Search

Background Patients infrequently mobilize at the surgical ward after cardiac surgery. Inactivity results in prolonged hospital stay, readmissions and increased cardiovascular mortality. Next, the course of in-hospital mobilization activities for patients is unclear. The aim was to evaluate early mobilization after heart surgery with a mobilization poster on the Activity Classification Guide for Inpatient Activities score from the American College for Sports Medicine (ACSM). Second, to develop a Thorax Centrum Twente (TCT) score to assess distinctive activities performed. Methods A poster was developed for the Moving is Improving! study to stimulate hospital mobilization after heart surgery. In this sequential-group study at a cardiothoracic surgery ward, 32 patients were included in the usual care group and 209 patients in the poster mobilization group. Change of ACSM and TCT scores over time were both defined as primary endpoints. Secondary endpoints included length of stay and survival. A subgroup analysis for coronary artery bypass grafting (CABG) was performed. Results ACSM score increased during hospital stay (p p = 0.27), nor in the CABG subgroup (p = 0.15). The poster increased mobility to chair, toilet, corridor (all p p = 0.02) as measured by the activity-specific TCT scores, without differences in length of stay or survival. Conclusions ACSM score measured day-to-day functional changes, without significant differences between the poster mobilization and usual care group. Actual activities measured with the TCT score did improve. The mobilization poster is now new standard care, and effects in other centers and other departments should be assessed. Trial registration This study does not fall under the ICMJE trial definition and was not registered.

Background: Arterial catheters are often used for blood pressure monitoring in the intensive care unit (ICU), but they can cause complications. Non-invasive continuous finger blood pressure monitors could serve as an alternative. However, failure to obtain finger blood pressure signals is reported in up to 12% of ICU patients. Objectives: Our primary objective was to identify the success rate of finger blood pressure monitoring in ICU patients. Secondary objectives were to assess whether patient admission characteristics could be used to identify patients unsuitable for non-invasive blood pressure monitoring and to determine the quality of non-invasive blood pressure waveforms. Methods: Retrospective observational study conducted in a cohort of 499 ICU patients. When available, the signal quality of the first hour of finger measurement was determined using an open-source waveform algorithm. Results: Finger blood pressure signals were obtained in 94% of patients. These patients had a high quality blood pressure waveform for 84% of the measurement time. Patients without a finger blood pressure signal significantly more frequently had a history of kidney and vascular disease, were more often treated with inotropic agents, had lower hemoglobin levels, and had higher arterial lactate levels. Conclusions: Finger blood pressure signals were obtained in nearly all ICU patients. Significant differences in baseline characteristics between patients with and without finger blood pressure signals were found, but they were not clinically relevant. The characteristics studied could therefore not be used to identify patients unsuitable for finger blood pressure monitoring.

Background Physical frailty is strongly related to adverse outcomes in heart failure (HF), and women are more likely to be physically frail than men; however, it is unknown if this sex difference affects outcomes. Objectives To determine if there are sex differences in the associations between physical frailty and health-related quality of life (HRQOL) and clinical outcomes in HF. Methods We conducted a prospective study of adults with HF. Physical frailty was assessed using the Frailty Phenotype Criteria. HRQOL was assessed using the Minnesota Living with HF Questionnaire. One-year clinical events (all-cause death or cardiovascular hospitalization or emergency department visit) were ascertained. We used generalized linear modeling to quantify associations between physical frailty and HRQOL, and Cox proportional hazards modeling to quantify associations between physical frailty and clinical events, adjusting for Seattle HF Model scores. Results The sample (n = 115) was 63.5 ± 15.7 years old and 49% women. Physical frailty was associated with significantly worse total HRQOL among women (p = 0.005) but not men (p = 0.141). Physical frailty was associated with worse physical HRQOL among both women (p < 0.001) and men (p = 0.043). There was a 46% higher clinical event risk for every one-point increase in physical frailty score among men (p = 0.047) but not women (p = 0.361). Conclusions Physical frailty is associated with worse overall HRQOL among women and higher clinical event risk among men, indicating a need to better understand contributors to sex-specific health differences associated with physical frailty in HF.

Abstract: Aging is characterized by progressive regression in tissue and organ functions and an increased risk of disease and death. Aging is also accompanied by chronic low-grade inflammation. Both obesity and aging are associated with the development of metabolic diseases, leading to an increase in the senescent cell burden in multiple organs. Chronic low-grade inflammation of adipose tissue is one of the mechanisms implicated in the progression of these diseases. As a real endocrine organ, adipose tissue secretes many mediators and hormones (adipokines) to maintain metabolic homeostasis, and their dysfunction has been causally linked to a wide range of metabolic diseases. Dysfunctional adipose tissue participates in interorgan communication both by producing new signaling mediators and by transforming or disrupting signal mediators, reaching from other organs. In addition to obesity and similar metabolic diseases, this situation causes dysfunction in more organs in the aging process, and the complexity of the problem causes challenges in the diagnosis and treatment processes. This review aims to highlight recent developments and current information supporting the relationship between obesity and adipose tissue dysfunction with aging and the role of homeostatic and physio-pathological processes that mediate interorgan communication in aging progress. More understanding clearly of interorgan communication in the process of obesity and aging will facilitate the early diagnosis as well as the management of treatment practices in short- and long-term organ dysfunction.

Abstract: In 2016, a mini-issue of Current Aging Science (CAS) entitled “Effects of Aging on Circadian and Sleep Timing” has been published to report the state of the art in the studies of the effects of aging on the circadian and sleep regulating processes. The emphasis has been given to the regulatory processes involved in age-specific problems with sleep timing, continuity, and duration. Such problems can serve as targets for novel treatments for geriatric and sleep disorders. In the following 6 years, some new findings provided further insight into the previously recognized age-specific problems and highlighted new questions of research on the relation of aging to the regulatory mechanisms underlying circadian rhythmicity, sleep, and sleepiness. The theoretic framework of one of the directions of this research regards the interaction between the competing drives for sleep and wake as one of the basic features of regulatory processes underlying circadian rhythms, including such rhythms as the sleep-wake cycle and the diurnal variation in alertnesssleepiness levels. Here, earlier and more recently highlighted questions of the research in this framework were briefly reviewed.

Background: Executive function performance has been extensively studied in extreme age groups, but the middle age population, where a decline could begin, is still under investigation. The role of factors like education and physical activity that might influence cognitive performance is not well understood. Objective: The study aimed to examine the influence of age, education, and physical activity on executive function performance and the interaction effects between these factors on two subpopulations of adults, i.e., young adults and middle-aged adults. Methods: 92 adults, 46 young adults (N = 24.4 ± 2.7 years, 25 postgraduates and 21 PhDs) and 46 middle-aged adults (N = 48.08 ± 5.79 years, 28 postgraduates and 18 PhDs), were included. Each subject performed Delayed Matching of Sample (DMS), Spatial Working Memory (SWM), and Multitasking (MTT) test on CANTAB. Physical activity levels were reported through IPAQ. Results: Results indicated age to have a major influence on DMS, SWM, and MTT performance; however, education was only found to influence SWM. MTT and SWM performance was found to be lower in middle-aged adults in comparison to young adults. On comparison of test scores between highly active and moderately active groups of middle-aged adults, no differences were found; however, in young adults, MTT correct scores (p < 0.05) were significantly higher in the highly active group in comparison to their counterparts. Interaction between age and level of education revealed better retrieval in middle-aged adults with higher education in comparison to their counterparts. Conclusion: In comparison to younger counterparts, executive function performance deteriorated around the middle ages. Education was found to play a protective role in executive abilities slowing during middle age. Also, physical activity may play some role in executive function performance.

Background: In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices. Objectives: To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location. Methods: Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis. Results: In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location not the catheter itself was an independent predictor of a catheter failure (HR 6.762; p = 0.023). Conclusions: The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC.

Purpose: Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. Methods: In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz’s 6-item ADL and Lawton Brody’s 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher’s exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. Results: The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls. Conclusion: Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

Background: Dementia is a neurocognitive disorder associated with the aging brain and mainly affects the hippocampus and cerebral cortex. The Hippo signaling pathway and autophagy proteins have been found to be perturbed in the brain affected by dementia processes. Objective: This systematic review aims to elaborate on the involvement of the Hippo signaling pathway and autophagy in modulating the progression and severity of dementia in aging. Methods: Searches were conducted on MEDLINE, Google Scholar, Scopus, and Web of Science databases. Results: The Hippo signaling pathway is dependent upon the transcriptional co-activator YAP/TAZ, which forms complexes with TEAD in the nucleus in order to maintain cell homeostasis. When the expression YAP/TAZ is reduced, transcriptional repression-induced atypical cell death, ballooning cell death, and necrosis will consequently occur in the neurons. Moreover, the autophagic proteins, such as LC3, ATG proteins, and Beclin, are reduced, resulting in the disruption of autophagosome formation and accumulation and the spread of misfolded proteins in the brain suffering from dementia. Conclusion: The impairment of the Hippo signaling pathway and autophagy in the dementia process in aging should be considered since it might predict the severity, treatment, and prevention of dementia.

Background: People with interstitial lung disease (ILD) present low levels of physical activity (PA) and spend most of their time at home, especially in advanced stages of the disease. The Lifestyle Integrated Functional Exercise for people with ILD (iLiFE) embedding PA in patients’ daily routines was developed and implemented. Objectives: This study aimed to explore the feasibility of iLiFE. Methods: A pre/post mixed-methods feasibility study was conducted. Feasibility of iLiFE was determined by participant recruitment/retention, adherence, feasibility of outcome measures and adverse events. Measures of PA, sedentary behaviour, balance, muscle strength, functional performance/capacity, exercise capacity, impact of the disease, symptoms (i.e., dyspnoea, anxiety, depression, fatigue and cough) and health-related quality of life were collected at baseline and post-intervention (12-weeks). Semi-structured interviews with participants were conducted in-person immediately after iLiFE. Interviews were audio-recorded, transcribed and analysed by deductive thematic analysis. Results: Ten participants (5,, 77§3y; FVCpp 77.1 § 4.4, DLCOpp 42.4 § 6.6) were included, but only nine completed the study. Recruitment was challenging (30%) and retention high (90%). iLiFE was feasible, with excellent adherence (84.4%) and no adverse events. Missing data were associated with one dropout and noncompliance with the accelerometer (n = 1). Participants reported that iLiFE contributed to (re)gain control in their daily life, namely through improving their well-being, functional status and motivation. Weather, symptoms, physical impairments and lack of motivation were identified as threats to keep an active lifestyle. Conclusions: iLiFE seems to be feasible, safe and meaningful for people with ILD. A randomised controlled trial is needed to strengthen these promising findings. published

Background: Examining the interrelationships between symptoms of depression and sociodemographic and behavioral correlates is challengeful using traditional regression analysis. Objective: to identify the sociodemographic, movement behaviors, and sleep correlates that contribute the most to symptoms of depression in Brazilian older females, using a network analysis approach. Methods: This cross-sectional study analyzed 1019 older females from Brazil. Data (sociodemographic, height (meters), weight (kilograms), symptoms of depression, physical activity, sleep) were self-reported via phone calls. The relationships between symptoms of depression and their correlates were assessed using the Network Analysis (qgraph package of the Rstudio) for entire sample and age groups (60-69; 70-79 and 80+ years old). Results: 60-69 and 70-79 groups have more weekly home exits, with aging “single, widowed or divorced” was progressively higher, and “married or stable union” and Overweight/obesity were progressively fewer (p < 0.05). 60-69 have more education years and fewest medicaments use. Sleep compliance (for the entire sample), body mass index (for the 60-69), compliance with moderate to vigorous physical activity (for the 70-79), and educational level (for 80+) were the variables with the highest expected influence values (p < 0.05) on symptoms of depression (1.370; 1.388; 1.129; and 1.354, respectively). Conclusion: Symptoms of depression vary throughout the aging process and thus determine that intervention strategies encompass these specific factors according to each age group. Poor sleep behavior has a strong positive association with symptoms of depression. This result highlights that health professionals must be aware of the importance of sleep to mitigate the worsening of depression among older Brazilian females.