To examine whether plasma neuroimmune pathway signatures are associated with cognition, function, clinical severity, and MRI-derived structural measures across the Alzheimer’s disease continuum. Complement–acute-phase scores were higher in dementia and were consistently associated with worse MMSE, CDR-SB, and FAQ scores. Endothelial-associated scores were associated with lower normalized hippocampal volume. Plasma neuroimmune signatures may capture pathway-specific aspects of Alzheimer’s disease, with the complement–acute-phase score associated with clinical impairment and the endothelial-associated score associated with lower hippocampal volume. This retrospective observational study included 506 Alzheimer’s Disease Neuroimaging Initiative participants: 53 cognitively normal individuals, 352 with mild cognitive impairment, and 101 with dementia. Plasma proteins from the quality-controlled Rules-Based Medicine multiplex dataset were standardized and grouped into five circulating protein scores: complement–acute-phase, endothelial-associated, extracellular matrix remodeling, myeloid, and interleukin. Outcomes included Mini-Mental State Examination, Clinical Dementia Rating Sum of Boxes, Functional Activities Questionnaire, normalized hippocampal volume, and normalized brain volume. Multivariable models were adjusted for age, sex, education, and APOE ε4 carrier status. In the primary cross-sectional pathway-level analyses, complement–acute-phase scores were higher in participants with dementia than in cognitively normal participants after FDR correction (β = 0.314, 95
This study aimed to clarify the links between amyloid-β42 (A), phosphorylated tau (T), and medial temporal atrophy (N) with verbal episodic memory performance, as well as to explore the moderating effect of age on these relationships. Our findings revealed significant interaction effects of age between amyloid-β42 (A) and medial temporal atrophy (N) in relation to verbal episodic memory recall. Specifically, the detrimental influence of Aβ42 and MTA abnormalities on episodic memory performance was attenuated with advancing age. The primary findings suggest that the association between ATN biomarkers and episodic memory is attenuated as age increases, which may have clinical implications. The relationship between age, biomarkers, and cognitive function at advanced ages remains underexplored. By utilizing a naturalistic memory clinic cohort, we aimed to clarify how the A/T/N biomarkers are associated with verbal episodic memory performance and the moderating effect of age. This cross-sectional study included 676 patients from memory clinics in the Stockholm metropolitan region, comprised of 141 with Alzheimer’s disease dementia, 403 with mild cognitive impairment, and 132 with subjective cognitive impairment. We used weighted least-squares regressions to evaluate the association between episodic memory and the biomarkers and the moderating effect of age. There was a significant interaction between age and A (Aβ42), where the negative impact of Aβ42 abnormality on Rey Auditory Verbal Learning (RAVLT) delayed recall was reduced with higher age (β = 0.22, p < 0.001). In addition, a corresponding interaction effect was observed between age and N (MTA) on RAVLT delayed recall (β = 0.13, p < 0.01). Additional exploration analyses showed that at age 80 or older, the ATN biomarkers showed weaker associations with episodic memory performance. Although interpretations should be conducted with caution, these findings raise questions about the justification for assessing CSF in patients older than 80 years, given its weak associations with core clinical measures, such as learning and free recall of episodic memory. Further clinical studies are needed to validate these results and also evaluate other core cognitive measures. The naturalistic nature of the memory clinic population, with its clinically driven diagnoses, may help clarify these findings.
Proximal femoral fractures (PFF) are a global health burden in aging populations. Evidence on the prevalence and clinical relevance of concomitant fractures in this population remains limited. This study investigated the impact of concomitant fractures on mortality, complications, transfusion requirements, and postoperative mobility in patients with geriatric PFF. This single-center cohort study included patients ≥ 65 years with a positive geriatric screening, who underwent surgery for a PFF after low-energy trauma between January 2019 and December 2023. Patients with concomitant fractures were compared with those with isolated PFF. Outcomes included mortality, perioperative parameters, complications, and mobility at discharge. Uni- and multivariable regression models were applied adjusting for age, sex, comorbidities, body mass index (BMI), and fracture type. A total of 1553 patients were analyzed; 164 (10.5
This qualitative study explored if older adults perceive a stigma around concerns about falls, how older adults discuss their concerns about falling, and older adults’ views on associated terminology. We found two distinct lived experiences of concerns about falls: 1) fear of falls; protective instinct in response to a specific threat, and 2) anxiety about falls; worry about an indirect threat of falling outside of its context. Further, there is a stigma of concerns about falls among older adults; participants were at ease in discussing concerns about falls with their peer group but not with others, and they were reluctant to speak with doctors about concerns about falls. Practitioners will need to be proactive and sensitive in discussing concerns about falls to help reduce the risk of falls among older adults. The 2022 world guidelines for falls prevention and management for older adults recommended the inclusion of concerns about falls in fall risk assessments, and to use the term ‘concerns about falling’. This qualitative study is the first to explore if older adults perceive a stigma around concerns about falls, how older adults discuss their concerns about falling, and older adults’ views on associated terminology. We conducted six focus groups with 22 community-dwelling older adults (16 women, 6 men, mean 75.10 years). Audio recordings were transcribed verbatim and thematically analysed inductively, and then deductively to directly address our research focus. Our sample did not express preference for particular terminology when discussing concerns about falling. We identified two themes: 1) Fear and anxiety of falling: While participants used terms interchangeably, fear and anxiety represented two distinct lived experiences: Fear was a protective instinct in response to a specific threat of falling in the moment, whereas anxiety was worry about an indirect threat of falling outside of its context. 2) Stigma of falls: Participants were at ease in discussing concerns about falls with their peer group but not with others due to stigma. They expressed a reluctance to speak with their doctor about their concerns about falls. Our findings suggest that there is a stigma of concerns about falling that may inhibit older adults seeking support to reduce their risk of falls. Practitioners will need to be proactive and sensitive in discussing concerns about falls with older adults.
To determine whether patients aged >75 years with spinal cord injury benefit from specialized inpatient rehabilitation regarding functional outcomes and discharge destination, compared with patients aged 60–75 years. Patients >75 years showed significantly lower functional gains but were still frequently discharged home after rehabilitation. Rates of in-hospital mortality and complications did not differ significantly between age groups. Many patients aged >75 years who underwent specialized inpatient rehabilitation were discharged home despite lower functional gains, highlighting that advanced age alone was not necessarily associated with institutional discharge within this rehabilitation-selected cohort. To evaluate functional outcomes and discharge destination after specialized inpatient rehabilitation in patients aged > 75 years with spinal cord injury (SCI). This retrospective single-center cohort study included 160 patients aged ≥ 60 years who completed inpatient SCI rehabilitation at the specialized SCI unit of BG Trauma Center Frankfurt, Germany (2010–2025). Patients were grouped into 60–75 and > 75 years. Functional status was assessed using the Spinal Cord Independence Measure (SCIM) at admission and discharge. Outcomes included discharge destination, functional gain (ΔSCIM), in-hospital complications, and medication at discharge. The mean age was 67 ± 5 years in the 60–75-year group and 80 ± 4 years in the > 75-year group; 75.0
To investigate the associations of malnutrition and dehydration with cognitive frailty in older adults undergoing comprehensive geriatric assessment. Malnutrition was highly prevalent among individuals with cognitive frailty and remained significantly more common than in matched robust controls, whereas hydration status did not differ significantly between groups. Improvements in nutritional status during follow-up were associated with resolution of cognitive frailty, while persistent cognitive frailty was accompanied by declining nutritional status. Malnutrition appears to be a key and potentially modifiable component of cognitive frailty, highlighting the importance of routine nutritional assessment and targeted nutritional interventions in older adults. Cognitive frailty (CF), defined as the coexistence of physical frailty and cognitive impairment without dementia, is a potentially reversible geriatric syndrome. Although malnutrition and dehydration are considered modifiable contributors, their relative roles in CF remain unclear. Adults aged ≥65 years who underwent comprehensive geriatric assessment were included. CF was defined using Fried’s frailty criteria and cognitive test scores (MoCA or MMSE). Nutritional status was assessed using the Mini Nutritional Assessment (MNA), and hydration status was evaluated by calculated plasma osmolarity. Age-, sex-, and Charlson Comorbidity Index comparisons were performed using 1:1 propensity score matching. Longitudinal changes in CF and nutritional status were examined in participants with follow-up data. Among 232 individuals with CF, malnutrition and dehydration were present in 31.3
Portugal is one of the most rapidly aging countries in Europe, highlighting the need for adequate undergraduate training in the care of older adults. However, Geriatric Medicine (GM) teaching in Portugal remains heterogeneous, and its alignment with the European Union of Medical Specialists (UEMS) undergraduate recommendations is unclear. We aim to map current GM education practices across Portuguese medical schools and to provide a national overview to support future curricular improvements. A descriptive observational study was conducted using an online structured questionnaire sent to the presidents of the pedagogical councils of all 11 Portuguese schools. The survey assessed the presence and characteristics of geriatrics teaching, including dedicated courses, mandatory or elective, and geriatrics content integrated into other curricular units, in accordance with the UEMS undergraduate framework. Responses were obtained from 9 out of the 11 Portuguese medical schools. Five schools reported offering a mandatory geriatrics course, three as standalone courses, with European Credit Transfer and Accumulation System credits ranging from 1 to 8 ( 28–224 h of estimated total student workload). Four schools reported offering an elective geriatrics course. Although most UEMS-recommended topics were addressed in schools with mandatory courses, several areas—including fecal incontinence, sexuality, palliative care, ethical and legal issues, and older people abuse—were inconsistently covered. GM teaching in Portugal remains uneven, with mandatory training present in only half of the medical schools and limited practical exposure. These findings highlight a gap between undergraduate medical education and the needs of future physicians caring for an aging population, supporting the need for curricular strengthening and greater national harmonization. To map current GM education practices across Portuguese medical schools and to provide a national overview to support future curricular improvements. Five schools reported offering a mandatory geriatrics course, three as standalone courses. Although most UEMS-recommended topics were addressed in schools with mandatory courses, several areas—including fecal incontinence, sexuality, palliative care, ethical and legal issues, and older people abuse—were inconsistently covered. There is an important gap between undergraduate medical education and the needs of future physicians caring for an aging population.
Multifactorial falls risk assessment incorporates assessment of modifiable falls risk factors, including fall-risk-increasing drugs(FRIDs) identified by Screening Tool of Older Persons Prescriptions in older adults with high fall risk(STOPPFall), orthostatic hypotension(OH) and mobility(measured by Timed-Up-and-Go(TUG)). The aim of this study is to assess the prevalence of these falls risk factors and incidence of falls in a large population-based cohort of community-dwelling older people. Data from The Irish Longitudinal Study on Ageing(TILDA) Waves 1,3,and 6 was used. STOPPFall medications were recorded at each wave. OH was defined as an orthostatic drop in systolic blood pressure ≥20 mmHg(upon standing from sitting) and/or reporting orthostatic unsteadiness. Mobility impairment was defined by TUG ≥12 s. Falls were self-reported. Participants aged ≥65 years at TILDA Waves 1(2009–2011,n=3507,mean age 73.3, 52.5
To examine the feasibility, acceptability, and preliminary effects of the co-created Join4Joy approach in nursing home residents, across three European countries. The intervention was feasible, safe, and well accepted with strong satisfaction, and no reported adverse events. Quantitative outcomes showed small positive changes or maintenance in physical and psychosocial measures, while qualitative data highlighted enjoyment, social connection, and perceived functional benefits. Join4Joy presents a co-created and enjoyable physical activity-based approach that may support engagement, well-being, and functional maintenance among nursing home residents. Nursing home residents increasingly enter care with advanced frailty, multimorbidity, and functional dependence, underscoring the need for engaging, adaptable physical activity (PA) programmes. Join4Joy is a co-created approach designed to promote movement and social connection among older adults through enjoyable activities. This study examined its feasibility, acceptability, and preliminary effects across five nursing homes in Spain, France, and Germany. This multicentre mixed-method study (ClinicalTrials.gov: NCT06100835) was delivered in two phases. Residents aged ≥ 65 years participated in 12 weekly 60-min PA sessions. Feasibility was assessed through attendance, procedural indicators, data completion, and retention; acceptability was evaluated using participant satisfaction and qualitative feedback, while safety was monitored throughout. Quantitative assessments evaluated physical function (SPPB), daily functioning (modified Barthel Index), quality of life (EQ-5D-5L), PA and sedentary behaviour (IPAQ-SF, SBQ, accelerometry), perceived improvement (PGI-I), and enjoyment (PACES-SF). Qualitative interviews and focus groups explored participant experiences. Of 81 enrolled residents, 75 completed the intervention (retention = 92.6
To describe the development of the European Geriatric Medicine Specialty Exam (EGeMSE), from its early conception within the European Union of Medical Specialists-Geriatric Medicine Section (UEMS-GMS) to implementation of the first pilot examinations. This narrative article was based on a review of UEMS-GMS meeting minutes, European Geriatric Medicine Society (EuGMS) educational documents, appendices, reports, presentations, policy documents, and other relevant archival and publicly available sources. The evolution of the EGeMSE was reconstructed chronologically. Discussions regarding a European Geriatric Medicine examination began in 2003 and evolved through successive working groups addressing postgraduate training, curricula, and assessment. During the following decade, the initiative became closely linked to development of a common European postgraduate curriculum and collaborative educational structures involving the UEMS-GMS, EuGMS, European Academy for Medicine of Ageing, International Association of Gerontology and Geriatrics–European Region, and other organisations. From 2018 onwards, the UEMS-GMS proposed a formal partnership with the British Geriatrics Society and the Federation of the Royal Colleges of Physicians of the United Kingdom, enabling adaptation of an established examination model to create a two-paper, multiple-choice, English-language European postgraduate examination. Following the first pilot examination in April 2025, the EGeMSE was recommended as a benchmark assessment of specialist knowledge within the 2025 European Training Requirements for the Specialty of Geriatric Medicine. The EGeMSE represents the culmination of more than 2 decades of European collaboration and provides a voluntary benchmark for specialist knowledge that supports the harmonisation of postgraduate Geriatric Medicine education across Europe. To describe the development of the pilot European Geriatric Medicine Specialty Exam (EGeMSE). The examination was developed through collaboration amongst multiple European organisations. It was implemented through a formal partnership between the European Union of Medical Specialists—Geriatric Medicine Section, the British Geriatrics Society, and the Federation of the Royal Colleges of Physicians of the United Kingdom, with support from the European Geriatric Medicine Society and others. The EGeMSE provides a voluntary European benchmark for specialist knowledge and supports harmonisation of postgraduate Geriatric Medicine education across Europe.
To compare dual-energy X-ray absorptiometry (DXA)- and bioelectrical impedance analysis (BIA)-based classifications of low muscle mass and sarcopenia under the Asian Working Group for Sarcopenia (AWGS) 2025 height-adjusted, body mass index (BMI)-adjusted, and combined criteria in older Korean adults. The BMI-adjusted criterion alone yielded closer DXA–BIA agreement than the height-adjusted criterion, but substantial discordance remained under the combined height-or-BMI definition. Overall sarcopenia agreement appeared high, because most participants had normal handgrip strength; among those with low handgrip strength, modality-dependent low-muscle-mass discordance persisted. DXA and BIA should not be treated as interchangeable for low-muscle-mass classification. Interpretation should specify the measurement device, derived muscle variable, and body-size adjustment criterion, and should be integrated with muscle-strength assessment. To compare dual-energy X-ray absorptiometry (DXA)- and bioelectrical impedance analysis (BIA)-based classifications of low muscle mass and sarcopenia under the Asian Working Group for Sarcopenia (AWGS) 2025 criteria. We analyzed nationally representative 2024 Korea National Health and Nutrition Examination Survey data from 1178 adults aged ≥65 years with both DXA and BIA measurements (survey-weighted mean age, 72.1 years; 54.3
To evaluate whether Machine Learning algorithms can identify, at the individual level, patients for whom BIA-derived Appendicular Skeletal Muscle Mass estimation is sufficiently reliable for clinical use. Estimation error was significantly higher in outpatients than in healthy subjects (MAPE 4.12
To describe and compare geriatricians’ roles in geriatric oncology and onco-surgical care across Europe. Geriatric oncology practices varied widely across 34 countries: 19
Circulating neudesin, nesfatin-1, and irisin levels were measured in older adults with primary sarcopenia, and their diagnostic value was evaluated. Older adults with sarcopenia exhibited significantly lower serum concentrations of neudesin, nesfatin-1, and irisin. After adjustment for body mass index (BMI), neudesin and nesfatin-1 remained independently associated with sarcopenia, while the association with irisin was attenuated. All three biomarkers demonstrated good discriminatory ability for identifying sarcopenia. The results support the hypothesis that sarcopenia is characterized by dysregulation of the brain–muscle–metabolic axis, in addition to muscle loss. Circulating biomarkers may contribute to future risk stratification strategies. However, larger prospective studies are required before clinical application. Sarcopenia is an age-related geriatric syndrome characterized by the progressive loss of skeletal muscle mass, strength, and physical performance. Although muscle-based assessments remain central to diagnosis, no specific circulating biomarker is currently available for early detection. Emerging evidence suggests that neudesin, nesfatin-1, and irisin are involved in muscle metabolism, energy homeostasis, and the regulation of inflammation. This study aimed to investigate the association of these biomarkers with primary sarcopenia in older adults and to evaluate their potential diagnostic utility. This study included 88 participants aged ≥ 65 years (58 women, 30 men), excluding secondary sarcopenia. Diagnosis was based on EWGSOP2 criteria. Serum neudesin, nesfatin-1, and irisin levels were measured by enzyme-linked immunosorbent assay (ELISA). Sociodemographic characteristics, comorbidities, medication use, anthropometric parameters, and comprehensive geriatric assessment data were collected. Serum concentrations of neudesin, nesfatin-1, and irisin were significantly lower in individuals with sarcopenia compared to non-sarcopenic controls (p = 0.001, p < 0.001, and p < 0.001, respectively). After adjustment for body mass index (BMI), neudesin and nesfatin-1 remained independently associated with sarcopenia, whereas the association between irisin and sarcopenia was attenuated. All three biomarkers demonstrated good discriminatory ability for sarcopenia. Reduced serum concentrations of neudesin, nesfatin-1, and irisin are significantly associated with primary sarcopenia in older adults. Nesfatin-1 and neudesin appear to be the most robust biomarker candidates, independent of adiposity. These results suggest that sarcopenia involves alterations in interconnected metabolic, endocrine, and neurotrophic pathways within the brain–muscle–metabolic axis. This study is the first to evaluate a combined neurotrophic, myokine, and metabolic biomarker panel in primary sarcopenia. Additional prospective studies are necessary to validate these findings and determine their clinical relevance.
This article evaluates Shoojit Sircar’s Piku [1] within the geriatric medical canon, examining its subversion of traditional aging tropes that equate old age with inevitable decline, loss of autonomy, and passive dependency. Centered on the protagonist Bhashkor Banerjee’s chronic constipation, the narrative explores the medicalization of the mundane, where both bowel motion and bodily movement become intertwined sites through which elderly agency is negotiated. Through a gerontological lens, the film portrays the domestic space as a site of conflict between the autonomy of the aging subject and the ethical demands of caregiving. By analyzing Bhashkor’s refusal to be governed—manifested in a cross-country road trip and his reclamation of physical agency via a bicycle ride in Kolkata—this study identifies a shift from the conventional senescence-as-loss narrative. It argues that Piku reimagines ageing through the interdependence of bodily autonomy, mobility, and caregiving, offering a reimagined framework for filial maturity that privileges the elderly subject’s right to pleasure, agency, and negotiated care over clinical safety.
To explore the association between specific classes of fall-risk-increasing drugs and both one-time (1 fall) and recurrent (≥ 2) falls in community-dwelling adults aged 75 and older, utilizing prospective fall ascertainment and adjusting for relevant confounders. Benzodiazepine-related drugs, strong anticholinergics, and antiepileptics were each significantly associated with recurrent falls when adjusting for clinical and sociodemographic factors in this cohort of well-functioning community-dwelling older adults. Fall-risk-increasing drugs are an important modifiable risk factor for recurrent falls among older adults, and identifying individuals at risk is essential when conducting medication reviews or prescribing for this patient group. Fall-risk-increasing drugs (FRIDs) are a significant and modifiable risk factor for falls in older adults. However, prospective data using robust fall ascertainment on specific FRID classes are scarce in community-dwelling populations. We aimed to investigate the association between individual FRID classes and both single and recurrent falls in older community-dwelling adults. We analysed data from a Danish prospective cohort of 241 community-dwelling adults aged ≥ 75 years. Medication records were collected at baseline, and drugs were classified using the STOPPFall consensus FRIDs list. Falls were recorded prospectively for 1 year using monthly fall-calendars, verified using telephone follow-ups. Associations between FRIDs and one-time (1 fall) and recurrent falls (≥ 2 falls) were explored using Cox proportional hazards model, adjusting for clinical and sociodemographic factors. The median (IQR) age was 82 (80, 86) years, 66.4
We set out to evaluate the outcomes of patients who underwent conservative management for undisplaced or valgus-impacted neck of femur fractures. 38 patients were included for analysis, of which 14 patients had no further re-admissions at our unit requiring additional treatment, while 13 patients subsequently underwent surgical correction due to pain, poor mobility or fracture displacement. The mean time to surgical correction following conservative management was 49 days (Range=1, 208), and the 30-day and 90-day mortality was 18
