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The maintenance of skeletal muscle mass relies on mitochondrial quality control, including balanced dynamics and mitophagy. Dynamin-related protein 1 (Drp1), a central mediator of mitochondrial fission, is essential for these processes, yet its role in muscle mass regulation remains incompletely defined. Here, we show that acute Drp1 deletion in the skeletal muscle increases Parkin-mediated mitochondrial degradation, reduces mitochondrial DNA (mtDNA) content, and leads to severe muscle atrophy. Although dual deletion of Drp1 and Parkin restores mtDNA content, muscle loss persists. Mechanistically, Drp1 loss impairs mitochondrial respiratory chain activity, suppressing extracellular signal-regulated kinase 1/2 (Erk1/2) signaling and down-regulating the nuclear receptor subfamily 4 group A member 1 (Nur77). Pharmacologic β2-adrenergic receptor activation with clenbuterol reactivated Erk1/2, restored Nur77 expression, and rescued muscle atrophy. These findings define a Drp1-Erk1/2-Nur77 signaling axis linking mitochondrial integrity to skeletal muscle mass and identify a potential therapeutic target for muscle degeneration in mitochondrial and metabolic diseases.
The implementation of humanistic care services in nursing homes is of great importance for improving the quality of life of older people, enhancing their sense of self-worth, and meeting their spiritual and psychological needs. However, there is currently a lack of standardized criteria and validated tools for the systematic assessment of the quality of humanistic care in nursing homes. Therefore, the aim of this study was to develop a comprehensive indicator system for evaluating the quality of humanistic care in nursing homes. Guided by the Quality Caring Model and Maslow's hierarchy of needs theory as the theoretical framework, an initial evaluation indicator system was developed through a literature review and semi-structured interviews. Based on the preliminary indicator system, an expert consultation questionnaire was designed, and two rounds of Delphi expert consultation were conducted with 32 experts from relevant fields to further refine and optimize the evaluation indicator system by integrating expert opinions. Subsequently, the Analytic Hierarchy Process was applied to determine the weight of each indicator, and consistency testing was performed. The effective recovery rates of the two rounds of expert consultation questionnaires were 94.12% and 100.00%, respectively, and the expert authority coefficients were 0.850 and 0.859. The Kendall's coefficients of concordance for the two rounds of expert consultation were 0.167 and 0.269, respectively (P < 0.001). Ultimately, a quality evaluation indicator system for humanistic care in nursing homes was established, comprising 3 primary-level indicators, 10 secondary-level indicators, and 38 tertiary-level indicators. The quality evaluation indicator system for humanistic care in nursing homes developed in this study demonstrates a certain degree of scientific rigor and rationality. It can provide a theoretical reference for promoting the standardization of humanistic care processes and the systematization of quality management in nursing homes in China, and offers a systematic framework for the subsequent evaluation and improvement of the quality of humanistic care.
While M2 macrophages are known to facilitate tissue repair, the specific paracrine mechanisms by which they modulate cardiomyocyte responses during hypertensive cardiac remodeling remain largely undefined. This study aimed to elucidate the role of M2 macrophage-derived exosomes (M2-exo) in regulating cardiac homeostasis under hypertensive stress and to identify the specific molecular cargo responsible for these effects. Exosomes were isolated from IL-4/IL-13-stimulated mouse peritoneal macrophages (M2-exo) and characterized via transmission electron microscopy, nanoparticle tracking analysis, and immunoblotting. The therapeutic potential of M2-exo was evaluated in Angiotensin II (Ang II)-infused hypertensive mice and in primary neonatal rat cardiomyocytes and fibroblasts in vitro. The underlying molecular mechanisms were dissected using miRNA sequencing, luciferase reporter assays, and AAV9-mediated gene transfer. Systemic administration of M2-exo markedly attenuated Ang II-induced cardiac hypertrophy and fibrosis in mice. In vitro, M2-exo suppressed fibrotic gene expression in cardiac fibroblasts and reduced hypertrophic growth in cardiomyocytes. miRNA profiling revealed enrichment of microRNA-124 (miR-124) in M2-exo compared to M0-exo. AAV9-mediated overexpression of miR-124 recapitulated the protective effects of M2-exo in vivo. Capn1, encoding Calpain-1, was identified as a direct target of miR-124. Both pharmacologic inhibition of Calpain-1 (MDL28170) and AAV9-mediated overexpression of calpastatin, an endogenous Calpain inhibitor, improved cardiac remodeling. However, these interventions did not further enhance the effects of M2-exo. Our study uncovers a novel immunomodulatory axis wherein M2 macrophages mitigate hypertensive cardiac remodeling via the exosomal transfer of miR-124. By directly targeting Capn1 to suppress deleterious Calpain-1 activation, the M2-exo/miR-124/Calpain-1 axis preserves myocardial structural integrity, presenting a precise therapeutic target for hypertensive heart disease.
Dementia prevalence is projected to rise most sharply in low-and middle-income countries, including Brazil. The Brazilian Black population (including individuals identified as Black and Brown) represents 56.5% of the population and is expected to comprise most older adults in the coming decades. This narrative review aims to synthesize studies on dementia, cognitive decline, and cognitive aging among Black Brazilians, analyzing publication characteristics and key findings to identify knowledge gaps and propose directions for future research. We searched PubMed, LILACS, and SciELO databases, and the SciSpace AI-powered tool. Eligible studies included those that: (a) examined the Brazilian Black population; and (b) provided descriptions or analyses of characteristics, clinical manifestations, risk factors, or responses to interventions related to cognitive decline, cognitive aging, and dementia. Publications that were not full-length articles were excluded. We identified 18 papers (2000-2025), mostly cross-sectional, published in international journals. The median proportion of Black participants among samples was 39.5%. Seven studies were conducted in the state of São Paulo, and ten were carried out in the Southeast region of Brazil. A recurring sociodemographic feature in nine studies was the low educational attainment among Black participants. Twelve studies identified modifiable risk factors for dementia among black individuals, mainly related to socioeconomic disadvantages. Cognitive performance was assessed using various standardized instruments, such as the Mini-Mental State Examination and Clinical Dementia Rating Scale. We did not find studies about dementia care or any clinical trials. Our findings indicate the underrepresentation of Black individuals in dementia research. Ensuring the inclusion of Black populations in research requires investment in recruiting Black professionals into research teams, conducting interventions, and developing partnerships within Black communities. Existing Brazilian evidence suggests socioeconomic factors exert greater influence on cognitive function than genetic factors, underscoring the need for public policies that address social, income, healthcare access, and educational inequities. Beyond social investments, local research should develop culturally appropriate cognitive assessment tools and culturally compatible protective activities and lifestyles among marginalized populations. Finally, culturally tailored strategies for person-centered dementia care and carers' support are needed.
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Patients with type 2 diabetic mellitus (T2DM) who recover from acute kidney injury (AKI) face substantial risks of cognitive decline and kidney disease progression. Whether sodium-glucosecotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) differentially affect incident dementia in this setting is uncertain. We conducted a target trial emulation using TriNetX electronic health records (2015-2024). Adults with T2DM hospitalized for AKI requiring emergent dialysis (AKI-D) were indexed 90 days post-discharge and classified as users of SGLT2i or GLP-1 RAs within that window (intention-to-treat). One-to-one (1:1) propensity score matching (PSM) was performed to control for potential confounding factors. The primary outcome was incident degenerative and vascular dementia. The prespecified secondary outcomes included all-cause mortality, kidney events, and major adverse cardiovascular events (MACE). Among 14,460 eligible patients, SGLT2i users showed a lower risk of degenerative dementia (2.8% vs. 3.9%, aHR 0.78, 95% CI 0.63-0.97; p = 0.028; E value 2.58) and adverse kidney events (7.2% vs. 9.2%, aHR 0.82, 95% CI 0.71-0.95; p = 0.006; E value 2.15) than GLP-1 RAs users. No significant differences were observed for vascular dementia, mortality, or MACE. Safety profiles were similar, with fewer gastrointestinal adverse events in the SGLT2i group. In patients with T2DM recovering from AKI, SGLT2i therapy was associated with reduced risks of degenerative dementia and kidney disease progression compared with GLP-1 RAs. These results suggest that SGLT2i may be a favorable option for cognition during AKI recovery, though further prospective studies are needed to confirm these findings.
This review explores the emerging relationship between climate change and sarcopenia, a progressive loss of skeletal muscle mass and strength that contributes to frailty and disability in aging populations. It aims to synthesize current evidence on how climate-related stressors may influence muscle health and accelerate sarcopenia onset. We conducted a comprehensive literature review integrating findings from epidemiological studies, mechanistic research, and public health reports. Key climate stressors, including heat stress, air pollution, ultraviolet radiation changes, extreme weather events, and food insecurity, were examined for their biological and environmental impacts on muscle physiology. Vulnerable populations and geographic disparities were also analyzed. Climate stressors impair muscle health through distinct pathways: heat stress activates inflammatory and catabolic signaling; air pollution induces oxidative damage and mitochondrial dysfunction; reduced ultravoilet exposure compromises vitamin D synthesis; and food insecurity limits access to protein and micronutrients. These factors interact with aging physiology, exacerbating muscle decline. Older adults, women, and individuals in tropical, urban, or high-altitude regions are disproportionately affected due to physiological and socioeconomic vulnerabilities. Climate change is a modifiable risk factor for sarcopenia. Integrating environmental indicators into sarcopenia screening, promoting climate-resilient nutrition, and adapting geriatric care systems are essential for mitigating its impact. Interdisciplinary approaches are needed to address the compounded effects of climate stress and aging on muscle health and to inform public health strategies in a warming world.
Frailty is a clinical syndrome characterised by impaired homeostatic mechanisms and reduced physiological reserve. Hospital admissions for ambulatory care sensitive conditions (ACSCs) are commonly used as indicators of quality in primary healthcare. We aimed to examine the association between frailty and the use of healthcare resources, including unplanned hospital visits due to ACSCs and non-ACSCs and visits to general practitioners (GPs) and medical specialists (MSs) in primary care. We hypothesised that frail individuals would have similar odds of hospital visits due to ACSCs and non-ACSCs. Registry-based epidemiological study. Data from the Danish Lolland-Falster Health Study and national health registers. Data were collected in a rural region of Denmark between February 2016 and February 2020. 10 154 randomly selected individuals aged ≥50 years participating in the Lolland-Falster Health Study with valid frailty measurements. Hospital visits due to any diagnosis, hospital visits due to ACSCs and non-ACSCs, and visits to GPs and MSs in the primary care sector. After adjustment for age, sex, comorbidity and socioeconomic factors, frail participants had higher odds of hospital visits due to any diagnosis (OR 1.27, 95% CI 1.02 to 1.57; p=0.03). The odds of hospital visits due to ACSCs (OR 1.42, 95% CI 0.97 to 2.08; p=0.07) and non-ACSCs (OR 1.16, 95% CI 0.91 to 1.47; p=0.22) were not significantly different. Frail individuals had higher odds of visiting their GP (OR 1.21, 95% CI 1.00 to 1.46; p=0.047) but not a medical specialist (OR 0.82, 95% CI 0.62 to 1.07; p=0.15). Among frail individuals, the distinction between unplanned hospital visits due to ACSCs and non-ACSCs is not meaningful. This finding is consistent with the understanding of frailty as a state of reduced physiological reserve, in which minor stressors may lead to hospital care regardless of diagnostic category.
This narrative review examines the interplay between frailty, heart failure (HF), and endothelial dysfunction, with a specific focus on the role of exercise-based cardiac rehabilitation (CR) in older and frail adults. Frailty and HF frequently coexist and share pathophysiological mechanisms - including chronic inflammation, oxidative stress, and impaired nitric oxide (NO) signaling - that exacerbate endothelial dysfunction and contribute to reduced functional capacity and poor prognosis. We synthesize current evidence linking endothelial impairment to both frailty and HF progression, and we evaluate findings from clinical trials investigating exercise-centered CR, hybrid CR, and cardiac telerehabilitation in this population. Across studies, CR consistently improves physical performance, exercise tolerance, and quality of life, with several trials reporting measurable enhancements in endothelial function, such as improved flow-mediated dilation or increased mobilization of endothelial progenitor cells. Benefits appear strongest when programs are multidomain and individualized to the frailty phenotype, integrating aerobic, resistance, balance, and mobility training. However, heterogeneity in study designs, limited enrollment of frail older adults, and the frequent designation of endothelial outcomes as secondary endpoints constrain the ability to draw firm mechanistic conclusions. Overall, available evidence indicates that CR is a feasible and effective therapeutic strategy to counteract vascular dysfunction, reduce frailty severity, and potentially disrupt the negative cycle that accelerates HF progression in older patients. Future studies should prioritize frail populations, adopt standardized endothelial assessments as primary outcomes, and evaluate long-term clinical impact. Tailored CR models, including hybrid and telerehabilitation programs, are likely essential to improve access, adherence, and vascular outcomes in this vulnerable group.
The number of older people in Germany has risen steadily in recent decades. One in four people is now aged 65 or over. As people age, their health problems tend to increase, as do their fundamental care needs. Nurses play a key role in addressing these needs through a holistic approach. To fulfil this responsibility effectively, it is necessary to examine existing nursing research on the fundamentals of care for older people and to identify gaps in the current evidence base. Therefore, we plan to conduct a mapping review with the aim of mapping the extent, range and nature of nursing research activities on the fundamentals of care, as defined in the physical, psychosocial and relational components of the Integration of Care dimension of the Fundamentals of Care Framework for older people in Germany. We will search the electronic databases PubMed/MEDLINE, CINAHL, CareLit and GeroLit, the catalogue of the German Federal Ministry of Research, Technology and Space and the German National Library for publications on nursing research based on the Integration of Care dimension of the Fundamentals of Care Framework among older people (≥ 65 years). There will be no time limit. We will include studies published in English and German. Initial screening of the first ten per cent of titles and abstracts and other stages will be carried out by two independent researchers. This process will be repeated until full agreement between the researchers. Any discrepancies will be resolved with consultation of a third reviewer. Results will be reported in a narrative synthesis and complemented by tabular and numerical presentations. To the best of our knowledge, this mapping review will be the first to provide an overview of current nursing research on the fundamentals of care for older people in Germany. The inclusion of German-language texts and the absence of time limits in this review are intended to complement previous reviews. The planned mapping review will also identify the evidence gap in research in this area and contribute to the determination of future scientific research in Germany. Consequently, the findings of the mapping review could be of great interest to nurses and other health professionals for evidence-based practice, research and educational programmes. In addition, the data can be used to develop a programme for the provision of age-friendly and caring living conditions for older people in the future. The protocol was registered with Open Science Framework (osf.io/9e3uv).
Small cell lung cancer (SCLC) is the most aggressive histological subtype of lung cancer and is characterized by rapid tumor proliferation, early dissemination, and poor prognosis. Currently, the standard first-line treatment for extensive-stage SCLC consists of platinum-based chemotherapy and immune checkpoint inhibitors. Although patients exhibit a high initial response rate to platinum-based chemotherapy, the majority develop acquired resistance within 6 months. Overcoming drug resistance and prolonging the duration of first-line therapy are critical for long-term survival in these patients. However, the definitive resistance mechanisms associated with chemotherapy and immunotherapy in SCLC remain unclear. In this context, we comprehensively review the diverse mechanisms contributing to therapeutic resistance in SCLC, including transcriptional subtype plasticity, the epithelial-mesenchymal transition, an enhanced DNA damage repair capacity, dysregulated autophagy and apoptosis, the presence of cancer stem cells, alterations in the tumor microenvironment, and the aberrant expression of cellular transporters. We particularly focus on the dynamic evolution of resistance from intrinsic to acquired states and the complex interplay among these mechanisms, aiming to provide an integrated theoretical framework to guide the development of rational combination strategies to overcome therapeutic resistance.
To identify the barriers and facilitators that influence the dissemination of clinical practice guidelines, and to explore the perceived usefulness, practical utility, expectations and unmet needs of end-users in relation to current dissemination strategies. This qualitative evidence synthesis is a part of mixed-methods evidence synthesis. We searched literature from MEDLINE, Embase, CINAHL, Web of Science, Scopus, Epistemonikos, Agency for Healthcare Research and Quality and Medical Guidelines Clearing house on 30th January 2025. Screening, data extraction and quality appraisal of the included studies were done by at least two authors independently and in duplicate. We performed reflexive thematic analysis of the data related to barriers, facilitators, usefulness, utility and unmet needs of dissemination products and channels. We assessed the confidence of evidence following the GRADE CERQual methods. We screened 31,853 titles and abstracts and found 40 eligible studies to be included in this qualitative evidence synthesis. We identified themes related to barriers and facilitators, practical utility and usefulness, unmet needs of dissemination products and unmet needs of dissemination channels. Key barriers were weak institutional support, language barriers, scepticism, low awareness and lack of training programmes. Main facilitators were related to leadership and institutional support, consumer and stakeholder involvement, training and multichannel dissemination. We identified the dissemination strategies that were perceived as useful when focused on improving clinical decision making and encouraging organisation adoption. Key aspects related to practical utility were the improved communication between healthcare professionals and patients or carers and better understandability of the guidelines when presented using simple layouts, visual features and multiple channels including social media. Unmet needs related to dissemination products included a demand for cultural and linguistic inclusivity, active promotion of guidelines, easier navigation through digital formats and training support for implementation. The key unmet need related to dissemination channels was the visibility and awareness of channels. This qualitative evidence synthesis identified key barriers and facilitators of dissemination strategies including unmet needs regarding the products and channels used in these strategies. The results can further inform organisations that develop and disseminate clinical practice guidelines.
Four peptide fractions (A1, A2, A3, A4) were extracted from hydrolysates of porcine blood meal using ultrafiltration and gel chromatography. Among these fractions, A4 showed the strongest hemin binding at 76.4%. Spectroscopic analysis revealed that the binding of hemin induced structural changes in A4, including a transition from α-helix to random coil and an increase in surface hydrophobicity. Furthermore, the antioxidant activity of A4 was significantly enhanced upon hemin binding, as demonstrated by improved radical scavenging capacities. The binding mechanism between A4 and hemin was elucidated through endogenous fluorescence spectroscopy and molecular docking, identifying three novel peptides (AAWGKVGGQAGAHGAEALER, FLANVSTVLTSK, and AWGKVGGQAGAHGAEALERM). Hydrogen bonds and hydrophobic forces were the dominant binding interaction forces, with key residues (A, V, H, and K) stabilizing the complexes. This study offers a scientific basis for utilizing porcine blood meal as antioxidant peptides and reveals peptide-hemin interaction mechanisms, supporting future applications in functional foods and nutraceuticals.
Self-care during medical education is challenging for both students and faculty, and results in high rates of burnout and depression. We analyzed data from participants in the Humanistic Elective in Advocacy, Reflective Transformation, and Integrative Medicine (HEART-IM) course as a lens for identifying potential areas of improvement in medical education for both learners and faculty. We surveyed student and faculty participants in the spring 2022 HEART-IM course shortly following course completion. Surveys involved open-ended questions, and we used a conventional content analysis approach to analyze the data. Survey completion rates were 59% and 42% for students and faculty, respectively. Our qualitative analyses identified four themes each from students and faculty. The student themes were self-care as professional development, healing from their medical education, connection with self, and confidence in being able to pursue personal wellness. The faculty themes were connection and community with/for students, crucial learning outside of current medical curriculum, faculty inspired by students, and renewed passion for medicine. Collectively, the eight qualitative themes suggested three meta themes: (a) the need for personal wellness and self-care, (b) cultivating community among students and faculty, and (c) healing the disconnect between one's whole self and one's academic self. Innovative curricula such as HEART-IM may provide a valuable lens for improving medical education for both learners and faculty.
BackgroundResearch on the mitochondrial genome variants of Alzheimer's disease (AD) in Chinese populations is lacking.ObjectiveThe study aimed to identify mitochondrial DNA (mtDNA) variants associated with AD risk and explore the relationship between mtDNA variants and plasma biomarkers in AD patients.MethodsWhole genome sequencing was performed in 1509 AD patients and 2010 controls from the Chinese population. mtDNA variants were called according to GATK's best practice mitochondrial pipeline. We evaluated the association of AD risk with mtDNA variants and mitochondrial haplogroup. Common variant (MAF≥0.01) based association analysis and gene-based tests of rare variants (MAF<0.01) were carried out with PLINK 1.9 and SKAT-O, respectively. Spearman correlation analysis was performed to assess the association between the burden of mtDNA variants and plasma biomarker levels.ResultsThe frequency of mitochondrial haplogroup G in AD group was nominally higher than control group (p = 0.019, OR = 1.48). Rare variants of MT-CYB gene were significantly enriched in controls compared to AD patients (p = 2.81 × 10-4, OR = 0.886). Besides, the control group exhibited considerably lower mRNA expression of MT-CYB in brain regions compared to AD patients in GEO database. Furthermore, the number of mtDNA indel variants per individual correlated positively with plasma Aβ42 levels.ConclusionsMitochondrial haplogroup G may serve as a risk factor for AD, while rare variants of MT-CYB gene acted as protective factor against AD in mainland China. Moreover, mtDNA variants were related to AD plasma biomarker levels. Our findings highlighted the role of mitochondrial genome variants in the pathogenesis of AD.
Orthogeriatric co-management (OGCM) significantly improves outcomes in older adults with hip fractures; however, it remains unclear whether older adults with pelvic fractures can similarly benefit. This study aimed to compare clinical and geriatric profiles of older adults with hip fractures and pelvic fractures across relevant medical and geriatric domains. Demonstrating comparable profiles would support future prospective studies evaluating OGCM in patients with pelvic fractures. We retrospectively analyzed data from an ongoing observational study at our institution including 611 hospitalized adults aged 70 years or older with hip fractures (n = 535) or pelvic fractures (n = 76). Variables included age, functional status, comorbidity burden and incidence of delirium. Group comparisons were performed using the χ2-test for categorical variables and the Kruskal-Wallis test for continuous variables. After Bonferroni adjustment, a p-value < 0.005 was considered statistically significant. The study was approved by the Ethics Committee of the Medical Faculty of Heinrich Heine University. The median age was 85 years (interquartile range 80-89 years) and 69% of patients were female. Hip fractures accounted for 87.6% of cases and pelvic fractures for 12.4%. Both groups showed a high burden of comorbidity and geriatric impairment, including cognitive impairment, functional limitations, frailty and medical comorbidity. Most clinical parameters were comparable between groups. Although surgery was performed much more frequently in the hip fracture group, no significant differences in the overall medical and geriatric profiles were observed except for transfusion rate and postoperative delirium. Older adults with hip fractures and pelvic fractures have largely comparable clinical and geriatric profiles. Given the established benefits of OGCM in hip fracture care, a similar approach could also benefit patients with pelvic fractures. This hypothesis should be evaluated in future prospective interventional studies. HINTERGRUND/ZIELSETZUNG: Orthogeriatrisches Komanagement verbessert die Behandlungsergebnisse bei älteren Erwachsenen mit Hüftfrakturen signifikant. Ob Patientinnen und Patienten mit Beckenfrakturen in ähnlicher Weise profitieren, ist bislang unklar. Ziel dieser Studie war es, die klinischen Profile geriatrischer Patientinnen und Patienten mit Hüft- und Beckenfrakturen in relevanten medizinischen und geriatrischen Domänen zu vergleichen. Der Nachweis vergleichbarer Profile würde zukünftige prospektive Studien zur Untersuchung des orthogeriatrischen Komanagements bei Patientinnen und Patienten mit Beckenfrakturen unterstützen. Retrospektiv analysiert wurden Daten einer laufenden Beobachtungsstudie an unserer Klinik von 611 hospitalisierten Patientinnen und Patienten im Alter von ≥ 70 Jahren mit Hüftfrakturen (n = 535) oder Beckenfrakturen (n = 76). Erfasst wurden u. a. Alter, Funktionalität, Morbidität und Inzidenz von Delir. Für Gruppenvergleiche wurden der Chi-Quadrat-Test für kategoriale Variablen und der Kruskal-Wallis-Test für kontinuierliche Variablen verwendet. Ein p-Wert < 0,005 wurde nach Bonferroni-Korrektur als statistisch signifikant angesehen. Die Studie wurde von der Ethikkommission an der Medizinischen Fakultät der Heinrich-Heine-Universität genehmigt. Das mediane Alter betrug 85 Jahre (Interquartilsabstand 80–89), 69 % der Patientinnen und Patienten waren weiblich. Hüftfrakturen machten 87,6% der Fälle aus und Beckenfrakturen 12,4%. Beide Gruppen wiesen eine hohe Belastung durch Komorbiditäten und geriatrische Syndrome auf, u. a. kognitive Beeinträchtigung, Funktionseinschränkungen und Frailty. Die meisten klinischen Parameter waren zwischen den Gruppen vergleichbar. Zwar wurde häufiger in der Hüftfrakturgruppe operiert, aber es fanden sich keine signifikanten Unterschiede in den medizinischen und geriatrischen Gesamtprofilen, außer bei der Transfusionsrate und beim postoperativen Delir. Ältere Erwachsene mit Hüft- und Beckenfrakturen weisen ähnliche klinische und geriatrische Profile auf. Aufgrund der etablierten Vorteile des orthogeriatrischen Komanagements bei Hüftfrakturen erscheint es plausibel, dass auch Patientinnen und Patienten mit Beckenfrakturen profitieren könnten. Diese Hypothese sollte in zukünftigen prospektiven Interventionsstudien geprüft werden.
Under the "Internet Plus" model, this study aims to develop a proof‑of‑concept intelligent decision‑support system for elderly disease risk assessment, with a specific focus on Alzheimer's Disease (AD). The primary objective is to evaluate whether blood‑based transcriptomic biomarkers can be translated into an interpretable and scalable risk stratification framework suitable for home‑care and community health settings. Whole‑blood transcriptomic and associated clinical data were obtained from a publicly available microarray dataset comprising 329 individuals (144 AD, 104 MCI, and 81 cognitively normal controls). Transcriptomic features were used exclusively for model training, while clinical variables-including cognitive scores, frailty index, depression scores, and medication adherence-were used post hoc for risk annotation and alert simulation. Rigorous preprocessing and quality control were applied, followed by differential gene expression analysis using the limma framework and biologically informed biomarker selection. A Random Forest classifier trained on selected transcriptomic biomarkers achieved an accuracy of 91.2%, with sensitivity of 88.5% and specificity of 93.6% under stratified five‑fold cross‑validation. Model interpretability was supported through permutation‑based feature importance and SHAP analysis, enabling identification of key genes contributing to risk prediction. Based on probabilistic outputs, subjects were categorized into simplified alert states such as "Alzheimer's Risk Flagged" and "Monitoring Recommended." Although real‑time home monitoring data were not collected, the proposed system simulates how omics‑driven risk scores could be integrated into EMR‑compatible and IoT‑enabled care platforms. This study demonstrates a scalable and interpretable computational framework that bridges transcriptomic research and practical decision support, highlighting the potential of non‑invasive, individualized, and deployable risk assessment tools for elderly care, particularly in resource‑limited or home‑based environments.
Climate change is increasingly recognized as a psychological stressor, with older adults representing a particularly vulnerable yet understudied group. This study evaluated the psychometric performance of three climate anxiety measures-the Hogge Climate Anxiety Scale (HCAS), Clayton Climate Change Anxiety Scale (CCCA), and Simon Climate Anxiety Scale (SCAS)-among 279 Persian-speaking older adults in Iran. Using a cross-sectional design, we examined structural validity, diagnostic accuracy, measurement invariance, and reliability, employing the GAI-SF as the criterion measure. All three instruments demonstrated acceptable construct validity based on exploratory and confirmatory factor analyses. SCAS showed a stable three-factor structure and excellent internal consistency (ω = 0.97). In classification analyses, SCAS achieved the highest sensitivity (0.89) and overall diagnostic accuracy (DOR = 3.09), whereas CCCA demonstrated slightly higher specificity (0.36). Bland-Altman analysis indicated that HCAS had the lowest measurement bias relative to GAI-SF scores. Measurement invariance testing supported full scalar invariance for SCAS across gender and anxiety subgroups, while HCAS and CCCA achieved only partial invariance. Mokken scale analysis further confirmed strong scalability (H > 0.40) and satisfactory reliability (α > 0.85) across all measures, with CCCA showing the highest Loevinger's H (0.52). Age significantly predicted climate anxiety scores across all three scales (p < 0.001). Overall, SCAS emerged as the most robust and reliable instrument for assessing climate anxiety in Persian-speaking older adults, while HCAS showed the closest agreement with the criterion measure. These findings highlight the importance of culturally adapted, psychometrically sound tools for capturing climate anxiety in aging populations.
Depressive symptoms in older adults are amplified by social isolation and limited access to clinic-based mental health care. Ecological momentary assessment (EMA) enables remote self-monitoring and unobtrusively captures response times (RTs), which may serve as indicators of psychomotor and cognitive functioning. This study investigated the use of EMA-based RT dynamics for predicting symptom change and profiling potential responders for repeated self-monitoring in late-life depression. Forty-nine community-dwelling adults aged 65 years or older (mean age 70.7, SD 5.8 years; female: 35; male: 14) with a history of major depressive disorder received case management incorporating daily EMA. Participants provided self-reports of mood, appetite, sleep quality, and general well-being. Preassessment and postassessment included the 15-item Short Geriatric Depression Scale (GDS-15), the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), the 9-item Patient Health Questionnaire, and the Beck Anxiety Inventory. RTs were cleaned with an asymmetric IQR rule, z standardized within-person × response level, and modeled with exponential decay curves over successive EMA trials. The efficacy of EMA-adjunctive care was evaluated using pre-post comparisons of symptom scales. We then examined associations between RT-derived features and symptom change using correlational analyses. Finally, Bayesian multilevel modeling was applied to assess the clinical relevance of RT dynamics, including group differences in adaptation patterns. Older adults at risk for depression showed significant symptom reductions over the 4-week EMA-adjunctive care period across all 4 psychological scales (CESD-R: mean Δ 11.5; rank-biserial r=0.78; GDS-15: mean Δ 2.14, Cohen d=0.76), alongside high EMA adherence (>90%). In correlational analyses, descriptive EMA score metrics and raw RTs showed modest, symptom-specific associations with symptom change (ΔCESD-R: |r|≈0.29; Δ9-item Patient Health Questionnaire: |r|≈0.32; ΔBeck Anxiety Inventory: |r|≈0.35) but were not significantly related to change in geriatric depression (ΔGDS-15: |r|≈0.24). In contrast, exponential-decay model parameters derived from standardized RT were significantly associated with geriatric depressive symptom change (Δ GDS-15), with the strongest effects observed for the feeling item (eg, decay rate θb: r=-0.398, asymptote θc: r=-0.321). Bayesian multilevel modeling further indicated that EMA-adjunctive care responders showed faster RT adaptation than nonresponders (median decay-rate ratio≈4.9, 95% credible interval 1.44-14.31), whereas differences in postadaptation RT levels were smaller and uncertain (median postadaptation RT ratio≈1.25, 95% credible interval 0.95-1.58). Sensitivity analyses showed consistent decay-rate effects across alternative specifications. Dynamic characteristics of EMA-based RTs emerged as a sensitive proxy for monitoring changes in depressive symptoms among older adults at risk. These findings highlight the potential use of RTs as digital biomarkers derived from brief, low-burden EMA self-monitoring, supporting the development of scalable and personalized mental health interventions for geriatric populations.