BACKGROUND:Skeletal muscle dysfunction contributes significantly to disability, which is one of the most common complications of diabetes in older adults. We aimed to assess whether diabetes was associated with a steeper muscle strength decline and whether lower strength is related to a higher diabetes incidence in older adults. METHODS:A prospective analysis of data from two Italian population-based studies in older adults (the Invecchiare in Chianti and Progetto Veneto Anziani studies). Diabetes was assessed at baseline and after a median of 4.4 (first follow-up) and 6.3 years (second follow-up) using multiple sources of information. Muscle function was assessed as handgrip strength. RESULTS:The sample comprised 3927 participants (58.6% females) with a mean age of 75.5 years (29.6% aged ≥80 years). After adjusting for potential confounders, the decline in muscle strength among individuals with diabetes exceeded that of those without diabetes by 0.70 kg (95% CI, -1.30 to -0.11) at the first follow-up and by 0.84 kg (95% CI, -1.61 to -0.07) at the second follow-up. In those taking oral antidiabetics, this association was even stronger. Over a median 5-year follow-up, 186 incident diabetes cases were recorded. In a multivariable Cox regression, each 1-SD higher in the handgrip/body weight ratio was associated with an 20% lower likelihood of incident diabetes (95% CI, 0.68-0.95, n = 3102). CONCLUSIONS:These findings demonstrate an independent circular relationship between diabetes and skeletal muscle strength. In older people, muscle dysfunction may be a long-term diabetes complication. Whether increasing muscle strength might reduce diabetes risk remains to be determined.

Abstract Atrial fibrillation (AF) is the most common arrhythmia in older adults and often coexists with other chronic conditions, exacerbating physical and cognitive decline and contributing to frailty. The interplay between frailty and comorbidity in AF remains underexplored, particularly regarding quality of life (QoL), health management, and outcome prioritization. Within the AFFIRMO project, this study investigated the experiences of older adults with AF and at least one chronic condition via an online survey. Frailty was assessed using the FRAIL questionnaire, and participants were grouped by frailty status and number of comorbidities. Health-related quality of life (HRQoL) was measured using the EQ-5D-3L and Visual Analogue Scale (VAS). Challenges in health management and prioritized outcomes were also explored. We included 659 participants (median age 72 years, 52.8% female). Those with pre-frailty or frailty and ≥ 3 comorbidities reported the poorest HRQoL. Comorbidity, particularly combined with frailty, was associated with health management difficulties, including healthcare visits, polypharmacy, and mobility limitations. Across all groups, maintaining independence and improving QoL were prioritized outcomes. Pain relief was especially important for those with higher comorbidities. In older adults with AF, comorbidity and frailty significantly affect QoL and health burden. Tailored, patient-centred care strategies and routine assessment of frailty and comorbidity are essential to improve care coordination and outcomes.

Long-term care facility (LTCF) residents represent one of the populations most vulnerable to SARS-CoV-2 infection and have experienced repeated vaccination and natural viral exposure since the beginning of the COVID-19 pandemic. The long-term dynamics of humoral and cellular immunity in this population remain incompletely characterized. In this multicenter longitudinal study, SARS-CoV-2-specific antibody responses were monitored in LTCF residents over 12 months. A total of 388 residents from LTCF across five Italian regions were enrolled and stratified according to receipt of the SARS-CoV-2 XBB.1.5 mRNA booster during the 2023–2024 vaccination campaign. In a subgroup of residents, peripheral B-cell phenotypes and Spike-specific memory B cells were characterized by flow cytometry and compared with those of younger healthcare workers vaccinated with the same formulation. Anti-Spike IgG titers peaked in residents who received the XBB.1.5 booster and subsequently declined over time, consistent with contraction of vaccine-induced humoral responses. In contrast, individuals who did not receive the booster maintained lower but stable antibody levels. Anti-nucleocapsid seroconversion and clinically diagnosed intercurrent infections occurred at broadly comparable observed rates in boosted and non-boosted residents, suggesting a comparable incidence of SARS-CoV-2 infection during follow-up. Regarding B-cell-mediated immunity, LTCF residents exhibited age-associated remodeling of the B-cell compartment, with reduced total B-cell frequencies but preserved antigen-experienced memory populations. Despite declining circulating antibodies, Spike-specific memory B-cell frequencies remained stable. A late increase in anti-Spike titers coincided with rising anti-nucleocapsid seropositivity, suggesting reactivation of immune memory following natural viral exposure. These findings indicate that repeated vaccination and natural exposure generate durable immunological memory in LTCF residents. In highly exposed populations, immune maintenance may increasingly rely on reactivation of memory responses rather than persistently high antibody titers.

Arterial hypertension is a frequent condition, affecting up to one-quarter of the global adult population. Both pharmacological and non-pharmacological treatments are recommended for hypertension management. Among the latter, recent studies have shown the positive effects of music therapy; however, evidence on the impact of vibroacoustic stimulation (VAS) is still limited. This pilot study aimed to explore the feasibility and effects of a VAS intervention on blood pressure (BP) and other cardiopulmonary and stress-related parameters in patients with hypertension. A pilot single-sequence cross-over experimental study was conducted on 11 male adults with mild to moderate hypertension. Patients underwent two sessions: on Day 1, they lay for 30 min without any vibratory or musical stimuli. On Day 2, they were placed on the vibroacoustic bed delivering 40 Hz vibration for 30 min, followed by 7 min of vibration combined with relaxing music. Physiological and stress-related parameters were measured at multiple time points during both sessions. Preliminary analysis showed no statistically significant differences between sessions. However, on Day 2, a more pronounced trend toward reductions in systolic and diastolic BP, heart and respiratory rate, and perceived stress was observed. A higher heart rate variability was recorded on Day 1 compared to Day 2. The VAS intervention appears feasible and may influence cardiovascular health parameters. Further studies with larger sample sizes are necessary to confirm these effects.

PurposeAtrial fibrillation (AF) often coexists with multiple chronic conditions, worsening health-related quality of life (HRQoL) and increasing the burden on patients and caregivers. While multimorbidity is known to worsen clinical outcomes, the role of distinct comorbidity patterns in shaping patients' experience remains unclear. This cross-sectional study assessed whether the number and patterns of comorbidities differentially affect HRQoL, care needs, and priorities of AF patients and caregivers.MethodsAn online survey on living with AF and multimorbidity was disseminated between May 2022 and January 2023 in the UK, Italy, Spain, Romania, and Denmark. The analysis included 633 AF patients (46.9% females, median age 73 years) and 198 caregivers (26.8% females, median age 57 years). Exposure variables were the number and patterns (derived through latent class analysis) of comorbidities. Outcomes included HRQoL (measured with the EQ-5D-3L), perceived management problems and health priorities assessed through a structured questionnaire developed ad hoc for the survey.ResultsThree patterns emerged: unspecific (65.5%), diabetes-kidney-liver (18.2%), and complex (16.4%). More comorbidities and belonging to the complex pattern were associated with worse HRQoL, mainly due to limited mobility, dependency, and pain. Main issues were managing multiple diseases, medi ions, and appointments. The diabetes-kidney-liver group prioritized improving quality of life (OR=3.08, 95%CI:1.68-6.00) and living longer (OR=1.67, 95%CI:1.05-2.64), while pain relief was a distinct priority in the complex pattern (OR=2.32, 95%CI:1.38-3.86).ConclusionBoth number and combinations of AF comorbidities shape patients' and caregivers' experiences. Considering comorbidity profiles can help define targeted care plans and caregiver support initiatives.

To investigate how delirium occurring at distinct perioperative phases affects functional status at discharge in older adults undergoing hip fracture surgery. Nearly 30

OBJECTIVES:The aim of this retrtospective study was to investigate the association between undernutrition and the trajectories of neurocognitive aging. METHODS:We used harmonized data from two population-based longitudinal studies: the Progetto Veneto Anziani and the Italian Longitudinal Study on Aging. Both studies included a baseline and two follow-up evaluations over 9 y. Undernutrition was defined according to the Global Leadership Initiative on Malnutrition criteria, and cognitive function was assessed using the Mini-Mental State Examination. RESULTS:The analytical sample comprised 3852 individuals (46% female) aged 65 to 96 y. During follow-up, growth mixture modeling identified three Mini-Mental State Examination score trajectories. Trajectory 1 (4.8% of participants) was characterized by a steep decline, trajectory 2 (22.1% of participants) by a gradual decrease, and trajectory 3 (73.1% of participants) by high scores that remained nearly stable throughout the follow-up period. Overall, 540 participants (14.1%) had undernutrition, with a prevalence significantly higher in trajectory 1 (26.9%) than in trajectory 2 (17.3%) or trajectory 3 (12.2%). Baseline undernutrition was associated with a higher probability of belonging to the rapidly decreasing trajectory 1 (odds ratio, 1.71, 95% confidence interval, 1.06-2.77, reference, trajectory 3), a finding driven mainly by the phenotypic Global Leadership Initiative on Malnutrition criteria. CONCLUSIONS:Undernutrition is associated with steeper cognitive decline in older adults, particularly when phenotypic signs are present. However, given the potential bidirectional relationship between cognitive status and undernutrition, reverse causation cannot be ruled out entirely. Nevertheless, our findings underscore the importance of assessing nutritional status in advanced age, as it represents a modifiable factor that may delay or prevent cognitive decline.

BACKGROUND:In younger individuals, fitness is mostly influenced by muscle mitochondrial oxidative phosphorylation (OxPhos) and cardiac output. However, compared with younger individuals, various impairments may also negatively affect fitness in older adults. OBJECTIVE:To investigate the relationship of OxPhos with cardiorespiratory fitness, the energetic cost of walking and aerobic resilience with respect to age. DESIGN:Cross-sectional. SETTING:Population. SUBJECTS:Six hundred and forty-nine Baltimore longitudinal study of ageing participants (mean age 64.5 years, 56.9% females). METHODS:Muscle mitochondrial OxPhos was measured as phosphocreatine recovery rate (kPCr) through 31P magnetic resonance spectroscopy. Based on age- and sex-specific kPCr z-scores, we classified individuals with low (≤ -0.5 standard deviations [SD]), average (-0.5 to 0.5SD) and high (>0.5SD) OxPhos. Cardiorespiratory fitness was measured as peak oxygen consumption (MVO2 peak) during a treadmill testing. The energetic cost of usual pace walking was expressed as the average oxygen consumption per 100 metres. Aerobic resilience was the ratio between MVO2 peak and average VO2 during usual pace walking. RESULTS:Participants with higher kPCr had 4.07 (95%CI: 2.88, 5.26) ml/kg/min higher MVO2 peak and 0.19 (95%CI: 0.06, 0.32) higher aerobic resilience than those with lower kPCr. The energetic cost of walking was greater by 0.84 (95% CI: 0.21, 1.47) ml/kg/100 m in those with high than low kPCr. A multiplicative interaction between age and kPCr was identified in the regressions predicting MVO2 peak and aerobic resilience (pinteraction = 0.01), with differences between OxPhos groups attenuating after age 70. CONCLUSION:Muscle mitochondrial OxPhos contributes to interindividual variability in cardiorespiratory fitness, especially in young and middle adulthood.

BACKGROUND:Atrial fibrillation (AF) is prevalent in older adults and has been associated with functional decline beyond its cardiovascular complications. However, the interplay between AF, multimorbidity, and functional decline remains poorly understood. In this study we investigated the effect of AF and multimorbidity on longitudinal transitions in functional status among older adults, considering initial self-sufficiency levels. METHODS:This longitudinal analysis included 3083 community-dwelling individuals aged 65 years or older from the Progetto Veneto Anziani (Pro.V.A.) study. Functional status was classified into 3 states-independent, moderately impaired, and severely impaired in activities of daily living-and modelled through continuous-time multistate models. Independent variables included AF, multimorbidity, and covariates such as age, sex, education, living arrangements, smoking status, body mass index, Mini-Mental State Examination and Geriatric Depression Scale scores. RESULTS:Over a median follow-up of 4.4 years (standard deviation, 0.5), 33.5% of independent individuals experienced functional decline, 13% died, and only 12.2% improved after moderate impairment. AF was significantly associated with transition from independence to severe functional impairment (hazard ratio [HR], 4.12; 95% confidence interval [CI], 1.83-9.24), although this estimate is on the basis of a small number of events and should be interpreted with caution, from moderate to severe impairment (HR, 1.75; 95% CI, 1.01-3.1), and with mortality in moderately impaired individuals (HR, 1.66; 95% CI, 1.16-2.38). Multimorbidity showed no association with worsening transitions but was associated with mortality among independent individuals (HR, 1.15; 95% CI, 1.07-1.24). CONCLUSIONS:AF is a marker of greater risk of severe functional decline in older adults, whereas multimorbidity primarily increases mortality. Routine functional assessments and person-centred interventions are essential to preserve autonomy and prevent disability in older adults with AF.

To investigate whether sarcopenia is associated with reduced diaphragmatic motility in older adults hospitalized for acute respiratory failure requiring high-flow nasal cannula or non-invasive ventilation. In this multicenter observational study including 127 patients, sarcopenia was present in over half of cases and was associated with significantly lower diaphragmatic excursion and thickening fraction. After adjustment for age, comorbidities, and respiratory severity, reduced diaphragmatic excursion remained independently associated with sarcopenia. Bedside diaphragmatic ultrasound can help identify older patients with respiratory muscle weakness and may support a more individualized management during acute respiratory failure. A Multicenter prospective observational study to investigate the association between sarcopenia and diaphragmatic motility in patients admitted for acute respiratory failure (ARF) requiring high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV), and to evaluate whether diaphragmatic ultrasound parameters predict short-term outcomes. A total of 127 patients hospitalized in the Sub-intensive care units of Fondazione Policlinico Universitario Campus Bio-Medico (Rome), Monaldi Hospital (Naples), and University Hospital of Ferrara with ARF due to various respiratory diseases and requiring respiratory support between January 2023 and January 2025. Sarcopenia was defined using EWGSOP2 criteria (reduced handgrip strength and calf circumference). Diaphragmatic excursion (DE) and thickening fraction (TF) were assessed by ultrasonography during spontaneous breathing prior to respiratory support. Logistic regression and Cox models were used to examine associations with sarcopenia, 3-month mortality and hospital outcomes. Sarcopenia was diagnosed in 52.7

BACKGROUND:Medication prescribing in long-term care facilities (LTCFs) is characterized by widespread polypharmacy and frequent exposure to potentially clinically relevant drug-drug interactions (DDIs). METHODS:Data from the Italian Prescription Day in LTCFs 2024, a national multicenter point-prevalence study conducted in 82 LTCFs, were analyzed. Prescriptions were classified using the Anatomical Therapeutic Chemical system, and DDIs were identified using an international consensus list. Resident-level variables were assessed using validated tools, and associations with DDI burden were examined using univariate mixed-effects Poisson regression models. Facility-level organizational characteristics were described by center-level DDI burden. RESULTS:The analysis included 3174 residents (mean age 84.8 years; 74.1% women), with a mean of 7.7 prescribed drugs. Drugs acting on the nervous system, alimentary tract and metabolism, and cardiovascular system were most frequently prescribed; furosemide, paracetamol, pantoprazole, quetiapine, and macrogol were the most commonly used active substances. Overall, 42.2% of residents were exposed to at least one potentially clinically relevant DDI, most commonly involving centrally acting drugs, cumulative anticholinergic burden, serotonergic combinations, and potassium-related interactions. Higher DDI burden was associated with greater pharmacological complexity, depression, sleep disorders, cardiopulmonary disease, and behavioral and psychological symptoms of dementia, whereas older age, severe cognitive impairment, malnutrition, and dysphagia were associated with fewer DDIs. Facility-level and staffing characteristics showed limited differentiation, with assisted living facilities under-represented at higher DDI burden. CONCLUSIONS:Potentially clinically relevant DDIs are common in Italian LTCFs and are primarily associated with resident-level clinical complexity, highlighting targets for medication review and deprescribing to improve medication safety.

Background Mild Behavioral Impairment (MBI) has been proposed to detect neuropsychiatric symptoms (NPS) associated with dementia development, but evidence from population-based settings is limited. Objectives To (i) investigate the association between NPS in late life and the onset of dementia over 15 years in community-dwelling older adults, and (ii) test the interplay of NPS and Cognitive Impairment, No Dementia (CIND) in dementia development. Methods 2597 dementia-free individuals aged 60+ from a longitudinal population-based cohort underwent cognitive assessments over 15 years. Thirty clinically-assessed NPS were mapped into five domains and, within each domain, a z-score was computed from the sum of the NPS’s points. MBI was identified when the z-score was above 1.5 standard deviations (SDs) in at least one of 5 neuropsychiatric domains. Based on a cognitive battery, CIND was defined as scoring ≥1.5 SDs below age-specific means in at least one cognitive domain. Dementia was diagnosed by DSM-IV criteria following standardized procedures. Results MBI, present in 16.1% of the sample, was associated with a higher hazard of incident dementia over 15 years (multi-adjusted hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.31–2.17). Decreased motivation and social inappropriateness were the domains associated with incident dementia (HR 2.23, 95%CI 1.59–3.14 and HR 3.29, 95%CI 1.83–5.94, respectively). Compared to those with neither, individuals with either MBI (HR 1.37, 95%CI 1.00–1.90) or CIND (HR 2.22, 95%CI 1.73–2.84) had increased dementia incidence, especially when co-occurring (HR 4.41, 95%CI 3.04–6.39). Conclusions Late life NPS, especially with co-occurring cognitive impairment, was associated with a higher dementia incidence.

Background: Atrial fibrillation (AF) is prevalent in older adults and has been associated with functional decline beyond its cardiovascular complications. However, the interplay between AF, multimorbidity, and functional decline remains poorly understood. In this study we investigated the effect of AF and multimorbidity on longitudinal transitions in functional status among older adults, considering initial self-sufficiency levels. Methods: This longitudinal analysis included 3083 community-dwelling individuals aged 65 years or older from the Progetto Veneto Anziani (Pro.V.A.) study. Functional status was classified into 3 states & horbar;independent, moderately impaired, and severely impaired in activities of daily living & horbar;and modelled through continuous-time multistate models. Independent variables included AF, multimorbidity, and covariates such as age, sex, education, living arrangements, smoking status, body mass index, Mini-Mental State Examination and Geriatric Depression Scale scores. Results: Over a median follow-up of 4.4 years (standard deviation, 0.5), 33.5% of independent individuals experienced functional decline, 13% died, and only 12.2% improved after moderate impairment. AF was significantly associated with transition from independence to severe functional impairment (hazard ratio [HR], 4.12; 95% confidence interval [CI], 1.83-9.24), although this estimate is on the basis of a small number of events and should be interpreted with caution, from moderate to severe impairment (HR, 1.75; 95% CI, 1.01-3.1), and with mortality in moderately impaired individuals (HR, 1.66; 95% CI, 1.16-2.38). Multimorbidity showed no association with worsening transitions but was associated with mortality among independent individuals (HR, 1.15; 95% CI, 1.07-1.24). Conclusions: AF is a marker of greater risk of severe functional decline in older adults, whereas multimorbidity primarily increases mortality. Routine functional assessments and person-centred interventions are essential to preserve autonomy and prevent disability in older adults with AF.

BACKGROUND:Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. OBJECTIVES:The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in "at risk" community-dwelling older adults. METHODS:A total of 105 participants (69% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0-30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0-14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. RESULTS:At baseline, the mean MNA score was 22.5 ± 2.3. After 6 mo, nutritional status improved significantly in both intervention groups compared with CON: mean differences in MNA were 2.7 [95% confidence interval (CI): 1.3, 4.2] for PROMED and 2.9 (95% CI: 1.5, 4.3) for PROMED-EX (both P < 0.001). Cognitive function also improved, with NTB z-score differences of 0.3 (95% CI: 0.1, 0.5; P = 0.01) in PROMED and 0.2 (95% CI: 0.0, 0.4; P = 0.02) in PROMED-EX compared with CON. Diet quality scores significantly increased with mean differences of 4.0 (95% CI: 2.9, 5.0) for PROMED and 3.9 (95% CI: 2.8, 4.9) for PROMED-EX compared with CON (both P < 0.001). Despite low adherence to exercise, additional benefits were observed for physical performance and quality of life. CONCLUSIONS:Dietary intervention improved nutritional status in community-dwelling older adults at risk of undernutrition. Correcting undernutrition could help to slow cognitive decline and promote physical health and quality of life during aging. This study was registered at clinicaltrials.gov as NCT05166564.

Although individuals with Mild Behavioral Impairment (MBI) show an increased rate of developing dementia, it remains uncertain whether MBI should be considered a risk factor or an actual early sign of neurocognitive disease. This systematic review and meta-analysis aimed to explore the association between MBI and neurobiological correlates of dementia. The study protocol followed PRISMA guidelines and was registered in PROSPERO (CRD42024589059). Five databases and gray literature were systematically searched from inception to January 31, 2025 to identify studies that explored the relationship between MBI and brain imaging findings or neurodegenerative and neuroinflammatory fluid biomarker levels. When studies employed comparable methodologies, a random-effects meta-analysis was performed to summarize the results; conversely, a qualitative synthesis was conducted. The Newcastle-Ottawa Quality Assessment Scale was used to assess the study quality. Of the 834 records, 27 studies were included. Most studies were cross-sectional and examined the presence of structural or functional abnormalities through brain imaging in individuals with MBI. Six studies, 4 of which were longitudinal, focused on MBI and cerebrospinal fluid or plasma biomarkers of neurodegeneration and neuroinflammation. Due to the high methodological heterogeneity across studies, five random-effects meta-analyses were conducted, each including two studies. These analyses reported a positive, cross-sectional correlation between MBI burden and brain deposition of amyloid-beta (Aβ) or tau. Conversely, MBI was not significantly associated with either plasma phosphorylated-tau181 levels or Magnetic Resonance Imaging (MRI) brain atrophy markers. Nevertheless, based on the qualitative synthesis of the 27 included studies, MBI was frequently linked to Alzheimer’s disease (AD) abnormalities – both in biomarkers and brain imaging studies. Across studies, MBI appears to be linked to specific neurobiological markers of AD, including Aβ and tau brain deposition, as well as alterations in the mesolimbic pathway and neurodegenerative and neuroinflammatory fluid biomarker levels. Although emerging evidence supports MBI as a potential early clinical sign of AD, heterogeneity across studies precludes definitive conclusions regarding its precise role in the onset and progression of the disease.

BACKGROUND:Sarcopenia is a complex and multifactorial condition, and recent studies have explored the role of neurological markers in its diagnosis and prediction. Although associations have been identified between reduced muscle strength, slow walking speed and elevated neurofilament levels (NfL), long-term evidence and sex-based differences in muscle health and sarcopenia remain underexplored. This study investigates the relationship between baseline blood biomarkers of Alzheimer's disease (AD) and long-term sarcopenia trajectories in a Swedish cohort of older adults, while also examining potential sex-based differences. METHODS:The study analysed 2291 participants aged ≥ 60 years (61.5% females) over a 12-year follow-up, classifying sarcopenia into three stages (no, probable and confirmed sarcopenia) using modified EWGSOP2 criteria. Muscle strength was assessed via handgrip or chair stand tests and muscle mass via calf circumference. Baseline data on AD biomarkers were collected. Latent class mixed models identified two sarcopenia trajectories: one with early progression accelerating around age 70 years and another with later progression accelerating after age 80 years, observed in both sexes. Regression analyses examined the associations between AD biomarkers, sarcopenia progression speed and incidence. RESULTS:Probable and confirmed sarcopenia were more prevalent in females (28.2% vs. 14.1% and 7.6% vs. 6.1%, respectively; p < 0.001). All AD biomarkers showed significantly different distributions across the three sarcopenia stages. Analysis revealed that only p-tau181 (OR 1.24 [1.09; 1.42], p = 0.002) and NfL (OR 1.56 [1.30; 1.91], p < 0.001) were independently associated with worse sarcopenia trajectories. These associations remained significant in individuals over 78 years (p-tau181: OR 1.32 [1.11; 1.59], p = 0.003; NfL: OR 1.77 [1.40; 2.28], p < 0.001) and in males (p-tau181: OR 1.39 [1.14; 1.73], p = 0.003; NfL: OR 1.38 [1.11; 1.82], p < 0.001). In females, only NfL remained significantly associated. NfL was significantly linked to sarcopenia development (HR 1.20 [1.10; 1.30], p < 0.001), with similar findings for females (HR 1.40 [1.20; 1.63], p < 0.001) and older individuals (HR 1.35 [1.15; 1.58], p < 0.001). Notably, both NfL and p-tau181 were significantly associated with sarcopenia incidence in younger participants (< 78 years) and in males, independent of dietary patterns. CONCLUSIONS:Our study, unique for its long follow-up duration, explores the relationship between sarcopenia and neurodegeneration biomarkers, highlighting the role of p-tau181 and NfL in the progression of the condition. These biomarkers could potentially serve as indicators for the early detection of sarcopenia, particularly in older adults and males, offering insights that may contribute to personalized screening and targeted interventions.

Infectious diseases are among the most common causes of hospitalization in older adults and may lead to a high burden on the individual’s health and healthcare system. However, it is unclear whether and to which extent these events might affect frailty, fastening its development or hampering its reversion. The aims of the INFRAGEN project are 1) to assess the impact of acute infections on frailty trajectories in older inpatients, and 2) to evaluate the modifying effect of sociodemographic, clinical, functional, and genetic/epigenetic factors on that association. INFRAGEN is a multicenter prospective observational study that will be conducted in the acute Geriatric Units of four Italian centers (Ferrara, Padova, Monza, and Napoli). The project will involve individuals aged ≥ 70 with no or mild-to-moderate pre-admission frailty (Clinical Frailty Scale [CFS] < 6) and diagnosis of acute infectious diseases at the time of hospital admission or during hospitalization. For each participant, we will record data concerning the multidimensional geriatric assessment and the type and severity of infectious diseases (diagnosed according to ICD-9 codes). Blood samples will be collected to assess Global DNA methylation, Leukocyte Telomere Length (LTL), and levels of circulating markers associated with biological processes related to frailty (inflammatory state, dysmetabolism, brain modifications, and oxidative stress). Frailty status will be evaluated through the CFS and Frailty Index at admission (referring to the 2 weeks before hospitalization), hospital discharge, and after 3 months. In a subsample, genetic/epigenetic analyses will also be performed at the 3-month follow-up. INFRAGEN will contribute to exploring the complex pathophysiologic mechanisms of frailty in the context of infections in older adults through a translational approach. NCT06430073 (ClinicalTrials.gov); Registration date: 2024–05-28.

OBJECTIVES:To evaluate the knowledge and attitudes of older patients and their caregivers towards generic drugs. DESIGN:Cross-sectional multicentre study. METHODS:Older patients or their caregivers from 15 Italian departments of geriatrics, internal medicine, and rehabilitation completed a structured questionnaire to investigate their attitude towards generic drugs. RESULTS:Among 312 patients (53.8 % females, mean age 79 years) and 163 caregivers (62.8 % females, mean age 62.8 years), caregivers reported knowing what a generic drug is more frequently than patients (96 % vs 84 %), and only 17 % in both groups declared to be well-informed on the subject. Patients were more likely than caregivers to believe that generic drugs take longer to become effective (22 % vs 12 %), are made with lower-quality substances (27 % vs 9 %), and are less effective (43 % vs 28 %) compared to brand-name drugs. CONCLUSIONS:Knowledge about generic drugs remains limited; educational and promotional initiatives are necessary to dispel misconceptions regarding generic drugs.

Background: Atrial fibrillation (AF), often accompanied by multimorbidity, places heavy demands on informal caregivers. Although caregiver burden is recognized in other chronic conditions, little is known about burden, health-related quality of life (HRQoL), and engagement among caregivers of patients with AF across Europe. Objectives: The aim of the study was to examine caregiver burden, HRQoL, and engagement among informal caregivers of patients with AF and multimorbidity, and to explore interrelationships between these outcomes and caregiving characteristics. Methods: A cross-sectional online survey was conducted between May 2022 and January 2023 with 179 informal caregivers from Italy, Romania, and Spain. Validated instruments assessed burden (Bakas Caregiving Outcomes Scale), HRQoL (EQ-5D-3L), and caregiver engagement (Caregiving Health Engagement Scale). Group differences were tested using nonparametric analyses, and associations were examined through partial Spearman correlations, adjusting for sociodemographic and caregiving variables. Results: Participants reported moderate burden and preserved HRQoL in physical domains, but frequent pain/discomfort and anxiety/depression. Engagement was generally low, with most informal caregivers in early or intermediate stages of engagement. Burden was higher among women, younger caregivers, and those in Italy and Romania, while HRQoL was poorer in older caregivers, cohabitants, and those caring for patients with a higher number of comorbidities or reduced mobility. Highly engaged caregivers reported lower burden, better overall health, and less anxiety/depression than low-engaged peers. Conclusions: Informal caregivers of patients with AF and multimorbidity face psychological strain despite preserved physical functioning. Engagement was a protective factor associated with a lower burden and improved well-being. Fostering engagement and collaboration with professionals may ease strain and support sustainability.