The role of surgical stabilization rib fractures (SSRF) in geriatric trauma patients remains controversial despite growing evidence supporting SSRF in selected patients with severe chest wall injuries. The decision to do surgical stabilization of rib fractures in the elderly patient is more complex with recommendations for surgery to be individualized on a case-by-case basis. In this preliminary report, we describe the development of a multidisciplinary Chest Wall Injury Service that utilizes a standardized treatment algorithm and the Pain-Inspiration-Cough (PIC) score to guide management of older adults with rib fractures. A retrospective descriptive review was performed of older adult trauma patients (≥65 years) undergoing SSRF after implementation of a Chest Wall Injury Service (CWIS) at an American College of Surgeons verified Level 1 Trauma Center. The service integrates trauma and orthopedic surgeons and employs radiographic criteria and PIC score assessment to assist in selection of patients for SSRF. Following the implementation of CWIS, 358 older adult patients sustained rib fractures, of whom 22 (6.1%) underwent SSRF. Mean age was 74.3 ± 6.3 years, mean Injury Severity Score was 16.1 ± 9.3, and 14 patients (64%) had flail chest. Mean time from admission to SSRF was 3.1 ± 2.2 days. One patient (4.5%) died within 30 days of surgery from cause unrelated to rib fixation. Four patients (18.2%) experienced minor complications. Incentive spirometry volumes improved significantly from 725 mL preoperatively to 1145 mL postoperatively (p < 0.001). A multidisciplinary CWIS incorporating trauma and orthopedic expertise and an objective treatment algorithm facilitated the management of selected geriatric patients with severe rib fractures. Preliminary outcomes demonstrated low mortality, acceptable morbidity, and significant improvement in pulmonary functioning after SSRF. Larger studies are needed to further evaluate this approach.
Despite well-established health benefits of regular physical activity, participation rates remain suboptimal among adults, particularly older adult populations. More evident during the COVID-19 pandemic, online exercise training has emerged as an interesting strategy for different groups of individuals to remain physically active. The present study explored perceptions, barriers, and facilitators of online exercise training in adults at different stages of adulthood. This qualitative study was a secondary analysis of de-identified data from semi-structured interviews previously conducted by an exercise specialist with 14 adult participants who had engaged in online exercise training for at least one year. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically by the research team. Across the 14 interviews with adults at different stages of adulthood (aged 34-71 years), four major themes emerged: (1) benefits of online exercise training, (2) enablers of online exercise training, (3) challenges of online exercise training, and (4) client and professional profile. Participants described perceived benefits, barriers, and facilitators of online exercise training, including convenience, individualized guidance, technological challenges, and digital literacy demand. These findings provide context for understanding how adults across adulthood, including older adults, experience online exercise training but do not establish comparative effectiveness, causal effects on adherence, or sustained engagement.
Multiple theories from the psychological and occupational therapy sciences suggest that there may be reciprocity between activity selection and the meanings we draw from them. As such, meaningfulness may be an important contextual mechanism through which activity engagement positively influences cognition, but no research has examined these links in healthy middle-aged and older adults. This study examined the predictive ordering of the associations between activity engagement, meaningfulness, and cognition. Eighty-one individuals aged 41-94 years old completed questionnaires on activity participation, engagement in meaningful activities, and a range of cognitive tests. Structural equation modeling controlling for age and education was used to test multiple mediation pathways linking activity and meaningfulness to cognition. There was a significant positive direct effect of meaningfulness on activity, where individuals who had higher ratings of meaningfulness also engaged more frequently in activity. However, neither activity nor meaningfulness significantly mediated the pathway to cognition, and direct effects between activity engagement with cognition and meaningfulness with cognition were unexpectedly not significant. Correlational results showed the strongest connection occurred between social activity and meaningfulness, highlighting domain specific effects, and suggesting that social health, a key part of successful aging, is linked to the perceived value of an activity. It remains possible that the links between activity, meaningfulness, and cognition may exist longitudinally or at the daily level.
Aging is defined as the accumulation of damage, and several factors have been recognized as “factors of aging”. A sensible holistic approach is appropriate to reduce the rate of accumulation of damage, while maintaining the well-being of the individual. The holistic approach of L-Raphael defines seven fields of intervention: Outdoor management, Physical management, Medical management, Nutritional management, Stress management, Aesthetic management, and Leisure management. These interventions apply to skin aging as well. Perhaps all of the known factors of skin aging induce the synthesis of intercellular adhesion molecule 1 (I-CAM 1) in endothelial cells. I-CAM 1 molecules bind circulating immune cells, who then exit the blood vessels, enter the dermis, and initiate an inflammatory process, which entails three oxidative bursts and the release of proteolytic enzymes. The micro-inflammatory theory of skin aging describes the different factors that accelerate the rate of aging and recommends biochemical interventions. These biochemical interventions fit the seven holistic managements quoted above. The principal factor of skin aging is known to be solar exposure, which generates DNA damage that triggers an inflammatory reaction. Hence the importance of Outdoor management that recommends protecting against UV and using boosters of DNA repair such as Nicotinamide. Anoxia associated with stationary standing positions induces the synthesis of I-CAM and consequently of varicose veins and of spider veins. Well-managed physical exercise is therefore recommended to avoid the onset of anoxia. Medical management of cutaneous hygiene helps avoid the damage provoked by the response to local infections. Tailored targeting of the skin microbiome might be an additional tool in that sense. Glycated proteins induce I-CAM 1. The skin of people with diabetes is particularly affected, and nutrition management could avoid favoring conditions that facilitate protein glycation. Psychological stress provokes the release of I-CAM 1-inducing neuropeptides in the skin. Stress management is very important to maintain skin inflammation-free. The aesthetics of the skin suffer because of tobacco smoking. This is especially true when the skin is exposed to UV. Tobacco smoke is vasoconstrictive and reduces nutrient supply to the skin. Undernourished cells undergo necrosis and trigger inflammatory responses. Leisure management and balanced time use are crucial. Sleep deprivation does negatively affect skin health, and sleep is a necessary condition for global well-being.
The editors of OBM Geriatrics would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2025. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers can download a certificate of recognition directly from our submission system. Additionally, reviewers can sign up to the Web of Science Reviewer Recognition Service (formerly Publons) (https://webofscience.com/wos/) to receive recognition. Of course, in these initiatives we are careful not to compromise reviewer confidentiality. Many reviewers see their work as a voluntary and often unseen part of their role as researchers. We are grateful for the time reviewers donate to our journals and the contribution they make.
