Search Results (5,378)

The growing demand for efficient, stable, and environmentally friendly materials for next-generation optoelectronic and photovoltaic applications has attracted significant interest in double perovskite compounds. First-principles density functional theory (DFT) calculations were performed to systematically investigate the structural, mechanical, electronic, and optical properties of Ba₂MReO₆ (M = Li, Na, K, and Rb) double perovskites. Structural optimization confirms that all compounds crystallize in the cubic Fm3̅m symmetry. The thermodynamic and geometric stability of the series is checked with negative formation energies and tolerance factor analyses (t, μ, τ). Mechanical analysis confirms that all compounds are mechanically stable; Ba₂LiReO₆ is the stiffest, while Ba₂RbReO₆ shows moderate stiffness with the highest ductility. Furthermore, ab initio molecular dynamics (AIMD) simulations at room temperature confirm the dynamical stability of all compounds, with negligible fluctuations in total energy under thermal conditions. The calculated band structures using both GGA-PBE and HSE06 hybrid functionals reveal that all compounds possess indirect band gaps, with HSE06 values of 2.236 eV for Ba₂LiReO₆, 2.133 eV for Ba₂NaReO₆, 2.116 eV for Ba₂KReO₆, and 1.395 eV for Ba₂RbReO₆. Optical measurements indicate that it is highly polarizable by dielectric polarizability, has high absorption coefficients (approximately 10⁶ cm⁻¹), and has large optical conductivity in the UV, with large inter-band interactions between 2 and 4 eV. The suitable band gap and favorable optical characteristics suggest that Ba₂RbReO₆ is the most promising candidate for photovoltaic and solar-cell applications. Full article

Background: Sarcopenia, characterized by age-related loss of muscle mass and strength, is a growing public health concern requiring early detection; this exploratory study evaluated a range of anthropometric measurements and indices to identify those most suitable for screening low muscle strength in hospitalized geriatric patients and to determine preliminary cut-off values that may support screening in settings with limited access to specialized equipment or trained personnel. Materials and Methods: In this cross-sectional study, 390 hospitalized geriatric-ward patients aged ≥ 60 years were included. The median age was 77.00 years (72.00, 82.00), and 258 participants (66.2%) were women. Anthropometric and body composition measurements were performed, and handgrip strength was assessed. Low muscle strength was defined according to The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Logistic regression analyses were used to assess associations between anthropometric measurements and low muscle strength, and receiver operating characteristic (ROC) curve analysis was used to evaluate their screening performance. Results: Among 390 participants, 67 (17.2%) had low muscle strength. Low muscle strength was associated with older age, lower body weight, BMI (Body Mass Index), fat-free mass, and smaller arm and calf circumferences. Higher arm and calf circumferences were significantly associated with a lower risk of low muscle strength in both women (OR = 0.913 and 0.884) and men (OR = 0.793 and 0.769; all p < 0.05). ROC analysis identified optimal screening cut-offs: arm 26.5 cm and calf 31.5 cm in women, and arm 29.5 cm and calf 33 cm in men, showing moderate screening performance, with an area under the ROC curve (AUC) of 0.63–0.78. Conclusions: Calf and arm circumferences are simple, quick, and non-invasive measurements that may be useful for screening low muscle strength in hospitalized geriatric patients, particularly in settings with limited access to specialized equipment. These measurements may help identify individuals who require further assessment for sarcopenia according to current clinical guidelines, with age being an important factor to consider. The proposed cut-off values should be considered hypothesis-generating rather than diagnostic thresholds for sarcopenia and require external validation in independent populations before they can be recommended for routine clinical use. 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/Objectives: Hyperkalemia is a common complication in patients receiving maintenance hemodialysis (HD). Conventional cation-exchange resins, including sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS), effectively lower serum potassium but may non-selectively bind magnesium. Sodium zirconium cyclosilicate (SZC) is a highly selective potassium binder with minimal affinity for magnesium. This study investigated changes in serum cation profiles and nutritional status after switching from conventional cation-exchange resins to SZC in patients undergoing maintenance HD. Methods: In this prospective, single-arm, before-and-after study conducted in routine clinical practice, 28 maintenance HD patients receiving SPS or CPS for chronic hyperkalemia were switched to SZC and followed for 12 weeks. Serum potassium, magnesium, corrected calcium, phosphorus, whole parathyroid hormone (whole-PTH), albumin, and the Geriatric Nutritional Risk Index (GNRI) were evaluated before and after the treatment transition. Results: Following the switch to SZC, median serum potassium increased modestly from 5.01 (4.66–5.39) to 5.26 (4.89–5.48) mEq/L (p = 0.031), whereas serum magnesium increased from 2.46 (2.29–2.66) to 2.66 (2.35–2.93) mg/dL (p < 0.001). Serum calcium, phosphorus, whole-PTH, albumin, and GNRI remained unchanged. Subgroup, correlation, and longitudinal analyses consistently supported the robustness of the observed increase in serum magnesium, irrespective of the previously prescribed resin or concomitant proton pump inhibitor use. Conclusions: Switching from conventional cation-exchange resins to SZC was associated with a significant increase in serum magnesium concentrations while maintaining acceptable potassium control and stable nutritional status in maintenance HD patients. These findings are consistent with the greater cation selectivity of SZC and suggest that replacement of conventional cation-exchange resins may contribute to preservation of serum magnesium concentrations. Further multicenter prospective studies evaluating magnesium metabolism together with clinically relevant outcomes are warranted to confirm these findings and clarify their clinical significance. Full article

Background/Objectives: Temporal muscle thickness (TMT) has been proposed as a practical surrogate marker for skeletal muscle mass, whereas the geriatric nutritional risk index (GNRI) reflects nutritional status. However, the independent and combined prognostic value of TMT and GNRI in surgically treated head and neck squamous cell carcinoma (HNSCC) remains unclear. Methods: We retrospectively analyzed 214 patients with HNSCC who underwent curative-intent surgery. Disease-free survival (DFS) and overall survival (OS) were evaluated using Cox proportional hazards models. In the primary analyses, TMT and GNRI were entered simultaneously as continuous variables and adjusted for age, sex, clinical stage, and postoperative adjuvant treatment. For clinical interpretability, Kaplan–Meier analyses were additionally performed using a composite TMT–GNRI score. Results: In the multivariable analyses, higher TMT was independently associated with longer DFS (hazard ratio [HR] 0.83 per 1 mm increase, 95% confidence interval [CI] 0.72–0.96, p = 0.014) and OS (HR 0.73, 95% CI 0.60–0.89, p = 0.002). GNRI was significantly associated with DFS and OS in the univariate analyses; after simultaneous adjustment for TMT and clinical covariates, it remained independently associated with OS (HR 0.98 per 1-point increase, 95% CI 0.96–0.99, p = 0.015) and showed a borderline association with DFS (HR 0.984, 95% CI 0.966–1.001, p = 0.068). Kaplan–Meier analyses using the composite TMT–GNRI score demonstrated clear risk stratification, with the poorest outcomes observed in patients with concomitantly low TMT and low GNRI. Conclusions: In surgically treated HNSCC, preoperative TMT was independently associated with both DFS and OS. GNRI may provide additional prognostic information, particularly for OS. Full article

Background and Objectives: This study aimed to translate and culturally adapt the Pictorial Fit–Frail Scale (PFFS) into Turkish and to evaluate its validity and reliability in older adults. Materials and Methods: The study included 156 community-dwelling older adults aged ≥ 65 years. Frailty status was determined using the Clinical Frailty Scale (CFS), and participants with a CFS ≥ 4 were classified as frail. All participants underwent the PFFS, Katz ADL, Lawton–Brody IADL, Short-Form Geriatric Depression Scale (GDS), Mini Nutritional Assessment—Short Form (MNA-SF), Standardized Mini-Mental State Examination (SMMSE), and Charlson Comorbidity Index (CCI). The reliability of the PFFS was assessed using internal consistency (Cronbach α), inter-rater reliability, and test–retest reliability (ICC); its construct validity was assessed using correlation analysis with the CFS. Furthermore, the diagnostic performance of PFFS in identifying frailty was analyzed using the ROC curve. Results: Of the 156 individuals participating in the study, 63.5% were women, and 89 individuals (57.1%) were frail. The Turkish version of PFFS showed high internal consistency (Cronbach α = 0.838). Inter-rater and test–retest reliability were found to be ICC = 0.995 and 0.996, respectively. A strong and positive correlation was found between PFFS and CFS scores (Spearman r = 0.760, p < 0.001). ROC analysis showed that PFFS had good performance in distinguishing frailty (AUC = 0.851, optimal cut-off ≥ 14; sensitivity = 69.7%, specificity = 83.6%). Frail individuals were older, had higher comorbidities, and showed greater dependence in activities of daily living. Conclusions: The Turkish version of the PFFS appears to be a reliable, valid, rapid, and multidimensional tool for assessing frailty in older adults. The PFFS can contribute to the effective assessment of frailty in clinical practice and research. Full article

Background/Objectives: Oral frailty is increasingly recognized as an age-related decline in oral function and a potential marker of broader health vulnerability. However, its association with multidimensional health within a standardized healthy aging framework remains insufficiently characterized. This study aimed to examine the association between oral frailty and multidimensional health among community-dwelling older adults in China using the WS/T 802–2022 healthy aging framework. Methods: This community-based cross-sectional study included 454 adults aged 60 years or older from Chenzhou, Hunan Province, China. Oral frailty was primarily assessed using the Oral Frailty Index-8 (OF-8), with the Screening Tool for Oral Frailty-6 (SOFT-6) used as an alternative definition. Overall, physical, mental, and social health were evaluated according to WS/T 802–2022. Associations were examined using ordinal regression models, supplemented by sensitivity and dose–response analyses. Results: Oral frailty was common, with prevalence estimates of 59.1% by OF-8 and 52.3% by SOFT-6. Compared with participants without oral frailty, those with OF-8-defined oral frailty were older and had lower body mass index, lower skeletal muscle mass index, lower grip strength, greater chronic disease burden, fewer remaining natural teeth, and lower overall and physical health scores. In the main adjusted model, OF-8-defined oral frailty was associated with lower odds of being in a better overall health category (odds ratio [OR] = 0.554, 95% confidence interval [CI]: 0.374–0.822). For physical health, threshold-specific estimates from partial proportional odds models were directionally consistent but did not reach statistical significance. The association with social health was nominal, whereas the association with mental health was not statistically significant. Across sensitivity analyses, estimates for overall health were directionally consistent, whereas domain-specific findings varied across alternative oral-frailty definitions and analytical approaches. In sensitivity analyses excluding participants with extreme total energy intake, the association with overall health remained statistically significant, whereas the associations with physical and social health were attenuated and no longer reached conventional statistical significance. Restricted cubic spline analyses showed approximately monotonic inverse associations between OF-8 score and overall, physical, and mental health scores, without evidence of significant nonlinearity. Oral frailty was highly prevalent and was associated with poorer multidimensional health, particularly overall health, among community-dwelling older adults. Conclusions: These findings suggest that oral frailty, assessed with OF-8, may be a simple, nutrition-relevant indicator that could help flag community-dwelling older adults for fuller multidimensional geriatric assessment. Because the design was cross-sectional and associations beyond overall health were inconsistent, the screening or predictive performance of oral frailty was not formally evaluated and requires confirmation in longitudinal, multicenter studies. Full article

Background: Mortality after geriatric hip-fracture surgery remains substantial. This study evaluated whether preoperative GNRI, comorbidity burden, and CBC-derived inflammatory indices were associated with one-year and long-term mortality after PFN for pertrochanteric/intertrochanteric fractures. Methods: In this single-centre retrospective cohort study of prognostic risk markers, 248 PFN records were screened. After excluding six incomplete records and 25 patients aged <65 years, 217 older fracture/surgical episodes formed the time-to-event cohort; 194 were evaluable for binary one-year mortality. Living patients/episodes with <365 days of follow-up were censored in survival analyses. Logistic and Cox models were supported by Firth penalized logistic regression, calibration assessment, and internal validation. Results: Median age was 82 years, 65.0% were female, and 68.7% were ASA III–IV. Overall, 96/217 (44.2%) died during median follow-up of 570 days. Thirty-day, 90-day, and one-year evaluable mortality were 7.4%, 15.2%, and 27.3%. GNRI < 82 identified a small high-risk subgroup: 10/13 evaluable patients/episodes (76.9%) died within one year versus 43/181 (23.8%) with GNRI ≥ 82. GNRI < 82 remained associated with one-year mortality in adjusted logistic regression, although with a wide confidence interval due to sparse subgroup size (OR 6.43, 95% CI 1.50–27.55; p = 0.012), and in Firth penalized sensitivity analysis (OR 5.51, 95% CI 1.34–22.61; p = 0.018). In Cox analysis, age, ASA III–IV, available Charlson-domain comorbidity burden, and lower continuous GNRI were associated with long-term mortality, whereas adding GNRI < 82 and NLR did not materially improve cross-validated discrimination. Conclusions: GNRI < 82 identified a small subgroup with high observed mortality after PFN. Because the subgroup was sparse and biomarker addition did not materially improve internally validated discrimination, GNRI should be treated as an alerting clinical flag rather than a stand-alone basis for patient-level risk prediction. External validation is required. Full article

Objectives: Dementia and osteoporosis are common and debilitating conditions that often coexist in older adults. We investigated mortality in patients with and without dementia as the primary outcome in a prospective memory clinic cohort. Falls and fractures were assessed as secondary outcomes, and associations with baseline acetylcholinesterase inhibitor (AChEI) use were explored. Methods: In a prospective observational cohort study, data were collected during routine clinical visits over four years. Data included demographics, dementia diagnosis, AChEI use, falls, fractures, bone mineral density (BMD) when clinically available, and mortality. Analysis included chi-square tests, Kaplan–Meier survival curves, Cox proportional hazards models, and recurrent-event models. Because AChEI analyses were exploratory and included several related endpoints, Benjamini–Hochberg false discovery rate (FDR) correction was applied to endpoint-level AChEI p-values. Results: 744 patients were enrolled; the mean age was 80.99 ± 6.8 years; 58.5% female; 55.8% with dementia. AChEI use was recorded in 113 patients (15.2%) at baseline. Over 4 years, 16.61% of participants experienced at least one fall with a cumulative fracture risk of 30.90%. Mortality was significantly higher in dementia patients (44.58% vs. 27.05%; p < 0.001). Dementia patients had double the mortality risk (OR: 1.956; 95% CI: 1.425–2.686). Annual and cumulative mortality rates increased progressively from 5.51% and in year 1 to 17.69% and 36.83% respectively by year 4. Baseline AChEI use was not significantly associated with mortality. Risk/100 for patient with dementia vs. without dementia for falls was 4.04 vs. 4.32 and fracture was 4.37 vs. 3.01. AChEI users had a trend of lower incidence/100 patient-years for falls of 3.01 vs. 4.37 and fractures 6.78 vs. 10.09. Conclusions: Dementia patients have higher mortality risk but not falls or fracture risk in this cohort. Although clinical cohort and animal studies suggest a benefit for AChEIs, this was not evident in this study possibly due to clinical cohort limitations. The trend of reduced falls and fracture in the AChEI cohort warrants further study. Full article

Objective: The objective of this study is to investigate the clinical value of the triglyceride-glucose (TyG) index combined with alanine aminotransferase (ALT) in identifying prevalent metabolic-associated fatty liver disease (MAFLD) in patients with obstructive sleep apnea (OSA), and to construct and validate a diagnostic risk-stratification model. Methods: Clinical data of OSA patients were retrospectively collected from two centers: the Department of Geriatrics, Peking University People’s Hospital (August 2021 to December 2025) and the Department of Geriatrics, Shijiazhuang People’s Hospital (June 2023 to December 2025). MAFLD was diagnosed by abdominal ultrasonography performed by experienced radiologists blinded to laboratory results. Candidate predictors were selected using univariate logistic regression, LASSO regression, and bootstrap stability testing. Model performance was assessed by discrimination (area under the receiver operating characteristic curve, AUC), calibration (Hosmer–Lemeshow test, calibration curves), and clinical utility (decision curve analysis). Internal validation was performed using 10-fold cross-validation and bootstrap resampling with optimism correction. External validation was conducted in an independent cohort. Sensitivity analyses included subgroup analyses stratified by sex, age, BMI, and OSA severity. Results: A total of 962 patients were included in the development set and 116 in the external validation set. Multivariate analysis identified TyG index (OR = 1.95, 95% CI: 1.51–2.53), LDL-C (OR = 1.24, 95% CI: 1.02–1.49), BMI (OR = 1.21, 95% CI: 1.16–1.26), and ALT (OR = 1.04, 95% CI: 1.02–1.05) as variables independently associated with prevalent MAFLD, while platelet-to-lymphocyte ratio (PLR) was protective (OR = 0.996, 95% CI: 0.993–0.999). The simplified TyG-ALT model achieved an AUC of 0.714 (95% CI: 0.685–0.744) in the development set, with an optimism-corrected AUC of 0.712, and an AUC of 0.783 (95% CI: 0.701–0.866) in external validation. The model demonstrated good calibration and favorable clinical net benefit within the threshold range of 0.30–0.70. The optimal cutoff was 0.564, with sensitivity of 68.7% and specificity of 79.6%. Conclusions: The TyG-ALT model demonstrates good discriminative ability, calibration, and clinical utility for case-finding and risk stratification of prevalent MAFLD in OSA patients, particularly for identifying high-risk individuals requiring confirmatory imaging. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) are a major source of morbidity following cardiac surgery, particularly in older adults. While malnutrition is linked to adverse outcomes, the optimal screening tool for identifying patients at risk of PPCs remains uncertain. This study compared the predictive performance of the Geriatric Nutritional Risk Index (GNRI), Mini Nutritional Assessment–Short Form (MNA-SF), Prognostic Nutritional Index (PNI), and Nutrition Alert Form (NAF) for PPCs in older adults undergoing elective cardiac surgery. Methods: This prospective cohort study enrolled 217 patients aged ≥ 60 years at a tertiary university hospital. Preoperative nutritional status was assessed using the GNRI, MNA-SF, PNI, and NAF. The primary outcome was PPC development during hospitalization. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression identified independent predictors. Results: PPCs occurred in 86 patients (39.6%). Patients who developed PPCs had significantly higher NAF scores than those who did not (median [IQR]: 7.5 [3–12] vs. 5 [2–8], p < 0.001), whereas GNRI, MNA-SF, and PNI scores did not differ significantly. NAF demonstrated the highest predictive performance (AUC: 0.643, 95% CI: 0.567–0.719), followed by PNI, MNA-SF, and GNRI. However, after adjusting for clinical covariates, none of the nutritional assessment tools remained independently associated with PPCs. Conclusions: Among the four tools evaluated, NAF showed the highest predictive performance among the evaluated nutritional assessment tools; however, its discriminative ability was modest, and none of the nutritional assessment tools remained independently associated with PPCs after multivariable adjustment. Nutritional assessment should complement, rather than replace, established clinical risk factors in perioperative risk stratification. Full article

Background: Postoperative delirium (POD) is a frequent and serious complication in elderly surgical patients. Liberalising preoperative fluid fasting has been shown to reduce its incidence. However, evidence on long-term cognitive and functional outcomes following POD or liberal fluid fasting remains limited. Objectives: This study investigates whether POD and different fluid fasting regimens are associated with changes in cognitive performance and activities of daily living twelve months after surgery. Methods: As a follow-up to the prospective ‘LFFgertrud’ trial, 89 geriatric patients were contacted by phone twelve months after elective trauma or orthopaedic surgery (March 2023–February 2024). Participants completed four validated questionnaires assessing cognition and everyday functioning: the Short Blessed Test (SBT), EQ-5D-5L, Barthel index (BI), and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: The hypotheses regarding the effects of POD and fluid fasting on cognitive and functional outcomes were not statistically supported. In contrast, neurodegenerative disease was strongly associated with poorer outcomes in three of the four follow-up measures (SBT: β = 1.27, p = 0.01; EQ-5D-5L: β = 1.43, p < 0.001; BI: β = −1.63, p < 0.001), and polymedication also emerged as a relevant predictor. Although not statistically significant, descriptive trends indicated that patients who developed POD showed lower cognitive performance and reduced quality of life at twelve months. Conclusions: POD and fluid fasting duration were not significantly associated with long-term cognitive or functional outcomes one year after hospitalisation. The findings highlight the importance of considering pre-existing neurocognitive disease and polypharmacy when assessing the risk of adverse long-term outcomes in older patients. Due to the multifactorial nature of recovery in this population, further research involving larger sample sizes is required in order to gain a better understanding of the factors that influence long-term outcomes. Full article

Introduction: Community-based day center programs may support healthy ageing by promoting functional ability, mental well-being, and social participation among older adults, but real-world evidence from Latin America remains limited. Objective: We aimed to examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre–post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index, the Lawton and Brody scale, and the Timed Up and Go test; mental health with the Mini-Mental State Examination and the 15-item Geriatric Depression Scale; and quality of life with the EuroQol-5D visual analogue scale. Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p ≤ 0.001). In 2023, the Barthel Index, the Timed Up and Go test, and the Geriatric Depression Scale improved (all p < 0.0001), and the EuroQol-5D visual analogue scale also improved (p < 0.01), whereas the Lawton and Brody scale (p = 0.204) and the Mini-Mental State Examination (p = 0.725) did not. Category-transition analyses showed significant improvements in basic activities of daily living and mobility in both cohorts (both p < 0.001), while significant categorical changes in instrumental activities of daily living, global cognition, depressive symptoms, and self-rated quality of life were observed only in 2022 (all p ≤ 0.01). Rural residence was associated with higher odds of improvement in basic activities of daily living (OR 1.62, 95% CI 1.17–2.25; p = 0.004), whereas age ≥75 years was associated with lower odds of improvement in depressive symptoms (OR 0.56, 95% CI 0.41–0.76; p < 0.001) and self-rated quality of life (OR 0.65, 95% CI 0.45–0.94; p = 0.023). Conclusions: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups. Full article

International evidence positions the built environment as an active component of the quality of life of older adults; however, the empirical quantification of that relationship and its hierarchization to guide design decisions in Latin American geriatric residences remain a persistent gap. Against this background, the present study examined how biophilic architecture relates to the quality of life of older adults residing in a geriatric residence in the Cercado de Lima district, adopting a single-case study approach. A quantitative approach with a non-experimental, cross-sectional, and correlational design was adopted. The sample comprised 81 proxy informants, relatives in close and ongoing contact with the residents, recruited by non-probabilistic convenience sampling. A structured questionnaire of 25 Likert-scale items, each with five response categories, was used to gather the data, administered through the QuestionPro platform. Content validity was established through the judgment of three architecture specialists; reliability was confirmed through Cronbach’s alpha coefficient ($\alpha$ = 0.943). Given that the data did not follow a normal distribution (Shapiro–Wilk, p < 0.05 in 9 of 10 variables), the inferential analysis relied on Spearman’s rho coefficient, with Kendall’s Tau-b as a complement. The results revealed a positive, statistically significant, and large-magnitude association between biophilic architecture and quality of life ($\rho$ = 0.792, p < 0.001). Dimensional analysis identified a hierarchical pattern organized in two statistically distinguishable levels. In biophilic architecture, a first level comprised the nature of the space ($\rho$ = 0.792) and sensory stimulation ($\rho$ = 0.783), and a second significantly lower level comprised natural analogs ($\rho$ = 0.621) and nature in the space ($\rho$ = 0.605). In quality of life, a first level comprised physical health ($\rho$ = 0.763), social relationships ($\rho$ = 0.753), and psychological health ($\rho$ = 0.720), and a second level comprised environment ($\rho$ = 0.564); coefficients within each level did not differ significantly, whereas the difference between levels was significant. The obtained empirical hierarchization was translated into evidence-informed design orientations, offering architects and facility managers a non-prescriptive guide for setting design priorities where infrastructure is limited, in alignment with Sustainable Development Goals (SDGs) 3 and 11. The study was conducted through proxy informants, family members with direct and sustained contact with the resident, a methodological configuration recognized in the specialized literature on institutionalized older adults and whose perceptual mediation remains as a residual consideration of the design when interpreting the findings. As a single-case study, the findings characterize the analyzed institutional context and constitute transferable hypotheses to be verified in further residences rather than generalizations to the broader population of geriatric residences. Full article

Background: Malnutrition is increasingly recognized as an important determinant of prognosis in patients with heart failure (HF). The Geriatric Nutritional Risk Index (GNRI) is a simple nutritional assessment tool associated with adverse cardiovascular outcomes, but its relationship with diabetes mellitus and in-hospital mortality in hospitalized HF patients remains incompletely characterized. This study evaluated the association between GNRI-defined nutritional risk, diabetes mellitus, and in-hospital mortality in patients hospitalized with HF. Methods: This prospective observational study included 278 consecutive patients hospitalized with HF at a tertiary cardiology center between September 2025 and March 2026. Nutritional status was assessed using GNRI, and patients were classified as having no nutritional risk (GNRI ≥ 98) or GNRI-defined nutritional risk (GNRI < 98). Logistic regression evaluated the association between GNRI and diabetes mellitus, while Cox proportional hazards regression and Kaplan–Meier analyses assessed in-hospital mortality. Results: GNRI-defined nutritional risk was identified in 42.1% of patients. Compared with patients without nutritional risk, those with GNRI-defined nutritional risk had a higher prevalence of diabetes mellitus (73.5% vs. 50.9%, p < 0.001), longer hospital stays, and a nearly threefold higher in-hospital mortality rate (29.1% vs. 10.6%, p < 0.001). Higher GNRI values were associated with a lower prevalence of diabetes mellitus. Lower GNRI values were also associated with higher in-hospital mortality in the main Cox models; however, this association was attenuated and no longer statistically significant after adjustment for markers of heart failure severity. Conclusions: Lower GNRI values identified patients with greater nutritional and clinical vulnerability during hospitalization for HF. Further studies are needed to determine whether GNRI provides incremental prognostic value beyond established HF risk markers. Full article