Search Results (606)

Sarcopenia is characterized by progressive loss of skeletal muscle mass and function and is a major contributor to frailty, disability, and mortality in older adults. Store-operated calcium entry (SOCE) is a crucial regulator of skeletal muscle calcium homeostasis, and impaired SOCE has been linked to age-related muscle weakness. Here, we identify the synaptophysin family member synaptophysin-like protein 2, also known as mitsugumin 29 (MG29; encoded by the human gene SYPL2 and the mouse ortholog Mg29), as a key organizer of triad membrane cholesterol and lipid signaling required for normal SOCE during aging. Using Mg29^−/− mice as a model of accelerated sarcopenia, together with RNA interference against Mg29 in adult muscle and primary myotubes, we quantified changes in muscle morphology, contractile function, SOCE activity, and targeted lipidomic profiles. Reduced MG29 expression led to decreased muscle fiber cross-sectional area, reduced specific force, blunted SOCE, and marked alterations in membrane cholesterol content and fatty acid-derived lipid mediators. Cholesterol depletion by methyl-β-cyclodextrin in wild-type myotubes produced SOCE defects similar to those observed in aged wild-type and young Mg29⁻/⁻ muscles, indicating that MG29-dependent maintenance of membrane cholesterol is required for normal SOCE. Acute Mg29 knockdown also altered myogenic differentiation, the expression of calcium-handling and stress-response genes, and the release and consumption of specific polyunsaturated fatty acid-derived lipid mediators. Together, these findings identify MG29 as a critical regulator of SOCE and lipid signaling in skeletal muscle and suggest that its age-related decline contributes to sarcopenia by disrupting triad membrane organization and excitation–contraction coupling. Full article

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

Background/Objectives: Frailty is a clinically significant syndrome in older patients with ischemic heart disease, associated with adverse outcomes including hospitalization, disability, and mortality. This study aimed to evaluate the association of potentially inappropriate medication (PIM) and the Geriatric Nutrition Risk Index (GNRI) with the incidence of frailty among elderly patients with ischemic heart disease (IHD). Methods: This retrospective cohort study enrolled elderly patients with IHD between January 2018 and March 2024. Patients were grouped by PIM use and GNRI levels (<92 vs. ≥92). Cox proportional hazards models assessed the associations of PIM and GNRI with the incidence of frailty. Subgroup and sensitivity analyses evaluated the consistency and robustness of these findings. Results: PIM use was associated with a significantly higher risk of frailty (HR = 3.01, 95% CI = 2.48–3.65) than non-use. Similarly, lower GNRI increased the risk of frailty compared to higher GNRI (HR = 1.31, 95% CI = 1.12–1.54). Patients with both PIM and lower GNRI may have a higher risk of frailty, with an adjusted aHR of 4.09. Subgroup analyses showed significant interactions between GNRI and hypertension. Sensitivity analyses indicated that PIM (aHR = 2.65) and lower GNRI (aHR = 1.14) remained significantly associated with frailty, even after including those with pre-existing frailty. Conclusions: For elderly patients with IHD, both PIM and lower GNRI were significantly associated with the incidence of frailty. These findings suggest that PIM exposure and low GNRI may serve as clinically accessible markers for identifying older IHD patients at elevated risk of frailty. Full article

The main purpose of this work is to critically review the literature on neurocognitive disorders (ND) diagnosis. A critical review was conducted in PubMed, Scopus, and EBSCO. Systematic reviews and meta-analyses focusing on ND diagnosis were included. The selected studies were critically analyzed and conceptually integrated to identify relevant dimensions for the diagnosis of ND. The review included 88 studies. Most studies focused on Alzheimer’s disease and mild cognitive impairment. The literature remained predominantly centred on isolated diagnostic domains, and important limitations were consistently identified, including methodological heterogeneity, lack of standardized thresholds, and reduced clinical applicability. Based on the identified conceptual and methodological limitations, a Multidimensional Model of Neurocognitive Disorders (MOND model) for ND diagnosis was proposed. The MOND model was developed as a multidimensional, multilevel, transdiagnostic model integrating biological, neurocognitive, neuropsychiatric, motor, functional, frailty, reserve-related, and socio-environmental dimensions. The model may contribute to research, symptom classification, severity characterization, prognosis, and personalized intervention planning across different ND trajectories. Future studies using the MOND model should focus on refining algorithms to estimate the risk of ND. Full article

This study examines likelihood-based estimation of the joint survival function $S(t_1,t_2)=Pr\{T^{\left(1\right)}>t_1,T^{\left(2\right)}>t_2\}$ for systems with two competing failure modes observed under right censoring. Rather than introducing a new distributional family, the study compares established dependence mechanisms within a common observed-data framework. Exponential and Weibull margins are combined with three types of dependence: Archimedean copulas, represented by the Gumbel and Clayton families; shared gamma frailty, used to model latent measurement-level heterogeneity; and Marshall–Olkin extensions, used to represent common shocks and simultaneous failures. The same observation scheme, likelihood construction, censoring design, and performance criteria are used across models. Model performance is evaluated through Monte Carlo simulation using bias, integrated mean squared error, and empirical coverage, and the workflow is illustrated with the Device G reliability data. The results show that ignoring dependence can distort joint survival estimates, especially under moderate or high censoring. They also show that copula, frailty, and Marshall–Olkin specifications can lead to different reliability assessments because they encode different stochastic mechanisms. The estimation workflow includes multi-start optimization and diagnostics for boundary solutions, Hessian stability, and irregular likelihood behavior. Full article

Background: Frailty impacts the prognosis of respiratory diseases but lacks standardized evaluation criteria. This pilot study aimed to develop a frailty assessment method using unsupervised clustering of various physical function tests. Methods: Clinical data, handgrip strength (HS), lower limb strength (LLS), the 6 min walk test (6 min WT), the 5 m walk test (5 m WT), body composition, such as skeletal muscle mass index (SMI), whole-body phase angle (WBPhA), and pulmonary function variables were measured. Frailty status was evaluated in three groups (frail, pre-frail, and robust) using the J-CHS and Kihon Checklist. Unsupervised hierarchical clustering was performed, followed by dimensionality reduction using Principal Component Analysis. Results: Ninety-eight patients and healthy volunteers (70 males, 28 females; mean age, 57.5 years) were divided into four clusters, ranging from robust to pronounced frailty. On the 2-principal component plane, data points formed clusters across the four regions. The biplot showed variables aggregating in two directions: one including %FEV₁, FEV₁%, 6 min WT, and 5 m WT speed (exercise tolerance), and the other including HS, LLS, SMI, and WBPhA (physical elements). Tracking 39 participants (mean, 636 days later) showed cluster shifts that were broadly reproducible, although the small follow-up sample warrants cautious interpretation. Conclusions: As an exploratory, hypothesis-generating pilot study with a small single-center sample, this novel frailty model may offer a more granular assessment to help guide management; however, external validation in larger cohorts is required before clinical application. Full article

Objective: This study aims to examine the association between the frailty index (FI) and stroke risk among Chinese adults, describe the burden of stroke in China, and explore the causal role of FI in ischemic stroke through Mendelian randomization. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) included 13,473 participants aged 45 years and older without a history of stroke. Cox models, restricted cubic splines, and sensitivity analyses were employed to assess the association between the modified frailty index (mFI) and incident stroke. Additionally, data from the Global Burden of Disease (GBD) 2021 data report were utilized to describe stroke trends in China from 1990 to 2021. Two-sample Mendelian randomization was conducted to evaluate the causal effects of FI on ischemic stroke subtypes. Results: During a median follow-up period of approximately 7 years, 811 incident strokes were recorded. Each 0.1-point increase in mFI was associated with a 16% increase in stroke risk (HR = 1.16, 95% CI: 1.06–1.27), demonstrating a linear dose–response relationship. From 1990 to 2021, the proportion of ischemic stroke rose from 46.9% to 63.2%. Mendelian randomization analysis provided genetic evidence supporting a causal association between FI and ischemic stroke (OR = 1.191, 95% CI: 1.046–1.357), particularly driven by large-artery atherosclerotic (OR = 1.852) and small-vessel stroke (OR = 1.415), but not by cardioembolic stroke. Conclusions: A higher FI is associated with an increased risk of stroke among Chinese adults, with genetic evidence supporting a causal role in ischemic stroke. Therefore, FI may serve as a valuable addition to existing risk assessment tools. Full article

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

Background: Evidence of the relationship between frailty and depression trajectories and digestive disease in real-world populations remains insufficient. Investigating the long-term dynamic effects of frailty and depression may provide valuable insights for clinical intervention and the precise classification of risk factors for gastrointestinal or liver disease. In the study, we aimed to elucidate the aforementioned association among two representative cohorts. Methods: The CHARLS dataset represents a cohort of 10,303 participants over 40 years of age in China, with a follow-up period from 2011 to 2018. First, a group-based trajectory modeling method was used to identify combined trajectories of frailty and depression over a 7-year follow-up period. Frailty was assessed using the frailty index, while depression was measured using CESD10 scores. Binary logistic models and discrete survival models were applied to explore the associations between combined frailty–depression trajectories and the outcomes of gastrointestinal or liver diseases. Second, after excluding participants with baseline gastrointestinal or liver diseases, a binary logistic regression model was used to analyze the association between baseline frailty and depression and disease outcomes, with the results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Third, Cox proportional hazards models with restricted cubic splines were applied to estimate the association between the baseline frailty index or CESD 10 scores and disease risk, with the results expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). Comprehensive sensitivity analyses and subgroup stratifications supported the findings. The SHARE dataset was used as validation to prove the reliability of the conclusions. The SHARE cohort comprises 5834 participants 40 years of age and older in Europe, with a follow-up period from 2011 to 2017, and uses the frailty index to assess frailty and the EURO-D scale to assess depression. A binary logistic regression model was used to analyze the association between the trajectory groups and disease outcomes after excluding participants with baseline gastrointestinal diseases, with the results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Three distinct combined trajectories were identified in the CHARLS cohort: G1 (59.7%), stable and robust with no depression; G2 (31.5%), moderate persistent frailty and depression; and G3 (8.8%), escalating frailty and high depression. In the fully adjusted binary model, compared with G1, the risk of gastrointestinal disease was elevated in G2 (OR = 1.94, 95% CI: 1.67–2.24) and G3 (OR = 2.73, 95% CI: 2.12–3.53). Similarly, the risk of liver disease was evidently elevated in G2 (OR = 1.72, 95% CI: 1.38–2.13) and G3 (OR = 3.44, 95% CI: 2.50–4.75). The SHARE findings were consistent with those from CHARLS, with three similar trajectory groups identified in the SHARE cohort. Compared with G1, the risk of gastrointestinal disease was evidently elevated in G2 (OR = 2.035, 95% CI: 1.359, 3.048) and G3 (OR = 4.588, 95% CI: 2.561, 8.218) in the fully adjusted model. Conclusions: Trajectories of frailty and depression were significantly correlated with increased occurrence of gastrointestinal and liver disease, with the results remaining robust across various sensitivity analyses and external cohort validations. A limitation of this study is that the outcome measures are based on self-reported data, which may be subject to measurement bias. These findings highlight the importance of sustained integrated physical–mental approaches and precise psychological screening and classification for the prevention and treatment of gastrointestinal and liver disease. Full article

Background/Objectives: Post-COVID-19 syndrome (PCS) is frequently accompanied by pain, which may coexist with alterations in multiple health domains. However, pain in PCS has rarely been explored from a multidimensional approach combining subjective and objective measures. Objective: To describe pain in subjects with PCS using pain intensity and the pressure pain threshold (PPT), and to examine the associations between these measures and descriptive characteristics as well as health status. Methods: A cross-sectional observational study was conducted in 45 previously hospitalised adults with PCS. Pain intensity was assessed using the visual analogue scale and PPT was assessed by algometry. Health status included fatigue, dyspnoea, anxiety, depression, quality of life, functionality, frailty, physical activity, muscle quality, muscle strength, physical performance, and functional capacity. Analyses were conducted using SPSS v30.0. Results: Participants showed moderate pain intensity and variability in PPT, with a significant inverse association between both measures. Bivariate analyses showed that higher pain intensity and lower PPT were associated with worse physical, psychological, and functional outcomes. In regression analyses, pain intensity was associated with sex, length of hospital stay, PPT, and quality of life; PPT was associated with sex, pain intensity, and grip strength. Model explanatory capacity varied, and some models were not statistically significant. Conclusions: Subjects with PCS exhibited moderate pain intensity and variability in pain sensitivity, with an association between subjective and objective pain measures. Pain measures were associated with multiple health domains at the bivariate level, while regression analyses identified a limited number of associations with variable explanatory capacity. These findings support comprehensive pain assessment in PCS. Full article

Background/Objective: Preoperative frailty assessment before open radical nephrectomy for renal cell carcinoma (RCC) is underused, and prospective data on the 5-Factor Frailty Index (5-IFi) are limited. We examined the association between the preoperative 5-IFi score and postoperative complications at a private tertiary center in Khyber Pakhtunkhwa, Pakistan. Methods: In this prospective cohort study, 30 adults with suspected or confirmed RCC scheduled for elective open radical nephrectomy were enrolled after ethics approval. The 5-IFi was scored preoperatively from records and medication lists. The primary outcome was any Clavien–Dindo grade ≥ II complication during the index hospitalization; secondary outcomes were length of stay and 30-day unplanned readmission. Groups were compared using Mann–Whitney U and Fisher’s exact tests. Associations were estimated by Firth penalized logistic regression with profile-likelihood confidence intervals (CIs) and receiver operating characteristic (ROC) analysis with bootstrapped CIs; adjusted models were exploratory given the sample size. Results: Fourteen patients (46.7%) developed a grade ≥ II complication, all grade II; nine (30.0%) were frail (5-IFi ≥ 2). The 5-IFi score was the only baseline variable significantly associated with the outcome (median 1.5 vs. 1.0; p = 0.030). Each 1-point increase was associated with higher odds (unadjusted OR 2.35, 95% CI 1.16–6.80; adjusted for age and creatinine, OR 2.10, 95% CI 1.00–5.91). Discrimination was moderate but imprecise (AUC 0.72, 95% CI 0.53–0.88). At the ≥2 threshold, frail patients had a higher complication rate than non-frail/pre-frail patients (77.8% vs. 33.3%; Fisher’s exact p = 0.046; exact OR 6.5, 95% CI 0.92–80.65), with sensitivity 50.0% and specificity 87.5%; length of stay was marginally longer in frail patients (p = 0.035). No grade ≥ III complications or deaths occurred. Conclusions: In this small single-center cohort, a higher 5-IFi score was associated with grade ≥ II complications, consistent after limited adjustment. Given the small sample, imprecise estimates, and exclusively grade II events, these findings are preliminary and hypothesis-generating. Multicenter validation is required before the 5-IFi can guide preoperative risk stratification or prehabilitation triage. Full article

Stroke remains a major cause of disability worldwide, and population-level indicators that integrate multidimensional vulnerability with physiological reserve may provide useful perspectives for characterizing cerebrovascular health in aging populations. This cross-sectional study examined the association between the Frailty-to-estimated Cardiorespiratory Fitness Ratio (FCR) and self-reported prevalent stroke among middle-aged and older adults using NHANES 2011–2014 data. FCR was calculated as a 23-item modified Frailty Index divided by estimated cardiorespiratory fitness, providing an interpretable load-to-reserve measure that linked accumulated health deficits with estimated cardiorespiratory reserve. The final analytical sample included 3511 participants aged 45 years or older. Survey-weighted logistic regression models, sensitivity analyses, exploratory subgroup analyses, and spline models were used to evaluate the association. The weighted prevalence of self-reported prevalent stroke increased across FCR quartiles, from 2.2% in Q1 to 12.9% in Q4. In the conventional clinical adjustment model, participants in the highest FCR quartile had greater odds of self-reported prevalent stroke than those in the lowest quartile (OR = 6.13, 95% CI: 2.97–12.66; $p<0.001$), with similar findings in the overlap-aware model (OR = 6.31, 95% CI: 3.07–12.97; $p<0.001$). Log-transformed FCR was also consistently associated with greater odds of self-reported prevalent stroke across adjustment models, and spline analysis suggested a generally increasing association. These findings support FCR, particularly when modeled using quartiles or log-transformed values, as an interpretable integrative load-to-reserve construct associated with self-reported prevalent stroke, and suggest its potential relevance for population-based characterization of cerebrovascular health in aging adults. Full article

Objectives: Tandem spinal stenosis (TSS) is often underdiagnosed and traditionally managed with multi-stage surgery (MSS). Single-stage surgery (SSS) is an alternative, but prior studies largely emphasize younger, healthier patients. This study evaluated perioperative and functional outcomes after SSS for TSS in a surgically diverse cohort. Methods: A retrospective chart review included 20 patients who underwent SSS for TSS at a single academic institution. Mean age was 63.75 years, and median modified frailty index was 2. Etiologies included degenerative, traumatic, and neoplastic disease across cervical, thoracic, and lumbar regions. Outcomes included operative characteristics, complications, readmissions, and functional recovery measured by Visual Analog Scale (VAS) pain and modified Japanese Orthopaedic Association (mJOA) scores. Results: The mean number of operated levels was 5.2, mean operative time was 232.4 min, total OR time was 355.1 min, and length of stay was 6.9 days. Surgical complications occurred in 15% of patients, medical complications in 25%, and 90-day readmission in 15%, with no 30-day mortality. Mean mJOA improved from 12.86 at baseline to 16.08 at first follow-up and 16.46 at 3 months; REML mixed-effects modeling showed a significant timepoint effect (F (4, 34.55) = 9.15, p < 0.001), with significant Sidak-adjusted improvement at both timepoints. VAS pain showed no significant longitudinal effect. Conclusions: SSS for TSS appears feasible in a real-world, surgically diverse cohort including older and moderately frail patients. These findings support individualized SSS candidacy assessment. Full article

Background and Objectives: Patients undergoing incisional hernia repair constitute a clinically heterogeneous population with variable postoperative outcomes. Conventional risk models based on isolated risk factors may inadequately capture this complexity. This study aimed to identify data-driven clinical phenotypes and evaluate their association with surgical outcomes. Methods and Materials: A retrospective cohort of 1262 patients undergoing retromuscular incisional hernia repair (Rives–Stoppa technique) was analyzed. Unsupervised clinical phenotyping was performed using latent class analysis based on seven preoperative variables. Model selection was guided by Akaike information criterion (AIC), Bayesian information criterion (BIC), entropy, and clinical interpretability. Postoperative outcomes were compared across phenotypes. Results: Three distinct phenotypes were identified: metabolic (34.6%), structural (33.9%), and frailty (31.5%). The structural phenotype showed the highest complication (22.7%) and recurrence rates (8.6%), while the frailty phenotype had the lowest complication burden (14.6%). The metabolic phenotype was characterized by obesity and diabetes, consistent with increased wound-related morbidity. Cluster robustness was supported by internal validation metrics and sensitivity analyses. Conclusions: In this retrospective single-center cohort, distinct clinical phenotypes with different outcome profiles were identified among patients undergoing incisional hernia repair, supporting the concept that this population comprises clinically heterogeneous subgroups with distinct patterns of vulnerability. These findings should be considered preliminary and hypothesis-generating. Further external validation and prospective studies are required to determine the clinical utility of phenotype-based risk stratification. Full article

Background: Chronic kidney disease (CKD) accelerates biological aging and amplifies the risk of adverse geriatric outcomes. Albuminuria reflects systemic endothelial dysfunction beyond renal damage, yet its specific relationship with falls, fear of falling, and frailty in predialysis CKD patients remains underexplored. Objectives: We aimed to evaluate the association between albuminuria levels (urinary albumin-to-creatinine ratio, ACR) with falls, fear of falling (Falls Efficacy Scale, FES), and frailty (FRAIL scale and Clinical Frailty Scale, CFS) in older adults with CKD. Methods: This cross-sectional study analyzed 295 patients aged ≥60 years attending nephrology and geriatrics clinics at Kayseri City Hospital, Turkey (April–June 2025). ACR was categorized per KDIGO (A1: <30, A2: 30–300, A3: ≥300 mg/g). Inflammatory indices (NLR, SII, CAR) were calculated. Hierarchical multivariable logistic regression and ROC analyses were performed. Results: Fall prevalence showed a clear dose-response across ACR categories: 31.2% (A1), 72.0% (A2), and 93.2% (A3) (p < 0.001). In the fully adjusted model, each unit increase in log-ACR was associated with a 3.84-fold increase in fall odds (OR 3.84, 95% CI 2.74–6.65). Although bivariate ACR-frailty associations were non-significant, fully adjusted models uncovered independent associations across both instruments and thresholds: FRAIL ≥ 3 (OR 1.41, 95% CI 1.05–2.03), FRAIL ≥ 2 (OR 1.49, 95% CI 1.08–2.21), CFS ≥ 5 (OR 1.87, 95% CI 1.38–2.83), and CFS ≥ 4 (OR 1.37, 95% CI 1.02–1.93). ACR showed good discriminative ability for falls (AUC 0.773, optimal cut-off 21.70 mg/g) but poor discrimination for frailty (AUC 0.50–0.54). The ACR–fall association was stronger in patients with GFR < 60 (OR 4.48) than GFR ≥ 60 (OR 2.18). Conclusions: Albuminuria is a strong, independent, and graded predictor of falls in older CKD patients, with a nearly 4-fold increase in risk per log-unit ACR increase after full adjustment. ACR measurement, already routine in CKD monitoring, could help identify older patients at increased fall risk and guide targeted geriatric assessment. However, ACR showed poor standalone discriminative ability for frailty across all definitions (AUC 0.50–0.54), establishing that it cannot serve as a frailty screening tool in isolation. Full article