Search Results (579)

The coexistence of obesity, osteoporosis, and sarcopenia has been associated with adverse outcomes such as risk of falls, fractures, immobility, disability and frailty, yet data from Latin American populations are scarce. This study aimed to determine the prevalence and associations of obesity, osteoporosis, and sarcopenia—individually and combined—with frailty in Mexican elderly women. We conducted a cross-sectional study in which patients with body mass index < 18.5 kg/m², uncorrected sensory deficits, immobility, musculoskeletal diseases, or patients with implanted devices were excluded. Frailty was assessed using the FRAIL scale, obesity by body fat percentage, osteoporosis according to American Association of Clinical Endocrinology (AACE) guidelines and sarcopenia following the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) recommendations. A total of 115 participants aged ≥60 years were assessed between January and June 2025. Frailty was present in 21.7% of the patients; 67.0% had obesity, 72.2% osteoporosis, 20.0% sarcopenia and 13.0% osteosarcopenic obesity. Sarcopenic phenotypes were associated with frailty: odds ratios (95% CI) were 3.05 (1.12–8.26) for sarcopenia, 4.23 (1.42–12.55) for sarcopenic obesity and 3.98 (1.28–12.40) for osteosarcopenic obesity. Sarcopenic phenotypes showed associations with frailty in Mexican elderly women. Full article

Stroke is the second leading cause of death globally and a major contributor to lower-limb disability, affecting gait, balance, and functional independence in elderly populations. While robot-assisted rehabilitation has demonstrated effectiveness in motor recovery, access remains limited due to high costs and geographic barriers, particularly in Latin America. This study presents ExoKnee, a low-cost knee exoskeleton designed through biomimetic principles and 3D-printed fabrication as a proof-of-concept device targeting gait rehabilitation in elderly adults. The system integrates a single-degree-of-freedom pneumatic actuator controlled by electromyography (EMG) signals from the quadriceps muscle, enabling knee flexion and extension (90° to 180°). The design was evaluated through finite element analysis and dynamic simulations in MATLAB/Simulink R2024a under constant, stepwise, and sinusoidal reference inputs in a digital-twin environment. Expert validation using the Content Validity Coefficient yielded a mean score of 0.8747, reflecting preliminary expert agreement on the conceptual design’s coherence and relevance. The prototype demonstrated controlled movements through a 6-bar pneumatic system with EMG-triggered relay activation, validated at the proof-of-concept level through simulation and single-subject threshold calibration. ExoKnee addresses critical gaps by offering an anthropometrically informed, biosignal-driven, and locally manufacturable rehabilitation platform for low- and middle-income countries, pending clinical validation. Future work will focus on clinical trials and adaptive EMG control strategies. Full article

Infective endocarditis (IE) is an uncommon but life-threatening condition characterized by infection and inflammation of the endocardial surface of the heart, most commonly affecting native or prosthetic valves. Recent data indicate in-hospital mortality rates ranging from 15% to 25%, with evidence of increasing mortality even in high-income countries. Beyond its fatal potential, IE poses a major public health burden, accounting for over 1.7 million disability-adjusted life years (DALYs) globally in 2019. This review aims to discuss recent advancements in the diagnosis and management of IE given the shifting epidemiology and pathogen profile of the disease. There is a rising incidence of healthcare-associated IE and an expanding population of vulnerable patients, including the elderly and those with prosthetic material or indwelling catheters. Diagnostic capabilities have rapidly advanced with the adoption of modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), cardiac CT, and cardiac magnetic resonance (CMR), particularly in patients with prosthetic valve endocarditis or culture-negative presentations. Additionally, the expanding indications for surgical intervention and increasing antimicrobial resistance have added complexity to management decisions. These developments underscore the need for a comprehensive review to support healthcare providers in navigating the modern diagnostic and therapeutic landscape of IE. Full article

Background: Implant-related mechanical failure remains a clinically relevant concern following posterior decompression and fusion in elderly patients with lumbar spinal stenosis (LSS). The relative contribution of host-related versus construct-related factors to failure risk requires further clarification. Methods: This retrospective single-center cohort study included 118 patients aged ≥65 years who underwent single-level hemilaminectomy with posterolateral fusion (PLF) for isolated L4–5 central LSS, with a minimum follow-up of 48 months (mean 51.0 ± 2.0 months). All procedures were performed using a standardized posterior technique with uniform 6.5-mm titanium rods and 6.5-mm pedicle screws. Mechanical failure was defined as revision surgery due to radiographically and clinically confirmed hardware-related complications in the absence of infection. Exploratory univariable analyses were conducted to evaluate associations between baseline variables and mechanical failure. Clinical outcomes were assessed using validated patient-reported outcome measures. The Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Visual Analog Scale (VAS) for pain were recorded. Results: Overall revision rate was 13.6% (16/118), including 14 cases (11.9%) of implant-related mechanical failure and 2 cases (1.7%) of infection-related revision. Higher age (p = 0.005), higher body mass index (BMI) (p = 0.005), lower bone mineral density (BMD) (p < 0.001), active smoking (p < 0.001), and diabetes mellitus (DM) (p = 0.023) were significantly associated with mechanical failure. Functional outcomes (ODI, RMDQ, VAS) improved significantly at final follow-up (all p < 0.001). Conclusions: Mechanical failure following hemilaminectomy with PLF appears to be predominantly influenced by host-related factors rather than construct characteristics when a standardized surgical technique is applied. Bone quality and modifiable systemic risk factors may play a critical role in long-term construct durability. Full article

Background: Frailty is a common finding in elderly subjects with severe aortic stenosis (AoS) and a strong predictor of mortality and disability after aortic valve surgery. The atherogenic index of plasma (AIP) is related to different cardiovascular (CV) risk factors, which in turn are correlated to the progression of frailty as well as of AoS. Aim: to analyze the association of AIP with different CV risk factors and frailty scores and its value as a determinant of mortality in older adults with severe AoS. Methods: The association of AIP with a multidimensional assessment of frailty by using Fried criteria and the following indices; timed up-and-go test (TUG) for gait function; Charlson Index (CI), basic activities of daily living (BADL) and instrumental activities of daily living (IADL) for disability; mini–mental state examination for cognitive function evaluation (MMSE); Geriatric Depression Score for mood disorder (GDS); Mini Nutritional Assessment (MNA) for nutritional status was assessed in 102 elderly AoS patients (33 males; mean age 83 ± 6 yrs). Moreover, the relationship between AIP and demographic, lifestyle, traditional CV risk factors and CV mortality was also evaluated. Results: Significant relationships between AIP and glycemia and inflammatory parameters (CRP, ESR and fibrinogen) as well as with troponin I were found. Moreover, AIP significantly correlates with CI, BADL, IADL and MNA. However, the Kaplan–Meier analysis did not show any significant difference for survival rates according to AIP intervals of risk, whereas ejection fraction remained the only significant determinant after multivariate adjustment for mortality at the Cox proportional hazard models analysis in this patient population. Conclusions: Higher AIP is significantly associated with cardiometabolic risk and increased physical dysfunction risk and frailty in AoS pts, evidencing its potential use as a simple biomarker in this clinical setting, although it did not represent a significant determinant for mortality in this population. Full article

Background: Liver cancer remains a persistent global health challenge due to its high occurrence and fatality rates, critically impacting health outcomes and quality of life. The disease burden in East Asia, considering China, Japan, South Korea, and Mongolia, is among the highest globally. This study aims to examine the patterns and trends of liver cancer in selected East Asian countries from 1990 to 2021. Methods: This study employed data from the Global Burden of Disease Study 2021 pertaining to key burden metrics—prevalence, incidence, mortality, years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs)—for selected East Asian countries from 1990 to 2021. Furthermore, the epidemiological trends and patterns were analyzed using decomposition analysis, Joinpoint regression, and age–period–cohort methods. Projections of the cancer burden through 2036 were generated using the Bayesian age–period–cohort model. Results: For all key indicators (incidence, prevalence, mortality, YLDs, YLLs, and DALYs), China had the highest values in both 1990 and 2021. The highest age-standardized rates for incidence (ASIR), mortality (ASMR), prevalence (ASPR), YLDs, YLLs, and DALYs (ASDR) were recorded in Mongolia. For all measured indicators of disease burden, the peak rates in each of the selected East Asian nations were consistently concentrated in the population aged 50 and above. Mongolia is forecasted to maintain the top-ranking ASIR values among the selected East Asian nations considered up to 2036. Conclusions: Over the past three decades, liver cancer has imposed a heavy disease burden on all selected East Asian nations, with rates being notably higher in the elderly population. These insights will provide policy-makers with evidence to guide public health strategies for disease prevention. Full article

Background: Through a meta-analysis and systematic review, the present study aimed to evaluate the prevalence, associated factors and prognosis of sarcopenic obesity in the elderly in the community. Methods: From database inception to 31 December 2025, this study performed a full database of PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG, and VIP database. Two researchers undertook a systematic process of data extraction and literature quality evaluation. Stata 17 was used to evaluate the prevalence, associated factors and prognosis of sarcopenic obesity in the elderly in the community. Results: Our study included a total of 37 sources, encompassing 80,337 elderly individuals in the community. The results showed that the sarcopenic obesity prevalence in this population was 10%(95%CI: 8–11%), with a 95% prediction interval of 1.4–31.2%, and its occurrence was related to multiple associated factors such as age (OR = 1.83, 95%CI: 1.21–2.76), male (OR = 3.38, 95%CI: 1.53–7.49), low physical activity (OR = 1.56, 95%CI: 1.13–2.16), moderate-to-high physical activity (OR = 0.62, 95%CI: 0.51–0.77), low income (OR = 1.71, 95%CI: 1.04–2.83), unemployment (OR = 1.88, 95%CI: 1.29–2.75) and insufficient energy intake (OR = 1.23, 95%CI: 1.02–1.50). The poor prognosis of sarcopenic obesity in the elderly in the community, including falls, disability, increased risk of hospitalization, and death, seriously affects their quality of life. Conclusions: The prevalence of sarcopenic obesity in the elderly in the community is relatively high. Age, gender, income level and other factors are closely associated with the occurrence of sarcopenic obesity and can lead to serious adverse consequences. It is recommended that primary medical institutions should focus on people at a high risk of sarcopenic obesity. Community medical personnel can formulate targeted prevention and control measures according to their associated factors to achieve early screening, diagnosis and intervention. Full article

Assistive bathing for the elderly and disabled presents significant challenges regarding caregiver workload and safety. This paper presents the design and verification of a multi-module integrated intelligent bathing assistance system. The system automates the entire bathing sequence through four coordinated modules: a robotic scrubbing unit, a climate-controlled cabin, a passive multifunctional wheelchair, and a multi-degree-of-freedom transfer device. A key innovation is the wheelchair’s passive design with an automated docking mechanism, ensuring safety in wet environments. Unlike existing commercial solutions and the existing literature, which primarily focus on fragmented, singular functionalities (such as transfer-only devices or fixed-spray cabins), the core advantage of the developed system lies in its holistic integration of safe physical transfer, adaptive robotic scrubbing, and microenvironment control into a seamless, unified architecture. Employing a modular and ergonomic approach, the system executes a predefined 12-step automated workflow. Experimental validation demonstrates an average bathing time of 16.6 min and a quantifiable 69.8% reduction in caregiver workload, confirming the system’s high efficiency and practical utility in alleviating caregiver burden. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common upper-extremity injuries in the elderly, with malunion leading to long-term pain and disability. This study aimed to compare the discriminative performance of the Cast Index (CI), Gap Index (GI), and Three-Point Index (TPI) for predicting malunion during follow-up after closed reduction and casting in elderly patients with dorsally displaced DRFs. Materials and Methods: This study retrospectively analyzed 274 patients aged ≥65 years (mean 73.6 ± 6.5 years) with dorsally displaced Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2R3A fractures treated conservatively between 2018 and 2023. Standard posteroanterior and lateral radiographs were evaluated immediately post-reduction, at 7–10 days, and at 4 weeks. Cast, Gap, and Three-Point Indices were measured independently by two observers, and the mean values were analyzed. Receiver operating characteristic (ROC) analysis was used to evaluate discriminative performance for the detection of malunion. Subgroup analyses were performed based on fracture stability according to La Fontaine criteria. Results: At the final follow-up, 136 fractures (49.6%) maintained acceptable alignment, while 138 fractures (50.4%) experienced malunion. There was no significant difference in radiographic parameters between groups immediately post-reduction or at 7–10 days. The Gap and Three-Point Indices were significantly higher in the malunion group at 7–10 days and at 4 weeks (p < 0.001), but the Cast Index showed no significant between-group difference. At 7–10 days, the Gap Index [Area Under the Curve (AUC) = 0.641; cut-off = 0.33] and the Three-Point Index (AUC = 0.640; cut-off = 1.51) demonstrated modest discriminative ability. In stable fractures, both indices were statistically significantly higher in the malunion group, whereas in unstable fractures, only the Three-Point Index was statistically significantly higher in the malunion group (p < 0.001). Conclusions: The Gap and Three-Point Indices showed greater discriminative ability than the Cast Index for malunion after conservative management of DRFs in elderly patients. Thresholds of GI ≥ 0.33 and TPI ≥ 1.51 at 7–10 days may serve as practical quantitative indicators to identify patients who may warrant closer follow-up and possible cast reassessment in conjunction with standard radiographic assessment and clinical judgment. Full article

In home-based elderly care, nursing beds play a crucial role in the daily lives of older adults. However, most existing nursing beds are designed for general patients, neglecting the specific needs of people with disabilities and their caregivers. To enhance user satisfaction with nursing beds, this study proposes a conceptual design approach based on a KANO-AHP integrated model based on behavioral design. First, the needs of caregivers and people with disabilities are identified through behavioral observations and in-depth interviews. The Fogg Behavior Model is then applied to translate these behavioral insights into extractable design elements, which are subsequently classified and prioritized systematically using the Kano model. Subsequently, the Analytic Hierarchy Process is employed to screen the most critical needs from the extracted ones and transform them into key design elements, thereby defining the structural components of the product. This integrated approach enables an accurate mapping from user requirements to design elements, thereby facilitating the development of nursing beds for people with disabilities. This study demonstrates the feasibility and effectiveness of the KANO-AHP model in design research for the aging population, offering valuable guidance and an innovative perspective for nursing bed design. Full article

Public bus systems are vital to achieving sustainable urban mobility in developing countries; yet, the quality of bus stops, a critical interface between users and transit services, remains widely overlooked. This study evaluates bus stop quality in Sulaymaniyah, Iraq, from bus users’ perspectives by integrating importance–performance analysis (IPA) and the customer satisfaction index (CSI) with level of conformity analysis (CR) using extensive, real-world survey data. The objective was to identify priority areas to help improve the quality of public bus stop provision in the city and ensure the most efficient allocation of resources by focusing on the quality attributes that matter most to bus users. The results highlight six critical service quality attributes that require immediate improvement due to their high importance to users and low service quality performance: (i) safety barriers to prevent traffic accidents while waiting at bus stops; (ii) accessibility of bus stops for elderly and disabled users; (iii) availability of signage and timetables/maps; (iv) overall bus stop quality; (v) narrow bus stop platforms; and (vi) waiting time at bus stops. Addressing these gaps is essential to enhance user satisfaction and ensure that users have a safer, more inclusive, and reliable PT experience. This study offers evidence-based recommendations to enhance bus stop design and service quality, thus contributing to improved user satisfaction and increased ridership. More broadly, the results can be applied to other rapidly urbanizing developing cities seeking to provide equitable, safe, and user-centered bus transit systems. Full article

Stroke is a major global health concern, particularly among the elderly, who frequently present with multiple comorbidities, most notably cardiovascular diseases. Importantly, atrial fibrillation confers a nearly fivefold increase in stroke risk and accounts for up to one-quarter of ischemic strokes in older adults. Stroke is a neurological disease characterised by a strong cardiovascular interplay, and its multifactorial nature requires an integrated preventive approach. This review focuses on primary and secondary prevention in this population, with a frailty-informed perspective. We synthesise evidence on blood pressure control, lipid-lowering (including LDL-C targets), glycemic management, and antithrombotic strategies—particularly oral anticoagulation for atrial fibrillation—as well as the role of frailty indices in guiding individualised risk–benefit decisions. We also discuss practical care pathways, including structured post-discharge programs, continuity of care, and the need for multidisciplinary collaboration involving cardiologists, neurologists, and primary care. We highlight how frailty indices refine risk–benefit assessments without justifying therapeutic nihilism, and how sex- and age-related factors shape treatment effectiveness and safety. By narrowing scope and emphasising practical, multidisciplinary prevention strategies, this review aims to support clinicians in reducing recurrent events, disability, and mortality in very old patients. Future work should prioritise pragmatic trials, including those involving the oldest old and the use of standardised frailty metrics, to inform prevention decisions. Full article

Dementia, a major cause of dependency, disability, and mortality, is characterized by a progressive cognitive decline. Alzheimer’s disease, a major neurodegenerative dementia, primarily affects the elderly. This study aimed to investigate the antioxidant and neuroprotective potential of plant phytoconstituents for the treatment of Alzheimer’s disease. Phytoconstituents of Colebrookea oppositifolia Sm. were investigated using aerial and root extracts. The antioxidant potential of the plant phytoconstituents was assessed using in vitro antioxidant assays such as 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and Ferric-Reducing Antioxidant Power (FRAP) assay. The plant extract (root) showed significant antioxidant potential. Additional studies are underway to comprehensively evaluate its potential applications. Full article

In indoor environments, the elderly, children, and people with disabilities are prone to abnormal behaviors like violent injuries and falls, threatening their health and safety and requiring real-time technical monitoring. However, existing technologies face issues including target occlusion, heavy background interference, feature ambiguity, posture deformation, and large-scale differences when detecting such behaviors in complex scenarios. To tackle these challenges, the present study puts forward the SCGS-YOLO real-time algorithm by improving YOLOv8s: replacing its backbone with ShuffleNet V2 to improve inference efficiency in resource-constrained environments; integrating CBAM into its backbone and SimAM into the feature fusion module, strengthening key features via dual-stream attention to suppress background interference and alleviate occlusion ambiguity; and using GIoU as the positioning loss function to facilitate model convergence and improve localization precision for complex human postures. Experiments on self-built VD-2025 and FD-2025 datasets show that SCGS-YOLO achieves 98.20% precision, 96.10% recall, and 98.70% mAP@0.5 for violence detection, and 97.10% precision, 93.80% recall, and 96.70% mAP@0.5 for fall detection. Compared to the original YOLOv8s and several representative models, it effectively balances detection precision and real-time response for the aforementioned groups’ indoor abnormal behaviors. Full article

Background: Stroke and subclinical cerebral ischemia remain important neurological complications of transcatheter aortic valve replacement (TAVR). The Sentinel cerebral embolic protection (CEP) device is designed to capture embolic debris during TAVR, but its impact on clinical and imaging outcomes remains incompletely characterized. Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing Sentinel CEP versus no protection when TAVR was performed. Outcomes of interest included all stroke, disabling stroke, infarct volume by diffusion-weighted MRI in protected and unprotected areas, all-cause mortality, acute kidney injury, and major vascular complications. Risk ratios (RRs) and median differences with 95% confidence intervals (CIs) were calculated using random-effects models and trial sequential analysis (TSA) assessed evidence robustness. Results: Four RCTs including 10,986 patients were analyzed. Sentinel CEP did not significantly reduce clinical stroke (RR 0.88, 95% CI 0.69–1.12) or disabling stroke (RR 0.68, 95% CI 0.41–1.14). Pooled DW-MRI data showed a significant reduction in new ischemic lesion volume within Sentinel CEP-protected territories (difference in medians −75.7 mm³; 95% CI −130.4 to −21.0). Subgroup analyses in elderly, female, and high-surgical-risk patients revealed no benefit with Sentinel CEP. Additionally, TSA indicated that current data are underpowered for definitive conclusions. Conclusions: The Sentinel CEP device during TAVR did not significantly reduce clinical stroke but was associated with lower MRI-detected ischemic lesion volumes compared with no protection. Further adequately powered RCTs integrating clinical and imaging endpoints are needed to define its role in neuroprotection during TAVR. Full article