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Discussions on real-world acupuncture treatments for chroni clow-back pain in older adults

Journal of Integrative Medicine 2019年第2期17卷 71-76页

作者： Arthur Yin Fan Hui Ouyang Xinru Qian Hui Wei David Dehui Wang Deguang He Haihe Tian Changzhen Gong Amy Matecki Sarah Faggert Alemi American TCM Association (ATCMA) McLean Center for Complementary and Alternative Medicine PLC YIN & YANG Healthcare Rusk Rehabilitation at NYU Langone Health Wei’s Chinese Medical Center Ohio State Integrative Medicine Wexner Medical Center Ohio State University New England School of Acupuncture Chinese Acupuncture and Herbs Center American Academy of Acupuncture & Oriental Medicine Division of Integrative Medicine Alameda Health System Affiliated with School of Medicine University of California San Francisco Eastern Roots Wellness PLC

Chronic low-back pain(CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association(ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity;therefore, it should be effective for CLBP in older adults.

关键词： Acupuncture Pragmatic clinical trials as topic Real world Treatment strategies Low-back pain older adults Discussion

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Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease

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Journal of Geriatric Cardiology 2019年第10期16卷 756-763页

作者： Ning ZHANG Wen-Ling ZHU Xiao-Hong LIU Wei CHEN Ming-Lei ZHU Lin KANG Ran TIAN Department of Geriatrics Peking Union Medical College HospitalBeijingChina Department of Cardiology Peking Union Medical College HospitalBeijingChina Department of Clinical Nutrition Peking Union Medical College HospitalBeijingChina

Background Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. However, there have been few systematic studies of the prevalence and prognostic values of sarcopenia in older patients with coronary heart disease(CHD). This study aimed to investigate the prevalence of sarcopenia in hospitalized older patients with CHD, and to prospectively evaluate the effect of sarcopenia on the short-term prognosis of these patients. Methods Patients aged ≥ 65 years, with the diagnosis of CHD from Peking Union Medical College Hospital between December 2017 and November 2018, were included. Sarcopenia was diagnosed according to consensus of the Asian Working Group for Sarcopenia in 2014. Follow-up items included unscheduled return visits, occurrence of major adverse cardiac and cerebral events (MACCE), and all-cause mortality. The MACCE-free survival curve of sarcopenic and non-sarcopenic older patients with CHD was estimated by the Kaplan-Meier method. Cox regression analysis was used to analyze the association between sarcopenia and an unscheduled return visits, MACCE, and all-cause mortality. Results A total of 345 older patients with CHD were enrolled in the study, with a median age of 74 years. Among the patients, 78 (22.6%) were diagnosed with sarcopenia. During the follow-up time, there were significantly more unscheduled return visits in sarcopenic patients than in non-sarcopenic patients (34.2% vs. 21.8%,χ^2 = 4.418, P = 0.036), while there was no significant difference in the occurrence of MACCE (χ^2 = 2.869, P = 0.09) or all-cause mortality (χ^2 = 1.673, P = 0.196) between these patient groups. The Kaplan-Meier curve showed that the MACCE-free survival time of sarcopenic patients was significantly shorter than that in non-sarcopenic patients (χ^2 = 4.102, P = 0.043). After adjusting for sex, age, and the Charlson comorbidity index, sarcopenia was not an independent risk fa

关键词： Coronary heart disease older adult Prognosis Sarcopenia

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Physical activity among older Chinese adults living in urban and rural areas: A review

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Journal of Sport and Health Science 2016年第3期5卷 281-286,383页

作者： Wenfei Zhu Aiping Chi Yuliang Sun School of Physical Education Shaanxi Normal University

With an increase in rural-to-urban migration, a rapidly aging population, and the rising risk of developing noncommunicable diseases in China,it is important to understand the epidemiology of physical activity(PA) and health in the context of disease prevention and population health.Despite its public health importance, there is a significant lack of knowledge about PA in older Chinese adults that may hamper primary prevention efforts of health promotion in an increasingly aging population. To fill this gap, this article presents a narrative review of PA in the older Chinese adult population with a special focus on residential settings(i.e., urban and rural). Using existing studies, the review examines overall PA patterns and their correlates and discusses public health implications and future research. Although there are some preliminary indications of urban and rural differences in PA in the aging population in China, continued research efforts are needed to facilitate primary prevention efforts aimed at reducing noncommunicable diseases and promoting an active lifestyle among the largest population of older people in the world.

关键词： China Exercise older adults Physical activity Public health Urbanization

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Recruitment of older adults into randomized controlled trials:Issues and lessons learned from two community-based exercise interventions in Shanghai

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Journal of Sport and Health Science 2016年第3期5卷 308-314页

作者： Lingyan Huang Jiaojiao Lü Nan Chen Yu Liu Key Laboratory of Exercise and Health Sciences of Ministry of Education Shanghai University of Sport Department of Rehabilitation Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Background: With the increasing need for high-quality exercise interventions in China, relatively little is known about issues and challenges related to recruitment of older Chinese adults into exercise-based disease prevention interventions. This study aims to describe the recruitment process and outcomes of 2 exercise interventions conducted in Shanghai, China.Methods: Recruitment information was ascertained from 2 community-based randomized controlled trials for 2 exercise interventions, the first designed to improve health outcomes for older women with knee osteoarthritis and the second to study changes in cognitive function in adults with mild cognitive impairment. Results were summarized in terms of recruitment sources, number screened, screening-to-enrollment ratios, and costs.Results: Recruitment was primarily achieved through working with local residential divisions(i.e., neighborhood associations and residential committees). Both studies achieved their planned target number of older adults(45 and 46, respectively) within a 1-year time frame, with a screening-to-randomized ratio of 5:1 and demonstrated excellent retention rates(range 87%–93%) at 6 months. The recruitment cost for the 2studies averaged RMB 189(about USD 30) per initial recruit and RMB 738(about USD 119) per participant randomized. Some major issues encountered during the recruitment process included(1) the use of community neighborhoods to support the conduct of the projects,(2) access to participants, and(3) feasibility.Conclusion: Analysis of the 2 randomized controlled trials has provided valuable insights into the recruitment process and identified resources that can help better planning and recruitment for future interventions. Recommendations aimed at increasing the success of future recruitment efforts are provided.

关键词： Community stakeholders Exercise intervention older adults Participant access Randomized controlled trial Recruitment

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Rate of anticoagulant use, and factors associated with not prescribing anticoagulant in older Thai adults with non-valvular atrial fibrillation: A multicenter registry

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Journal of Geriatric Cardiology 2019年第3期16卷 242-250页

作者： Rungroj Krittayaphong Arintaya Phrommintikul Pornchai Ngamjanyaporn Khanchai Siriwattana Wiwat Kanjanarutjawiwat Thoranis Chantrarat Roj Rojjarekampai Pontawee Kaewcomdee Patthrapon Sonkhammee Division of Cardiology Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand Faculty of Medicine Chiang Mai UniversityChiang MaiThailand Chonburi Hospital ChonburiThailand Nakornping Hospital Chiang MaiThailand Prapokklao Hospital ChanthaburiThailand Phramongkutklao College of Medicine Mahidol UniversityBangkokThailand Faculty of Medicine Thammasat UniversityPathum ThaniThailand

Objectives To investigate the rate of anticoagulant use,the reasons for not prescribing anticoagulant,and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fibrillation.Methods A multicenter registry of patients with non-valvular atrial fibrillation was conducted during 2014 to 2017 in Thailand.Demographic,medical history,antithrombotic medication,non-antithrombotic medication,and laboratory data were collected and analyzed.Data were compared between the older adult (≥ 65 years) and younger adult (older adult group.Anticoagulant was prescribed in 2422 patients (75.3%): 81.4% in the older adult group and 65.7% in the younger adult group.The three main reasons for not prescribing anticoagulant were already taking antiplatelets,patient refusal,and bleeding risk.These reasons were more common in older adults as compared to younger adults.Multivariate analysis revealed current use of antiplatelets to be the most important factor that predict the non-prescription of anticoagulant in older population.Conclusions The prevalence of anticoagulant prescription among older Thai adults with atrial fibrillation is 81.4%.Taking antiplatelet drugs was found to be the strongest reason that predicts the non-prescription of anticoagulant in this patient population.A guideline should be developed to optimize the use of anticoagulant and antiplatelet in older adults.

关键词： Anticoagulant use Multicenter registry Non-valvular atrial fibrillation older Thai adults

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Associations between individual and environmental factors and habitual physical activity among older Chinese adults:A social–ecological perspective

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Journal of Sport and Health Science 2016年第3期5卷 315-321,383页

作者： Xiangren Yi Zachary Pope Zan Gao Shumei Wang Fang Pan Jingpeng Yan Meng Liu Peipei Wu Jingjing Xu Rui Wang School of Physical Education Shandong University School of Kinesiology University of Minnesota Twin Cities School of Public School Shandong University School of Medicine Shandong University

Purpose: To examine, within a social–ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity(HPA) among older Chinese adults.Methods: Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social–ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults(n = 1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social–ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling.Results: Factors related to intrapersonal(medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education),interpersonal(social support, social activity, and social norms), and community and physical environmental resources(safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults' participation in HPA.Conclusion: The findings provide an initial validation of a social–ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active.

关键词： Exercise Interpersonal resources Intrapersonal resources older adults Physical activity Social–ecological

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The association between socioeconomic status and visual disability among older adults in China

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International Journal of Ophthalmology(English edition) 2019年第1期12卷 106-113页

作者： Wan-Wei Dai Jia-Min Gao Ping He Zheng Ma Xiao-Xiao Tian Xiao-Ying Zheng Institute of Population Research APEC Health Science Academy (HeSAY)Peking University The Third Hospital Peking University Guanghua School of Management Institute of Strategic ResearchPeking University Institute of Population Research APEC Health Science Academy (HeSAY)Peking University China Center for Health Development Studies Peking University

AIM: To investigate the association between socioeconomic status(SES) and visual disability(VD) among older Chinese adults. METHODS: We obtained data from the Second National Sample Survey on Disability, conducted in China in 2006. A total number of 192 375 older adults(aged≥65 y) were screened for suspected VD via interviews with trained examiners. Those who screened positively for VD were referred to ophthalmologists to obtain a final diagnosis. RESULTS: VD was prevalent among 7.29% of Chinese adults aged 65 and older, and was higher in rural areas(8.71%) than in urban areas(4.82%). After adjusting for SES indicators and covariates, we found that lesseducated older adults were more likely to suffer from VD, with an odds ratio(OR) of 2.50(95%CI: 2.26-2.82) for illiterates, compared with those who graduated from senior high school or above. older adults who were in the lowest income quintile were more at risk of VD, with an OR of 1.81(95%CI: 1.68-2.95), compared with adults in the highest income quintile. In urban areas, when compared with adults who graduated from senior high school or above, those who did not continue their education after junior high school, primary school, or those who were illiterate, were more likely to suffer from VD, with an OR of 1.35(95%CI: 1.51-1.59), 1.84(95%CI: 1.60-2.12), and 2.63(95%CI: 2.27-3.04), respectively. Lower levels of income were statistically significant when associated with VD. In rural areas, adults who were illiterate had an OR of 2.21(95%CI:1.75-2.79) when compared to adults with senior high school or above education level. Per capita, household income remained significantly associated with VD. older adults who were ≥85, female, single, and residing in rural areas were associated with higher risks of VD. CONCLUSION: Individual-level SES among the elderly, in the form of education and income, is associated with VD among elderly Chinese adults in both urban and rural areas; however, the association is stronger in rural areas. Further studies are still required to expl

关键词： visual disability prevalence socioeconomic status older adults risk factors

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Differences in clinical characteristics, muscle mass, and physical performance among different frailty levels in Chinese older men

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Chinese Medical Journal 2019年第3期132卷 352-355页

作者： Li Meng Hong Shi Jing Shi Pu-Lin Yu Huan Xi Beijing Institute of Geriatrics Beijing HospitalNational Center of GerontologyBeijing 100730China Department of Geriatric Beijing HospitalNational Center of GerontologyBeijing 100730China

To the Editor: Frailty is defined as a vulnerable state that places older adults at increased risk for adverse health outcomes, and can explain substantial heterogeneity of health status. Previous studies have demonstrated the utility of the frailty phenotype scale and frailty index (FI) in identifying frail older people in China.[1] Several experimental and clinical studies on frailty have been published using the above methods in recent years, but influential factors for discriminating frailty levels in Chinese older adults have not yet been determined. Elucidating this issue is of importance, because early detection of frailty-related factors and subsequent intervention are essential for safeguarding functionality and preventing the occurrence of adverse consequences among older people.

关键词： Chinese older men muscle mass health status

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Cirrhotic patients and older people

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World Journal of Hepatology 2019年第9期11卷 663-677页

作者： Paul Carrier Marilyne Debette-Gratien Jérémie Jacques Véronique Loustaud-Ratti Fédération d’Hépatologie Centre Hospitalier Universitaire Dupuytren de LimogesLimoges 87042France Facultéde Médecine et de Pharmacie de Limoges Rue Docteur MarclandLimoges 87042France Service de Gastroentérologie Centre Hospitalier Universitaire Dupuytren de LimogesLimoges 87042France

The global population is aging,and so the number of older cirrhotic patients is increasing.older patients are characterised by a risk of frailty and comorbidities,and age is a risk factor for mortality in cirrhotic patients.The incidence of nonalcoholic fatty liver disease as an aetiology of cirrhosis is increasing,while that of chronic viral hepatitis is decreasing.Also,cirrhosis is frequently idiopathic.The management of portal hypertension in older cirrhotic patients is similar to that in younger patients,despite the greater risk of treatment-related adverse events of the former.The prevalence of hepatocellular carcinoma increases with age,but its treatment is unaffected.Liver transplantation is generally recommended for patientsolder people,little data are available and few recommendations have been proposed.This review suggests that comorbidities have a considerable impact on older cirrhotic patients.

关键词： Liver cirrhosis Portal hypertension Liver cancer Liver transplantation Old age older Elderly

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Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials

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World Journal of Psychiatry 2019年第5期9卷 78-82页

作者： Rajesh R Tampi Aarti Chhatlani Hajra Ahmad Kripa Balaram Joel Dey Ricardo Escobar Thejasvi Lingamchetty Department of Psychiatry and Behavioral Sciences Cleveland Clinic Akron GeneralOhioNH 44106United States Cleveland Clinic Lerner College of Medicine of Case Western Reserve University ClevelandOH 44109United States Savant Care Clinic CaliforniaCA 90277United States Department of Psychiatry MetroHealthClevelandOH 44109United States Case Western Reserve University School of Medicine ClevelandOH 44109United States

Substance use disorders(SUDs)are a growing problem among older adults.Acamprosate,disulfiram,and naltrexone are United States Food and Drug Administration(referred to as FDA)approved for the treatment of alcohol use disorder,and buprenorphine is approved for the treatment of opiate use disorder among adults.However,the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials(referred to as RCTs).A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults(≥50 years).One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals,50-70 years in age.The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age.Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder.However,we did not identify any RCTs that studied the use of buprenorphine,acamprosate,or disulfiram for SUDs among older adults.Based on available evidence,it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults.However,data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.

关键词： older adults Substance use Naltrexone Acamprosate Disulfiram Buprenorphine

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