Search Results (756)

Background/Objectives: Osteoporosis and coronary artery disease coronary artery disease (CAD) share common risk factors and biological pathways, yet their relationship in older adults with chronic coronary syndrome (CCS) remains incompletely understood. This study investigated the association between dual-energy X-ray absorptiometry (DXA)-defined osteoporosis and angiographic CAD burden in older adults with CCS. Methods: This two-center cross-sectional study included 451 consecutive adults aged ≥60 years with CCS who underwent DXA and invasive coronary angiography between July 2023 and June 2024. Osteoporosis was defined according to the World Health Organization criteria. CAD burden was assessed by disease extent (≥2-vessel or left main disease and ≥3-vessel or left main disease) and angiographic severity using the Gensini score. Multivariable logistic regression was performed after adjustment for age, sex, body mass index, hypertension, diabetes mellitus, chronic kidney disease, and smoking history. Results: Osteoporosis was identified in 151 participants (33.5%). Compared with participants without osteoporosis, those with osteoporosis had significantly higher prevalences of ≥2-vessel or left main disease (79.5% vs. 55.7%, p < 0.001), ≥3-vessel or left main disease (66.9% vs. 33.3%, p < 0.001), and severe CAD (Gensini score > 54; 29.0% vs. 15.0%, p = 0.022). After multivariable adjustment, osteoporosis remained independently associated with ≥2-vessel or left main disease (adjusted odds ratio [OR] 3.97, 95% confidence interval [CI] 2.31–6.81), ≥3-vessel or left main disease (adjusted OR 5.07, 95% CI 3.06–8.41), and severe CAD (adjusted OR 3.08, 95% CI 1.50–6.36; all p ≤ 0.002). Conclusions: DXA-defined osteoporosis was independently associated with a substantially greater angiographic burden of coronary artery disease in older adults with CCS. These findings suggest that osteoporosis may serve as a marker of more advanced coronary atherosclerosis and support closer cardiovascular risk assessment in this high-risk population. Full article

Background: Tooth loss and periodontal disease have been linked to cardiovascular disease; however, the role of posterior occlusal support remains unclear, especially among older adults. This study examined the association between posterior occlusal support and a history of cerebral or myocardial infarction in 88-year-old institutionalized older adults. Methods: This cross-sectional study included 88-year-old adults who underwent dental examinations at long-term care facilities. Posterior occlusal support was categorized as “no,” “partial,” or “complete support” based on the Eichner classification. The outcome was a self-reported history of cerebral or myocardial infarction. Logistic regression analyses were adjusted for sex, obesity, diabetes mellitus, smoking history, periodontal pocket status, and number of remaining teeth. Results: Compared to participants with no occlusal support, those with partial occlusal support had lower odds of infarction history after adjusting for cardiovascular risk factors (OR: 0.21, 95% CI: 0.05–0.99). Complete occlusal support exhibited a similar direction, although the association was not statistically significant after adjusting for cardiovascular risk factors (OR: 0.40, 95% CI: 0.11–1.50). Conclusions: Preserved posterior occlusal support was associated with lower odds of a history of cerebral or myocardial infarction in 88-year-old institutionalized older adults. The findings of this exploratory study suggest that posterior occlusal support was associated with a history of myocardial or cerebral infarction independently of tooth count. However, these findings should be interpreted cautiously because of the cross-sectional design, small reference group, self-reported outcomes, and the possibility of residual confounding, and require confirmation in larger prospective studies. Full article

Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain. Full article

Background: Heart failure (HF) is the leading cause of hospitalisation in older adults, with incidence increasing markedly with age. However, long-term outcome data in patients aged ≥85 years remain limited. We evaluated survival and predictors of mortality in this very elderly HF population enrolled in a structured outpatient programme. Methods: A retrospective observational study was conducted, including patients aged ≥85 years assessed at a Comprehensive HF Management Unit between 2012–2023. Demographic characteristics, comorbidities, functional (Barthel) and cognitive (Pfeifer) status, laboratory parameters, hospitalisations, and survival status were collected. Long-term survival was estimated using the Kaplan–Meier method, and predictors of mortality were analysed using Cox regression models. Results: A total of 514 patients were included (mean age 88.4 ± 3 years, 46.1% male); 340 (66.1%) died during follow-up. Survival was 77% at 1 year, 50% at 2.5 years, and 25% at 5 years. Mortality was associated with diabetes (p = 0.038), advanced chronic kidney disease (p = 0.008), dementia (p < 0.001), neoplasia (p = 0.007), ischaemic heart disease (p < 0.001), history of HF (p = 0.043), NYHA III–IV (p < 0.001) and elevated NT-proBNP (p < 0.001). Worse functional and cognitive status, higher comorbidity according to the Charlson Comorbidity Index and readmission at one year (all p < 0.001) were also related to mortality. In the first multivariable model, worse cognitive and functional status, a higher Charlson comorbidity index, NYHA class III–IV, and high NT-proBNP were independent predictors of mortality. When 1-year HF readmission was added to the model, the Charlson index (HR:1.10; 95%CI 1.01–1.19), high NT-proBNP (HR:1.76; 95%CI 1.30–2.38) and HF readmissions within 1 year (HR:2.68; 95%CI 1.72–4.16) remained independently associated with mortality. Conclusions: In patients aged ≥85 years with HF, survival was poor, with only half alive at 2.5 years and 25% at 5 years. Comorbidity burden, high natriuretic peptides, and early readmission independently predicted mortality, underscoring the importance of comprehensive assessment in this population. Full article

Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being. Full article

Background/Objectives: Telerehabilitation for physiotherapy programs (TelePhysio) has been shown to improve knee extension force (KEF) in older patients with type 2 diabetes mellitus (T2DM), but factors associated with responsiveness remain unclear. This exploratory secondary analysis investigated whether baseline eating behaviors modified the effectiveness of TelePhysio in KEF. Methods: This secondary analysis included 74 older patients with T2DM enrolled in a randomized controlled trial. The participants were assigned to the TelePhysio (n = 39) or non-intervention group (n = 35). Baseline eating behaviors were assessed using an Eating Behavior Questionnaire. Multiple regression analysis was performed using 6-month KEF as the dependent variable, adjusting for baseline KEF, age, sex, body mass index, diabetic polyneuropathy, intervention group, baseline eating behavior score, and their interactions. The original trial was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000024416; registered on 15 October 2016). Results: A significant interaction was found between the intervention group and baseline eating behavior score (B = −0.0064, p = 0.0352). Estimated TelePhysio effects on eating behavior scores corresponding to mean − 1 standard deviation (SD), mean, and mean + 1 SD were +0.36, +0.12, and −0.12 Nm/kg, respectively. None of the seven domain-specific group-by-domain interactions reached statistical significance. Sensitivity analyses using KEF changes showed a similar directional trend but were not statistically significant (p = 0.2913). Conclusions: Baseline eating behaviors may be associated with differential responsiveness to TelePhysio in older adults with T2DM. The estimated effect of TelePhysio on KEF was smaller at higher baseline Eating Behavior Questionnaire scores. These findings should be cautiously interpreted because the interaction was not confirmed using sensitivity analysis regarding changes in the KEF. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is increasingly recognised as a risk factor for physical frailty, driven by sarcopenia, microvascular disease, and chronic hyperglycaemia. Simple, low-cost performance tests may offer a practical means of identifying frailty risk in this population, but data combining several such measures in T2DM remain limited. This study aimed to characterise physical performance and quantify the proportion of adults with T2DM meeting thresholds for low physical performance. Methods: In this cross-sectional study, physical performance was assessed in adults with T2DM using the Timed Up and Go (TUG) test, handgrip strength (HGS), and the six-minute walk distance (6MWD). TUG cutoffs of 8 and 10 s were applied as exploratory external reference thresholds, consistent with cutoffs previously applied in chronic disease and older-adult populations. Results: Participants had a mean age of 55.6 ± 4.8 years; 42 (64.6%) were male, and mean BMI was 29.6 ± 4.4 kg/m². Mean TUG time was 9.30 ± 3.02 s, right and left HGS were 30.8 ± 10.1 kg and 28.0 ± 9.3 kg, and mean 6MWD was 401.2 ± 96.3 m. Forty-four participants (67.7%; 95% CI 55.6–77.8) exceeded the 8 s threshold, and 16 (24.6%; 95% CI 15.8–36.3) exceeded 10 s. TUG correlated strongly and inversely with 6MWD (r = −0.75, 95% CI −0.84 to −0.61; p < 0.001). This remained unchanged after adjustment for age, sex, and BMI (r = −0.76) and held within men (r = −0.79) and women (r = −0.78) separately. Handgrip strength correlated with 6MWD (right r = 0.40; left r = 0.39; both p ≤ 0.001) and attenuated to non-significance after adjustment for sex (r = 0.22, p = 0.076) and for age, sex, and BMI (r = 0.18, p = 0.16). In multivariable regression, TUG was independently associated with 6MWD (−21.4 m per second, p < 0.001), whereas handgrip strength was not (p = 0.064). Conclusions: A substantial proportion of adults with T2DM in this cohort displayed low-physical-performance profiles. Simple performance batteries combining TUG, handgrip strength, and 6MWD warrant further study as a potential means of identifying patients with T2DM who could benefit from targeted rehabilitation. Full article

Background: Epicardial adipose tissue (EAT) has been associated with coronary artery disease (CAD) in middle-aged and mixed-age populations, but its value in adults aged 80 years and older remains uncertain. This study investigated whether computed tomography (CT)-derived EAT volume provides incremental value for discriminating CAD in this very elderly population. Methods: We retrospectively included 155 patients aged ≥80 years who underwent coronary imaging evaluation between 2020 and 2022. EAT volume was quantified from non-contrast chest CT. Logistic regression, CatBoost modeling, and SHapley Additive exPlanations (SHAP) were used to assess the association of EAT with CAD, its discriminative value, and its relative contribution. Results: Forty-five patients (29.0%) had CAD. Median EAT volume did not differ between groups (p = 0.716) and was not associated with CAD after adjustment for age, sex, body mass index, diabetes, and glycated hemoglobin A1c (HbA1c). Adding EAT did not improve discrimination in logistic regression [area under the curve (AUC) 0.698 vs. 0.697; likelihood-ratio p = 0.945] or in cross-validated CatBoost analysis (AUC 0.623 vs. 0.614). SHAP ranked EAT eighth of eighteen predictors, below lipoprotein(a), total cholesterol, left atrial diameter, HbA1c, low-density lipoprotein cholesterol, diabetes, and atrial fibrillation. Conclusions: In adults aged 80 years and older, CT-derived EAT volume was not independently associated with CAD and added no discriminative value beyond conventional clinical risk factors. Total EAT volume may have limited utility as a CAD marker in very elderly adults. Full article

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in substantial global morbidity and mortality since its emergence in late 2019. This retrospective study aims to determine the comorbidity patterns, co-occurrence networks, and associated demographic factors among 244 deceased COVID-19 cases in Grenada between 2021 and 2022. The prevalence of comorbid conditions varied considerably across diseases. Hypertension was the most frequently observed condition (41%) followed by diabetes (34.8%), and ARDS (27%). Our co-occurrence analysis revealed a densely interconnected core of cardiometabolic and respiratory conditions, particularly involving hypertension, diabetes, and ARDS. Stratified clustering analyses demonstrated that multimorbidity patterns were broadly consistent across gender but differed by age group and vaccination status, with older individuals showing more pronounced clustering of cardiometabolic conditions. Logistic regression analysis further identified age and gender as significant factors associated with the distribution of specific comorbidities, including higher odds of hypertension among older individuals. This study highlights the central role of cardiometabolic diseases and older age in COVID-19 mortality in Grenada in 2021–2022 and underscores the importance of multimorbidity structures rather than isolated conditions. We suggest early identification of high-risk multimorbidity profiles, particularly among older adults, to improve clinical management and preventive strategies during future infectious disease outbreaks. Full article

The substantial burden of cardiovascular disease (CVD) attributable to air pollution remains a critical public health challenge, yet its combined effect with cardiometabolic factors is not fully understood. This study leveraged data from the Global Burden of Disease Study (GBD) and the China High Air Pollutants (CHAP) database to evaluate the CVD burden attributable to air pollution, which was found to increase progressively with age. We conducted a cross-sectional analysis using baseline (2011) data from 7420 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS), and a prospective cohort analysis in 8792 participants followed through 2020. In the longitudinal analysis, long-term exposure to PM_2.5 (HR = 1.09, 95% CI: 1.03–1.16) and PM₁₀ (HR = 1.07, 95% CI: 1.04–1.10) was significantly associated with an elevated risk of incident CVD, whereas the association for NO₂ was nominally significant (HR = 1.12, 95% CI: 1.00–1.24) and that for O₃ was not statistically significant (HR = 1.08, 95% CI: 0.93–1.27). Furthermore, prolonged exposure to these pollutants was associated with a higher prevalence of hypertension, diabetes, dyslipidemia, and obesity, and with adverse levels of metabolic indicators, including the TyG, TyG-BMI, and TyG-WC indices. A random forest model showed modest discrimination for incident CVD (AUC = 0.656), identifying PM₁₀ and PM_2.5 as the most important predictors. In conclusion, long-term exposure to ambient air pollution, particularly particulate matter, is associated with an increased risk of CVD and cardiometabolic disorders in middle-aged and older Chinese adults. Full article

Background: The Falls Efficacy Scale-International (FES-I) is an assessment tool designed to measure the level of fear of falling in older adults. This scale was developed to evaluate how much an individual fears falling during various daily activities. The aim of the study was to assess the discriminatory power of FES-I to predict falls within 2 years. The secondary objective was to evaluate the relationship between FES-I and vascular status. Material and Methods: In this prospective study, 130 patients (mean age, 64.7 ± 14.6 years) with chronic kidney disease (CKD) were analyzed. Of these, 90 patients had nondialysis CKD: 15 had stage G3 (G3a, n = 5; G3b, n = 10), 38 had stage G4, and 37 had stage G5. The remaining 40 patients (30.7%) were prevalent patients receiving maintenance hemodialysis. The most frequent cause of CKD was hypertension and diabetes in 57 (43.8%) of patients. The Falls Efficacy Scale-International (FES-I) was used to assess fear of falling. The Charlson Comorbidity Index (CCI) was used to measure comorbidity, and the 10-year cardiovascular risk was assessed using a web-based calculator QRESEARCH Cardiovascular Risk Algorithm, version 3 (QRISK^®3), and hemodynamic parameters were measured using a Mobil-O-Graph monitor. Participants were followed for 2 years to assess the occurrence of falls. Results: During the two-year follow-up, 49 of 130 participants (37.7%) experienced at least one fall. FES-I demonstrated good discrimination for falls (AUC 0.836; bootstrap 95% CI, 0.760–0.903). In multivariable logistic regression adjusted for age, sex, dialysis status, comorbidity, and functional status, FES-I remained independently associated with falls (adjusted OR per 1-point increase, 1.145; 95% CI, 1.060–1.237; p < 0.001). Addition of FES-I to the basic clinical model increased the AUC from 0.826 to 0.874, although the difference was of borderline statistical significance in paired receiver operating characteristics (ROC) comparison (p = 0.053). The data-derived Youden-optimal threshold was 25 points; however, bootstrap analysis indicated threshold variability, and this cut-off should be considered exploratory. Conclusions: Higher FES-I scores were independently associated with falls during two-year follow-up and may provide additional prognostic information beyond selected clinical risk factors. FES-I may represent a candidate screening instrument for fall-risk assessment in CKD; however, the proposed cut-off (25 points) requires prospective external validation. Full article

Background: Several strategies have been proposed to promote hydration among institutionalized older adults, including systematic hydration rounds and, more recently, the use of Socially Assistive Robots (SAR). However, their implementation in nursing homes remains limited. Objective: To compare changes in fluid intake over a one-month period among residents exposed to two hydration-promotion strategies and to identify baseline characteristics associated with fluid intake. Methods: A quasi-experimental study was conducted in a nursing home. Residents were assigned to either a systematic hydration rounds intervention with manual recording or a SAR-supported multicomponent educational intervention including reminders, positive reinforcement, and digital intake monitoring. Fluid intake was monitored for one month and analyzed using adjusted mixed-effects linear regression models. Results: Residents in the systematic hydration rounds group showed higher fluid intake throughout follow-up. In the longitudinal analysis, assignment to the SAR-supported group was independently associated with lower fluid intake during follow-up (β = −354.24 mL/day; p < 0.001), after adjustment for baseline fluid intake and functional dependence. No significant differences were observed in intake trajectories between strategies. Dysphagia was independently associated with lower fluid intake, whereas diabetes was associated with higher fluid intake. Conclusions: Residents assigned to the systematic hydration rounds group showed higher fluid intake during follow-up. Dysphagia was associated with lower fluid intake, highlighting the need to adapt hydration-promotion strategies to residents’ swallowing-related needs. Although the SAR-supported intervention was not associated with higher fluid intake, the findings suggest that technological tools for hydration promotion and monitoring require adequate integration into routine clinical practice. Full article

Background/Objectives: Diabetes mellitus is associated with cognitive impairment, but evidence from southern Morocco remains limited. This study examined the associations of diabetes status, HbA1c, and diabetes duration with Mini-Mental State Examination (MMSE) performance among adults aged 45 years or older in Dakhla. Methods: This hospital-based comparative cross-sectional study included 100 participants (50 with diabetes and 50 without diabetes). Data were collected through a structured bilingual questionnaire and medical records. MMSE scores below 27 defined MMSE-based cognitive impairment. Crude and age-, sex-, and education-adjusted linear regression models with HC3 robust standard errors were complemented by correlation, subgroup, chi-square, and odds-ratio analyses. Results: Mean MMSE scores were lower in participants with diabetes than in those without diabetes (24.4 ± 5.39 vs. 28.8 ± 2.08). After adjustment, diabetes remained associated with a 4.13-point lower score (β = −4.13; 95% CI: −5.57 to −2.69; p < 0.001). MMSE-defined impairment occurred in 54% and 14% of the diabetic and non-diabetic groups, respectively (OR = 7.21; 95% CI: 2.72–19.05; p < 0.001). Within the diabetic group, MMSE scores correlated inversely with diabetes duration (r = −0.523; p < 0.001) and HbA1c (r = −0.393; p = 0.005), but neither remained independently associated after adjustment. Participants with type 1 diabetes had lower median MMSE scores and longer disease duration than those with type 2 diabetes, although this subgroup comparison was exploratory. Conclusions: Diabetes was strongly associated with lower MMSE performance and a higher prevalence of MMSE-defined impairment in this hospital-based sample. The cross-sectional design precludes causal interpretation, and the findings require confirmation in larger prospective studies. Full article

Background: Elderly patients with type 2 diabetes mellitus (T2DM) often experience cognitive decline and physical function degradation. However, whether cognitive function mediates the association between T2DM and physical performance in older adults has not been previously examined. This study aimed to explore whether cognitive function was statistically associated with the relationship between T2DM and physical performance in older adults using mediation analysis. Methods: We conducted a cross-sectional study, and a total of 102 participants aged ≥60 were included (46 patients with T2DM and 56 non-diabetes controls). Cognition was assessed using standardized neuropsychological tests (global cognition, as assessed by the MoCA total score; and domain-specific measures). Physical performance was quantified by walking speed and handgrip strength. Mediation analyses were performed to test whether the cognitive function statistically accounted for part of the association between the T2DM state and the physical performance. Results: Participants with T2DM had poorer cognitive performance and lower physical performance than controls. In mediation models, the MoCA total score statistically accounted for approximately 18% of the association between T2DM and gait speed (ACME −5.19 cm/s, 95% CI −8.73 to −2.32; proportion mediated 0.18, 95% CI 0.08–0.32). For grip strength, the corresponding proportion was estimated at 60% (ACME −2.16 kg, 95% CI −3.78 to −0.81; proportion mediated 0.60, 95% CI 0.23–1.81), although this estimate should be interpreted cautiously because of the wide confidence interval. Conclusions: This study suggests that poorer cognitive performance may partially account for the observed relationship between T2DM and the decline in physical performance of the elderly. The results support the presence of concurrent cognitive and physical impairment among older adults with T2DM. Given the cross-sectional design, these findings should be regarded as exploratory and hypothesis-generating, and longitudinal studies are required to establish temporal relationships. Full article

Background/Objectives: Studies consistently demonstrate that microprocessor-controlled prosthetic knees (MPKs) improve mobility and quality of life for people with lower limb loss or absence by enhancing balance and reducing falls. However, the extent to which these benefits apply across demographic groups remains unclear. Therefore, we conducted a literature review to evaluate how representative and transferable research on MPKs is across different populations, and which factors influence this. Methods: Using systematic review principles and PRISMA guidelines, 27 studies were analysed from databases including Cochrane, CINAHL, MEDLINE, and PubMed, as of 20th September 2025. The included studies primarily focused on young-to-middle-aged adults, men, individuals with trauma-related amputation, and higher mobility levels. Results: We found that older adults, women, and individuals with amputation caused by vascular disease or diabetes were under-represented in MPK research. Moreover, variability in time since amputation complicates the generalisability of findings, as this factor significantly influences adaptation and functional outcomes. Conclusions: While evidence supports MPKs’ effectiveness in enhancing mobility and reducing the risk of falls, their benefits may not fully apply to under-represented groups, such as older adults, women, or low-activity users. Future research should prioritise more diverse participant samples to improve the generalisation of MPK outcomes across different demographics and functional levels. Full article