Search Results (747)

Background/Objectives: To evaluate the utility of phase angle (PhA) derived from bioelectrical impedance analysis as a screening indicator for pre-frailty in community-dwelling older adults. Methods: This cross-sectional study included 171 participants (36 men and 135 women) in Japan in 2023. PhA at 50 kHz was measured using bioelectrical impedance analysis and evaluated as a potential screening indicator for pre-frailty. Assessments included body composition, physical function tests (maximum walking speed, Timed Up and Go (TUG), grip strength, knee extension strength, and one-leg stance time with eyes open), cognitive function (MoCA-J), and the Motor Fitness Scale (MFS), a questionnaire assessing physical function, along with the Kihon Checklist (KCL). Frailty status was defined using KCL scores (4–7: pre-frailty; ≥8: frailty), and participants were classified into robust and pre-frail/frail groups. Results: PhA was significantly correlated with physical function measures, including grip strength (r = 0.54, p < 0.01), MFS (r = 0.36, p < 0.01), maximum walking speed (r = 0.20, p < 0.05), knee extension strength (r = 0.16, p < 0.05), and TUG (r = −0.17, p < 0.05). In women, logistic regression analysis showed that PhA was independently associated with pre-frailty (age-adjusted odds ratio: 2.38; 95% CI: 1.08–5.23; p < 0.05). ROC analysis yielded an area under the curve of 0.65 (95% CI: 0.56–0.74), indicating modest discriminative ability. Age-adjusted cutoff values of PhA were 4.19° and 4.74°, corresponding to points prioritizing sensitivity and specificity, respectively. Conclusions: PhA is associated with physical function and may serve as a simple, non-invasive indicator for identifying pre-frailty in community settings. However, given its modest discriminative ability, PhA alone may not be sufficient as a standalone screening tool and should be used in combination with other clinical indicators for clinical application. Full article

Background: Frailty is a major determinant of adverse outcomes in older adults with cardiovascular disease. Automated digital tools may facilitate routine frailty assessment in hospital settings; however, their validity and prognostic relevance in acutely hospitalized patients remain insufficiently established. Methods: In this prospective cohort study, 113 hospitalized cardiology patients underwent frailty assessment using both manual Short Physical Performance Battery (mSPPB) and an automated electronic SPPB (eSPPB) system. Agreement between methods was evaluated using Pearson correlation, intraclass correlation coefficients (ICCs), and Bland–Altman analysis. Frailty was defined as SPPB < 5. The association between frailty and 30-day mortality was assessed using logistic regression and Kaplan–Meier survival analysis. Results: Seventeen patients (15.0%) were classified as frail. Automated and manual SPPB scores were highly correlated (r = 0.994, p < 0.001) and demonstrated good agreement (ICC = 0.80). Bland–Altman analysis showed a mean difference of −1.63 points (95% limits of agreement −4.41 to 1.16). Frailty was associated with significantly higher 30-day mortality (17.6% vs. 2.1%, p = 0.009), corresponding to a tenfold increase in mortality odds (OR 10.07; 95% CI 1.5–67.5). An exploratory model showed apparent discriminative performance (AUC 0.83; 95% CI 0.71–0.95). Conclusions: Automated eSPPB demonstrated good agreement with manual assessment and was significantly associated with short-term mortality in hospitalized cardiovascular patients. These findings support the validity and potential clinical utility of automated frailty assessment for risk stratification in acute cardiology settings. Full article

Background: Migraine in older adults represents an increasingly relevant yet underrecognized clinical challenge in aging societies, where multimorbidity, frailty, and polypharmacy complicate both diagnosis and management. Although traditionally considered a disorder of younger individuals, migraine frequently persists or presents after the age of 60 with atypical features, contributing to diagnostic uncertainty. Methods: This narrative review, conducted in accordance with the SANRA principles, aims to provide a comprehensive overview of the epidemiology, clinical presentation, pathophysiology, and management of migraine in older adults, with particular emphasis on age-related complexities, therapeutic challenges, and unmet clinical needs. Results: Migraine in this population often presents with atypical or misleading features, such as aura without headache, vestibular symptoms, or overlap with cerebrovascular conditions, leading to delayed or incorrect diagnoses. The burden of disease is substantial, affecting physical function, mobility, cognition, emotional well-being, and social participation, and is further amplified by comorbid conditions including cardiovascular and metabolic disorders, mood disturbances, and chronic pain syndromes. Aging-related neurobiological changes, such as impaired pain modulation, endothelial dysfunction, and neuroinflammation, may influence disease expression and treatment response. Therapeutic management is challenged by contraindications, increased susceptibility to adverse drug effects, and the complexity of polypharmacy, highlighting the importance of individualized and non-pharmacological approaches. Conclusions: Migraine in older adults is a significant but often overlooked contributor to disability and reduced quality of life. Improved recognition of its unique clinical features and age-specific vulnerabilities is essential to optimize patient-centered care. Future research should prioritize the inclusion of older populations and the development of tailored, safe, and effective management strategies. Full article

Objective: To validate the Oldfry instrumental device for efficiently detecting the risk of falls and frailty in older adults. Design and Methods: An observational, analytical, cross-sectional, multicenter, non-randomized study to validate an instrumental device. It was conducted in several nursing homes for the elderly in the province of Castellón, Comunidad Valenciana, Spain, from February to April 2024. The estimated necessary sample size was 149 people. Specific selection criteria and voluntary acceptance to participate in the study were established. Sociodemographic, anthropometric, and other variables such as fall history in the past year were collected. A descriptive and comparative analysis of the variables was performed. The validity and reliability of the device in its measurements were determined to compare the results of the Timed Up and Go (TUG) test and the Short Physical Performance Battery test (SPPB), with respect to the Oldfry instrumental device. Informed consent was obtained from all participants, and the study was approved by the Bioethics Committee of the University Jaume I. Results: The sample consisted of 151 participants with a median age of 84 years (IQR [78.0–91.0]), comprising 39.10% men and 60.90% women, 65 years of age or older. Oldfry presents a sensitivity of 45.90% and a specificity of 72.7% for the risk of falls with a correlation R: 0.773 and an ICC concordance: 0.821. For frailty assessment, it shows a sensitivity of 91.90% and a specificity of 9.10% with an R: 0.854 and ICC: 0.805. Conclusions: This device has proven to be an effective tool for detecting both the risk of falls and frailty in older adults residing in institutions, showing high levels of reliability, sensitivity, and high concordance and correlation in both measurements. Future studies are anticipated to evaluate the benefits of this application. Full article

Background: In the context of global population aging, nutritional risk has emerged as an important factor associated with both physical and mental health among older adults. This study aimed to examine the associations between nutritional risk, depression, and cognitive function in older adults and to explore potential variations across residential area, educational attainment, employment status, frailty status, and activities of daily living (ADL). Methods: Data were obtained from 9955 community-dwelling older adults aged 65 years and older who participated in the 2023 National Survey of Older Koreans. Nutritional risk was assessed using the DETERMINE checklist (21-point scale), a multidimensional screening tool reflecting dietary, functional, and social risk factors. Depression was measured using the Short-form Geriatric Depression Scale (15-point scale), and cognitive function was assessed using the Korean version of the Mini-Mental State Examination-2 (K-MMSE-2; 30-point scale). Hierarchical multiple linear regression, correlation, subgroup, and sensitivity analyses were conducted, adjusting for sociodemographic characteristics, health behaviors, and geriatric factors. Results: Correlation analyses showed significant associations between nutritional risk and cognitive function (r = −0.191, p < 0.05), nutritional risk and depression (r = 0.440, p < 0.05), and depression and cognitive function (r = −0.259, p < 0.05). Higher nutritional risk scores were significantly associated with greater depressive symptoms (B = 0.314, p < 0.001) and lower cognitive function (B = −0.051, p < 0.05). While some subgroup differences were observed, not all interaction effects reached statistical significance, and these findings should be interpreted with caution. Conclusions: These findings suggest that nutritional risk is associated with depressive symptoms and cognitive function in older adults. Given that the DETERMINE checklist reflects multidimensional vulnerability, the results should be interpreted as indicating broader risk contexts rather than direct nutritional status alone. These findings highlight the importance of integrated, multidimensional approaches to support older adults at nutritional risk in community settings. Full article

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition—multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes—to characterize constipation in older adults as a “systemic geriatric syndrome,” and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain–gut–microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework. Full article

Background and Objectives: represents a major public health challenge in rapidly aging societies. While lifestyle behaviors are established modifiable risk factors for frailty, the longitudinal impact of composite lifestyle trajectories—particularly by sex—remains poorly understood. This study examined sex-stratified associations between Healthy Lifestyle Score Trajectories (HLSTs) and frailty among community-dwelling middle-aged and older adults in South Korea. Using 19 years of nationally representative panel data from the Korean Longitudinal Study of Aging (2006–2024), we analyzed 6603 participants (2684 males; 3919 females). Materials and Methods: Group-Based Trajectory Modeling was applied to Waves 1–6 to derive sex-specific HLSTs based on smoking, alcohol consumption, physical activity, and body mass index. Generalized Estimating Equations were used to assess longitudinal associations between HLSTs and Frailty Index (FI) scores across Waves 6–10, adjusting for sociodemographic covariates. Results: Five distinct HLSTs were identified in both sexes. In both males and females, persistently poor or deteriorating trajectories were independently associated with higher FI scores relative to the Favorable HLST reference group. The effect size for Poor HLST was more than twice as large in females (B = 0.039) than in males (B = 0.018), consistent with the sex-frailty paradox. Among females, the Improving HLST group did not demonstrate a statistically significant frailty benefit (B = 0.014, p = 0.091). Stratified analyses revealed that the lifestyle–frailty association among males was significant only in rural-dwelling participants, whereas in females the association was consistent across both urban and rural settings. Conclusions: Persistently unfavorable composite lifestyle trajectories were independently associated with higher frailty burden, with disproportionately greater impact in women. Late-life lifestyle improvement was not significantly associated with reduced frailty in women, reinforcing the importance of early and sustained behavioral maintenance. The rural-specific association in men highlights the role of structural disadvantage in amplifying lifestyle-related frailty risk. However, given the observational design of this study, the possibility of reverse causality cannot be excluded, and these findings should be interpreted as associative rather than causal. These findings support sex-sensitive, trajectory-based, and geographically tailored frailty prevention strategies. Full article

Aging is a progressive and heterogeneous biological process influenced by multiple factors that may compromise physical and cognitive capacities and increase the risk of frailty, functional decline, and falls in older adults. Falls represent a major public health concern due to their impact on independence and long-term care demand. Immersive virtual reality (IVR) delivered through active video games (exergames) has emerged as a preventive strategy that integrates sensory, motor, and cognitive stimulation within controlled and engaging environments, particularly where traditional programs face challenges related to adherence and individual adaptation. This study aims to determine the feasibility and implementation of an IVR-based program for falls prevention in older adults at risk of frailty in primary health care (PHC). A quasi-experimental pre–post design will be conducted with an intervention group (IVR/exergames) and a conventional control group, including a total sample of 40 participants (20 per group). The protocol comprises three phases: baseline assessment and IVR familiarization; a 12-week intervention delivered twice weekly; and post-intervention assessment. The primary outcome will be fall risk assessed using the Timed Up and Go (TUG) test. Secondary outcomes include physical performance (Short Physical Performance Battery, SPPB, and handgrip dynamometry) and psychological aspects related to falls (Falls Efficacy Scale International, FES-I, and Activities-specific Balance Confidence Scale, ABC). Feasibility indicators will include recruitment, adherence, retention, and cybersickness. A reduction in TUG time is expected, providing preliminary evidence on the feasibility of integrating IVR-based programs for falls prevention within PHC systems. Full article

Frailty is a multifactorial geriatric syndrome marked by reduced physiological reserves and increased vulnerability to adverse outcomes. This multicenter observational study adopted a One Health approach to examine the association between frailty and biological sex, denture use, and antidepressant medication, as well as their impact on bite force, in two transnational cohorts of physically active older adults. The sample included 499 individuals aged ≥60 years (295 from Brazil and 204 from Portugal), all with functional dentition and regular physical activity. Frailty was assessed using the adapted Fried phenotype and classified as non-frail (G0), pre-frail (G1), or frail (G2). Oral health, depressive symptoms (CES-D), bite force, and self-reported use of dentures and antidepressants were analyzed. Frailty was significantly associated with biological sex (p < 0.001), with higher prevalence among women, especially in G2. Antidepressant use was associated with frailty in the Portuguese cohort (p < 0.001) and in the total sample (p = 0.005), but not in Brazil. No significant association was observed between denture use and frailty. However, Brazilian participants without dentures showed significantly higher bite force (p < 0.001), indicating a functional oral health effect. Frailty was associated with female sex and antidepressant use, while bite force emerged as a complementary functional marker for geriatric assessment. Full article

Population aging has markedly increased the burden of cancer in older adults, in whom frailty, sarcopenia, and reduced physiological reserve limit tolerance to treatment and worsen clinical outcomes. Aging is accompanied by progressive functional decline and by biological processes such as cellular senescence, characterized by irreversible cell cycle arrest, chronic low-grade inflammation, and impaired immune surveillance. The accumulation of senescent cells and the persistence of a senescence-associated secretory phenotype contribute to tissue dysfunction and generate a microenvironment that favors tumor initiation and progression. Physical exercise has been associated with attenuation of inflammation, improvements in metabolic and immune function, and with lower levels of senescence-related biomarkers. Although aerobic exercise has been extensively studied in this setting, resistance training holds relevance for older adults due to its capacity to counteract sarcopenia, preserve muscle strength and power, and sustain functional independence. Structured and periodized approaches to resistance exercise may further enhance these benefits by delivering targeted stimuli aligned with age-related physiological deficits. Block strength training (BST), a periodized model that concentrates training adaptations into sequential phases of maximal strength, power, and muscular endurance, has demonstrated consistent improvements in functional performance and reductions in frailty risk in community-dwelling older adults. BST improves physical function. It may also influence biological processes related to aging and cancer; however, mechanistic evidence specific to BST remains to be established. We hypothesized that the exercise in block as a targeted, a structured and physiologically grounded resistance training intervention highlights the potential of BST to promote functional aging and healthy. In the case of cancer biology, and the environment near to tumour, the relationship between aging mechanisms in older adults and controlled exercise effects are currently in advance, but mechanistic trials are still lacking. Finally, we propose a novel training method, structured and personalized, that could impact different clinical outcomes in older patients with cancer. Full article

The oral cavity performs several functions that are essential for sustaining life and carrying out daily activities. Given the importance of maintaining functional abilities for healthy aging, exploration of the adverse health outcomes that may result from impaired oral function is needed. This cross-sectional study examined oral functional status in 176 community-dwelling older adults with preserved cognitive function and activities of daily living, and analyzed the association between oral hypofunction and physical frailty. Oral hypofunction was diagnosed using seven parameters. Frailty was assessed using the Korean version of the Fried Frailty Phenotype, which focuses on physical characteristics. Independent t-tests, one-way analysis of variance, the Kruskal–Wallis test, and multiple logistic regression analysis were conducted to examine the association between oral hypofunction and frailty. The prevalences of oral hypofunction and physical frailty were approximately 48% (n = 85) and 40% (n = 71), respectively. After adjusting for frailty-related factors, including sociodemographic and health-related characteristics, higher oral hypofunction scores were associated with an increased likelihood of physical frailty (odds ratio, 1.382; 95% confidence interval, 1.017–1.876). These findings suggest that maintaining the various functions of the oral cavity, including mastication, within normal ranges and restoring impaired oral abilities as early as possible may be relevant to healthy aging. Full article

Background/Objectives: Frailty is common among rural Chinese older adults despite relatively high daily physical activity, a phenomenon known as the “rural frailty paradox.” Conventional moderate-to-vigorous physical activity (MVPA) metrics rely on absolute cut-points and are often highly correlated with activity volume, limiting their ability to distinguish the roles of activity volume and activity intensity distribution. We therefore applied a cut-point-free accelerometer approach using average acceleration (AvAcc) and intensity gradient (IG) to distinguish activity volume from activity intensity distribution and to examine whether activity intensity distribution, together with diet quality, could help explain the rural frailty paradox beyond total activity volume alone. Methods: In this cross-sectional analysis of the Healthy Aging and Lifestyle Enhancement study, 1203 rural older adults were included. Physical activity (PA) was objectively measured using triaxial accelerometers to derive AvAcc and the IG. Diet quality was assessed using the China Prime Diet Quality Score (CPDQS), and frailty was assessed using the Fried frailty phenotype adapted for rural Chinese older adults. Multiple linear regression, joint effect models, and restricted cubic spline analyses were conducted after adjustment for age, sex, chronic disease status, total energy intake, and related covariates. Results: In mutually adjusted models, higher IG and CPDQS were independently associated with lower frailty scores, whereas AvAcc was not. In the fully adjusted model, IG (β = −0.14, p < 0.001) and CPDQS (β = −0.10, p < 0.001) were inversely associated with frailty score, while AvAcc showed no significant association (p = 0.665). In joint analyses, compared with the low-IG/low-CPDQS group, participants with high IG/high CPDQS had the lowest frailty scores (β = −0.28, p < 0.001), followed by those with low IG/high CPDQS (β = −0.20, p = 0.002). Restricted cubic spline analyses indicated a non-linear association between IG and frailty and an approximately linear inverse association for CPDQS. Conclusions: These findings suggest that, among rural older adults, frailty may be more strongly associated with activity intensity distribution than with total activity volume alone. Together with diet quality, this may help explain the rural frailty paradox. Full article

Objective: To evaluate the prognostic utility of the five-item modified Frailty Index (mFI-5) for postoperative outcomes in older adults undergoing posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease and to develop an interpretable preoperative risk model for medical complications (CxME). Methods: We retrospectively reviewed consecutive patients aged ≥65 years who underwent PLIF for lumbar spondylosis at a single tertiary institution. Baseline demographics, comorbidities, symptoms, American Society of Anesthesiologists (ASA) physical status, bone mineral density, antithrombotic use, perioperative laboratory findings, and operative variables were collected. CxME were defined as Clavien–Dindo grade ≥ II complications occurring during index hospitalization or within 30 days postoperatively. mFI-5 was calculated from five preoperative variables and stratified as 0, 1, and ≥2. Multivariable logistic regression was used to identify independent predictors of CxME. Results: Among 255 patients (mean age 72.6 years), 53 (20.8%) developed CxME. Patients with CxME were older and had higher rates of diabetes mellitus and preoperative dependency. mFI-5 ≥ 2 was more frequent in patients with CxME than in those without (66.0% vs. 27.3%, p < 0.001). Higher frailty was associated with older age, greater comorbidity burden, higher ASA class, lower preoperative hemoglobin, greater transfusion exposure, longer hospital stay, and a higher incidence of CxME (14.0%, 9.6%, and 38.9% for mFI-5 scores 0, 1, and ≥2, respectively; p < 0.001). In multivariable analysis, age (OR 1.133, 95% CI 1.055–1.216; p < 0.001) and mFI-5 (OR 2.103, 95% CI 1.387–3.188; p < 0.001) independently predicted CxME. The Age + mFI-5 model showed fair discrimination (optimism-corrected area under ROC 0.734). Conclusions: Preoperative frailty and age independently predicted postoperative medical complications after PLIF in older adults. The Age + mFI-5 model may support risk stratification, counselling, and perioperative optimization. Full article

Background/Objective: Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is a potentially reversible and high-risk state for dementia. This study examined the association between Color Kanji Pick-out Test (CKPT) app performance and cognitive frailty independent of Mini-Mental State Examination (MMSE) scores in community-dwelling older women. Methods: In this cross-sectional study, the participants were 102 community-dwelling older women without dementia and with MMSE scores ≥ 27 (73.6 ± 6.0 years). Reversible cognitive frailty was defined as subjective cognitive decline (≥1 point in the cognitive domain of the Kihon Checklist) plus physical frailty or prefrailty, according to the Japanese Cardiovascular Health Study (J-CHS) criteria. Firth’s penalized logistic regression using three prespecified models, adjusted for age and education, was used to examine the independent associations between CKPT app performance and MMSE scores with reversible cognitive frailty. Results: Fourteen participants (13.7%) met the criteria for cognitive frailty. In separate models, higher CKPT app and MMSE scores were significantly associated with lower odds of cognitive frailty (CKPT: odds ratio [OR] 0.470, p = 0.019; MMSE: OR 0.548, p = 0.020). In a multivariable model including both measures, the CKPT app (OR 0.499, p = 0.031) and MMSE scores (OR 0.553, p = 0.031) remained independently associated with cognitive frailty, and this model had the lowest Akaike information criterion. Conclusions: The CKPT app performance was independently associated with cognitive frailty beyond global cognition. The CKPT app may detect subtle executive and attentional vulnerabilities not captured by the MMSE, supporting practical, objective, early screening and risk stratification of cognitive frailty. Full article

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to >80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform ‘fistula-first’ approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams. Full article