To assess the acceptability and feasibility of a digital health platform for long-term disease management combined with health coaching for people living with mild-moderate frailty in Southwest England. Older adults (65 years+) with frailty (using electronic Frailty Index) and one or more co-morbidities were recruited from four primary care networks in a pre-post mixed methods study. They engaged with a digital health coaching programme with access to a digital platform between June 2023 and February 2024. Feasibility was assessed from participant recruitment, retention and adherence to the intervention. Eleven older adults with frailty, 5 health and wellbeing coaches and 2 health care professionals were interviewed to assess acceptability. Outcome measures included frailty, function, quality of life, social engagement, diet quality, self-reported indicators. Of 38 eligible participants, 34 accessed the online platform (mean age 77 years). Of these 34 participants, 24 (70.6
Background Osteoporotic hip fractures cause significant morbidity, mortality, and healthcare burden. Substantial gaps persist in osteoporosis diagnosis and secondary fracture prevention, particularly in Saudi Arabia. Aims To evaluate the osteoporosis care gap, mortality outcomes, and predictors of mortality among patients with fragility hip fractures at a tertiary care center in Riyadh, Saudi Arabia. Methods This retrospective cohort study included 273 patients aged ≥ 50 years admitted with fragility hip fractures between 2016 and 2024. Kaplan–Meier analysis estimated survival; Cox proportional hazards regression identified predictors of mortality. Results Mean age was 76.2 ± 9.4 years. Only 12.5% underwent DXA before fracture and 21.6% received post-fracture osteoporosis treatment, leaving 78.4% untreated. Kaplan–Meier-estimated mortality was 2.2% at 30 days, 16.3% at 1 year, and 42.0% at 5 years; median survival was 6.1 years (95% CI 5.3–8.7). Increasing age independently predicted higher mortality (HR 1.05/year; 95% CI 1.02–1.08; p < 0.001), and surgical management was associated with lower mortality hazard (HR 0.32; 95% CI 0.13–0.84; p = 0.02), though this should be interpreted cautiously given the small non-operative group. Refracture was documented in 32 patients (11.7%); among the 14 patients with recorded refracture dates, the median time to refracture was 1.38 years. Discussion These findings highlight persistent missed opportunities for secondary fracture prevention and the need for coordinated post-fracture osteoporosis care. Conclusion Fragility hip fractures in Saudi Arabia are associated with substantial mortality and a major osteoporosis care gap. Structured post-fracture pathways, particularly fracture liaison services, are needed to strengthen secondary fracture prevention.
Healthcare for complex multimorbidity (CMM) remains inadequately prioritised and poorly integrated. CMM is associated with significant palliative care needs. The burden of CMM among older adults with palliative care needs in India has not been studied. Using data from Wave 1 of the Longitudinal Ageing Study in India (LASI), 2,903 older adults with palliative care needs were identified using the Supportive and Palliative Care Indicator Tool for Low-Income Settings. CMM was defined as the concurrent presence of: (i) chronic morbidity, (ii) five or more functional limitations, and (iii) at least one geriatric syndrome. Healthcare utilisation and access to supportive or assistive devices among those with CMM were assessed. Chi-square tests and multivariate logistic regression were used to examine associated factors. Overall, 37.1
Transcatheter aortic valve implantation (TAVI) is the main interventional option for elderly patients with severe aortic stenosis who are at high surgical risk. However, the role of systematic geriatric assessment in the pre-TAVI work-up remains insufficiently defined. The objective of this study was to identify factors associated with mortality and rehospitalization at one year by analysing the characteristics of a cohort of patients evaluated by a mobile geriatric team (MGT). This was a single-center retrospective study including patients aged ≥ 65 years who were assessed by the MGT as part of a pre-TAVI assessment between January 2018 and December 2022. Data collected included functional status (ADL, mini-IADL), cognition (MMSE), multimorbidity (≥ 5 comorbidities), polypharmacy (> 5 medications), and whether or not TAVI was performed. One hundred and thirty-two patients were included (mean age 85.2 ± 4.9 years). 52
Sarcopenia is prevalent in long-term care facilities (LTCFs) and is associated with falls, functional decline, and mortality. This proof-of-concept study, within the I-COUNT pilot randomized controlled trial, evaluated the feasibility and diagnostic performance of a non-invasive sarcopenia screening approach based on wearable surface electromyography (sEMG) combined with artificial intelligence. Eighteen older adults residing in two Italian LTCFs (6 sarcopenic, 12 controls; 33.3
Malnutrition may impair recovery after hip fracture, but the association between preoperative geriatric nutritional risk index (GNRI) and postoperative walking outcomes remains unclear. We examined the association between GNRI and loss of walking independence (LWI) 180 days after hip fracture surgery. This was a retrospective cohort study of patients aged 65 years and older who sustained a hip fracture and underwent surgery at a tertiary referral hospital between January 2021 and December 2023. The exposure was the GNRI, calculated based on admission blood test results using the following formula: 1.489 × serum albumin concentration [g/L] + 41.7 × (actual bodyweight / ideal bodyweight). LWI was defined as a Functional Independence Measure–Locomotion score ≤ 5 at telephone follow-up. Restricted cubic spline (RCS) was used to assess the shape of the association. Multivariable logistic regression estimated the odds ratio (OR) for LWI per 10-point decrease in GNRI. Robustness was evaluated using multiple sensitivity and prespecified subgroup analyses. The cohort consisted of 1,345 patients (925 female [68.8
Mild cognitive impairment (MCI) may progress to dementia, and clinical characteristics present at the initial visit may help inform follow-up and supportive care. To explore initial-visit clinical characteristics associated with subsequent conversion to dementia in patients with MCI. This retrospective exploratory study included patients diagnosed with MCI at their initial visit to a university hospital dementia outpatient clinic between 2012 and 2021. Patients were classified into converter and non-converter groups according to clinical outcomes during follow-up. Medical-record data were compared using the Mann–Whitney U test and Fisher’s exact test. Sensitivity analyses were also conducted to examine the influence of follow-up duration on the findings. Of 277 patients with MCI, 28 converted to dementia, with a median time to diagnosis of 497 days. The primary analysis compared these 28 converters with 30 non-converters followed for more than 497 days without a dementia diagnosis. Converters were older and less likely to report subjective memory complaints. Changes in “cooking and eating” and “money management” were more frequent among converters. They also had higher Functional Assessment Staging scores and lower Mini-Mental State Examination and Addenbrooke’s Cognitive Examination III scores. Behavioral and psychological symptoms did not differ significantly. Some findings varied across sensitivity analyses. Differences in subjective memory complaints, daily functioning, and neuropsychological performance may already be present at the initial visit, although their consistency depended partly on the definition of non-conversion. Routinely collected outpatient information may help inform clinical assessment, follow-up planning, and supportive care in patients with MCI.
Dysphagia and voice disorders are common among older adults and may share anatomical, physiological, and clinical determinants. However, these conditions are usually investigated separately, particularly in long-term care settings. To investigate the coexistence of dysphagia symptoms and voice-related complaints and identify shared determinants among institutionalized older adults. A multicenter cross-sectional study was conducted among 279 older adults residing in 16 long-term care facilities in Brazil. Dysphagia symptoms were assessed using the Eating Assessment Tool (EAT-10), and voice-related complaints were evaluated using the Screening Index for Voice Disorder (SIVD). Sociodemographic characteristics, sarcopenia, frailty, functional dependence, nutritional status, polypharmacy, and xerostomia were assessed using validated instruments. Spearman correlation and multivariable negative binomial regression models were used to examine associations. Dysphagia symptoms and voice-related complaints were identified in 34.1
Spine–hip bone mineral density (BMD) discordance frequently complicates fracture-risk assessment in clinical practice. Although its prevalence is well recognized, the extent to which discordance contributes to diagnostic misclassification across dual-energy X-ray absorptiometry (DXA) strategies remains insufficiently quantified. This retrospective cross-sectional study included 4,059 postmenopausal women aged ≥ 50 years who underwent DXA of the lumbar spine, total hip, and femoral neck between 2022 and 2024. Diagnostic performance (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) was compared across single-site and combined-site strategies. Multivariable logistic regression evaluated independent associations with prevalent fractures, while continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) quantified the incremental value of multi-site assessment. Lumbar spine–total hip discordance occurred in 41.3
This study aimed to evaluate the prognostic performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) score for predicting 30-day mortality in geriatric patients with acute heart failure (AHF) and to determine whether incorporating brain natriuretic peptide (BNP) and endotracheal intubation status could improve risk prediction. This retrospective, single-center observational study included patients aged ≥ 65 years with AHF who presented to the emergency department and were subsequently hospitalized between January 2024 and January 2026. Demographic, clinical, laboratory, and outcome data were obtained from electronic medical records. A multivariable prediction model integrating the EHMRG score, BNP, and endotracheal intubation status (EHMRG-BI) was derived and initially evaluated in the same cohort. Because model development and initial performance assessment were conducted in the same cohort, internal validation with 1,000 bootstrap resamples was performed to quantify optimism and obtain optimism-corrected performance estimates. A total of 348 patients were included, of whom 60 (17.2
Older adults with Type 2 Diabetes (T2D) are at increased risk for cognitive decline, particularly in executive and working-memory processes that support everyday functioning. Visuospatial working-memory binding (VSWMB), which involves integrating object identity and spatial location, may be especially vulnerable to age- and diabetes-related cognitive changes. Heart rate variability (HRV), an index of cardiac vagal modulation, has been associated with cognitive functioning in aging populations; however, its relationship with VSWMB in older adults with T2D remains unclear. This exploratory study examined associations between vagal modulation and VSWMB efficiency in older adults with T2D. Twenty-five older outpatients with T2D (mean age = 73.8 ± 6.1 years) underwent electrocardiographic assessment at rest, during, and following a visuospatial binding task (VBT) visuospatial binding task (TNABV). Cardiac vagal modulation was indexed using the root mean square of successive differences (RMSSD). Correlational analyses, group comparisons, and exploratory receiver operating characteristic (ROC) analyses were conducted. Resting RMSSD was positively associated with TNABV Efficiency Index 3, the most cognitively demanding visuospatial binding condition (r = .53, p = .007), and task-averaged RMSSD showed a similar association (r = .44, p = .034). Participants with impaired binding performance exhibited lower resting RMSSD (U = 19, Z = 2.95, p = .002) and lower task-averaged RMSSD (U = 31, Z = 1.98, p = .046) than those without impairment. Exploratory ROC analyses indicated that resting RMSSD discriminated participants with and without binding impairment (AUC = 0.86, sensitivity = 0.80, specificity = 0.79). No significant associations were observed for heart rate measures. These findings provide preliminary evidence that reduced cardiac vagal modulation is associated with poorer visuospatial working-memory binding efficiency in older adults with T2D. The results support further investigation of autonomic regulation as a correlate of cognitive functioning in metabolic aging and suggest that HRV may help identify older adults with T2D who are more vulnerable to cognitive inefficiency.
Non-invasive ECG-based screening for atrial fibrillation (AF) in older adults may increase detection of silent AF and uptake of oral anticoagulation (OAC), but screening strategies, AF definitions, AF burden, and downstream treatment thresholds vary across trials. We performed a a GRADE-assessed meta-analysis of randomized controlled trials (RCTs) comparing short-term or intermittent non-invasive ECG-based AF screening strategies versus usual care, opportunistic detection, or no invitation in older adults without known AF. For dichotomous outcomes, pooled risk ratios (RRs) with 95
Malnutrition is highly prevalent among patients with pancreatic cancer and has a substantial impact on prognosis, treatment tolerability, and quality of life. However, the prognostic significance of the Geriatric Nutritional Risk Index (GNRI), a simple and objective tool for assessing nutritional status, in pancreatic cancer remains incompletely characterized, and the available evidence has not been comprehensively synthesized. Therefore, this study aimed to systematically evaluate the association between GNRI and overall survival in patients with pancreatic cancer. A systematic literature search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was conducted (PROSPERO: CRD420251177304) to identify prospective and retrospective observational studies published up to November 2025 that reported quantitative data on the association between GNRI and survival outcomes in patients with pancreatic cancer. Eligible studies were included in a systematic review, and those meeting predefined criteria were pooled in a meta-analysis. Eighteen observational studies were included, of which 13 were eligible for meta-analysis. High nutritional risk according to the GNRI was associated with significantly worse overall survival (pooled HR = 1.79; 95
Type 2 diabetes mellitus is extremely frequent in older patients. The coexistence of multimorbidity and frailty may bear a significant impact on the management of this condition. Aim of this study was to describe the clinical profile, including the frailty status, in an outpatient population of elderly subjects with respect to diabetes. Data were collected within a cross-sectional retrospective design from the Cardiogeriatrics Clinic of the University Hospital of Baggiovara-Modena, Italy in the period 2010–2025. The population included 1402 subjects without diabetes (42.1
Sarcopenia, a progressive skeletal muscle disorder associated with falls, fractures, and mortality, poses significant challenges for Southeast Asia’s aging population. This systematic review and meta-analysis determined sarcopenia prevalence among Southeast Asian older adults and identified associated risk factors. We searched PubMed/MEDLINE, Embase, Scopus, and Web of Science through December 2024 for studies reporting sarcopenia prevalence in adults aged ≥ 45 years using validated criteria (AWGS, EWGSOP). Two reviewers independently conducted selection, extraction, and quality assessment using the JBI Critical Appraisal Checklist. Random-effects meta-analysis calculated the pooled prevalence with 95
Physical inactivity contributes to functional decline and is associated with increased risk of adverse outcomes in patients hospitalized with community-acquired pneumonia (CAP). Exercise programs applied during acute hospitalization may mitigate these effects, particularly in older adults. This study aimed to evaluate the effect of standard care versus supervised in-bed cycling or booklet-exercise, including resistance and endurance exercises, on functional ability, body composition, and physical activity level in patients hospitalized with CAP. In this randomized controlled trial, 178 patients hospitalized with CAP were allocated to standard care (n = 59), in-bed cycling (n = 58), or booklet-exercise (n = 61). Functional ability was assessed using grip strength, the 30-second sit-to-stand, and the Barthel index. Body composition was measured with bioelectrical impedance analysis, and physical activity was monitored using accelerometers. Outcomes were evaluated from admission to 3-month post-discharge using linear mixed-effect models. Baseline measures were comparable across groups. At 3 months post-discharge, participants performing in-bed cycling showed a significant improvement in the Barthel index compared to standard care (mean difference: 4.15 points, 95
Disability is a major challenge affecting older adults’ quality of life. Although the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has been shown to protect against functional disability in Western populations, its applicability across different cultural and diet contexts remains insufficiently validated. Therefore, this study aimed to investigate the association between the Chinese MIND (cMIND) diet and Basic/Instrumental Activities of Daily Living (BADL/IADL) disability. Methods: Using cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), cMIND scores were categorized into Q1 (0–4), Q2 (4–5), Q3 (5–6.5), and Q4 (≥ 6.5). Potential confounders were identified using a directed acyclic graph (DAG). Logistic regression was employed to analyze the association between the cMIND diet and BADL/IADL disability. Restricted Cubic Splines (RCS) were used to assess linearity, alongside subgroup, interaction, and sensitivity analysis. Results: Among 9,511 participants, the prevalence of disability in BADL and IADL was 23.74
Malnutrition is highly prevalent among individuals receiving palliative care and represents a major, yet often under-recognized, determinant of adverse clinical outcomes, including mortality. In adult patients receiving palliative care, the interplay between malnutrition, frailty, and disease burden further exacerbates vulnerability. Despite its clinical relevance, the prognostic value of standardized nutritional screening tools in palliative care settings remains insufficiently characterized. This study aimed to determine the prevalence of malnutrition and to evaluate its association with mortality using the Nutrition Risk Screening-2002 (NRS-2002) and the Mini Nutritional Assessment (MNA). This prospective observational cohort study was conducted in the palliative care unit of a university hospital. Patients were recruited between November 2022 and March 2023, and follow-up was completed in June 2023. A total of 250 patients receiving inpatient or outpatient palliative care were included. Nutritional status was assessed at baseline using NRS-2002 and MNA and reassessed after three months. Demographic characteristics and anthropometric measurements were recorded. The association between nutritional status and mortality was examined using multivariable logistic regression and ROC analyses. The mean age of the cohort was 62.82 ± 12.43 years, and 45.6
Declining global fertility has produced a growing, often invisible population facing Elderly Companionship Collapse—older adults who are childless, kinless, sole family survivors, or aging solo. AI companions already simulate presence; Phase II avatars that digitally resurrect deceased loved ones are now feasible. This prospect offers solace but risks a “perfection trap” that could incentivize replacing human partners, and ontological confusion by blurring the boundary between life and death. We propose a “logic of difference” (preserving otherness in avatars) and “differential companionship” (avatars as mourning guides, not replicas) as essential guardrails to ensure AI mends rather than deepens this collapse.
