Search Results (577)

Background and Objectives: A relationship between cognitive decline (CD) and chronic coronary syndrome (CCS), common among the elderly population, has not yet been clearly established. Our study aims to evaluate the link between severe cognitive impairment and cognitive impairment, as measured by various neuropsychological tests in patients with or without CCS. In addition, we sought to identify cardiovascular risk factors (CVRFs) that influence the severity of CD and severe cognitive impairment. Materials and Methods: This observational study was conducted on 264 people with CVRFs. Of the 264, 132 were classified as patients with CCS and 132 as control subjects without CCS. Neuropsychological assessment tools included the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) scales, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale (GDS-15). Clinical characteristics, echocardiographic measures, and vascular parameters of all subjects were also evaluated. Results: Patients with CCS had significantly lower cognitive performance (MMSE, p = 0.010; MoCA, p = 0.021), reduced functional status (IADL, p = 0.030; ADL, p = 0.012), and higher depression scores (p = 0.004) compared with controls. They also had worse cardiovascular profiles, including lower left ventricular ejection fraction (LVEF) (p = 0.001), higher NT-proBNP levels (p = 0.005), and increased carotid intima-media thickness (IMT) (p < 0.05). IMT and blood pressure values were negatively correlated with cognitive and functional scores and positively correlated with depression severity (p < 0.001). Multivariate analysis identified systolic and diastolic blood pressure, age, body mass index, heart rate, reduced daily activity, and depression as independent predictors of cognitive decline in patients with CCS. In the GDS-15 score, each unit increase was associated with a 32.1% higher risk of cognitive decline and a 37.1% higher risk of MMSE-defined severe cognitive impairment, while improved ADL scores significantly reduced this risk. Conclusions: CCS is associated with an increased risk of severe cognitive impairment and also with cognitive decline, influenced by hypertension, subclinical atherosclerosis, depression, and reduced functional status. These findings emphasize the importance of early identification and multidisciplinary management of cognitive impairment in patients with CCS to prevent progression to severe cognitive impairment. Full article

Population aging has increased the importance of identifying modifiable lifestyle factors that promote psychological well-being and support brain health in later life. Aerobic exercise has consistently been associated with positive mental health outcomes; however, further evidence is needed regarding its relationship with depressive symptoms, purpose in life, and quality of life among community-dwelling older adults. The present study aimed to investigate the associations between aerobic exercise, depression, purpose in life, and quality of life in older adulthood, as well as their implications for healthy aging and brain health. A cross-sectional quantitative design was employed involving 151 older adults aged 65 years and older. Participants were recruited from Open Care Centers for the Elderly (KAPI) in the Municipality of Corinth, Greece, and through home visits in nearby communities. Data collection was conducted using the Purpose in Life Questionnaire–Short Form (PIL-SF), the Geriatric Depression Scale–Short Form (GDS-SF), and the WHOQOL-OLD Brief Form. Statistical analyses were performed using IBM SPSS Statistics, while non-parametric analyses were applied due to deviations from normality. The findings demonstrated that a higher frequency of aerobic exercise was significantly associated with lower depressive symptomatology, higher levels of purpose in life, and better quality of life. Participants who exercised almost daily reported significantly fewer depressive symptoms compared with those who exercised rarely or not at all. Furthermore, depressive symptoms were negatively correlated with both purpose in life and quality of life, whereas purpose in life was positively associated with quality of life. Gender differences were also observed, suggesting that the relationship between exercise and depressive symptoms may vary between men and women. Overall, the findings suggest that regular aerobic exercise may represent an important protective lifestyle factor associated with emotional well-being, psychological resilience, quality of life, and healthy aging among older adults. The study further supports the role of physical activity as a potentially beneficial non-pharmacological strategy for promoting mental health and supporting brain health in later life. Full article

Background and Objectives: Elderly patients with head and neck tumours frequently present with multiple comorbidities and a potentially difficult airway, making general anaesthesia high-risk. Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, provides conscious sedation without clinically significant respiratory depression, offering a compelling locoregional alternative. This study evaluated the haemodynamic profile, sedation kinetics, and satisfaction outcomes of a standardised dexmedetomidine-based protocol for head and neck surgery under local infiltration anaesthesia. Materials and Methods: A prospective, single-centre observational study was conducted at the University Hospital Centre Zagreb. Twenty-three consecutive adult patients received a continuous dexmedetomidine infusion at 0.5 μg/kg/h, initiated preoperatively in the post-anaesthesia care unit without a loading dose. Haemodynamic parameters, sedation-to-incision interval, cumulative dose, and postoperative patient and surgeon satisfaction (NRS 1–10) were recorded. Spearman rank-order correlation and the Mann–Whitney U test were used for statistical analysis. Results: The primary outcome of haemodynamic stability—defined as the absence of vasoactive or inotropic rescue—was achieved in all 23 patients (100%). The median cumulative dexmedetomidine dose was 52 μg (IQR 44–68 μg). Controlled hypotension was achieved in all patients, with a median nadir systolic blood pressure of 98 mmHg. Supplemental oxygen was required in only 2 of 23 patients (8.7%). Patient and surgeon satisfaction reached a median NRS score of 10 in both groups. The sedation-to-incision interval correlated with total drug dose (ρ = 0.74, p < 0.001), consistent with fixed-rate infusion pharmacokinetics. Hypertensive patients exhibited a greater reduction in systolic blood pressure (median 45 vs. 28 mmHg; p = 0.015). Conclusions: A fixed-rate dexmedetomidine infusion initiated in the post-anaesthesia care unit provides a feasible and potentially effective conscious sedation strategy for head and neck surgery under local infiltration anaesthesia in selected elderly and comorbid patients. In this pilot series, the protocol was associated with haemodynamic stability in all cases, low supplemental oxygen requirements, and high procedural satisfaction among both patients and surgeons. These findings are preliminary and require confirmation in larger, controlled studies. 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

Background: Penetrating keratoplasty (PK) is a technically demanding corneal transplant procedure frequently performed in elderly patients with substantial systemic comorbidities. In this population, an anesthetic strategy that ensures hemodynamic stability, cooperative sedation, adequate analgesia, and preserved spontaneous ventilation is highly desirable. Dexmedetomidine, a highly selective alpha2-adrenergic agonist, provides “cooperative” sedation with minimal risk of respiratory depression and additional sympatholytic benefits. Methods: This single-center retrospective observational case series included 50 consecutive patients (American Society of Anesthesiologists [ASA] II–III, age 50–90 years) undergoing PK under sub-Tenon block combined with continuous dexmedetomidine infusion. Dexmedetomidine was administered without a loading bolus at 0.7 mcg/kg/h for 10–15 min, then reduced to 0.5 mcg/kg/h, targeting a Ramsay Sedation Scale (RSS) score of 2–3. The sub-Tenon block was performed using a mixture of levobupivacaine 0.5% and lidocaine 2% (3–5 mL). Heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂) and RSS were recorded in nine predefined perioperative phases. Data were analyzed descriptively. Results: The mean age was 72 ± 9 years; 52% of patients were ASA III. Hypertension was present in all patients; 30% had cardiovascular disease, 28% diabetes mellitus type II, and 30% chronic obstructive pulmonary disease. Progressive, controlled bradycardia was observed (mean HR decreased from 76 to 57 beats/min during graft transplantation), while MAP gradually decreased from hypertensive baseline values (150–160 mmHg) to an optimal intraoperative range of 115–130 mmHg, without episodes of clinically significant hypotension. SpO₂ remained stable at 98–99% throughout all phases, with no episodes of desaturation or need for airway intervention or supplemental oxygen. Target sedation (RSS 2–3) was achieved in all patients (median RSS 3), with preserved spontaneous breathing and cooperation. Sub-Tenon block-related bulging occurred in 6% of cases. No episodes of clinically significant bradycardia, malignant arrhythmia, respiratory compromise, or need to discontinue dexmedetomidine were recorded. No opioids or non-steroidal analgesics were required intraoperatively or in the early postoperative period. Conclusions: The combination of sub-Tenon block and continuous dexmedetomidine sedation without a loading bolus represents a hemodynamically stable and respiratory-safe anesthetic strategy for PK in elderly, high-risk patients. These preliminary, hypothesis-generating findings suggest that the protocol provides stable surgical conditions and a favorable safety profile, justifying future prospective randomized controlled trials to establish its comparative efficacy against general anesthesia or standard sedative regimens. Full article

Background/Objectives: This study aims to evaluate the association between frailty syndrome and depressive symptoms within a cohort of patients with ischemic heart disease (IHD). Methods: This single-center cross-sectional study included 169 patients with IHD admitted for elective percutaneous coronary intervention. The median age was 68.00 [63.00–73.00] years; 59.7% of the patients were male. Frailty screening was performed using the European PRISMA-7 questionnaire, where a score of 3 or higher indicated a high probability of frailty. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The total GDS-15 score was interpreted as follows: 0–5 points indicated no depressive symptoms, 6–10 points indicated mild depression, and 11–15 points indicated severe depression. Results: The prevalence of frailty in the study cohort, based on the PRISMA-7 questionnaire, was 52.7%. The Geriatric Depression Scale (GDS-15) indicated a high probability of depressive symptoms in 19.5% of patients with IHD. The prevalence of depressive symptoms was significantly higher in frail than in non-frail patients. Furthermore, depressive disorders were 2.913 times more frequent among elderly frail patients with IHD compared to non-frail patients (95% CI: 1.262–6.725; p = 0.010). Correlation analysis confirmed a direct positive relationship between PRISMA-7 scores and GDS-15 scores (ρ = 0.392; p < 0.001). Conclusions: A significant association was identified between frailty and depressive symptoms in patients with IHD. Full article

Introduction: Obstructive sleep apnea (OSA) is highly prevalent, affecting up to 50% of individuals over 65 years. Elderly patients often present with atypical, fewer and less severe symptoms, suggesting age-specific phenotypes. However, comprehensive clinical phenotyping that incorporates cognitive outcomes remains limited. This study aimed to characterize OSA phenotypes through cluster analysis and evaluate their association with cognitive impairment, independently of age. Materials and Methods: Between 2020 and 2024, 409 adults with moderate-to-severe OSA were enrolled and stratified into three age groups (<65, 65–74, ≥75 years). All underwent home sleep apnea testing (HSAT), comprehensive symptom assessment, Epworth Sleepiness Scale (ESS), and Montreal Cognitive Assessment (MoCA, pathological ≤ 25 pts). Hierarchical cluster analysis (Ward’s method) used AHI, T90, BMI, and ESS. Logistic regression identified independent predictors of cognitive impairment. Results: Older groups showed lower BMI, higher comorbidity burden, fewer symptoms, and greater cognitive impairment prevalence (4.5% vs. 9.7% vs. 45.9%; p < 0.001), despite comparable polysomnographic severity across age groups. Cluster analysis identified three phenotypes: Cluster 1 (classical OSA: high AHI, BMI, T90, ESS); Cluster 2 (geriatric phenotype: low AHI, BMI, T90, ESS, highest cognitive impairment rate: 27.7%); Cluster 3 (hypersymptomatic: low AHI and T90, high sleepiness and asthenia, prevalent depression). On multivariate regression, age (OR 1.155; p < 0.001), male sex (OR 2.223; p = 0.034), and Cluster 2 (OR 3.131; p < 0.001) were independent predictors of cognitive impairment. Conclusions: Three clinically distinct OSA phenotypes were identified regardless of age and severity. The geriatric phenotype was associated with three-fold increased risk of cognitive impairment, supporting routine cognitive screening and age-adapted diagnostic strategies in elderly OSA patients. Full article

Background: Subthreshold depression is a prevalent condition among the elderly and often remains untreated due to the limited efficacy and poor tolerability of standard antidepressants. Choline alfoscerate, a cholinergic precursor, is indicated for the treatment of a condition, pseudodepression in the elderly, that is currently clinically classified as subthreshold depression in older adults. Also, choline alfoscerate has shown neuroprotective and antidepressant-like effects. Objective: This pilot study aims to evaluate the efficacy and safety of choline alfoscerate in elderly patients with subthreshold depressive symptoms, using contemporary diagnostic criteria and standardized outcome measures. Methods: Seventeen patients aged ≥65 years were enrolled in an open-label, single-arm study and received 1200 mg/day of choline alfoscerate for 8 weeks. Clinical and neuropsychological assessments were performed at baseline, after 4 weeks, and at the study’s end. Results: A statistically significant improvement was observed in depressive symptoms, as reflected by reductions in HAMD-17 (p < 0.001) and GDS-15 scores (p < 0.05), as well as in overall clinical severity assessed by the Clinical Global Impression–Severity scale (CGI-S, p < 0.05). No significant changes were noted in cognitive performance (MOCA) or apathy (AES-I). The treatment was well tolerated. Conclusions: Choline alfoscerate may represent a potentially safe and promising therapeutic option for subthreshold depression in older adults. However, given the exploratory nature of this open-label pilot study, these findings should be considered preliminary and hypothesis-generating and require confirmation in randomized controlled trials. Full article

Patients with chronic kidney disease (CKD) frequently experience depressive symptoms, which substantially impair their quality of life. To facilitate the early identification of high-risk individuals, this study aimed to develop a predictive model for assessing depression risk among CKD patients. This study was based on data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 wave, including 1777 middle-aged and elderly participants with self-reported CKD diagnosed by a physician. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D 10). A total of 29 variables were included, covering lifestyle factors, health status, comorbidities, and sociodemographic characteristics. The Elastic Net algorithm was employed to select 11 features with the highest predictive value. Seven machine learning models, including XGBoost and support vector machine (SVM), were compared, with CHARLS 2020 data used as a temporal validation set. In the multi-model comparison, XGBoost demonstrated discrimination performance comparable to logistic regression (LR), SVM, and multilayer perceptron (MLP) (DeLong test, p > 0.05). However, considering its superior calibration performance and ability to capture nonlinear interactions, XGBoost was selected as the final model. In the validation set, the model achieved an area under the curve (AUC) of 0.8017 and an accuracy of 72.39%. SHAP analysis further revealed the nonlinear effects of predictors, with life satisfaction, sleep duration, and self-rated health showing high contributions and negative associations with depression risk, whereas limitations in activities of daily living (ADL), physical pain, and digestive system diseases were significantly associated with an increased risk of depression. Overall, the risk of depression in CKD patients is influenced by multiple dimensions, including psychological cognition, quality of life, physical function, and social environment. The predictive model developed in this study may provide a valuable reference for the early screening of high-risk populations. However, its applicability to non-CKD populations requires further validation. Full article

Introduction: Previous research has shown that L-carnosine (β-alanyl-L-histidine) can reduce cognitive decline and improve mental health outcomes, but an updated systematic review of the effects of carnosine alone or in combination with other supplemental nutrients or bioactive compounds on these interconnected outcomes is lacking. Methods: We searched multiple databases from 1 January 2006 to 30 June 2025 for clinical trials evaluating the effects of all forms of carnosine (e.g., L-carnosine, zinc–L-carnosine) alone or in combination with other supplements on cognition, brain structure and function, mood, depression, or quality of life (QOL) outcomes. The Cochrane Risk of Bias (ROB) 2.0 tool was used to assess the ROB in randomized controlled trials (RCTs). When data were sufficient, random-effects meta-analyses were conducted. Strength of evidence (SoE) across studies was rated using the GRADE approach. Results: A total of 13 distinct studies (12 RCTs; 1 single-arm trial) involving healthy adults and patients with psychiatric or neurocognitive disorders were included. Studies were also heterogeneous in carnosine supplement dosage and duration. Overall 58% of included RCTs were rated ‘some concerns’ for ROB. Ten RCTs evaluated cognitive function, seven RCTs and one single-arm trial assessed mood and depression, four RCTs measured QOL, and three RCTs examined brain structure and function. Results from five RCTs found no significant differences in the majority of the cognitive function measures between L-carnosine supplement and placebo, but random-effects meta-analysis of three RCTs from a single research team found that anserine/L-carnosine supplementation significantly improved WMS-LM2 scores (pooled net change = 1.70; 95% CI 0.19, 3.2; I² = 58.3%) but not WMS–Local Memory Immediate Recall (LM1) scores (pooled net change = 0.76; 95% CI −0.18, 1.71; I² = 8.5%). Additionally, meta-analysis results showed that L-carnosine combined with anserine or antioxidant supplementation significantly improved the MMSE score compared to placebo (pooled net change = 0.62; 95% CI 0.23, 1.01), with small statistical heterogeneity (I² = 21.3%). Most of the studies did not show significant effects in a wide range of mood and depression outcome measures or health-related QOL (data cannot be meta-analyzed). Conclusions: A low strength of evidence suggests that L-carnosine supplement combined with anserine or antioxidants can slow cognitive function decline among healthy elderly or patients with probable Alzheimer’s Disease or mild neurocognitive disorder. More high-quality RCTs are needed to verify these findings and to improve the certainty level of this body of evidence. 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

Previous research has found an association between PM_2.5 exposure and worsening depression; however, studies specifically examining the harmful effects of individual PM_2.5 components are relatively limited. This national survey enrolled individuals aged 45 and older in mainland China, collecting personal data and assessing depression. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). Monthly exposure to PM_2.5 and its seven components—black carbon (BC), organic matter (OM), nitrate (NO₃⁻), sulfate (SO₄²⁻), ammonium (NH₄⁺), soil particles (SOIL), and sea salt (SS)—was matched to each participant’s residence. Linear mixed-effects models (LMEs) assessed the association between single pollutants and depression score, while weighted quantile sum (WQS) regression examined the effect of mixed exposure and identified the contribution of each component. Modifying effects of social activity and green space were also evaluated. A total of 9725 participants were included. In single-exposure models, each interquartile range (IQR) increase in PM_2.5 (29.18 μg/m³), BC (2.25 μg/m³), OM (7.18 μg/m³), SOIL (6.04 μg/m³), and SS (0.14 μg/m³) was significantly associated with an increase in depression score of 0.90 (95% CI: 0.59, 1.20), 0.71 (95% CI: 0.42, 1.09), 0.94 (95% CI: 0.61, 1.26), 0.51 (95% CI: 0.38, 0.63), and 0.53 (95% CI: 0.33, 0.73) points, respectively. In mixed-exposure models, each IQR increase in the mixture of all components was associated with a 1.104-point rise in depression score (95% CI: 0.901, 1.307), with BC having the largest weight (33.6%), followed by SOIL (28.59%) and SS (25.05%). The harmful effects of PM_2.5 and specific components on depression were lower among those who participated in social activities or lived in areas with higher levels of green space (p < 0.05). These findings suggest that the harmful effects of PM_2.5 on depression may be influenced by its components, and that social activity and green space could reduce the risk of depression associated with PM_2.5 and its components. Full article

Background and Objectives: The joint study of cerebral asymmetries and bipolar disorder (BD) has long attracted the interest of researchers and clinicians. Nevertheless, despite the increasing awareness of hemispheric asymmetries in BD, the combined investigation of these two constructs constitutes a relatively recent area of inquiry. The main objective of the present systematic review is to systematically examine the existing literature in order to identify, integrate and critically discuss evidence of hemispheric asymmetry in BD patients in terms of brain anatomy, physiology and neuropsychological function. The initial hypotheses support the presence of atypical cerebral asymmetry and differential hemispheric activation as a function of mood states in BD. Materials and Methods: Following the collection and analysis of numerous research papers through several databases and search engines, specific papers were identified and screened according to specified inclusion and exclusion criteria. Research papers on the adult bipolar population were included, while papers including comorbidity with other disorders, lesions, or an underage or elderly population, as well as meta-analyses and reviews, were excluded. This paper aligns with the procedures in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines, and was assessed for risk of bias according to the Cochrane guidelines by the Newcastle–Ottawa Scale (NOS). Results: A total of 56 papers were identified as eligible in this review. Despite inconsistent findings across the included studies, an emerging pattern suggests the presence of atypical hemispheric asymmetry in BD, both in terms of specific brain structures and functional activity. Moreover, several studies associate depressive states with increased activation of the right hemisphere, whereas manic states appear to be linked with increased activation of the left hemisphere. Conclusions: These findings support the aforementioned hypotheses and partly align with the theoretical framework of emotional laterality theories. However, although certain patterns were observed, a comprehensive understanding of functional hemispheric asymmetry in BD has not yet been achieved. The presence of contradictory findings highlights the need for further extensive and systematic research to improve understanding of this topic. Full article

Psychological factors such as depression, anxiety, and loneliness significantly affect sleep quality, particularly among elderly individuals living in nursing homes. This study aimed to examine the relationship between sleep quality and depression, anxiety, and loneliness among elderly residents of nursing homes in Indonesia, as well as to explore the underlying pathway mechanisms. A quantitative cross-sectional design was used to assess correlational relationships among elderly individuals residing in nursing homes in Jakarta and Tangerang. Data were analyzed using JASP statistical software through descriptive, bivariate, and path analyses. The results demonstrated significant associations between poorer sleep quality and higher levels of loneliness, anxiety, and depression. Path analysis revealed a significant chain mediation pattern, in which loneliness was associated with higher anxiety levels, anxiety was associated with depressive symptoms, and depressive symptoms were associated with poorer sleep quality (β = −0.040, p = 0.045). These findings indicate that sleep disturbances in the elderly are statistically associated with interconnected psychological factors, highlighting the importance of comprehensive psychosocial interventions to improve sleep quality in this population. Full article

Background: Propofol is widely used for anesthesia in colorectal cancer surgery, but is frequently associated with hypotension and respiratory depression. Remimazolam, a novel ultra-short–acting benzodiazepine, may offer improved hemodynamic stability with similar anesthetic depth and recovery characteristics. However, evidence directly comparing remimazolam and propofol in the setting of colon cancer surgery remains limited. Therefore, the aim of this study was to systematically evaluate the efficacy, safety, perioperative hemodynamic stability, and recovery outcomes of remimazolam versus propofol in older adults undergoing colon cancer surgery. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials and comparative cohort studies evaluating remimazolam versus propofol in adult patients undergoing colon or colorectal cancer surgery. PubMed, Scopus, and Web of Science were searched from the start of each database to October 2025. Outcomes included perioperative hemodynamics (MAP and HR), recovery parameters, intraoperative remifentanil consumption, anesthesia duration, and adverse events. Random-effect models were used to calculate pooled mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results: Six studies involving 542 patients (remimazolam n = 276; propofol n = 266) were included. Remimazolam produced significantly higher perioperative MAP (overall MD = 2.86 mmHg, 95% CI 1.52–4.21; p < 0.0001) and slightly higher HR (MD = 2.30 bpm, 0.08–4.52; p = 0.04). Differences were largest immediately after incision and at the end of surgery. No significant differences were found in PACU stay, overall recovery duration, remifentanil consumption, or anesthesia duration. Postoperative nausea and vomiting were comparable (RR = 0.93; p = 0.86), while respiratory depression was numerically lower with remimazolam (RR = 0.49; p = 0.17). Conclusions: Remimazolam provides anesthetic efficacy comparable to propofol in colon cancer surgery while offering modest, but clinically meaningful improvements in intraoperative hemodynamic stability. Recovery times, opioid requirements, and adverse-event rates were similar between agents. Remimazolam may be particularly advantageous for elderly or hemodynamically vulnerable patients undergoing major colorectal procedures. Larger, high-quality trials are warranted to clarify long-term and oncologic outcomes. Full article