Search Results (335)

UK cancer waiting-time standards inadequately address the complex needs of older patients, and no standardised, implementable comprehensive geriatric assessment (CGA) case-finding framework exists for this population. Using a nominal group technique involving clinicians and advocates, a consensus was reached to develop the Cancer Risk Assessment and Needs Evaluation (CRANE) CGA case-finding framework. CRANE was designed to be completed in 10–15 min for patients aged 70 and over, incorporating ten key domains, including comorbidity, cognitive function, and social situation, considered essential for routine NHS use. CRANE represents a consensus-derived, pragmatic case-finding framework for identifying unmet geriatric needs in older adults with cancer in NHS pathways. It should be regarded as a consensus framework rather than a validated screening instrument. Prospective implementation and validation studies are required before routine clinical adoption. Full article

Background/Objectives: Urinary incontinence (UI) and impaired balance are common geriatric syndromes that negatively affect health and quality of life in older women. However, the combined effects of power-based multicomponent training (PMT), pelvic floor muscle (PFM) activation instructions, and psychoeducational (PSY) support remain unclear. This study aims to evaluate the effects of a PMT, alone or progressively combined with PFM activation instructions and PSY support, on PFM function, UI symptoms, balance, fear of falling, and physical function in community-dwelling older women. Methods: This study describes the protocol for an 18-week, four-arm additive, parallel-group, assessor- and analyst-blinded randomized controlled trial with a 6-month follow-up. A total of 120 women aged 60–80 years with UI will be randomly assigned to four groups: (1) PMT only (EX), (2) PMT plus verbal PFM activation instructions (EXVERB), (3) PMT combined with PFM activation instructions and psychoeducational sessions (EXVERBPSY), or (4) a control group receiving educational sessions on geriatric syndrome prevention. Sessions will be conducted twice weekly for 18 weeks. The single primary endpoint is maximal PFM strength assessed by the manometric perineometry. Pre-specified secondary outcomes include additional PFM function measures, upper- and lower-limb (LL) strength and power, balance performance, fear of falling, quality of life, psychological well-being, and anthropometric variables. Assessments will be conducted at baseline, post-intervention, and 6-month follow-up. The trial is registered at ClinicalTrials.gov (NCT06839040). Expected results: This trial is expected to provide evidence on the effectiveness of a multidisciplinary intervention combining exercise, PFM activation strategies, and PSY support for reducing UI severity and improving balance performance and fear of falling in older women. Conclusions: This protocol describes a four-arm additive randomized controlled trial evaluating a multidisciplinary intervention targeting two highly prevalent and interrelated geriatric syndromes. The study may contribute to the development of more comprehensive exercise-based and PSY interventions for older women and may inform healthcare strategies aimed at promoting healthy ageing and improving the management of UI and fear of falling. Full article

Background/Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in older adults and are frequently associated with multidimensional frailty and reduced quality of life. The present study aimed to investigate the associations among multiple domains of the Comprehensive Geriatric Assessment (CGA), including frailty, cognitive status, emotional status, nutritional status, functional status, fall risk, psychological resilience, and perceived quality of life, in older adults with cardiovascular disease. Methods: A cross-sectional observational study was conducted on 100 patients aged ≥60 years admitted to the Geriatrics Department of the “Dr. C.I. Parhon” Clinical Hospital, Iași. Cognitive, emotional, nutritional, and functional status, fall risk, frailty (Fried and Tilburg scales), resilience- Connor–Davidson Resilience Scale-25 (CD-RISC-25), and quality of life- World Health Organization Quality of Life–BREF (WHOQOL-BREF) were assessed. Statistical analysis included chi-square or Fisher’s exact tests and exploratory discrimination analysis using ROC curves. Results: Overall, 61% of participants reported a very good quality of life, whereas the remaining 39% reported a moderately reduced quality of life. Better perceived quality of life was significantly associated with preserved cognitive status, fewer depressive symptoms, better nutritional status, lower frailty (as assessed by both the Fried Frailty Phenotype and the Tilburg Frailty Indicator), preserved functional independence, lower fall risk, and greater psychological resilience (all p < 0.05). In contrast, neither demographic characteristics nor cardiovascular diagnoses were significantly associated with quality of life. Exploratory receiver operating characteristic (ROC) analysis demonstrated modest discriminatory performance for cognitive status— Mini-Mental State Examination (MMSE) (AUC = 0.660; p = 0.007), nutritional status— Mini Nutritional Assessment (MNA) (AUC = 0.624; p = 0.038), and the Tilburg Frailty Indicator (AUC = 0.635; p = 0.024), whereas psychological resilience exhibited an inverse relationship with the predefined outcome (AUC = 0.293; p = 0.001). Conclusions: In hospitalized older adults with cardiovascular disease, perceived quality of life was primarily associated with multidimensional geriatric, functional, nutritional, cognitive, and psychosocial factors, rather than with demographic characteristics or cardiovascular diagnoses. Psychological resilience was identified as an important psychosocial correlate of better perceived quality of life, supporting its inclusion in individualized comprehensive geriatric interventions. These findings highlight the importance of comprehensive geriatric assessment in identifying factors associated with quality of life. Given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects and require confirmation in prospective longitudinal studies. Full article

Background and Objectives: Sarcopenia is highly prevalent among older adults with chronic kidney disease (CKD) and is associated with adverse clinical outcomes. The finger-ring (Yubi-wakka) test is a simple anthropometric screening tool based on calf circumference; however, its performance in older adults with CKD remains unclear. This study aimed to investigate the association of the finger-ring test with low muscle mass, sarcopenia, and comprehensive geriatric assessment parameters and to evaluate its diagnostic performance for identifying low muscle mass in older adults with CKD. Materials and Methods: This cross-sectional study included 115 patients aged ≥65 years with CKD who were evaluated in geriatric and nephrology inpatient services. After excluding two participants with missing finger-ring measurements, 113 individuals were analyzed. Muscle mass was assessed using bioelectrical impedance analysis and low muscle mass was defined according to EWGSOP2-based Turkish cut-off values. Demographic characteristics, anthropometric measurements, laboratory findings, and comprehensive geriatric assessment parameters were recorded. Correlation analyses, logistic regression models, receiver operating characteristic (ROC) analyses, and likelihood-ratio tests were performed. Results: Among 113 participants, 62 were classified as finger-ring positive (FR = 0) and 51 as finger-ring negative (FR = 1). Low muscle mass was significantly more frequent in the FR = 0 group than in the FR = 1 group (51.6% vs. 24.0%, p = 0.005). Finger-ring test results showed strong correlations with calf circumference (rho = 0.689, p < 0.001) and body mass index (BMI) (rho = 0.631, p < 0.001), whereas the correlation with muscle mass was modest (rho = 0.250, p = 0.008). For detecting low muscle mass, the finger-ring test demonstrated an area under the curve (AUC) of 0.643 (95% CI 0.554–0.732), sensitivity of 72.7%, specificity of 55.9%, positive predictive value of 51.6%, and negative predictive value of 76.0%. In multivariable analyses, BMI remained the strongest independent determinant of finger-ring test results, whereas the association with muscle mass lost statistical significance after BMI adjustment. Adding age and sex significantly improved discrimination, while the contribution of nutritional status was limited. Conclusions: The finger-ring test is associated with low muscle mass in older adults with CKD; however, its diagnostic performance is modest and appears to be substantially influenced by body size and calf circumference. Therefore, the finger-ring test should be considered a simple adjunctive screening tool rather than a stand-alone method for identifying low muscle mass in this population. Full article

Background/Objectives: Individualized nursing care is a fundamental component of high-quality healthcare, particularly in geriatric populations. However, its consistent implementation remains challenging, a situation further exacerbated by the COVID-19 pandemic due to increased workloads and resource constraints. This study aimed to assess nurses’ perceptions of individualized care for older adults in Spain and to examine the influence of the workplace ethical climate on these perceptions. Methods: A cross-sectional observational study was conducted using two validated instruments: the Individualized Care Scale–Nurse version (ICS-Nurse) and the Hospital Ethical Climate Survey (HECS). Descriptive and inferential analyses were performed to assess individualized care, ethical workplace climate, and the associations between both constructs. Results: A total of 96 nursing professionals participated in the study. Participants reported an overall favorable perception of individualized care. The highest scores were observed in the clinical situation dimension, whereas lower scores were reported for aspects related to hygiene organization and the incorporation of patients’ preferences. A moderate, positive, and statistically significant association was observed between ethical workplace climate and individualized care, particularly in dimensions related to patients and physicians. Participants working in hospital settings reported higher recent-experience individualized care scores than those working in nursing homes. Conclusions: These results highlight the critical role of an ethical workplace climate in supporting nurses’ capacity to deliver individualized care. They also underscore the need for targeted strategies to strengthen organizational support, enhance interprofessional collaboration—particularly with physicians—and promote training in individualized care practices. Addressing these factors may facilitate more consistent and comprehensive individualized care, especially in long-term care settings where structural challenges persist. Full article

Introduction: Sleep disorders are common in older adults, and quality of life is often diminished due to gradual declines in physical and mental abilities. Among the treatment strategies routinely applied in older adults, comprehensive health resort treatment is considered a promising option because of its multifaceted nature and low risk of adverse effects. Objective: The primary objective of this study was to evaluate the impact of comprehensive health resort treatment on insomnia and quality of life in older adults. The secondary objective was to examine whether treatment-induced changes in these parameters were associated with participants’ age. Material and Methods: The study group consisted of 83 participants (14 men and 69 women) with a mean age of 71.94 ± 6.00 years who underwent a 21-day comprehensive, individually tailored health resort treatment for degenerative joint disease. Insomnia was assessed using the Athens Insomnia Scale. Health-related quality of life was evaluated with the European Quality of Life Five Dimensions—Five Levels (EQ-5D-5L) instrument. Assessments were conducted twice: upon admission to and discharge from the sanatorium. Results: The mean Athens Insomnia Scale (AIS) score at baseline was 6.97 ± 6.21 across all participants. Following treatment, the AIS score decreased to 4.78 ± 4.95 (p < 0.0001). The baseline mean EQ-5D-5L index was 0.956 ± 0.064. After health resort treatment, the mean EQ-5D-5L index increased to 0.969 ± 0.042 (95% CI: 0.006 to 0.022; p = 0.001). Age was not associated with the magnitude of changes in the AIS score, EQ-5D-5L index or EQ-5D-5L VAS in the studied population. Conclusions: Comprehensive health resort treatment was associated with improvements in insomnia severity and quality of life in older adults, with similar changes observed across age groups. These findings suggest that comprehensive health resort treatment may be a beneficial component of geriatric health care. Full article

Background/Objectives: Cognitive impairment, frailty, and systemic comorbidity burden are common in elderly patients with glaucoma and may influence both visual field (VF) performance and glaucoma severity. This study investigated the associations of comprehensive geriatric assessment (CGA) parameters, including Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI), with VF sensitivity and VF reliability indices in glaucoma patients. Methods: This retrospective cross-sectional study included 1125 eyes of 622 glaucoma patients who underwent Humphrey VF testing and CGA at a tertiary referral center. Associations between CGA parameters and VF indices, including mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity, fixation loss rate (FL), false-negative rate (FN), and false-positive rate (FP), were evaluated. Generalized linear mixed models were used to assess independent associations after adjustment for demographic, systemic, and ocular covariates. Results: In univariate analyses, lower Mini-Cog and G8 scores and higher ACCI scores were associated with several VF sensitivity and reliability indices. After multivariable adjustment, ACCI remained independently associated with lower MD (estimate = −0.52, p = 0.004), higher PSD (estimate = 0.27, p = 0.04), and lower foveal sensitivity (estimate = −0.36, p = 0.01). Lower G8 scores and higher ACCI scores were independently associated with increased FN rates, whereas higher G8 scores were associated with increased FP rates. Conclusions: Systemic comorbidity burden, assessed using ACCI, was independently associated with both glaucomatous functional impairment and selected VF reliability indices. Frailty, assessed using G8, was associated with VF reliability but not VF sensitivity. Although cognitive function measured by Mini-Cog was associated with VF parameters in univariate analyses, these associations were not retained after multivariable adjustment. Consideration of systemic health status and geriatric vulnerability may improve interpretation of VF results in patients with glaucoma. Full article

Background: Gender differences in aging among people with HIV (PWH) remain poorly characterized. Women with HIV (WWH) may experience more complex aging trajectories, due to the interplay of biological, clinical, and psychosocial factors. In this context, we aimed to investigate gender-specific determinants of frailty among older people with HIV, with a particular focus on women, to better inform tailored clinical care. Methods: Cross-sectional analysis of the Over50 Cohort, including PWH aged ≥50 years from two tertiary hospitals in Spain. Participants underwent a comprehensive geriatric assessment across demographic, clinical, functional, cognitive, psychological, and social domains. Gender-stratified multivariable analyses examined frailty (by Fried criteria) and associated factors. Results: Among 588 participants, 139 (23.6%) were cisgender WWH. Despite younger age and better immune status, WWH showed higher prevalence of frailty (17% vs. 9%), musculoskeletal disease (47% vs. 28%), depressive symptoms (45% vs. 30%), sleep disturbances (10% vs. 5%), and cognitive complaints (23% vs. 11%). Men with HIV (MWH) more frequently had cardiovascular (48% vs. 35%) and renal disease (22% vs. 15%). In multivariable models, frailty in WWH was independently associated with musculoskeletal disease (OR 3.85), cognitive impairment (OR 3.21), depressive symptoms (OR 2.67), and malnutrition (OR 2.14). In MWH, frailty was associated with musculoskeletal disease, cognitive impairment, malnutrition, and older age. Conclusions: Frailty exhibits gender-specific patterns: a multidimensional phenotype in WWH versus age-driven in MWH, supporting tailored, gender-responsive care integrating geriatric, mental, and musculoskeletal health. Full article

Background/Objectives: Glaucoma medication adherence is influenced by multiple factors, including treatment-related knowledge, eye drop instillation technique, cognitive function, and systemic health status. However, the relationships between comprehensive geriatric assessment (CGA) results and specific adherence-related problems remain poorly understood. This study investigated the associations between CGA results and glaucoma eye drop adherence-related problems using the newly developed Shimane University Glaucoma Eye Drop Adherence Questionnaire (SU-GAQ). Methods: This retrospective study included 187 consecutive glaucoma patients who underwent CGA and completed the SU-GAQ at Shimane University Hospital. The SU-GAQ consists of Knowledge (Q1–Q5) and Technique (Q6–Q15) domains. CGA included the Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI). Associations between questionnaire responses and CGA results were evaluated using Spearman’s rank correlation and generalized regression analyses. Exploratory factor analysis (EFA) based on tetrachoric correlations was performed to evaluate the questionnaire structure. Results: Lower Mini-Cog scores were significantly associated with higher Knowledge-domain scores (ρ = −0.27, p = 0.0002) and higher overall questionnaire scores (ρ = −0.23, p = 0.002). In multivariate analysis, Mini-Cog remained independently associated with the Knowledge domain (estimate = −0.31, p < 0.0001) and total score (estimate = −0.44, p = 0.002). Higher ACCI scores were associated with higher Technique-domain scores (ρ = 0.19, p = 0.009) and remained significant in multivariate analysis (estimate = 0.16, p = 0.02). G8 scores were not significantly associated with questionnaire outcomes. EFA identified a two-factor structure corresponding to the predefined Knowledge and Technique domains, accounting for 71.2% of the total variance. Conclusions: Lower cognitive function was primarily associated with knowledge-related barriers to glaucoma medication adherence, whereas greater comorbidity burden was associated with technical difficulties in eye drop instillation. The SU-GAQ demonstrated a clinically meaningful two-domain structure and may facilitate identification of specific adherence-related barriers in glaucoma patients. Full article

Background: The number of older patients undergoing cardiac surgery is increasing, and a substantial proportion of these patients are frail. Frailty is associated with increased mortality, psychological complications, functional decline, and reduced health-related quality of life, complicating treatment decision-making. Currently, treatment recommendations are formulated by the multidisciplinary Heart Team and are mainly based on disease-related parameters. To better integrate patient preferences, geriatric assessment, and shared decision-making into routine cardiothoracic practice, a nurse-led preoperative outpatient pathway was developed: the Preoperative RIsk assessment and shared decision-Making in patients Eligible for cardiac surgery (PRIME) clinic. This study aims to evaluate whether the implementation of PRIME consultation influences Heart Team treatment recommendations and to assess its cost-effectiveness. Methods: This single-center, non-randomized prospective study is conducted in the Netherlands. Patients aged ≥70 years who are eligible for cardiac surgery and have two or more risk factors for adverse postoperative outcomes are included. All patients are initially discussed in the Heart Team, resulting in a treatment recommendation. Patients in the intervention group subsequently visit the PRIME clinic, where a comprehensive geriatric assessment and a shared decision-making consultation are performed. Following this visit, patients are re-evaluated by the Heart Team. The primary outcome is the comparison between the initial and subsequent Heart Team treatment recommendations. Secondary outcomes include health-related quality of life and cost-effectiveness. Discussion: This prospective exploratory study evaluates the implementation of a novel, patient-centered preoperative care model integrating geriatric assessment and shared decision-making into routine cardiac surgical practice. By focusing on outcomes meaningful to older patients and their relatives, the study contributes to the development of value-based, individualized surgical care. Trial registration: The PRIME study was registered in ClinicalTrials.gov (trial registration number: NCT06616129). Full article

Background: Lowering low-density lipoprotein cholesterol (LDL-C) effectively reduces the risk of cardiovascular events. Therefore, we investigated LDL-C levels in geriatric patients undergoing comprehensive inpatient geriatric care. Methods: Patients aged ≥65 years who underwent inpatient comprehensive geriatric care were analyzed. Baseline, clinical, laboratory, and medical data were obtained from case records. For cardiovascular risk stratification, SCORE2, SCORE2-OP, or SMART2 was applied, and LDL-C targets for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD) were defined. Factors associated with LDL-C values within guideline-recommended targets in the univariate analysis were entered into a logistic regression model to identify independent predictors. Results: Of 486 patients, 433 (median age 84.0 years; 67.2% female) were included in the final analysis. The majority of patients (371/433; 85.7%) had a very high cardiovascular risk profile. Lipid-lowering therapy (LLT) was identified in 222 patients (51.3%), while 205 patients (47.3%) had received LLT for ≥3 months. In 219 patients (98.7%), LLT was statin-based, either as monotherapy or in combination. The median LDL-C level in the entire cohort was 85 mg/dL (IQR: 63–114 mg/dL), whereas patients receiving LLT had a median LDL-C level of 66 mg/dL (IQR: 52–83 mg/dL). Overall, 193 patients (44.6%) achieved guideline-recommended LDL-C targets; among patients receiving LLT, 61.5% (126/205) were within target range. Intake of ≥5 medications per day was associated with pre-existing LLT (odds ratio: 3.036; 95% CI: 1.081–8.523; p = 0.035). Statin-based LLT was independently associated with achieving LDL-C targets (odds ratio: 3.383; 95% CI: 2.248–5.092; p < 0.001). Conclusions: Most patients did not achieve guideline-recommended LDL-C targets, while only half received lipid-lowering therapy, predominantly statin-based. Current risk assessment tools and approaches to polypharmacy may require adaptation for geriatric patients. Nevertheless, even the simple implementation of statin therapy alone could substantially improve cardiovascular preventive care in a large proportion of untreated older patients. Full article

Background: Adverse drug reactions (ADRs) represent a major and often underestimated source of morbidity, hospitalization, and functional decline in older adults. The convergence of age-related pharmacokinetic and pharmacodynamic changes, multimorbidity, polypharmacy, and frailty creates a clinical environment in which ADR risk is not static but evolves along progressive trajectories—from mild, early manifestations toward severe, potentially irreversible outcomes. Understanding these trajectories is essential for rational geriatric prescribing. Methods: This narrative review synthesizes evidence from epidemiological studies, systematic reviews, Cochrane analyses, and clinical trials published between 2000 and 2025, focusing on adults aged 65 years and older with two or more chronic conditions. Sources were identified through a structured, non-systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus using the terms ‘adverse drug reactions’, ‘polypharmacy’, ‘multimorbidity’, ‘frailty’, ‘deprescribing’, and ‘pharmacokinetics’ in older adults, alone and in combination. Evidence quality was assessed narratively, distinguishing trial evidence from observational and expert consensus data. Results: ADRs in older adults are best classified using complementary frameworks—the augmented Type A to withdrawal Type E and failure-of-therapy Type F taxonomy (Types A–F), the Dose-Time-Susceptibility (DoTS) classification, and the EIDOS mechanistic scheme—which together capture the heterogeneity of drug-related harm in this population. Age-related pharmacokinetic changes (altered absorption, increased volume of distribution of lipophilic drugs, reduced hepatic and renal clearance) and pharmacodynamic shifts (heightened receptor sensitivity, baroreflex impairment, increased blood–brain barrier permeability) interact with polypharmacy and frailty to amplify ADR trajectories from mild to severe. Anticholinergic burden, prescribing cascades, and inappropriate polypharmacy function as structural accelerators of these trajectories. Medication review and deprescribing improve prescribing quality but evidence for hard outcome benefits remains of low to very low certainty. Emerging AI-enabled digital tools show promising accuracy for identifying frailty and pharmacological vulnerability, but this performance relates to frailty classification and has not yet been shown to prevent ADR trajectories; they require validation for routine clinical use. Conclusions: Recognizing ADRs in older adults as dynamic trajectories rather than isolated events repositions prescribing review and deprescribing from optional to essential clinical acts. An integrated approach combining pharmacological vigilance, comprehensive geriatric assessment, structured deprescribing, and emerging digital decision-support tools offers the most realistic pathway to reduce the trajectory-related burden of drug-related harm in complex older patients. Full article

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article

Background: Vitamin D deficiency is highly prevalent in older adults and has been increasingly recognised as a potential contributor to cognitive decline, depressive symptomatology, and functional impairment. However, the clinical significance of specific 25-hydroxyvitamin D thresholds in relation to this multidomain geriatric phenotype remains incompletely characterised. Methods: We conducted a cross-sectional study of 1438 consecutive patients aged 65 years or older admitted for comprehensive geriatric assessment at a tertiary centre in Cluj-Napoca, Romania, between January 2023 and November 2025. Serum 25-hydroxyvitamin D [25(OH)D] was categorised as deficient (<20 ng/mL), insufficient (20–30 ng/mL), or sufficient (≥30 ng/mL). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale (GDS-30 and GDS-SF), and functional status using Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Multivariable linear regression analyses were adjusted for age, body mass index, serum albumin, and estimated glomerular filtration rate (eGFR). Results: Suboptimal vitamin D status was highly prevalent in this geriatric cohort, with 43.3% of participants meeting criteria for frank deficiency (<20 ng/mL). Lower 25(OH)D concentrations were significantly associated with worse cognitive performance, greater depressive symptom burden, and higher functional dependency. Serum 25(OH)D correlated positively with MoCA and MMSE scores and inversely with ADL, IADL, and GDS scores. In adjusted models, vitamin D remained independently associated with MoCA, IADL, and GDS. Stratified analyses suggested that the main clinical deterioration occurred below 20 ng/mL, while the 20–30 ng/mL range behaved as an intermediate phenotype closer to sufficiency than to frank deficiency. Conclusions: In this large cohort of hospitalised older adults, serum 25(OH)D deficiency below 20 ng/mL was independently associated with poorer cognition, more depressive symptoms, and greater functional impairment. These findings support routine vitamin D assessment in geriatric practice and suggest that the <20 ng/mL threshold identifies a clinically relevant high-risk phenotype. Full article