Risk Factors and Cardiovascular Disease in the Elderly

Moderate drinking benefits cognitive health in middle-aged and older Chinese: A latent class growth model analysis based on CHARLS

While alcohol use among older population is linked to various health risks, recent studies indicate potential benefits from moderate consumption, highlighting a contentious debate regarding its impact on health in this demographic. This study aims to identify distinct trajectories of alcohol use among middle-aged and older adults in China and examine their associations with multidimensional health outcomes, including cardiovascular, cognitive, and psychological health. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), tracking a sample of 10,927 participants (54.33 % female; mean age = 57.61, SD = 8.95) through five waves of data collection. Latent Class Growth Modeling (LCGM) was employed to analyze alcohol use trajectories. Health outcomes were assessed through self-reported health measures and clinical data including lipoprotein levels. Four distinct alcohol use trajectories were identified: Moderate (6.3 %), Decreasing (11.0 %), Increasing (6.9 %), and Constantly Low (75.8 %). The Moderate trajectory was associated with significant higher cognitive scores compared to Increasing (p = .027) and Constantly Low group (p = .012). Moreover, higher levels of high density lipoprotein were linked with the Increasing and Decreasing trajectories, suggesting a protective cardiovascular effect. The findings highlight the complexity of alcohol use behaviors among older adults in China and underscore the need for targeted health interventions. Understanding the nuanced impacts of different drinking patterns on multidimensional health outcomes can aid in developing more effective public health strategies and clinical practices tailored to the needs of aging populations. Further research is recommended to explore the causal relationships and long-term health impacts of these trajectories.

[Peculiarities in the management of arterial hypertension in the elderly: Consensus document of the Central American and Caribbean Society of arterial hypertension]

Arterial hypertension is one of the most prevalent diseases in the field of geriatrics and is also a risk factor for pathologies that frequently result in hospital admissions, such as heart failure and stroke. This article addresses both pharmacological and non-pharmacological diagnosis and treatment strategies, focusing on the role of frailty as a guiding principle in determining the most appropriate course of treatment, emphasizing patient-centred prescribing. Furthermore, the article reviews other frequent topics, such as polypharmacy and orthostatic hypotension. Moreover, a concise overview of the current evidence in geriatrics on ambulatory blood pressure monitoring and self-measurement of blood pressure will be provided. Furthermore, a brief summary of the underlying pathophysiology and current epidemiological trends is provided. This consensus is founded upon the initial premise that a comprehensive geriatric assessment should be conducted to ascertain whether a blood pressure reduction strategy could confer a net benefit for elderly patients while simultaneously avoiding an increase in the safety risks associated with these strategies and preventing a de-prescription due to ageism. This is particularly important given the significance of maintaining optimal blood pressure control to prevent related complications.

Safety of solid oncology drugs in older patients: a narrative review

The older population represents ∼50%-60% of the population of newly diagnosed patients with cancer. Due to physiological and pathological aging and the increased presence of comorbidities and frailty factors, this population is at higher risk of serious toxicity from anticancer drugs and, consequently, often under-treated. Despite the complexity of these treatments, a good knowledge of the pharmacology of anticancer drugs and potentially risky situations can limit the emergence of potentially lethal toxicities in this population. This review focuses on optimizing systemic oncology treatments for older patients, emphasizing the unique characteristics of each therapeutic class and the necessity for a precautionary approach for this vulnerable population.

Management of Acute Coronary Syndrome in Elderly Patients: A Narrative Review through Decisional Crossroads

Diagnosis and treatment of acute coronary syndrome (ACS) pose particular challenges in elderly patients. When high troponin levels are detected, the distinction between non-ischemic myocardial injury (NIMI), type 1, and type 2 myocardial infarction (MI) is the necessary first step to guide further care. However, the assessment of signs of ischemia is hindered in older patients, and no simple clinical or laboratory tool proved useful in this discrimination task. Current evidence suggests a benefit of an invasive vs. conservative approach in terms of recurrence of MI, with no significant impact on mortality. In patients with multivessel disease in which the culprit lesion has been treated, a physiology-guided complete percutaneous revascularization significantly reduced major events. The management of ACS in elderly patients is an example of the actual need for a multimodal, thorough clinical approach, coupled with shared decision-making, in order to ensure the best treatment and avoid futility. Such a need will likely grow throughout the next decades, with the aging of the world population. In this narrative review, we address pivotal yet common questions arising in clinical practice while caring for elderly patients with ACS.

Tai Chi Movement Recognition and Precise Intervention for the Elderly Based on Inertial Measurement Units and Temporal Convolutional Neural Networks

(1) Background: The objective of this study was to recognize tai chi movements using inertial measurement units (IMUs) and temporal convolutional neural networks (TCNs) and to provide precise interventions for elderly people. (2) Methods: This study consisted of two parts: firstly, 70 skilled tai chi practitioners were used for movement recognition; secondly, 60 elderly males were used for an intervention study. IMU data were collected from skilled tai chi practitioners performing Bafa Wubu, and TCN models were constructed and trained to classify these movements. Elderly participants were divided into a precision intervention group and a standard intervention group, with the former receiving weekly real-time IMU feedback. Outcomes measured included balance, grip strength, quality of life, and depression. (3) Results: The TCN model demonstrated high accuracy in identifying tai chi movements, with percentages ranging from 82.6% to 94.4%. After eight weeks of intervention, both groups showed significant improvements in grip strength, quality of life, and depression. However, only the precision intervention group showed a significant increase in balance and higher post-intervention scores compared to the standard intervention group. (4) Conclusions: This study successfully employed IMU and TCN to identify Tai Chi movements and provide targeted feedback to older participants. Real-time IMU feedback can enhance health outcome indicators in elderly males.

The Role of Cardiovascular Rehabilitation in the Elderly Patient

BACKGROUND

Cardiovascular disease is the leading cause of morbidity and mortality in the elderly population. Coronary artery disease, heart failure, and peripheral artery disease constitute the prevailing conditions. Cardiac rehabilitation (CR) represents a cornerstone in the secondary prevention of cardiovascular disease, since it has been associated with significant cardiovascular benefits in the above-mentioned conditions, by significantly reducing cardiovascular outcomes and improving functional independence and quality of life. Besides, CR offers the background for optimizing the control of cardiovascular risk factors and implementing physical exercise, also providing psychological and social support.

SUMMARY

The prevalence of cardiovascular disease increases with age, associating high morbidity and mortality. In addition, comorbidities, frailty, and other geriatric conditions, entities that also entail poor prognosis, are often present in elderly patients. Indeed, frailty is recommended to be systematically addressed in elderly patients with cardiovascular disease, and there is growing evidence regarding the benefits of CR programs in this setting, also associated with lower adverse events during follow-up. However, elderly patients are less often referred to CR after a cardiovascular event when compared to their younger counterparts. In this review, we summarized the benefits of CR programs in the elderly population with established cardiovascular disease, proposing a comprehensive framework that integrates personalized care strategies.

KEY MESSAGES

Cardiovascular disease is the leading cause of morbimortality, especially in the elderly. The management of cardiovascular disease in elderly patients poses unique challenges, since they represent a heterogeneous group and evidence is low. CR can provide significant benefits in older patients, encompassing physical training and specific management of geriatric syndromes.

Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex

PURPOSE OF REVIEW

Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women.

RECENT FINDINGS

Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.