Sarcopenic obesity is an emerging geriatric syndrome defined by the simultaneous presence of reduced skeletal muscle mass and function alongside excess adiposity. As populations age and obesity prevalence rises, this condition has grown in clinical importance, carrying risks of frailty, falls, disability, metabolic syndrome, cardiovascular disease, poor quality of life, and premature mortality that exceed those associated with either condition independently. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, clinical consequences, diagnostic challenges, and management of sarcopenic obesity in older adults. Its development involves a complex interplay of age-related muscle atrophy, adipose tissue dysfunction, chronic low-grade inflammation, insulin resistance, hormonal alterations, mitochondrial impairment, and diminished regenerative capacity, mechanisms that collectively reinforce one another in a self-perpetuating cycle. Diagnosis is hampered by the absence of a universally accepted definition; current frameworks differ in their choice of muscle mass indices, strength thresholds, performance measures, and adiposity cut-offs. Recent international consensus statements have proposed stepwise approaches to improve clinical recognition. Management centers on progressive resistance exercise combined with optimized protein intake and multidisciplinary care. Emerging pharmacological options, notably glucagon-like peptide-1 receptor agonists, offer important metabolic benefits but require careful use in older adults because of the risk of lean mass loss. Early detection, standardized diagnostic frameworks, and integrated lifestyle interventions are essential to mitigate the functional and metabolic burden of sarcopenic obesity.
Occupational therapy (OT) in emergency departments (EDs) plays a vital role in supporting frail older adults, yet traditional OT assessments often lack the multidimensional scope required for comprehensive functional and cognitive evaluation. This study evaluated the association between implementing a modified Comprehensive Geriatric Assessment (CGA) tool, the Mini OT CGA, a structured 8-domain assessment covering cognition, functional ability, falls history, social circumstances, rehabilitation potential, and discharge planning, and discharge-related outcomes within an urban hospital ED. A retrospective pre-post audit compared two 2-month periods: February-March 2020 (standard OT assessment; n=217) and February-March 2021 (Mini OT CGA; n=175). Fisher’s exact tests with 95% confidence intervals and Cramér’s V were used to assess differences in ED therapy codes, discharge destination, and community service utilization, with the Benjamini-Hochberg adjustment applied to control for multiple post hoc comparisons. Demographic characteristics were comparable between cohorts. Following implementation of the Mini OT CGA, cases recorded as “No Capacity in Team/Ward/Unit” decreased from 28.6% to 6.9% (adjusted p<0.01; Cramér’s V=0.32), and discharges home with Rapid Response Team support increased from 5.1% to 12.6% (adjusted p≈0.01; Cramér’s V=0.26). Although statistically detectable, these effects were of small-to-moderate magnitude. The structured assessment was associated with improved identification of functional, cognitive, and social needs; more consistent discharge planning; and increased utilization of community-based pathways, without an increase in acute admission rates. These findings suggest that embedding a multidomain geriatric assessment into routine OT practice in the ED is feasible and may support incremental improvements in care coordination for frail older adults. Further evaluation should explore long-term outcomes, readmission risk, and cost-effectiveness to determine broader applicability across diverse healthcare settings.
Introduction. Respiratory failure in older adults is associated with high mortality. The Multidimensional Prognostic Index, derived from comprehensive geriatric assessment, is a validated prognostic tool. This study evaluated the association between the Multidimensional Prognostic Index and in-hospital mortality in geriatric patients with respiratory failure. Materials and Methods. We conducted a retrospective observational study including patients aged 65 years or older hospitalized for respiratory failure. Demographic and clinical data and the Multidimensional Prognostic Index at admission were collected. The primary outcome was in-hospital mortality. Logistic regression with bootstrap validation and penalized models was applied. Discrimination was assessed by receiver operating characteristic curve. Results. Higher values of the Multidimensional Prognostic Index were independently associated with increased in-hospital mortality. Each 0.1-point increase corresponded to a higher risk of death. The model showed good discriminative ability, with an area under the curve of 0.74. Results were confirmed by bootstrap and penalized regression. The type of respiratory failure had a limited impact compared to the Multidimensional Prognostic Index. Conclusions. The Multidimensional Prognostic Index is an independent predictor of in-hospital mortality in older patients with respiratory failure and may support risk stratification and clinical decision-making in frail patients.
The prevalence of delirium in general medical settings varies between 23% and 42%. The populations at significant risk for delirium include hospitalized adults aged 65 years and older. Delirium is associated with falls, functional decline, cognitive impairment, and high medical costs. A SWOT (strengths, weaknesses, opportunities, and threats) analysis of Vassar Brothers Medical Center’s strengths included adopting the Short-CAM delirium screening tool for patients aged 18 years and older. However, delirium remained underrecognized. Nurses have a significantly higher rate of patient interaction than any other healthcare professional. A literature review found that nurses lacked theoretical knowledge of delirium, and multimodal education effectively increased knowledge. The Iowa model framework was used due to its practicality and adaptability in the clinical setting. A practice change project consisting of a pre-and post-assessment method for 30 seasoned and novice nurses in the 30-bed neuroscience medical-surgical unit was developed. It included a 50-minute web-based module sent via email and eight 10-minute in-person sessions. The expected outcomes were to improve nurses’ knowledge of delirium and improve nurses’ recognition of delirium risk factors by 20% within 5 weeks. There was a statistically significant increase in mean percentage scores from the pre-assessment to the post-assessment surveys (z=-3.77, p≤0.001). Nurses’ post-assessment scores increased in knowledge of delirium, tools used for delirium assessments, and recognition of delirium risk factors. There was a limitation in the small sample size of 22. Delirium education should be part of the annual education of nurses and should be available to new nurses during orientation.
Chronic pain in older adults is a major clinical challenge due to its high prevalence, complex pathophysiology, and frequent impact on function and quality of life. Polypharmacy and prolonged analgesic use, particularly opioids, often complicate management, leading to dependence and adverse effects. We report the case of a 75-year-old woman with chronic low back pain associated with significant functional impairment and opioid dependence. A multimodal, patient-centered approach was implemented, including gradual morphine tapering, transcutaneous electrical nerve stimulation, functional rehabilitation, and structured psychological support. This integrated strategy aimed to control pain while improving mobility and autonomy and addressing psychological dimensions of chronic pain. The patient showed a favorable evolution, with reduced pain intensity, improved functional capacity, and decreased reliance on opioids. Functional autonomy improved the Instrumental Activities of Daily Living score from 4/8 to 6/8; transition from Groupes Iso-Ressources 2 to 4, along with social reintegration. She also reported a subjective improvement in quality of life and increased engagement in her care. This case emphasizes the value of multimodal, non-pharmacological strategies and individualized, function-oriented management in older adults with chronic pain.
