Search Results (4,361)

Cardio-oncology has emerged as a critical discipline addressing cardiovascular toxicities from cancer therapies, yet substantial evidence gaps persist for elderly patients, who represent over 60% of new cancer diagnoses. This narrative review synthesizes the current literature on cardio-oncology challenges in older adults (≥65 years), highlighting underrepresentation in clinical trials, compounded risks from frailty, multimorbidity, and polypharmacy, and the paucity of geriatric-specific guidelines. Older adults exhibit heightened susceptibility to cardiotoxicity from antineoplastic therapies due to age-related declines in cardiac reserve and renal function, and baseline atherosclerosis. Comprehensive geriatric assessments (CGA) identify frailty as a key predictor of adverse outcomes, yet their integration into cardio-oncology protocols remains inconsistent, with limited prospective data on risk-stratification tools such as echocardiography and biomarkers. Observational studies underscore disparities in surveillance and management, leading to the undertreatment of cancer and overtreatment of comorbidities. Current cardio-oncology guidelines recognize older age, multimorbidity, frailty, and individualized assessment as important considerations in clinical decision-making. However, validated geriatric-specific thresholds, surveillance strategies, and management algorithms remain limited, particularly for frail older adults and the oldest-old populations. Emerging priorities include multidisciplinary models incorporating geriatricians, randomized trials in frail populations, and real-world evidence on novel agents. This review advocates tailored strategies to optimize shared decision-making, enhance equity, and address current knowledge gaps through CGA-driven research, while proposing a pragmatic age- and frailty-stratified framework to support individualized cardiovascular assessment in elderly cancer patients. Full article

Background/Objectives: Enhanced Recovery After Surgery (ERAS) has substantially advanced perioperative care across multiple surgical disciplines. Research in colorectal surgery has clearly demonstrated the effectiveness of ERAS programs; however, evidence regarding the application of these protocols in elderly patients undergoing upper gastrointestinal (GI) surgery remains limited. This population has a high prevalence of multimorbidity, frailty, and diminished physiological reserve, factors that collectively increase vulnerability to postoperative complications and may influence adherence to ERAS pathways. Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. The search identified randomized controlled trials (RCTs), observational studies, meta-analyses, and clinical guidelines evaluating ERAS protocols in elderly patients undergoing upper GI surgery. Results: Available evidence indicates that ERAS protocols are feasible and safe in elderly patients undergoing upper GI surgery, including gastrectomy and esophagectomy. Studies consistently associate their implementation with shorter hospital stays, faster gastrointestinal recovery, and no significant increase in postoperative complications or readmission rates. However, heterogeneity in study designs, ERAS components, and definitions of ‘elderly’ limits comparability across studies. Conclusions: ERAS protocols represent a promising perioperative strategy for elderly patients undergoing upper GI surgery. When implemented within a multidisciplinary framework and tailored to patients’ frailty and comorbidities, these protocols may improve postoperative recovery while maintaining safety. Future research should prioritize multicenter RCTs to identify the most effective ERAS components and evaluate long-term clinical and functional outcomes in this population. Full article

Background: Population aging is intensifying the burden of cognitive decline and dementia, while sustainability is becoming central to how health and care systems respond; yet the research at the intersection of these two agendas has not been mapped. Methods: A bibliometric and thematic analysis was conducted on 1100 documents retrieved from the Web of Science Core Collection and Scopus (2000–2026) and analyzed with the bibliometric package, combining performance analysis, science mapping, and an interpretive labelling of the keyword co-occurrence clusters. Results: The literature grew rapidly (19.9% annual growth) and was concentrated in high-income countries, with the United States and the United Kingdom as the leading collaborators. Four themes were identified: multidomain lifestyle prevention of dementia and mental health; the cognitive health continuum; caregiving and sustainable care delivery for the oldest old; and sustainability as a transversal, foundational dimension. Sustainability appeared as a basic, transversal theme rather than an explicit research focus, and quality of life recurred across the themes. Conclusions: Research on elderly brain care rests on a largely implicit foundation of sustainability. Making sustainability explicit, linking brain health to healthy–longevity and brain–capital frameworks, and broadening participation beyond high-income settings are the field’s main priorities. Full article

Rapid urban population aging and increasing land constraints pose significant challenges for improving both service coverage and spatial equity in elderly care facility planning. This study develops an integrated optimization framework that simultaneously addresses accessibility, efficiency, and equity in the spatial allocation of elderly care facilities. First, an improved Gaussian Two-Step Floating Catchment Area (G2SFCA) method is employed to evaluate accessibility patterns across multiple facility types under both walking and driving scenarios. Second, resource allocation equity is quantified using Lorenz curves and spatial Gini coefficients to identify mismatches between elderly care supply and population demand. Building upon these analyses, a fairness-oriented maximum covering location model—termed the Equity Maximum Covering Location Problem (EMCLP)—is formulated and further transformed into a Markov Decision Process. A deep reinforcement learning-based algorithm is subsequently designed to solve the EMCLP under complex spatial constraints. Experiment results demonstrate that the proposed approach achieves improved computational efficiency while maintaining robust solution quality, and effectively enhances service provision in underserved areas through differentiated functional allocation strategies. Full article

As global aging accelerates, identifying age- and lifestyle-associated gut microbiota alterations has become critical for understanding healthy aging and microbiota-targeted interventions. To explore the associations of age and lifestyle factors with gut microbiota profiles in community-dwelling adults, 159 Chongqing residents were divided into young (18–39, n = 44), middle-aged (40–59, n = 71) and elderly (60–89, n = 44) groups. Fecal samples were analyzed by 16S rRNA gene sequencing, and lifestyle factors were assessed using a study-specific structured questionnaire. The Shannon index differed significantly between the young and middle-aged groups (p < 0.05), whereas other α-diversity and β-diversity analyses showed no significant differences. Age-related shift trends included decreased Bacillota and increased abundance of Bacteroidota. Young adults were enriched in Parasutterella, the [Eubacterium] ventriosum group and Anaerostipes; middle-aged adults were enriched in Clostridium sensu stricto 4, Clostridium sensu stricto 1 and Holdemanella; and elderly adults were enriched in Prevotellaceae UCG-004, Helicobacter, Lactobacillus, Streptococcus and Fusobacterium. Lifestyle factors were independently associated with specific microbial signatures, including tea-related enrichment of Catenibacterium and Escherichia–Shigella, exercise-related enrichment of Dialister and Bavariicoccus, and milk-related enrichment of Bacillus and Klebsiella (formerly Raoultella). Overall, these findings provide population-based evidence linking age and lifestyle factors with gut microbial profiles and may inform microbiota-targeted strategies for healthy aging. Full article

Background and Objectives: Urinary tract infections are common in clinical practice, but in hospital settings, especially among older and catheterized patients, the microbial ecology and resistance burden may differ substantially from community-acquired infections. Local surveillance is therefore essential to support appropriate empirical treatment and antimicrobial stewardship. The objective is to describe the microbiological epidemiology of urinary isolates in a tertiary hospital and evaluate temporal trends in antimicrobial resistance among the most frequently isolated microorganisms. Materials and Methods: This retrospective observational study analyzed microbiology laboratory data from Tor Vergata University Hospital, Rome, Italy, collected from January 2022 to June 2025. After WHONET-based deduplication using a 30-day repeat-isolate rule, 5788 deduplicated urinary isolates and 85,888 microorganism–drug associations were included. Descriptive analyses, cumulative antibiograms/antimycograms, and quarterly resistance trends were assessed using univariable and multivariable regression analyses. Results: The population was predominantly elderly, inpatient, and catheter-exposed. Gram-negative organisms predominated, followed by Gram-positive bacteria and fungi. The most frequent isolates were E. coli, K. pneumoniae, E. faecalis, and C. albicans. Although microorganism distribution remained broadly stable over time, resistance increased in several clinically relevant organism–drug combinations, especially among major Enterobacterales. Conclusions: In this high-complexity hospital population, urinary isolates showed a relatively stable microorganism distribution but progressive changes in susceptibility among selected urinary isolates. These findings support setting-specific microbiological surveillance and stewardship-informed empirical treatment strategies. Full article

Background: Insulin resistance (IR) indices—C-reactive protein–triglyceride–glucose index (CTI), triglyceride–glucose (TyG) index, and weight-adjusted waist index (WWI)—are linked to cardiovascular disease (CVD), but their comparative utility in prediabetic populations remains unclear. To evaluate the associations and exploratory mediating roles of CTI, TyG and WWI with prevalent CVD in middle-aged and elderly patients with prediabetes. Methods: The study included 3121 NHANES participants aged ≥45 with prediabetes. Four machine learning algorithms identified key variables. Multivariable logistic regression and restricted cubic spline analyses examined the associations between IR and CVD. Model performance was assessed via receiver operating characteristic curves, net reclassification improvement, integrated discrimination improvement, calibration, and decision curve analysis. Subgroup analyses tested robustness. Mediation analysis assessed the mediating roles of IR in the WWI–CVD relationship. External validation used CHARLS. Results: Individuals in the highest tertiles of TyG, TyG–WWI, and CTI had approximately twofold higher CVD risk (ORs: 1.80–1.97). RCS showed a significant linear increase in CVD risk with higher IR index levels. In fully adjusted models, AUCs improved markedly over baseline: TyG–WWI 0.771 vs. 0.579. Mediation analyses indicated that CTI and TyG mediated 22.13–26.30% of the WWI–CVD association. Subgroup analyses and external validation in CHARLS supported the robustness. Conclusions: IR, as captured by TyG, TyG–WWI, and CTI, independently elevates CVD risk among middle-aged and older adults with prediabetes. WWI is associated with greater odds of prevalent CVD, potentially driven by adiposity accumulation, with CTI and TyG partially mediating this effect. Full article

α-Linolenic acid (ALA) is an essential omega-3 polyunsaturated fatty acid, yet how dietary ALA enrichment interacts with population-specific gastrointestinal physiology to dictate bioaccessibility and lipid peroxidation remains insufficiently understood. This study systematically evaluated the in vitro digestive behaviors and oxidation risks of flaxseed oils containing 52% and 68% ALA using simulated models representative of distinct population groups (infants, adults, and the elderly). Digestive efficiency peaked in the adult model, achieving ALA bioaccessibility of 49.2% (52% ALA oil) and 46.5% (68% ALA oil), significantly outperforming those observed in infants (23.1% and 19.5%) and the elderly (39.4% and 37.3%). Crucially, malondialdehyde (MDA) accumulation directly correlated with digestive lipolysis efficiency across population groups, reaching its maximum in adults (5.00 nmol/mL for 52% ALA oil; 7.54 nmol/mL for 68% ALA oil), followed by the elderly (3.06 nmol/mL and 4.02 nmol/mL), and remaining lowest in infants (0.92 nmol/mL and 1.49 nmol/mL). Within each population cohort, although the 68% ALA oil yielded a higher absolute ALA release amount, its relative bioaccessibility was slightly lower while generating elevated MDA levels. These findings demonstrate that increasing ALA concentration imposes a critical trade-off between lipolytic efficiency and oxidative safety across different population groups, providing a solid scientific rationale for designing population-tailored flaxseed oil products optimized for both nutrient delivery and safety. Full article

As rapid population aging coincides with intensifying urban heat island (UHI) effects, ensuring the outdoor thermal comfort of the elderly in hot–humid regions has become a critical challenge. This study investigates the influence of residential spatial morphology and wind environment on elderly thermal comfort in Fuzhou, China, by integrating PHOENICS and RayMan numerical simulations with a multivariate statistical framework. The Physiological Equivalent Temperature (PET) was calculated across three metabolic intensities (sedentary, walking, and exercising), while the LMG algorithm was used in R to identify the driving mechanisms. Residential layouts are stratified into High-Performance (Group A) and High-Risk (Group B) categories based on their thermal risk. In Group A, the microclimate is convective-dominant wind speed and air changes per hour are the primary determinants of thermal comfort. Conversely, Group B exhibits a radiation-dominant mechanism, with the sky view factor acting as the primary driver of heat stress in confined environments. Furthermore, metabolic intensity emerges as a decisive factor, as physical exercise frequently pushes PET beyond the 37.1 °C threshold even in high-performance layouts. Accordingly, this study proposes differentiated strategies: prioritizing ventilation-led optimization for Group A and radiation-shielding interventions for Group B, while advocating for supplementary active cooling in high-intensity activity zones to safeguard the geriatric population during peak summer heat. Full article

Background: Single-access transfemoral transcatheter aortic valve implantation (TAVI) reduces the need for multiple vascular access and therefore, the related risk of related complications. However, the impact of patient age on its clinical outcomes remains uncertain. Methods: This is a secondary analysis of previously reported propensity score matched study comparing clinical outcomes of single- versus dual-access transfemoral TAVI using SAPIEN-3-Ultra. We examined the relation between patient age, access strategy and outcomes—specifically, 30-day safety endpoint according to the Valve Academic Research Consortium 3 (VARC-3) and major adverse cardiovascular events (MACE), defined as death, permanent pacemaker, neurological or vascular complications—using logistic regression interaction analyses, and restricted cubic spline modelling. Results: A total of 204 patients (propensity score-matched cohort) were included in the study. The elderly group were more likely to have hypertension, peripheral vascular disease or stroke. The use of single access was comparable. The elderly cohort demonstrated a tendency toward longer fluoroscopy and procedural times compared with the non-elderly group. This pattern likely reflects the greater technical complexity and heightened procedural caution often associated with older patients, including more challenging vascular anatomy and the need for careful device handling. Although not statistically significant, these findings remain clinically meaningful and are consistent with the notion that procedures in elderly patients frequently require more meticulous planning and execution. There was a significant interaction between access strategy and age in reducing MACE, but not in VARC-3 safety outcomes. Single access was associated with a significant reduction in MACE (5.4% vs. 26.7%, p = 0.015) with comparable technical and safety outcomes when compared with elderly patients who underwent dual-access TAVI. Conclusions: Single-access TAVI was linked to favourable early outcomes, maintained procedural success, and suggested a possible age-dependent pattern in the occurrence of MACE. Our findings support the need for randomised studies to demonstrate superiority of single- versus dual-access TAVI, particularly in the elderly population. Full article

Background: Chronic obstructive pulmonary disease (COPD) disproportionately affects older adults. While targeted biologic therapies have shown efficacy in type 2 eosinophilic endotypes, elderly patients remain underrepresented in pivotal clinical trials. This narrative review examines the pathophysiological rationale, efficacy data, and unique geriatric challenges of biologic therapies in older adults. Methods: A literature search was conducted in PubMed and Scopus for phase II and III randomized controlled trials (RCTs) and observational studies evaluating biologic agents (anti-IL-5, anti-IL-4/IL-13, and anti-alarmins) in COPD, focusing on populations aged ≥ 65 years, comorbidities, and frailty. Discussion: Phase III data for dupilumab and mepolizumab indicate significant reductions in annualized exacerbations in patients with blood eosinophils ≥ 300 cells/μL. However, the mean age in the landmark trials (65 years) is a decade lower than the real-world average. Age-related immune remodeling—specifically immunosenescence and inflammaging—coexists with disease-specific pathways, potentially altering therapeutic responses. Furthermore, clinical trials systematically exclude older individuals with severe multimorbidity, physical frailty, cognitive impairment, and malnutrition. Conclusions: Biologics provide a precise, mechanism-based approach, yet evidence in the oldest-old remains limited. Future management should utilize the treatable traits framework, shifting selection criteria from chronological age to biological age metrics, including frailty status and functional reserve. Full article

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide. The growing prevalence of antimicrobial resistance among Enterobacterales, particularly to β-lactam antibiotics, contributes to treatment failures and prolonged hospital stays. This single-center descriptive surveillance study aimed to evaluate the distribution of Enterobacterales recovered from culture-positive urine samples in the Provincial Specialist Hospital in Włocławek, Poland, and to determine the prevalence of β-lactam resistance phenotypes among these isolates. Urine culture results collected between January and December 2025 from all hospital wards and the outpatient urology clinic were retrospectively analyzed in this study, with 1090 positive urine cultures included. For a subset of 85 isolates, microbiological findings were additionally linked with patients’ clinical characteristics. Bacteria of the genus Escherichia were the most frequently isolated (53.8%), followed by Klebsiella (22.9%) and Proteus (14.2%), with the remaining Enterobacterales genera recovered at frequencies ranging from 0.6% to 4.5%. Most isolates presented no detectable β-lactam resistance phenotype; however, resistance mediated by β-lactamase production was observed in some of them. Phenotypic ESBL and AmpC producers accounted for 25.3% and 0.6% of isolates, respectively, whereas phenotypic carbapenemase-producing strains were detected less frequently, with MBL and KPC producers representing 1.4% and 0.3% of isolates, respectively. No clear associations were identified between patient characteristics and the occurrence of specific bacterial isolates or resistance mechanisms, which may be explained by the relatively homogeneous study population, the majority of whom were ≥70 years old (66/85; 77.6%) and had a similar burden of comorbidities. In conclusion, the current level of β-lactam resistance phenotypes among urinary Enterobacterales in our setting can be considered moderate. Nevertheless, continuous surveillance of local urine-derived bacteria and their antimicrobial resistance profiles remains essential for optimizing effective control strategies. Full article

Background: Aging of the population increases the incidence of osteoporosis with atlantoaxial instability. Poor bone microarchitecture causes high rates of screw loosening, implant failure, and revision surgery, which remains a critical challenge for upper cervical surgery. Traditional atlantoaxial fixation is less effective in those with low bone mineral density, while thoracolumbar screw augmentation techniques are limited by the complex craniocervical anatomy. Methods: This review systematically summarizes the mainstream screw optimization strategies from a bioengineering perspective, including low-modulus alloy substrate modification, bionic threaded structural design, bioactive surface coatings, expandable screws, and cement-augmented cannulated screws. We compare the biomechanical anchorage performance, osteogenic capacity, and clinical complications of each technique. Results: Low-elastic-modulus titanium alloys reduce stress shielding; gradient multi-thread, bicortical, and CBT trajectory designs significantly improve anti-pullout stability; HA, tantalum, and composite extracellular matrix coatings promote osseointegration; and expandable screws and fenestrated cement screws can achieve reliable reinforcement. However, a narrow atlantoaxial space restricts the application of cement augmentation and expandable implants, and long-term, large-sample clinical evidence for the efficacy of novel screws is insufficient. Conclusion: Patient-specific porous degradable screws, which combine 3D-printed biomaterials, gradient alloys, and sustained-release bioactive coatings, represent a promising future research direction. This review provides theoretical support for the development of atlantoaxial internal fixation devices targeting elderly osteoporotic patients. Full article

This study examines the long-term associations between ambient air pollutants and the burden of major respiratory and infectious diseases in this geographically sensitive region. A retrospective analysis was conducted using ICD-10-coded hospital records of patients diagnosed with asthma, chronic obstructive pulmonary disease (COPD), bronchitis, and tuberculosis from January 2020 to June 2026. These data were integrated with in situ air quality measurements, including PM₁₀, PM_2.5, and SO₂, as well as satellite-derived Aerosol Optical Depth (AOD) from MODIS. Disease incidence was stratified by year, sex, and age groups (0–85+ years) to assess demographic susceptibility patterns. Respiratory diseases constituted a substantial public health burden over the study period. Asthma showed a marked female predominance (≈29,700 females vs. ≈16,000 males) and a bimodal age distribution with peaks in early childhood (0–5 years) and mid-adulthood (35–50 years). COPD was predominantly observed in males (≈8300 males vs. ≈5500 females), with a higher median age range (≈67–70 years). Bronchitis exhibited a similar bimodal pattern, disproportionately affecting both pediatric and elderly populations, while overall case numbers declined over time. Tuberculosis incidence was approximately threefold higher in males than females, with notable age-related divergence, affecting younger females (≈30–32 years) and middle-aged males (≈42–45 years). The findings suggest a spatial–temporal correspondence between elevated pollutant concentrations and respiratory disease prevalence in the Iğdır Basin. The observed sex- and age-specific disparities underscore the potential value of region-specific environmental health strategies, strengthened air quality management, and continuous epidemiological surveillance in enclosed basin environments. Full article

Background/Objectives: Ambient fine particulate matter (PM_2.5) poses significant health risks to older adult populations, yet the specific contributions of its chemical constituents, particularly non-phthalate and non-organophosphate ester compounds, remain poorly understood. This study aimed to elucidate the mechanistic links between PM_2.5-bound ester exposures and metabolic pathway alterations in elderly individuals. Methods: A total of 258 elderly residents aged 60 years or older from Fuzhou, China, were recruited. Personal PM_2.5 exposure was monitored over 72 h using UPAS V2 samplers, with chemical components analyzed via gas chromatography–mass spectrometry (GC–MS). Plasma metabolomic profiling was conducted using liquid chromatography–mass spectrometry (LC–MS), and metabolic pathway enrichment was performed using MetaboAnalyst 5.0. Linear regression models adjusted for covariates (age, sex, BMI, lifestyle factors) assessed associations between ester exposures and metabolite abundance. Results: The mean PM_2.5 concentration was 38.06 μg/m³, with ester compounds dominating the chemical composition. Twenty high-concentration non-target esters were prioritized for analysis. PM_2.5 ester exposure was associated with alterations in key metabolic pathways, including steroid biosynthesis, glycolysis/gluconeogenesis, glycerophospholipid metabolism, and purine/pyrimidine metabolism. When interpreted alongside prior epidemiological evidence, these alterations represent putative links to increased risks of insulin resistance, cardiovascular dysfunction, and metabolic syndrome—relationships that require confirmation in prospective cohort studies and controlled toxicological experiments. Conclusions: Putatively annotated PM_2.5-bound ester compounds, particularly non-regulated subclasses, are associated with systemic metabolic alterations in older adults, coincident with perturbations in steroid and lipid metabolism. While these findings are exploratory and hypothesis-generating, they highlight the need to incorporate specific ester profiles into PM_2.5 risk assessments and develop targeted interventions for vulnerable aging populations. Full article