Search Results (535)

As societies continue to age, brain tumors increasingly affect older patients. Still, large-scale evidence on whether the relationship between age and brain tumor has been evolving over time is scarce. We examined longitudinal trends among different age groups of patients with brain tumors at 78 German hospitals. Two time periods were compared as follows: phase 1 (1 January 2016–31 December 2019; pre-pandemic) and phase 2 (1 January 2020–31 December 2022; pandemic). Patients were categorized as non-elderly (<65 years) or elderly (≥65 years), and according to 10-year age brackets. The clinical condition was quantified using the Elixhauser Comorbidity Index (ECI) and the Hospital Frailty Risk Score (HFRS). Among the 20,005 patients included, changes in characteristics of non-elderly/elderly patients over time behaved similarly, with improvements in ECI (19.3 to 18.4/15.2 to 14.3; each p < 0.01) and HFRS (2.1 to 1.6/4.7 to 4.1; each p < 0.01), and increases in rates of brain tumor resection (26.1% to 31.8%/22.7% to 27.8%; each p < 0.01). Only patients aged 75–84 years did not follow any of those trends. Over the examined 7-year period, general trends in brain tumor care in elderly subjects resembled those observed in non-elderly patients, except for those aged 75–84 years. Full article

Background and objectives: In older and frail patients, in-hospital cardiac arrest (IHCA) is associated with high mortality. Early warning scores such as the National Early Warning Score 2 (NEWS2) are widely used to detect clinical deterioration, but their predictive accuracy in frail populations remains uncertain. This study aimed to assess whether integrating frailty measures with NEWS2 could better describe elderly IHCA patients. Materials and Methods: We conducted a single-center, retrospective observational study in adult and frail patients (≥18 years) admitted to medical and surgical wards of the University Hospital of Siena who experienced IHCA between January 2022 and January 2024. Data on demographics, such as last NEWS2 before IHCA, Clinical Frailty Scale (CFS), Barthel Index (BI), and Charlson Comorbidity Index (CCI) were retrospectively collected and analyzed. Patients were stratified into three categories, according to NEWS2: Stable (A), Potentially Unstable or Unstable (B), and Critical (C). Results: Seventy patients were analyzed (mean age 76.9 ± 11.0 years; 56% male). The mean pre-IHCA NEWS2 score was 6.0 ± 3.5, with 41% of patients classified as NEWS2-C, 48% classified as NEWS2-B, and 11% classified as NEWS2-A. The NEWS2-A category showed higher BI and lower CFS than NEWS2-B and NEWS2-C (p < 0.01), while CCI and age did not significantly differ. Conclusions: The association of NEWS2 with frailty scores could identify some elderly patients with limited pre-arrest physiological derangements but high frailty who suffered from IHCA. These findings provide descriptive insights that may inform monitoring strategies for “at-risk” elderly patients to help prevent IHCA. Full article

Background and Objectives: Thoracic trauma usually results in high morbidity and mortality. It is the leading cause of death in patients within the first four decades of life. In this study, we aimed to identify risk factors for intensive care mortality and to evaluate factors affecting clinical outcomes and complications in patients with thoracic trauma who were treated in the intensive care unit (ICU). Materials and Methods: This was a retrospective, single-center study. Patients diagnosed with thoracic trauma and followed up in the ICU between 1 May 2023 and 1 January 2025 were included. Critically ill patients aged 18 years and older whose admission blood values were available and who had undergone radiological imaging were included in the study. Patients were grouped as Survivors or Non-survivors. The primary outcome was to determine risk factors for mortality. The secondary outcome was to evaluate factors affecting clinical outcomes and complications. The tertiary outcome was to determine the predictive value of the Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) for mortality. Results: A total of 104 patients (male/female ratio: 76/28) were included in the study. Twenty-four patients (23.1%) died, and eighty (76.9%) were discharged. Age in the Non-survivor group was found to be significantly higher (59.33 ± 22.21 vs. 40.50 ± 17.71; p < 0.001), and the proportion of women was also significantly higher in the Non-survivor group (p = 0.0082). Mortality was associated with advanced age, female sex, lower GCS score (p < 0.001), higher APACHE II scores (p < 0.001), and the presence of comorbid conditions (p = 0.003), including head trauma (p = 0.024) and cardiac arrest before ICU admission (p = 0.011). The Non-survivor group more frequently required mechanical ventilation (p < 0.001), vasopressor support (p < 0.001), and continuous renal replacement therapy (p < 0.001), and they developed ventilator-associated pneumonia (p < 0.001) and acute respiratory distress syndrome (p < 0.001) at higher rates. ICU length of stay was also significantly longer in the Non-survivor group (p = 0.045). The APACHE II score demonstrated the highest discriminatory performance, emerging as the strongest clinical predictor of mortality (AUC = 0.751, 95% CI: 0.630–0.872; p < 0.001). Age (OR: 1.06) and serum lactate levels (OR: 1.57) consistently emerged as strong independent predictors of mortality. The presence of head trauma significantly increased the risk of mortality, particularly in the APACHE II-adjusted model (OR: 9.08). The APACHE II–based model yielded high specificity (96.3%) and accuracy (88.5%), with good discrimination (AUC = 0.894) and the highest Nagelkerke R² (0.548). Conclusions: Factors that may shorten the length of ICU stay include infection control, early correction of acidosis, and maintenance of hemodynamic stability, which may reduce mortality. APACHE II was more closely related to overall clinical severity than the other scoring systems. Our data indicate that age-related frailty and acute physiological derangement, as best represented by the APACHE II score, are more significant determinants of survival than anatomic injury severity alone. Full article

We develop a unified likelihood-based framework for limited outcomes built on the two-piece normal family. The framework includes a censored specification that accommodates boundary inflation, a doubly truncated specification on $(0,1)$ for rates and proportions, and a survival formulation with a log-two-piece normal baseline and Gamma frailty to account for unobserved heterogeneity. We derive closed-form building blocks (pdf, cdf, survival, hazard, and cumulative hazard), full log-likelihoods with score functions and observed information, and stable reparameterizations that enable routine optimization. Monte Carlo experiments show a small bias and declining RMSE with increasing sample size; censoring primarily inflates the variability of regression coefficients; the scale parameter remains comparatively stable, and the shape parameter is most sensitive under heavy censoring. Applications to HIV-1 RNA with a detection limit, household food expenditure on $(0,1)$, labor-supply hours with a corner solution, and childhood cancer times to hospitalization demonstrate improved fit over Gaussian, skew-normal, and beta benchmarks according to AIC/BIC/CAIC and goodness-of-fit diagnostics, with model-implied censoring closely matching the observed fraction. The proposed formulations are tractable, flexible, and readily implementable with standard software. Full article

Background: Bladder cancer (BC) predominantly affects older patients, and their multidisciplinary treatment often includes surgical intervention. Frailty can influence treatment decisions and is associated with poorer outcomes. This study analyses trends in demographics, treatment patterns and frailty in a large, nationwide, real-world inpatient cohort in Germany. Methods: This retrospective observational study included a total of 49,139 consecutive patients, who received inpatient care for BC at all HELIOS hospitals in Germany between 2016 and 2022. Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorised as low (<5), intermediate (5–15), or high (>15). Trends in HFRS, treatment modalities, and demographic variables were analysed using regression models and compared between the periods 2016–2019 and 2020–2022. Results: Of the 49,139 patients, 27,979 were treated between 2016–2019 and 21,160 between 2020–2022. Patients treated in the later period were slightly older but had a lower comorbidity index. The proportion of patients with low frailty increased (73.4% vs. 75.5%, p < 0.01), intermediate frailty decreased (23.5% vs. 21.5%, p < 0.01) and the proportion of highly frail patients remained stable at 3.0% (p = 0.95). Rates of transurethral resection declined over time, whereas rates of RC remained stable (p = 0.12). The use of systemic therapy increased (p = 0.003), particularly among low frailty elderly patients. Early intravesical chemotherapy following transurethral resection declined significantly in 2020–2022 (p < 0.001), particularly among elderly patients with high frailty. Mean length of hospital stay decreased by one day, while ICU admission rates and in-hospital mortality remained stable across time periods. Conclusions: This study shows frailty-specific changes in hospitalisation patterns and inpatient management of BC in Germany, underscoring the value of frailty assessment in population-based research. The proportion of patients classified as having low frailty increased over time. Significant changes in the use of intravesical chemotherapy and systemic therapy were associated with frailty. The decline in early intravesical chemotherapy may have implications for recurrence risk and downstream healthcare utilisation. Full article

Background/Objectives: The study aimed to examine the association between the total SPPB score and serum leptin levels in patients with coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI). Methods: A cross-sectional study included 204 prospectively enrolled patients with CAD who were admitted for elective PCI. The mean age was 67.45 ± 8.63 years; 63.2% of patients were male. The Short Physical Performance Battery (SPPB) was used to screen for prefrailty and frailty (10–12 points: no frailty; 8–9 points: prefrailty; ≤7 points: frailty). The levels of leptin, a biomarker of fat remodeling, were measured by a highly sensitive and highly specific enzyme immunoassay using a Diagnostics Biochem Canada Inc. Leptin ELISA Kit (London, ON, Canada). Results: The prevalence of frailty and prefrailty in patients with stable CAD was 20.1% and 40.2%, respectively. A comparative analysis revealed that frailty was significantly more likely in older women with CAD before elective PCI. The total serum leptin level was 13.00 [8.00–50.00] ng/mL. Frail patients with CAD had higher leptin levels than patients without frailty (25.40 [7.00–60.00] ng/mL vs. 12.00 [5.15–19.70] ng/mL, p = 0.037). The leptin level in patients with prefrailty was 16.70 [13.00–49.10] ng/mL. Moreover, there was a moderate inverse correlation between the total SPPB score and serum leptin levels before PCI (p = 0.006). A regression analysis found that the total SPPB score in patients with stable CAD was associated with high serum leptin levels (p < 0.001) and older age (p = 0.017). Conclusions: Our study found that frail patients with CAD undergoing PCI had higher serum leptin levels than patients without frailty. Full article

Objectives: This pilot study examined telerehabilitation, which has emerged as a crucial modality in light of recent global challenges such as the COVID-19 pandemic. We examined the effectiveness of a mobile health telerehabilitation intervention developed for older adults with frailty. Methods: Six participants received a telerehabilitation intervention (Rehab Studio) that included exercise training videos. The participants were aged ≥65 years, had no history of dementia or psychiatric disorders, and had mild-to-moderate care needs. For 1 month, the participants received 1 h live online rehabilitation sessions with real-time communication with rehabilitation specialists (physical therapists and occupational therapists: PTs/OTs). The quality of life (QoL) (EuroQol 5 dimensions 5-level [EQ-5D-5L] questionnaire) and self-rated health scores were recorded before and after the intervention, and the data were analyzed using paired t-tests to determine whether the service was effective. Results: Significant differences were found in the total EQ-5D-5L and self-rated health scores (p < 0.05). The mean EQ-5D-5L score increased from 0.63 ± 0.13 before the intervention to 0.77 ± 0.14 after the intervention (p = 0.010), while the mean self-rated health score increased from 66.0 ± 18.0 to 83.3 ± 10.3, respectively (p = 0.019). Conclusions: This study revealed that the mobile health telerehabilitation intervention is safe and can improve QoL for older adults with frailty. However, the effectiveness of the intervention needs to be further investigated in patients with poor performance in daily living activities. Telerehabilitation could help to reduce the burden of nursing care in aging societies with declining birthrates. However, given the extremely small sample size (N = 6), these p-values should be interpreted with considerable caution. Statistical significance in such a small sample does not provide strong evidence for population-level effects, and our findings should be regarded as hypothesis-generating rather than confirmatory. Full article

Background/Objectives: Loneliness is a critical public health concern associated with adverse mental and physical health outcomes in later life. However, few large-scale studies have examined loneliness in relation to depression, aspiration risk, frailty, and social participation among Japanese older adults. This study examined associations between loneliness and psychosocial and health-related factors among older adults. Methods: This cross-sectional study involved a secondary analysis of data obtained from online surveys conducted in 2018 and 2021 among 1000 community-dwelling Japanese adults (≥65 years). Loneliness was assessed using the UCLA Loneliness Scale Version 3 and dichotomized at the median to define a high-loneliness group. Depressive symptoms, aspiration risk, frailty, conversation frequency, and volunteering participation were assessed using validated scales. Multivariable logistic regression was used to identify factors associated with loneliness and interaction terms were examined to assess effect modification. Results: High loneliness was observed in 52.2% of participants. Greater loneliness was significantly associated with depressive symptoms (GDS ≥ 5; OR = 4.69, 95% CI: 2.84–7.76), higher dysphagia risk (DRACE score; OR = 1.08, 95% CI: 1.00–1.16), and lower daily conversation frequency (OR = 0.76, 95% CI: 0.67–0.86); however, volunteering (OR = 0.475, 95% CI: 0.23–0.87) was a protective factor. Conclusions: Loneliness among Japanese older adults is closely linked to depressive symptoms and aspiration risk, while frequent conversations and volunteer participation appear to be protective. Community-based interventions promoting social engagement and oral health may mitigate loneliness and its health consequences and improve quality of life for older adults. Given the cross-sectional design, the observed associations should not be interpreted as causal. Full article

Sarcopenia and physical frailty are interconnected geriatric syndromes that frequently coexist in older adults, sharing common pathophysiological pathways. However, their early detection in community settings is limited by resource constraints and by the lack of simplified, scalable diagnostic tools. This cross-sectional study aimed to estimate the prevalence and overlap of sarcopenia and frailty in a real-world public health screening programme and to evaluate the diagnostic performance of a pragmatic two-step algorithm. In September 2025, a total of 256 consecutive community-dwelling adults aged ≥65 years underwent standardized assessment using the SARC-F questionnaire, handgrip strength dynamometry, and selective bioelectrical impedance analysis (BIA). Sarcopenia was defined according to 2019 EWGSOP2 criteria, and frailty according to the Fried phenotype. Confirmed sarcopenia was identified in 37 participants (14.5%, 95% CI 10.7–19.1%) and frailty in 31 (12.1%, 95% CI 8.6–16.7%), with substantial overlap (77.4% of frail individuals also had sarcopenia; Cohen’s κ = 0.62). The two-step algorithm (Step 1: SARC-F ≥ 4; Step 2: handgrip strength and BIA only in screen-positive participants) demonstrated excellent accuracy for confirmed sarcopenia (AUC 0.913, 95% CI 0.871–0.955), with sensitivity 91.9%, specificity 81.3%, and a 53.9% reduction in BIA use. Factors independently associated with confirmed sarcopenia included older age, BMI < 22 kg/m², physical inactivity, and higher SARC-F score. A simple, function-centered two-step approach enables efficient and scalable identification of sarcopenia and frailty in community settings, supporting early preventive strategies to preserve physical function. Full article

Background: Kidney dysfunction is common in intracerebral hemorrhage (ICH), but it is unclear whether reduced estimated glomerular filtration rate (eGFR) on admission is an independent driver of short-term outcomes or a marker of overall vulnerability. Methods: In this single-center retrospective study, we analyzed the data of consecutive patients with spontaneous ICH. Results: Among 276 patients, 92 (33.3%) presented with eGFR < 60 mL/min/1.73 m² on admission. Only 17/92 (18.5%) had documented pre-existing chronic kidney disease (CKD). Acute kidney injury (AKI) occurred more often in patients with eGFR < 60 mL/min/1.73 m² than in those with eGFR ≥ 60 mL/min/1.73 m² (25.0% vs. 10.3%). In survival models, eGFR ≥ 60 mL/min/1.73 m², predicted higher 90-day survival in the baseline model (OR 3.031, p = 0.013) but was attenuated after adjustment for age and premorbid modified Rankin Scale (mRS) and was no longer independent after additional adjustment for laboratory markers. Across all models, the National Institutes of Health Stroke Scale (NIHSS) score, hematoma volume, and history of coronary artery disease remained robust predictors. Higher leukocyte count predicted lower survival, whereas higher hemoglobin predicted higher survival. Among survivors, favorable functional outcome was independently associated with lower NIHSS, younger age, lower premorbid mRS, and absence of documented CKD. Admission eGFR category was not independently associated. Conclusions: Reduced admission eGFR primarily reflects baseline frailty and systemic derangement rather than an independent determinant of short-term survival after full adjustment, whereas documented CKD is more informative for disability among survivors. AKI occurs more frequently in patients presenting with reduced eGFR, supporting close renal monitoring in acute ICH. Full article

Background/Objectives: Frailty, a syndrome characterized by diminished physiological reserves and increased vulnerability to stressors, is a strong predictor of adverse outcomes in heart failure. The MECKI (Metabolic Exercise Cardiac Kidney Index) score, derived from cardiopulmonary exercise testing and renal function parameters, has demonstrated prognostic value in HF patients. This study aimed to evaluate the prognostic value of physical frailty on mortality in patients with advanced heart failure and to compare it directly with the MECKI score. Methods: A total of 104 patients with advanced HF receiving optimized guideline-directed medical therapy were prospectively enrolled. At baseline, all patients underwent clinical, echocardiographic, and laboratory assessment and CPET for MECKI score calculation. Physical frailty was assessed using a modified Fried phenotype tailored for HF. The composite endpoint comprised all-cause mortality, urgent heart transplantation, or LVAD implantation. Results: Over a mean follow-up of 30.0 ± 15.3 months, there were 25 deaths, 5 urgent heart transplants, and 1 LVAD implantation. Patients who experienced the composite outcome had significantly worse NYHA class, higher NT-proBNP, lower VO₂max, higher VE/VCO₂ slope, higher frailty, and higher MECKI score (all p < 0.001). Frailty was significantly correlated with all MECKI score components, as demonstrated by Spearman’s rank correlation analysis. Both frailty (HR = 1.89; 95% CI 1.22–2.93; p = 0.005) and MECKI score (HR = 1.04; 95% CI 1.00–1.08; p = 0.037) independently predicted outcomes. ROC analysis showed high and comparable discriminative performance (AUC = 0.86 for frailty; AUC = 0.88 for MECKI). Conclusions: Physical frailty and MECKI scores independently predict mortality and adverse events in advanced HF. Physical frailty, despite its simplicity and low cost, provides prognostic insight comparable to the MECKI score and may represent a practical alternative when CPET is unavailable. Full article

Background/Objectives: Frailty has been associated with various physical, psychological, and social factors; however, the influence of the residential environment—particularly walk-up buildings without elevators—remains unclear. This study aimed to examine the association between the floor of residence and frailty among functionally independent older adults. Methods: A total of 793 older adults (mean age: 76.46 ± 6.29 years; 58.83% women) living in walk-up buildings without elevators and not certified as requiring long-term care participated in a questionnaire survey. Frailty was assessed using the Kihon Checklist (KCL) and the FRAIL Scale (FS). Logistic regression analyses were conducted to examine the association between floor of residence and frailty status (non-frail vs. frail), adjusting for potential confounders. Sensitivity analyses were performed using stratified models based on age group, functional status, and living conditions. Results: Frailty prevalence was 23.28% (KCL) and 16.88% (FS). Higher floor of residence was significantly associated with lower odds of frailty (KCL: odds ratio [OR] = 0.82, 95% confidence interval [CI]: 0.69–0.97; FS: OR = 0.80, 95% CI: 0.65–0.97). Stratified analyses showed consistent associations in subgroups including those aged ≥ 75 years, with full Instrumental Activities of Daily Living scores, non-homebound status, poor subjective economic status, and living alone (all p < 0.05). Conclusions: Living on higher floors in walk-up buildings without elevators may be protective against frailty among functionally independent older adults. While barrier-free environments are essential for those with functional decline or disabilities, moderate physical challenges such as stairs may contribute to frailty prevention in populations who maintain independence. Full article

Background: Cognitive aging is a physiological process that involves gradual and mild changes in mental functions. When these changes significantly affect cognitive performance, it is considered cognitive decline. Objective: This analytical cross-sectional pilot study examined the association between periodontal status, systemic conditions, and cognitive performance in middle-aged and older adults. Methods: Forty adults aged 35–59 years (n = 20) and ≥60 years (n = 20) from northeastern Mexico were evaluated. Oral assessments included the Modified Gingival Index and detection of Porphyromonas gingivalis and Fusobacterium nucleatum using qPCR. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE), and frailty with the Clinical Frailty Scale (CFS) and Oral Frailty Checklist (OF-5). Systemic medical history and oral hygiene habits were determined using a questionnaire. Results: MMSE scores were lower in older adults compared with middle-aged adults, and the magnitude of the difference was small. The presence of P. gingivalis or F. nucleatum was similar between groups. Frailty indicators were more prevalent in older adults. Logistic regression identified age and frailty-related variables as the strongest predictors of lower cognitive performance, whereas microbiological findings were not significant predictors. Conclusions: Age and frailty indicators, rather than bacterial presence alone, were associated with reduced cognitive performance in this pilot sample. Although no microbiological differences were observed, the findings highlight the need for larger analytical studies incorporating quantitative bacterial load and additional confounders to better understand the oral–systemic–cognitive interactions. Full article

Physical activity often remains low after hospitalisation for acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Although post-hospitalisation rehabilitation has shown to support recovery, its impact on daily activity levels in the early post-exacerbation phase is unclear. This study describes the changes in physical activity (PA) and clinical outcomes during an 8-week rehabilitation following hospitalisation for AECOPD. This prospective observational cohort study included patients recently discharged after AECOPD from Aalborg University Hospital, Denmark. Participants received municipality-delivered post-hospitalisation rehabilitation consisting of tailored physiotherapy and occupational therapy of individually determined frequency. PA was assessed using thigh-worn triaxial accelerometers measuring 24 h/day over 8 weeks. Clinical outcomes included lung function (FEV1% predicted), dyspnoea scores, health-related quality of life (EuroQol 5-dimension, 5-level (EQ-5D-5L); EuroQol visual analogue scale (EQ-VAS)), frailty (Clinical Frailty Scale (CFS)), functional status (Short Physical Performance Battery (SPPB)), and symptom burden (COPD Assessment Test (CAT); St. George’s Respiratory Questionnaire (SGRQ)). Changes from baseline to 8 weeks were analysed using linear mixed-effects models and bootstrap resampling. Forty-three participants with a mean age 73.4 years, 67.4% female, and moderate frailty (CFS 5.4 ± 1.3) were included. Physical activity remained largely unchanged. Gait speed and total SPPB declined, whereas self-perceived health improved (EQ-VAS Δ +7.8, p = 0.008). Lung function, dyspnoea, and health related quality of life scores showed no significant change. In this frail, recently admitted COPD population, physical activity did not increase during the rehabilitation period, and some functional parameters declined. The improvement in self-perceived health suggests a divergence between subjective and objective outcomes. These findings highlight the need for long-term, tailored, and flexible approaches to support recovery after AECOPD. Full article

Background/Objectives: Older individuals are more vulnerable to stress and trauma. Although pressure injuries (PIs) are recognized as a significant complication, the specific impact of frailty on PI development in older Asian trauma patients remains insufficiently explored. This study aims to investigate the factors associated with the occurrence of hospital-acquired pressure injuries (HAPU) in older patients aged ≥65 years, including frailty. Methods: This study is a retrospective secondary data analysis of 3418 older trauma patients admitted to a regional trauma center (including ICU and trauma ward) from 1 January 2020 to 31 December 2023. Patients with PIs present on admission (POA) were excluded to strictly analyze new PI occurrence. Frailty was assessed using the mFI-5. Results: The mean age of participants was 77.33 years. During hospitalization, 2.5% (n = 84) of patients developed new PIs. Multivariate logistic regression identified that higher frailty score (Odds Ratio [OR] = 1.59, 95% Confidence Interval [CI]: 1.26–2.02), lower BMI (OR = 0.93, 95% CI: 0.86–0.99), hypoalbuminemia (OR = 0.55, 95% CI: 0.36–0.84), and prolonged hospital stay (OR = 1.05, 95% CI: 1.04–1.06) were independently associated with PI occurrence. Chronological age was not a significant predictor in the multivariate model. Conclusions: Frailty, nutritional status (BMI, albumin), and prolonged hospital stay are significant factors associated with HAPU in older trauma patients. Full article