Search Results (66)

Background/Objectives: The aim of this systematic review was to compare the effectiveness of virtual reality (VR)-based training with conventional exercise programs in improving functional outcomes related to fall risk among older adults with various health conditions. Methods: The review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (registration number CRD42022345678). The databases Scopus, PubMed, Web of Science, and EBSCO were searched up to 31 March 2025. Randomized controlled trials (RCTs) were included if they involved participants aged ≥60 years, a VR intervention lasting ≥6 weeks, and a control group performing traditional exercises or receiving usual care. Methodological quality was assessed using the PEDro scale, and a narrative synthesis was performed across four outcome domains: balance, mobility, cognitive function, and fall risk. Results: Seven RCTs were included in the analysis (totaling 664 participants). VR training was found to be at least as effective as conventional exercise in improving balance (e.g., Berg Balance Scale) and mobility (e.g., Timed Up and Go), with some studies showing superior effects of VR. One RCT demonstrated that combining VR with balance exercises (MIX) yielded the greatest improvements in muscle strength and physical performance. Additionally, two studies reported cognitive benefits (e.g., MoCA) and a 42% reduction in fall incidence within six months following VR intervention. The methodological quality of the included studies was moderate to high (PEDro score 5–9/10). Conclusions: VR-based training represents a safe and engaging supplement to geriatric rehabilitation, effectively improving balance, mobility, and, in selected cases, cognitive function, while also reducing fall risk. Full article

Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality. Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality. Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07, p = 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07, p < 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality. Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment. Full article

Background/Objectives: With aging linked to increased oral health conditions, the communication skills of dental professionals are vital to ensure patient satisfaction and improve the quality of geriatric dental care. This cross-sectional study evaluated geriatric patients’ satisfaction with communication at a university dental clinic, comparing interactions with dentists and fifth-year dental students. Methods: A self-report questionnaire was administered to 111 patients, assessing sociodemographic data, general health, and satisfaction across six communication dimensions: verbal and nonverbal communication, empathy, respect, problem-solving, and support materials. The data were analyzed using Mann–Whitney U tests (α = 0.05). Results: The geriatric patients exhibited higher levels of satisfaction when interacting with dentists compared to students, particularly in the domains of nonverbal communication (p = 0.007), empathy (p = 0.035), and respect (p = 0.017). However, no statistically significant differences (p > 0.05) were observed in terms of verbal communication, problem-solving, and support materials. Conclusions: The geriatric patients demonstrated greater satisfaction with interactions with practicing dentists. These findings indicate that an attending dentist’s clinical experience enhances interpersonal interactions with geriatric patients. Therefore, developing the interpersonal skills of future dentistry professionals, as well as adapting communication to the needs of the elderly, is essential to provide more satisfactory experiences in geriatric dental care. Full article

Objectives: The present study examined cross-sectional and longitudinal associations between dysphagia and a variety of health-related parameters, including physical performance, cognitive function, malnutrition, sarcopenia, disability, frailty, falls, hospitalization, and mortality in a cohort of octogenarians living in the mountainous Sirente region of Central Italy. Methods: Dysphagia was operationalized as the need to modify the diet to facilitate swallowing and/or the exclusive consumption of specific food consistencies due to swallowing difficulties. Physical performance, cognitive function, malnutrition, disability, falls, and hospitalizations were assessed via the Minimum Data Set for Home Care. Sarcopenia was defined as the coexistence of low muscle mass and dynapenia, while frailty was operationalized according to Fried’s phenotype. History of falls and incident falls, as well as disability, were tracked over two years, while survival status was followed for up to ten years. Results: Data of 362 older adults (men age: 85.9 ± 4.8; body mass index: 25.6 ± 4.53; women: 66.9%; multimorbidity: 21.5%; dysphagia: 6.6%) were analyzed. The results indicated that dysphagia was significantly and cross-sectionally associated with poor physical performance and reduced cognitive function. In contrast, no longitudinal associations were observed. Conclusions: Dysphagia appears to be linked to deficits in physical and cognitive domains, underscoring the value of comprehensive geriatric assessment and the development of multidomain intervention strategies. Full article

Background/Objectives: Frailty is a multifactorial condition influenced by physical and psychosocial factors. Understanding longitudinal changes in these domains may guide prevention strategies. This study examines the relationship between frailty status, physical fitness, and psychosocial conditions in community-dwelling older adults using five-year longitudinal data. Methods: Participants were 52 out of 89 older adults who completed both baseline and five-year follow-up assessments (follow-up rate: 58.4%). Data were collected using 10 physical fitness indicators, the fitness age score (FAS), geriatric depression scale (GDS), Lubben social network scale short form (LSNS-6), and relevant items in the six Kihon Checklist (KCL) domains. Due to low prevalence of frailty, individuals with pre-frailty and frailty were combined into the frailty-risk group. Repeated measures ANOVA with sex as a covariate was conducted to compare groups. Logistic regression was used to identify baseline predictors of frailty status at five years. Statistical significance was set at p < 0.05. Results: GDS, LSNS-6, and KCL scores remained stable over five years. However, physical fitness significantly declined in several measures, including grip strength, vertical jump height, knee extension strength, functional reach, and FAS. A significant interaction for the timed up and go test showed that the robust group maintained function, while the frailty-risk group declined. Logistic regression identified KCL oral function as a significant predictor (OR = 5.331, 95% CI = 1.593–17.839, p = 0.007). Conclusions: Maintaining both oral function and physical fitness is vital for preventing frailty, even among health-conscious older adults. Proactive strategies may support healthy aging. Full article

Background/Objectives: Neuropsychological testing is key in defining cognitive profiles at early stages of dementia. More importantly, the detection of subtle cognitive changes, such as subjective cognitive complaints (SCCs), an understudied phenomenon, is critical for early detection and preventive interventions. Methods: This systematic review analyzes the empirical data on the cognitive domains and neuropsychological tests used in studies addressing SCC in the last 15 years (2009–2024). Results: A selection of 15 papers with exploratory, cross-sectional, and prospective scope in this field was obtained from PubMed and Embase databases. They used screening tests (17%) and a broad spectrum of neurocognitive domains. Yet, we identified three main targeted cognitive domains: executive functions (28%), language (17%), and memory (17%). Myriad assessment tools were also applied, but the most commonly used was a set of eight tests: Mini-mental Scale Examination (MMSE), Trail Making Test (A-B), Stroop test, Digit span test (DST), Semantic and Phonological fluency test, Rey Auditory Verbal Learning Test (RAVLT), Weschler Memory Scale (WMS), and Boston Naming Test (BNT). New approaches involved including the Geriatric Depression Scale (GDS) and self/informant reports. Conclusions: Despite scarce agreement in the assessment protocols, the identification of early neurocognitive symptoms to objectivate the SCC phenomenon envisions a broad field of research. Full article

Background: The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. Methods: This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. Results: Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3–5 adverse effects of chemotherapy in particular and improve quality of life. Conclusions: Co-management between geriatricians and other specialties should be encouraged wherever possible. Full article

Objective: This scoping review aims to explore and synthesize the core competencies and skills required for primary care nurses conducting comprehensive geriatric assessments. Comprehensive geriatric assessments have become integral to providing holistic, patient-centered care for older adults with complex health needs, but the specific competencies required in primary care remain underresearched. Design: The review followed Arksey and O’Malley’s five-stage scoping review framework, incorporating studies from PubMed, CINAHL, EMBASE, and the Cochrane Library. A comprehensive search was conducted from May 2014 to May 2024, and a population–concept–context (PCC) framework was used to identify relevant studies. Results: Nineteen studies met the inclusion criteria, revealing six key competency domains for nurses involved in comprehensive geriatric assessments: Clinical Assessment and Diagnostic Competencies, Care Planning and Coordination, Professional and Interpersonal Competencies, Environmental and Systemic Competencies, Technical and Procedural Competencies, and Quality Improvement and Evidence-Based Practice. These competencies are essential for providing high-quality care to older adults and supporting integrated, multidisciplinary approaches to geriatric care. Conclusions: The identified competency domains provide a structured framework that can enhance primary care nurses’ ability to deliver more effective, individualized, and coordinated care to older adults. However, the standardization of these competencies remains crucial for ensuring consistency in practice. Full article

Background/Objectives: The current study aimed to evaluate the oral health self-perception on quality of life in the elderly using the Geriatric Oral Health Assessment Index (GOHAI) to assess the impact of demographic and oral health factors on oral health-related quality of life. Methods: An observational prospective cross-sectional study for the entire six-month period was conducted in a dental health care center in the United Arab Emirates. The principal inclusion criterion is being aged 60 and over. The GOHAI questionnaire is composed of 4 domains of 12 items that address functional limitation, pain and discomfort, psychological impacts, and behavioral impacts. Patients were questioned about the frequency at which they experience any of the 12 listed problems. Results: A total of 318 respondents participated in the study and completed the whole questionnaire. Among these participants, 63.5% (n = 202) were male and 86.8% (n = 276) were ≤70 years. The average GOHAI score was 13.25, with a 95% confidence interval (CI) [12.4%, 14%], indicating a low self-perception of oral health by the allocated sample. Statistical modeling identified dry mouth (OR = 2.21, 95% CI 1.40–3.48) and chewing problems (OR = 1.87, 95% CI 1.09–3.20) as the strongest determinants of poor oral health-related quality of life (OHRQoL) in the elderly population. Conclusions: Healthcare professionals should develop targeted strategies to address the specific needs of this population, ensuring sustained improvements in their quality of life. Full article

Background: Frailty, sarcopenia, nutritional risk, and cognitive impairment are prevalent geriatric syndromes that adversely affect health outcomes in older adults, underscoring the need for an effective screen tool to enable early detection and timely intervention. Methods: This study employed a cross-sectional validation design and translated, culturally adapted, and validated the Chinese version of the Rapid Geriatric Assessment (C-RGA) among 416 nursing home residents. The C-RGA consists of four subscales: the simple frail questionnaire screening tool (FRAIL), SARC-F for sarcopenia (SARC-F), the Simplified Nutritional Assessment Questionnaire (SNAQ), and the Rapid Cognitive Screen (RCS). Results: The C-RGA demonstrated high content validity (S-CVI/Ave = 0.982) and strong internal consistency (Cronbach’s α = 0.839). Factor analysis confirmed its four-domain structure, accounting for 61.497% of the variance. Model fit indices demonstrated good construct validity (χ²/df = 1.122, RMSEA = 0.024, GFI, AGFI, and CFI > 0.90), supporting the robustness of the assessment tool. Pearson correlation analysis revealed a strong association between FRAIL and SARC-F with SNAQ (r = −0.671, 95% CI: [−0.742, −0.600], p < 0.01) and a moderate correlation with RCS (r = −0.426, 95% CI: [−0.513, −0.339], p < 0.01), underscoring the interplay among nutritional deficits, muscle weakness, and cognitive impairment. Conclusions: The C-RGA demonstrates strong psychometric properties, supporting its potential use as a screening tool for the early detection of frailty, sarcopenia, nutritional risk, and cognitive impairment among nursing home residents, enabling timely and targeted interventions. Future research should further assess its applicability across diverse healthcare settings to enhance its generalizability and clinical utility. Full article

Background: Better prognostic biomarkers are needed in older adults with cancer. There are established links between N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and sarcopenia, and sarcopenia is associated with poorer cancer survival. However, there are limited data regarding baseline NT-proBNP as a biomarker of cancer outcome. The GO2 trial recruited older and/or frail United Kingdom (UK) patients with advanced gastroesophageal cancer and investigated the role of chemotherapy dose de-escalation. Using the GO2 database, we sought to investigate the prognostic role of NT-proBNP as well as the interaction between NT-proBNP and frailty. Methods: This was a post-hoc analysis of a completed clinical trial. Frailty measures included ECOG performance status (PS) and GO2 frailty grouping (based on an assessment of nine geriatric domains). A corrected NT-proBNP (cBNP) was calculated for each patient, adjusting for the upper limit of normal (ULN) reference from each centre. Results: A total of 241 patients were eligible to be included in the analysis. The median age was 76 (range 52–89), 187 (77.6%) were male and 211 (87.6%) had adenocarcinoma. Eighty (33.2%) patients had a baseline NT-proBNP above the local ULN. There was no association between cBNP and ECOG PS (p = 0.36) or the GO2 frailty group (p = 0.58). Those with the highest cBNP (n = 59) had significantly inferior median overall survival: 5.3 months (mos.) vs. 6.8 mos. (medium, n = 120) vs. 8.2 mos. (low, n = 61); HR 1.57 (95% CI; 1.04–2.37), p = 0.031. This was maintained on a Cox regression analysis (HR 1.69, p = 0.01) accounting for the GO2 trial stratification factors. There was no clear association between frailty and NT-proBNP. Conclusions: In this study, NT-proBNP appeared to be prognostic-independent of other factors. Further investigation and validation are needed to confirm our findings and to determine the potential beneficial role of cardioprotective therapy in at-risk patients with cancer identified in this manner. Full article

Chronic lymphocytic leukemia (CLL) treatment has undergone a significant evolution with a shift from historical chemotherapeutic regimens to targeted therapies such as Bruton tyrosine kinase (BTK) and BCL-2 inhibitors. These advancements have been associated with a notable improvement in survival rates with a transformation of CLL into a chronic and manageable condition for most persons with this disease. However, as a consequence of improved outcomes, long-term CLL survivors now face emergent challenges which include a risk of infections, cardiovascular complications, and secondary malignancies. In this changed scenario, holistic models of care are essential to address emergent health risks. Such models of care for CLL patients require a multidisciplinary approach that integrates CLL treatment with the proactive management of frailty, comorbidities, and psychosocial well-being to enhance both survival and quality of life (QoL). CLL predominantly affects older persons, many of whom present with concurrent frailty and comorbidities that may complicate CLL treatment and impact QoL. Comprehensive geriatric assessments (GA) may play a critical role in the identification of persons at a heightened risk of treatment-related toxicity and may help guide rational therapy selection, particularly in very frail persons. In addition to the assessment of hematological responses, the prospective assessment of patient-reported outcomes (PROs) and frailty metrics may offer a more nuanced understanding of the global treatment benefits. A survivorship-focused care model is crucial to address the multifaceted needs of CLL patients with the extension of patient care into the broader domain of long-term health maintenance with associated improvements in QoL. Full article

Background/Objectives: Subjective cognitive decline (SCD) may serve as an early indicator of Alzheimer’s disease (AD). This study investigates regional cerebral blood flow (rCBF) alterations in individuals with SCD using single photon emission computed tomography (SPECT). To characterize rCBF patterns in SCD patients compared to healthy controls and examine the relationship between rCBF and cognitive function. Methods: We compared rCBF in 20 SCD patients and 20 age- and sex-matched healthy controls using 99mTc-ECD SPECT imaging. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS), and Cognitive Abilities Screening Instrument (CASI). Results: SCD patients demonstrated significantly reduced rCBF in the right superior temporal gyrus (rSTG) (mean uptake ratio [UR] = 0.864 ± 0.090 vs. 1.030 ± 0.074, p < 0.001) and right caudate (mean UR = 0.783 ± 0.068 vs. 0.947 ± 0.062, p < 0.001) compared to controls. Additionally, negative correlations were observed between rCBF in these regions and CDR scores, particularly in the memory domain (rSTG: r = −0.37, p = 0.016; right caudate: r = −0.39, p = 0.011). Conclusions: Reduced rCBF in the rSTG and right caudate may represent early biomarkers for SCD, which could aid in the early detection of AD. These findings suggest that SPECT imaging might be a valuable tool for identifying individuals at risk of cognitive decline, potentially allowing for earlier intervention and targeted preventive strategies in the management of AD. Full article

Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes. Full article

(1) Background: Mild cognitive impairment in older adults is a condition characterized by a decrease in mental abilities that affects their quality of life. The aim of this study is to evaluate the effects of an aerobic training program based on dance on depression, sleep quality, and quality of life in older adults with mild cognitive impairment. (2) Methods: This study employed a randomized controlled trial design with a total of 92 older adults with cognitive impairment, randomly assigned to an experimental group (n = 47) undergoing dance-based aerobic training and a control group (n = 45) who did not receive any intervention. Depression was assessed using the Yesavage Geriatric Depression Scale, sleep quality through the Pittsburgh Sleep Quality Index (PSQI), and quality of life through the SF-36 questionnaire. (3) Results: Statistically significant improvements were observed in depression (t(46) = 4.783, p = 0.000) and in the PSQI domains: subjective sleep quality (t(46) = 3.333, p = 0.002, and Cohen’s d = 0.35), sleep duration (t(46) = 5.511, p = 0.000, and Cohen’s d = 0.73) and PSQI total score (t(46) = 2.116, p = 0.040, and Cohen’s d = 0.20). Regarding quality of life, improvements were observed in all domains of the questionnaire: the general health (t(46) = −9.374, p = 0.000, and Cohen’s d = 0.03), physical function (t(46) = −9.374, p = 0.000, and Cohen’s d = 0.03), the physical role (t(46) = −5.954, p = 0.000, and Cohen’s d = 1.06), the emotional role (t(46) = −6.200, p = 0.000, and Cohen’s d = 0.80), social function (t(46) = −5.585, p = 0.000, and Cohen’s d = 0.53), physical pain, (t(46) = −9.224, p = 0.000, and Cohen’s d = 1.04), vitality (t(46) = 2.289, p = 0.027, and Cohen’s d = 1.27), mental health, (t(46) = −7.985, p = 0.000, and Cohen’s d = 1.33), the physical summary component, (t(46) = −13.532, p = 0.000, and Cohen’s d = 1.81), and in the mental summary component (t(46) = −10.6 81, p = 0.000, and Cohen’s d = 0.06); (4) Conclusions: The results of the present study showed that they suggest that a dance-based aerobic training program improves mental health and quality of life in older people with mild cognitive impairment, providing a non-pharmacological approach to improve general well-being in this population. Full article