Geriatrics

Background: Pleural empyema remains a serious clinical condition with high morbidity and mortality, especially in elderly patients. As life expectancy increases, a growing number of older individuals require surgical treatment. This retrospective single-center study investigated age-related differences in clinical presentation, perioperative features, and postoperative outcomes in patients undergoing surgery for pleural empyema. Methods: We conducted this retrospective study at Helios University Hospital Wuppertal, Witten Herdecke University in Germany, from December 2019 to May 2024. We stratified the patients into two age groups: <65 and ≥65 years. We compared baseline characteristics, American Society of Anesthesiologists (ASA) physical status classification, empyema stage, hospital stay, drainage duration, complication rates, and in-hospital mortality. Results: A total of 103 patients were included, of whom 43 (41.7%) were aged ≥ 65 years. Older patients had significantly higher ASA scores and presented with more advanced empyema stages. Hospital stay was significantly longer in this group. However, complication rates (60.0% vs. 44.9%; p = 0.25), drainage duration, ICU admissions (91.4% vs. 83.7%; p = 0.48), and in-hospital mortality (0% in both groups) did not differ significantly. Conclusions: Although older patients had higher perioperative risks, their surgical outcomes were similar to those of younger patients. Chronological age alone should not be a limiting factor for surgical treatment of pleural empyema. Surgical decisions should be based on clinical condition rather than chronological age. Full article

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

Background/Objectives: With aging linked to increased oral health conditions, the communication skills of dental professionals are vital to ensure patient satisfaction and improve the quality of geriatric dental care. This cross-sectional study evaluated geriatric patients’ satisfaction with communication at a university dental clinic, comparing interactions with dentists and fifth-year dental students. Methods: A self-report questionnaire was administered to 111 patients, assessing sociodemographic data, general health, and satisfaction across six communication dimensions: verbal and nonverbal communication, empathy, respect, problem-solving, and support materials. The data were analyzed using Mann–Whitney U tests (α = 0.05). Results: The geriatric patients exhibited higher levels of satisfaction when interacting with dentists compared to students, particularly in the domains of nonverbal communication (p = 0.007), empathy (p = 0.035), and respect (p = 0.017). However, no statistically significant differences (p > 0.05) were observed in terms of verbal communication, problem-solving, and support materials. Conclusions: The geriatric patients demonstrated greater satisfaction with interactions with practicing dentists. These findings indicate that an attending dentist’s clinical experience enhances interpersonal interactions with geriatric patients. Therefore, developing the interpersonal skills of future dentistry professionals, as well as adapting communication to the needs of the elderly, is essential to provide more satisfactory experiences in geriatric dental care. Full article

Background/Objectives: Diffuse idiopathic skeleton hyperostosis (DISH) is also known as Forestier–Rotes-Querol syndrome. The etiology of DISH is unknown. DISH is characterized by ossification of the anterior longitudinal ligaments of the spine. The area most frequently involved in the disease is the thoracic region of the spine. DISH in most cases is asymptomatic. If the cervical spine is involved, the most common symptoms are dysphagia and dyspnea. The ossifications in the cervical region of the spine are localized most frequently in its lower segments. Case presentation: The authors present the case of a 92-year-old cachectic female patient (body mass index (BMI) of 17; lost 13% of her body weight within the last 6 months). The patient underwent resection of the anterior osteophytes C2-T1. Results: At one-year follow up, the patient had gained weight (BMI—20) and regained her ability to consume solid products. To our knowledge, this is the oldest patient treated surgically for DISH. Conclusions: If dysphagia or dyspnea appears among elderly patients, cervical spine inspection should be conducted. If DISH is diagnosed safe, effective surgical treatment should be considered. Full article

Background/Objectives: Sarcopenia is an age-related muscle disease that reduces strength and function in older adults. Exercise is a key intervention, but existing protocols vary widely and often lack adaptation to sarcopenia severity. The present study aims to review the effectiveness of exercise protocols developed after the EWGSOP2 consensus and evaluate their adaptation to sarcopenia severity stages. Methods: This systematic review followed PRISMA guidelines. PubMed and Scopus were searched for studies published after the EWGSOP2 consensus involving participants of 65 years and over with primary sarcopenia and managed through exercise-only interventions. Risk of bias was assessed with the Cochrane Risk of Bias tool, and quality and transparency of exercise intervention were assessed with the Consensus on Exercise Reporting Template. Results: Ten studies met the inclusion criteria, with a total of 558 participants. Most interventions included resistance training, often within multicomponent programs. Statistically significant improvements were reported in muscle strength, mass, and physical performance. Additional benefits included enhancements in sleep quality, respiratory function, and specific biomarkers. However, only two studies classified sarcopenia severity, and reporting quality varied considerably. Conclusions: Exercise interventions, especially multicomponent and individualized protocols, are effective at improving outcomes related to sarcopenia in older adults. However, better alignment with diagnostic classifications and standardized reporting are needed to improve clinical translation and program replication. Full article

Objectives: To describe, understand, and correlate willingness to forgive with self-perceived health-related quality of life, including the components of quality of physical health and mental health. Methods: Conducted with 30 older individuals, ≥65 years old, with preserved cognitive abilities, literacy ≥ four years of education, living in Portugal and Spain. The 12-Item Short-Form Health Survey (SF-12) was used to assess self-perceived health-related quality of life, and the Heartland Forgiveness Scale (HFS) was used to measure willingness to forgive. Results: There was a direct positive correlation between willingness to forgive and perception of health-related quality of life, especially for the mental health component, educational level, cohabitation, and work activity. Conclusions: Forgiveness could play a significant role in the emotional health and quality of life of the elderly. Strategies to develop forgiveness can benefit the active aging process, contributing to improved health-related quality of life in older individuals. Full article

Background/Objectives: Depression impairs the quality of life in older adults and represents a significant public health issue. Cognitive reserve may act as a protective factor against depressive symptoms in older adults. Additionally, interaction with pets may serve as another potential protective factor against these symptoms. Thus, this study aimed to evaluate whether higher cognitive reserve could predict a reduction in depressive symptoms in older adults and to investigate the moderating role of pet companionship in this relationship. Methods: The following instruments were used: a Sociodemographic Data Sheet, the Modified Telephone Interview for Cognitive Status (TICS-M), the Cognitive Reserve Index Questionnaire (CRIq), and the Geriatric Depression Scale (GDS-15). Data were collected via video calls through WhatsApp and analyzed using a moderation analysis with PROCESS for SPSS. Results: The final sample consisted of 215 older adults with a mean age of 69.13 years (SD = 6.89). Among the participants, 53% owned pets and 47% did not. The overall model revealed a significant association between the predictor variables and the outcome (F(3, 211) = 4.24, p < 0.01). For the group without pets, the effect was not significant (β = −0.1082, p = 0.2916), but for the group with pets, the effect was substantial and negative on the GDS (β = −0.1936, p < 0.05). Conclusions: We concluded that the relationship between cognitive reserve and depressive symptoms is moderated by the presence of pets in individuals’ lives. These findings highlight the role of pets in protecting against depressive symptoms in older adults. Future studies should explore this relationship with more diverse samples. Full article

Background: Delirium frequently manifests in hospitalized geriatric patients and is associated with negative health outcomes. Available large-scale data regarding its prevalence rate and impact on older Thai patients are limited. This study aimed to analyze trends in the prevalence rate, its consequences, and the factors contributing to death at discharge among this population. Methods: A retrospective study of inpatients over the age of 60 who received a diagnosis of delirium was conducted, utilizing inpatient medical expense documentation for the fiscal years 2019–2023. The identification of delirium was conducted by the National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) code F05. Results: The 5-year prevalence rate and mortality rate of delirium were 215.1 and 18.7/100,000 population, respectively, and tended to rise over the studied periods. The average hospitalization was 10 days, and the average healthcare expenditure was about 1470 USD/visit. Respiratory disease emerged as the most common primary diagnosis in delirious patients (23.5%). Factors associated with mortality were individuals aged >80 years when juxtaposed with the cohort aged 61–70 years (adjusted odds ratio [AOD] 1.07), being female (AOR 1.13), and a primary diagnosis of respiratory disease (AOR 2.72), cardiovascular disease (AOR 1.68), musculoskeletal disease (AOR 0.61), systemic infection/septicemia (AOR 2.08); or malignancy (AOR 2.97). Conclusions: There was an upward trend in rates of both prevalence and mortality associated with delirium among hospitalized geriatric patients. Advancing age, gender, and particular primary diagnoses were associated with mortality at hospital discharge. Full article

Background/Objectives: Visual impairment (VI) represents a significant health challenge among older adults, particularly due to their limited understanding of health information. This study aimed to investigate and compare the health information-seeking behavior (HISB) of older adults with VI across different stages of eye care. Methods: A cross-sectional comparative study was conducted in 248 older adults with VI in various stages of eye care, including the pre-visit stage (n = 84), treatment stage (n = 83), and follow-up stage (n = 81) at the Shenzhen Eye Hospital from July to October 2024. Participants completed an HISB questionnaire encompassing four dimensions: attitude, needs, sources, and barriers. Results: The overall mean score of HISB varied significantly among the different eye care stages. The treatment stage had the highest scores (3.70 ± 0.32), particularly in attitudes toward health information and information needs. Poor self-reported overall health facilitated HISB in each stage. In the pre-visit stage, higher income was associated with increased HISB, while a lack of internet access reduced it. In the treatment stage, higher education was associated with higher HISB, whereas moderate-to-severe VI and certain income levels were associated with negative effects. In the follow-up stage, rural residence and spousal or child caregiving emerged as key facilitators of HISB. Conclusions: The treatment stage is a critical period for HISB engagement in older adults with VI. Healthcare providers should consider stage-specific factors of HISB to optimize health information delivery. Full article

The global aging population has led to a growing incidence of malignancies, including metastatic non-small-cell lung cancer (mNSCLC). Immunosenescence may affect the efficacy of immune checkpoint inhibitors (ICIs). The prognostic role of age in ICI-treated mNSCLC remains uncertain. Objectives: This study aims to assess whether age independently influences survival, response, and toxicity in mNSCLC patients treated with ICIs, and to examine potential interactions with clinical factors. Methods: In this retrospective cohort study, 105 patients with mNSCLC treated with ICIs were enrolled. Patients were stratified into four groups based on age quartiles. Clinical, pathological, and treatment data were collected. Survival outcomes were analyzed using Kaplan–Meier curves, ROC curve and multivariable Cox regression models adjusted for confounders. Interaction and restricted cubic spline analyses were performed to explore age-related effects. The p < 0.05 was considered as statistically significant. Results: The median age was 60.8 years. Clinical benefit—defined as objective response rate (51.4%) and disease control rate (86.6%)—did not significantly differ across age quartiles (p = 0.551 and p = 0.257, respectively). Median overall survival also did not differ significantly (p = 0.2853). Cox regression and spline modeling demonstrated no independent association between chronological age and all-cause mortality (Model 3: HR = 1.00, 95% CI: 0.95–1.04, p = 0.889). However, interaction analyses revealed that poor ECOG performance status (p = 0.001), longer duration of ICI treatment (p < 0.0001), and low PD-L1 expression (p = 0.017) were stronger predictors of mortality in older patients. Age was associated with increased immune-related adverse events and higher Charlson Comorbidity Index scores, suggesting the need for age-specific management strategies. Conclusions: Age alone does not predict survival in mNSCLC patients receiving ICIs. However, functional status, treatment duration and PD-L1 expression may modify age-related outcomes. Full article

Background: To examine the association between allostatic load and the progression of multimorbidity and the role of socioeconomic factors among older Americans. Methods: Data from the Health and Retirement Study (HRS), a longitudinal study of older American adults, were used. Data were included from waves 8 (2006), 10 (2010), 11 (2012), and 13 (2016). Self-reported diagnoses of five chronic conditions (diabetes, heart disease, lung diseases, cancer, and stroke) indicated multimorbidity and were dichotomised to reflect having two or more conditions versus one or fewer. Multimorbidity in 2006 was subtracted from that in 2016 to calculate ten-year change in multimorbidity. Sociodemographic data (age, gender, education, and wealth) were from wave 8 (2006). Behaviours (physical activity and smoking) were from wave 10 (2010). Allostatic load, indicated by five biomarkers (waist circumference, high blood pressure, glycosylated haemoglobin, high-density lipoprotein, and c-reactive protein), was from wave 11 (2012). Structural Equation Modelling (SEM) was used to assess the longitudinal association between the aforementioned factors and the incidence of multimorbidity in 2016. Results: Given that allostatic load was assessed in a subsample of HRS, 8222 were excluded for lack of relevant data. A total of 3336 participants were included in the final analysis. The incidence of multimorbidity in 2016 was 19%. Allostatic load in 2012 was significantly associated with the incidence of multimorbidity in 2016 (estimate 0.10, 95% Confidence Interval (CI) 0.07, 0.14); in other words, for an additional marker of allostatic load, there was an average 0.1 change in the incidence of multimorbidity. Wealth and education (2006) were indirectly associated with multimorbidity through allostatic load and behaviours. Smoking (2010) was positively associated with multimorbidity in 2016, while physical activity showed a negative association. Conclusions: Biological markers of stress indicated by allostatic load were associated with multimorbidity. Adverse socioeconomic conditions appear to induce allostatic load and risk behaviours, which impact the progression of multimorbidity. Full article

Background/Objectives: There is a high prevalence of anxiety and anxiety symptoms in older adults, which can have cognitive, emotional, and physical repercussions on older adults. It is important to understand the risk factors from psychological variables and sociodemographic variables that may be influencing anxiety symptoms to generate more effective interventions based on modifiable variables. In this context, the objective of this review was to identify psychological and sociodemographic variables as risk factors for anxiety and anxiety symptoms in older adults. Methods: The Scoping review followed the guidelines of the (PRISMA-ScR 2018). Five databases were used to reduce bias and identify relevant evidence: Medline via Ovid, PUBMED, CINAHL, PsycINFO, and Web of Science. Results: A total of 2150 articles were identified across the five databases; 16 articles were included for data synthesis and methodological quality assessment. Conclusions: The variables that maintain the strongest association as both risk and protective factors are age, female sex, physical activity, physical health or medical conditions, depression, perceived and family support, and social and family participation. However, methodological limitations—including inconsistent definitions, diverse and often inadequate measurement tools, and lack of causal inference—restrict the generalizability of findings. These results underscore the need for validated age-appropriate instruments and more rigorous research designs in geriatric anxiety studies. Full article

Background/Objectives: Frailty is a multifactorial condition influenced by physical and psychosocial factors. Understanding longitudinal changes in these domains may guide prevention strategies. This study examines the relationship between frailty status, physical fitness, and psychosocial conditions in community-dwelling older adults using five-year longitudinal data. Methods: Participants were 52 out of 89 older adults who completed both baseline and five-year follow-up assessments (follow-up rate: 58.4%). Data were collected using 10 physical fitness indicators, the fitness age score (FAS), geriatric depression scale (GDS), Lubben social network scale short form (LSNS-6), and relevant items in the six Kihon Checklist (KCL) domains. Due to low prevalence of frailty, individuals with pre-frailty and frailty were combined into the frailty-risk group. Repeated measures ANOVA with sex as a covariate was conducted to compare groups. Logistic regression was used to identify baseline predictors of frailty status at five years. Statistical significance was set at p < 0.05. Results: GDS, LSNS-6, and KCL scores remained stable over five years. However, physical fitness significantly declined in several measures, including grip strength, vertical jump height, knee extension strength, functional reach, and FAS. A significant interaction for the timed up and go test showed that the robust group maintained function, while the frailty-risk group declined. Logistic regression identified KCL oral function as a significant predictor (OR = 5.331, 95% CI = 1.593–17.839, p = 0.007). Conclusions: Maintaining both oral function and physical fitness is vital for preventing frailty, even among health-conscious older adults. Proactive strategies may support healthy aging. Full article

Background: Associations between high physical activity (PA) levels and incident atrial fibrillation (AF) is found in some earlier studies. We aim to study the association between levels of PA and AF in two cohorts. Methods: We used data from the Uppsala Longitudinal Study of Adult Men (ULSAM) study, initiated in 1970, included men aged 50 years, with 2202 included in the study. Examinations were reiterated three times, with follow-up after in median 33 years, with 3.8–6.0% on the highest PA level. We also used data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; with women 50%); mean age 70 years, baseline 2001–2004, median follow-up 15 years, with 961 included in the study, with 4.8% on the highest PA level. Cox regression analysis with hazard ratios (HRs) was used to study association between PA levels and incident AF, adjusted for CV risk factors: systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking. Results: Totally, in ULSAM 504 men during 59,958 person-years at risk, and in PIVUS 204 individuals during a follow-up of 11,293 person-years experienced an AF. Neither in ULSAM, PIVUS, nor in the meta-analysis of both cohorts, individuals with the highest PA level showed an increased AF risk, compared to individuals with lowest level of PA. Conclusions: The benefits of PA in community dwelling individuals for its benefits to mental, metabolic, and cardiovascular health should guide public recommendations, rather than a possible risk of AF. Lay Summary: We studied the risk of incident atrial fibrillation at various levels of physical activity in two cohorts and found no statistically significant increased risk after adjusting for cardiovascular risk factors (systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking). Full article

Background: Dementia is a syndrome with a high global prevalence that includes a number of progressive diseases of the brain affecting various cognitive domains such as memory and thinking and the performance of daily activities. It manifests as symptoms which often include significant mood and behaviour changes that are highly varied. Changed moods and behaviours due to dementia may reflect distress and may be stressful for both the person living with dementia and their informal and formal carers. To provide dementia care support specific to mood and behaviour changes, the Behaviours in Dementia Toolkit website (BiDT) was developed using human-centred design principles. The BiDT houses a user-friendly, digital library of over 300 free, practical, and evidence-informed resources to help all care partners better understand and compassionately respond to behaviours in dementia so they can support people with dementia to live well. Objective: (1) To characterize the users that visited the BiDT; and (2) to understand the platform’s early impact on these users. Methods: A multi-method, descriptive study was conducted in the early post-website launch period. Outcomes and measures examined included the following: (1) reach: unique visitors, region, unique visits, return visits, bounce rate; (2) engagement: engaged users, engaged sessions, session duration, pages viewed, engagement rate per webpage, search terms, resources accessed; (3) knowledge change; (4) behaviour change; and (5) website impact: relevance, feasibility, intention to use, improving access and use of dementia guidance, recommend to others. Data was collected using Google Analytics and an electronic survey of website users. Results: From 4 February to 31 March 2024, there were 76,890 unique visitors to the BiDT from 109 countries. Of 76,890 unique visitors to the BiDT during this period, 16,626 were engaged users as defined by Google Analytics (22%) from 80 countries. The highest number of unique engaged users were from Canada (n = 8124) with an engagement rate of 38%. From 5 March 2024 to 31 March 2024, 100 electronic surveys were completed by website users and included in the analysis. Website users indicated that the BiDT validated or increased their dementia care knowledge, beliefs, and activities (82%) and they reported that the website validated their current care approaches or increased their ability to provide care (78%). Further, 77% of respondents indicated that they intend to continue using the BiDT and 81.6% said that they would recommend it to others to review and adopt. Conclusions: The BiDT is a promising tool for sharing practical and evidence-informed information resources to support people experiencing dementia-related mood and behaviour changes. Early evaluation of the website has demonstrated significant reach and engagement with users in Canada and internationally. Survey data also demonstrated high ratings of website relevance, feasibility, intention to use, knowledge change, practice support, and its contribution to dementia guidance. Full article

Background: Falls in older adults are a major barrier to healthy longevity. Recent studies suggest that muscle quality is associated with fall risk. This study aimed to determine whether a functional muscle quality index (MQI) using the 5-repetition sit-to-stand test (5R-STS) reflects fall risk in community-dwelling older adults. Methods: This cross-sectional study included 137 community-dwelling older adults (≥65 years) in Japan. Lower limb skeletal muscle mass (SMM) was measured using the BIA method, and muscle function was assessed using the 5R-STS. The MQI was calculated as “(5R-STS (s)/SMM (kg)) × 10”. Fall history was collected using a self-administered questionnaire, and binary logistic regression analysis including gait speed and physical frailty was performed. Results: Participants were divided into fallers (n = 36; age = 78.2 ± 5.6) and non-fallers (n = 101; age = 76.9 ± 5.3). Significant differences were found between the groups in gait speed (p = 0.01), TUG (p < 0.01), 5R-STS (p < 0.01), and MQI (p < 0.01). Binary logistic regression identified MQI (OR = 1.28; p < 0.01) and gait speed (OR = 0.14; p = 0.02) as explanatory variables for fall history. The results of the evaluation using the receiver operating characteristic (ROC) curve showed that the cutoff value for MQI to distinguish fall history was 8.04 s/kg, and the cutoff value for gait speed was 1.21 s. Conclusions: The MQI using the 5R-STS shows promise as an indicator of fall risk in older adults. Further longitudinal studies are needed to clarify the causal relationship. Full article

Background/Objectives: Research suggests that attitudes toward aging significantly impact health and well-being outcomes in older adults and are influenced by various factors. Our study aims to identify gender differences in attitudes toward aging among aging individuals with disabilities while also examining the influence of demographic and psychological factors on these attitudes. Methods: For this cross-sectional study, we collected data from 393 middle-aged and older adults with disabilities via an online Qualtrics survey administered through the Prolific platform in the United States. Participants completed the Attitudes Towards Aging Questionnaire Short Form, Purpose in Life Test Short Form, Mindfulness Attention Awareness Scale, Acceptance of Chronic Health Conditions Scale, and Three-Item Loneliness Scale. Descriptive and correlation analyses, t-tests, and multiple regression analyses were performed. Results: The independent t-test findings reveal significant differences in physical change and psychological growth between men and women, with men scoring higher in physical change and women in psychological growth. In multiple regression analyses, purpose in life significantly predicted all three domains of attitudes toward aging in men, while both purpose in life and acceptance were predictors across all domains in women. Additionally, age, employment, and financial stability contributed to aging attitudes only among women. Conclusions: Attitudes toward aging, specifically physical change and psychological growth, were found to vary by gender, with purpose in life, acceptance, and loneliness influencing these attitudes among both groups, while certain demographic factors influenced aging attitudes only among women. These findings underscore the need for gender-specific interventions addressing these substantial factors. Full article