Search Results (2,114)

Multiple myeloma (MM) is predominantly a disease of the elderly. In recent years, a surge of highly effective plasma cell therapies has revolutionized the care of elderly multiple myeloma (MM) patients, for whom frailty and age-related competing causes of mortality determine management. Traditionally, the treatment of newly diagnosed elderly patients has centered on doublet or triplet combinations composed of immunomodulators (IMIDs), proteasome inhibitors (PIs), anti-CD38 monoclonal antibodies (mAbs), and corticosteroids producing median progression-free survival (PFS) rates between 34 and 62 months. However, recently, a series of large phase III clinical trials examining quadruplet regimens of PIs, IMIDs, corticosteroids, and anti-CD38 mAbs have shown exceptional outcomes, with median PFS exceeding 60 months, albeit with higher rates of peripheral neuropathy (≥Grade 2: 27% vs. 10%) when PIs and IMIDs are combined, and infections (≥Grade 3: 40% vs. 29–41%) with the addition of anti-CD38mAbs. The development of T-cell redirecting therapies including T-cell engagers (TCEs) and CAR-T cells has further expanded the therapeutic arsenal. TCEs have shown exceptional activity in relapsed disease and are being explored in the newly diagnosed setting with promising early results. However, concerns remain regarding the logistical challenges of step-up dosing, which often necessitates inpatient admission, the infectious risks, and the financial burden associated with TCEs in elderly patients. CAR-T, the most potent commercially available therapy for MM, offers the potential of a ‘one and done’ approach. However, its application to elderly patients has been tempered by significant concerns of cytokine release syndrome, early and delayed neurological toxicity, and its overall tolerability in frail patients. Robust data in frail patients are still needed. How CAR-T and TCEs will be sequenced among the growing therapeutic armamentarium for elderly MM patients remains to be determined. This review explores the safety, efficacy, cost, and logistical barriers associated with the above treatments in elderly MM patients. Full article

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that can greatly affect quality of life in middle-aged and elderly individuals. Nutritional supplements are increasingly used for KOA due to their low risk, but direct comparative evidence on their efficacy and safety remains scarce. This study aimed to systematically compare the effectiveness and safety of seven common nutritional supplements for KOA. Methods: A systematic review and network meta-analysis were conducted following PRISMA guidelines. Embase, PubMed, and the Cochrane Library were searched through December 2024 for randomized controlled trials (RCTs) evaluating use of eggshell membrane, vitamin D, Boswellia, curcumin, ginger, krill oil, or collagen, versus placebo, in adults with KOA. Primary outcomes included changes in scores for WOMAC pain, stiffness and function, and pain visual analog scale (VAS). Adverse events were also assessed. Bayesian network meta-analyses estimated ranking probabilities for each intervention. Results: In total, 39 RCTs (42 studies; 4599 patients) were included. Compared with placebo, Boswellia showed significant improvements in WOMAC pain (mean difference [MD] = 10.58, 95% CI: 6.45 to 14.78, p < 0.05), stiffness (MD = 9.47, 95% CI: 6.39 254 to 12.74, p < 0.05), function (MD = 14.00, 95% CI: 7.74 to 20.21, p < 0.05), and VAS pain (MD = 17.26, 95% CI: 8.06 to 26.52, p < 0.05). Curcumin, collagen, ginger, and krill oil also demonstrated benefits in some outcomes. No supplement was associated with increased adverse events compared to placebo. Bayesian rankings indicated Boswellia had the highest probability of being most effective for pain and stiffness, with krill oil and curcumin showing potential for function improvement. Conclusions: Nutritional supplements, particularly Boswellia, appear to be effective and well-tolerated for improving KOA symptoms and function. These results suggest that certain supplements may be useful as part of non-pharmacological KOA management. However, further large-scale, well-designed randomized controlled trials (RCTs) are needed to confirm these findings, particularly those that include more standardized dosages and formulations, as well as to evaluate their long-term efficacy. Full article

As the size of the elderly population increases, the need for an improved understanding of what leads to the age-related decline in physiological function continues to grow. SAMP8 mice were selected for their accelerated aging phenotype. The low levels of glyoxalase 1 (Glo1), the main enzyme that removes the reactive dicarbonyl methylglyoxal (MGO), in the cerebral cortex of SAMP8 mice prompted us to produce the first transgenic mice overexpressing Glo1 against the SAMP8 background, aimed at rescuing the accelerated aging phenotype. Selected health and biochemical endpoints were assessed in ten-month-old SAMP8 mice overexpressing Glo1. Glo1 overexpression increased median survival in males (21%) and females (4.6%), which was associated with better memory performance. Glo1 overexpression also increased synaptic markers (synaptophysin and SNAP25) as well as markers of mitochondrial function (NDUFB8, SDHB) and negative modulators of oxytosis/ferroptosis (NQO1, FTH1, and GPx4) in the cerebral cortex. For all parameters analyzed, the effect of Glo1 overexpression was more pronounced in males. Overall, the data support the beneficial effects of overexpressing Glo1 in multiple tissues, especially in SAMP8 males, suggesting a possible gender effect of MGO in aging. Both modulation of oxytosis/ferroptosis and mitochondrial metabolism warrant further investigation as potential mechanisms underlying the improved health span of Glo1 mice. Full article

While surgical procedure has been considered as the golden standard treatment for spasmodic entropion, Botulinum Neurotoxin A can be indicated in the treatment of spasmodic entropion for fragile elderly patients. This retrospective cohort study included 50 outdoor patients treated for spasmodic entropion, for whom palpebral surgery was recused. The intent of the present study was to describe an alternative outdoor treatment, to detail precisely the Botulinum Neurotoxin (BoNT) treatment pattern, the dosage of BoNT needed, the frequency of re-injection, the efficiency and the complications encountered. Fifty patients, 87.9 years old in average (±14.3) have been injected with BoNT. The average total dosage of BoNT is 7.62 ± 1.38 units of Incobotulinum, 10.2 ± 1.03 units of Onabotulinum and 17.2 ± 1.33 Speywood-units of Abobotulinum. Spasmodic entropion resolved in 3 ± 2 days after the BT injection. The average for re-injection is every 4.25 ± 1.30 months. By adjusting age and total dose, we have not been able to show any statistically significant relationship between time needed for re-injection and type of botulinum toxin A (p = 0.59). Patients with spasmodic entropion have responded significantly to BoNT injection. No systemic complications have been reported in this study. BoNT treatment is safe and effective for fragile elderly patients with spasmodic entropion and can be proposed instead of surgery or while waiting for their procedure. Full article

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an interfascial regional technique, offers promising analgesic benefits in thoracic wall procedures but remains underutilized in cardiac electrophysiology. Materials and Methods: We conducted a prospective, controlled, non-randomized clinical study including 106 patients undergoing de novo CIED implantation. Patients were assigned to receive either a PECS II block (n = 53) or standard lidocaine-based local anesthesia (n = 53). Pain intensity was assessed using the numeric rating scale (NRS) intraoperatively and at 1, 6, and 12 h postoperatively. Secondary outcomes included the need for rescue analgesia, procedural duration, length of hospitalization, and patient satisfaction. Results: Patients in the PECS II group reported significantly lower NRS scores at all time points (mean intraoperative score: 2.1 ± 1.2 vs. 5.7 ± 1.6, p < 0.001; at 1 h: 2.5 ± 1.5 vs. 6.1 ± 1.7, p < 0.001). Rescue analgesia (metamizole sodium) was required in only four PECS II patients (7.5%) vs. 100% in the control group within 1 h. Hospital stay and procedural time were also modestly reduced in the PECS II group. Patient satisfaction scores were significantly higher in the intervention group. Conclusions: The ultrasound-guided PECS II block significantly reduces perioperative pain and the need for additional analgesia during CIED implantation, offering an effective, safe, and opioid-sparing alternative to conventional local infiltration. Its integration into clinical protocols for device implantation may enhance procedural comfort and recovery. Full article

Aging is a multifactorial process that affects various physiological functions, including masticatory performance, which is crucial for oral health and nutritional well-being. Impaired masticatory function, often due to factors such as tooth loss, reduced salivation, or muscle atrophy, can lead to significant nutritional challenges and compromise the overall health of elderly individuals. Recent research has illuminated the interconnectedness of masticatory function, oral microbiota, and gut health, suggesting that altered chewing ability may disrupt oral microbial communities, which in turn affect gastrointestinal health and systemic inflammation. This commentary review provides a comprehensive analysis of the role of masticatory function in aging, exploring its impact on the oral microbiota, gut health, and broader nutritional status. We discuss the potential consequences of impaired mastication, including malnutrition, dysbiosis, and gastrointestinal disorders, and explore possible strategies for improving masticatory function and maintaining a healthy gut microbiome through interventions like dietary modifications, oral care, and rehabilitation. We aim to underscore the importance of integrating masticatory function management into the broader context of aging-related healthcare, promoting holistic, multidisciplinary approaches to support nutritional needs and quality of life in older adults. Full article

Background: Pneumococcal disease is a significant health burden, particularly among older adults and individuals with chronic conditions. Sequential pneumococcal vaccination (PCV13 followed by PPSV23) has been recommended in Italy since 2017 for its demonstrated efficacy, safety, and cost-effectiveness in preventing invasive pneumococcal disease (IPD). Nevertheless, limited data are available on the sequential pneumococcal vaccination coverage in Italy. This study aimed to evaluate the coverage and trends of sequential pneumococcal vaccination among individuals who turned 65 years old within the Viterbo Local Health Authority between 2018 and 2023. Methods: A retrospective cohort study was conducted using data from the Regional Vaccination Registry (AVR), a comprehensive digital vaccination dataset. Vaccination coverage was calculated based on individuals completing the sequential pneumococcal vaccination within two years after turning 65 years old. Trends as well as subgroup variations based on sex, citizenship, district of residence, and municipality size were analyzed. Results: Among 27,657 individuals who turned 65 years of age during the study period, only 2.32% completed the sequential pneumococcal vaccination. Coverage increased steadily from 2018 (0.60%) to a peak in 2020 (3.27%), followed by a plateau and a decline in 2023 (2.53%). Coverage varied across demographic and geographic subgroups: females (2.58%) had higher coverage than males (2.04%), Italian citizens (2.45%) exceeded foreign residents (0.64%), and residents in District C (3.03%) led over District A (1.08%). Smaller municipalities (≤10,000 inhabitants) showed higher coverage (2.52%) than larger ones (1.98%). Conclusions: Adherence to sequential pneumococcal vaccination has been very low throughout the considered study period. This is highly relevant information to consider in the view of new available pneumococcal vaccines for immunization of the elderly. Furthermore, geographic and demographic differences highlight the need for targeted public health interventions. Full article

This study focuses on the current service/care difficulties and challenges that social institutions in Hungary are facing during their daily operations; how they can react to them utilizing their internal resources, mechanisms, and capacities; and what concrete, tangible needs and demands are emerging in terms of methodological professional support, potential forms, interventions, and direction for professional development. A total of 24 general and 55 specific service and operational problems were identified and assessed in eight different service areas (family and child welfare services, family and child welfare centers, respite care for children, care for the homeless, addiction intervention, care for people with disabilities, care for psychiatric patients, specialized care for the elderly, and basic services for the elderly). The empirical base of the study uses a database of 201 online questionnaires completed by a professional target group working for social service providers in two counties (Győr-Moson-Sopron and Veszprém), representing 166 social service providers. The questionnaires were completed between November and December of 2022. The findings will be used to develop a professional support and development problem map. Social institutions face complex and serious service/care difficulties and challenges in their daily operations. Three distinctive basic problems clearly stand out in both severity and significance from the complex set of factors assessed. The biggest problem in the social care system is clearly the complex challenge of low wages, followed by the administrative burdens in the ranking of operational difficulties, and the third key factor was the psycho-mental workload of staff. Full article

The rapid growth of mobile financial services provides significant opportunities for enhancing digital financial inclusion among older adults. However, elderly consumers often lag in adoption and sustained usage due to psychological barriers (e.g., technology anxiety) and factors related to prior experience and comfort with technology (e.g., technology familiarity). This study investigates how technology anxiety and technology familiarity influence elderly consumers’ continuance intention toward mobile banking, while examining age as a moderator by comparing younger older adults (aged 60–69) and older adults (aged 70+). Using data from an online survey of 488 elderly mobile banking users in South Korea, we conducted hierarchical regression analyses. The results show that technology anxiety negatively affects continuance intention, whereas technology familiarity positively enhances sustained usage. Moreover, age significantly moderated these relationships: adults aged 70+ were notably more sensitive to both technology anxiety and familiarity, highlighting distinct age-related psychological differences. These findings underscore the importance of targeted digital literacy initiatives, age-friendly fintech interfaces, and personalized support strategies. This study contributes to the fintech literature by integrating psychological dimensions into traditional technology adoption frameworks and emphasizing age-specific differences. Practically, fintech providers and policymakers should adopt tailored strategies to effectively address elderly consumers’ unique psychological needs, promoting sustained adoption and narrowing the digital divide in financial technology engagement. Full article

Modern Western societies are “aging” at a very high rate, and more and more people require assistance and care. Old age has different faces, which is due to genetic conditions, as well as the different contexts and lifestyles of people. To ensure good adaptation of seniors, it is important to determine the conditions for “successful aging”. Therefore, the purpose of the conducted study was to determine the importance of selected predictors, including the level of religiosity, assessment of health, and the intensity of motivational needs of seniors—students of the University of the Third Age—for the level of their well-being. A total of 115 people were surveyed, including 93 women and 21 men who were students in the first year of the Third Age University at the Pontifical University of John Paul II in Krakow. The surveyed seniors represented an autonomous type of religiosity, a high level of realization of the needs of self-determination, namely autonomy and competence, declared an average assessment of the state of their health, and revealed an increased level of eudaimonic well-being. Predictors of the level of well-being of the surveyed seniors turned out to be the variables religious experience, need for autonomy and competence, and health status, as assessed by the seniors. Full article

Heatwaves intensified by climate change increasingly threaten urban populations, especially the elderly. However, most existing studies have concentrated on short-term or single-scale analyses, lacking a comprehensive understanding of how land cover changes and urbanization affect the vulnerability of the elderly to extreme heat. This study aims to investigate the spatiotemporal distribution patterns of heat-related health risks among the elderly in Nanchang City and to identify their key driving factors within the context of rapid urbanization. This study employs Crichton’s risk triangle framework to the heat-related health risks for the elderly in Nanchang, China, from 2002 to 2020 by integrating meteorological records, land surface temperature, land cover data, and socioeconomic indicators. The model captures the spatiotemporal dynamics of heat hazards, exposure, and vulnerability and identifies the key drivers shaping these patterns. The results show that the heat health risk index has increased significantly over time, with notably higher levels in the urban core compared to those in suburban areas. A 1% rise in impervious surface area corresponds to a 0.31–1.19 increase in the risk index, while a 1% increase in green space leads to a 0.21–1.39 reduction. Vulnerability is particularly high in economically disadvantaged, medically under-served peripheral zones. These findings highlight the need to optimize the spatial distribution of urban green space and control the expansion of impervious surfaces to mitigate urban heat risks. In high-vulnerability areas, improving infrastructure, expanding medical resources, and establishing targeted heat health monitoring and early warning systems are essential to protecting elderly populations. Overall, this study provides a comprehensive framework for assessing urban heat health risks and offers actionable insights into enhancing climate resilience and health risk management in rapidly urbanizing regions. Full article

Background: Chryseobacterium indologenes, an environmental bacterium, is increasingly recognized as an emerging nosocomial pathogen, particularly in Asia, and is often characterized by multidrug resistance. Objectives: This study aimed to investigate the genomic features of clinical C. indologenes isolates from Maharaj Nakorn Chiang Mai Hospital, Thailand, to understand their mechanisms of multidrug resistance, virulence factors, and mobile genetic elements (MGEs). Methods: Twelve C. indologenes isolates were identified, and their antibiotic susceptibility profiles were determined. Whole genome sequencing (WGS) was performed using a hybrid approach combining Illumina short-reads and Oxford Nanopore long-reads to generate complete bacterial genomes. The hybrid assembled genomes were subsequently analyzed to detect antimicrobial resistance (AMR) genes, virulence factors, and MGEs. Results: C. indologenes isolates were primarily recovered from urine samples of hospitalized elderly male patients with underlying conditions. These isolates generally exhibited extensive drug resistance, which was subsequently explored and correlated with genomic determinants. With one exception, CMCI13 showed a lower resistance profile (Multidrug resistance, MDR). Genomic analysis revealed isolates with genome sizes of 4.83–5.00 Mb and GC content of 37.15–37.35%. Genomic characterization identified conserved resistance genes (bla_IND-2, bla_CIA-4, adeF, vanT, and qacG) and various virulence factors. Phylogenetic and pangenome analysis showed 11 isolates clustering closely with Chinese strain 3125, while one isolate (CMCI13) formed a distinct branch. Importantly, each isolate, except CMCI13, harbored a large genomic island (approximately 94–100 kb) carrying significant resistance genes (bla_OXA-347, tetX, aadS, and ermF). The absence of this genomic island in CMCI13 correlated with its less resistant phenotype. No plasmids, integrons, or CRISPR-Cas systems were detected in any isolate. Conclusions: This study highlights the alarming emergence of multidrug-resistant C. indologenes in a hospital setting in Thailand. The genomic insights into specific resistance mechanisms, virulence factors, and potential horizontal gene transfer (HGT) events, particularly the association of a large genomic island with the XDR phenotype, underscore the critical need for continuous genomic surveillance to monitor transmission patterns and develop effective treatment strategies for this emerging pathogen. Full article

A process evaluation was embedded in the multinational Music Interventions for Dementia and Depression in ELderly care (MIDDEL) trial to better understand barriers and facilitators for implementing music-based interventions (MBIs). Stakeholders from 66 care home units across 5 countries completed a survey at baseline (n = 229) and after a six-month intervention period (n = 101), comparing expectations and experiences between countries, intervention groups, and stakeholders. MBIs were evaluated and found to be relevant and feasible. Barriers include a lack of support, turnover among employees, and a lack of motivation. Facilitators include individual stakeholders who proactively facilitate and stimulate implementation, as well as the presence of stable, well-functioning teams, clear communication, and adhering to project plans. Fewer barriers than expected related to care staff workload and the time needed for implementing new MBIs in care homes. MBIs can be beneficial for people with dementia, yet implementation in care homes can be challenging due to contextual factors. Involving stakeholders in key positions is essential: care home managers are pivotal for policy-making and the sustainable adoption of MBIs, whereas the commitment and the involvement of care staff are needed for day-to-day implementation. Insight into these barriers to and facilitators of implementation can contribute to the interpretation of trial results. Full article

Awareness of design when planning public urban spaces assumes particular importance through its mission to meet the diverse needs of the different segments within the community. The elderly is considered one of the pivotal segments, with their influence on strengthening social cohesion, fortifying values, and upholding traditions. On the other hand, such a segment demands special physical, behavioral, and mental requirements that would entail specific consideration in the design process of public common spaces. The study aimed to identify and evaluate the most relevant and important indicators pertaining to the most effective design of an age-friendly public space, with community parks taken as a particular case. The study relies on a mixed approach, combining desk research, expert views, the Delphi technique, and the Analytical Hierarchy Process to achieve that purpose. It resulted in a group of sourced, filtered, and evaluated indicators classified into Physical, Experiential, and Social/Emotional categories, which were evaluated by a mixed representative group of academics, practitioners, governmental officials, and end users, being the elderly or their caretakers. Focus was placed on the central park in the Dahiyat Al-Hussein suburb in Amman, Jordan, which was utilized as a contextual case through which a refined design framework was extracted. This framework serves as a potential base that can be expanded and adapted to create a more generalizable model. Full article