Search Results (564)

Osteosarcopenia is a widespread geriatric condition resulting from the coexistence of osteoporosis and sarcopenia, where the connection between bone and muscle is, in part, driven by bone–muscle crosstalk. Given the close, reciprocal influence of muscle on nerve, and vice versa, it is not surprising that there are corresponding aging changes in the biochemistry and morphology of the neuromuscular junction (NMJ). Indeed, degeneration of motor neurons and progressive disruption of the neuromuscular connectivity were observed in old age. Extracellular vesicles (EVs) derived from human amniotic fluid stem cells (hAFSC), exhibiting antioxidant properties, which can also explain their anti-aging and cytoprotective effects, can be considered as potential treatment for age-related diseases. To study cell interactions under both healthy and pathological conditions occurring in musculo–skeletal apparatus, we developed a three-culture system exploiting the use of well-known transwell supports. This system allows both myotubes and neurons, eventually treated with EVs, and osteoblasts, induced to osteoporosis, to interact physically and biochemically. Collectively, this method allowed us to understand how the modifications induced in osteoblasts during bone disorders trigger a cascade of detrimental effects in the muscle and neuron parts. Moreover, we demonstrated the efficacy of hAFSC-EVs in preventing NMJ dysfunction, muscle atrophy, and osteoblast impairment. Full article

Calcific aortic stenosis (CAS) is a newly emerging pandemic in elderly individuals due to the aging of the population in the world. Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) are the cornerstone of the management of severe aortic stenosis accompanied by one or more symptoms. Moreover, an appropriate interventional treatment of CAS, in elderly patients, is a very complex decision for heart teams, to avoid bad outcomes such as operative mortality, cardiovascular and all-cause death, hospitalization for heart failure, worsening of quality of life. In fact, CAS in the elderly is not only a focal valve disease, but a very complex clinical picture with different risk factors and etiologies, differing underlying pathophysiology, large phenotypic heterogeneity in a context of subjective biological, phenotypic and functional aging until frailty and disability. In this review, we analyzed separately and in a more integrated manner, the natural and prognostic histories of the progression of aortic stenosis, the phenotypes of myocardial damage and heart failure, within the metrics and aging trajectory. The aim is to suggest, during the clinical timing of valve disease, the best interval time for an appropriate and effective interventional treatment in each older patient, beyond subjective symptoms by integration of clinical, geriatric, chemical, and advanced imaging biomarkers. Full article

Aging is associated with complex immune dysfunction that contributes to the onset and progression of the “geriatric giants”, including frailty, sarcopenia, cognitive decline, falls, and incontinence. Central to these conditions is immunosenescence, marked by thymic involution, the loss of naïve T cells, T-cell exhaustion, impaired B-cell class switch recombination, and increased autoreactivity. Concurrently, innate immunity deteriorates due to macrophage, neutrophil, and NK cell dysfunction, while chronic low-grade inflammation—or “inflammaging”—amplifies systemic decline. Key molecular pathways such as NF-κB, mTOR, and the NLRP3 inflammasome mediate immune aging, interacting with oxidative stress, mitochondrial dysfunction, and epigenetic modifications. These processes not only impair infection control and vaccine responsiveness but also promote tissue degeneration and multimorbidity. This review explores emerging interventions—ranging from senolytics and immunonutrition to microbiome-targeted therapies and exercise—that may restore immune homeostasis and extend healthspan. Despite advances, challenges remain in translating immunological insights into clinical strategies tailored to older adults. Standardization in microbiome trials and safety optimization in senolytic therapies are critical next steps. Integrating geroscience into clinical care could help to mitigate the burden of aging-related diseases by targeting fundamental drivers of immune dysfunction. Full article

This narrative review examines the effects of caffeine on brain health in older adults, with particular attention to its potential for dependence—an often-overlooked issue in geriatric care. Caffeine acts on central adenosine, dopamine, and glutamate systems, producing both stimulating and rewarding effects that can foster tolerance and habitual use. Age-related pharmacokinetic and pharmacodynamic changes prolong caffeine’s half-life and increase physiological sensitivity in the elderly. While moderate consumption may enhance alertness, attention, and possibly offer neuroprotective effects—especially in Parkinson’s disease and Lewy body dementia—excessive or prolonged use may lead to anxiety, sleep disturbances, and cognitive or motor impairment. Chronic exposure induces neuroadaptive changes, such as adenosine receptor down-regulation, resulting in tolerance and withdrawal symptoms, including headache, irritability, and fatigue. These symptoms, often mistaken for typical aging complaints, may reflect a substance use disorder yet remain under-recognized due to caffeine’s cultural acceptance. The review explores caffeine’s mixed role in neurological disorders, being beneficial in some and potentially harmful in others, such as restless legs syndrome and frontotemporal dementia. Given the variability in individual responses and the underestimated risk of dependence, personalized caffeine intake guidelines are warranted. Future research should focus on the long-term cognitive effects and the clinical significance of caffeine use disorder in older populations. Full article

Objectives: The relationship between oral health and general health of geriatric in-hospital patients (GIH) who are poly-morbid and edentulous is currently unclear. This study determined the relationship between oral health and general health, and further implications and recommendations were derived. Methods: This retrospective cohort study included 81 GIH patients with impairment of oral state and masticatory function and need for immediate prosthetic treatment. The number of medical diagnoses, particularly main diagnoses of being hospitalized, comorbid diagnoses and the dental/oral state, were evaluated. Laboratory data of vitamin D3 and albumin concentrations were measured. Intraoral risk factors (IRF) affecting the masticatory function were intraoral inflammation, mucogingival impairment (MGI) and severe bone crest atrophy (SBCA). Masticatory function was evaluated by DMF*-T Index (number of destroyed/diseased, missing teeth and artificial fabrication), Eichner Index and Scores. The clinical relevance was surveyed by significance and effect size calculations. Results: In GIH, the number of medical diagnoses correlated significantly with the occurrence of IRFs. SBCA was the most affecting IRF, as measured by Eichner Index at baseline (p = 0.001). Single main diagnoses CNS and gastro-intestinal disease (GID) correlated with both deficiency of vitamin D3 levels (p = 0.011; p = 0.028) and hypoalbuminemia (p = 0.013; p = 0.023). Single comorbid diagnoses significantly correlated with both vitamin D3 deficiency and hypoalbuminemia (CVD (p = 0.031); DM (p = 0.042). Hypoalbuminemia was further found to be correlated with the sum of comorbid diagnoses (p = 0.033). Conclusions: GIH patients suffered from general and dental poly-morbidity. The prevalence of diseases was higher due to SBCA and impaired masticatory function. Deficiency of vitamin D3 and hypoalbuminemia were possible malnutrition markers. Full article

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample. Full article

Objectives: This study aims to describe the clinical features and genetic findings of nine Vietnamese patients with autosomal recessive bestrophinopathy. Methods: This retrospective and cross-sectional study included individuals diagnosed with autosomal recessive bestrophinopathy at the Eye Clinic, Vietnam National Geriatric Hospital between May 2024 and April 2025. The patients underwent a visual acuity assessment, retinal multimodal imaging, and molecular testing through BEST1 gene sequencing. Results: Nine patients from seven unrelated families were included. The mean age was 38.6 years (range: 14.1–79.6). Visual acuity ranged from 20/20 to 20/125. All patients showed vitelliform lesions, subretinal deposits, and both intraretinal and subretinal fluid. Other main features included diffuse macular hyperfluorescence and hyperopia. Less common clinical features encompassed glaucoma, retinoschisis, outer retinal thinning, serous retinal detachment, retinal thickening, and thinning of the retinal pigment epithelium. Compound heterozygous or homozygous variants were detected in all patients. Among the five identified BEST1 variants, the most frequent were p.(A195V) and p.(R200*). One novel variant, p.(K289*), was detected. Conclusions: The main clinical retinal features of nine Vietnamese patients with autosomal recessive bestrophinopathy included vitelliform lesions, subretinal deposits, retinal fluid, and diffuse macular hyperfluorescence. The most common variants were p.(A195V) and p.(R200*). Additionally, the identification of various compound heterozygotes and a novel BEST1 variant expands the mutation spectrum of the disease. Full article

Background: Clostridioides difficile (CD) is the main cause of nosocomial diarrhea, resulting in increased morbidity and mortality, and is thought to be greatly affected by strict hygiene. In this study, we assessed changes in CD infection prevalence and outcomes pre- and during the COVID-19 pandemic (CP). Methods: This was an observational cohort performed at a tertiary medical center (MC) and a geriatric hospital (GH). Patients from both hospitals diagnosed with CD were included, and the period of one year prior to the pandemic to one year after was compared. Data was extracted from electronic medical records (EMR). Results: A total of 145 CD-associated diarrhea (CDAD) cases were diagnosed in the MC and 54 in the GH. There was no change in CDAD prevalence or mortality between the study periods in either hospital. Disease duration, measured as days with diarrhea (DWD), was shorter during the CP in the GH (10.6 days vs. 8.1 days, p < 0.01). CDAD was more prevalent in the GH during both periods; however, the disease was milder, with only three mortality cases and a significantly shorter disease duration (3.19 DWD vs. 10.67 in the MC before CP; 3.11 vs. 8.1 during CP, p < 0.01). In a survival analysis for MC patients, no significant differences were found between periods before and after adjustment for age, gender and period. Conclusions: The CP affected the duration but not the prevalence of CDAD. The milder course of CDAD in the GH may have been due to the quality of treatment provided in an academic GH and the subsequent faster diagnosis and treatment. Full article

Background: Delirium frequently manifests in hospitalized geriatric patients and is associated with negative health outcomes. Available large-scale data regarding its prevalence rate and impact on older Thai patients are limited. This study aimed to analyze trends in the prevalence rate, its consequences, and the factors contributing to death at discharge among this population. Methods: A retrospective study of inpatients over the age of 60 who received a diagnosis of delirium was conducted, utilizing inpatient medical expense documentation for the fiscal years 2019–2023. The identification of delirium was conducted by the National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) code F05. Results: The 5-year prevalence rate and mortality rate of delirium were 215.1 and 18.7/100,000 population, respectively, and tended to rise over the studied periods. The average hospitalization was 10 days, and the average healthcare expenditure was about 1470 USD/visit. Respiratory disease emerged as the most common primary diagnosis in delirious patients (23.5%). Factors associated with mortality were individuals aged >80 years when juxtaposed with the cohort aged 61–70 years (adjusted odds ratio [AOD] 1.07), being female (AOR 1.13), and a primary diagnosis of respiratory disease (AOR 2.72), cardiovascular disease (AOR 1.68), musculoskeletal disease (AOR 0.61), systemic infection/septicemia (AOR 2.08); or malignancy (AOR 2.97). Conclusions: There was an upward trend in rates of both prevalence and mortality associated with delirium among hospitalized geriatric patients. Advancing age, gender, and particular primary diagnoses were associated with mortality at hospital discharge. Full article

Cardiotoxicity is a leading cause of mortality in the growing populations of elderly breast cancer (BC) patients. Breast cancer treatment in the elderly is highly challenging due to its heterogeneous nature and the lack of specific evidence, as this population is usually underrepresented in randomized clinical trials. Decision making requires a comprehensive approach, considering the type and stage of BC, the patient’s overall health status, life expectancy, geriatric and frailty assessment, the risk of cancer recurrence, comorbidities, cardiotoxicity risk, and the patient’s preferences. The cardiotoxic effects of BC treatments cover the whole spectrum of cardiovascular diseases: heart failure, hypertension, arrhythmias, and myocardial ischemia. Cardiotoxicity risk in these patients is defined by several factors: anticancer therapies, polypharmacy, established cardiovascular disease, comorbidities, frailty, cellular senescence, hormonal changes, and genetic predisposition. Preventive oncological and cardio-oncological strategies, as well as patients’ education, are critical for improved outcomes. Prospective clinical trials in this population are urgently needed. Full article

Background: Falls are a major cause of morbidity and mortality among older adults and are influenced by comorbidities and polypharmacy. Cardiovascular diseases (CVDs) and their associated treatments are particularly prevalent in this population and may contribute to fall risk. Objectives: The objectives of this study were to examine the association between cardiovascular pharmacotherapy and fall risk in older adults and to identify potential preventive strategies. Methods: This observational case–control study was conducted between June and December 2024 and included 200 participants aged over 55 years who provided informed consent. Participants were assessed using the Downton Fall Risk Index and divided into two equal groups, with those at high risk of falling and controls. All participants underwent a comprehensive geriatric assessment, including anamnesis, clinical evaluation, and laboratory testing focused on cardiovascular risk factors. The prevalence of CVD and the use of specific cardiovascular medications were analyzed. Results: Patients at high risk of falling showed significant differences compared to the control group in several parameters, including systolic blood pressure (SBP: 140.41 mmHg vs. 151.28 mmHg, p = 0.001), ankle brachial index (left ABI: 1.09 vs. 1.15., p = 0.033), and presence of cardiovascular diseases (p = 0.001), as well as total cholesterol (p = 0.005) and triglyceride levels (p = 0.047). Certain cardiovascular medications were significantly associated with increased fall risk, including spironolactone (OR = 4.10, p = 0.001), beta-blockers (OR = 1.88, p = 0.031), and calcium channel blockers (OR = 2.05, p = 0.014), especially in combination with one another. Additional risk factors included frailty, cognitive impairment, diabetes, and neurological or osteoarticular conditions. Interventions such as medication review, deprescribing, and dosage adjustments may help reduce fall risk without compromising cardiovascular disease management. Conclusions: Cardiovascular diseases and related pharmacotherapy are significantly associated with an increased risk of falls in older adults. Regular medication reviews, deprescribing where appropriate, and individualized treatment plans may help minimize fall risk while maintaining the effective cardiovascular care of this vulnerable population. Full article

Background: Invasive aspergillosis (IA) is a severe fungal infection increasingly affecting elderly patients with chronic respiratory diseases and prolonged corticosteroid use. Methods: We evaluated clinical, biochemical, and fungal biomarkers in 45 patients over 80 years diagnosed with IA and hospitalized in a Spanish Acute Geriatric Unit. Patients received either voriconazole or isavuconazole. Mortality rates and associated risk factors were analyzed. Results: Overall mortality was 35.61%. Significant mortality risk factors included leukocytosis (p = 0.0371), neutrophilia (p = 0.0144), and lymphopenia (p = 0.0274). Deceased patients had longer hospital stays (26.6 vs. 16.8 days; p = 0.00353). Voriconazole treatment was associated with higher 30-day mortality (61.5% vs. 19.2%; p = 0.0001) and a higher incidence of adverse effects (60% vs. 5%; p = 0.0003) compared to isavuconazole. Voriconazole also showed greater pharmacokinetic variability, with 76.9% of cases outside the therapeutic range. Conclusions: Voriconazole may not be optimal for IA treatment in patients over 80 years. Isavuconazole demonstrated a more favorable safety and efficacy profile. Personalized therapeutic strategies and a multidisciplinary approach are essential to improve clinical outcomes and quality of life in this vulnerable population. Full article

Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights some of the particularities of using direct oral anticoagulants (DOACs) in the geriatric population. We focused on the difficulties of managing DOAC treatment in the presence of geriatric syndromes. We highlighted the practical steps needed to overcome the challenges related to the risk of falling, cognitive impairment, swallowing disorders, and polypragmasy to improve patient care. We provided data to help guide the choice of anticoagulant and dose. Full article

Background/Objectives: Patterned Sensory Enhancement (PSE), a Neurologic Music Therapy technique, utilizes rhythm and other musical elements to facilitate functional movement in diverse clinical populations. This scoping review is the first to systematically synthesize the current evidence surrounding PSE’s use and its effects on motor function across various populations in order to evaluate its therapeutic potential, identify gaps in the existing literature, and guide future research efforts. Methods: A literature search was conducted across five major databases (MEDLINE, Embase, PsycINFO, CINAHL, and Scopus) in accordance with the PRISMA-ScR guidelines. Results: From 1018 screened articles, 15 met the inclusion criteria. PSE has been demonstrated as effective across clinical populations, including Cerebral Palsy, stroke, Parkinson’s Disease, and psychiatric conditions. However, the results for studies on geriatric populations remain inconsistent. Despite the variability in the outcome measures and movement types assessed, PSE is consistently supported as an effective approach for enhancing motor function. However, to date, only a small number of studies across populations have been conducted. Conclusions: This scoping review suggests that PSE holds significant potential for improving motor function across a range of clinical populations. Further research is needed to explore the long-term effects, use standardized terminology, and identify the optimal implementation strategies tailored to the unique needs of different populations to maximize its therapeutic benefit. Full article