Search Results (360)

The United States is experiencing rapid population aging, making geriatric oral health an increasingly important public health and clinical concern. Older adults bear a disproportionate burden of oral diseases, including dental caries, periodontal disease, edentulism, xerostomia, and oral cancer, many of which are closely linked to chronic systemic conditions such as diabetes, cardiovascular disease, and cognitive impairment. This narrative review synthesizes current evidence on oral disease patterns and trends among older adults in the United States, with particular attention to the bidirectional relationships between oral and systemic health. It further examines the organization of oral health care delivery and financing for this population, including the roles of Medicare and Medicaid. Persistent inequities in access to preventive and restorative dental services are highlighted, especially among low-income individuals, racial and ethnic minorities, rural residents, and older adults with functional or cognitive limitations. Workforce shortages, fragmented care models, and limited integration of oral health into primary and geriatric care further exacerbate these disparities. Finally, this review identifies future directions to improve geriatric oral health, including policy reforms to expand dental coverage, integration of oral health into medical and long-term care settings, adoption of minimally invasive approaches, and strengthened interprofessional education and research. Addressing these challenges is essential to promoting healthy aging and reducing oral health disparities among older adults in the United States. Full article

Background/Objectives: Multiple age-related systemic conditions, including frailty, cognitive impairment, and comorbid diseases, have been suggested to be associated with glaucoma. However, their relationship with corneal biomechanical properties in patients with glaucoma remains unclear. Methods: This retrospective cross-sectional study included patients with glaucoma who attended the Department of Ophthalmology at Shimane University Hospital between May 2019 and August 2024. Corneal biomechanical parameters, including corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure (IOPg), were measured using the Ocular Response Analyzer (ORA; Reichert Technologies, Depew, NY, USA). Geriatric assessments, including the Geriatric 8 (G8), Mini-Cog, and Charlson Comorbidity Index (CCI), were also evaluated. Associations between geriatric assessment measures and ocular parameters were examined using multivariable linear mixed-effects models adjusted for age, sex, medication score, and glaucoma subtype. Results: A total of 280 patients (456 eyes) were included. The mean age was 70.2 ± 11.1 years, and 126 patients (45.0%) were women. In multivariable linear mixed-effects models, lower G8 scores were significantly associated with lower CRF (β = 0.18, 95% CI: 0.05 to 0.30), lower IOPcc (β = 0.55, 95% CI: 0.18 to 0.92), and lower IOPg (β = 0.62, 95% CI: 0.25 to 1.00). In contrast, no significant association was observed between G8 scores and CH (β = −0.02, 95% CI: −0.12 to 0.09). Neither Mini-Cog nor CCI was significantly associated with any ocular parameters. Conclusions: In patients with glaucoma, frailty may be associated with corneal biomechanical properties, particularly CRF and intraocular pressure-related parameters. Full article

Background: Adverse drug reactions (ADRs) represent a major and often underestimated source of morbidity, hospitalization, and functional decline in older adults. The convergence of age-related pharmacokinetic and pharmacodynamic changes, multimorbidity, polypharmacy, and frailty creates a clinical environment in which ADR risk is not static but evolves along progressive trajectories—from mild, early manifestations toward severe, potentially irreversible outcomes. Understanding these trajectories is essential for rational geriatric prescribing. Methods: This narrative review synthesizes evidence from epidemiological studies, systematic reviews, Cochrane analyses, and clinical trials published between 2000 and 2025, focusing on adults aged 65 years and older with two or more chronic conditions. Sources were identified through a structured, non-systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus using the terms ‘adverse drug reactions’, ‘polypharmacy’, ‘multimorbidity’, ‘frailty’, ‘deprescribing’, and ‘pharmacokinetics’ in older adults, alone and in combination. Evidence quality was assessed narratively, distinguishing trial evidence from observational and expert consensus data. Results: ADRs in older adults are best classified using complementary frameworks—the augmented Type A to withdrawal Type E and failure-of-therapy Type F taxonomy (Types A–F), the Dose-Time-Susceptibility (DoTS) classification, and the EIDOS mechanistic scheme—which together capture the heterogeneity of drug-related harm in this population. Age-related pharmacokinetic changes (altered absorption, increased volume of distribution of lipophilic drugs, reduced hepatic and renal clearance) and pharmacodynamic shifts (heightened receptor sensitivity, baroreflex impairment, increased blood–brain barrier permeability) interact with polypharmacy and frailty to amplify ADR trajectories from mild to severe. Anticholinergic burden, prescribing cascades, and inappropriate polypharmacy function as structural accelerators of these trajectories. Medication review and deprescribing improve prescribing quality but evidence for hard outcome benefits remains of low to very low certainty. Emerging AI-enabled digital tools show promising accuracy for identifying frailty and pharmacological vulnerability, but this performance relates to frailty classification and has not yet been shown to prevent ADR trajectories; they require validation for routine clinical use. Conclusions: Recognizing ADRs in older adults as dynamic trajectories rather than isolated events repositions prescribing review and deprescribing from optional to essential clinical acts. An integrated approach combining pharmacological vigilance, comprehensive geriatric assessment, structured deprescribing, and emerging digital decision-support tools offers the most realistic pathway to reduce the trajectory-related burden of drug-related harm in complex older patients. Full article

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

Falls represent a severe public health issue and a primary cause of impairment across both geriatric and adults clinical populations, underscoring the importance of early and tailored prevention. Research evidence shows that technology-assisted rehabilitation may enhance balance and reduce fall risk; however, long-term real-world evidence remains limited. This retrospective study evaluated the impact of personalized balance training by hunova^® robotic platform on fall risk in a heterogeneous clinical cohort (n = 355; mean age 58.24 ± 19.63 years) comprising neurological and orthopedic conditions. Fall risk was assessed using the Silver Index, a sensor-based robotic posturographic score to predict 12-month fall probability at baseline (T0), after 6 weeks (T1), and at 6 months (T6). Robotic rehabilitation was provided to 162 patients (TREAT-G), while 193 served as a control group (NOTREAT-G). TREAT-G demonstrated a significant reduction in fall risk over time (p = 0.036), with improvements from T0–T1 (p < 0.001) and T0–T6 (p = 0.009). Domain-specific analysis showed significant increases in limits of stability, sit-to-stand, and gait speed (p < 0.001). Significant time × group interactions were observed for limits of stability (p = 0.004) and sit-to-stand (p < 0.001). Based on the occurrence of falls in the previous six months, the sample was then divided into ‘Fallers’ (at least one fall) and ‘No-Fallers’ (no falls). Subgroup analysis revealed significant improvements in ‘Fallers’ (p = 0.016) and ‘No-Fallers’ (p = 0.034) following treatment in contrast to untreated patients—both ‘Fallers’ and ‘No-Fallers’. These results indicate that tailored robot-assisted therapy with hunova^® significantly reduces risk of fall and improves long-term dynamic balance. This study supports the clinical integration of robotic assessment and therapy as a robust tool for proactive fall prevention in diverse clinical settings. Full article

Heart failure (HF)—a highly prevalent condition among older adults—is characterized by recurrent exacerbations and progressive symptom burden, significantly affecting functional autonomy and quality of life. Palliative care may alleviate symptoms and improve quality of life for patients and their families, promoting personalized care aligned with individual preferences. Although international guidelines recommend the early integration of palliative care into standard HF management, its implementation in real-world practice remains limited. Improving awareness and competencies in identifying end-of-life needs and in advance care planning may facilitate earlier integration of palliative care into HF clinical pathways. This paper presents a case of advanced HF in which palliative care was introduced only during the final hospitalization, highlighting the importance of the earlier integration of palliative care throughout the disease trajectory. This paper results from a collaboration between young members of the Italian Society of Palliative Care and the Italian Society of Gerontology and Geriatrics. The case serves as a practical training model for healthcare professionals in applying a palliative care approach to advanced HF. It illustrates key strategies and tools employed across different stages of care, including patient identification, multidimensional assessment, shared decision-making, advance care planning, symptom management, medication review, and palliative sedation. Full article

Calcium-induced polysaccharide hydrogels have attracted growing interest in food science because of their mild gelation conditions, tunable structures, and compatibility with food-grade formulation. This review focuses on edible Ca²⁺-mediated polysaccharide hydrogels and related composite networks, focusing on alginate, low-methoxyl pectin, gellan gum, and carrageenan. Rather than treating all calcium-containing polysaccharide materials as well-defined complexes, we distinguish direct coordination, ionic bridging, charge screening, helix stabilization, and composite-assisted network regulation. Current evidence indicates that Ca²⁺-mediated assembly is governed by polysaccharide fine structure, calcium-release behavior, pH, ionic strength, and processing conditions, thereby determining crosslinking density, digestibility gel strength, water distribution, rheological properties, release behavior, and texture-related functionality. For texture-modified foods for older adults, these hydrogels may provide a useful material basis for designing swallowing-friendly matrices, sustained nutrient-delivery systems, and soft composite foods. However, available evidence is still largely derived from model gels, in vitro characterization, and static digestion models, while validation in real food matrices, dynamic gastrointestinal conditions, oral processing, sensory acceptance, and older-adult populations remains limited. Future studies should establish structure–function–population evidence chains linking molecular assembly to reliable geriatric food performance. Full article

Background: Population ageing has increased the burden of geriatric syndromes among older adults with cardiovascular disease, where frailty is associated with adverse outcomes, including hospitalization, functional decline, and mortality. Digital technologies and Living Lab approaches offer new opportunities for the early detection, prevention, and monitoring of these conditions through user-centred innovation and stakeholder collaboration. Our purpose is to review the role of technology in the detection, prevention, and monitoring of geriatric syndromes in older adults with cardiovascular disease and to explore the potential of the Living Lab model for developing and implementing innovative solutions in geriatric care. Materials and Methods: A narrative review was conducted using PubMed, CINAHL, MEDLINE, and ScienceDirect. Eleven studies were included. Evidence on physical, cognitive, psycho-emotional, and social frailty, as well as technology-enabled assessment and monitoring approaches, was synthesized. Results: Digital technologies, including wearable sensors, telemonitoring platforms, mobile health applications, machine-learning models, and digital phenotyping tools, supported the early identification and monitoring of frailty, fall risk, cognitive decline, depressive symptoms, and functional deterioration. Technology-assisted interventions improved physical and cognitive performance and promoted social engagement. The Living Lab model facilitated the co-creation, evaluation, and validation of technologies in real-world settings, enhancing usability, acceptability, and implementation in clinical practice. Conclusions: Technology-supported assessment and monitoring can improve the management of geriatric syndromes in older adults with cardiovascular disease. Living Labs provide a valuable framework for the user-centred development and integration of these innovations, supporting personalized and proactive care strategies that promote healthy ageing. Full article

Oropharyngeal dysphagia (OD) is traditionally managed as a mechanical swallowing impairment. This narrative review proposes a conceptual model that reframes chronic, severe OD as a high-risk clinical condition driving systemic malnutrition and progressive nutritional deterioration. We examine the epidemiological burden of OD-associated malnutrition across geriatric, neurological, and oncological populations, exploring how diagnostic heterogeneity influences reported prevalence ranges. The pathophysiological narrative synthesizes hypotheses regarding the potential disruption of the cephalic phase of digestion, the rheological limitations of texture-modified diets (TMDs), and the theoretical bioenergetic cost of impaired swallowing. Central to this review is the hypothetical sarcopenia–dysphagia vicious cycle, evaluating how molecular pathways—such as systemic inflammation, ubiquitin–proteasome-mediated proteolysis, and suppression of muscle protein synthesis—are inferred from broader cachexia models to affect oropharyngeal function. We discuss structured nutritional management strategies, including micro-volume fortification, application of the IDDSI framework with xanthan gum-based thickeners, and monitoring via GLIM criteria, bioelectrical impedance analysis, and routine laboratory parameters. Finally, we analyze the ethical challenges of transitioning to enteral nutrition and outline the translational limitations of emerging fields like 3D food printing. This model aims to encourage clinical focus on comprehensive nutritional restoration alongside airway safety. Full article

Background/Objective: The increasing global population of older adults presents significant challenges for oral healthcare, particularly regarding the management of chronic conditions and prosthetic rehabilitation. Teledentistry, combined with intraoral scanning, offers a promising solution to enhance access, interdisciplinary collaboration, and clinical outcomes in geriatric populations. This study aimed to evaluate the utilisation of intraoral digital scanning within teledentistry for interdisciplinary oral assessment of older patients. Specifically, it investigated current clinical practices, collaboration among healthcare professionals, and perceptions regarding the effectiveness, challenges, and future potential of teledentistry in prosthodontic care. Methods: An analytical cross-sectional survey was conducted among 84 healthcare professionals, including dentists, prosthodontists, and postgraduate students, recruited via an international network. Participants completed a 40-item electronic questionnaire covering demographics, clinical practice, digital technology use, interdisciplinary collaboration, and attitudes toward research and innovation. Descriptive statistics summarised responses, and inferential analyses, including chi-square tests and Spearman correlations, examined associations between career stage, technology adoption, and interdisciplinary practices. Results: Early-career professionals demonstrated the highest adoption of intraoral scanning (76.3%), while mid-career adoption was lowest (28.6%). Sustained usage significantly increased after one year of adoption (93.8%). While 91.7% of respondents valued interdisciplinary care, active collaboration remained limited. Cost, technical barriers, and training gaps were identified as primary obstacles. Professionals perceived intraoral scanning as beneficial for prosthodontic outcomes and chronic inflammation management, though adoption was influenced by experience, systemic factors, and financial support. Conclusions: Teledentistry integrated with intraoral scanning has substantial potential to improve geriatric oral healthcare. Successful implementation depends on structured training, financial investment, and promotion of interdisciplinary collaboration. Future longitudinal and multicenter studies are warranted to evaluate clinical, economic, and patient-centred outcomes, supporting sustainable digital transformation in geriatric dental care. Full article

Background/Objectives: Large language models (LLMs) and generative AI are rapidly being integrated into healthy ageing initiatives for tasks ranging from companionship and cognitive support to personalised health advice and reduction in social isolation among older adults. Current ethical discussions predominantly address bias, privacy, and accuracy, leaving unresolved three critical governance questions: How do LLM sentiments towards transformative technologies diverge from human values in ageing contexts? What epistemic status do LLM outputs hold when applied to geriatric care? When is trust in those outputs justified for older adults? And who bears responsibility when AI-informed decisions affect functional ability or well-being? Methods: The framework was developed through normative conceptual analysis, synthesizing philosophical principles of medical knowledge and trust, ethical theories of responsibility, empirical evidence on LLM sentiment divergence, digital ageism, and applications of AI in geriatric care (structured searches in PubMed, PhilPapers, and relevant databases, January 2020–March 2026). Results: The integrated framework produces (i) adaptation of SAIA for multidimensional evaluation of human–machine value convergence specific to healthy ageing values (functional ability, autonomy, dignity, equity); (ii) a four-tier classification of LLM outputs tailored to geriatric scenarios; (iii) conditions for warranted trust calibrated to age-related vulnerabilities such as cognitive decline and digital divide; and (iv) responsibility allocation via RACI models with testable hypotheses linking governance design to trust calibration and patient safety outcomes. Conclusions: Without explicit societal alignment and epistemic governance, generative AI risks reinforcing benevolent ageism, automation bias, and responsibility gaps in healthy ageing. The 2025–2027 period offers a decisive window to shape institutional norms that place functional capacity, human dignity, and value convergence at the centre of AI deployment in geriatric care. Full article

Background and Objectives: Sarcopenia is a major geriatric condition associated with functional decline and adverse outcomes. Cardiac fat depots exhibit metabolic activity and are linked to cardiometabolic risk; however, the extent to which epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) quantified on standard thoracic computed tomography (CT) scans are associated with sarcopenia in older inpatients remains inadequately explored. This study investigated the associations of EAT and PCAT thickness with sarcopenia. Materials and Methods: This is a retrospective observational study using CT data obtained for clinical purposes and routine geriatric assessment data. In this single-center retrospective study, 101 inpatients aged ≥65 years who underwent unenhanced thoracic CT and bioelectrical impedance analysis within 3 months were included. EAT and PCAT thicknesses were measured using standardized methods. Sarcopenia status was based on a previously established clinical diagnosis according to EWGSOP2 criteria. Multivariable logistic regression, body mass index (BMI)-stratified analyses, and ROC curve evaluations were performed. Results: The participants had a mean age of 78.5 ± 7.6 years; 54.5% were female. Fifty-five patients (54.5%) met the diagnostic criteria for sarcopenia. PCAT was significantly thicker in sarcopenic participants relative to non-sarcopenic ones (12.25 ± 2.50 vs. 11.17 ± 2.32 mm, p = 0.028), while no corresponding difference was observed for EAT (p = 0.959). After controlling for age, sex, and BMI, each 1 mm increase in PCAT thickness was independently associated with an increased odds of sarcopenia (OR 1.399, 95% CI 1.133–1.727, p = 0.002). With the addition of the PCAT, the discriminatory power was modest (AUC 0.637 overall and 0.715 for BMI ≥25 kg/m²). In exploratory stratified analyses, the association was numerically larger in the BMI ≥25 kg/m² subgroup (OR 1.48, p = 0.008); however, the formal BMI-by-PCAT interaction was not statistically significant (p = 0.290), so this subgroup finding is considered hypothesis-generating. Conclusions: PCAT thickness measured on routine non-contrast thoracic CT was associated with prevalent sarcopenia, whereas EAT thickness was not. ROC analyses showed modest discrimination; therefore, any proposed cut-offs should be considered exploratory and require prospective validation and external confirmation before clinical use. Full article

Background/Objectives: Population ageing is accompanied by an increasing burden of multimorbidity and frailty, both of which are consistently associated with poorer health-related quality of life (QoL). Although several geriatric domains influence QoL in older adults, their combined association remain insufficiently explored in institutionalised populations. This study aimed to examine the independent and combined associations between age, multimorbidity, frailty, and QoL in institutionalised older adults and to explore which quality-of-life domain was most strongly associated with geriatric assessment variables. Methods: A cross-sectional study was conducted in 72 institutionalised older adults in Spain. Multimorbidity (number of chronic conditions), frailty (Fried phenotype), functional status, nutritional status, fall risk, and QoL were assessed using validated instruments, including the World Health Organization Quality of Life questionnaire. Pearson correlations and canonical correlation analysis were used to examine relationships between geriatric assessment variables and QoL domains. Analysis of variance and regression tree were subsequently applied to explore associations affecting the Physical Health domain. Results: A correlation analysis identified the Physical Health domain as the QoL dimension most strongly associated with geriatric variables. On the other hand, frailty, age and number of chronic diseases turned out to be the most explanatory in our study and were classified: the first according to the standard protocol, and the other two using a regression tree. Then, a three-way additive ANOVA explained 36.4% of the variance, with age as main influential. Namely, we estimate that the poorest QoL occurs in subjects over 84 who have more than three chronic conditions and are classified as frail. However, this is not a validated clinical decision rule since these cutoff points may vary in other samples. Conclusions: In this sample of institutionalised older adults, age emerged as the main variable associated with lower physical QoL, multimorbidity contributes to the cumulative burden of disease, and frailty may reflect the systemic decline in physiological reserves. Full article

Background: Syncope in older adults is a frequent and diagnostically challenging presentation in prehospital emergency care, particularly in geographically remote areas with limited access to advanced cardiac services. While many syncopal episodes are benign, some are caused by life-threatening conduction disorders such as complete atrioventricular block (CAVB), which may manifest with seizure-like activity due to severe cerebral hypoperfusion. Case Presentation: We report the case of a 70-year-old man with a history of hypertension, residing in a remote rural area, who experienced a nocturnal tonic–clonic episode followed by recurrent loss of consciousness. Due to difficult ground access, a helicopter emergency medical service (HEMS) team was deployed. On arrival, the patient was hypotensive and severely bradycardic, with recurrent syncopal episodes. Electrocardiography (ECG) confirmed CAVB with a slow escape rhythm. Temporary transvenous pacing was initiated but required progressively higher output, up to approximately 80 mV, with intermittent loss of capture, indicating a high risk of pacing failure and asystole. The patient was transported by helicopter to a tertiary interventional cardiology center, where he experienced additional syncopal episodes before undergoing emergent implantation of a permanent single-chamber ventricular pacemaker (VVI). Permanent pacing resulted in immediate hemodynamic stabilization, and no further syncopal or seizure-like episodes were observed. Conclusions: In geriatric patients presenting with convulsive syncope, cardiac causes such as CAVB must be rapidly identified. Unstable temporary pacing with high capture thresholds represents a life-threatening condition requiring urgent permanent pacemaker implantation. HEMS plays a critical role in ensuring timely access to definitive cardiac care in geographically isolated regions. Full article

Background: This study aimed to evaluate referral reasons, distribution of allergic diseases, atopic status, and comorbidity associations among patients aged 65 years and older presenting to a tertiary allergy clinic. Methods: This retrospective study included all geriatric patients (≥65 years) who attended the Immunology and Allergy outpatient clinic at Ankara Bilkent City Hospital between January 2024 and December 2025. Demographic characteristics, comorbidities, referral complaints, and allergic diagnoses were recorded. Allergen sensitization was assessed using skin tests and/or allergen-specific IgE measurements. Results: A total of 1302 geriatric patients were included (mean age 70.9 years; 59.8% female). At least one comorbidity was present in 62.6% of patients, with hypertension being the most common(39.4%). The leading referral complaints were rhinorrhoea/sneezing (22.8%), pruritus (19.1%), drug allergy/adverse drug reactions (14.8%), and chronic urticaria (10.9%). The most common diagnoses were rhinitis (63.2% non-allergic), non-allergic pruritus, drug allergy, and chronic urticaria. Among inhalant allergens, pollen sensitivity (42.2%) was most frequent, followed by house dust mite (32.5%). The most frequently implicated drug groups were antibiotics (42.4%) and analgesics (21.7%). Chronic urticaria and ACE inhibitor-associated angioedema showed significant gender differences: 68.6% female (p = 0.001) and 66.7% male (p = 0.008), respectively. Patients with asthma, rhinitis, or angioedema frequently had comorbid conditions (91.1%, 55.8%, and 83.7%, p = 0.001, p = 0.013, and p = 0.001, respectively). Conclusions: Allergy clinic presentations in elderly patients reflect a broad clinical spectrum, including non-allergic conditions, frequent drug-related reactions in elderly patients with multiple comorbidities, and age-related immunological changes alongside atopic diseases. A comprehensive, individualized diagnostic approach is essential when evaluating allergic complaints in the geriatric population. Full article