Search Results (285)

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

Objectives: To identify clinical, functional, laboratory, and patient-reported parameters associated with medium-term risk of hospitalization or death among older adults attending a multidisciplinary outpatient clinic, and to assess the predictive performance of these measures for individual risk stratification. Methods: In this cohort study, 350 adults aged ≥65 years were assessed at baseline and followed for an average of 8 months. The primary outcome was a composite of hospitalization or all-cause mortality. Parameters assessed included frailty and comorbidity measures, functional parameters, such as gait speed and grip strength, laboratory biomarkers, and patient-reported measures, such as quality of life (QoL, assessed on a Likert scale) and the presence of depressive symptoms. Predictive performance was evaluated using univariable logistic regression and multivariable modeling. Discriminative ability was assessed via area under the ROC curve (AUC), and selected models were internally validated using repeated k-fold cross-validation. Results: Overall, 40 participants (11.4%) experienced hospitalization or death. Traditional clinical risk indicators, including frailty and comorbidity scores, were significantly associated with the outcome. Patient-reported QoL (AUC = 0.74) and Geriatric Depression Scale (GDS) scores (AUC = 0.67) demonstrated useful overall discriminatory ability, with high specificities at optimal cut-offs, suggesting they could act as “red flags” for adverse outcomes. However, the limited sensitivities of individual predictors underscore the need for more comprehensive screening instruments with improved ability to identify at-risk individuals earlier. A multivariable model that incorporated several predictors did not outperform QoL alone (AUC = 0.79), with cross-validation confirming comparable discriminative performance. Conclusions: Patient-reported measures—particularly quality of life and depressive symptoms—are valuable predictors of hospitalization or death and may enhance traditional frailty and comorbidity assessments in outpatient geriatric care. Future work should focus on developing or integrating screening tools with greater sensitivity to optimize early risk detection and guide preventive interventions. Full article

Background: Apathy predicts functional and cognitive decline in community-dwelling older adults. However, the behavioral correlates of apathy, which could promote cognitive decline have not been described. Our objective was to investigate the associations of apathy with leisure and social engagement. Methods: N = 538 older adults enrolled in the Central Control of Mobility in Aging study. We used the GDS3A, a 3-item subscale of the Geriatric Depression Scale, to define apathy and the frequency of participation in cognitive, physical, and social leisure activities. Linear regression models were conducted to assess the association between apathy and its behavioral correlates: social engagement and leisure activity participation. Covariates included age, gender, education level, multimorbidity, and dysphoria. Results: Apathy was present in 29.7% of participants and was significantly associated with less frequent participation in physical activity days per week (−1.688. p = 0.003) but not cognitive (−1.094, p = 0.252) or social (−0.654, p = 0.103) leisure activities. Apathy was also associated with a decreased social behavior composite score (−0.055, p < 0.001), Social Network Index (−0.478, p = 0.003), and Medical Outcomes Study Social Support scores (−0.26, p = 0.001). Conclusions: Our findings suggest that apathy presents with reduced participation in physical leisure activities and reduced social engagement, which may provide a way for clinicians and caregivers to identify apathy in the future. Full article

Hip fractures in elderly patients pose significant clinical challenges, confronting us with high morbidity and mortality rates. A comprehensive geriatric assessment plays an important role in determining prognosis as well as the indication for surgery. Aim: In this study, we aim to (1) assess frailty-based functional status in seniors with hip fractures, (2) evaluate geriatric assessment’s predictive value for postoperative recovery, and (3) analyze 1-year postoperative survival. Material and Methods: This prospective study included 60 senior patients admitted for hip fracture in the Orthopedics Department. Patients were examined using geriatric assessment instruments Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), and Frailty Groningen Indicator (GFI). We recorded the sex, marital status, number of comorbidities, and number of recommended drugs. Results: In total, 65% of patients were frail pre-surgery; the proportion increased post-surgery to 86.7%; (p = 0.005). Age greater than 80 years and unmarried marital status were associated with higher frailty risk (p = 0.04; p = 0.03). Preoperatively, important predictors of frailty were mild–moderate cognitive impairment (p = 0.017), mild–moderate depression (p = 0.01), and malnutrition (p = 0.04). Postoperatively, only mild–moderate cognitive impairment (p = 0.04) and mild–moderate depression (p = 0.01) proved to be important predictors of frailty. According to the ROC curve, good predictors of postoperative frailty were shown to be preoperative frailty and the degree of polypharmacy and comorbidity. Of all parameters predictive of postoperative frailty, only the number of medications reached statistical significance (p < 0.038). The study identified a 1-year all-cause mortality rate of 42.6% in elderly patients who underwent hip fracture surgery, with a significant association between mortality and preoperative MMSE, GDS, and MNA scores. Conclusions: Complex geriatric assessment of senior patients with hip fracture can stratify postoperative risk and predict 1-year mortality and postoperative functional recovery. Key predictors include cognitive status, depression, malnutrition, and comorbidities. Multidisciplinary care and standardized evaluation are essential for improving outcomes. Full article

Despite the benefits of resistance training in mitigating sarcopenia, adherence among frail older adults is often limited by osteoarticular pain, comorbidities, and logistical barriers. Pulsed electromagnetic field (PEMF) therapy has emerged as a potential alternative. However, evidence regarding its effects on functional and psychological parameters remains scarce. Objectives: To assess the effects of 12 PEMF therapy sessions on knee extensor strength and functional performance (Timed Up and Go test—TUG) in older adults with sarcopenia. Secondary outcomes included changes in calf circumference (CC), SARC-F + CC scores, and depressive symptoms. Methods: A controlled, non-randomized experimental design was employed, with a pre-intervention control group serving as a baseline reference (PEMF group: n = 25; control group: n = 16). Participants received 12 PEMF therapy sessions (three times per week) targeting the quadriceps and gastrocnemius muscles. Outcomes were measured using knee-extension dynamometry, TUG, CC, SARC-F + CC, and the Yesavage Geriatric Depression Scale. Statistical analyses included ANCOVA, with baseline values as covariates. Results: Significant improvements were observed in knee-extension strength, which increased from 13.05 ± 4.8 kgf to 18.56 ± 8 kgf (p < 0.001); TUG test time improved from 23.1 ± 14.4 to 18.7 ± 10 s (p = 0.048); SARC-F + CC scores decreased from 11.6 ± 8.2 to 6.5 ± 7.6 (p < 0.001), though the interaction effect with time was not significant (p = 0.252). No statistically significant changes were observed in CC, which increased from 34.0 ± 4.0 cm to 36.0 ± 3.9 cm following the intervention (p = 0.548). Yesavage Geriatric Depression Scale scores improved significantly (7.9 ± 2.4 to 5.4 ± 1.7, p = 0.0013). Conclusions: PEMF therapy significantly improved lower-limb muscle strength and functional mobility in elderly individuals with sarcopenia. Additionally, depressive symptoms were significantly reduced. However, no significant changes were observed in CC or SARC-F + CC. Full article

Depression and cognitive impairment frequently co-occur in older adults, but their temporal relationship remains unclear. While depression is often considered a risk factor for cognitive decline, evidence is mixed, particularly in individuals with mild cognitive impairment or early dementia (MCI/ED). This study analyzed longitudinal data from 1086 participants (M = 74.49, SD = 7.24) in the SMART4MD clinical trial, conducted in Spain and Sweden over 18 months, with assessments every six months. Cognitive impairment was measured using the Mini-Mental State Examination, and depression was assessed with the Geriatric Depression Scale-15. Findings revealed a concurrent association between depressive symptoms and cognitive impairment. In regression mixed analysis, depression levels predicted increased cognitive decline over time, but no evidence was found for cognitive impairment predicting future depression. These associations were confirmed using a bivariate latent growth curve model with cross-lagged paths, which revealed early but attenuating bidirectional effects between depression and cognition. These results highlight depression as a medium-term risk factor for cognitive decline, emphasizing the importance of addressing depressive symptoms to mitigate cognitive deterioration in MCI/ED populations. Full article

Background/Objectives: Depression impairs the quality of life in older adults and represents a significant public health issue. Cognitive reserve may act as a protective factor against depressive symptoms in older adults. Additionally, interaction with pets may serve as another potential protective factor against these symptoms. Thus, this study aimed to evaluate whether higher cognitive reserve could predict a reduction in depressive symptoms in older adults and to investigate the moderating role of pet companionship in this relationship. Methods: The following instruments were used: a Sociodemographic Data Sheet, the Modified Telephone Interview for Cognitive Status (TICS-M), the Cognitive Reserve Index Questionnaire (CRIq), and the Geriatric Depression Scale (GDS-15). Data were collected via video calls through WhatsApp and analyzed using a moderation analysis with PROCESS for SPSS. Results: The final sample consisted of 215 older adults with a mean age of 69.13 years (SD = 6.89). Among the participants, 53% owned pets and 47% did not. The overall model revealed a significant association between the predictor variables and the outcome (F(3, 211) = 4.24, p < 0.01). For the group without pets, the effect was not significant (β = −0.1082, p = 0.2916), but for the group with pets, the effect was substantial and negative on the GDS (β = −0.1936, p < 0.05). Conclusions: We concluded that the relationship between cognitive reserve and depressive symptoms is moderated by the presence of pets in individuals’ lives. These findings highlight the role of pets in protecting against depressive symptoms in older adults. Future studies should explore this relationship with more diverse samples. Full article

Background: This study aimed to evaluate the impact of physical activity levels on selected biochemical markers (glucose, insulin, cholesterol, triglycerides, interleukin-6 [IL-6]), brain-derived neurotrophic factor (BDNF), cognitive functions, and additional macronutrient intake in postmenopausal women. Method: A total of 72 generally healthy women aged 55–73 from western Poland participated in the study. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ), resulting in two distinct groups: 56 women in the lower activity level group and 16 in the higher activity level group. We calculated body mass index (BMI), measured body composition and blood pressure, and conducted cognitive assessments, including the Mini-Mental State Examination (MMSE), motor and psychomotor skills tests, the Clock Drawing Test, and the Geriatric Depression Scale (GDS). Nutritional intake was evaluated using a detailed 3-day food record to analyze macronutrient consumption and total caloric intake. Results: A statistically significant difference in total blood cholesterol levels (p = 0.0277) was observed between the two groups, with the higher physical activity group showing elevated cholesterol levels. Although no other biochemical markers showed statistically significant differences, variations in BDNF, glucose, triglycerides, IL-6, and insulin levels were noted between groups. Moreover, correlations between these markers and cognitive performance, like motor and psychomotor speeds, varied depending on physical activity level. The analyzed dietary pattern of the studied group shows slight deviations from current nutritional recommendations. Conclusions: The findings suggest that physical activity level may influence certain biochemical markers and cognitive functions in postmenopausal women. While these results highlight the potential benefits of physical activity, further research is needed to clarify underlying mechanisms and to validate physical activity as an effective strategy for improving postmenopausal health. Full article

Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: FOF was assessed using two measures: a single-item question (SIQ) asking, “Are you currently afraid of falling?” with responses scored as (0) not at all; (1) a little; (2) quite a bit; (3) very much, and the Falls Efficacy Scale International (FES-I). FES-I scores were categorized into low (FES-I 16–19), moderate (FES-I 20–27), and high (FES-I 28–64) concerns about falling. FOF scores were analyzed in relation to patients’ characteristics and functional performance. Results: A total of 103 patients were included in the final analysis (mean age: 81.9 years, 64.1% female). Upon hospital admission, 74.8% of patients reported FOF (SIQ ≥ 1), with no significant change at discharge (73.8%, p > 0.999). Patients’ FES-I scores indicated high concerns about falling, with only slight improvements following CGC. The median FES-I score upon admission decreased from 31 (IQR: 23.5–40) to 30 (IQR: 23.5–38) at discharge (p < 0.001). Logistic regression analysis revealed that persistently high concerns about falling (FES-I 28–64) after undergoing CGC were associated with depressive symptoms (Geriatric Depression Scale score ≥ 6; OR: 3.61, 95% CI: 1.30–10.04) and a diagnosis of heart failure (OR: 3.63, 95% CI: 1.30–10.11). Patients’ scores in the Barthel Index, Timed Up and Go Test, and Tinetti Test improved after treatment, but these changes (Δ) did not show a significant correlation with those in the FES-I or SIQ. Conclusions: Our findings demonstrate that FOF is highly prevalent among older adults hospitalized for CGC and persists with only minimal improvement following treatment. Persistently high concerns about falling even after completing CGC were associated with depressive symptoms and a diagnosis of heart failure. These results highlight the potential for more targeted interventions within CGC to more effectively address FOF in this vulnerable population. Full article

Objective: To clarify the relationship between constipation and depressive symptoms among the elderly. Methods: This single-center, cross-sectional study was performed using baseline data obtained at the time of enrollment in the prospective cohort of the JUSTICE-TOKYO study. Participants underwent assessments including patient profiling, drug use history, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale 15 (GDS-15), gastrointestinal-related quality of life (QOL), and the constipation scoring system (CSS). Geriatric depressive symptoms were evaluated based on GDS-15. We investigated correlations between GDS-15 scores and various abdominal symptoms and assessed risk factors for geriatric depressive symptoms using multiple regression analysis. Results: A total of 984 elderly participants (57% female, mean age 78.1 ± 6.1 year) were included. The GDS-15 scores were significantly correlated with body mass index (BMI) (r = −0.056) and MMSE (r = −0.092), reflex-related QOL (r = 0.253), pain-related QOL (r = 0.229), fullness-related QOL (r = 0.269), constipation-related QOL (r = 0.329), diarrhea-related QOL (r = 0.264), and CSS (r = 0.285) scores. Multiple regression analysis indicated that BMI (β = −0.069, p = 0.020) and MMSE (β = −0.074, p = 0.013), constipation-related QOL (β = 0.136, p = 0.002), reflex-related QOL (β = 0.126, p < 0.001), diarrhea-related QOL (β = 0.095, p = 0.006), and CSS (β = 0.098, p = 0.016) scores were significantly correlated with GDS-15 scores. Conclusions: Depressive symptoms among older individuals are associated with various abdominal symptoms, particularly constipation. However, the causality between depressive symptoms and constipation cannot be inferred due to the study’s cross-sectional design. 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: As societies rapidly age, the prevalence of mental health disorders and chronic kidney disease (CKD) is simultaneously rising, and data on the link between these conditions remain inconclusive. This study aimed to investigate the associations among cognitive impairment, depression, and kidney involvement in elderly patients. Methods: A cross-sectional analysis was conducted among hospitalized patients aged ≥65 years. Standardized tools such as the geriatric depression scale (GDS) and Montreal Cognitive Assessment (MoCA) were used to assess depression and cognitive impairment, and kidney function was evaluated using eGFR and albuminuria. Bivariate and multivariate logistic regressions were performed to identify associations. Results: The study population consisted of 719 participants with a median age of 80 years. Kidney and mental health issues were highly prevalent: CKD was identified in 59.4%, cognitive impairment in 74%, and depression in 61.9% of patients. Patients with CKD were older and exhibited lower MoCA scores (p = 0.001), higher GDS scores (p = 0.007), reduced albumin (p < 0.001), lower hemoglobin levels (p < 0.001), and elevated C-reactive protein (p < 0.001). Increased albuminuria was associated with poorer cognition (p < 0.001) but showed no correlation with GDS scores. Additionally, worse cognitive scores (p = 0.001) and increased depression symptoms (p < 0.001) were correlated with declining estimated glomerular filtration rate (eGFR). Conclusions: Cognitive impairment and depressive symptoms are highly prevalent among elderly hospitalized patients. Cognitive decline correlates with increased albuminuria and reduced eGFR, while depression worsens with declining kidney function. These findings highlight the complex interplay between renal health and neuropsychiatric conditions in aging populations. Full article

Background: Depressive symptoms and cognitive decline are common in older adults. The aims of this study were (i) to assess the frequency of depressive symptoms and cognitive impairment in users of municipal home care services and (ii) to explore factors that may pertain to seeking in-depth neuropsychiatric diagnostic workup, if recommended. Methods: The study was mainly conducted in low-resource areas of south-western Greece. The Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) were employed. The study included the tracking of whether participants sought medical consultation within 12 months after receiving the recommendation for further neuropsychiatric diagnostic workup. Results: The study encompassed 406 individuals. Cognitive deficits were detected in 312 (76.84%) study participants, of whom only 82 (26.28%) had received the diagnosis of a mental or neurological disorder. Depressive symptoms were detected in 236 (58.27%) individuals, of whom only 18 (4%) had received the diagnosis of a mental or neurological disorder. Only just over a third of individuals consulted physicians. Reluctance towards in-depth neuropsychiatric workup mainly derived from a lack of insight and fears related to COVID-19. Previously diagnosed neuropsychiatric disorders slightly correlated with the decision to consult a physician. Conclusions: Developing pragmatic cognitive and mental healthcare services to address the needs of older people with disabling chronic disorders who live in low-resource settings is urgently needed. Full article

Background and Objectives: Globally, there is a demographic transition toward an increase in the number of older adults, and with it, the comorbidities associated with aging. This requires healthcare providers to understand which variables can affect functional independence for performing activities of daily living. The general objective of this study was to determine the predictive effect of left and right handgrip strength, depression, mild to moderate dementia, and cognitive function on functional independence in older adults. Materials and Methods: This study featured a predictive cross-sectional design with n = 84 older adults with some level of physical independence; older adults with completely limited physical independence and those with severe dementia were excluded. To assess depression, the Geriatric Depression Scale was used; for dementia, the Hachinski Ischemic Scale was used; for cognitive impairment, the Folstein version of the MMSE was used; for functional independence, the Barthel Index was used; for handgrip, a 90-kg Dynatron^® professional hydraulic dynamometer (UT 84121) Number Series. 11010141, from the Dynatronics Corporation located in Salt Lake City, Utah USA, was used. Results: In total, 58.8% of the participants were female, with a mean age of 84.89 ± 7.095, with ranges from 68 to 102 years. Multiple regression analysis showed that the level of cognition, left-hand grip strength, and a low level of depression are strong predictors of independence in activities of daily living in the elderly, with an explained variance of R² = 0.34. Conclusions: Cognitive function, left-hand grip strength, and depression significantly predict the independence of older adults. Studies with larger sample sizes are recommended to confirm the veracity of the results and to design methodologically rigorous interventions that include psychological aspects such as cognitive stimulation, promoting physical activity, and addressing depressive problems to improve the functional independence of older adults. Full article

Dual-task paradigms that combine cognitive and motor tasks offer a valuable lens for detecting subtle impairments in cognitive and physical functioning, especially in older adults. This study used artificial neural network (ANN) modeling to predict clinical, cognitive, and psychosocial outcomes from integrated gait, speech-linguistic, demographic, physiological, and psychological data collected during single- and dual-task conditions. Forty healthy adults (ages 20–84) completed physical, cognitive, and psychosocial assessments and a dual-task walking task involving cell phone use. ANN models were optimized using hyperparameter tuning and k-fold cross-validation to predict outcomes such as the Montreal Cognitive Assessment (MOCA), Trail Making Tests (TMT A and B), Activities-Specific Balance Confidence (ABC) Scale, Geriatric Depression Scale (GDS), and measures of memory, affect, and social support. The models achieved high accuracy for MOCA (100%), ABC (80%), memory function (80%), and social support satisfaction (75%). Feature importance analyses revealed key predictors such as speech-linguistic markers and sensory impairments. First-person plural pronoun used and authenticity of internal thoughts during dual-task emerged as strong predictors of MOCA and memory. Models were less accurate for complex executive tasks like TMT A and B. These findings support the potential of ANN models for the early detection of cognitive and psychosocial changes. Full article