Geriatrics

13 pages, 398 KB

Open AccessArticle

Appropriateness and Outcome of a Statin Deprescription Intervention in Hospitalized Frail Older Adults: A Retrospective Study

by Giuseppe Castiglia, Nicola Veronese, Gianluca Gortan Cappellari, Erica Voinovich, Paolo De Colle and Michela Zanetti

Geriatrics 2026, 11(2), 50; https://doi.org/10.3390/geriatrics11020050 - 20 Apr 2026

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Abstract

Background/Objectives: The appropriateness of statin treatment in frail older adults is controversial because of insufficient evidence on its efficacy. The aim of this study was to assess the appropriateness of statin prescription at admission and discharge from hospital and the association of [...] Read more.

Background/Objectives: The appropriateness of statin treatment in frail older adults is controversial because of insufficient evidence on its efficacy. The aim of this study was to assess the appropriateness of statin prescription at admission and discharge from hospital and the association of deprescription with one-year mortality in a cohort of older patients. Methods: Monocentric retrospective observational study of older (≥65 year) adults admitted to a Geriatric Unit. Patients underwent comprehensive geriatric assessment and prevalence of statin prescription at admission and discharge was recorded. Appropriateness of prescription was determined using the Medication Appropriateness Index (MAI), multidimensional frailty using the Multidimensional Prognostic Index (MPI). Mortality at 12 months was recorded. Results: Among 528 consecutively admitted patients, 112 (mean age 83.6 ± 6.2 years) were treated with statins and were included in the study. In addition, 87.5% of patients showed at least one inappropriate criterion for statin prescription at admission and 91.7% at discharge. Deprescription occurred in 46.4% of patients at discharge, particularly in those who were older and in MPI high mortality risk class. Mean MAI did not differ between admission and discharge in the whole study cohort, but it decreased in patients at highest mortality risk (from 3.2 ± 4.0 to 2.0 ± 1.2). In multivariate analysis, compared with patients who continued statins after discharge, those who were deprescribed did not show increased one-year mortality risk. Conclusions: Inappropriate statin prescription is common at hospital admission in frail older patients and deprescription does not affect one-year residual survival. Therefore, rigorous assessment of mortality risk and medication appropriateness should be encouraged. Full article

(This article belongs to the Section Cardiogeriatrics)

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11 pages, 747 KB

Open AccessArticle

Screening for Pre-Frailty Using Phase Angle Derived from Bioelectrical Impedance Analysis in Community-Dwelling Older Adults

by Masayuki Hoshi, Tomoka Ogata, Maaya Chiguchi, Ayane Nakamaru, Tatsuya Nakanowatari, Akihiko Asao, Natsumi Kimura, Maki Ogasawara, Yuko Horikoshi, Rie Sakuraba-Hirata, Akiomi Yoshihisa, Hiroshi Hayashi, Toshimasa Sone and Yoshitaka Shiba

Geriatrics 2026, 11(2), 49; https://doi.org/10.3390/geriatrics11020049 - 20 Apr 2026

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Abstract

Background/Objectives: To evaluate the utility of phase angle (PhA) derived from bioelectrical impedance analysis as a screening indicator for pre-frailty in community-dwelling older adults. Methods: This cross-sectional study included 171 participants (36 men and 135 women) in Japan in 2023. PhA at 50 [...] Read more.

Background/Objectives: To evaluate the utility of phase angle (PhA) derived from bioelectrical impedance analysis as a screening indicator for pre-frailty in community-dwelling older adults. Methods: This cross-sectional study included 171 participants (36 men and 135 women) in Japan in 2023. PhA at 50 kHz was measured using bioelectrical impedance analysis and evaluated as a potential screening indicator for pre-frailty. Assessments included body composition, physical function tests (maximum walking speed, Timed Up and Go (TUG), grip strength, knee extension strength, and one-leg stance time with eyes open), cognitive function (MoCA-J), and the Motor Fitness Scale (MFS), a questionnaire assessing physical function, along with the Kihon Checklist (KCL). Frailty status was defined using KCL scores (4–7: pre-frailty; ≥8: frailty), and participants were classified into robust and pre-frail/frail groups. Results: PhA was significantly correlated with physical function measures, including grip strength (r = 0.54, p < 0.01), MFS (r = 0.36, p < 0.01), maximum walking speed (r = 0.20, p < 0.05), knee extension strength (r = 0.16, p < 0.05), and TUG (r = −0.17, p < 0.05). In women, logistic regression analysis showed that PhA was independently associated with pre-frailty (age-adjusted odds ratio: 2.38; 95% CI: 1.08–5.23; p < 0.05). ROC analysis yielded an area under the curve of 0.65 (95% CI: 0.56–0.74), indicating modest discriminative ability. Age-adjusted cutoff values of PhA were 4.19° and 4.74°, corresponding to points prioritizing sensitivity and specificity, respectively. Conclusions: PhA is associated with physical function and may serve as a simple, non-invasive indicator for identifying pre-frailty in community settings. However, given its modest discriminative ability, PhA alone may not be sufficient as a standalone screening tool and should be used in combination with other clinical indicators for clinical application. Full article

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12 pages, 472 KB

Open AccessArticle

Effects of Intraoperative Prone Versus Supine Positioning on Postoperative Delirium

by Theresa E. Hering, Maria Wittmann, Vera Guttenthaler, Robert Pflugmacher and Rudolf Hering

Geriatrics 2026, 11(2), 48; https://doi.org/10.3390/geriatrics11020048 - 19 Apr 2026

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Abstract

Background: Postoperative delirium (POD) is a common complication in geriatric patients. This prospective cohort study evaluated a possible influence of intraoperative positioning on the occurrence of POD, as intraoperative prone positioning could affect cerebral perfusion. Methods: We included 760 patients of ≥60 [...] Read more.

Background: Postoperative delirium (POD) is a common complication in geriatric patients. This prospective cohort study evaluated a possible influence of intraoperative positioning on the occurrence of POD, as intraoperative prone positioning could affect cerebral perfusion. Methods: We included 760 patients of ≥60 years scheduled for elective surgery in prone or supine positions. The primary outcome was POD incidence on the first five days after surgery, assessed via 3D-Confusion Assessment Method (3-D CAM) or Confusion Assessment Method for Intensive Care Units (CAM-ICU). Preoperative assessments included the American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) classifications as well as short screenings for the cognitive (modified Montreal Cognitive Assessment (MoCA)) and self-care status of the patient. Secondary outcomes were length of hospital stay (LOS) and mortality rates. Results: Postoperative delirium rates were similar in prone and supine patients (7.6% vs. 5.5%; p = 0.31), and logistic regression analysis revealed no association of intraoperative prone positioning with POD (odds ratio 1.42 (95% CI 0.68–2.92; p = 0.342)). The overall incidence of POD was 6.1% and was associated with older age (81.5 (CI 76.2–84.8) vs. 72.0 (CI 67.0–79.0) years; p < 0.01), higher ASA and NHYA classifications, lower preoperative modified MoCA, reduced independence in self-care (p < 0.001, respectively), and longer incision-to-suture times (107.0 (CI 73.0–173.0) vs. 85.0 (CI 60.0–130.0) minutes; p < 0.01). Postoperative delirium resulted in longer LOS (14.5 (CI 9.0–27.0) vs. 7.0 (CI 4.0–9.0) days; p < 0.001), and increased mortality (13.0% vs. 1.7%; p < 0.001). Conclusions: Intraoperative prone positioning was not associated with POD in patients aged 60 years or older (OR 1.42; CI 0.68–2.92; p < 0.340), and LOS and mortality as secondary outcome parameters were also similar in patients after prone and supine surgery. Future studies assessing additional and possible confounding factors and intraoperative systemic and regional hemodynamics and oxygenation are needed to verify this result and to evaluate cerebral hypoperfusion as a possible mechanism of POD. Full article

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21 pages, 1446 KB

Open AccessReview

Constipation in Older Adults: Pathophysiology, Clinical Impact, and Management Strategies

by Shima Mimura, Asahiro Morishita, Atsuo Kitaoka, Kota Sasaki, Hiroki Tai, Rie Yano, Mai Nakahara, Kyoko Oura, Tomoko Tadokoro, Koji Fujita, Joji Tani, Takashi Himoto and Hideki Kobara

Geriatrics 2026, 11(2), 47; https://doi.org/10.3390/geriatrics11020047 - 16 Apr 2026

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Abstract

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, [...] Read more.

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition—multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes—to characterize constipation in older adults as a “systemic geriatric syndrome,” and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain–gut–microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework. Full article

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11 pages, 347 KB

Open AccessArticle

Clinical Utility of Gait Speed Indices for Identifying Sarcopenia in Older Adults with Type 2 Diabetes

by Kensaku Kashima, Rie Nishimura, Hisashi Sugano and Shimpei Fujimoto

Geriatrics 2026, 11(2), 46; https://doi.org/10.3390/geriatrics11020046 - 14 Apr 2026

Viewed by 543

Abstract

Background/Objectives: This study aimed to compare the diagnostic performance of usual gait speed (UGS), maximal gait speed (MGS), and gait speed reserve (GSR) for identifying sarcopenia in older adults with type 2 diabetes (T2D), and to examine whether combining gait indices improves [...] Read more.

Background/Objectives: This study aimed to compare the diagnostic performance of usual gait speed (UGS), maximal gait speed (MGS), and gait speed reserve (GSR) for identifying sarcopenia in older adults with type 2 diabetes (T2D), and to examine whether combining gait indices improves diagnostic performance. Methods: This cross-sectional study included 117 older adults with T2D hospitalized for glycemic control. UGS and MGS were measured in the central 10-m section of a 16-m course, which included 3-m acceleration and deceleration zones on either side. GSR was calculated as the difference between MGS and UGS. Sarcopenia was diagnosed according to the AWGS 2025 criteria. Multivariable logistic regression was used to examine the associations between each gait index and sarcopenia. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and the usefulness of a combined criterion based on UGS and GSR was also assessed. Results: Sarcopenia was identified in 32 participants (27.4%). UGS, MGS, and GSR were each associated with sarcopenia independently of clinical factors. UGS showed the highest sensitivity (90.6%), suggesting its potential usefulness as a screening measure, whereas GSR showed the highest specificity (83.5%), suggesting its potential usefulness in reducing false positives when identifying sarcopenia. In the ROC analysis of the three gait-related indices, the area under the curve (AUC) for MGS was the highest (0.79), but it was not significantly different from the AUC for UGS. The combined criterion of UGS < 1.07 m/s and GSR < 0.21 m/s improved specificity and yielded a high positive likelihood ratio (PLR = 6.5). Conclusions: UGS, MGS, and GSR each exhibit distinct diagnostic characteristics for sarcopenia. UGS may be useful for screening, whereas GSR may help improve specificity. In particular, combining UGS and GSR may provide complementary diagnostic information for identifying sarcopenia in older adults with T2D. Full article

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29 pages, 4117 KB

Open AccessReview

Cognitive Testing in Spanish Older Adults: A Scoping Review

by Lucía Sáez-González, Luis A. Martínez, Gema Blázquez-Abellán, José Antonio Carbajal de Lara, Rosa M. Martinez-Garcia and Lucía Castro-Vázquez

Geriatrics 2026, 11(2), 45; https://doi.org/10.3390/geriatrics11020045 - 10 Apr 2026

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Abstract

Background/Objectives: Cognitive impairment is a major concern in aging populations. Early detection through validated neuropsychological tests is essential for dementia risk stratification and preventive interventions. This scoping review (PRISMA-ScR, 2013–2023, registration protocol: 10.17605/OSF.IO/8NHJF) evaluated cognitive testing trends in aging research and identified the [...] Read more.

Background/Objectives: Cognitive impairment is a major concern in aging populations. Early detection through validated neuropsychological tests is essential for dementia risk stratification and preventive interventions. This scoping review (PRISMA-ScR, 2013–2023, registration protocol: 10.17605/OSF.IO/8NHJF) evaluated cognitive testing trends in aging research and identified the most frequently used neuropsychological screening tests in Spanish populations. Methods: Searches in PubMed and Web of Science (March 2024) yielded 730 records; 156 were reviewed in full, and 15 met inclusion criteria for Spanish adults ≥65 years. Results: The Mini-Mental State Examination was the most-used test, followed by verbal fluency and Trail Making Test. No test covered all six DSM-5 cognitive domains, and social cognition was never assessed in any of the studies. The Montreal Cognitive Assessment was underused despite its superior sensitivity. Conclusions: Findings support developing a tailored, multidomain battery combining global and domain-specific tests. Social cognition assessments should be included to ensure a complete cognitive domain coverage. Full article

(This article belongs to the Special Issue Current Issues in Cognitive Testing of Older Adults)

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9 pages, 935 KB

Open AccessArticle

Comparison of Physical Performance and Muscle Thickness Between Older Women with High and Low Fall Risk: A Bayesian Approach

by Claudineia Matos de Araujo, Rafael Pereira, Joanderson Felipe Soares Silva, Cláudia Thais Pereira Pinto, Alinne Alves Oliveira, Luciano Magno de Almeida Faria, Ludmila Schettino, Mikhail Santos Cerqueira and Marcos Henrique Fernandes

Geriatrics 2026, 11(2), 44; https://doi.org/10.3390/geriatrics11020044 - 10 Apr 2026

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Abstract

Objective: The present study aimed to compare muscle thickness and physical performance in different functional tests predicting falls between older adults with low and high fall risk. Methods: Seventy-one community-dwelling older women (74.5 ± 8.5 years old) volunteered for this study. The Berg [...] Read more.

Objective: The present study aimed to compare muscle thickness and physical performance in different functional tests predicting falls between older adults with low and high fall risk. Methods: Seventy-one community-dwelling older women (74.5 ± 8.5 years old) volunteered for this study. The Berg Balance Scale (BBS) was used to stratify the sample as low and high risk for fall (BBS cutoff = ≥ 50 points). The performance in the Timed Up and Go Test (TUGT), 5-repetition sit-to-stand test (5xSST), 3 m walk test (3mWT), and 3 m backward walk test (3mBWT) was assessed. The elbow flexor and knee extensor muscle thickness were obtained by ultrasound (USD). A linear mixed model analysis was used to determine between-group differences in functional mobility and muscle thickness, and Bayesian analysis was applied to check the probability to replicate the same results (i.e., the magnitude of the evidence). Results: The low-fall-risk group exhibited significantly better performance only in 3mWT (mean difference = 0.84 s [95% CI: 0.40 to 1.29 s]; p = 0.001) and 3mBWT (mean difference = 1.54 s [95% CI: 0.21 to 2.85 s]; p = 0.024). The Bayes Factor (BF) for performance on the 3mWT and 3mBWT shows that the low-fall-risk group has a probability of 98.7% (BF10 = 77.3) and 99.7% (BF10 = 368), respectively, of performing better than the high-fall-risk group. Conclusions: Based on inferential and Bayesian analysis, the performance in 3mWT and that in 3mBWT were classified as very strong to excellent instruments, respectively, for differentiating older women with high fall risk. Full article

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13 pages, 1308 KB

Open AccessArticle

Exploring the Interplay Between Core Stability, Pulmonary Function, and Cardiorespiratory Fitness in Older Adults: A Randomized Controlled Trial of an 8-Week Mat Pilates Intervention

by Bulin Jirapongsatorn, Decha Chinaksorn, Kanapot Pengked, Wannaporn Tongtako and Timothy Mickleborough

Geriatrics 2026, 11(2), 43; https://doi.org/10.3390/geriatrics11020043 - 9 Apr 2026

Viewed by 549

Abstract

Background: Identifying multimodal interventions to counteract age-related physiological decline is a critical public health priority. This study investigated the impact of an 8-week Mat Pilates intervention (MPT) on the interplay between core stability, pulmonary function, and cardiorespiratory fitness in older adults, specifically examining [...] Read more.

Background: Identifying multimodal interventions to counteract age-related physiological decline is a critical public health priority. This study investigated the impact of an 8-week Mat Pilates intervention (MPT) on the interplay between core stability, pulmonary function, and cardiorespiratory fitness in older adults, specifically examining the mechanistic link between trunk stabilization and respiratory mechanics. Methods: Twenty older adults (18 females, 2 males; age 60—77 years) were randomized (stratified by sex, age, and baseline stability) into an MPT group (n = 10; 60-min sessions, 3×/week) or a control group (CON, n = 10). Primary outcomes included core stability (plank test), functional flexibility (sit-and-reach; back-scratch), pulmonary function (FVC, FEV₁, FEV₁/FVC, FEF_25–75%, MVV), and cardiorespiratory fitness (6-min walk test; 6MWT). Results: Post-intervention, the MPT group demonstrated significant improvements in core stability, flexibility, and all pulmonary variables (FVC, FEV₁, FEF_25–75%, MVV) compared to the CON group (p < 0.001). A significant reduction in body weight was also observed (p < 0.001). Notably, MPT participants achieved superior 6MWT distances and reduced perceived exertion (p = 0.006). Correlation analysis revealed strong positive associations between core stability gains and pulmonary function (r = 0.892, p < 0.01), supporting the mechanistic link between trunk stabilization, enhanced ventilatory mechanics, and functional aerobic capacity. Conclusions: Mat Pilates is a potent intervention for older adults, facilitating a physiological synergy where core strengthening optimizes pulmonary function and cardiorespiratory endurance. These findings suggest MPT is a comprehensive modality for maintaining musculoskeletal and respiratory health, proving superior to habitual activity alone in promoting functional independence. Full article

(This article belongs to the Special Issue Exercise Interventions for Healthy Aging)

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11 pages, 396 KB

Open AccessArticle

Impact of Inflammation and Muscle Mass on Prognosis in Hospitalized Patients with Suspected Dysphagia at a Tertiary Hospital

by Mario Alfredo Saavedra-Vásquez, Juan José López-Gómez, Beatriz Ramos-Bachiller, Olatz Izaola-Jauregui, Eva López-Andrés, Isabel Pérez-Mellén, Sara Cuenca-Becerril, María Jesús Villameriel-Galván, Jaime González-Gutiérrez, Lucia Estevez-Asensio, María Ángeles Castro-Lozano and Daniel Antonio De Luis-Román

Geriatrics 2026, 11(2), 42; https://doi.org/10.3390/geriatrics11020042 - 9 Apr 2026

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Abstract

Background/Objectives: Dysphagia is associated with an increased risk of in-hospital complications and adverse outcomes. Prognosis in frail hospitalized populations is influenced by systemic inflammation and reduced muscle mass. Calf circumference (CC) and an estimated appendicular skeletal muscle index (ASMI) can serve as [...] Read more.

Background/Objectives: Dysphagia is associated with an increased risk of in-hospital complications and adverse outcomes. Prognosis in frail hospitalized populations is influenced by systemic inflammation and reduced muscle mass. Calf circumference (CC) and an estimated appendicular skeletal muscle index (ASMI) can serve as indirect measures of muscle mass, while inflammatory status may be captured by C-reactive protein (CRP), albumin, and the CRP/albumin ratio. This study aimed to evaluate the prognostic value of indirect biomarkers of inflammation and muscle mass to predict prognosis in hospitalized patients with suspected dysphagia. Methods: A retrospective observational study was conducted at a tertiary hospital and included patients admitted with suspected dysphagia between April 2015 and October 2024. On admission, demographic variables (sex and age), anthropometry (weight, height, and CC), EAT-10 (Eating Assessment Tool) score, and serum laboratory parameters (CRP, albumin) were collected. ASMI was estimated using the formula −10.427 + (CC × 0.768) − (age × 0.029) + (sex × 7.523)/(height²). Outcomes were in-hospital mortality and length of hospital stay. Comparisons were performed between survivors and non-survivors, and multivariable models adjusted for age and sex were used to identify independent associations with mortality. Results: A total of 4241 patients were included (51.2% women), with a median age of 85 (Interquartile range [IQR] 14) years and a mean EAT-10 score of 15.98 (SD 7.79). In-hospital mortality was 18.13% (n = 769). Non-survivors were older (86 [IQR 11] vs. 84 [IQR 14] years; p < 0.001) and displayed a more inflammatory profile, with higher CRP (78.1 [IQR 114.28] vs. 44 [IQR 96] mg/L) and CRP/albumin ratio (27.27 [IQR 43.04] vs. 13.64 [IQR 31.77]; p < 0.001), and lower albumin (3 [IQR 0.8] vs. 3.3 [IQR 0.8] g/dL; p < 0.001). They also had lower muscle mass, with reduced CC and lower ASMI in both sexes. In multivariable analysis, a higher CRP/albumin ratio was independently associated with increased odds of death (OR 1.011; 95% CI 1.008–1.014; p < 0.001), whereas a higher ASMI was protective (OR 0.885; 95% CI 0.801–0.978; p = 0.017). Higher CRP/albumin ratios were also associated with longer hospital stays and lower albumin, CC, and ASMI values. Conclusions: In hospitalized patients with suspected dysphagia, systemic inflammation and lower muscle mass were associated with worse clinical outcomes. The CRP/albumin ratio independently predicted higher in-hospital mortality and prolonged hospitalization, whereas higher estimated ASMI was associated with lower mortality risk, supporting the combined prognostic value of inflammatory and muscle-mass indicators in this population. Full article

(This article belongs to the Section Dysphagia)

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13 pages, 399 KB

Open AccessArticle

Association Between the Color Kanji Pick-Out Test App Performance and Cognitive Frailty as a Potential Early Screening Marker for Cognitive Decline

by Akio Goda, Hideki Nakano, Yuki Kikuchi, Tsuyoshi Katsurasako, Kohei Mori, Atsuko Kubo, Kayoko Nonaka, Kohei Iwamoto, Nozomi Mitsumaru, Takaki Shimura and Shin Murata

Geriatrics 2026, 11(2), 41; https://doi.org/10.3390/geriatrics11020041 - 9 Apr 2026

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Abstract

Background/Objective: Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is a potentially reversible and high-risk state for dementia. This study examined the association between Color Kanji Pick-out Test (CKPT) app performance and cognitive frailty independent of Mini-Mental State Examination (MMSE) [...] Read more.

Background/Objective: Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is a potentially reversible and high-risk state for dementia. This study examined the association between Color Kanji Pick-out Test (CKPT) app performance and cognitive frailty independent of Mini-Mental State Examination (MMSE) scores in community-dwelling older women. Methods: In this cross-sectional study, the participants were 102 community-dwelling older women without dementia and with MMSE scores ≥ 27 (73.6 ± 6.0 years). Reversible cognitive frailty was defined as subjective cognitive decline (≥1 point in the cognitive domain of the Kihon Checklist) plus physical frailty or prefrailty, according to the Japanese Cardiovascular Health Study (J-CHS) criteria. Firth’s penalized logistic regression using three prespecified models, adjusted for age and education, was used to examine the independent associations between CKPT app performance and MMSE scores with reversible cognitive frailty. Results: Fourteen participants (13.7%) met the criteria for cognitive frailty. In separate models, higher CKPT app and MMSE scores were significantly associated with lower odds of cognitive frailty (CKPT: odds ratio [OR] 0.470, p = 0.019; MMSE: OR 0.548, p = 0.020). In a multivariable model including both measures, the CKPT app (OR 0.499, p = 0.031) and MMSE scores (OR 0.553, p = 0.031) remained independently associated with cognitive frailty, and this model had the lowest Akaike information criterion. Conclusions: The CKPT app performance was independently associated with cognitive frailty beyond global cognition. The CKPT app may detect subtle executive and attentional vulnerabilities not captured by the MMSE, supporting practical, objective, early screening and risk stratification of cognitive frailty. Full article

(This article belongs to the Section Geriatric Psychiatry and Psychology)

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29 pages, 946 KB

Open AccessReview

Personalized Hemodialysis Approaches in Frail Older Individuals

by Guido Gembillo, Luca Soraci, Matteo Floris, Lorenzo Lo Cicero, Claudia Lo Re, Elvira Filicetti, Michela Calderone, Carmelo Giorgio Benenati, Andrea Corsonello and Domenico Santoro

Geriatrics 2026, 11(2), 40; https://doi.org/10.3390/geriatrics11020040 - 7 Apr 2026

Viewed by 902

Abstract

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant [...] Read more.

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to >80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform ‘fistula-first’ approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams. Full article

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9 pages, 201 KB

Open AccessProject Report

Impact of Comprehensive Geriatric Assessments on Dementia Care

by Shazia Durrani, Minhal Mussawar and Mariam Alaverdashvili

Geriatrics 2026, 11(2), 39; https://doi.org/10.3390/geriatrics11020039 - 1 Apr 2026

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Abstract

Introduction: According to the Alzheimer Society of Canada, over 770,000 people in Canada are living with dementia. This number is expected to rise to nearly 1 million people by 2030. Although the provision of team-based interprofessional assessment in gerontological care is critical for [...] Read more.

Introduction: According to the Alzheimer Society of Canada, over 770,000 people in Canada are living with dementia. This number is expected to rise to nearly 1 million people by 2030. Although the provision of team-based interprofessional assessment in gerontological care is critical for the early detection and prevention of dementia, its planning and delivery can be a challenge. In Saskatchewan, previous assessments have identified significant gaps between actual and best practices in dealing with this medical condition. The emergence of Geriatric Services Resource Teams (GSRTs), which apply an innovative, team-based model to improve the diagnosis and care of older adults with complex health practices, can be proven beneficial in this regard. The purpose of this study is to compare the efficacy of the care provision process between a GSRT and a traditional medical care channel (i.e., primary health) with respect to dementia patients. Methods: A retrospective patient chart review was conducted by collecting data from a large Primary Care practice (n = 90) and the GSRT in Regina (n = 75). Collected data included information on patient demographics and treatment, and the diagnosis process itself. Results: While demographic characteristics between patient groups were similar, significant differences (p < 0.05) were found in the involvement of pharmacy and other healthcare professionals, prescriptions for memory loss, and in who made the diagnosis. Moreover, although the dementia diagnosis was usually made first in Primary Care, further clarification of the type of dementia, counseling of diagnosis, review of medication, and assessment of functions and social supports were better managed in the GSRT group. Discussion: The use of Geriatric Services Resource Teams is a relatively new concept in Saskatchewan. As these teams are established, initial results show that their role in complex care management has beneficial outcomes for dementia patients. Full article

15 pages, 520 KB

Open AccessSystematic Review

The Need for Standardized Data Collection to Improve Harmonization and Pooling of Information About Modifiable Risk Factors for Alzheimer’s Diseases in Italian Clinical Studies: A Systematic Review

by Patrizio Allegra, Manuela Lodico, Claudia Migliazzo, Domenico Tarantino, Tommaso Piccoli, Nicola Vanacore, Giuseppe Salemi, Laura Maniscalco and Domenica Matranga

Geriatrics 2026, 11(2), 38; https://doi.org/10.3390/geriatrics11020038 - 31 Mar 2026

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Abstract

Background/Objectives: At the international level, harmonized networks of dementia clinical studies are available, but Italian participation remains limited. This systematic review aims to define harmonization rules to facilitate the inclusion of Italian clinical studies in existing networks and to propose standardized data collection [...] Read more.

Background/Objectives: At the international level, harmonized networks of dementia clinical studies are available, but Italian participation remains limited. This systematic review aims to define harmonization rules to facilitate the inclusion of Italian clinical studies in existing networks and to propose standardized data collection methods to enable comparison of the study results. Methods: A systematic review was conducted (January 2019–December 2024) to identify Italian clinical studies evaluating Alzheimer’s disease and other dementias as outcomes. Eight modifiable risk factors were extracted: BMI, arterial hypertension, diabetes, dietary patterns, alcohol consumption, smoking habits, depressive symptomatology, and physical activity. WHO definitions and internationally accepted criteria were used as reference standards. Variable harmonization potential was assessed using the DataSHaPER methodology and classified as complete, partial, or impossible, considering information loss across studies. Results: Of 365 records identified, 18 studies met the inclusion criteria. Obesity assessed via BMI showed the highest harmonization potential (44% complete, 33% partial), along with dietary habits measured by food frequency questionnaires (44% complete). Diabetes and physical inactivity followed (33% complete), assessed through fasting glucose or pharmacological treatment and the IPAQ, respectively. Smoking habits classified as current, former, or never smokers were reported in 28% of studies. Depression (assessed by GDS or CES-D) and hypertension (blood pressure measurement or antihypertensive treatment) showed complete harmonization in only 22% of studies. Conclusions: Italian studies show substantial limitations in the harmonization of modifiable risk factor data for Alzheimer’s disease, mainly due to heterogeneous and non-standardized data collection methods, highlighting the need for uniform research protocols. Full article

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Open AccessCommentary

Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity

by Adrian Bryła, Jarosław Woroń, Miłosz Miedziaszczyk, Barbara Lorkowska-Zawicka, Beata Bujak-Giżycka, Daniel Orzechowski, Paulina Połetek and Wojciech Pałys

Geriatrics 2026, 11(2), 37; https://doi.org/10.3390/geriatrics11020037 - 31 Mar 2026

Viewed by 961

Abstract

The aging of the population and the increasing prevalence of multimorbidity contribute to the widespread use of polypharmacotherapy, which in turn elevates the risk of adverse drug reactions and clinically significant drug–drug interactions. One of the key yet frequently underestimated issues in clinical [...] Read more.

The aging of the population and the increasing prevalence of multimorbidity contribute to the widespread use of polypharmacotherapy, which in turn elevates the risk of adverse drug reactions and clinically significant drug–drug interactions. One of the key yet frequently underestimated issues in clinical practice is the prescribing cascade, which occurs when an adverse drug reaction is misinterpreted as a new medical condition, leading to the initiation of an additional medication. This phenomenon is particularly relevant in the older population, in whom altered pharmacokinetics and pharmacodynamics, together with reduced organ reserve, increase susceptibility to adverse drug events, including nephrotoxicity (renal impairment is used throughout the review as a clinically relevant example of organ-specific harm resulting from prescribing cascades, rather than as the sole focus of the analysis). This article discusses the mechanisms and clinical consequences of the prescribing cascade—with particular emphasis on renal function deterioration—as well as strategies for its prevention in the geriatric population. Analysis of the literature indicates that prescribing cascades remain insufficiently recognized in clinical practice, despite the availability of pharmacotherapy assessment tools such as The American Geriatrics Society (AGS) Beers Criteria and the STOPP/START criteria. Documented prescribing cascades have been shown to contribute to deterioration in health status and quality of life, an increased frequency of hospitalizations, and a greater burden on healthcare systems. Particularly concerning are cascades involving cardiovascular, neurological, and analgesic medications, which may induce or exacerbate renal injury, ultimately leading to chronic kidney disease and organ failure. Prescribing cascades represent a significant yet frequently underestimated threat to the efficacy and safety of pharmacotherapy in older adults. Their consequences may extend beyond reduced quality of life and increased treatment costs to include serious complications such as the development of renal failure. Enhancing clinicians’ awareness, conducting systematic medication reviews, and employing validated assessment tools are essential for the identification and prevention of prescribing cascades, thereby reducing the risk of renal injury and improving clinical outcomes. Full article

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14 pages, 839 KB

Open AccessArticle

Emergency Ventral Hernia Management in Older Adults: A Retrospective Cohort Study and Structured Review of the Literature

by Ivan Tomasi, Jeremy Samuel, Eimante Raupelyte, Antonia Elizabeth Loizou, Angela Wang Yihui, Lilian Chioma Ujunwa Nwosu, Sneha Mehrotra, Mariia Druziagina, Kenneth Wing Ngai Law and Magda Sbai

Geriatrics 2026, 11(2), 36; https://doi.org/10.3390/geriatrics11020036 - 27 Mar 2026

Viewed by 740

Abstract

Background/Objectives: Older adults frequently present with emergency ventral hernias, a situation that carries significant physiological risks and often requires challenging clinical decisions. Despite the prevalence of these cases, there is a lack of robust evidence to inform emergency care in this demographic, [...] Read more.

Background/Objectives: Older adults frequently present with emergency ventral hernias, a situation that carries significant physiological risks and often requires challenging clinical decisions. Despite the prevalence of these cases, there is a lack of robust evidence to inform emergency care in this demographic, as most existing research centres on short-term mortality rates and operative variables. Key aspects such as the impact of frailty and the course of recovery following surgery are insufficiently addressed in the literature. This study aimed to describe management strategies, frailty burden and postoperative outcomes in older adults presenting with emergency ventral hernias. Methods: This study retrospectively examined patients aged 65 and older who were admitted to a UK tertiary centre with emergency ventral hernias from February 2016 to July 2024. Data, including patient demographics, comorbid conditions, frailty status (as measured by the Clinical Frailty Scale), management approach, healthcare resource use, and clinical outcomes, were analysed descriptively. Additionally, a structured literature review was conducted in accordance with PRISMA guidelines to identify research on emergency ventral hernia treatment outcomes in adults aged 60 years and older. Results: A total of 67 patients met the inclusion criteria for the cohort. High rates of frailty and multiple coexisting health conditions were observed. While surgical intervention was the predominant management strategy, a subset of patients received conservative or palliative care. Greater degrees of frailty correlated with longer hospital stays and an increased need for critical care, even though six-month mortality remained comparatively low. Traditional risk assessment tools tended to overpredict mortality risk and failed to reflect the true postoperative burden or the recovery process. The systematic review yielded 7 studies, most of which documented mortality and complication rates, but few addressed frailty or provided detailed postoperative recovery data. Conclusions: The management of emergency ventral hernias in older adults is highly variable, with a significant postoperative impact that extends beyond mortality statistics. Assessing frailty appears to provide additional information that may support clinical decision-making and help anticipate recovery after surgery. Integrating frailty evaluation into emergency hernia care could enhance multidisciplinary collaboration and help ensure that treatment plans are better tailored to patient vulnerability and individual care goals. Full article

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16 pages, 304 KB

Open AccessReview

Neoplastic Disorders and Cardiovascular Comorbidities in Geriatric Patients: A Simple Association?

by Andreea Taisia Tiron, Marian-Vlad Lăpădat, Maria Mădălina Georgică, Lavinia Alice Bălăceanu, Ion Daniel Baboi and Ion Dina

Geriatrics 2026, 11(2), 35; https://doi.org/10.3390/geriatrics11020035 - 27 Mar 2026

Viewed by 682

Abstract

Cardiovascular disease (CVD) and cancer frequently coexist in older patients, posing significant challenges in clinical management due to overlapping risk factors and treatment-related complications. This narrative review summarizes current knowledge on the epidemiology, shared pathophysiological mechanisms and clinical impact of neoplastic comorbidities in [...] Read more.

Cardiovascular disease (CVD) and cancer frequently coexist in older patients, posing significant challenges in clinical management due to overlapping risk factors and treatment-related complications. This narrative review summarizes current knowledge on the epidemiology, shared pathophysiological mechanisms and clinical impact of neoplastic comorbidities in older adults with cardiovascular diseases. It highlights the increased mortality, morbidity and diminished quality of life resulting from the coexistence of these conditions. The review also discusses personalized management strategies, emphasizing comprehensive geriatric and cardiac assessments, and tailoring oncologic treatments to minimize cardiotoxicity, as well as the role of prevention and rehabilitation programs. As the population ages and cancer survival improves, integrated cardio-oncology care adapted to older adults becomes increasingly essential to optimize outcomes and preserve functional status. Full article

(This article belongs to the Section Cardiogeriatrics)

13 pages, 595 KB

Open AccessReview

Integrating a Palliative Approach into Cardiogeriatric Decision-Making for Frail Older Adults with Heart Failure

by Rémi Esser, Marine Larbaneix, Alejandro Mondragon, Marlène Esteban, Christine Farges, Sophie Nisse Durgeat, Marc Harboun and Olivier Maurou

Geriatrics 2026, 11(2), 34; https://doi.org/10.3390/geriatrics11020034 - 25 Mar 2026

Cited by 1 | Viewed by 702

Abstract

Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive [...] Read more.

Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive vulnerability, and prognostic uncertainty, and remains insufficiently addressed by conventional disease-centred heart failure pathways. Methods: This narrative review synthesizes current evidence from heart-failure guidelines, geriatric medicine, and palliative care literature to propose a cardiogeriatric framework for end-of-life decision-making in advanced HF. Results: In older adults, functional decline and geriatric vulnerability often progress independently of cardiac parameters, limiting the relevance of prognosis-based thresholds. The palliative turning point should be understood as a multidimensional process resulting from converging cardiological, geriatric, organizational, and patient-reported signals. Therapeutic decisions should be guided by proportionality between expected benefit, treatment burden, and patient priorities. Longitudinal, iterative communication is essential to align care with evolving goals. Conclusions: A cardiogeriatric approach integrating cardiology, geriatrics, and palliative principles supports timely palliative integration, shared decision-making, and coordinated care in very old patients with advanced HF. Full article

(This article belongs to the Section Cardiogeriatrics)

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14 pages, 479 KB

Open AccessArticle

Reliability and Construct Validity of the Short Physical Performance Battery in Croatian Older Adults

by Tatjana Njegovan Zvonarević, Ivan Jurak, Mirjana Telebuh, Ana Mojsović Ćuić, Edina Pulić, Ivna Kocijan, Želimir Bertić, Miljenko Franić, Igor Filipčić, Vlatko Brezac, Klara Turković and Lana Feher Turković

Geriatrics 2026, 11(2), 33; https://doi.org/10.3390/geriatrics11020033 - 19 Mar 2026

Viewed by 881

Abstract

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk [...] Read more.

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk of falls, hospitalization, and mortality in older adults. Reliable and valid tools to assess physical performance are therefore essential in both clinical and research settings. The Short Physical Performance Battery (SPPB) is a widely used instrument for assessing lower-extremity physical performance in older adults and is recommended within the diagnostic algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) for evaluating physical performance severity. However, the SPPB has not yet been psychometrically validated in the Croatian older population. This study aimed to evaluate the reliability and validity of the SPPB in Croatian older adults. Methods: This study examined the metric properties of the SPPB in a sample of 153 older adults recruited from nursing homes and community settings. Results: The SPPB demonstrated acceptable internal consistency (Cronbach’s alpha = 0.74) and good test–retest reliability (ICC = 0.893) for the total score. Convergent and construct validity were supported by significant associations with established measures of functional mobility and muscle strength. Conclusions: The Croatian version of the SPPB is a reliable and valid instrument for assessing lower-extremity physical performance in older adults. Its use is supported in clinical practice and research settings in Croatia. Further studies should examine responsiveness and predictive validity in nationally representative samples. Full article

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Open AccessArticle

Dose–Response Relationship Between Sleep Regularity Index and Stage-Specific Alzheimer’s Disease: Cross-Sectional Evidence from Japanese Adults

by Yue Cao, Jaehee Lee, Jaehoon Seol, Kenji Tsunoda, Kyohei Shibuya, Jieun Yoon, Tetsuaki Arai and Tomohiro Okura

Geriatrics 2026, 11(2), 32; https://doi.org/10.3390/geriatrics11020032 - 18 Mar 2026

Viewed by 805

Abstract

Background/Objectives: Daily sleep patterns are associated with cognitive health and Alzheimer’s disease (AD). However, it remains unclear how suboptimal irregular sleep manifests in AD from the preclinical stage to dementia. This study aimed to establish the dose–response association between sleep irregularity and [...] Read more.

Background/Objectives: Daily sleep patterns are associated with cognitive health and Alzheimer’s disease (AD). However, it remains unclear how suboptimal irregular sleep manifests in AD from the preclinical stage to dementia. This study aimed to establish the dose–response association between sleep irregularity and psychometrically defined stage-specific AD as well as executive dysfunction, among adults with subjective cognitive and sleep issues. Methods: Cross-sectional data were obtained from 532 Japanese adults (mean age = 63.9 years) between March 2023 and April 2024. Sleep irregularity was quantified using the Sleep Regularity Index (SRI) with 24/7 accelerometer data. A modified Poisson regression with cubic splines was performed to establish the dose–response association. Results: This study identified novel non-linear associations. The prevalence ratios of cognitive impairment, defined as being in the preclinical and more advanced stages of AD, significantly declined beyond a median SRI of 60. Participants within this SRI range also showed significantly lower prevalence ratios of poorer Trail Making Test B performance. All results were independent of age, sleep duration, and risk of depression. Conclusions: Maintaining balanced-to-regular daily sleep patterns might be optimal for AD progress from its preclinical stages, with a potential benchmark at SRI of 60, especially for those individuals at risk for cognitive decline and sleep disorders. Further research is needed to replicate this benchmark in diverse populations and to evaluate the effect of rigid sleep regularity on cognitive health. Full article

(This article belongs to the Section Healthy Aging)

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14 pages, 436 KB

Open AccessArticle

Effects of a Proactive Driving Transition Class on Extending Safe Driving and Preparing for Life After Driving Cessation Among Older Drivers

by Tsutomu Sasaki, Kyohei Yamada, Takeshi Yamakita, Naoto Sakuta, Hajime Yoshida and Takeshi Tominaga

Geriatrics 2026, 11(2), 31; https://doi.org/10.3390/geriatrics11020031 - 16 Mar 2026

Viewed by 467

Abstract

Background/Objectives: Driving cessation is associated with adverse health outcomes. Proactive support that extends safe driving while preparing for life after driving cessation has been emphasized, but empirical evidence remains limited. This study examined the effects of a proactive class for older drivers on [...] Read more.

Background/Objectives: Driving cessation is associated with adverse health outcomes. Proactive support that extends safe driving while preparing for life after driving cessation has been emphasized, but empirical evidence remains limited. This study examined the effects of a proactive class for older drivers on awareness and behavior related to driving and mobility (Study 1) and on longitudinal changes in on-road driving behavior (Study 2). Methods: The proactive class was implemented as a municipal program, including information provision, training activities, group discussions, and optional on-road driving evaluations. Study 1 included 71 older drivers who attended the class at least five times annually and completed an anonymous questionnaire assessing perceived changes in awareness and behavior. Study 2 included 29 participants who completed standardized on-road driving evaluations at baseline and at a 1-year follow-up. Paired t-tests or Wilcoxon signed-rank tests with effect sizes were applied. Results: In Study 1, participants reported increased awareness of safe driving, greater confidence in continuing to drive, heightened risk perception, initiation of health-related behaviors, trial use of public transportation, and increased healthcare utilization, particularly ophthalmology visits. In Study 2, total scores on the on-road driving skill test improved significantly at follow-up (Cohen’s dz = 0.805). No significant changes were observed in individual on-road driving skill subitems, physical function, cognitive function, or daily functioning after correction for multiple comparisons, except for a reduction in driving simulator accidents. Conclusions: Participation in a proactive, continuous driving transition support class was associated with multidimensional behavioral changes and improved on-road driving performance among older drivers, potentially contributing to safer mobility and healthier aging. Full article

(This article belongs to the Section Healthy Aging)

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13 pages, 595 KB

Open AccessArticle

The Use of Direct Oral Anticoagulants (DOACs) in Older Adults Receiving Multidose Drug Dispensing; Interactions, Anticholinergic and Fall-Risk Increasing Drugs

by Anette Vik Josendal, Ole Martin Sobakk, Anne Gerd Granas and Anne Katrine Eek

Geriatrics 2026, 11(2), 30; https://doi.org/10.3390/geriatrics11020030 - 6 Mar 2026

Viewed by 1015

Abstract

Objectives: To examine the prescribing of non-vitamin K-dependent oral anticoagulants (DOACs) among multidose drug dispensing (MDD) users aged ≥65 years, and to describe associated drug–drug interactions (DDIs), concomitant use of fall-risk increasing drugs (FRIDs) and anticholinergic drugs (AC). Methods: Cross-sectional analysis of [...] Read more.

Objectives: To examine the prescribing of non-vitamin K-dependent oral anticoagulants (DOACs) among multidose drug dispensing (MDD) users aged ≥65 years, and to describe associated drug–drug interactions (DDIs), concomitant use of fall-risk increasing drugs (FRIDs) and anticholinergic drugs (AC). Methods: Cross-sectional analysis of anonymized MDD medication lists from 87,519 patients in 2018. DDIs were identified using The Norwegian Medical Products Agency interaction tool, FRIDs were defined using the Swedish National Board of Health and Welfare list, and the CRIDECO Anticholinergic Load Scale assessed anticholinergic burden. Results: Among the 13,215 patients aged 65 and older the mean number of prescribed medications was 10.3. At least one DDI involving the prescribed DOACs was present in 26.8% of patients, whereas severe DDIs were rare (0.2%). Almost all (96.7%) used at least one FRID, and nearly half (46.8%) had an anticholinergic score ≥ 3. Conclusions: DOACs are frequently prescribed together with medications that increase the risk of falls and bleeding. These findings highlight the need for individualized risk–benefit evaluations and deprescribing or substituting high impact FRIDS and ACs when clinically appropriate. Full article

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10 pages, 666 KB

Open AccessArticle

Development of a Prediction Model for Community-Dwelling Older Adults at Risk of Long-Term Care with Dementia

by Kana Kazawa, Ken Sugimoto, Yoko Aihara and Michiko Moriyama

Geriatrics 2026, 11(2), 29; https://doi.org/10.3390/geriatrics11020029 - 5 Mar 2026

Viewed by 742

Abstract

Background: Early detection of modifiable risk factors for long-term care certification with dementia is essential. This study aimed to develop a risk-scoring tool using data from the Kihon Checklist and Questionnaire for the Late-Stage Elderly over a 2-year period to predict long-term care [...] Read more.

Background: Early detection of modifiable risk factors for long-term care certification with dementia is essential. This study aimed to develop a risk-scoring tool using data from the Kihon Checklist and Questionnaire for the Late-Stage Elderly over a 2-year period to predict long-term care certification with dementia under Japan’s Long-Term Care Insurance system. Methods: Participants included 2041 functionally independent, community-dwelling older adults in Kure City, Japan, as of March 2021. A retrospective cohort study was conducted. Associations between KCL and LSEQ domains and certification for long-term care with dementia were examined using logistic regression. To improve practical use, a score chart was developed to predict certification for long-term care with dementia. Results: Two years after completing the Kihon Checklist and Questionnaire, 143 participants (7.0%) were certified for long-term care with dementia. Factors independently associated with certification for long-term care with to dementia included age, homebound status, cognitive decline, and locomotor decline. The prediction model, developed using these variables, showed excellent discriminatory ability, with an area under the curve of 0.790 (95% confidence interval: 0.754–0.827). Conclusions: We developed an effective predictive model for future long-term care certification with dementia using routinely collected administrative data. This tool may help healthcare providers and health planners identify older adults at increased risk of long-term care certification with dementia. Full article

(This article belongs to the Special Issue Care, Connection and Equity: Advancing the Science of Caregiving in Aging)

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12 pages, 389 KB

Open AccessArticle

Aging Redefined: Cognitive and Physical Improvement with Positive Age Beliefs

by Becca R. Levy and Martin D. Slade

Geriatrics 2026, 11(2), 28; https://doi.org/10.3390/geriatrics11020028 - 4 Mar 2026

Viewed by 32937

Abstract

Background/Objectives: A widespread assumption exists among scientists, health care providers, and the public that later life is a time of inevitable and universal cognitive and physical decline. This assumption is likely due to considering older persons who improve to be exceptions, and [...] Read more.

Background/Objectives: A widespread assumption exists among scientists, health care providers, and the public that later life is a time of inevitable and universal cognitive and physical decline. This assumption is likely due to considering older persons who improve to be exceptions, and the reliance on aging-health measures that do not allow for improvement. In contrast, we utilized a measure that allowed for an upward trajectory to occur. Our objective was to examine whether a meaningful number of older persons improve with this measure and, if so, to examine whether a promising modifiable culture-based variable, positive age beliefs, contributes to this improvement. Methods: Individuals 65 years and older, who participated in a nationally representative longitudinal study, had their physical health assessed by walking speed and their cognitive health assessed by a global performance measure. We calculated the percentage of the sample that showed improvement in each domain from baseline to the last measurement up to 12 years later. We also examined whether a positive-age-belief measure predicted this improvement in regression models. Results: It was found that 45.15% of persons improved in cognitive and/or physical function over this period, and positive age beliefs predicted these two types of improvement, both with and without adjusting for relevant covariates. Conclusions: Our findings underscore the need to instill or magnify the positivity of age beliefs and to redefine aging so that it includes the possibility of improvement. Full article

(This article belongs to the Section Geriatric Psychiatry and Psychology)

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19 pages, 545 KB

Open AccessArticle

Effects of a Community-Based Multi-Component Intervention on Subjective Well-Being in Older Adults: The Chofu–Digital–Choju Project in Japan

by Tsubasa Nakada, Kayo Kurotani, Satoshi Seino, Takako Kozawa, Shinichi Murota, Miki Eto, Junko Shimasawa, Yumiko Shimizu, Shinobu Tsurugano, Fuminori Katsukawa, Kazunori Sakamoto, Hironori Washizaki, Yo Ishigaki, Maki Sakamoto, Keiki Takadama, Keiji Yanai, Osamu Matsuo, Chiyoko Kameue, Hitomi Suzuki and Kazunori Ohkawara

Geriatrics 2026, 11(2), 27; https://doi.org/10.3390/geriatrics11020027 - 3 Mar 2026

Viewed by 1150

Abstract

Background: Subjective well-being (SWB) is an essential indicator of successful aging. Although social connections enhance SWB among older adults, few interventions have integrated community-based approaches with information and communication technology (ICT). This study evaluated the Chofu–Digital–Choju (CDC) project, a multi-component community intervention fostering [...] Read more.

Background: Subjective well-being (SWB) is an essential indicator of successful aging. Although social connections enhance SWB among older adults, few interventions have integrated community-based approaches with information and communication technology (ICT). This study evaluated the Chofu–Digital–Choju (CDC) project, a multi-component community intervention fostering in-person and online social connections among community-dwelling older adults in urban Japan. Methods: This quasi-experimental study (January 2022 to March 2024) included community-dwelling older adults aged 65–84 years in Chofu City, Tokyo, Japan. The intervention consisted of online classes, community hubs as local third places, and community events. Baseline and follow-up data were collected using self-administered questionnaires. Propensity score matching (1:1) was used to reduce selection bias, and generalized estimating equations were applied to evaluate the intervention effects. The primary outcome was SWB (Cantril Ladder). The secondary outcomes included social isolation, neighborhood relationships, social participation, health literacy, psychological health, physical activity, and ICT use. Results: Among the 1599 participants who completed both surveys, 209 (13.1%) participated in at least one CDC intervention component. After propensity score matching, 195 pairs were analyzed. No significant interaction effect was observed for SWB (β = 0.08, 95% confidence interval [CI]: −0.20, 0.37; p = 0.565). However, a significant interaction effect favored the intervention group for Internet usage frequency (odds ratio = 1.53, 95% CI: 1.08, 2.16; p = 0.016). A significant borderline interaction was also observed in health literacy (β = 0.13, 95% CI: −0.00, 0.26; p = 0.056), which reached significance in covariate-adjusted sensitivity analysis (p = 0.044). Subgroup analyses revealed that community hub participants showed significant interaction effects in health literacy (p = 0.021) and a trend toward reduced depressive symptoms (p = 0.084). Conclusions: The CDC intervention did not improve SWB over 2 years but enhanced Internet use and supported health literacy and depressive symptoms, particularly among hub participants. Community-based, multi-component interventions that integrate online and in-person activities may foster digital inclusion and specific health behaviors. Although SWB did not change in this study, these proximal gains may serve as foundational steps for long-term improvement. The study protocol was preregistered in the UMIN Clinical Trials Registry (UMIN000051393; Registered on 21 June 2023). Full article

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16 pages, 242 KB

Open AccessArticle

Aging Successfully Despite Limitations? Meanings and Perceptions of Aging Well Among Older Adults Living in Long-Term Care Institutions

by Feliciano Villar, Nuria Ramón and Juan José Zacarés

Geriatrics 2026, 11(2), 26; https://doi.org/10.3390/geriatrics11020026 - 28 Feb 2026

Viewed by 883

Abstract

Background/Objectives: Dominant models of successful aging emphasize health, autonomy, and active engagement, often excluding older adults belonging to vulnerable groups, such as those living in long-term care facilities (LTCFs). This study aims to address this limitation by exploring how LTCF residents define [...] Read more.

Background/Objectives: Dominant models of successful aging emphasize health, autonomy, and active engagement, often excluding older adults belonging to vulnerable groups, such as those living in long-term care facilities (LTCFs). This study aims to address this limitation by exploring how LTCF residents define “aging well” and by examining whether they perceive themselves as aging well according to their own criteria. Methods: A qualitative design was employed using semi-structured interviews with 30 residents aged 67–95 living in three long-term care facilities located in Barcelona, Spain. Interview transcripts were analyzed using inductive thematic analysis. Results: Five core themes emerged in the participants’ definitions of aging well: health, attitude, social ties, security, and activities. Health was the most frequently mentioned domain but was conceptualized in undemanding terms, focusing on basic autonomy and cognitive functioning. Psychological attitudes and meaningful social relationships were also key, alongside contextual factors, such as security and access to activities. Two-thirds of the participants perceived themselves as aging well, with justifications closely aligned with their personal definitions; negative self-perceptions were mainly associated with poor health, loss of autonomy, or loneliness. Conclusions: The findings suggest that, in contrast with academic definitions, LTCF residents define aging well in a broader, more context-sensitive manner, which allows them to view themselves positively despite their limitations. Person-centered care environments may play a crucial role in supporting aging well in institutional settings. Full article

(This article belongs to the Section Geriatric Psychiatry and Psychology)

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16 pages, 1688 KB

Open AccessArticle

Tablet Acceptability in Older Outpatients Undergoing Cancer Chemotherapy

by Eri Hikita, Mami Oosaki, Ayano Suzuki, Maiko Anzai, Nanako Yoshioka, Yoshiyasu Terayama and Takeo Yasu

Geriatrics 2026, 11(2), 25; https://doi.org/10.3390/geriatrics11020025 - 26 Feb 2026

Viewed by 728

Abstract

Background/Objectives: Patient acceptability of oral anticancer drugs is a critical factor that influences treatment in older outpatients receiving cancer chemotherapy and plays a central role in enhancing adherence and treatment effectiveness. Identifying older outpatients receiving cancer chemotherapy who exhibit poor tablet acceptability before [...] Read more.

Background/Objectives: Patient acceptability of oral anticancer drugs is a critical factor that influences treatment in older outpatients receiving cancer chemotherapy and plays a central role in enhancing adherence and treatment effectiveness. Identifying older outpatients receiving cancer chemotherapy who exhibit poor tablet acceptability before initiating oral anticancer therapy and offering alternative treatment options are beneficial. Therefore, we investigated the characteristics of patients with poor tablet acceptability by focusing on the tablet size, geriatric assessment, and polypharmacy. Methods: A questionnaire survey on experiences with tablet medication was conducted among patients who received chemotherapy at the Outpatient Treatment Center of Tokyo Metropolitan Bokutoh Hospital from September 2024 to September 2025. The median values of the long diameter (12 mm) and the combined length, width, and thickness (26 mm) of the tablets reported as acceptable in the questionnaire described in Method 1 were used as cutoff values. Patients whose reported acceptable tablet dimensions were below these median values were classified as “poor tablet acceptability,” whereas those with values above the median were classified as “good tablet acceptability”. Univariate and multivariate logistic regression analysis was performed to identify characteristic factors associated with poor tablet acceptability in older outpatients receiving cancer chemotherapy, with poor tablet acceptability as the dependent variable and patient sex, body mass index, Geriatric 8 score, each item of the Oral Frailty 5-item Checklist, and polypharmacy as explanatory variables. Results: 90 patients completed the questionnaire survey. Female sex and polypharmacy were independent factors associated with poor tablet acceptability in older outpatients receiving cancer chemotherapy. In addition, subjective difficulty in chewing tended to be associated with poor tablet acceptability. Conclusions: This study suggests that assessing polypharmacy and oral function, along with early multidisciplinary intervention before and during oral anticancer therapy, particularly in females, patients taking multiple medications, and those reporting difficulty in chewing, may help maintain tablet acceptability and improve adherence. Full article

(This article belongs to the Section Geriatric Oncology)

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15 pages, 258 KB

Open AccessArticle

Comparisons of Functional, Physical, and Mental Health Outcomes Among Young and Old Stroke Survivors

by Molly M. Jacobs and Charles Ellis, Jr.

Geriatrics 2026, 11(2), 24; https://doi.org/10.3390/geriatrics11020024 - 26 Feb 2026

Viewed by 1120

Abstract

Objective: The objective of this study was to examine how functional, mental, and physical health outcomes differ between younger (<age 50) and older (≥age 50) stroke survivors. Methods: Data from adult stroke survivors examined health-related outcomes (physical and mental health) over the past [...] Read more.

Objective: The objective of this study was to examine how functional, mental, and physical health outcomes differ between younger (<age 50) and older (≥age 50) stroke survivors. Methods: Data from adult stroke survivors examined health-related outcomes (physical and mental health) over the past 30 days. Logistic regression models were used for binary functional outcomes, and Poisson regression models were used to estimate count outcomes for poor mental and physical health days. Results: Compared with older adults, younger stroke survivors were more likely to report difficulty concentrating or remembering (41.1% vs. 23.2%, p < 0.0001) and difficulty doing errands alone (27.11% vs. 23.67%, p = 0.00), but less likely to report difficulty walking or climbing stairs (34.3% vs. 47.6%, p < 0.0001). Additionally, younger adults with stroke reported significantly more poor mental health days (10.81 vs. 5.76, p < 0.0001) than older adults. In adjusted models, being out of work or out of the labor force was consistently associated with greater odds of functional limitations (e.g., OR for activity difficulty = 2.07, 95% CI: 1.56–2.75) and higher counts of poor mental and physical health days. Younger stroke survivors who were out of the labor force had significantly greater odds of difficulty concentrating (OR = 2.02, 95% CI: 1.17–3.48) and increased days of poor mental (IRR = 1.27, 95% CI: 1.19–1.70) and physical health (IRR = 1.26, 95% CI: 1.19–1.53). Conclusions: These findings highlight the intersection of age and employment on stroke outcomes. Younger stroke survivors face unique and disproportionate challenges in functional and mental health. Full article

(This article belongs to the Section Geriatric Neurology)

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19 pages, 922 KB

Open AccessArticle

Risk Stratification for In-Hospital Mortality in Alzheimer’s Disease Using Interpretable Regression and Explainable AI

by Tursun Alkam, Ebrahim Tarshizi and Andrew H. Van Benschoten

Geriatrics 2026, 11(2), 23; https://doi.org/10.3390/geriatrics11020023 - 24 Feb 2026

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Abstract

Background: Older adults with Alzheimer’s disease (AD) face a heightened risk of adverse hospital outcomes, including mortality. However, early identification of high-risk patients remains a challenge. While regression models provide interpretable associations, they may miss non-linear interactions that machine learning can uncover. Objective: [...] Read more.

Background: Older adults with Alzheimer’s disease (AD) face a heightened risk of adverse hospital outcomes, including mortality. However, early identification of high-risk patients remains a challenge. While regression models provide interpretable associations, they may miss non-linear interactions that machine learning can uncover. Objective: To identify key predictors of in-hospital mortality among AD patients using both survey-weighted logistic regression and explainable machine learning. Methods: We analyzed hospitalizations among AD patients aged ≥60 in the 2017 Nationwide Inpatient Sample (NIS). The outcome was in-hospital death. Predictors included demographics, hospital variables, and 15 comorbidities. Logistic regression used survey weighting to generate nationally representative inference; XGBoost incorporated NIS discharge weights as sample weights during 5-fold hospital-grouped cross-validation and used the same weights in performance evaluation. Missing-value imputation and feature scaling were performed within the cross-validation pipelines to prevent data leakage. Model performance was assessed using AUROC, AUPRC, Brier score, and log loss. Feature importance was assessed using adjusted odds ratios and SHapley Additive exPlanations (SHAP). A sensitivity analysis excluded palliative care and DNR status and was re-evaluated under the same grouped cross-validation. Results: In the full model, logistic regression achieved AUROC 0.879 and AUPRC 0.310, while XGBoost achieved AUROC 0.887 and AUPRC 0.324. Palliative care (aOR 6.19), acute respiratory failure (aOR 5.15), DNR status (aOR 2.20), and sepsis (aOR 2.26) were the strongest logistic predictors. SHAP analysis corroborated these findings and additionally emphasized dysphagia, malnutrition, and pressure ulcers. In sensitivity analysis excluding palliative care and DNR status, logistic regression performance declined (AUROC 0.806; AUPRC 0.206), while XGBoost performed similarly (AUROC 0.811; AUPRC 0.206). SHAP corroborated the dominant signals from end-of-life documentation and acute organ failure in the full model; in the restricted model (excluding DNR and palliative care), SHAP highlighted physiologic and frailty-related features (e.g., dysphagia, malnutrition, aspiration risk) that may be more actionable when end-of-life documentation is absent. Conclusions: Combining regression with explainable machine learning enables robust mortality risk stratification in hospitalized AD patients. Restricted models excluding end-of-life indicators provide actionable risk signals when such documentation is absent, while the full model may better support resource allocation and goals-of-care workflows. Full article

(This article belongs to the Section Geriatric Neurology)

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Geriatrics, Volume 11, Issue 2 (April 2026) – 28 articles

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