Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim's home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study's detection rate (<1%) falls critically short of international benchmarks (3-5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments.
Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (≥65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth's role in the care of this population.
Introduction: Community-based day center programs may support healthy ageing by promoting functional ability, mental well-being, and social participation among older adults, but real-world evidence from Latin America remains limited. Objective: We aimed to examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre-post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index, the Lawton and Brody scale, and the Timed Up and Go test; mental health with the Mini-Mental State Examination and the 15-item Geriatric Depression Scale; and quality of life with the EuroQol-5D visual analogue scale. Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p ≤ 0.001). In 2023, the Barthel Index, the Timed Up and Go test, and the Geriatric Depression Scale improved (all p < 0.0001), and the EuroQol-5D visual analogue scale also improved (p < 0.01), whereas the Lawton and Brody scale (p = 0.204) and the Mini-Mental State Examination (p = 0.725) did not. Category-transition analyses showed significant improvements in basic activities of daily living and mobility in both cohorts (both p < 0.001), while significant categorical changes in instrumental activities of daily living, global cognition, depressive symptoms, and self-rated quality of life were observed only in 2022 (all p ≤ 0.01). Rural residence was associated with higher odds of improvement in basic activities of daily living (OR 1.62, 95% CI 1.17-2.25; p = 0.004), whereas age ≥75 years was associated with lower odds of improvement in depressive symptoms (OR 0.56, 95% CI 0.41-0.76; p < 0.001) and self-rated quality of life (OR 0.65, 95% CI 0.45-0.94; p = 0.023). Conclusions: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups.
Background/Objectives: Telemedicine offers significant potential to improve the quality and accessibility of geriatric care, particularly in resource-constrained settings. However, its effective implementation depends largely on healthcare professionals' acceptance and willingness to use such systems. Drawing on an extended Technology Acceptance Model (TAM), this study examines the determinants of doctors' and nurses' intentions to adopt telemedicine for elderly care in Algeria, with particular emphasis on self-efficacy and institutional support. Methods: This cross-sectional study employed a structured questionnaire administered to 130 healthcare professionals, including physicians and nurses, in Algeria. Hierarchical multiple regression analysis was conducted to test the proposed hypotheses and assess the incremental explanatory power of the extended model. Results: The extended TAM accounted for 48.7% of the variance in intention to use telemedicine. Institutional support (β = 0.432, p < 0.001) and self-efficacy (β = 0.264, p = 0.001) emerged as the strongest predictors. Perceived ease of use (β = 0.178, p = 0.038) and perceived usefulness (β = 0.139, p = 0.021) also had significant positive effects. The inclusion of self-efficacy and institutional support increased the model's explanatory power by 23.5%. Conclusions: The findings highlight the critical role of organizational support mechanisms, digital competencies, and system usability in fostering telemedicine adoption among healthcare professionals. The study provides practical implications for policymakers and healthcare institutions, emphasizing the need for targeted training programs, supportive infrastructure, and institutional policies that enhance confidence and facilitate the integration of telemedicine into clinical workflows.
Introduction: The Trauma Medical Home (TMH) randomized clinical trial tested the efficacy of a collaborative care intervention on the biopsychosocial recovery of older injured adults compared to usual care. Study enrollment occurred between 11 October 2017 and 13 October 2021 and study operations were impacted by the COVID-19 pandemic. It is important to measure the potential effects of COVID-19 on research study participants to ensure accurate reporting of results. The purpose of this secondary analysis was to compare depression and anxiety symptoms and health-related quality of life in older adults at TMH study enrollment pre-COVID-19 and during COVID-19. We hypothesized that those enrolled during COVID-19 would have worse symptoms and quality of life. Methods: This study was a secondary analysis of data from a multicenter randomized clinical trial (R01AG052493-01A1) TMH, that examined the ability of a collaborative care model to enhance the recovery of older injured adults compared to usual care. It was hypothesized that the TMH intervention would improve biopsychosocial recovery for injured older adults compared to usual care. The enrollment periods pre-COVID-19 and during COVID-19 were compared. Chi-square tests and Wilcoxon Rank Sum tests, then multivariable linear and logistic regressions were completed with SF-36 component scores and depression (PHQ-9) and anxiety (GAD-7) scores as the dependent variables, respectively. Results: A total of 429 participants were analyzed. There was no significant difference in anxiety and depression symptoms between the pre-COVID-19 and during-COVID-19 enrollment periods. Perceived limitations due to physical health problems were worse for those enrolled during COVID-19 (adjusted β = -9.8, 95% CI -18.3 to -1.4), but other health-related quality of life measures were similar between the two groups. Conclusions: These findings support the conclusion that the negative psychological impacts of the pandemic are likely due to individual factors other than age or COVID-19. These results suggest a high degree of psychological resiliency in older adults under stress. Future research should focus on the potential effects of socioeconomic status, demographic background, and level of physical functioning on psychological outcomes.
Background/Objectives: Senior living communities have become a popular living arrangement for older adults seeking supportive environments for aging in place. However, older adults may enter these communities with existing health vulnerabilities. This study described the prevalence of frailty, sarcopenia risk, and cognitive risk among residents and examined their associations with relocation reasons and fitness amenity utilization. Methods: A cross-sectional survey was conducted among residents aged ≥65 years who had lived in the community for at least 3 months. Survey items included demographics, health status, living history, relocation reasons, physical activity, fitness amenity use, and screening tools for frailty, sarcopenia risk, and cognitive impairment. Descriptive statistics, Mann–Whitney U tests, and Spearman rank correlations were conducted. Results: A total of 147 residents (Mean age = 80.2 years, SD = 7.1) responded to the survey. Overall, 28.5% met criteria for frailty, 19.7% screened positive for sarcopenia risk, and 21.8% for cognitive risk. Residents who reported a health-related reason for relocation showed greater frailty (U = 410, p < 0.001), sarcopenia risk (U = 393, p < 0.001), and cognitive impairment (U = 1062, p = 0.01). More frequent fitness amenity use was associated with lower frailty and sarcopenia risk scores (Spearman’s Rho = −0.30 and −0.40, respectively, both p < 0.01), but not cognitive impairment. Conclusions: A meaningful subset of senior living residents were at risk for frailty, sarcopenia, and cognitive impairment. Routine screening and interventions promoting fitness amenity use may support healthy aging in senior living communities.
The United States is experiencing rapid population aging, making geriatric oral health an increasingly important public health and clinical concern. Older adults bear a disproportionate burden of oral diseases, including dental caries, periodontal disease, edentulism, xerostomia, and oral cancer, many of which are closely linked to chronic systemic conditions such as diabetes, cardiovascular disease, and cognitive impairment. This narrative review synthesizes current evidence on oral disease patterns and trends among older adults in the United States, with particular attention to the bidirectional relationships between oral and systemic health. It further examines the organization of oral health care delivery and financing for this population, including the roles of Medicare and Medicaid. Persistent inequities in access to preventive and restorative dental services are highlighted, especially among low-income individuals, racial and ethnic minorities, rural residents, and older adults with functional or cognitive limitations. Workforce shortages, fragmented care models, and limited integration of oral health into primary and geriatric care further exacerbate these disparities. Finally, this review identifies future directions to improve geriatric oral health, including policy reforms to expand dental coverage, integration of oral health into medical and long-term care settings, adoption of minimally invasive approaches, and strengthened interprofessional education and research. Addressing these challenges is essential to promoting healthy aging and reducing oral health disparities among older adults in the United States.
Background/Objectives: Sarcopenia significantly increases the risk of hospitalization and mortality in older adults. However, the prevalence by sex varies across populations and according to the criteria used by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Hence, in the current study, we aim to characterize the prevalence of sarcopenia by jointly evaluating all three diagnostic domains in a Mexican cohort of older adults subscribed to a health insurance plan. Methods: We performed binomial and multinomial regression models, ordinal logistic regression, and multiple linear regression from the data corresponding to muscle mass (ASMI), muscle strength (handgrip dynamometry), and physical performance (SPPB) from 556 Mexican older adults (62.2% female; 72.27 ± 6.35 y.o.) categorized by sarcopenia severity according to the EWGSOP2. Results: Men exhibited significantly higher absolute muscle mass and strength across all categories (p < 0.001). Additionally, our statistical analyses demonstrate that age, but not sex, is involved in sarcopenia severity in this population. Moreover, when analyzing the disaggregated EWGSOP2 domains, the results demonstrate that sex is significantly associated with muscle mass (ASMI) and muscle strength (Handgrip strength). Conclusions: These results suggest that sex only influences both muscle mass (ASMI) and muscle strength (handgrip strength) while sarcopenia severity only depends on age.
Background/Objectives: Frailty is an under-recognized preoperative risk factor for poor surgical outcomes. Recovery of preoperative ambulation levels one month after surgery represents an important patient-centered outcome. The purpose of this study was to (1) identify a preoperative daily step count threshold associated with frailty, and (2) characterize the one-month ambulation recovery (steps/day) of older adults (≥60 years) with and without frailty following major elective inpatient operations. Methods: This single-center observational pilot study included older adults undergoing elective inpatient operations at a Veterans Affairs Hospital. Frailty was assessed before surgery. Ambulation (steps/day) was measured continuously from ≥3 full days before surgery, to at least 28 days after surgery, using a wrist-worn accelerometer. Sensitivity analysis identified a step count threshold associated with frailty. The primary outcome was the percentage of daily steps recovered at 28 days. Results: The average age of participants (n = 109) was 69 years, and 37.6% (41/109) were identified as prefrail or frail. Preoperative steps/day were lower in the frail cohort (3322.00 [2654.70, 5483.20] versus 4993.95 [3540.90, 6599.97], p < 0.05). Sensitivity analysis showed 4137 steps/day to be associated with preoperative frailty, and this remained significant in multivariate analysis. At 28 days, the percentage of daily steps recovered did not differ between groups (72.57% [49.15, 92.06] overall). Conclusions: Preoperative frailty is associated with lower daily step counts (<4137 steps/day), identifying individuals at increased likelihood of frailty in this older Veteran cohort undergoing major surgery. The median daily step count, regardless of frailty status, was <5000 steps/day, consistent with a sedentary lifestyle, and likely too low to show a difference in one-month ambulation recovery. This finding underscores the need to explore walking interventions in older Veterans awaiting surgery.
Chosen family caregivers assume caregiving roles by choice rather than by blood or legal relation. Chosen family caregivers play a critical yet often invisible role in supporting older adults living with HIV. Unlike traditional family caregivers, many chosen family members are themselves living with HIV or other chronic health conditions, creating unique dynamics of mutual support, resilience, and vulnerability. Older LGBTQ adults are disproportionately reliant on chosen family, often due to stigma, estrangement from biological family, or social marginalization, highlighting distinct challenges in caregiving relationships. Women in chosen family roles frequently experience compounded burdens, balancing emotional, physical, and logistical care responsibilities alongside broader social and structural pressures. Despite their essential contributions, chosen family caregivers remain largely unrecognized within healthcare systems, limiting their access to formal support, respite, and decision-making authority. This commentary synthesizes the existing literature and conceptual perspectives to examine the social, gendered, and health-related dimensions that distinguish chosen family caregiving. It highlights key gaps in recognition and support and outlines implications for policy, research, and practice aimed at strengthening care for older adults living with HIV.
Background and Aims: Insufficient dietary intake is common among hospitalized older (≥65 years) adults with or at risk of malnutrition. Identifying barriers and facilitators is essential for improving nutritional care in this population. This study aimed to identify the most frequently reported and observed barriers and facilitators linked to the achievement of estimated dietary requirements during a nutritional intervention. Methods: This descriptive, inductive qualitative content analysis used data from the intervention group (n = 65) of the OptiNAM trial (NCT03741283), a randomized controlled trial evaluating a multidisciplinary nutritional intervention among acutely admitted older adults at Copenhagen University Hospital, Hvidovre. A total of 23 of the 65 participants were hospitalized for ≥24 h, allowing dietary intake to be assessed by a dietitian using validated 24 h dietary records, supplemented by dietitian-conducted 24 h recalls when records were unavailable. Individual energy and protein requirements were estimated, and intake was validated and recorded. Meaning units were derived from free-text data from patient interviews or observations during patient interviews that were linked to dietary intake and categorized as barriers or facilitators depending on whether dietary intake was below or above the estimated requirements. Results: In acutely admitted older adults with malnutrition or malnutrition risk receiving a nutritional intervention during hospitalization, poor appetite was the most frequently reported barrier to sufficient dietary intake (73.9%), followed by disliking the food (39.1%). In contrast, intrinsic motivation (69.6%), good appetite (34.8%), and support from relatives (30.4%) were the most commonly reported facilitators. Conclusions: Appetite, hospital meals, motivation, and support from relatives play central roles in achieving sufficient dietary intake among acutely admitted older adults with or at risk of malnutrition receiving a nutritional intervention.
Background: Aging involves several social, psychological, and biological changes, including changes in perceived energy. Within Self-Determination Theory, Subjective Vitality refers to the experience of having energy available to the self. Despite its relevance for older adults, no review has mapped how Subjective Vitality has been studied in this population. This scoping review aimed to map the literature on Subjective Vitality in older adults and identify gaps in the evidence base. Method: Following Joanna Briggs Institute guidance, five electronic databases were searched for peer-reviewed quantitative articles published between 1997 and 2026 in which Subjective Vitality was assessed in samples with a mean age of 65 years or older. Of the 1915 records identified, 11 reports were included, corresponding to eight independent samples. Results: Studies were conducted in a limited number of countries, predominantly Western, and showed substantial heterogeneity across research domains. Subjective Vitality was most often assessed using the Subjective Vitality Scale, although different versions and response formats were used, and psychometric or adaptation evidence specific to older adults was limited. Potential antecedents and mechanisms included basic psychological need satisfaction, autonomy support, autonomous regulation, intrinsic goals, flow, social contacts, ego integrity, and meaning in life. Intervention studies suggested that leisure education and endurance training may support Subjective Vitality, although evidence remains limited. Conclusions: Future studies should use clearer sampling procedures, validated and well-reported measures, and stronger longitudinal and intervention designs capable of testing temporal and causal relationships.
Background: The association between dietary supplement use and risk of sarcopenia in older adults remains poorly investigated. The primary objective of this study was to investigate the association between risk of sarcopenia and supplement use in older adults. Methods: A cross-sectional study was conducted to analyze the association between supplement use and risk of sarcopenia, assessed by the SARC-F questionnaire, in older outpatients. The associations between risk of sarcopenia and dietary supplement use were examined through logistic regression models. Results: A total of 162 participants were included in this study. Among supplement users (92 patients), 55.4% were identified as being at risk of sarcopenia (SARC-F ≥ 4). Regarding SARC-F components, dietary supplement users exhibited significantly higher median scores for walking assistance (median 1 vs. 0, p = 0.004) and rising from a chair (median 1 vs. 0, p = 0.04) compared to non-users. Individuals at risk were significantly more likely to use dietary supplements compared with those not at risk (OR 1.98, 95% CI 1. 05–3.76; p = 0.034), and this association remained significant after adjustment for confounders, such as sex, age, study, and marital status (OR 2.35, 95% CI 1.21–4.72; p = 0.013). Cognitive decline was the most frequently reported reason for supplement use in both groups. Conclusions: Dietary supplement use is highly prevalent among older adults and independently associated with sarcopenia risk, particularly tracking with functional limitations. Rather than a causal factor, supplementation may serve as a surrogate indicator of overall clinical vulnerability. These findings underscore the importance of assessing muscle health in older supplement users.
Background/Objectives: The main objective of this study was to estimate 1- and 3-year overall survival and relative survival in patients aged >65 years who underwent surgery for a second contralateral hip fracture. Methods: Retrospective cohort study including patients aged ≥65 years who underwent surgery for a first or second contralateral hip fracture between June 2010 and December 2021. Overall survival (OS) was estimated from the date of surgery to death from any cause or end of follow-up. Relative survival (RS) was calculated as the ratio between observed survival and expected survival derived from general population mortality tables for Catalonia implemented in the WebSurvCa application. Results: A total of 2642 patients were included (2467 primary fractures; 175 s contralateral fractures). Patients with a second fracture were older and had worse pre-fracture functional and cognitive status. At 3 years, overall survival was 53.8% (95% CI: 51.7-55.9) after a first fracture and 43.7% (95% CI: 36.3-52.4) after a second contralateral fracture. Relative survival estimates were 70.5% (95% CI: 67.7-73.3) and 59.0% (95% CI: 49.1-70.8), respectively. Divergence between expected and relative survival became more evident at 3 years than at 1 year. Advanced age, male sex, and worse pre-fracture functional or cognitive status were associated with poorer survival in both cohorts. Conclusions: A second contralateral hip fracture may represent a clinically relevant marker of increased vulnerability and greater clinical complexity, associated with substantial excess mortality compared with general population matched by age and sex. Relative survival highlights the true prognostic burden of a primary or second fracture and supports intensive secondary prevention and tailored follow-up.
Background: Caregiving grandparents face unique stressors that may affect cognitive health. Discrimination is associated with poorer cognitive performance, whereas stronger perceived control over cognitive aging is associated with better performance. This study examined how everyday discrimination and perceived control over cognitive aging relate to executive function in caregiving grandparents. Methods: Using cross-sectional data from the Midlife in the United States study (MIDUS 3), we analyzed 1326 grandparents (166 caregiving and 1160 non-caregiving) with complete data on all study measures. Everyday discrimination, perceived control over cognitive aging, and executive function were assessed with self-report surveys and telephone-based cognitive assessments. Mediation and moderated mediation models were estimated with covariates. Results: Perceived control over cognitive aging mediated the relation between discrimination and executive function, and this mediation was moderated by caregiving status. Among non-caregivers, stronger perceived control was associated with a weaker negative relation between discrimination and executive function. This protective pattern was not observed among caregiving grandparents. The moderation was attenuated to nonsignificance when an expanded covariate set was added, so it should be considered preliminary. Conclusions: The demands of caregiving may lessen the influence of control beliefs on cognitive performance. Because the design is cross-sectional, these results describe statistical rather than temporal mediation. The findings support targeted interventions for this vulnerable population, although they warrant further investigation.
Background: Dementia is a global public health priority, and visual impairment has been identified as a modifiable risk factor. While cataract surgery improves quality of life in mild cognitive impairment, its impact on the burden of caregivers supporting patients with moderate-to-severe dementia remains underexplored. Objectives: To explore changes in caregiver burden following cataract surgery in older adults with dementia. Methods: This prospective, single-center, observational pilot study included 28 patient–caregiver pairs aged ≥ 75 years with dementia who underwent cataract surgery. Caregiver burden was assessed using the Japanese version of the Zarit Burden Interview (J-ZBI) at baseline and 3 months postoperatively. Patient outcomes included best-corrected visual acuity (logMAR), Mini-Mental State Examination (MMSE), and the Barthel Index (BI). Pre- and postoperative values were compared using paired t-tests, with exploratory analyses to identify factors associated with postoperative burden. Results: Visual acuity significantly improved after surgery (p < 0.001). The retention rate was 84.8%, indicating feasibility of postoperative follow-up. No detectable short-term changes were observed in J-ZBI (p = 0.48), BI (p = 0.15), or MMSE (p = 0.89). In exploratory analyses, higher preoperative burden and younger caregiver age were associated with higher postoperative burden. Conclusions: Cataract surgery significantly improved visual acuity in older adults with moderate-to-severe dementia. However, no detectable short-term changes were observed in caregiver burden, cognitive function, or activities of daily living during the 3-month follow-up period. In exploratory analyses, potentially hypothesis-generating associations were suggested between higher baseline J-ZBI scores, younger caregiver age, and higher postoperative burden. The study nevertheless demonstrated the feasibility of conducting prospective research in this population and provides preliminary data for future studies with larger sample sizes and longer follow-up periods.
Background: Hyponatraemia is the commonest electrolyte disturbance encountered in older adults admitted with neck of femur (NOF) fracture. It is now recognised both as associated with fragility fracture and as an independent prognostic indicator for adverse post-operative outcomes. Methods: Narrative review of the literature, with emphasis on cohort studies, meta-analyses and mechanistic investigations pertinent to hip fracture in adults. Results: Admission hyponatraemia affects approximately 13–20% of NOF patients, twice the prevalence observed in age-matched community-dwelling elders and broadly comparable to general geriatric inpatients. A further 20–30% develop in-hospital, predominantly post-operative, hyponatraemia. Mild hyponatraemia (130–135 mmol/L) accounts for 75–85% of cases. Pathophysiology is multifactorial: hypovolaemia from the fracture haematoma, fasting and pre-admission “long lie”; drug effects (thiazides, selective serotonin reuptake inhibitors (SSRIs), proton pump inhibitors, carbamazepine, opioids); and non-osmotic arginine vasopressin (AVP) release driven by pain, nausea and peri-operative stress. Chronic hyponatraemia is hypothesised to contribute to fracture risk through three convergent mechanisms, direct sodium-dependent stimulation of osteoclastogenesis with AVP-mediated bone resorption, subtle cerebral dysfunction producing gait and attention deficits, and sarcopenia, although much of this mechanistic evidence derives from animal and in vitro studies rather than from patients with hip fracture. Hyponatraemia is reproducibly associated with longer length of stay, delayed surgery, and an adjusted 30-day mortality hazard of approximately 1.15–1.40. A dose–response relationship with severity is demonstrable; pre-operative correction has not been shown to improve outcomes in any randomised trial. Conclusions: Hyponatraemia in NOF fracture is consistently a consequence of the acute event and, at minimum, a robust marker of frailty and adverse prognosis. Whether it also causally contributes to fracture risk remains unproven, since the supporting human evidence is entirely observational and mechanistic, each contributing study carries methodological weaknesses that warrant caution, and no interventional study has established causality. Where hyponatraemia is mild and isolated, current evidence does not support delaying surgery; moderate and severe hyponatraemia warrant individualised assessment, with cautious correction proceeding alongside surgical planning rather than postponing it. Given the absence of interventional evidence, no correction strategy can yet be recommended to improve fracture or surgical outcomes. Prospective trials of targeted correction strategies and rehabilitation outcomes are overdue.
Background/Objectives: Cognitive impairment can compromise toothbrushing and other oral self-care functions, increasing the risk of oral diseases and related complications. However, how toothbrushing ability declines across stages of cognitive impairment remains unclear. This study aimed to describe functional deficits in toothbrushing among older adults with different levels of cognitive function. Method: Sixty-five older adults (14 cognitively healthy and 51 with documented cognitive impairment) were classified into five cognitive levels based on Standardized Mini-Mental State Examination scores. Participants completed a toothbrushing task as they normally would at home. Performance was videotaped, coded, and evaluated across four domains (task initiation, completion, thoroughness, and quality) with total scores reflecting overall toothbrushing ability. Overall performance, functional deficits, and assistance needs were analyzed in relation to cognitive levels. Results: Participants averaged 76.5 years of age. Toothbrushing ability declined gradually with worsening cognitive impairment, followed by a sharp deterioration at the profound stage (e.g., SMMSE ≤ 5). Compared with cognitively healthy participants (n = 14), those with mild cognitive impairment (MCI, n = 20) or mild (n = 10), moderate (n = 10), or severe dementia (n = 11) lost an average of 3%, 8%, 12%, and 37% of overall toothbrushing ability, respectively. Brushing efficiency declined earlier and more rapidly, decreasing by 13% in MCI and up to 46% in severe dementia (p < 0.001). All participants with MCI or mild dementia completed the task independently, whereas 20% with moderate dementia and 80% with severe dementia required assistance to initiate or complete the task. Conclusions: Overall toothbrushing ability remains relatively preserved until the later stages of cognitive impairment, but brushing quality deteriorates much earlier and quicker. These findings highlight the importance of early caregiver–patient partnerships, functionally tailored oral self-care rehabilitation, and personalized caregiver training to support oral hygiene among older adults with cognitive impairment.
Background: Esophageal cancer (EC) poses a growing global challenge in the context of an ageing population. Evidence on the role of curative esophagectomy in octogenarians is limited. This study aims to compare the long-term survival and post-operative mortality and morbidity in octogenarians undergoing curative esophagectomy for EC with those in non-octogenarians. Methods: A systematic search was performed on PubMed, Embase, Web of Science and Cochrane Library up to Jan 2026. The inclusion criteria were studies that compared outcomes of esophagectomy for EC between octogenarians and non-octogenarians. Exclusion criteria were single-arm studies and studies using different age cut-offs. Results: There were 18 studies with 73,776 patients (octogenarians n = 6234 and non-octogenarians patients n = 67,542), with smaller subsets of studies being analysed for individual outcomes. The overall incidence of open esophagectomy and minimally invasive esophagectomy (MIE) were 78.4% (n = 459/585) and 21.2% (n = 124/585), respectively, in octogenarians, and 69.8% (n = 3270/4688) and 29.4% (n = 1380/4688), respectively, in non-octogenarians. R0 resection was achieved in 85.2% (n = 1759/2064) of octogenarians and 91.9% (n = 30,764/33,480) of non-octogenarians. Pooled OS was inferior in the octogenarian group compared to the non-octogenarian group (n = 35,441, HR 2.29, 95% CI: 1.38–3.79). Pooled in-hospital mortality, 30-day mortality and 90-day mortality were higher in octogenarians. In terms of post-operative complications, pooled analysis demonstrated a higher overall complication rate in the octogenarian group (n = 6515, OR 1.40, 95% CI: 1.11–1.78), while rates of anastomosis leakage, chylothorax, respiratory complication, surgical site infection and recurrent laryngeal nerve injury were comparable between the two groups. Conclusions: Curative esophagectomy for EC is associated with worse overall survival, mortality and overall post-operative complication rate in octogenarians than non-octogenarians. Further research on the role of MIE in octogenarians should be conducted.
Background/Objectives: To evaluate the safety of cholecystectomy in nonagenarians. Methods: In compliance with the PRISMA statement standards, a systematic review including random-effects meta-analysis and meta-regression models was conducted. All studies reporting postoperative outcomes in patients aged ≥90 undergoing cholecystectomy were included and analyzed. Results: Six studies (1223 patients) were included. The risk of 30-day mortality was 5.4% (95% CI 3.1–7.7); 30-day morbidity occurred in 22% (95% CI 11.3–32.8). The mean length of hospital stay was 11.5 days (95% CI 8.3–14.6). Postoperative mortality was not affected by male sex (coefficient: 0.028, p = 0.832), ASA status ≥ III (coefficient: 0.051, p = 0.309), cholecystitis as indication for cholecystectomy (coefficient: −0.166, p = 0.051), cholecystectomy in emergency setting (coefficient: −0.020, p = 0.425), laparoscopic (coefficient: −0.104, p = 0.09) or open approach (coefficient: 0.104, p = 0.09), and conversion to open surgery (coefficient: 0.043, p = 0.820). The GRADE certainty of evidence was low to moderate. Conclusions: Subject to selection bias and confounding by fitness, the available evidence suggests that cholecystectomy in highly selected nonagenarians with good performance status, who have passed robust preoperative fitness assessment tests, may be safe with an acceptable risk of morbidity and mortality.
