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Chronic Disease Management and Rehabilitation in Older Adults

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A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Geriatric Medicine".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 12357

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Dr. Justyna Mazurek

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Division of Clinical Physiotherapy and Rehabilitation, University Centre of Physiotherapy and Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
Interests: geriatric rehabilitation; geriatric physiotherapy; clinical rehabilitation; neurorehabilitation; orthorehabilitation; virtual reality in rehabilitation; technology-based physical activity promotion
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Special Issue Information

Dear Colleagues,

The phenomenon often referred to as the "silver tsunami" reflects a global demographic shift, with projections indicating that by 2050, approximately 21% of the world’s population will be aged 60 years or older. According to the National Council on Aging, nearly 80% of older adults are affected by at least one chronic condition.

The World Health Organization defines chronic diseases as health conditions persisting for one year or longer, often requiring ongoing medical attention or limiting daily activities. While chronic diseases can affect individuals of any age, their prevalence is significantly higher among the elderly. This trend is largely driven by global factors such as rapid urbanization, unhealthy lifestyle habits, and the natural consequences of aging. Simultaneously, advancements in medical technology and healthcare have contributed to increased life expectancy worldwide. However, longevity does not necessarily equate to healthy aging; approximately 60% of older adults develop chronic conditions, largely attributed to poor dietary habits and sedentary behavior.

As the burden of chronic disease among the aging population intensifies, there is a growing need for governments to strategically reallocate financial and healthcare resources. Investment in age-specific healthcare infrastructure and services is essential in meeting the complex needs of older adults and supporting sustainable health systems to meet the challenge of demographic aging.

Geriatric rehabilitation plays a vital role in healthcare, particularly in managing both acute and chronic conditions among older adults. As life expectancy continues to rise globally, so does the proportion of the geriatric population. This demographic shift is accompanied by an increase in age-related disabilities, commonly associated with musculoskeletal disorders, diabetes, cardiovascular diseases, frailty syndrome, neurological conditions, and mental health issues such as anxiety and depression, many of which significantly impact mobility and daily functioning. As a result, the demand for comprehensive and effective rehabilitation services is expected to grow substantially.

Geriatric rehabilitation involves a holistic and multidisciplinary approach designed to reduce the burden of these conditions by minimizing functional impairments and improving quality of life. It focuses not only on physical recovery but also on restoring the individual’s sense of wholeness and well-being. The goal of GR is to address the sense of disconnection that individuals may feel toward their bodies due to illness or dysfunction and to foster a renewed belief in their capacity for active, meaningful participation in society.

By tackling core issues such as pain and mobility limitations, geriatric rehabilitation enables older adults to re-engage with everyday life roles—including social interaction and, where possible, employment. This contributes to broader health, social, and economic benefits on a global scale. In light of the worldwide aging of the population and the growing prevalence of noncommunicable diseases, rehabilitation is increasingly being recognized as an essential component of healthcare systems.

For this Special Issue, we invite contributions that explore the effectiveness of various management strategies for chronic diseases in older adults, as well as geriatric rehabilitation models and programs, particularly in relation to health promotion, disease prevention, and the management of age-related conditions.

I look forward to receiving your submissions.

Dr. Justyna Mazurek
Guest Editor

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Keywords

chronic disease
older adults
geriatric rehabilitation
holistic physiotherapy
physical activity
health outcomes
elderly people
geriatric care
health promotion

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Published Papers (7 papers)

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Research

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13 pages, 568 KB

Open AccessArticle

Antigravity Versus Body-Weight-Supported Treadmill Training in Lower-Limb Arthroplasty Rehabilitation: A Randomized Controlled Pilot Trial

by Justyna Mazurek, Adam Wrzeciono, Małgorzata Ratajczyk, Olga Witczak, Joanna Szczepańska-Gieracha and Błażej Cieślik

J. Clin. Med. 2026, 15(13), 4918; https://doi.org/10.3390/jcm15134918 - 24 Jun 2026

Viewed by 565

Abstract

Objective: To evaluate the feasibility of adding antigravity treadmill training (ATT) or harness-based body-weight-supported treadmill training (BWSTT) to standard inpatient rehabilitation after primary hip or knee arthroplasty and to explore preliminary effects on osteoarthritis-related outcomes, balance, and psychological status. Methods: In this single-center, assessor-blinded pilot randomized trial, 60 adults within 3 months after primary hip or knee arthroplasty for osteoarthritis were allocated 1:1:1 to ATT, BWSTT, or standard inpatient rehabilitation over 6 weeks. Feasibility outcomes included recruitment, retention, and adherence. ATT and BWSTT additionally included unloading-based treadmill gait training using lower-body positive pressure or a harness system. Exploratory clinical outcomes included WOMAC total and subscale scores, analyzed using baseline-adjusted ANCOVA estimated marginal means. Secondary exploratory outcomes were BBS, FES-I, PHQ-9, and PSS-10. Results: Post-intervention data were available for 47 participants, with differential attrition across groups. Exploratory ANCOVA suggested between-group differences for WOMAC total (p = 0.004) and WOMAC function (p < 0.001). Compared with standard rehabilitation, ATT showed lower adjusted WOMAC total and function scores (both p < 0.01). ATT versus BWSTT contrasts for WOMAC total and function were statistically significant in the primary exploratory model but attenuated after hypertension adjustment. Exploratory signals were also observed for BBS and FES-I, although FES-I was less robust in sensitivity analysis. No clear between-group differences were observed for WOMAC pain, stiffness, PHQ-9, or PSS-10. No formal multiplicity adjustment was applied across exploratory endpoints. Conclusions: In this single-center pilot randomized trial, ATT suggested preliminary function- and balance-related signals that require confirmation in adequately powered multicenter trials. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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17 pages, 4543 KB

Open AccessArticle

Albuminuria Levels and Geriatric Outcomes in Predialysis: Chronic Kidney Disease: Falls, Fear of Falling, and Frailty in a Cross-Sectional Study

by Vedat Gençer, Yavuz Sultan Selim Akgül, Burcu Eren Cengiz and İsmail Altıntop

J. Clin. Med. 2026, 15(12), 4772; https://doi.org/10.3390/jcm15124772 - 19 Jun 2026

Viewed by 556

Abstract

Background: Chronic kidney disease (CKD) accelerates biological aging and amplifies the risk of adverse geriatric outcomes. Albuminuria reflects systemic endothelial dysfunction beyond renal damage, yet its specific relationship with falls, fear of falling, and frailty in predialysis CKD patients remains underexplored. Objectives: We aimed to evaluate the association between albuminuria levels (urinary albumin-to-creatinine ratio, ACR) with falls, fear of falling (Falls Efficacy Scale, FES), and frailty (FRAIL scale and Clinical Frailty Scale, CFS) in older adults with CKD. Methods: This cross-sectional study analyzed 295 patients aged ≥60 years attending nephrology and geriatrics clinics at Kayseri City Hospital, Turkey (April–June 2025). ACR was categorized per KDIGO (A1: <30, A2: 30–300, A3: ≥300 mg/g). Inflammatory indices (NLR, SII, CAR) were calculated. Hierarchical multivariable logistic regression and ROC analyses were performed. Results: Fall prevalence showed a clear dose-response across ACR categories: 31.2% (A1), 72.0% (A2), and 93.2% (A3) (p < 0.001). In the fully adjusted model, each unit increase in log-ACR was associated with a 3.84-fold increase in fall odds (OR 3.84, 95% CI 2.74–6.65). Although bivariate ACR-frailty associations were non-significant, fully adjusted models uncovered independent associations across both instruments and thresholds: FRAIL ≥ 3 (OR 1.41, 95% CI 1.05–2.03), FRAIL ≥ 2 (OR 1.49, 95% CI 1.08–2.21), CFS ≥ 5 (OR 1.87, 95% CI 1.38–2.83), and CFS ≥ 4 (OR 1.37, 95% CI 1.02–1.93). ACR showed good discriminative ability for falls (AUC 0.773, optimal cut-off 21.70 mg/g) but poor discrimination for frailty (AUC 0.50–0.54). The ACR–fall association was stronger in patients with GFR < 60 (OR 4.48) than GFR ≥ 60 (OR 2.18). Conclusions: Albuminuria is a strong, independent, and graded predictor of falls in older CKD patients, with a nearly 4-fold increase in risk per log-unit ACR increase after full adjustment. ACR measurement, already routine in CKD monitoring, could help identify older patients at increased fall risk and guide targeted geriatric assessment. However, ACR showed poor standalone discriminative ability for frailty across all definitions (AUC 0.50–0.54), establishing that it cannot serve as a frailty screening tool in isolation. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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12 pages, 460 KB

Open AccessArticle

Assessment of Depression and Anxiety in Hemodialysis Patients Undergoing VR Therapy—Pilot Study

by Łukasz Rogowski, Mariusz Kusztal, Joanna Kowalska, Małgorzata Stefańska, Agnieszka Zembroń-Łacny, Tomasz Gołębiowski and Wioletta Dziubek

J. Clin. Med. 2026, 15(4), 1489; https://doi.org/10.3390/jcm15041489 - 13 Feb 2026

Cited by 1 | Viewed by 800

Abstract

Background/Objectives: Patients with end-stage renal disease (ESRD) are at a significant risk for depressive and anxiety disorders, including severe depression. The use of virtual reality (VR) during hemodialysis can significantly impact psychological well-being and thus overall quality of life. The aim of the study was to assess the effects of VR therapy undertaken by hemodialysis (HD) patients on depression, anxiety, perceived self-efficacy and life satisfaction. Methods: Hemodialysis (HD) patients were recruited from the Dialysis Centre at St. Luke’s Hospital in Bolesławiec. Group I (experimental EG) included 16 HD patients, and Group II (control CG) included 22 HD patients (no VR session). The EG used VR for one month (maximum 14 sessions); the CG was the same group of patients assessed over a one-month period prior to the intervention. VR therapy took place at the beginning of dialysis, three times a week for one month. A personal questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-10), the General Self-Efficacy Scale (GSES) and the Satisfaction with Life Scale (SWLS) were used. Results: In the group of patients undergoing VR therapy, a significant reduction in the level of anxiety, depression and stress was observed, as well as a significant increase in life satisfaction and self-efficacy levels compared to the control group. Conclusions: Undertaking VR therapy during dialysis for patients with ESRD is beneficial, improves mood, satisfaction with life, and perceived self-efficacy, and reduces anxiety, but multi-center studies are needed on a larger group of patients. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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18 pages, 562 KB

Open AccessArticle

Sarcopenia, Obesity, and Sarcopenic Obesity in Relation to Functional Limitations in Older Adults

by Marika Murawiak, Marta Lewandowicz-Czarnecka, Beata Kaczmarek, Ewa Deskur-Śmielecka, Katarzyna Wieczorowska-Tobis and Roma Krzymińska-Siemaszko

J. Clin. Med. 2026, 15(3), 1000; https://doi.org/10.3390/jcm15031000 - 26 Jan 2026

Cited by 2 | Viewed by 2479

Abstract

Background/Objectives: Sarcopenia, obesity, and sarcopenic obesity (SO) are common in older adults and may be associated with functional limitations in Basic (BADL) and Instrumental (IADL) Activities of Daily Living. This study aimed to evaluate the association between body composition phenotypes and BADL/IADL limitations among older adults. Methods: A cross-sectional study included 440 community-dwelling adults aged ≥60 years (281 women, 159 men; mean age 74.7 ± 7.8 years). Sarcopenia was diagnosed according to EWGSOP2 criteria, obesity was defined as Percent Body Fat > 42% in women and >30% in men, and SO was classified based on the ESPEN/EASO recommendations. The reference phenotype was ‘non-sarcopenic, non-obese’. Functional status was evaluated using the Katz and Lawton scales, with limitations defined as BADL ≤ 5 and IADL ≤ 26 points, respectively. Multivariate logistic regression was performed to determine associations between body composition phenotypes and BADL/IADL limitations. Results: Over half of the participants (57.1%) had abnormal body composition: 31.6% obesity, 11.4% sarcopenia, and 13.2% SO. Sarcopenic obesity was associated with nearly threefold higher odds of BADL limitations (OR = 2.86; p = 0.003) and 3.7-fold higher odds of IADL limitations (OR = 3.68; p < 0.001), compared to the reference phenotype. Sarcopenia was associated with IADL limitations only in the unadjusted model (OR = 2.44; p = 0.010). Beyond adverse body composition phenotypes, BADL/IADL limitations were also associated with lower muscle strength, multimorbidity, and poorer nutritional status. Conclusions: SO was linked to both BADL and IADL limitations, while sarcopenia was associated only with IADL deficits. Isolated obesity showed no consistent relationship with functional impairment. These findings support prioritizing SO in screening and prevention, although the cross-sectional design precludes causal inference. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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10 pages, 633 KB

Open AccessArticle

Impact of an Interdisciplinary Care Program on Health Outcomes in Older Patients with Multimorbidity

by Pilar Cubo-Romano, Pilar García-de-la-Torre, Carolina Medina-de-Campos, Irene Casado-López, María de-Castro-García, Alejandro Estrada-Santiago, Yolanda Majo-Carbajo, Sara Núñez-Palomares and José Manuel Casas-Rojo

J. Clin. Med. 2025, 14(24), 8856; https://doi.org/10.3390/jcm14248856 - 15 Dec 2025

Cited by 2 | Viewed by 1399

Abstract

Background/Objectives: Evidence on the optimal components and effectiveness of care programs for patients with multimorbidity is limited. This study aimed to evaluate the impact of a structured interdisciplinary program on the incidence of emergency visits, hospitalizations, and avoidable outpatient consultations following an admission or emergency visit. Methods: This retrospective observational study included 200 patients enrolled in the Multimorbidity Care Program at Hospital Universitario Infanta Cristina. Event rates were compared during the year before and after program inclusion. Multiple-event survival analysis was performed using the counting process method. Results: After program inclusion, patients showed a significant reduction in emergency visits (HR 0.74, 95% CI 0.60–0.92, p = 0.006), in conventional hospitalizations (HR 0.54, 95% CI 0.44–0.68, p = 0.001), and in avoidable outpatient visits (HR 0.66, 95% CI 0.51–0.86, p = 0.005). Conclusions: An interdisciplinary care model for patients over 65 with multimorbidity, integrating comprehensive multidimensional assessment, structured patient education, early management of decompensations in a day hospital, and systematic medication review, significantly reduces healthcare utilization. These findings support implementing integrated care programs for complex patients, though multicenter studies and cost-effectiveness analyses are needed to confirm generalizability and sustainability. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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16 pages, 1064 KB

Open AccessArticle

Telerehabilitation for Fall Prevention in Saudi Arabia: Readiness and Predictors Among Physical Therapists

by Saad M. Bindawas, Hussam M. Alsaleh and Vishal Vennu

J. Clin. Med. 2025, 14(21), 7838; https://doi.org/10.3390/jcm14217838 - 4 Nov 2025

Viewed by 1243

Abstract

Background: Telerehabilitation can extend fall prevention to underserved groups. Clinician uptake remains limited. We evaluated factors associated with physical therapists’ belief in and readiness to implement the Otago Exercise Program (OEP) via telerehabilitation in Saudi Arabia. Methods: We conducted a national cross-sectional survey of physical therapists (n = 120). Exposures included fall-prevention training, education outside versus inside Saudi Arabia, and familiarity with telerehabilitation. Outcomes were belief in telerehabilitation efficacy for the OEP (5-point Likert) and high readiness, defined as familiarity plus knowledge ≥4 of 5 and belief ≥4 of 5. We utilized ordinal logistic regression for assessing belief and binary logistic regression for assessing readiness. We conducted two-sided tests with alpha equal to 0.05 and prespecified covariates. Sensitivity analyses using penalized likelihood methods confirmed the robustness of the results. Results: The OEP prescription did not differ with telerehabilitation familiarity (χ² = 0.28; p = 0.597). In multivariable models using complete cases (n = 117; 21 readiness events), fall-prevention training was associated with higher belief (odds ratio [OR] = 3.997; 95% CI = 1.568–10.184; p = 0.004) and higher readiness (OR = 4.520; 95% CI = 1.546–13.210; p = 0.006). Education outside Saudi Arabia was associated with higher readiness (OR = 5.170; 95% CI = 1.435–18.636; p = 0.012). Results were directionally consistent in Firth and pilot-exclusion analyses. Conclusions: Training and international educational exposure were associated with stronger beliefs and greater readiness to implement the OEP via telerehabilitation. Basic familiarity alone was not associated with the OEP use. Programs should prioritize competency-based training and curricular updates to support implementation. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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Review

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19 pages, 1142 KB

Open AccessReview

Virtual Reality Exergaming in Outpatient Stroke Rehabilitation: A Scoping Review and Clinician Roadmap

by Błażej Cieślik

J. Clin. Med. 2025, 14(20), 7227; https://doi.org/10.3390/jcm14207227 - 13 Oct 2025

Cited by 2 | Viewed by 3912

Abstract

Background/Objectives: Outpatient stroke rehabilitation is expanding as inpatient episodes shorten. Virtual reality (VR) exergaming can extend practice and standardize progression, but setting-specific effectiveness and implementation factors remain unclear. This scoping review mapped VR exergaming in outpatient stroke care and identified technology typologies and functional outcomes. Methods: Guided by the JBI Manual and PRISMA-ScR, searches of MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were conducted in April 2025. The study included adults post-stroke undergoing VR exergaming programs with movement tracking delivered in clinic-based outpatient or home-based outpatient settings. Interventions focused on functional rehabilitation using interactive VR. Results: Sixty-six studies met the criteria, forty-four clinic-based and twenty-two home-based. Serious games accounted for 65% of interventions and commercial exergames for 35%. Superiority on a prespecified functional endpoint was reported in 41% of trials, 29% showed within-group improvement only, and 30% found no between-group difference; effects were more consistent in supervised clinic programs than in home-based implementations. Signals were most consistent for commercial off-the-shelf and camera-based systems. Gloves or haptics and locomotor platforms were promising but less studied. Head-mounted display interventions showed mixed findings. Adherence was generally high, and adverse events were infrequent and mild. Conclusions: VR exergaming appears clinically viable for outpatient stroke rehabilitation, with the most consistent gains in supervised clinic-based programs; home-based effects are more variable and sensitive to dose and supervision. Future work should compare platform types by therapeutic goal; embed mechanistic measures; strengthen home delivery with dose control and remote supervision; and standardize the reporting of fidelity, adherence, and cost. Full article

(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)

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