Search Results (2,837)

Background/Objectives: Traffic accidents are a significant public health issue. Pedestrians are considered the most vulnerable victims, showing the highest mortality rates. Thus, mortality rate indicators reflect the effectiveness of policies and safety measures applied to urban mobility. Therefore, the study objective is to identify trends in pedestrian mortality to foster an understanding of the local reality and to propose effective interventions for the safety and mobility of this population. Methods: This ecological time-series study used secondary data from the Unified Health System Information System (DATASUS) on all traffic accident-related deaths in Espírito Santo, Brazil, from 2009 to 2020. Data were classified according to the 10th Revision of the International Classification of Diseases (ICD-10). Variables included sex (male; female), age group (in years: 0 to 80+), and victim type (pedestrian). Mortality rates were logarithmically transformed (base 10), and the Prais–Winsten regression model was employed using STATA 13.0. Results: A total of 1969 traffic accident-related deaths were recorded. Males accounted for 75% of deaths, individuals of mixed race (pardo) represented 57%, and 72% were unmarried. A significant reduction in mortality rates was observed across age groups, especially among individuals aged 0–24 years. Mortality trends remained stationary only among individuals aged 80 years and older. Overall, the mortality rate decreased throughout the study period, from 5.51 to 1.69 deaths per 100,000 inhabitants. Conclusion: Pedestrian mortality rates from traffic accidents in Espírito Santo showed a decreasing trend, particularly among children and young people, while remaining stable among the elderly. Full article

Background/Objectives: Age-related hearing loss (ARHL) is a common sensory impairment in the elderly, and its early prediction and intervention are crucial for improving the quality of life in older adults. This study aims to develop and validate an interpretable machine learning model based on routine blood biomarkers to predict the risk of ARHL occurrence. Methods: A total of 542 participants were selected from the National Health and Nutrition Examination Survey (NHANES) database, including 271 ARHL patients and 271 healthy controls. The samples were randomly divided into a training set (50%) and two independent internal validation sets (25% each). Through systematic comparison of 113 machine learning algorithm combinations, the optimal predictive model (glmBoost+Stepglm[forward]) was constructed, and the SHAP method was employed for feature interpretation. To evaluate the model’s generalization ability, external validation was further performed using a cohort of 92 cases from Chongqing People’s Hospital. Additionally, an openly accessible interactive prediction web page was developed based on the R Shiny framework, supporting real-time clinical risk assessment and visual interpretation. Results: The model achieved an AUC of 0.948 in the training set, with AUCs of 0.893 and 0.945 in two internal validation sets, respectively, and an overall accuracy rate of 86.3%. In the external validation cohort (albeit with a limited sample size of 92 from a single center), the model maintained good performance with an AUC of 0.839 (95% CI: 0.750–0.918) and an accuracy of 77.2%. The model identified nine key predictive features, with the top three being glycated hemoglobin (HbA1c), mean corpuscular volume (MCV), and blood glucose according to SHAP interpretability analysis. Conclusions: This study successfully developed and validated an interpretable machine learning model based on routine blood biomarkers for community-based risk stratification of age-related hearing loss. The model demonstrated robust performance in internal and external validations, including an age-matched elderly subgroup. An interactive web tool was developed to facilitate real-time risk assessment. While the model is intended as a prescreening tool for large-scale populations rather than a diagnostic test for age-matched individuals, it provides a novel approach for early identification of individuals at higher risk of ARHL and offers insights into its systemic pathogenesis. Full article

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

The Lazarus phenomenon (LP), also called auto-resuscitation, may happen after the end of ineffective cardiopulmonary resuscitation (CPR), or after death is confirmed in a person who did not undergo CPR, and heart activity returns spontaneously. The aim of the study was to focus on older individuals (aged >60) experiencing the LP and to analyse distractors that cause this phenomenon. Methods. PubMed, Scopus, and Web of Science electronic databases were searched to find cases of LP from the year 1982 until 31 December 2025. Of the 81 total cases found, 48 patients were included in the study. For the analysis they were divided into two subgroups dependent on age: No 1 (60–79), No 2 (≥80). Results. Based on the descriptive analysis, the causes of cardiac arrest were divided almost equally between cardiac and non-cardiac causes (47.6% and 52.3% respectively). Cardiac arrest occurred equally in the IH and OH. In 16 out of 37 cases where such data were reported, a return to consciousness was confirmed, representing 43.2%. Conclusions. In older people, even those of very advanced age, the Lazarus phenomenon may occur. Based on the analysis carried out and given the lack of available data and the small sample size (48 individuals), it is not possible at this stage to definitively identify the causes of LP in the elderly population. As a potential cause of LP, age-related changes should be taken into account. Given that LP also occurs in the older population, consideration should be given to the need for extended monitoring of vital signs following the declaration of death. With a view to raising awareness of LP, it seems appropriate to include information on this phenomenon in the CPR guidelines. Full article

Neuropharmacology has emerged in recent years as a field of active research, driven by the need to address increasing challenges posed by clinical conditions such as neurodegenerative disorders, which affect more and more elderly people worldwide as the average life expectancy extends progressively [...] Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

Home healthcare has recently been promoted in response to the increase in vulnerable people, such as elderly patients who can have difficulty accessing clinics and hospitals in Japan. A characteristic specific to home healthcare is that laboratory tests using specimens are conducted by transport from home to laboratory centers or by point-of-care testing at home. In this case, several issues can lead to inaccurate test values. This narrative literature review summarizes issues in the preanalytical process, a critical phase for ensuring the accuracy of laboratory tests. Specimen collection may not always be smooth in the pathological conditions of some elderly patients and/or in the non-clinic/hospital environments. The preservation of specimens, considering prolonged pre-centrifugation time and storage temperature, can alter the values of various analytes, including blood glucose, potassium, and lactate dehydrogenase. In addition, hemolytic phenomenon caused by insufficient specimen collection, vibration during specimen transport, and excessive milking during fingertip blood sampling can also be an issue. Awareness of the preanalytical process in testing specimens is important for obtaining accurate laboratory tests in home healthcare settings. This comprehensively summarized paper will be helpful in securing test quality and patient care. Full article

Background: The pivotal role of caregivers in HIV care for older people living with HIV (PLWH) stands in stark contrast to the scarcity of research on their experiences, particularly regarding affiliate stigma. Older PLWH face a unique intersection of HIV-related stigma and ageism, which may place their family caregivers at heightened risk of affiliate stigma. However, the manifestations, sources, and coping strategies related to this stigma remain poorly understood. Methods: The descriptive phenomenological study was conducted between May and June 2025 at an HIV care clinic of a tertiary hospital in Sichuan Province, China. Using purposive sampling, fifteen caregivers of elderly individuals living with HIV were recruited. Data were collected through face-to-face, semi-structured interviews. Results: Four overarching themes and eleven sub-themes were extracted: (1) sources of affiliate stigma—‘Inadequate knowledge of HIV transmission routes’, ‘Ageism’, and ‘Infidelity stigma’; (2) experiences of affiliate stigma—‘Stigma endorsement’, ‘Concealment of a family member’s HIV-positive status’ and ‘Psychological distress’; (3) consequences of affiliate stigma—‘Estrangement among family members’, ‘Substantial caregiver burden’ and ‘Social avoidance’; and (4) coping with affiliate stigma—‘Enhancing knowledge of HIV/AIDS’ and ‘Seeking social support’. Conclusion: This study investigates affiliate stigma among caregivers of older people with HIV. Healthcare providers should recognize this stigma and its negative effects. Effective interventions must be developed to alleviate this burden, thereby improving the welfare of both caregivers and patients. Full article

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of permanent deterioration of central vision in elderly people. While anti-VEGF therapy remains the standard of care for neovascular AMD, disease progression and functional deterioration remain common. Methods: This pilot prospective controlled study evaluated the effects of an individualized dietary intervention in patients with neovascular AMD receiving anti-VEGF therapy. A total of 43 patients completed a six-month follow-up and were divided into a control group (standard treatment) and an intervention group receiving a personalized dietary plan. Anthropometric and body composition parameters were assessed using bioelectrical impedance analysis (BIA). Clinical retinal outcomes were classified as improvement, no change, or deterioration. Statistical analyses included parametric and non-parametric tests. Results: Retinal outcomes did not differ significantly between groups, although patients with retinal improvement or stabilization in the intervention group tended to exhibit more favorable changes in body composition. After adjustment for baseline values using analysis of covariance (ANCOVA), the dietary intervention remained significantly associated with reductions in body weight and BMI (p < 0.01). After 6 months, the intervention group demonstrated a numerically higher frequency of retinal improvement and a lower frequency of retinal deterioration compared with the control group; however, these differences were not statistically significant (p = 0.386). Conclusions: An individualized dietary intervention effectively improved body composition in patients with neovascular AMD but did not produce a statistically significant effect on retinal status over six months. Nevertheless, the dietary intervention group showed numerically more favorable retinal outcomes than the control group. Dietary modification may support general health and weight management. Full article

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

Background/Objectives: Anxiety disorders in people over 65 y of age are common. Treatment of those disorders is often based on studies involving much younger patients. Experience shows that those treatments are regularly ineffective in the elderly, due to differences in physiology and the disparate etiology of the disease. Here, we examine current trends in research to generate data for evidence-based approaches to treat anxiety disorders in the elderly. Our objective was to evaluate the scope, methodological characteristics, and therapeutic focus of current clinical trials for anxiety disorders in the elderly, and to determine whether the existing evidence pipeline is likely to meet the substantial unmet need for effective and well-tolerated treatments. Methods: We searched clinicaltrials.gov for studies addressing “Anxiety disorder” and related readouts and selected those studies that included patients older than 65 y, and that had anxiety measures as primary or secondary endpoints. Results: We find that over 99% of clinical “anxiety” trials exclude patients older than 65 y. Sixty-six trials fulfilled our inclusion criteria. Trials specifically recruiting the elderly are a rare exception. Unexpectedly, only 10 “anxiety” trials are sponsored by the pharmaceutical industry, despite the potential rewards in such investments. Discussion and Conclusions: Although most clinical trials are registered in clinicaltrials.gov., our work is limited by the fact that not all clinical trials carried out world-wide are included in that database. Our findings indicate that ongoing clinical research supporting evidence-based recommendations for the treatment of anxiety in the elderly is scarce. Detailed secondary analysis of clinical trial results for the efficacy and safety of anxiolytics in various age cohorts may at least be a useful instrument for hypothesis generation, to trigger additional clinical research specifically designed to address anxiety treatment in the elderly. Full article

Background: The role of healthcare workers (HCWs) is crucial in promoting and educating about sustainable behaviors. This study aimed to assess Italian HCWs’ knowledge, attitudes, practices, and educational role regarding climate change and its health implications. Methods: A cross-sectional study was conducted from May to December 2024. Results: Among the 564 HCWs who participated, 45% and 40.3% considered climate change very important and urgent, respectively. Nurses, who had at least one chronic disease, who self-assessed their knowledge of climate change as good/very good, who needed additional information, and those who knew that problems in global food supply are consequences of climate change were more likely to consider it an urgent problem. Women, those married/cohabitant, and who knew that the spread of infectious diseases, problems in the global food supply, water scarcity or clean water conservation were consequences of climate change, were more likely to believe that climate change is causing health problems. Men, who had at least one chronic disease, who knew that infants/children, elderly and people with multiple medical conditions are more sensitive to climate change, those very scared of climate change, and who received information in training courses were more likely to educate patients for improving sustainability and health protection. Conclusions: Tailored training and integrating sustainability for HCWs could significantly support the health sector in adapting in climate change mitigation. Full article

Background/Objectives: The growing elderly population and concomitant increase in physical activity of older adults has led to a growing number of seriously injured elderly patients. The aim of this retrospective cohort study was to investigate the influence of the leading region of injury in severely injured patients on the risk of mortality in different age groups, with focus on elderly patients. Methods: Data from the TraumaRegister DGU^® from 2015 to 2020 were analyzed, including severely injured patients admitted to Swiss, German and Austrian trauma centers. Inclusion criteria were a minimum age of 18 years and an Abbreviated Injury Scale (AIS) score of three or higher in at least one of the body regions. Descriptive analysis and odds ratios for mortality derived from multivariable analysis were calculated, stratified by age and leading region of injury. Results: Out of 213,216 patients, 98,481 met the inclusion criteria. Mortality increased from 6.9% in the control group (18–54 years) to a maximum of 35.9% in the 90+ age group. Leading head injuries had a mortality rate of 22%. The odds ratio for the risk of mortality increased with age and reached a maximum value of 17.0 in the 90+ age group. However, the increase in risk of mortality for leading head injury with increasing age was lower than in the other regions, with an OR of 11.7 in the 90+ age group. In contrast, the group with a leading thoracic injury increased to an OR of 22.5, abdomen to an OR of 75.2 and extremities to an OR of 28.7. Conclusions: The risk of mortality from traumatic head injury is less pronounced in elderly people compared to other injury regions. Our data suggests that traditional scoring systems like the AIS might not display nuances of different injury severities in different age groups, especially for head injuries caused by low-energy trauma and therefore should be reevaluated. Full article

Elderly individuals in rural China are highly vulnerable to extreme weather events and temperature fluctuations due to inadequate infrastructure in the built environment and constrained economic conditions, thereby increasing their health risks. Outdoor spaces represent one of the primary daily activity settings for rural older adults. However, existing research rarely links spatiotemporal patterns of outdoor activities to evidence-based thermal environment optimization, leaving a critical knowledge gap for age-friendly and sustainable rural design. This study focuses on the spatiotemporal differentiation patterns of daily outdoor activities among elderly people aged 60 years and above in rural Xi’an, as well as the optimization of spatial variations in thermal environments. Using on-site interviews, thermal environment measurements, thermal comfort questionnaires, continuous thermal environment monitoring, and machine learning based on random forest, this study drew the following conclusions: (1) outdoor activities in winter were concentrated between 9:00–11:00 and 13:00–17:00, while in summer, they shifted to the morning and evening periods, namely 6:00–9:00 and 17:00–21:00. (2) Models for outdoor clothing adjustment, thermal sensation, and thermal acceptability among elderly residents were established. The calculated neutral temperature was 10.19 °C, with a 90% outdoor thermal acceptability range of 9.6–27.2 °C and an 80% outdoor thermal acceptability range of 6.2–30.6 °C. These findings differ from those documented in regions with distinct climate zones and geographical settings. This discrepancy stems from regional climatic features, lifestyle variations between urban and rural older adults, and differences in the thermal environment quality of elderly-oriented outdoor activity spaces. (3) In winter, the acceptable period of the Universal Thermal Climate Index (UTCI) at south-facing entrances (10:30–16:30) was significantly longer than that in the courtyard (13:30–14:00). In summer, the comfortable period in the courtyard (before 10:00 and after 20:00) was longer than that at north-facing entrances (before 09:00). A random forest model for thermal sensation was established, and the relative importance of each parameter influencing thermal sensation was analyzed. On this basis, priority improvement pathways and strategies for the thermal environment, as well as suggestions for the subjective adaptive behaviors of elderly residents, were proposed. The research results of this study can provide technical solutions for age-friendly thermal environment design in rural areas, thereby safeguarding the comfort, health, and social well-being of the elderly population in rural areas. Full article

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. Full article