Search Results (188)

Background: We aim to estimate the variation in the prevalence of chronic kidney disease (CKD) in patients from a Brazilian cardiologic center. Methods: The outpatient serum creatinine level and urine albumin–creatinine ratio (UACR) in samples from patients ≥18 years old between 2014 and 2023 were evaluated. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Participants were categorized into low-, moderate-, high- or very high-risk groups according to the CKD heatmap, which combines eGFR with UACR results. Results: The mean number of adults with serum creatinine results per year was 36,477 ± 7239, and the mean number of those with UACR results was 16,870 ± 4310. The age- and sex-adjusted prevalence of participants with CKD increased significantly (from 20% to 31%; R² = 0.853; p < 0.001), as was the prevalence of individuals in the high or very high CKD risk groups (14% to 21%; R² = 0.945; p < 0.001). The cumulative incidence of CKD during the study period was 21.7% and was higher in females and in older age groups. Conclusions: The roughly 50% increase in the laboratory-based CKD prevalence over 10 years underscores the need for healthcare services to adapt to managing a population with growing complexity and a heightened risk of requiring kidney replacement therapy. Full article

Objectives: This study aims to describe real-world clinical profiles, treatment patterns and one-year outcomes of older adults hospitalized for acute heart failure (HF) across different admission services, and to examine whether sex influences these characteristics and outcomes. Methods: We performed a retrospective study including 1226 patients aged ≥80 years hospitalized for acute HF between 2018 and 2021. Patients were categorized by admitting service (cardiology [CAR] or internal medicine [IM]) and sex. The primary endpoint was all-cause mortality at 12 months, with secondary endpoints including HF readmission and a composite of death or HF readmission. Results: The mean age was 87.4 ± 4.4 years, 65.8% were women, and 80% presented HF with preserved ejection fraction (HFpEF). Admission services reflected differing patient profiles: individuals admitted under IM were older, predominantly female, and more frequently presented with HFpEF and worse functional class, while CAR admissions included a higher proportion of patients with ischemic disease. Use of guideline-directed medical therapy varied according to clinical characteristics and admitting service. At 12 months, mortality and the composite endpoint differed across admission services, whereas HF readmission rates were similar. Sex-stratified analyses showed no difference in all-cause mortality or in the composite endpoint, but women experienced more frequent HF readmissions. Conclusions: Among very old adults hospitalized for acute HF, clinical profiles, therapeutic patterns, and outcomes differ according to patient characteristics and hospital admission pathways. Sex also shapes clinical presentation and readmission patterns. These findings highlight the importance of harmonized, multidisciplinary, and sex-sensitive HF care pathways to address the diverse needs of an aging HF population. Full article

Leukocyte telomere length (LTL) has been proposed as a molecular marker of biological aging reflecting cumulative cellular stress and replicative senescence. Multimorbidity represents a major challenge in aging populations and reflects the progressive accumulation of chronic diseases. However, the relationship between LTL and multimorbidity burden remains incompletely understood. We investigated the association between LTL and multimorbidity burden, assessed using Cumulative Illness Rating Scale (CIRS) indices, in a cohort of older nursing home residents. Sex-stratified analyses were performed to explore potential biological heterogeneity. In multivariate analyses, shorter LTL was significantly associated with higher multimorbidity burden among women, particularly when considering severity- and comorbidity-weighted CIRS indices [False discovery rate-adjusted q-values (qFDR < 0.01)], whereas no significant associations were observed in men. Adjustment for functional status partially attenuated but did not eliminate these associations. Organ-specific analyses indicated that these associations in women were primarily driven by cardiovascular, respiratory, gastrointestinal, and genitourinary domains, systems commonly characterized by chronic inflammatory and oxidative stress processes that may promote telomere attrition. Overall, these findings support a sex-specific relationship between telomere dynamics and clinically relevant multimorbidity patterns in very old adults. LTL may reflect biologically meaningful aspects of disease severity and systemic stress regulation rather than merely the accumulation of diagnoses. Full article

Background: Population ageing increases reliance on family caregivers (FCGs) for very old adults (80+). While caregiving is often studied as a source of burden, its impact on caregivers’ daily life and occupational balance remains underexplored. This study aimed to explore how caregiving responsibilities shape the daily lives, occupational balance, and support needs of FCGs, using the Stress Process Model (SPM) and the concept of Occupational Balance (OB). Methods: A qualitative study was conducted in the PACA region (France) within the SCOPE project. Seventeen semi-structured interviews were analysed using thematic content analysis, with independent double coding by two researchers. Results: Six themes were identified: caregiving role and identity, consequences, occupational patterns, needs, proposed actions, and barriers and facilitators. Caregiving generated both primary stressors (physical and emotional demands) and secondary stressors (role conflicts, financial strain, and social isolation). It also led to occupational imbalance, characterized by reduced leisure, diminished self-care, and reorganization of daily routines. Working FCGs reported greater role strain and time constraints, whereas retired FCGs emphasized informational needs and adaptation strategies. Across both groups, caregivers’ needs were rarely formally assessed. Conclusions: These findings highlight that caregiving for very old adults profoundly reshapes caregivers’ daily lives through both stress-related mechanisms and disruptions in occupational balance. They underscore the need for tailored, context-sensitive support strategies, including systematic needs assessment and more structured, individualized coordination approaches such as case management. Full article

Human metapneumovirus or HMPV is an important respiratory pathogen of public health significance that primarily affects the immunocompromised, the very old, and young infants. However, recent studies have long since dispelled the idea that healthy adults are not at risk for serious sequelae, though it seems that HMPV has a particular affinity to infect children rather than adults. HMPV was first identified in 2001 and is implicated in a range of respiratory illnesses, from less severe upper respiratory infections to more severe pneumonia. This review compiles the recent literature on the epidemiology, molecular virology, and clinical characteristics of HMPV with an emphasis on, importantly, the virus’s significant contribution to respiratory morbidity and the requirement for better diagnostic capabilities and public health measures against this very much underappreciated viral pathogen. Full article

Objective: The present study aimed to compare muscle thickness and physical performance in different functional tests predicting falls between older adults with low and high fall risk. Methods: Seventy-one community-dwelling older women (74.5 ± 8.5 years old) volunteered for this study. The Berg Balance Scale (BBS) was used to stratify the sample as low and high risk for fall (BBS cutoff = ≥ 50 points). The performance in the Timed Up and Go Test (TUGT), 5-repetition sit-to-stand test (5xSST), 3 m walk test (3mWT), and 3 m backward walk test (3mBWT) was assessed. The elbow flexor and knee extensor muscle thickness were obtained by ultrasound (USD). A linear mixed model analysis was used to determine between-group differences in functional mobility and muscle thickness, and Bayesian analysis was applied to check the probability to replicate the same results (i.e., the magnitude of the evidence). Results: The low-fall-risk group exhibited significantly better performance only in 3mWT (mean difference = 0.84 s [95% CI: 0.40 to 1.29 s]; p = 0.001) and 3mBWT (mean difference = 1.54 s [95% CI: 0.21 to 2.85 s]; p = 0.024). The Bayes Factor (BF) for performance on the 3mWT and 3mBWT shows that the low-fall-risk group has a probability of 98.7% (BF10 = 77.3) and 99.7% (BF10 = 368), respectively, of performing better than the high-fall-risk group. Conclusions: Based on inferential and Bayesian analysis, the performance in 3mWT and that in 3mBWT were classified as very strong to excellent instruments, respectively, for differentiating older women with high fall risk. Full article

Despite ongoing population aging, older adults remain underrepresented in educational and digital media research, particularly individuals from the fourth and fifth ages. Available data suggest a decline in participation in formal education, as well as decreasing numbers of internet users with advancing age. However, detailed information on very old adults’ perspectives on learning and digital devices remain limited, especially regarding informal learning activities. This study aims to examine attitudes toward and the perceived relevance of informal and digital learning among individuals aged 90 years and over. In total, seven interviews with older adults aged 90 years and older were conducted using a combination of biographical-narrative and problem-centered interview methods. Data were analyzed using Reflexive Thematic Analysis. Two overarching themes, consisting of a total of seven themes, were developed: perspectives on learning developed over the course of life and current perspectives on learning. Results indicate that the aging process itself becomes a salient learning process. Although age-related stereotypes such as ‘You can’t teach an old dog new tricks’ persist, nursing homes were identified as environments that support learning. This study sheds light on informal learning processes in advanced age. 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

Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive vulnerability, and prognostic uncertainty, and remains insufficiently addressed by conventional disease-centred heart failure pathways. Methods: This narrative review synthesizes current evidence from heart-failure guidelines, geriatric medicine, and palliative care literature to propose a cardiogeriatric framework for end-of-life decision-making in advanced HF. Results: In older adults, functional decline and geriatric vulnerability often progress independently of cardiac parameters, limiting the relevance of prognosis-based thresholds. The palliative turning point should be understood as a multidimensional process resulting from converging cardiological, geriatric, organizational, and patient-reported signals. Therapeutic decisions should be guided by proportionality between expected benefit, treatment burden, and patient priorities. Longitudinal, iterative communication is essential to align care with evolving goals. Conclusions: A cardiogeriatric approach integrating cardiology, geriatrics, and palliative principles supports timely palliative integration, shared decision-making, and coordinated care in very old patients with advanced HF. Full article

Interventional treatment of very elderly patients with severe coronary artery disease is currently one of the central topics in interventional cardiology. Technological progress and increased life expectancy have made these patients appropriate candidates for contemporary standards of care, especially those with an active lifestyle. We hereby report the case of a 95-year-old patient hospitalized for acute myocardial infarction, who underwent a complex percutaneous coronary intervention with mechanical circulatory support. A literature review on mechanical circulatory support devices in older adults is also provided. Full article

Cultured meat, a sustainable alternative to conventional meat, addresses ethical and environmental challenges in livestock production. Its production relies on bovine muscle stem cells from adult muscle or fetal tissue, whose proliferation and differentiation vary with age and developmental stage. However, the molecular mechanisms underlying these variations remain unclear. RNA sequencing was performed to characterize the transcriptomic landscape of bovine muscle stem cells across developmental stages, including myogenic maturation. Differentially expressed genes and key signaling pathways regulating myogenesis were identified, and the functional impact of modulating the AKT-autophagy pathway on differentiation was assessed. Transcriptomic analysis revealed distinct age-dependent gene expression patterns. It was possible to classify cells into three categories: young undifferentiated, young differentiated, and old differentiated. Young undifferentiated-like cells exhibited upregulation of genes associated with active states during the transitions from quiescence to activation and, ultimately, to commitment, indicating that they had robust differentiation potential. In contrast, aged myogenic samples displayed gene expression profiles that acted as barriers to efficient myogenic differentiation. Notably, modulation of the AKT-autophagy pathway both facilitated the production of very mature myogenic cells and prevented spontaneous differentiation, thereby preserving differentiation capacity in vitro. These findings provide insights into age-dependent muscle stem cell differentiation and suggest strategies to optimize cultured meat production. The appropriate modulation of key signaling pathways may help us to overcome major challenges in achieving scalable and efficient cultured meat manufacturing. Full article

Objective: Bone-modifying agents (BMA) are central to the prevention of skeletal-related events (SREs) in patients with cancer bone metastases, yet evidence guiding agent selection in very old patients remains limited. This study aimed to compare the effectiveness and safety of Denosumab versus bisphosphonates in patients aged ≥75 years with solid tumour-related bone metastases using a target trial emulation framework. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network to emulate a hypothetical randomised trial. Patients aged ≥75 years with solid tumour-related bone metastases initiating Denosumab or bisphosphonates were included. After 1:1 propensity score matching (PSM), 10,662 patients were analysed in each treatment group. The primary outcome was time to first SRE. Secondary outcomes included individual SRE components, all-cause mortality, and safety events. Results: Among 21,324 matched patients (mean age, 75.6 years), bisphosphonate use was associated with a higher risk of SREs compared with Denosumab (hazard ratio [HR], 1.15; 95% CI, 1.06–1.25). The excess risk was driven by pathological fractures (HR, 1.28; 95% CI, 1.10–1.49), whereas other SRE components did not differ significantly. All-cause mortality was higher among bisphosphonate users (HR, 1.41; 95% CI, 1.33–1.49, p < 0.001). Hypocalcaemia occurred more frequently with Denosumab (5.7% vs. 2.4%), while risks of acute kidney injury and end-stage renal disease (ESRD) were similar. Findings were consistent across sensitivity and subgroup analyses. Conclusions: In patients aged ≥75 years with solid tumour-related bone metastases, Denosumab was associated with lower risks of skeletal-related events—particularly pathological fractures—and reduced all-cause mortality compared with bisphosphonates. These results extend randomised trial evidence to a clinically vulnerable population and support Denosumab as a preferred BMA in older adults. Full article

Stroke is a major global health concern, particularly among the elderly, who frequently present with multiple comorbidities, most notably cardiovascular diseases. Importantly, atrial fibrillation confers a nearly fivefold increase in stroke risk and accounts for up to one-quarter of ischemic strokes in older adults. Stroke is a neurological disease characterised by a strong cardiovascular interplay, and its multifactorial nature requires an integrated preventive approach. This review focuses on primary and secondary prevention in this population, with a frailty-informed perspective. We synthesise evidence on blood pressure control, lipid-lowering (including LDL-C targets), glycemic management, and antithrombotic strategies—particularly oral anticoagulation for atrial fibrillation—as well as the role of frailty indices in guiding individualised risk–benefit decisions. We also discuss practical care pathways, including structured post-discharge programs, continuity of care, and the need for multidisciplinary collaboration involving cardiologists, neurologists, and primary care. We highlight how frailty indices refine risk–benefit assessments without justifying therapeutic nihilism, and how sex- and age-related factors shape treatment effectiveness and safety. By narrowing scope and emphasising practical, multidisciplinary prevention strategies, this review aims to support clinicians in reducing recurrent events, disability, and mortality in very old patients. Future work should prioritise pragmatic trials, including those involving the oldest old and the use of standardised frailty metrics, to inform prevention decisions. Full article

Background/Objectives: Population ageing is accelerating, and adults aged ≥75 years (the “very old”) have distinct functional, cognitive, and social needs. Game-based digital interventions—including exergames, serious/digital games, and gamification—may promote multidimensional well-being; however, findings are often reported for broad “older adult” samples without age-disaggregated results. This scoping review mapped the use and effects of game-based digital interventions in adults aged ≥75 years and assessed how frequently studies reported age-specific outcomes. Methods: The review was conducted in accordance with JBI guidance. PubMed, CINAHL, PsycINFO, Scopus, and Web of Science were searched. Records were screened in Rayyan by two reviewers. Data were extracted using a standardized charting form, and outcomes were classified into predefined outcome domains and implementation-related categories. Results: Nineteen studies were included, predominantly European and largely conducted in supervised institutional settings. Exergames were the most common intervention type. Physical outcomes were reported most frequently, whereas cognitive, emotional, social, and quality-of-life outcomes were assessed less consistently. Conclusions: In adults aged ≥75 years, evidence on game-based digital interventions is mainly based on supervised exergame programmes and emphasizes physical-function outcomes, while age-disaggregated reporting and person-centred outcomes remain limited. Future research should routinely report results specific to participants aged ≥75 and broaden outcome assessment to better inform intervention design for the very old. Full article

Iron deficiency (ID) is highly prevalent in older adults and remains frequently underdiagnosed despite its relevant prognostic impact. ID may be absolute or functional and is observed across multiple geriatric clinical settings, including heart failure, chronic kidney disease, malnutrition, fragility fractures and long-term care facilities. Beyond anaemia, ID contributes to impaired mitochondrial function, reduced exercise capacity, frailty, cognitive and functional decline, increased hospitalizations and mortality. In heart failure and CKD, ID – irrespective of haemoglobin – worsens clinical outcomes. Systematic assessment of iron status should be integrated into geriatric evaluation. Oral iron therapy is often limited by poor tolerance and hepcidin-mediated malabsorption, whereas intravenous formulations show greater efficacy in selected patients. Early identification and targeted correction of ID may improve symptoms, quality of life and functional recovery in elderly populations, although further large trials in very old and frail subjects are needed. Full article