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Challenges and Advances in Geriatrics and Gerontology

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Geriatric Medicine".

Deadline for manuscript submissions: 24 April 2026 | Viewed by 3729

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Special Issue Editor

Dr. Elisa Fabbri

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Guest Editor

1. Division of Internal Medicine, Morgagni-Pierantoni Hospital Forlì, Forlì, Italy
2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Interests: multimorbidity; frailty; biology of aging; inflammation; geriatric medicine; cognition; cardiovascular diseases

Special Issue Information

Dear Colleagues,

The aging population is a worldwide phenomenon resulting in an increasing burden of multimorbidity, frailty, and disability with relevant challenges for healthcare systems and society. Older and frail patients with multiple chronic conditions are more complex than their younger counterparts and not adequately represented in clinical trials and guidelines, with consequent difficulties in decision-making and clinical/surgical management. Therefore, an urgent need is to optimally implement tailored treatments and recommendations for older and complex patients. Indeed, a holistic approach and a multidisciplinary team are required to provide personalized models of care, centered on the patient’s needs and priorities. Moreover, strategies for primary, secondary, and tertiary prevention are necessary to promote healthy aging, starting from a life course perspective, even from early life. Whether and how technology advances, such as artificial intelligence, may be useful to achieve these goals is still a matter of discussion.

The Journal of Clinical Medicine (JCM) is introducing this Special Issue, which aims to discuss challenges and recent advances in geriatric medicine and gerontology. We sincerely welcome contributions (original clinical and experimental research studies, reviews, and meta-analyses) focused on promoting healthy longevity and implementing personalized care for older adults with frailty and multimorbidity.

Dr. Elisa Fabbri
Guest Editor

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Keywords

aging
geriatric medicine
frailty
multimorbidity
sarcopenia
cognition
personalized-care
healthy longevity
decision making-management
prevention
artificial intelligence

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Published Papers (5 papers)

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Research

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12 pages, 391 KB

Open AccessArticle

Early Outcomes of Lecanemab for Alzheimer’s Disease in the Veterans Health Administration

by Alison J. O’Donnell, Xinhua Zhao, Alyssa Parr, Sherrie Aspinall and Timothy S. Anderson

J. Clin. Med. 2025, 14(23), 8277; https://doi.org/10.3390/jcm14238277 - 21 Nov 2025

Viewed by 460

Abstract

Background/Objectives: While lecanemab (Leqembi) and several amyloid targeting therapies were approved for Alzheimer’s disease, questions remain on real-world implementation, safety, and effectiveness. The objective of this study was to describe the uptake and early outcomes of Veterans initiating lecanemab. Methods: This retrospective cohort study included Veterans who initiated lecanemab in the Veteran’s Health Administration (VHA) between October 2023 and July 2024. Treatment persistence and monitoring, change in Montreal Cognitive Assessment (MoCA) score, incidence of adverse events, including amyloid-related imaging abnormalities (ARIA), and healthcare utilization were analyzed at 7 months. Results: Overall, 32 Veterans (mean [SD] age 75.3 [6.0] years, 100% male, 97% white, 84% urban dwelling) initiated lecanemab. Seventeen patients (53%) had mild cognitive impairment, 15 (47%) had mild dementia; mean baseline MoCA score was 21.3 (SD 3.4). At 7 months following treatment initiation, we assessed process, safety, and effectiveness outcomes. Process outcomes: In all, 25 patients (78%) were persistent with treatment. Safety outcomes: Three patients (9%) experienced a stroke, and 7 (22%) experienced ARIA. Effectiveness outcomes: Only 12 (38%) patients had a MoCA completed by 7 months, and the mean change in MoCA was 0.0 (SD 3.7, p = 1.0). A follow-up amyloid positron emission tomography (PET) scan was completed by 9 (28%) patients, and 5 had reductions in amyloid. Conclusions: Initial observations in a small VHA cohort suggest that uptake of lecanemab was limited, and the finding that nearly 30% of patients experienced ARIA or stroke within 7 months of initiation underscores the importance of monitoring the lecanemab safety and effectiveness long-term. These early findings should be interpreted cautiously given the limited sample size and very limited follow-up MoCA data. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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17 pages, 629 KB

Open AccessArticle

Prevalence and Predictors of Falls Among Younger and Older Adult Pilgrims During the Hajj Mass Gathering: An Age-Stratified Cross-Sectional Study

by Hammad Alhasan and Mansour Abdullah Alshehri

J. Clin. Med. 2025, 14(21), 7775; https://doi.org/10.3390/jcm14217775 - 2 Nov 2025

Viewed by 546

Abstract

Background/Objectives: Hajj is a physically demanding mass gathering that presents distinct health risks, particularly for older adults and individuals with comorbidities. Falls are a major cause of injury in such environments; however, limited data exist on their prevalence and determinants during Hajj. This study aimed to (1) estimate the prevalence of falls among adult pilgrims during the Hajj pilgrimage in Saudi Arabia and (2) identify key demographic, behavioural/clinical, and musculoskeletal predictors of fall risk, stratified by age group. Methods: A cross-sectional survey was conducted among 1429 adult pilgrims. Data were collected at major pilgrimage sites in Mecca during the Hajj season. Variables included age, sex, body mass index, smoking status, hypertension, diabetes, physical exhaustion, and musculoskeletal pain. Bivariate chi-square tests and multivariable regression analyses were performed. Age-stratified models were developed for younger adults (≤29 years) and older adults (≥50 years) to account for physiological differences. Results: The overall fall prevalence was 13.6%, with significantly higher rates among older adults (21%) than younger adults (10.5%). In the full sample, independent predictors of falls included older age, obesity, hypertension, diabetes, physical exhaustion, and musculoskeletal pain in the upper arm, elbow, and hip/pelvis. In age-specific models, obesity, physical exhaustion, and upper arm pain predicted falls among younger adults, while obesity, hypertension, physical exhaustion, and hip/pelvis pain were significant among older adults. Conclusions: Falls during Hajj result from a multifactorial interplay of age, comorbidities, fatigue, and site-specific musculoskeletal pain. These findings support the development of targeted, age-specific fall prevention strategies in mass gathering contexts. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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15 pages, 924 KB

Open AccessArticle

The Role of Periarticular Knee Muscle Torques in Ensuring the Body Balance of Older Adults with Balance Disturbances

by Piotr Prochor, Łukasz Magnuszewski, Paulina Zalewska, Michał Świętek, Zyta Beata Wojszel and Szczepan Piszczatowski

J. Clin. Med. 2025, 14(9), 3251; https://doi.org/10.3390/jcm14093251 - 7 May 2025

Viewed by 712

Abstract

Background: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight of 75.10 ± 13.42 kg, and height of 163.92 ± 8.80 cm) to determine the role of the knee muscles in balance maintenance. Methods: The clinical examination included the Dizziness Handicap Inventory (DHI), the Geriatric Depression Scale (GDS), the Performance-Oriented Mobility Assessment (POMA), the Functional Reach Test (FRT), the Falls Efficacy Scale—International (FES-I), and bioimpedance parameters (skeletal muscle mass—SMM—and its derived parameter—Diff SMM). The biomechanical assessment involved parameters that characterize muscle torques of knee joint extensors and flexors in isokinetic and isometric conditions, as well as changes in the centre of pressure (COP) position while standing with eyes open and closed. Results: Based on treatment history and DHI results (>10 points), 26 participants were identified as having balance disorders, while the remaining participants formed the control group. Statistical analysis was performed to determine differences between the groups. The groups significantly differed in terms of the results obtained from the DHI (p < 0.001) and GDS (p = 0.04) questionnaires as well as FES-I (p < 0.001) and POMA (p = 0.002) tests. While SMM (p = 0.012) was similar in the groups, Diff SMM (p = 0.04) significantly differed. The multiple regression analysis confirmed the knee joint extensor parameters’ significant role in predicting the COP path (p = 0.03 and p = 0.04 for two assumed models). Conclusions: The obtained results proved that the muscle torques of knee extensors can be used in the diagnostic process of older patients with balance disorders, indicating possible rehabilitation directions. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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17 pages, 696 KB

Open AccessReview

Age Versus Immunity: Dietary Influences on Immunosenescence

by Karolina Daniłowska, Natalia Picheta, Julia Piekarz, Dominika Żyła, Katarzyna Zych, Katarzyna Szklener and Sławomir Mańdziuk

J. Clin. Med. 2025, 14(23), 8313; https://doi.org/10.3390/jcm14238313 - 22 Nov 2025

Viewed by 381

Abstract

Background: Immunosenescence, or the age-related weakening of the immune system, leads to greater susceptibility to chronic diseases, infections, and metabolic disorders. This process involves changes in the number and function of lymphocytes, increased levels of inflammatory markers, and modifications to the gut microbiome. In recent years, increasing importance has been placed on diet—both functional, rich in bioactive ingredients, and conventional, often pesticide-laden—as a factor modulating immune system aging. Methods: This paper provides a literature review on the effects of dietary components on immunosenescence. Results from 2010 to 2025 and from clinical and experimental studies on substances such as curcumin, butyrate, vitamin D3, omega-3 fatty acids, and conventional products containing pesticides were analyzed. Their impact on the microbiome, intestinal barrier integrity, inflammatory biomarkers, and the overall immune response was considered. Results: Numerous beneficial effects of functional foods were identified. Curcumin increases microbiota diversity and lowers C-Reactive Protein (CRP) and Tumor Necrosis Factor α (TNF-α) levels. Butyrate supports remission in inflammatory bowel disease by reducing Interleukin (IL) 6 and TNF-α levels. Vitamin D3 lowers inflammatory markers and reduces calprotectin in inflammatory bowel disease. Omega-3 fatty acids modulate microbiome composition and improve lipid profiles. In contrast, conventional foods high in pesticides lead to dysbiosis, intestinal barrier damage, and increased pro-inflammatory cytokines. Conclusions: Diet is a key factor in modulating immunosenescence. Functional foods can support the microbiome and reduce chronic inflammation, while conventional foods may exacerbate the aging process of the immune system. Further clinical research is needed to develop dietary recommendations to support immunity in older adults. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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20 pages, 541 KB

Open AccessReview

Anticoagulation in Frail Older Adults with Non-Valvular Atrial Fibrillation: Clinical Challenges and Personalized Approach

by Elisa Fabbri, Lorenzo Maestri and Paolo Muratori

J. Clin. Med. 2025, 14(22), 8079; https://doi.org/10.3390/jcm14228079 - 14 Nov 2025

Viewed by 1019

Abstract

The prevalence of atrial fibrillation (AF) is increasing and often coexists with frailty. The management of anticoagulation therapy in frail older adults with AF is especially challenging due to the high risk of bleeding complications. The aim of this narrative review is to provide a comprehensive overview of current evidence about the management of anticoagulation in frail older adults with non-valvular AF. First, frailty itself should not be considered a contraindication. A comprehensive geriatric assessment is recommended to identify and potentially address conditions that may increase the risk of bleeding, such as inappropriately prescribed medications or malnutrition. Overall, the net clinical benefit remains in favour of oral anticoagulation in frail older adults, even if it decreases with increasing frailty severity. Direct Oral Anticoagulants (DOACs) show a better effectiveness and safety profile compared with Vitamin K antagonists (VKAs) in this population. Among DOACs, apixaban seems to be the safest. Also, edoxaban at a very low dosage (15 mg/day) could be an effective therapy in patients for whom the standard anticoagulation is contraindicated. Moreover, switching from VKAs to DOACs in frail older adults is a complex decision and should be personalized according to the stability of the ongoing anticoagulant therapy, the bleeding risk profile, and the severity of frailty. Finally, although further studies are required to confirm their effectiveness, factor XIa inhibitors are emerging as new promising alternative therapies because they have been associated with a lower bleeding risk compared with DOACs. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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