Sarcopenia, characterized by progressive loss of skeletal muscle mass, strength, and physical performance, is increasingly recognized as a relevant comorbidity in patients with heart failure (HF). Multiple systematic reviews and meta-analyses have explored this relationship, yet a comprehensive synthesis of existing evidence is lacking. This umbrella review aimed to summarize and critically appraise the evidence from published systematic reviews and meta-analyses investigating the prevalence, prognostic impact, and outcomes associated with sarcopenia in HF populations. Eight systematic reviews and meta-analyses, including between 38 and 21 primary studies encompassing 1,594 to 68,556 participants, were identified. The prevalence of sarcopenia among HF patients ranged from 31
Emergency medicine physicians (EMP) are routinely called upon to assist patients and their families in making serious, often life altering, medical decisions. These decisions are regularly made with limited information and during times of crisis. With patient autonomy at the forefront of EMPs minds, this review provides both background and pragmatic approaches to the evaluation of the older adult patient’s capacity to participate in this medical decision-making process. It is important for the reader to recognize this article is meant to provide an overview of the literature in an effort to educate clinicians who care for older adult patients. It should be viewed as a medical reference. As the clinical care of patients can be impacted by many variables, this article should not be seen as an effort to strictly define the standard of care for all medical providers in all settings. The landscape of emergency medicine (EM) continues to evolve in the post-COVID era. With recent increased focus on high-value, often ambulatory based care and continued emphasis on patient autonomy, medical decision-making capacity evaluations are being considered within contemporary contexts. This article aims to summarize the approach to these evaluations within the modern-day practice environment of EM. Caring for older adults in the emergency department (ED) is common and becoming more so. As such, there is a need for EMPs to be well versed in capacity evaluations among this cohort. The T.A.S.K approach, establishing trust, asking about the key capacity elements, considering said elements within the context of the sliding scale principle and keeping an accurate and concise record of the evaluation is one method EMPs might employ when conducting such assessments. It is further important for the EMP to recognize the unique biopsychosocial aspects among older adults that can influence the process and results of this capacity evaluation.
Transitions of care from the emergency department (ED) represent a period of heightened vulnerability for older adults, driven by medical complexity, functional impairment, and social factors. This review examines ED-based geriatric models and interventions aimed at improving transitions of care, with a focus on how outcomes are defined and measured. Geriatric emergency department (GED) models emphasize multidisciplinary assessment, targeted screening, and care coordination to address risks during ED transitions. While a growing body of literature describes promising interventions including screening linked to services, care management, medication review, and post-ED follow-up, evidence remains heterogeneous. Outcomes are frequently measured using utilization-based metrics, which may inadequately capture patient-centered goals such as function, symptom burden, and care continuity. GED models provide a valuable framework for identifying risks related to transitions of care for older adults, but current evidence is limited by inconsistent outcome definitions and system-level constraints. Future research should prioritize patient-centered outcomes, pragmatic implementation strategies, and alignment with post-acute care capacity to meaningfully improve transitions from the ED for older adults. Older adults are especially vulnerable during transitions of care, and this may be especially true after an ED visit. Risks for geriatric patients encompass many elements of care, including medication changes and interactions, unrecognized cognitive and functional decline, inadequate social support, and ability to coordinate needed follow-up. The broad scope of transitional needs makes pinpointing sustainable and scalable interventions challenging. GED models can help standardize processes targeting elder-specific vulnerabilities and identify the resources needed to improve safety for older patients. Data remain limited regarding what is most impactful on older patients transitioning from the ED, but multidisciplinary interventions offering support such as targeted care management, thorough medication reconciliation, PT/OT evaluation, and scheduling assistance show promise. Gaps in existing literature include the lack of a shared framework regarding meaningful, patient-centered outcomes and little exploration to date regarding scalability and equity. Additionally, post-acute care bottlenecks pose real challenges to ED transitions of care that cannot be addressed directly with ED-initiated interventions.
Sarcopenic obesity represents the coexistence of excess adiposity and impaired muscle function, contributing to disability and loss of independence. This review examines how intentional weight loss treatments interact with muscle capacity and mobility outcomes in this population, with a focus on rehabilitation and exercise-based strategies. Weight loss improves cardiometabolic health and reduces mechanical load but may accelerate declines in lean mass and strength if not paired with resistance training. Multicomponent exercise interventions combining resistance, aerobic, and balance training provide benefits for preserving muscle function and improving physical function. Data on pharmacologic weight-loss therapies remain limited with respect to muscle and mobility outcomes. Weight loss in adults with sarcopenic obesity is a clinical double-edged sword. Mobility-centered, exercise-based interventions are essential to preserve muscle capacity during adiposity reduction. Future research should prioritize functionally meaningful outcomes and standardized rehabilitation frameworks to optimize mobility and independence.
This review synthesizes current evidence on the challenges, availability of services, workforce development, and delivery models for geriatric rehabilitation in Pakistan. The aim is to identify key gaps in policy and practice and to propose actionable recommendations relevant to Pakistan and comparable low- and middle-income countries (LMICs). Pakistan’s population aged 60 years and above is projected to increase from approximately 11.3
This article aims to provide an update on the management of depression in older adults. The article describes the prevalence of depression in older adults, theories on the etiology of late-life depression, and evidence-based interventions for managing depression in older adults. Depressive disorders are a common health condition affecting older adults. Depression in older adults is important to recognize and treat as it impacts both quality of life and mortality. Managing geriatric depression offers unique challenges compared to treating other adults with depression including reduced efficacy of medications as well as the tendency for older adults to experience polypharmacy and adverse effects from medications. Nonpharmacologic interventions such as exercise and psychotherapy, antidepressant medications, and interventional therapies such as electroconvulsive therapy are some of the tools used to manage depression in older adults. Understanding the complexities of diagnosing and managing late life depression has the potential to improve outcomes and quality of life for our older adult patients.
Older adults comprise a growing share of Emergency Medical Services (EMS) encounters in the United States. As frequent users, older adults contribute disproportionately to prehospital workload and experience outcomes shaped by frailty, multimorbidity, polypharmacy, and cognitive vulnerability. This review summarizes current and identifies future research priorities for EMS care of older adults. Themes at the intersection of EMS and geriatrics over the last 5 years were organized based on the “4Ms:” What Matters, Medication, Mentation, and Mobility, in addition to “Multicomplexity.” The literature is representative of several continents and depicts background information and creative solutions to care for older adults. Understanding patient and provider perspectives, addressing medications, adapting techniques to manage cognitive impairment, and fall prevention are common motifs. EMS–geriatrics evidence remains dominated by descriptive studies and fall research. Future work should prioritize scalable age-friendly prehospital protocols, ED–EMS integration, novel mechanisms for symptom management, and implementation strategies.
Vestibular disorders can occur across the life span, with a higher prevalence among older adults. Vestibular disorders can result from peripheral vestibular organ pathology or central nervous system pathology. Given other natural processes of aging, there are some special considerations for implementing vestibular rehabilitation in older adults to ensure optimal outcomes. Among peripheral vestibular pathologies, new canalith repositioning maneuvers better accommodate limitations in functional mobility and the cervical spine that can affect traditional maneuvers. When addressing impairments in gaze stability, new protocols have been shown to improve vestibular function and overall balance impairments by adding vergence or head-impulse exercises to conventional exercises. Several central nervous system pathologies can present with vestibular impairments, such as traumatic brain injury, cerebrovascular accident, and Parkinson’s disease. Within the traumatic brain injury population, special attention should be provided, as older adults with vestibular disorders are at a higher risk of falling and sustaining a brain injury. After the brain injury, vestibular symptoms may occur. Vestibular rehabilitation can be easily implemented for older adults. In some instances, vestibular disorders may be under-screened, especially for benign paroxysmal positional vertigo (BPPV) or central nervous system pathologies. Still, they can be easily addressed to improve an older adult’s quality of life.
Our aim was to review recent advances in bronchiectasis and how these relate to older individuals. Bronchiectasis is predominantly a disease of older individuals. Advancing age is a determinant of outcome in bronchiectasis. Novel therapies with the potential to alter the disease course have recently been approved. Older individuals are underrepresented in clinical trials. Bronchiectasis is common in older populations. The impact on this demographic is also significant. Our understanding of bronchiectasis has grown rapidly over the past five years, resulting in novel therapies.
This review outlines the utility of psychodynamic psychotherapy for older adults, particularly whether it is a valid and evidence-based treatment compared to other psychotherapies, its indications, and special considerations. Psychodynamic psychotherapy includes a family of related therapies based in psychoanalytic theory that can be short-term or long-term, structured or unstructured, and with variable amounts of experiential (i.e., emotion-focused) components. Short-term psychodynamic psychotherapy is listed as an evidence-based practice for geriatric depression by the American Psychological Association. More recently, emotional awareness and expression therapy (EAET), a structured, time-limited, and highly experiential psychodynamic treatment has shown substantial efficacy for older adults with chronic pain. Psychodynamic psychotherapies, especially EAET and other short-term structured approaches, are evidence-based for older adults with depression and chronic pain. Most older adults are appropriate for psychodynamic therapy, as long as they have some preserved capacity to learn and a motivation to self-reflect.
To summarize the features and management of asbestos related lung disease while highlighting some potential challenges that may be faced by healthcare providers when managing this heterogenous group of disease in the elderly. Immunotherapy is effective in improving survival rates in patients with mesothelioma and asbestos related lung cancer; however, the elderly are currently under represented in clinical trials making it challenging for clinicians to possibly decide optimal treatment for this group of patients. Compensation claims for mesothelioma associated with occupational exposure is lower in older patients suggesting that awareness is low in this cohort. The geriatric population is a unique group of patients that present with unique challenges such as co-existing multi-morbidities, polypharmacy, frailty, and psychosocial/ social-economic issues. A more holistic approach including comprehensive frailty assessment is needed when managing this group of patients especially in asbestos associated malignant disorders.
To present and analyze recent developments in remote cardiac rehabilitation for older adults, review outcomes data regarding clinical effectiveness of these modalities, and discuss implementation strategies targeted at older adults. Data from recent studies enrolling older adults into remote cardiac rehabilitation programs have yielded mixed results with some showing encouraging improvements in functional capacity and quality of life comparable to those obtained with center-based rehabilitation programs. Studies that showed no improvement in outcomes identified decreased patient engagement as an important driver of results. This underscores the importance of adapting remote cardiac rehabilitation programs to the intended population and consider factors such as digital literacy that are relevant to older adults and critical for successful implementation of cardiac rehabilitation programs. Virtual and remote cardiac rehabilitation models continue to evolve and are important programs for providing secondary prevention for older adults but require an intentional approach when adapting for clinical practice.
Aging individuals are often overlooked in substance use disorder (SUD) research and interventions. This scoping review examined recent clinical trials (2014–2024) and review articles (2019–2024) focused on SUD interventions for aging populations. Three intervention trials were identified: two for alcohol, one for tobacco, and none for cannabis, opioids, or benzodiazepines. Six review articles characterized substance-specific interventions and community-based approaches. These reviews confirmed no intervention trials for cannabis and benzodiazepines, while opioid literature was limited to observational studies. Evidence-based SUD interventions tailored to older adults remain scarce with most outcomes centered around reduction and abstinence, rarely addressing psychosocial or quality of life domains. The lack of evidence-based interventions limits informed and precise clinical decision-making. Future research should expand beyond alcohol and tobacco to develop age-specific interventions incorporating digital therapeutics and community-based approaches. Given the complex comorbidities of aging, a broader, age-specific definition of recovery is needed to guide effective care.
This review examines the multifaceted challenges of managing asthma in elderly patients, focusing on diagnostic hurdles, age-related physiological changes, and comorbidity burdens in an aging global population. Key questions include: How do overlaps with conditions like COPD and heart failure complicate diagnosis? What mechanistic shifts drive exacerbations? And what implications arise for personalized care? Elderly asthma emerges as a distinct phenotype with worse obstruction, reduced atopy, elevated neutrophilic inflammation (e.g., higher IL-17, IFN-γ), and steroid resistance, partly due to airway trapping and microvascular changes. Comorbidities like cardiovascular disease and GERD are markedly higher, with exacerbations amplifying risks, especially in women and former smokers. Elderly asthma demands a “geriatric” approach integrating multidisciplinary education and patient-centred strategies to boost adherence. Major takeaways emphasize targeting neutrophilic pathways and mitigating multimorbidity to curb exacerbations. Future research should prioritize inclusive trials to refine therapies, ultimately improving outcomes in this vulnerable and often overlooked group.
Idiopathic pulmonary fibrosis (IPF) is a progressive form of fibrotic interstitial lung disease of unknown cause with a poor prognosis. IPF is generally thought of as a disease of older men, with an increasing proportion of patients over the age of 75. Treatment can be a challenge in an older population, with the side-effect burden of antifibrotics and prevalence of contraindications for lung transplantation. Several factors predict a shorter survival time, including advanced age, male sex, environment, genetic predisposition, physiological characteristics, an increasing symptom burden, and a greater extent of fibrosis on high-resolution computed tomography (HRCT). Understanding prognostic factors in IPF enables physicians to engage in timely and empathetic discussions about disease trajectory, advanced care planning, and treatments with patients and their families. Palliative care approaches should be considered early, given the unpredictable course of the disease and the shorter survival time in older IPF patients.
There are increasing numbers of nursing home residents across the world, at greater risk of hospitalisations. These admissions are potentially avoidable and have an economic and societal cost, in health and quality of life, to residents and the wider healthcare system. Guided by the Arksey and O’Malley framework, we conducted a scoping review of randomised controlled trials (RCTs) on interventions to reduce hospitalisations in nursing home residents, identifying the interventions studied, methods used, and outcomes reported to highlight gaps for future research. We undertook the scoping review following the suggestions of Arksey and O’Malley, using a comprehensive search strategy in Medline and EMBASE. Studies eligible for inclusion were randomised controlled trials published in English, with residents of institutionalised care facilities ≥ 65 years, considering any intervention that aimed to reduce hospitalisations and examined general hospitalisation as an outcome. Studies were excluded if the intervention focused on preventing specific chronic conditions. 43 trials were included in the scoping review, covering a variety of themes, including advanced care planning, multidisciplinary approaches and medication reviews. A variety of interventions to reduce hospitalisation have been trialed, but little randomised trial evidence is available for interventions extending beyond procedural aspects within the nursing home, particularly health promotion interventions such as physical activity. This review calls for further systematic reviews on the themes of intervention, and additional research in those themes where limited research was identified.
This review article highlights the challenges of diagnosing and managing spontaneous and traumatic pneumothorax in the elderly population, with a focus on age-related physiological changes, frailty and treatment considerations. Recent data indicate that secondary spontaneous pneumothorax is more common than primary, with a significant peak during the COVID pandemic. Management strategies need to be individualised with MDT input. Resurgence of older practices (autologous blood patch) and novel devices (endobronchial valves) support a move towards less invasive approaches when feasible. Surgical options are effective but require careful risk assessment due to reduced physiological reserve. Pneumothorax in the elderly requires heightened clinical awareness and acknowledgement of the distinct challenges including recurrence and higher morbidity. A tailored approach to both diagnosis and intervention is essential, taking comorbidities and frailty into consideration and balancing minimally invasive interventions with the patient's overall health status to improve outcomes.
To introduce the Biopsychosocial-Environmental (BPSE) model to guide an exercise intervention to address pain related to osteoarthritis (OA) among people living with dementia (PLWD). This review [1] synthesizes literature on the biological, psychological, social, and environmental aspects of pain from OA in the knee, neurodegeneration in PLWD, and exercise implications for these comorbidities, and [2] demonstrates the clinical utility of the BPSE model in designing tailored exercise interventions to manage knee OA pain in PLWD. Research indicates that pain from knee OA and neurodegeneration from dementia interact across multiple factors, including psychological, social, and environmental. These factors compound the biological interactions of the comorbidities, further challenging function and quality of life. The BPSE model provides a structured framework for tailoring exercise interventions to PLWDs’ interests and preserved abilities. Applying this model may improve pain management, mobility, and quality of life while informing future chronic disease management in PLWD.
This review briefly highlights the current knowledge about the intersection between circadian rhythm and aging, providing an overview of the diagnosis and management of common Circadian Rhythm Sleep-Wake Disorders (CRSWDs) in older adults. Addressing CRSWDs and other prevalent sleep disorders is essential for promoting healthy aging and improving the quality of life for older adults, potentially mitigating risks for cognitive decline and cardiovascular complications. CRSWDs are likely underdiagnosed, and rates are higher in individuals with psychiatric diagnoses. CRSWDs and insomnia can be difficult to differentiate due to similar symptoms and potential co-occurrence. Melatonin and light therapy remain the mainstays of treatment, along improved sleep hygiene, while hypnotic medications are generally discouraged in older adults. The current literature reveals a notable deficiency in robust epidemiological studies focusing on sleep disorders in older adults, hindering the development of targeted interventions and potentially exacerbating age-related health conditions.
To investigate how current technology was supporting older adults living with dementia to age in place in their own homes and communities by identifying the feasibility, outcomes, and equity issues of interventions using digital tools. In recent years, the COVID-19 pandemic accelerated the use of technology for care when in-person contact was restricted. However, the research on technology-related interventions for persons living with dementia remains fragmented with studies often focusing on single devices or narrow aspects of care. These limits understanding of how technologies may work together to support aging in place. This review identified 27 studies. Technology-enabled care for persons living with dementia has promise in improving caregiver and care outcomes such as self-efficacy, knowledge, emotional health, reduced depressive symptoms, and social connectedness. However, most studies had small samples, short follow-up, and varied measures. Few studies examined cost-effectiveness, long-term outcomes, or equity considerations. Future research should integrate equity-focused design, recruit diverse populations, and assess sustainability. Broadening the digital health intervention framework to include social and structural determinants will be essential for reducing disparities and ensuring that technology contributes to independence, dignity, and quality of life for persons living with dementia and their caregivers.
