcopenia on the occurrence and aggravation of the disability.Results:Among the 180 elderly patients, 27.2%(49/180)met the diagnosis of malnutrition and 39.4%(71/180)of sarcopenia, and 22.2%(40/180)of malnutrition and sarcopenia overlapped.The incidence of disability was 36.7%(66/180)at baseline and the incidence of an aggravation of disability was 31.7%(57/180)at 1-year follow-up.After adjustment for confounding factors, multivariate Logistic regression analysis showed that malnutrition( OR=3.70, 95% CI=1.27-10.80, P=0.017)and sarcopenia( OR=2.93, 95% CI=1.12-7.64, P=0.028)were risk factors for disability in elderly patients, and sarcopenia was a risk factor for aggravation of disability in elderly patients after a 1-year follow-up( OR=3.99, 95% CI=1.47-10.83, P=0.007). Conclusions:Malnutrition and sarcopenia are closely associated with the occurrence and development of disability in older hospitalized patients.

Influence of geriatric syndromes on physical performance and fall risk in elderly patients with type 2 diabetes mellitus / 中华老年医学杂志

Objective:To investigate the impact of geriatric syndromes on physical performance and fall risk in elderly patients with type 2 diabetes mellitus.Methods:A total of 179 elderly inpatients and outpatients with diabetes mellitus in the geriatric department of Zhejiang Hospital were recruited in this cross-sectional study.According to the number of geriatric syndromes including frailty, cognitive impairment, malnutrition, depression, poly-pharmacy and co-morbidity, patients were classified into Group A(n=40, with ≤1 geriatric syndrome), Group B(n=84, with 2-3 geriatric syndromes)and Group C(n=55, with ≥4 geriatric syndromes). Clinical data and physical performance status, fall risk and one-year fall history were compared between the groups.Effects of each geriatric syndrome on disability in daily life, balance and gait ability, and increased fall risk in elderly patients were further analyzed.Results:Patients with more geriatric syndromes were older, had a higher proportion of using walking aids and a higher prevalence of disability in daily life, balance and gait impairment, and increased fall risk( P<0.05). Furthermore, univariate and multivariate Logistic regression indicated that frailty and malnutrition were risk factors for disability in daily life( OR=3.467 and 3.369, P<0.05)and balance and gait impairment( OR=3.031 and 3.266, P<0.05), and that cognition impairment was a risk factor for increased fall risk( OR=2.559, P<0.05)and balance and gait impairment( OR=3.930, P<0.05). Conclusions:Frailty, malnutrition and cognition impairment can lead to physical performance impairment and increased fall risk in elderly patients with type 2 diabetes mellitus.Clinical intervention should be conducted to improve the quality of life in elderly adults.

Detection rate and risk factors analysis of motoric cognitive risk syndrome / 中华老年医学杂志

Objective To investigate the detection rate of motoric cognitive risk syndrome (MCR)and explore the possible risk factors.Methods A total of 429 elderly patients from geriatric department of Zhejiang Hospital from October 2014 to September 2018 were recruited in the crosssectional study.General information and functional assessment including fall history,self-reported visual impairment and hearing impairment,depressive symptom,cognitive function and gait speed were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Multiple logistic regression analysis was used to analyze the associated risk factors.Results Seventeen patients(4.0％)met the MCR diagnostic criteria.The proportions of obesity,polypharmacy,cerebral vascular diseases,self-reported hearing impairment,depressive symptoms and slow gait were higher in MCR patients than in non-MCR patients(P＜0.05).Compared with non-MCR patients,MCR patients had lower mini mental state examination (MMSE) scores (P ＜ 0.01).After adjusting for associated confounding factors,multiple logistic regression analysis showed obesity (OR =3.74,95 ％ CI:1.14-12.23,P ＜ 0.05) and depressive symptoms (OR =5.79,95％ CI:1.76-19.06,P ＜ 0.01) were risk factors for MCR.Conclusions MCR is not uncommon in elderly patients.Obesity and depressive symptoms are closely associated with an increased risk of MCR.

Vitamin D supplementation decreases the expression of TGF-β1 in rats with asthma and thereby suppressing airway remodeling / 中国医师杂志

Objective To investigate the preventive and therapeutic effects of 1,25-(OH) 2D3 on airway remodeling in asthmatic rats,and to explore the effect of 1,25-(OH) 2D3 on the expression of transforming growth factor-β 1 (TGF-β 1) and the related mechanism between them.Methods Seventy male Sprague Dawley (SD) rats were randomly divided into seven groups:normal control group (group A,n =10),asthmatic group (group B,n =10),dexamethasone group (group C,n =10),1,25-(OH)2D3 2 μg/(kg·d) group (group D,n=10),1,25-(OH)2D3 4 μg/(kg · d) group (group E,n =10),1,25-(OH)2D3 8 μg/(kg · d) group (group F,n =10),1,25(OH)2D3 16 μg/(kg · d) group (group G,n=10).Rats were sensitized and challenged with ovalbumin (OVA) to establish the asthmatic model in B,C,D,E,F,G group respectively.Rats in group B and group C were fed with normal saline 10 ml/(kg · d) and dexamethasone 2 mg/(kg · d) before atomization.While group D-G was 1,25-(OH)2D3 intervention group,rats were fed with vitamin D 2,4,8,16 μg/(kg · d) before atomization.The number of total and different cells of the bronchoalveolar lavage fluid (BALF) from the 7 groups was counted for analysis;The change of the thickness,the area of airway wall and the number of ASMC nucleus and pulmonary tissue changes were observed by microscope.The protein and mRNA expression of TGF-β1 in the lung tissue was measured by immunochemistry and real-time polymerase chain reaction (RT-PCR).Results (1) The airway remodeling and pulmonary inflammatory exudation in the B group were significantly heavier than those in the A,C and G groups (P ＜0.01);and the difference between groups of different doses of vitamin D [D group (minimum dose) and G group(the maximum dose)] was statistically significant (P ＜ 0.01).(2) The results of TGF-β1 mRNA and protein levels in rats of each group showed that the expression level of TGF-β1 mRNA and integrated option density (IOD) value in A group were significantly lower than those in other groups (P ＜0.01);the expression level of TGF-β1 mRNA and IOD value in B group was higher than the other groups (P ＜0.01);Compared with the B group,the expression level of TGF-β1 mRNA and IOD value in G group (large dose vitamin D group) was decreased,with statistically difference.Conclusions In the rat model of asthma,1,25-(OH) 2D3 may alleviate airway remodeling by regulating the expression of TGF-beta 1 and play its opposite biological effect in the prevention and treatment of asthma.

The associations of depressive symptoms with cognitive and physical functions and frailty in elderly outpatients / 中华老年医学杂志

Objective To explore the associations of depressive symptoms with functional status and frailty in elderly outpatients.Methods A total of 297 geriatric outpatients(aged 65 years and over) from Zhejiang Hospital were recruited in the cross-sectional study from January 2014 to December 2015.We gathered general information,and evaluated depressive symptoms by Geriatric Depression Scale-15 (GDS-15),cognitive function by mini-mental state examination(M MSE),frailty by clinical frailty scale(CFS),activities of daily living (ADL)by Barthel index,instrumental activities of daily living (IADL),balance,POMA and gait by Tinetti-performance oriented mobility assessment (Tinetti-POMA),grip strength and 4m gait speed by 4-meter walk gait speed test.According to the GDS-15 scores,297 geriatric outpatients were divided into a depression symptom group(n=35,GDS-15 ≥6)and a nomdepressive symptom group(n=262,GDS-15＜6).The frailty and functional status were compared between two groups by SPSS 23.0.Results As compared with non-depressive symptoms,the depressive symptoms group had higher clinical frailty scale(CFS),lower body mass index(BMI),lower cognitive function and poorer grip strength and balance(all P＜0.05).There were significantly negative correlations of Geriatric Depression Scale-15 (GDS-15) with ADL,IADL,gait,balance,POMA and grip strength(r=-0.165、-0.154、-0.216、-0.291、-0.305、-0.314,All P＜ 0.05),while there were significantly positive correlations with CFS score,gait speed(r=0.256、0.198,both P＜0.05).The more severe the frailty was,the higher the risk of depressive symptoms was(OR=3.650,95％ CI 1.611-8.271).Conclusions The cognitive and physical functions in the elderly with depression symptoms are poorer as compared with the elderly without depression symptoms.Elderly outpatients with more severe frailty have a higher risk for depressive symptoms.