Geriatrics doi: 10.3390/geriatrics11040083

Authors: Maria-Dolors Rosinés-Cubells Mercè Castejón Joan Espaulella-Panicot Andrew Ore-Zuñiga Anna Arnau

Background/Objectives: The main objective of this study was to estimate 1- and 3-year overall survival and relative survival in patients aged >65 years who underwent surgery for a second contralateral hip fracture. Methods: Retrospective cohort study including patients aged ≥65 years who underwent surgery for a first or second contralateral hip fracture between June 2010 and December 2021. Overall survival (OS) was estimated from the date of surgery to death from any cause or end of follow-up. Relative survival (RS) was calculated as the ratio between observed survival and expected survival derived from general population mortality tables for Catalonia implemented in the WebSurvCa application. Results: A total of 2642 patients were included (2467 primary fractures; 175 s contralateral fractures). Patients with a second fracture were older and had worse pre-fracture functional and cognitive status. At 3 years, overall survival was 53.8% (95% CI: 51.7–55.9) after a first fracture and 43.7% (95% CI: 36.3–52.4) after a second contralateral fracture. Relative survival estimates were 70.5% (95% CI: 67.7–73.3) and 59.0% (95% CI: 49.1–70.8), respectively. Divergence between expected and relative survival became more evident at 3 years than at 1 year. Advanced age, male sex, and worse pre-fracture functional or cognitive status were associated with poorer survival in both cohorts. Conclusions: A second contralateral hip fracture may represent a clinically relevant marker of increased vulnerability and greater clinical complexity, associated with substantial excess mortality compared with general population matched by age and sex. Relative survival highlights the true prognostic burden of a primary or second fracture and supports intensive secondary prevention and tailored follow-up.

Geriatrics doi: 10.3390/geriatrics11040082

Authors: Armando Cifuentes-Amigo Claudia Fica Ignacio Salas Nacim Molina Diego Arauna Eduardo Fuentes Iván Palomo

Introduction: Community-based day center programs may support healthy ageing by promoting functional ability, mental well-being, and social participation among older adults, but real-world evidence from Latin America remains limited. Objective: We aimed to examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre–post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index, the Lawton and Brody scale, and the Timed Up and Go test; mental health with the Mini-Mental State Examination and the 15-item Geriatric Depression Scale; and quality of life with the EuroQol-5D visual analogue scale. Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p ≤ 0.001). In 2023, the Barthel Index, the Timed Up and Go test, and the Geriatric Depression Scale improved (all p < 0.0001), and the EuroQol-5D visual analogue scale also improved (p < 0.01), whereas the Lawton and Brody scale (p = 0.204) and the Mini-Mental State Examination (p = 0.725) did not. Category-transition analyses showed significant improvements in basic activities of daily living and mobility in both cohorts (both p < 0.001), while significant categorical changes in instrumental activities of daily living, global cognition, depressive symptoms, and self-rated quality of life were observed only in 2022 (all p ≤ 0.01). Rural residence was associated with higher odds of improvement in basic activities of daily living (OR 1.62, 95% CI 1.17–2.25; p = 0.004), whereas age ≥75 years was associated with lower odds of improvement in depressive symptoms (OR 0.56, 95% CI 0.41–0.76; p < 0.001) and self-rated quality of life (OR 0.65, 95% CI 0.45–0.94; p = 0.023). Conclusions: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups.

Geriatrics doi: 10.3390/geriatrics11040081

Authors: Chiung-ju Liu Gabriella Ulloa Kelly Leal Chia-Wei Fan Pei-Shiun Chang Inga Wang

Background/Objectives: Senior living communities have become a popular living arrangement for older adults seeking supportive environments for aging in place. However, older adults may enter these communities with existing health vulnerabilities. This study described the prevalence of frailty, sarcopenia risk, and cognitive risk among residents and examined their associations with relocation reasons and fitness amenity utilization. Methods: A cross-sectional survey was conducted among residents aged ≥65 years who had lived in the community for at least 3 months. Survey items included demographics, health status, living history, relocation reasons, physical activity, fitness amenity use, and screening tools for frailty, sarcopenia risk, and cognitive impairment. Descriptive statistics, Mann–Whitney U tests, and Spearman rank correlations were conducted. Results: A total of 147 residents (Mean age = 80.2 years, SD = 7.1) responded to the survey. Overall, 28.5% met criteria for frailty, 19.7% screened positive for sarcopenia risk, and 21.8% for cognitive risk. Residents who reported a health-related reason for relocation showed greater frailty (U = 410, p < 0.001), sarcopenia risk (U = 393, p < 0.001), and cognitive impairment (U = 1062, p = 0.01). More frequent fitness amenity use was associated with lower frailty and sarcopenia risk scores (Spearman’s Rho = −0.30 and −0.40, respectively, both p < 0.01), but not cognitive impairment. Conclusions: A meaningful subset of senior living residents were at risk for frailty, sarcopenia, and cognitive impairment. Routine screening and interventions promoting fitness amenity use may support healthy aging in senior living communities.

Geriatrics doi: 10.3390/geriatrics11040080

Authors: Kristina M. Kokorelias Luxey Sirisegaram Dean Valentine Stephanie Hatzifilalithis

Chosen family caregivers assume caregiving roles by choice rather than by blood or legal relation. Chosen family caregivers play a critical yet often invisible role in supporting older adults living with HIV. Unlike traditional family caregivers, many chosen family members are themselves living with HIV or other chronic health conditions, creating unique dynamics of mutual support, resilience, and vulnerability. Older LGBTQ adults are disproportionately reliant on chosen family, often due to stigma, estrangement from biological family, or social marginalization, highlighting distinct challenges in caregiving relationships. Women in chosen family roles frequently experience compounded burdens, balancing emotional, physical, and logistical care responsibilities alongside broader social and structural pressures. Despite their essential contributions, chosen family caregivers remain largely unrecognized within healthcare systems, limiting their access to formal support, respite, and decision-making authority. This commentary synthesizes the existing literature and conceptual perspectives to examine the social, gendered, and health-related dimensions that distinguish chosen family caregiving. It highlights key gaps in recognition and support and outlines implications for policy, research, and practice aimed at strengthening care for older adults living with HIV.

Geriatrics doi: 10.3390/geriatrics11040079

Authors: Martina Focardi Paola D’Onofrio Marco Carnevali Francesca Romana Ermini Edoardo Orlandi Ilenia Bianchi Barbara Gualco Vilma Pinchi Beatrice Defraia

Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim’s home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study’s detection rate (<1%) falls critically short of international benchmarks (3–5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments.

Geriatrics doi: 10.3390/geriatrics11040078

Authors: Leandro Amato Isabella Napoleoni Noemi Giannetta Emanuele Di Simone Nicolò Panattoni Alessandra Improta Erika Renzi Azzurra Massimi Marco Di Muzio Sofia Taborri

Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (≥65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth’s role in the care of this population.

Geriatrics doi: 10.3390/geriatrics11040077

Authors: Selma Karime Castillo-Vazquez Nadia Alejandra Rivero-Segura Juan Carlos Gomez-Verjan Jazmin Camacho Daniel Hernández-Pando

Background/Objectives: Sarcopenia significantly increases the risk of hospitalization and mortality in older adults. However, the prevalence by sex varies across populations and according to the criteria used by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Hence, in the current study, we aim to characterize the prevalence of sarcopenia by jointly evaluating all three diagnostic domains in a Mexican cohort of older adults subscribed to a health insurance plan. Methods: We performed binomial and multinomial regression models, ordinal logistic regression, and multiple linear regression from the data corresponding to muscle mass (ASMI), muscle strength (handgrip dynamometry), and physical performance (SPPB) from 556 Mexican older adults (62.2% female; 72.27 ± 6.35 y.o.) categorized by sarcopenia severity according to the EWGSOP2. Results: Men exhibited significantly higher absolute muscle mass and strength across all categories (p < 0.001). Additionally, our statistical analyses demonstrate that age, but not sex, is involved in sarcopenia severity in this population. Moreover, when analyzing the disaggregated EWGSOP2 domains, the results demonstrate that sex is significantly associated with muscle mass (ASMI) and muscle strength (Handgrip strength). Conclusions: These results suggest that sex only influences both muscle mass (ASMI) and muscle strength (handgrip strength) while sarcopenia severity only depends on age.

Geriatrics doi: 10.3390/geriatrics11040076

Authors: Kamel Mouloudj Anuli Njoku Ahmed Chemseddine Bouarar Dachel Martínez Asanza Marian A. Evans Snehal Baviskar

Background/Objectives: Telemedicine offers significant potential to improve the quality and accessibility of geriatric care, particularly in resource-constrained settings. However, its effective implementation depends largely on healthcare professionals’ acceptance and willingness to use such systems. Drawing on an extended Technology Acceptance Model (TAM), this study examines the determinants of doctors’ and nurses’ intentions to adopt telemedicine for elderly care in Algeria, with particular emphasis on self-efficacy and institutional support. Methods: This cross-sectional study employed a structured questionnaire administered to 130 healthcare professionals, including physicians and nurses, in Algeria. Hierarchical multiple regression analysis was conducted to test the proposed hypotheses and assess the incremental explanatory power of the extended model. Results: The extended TAM accounted for 48.7% of the variance in intention to use telemedicine. Institutional support (β = 0.432, p < 0.001) and self-efficacy (β = 0.264, p = 0.001) emerged as the strongest predictors. Perceived ease of use (β = 0.178, p = 0.038) and perceived usefulness (β = 0.139, p = 0.021) also had significant positive effects. The inclusion of self-efficacy and institutional support increased the model’s explanatory power by 23.5%. Conclusions: The findings highlight the critical role of organizational support mechanisms, digital competencies, and system usability in fostering telemedicine adoption among healthcare professionals. The study provides practical implications for policymakers and healthcare institutions, emphasizing the need for targeted training programs, supportive infrastructure, and institutional policies that enhance confidence and facilitate the integration of telemedicine into clinical workflows.

Geriatrics doi: 10.3390/geriatrics11040075

Authors: Xi Chen Jirakate Madiloggovit-Lower Carissa Comnick Daniel Tranel Lisa Jacobson Natalie Denburg

Background/Objectives: Cognitive impairment can compromise toothbrushing and other oral self-care functions, increasing the risk of oral diseases and related complications. However, how toothbrushing ability declines across stages of cognitive impairment remains unclear. This study aimed to describe functional deficits in toothbrushing among older adults with different levels of cognitive function. Method: Sixty-five older adults (14 cognitively healthy and 51 with documented cognitive impairment) were classified into five cognitive levels based on Standardized Mini-Mental State Examination scores. Participants completed a toothbrushing task as they normally would at home. Performance was videotaped, coded, and evaluated across four domains (task initiation, completion, thoroughness, and quality) with total scores reflecting overall toothbrushing ability. Overall performance, functional deficits, and assistance needs were analyzed in relation to cognitive levels. Results: Participants averaged 76.5 years of age. Toothbrushing ability declined gradually with worsening cognitive impairment, followed by a sharp deterioration at the profound stage (e.g., SMMSE ≤ 5). Compared with cognitively healthy participants (n = 14), those with mild cognitive impairment (MCI, n = 20) or mild (n = 10), moderate (n = 10), or severe dementia (n = 11) lost an average of 3%, 8%, 12%, and 37% of overall toothbrushing ability, respectively. Brushing efficiency declined earlier and more rapidly, decreasing by 13% in MCI and up to 46% in severe dementia (p < 0.001). All participants with MCI or mild dementia completed the task independently, whereas 20% with moderate dementia and 80% with severe dementia required assistance to initiate or complete the task. Conclusions: Overall toothbrushing ability remains relatively preserved until the later stages of cognitive impairment, but brushing quality deteriorates much earlier and quicker. These findings highlight the importance of early caregiver–patient partnerships, functionally tailored oral self-care rehabilitation, and personalized caregiver training to support oral hygiene among older adults with cognitive impairment.

Geriatrics doi: 10.3390/geriatrics11030074

Authors: Keon Woo JungHoon Lee YoonSoo Choy

Background and Objectives: This study examined the association between active aging and health-related quality of life (HRQoL) in older Korean adults. Furthermore, it examined how socioeconomic factors were related to active aging and HRQoL. Methods: Data were analyzed using the 8th Korea National Health and Nutrition Examination Survey (KNHANES). This study used the Health-Related Quality of Life Instrument with Eight Items (HINT-8), a Korean-specific HRQoL instrument. Multivariable regression analyses were conducted to estimate the associations of overall active aging and its health, participation, and security domains with HRQoL. Results: The health domain showed the largest coefficient, and the security domain was also significantly associated with HRQoL. The participation domain showed a relatively limited and statistically non-significant association, which may partly reflect measurement constraints in the operationalization of participation. Older adults with lower educational levels and those residing in rural areas had lower levels of both active aging and HRQoL. Conclusions: Active aging was positively associated with HRQoL among older Korean adults. These findings highlight health as the domain most strongly associated with HRQoL and identify security as an additional relevant domain, while participation-related findings should be interpreted cautiously given the limited operationalization of participation and its statistically non-significant association. However, longitudinal or intervention studies are needed to examine temporal and causal relationships between active aging and HRQoL.

Geriatrics doi: 10.3390/geriatrics11030073

Authors: Evangelos C. Fradelos Sini Eloranta Ioanna Tsatsou Ioanna Dimitriadou Susanna Mört Nina Korsström Anna Lundberg Magdalena Häger Jekaterina Šteinmiller Agita Melbarde-Kelmere Kristaps Circenis Sigrun S. Skuladottir Ingibjörg Hjaltadòttir Maria Saridi

Background/Objectives: Population aging has increased the demand for comprehensive and coordinated care for older adults, placing primary health care (PHC) nurses at the forefront of comprehensive geriatric assessment (CGA) implementation. However, limited evidence exists regarding nurses’ experiences and educational needs related to CGA across different European healthcare contexts. This study aimed to explore the experiences, perceived challenges, and educational needs of PHC nurses regarding the implementation of CGA in five European countries. Methods: A qualitative study design was employed using five focus groups, one in each participating country: Greece, Iceland, Finland, Estonia, and Latvia. A total of 29 PHC nurses participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three overarching themes and nine subthemes were identified in relation to good practices in CGA: (1) embracing the complexity of holistic assessment; (2) balancing consistency with flexibility in clinical practice; and (3) advancing professional expertise through structured learning. Participants highlighted the importance of standardized assessment tools and effective multidisciplinary collaboration. At the same time, they reported significant gaps in formal education, limited organizational resources, and insufficient training in cultural competence, which hinder consistent CGA implementation. Conclusions: PHC nurses recognize the value of a holistic and structured approach to CGA but require clearer educational pathways and evidence-based training to address the complex needs of older adults. Strengthening curricula that emphasize interprofessional collaboration, practical competencies, and contextual adaptability may support more effective and sustainable implementation of CGA in primary care settings across Europe.

Geriatrics doi: 10.3390/geriatrics11030072

Authors: Asiye Tuba Ozdogar Pervin Yesiloglu Yuval Levitan Marcus Alon Kalron

Background: Falls and fall-related injuries are common in older adults and are frequently accompanied by fear of falling (FoF), which may lead to activity avoidance and functional decline. Because many interventions target falls or FoF in isolation, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to identify, describe, and evaluate interventions reporting both falls and FoF outcomes in older adults. Methods: This systematic review and meta-analysis were registered in PROSPERO (CRD420251113137) and conducted in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception to 4 November 2025. Eligible studies were English-language RCTs that included adults aged ≥60 years, evaluated nonpharmacological interventions, and reported both FoF and falls. Methodological quality was assessed using the PEDro scale. Random-effects meta-analyses were performed for FoF (Hedges g), and Bayesian random-effects binomial meta-analyses were conducted for falls. Results: Ten RCTs published between 1998 and 2018 (sample sizes per trial: n = 27–540) were included. Interventions included cognitive–behavioral therapy-based programs, Tai Chi, physiotherapist-led strength and balance training, computerized visual feedback, and video-guided home exercise. PEDro scores ranged from 6 to 9 (mean, 7.7). Pooled analyses showed no significant effect on FoF at the end of intervention (g = −0.20, 95% CI −1.45 to 1.05; p = 0.68; high heterogeneity) or at follow-up (g = −0.14, 95% CI −0.60 to 0.33; p = 0.50). For falls, postintervention evidence favored the null (BF10 = 0.16; pooled estimate −0.01, 95% credible interval [CrI] −0.30 to 0.14). Follow-up results were inconclusive (BF10 = 2.07; pooled CrI −0.56 to 0.00), with substantial uncertainty. Conclusions: Across RCTs that measured both outcomes, interventions did not consistently improve both FoF and falls outcomes. These findings may suggest a partial dissociation between psychological and physical fall-related outcomes, highlighting the need for integrated, adequately powered trials that utilize standardized measures and longer follow-up periods.

Geriatrics doi: 10.3390/geriatrics11030071

Authors: Takahiko Nagamine

Background: Inhibitory processes in the nervous system are traditionally conceptualized as suppressive mechanisms; however, their fundamental role is the refinement and optimization of sensory information. In nociception, this function is mediated by the descending pain inhibitory system (DPIS), which modulates nociceptive transmission at multiple hierarchical levels. Biological sex and gender-related factors significantly influence these inhibitory pathways, yet they are often overlooked in clinical frameworks. Methods: A narrative review was conducted using PubMed, MEDLINE, and Scopus databases, focusing on studies published between 2010 and 2025. Search terms included “descending pain inhibitory system,” “nociplastic pain,” “aging,” “sex differences,” “gender,” and “gut–brain axis.” Approximately 30 key references were synthesized. Results: The DPIS enhances the precision of nociceptive signals through mechanisms analogous to lateral inhibition. In chronic and nociplastic pain, this refinement process is impaired, leading to “sensory blurring.” Aging exacerbates these changes through neurochemical depletion and neuroinflammation. Crucially, this decline follows sex-specific trajectories; estrogen depletion in post-menopausal females accelerates the loss of monoaminergic inhibitory reserves, while gender-related sociocultural stressors can further disrupt top-down executive control. Additionally, alterations in the gut–brain axis signaling—modulated by sex-specific gut microbiota profiles—further disrupt inhibitory control. Conclusions: Chronic pain may be conceptualized as a disorder of sensory refinement rather than excessive nociceptive input. Inclusion of sex and gender as biological variables is essential for precision pain management. Therapeutic strategies should focus on restoring inhibitory precision through both central and systemic approaches, tailored to the patient’s hormonal and physiological profile.

Geriatrics doi: 10.3390/geriatrics11030070

Authors: Jia-Ni Wu Jia-Huan Xu Jia-Yi Ge Bo-Ran Deng Xing-Jun Liu

Postoperative delirium (POD) is an acute, reversible neurocognitive disorder characterized by confusion and altered consciousness. With the improvement in research methodologies and the introduction of innovative clinical drugs in recent years, a growing number of randomized controlled trials have been conducted. This article aims to conduct a comprehensive review of the efficacy of general anesthetics—including propofol, ciprofol, sevoflurane, ketamine, esketamine, dexmedetomidine, benzodiazepines, opioids, and lidocaine—in preventing and managing POD, based on randomized controlled trials published in the past five years. Propofol has advantages in preventing POD in pediatric patients. However, its efficacy compared with inhalational anesthetics still requires individualized evaluation in elderly patients. The novel drugs ciprofol and remimazolam exhibit favorable safety profiles and do not increase the risk of POD. The efficacy of dexmedetomidine shows variability across patient populations and surgical types. In addition, specific opioid drugs and lidocaine also demonstrate preventive potential when administered in a standardized manner.

Geriatrics doi: 10.3390/geriatrics11030069

Authors: Dimitrios Vouros Belen Conde Inarejos James Fowler Sarthak Jain Vasileios Kotsarinis Maaz Ullah Awais Asif Chaudhary Martyn Charles Stott Ahmad Hassan Shahin Hajibandeh Shahab Hajibandeh Jacob Kadamapuzha Thomas Satyadas

Background/Objectives: To evaluate the safety of cholecystectomy in nonagenarians. Methods: In compliance with the PRISMA statement standards, a systematic review including random-effects meta-analysis and meta-regression models was conducted. All studies reporting postoperative outcomes in patients aged ≥90 undergoing cholecystectomy were included and analyzed. Results: Six studies (1223 patients) were included. The risk of 30-day mortality was 5.4% (95% CI 3.1–7.7); 30-day morbidity occurred in 22% (95% CI 11.3–32.8). The mean length of hospital stay was 11.5 days (95% CI 8.3–14.6). Postoperative mortality was not affected by male sex (coefficient: 0.028, p = 0.832), ASA status ≥ III (coefficient: 0.051, p = 0.309), cholecystitis as indication for cholecystectomy (coefficient: −0.166, p = 0.051), cholecystectomy in emergency setting (coefficient: −0.020, p = 0.425), laparoscopic (coefficient: −0.104, p = 0.09) or open approach (coefficient: 0.104, p = 0.09), and conversion to open surgery (coefficient: 0.043, p = 0.820). The GRADE certainty of evidence was low to moderate. Conclusions: Subject to selection bias and confounding by fitness, the available evidence suggests that cholecystectomy in highly selected nonagenarians with good performance status, who have passed robust preoperative fitness assessment tests, may be safe with an acceptable risk of morbidity and mortality.

Geriatrics doi: 10.3390/geriatrics11030068

Authors: Hongyu Li Chenxiang Cao Xiaoyi Wang Jing Zhang Wenhui Zhao

Background: Hypothyroidism is a prevalent endocrine disorder capable of affecting multiple organ systems. While somatic symptoms are common, prominent neuropsychiatric manifestations such as visual hallucinations and cognitive deficits are exceptionally rare as an initial presentation. This atypical clinical picture frequently leads to misdiagnosis as primary psychiatric disorders or neurodegenerative conditions. Case Presentation: We report the case of a 75-year-old male who presented with a three-month history of complex visual hallucinations and progressive cognitive decline. The hallucinations were notably dependent on environmental light. Initial assessments raised concerns about the neurodegenerative process. However, laboratory investigations revealed severe autoimmune hypothyroidism with high titers of anti-thyroid antibodies. Following timely levothyroxine replacement therapy, the patient achieved complete remission of visual hallucinations and significant cognitive recovery. Conclusions: This case illustrates that severe hypothyroidism can manifest as a reversible metabolic encephalopathy mimicking dementia. It underscores the importance of screening for thyroid dysfunction in elderly patients presenting with unexplained acute neuropsychiatric symptoms to ensure appropriate management.

Geriatrics doi: 10.3390/geriatrics11030067

Authors: Liyang Xiao Kai Siang Chan Isaac Chan Aung Myint Oo

Background: Esophageal cancer (EC) poses a growing global challenge in the context of an ageing population. Evidence on the role of curative esophagectomy in octogenarians is limited. This study aims to compare the long-term survival and post-operative mortality and morbidity in octogenarians undergoing curative esophagectomy for EC with those in non-octogenarians. Methods: A systematic search was performed on PubMed, Embase, Web of Science and Cochrane Library up to Jan 2026. The inclusion criteria were studies that compared outcomes of esophagectomy for EC between octogenarians and non-octogenarians. Exclusion criteria were single-arm studies and studies using different age cut-offs. Results: There were 18 studies with 73,776 patients (octogenarians n = 6234 and non-octogenarians patients n = 67,542), with smaller subsets of studies being analysed for individual outcomes. The overall incidence of open esophagectomy and minimally invasive esophagectomy (MIE) were 78.4% (n = 459/585) and 21.2% (n = 124/585), respectively, in octogenarians, and 69.8% (n = 3270/4688) and 29.4% (n = 1380/4688), respectively, in non-octogenarians. R0 resection was achieved in 85.2% (n = 1759/2064) of octogenarians and 91.9% (n = 30,764/33,480) of non-octogenarians. Pooled OS was inferior in the octogenarian group compared to the non-octogenarian group (n = 35,441, HR 2.29, 95% CI: 1.38–3.79). Pooled in-hospital mortality, 30-day mortality and 90-day mortality were higher in octogenarians. In terms of post-operative complications, pooled analysis demonstrated a higher overall complication rate in the octogenarian group (n = 6515, OR 1.40, 95% CI: 1.11–1.78), while rates of anastomosis leakage, chylothorax, respiratory complication, surgical site infection and recurrent laryngeal nerve injury were comparable between the two groups. Conclusions: Curative esophagectomy for EC is associated with worse overall survival, mortality and overall post-operative complication rate in octogenarians than non-octogenarians. Further research on the role of MIE in octogenarians should be conducted.

Geriatrics doi: 10.3390/geriatrics11030066

Authors: Lucia Federica Stefanelli Marianna Alessi Martina Cacciapuoti Rime Khalf Dorella Del Prete Francesca Katiana Martino Lorenzo A. Calò Federico Nalesso

Background/Objectives: Kidney transplantation (KT) in older recipients remains challenging due to age-related conditions such as frailty and comorbidities, as well as immunological changes related to immunosenescence, which expose older KTRs to a higher risk of infection and infection-related complications. The aim of this study was to evaluate clinical and immunological outcomes in older KTRs, analyzing the incidence of cardiovascular, infective, and neoplastic complications, as well as graft and patient survival and the associated risk factors. Methods: This monocentric study includes 157 KTRs aged over 65 years, followed at the Transplant Ambulatory of Padua University Hospital and transplanted between January 2013 and December 2023. Clinical and immunological outcomes were evaluated, including surgical complications, incidence of delayed graft function (DGF), and renal function at 1, 3, and 5 years after KT. Results: Patient survival rates were 96%, 91.5%, and 71.6% at 1, 3, and 5 years after KT, respectively, while graft survival rates were 94%, 87%, and 68%. Major complications were malignancies (40.1%), cardiovascular disease (33.1%), and bacterial infections (22%). In the multivariate analysis, donor age and history of malignancy were identified as independent risk factors for mortality (p = 0.048 and p = 0.056, respectively). Kaplan–Meier survival analysis confirmed donor age as the only significant risk factor for patient survival. Regarding graft survival, multivariate analysis identified hypertension as an independent risk factor for graft failure (p = 0.009), while Kaplan–Meier analysis showed diabetes (p = 0.040) and single-kidney transplantation (p = 0.003) as significant risk factors. Conclusions: KT in older recipients represents a safe and beneficial therapeutic option, offering favorable patient and graft survival outcomes. However, this epidemiological study highlights the need for personalized follow-up strategies and improved prognostic assessment in older KTRs.

Geriatrics doi: 10.3390/geriatrics11030065

Authors: Hui Gao Man Lang Mustapha Mangdow Wen Liu

Objectives: Stroke predominantly affects older adults and is accompanied by age-related declines in balance and mobility. Given the inter-individual variability in post-stroke functional capacity, identifying the most effective dual-task training modalities for specific patient profiles is essential for precision-based stroke rehabilitation. This systematic review and meta-analysis aimed to investigate the differential effectiveness of motor dual-task training (MDT) and cognitive dual-task training (CDT) on gait performance, balance control, and motor function while exploring other moderating factors. Methods: The study followed the PRISMA guidelines. A comprehensive search of six English databases (Web of Science, PubMed, Medline, Embase, Cochrane Library, CINAHL) and one Chinese database (CNKI) was conducted from November 2023 to June 2025. Randomized controlled trials involving adult stroke survivors were included. Outcomes included gait, balance, and lower-extremity motor function. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed to evaluate modality-specific effects and moderating factors. Results: Twenty-one RCTs (n = 786) were included. Dual-task training demonstrated moderate improvements in both temporal (SMD = 0.50, p = 0.03) and spatial (SMD = 0.5, p = 0.04) gait performance and balance control (SMD = 0.71, p = 0.02), but not motor function. MDT demonstrated superior effects on gait speed and stride length (SMD = 1.15, p = 0.01; SMD = 0.89, p < 0.01), whereas CDT showed greater benefits for balance (SMD = 0.59, p < 0.01). Greater balance improvements were observed in individuals at high fall risk, and subacute patients showed enhanced responsiveness. Conclusions: These findings provide guidance for tailoring dual-task modality and timing to individual patient profiles, though high heterogeneity and the lack of direct comparisons between MDT and CDT limit definitive conclusions.

Geriatrics doi: 10.3390/geriatrics11030064

Authors: Yoshiharu Yokokawa Keisuke Nakamura Tomohiro Sasaki Shinobu Yokouchi

Objective: We aimed to identify predictors of the transition to pre-frailty among older adults undergoing frailty health checkups and to evaluate their relative importance. Methods: A longitudinal analysis was conducted using data from a frailty health checkup project involving 830 older adults participating in community exercise classes in Matsumoto City, Nagano Prefecture, Japan. Among them, 502 individuals classified as robust (healthy) at baseline were followed for 1 year. Predictors of transition to pre-frailty were examined using multivariate logistic regression analysis. Given the low follow-up rate (43.4%), a sensitivity analysis using inverse probability weighting (IPW) was performed. Model performance was internally validated using bootstrap resampling and calibration assessment. Results: Of the 218 participants who completed the follow-up period, 45 (20.6%) transitioned to pre-frailty. Increasing age was a significant risk factor (OR = 1.13, 95% CI: 1.06–1.20), whereas higher health literacy was a protective factor (OR = 0.51, 95% CI: 0.29–0.86). In the IPW sensitivity analysis, the association with age remained stable, while health literacy demonstrated borderline significance (p = 0.08). The model showed acceptable discrimination (area under the curve [AUC] = 0.737; 0.728 after optimism correction) and good calibration (Hosmer–Lemeshow test, p = 0.124). Conclusions: Age and health literacy were independent predictors of transition to pre-frailty. As a modifiable factor, health literacy may represent a promising target for interventions aimed at preventing the progression to pre-frailty.

Geriatrics doi: 10.3390/geriatrics11030063

Authors: Masanobu Iwai Kazuya Takeda Soichiro Koyama Ikuo Motoya Yuichi Hirakawa Hiroaki Sakurai Yoshikiyo Kanada Nobutoshi Kawamura Mami Kawamura Shigeo Tanabe

Background/Objectives: Advanced age in Parkinson’s disease (PD) is linked to worse motor function, more severe symptoms, and impaired activities of daily living (ADLs). Lee Silverman Voice Treatment (LSVT)® BIG may be suitable for older patients, as it can be adapted to individual abilities. This study evaluated whether age affects the effectiveness of LSVT® BIG on gait speed, motor symptoms, ADLs, and quality of life (QoL) in PD. Methods: In this retrospective, single-center cohort study, 22 patients with PD were divided into an older group (≥65 years; n = 16) and a younger group (<65 years; n = 6). All participants completed 16 one-hour, face-to-face LSVT® BIG sessions. Gait speed was assessed with the 10-m walk test; motor symptoms with Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III; ADLs with MDS-UPDRS Part II; and QoL with the Parkinson’s Disease Questionnaire-39 Summary Index. Two-way mixed-design analysis of variance with aligned rank transformation was used for statistical analysis. Results: Significant improvements were observed for all outcomes (gait speed, motor symptoms, ADLs, and QoL) after the intervention. A significant effect of age group was found for gait speed, with younger patients walking faster overall. No significant interaction between timepoint and group was observed for any measure. Conclusions: LSVT® BIG appears to improve gait speed, motor symptoms, ADLs, and QoL in patients with PD, regardless of age, suggesting it is an effective intervention for both older and younger patients.

Geriatrics doi: 10.3390/geriatrics11030062

Authors: Tobias Philip Schmidt Christian Jacquemain Jule Rupprecht Kerstin Jütten Laura Schlager Christian Blume Michael Veldeman Hans Clusmann Anke Höllig Catharina Conzen-Dilger

Objectives: Frailty, reflecting reduced physiological reserve, has emerged as a predictor of postoperative outcomes in neurosurgery and may provide greater prognostic value than age. In chronic subdural hematoma (cSDH), prospective data remain scarce. This study investigates the association between preoperative frailty, assessed using the Clinical Frailty Scale (CFS), and postoperative recovery in cSDH patients. Methods: In this ongoing prospective single-center cohort study, 78 consecutive patients (≥60 years) with cSDH were enrolled between August 2022 and October 2024. After exclusion of four conservatively managed patients, 74 surgically treated patients were included in the analysis. Frailty was defined as Clinical Frailty Scale (CFS) ≥ 5. The primary outcome was the Glasgow Outcome Scale-Extended at 6 months (GOSE6). Secondary outcomes included GOSE at discharge (GOSE0) and three months (GOSE3), revision surgery, intensive care unit (ICU) admission, and mortality after six months. Results: Higher CFS scores significantly correlated with poorer outcome at 6 months (r = −0.68, padj = 0.011). In regression analysis, frailty (p < 0.001), age (padj = 0.014), and revision surgery (padj = 0.009) were significant predictors of outcome. Frailty was associated with a reduced likelihood of a good neurological outcome (OR = 0.02, 95% CI: [0.004, 0.085]). Frail patients had significantly poorer outcomes at all timepoints (all padj = 0.014) and none achieved a favorable outcome (GOSE ≥ 6). Six-month mortality was significantly higher in frail patients compared to non-frail patients (32% vs. 4%, padj = 0.048, relative risk RR = 3.29, 95% CI [1.67, 5.78]). Conclusions: Our interim results suggest that preoperative frailty, as measured by the CFS, is strongly associated with poorer neurological recovery and higher mortality following surgical treatment of cSDH. Frailty assessment may facilitate individualized treatment strategies and improve risk stratification beyond age or comorbidity burden.

Geriatrics doi: 10.3390/geriatrics11030061

Authors: Eli Magen Israel Magen Eugene Merzon Ilan Green Avivit Golan-Cohen Shlomo Vinker Ariel Israel

Background/Objectives: To evaluate the association between fibromyalgia and dementia, with emphasis on temporal directionality and Alzheimer’s disease-related dementia. Methods: We conducted a nationwide, population-based matched case–control study including 9232 patients with fibromyalgia and 46,160 age- and sex-matched controls. Diagnoses in the Leumit Health Services database are recorded using a hybrid coding scheme that combines ICD-9-CM and WHO ICD-10 codes; the specific codes used to ascertain fibromyalgia and each dementia subtype are listed in the Methods. Outcomes were assessed within two predefined windows: up to 20 years before and up to 10 years after fibromyalgia diagnosis. Alzheimer disease-related dementia was defined as the primary outcome. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: During the 20 years preceding fibromyalgia diagnosis, no increased dementia prevalence was observed; Alzheimer disease-related dementia was less frequent among fibromyalgia patients (0.16% vs. 0.31%; absolute difference −0.15 percentage points; OR 0.52, 95% CI 0.31–0.89). In contrast, during the 10 years following diagnosis, fibromyalgia was associated with a higher prevalence of Alzheimer’s disease-related dementia (1.43% vs. 0.99%; absolute difference +0.44 percentage points; OR 1.45, 95% CI 1.18–1.78). No consistent associations were found for other dementia subtypes, which should be interpreted as exploratory given low event counts. Conclusions: Fibromyalgia is associated with a higher prevalence of Alzheimer’s disease-related dementia in the years following diagnosis, with no evidence of pre-diagnostic elevation. Although this temporal pattern argues against reverse causation, the prevalence-based design and residual confounding preclude causal inference. Fibromyalgia should be regarded as a potential risk marker for subsequent Alzheimer-related neurodegeneration rather than a demonstrated causal factor.

Geriatrics doi: 10.3390/geriatrics11030060

Authors: Dubi Lufi Iris Haimov

Background/Objectives: The purpose of the present study was to assess the relationships between attention level and personality traits among 44 older adults aged from 65 to 75 in the Israeli population. The participants were 19 females and 25 males, with a mean age of 68.13 years, and 12.32 years average of formal education, who provided clinical history for screening. Methods: The participants completed the 44-item Big Five Inventory, the d2 Test of Attention, and the Mathematics Continuous Performance Test (MATH-CPT), a computerized test that measures participants’ attention levels by recording their responses to visual stimuli. Results: The results showed significant correlations between attention and the domains of Conscientiousness and Neuroticism. Linear regression analysis, with the MATH-CPT measures as the dependent variable and the Big Five personality factors as independent variables, revealed a significant model explaining 41.60% of the variance in MATH-CPT performance. Linear regression analysis of the measures of the d2 test of attention as dependent variables and the Big Five factors as independent variables showed a significant model that explained 47.70% of the variance. No association was found between age and the domains of the Big Five personality traits. Conclusions: This study discusses the implications of the significant correlations between personality domains and measures of attention in older adults. The findings suggest that individuals who are organized, task-oriented, goal-focused, responsible, imaginative, creative, and interested in educational experiences may be better able to perform attention-related tasks in older age.

Geriatrics doi: 10.3390/geriatrics11030059

Authors: Luis Perotti Oskar Stamm Susan Vorwerg-Gall Lisa Mesletzky Drin Ferizaj Steffen Dißmann Sandra Stube-Lahmann Marc Fournelle Nils Lahmann Ursula Müller-Werdan

Purpose: This study explores how older adults with chronic back pain (CBP) evaluate different user interface (UI) designs and gamification elements for an ultrasound-based wearable providing real-time biofeedback during segmental stabilization exercises (SSE). The aim is to identify design preferences and motivational factors to enhance usability, engagement, and adherence in this specific population. Methods: We conducted a mixed-methods study with 15 older adults (aged ≥ 65) experiencing CBP. Participants interacted with three UI mockups (simple, anatomical, and playful) via a Wizard-of-Oz simulation and evaluated additional motivational elements (e.g., points, badges, progress charts). Semi-structured interviews and the Technology Usage Inventory (TUI) subscales were used to assess usability, acceptance, and intention to use. Results: Participants preferred the simple and anatomical UI designs, citing clarity, professionalism, and ease of interpretation. The playful design was viewed as less appropriate due to perceived infantilization. Game elements such as progress tracking, points, and levels were positively received, while competitive features like leaderboards were viewed critically. Most participants expressed interest in integrating pain education, favoring multimedia formats. Conclusions: Digital health tools for older adults must prioritize intuitive, medically reliable interfaces and allow personalization of motivational and educational components. The findings highlight the need for age-appropriate UI design and suggest that well-balanced gamification and educational features may enhance perceived acceptance and have the potential to support long-term use, which should be evaluated in longitudinal studies.

Geriatrics doi: 10.3390/geriatrics11030058

Authors: Miffy M. F. Lam Florence M. F. Wong

Background/Objectives: Oral health is integral to the overall well-being and quality of life of older adults. For institutionalized older residents who depend on staff for daily care, the knowledge, attitudes, and practices (KAP) of healthcare providers directly influence oral health outcomes. This study aimed to assess oral care KAP among healthcare providers in Macao’s residential care facilities and to examine the relationships between KAP and personal characteristics. Methods: A cross-sectional study was conducted from September to December 2023 using a structured KAP questionnaire. Data were collected from 225 healthcare providers across four nursing homes in Macao. Results: Significant positive correlations were found among KAP (Spearman’s γ = 0.293–0.419; p < 0.001). Mean scores were 15.60 (SD = 2.27)/19 for knowledge, 52.13 (SD = 5.75)/65 for attitudes, and 45.87 (SD = 5.93)/55 for practices. Denture care was the major knowledge deficit. Knowledge was associated with age 18–20 (p = 0.002), age 31–40 (p = 0.015), and university education (p = 0.003). Attitudes were associated with age 18–20 (p = 0.002), female gender (p = 0.005), and primary education (p = 0.044). Practice was associated with training programme attendance (p = 0.006) and female gender (p = 0.016). All associations involving the age 18–20 subgroup (n = 3) and male gender (n = 16) should be interpreted with caution due to very small sample sizes. Conclusions: Oral care KAP among HAs and PCWs in Macao’s residential care homes are positively but modestly correlated. Most providers acquired knowledge through induction training with verified competency outcomes and personal experience. These findings highlight the need for structured, repeatable training and suggest that Macao’s data can contribute to international efforts to improve oral care in institutionalized aging populations. Future research should employ longitudinal or observational designs and include all elderly care facilities in Macao.

Geriatrics doi: 10.3390/geriatrics11030057

Authors: Moisés Martínez Briseño Manuel Abraham Gómez-Martínez Diana Rodríguez-Vera Kenneth Rubio Carrasco Raúl Lugo Villegas María de los Ángeles Frías Fernández Marco A. Loza-Mejía José A. Morales-González Rodolfo Pinto-Almazán Etzel Cruz Cruz Arely Vergara-Castañeda

Background/objective: Hypertension and type 2 diabetes are major causes of morbidity in older adults. Although pharmacological treatments remain the cornerstone of management, structured physical activity has been shown to provide additional benefits, yet evidence from institutionalized populations in Latin America is limited. This study evaluated the impact of a 12-month supervised exercise program on blood pressure (BP), glycated hemoglobin (HbA1c), and body composition in elderly people attending welfare homes in Mexico. Methods: A community-based intervention trial was conducted (February 2018–January 2019) with 260 adults (aged > 60 years) with hypertension and/or diabetes. Participants were allocated based on shelter site to either a control group (n = 129; pharmacological treatment only) or an intervention group (n = 131; pharmacological treatment plus five one-hour supervised recreational physical activity sessions per week). Monthly anthropometric, clinical, and biochemical measurements were analyzed using parametric/non-parametric tests and estimation of effect size (Cohen’s d). Results: Median age was 70 years (86% female). After 12 months, systolic BP decreased from 148.4 to 129.7 mmHg in the intervention group vs. 147.7 to 131.3 mmHg in controls. Diastolic BP showed greater reduction in the intervention group (−25%; 93.1 to 68.9 mmHg) than in controls (−13.5%; 88.1 to 76.2 mmHg). HbA1c reductions were also superior in the intervention group (–2.28% vs. –1.86%). Both groups lost fat mass, but lean mass preservation was limited. Conclusions: Structured community-based physical activity significantly improves BP, glycemic control, and body composition, supporting its integration into routine institutional care with limited resources.

Geriatrics doi: 10.3390/geriatrics11030056

Authors: Hitoshi Shitara Tsuyoshi Tajika Eiji Takasawa Hirotaka Chikuda

Background/Objectives: Locomotive syndrome (LS) is associated with impaired balance and functional decline in older adults. Although locomotive training (LT) improves mobility, whether central neuromodulation enhances short-term balance adaptation remains unclear. This pilot randomized controlled trial examined the additive effect of anodal transcranial direct current stimulation (tDCS) with LT on balance. Methods: Sixteen community-dwelling adults aged ≥ 65 years with LS were randomized (1:1:1) to anodal tDCS + LT (n = 6), sham tDCS + LT (LT group, n = 6), or anodal tDCS alone (n = 4). Participants underwent five consecutive days of intervention. The primary outcome was eyes-open single-leg stance time, assessed before stimulation and at 10, 20, 50, and 80 min during and after stimulation on days 1–5. Group × time interactions were evaluated using linear mixed-effects models adjusted for baseline and age. Long-term outcomes were assessed on days 1, 5, and 12. Results: In the primary analysis, a significant group × time interaction for right-sided single-leg stance time was observed between the anodal tDCS + LT and the LT groups (F(1,58) = 6.08, p = 0.017; β = 0.966), indicating greater within-day improvement with combined therapy, but not in sensitivity analyses treating time as a categorical variable. No significant interactions were observed on the left side. Secondary outcomes showed time-dependent improvements without consistent group-specific effects or significant group × day interactions over the long term. No serious adverse events occurred. Conclusions: Anodal tDCS with LT improved short-term balance in the primary analysis; however, these effects were model-sensitive and not sustained over 12 days. These findings should be considered preliminary and hypothesis-generating. Larger trials are needed to determine optimal stimulation dosing and long-term efficacy.

Geriatrics doi: 10.3390/geriatrics11030055

Authors: Rachel Aitken Katherine Gregorevic Michelle Preeo Ross Bicknell Alyssa Griffiths Jared Tower Ned Douglas Chuan-Whei Lee Janette Wright Jai Darvall Wen Kwang Lim

Background/Objectives: As mounting numbers of older people consider surgery, the importance of aligning treatments with patient values and goals is paramount. This has led to the growth of POPS (Perioperative care of Older Patients) services internationally and across Australia. An observational pilot evaluation of the Melbourne Health POPS service was conducted throughout 2022, with the aims of describing the population, measuring patient-reported outcomes and comparing postoperative outcomes to a matched historical cohort. Methods: Data were sourced from clinical review, electronic medical records and health intelligence. Patients who pursued surgery were matched 2:1 with a 2020 control cohort on up to 10 characteristics ranked on clinical judgement. Patient-reported outcomes were collected at 3 months post-surgery or at the clinic in consenting participants. Results: There were 128 participants, of whom 64 (50%) pursued non-surgical management. Participants were older (median 79 [13] years), frail (median CFS 5 [2]), and multimorbid (median CCI 5 [2.25]). Despite increased perioperative risk amongst the POPS surgical group (ASA-4 23.4% vs. 5.5%, p < 0.001), increased incidence of postoperative delirium (15% vs. 5.8%, p = 0.042) and ICU admission (21.7% vs. 7.5%, p = 0.006) compared to the control group, median length of stay was similar (4.3 [6.7] vs. 4.3 [5.1] days, p = 0.537). Patient-reported outcomes were similar between surgical and non-surgical POPS groups (90.7% vs. 88.1% would make the same surgical decision, p = 0.697). Conclusions: Patients attending POPS were multimorbid with geriatric syndromes and elevated perioperative risk. A high proportion pursued non-operative care. Patient-reported feedback was high with low decisional regret.

Geriatrics doi: 10.3390/geriatrics11030054

Authors: Judit Groman Zsolt Viktor Göböl Andrea Virág Gyula Domján Klara Gadó

Background: The growing number of older adults undergoing surgical procedures requires care models that minimise hospital exposure, optimise safety, and support rapid recovery. Day surgery has become an increasingly attractive option for selected older patients, provided their medical, functional and psychosocial needs are carefully assessed. Recent developments in prehabilitation, geriatric-focused perioperative pathways and enhanced post-discharge follow-up have further expanded its potential. This narrative review aims not only to synthesise current evidence, but also to provide a clinically oriented framework for patient selection, perioperative optimisation, and safe implementation of day surgery pathways in older adults. Main findings: Evidence from the past decade indicates that day surgery can be safe and effective for adults aged ≥65 when supported by structured preoperative assessment, targeted optimisation, and clear discharge criteria. Older patients benefit particularly from reduced risks of hospital-acquired complications, including infection, delirium, immobility and functional decline. Prehabilitation programmes focusing on nutrition, strength, balance and medication review are associated with improved postoperative stability and faster return to baseline function. Multidisciplinary teamwork, integrating surgeons, anaesthetists, geriatricians, nurses, physiotherapists, dietitians and caregivers, play a key role in identifying modifiable risks and ensuring continuity of care. Studies also highlight the value of post-discharge telephone follow-up, caregiver engagement and close collaboration with primary care in preventing readmissions. Conclusions: Day surgery is a viable and patient-centred option for many older adults when careful selection and preparation are combined with age-sensitive perioperative care. Most adverse outcomes can be mitigated through systematic prehabilitation, thoughtful anaesthetic planning, early mobilisation and structured follow-up. The evidence suggests that older patients may benefit from reduced hospital stay, less exposure to harm, and faster functional recovery. Implications for practice: The findings support broader integration of geriatric day surgery into routine care pathways, especially within health systems facing capacity constraints. Clinicians should consider implementing standardised geriatric assessment, multidisciplinary optimisation strategies, and robust discharge and follow-up protocols to enhance safety and effectiveness. With appropriate preparation and coordinated teamwork, day surgery can contribute meaningfully to safer, more efficient and more patient-centred surgical care for older adults.

Geriatrics doi: 10.3390/geriatrics11030053

Authors: Valéria Feijó Martins Edilson Fernando de Borba Lucas de Liz Alves Leonardo A. Peyré-Tartaruga Flávia Gomes Martinez

Background: In dual-task (DT) conditions, individuals must walk while simultaneously engaging in cognitive or motor tasks, which impacts gait performance, especially in older adults and individuals with Parkinson’s disease (PD). Gait impairments in PD under DT conditions have implications for intersegmental coordination. Research question: Intersegmental coordination and gait biomechanics during the DTs were compared between people with PD and older adults. Methods: Thirty-two individuals (16 PD, H&Y 1–3; and 16 older adults) participated in this study and were asked to walk under the following self-selected conditions: single task, DT with a math component, and texting on a cell phone. Spatiotemporal, angular, and intersegmental coordination data were collected using a markerless motion analysis system (OpenCap). Results: Dual-task conditions significantly affected spatiotemporal and kinematic variables, as well as intersegmental coordination. A significant task effect was observed for thigh–shank coordination, whereas no significant group effect was found for the main coordination outcomes. Significance: Significant task effects were observed for intersegmental coordination (thigh–shank CRP), with no significant group differences. The concurrent demands of processing visual and motor information for texting and walking lead to significant reductions in gait speed and lower limb movement, as well as altered intersegmental coordination, with task demands rather than disease status being the primary driver of coordination changes.

Geriatrics doi: 10.3390/geriatrics11030052

Authors: Agali Y. López-Miguel Ángel E. Brizuela-Araujo Omar A. López-López Juan J. Calleja-Núñez Roberto Espinoza-Gutiérrez Elena C. Guzmán-Gutiérrez Aracely Serrano-Medina José Moncada-Jiménez Jorge A. Aburto-Corona

Background: The purpose of this study was to compare the effects of two months of exergaming, conventional resistance exercise training, and no exercise on body composition and cardiometabolic risk factors in physically inactive older adults. Methods: For the preliminary study, twenty-four physically inactive adults aged 60–74 yrs. were allocated to an active video game training group (AVG n = 8), a conventional exercise group (CEG n = 7), or a non-exercising control group (CON n = 9). The AVG and CEG completed 24 supervised exercise training sessions over two months (three sessions per week) at self-selected, predominantly moderate-to-vigorous intensity, while the CON maintained usual daily activities. Body weight, skeletal muscle mass, body fat percentage, phase angle, and fasting blood biomarkers (glucose, total cholesterol, LDL, HDL, VLDL, and triglycerides) were assessed before and after the intervention. Results: No significant interactions were observed for body composition variables. Body weight decreased significantly following exercise training in both the AVG and CEG (p < 0.05). Significant interactions were found for total cholesterol (p = 0.001) and LDL cholesterol (p = 0.009). The AVG demonstrated significant reductions in fasting glucose, total cholesterol, and LDL cholesterol (p < 0.05), whereas the CEG showed a significant reduction only in total cholesterol. In contrast, the CON exhibited a significant increase in total cholesterol over the same period (p < 0.05). Conclusions: Two months of exergaming-based exercise training may lead to greater improvements in lipid-related cardiometabolic risk factors compared with conventional resistance exercise training in physically inactive older adults. These findings suggest that exergaming could be a promising exercise modality for supporting cardiometabolic health in aging populations.

Geriatrics doi: 10.3390/geriatrics11030051

Authors: Huong Thi Thu Nguyen Vasi Naganathan Thanh Xuan Nguyen Tam Ngoc Nguyen Thu Thi Hoai Nguyen Huyen Thi Thanh Vu Anh Lan Nguyen Vien Chi Le Narelle Warren Hoa Lan Nguyen Robert J. Goldberg Anh Trung Nguyen

Background/Objectives: Sarcopenia frequently coexists with other geriatric syndromes, and its severity may influence their clinical manifestation. This study examines the prevalence of geriatric syndromes in older adults with non-severe and severe sarcopenia and explores the associations between sarcopenia severity and individual geriatric syndromes in Vietnam. Methods: A cross-sectional study was conducted among 726 older outpatients with sarcopenia. Non-severe and severe sarcopenia were diagnosed according to the Asian Working Group for Sarcopenia algorithm. Fifteen geriatric conditions spanning physical and psychological health, functional status, and social circumstances were assessed using components of the Comprehensive Geriatric Assessment. Logistic regression models were used to examine associations between sarcopenia severity and geriatric syndromes. Results: A total of 726 older patients with sarcopenia (mean age 74.4 years, 77.4% females) were included, of whom 53.4% had severe sarcopenia. A significantly higher prevalence of geriatric syndromes was observed in patients with severe compared with non-severe sarcopenia, including sleep disturbances (79.4% vs. 67.5%), frailty (71.4% vs. 54.7%), malnourishment/risk of malnutrition (61.9% vs. 50.0%), depression (54.9% vs. 34.9%), polypharmacy (49.5% vs. 42.0%), impairment in activities of daily living (52.8% vs. 32.5%), and impairment in instrumental activities of daily living (58.2% vs. 39.3%). After adjustment for potential confounders, severe sarcopenia remained associated with sleep disturbance (adjusted OR 1.49, 95%CI 1.02–2.18, p = 0.046), depression (adjusted OR 1.90, 95%CI 1.36–2.66, p < 0.001), and mobility impairment (adjusted OR 3.01, 95%CI 2.12–4.27, p < 0.001). Conclusions: Older Vietnamese adults with sarcopenia had a high burden of geriatric syndromes, particularly among those with severe disease. Severe sarcopenia was independently associated with sleep disturbance, depression, and impaired mobility—clinically relevant and potentially modifiable conditions. These findings highlight the importance of evaluating sarcopenia within a broader geriatric framework and may inform early identification and prioritization of coexisting geriatric syndromes, especially in resource-limited settings.

Geriatrics doi: 10.3390/geriatrics11020049

Authors: 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 Yoshitaka Shiba

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.

Geriatrics doi: 10.3390/geriatrics11020050

Authors: Giuseppe Castiglia Nicola Veronese Gianluca Gortan Cappellari Erica Voinovich Paolo De Colle Michela Zanetti

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.

Geriatrics doi: 10.3390/geriatrics11020048

Authors: Theresa E. Hering Maria Wittmann Vera Guttenthaler Robert Pflugmacher Rudolf Hering

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.

Geriatrics doi: 10.3390/geriatrics11020047

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

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.

Geriatrics doi: 10.3390/geriatrics11020046

Authors: Kensaku Kashima Rie Nishimura Hisashi Sugano Shimpei Fujimoto

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.

Geriatrics doi: 10.3390/geriatrics11020045

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

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.

Geriatrics doi: 10.3390/geriatrics11020044

Authors: 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 Marcos Henrique Fernandes

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.

Geriatrics doi: 10.3390/geriatrics11020043

Authors: Bulin Jirapongsatorn Decha Chinaksorn Kanapot Pengked Wannaporn Tongtako Timothy Mickleborough

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, FEF25–75%, 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, FEF25–75%, 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.

Geriatrics doi: 10.3390/geriatrics11020042

Authors: 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 Daniel Antonio De Luis-Román

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.

Geriatrics doi: 10.3390/geriatrics11020041

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

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.

Geriatrics doi: 10.3390/geriatrics11020040

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

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.

Geriatrics doi: 10.3390/geriatrics11020039

Authors: Shazia Durrani Minhal Mussawar Mariam Alaverdashvili

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.

Geriatrics doi: 10.3390/geriatrics11020038

Authors: Patrizio Allegra Manuela Lodico Claudia Migliazzo Domenico Tarantino Tommaso Piccoli Nicola Vanacore Giuseppe Salemi Laura Maniscalco Domenica Matranga

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.

Geriatrics doi: 10.3390/geriatrics11020037

Authors: Adrian Bryła Jarosław Woroń Miłosz Miedziaszczyk Barbara Lorkowska-Zawicka Beata Bujak-Giżycka Daniel Orzechowski Paulina Połetek Wojciech Pałys

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.

Geriatrics doi: 10.3390/geriatrics11020036

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

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.

Geriatrics doi: 10.3390/geriatrics11020035

Authors: Andreea Taisia Tiron Marian-Vlad Lăpădat Maria Mădălina Georgică Lavinia Alice Bălăceanu Ion Daniel Baboi Ion Dina

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.

Geriatrics doi: 10.3390/geriatrics11020034

Authors: Rémi Esser Marine Larbaneix Alejandro Mondragon Marlène Esteban Christine Farges Sophie Nisse Durgeat Marc Harboun Olivier Maurou

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.

Geriatrics doi: 10.3390/geriatrics11020033

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

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.

Geriatrics doi: 10.3390/geriatrics11020032

Authors: Yue Cao Jaehee Lee Jaehoon Seol Kenji Tsunoda Kyohei Shibuya Jieun Yoon Tetsuaki Arai Tomohiro Okura

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.

Geriatrics doi: 10.3390/geriatrics11020031

Authors: Tsutomu Sasaki Kyohei Yamada Takeshi Yamakita Naoto Sakuta Hajime Yoshida Takeshi Tominaga

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.

Geriatrics doi: 10.3390/geriatrics11020030

Authors: Anette Vik Josendal Ole Martin Sobakk Anne Gerd Granas Anne Katrine Eek

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.

Geriatrics doi: 10.3390/geriatrics11020029

Authors: Kana Kazawa Ken Sugimoto Yoko Aihara Michiko Moriyama

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.

Geriatrics doi: 10.3390/geriatrics11020028

Authors: Becca R. Levy Martin D. Slade

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.

Geriatrics doi: 10.3390/geriatrics11020027

Authors: 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 Kazunori Ohkawara

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).

Geriatrics doi: 10.3390/geriatrics11020026

Authors: Feliciano Villar Nuria Ramón Juan José Zacarés

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.

Geriatrics doi: 10.3390/geriatrics11020025

Authors: Eri Hikita Mami Oosaki Ayano Suzuki Maiko Anzai Nanako Yoshioka Yoshiyasu Terayama Takeo Yasu

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.

Geriatrics doi: 10.3390/geriatrics11020024

Authors: Molly M. Jacobs Charles Ellis

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.

Geriatrics doi: 10.3390/geriatrics11020023

Authors: Tursun Alkam Ebrahim Tarshizi Andrew H. Van Benschoten

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.

Geriatrics doi: 10.3390/geriatrics11010022

Authors: Joanna Cheuk Yan Hui Lindsey Lingxi Hu Alice Kit Ying Chan Chun Hung Chu

Oral health in older adults is a critical component of overall well-being requiring integrated, interdisciplinary approaches to address its complex interplay of medical, functional, and psychosocial challenges. The aim of this is to examine strategies to enhance interdisciplinary collaboration among dental professionals, physicians, nurses, nutritionists, and caregivers to improve oral health outcomes in aging populations. Older adults commonly face dental problems such as periodontal disease which can be exacerbated by polypharmacy, systemic diseases, and barriers to accessing care. These multifaceted needs necessitate coordinated efforts across dentistry, geriatric medicine, nursing, and social support systems. Strategies of effective interdisciplinary care include: (1) Medical-dental integration, enabling physicians to screen for oral health issues during routine assessments; (2) Nursing and caregiver engagement in daily oral hygiene support and early problem identification; (3) Nutritional interventions tailored to address chewing difficulties and prevent malnutrition; (4) Social support systems to improve access to affordable care; and (5) Technology-driven solutions such as tele-dentistry to enhance communication, early detection, and care coordination. Despite these opportunities, systemic barriers persist, including fragmented healthcare systems, financial constraints, workforce shortages, cultural biases, and technological gaps. Progress requires commitment from policymakers, healthcare institutions, and health care professionals to prioritize geriatric oral health as a public health imperative. In conclusion, interdisciplinary collaboration enhances older adults’ oral-systemic health via cross-sector policies and healthcare workforce education. Implementing these strategies can mitigate oral health disparities, reduce the burden of chronic diseases, and improve quality of life for aging populations through holistic, patient-centered care.

Geriatrics doi: 10.3390/geriatrics11010021

Authors: Itziar Ostolaza Tazón Héctor Alonso Valle Pedro Muñoz Cacho

Background/Objectives: Acute heart failure (AHF) is a common cause of hospitalization in older adults, associated with high morbidity and mortality. In this population, frailty, comorbidity, and functional variability significantly influence prognosis. This study evaluated short-term (30-day) and long-term (1-year) mortality predictors in elderly patients with AHF treated in the emergency department (HED), considering clinical variables, comorbidities, and precipitating factors (PFs). Materials and Methods: An observational cohort study was conducted based on a secondary analysis of older patients with AHF included in the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry, treated at Hospital Universitario Marqués de Valdecilla (HUMV) between 2007 and 2022. Clinical, laboratory, and PF-related variables were collected. The primary outcome was all-cause mortality at 30 days and 1 year. Univariate and multivariate logistic regression analyses were performed. Results: A total of 548 patients were included (mean age: 80.7 years), of whom 78.6% required hospitalization, mainly in the Internal Medicine department. Mortality was 11.1% at 30 days and 29.9% at 1 year. Age, valvular heart disease, dementia, and elevated creatinine levels were independently associated with higher mortality. Hypoxemia and low-output symptoms were linked to short-term mortality, while NYHA class III and anemia were associated with long-term mortality. Among PFs, acute coronary syndrome (ACS) was related to worse short-term outcomes, whereas rapid atrial fibrillation (AF) was inversely associated with long-term mortality. Conclusions: The prognostic relevance of risk factors differs between short- and long-term outcomes in older patients with AHF. Incorporating clinical characteristics and PFs into risk stratification models may support individualized management and guide follow-up strategies tailored to the geriatric profile. This multidimensional approach is essential to improve clinical decision-making and outcomes in a highly vulnerable population.

Geriatrics doi: 10.3390/geriatrics11010020

Authors: Alexander Schmidt Marie-Christin Lehmann Steffen Schlee Maximiliane Amelie Schlenz Bernd Wöstmann

Objectives: This study investigated the impact of age on the diagnostic accuracy and patient acceptance of two chewing efficiency tests: the digital Mini Dental Assessment (MDA) using carrots and the CHEW test by Slavicek using fruit gum, applied in both clinical and nursing home settings. Methods: Seventy participants aged 18 to 99 years from dental clinics and nursing homes were included. All participants received a standardized dental examination (reference standard) and performed the MDA and CHEW tests. Sensitivity, specificity, and AUC values were calculated using ROC analysis. Participants rated both tests in terms of taste, consistency, comprehensibility, required time, and subjective chewing sensation. Acceptance was analyzed across age groups and prosthesis types. Results: Both chewing efficiency tests showed good agreement with the clinical reference standard. The AUC was 0.72 for the MDA and 0.78 for the CHEW test (p = 0.192). Sensitivity was higher for the CHEW test (100%) compared to the MDA (83.3%), while the MDA demonstrated slightly higher specificity (59.6% vs. 55.8%). Age significantly influenced both diagnostic outcomes and test acceptance (p < 0.05). Younger participants (<70 years) were more often correctly classified as healthy and tended to prefer the MDA, whereas older participants (≥70 years) preferred the CHEW test, primarily due to taste. Misclassifications occurred most frequently among participants with complete dentures. Conclusions: Both the digital MDA and the CHEW chewing test demonstrated good diagnostic performance in identifying treatment need. Acceptance varied significantly with age, suggesting that test selection may be optimized based on patient characteristics. These simple and rapid assessments may support early detection of dental treatment needs in clinical and nursing home settings.

Geriatrics doi: 10.3390/geriatrics11010019

Authors: Ahmed Hassan Martyn Charles Stott Sarthak Jain Vasileios Kotsarinis Hadiyat A. Ogunlayi Lydia Loutzidou Dimitrios Vouros Amr Ebrahim Shahin Hajibandeh Shahab Hajibandeh Jacob Kadamapuzha Thomas Satyadas

Background/Objectives: To evaluate short-term postoperative outcomes in octogenarians undergoing robotic pancreaticoduodenectomy. Methods: In compliance with the PRISMA statement standards, a systematic review and random-effects meta-analysis was conducted. All studies reporting short-term postoperative outcomes in patients aged ≥ 80 undergoing robotic pancreaticoduodenectomy were included and analyzed. Results: A total of 321 octogenarians from five studies were included. The mean operative time was 459.7 min (95% CI 398.6–520.8) and the estimated intraoperative blood loss was 216.1 mL (95% CI 147.4–284.8). Conversion to open occurred in 3.8% (95% CI 0.0–7.7). The risk of postoperative mortality was 4.5% (95% CI 1.7–7.2) and Clavien-Dindo grade ≥ III (major) complications occurred in 28.0% (95% CI 22.9–33.1). The risk of grade B or C postoperative pancreatic fistula was 10% (95% CI 6.5–13.5). The hospital stay was 14.9 days (95% CI 10.2–19.5). The risk of reoperation and readmission were 8.0% (95% CI 4.4–11.7) and 25.6% (95% CI 16.9–34.3), respectively. Compared to patients aged <80, the risk of major complications was higher (OR: 1.81, p = 0.010) and hospital stay was longer (MD: 5.19 days, p = 0.030) in octogenarians. Compared to the open approach, robotic approach was associated with longer operative time (MD: 137.08 min, p = 0.0009), less intraoperative blood loss (MD: −246.00 mL, p = 0.010), and lower major complications (OR: 0.62, p = 0.020). Conclusions: Subject to selection and confounding bias, robotic pancreaticoduodenectomy may be safe with acceptable postoperative mortality and morbidity in highly selected octogenarians with good performance status. The results of the current study can be used for hypothesis synthesis and power analysis in future comparative studies.

Geriatrics doi: 10.3390/geriatrics11010018

Authors: Mihaela Simona Popoviciu Timea Claudia Ghitea

Background: Susception to cardio–reno–metabolic disorders increases markedly with age; however, the dominant contributors to risk may differ across the adult life course. While metabolic abnormalities often predominate at younger ages, vascular and renal alterations become more prominent in older populations. Understanding how these risk components reconfigure with aging may inform age-tailored prevention strategies. Methods: This cross-sectional observational study included 287 adults undergoing clinical and biochemical evaluation for cardio–metabolic risk. Participants were stratified into three age categories: <65 years (n = 175), 65–75 years (n = 84), and >75 years (n = 28). Anthropometric measurements, blood pressure, metabolic parameters, liver enzymes, inflammatory markers, and renal function indices were assessed. Insulin resistance was estimated using the triglyceride–glucose (TyG) index, and renal function was evaluated by estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Comparisons across age groups were performed using one-way analysis of variance (ANOVA). Results: Younger participants (<65 years) exhibited a predominantly metabolic risk profile, characterized by higher body mass index, waist circumference, fasting plasma glucose, triglycerides, and TyG index (all p < 0.05). In contrast, advancing age was associated with a progressive vascular–renal phenotype, including higher systolic blood pressure, lower diastolic blood pressure, and a marked decline in eGFR (p < 0.001). Liver enzymes decreased with age, while the FIB-4 index increased. UACR and C-reactive protein levels did not differ significantly between age groups. Despite these differences in individual risk markers, the composite risk category score was similar across age strata. Conclusions: Cardio–reno–metabolic risk profiles show distinct age-stratified patterns in dominant risk markers, with metabolic predominance more evident at younger ages and vascular–renal vulnerability more prominent in older adults. These findings support a life-course perspective on risk assessment and highlight the potential importance of early detection of vascular and microvascular risk in metabolically burdened younger individuals, prior to the development of overt renal dysfunction and advanced vascular aging.

Geriatrics doi: 10.3390/geriatrics11010017

Authors: Luca Soraci Guido Gembillo Maria Elsa Gambuzza Edlin Villalta Savedra Chiara Chinigò Elvira Filicetti Mara Volpentesta Giada Ida Greco Domenico Santoro Andrea Corsonello

Background/Objectives: Chronic kidney disease (CKD) in older adults is frequently accompanied by substantial medication burden, increasing risks of adverse drug events and poor adherence. The Planetary Health Diet Index (PHDI), emphasizing plant-based foods and sustainable dietary patterns, may improve cardiometabolic health and reduce medication requirements. This study examined the association between PHD adherence as measured by the PHDI and medication burden among older adults with CKD. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2003–2018 cycles. Older individuals aged ≥ 65 years with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-to-creatinine ratio > 30 mg/g) at the baseline visit were included (n = 3161). PHDI scores (0–150) were calculated from two consecutive 24 h dietary recalls. Medication burden was assessed as the total prescription medication count and frequency of individual classes. Multivariable Poisson regression models evaluated associations between PHDI score and number of prescribed medications, adjusting for sociodemographic, lifestyle, and clinical covariates; logistic regression models were used to evaluate the association between PHDI score and specific medication classes. Results: Mean (SD) age was 75.0 (5.5) years; mean PHDI score was 62.4 (18.7). Participants in the highest PHDI tertile had significantly lower medication burden compared to the lowest tertile. In fully adjusted Poisson regression models, each 10-point increase in PHDI score was associated with 3% fewer medications (RR: 0.97, 95% CI: 0.96–0.99, p = 0.011). Participants in the highest PHDI tertile had 8% fewer medications compared to the lowest tertile (RR: 0.92, 95% CI: 0.87–0.98, p = 0.013). Higher PHDI scores were significantly associated with lower odds of proton pump inhibitor use (OR: 0.86, 95% CI: 0.79–0.94 per 10-point increase) and nonsteroidal anti-inflammatory drug prescription (OR: 0.86, 95% CI: 0.76–0.97 per 10-point increase). Participants in the highest PHDI tertile had 34% lower odds of PPI use (OR: 0.66, 95% CI: 0.49–0.89) and nonsignificant lower odds of NSAID use (OR: 0.67, 95% CI: 0.40–1.11) compared to those in the lowest tertile. Conclusions: Higher PHDI adherence was independently associated with lower medication burden in older adults with CKD. These findings suggest that plant-forward, sustainable dietary patterns may reduce pharmacological complexity in this vulnerable population. Prospective studies are needed to assess causality and clinical implementation strategies.

Geriatrics doi: 10.3390/geriatrics11010016

Authors: Sanjay Shete Anita Verma Ranjeet Singh Bhogal Subodh Tiwari

Background: Advancing age is frequently associated with balance impairment, increased fall risk, and psychological distress, which together contribute to loss of independence and reduced quality of life. Yoga, as a mind–body practice, has the potential to enhance physical stability as well as mental well-being in older adults. Therefore, the objective of this study was to evaluate the effects of a structured yoga program on balance, fear of falling, mobility, and mental health outcomes among older adults. Methods: A quasi-experimental pretest–post-test study was conducted at Nagpur, India. A total of 64 eligible participants (65–85 years) were purposively assigned to a yoga intervention group (n = 32) or a waitlist control group (n = 32). The 12-week intervention comprised preparatory exercises, yoga postures, breathing practices, and meditation. Outcomes assessed at baseline and post-intervention included balance, fear of falling, mobility, depression, and anxiety. Results: Data from 50 participants (yoga: n = 26; control: n = 24) were analyzed. The yoga group showed significant improvements in balance (p < 0.001) and functional mobility (p < 0.001), with significant reductions in fear of falling (p = 0.009), anxiety (p = 0.0003), and depression (p = 0.004). In contrast, the control group exhibited deterioration in functional mobility (p = 0.001) and anxiety (p = 0.009), with no significant gains in other measures. Between-group comparisons confirmed significantly greater improvements in the yoga group across all outcomes. Conclusions: A 12-week yoga program was feasible and effective in improving balance, functional mobility, and mental health, while reducing fear of falling among older adults. Yoga may serve as a safe, non-pharmacological intervention to promote healthy aging in institutionalized populations. Trial registration: This study was prospectively registered with the Clinical Trial Registry of India (Registration No: CTRI/2023/10/058682; Registered on: 16 October 2023).

Geriatrics doi: 10.3390/geriatrics11010015

Authors: Reza Karimi Jason Kuan June Kume

Background/Objectives: This pilot study aimed to evaluate the feasibility of applying the Beers criteria in the community pharmacy setting and aid pharmacists in identifying and emphasizing adverse effects from potentially inappropriate medications (PIMs) for older adults. Methods: We applied a single-center retrospective study to collect demographic and outcome data in order to analyze dispensed PIMs for older adults. We used an evaluation tool to compare warnings between pharmacy dispensing software and the Beers criteria. Descriptive statistics were computed via standard statistical software. Results: Culled from a random selection of 215 patients, the medical records from 50 subjects ≥65 years old were reviewed, including 440 of their medications. Our data demonstrated that 96% of subjects were dispensed at least one PIM, with a total of 34 different PIMs distributed at varying frequencies. A comparative analysis indicated that 74% of dispensed medications had similar, but not identical, warning profiles presented in the dispensing software and Beers criteria. Anticholinergic burden of dispensed PIMs indicated that older adults were at risk of falls and delirium. By supplementing the dispensing software with Beers criteria, we were able to create clinical communication notes for providers, patients, and pharmacy students to emphasize the role pharmacists can play to minimize PIM’s adverse effects on older adults. Conclusions: Our data indicates the feasibility of implementing the Beers criteria in the community pharmacy setting. Integrating the dispensing software warnings with Beers criteria created a structured intervention strategy to prevent potential adverse effects and develop clinical communication notes to emphasize a more engaging role that the community pharmacy setting can play to optimize therapeutic outcomes for older adults.

Geriatrics doi: 10.3390/geriatrics11010014

Authors: Anastasia Ganina Madina Karimova Dana Idrissova Aigul Brimova Manarbek Askarov Larissa Kozina

Lung cancer is one of the most common malignant tumors and is associated with a high mortality rate, especially in aged patients. Immunotherapy is an effective method for treating lung cancer, particularly when used in combination with other treatments like chemotherapy. One of the types of immunotherapy is the use of autologous immune cells that are pre-activated before injection back to a patient. The effectiveness of this type of immunotherapy is determined by the specificity of its action on cancer cells through the activation of immune cell, e.g., lymphocytes. However, this treatment is not extensively used in elder patients due to higher risk of complications. On the other hand, in those aged patients who suffer from late stage cancer, the immune-cell based immunotherapy may come as a last resort. In this study, we present a clinical case of a 63-year-old patient with advanced-stage lung cancer and CT-confirmed infiltration of the left main bronchus. Treatment of the patient with immunotherapy using autologous activated lymphocytes combined with tomotherapy resulted in prominent improvement and decreased size of the malignancy. This positive effect was accompanied by a decrease in the number of circulating tumor cells in the blood. The patient was treated in May-June 2024 and is still alive with good condition as of August 2025. We conclude that combined treatment is a reliable option for selected aged patients with advanced-stage lung cancer.

Geriatrics doi: 10.3390/geriatrics11010013

Authors: Antonio Maria D’Onofrio Gaspare Filippo Ferrajoli Lodovico Maria Balzoni Marco Massetti Andrea Zanzarri Giuseppe Marano Marianna Mazza Alexia Koukopoulos Georgios D. Kotzalidis Lorenzo Moccia Alessio Simonetti Delfina Janiri Marco Di Nicola Gabriele Sani Giovanni Camardese

Background: Late-onset depression (LOD) represents a distinct clinical and biological phenotype emerging in the context of global population ageing. This study aims to synthesize current evidence on the epidemiology, risk factors, mechanistic pathways, and therapeutic approaches of LOD, integrating biological, psychological, and social dimensions. Methods: This narrative review synthesizes recent evidence across epidemiology, clinical symptomatology, neurobiology, and treatment. Where conceptually appropriate or empirically overlapping, we incorporate findings from the broader late-life depression (LLD) literature. Results: LOD emerges (as a distinct clinical and biological entity in later life) as a clinically and biologically meaningful presentation of depression in later life, representing a minority of depressive cases. It is defined by prominent apathy, psychomotor slowing, and cognitive impairment, and is closely linked to frailty, medical comorbidity, and heightened dementia risk. Pathophysiological mechanisms converge on vascular, inflammatory, oxidative, and neuroplasticity pathways, while psychosocial adversity further shapes onset and course. Treatment prioritizes efficacy and tolerability amid multiple morbidity; SSRIs and SNRIs are first-line, with pro-dopaminergic or dual-action agents addressing anhedonia and apathy, and neuromodulation or augmentation strategies reserved for resistance. Integrative approaches combining pharmacotherapy, psychotherapy, and lifestyle interventions are essential to optimize outcomes in aging populations. Conclusions: Late-onset depression (is a distinct, biologically and psychosocially driven disorder) represents a biologically and psychosocially enriched subtype in its own within the spectrum of late-life depression, requiring integrated, personalized care. Addressing neurovascular mechanisms, psychosocial adversity, and prevention through coordinated geriatric and psychiatric strategies may improve outcomes in aging populations.

Geriatrics doi: 10.3390/geriatrics11010012

Authors: Corina-Aurelia Zugravu Marta Petre Ciprian Constantin

Background: Ageing profoundly alters endocrine regulation and nutrient metabolism, predisposing older adults to thyroid dysfunction. Iodine, an essential micronutrient, lies at the center of this vulnerability due to its narrow physiological range and multiple interactions with nutrition, medications, renal function, and, presumably, gut microbiota. Objective: This narrative review integrates evidence on how ageing modifies iodine–thyroid homeostasis, emphasizing the roles of dietary intake, pharmacologic exposures, microbiota composition, and age-related metabolic alterations that influence iodine handling and thyroid hormone economy. Main Findings: Physiological ageing reduces renal iodine clearance, thyroidal reserve, and peripheral hormone conversion, while chronic inflammation and multimorbidity increase susceptibility to both iodine deficiency and excess. Polypharmacy, including amiodarone, lithium, and proton pump inhibitors, further destabilizes thyroid function. Age-related dysbiosis may impair micronutrient absorption and immune tolerance, linking gut ecology to thyroid autoimmunity. The gut microbiota may influence thyroid function through immune and metabolic pathways, although current evidence in older adults remains limited. Together, these factors shift the balance between iodine intake and utilization, heightening the risk of subclinical or overt hypothyroidism in older adults. Conclusions: Overall, variations in iodine intake emerge as one of the main determinants of thyroid dysfunction in ageing with nutritional, pharmacologic, and other modifiers primarily influencing iodine-related thyroid vulnerability. The adoption of age-adjusted thyroid reference ranges and preventive monitoring can reduce overtreatment and improve metabolic resilience in later life.

Geriatrics doi: 10.3390/geriatrics11010011

Authors: Juliane Frydenlund David J. Williams Frank Moriarty Emma Wallace Ciara Kirke Kathleen Bennett Caitriona Cahir

Background: This study examined whether adverse drug reaction (ADR)-related hospital admissions or adverse drug events (ADE) in primary care are associated with changes in health-related quality of life (HRQOL), functional decline, and A&E visits, over time, in two separate prospective cohort studies of older adults in Ireland. Methods: The Adverse Drug reactions in an Ageing PopulaTion (ADAPT) (Study 1: N = 230) and the Centre for Primary Care Research (CPCR) (Study 2: N = 605) prospective cohorts were used. Participants completed health outcome questionnaires at baseline and again at 3 months (Study 1) and at 24 months (Study 2). ADR-related admissions and ADEs were assessed at baseline. Multivariable linear, logistic, and ordinal logistic regressions were used to examine associations between ADR-related admissions/ADEs and changes in HRQOL (EQ-5D-5L/3L), functional decline, and A&E visits, adjusting for age, sex, comorbidity, and polypharmacy. Results: In Study 1 (ADAPT cohort), frailty increased and A&E visits decreased over 3 months in both ADR/non-ADR groups (p < 0.01). In Study 2 (CPCR cohort), HRQOL decreased, and functional decline and A&E visits increased for both ADE/non-ADE groups over 24 months (p < 0.05). Individuals with ADEs had lower HRQOL and greater functional decline at both time points (p < 0.001). However, experiencing an ADR or an ADE was not significantly associated with changes in HRQOL, functional decline, or A&E visits over time, after adjustments. Conclusions: There were no substantial differences in the short-term healthcare burden of ADRs, while ADEs had poorer long-term outcomes.

Geriatrics doi: 10.3390/geriatrics11010010

Authors: Patrick Kutschar Chiara Muzzana Simon Krutter Ingrid Ruffini Bernhard Iglseder Giuliano Piccoliori Maria Flamm Dietmar Ausserhofer

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.

Geriatrics doi: 10.3390/geriatrics11010009

Authors: Javier López Maria Dolores Ortiz Cristina Noriega

Background/Objectives: Current studies have shown that caregiving anxiety is associated with an individual’s dysfunctional thoughts. The aim of this study was to assess the mediating effect of caregivers’ forgiveness (benevolence, lack of avoidance and lack of revenge) on the relationship between dysfunctional thoughts and anxiety in the informal caregivers of dependent older adults. Methods: Participants were 222 family caregivers. We conducted path analysis to test the hypothesized model. Results: We found a model that showed a good fit (χ2 = 3.410; χ2/gL = 5; p = 0.63; GFI = 0.994; CFI = 0.999; RMSEA = 0.001). It showed a direct and negative association between dysfunctional thoughts and lack of revenge, and this variable was related positively with both benevolence and lack of avoidance. In turn, benevolence was associated with lower levels of anxiety. The associations between dysfunctional thoughts and anxiety were mediated by caregiver forgiveness. Conclusions: Our research suggests the importance of health workers seeking to understand how individuals judge their avoidance, revenge and lack of benevolence, which affect individuals’ anxiety, for change. This study demonstrates the relevance of forgiving strategies in developing and testing informal caregiving assessments. It is necessary to detect and reduce avoidance and revenge related to caregivers. It is also necessary to detect and improve benevolence.

Geriatrics doi: 10.3390/geriatrics11010008

Authors: Alice Kit Ying Chan Joanna Cheuk Yan Hui Lindsey Lingxi Hu Chun Hung Chu

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues—including depression, anxiety, cognitive decline, and the use of psychotropic medications—reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth–mind connection promotes holistic health rather than functional decline.

Geriatrics doi: 10.3390/geriatrics11010007

Authors: Eliana Hanna-Deschamps François R. Herrmann Diana Chirouzes Laurence Claudepierre Buratti Christophe Luthy Emilia Frangos Sophie Pautex Laurence Genton Dina Zekry Christophe E. Graf Aline Mendes

Background: Sarcopenia is highly prevalent among hospitalized older adults and is associated with poor clinical outcomes. Multiple diagnostic criteria exist, but the comparative implications of different handgrip strength (HGS) thresholds and measurement tools are less explored. Objectives: This study aimed to assess the prevalence of sarcopenia, comparing the diagnostic yield of different HGS thresholds using two measurement instruments (dynamometer and vigorimeter) in hospitalized older adults. Design: This was a cross-sectional observational study. Setting: A tertiary geriatric hospital with acute, rehabilitation, and long-term care wards was included. Participants: A total of 376 hospitalized older adults with complete HGS and bioelectrical impedance analysis (BIA) data were recruited. Measurements: HGS was measured using both a hydraulic dynamometer and a pneumatic vigorimeter. Sarcopenia was defined using cut-offs from EWGSOP2, SDOC, and two DO-HEALTH-derived thresholds. Low muscle mass was identified using the fat-free mass index (FFMI) by BIA. Multivariate logistic regression was used to identify predictors of sarcopenia. Results: The prevalence of probable sarcopenia ranged from 68.1% to 89.4%, and confirmed sarcopenia from 39.6% to 50.3%, depending on the thresholds applied. Sarcopenic patients were older (86.1 ± 9.8 vs. 80.4 ± 11.0 years; p < 0.001), had lower BMI (20.7 ± 2.9 vs. 26.1 ± 4.8 kg/m2; p < 0.001), and were more frequently in long-term care (p = 0.014–0.043). Older age (OR 1.03–1.07 per year; p < 0.05) and lower BMI (OR 0.59–0.68 per kg/m2; p < 0.001) were independently associated with sarcopenia; sex and fall history were not. Conclusions: Sarcopenia prevalence was high and varied widely across diagnostic definitions and measurement tools, reflecting both methodological variability and the high vulnerability of hospitalized older adults. These findings highlight the need for standardized, context-adapted diagnostic strategies to guide timely intervention in high-risk hospitalized older adults.

Geriatrics doi: 10.3390/geriatrics11010006

Authors: Jethro Raphael M. Suarez Kworweinski Lafontant Chitra Banarjee Rui Xie Joon-Hyuk Park Ladda Thiamwong

Background/Objectives: This study aimed to assess the impact of a physio-feedback exercise program (PEER) on the static balance of community-dwelling older adults. Methods: A clustered randomized controlled trial involving community-dwelling older adults (≥60 years of age) in the Central Florida area was conducted. Participants were randomized by research site into either (1) an 8-week exercise intervention program consisting of group-based and at-home exercises, along with a discussion with a researcher regarding their physiological health before and after the intervention period, or (2) a control group. Static balance outcomes included anterior–posterior root mean square (AP RMS), medial-lateral RMS (ML RMS), sway speed variability, and sway area measured using the Balance Tracking System (BTrackS) at baseline (T1), post-intervention (T2), one-month post-intervention (T3), and three months post-intervention (T4). Results: Among 373 community-dwelling older adults (mean age = 74.3 ± 7.1 years), a trend towards short-term improvement of sway area was observed for the intervention group, as seen through a small, marginally significant reduction in sway area at T2 (standardized β = −0.07; p = 0.050). However, the trend dissipated during post-intervention follow-up periods (T3 and T4). Sway speed variability significantly increased for the intervention group at T4 (standardized β = 0.10; p = 0.014). Conclusions: The PEER intervention may need to increase the total duration of the intervention, the frequency of the weekly exercise sessions, and the amount of standing stance exercises during the group-based and at-home exercise sessions to elicit improvements in static balance among older community-dwelling adults.

Geriatrics doi: 10.3390/geriatrics11010005

Authors: Chaowalit Srisoem Mia Haddad Jittima Panyasarawut Ling Shi

Background: Depression in older adults is a multifactorial condition influenced by health status, functional capacity, and lifestyle factors. This study aimed to investigate the individual and combined associations of these factors with late-life depression. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), this study evaluated the associations of general health, chronic conditions, functioning, and lifestyle behaviors (including physical activity, sleep, diet quality, smoking, and alcohol use) with depressive symptoms among U.S. adults 65 years and older. Weighted logistic regression models, accounting for the complex survey design of NHANES, were used to examine the factors both individually and in combination. Results: Depressive symptoms were more prevalent among individuals with poor self-rated health, physical and cognitive functional limitations, hypertension, obesity, current smoking, physical inactivity, and alcohol abstinence. A clear cumulative risk gradient was observed with increasing numbers of risk factors: older adults with six or more risk factors had at least 20-fold higher likelihood of depressive symptoms compared with those with one or no risk factors. Conclusions: These findings highlight the interdependent influences of health, function, and lifestyle on late-life depressive symptoms and underscore the need for integrative prevention and intervention strategies to promote mental well-being in aging populations.

Geriatrics doi: 10.3390/geriatrics11010004

Authors: Setor K. Kunutsor Jari A. Laukkanen

Background/Objectives: The cardiometabolic index (CMI) is a simple anthropometric–metabolic indicator that has recently gained attention as a marker of cardiometabolic risk. This study compared the associations and predictive utility of CMI, body mass index (BMI), and waist circumference (WC) for cardiometabolic multimorbidity (CMM). Methods: Data were drawn from 3348 adults (mean age 63.5 years; 45.1% male) in the English Longitudinal Study of Ageing who were free of hypertension, coronary heart disease, diabetes, and stroke at wave 4 (2008–2009). CMI was calculated using the triglyceride-to-HDL-cholesterol ratio and the waist-to-height ratio. Incident CMM at wave 10 (2021–2023) was defined as the presence of ≥2 of these conditions: hypertension, cardiovascular disease, diabetes, or stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) and measures of discrimination were estimated. Results: During 12–15 years of follow-up, 197 CMM cases were recorded. CMI, BMI, and WC were each linearly related to CMM. Higher CMI was associated with increased CMM risk (per 1-SD increase: OR 1.25, 95% CI 1.08–1.44; highest vs. lowest tertile: OR 1.88, 95% CI 1.09–3.25), with similar effect sizes for BMI. WC showed stronger associations (per 1-SD increase: OR 1.46, 95% CI 1.25–1.71; highest vs. lowest tertile: OR 2.16, 95% CI 1.35–3.44). Adding CMI to a base model resulted in a small, non-significant improvement in discrimination (ΔC-index = 0.0032; p = 0.55) but significantly improved model fit (−2 log-likelihood p = 0.004), with comparable effects for BMI and greater improvements for WC. Conclusions: In this older UK cohort, higher CMI levels were associated with increased long-term risk of CMM but did not outperform traditional adiposity measures such as BMI and WC.

Geriatrics doi: 10.3390/geriatrics11010003

Authors: Kasumi Ikuta Maiko Noguchi-Watanabe Miya Aishima Tatsuhiko Anzai Kunihiko Takahashi Sakiko Fukui

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Geriatrics doi: 10.3390/geriatrics11010002

Authors: Jiri Remr

Background/Objectives: Ageism is a pervasive form of prejudice that undermines health, social participation, and intergenerational solidarity, yet validated research tools for measuring ageism are lacking in many countries. The Fraboni Scale of Ageism (FSA) is one of the widely used instruments, but its psychometric properties have not previously been examined in the Czech context. This study aimed to translate the 29-item FSA, evaluate its reliability and validity, and describe ageism across generations. Methods: A quantitative cross-sectional survey based on face-to-face interviews was conducted in March 2024 among the Czech population aged 15–74 years (n = 1096). Data analysis included descriptive statistics, internal consistency indices (Cronbach’s α, McDonald’s ω, Composite Reliability, Average Variance Extracted), exploratory factor analysis (EFA) on a random half-sample, and confirmatory factor analysis (CFA) on the second half. Construct validity was also examined. Results: The Czech FSA showed very good distributional characteristics with no floor or ceiling effects and excellent internal consistency (α = 0.949; subscales α = 0.848–0.898). EFA replicated the original three-factor structure (Antilocution, Avoidance, and Discrimination) explaining 57.6% of variance. CFA supported this structure with good-to-excellent model fit. FSA scores increased systematically from Baby Boomers to Generation Z, indicating higher ageism among younger cohorts. Higher fear of old age, lower education, an earlier subjective boundary of old age, and absence of an older co-resident were associated with higher ageism scores. Conclusions: The Czech version of the FSA is a reliable and valid instrument for assessing ageist attitudes in the Czech population. Its robust psychometric properties and sensitivity to theoretically relevant correlates support its use for monitoring ageism, evaluating interventions, and enabling cross-national comparisons in aging research and policy.

Geriatrics doi: 10.3390/geriatrics11010001

Authors: Aderonke Agboji Shannon Freeman Davina Banner Joshua Armstrong Melinda Martin-Khan Alexandria Freeman-Idemilih

Background/Objectives: Apathy, characterized by diminished motivation and reduced engagement in goal-directed behavior, is a prevalent concern among older adults, particularly in rural communities where opportunities for meaningful engagement may be limited. This study explores the preliminary impact of an in-person eBook club program on apathy among community-dwelling older adults in Northern British Columbia. Methods: This eight-week pilot single-group, pre-post mixed-methods study combined the use of eReaders to access weekly reading materials with facilitated in-person group discussions designed to foster emotional and social connection. Apathy was assessed using the 3-item Geriatric Depression Scale (GDS-3A) before and after the program. Results: A Wilcoxon signed-rank test revealed a statistically significant reduction in apathy scores (Z = −4.01, p < 0.001), with a large effect size (r = 0.76). While not powered for hypothesis testing, these findings suggest the program may have a meaningful effect. Qualitative analysis of participants who reported higher baseline apathy scores identified three key mechanisms of change: positivity effect, selective pruning of social networks, and adaptive coping, consistent with socioemotional selectivity theory. Conclusions: These preliminary results support the feasibility and potential value of theory-informed, low-cost group reading programs for addressing apathy in older adults and can inform the design of a larger, controlled study.

Geriatrics doi: 10.3390/geriatrics10060172

Authors: Alexandra Allaica Cuenca Ana Balseca Morales Jorge López Bundschuh Luis Chauca-Bajaña Byron Velasquez Ron

Introduction: White coat hypertension in geriatric patients can complicate dental procedures in the presence of intense anxiety. Objective: To evaluate the effectiveness of a combined approach of psychological intervention and sedation for the control of the syndrome during multiple extractions. Case presentation: A 76-year-old woman with a diagnosis of white coat hypertension (WCH) and a history of dental anxiety. In two previous attempts, the surgery was suspended due to blood pressure elevation. The Dental Perception Reprogramming Protocol (DPRP) was applied along with conscious sedation (midazolam, fentanyl, dexmedetomidine) which allowed agitation, so deep sedation with propofol was used. Result: The patient had stable blood pressure (119/82 mmHg) and successfully completed the intervention without complications. Conclusions: The integration of psycho-behavioral and pharmacological techniques allowed effective hemodynamic control, and a key interdisciplinary approach is suggested for the management of the syndrome in older adults.

Geriatrics doi: 10.3390/geriatrics10060171

Authors: Irene Hartigan Catherine Buckley Nicola Cornally Kevin Brazil Julie Doherty Catherine Walshe Andrew J. E. Harding Nancy Preston Laura Bavelaar Jenny T. van der Steen Paola Di Giulio Silvia Gonella Sharon Kaasalainen Tamara Sussman Bianca Tétrault Martin Loučka Karolína Vlčková Rene A. Gonzales on behalf of the mySupport Study Group on behalf of the mySupport Study Group

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the “Caregiver Decision Support” (mySupport) study (2019–2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes.

Geriatrics doi: 10.3390/geriatrics10060170

Authors: Rafaela F. Rodrigues Carlos Marcelo de Barros André A. V. Lima Felipe T. Vilela Vanessa B. Boralli

Background and Objectives: Osteoarthritis (OA) is a common cause of chronic pain. In refractory cases, cooled radiofrequency (CRF) of the genicular nerves is indicated. However, recent studies suggest that traditional targets may be insufficient, proposing the inclusion of the recurrent fibular nerve and the infrapatellar branch of the saphenous nerve. This study reports a prospective four-case series evaluating short-term outcomes of CRF at five revised targets in elderly Brazilian patients. Case Report: The study (CAAE No.: 55647722.5.0000.5142) included four patients (three women, one man; mean age 73.8 years) with moderate to severe refractory knee pain underwent diagnostic nerve block followed by ultrasound-guided CRF. After 30 days, three patients reported pain reduction, including two who experienced substantial improvement. One patient maintained severe pain. Improvements in physical performance, knee flexion, and extension were observed in patients who responded clinically, while individuals with coexisting myofascial pain showed limited functional gains. One patient experienced mild transient pruritus. In this prospective case series, CRF applied to five revised targets appeared feasible and well tolerated, with short-term improvement in pain and function in some patients. These preliminary descriptive findings support further investigation in larger controlled studies.

Geriatrics doi: 10.3390/geriatrics10060169

Authors: Roni Chaim Mukamal Viviane Gontijo Augusto Laiane Moraes Dias Thiago Dias Sarti Guilhermina Rego

Background: Population aging has led to a rise in dementia prevalence, increasing the demand for innovative care models. Telemedicine offers an opportunity to improve access, continuity, and caregiver support for older adults with cognitive impairment. Methods: This qualitative descriptive study was conducted at the Geriatrics and Gerontology Service of Cassiano Antônio de Moraes University Hospital (HUCAM-UFES), Brazil. Semi-structured interviews were carried out with 11 caregivers of older adults living with dementia who participated in telemedicine consultations. Data was analyzed thematically using a reflexive thematic analysis approach. Results: Caregivers considered telemedicine useful, accessible, and safe, facilitating the continuity of care and strengthening the caregiver–professional relationship. The main limitations were the absence of physical examination and occasional technical difficulties. Most caregivers favored a hybrid care model, combining remote and in-person visits. Conclusions: Telemedicine proved to be a feasible and well-accepted strategy for the care of older adults with dementia, improving caregiver support and communication with healthcare teams. Public policies should foster digital inclusion and training for both caregivers and professionals, consolidating hybrid, person-centered models of care.

Geriatrics doi: 10.3390/geriatrics10060168

Authors: Randi Shen Dima Hadid Stephanie Ayers Sandra Clark Rebekah Woodburn Roland Grad Anthony J. Levinson

Background/Objectives: Delirium, an acute cognitive disturbance, is often unrecognized by family or friend care partners, contributing to delayed interventions and negative health outcomes. UnderstandingDelirium.ca is an e-learning lesson developed to address this gap by improving delirium knowledge among the public, patients, and family/friend care partners. Our objective was to evaluate the acceptability, intention to use, and perceived impact of Understanding Delirium e-learning among public users. Methods: A convergent mixed-methods observational evaluation combining survey-based quantitative data and thematic analysis was conducted. The survey included the Net Promoter Score (NPS), the short-form Information Assessment Method for patients and consumers (IAM4all-SF), and an open-text feedback item. Descriptive statistics were used to summarize IAM4all-SF responses, assessing perceived relevance, understandability, intended use, and anticipated benefit. Open-text comments were analyzed thematically by two independent reviewers who reached consensus through discussion. Subgroup analysis of qualitative themes was performed by age, gender, and NPS category. Results: Among 629 survey respondents, over 90% of respondents agreed that the lesson was relevant, understandable, likely to be used, and beneficial. The NPS was rated ‘excellent’ (score of 71), and lesson uptake included over 7000 unique users with a 35% completion rate. Qualitative analysis revealed themes of high educational value, emotional resonance, and perceived gaps in prior healthcare communication. Respondents emphasized the lesson’s clarity, intent to share, and potential for wider dissemination. Conclusions: UnderstandingDelirium.ca is a promising, guideline-aligned digital intervention that has potential to enhance delirium literacy and reduce care partner distress. Findings suggest that the Understanding Delirium e-learning can effectively improve public delirium literacy and should be integrated into care partner and clinical workflows.

Geriatrics doi: 10.3390/geriatrics10060167

Authors: Keisuke Nakamura Yasushi Kurobe Keita Sue Shuhei Yamamoto Kimito Momose

Background/Objective: Hip fractures in older adults are a major public health concern due to their high rates of morbidity, mortality, and long-term disability. Although surgical and postoperative care have improved, recovery outcomes remain highly variable. Identifying early functional recovery patterns could support individualized rehabilitation and discharge planning. This study aimed to identify distinct early recovery trajectories of motor function within 30 days after hip fracture surgery using growth mixture modeling (GMM) and to examine patient- and hospital-level factors associated with these patterns. Methods: A retrospective cohort study was conducted using data from the Nagano Hip Fracture Database, including 2423 patients aged ≥65 years across 17 acute care hospitals in Japan (2019–2024). Functional recovery was measured using the motor subscale of the Functional Independence Measure (FIM-motor) at 0, 7, and 28 days post-admission. Latent trajectory model was used to identify distinct recovery patterns. Multinomial logistic regression analyzed predictors of class membership. Results: Three recovery trajectories were identified: high/rapid improvement (26.7%), intermediate (32.6%), and poor/flat recovery (40.7%). Older age, cognitive impairment, and lower baseline mobility were strongly associated with membership in the poor-recovery class. Early trajectory classes significantly predicted discharge outcomes, including FIM-motor scores and discharge destination. Sensitivity analysis confirmed the robustness of findings, with minimal impact from hospital-level clustering. Conclusions: Distinct early recovery trajectories exist after hip fracture surgery and are strongly influenced by baseline cognitive and functional status. Early identification of recovery patterns can enhance personalized rehabilitation and inform discharge planning, offering valuable insights for clinical practice.

Geriatrics doi: 10.3390/geriatrics10060166

Authors: Justine Schneider Joanne Ablewhite Jodie Bloska Martin Orrell Helen Odell-Miller Jorg Assmus Christian Gold Vigdis Sveinsdottir

Background: We report UK findings from Music Interventions for Depression and Dementia in Elderly care (MIDDEL), a cross-national, clustered, randomised trial undertaken in 2018–2023 to evaluate the effectiveness of music interventions for depression symptoms in care home residents living with dementia (NCT03496675, clinicaltrials.gov (accessed on 1 December 2024)). The trial compared the effects of Group Music Therapy (GMT) with Recreational Choir Singing (RCS); GMT and RCS combined; and treatment as usual (TAU). Methods: In the intervention arms, the protocolized music interventions were delivered in care home units twice per week for three months, then once per week for three months. The primary outcome was depressive symptoms after six months, measured by MADRS. Secondary outcomes included well-being—EQ-5D-5L, Visual Analogue Scale (VAS); quality of life—QOL-AD; symptoms of dementia—SIB-8, NPI-Q; and caregiver distress—NPI-Q. The change in MADRS score from baseline to 6 months was assessed using a linear mixed-effects model. We report the multivariate model having both treatments as predictors, both unadjusted and adjusted, for the interaction between the treatments. Results: The UK trial started in 2022 after the pandemic lockdown, when 16 care home units were recruited and randomised, four per arm; 192 residents aged over 65 with depression and dementia participated. An ITT analysis of 146 participants retained at 6 months found neither intervention had a significant positive effect on any outcome. Significant unfavourable effects were found for RCS participants on MADRS, NPI symptom severity, and EQ-VAS. The combination of RCS + GMT had a detrimental effect on caregiver distress. Conclusions: MIDDEL UK findings do not support the use of GMT or RCS to alleviate depression in care home residents with dementia.

Geriatrics doi: 10.3390/geriatrics10060165

Authors: How Foong Kwan Hazlina Mahadzir Nor Rafeah Tumian Azimatun Noor Aizuddin Shue Hong Kong

Background/Objectives: Non-valvular atrial fibrillation (NVAF) is a common arrhythmia in the elderly and carries a high risk of cardioembolic stroke. Oral anticoagulation is central to prevention, with direct oral anticoagulants (DOACs) increasingly replacing warfarin due to better safety and convenience. However, major bleeding remains a key concern, particularly in older patients. This study aimed to determine the prevalence of major bleeding among elderly patients (≥65 years) with NVAF treated with oral anticoagulants. Methods: A retrospective cohort study was conducted on 886 elderly NVAF patients managed at a tertiary hospital between January 2012 and December 2023. Data on demographics, anticoagulant type, comorbidities, and bleeding events were collected. Associations between categorical variables were tested using Chi-square or Fisher’s exact tests, while logistic regression identified predictors of major bleeding. Results: The mean age was 78.4 ± 7.2 years, with equal gender distribution. Most patients (87.1%) received DOACs, while 12.9% were prescribed warfarin. A total of 63 patients (7.1%) experienced major bleeding, including 51 (6.6%) in the DOAC group and 12 (10.5%) in the warfarin group. Intracranial and intra-/retroperitoneal hemorrhages were most common. Logistic regression showed older age, prior bleeding, a higher HASBLED score, and antiplatelet use as significant predictors. Among patients with a recorded weight (n = 70), dosing adherence was better for apixaban and edoxaban compared to dabigatran and rivaroxaban. Conclusions: DOACs were associated with fewer major bleeding events than warfarin. Bleeding risk was strongly linked to age, prior bleeding, HASBLED score, and concomitant antiplatelet therapy, highlighting the importance of appropriate DOAC dosing for safety.

Geriatrics doi: 10.3390/geriatrics10060164

Authors: Janique Boots-van der Heiden Jos van Campen Tessa Kooistra Irene van de Vorst Miriam Goudsmit

Objective: The non-verbal nature of the Clock Drawing Test (CDT) suggests it is a suitable cognitive screening instrument for populations with lower educational levels and/or language barriers. This study evaluates whether the CDT is a valid screening instrument for low-educated patients and includes a qualitative analysis of CDT errors. Method: A total of 503 participants were included, divided into four groups (dementia, MCI, no cognitive impairment, and other diagnosis), based on a clinical diagnosis by a geriatrician. Educational levels were categorized into four groups: no education and low, middle, and high education. CDT scores were assessed using the seven-point scoring system (Freedman), and two cutoff points were evaluated. Results: Results showed that in all education categories, the dementia group scored significantly lower on the CDT compared to the non-dementia group. The difference was smallest in participants with no education. Two cut-off points were assessed: <4 and <3. A cut-off of <4 showed better sensitivity versus <3, particularly for low-educated groups. A cut-off of <3 provided better specificity versus <4. Error analysis showed that errors made by low-educated participants without dementia were similar to those of patients with dementia. Conclusions: These findings show that the CDT (both total score and qualitative error analysis) has limited value in dementia case-finding in low-educated groups. The CDT is recommended primarily for middle- and high-educated groups.

Geriatrics doi: 10.3390/geriatrics10060163

Authors: Toshiya Shimamoto Yohei Misumi Katsuhisa Uchino Akira Mori Takuya Motoshima Makoto Uchino Mitsuharu Ueda

Background: Parkinson’s disease (PD) is a prevalent neurodegenerative disorder among the elderly, with its incidence increasing as the population ages. Despite the predominance of patients with PD aged 75 years and older in clinical settings, limited research has focused on their rehabilitation. This study aimed to compare the clinical characteristics and rehabilitation outcomes of elderly patients aged 75 years and older. Methods: A retrospective analysis was conducted on 141 patients with PD aged 65 years and older who underwent intensive inpatient rehabilitation. Patients were categorized into two subgroups: the young-old group (65–74 years, n = 58) and the old-old group (≥75 years, n = 83). The rehabilitation program included daily 2 h sessions, 6 days a week, combining physical, occupational, and speech–language–hearing therapies to enhance functional impairments and activities of daily living (ADL). Clinical characteristics and rehabilitation outcomes were compared between these groups. Results: The old-old group exhibited significantly higher rates of sarcopenia, higher Unified Parkinson’s Disease Rating Scale (UPDRS) scores, poorer balance scores and cognitive function, and lower ADL scores compared with the young-old group. However, both groups demonstrated significant improvements in UPDRS, Berg Balance Scale, 10 m walk test, and Functional Independence Measure scores, indicating enhanced motor function and ADL. Conclusions: Our retrospective study suggests that inpatient rehabilitation is associated with improvement in parkinsonism, motor symptoms, and ADL in patients with PD aged 75 years or older, highlighting the potential benefits of intensive rehabilitation even in advanced age. These findings underscore the need for prospective studies to confirm these effects. Trial registration: UMIN000056042 (last amendment 5 November 2024, retrospectively registered).

Geriatrics doi: 10.3390/geriatrics10060162

Authors: Emanuele Marzetti Hélio José Coelho-Júnior

Aim: The present study aimed to evaluate the agreement between calf circumference (CC) and dual-energy X-ray absorptiometry (DEXA) in assessing muscle mass, and to determine how possible discrepancies influence the diagnosis of malnutrition and its relationship with frailty and disability in older adults. Methods: We analyzed cross-sectional data from 1048 adults aged 65 years and older who participated in the 2001–2002 National Health and Nutrition Examination Survey (NHANES). Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and muscle mass was estimated using both DEXA and CC. Agreement between the two assessment methods was tested with Kappa statistics, while multivariable logistic regression models were used to explore the associations between malnutrition (as determined by each method) and frailty or disability, controlling for age, sex, physical activity, polypharmacy, and urinary albumin levels. Results: CC and DEXA-based appendicular skeletal muscle mass (ASM) showed a moderate correlation (r = 0.592). The prevalence of malnutrition was 10.3% when defined by CC and 9.1% when defined by DEXA (κ = 0.635, p = 0.001). In both cases, malnutrition was significantly associated with frailty (OR: 1.56; 95% CI: 1.240, 1.970, p < 0.001), but not with disability. Adjusting for albumin levels did not substantially change these associations. Conclusions: CC and DEXA demonstrate moderate concordance in estimating ASM. While this level of agreement slightly affects malnutrition prevalence estimates, it does not alter the observed relationship between malnutrition and frailty or disability in older adults.

Geriatrics doi: 10.3390/geriatrics10060161

Authors: Carmela Leone Clare Wilding Tshepo Rasekaba Megan E. O’Connell Debra Morgan Irene Blackberry

Background/Objectives: In rural communities, caregivers of people living with dementia face limited access to support services. Digital interventions offer potential solutions for support. This paper reports on the evaluation of Verily Connect, a web-based multicomponent intervention developed to support caregivers. The aim of this qualitative study was to critically evaluate the implementation of Verily Connect to better understand its barriers and enablers. Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative data were collected through semi-structured interviews with 24 health service professionals across 12 rural Australian communities. Thematic analysis was conducted to identify barriers and facilitators to implementation. Results: Key barriers included limited digital literacy, resistance to technology and privacy concerns, as well as competing organisational priorities, and inadequate technological infrastructure. Facilitators included organisational alignment and supportive management. Conclusions: The perceived relevance and usability of Verily Connect were enhanced by its co-design with caregivers and integration into health service models. Addressing digital literacy for caregivers, infrastructure limitations, and organisational readiness is essential for future technology-based health interventions in rural dementia care.

Geriatrics doi: 10.3390/geriatrics10060160

Authors: Kayo Kurotani Hikaru Tanabe Keiji Yanai Kazunori Sakamoto Kazunori Ohkawara

Background/Objectives: Although information and communication technology (ICT) offers opportunities to address challenges, evidence among frail populations is limited. We aimed to evaluate the effectiveness and feasibility of an ICT-based intervention incorporating an artificial intelligence (AI)-assisted smartphone dietary application and group communication tools to improve dietary quality and social connection among community-dwelling older adults with frailty. Methods: A non-randomized, quasi-experimental study was conducted among 29 older adults (≥65 years) in Tokyo, Japan. Participants were assigned to the intervention (n = 11) or control (n = 18) group. The 3-month intervention included weekly photo uploads of meals via an AI-based dietary application providing automated image analysis and personalized feedback, supervised by registered dietitians, along with peer communication through a group chat. The primary outcome was dietary quality. The secondary outcomes included body weight, body mass index (BMI), skin carotenoid score, and loneliness. Results: The adjusted Japanese Food Guide Spinning Top Score at 3-month follow-up was 49.0 (standard error [SE] = 2.6) and 39.5 (SE = 2.0) in the intervention and control groups, respectively. The adjusted mean difference between groups was +9.5 (95% confidence interval: 2.3 to 16.7, p = 0.01). After using analysis of covariance for adjusting for respective baseline values, age, education status, and antihypertension drug use, no statistically significant between-group differences were observed at 3-month follow-up for any secondary outcomes. Conclusions: AI-based dietary intervention and peer communication effectively improved dietary quality among older adults, highlighting the potential of such an intervention to promote healthier eating habits in this population.

Geriatrics doi: 10.3390/geriatrics10060159

Authors: Grace Farhat Jhama Malla Emad A. S. Al-Dujaili Jay Vadher Pradeepa Nayak Kenneth Drinkwater

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Geriatrics doi: 10.3390/geriatrics10060158

Authors: Imaan Hirji Divya John Jeena Jith Hiro Khoshnaw Myooran Ganeshananthan

Background: Clostridioides difficile infections (CDIs) are caused by a Gram-positive, spore-forming bacillus and are defined by more than three episodes of watery diarrhoea per day. CDI is a major cause of morbidity and mortality in older adults, particularly over 65 years. Recurrent CDI leads to higher mortality and prolonged, debilitating illness. Case Presentations: This article presents two patients, aged over 80 years old, who developed recurrent CDI causing complicated and prolonged treatment courses. Patient 1 required an extended course of antibiotics for treatment of discitis and a congruent psoas abscess. Patient 2 developed CDI after multiple short courses of antibiotics for urinary tract infections (UTIs) in the context of multiple comorbidities. Both patients experienced three distinct episodes of CDI and were treated in collaboration with microbiology specialists. Following the third episode, both were successfully treated with oral capsule faecal microbiome transplants (FMTs). Their cases highlight the challenge of balancing systemic antibiotic use against CDI risk. Discussions: These cases underscore known risk factors for recurrent CDI, including advanced age and prolonged antibiotic exposure. Recurrence rates in patients over 65 can reach 58%. The British Society of Gastroenterology and Healthcare Infection Society support the use of FMTs in recurrent cases. Environmental decontamination, including terminal cleaning with sporicidal agents, is critical in reducing reinfection in hospital settings. Conclusions: Recurrent CDI in elderly patients reflects a complex interplay between infection control and managing comorbidities. New guidelines suggest that FMTs can significantly reduce morbidity and mortality. These cases emphasise the need for individualised, multidisciplinary care, adherence to guidelines, and further research to improve safe, effective CDI management in older adults.

Geriatrics doi: 10.3390/geriatrics10060157

Authors: Lujain Sahab Jonathon Timothy Newton Wael Sabbah

Background/Objectives: The study aimed to examine the impact of allostatic load on healthy ageing over a decade and whether social participation attenuates this relationship among older American adults. Methods: Data were extracted from three waves (wave 8, wave 10, wave 13) of the Health and Retirement Study, a longitudinal survey of American adults. The analysis included allostatic load, socioeconomic (education) and demographic (gender, age, ethnicity, and marital status) factors at baseline, social participation in wave 10, and healthy ageing in wave 10 and wave 13. A latent variable was created for allostatic load that included waist circumference, C-reactive protein, glycated hemoglobin, and blood pressure. Healthy ageing was defined as an aggregate measure including freedom from disability, freedom from cognitive impairment, and high physical functioning. Social participation was a dichotomous variable that included individuals’ work status, perceived neighbourhood safety, and partaking in volunteer work. Structural equation modelling was used to examine the direct and indirect relationships between these factors and healthy ageing. Results: A total of 14,537 participants with complete data in all waves were included in the analysis. The mean age at baseline was 68.7 years. Results showed a significant association between higher allostatic load and lower healthy ageing (estimate = −0.12, 95% CI: −0.14, −0.11). Allostatic load was negatively associated with social participation (estimate = −0.32, 95% CI: −0.34, −0.30). Social participation showed a positive significant association with healthy ageing, indicating partial buffering that accounted for 12% of the total effect. Higher educational attainment was associated with better healthy-ageing outcomes, whereas non-Black ethnicity was linked to poorer healthy ageing. Conclusions: Elevated allostatic load was associated with poorer ageing outcomes, with social participation partially attenuating the relationship. Higher education predicted more favourable trajectories, while ethnic differences suggested resilience among older Black adults. These results indicate that both physiological and social factors contribute to variations in healthy ageing.

Geriatrics doi: 10.3390/geriatrics10060156

Authors: Erika Friedmann Nancy R. Gee Eleanor M. Simonsick Barbara Resnick Merve Gurlu Ikmat Adesanya Soyeon Shim

Introduction: While pet ownership (PO) is generally associated with better psychological health, research does not consistently demonstrate this relationship among community living older adults. Pet attachment has been suggested as a mechanism for the health benefits associated with pet ownership. We examine the contributions of PO and pet attachment to maintaining psychological health among generally healthy, cognitively intact, community-dwelling older adults as they age. Methods: Older adults (N = 596; age: ≥50, M = 67.6, SD = 9.5 years, pet owners N = 178) completed PO history and assessments of anxiety, depression, happiness, and mental wellbeing every 1–4 years. Pet owners completed demographic and pet attachment assessments. Linear mixed models with random intercepts and covariates of initial age, sex, race, live alone, married, and comorbidities quantified longitudinal changes (M = 7.5, SD = 3.6 years) according to time-varying PO, pet attachment, and dog walking to these changes. Results: PO moderated changes in anxiety (p = 0.011) and happiness (p = 0.037), which improved in pet owners and deteriorated in non-owners, and in mental wellbeing (p = 0.007), which deteriorated faster in pet owners; PO was not related to changes in depression. Pet attachment was related to worsening mental wellbeing (p = 0.012). Dog walking was related to slower increases in anxiety (p = 0.005) and depression (p = 0.004). Conclusions: This study provides important longitudinal evidence that PO may reduce age-related decline in owners’ psychological health later in life. Pet attachment does not appear to be the mechanism for the advantages of PO. We suggest potential reasons. Additional research is needed to confirm mechanisms.