The effects of testosterone include sex differentiation, muscle formation, increase in bone density, promotion of erythropoiesis, erectile function, etc. With aging, the concentration of testosterone in serum decreases at a rate of 0.4-2.6% per year. Hypotestosterone is a well-studied disease and the deficiency is defined as a clinical syndrome associated with increasing age and comorbidities. It is characterized by the level of testosterone in the blood and its correlation with other complicating conditions. Low testosterone is defined as < 350 ng/dL (12 nmol/L). The aim is to review the latest work on testosterone treatments, including their advantages and disadvantages, and to address important issues in testosterone therapy. Keywords: Metabolic syndrome, cardiovascular risk, testosterone replacement therapy, blood testosterone concentration, obesity in the elderly

Abstract Old-aged adults often suffer from nutrient deficiency or appetite loss resulting from taste and smell degeneration, poor oral and dental functions, and chewing and swallowing difficulties in addition to having poor digestion and gastrointestinal tract absorption or delayed stomach emptying. Consequently, anorexia and less food consumption occur, not to mention the medication–food interaction that will aggravate insufficient nutrient intake. Moreover, aged people tend to isolate or suffer from depression, and insomnia, which can all weaken and empty their body and soul, leading to undernourishment. Older adults who are picky eaters are 2.5 times more prone to develop weakness in the future than average individuals, as well as a significant increase in disability risk by 40%. Anorexia nervosa, which refers to a decline in appetite or food intake, is common in this population because of the degradation of chewing and swallowing functions. In fact, those who are 65 years old and above have a 21.8% chance of choking on food at least thrice a week, for which 12.8% of them were diagnosed with dysphagia, statistically equivalent to 1 out of every 10 old-aged adults having a mild or more severe swallowing disorder.

Approximately 43% of patients with REM sleep behavior disorder (RBD) will develop Parkinson's disease and 25% with Lewy body dementia. The long-term clinical trial of RBD patients showed over 90% risk of developing neurodegenerative diseases. REM sleep behavior disease is characterized by the enactment of dreams, involving complex motor functions. The disease is now considered a prodrome to Parkinson’s disease. In the future, it is recommended for researchers to investigate the potential of REM sleep without tension as a clinical indication of neurodegenerative diseases, for which physicians can rely on to detect diseases for early intervention and treatment.

The biggest impact of Taiwan's population aging on society is the increase in the demand for geriatric medical care and the increase in the burden of social and economic welfare. It will have an impact on domestic consumption, domestic demand and labor supply, and changes in the demographic structure will also have an impact on the economy. There will be a series of changes in consumer demand and in-frastructure as the workforce shrinks and productivity weakens. The negative effects of sarcopenia in obese or osteoporotic populations are greater than those in the general healthy population, and sar-copenia is additive to the effects of obesity and osteoporosis on metabolism and physical activity. The increase of adipose tissue in the elderly can also lead to an increase in chronic inflammation in the body, increase insulin resistance, reduce muscle synthesis and increase muscle breakdown, resulting in an in-crease in the prevalence of sarcopenic obesity in the elderly. Studies have shown that sarcopenia in-creases the risk of falls in the elderly, and also causes obese elderly people to easily lose muscle under a calorie-restricted diet. It can be seen from the above that nutritional supplementation and moderate aerobic and resistance exercise can reduce the risk of sarcopenia and falls in the obese elderly. Falls and their related injuries represent one major health care issue in the elderly population. Falls are a com-mon event among older adults and are associated with increased morbidity and disability.Copyright & COPY; 2023, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

Osteoporosis is a skeletal disease caused by changes in the structure of the human skeleton, resulting in fragile and easily fractured bones. Because it is more common in postmenopausal women or the elderly, fractures may cause disability in the elderly, resulting in reduced quality of life, bedridden, or increased mortality. Therefore, the treatment of osteoporosis is one of the important issues in today’s aging society. In addition, diseases such as bone metastasis of cancer and multiple myeloma also need to be paid attention to. Drugs for the treatment of osteoporosis have been widely used in the prevention and treatment of osteoporosis because of their inhibitory effect on osteoclast activity, and even become the first-choice drug for bone metastases of some malignant tumors. Drugs for the treatment or prevention of osteoporosis can inhibit osteoclasts, and can also be used to treat hypercalcemia complications of malignant tumors or bone-related systemic diseases. For example, bisphosphonates or monoclonal antibody preparations (eg: Denosumab, Romosozumab, etc.) can resist bone resorption. However, in recent years, the literature pointed out that patients using anti-bone resorption drugs may have adverse reactions to maxillofacial osteonecrosis. Medication-Related Osteonecrosis of the Jaw (MRONJ) may occur in patients with osteoporosis and tumors. Bisphosphonates or synthetic human monoclonal antibodies can inhibit bone resorption and are currently the most commonly used drugs for the treatment of osteoporosis in the world. The literature for nearly 20 years has shown that long-term use of such antiresorptive drugs increases the risk of osteonecrosis of the jaw in the oral cavity. Therefore, MRONJ is still a complication that we must pay attention to. Once MRONJ occurs, it is recommended to refer to an oral surgeon immediately; the current clinical treatment methods include the use of antibacterial mouthwash and drugs to control pain in mild cases, and antibiotics for infection control in moderate cases.

Cranberries are known to prevent urinary tract infection and it is also helpful in maintaining oral health. Cranberry juice is a widely consumed and recommended beverage for preventing urinary tract infections. Clinical studies in women have shown that cranberries help to stop the recurrence of infection, as the evidence showed the presence of various extracts of cranberries in the patients’ urinary tracts, proving the effectiveness and the mechanism. The primary compound involved in the fight against the infection is Proanthocyanidin A which is now the focus of studies to treat common diseases such as Helicobacter pylori-associated gastritis, as well as dental caries and periodontal disease, from which it is speculated the mechanism involves disrupting the bacterial adhesion.

According to the WHO’s report, the number of people with diabetes worldwide is increasing, and the prevalence of type 2 diabetes in adults who is over 18 years old has risen from 4.7% in the 1980s to 8.5% in 2014. Among them, the prevalence of diabetes in low- and middle-income countries has even reached as high as 9.3% over the decades. Metabolic-Associated Fatty Liver Disease (MAFLD) is not only affecting the liver but is also considered a problem for the heart, as there is about 25% of the patients suffer from the cardiovascular syndrome. Around the world, the elderly population is growing rapidly. The elderly population is growing faster than expected, with Taiwan becoming an aged society in 2018. One of the health issues associated with aging is the population with cardiovascular disease increases. Patient care may result in huge expenditures on the national economy, society, family care, medical resources, and drugs. This article adopts perspectives from literature reviews using databases such as Cochrane Library, PubMed (Medline), Up-to-date and Google scholar using three main methods: search for keywords cardiovascular disease, physical fitness, exercise prescription intervention, quality of life, cardio metabolic disease, etc.; search for related articles on physical activity and cardiovascular disease, neuroendocrine, molecular biology, etc.; combined with case-control studies, systematic review and meta-analysis, analytical research, and randomized control studies to explore the effects of physical activity intervention and the fitness level of the elderly on the epidemiology of the cardiovascular disease, prevention of cardio metabolic disease, improvement of quality of life. Understanding which types of exercise intervention help improve the quality of life of patients with cardiovascular disease. This article aims to propose exercise prescriptions for physical fitness to prevent cardiovascular disease; be used as a reference for health promotion in the world, provide guidance on cardiovascular disease prevention and cardiovascular disease care for the elderly, and construct guidelines on physical fitness and exercise prescriptions in Taiwan.

Human body cannot produce omega-3 fatty acids and must obtain it from diet. There are three types of omega-3 fatty acids that are needed by the human body, namely α-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Although studies have shown that omega-3 fatty acids cannot prevent or treat diabetes or heart diseases, it did improve the condition of insulin resistance and the level of triglycerides in the body. It is well known that overweight leads to insulin resistance, which in turn leads to metabolic syndrome. Many animal experiments have already confirmed that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA) are beneficial in promoting insulin sensitivity. It inhibits nuclear transcription factor kappa B (NFκB), which is a key transcription factor for gene expression of inflammatory cytokines. On the other hand, studies have also pointed out that omega-3 polyunsaturated fatty acids do not improve the function of kidney’s endothelial cells and high blood pressure in patients of type 2 diabetes.

Normally, the body can produce vitamin D at sun exposure. Vitamin D plays a key role in bone and tooth mineralization, and when levels are unregulated it can lead to the “rachitic tooth”, which is a defective and hypomineralized organ highly susceptible to fracture and decay. The conditions like recurrent aphthous stomatitis, atrophic glossitis or a painful, burning tongue which is characterized by inflammation and defoliation of the tongue, are possibly caused by nutritional deficiencies such as vitamin B and iron deficiencies. The deficiency has been linked to a variety of diseases, including in the oral cavity. Inadequate sun exposure may accelerate the onset of these diseases since the synthesis of vitamin D is interrupted. Vitamin D not only benefits the overall health of oral cavity but is also associated with tooth mineralization. It can help to fight against inflammation and stimulate the production of antimicrobial peptides for immune response. Thus, in this paper, we will briefly discuss the origin of various oral diseases caused by insufficient level of vitamin D in the body and shed light on the potential benefits of safe sun exposure to maintain both oral and body health. Lack of vitamin D can lead to dental caries, and weak or brittle teeth that easily break, chip, and crack. Their inadequacy leads to absorption impairment, increased bleeding tendency, bone resorption, looseness, and premature tooth loss. Inadequacy of those essential minerals is associated with delayed tooth eruption and with enamel or dentin hypoplasia.

Oral lichen planus is a chronic inflammatory autoimmune disease affecting the oral mucous membrane. Its causes may include chronic medication use, metal denture friction, stress, and emotional disturbance. It is characterized by swelling and irritation with slight desquamation of the membrane, as well as Wickham striae under dermoscopy. Another common benign condition of skin hyperplasia is lichenoid keratosis, which involves an erythematous rash in the trunk or upper limbs triggered by friction. Although the two aforementioned conditions may occur separately, simultaneous sighting of two to three lesions in the skin has been reported.

Fibromyalgia is a systemic disease with multiple muscle and fascia tender points, combined with chronic inflammation or neuropathies. Apart from feeling many tender points all over the body, patients also have many atypical symptoms, such as anxiety and migraine. Pain can be caused by even light activities. Additionally, the incidence rate of women aged 20–50 years is much higher than that of men, and the main clinical symptoms are chronic and extensive pain and tenderness. Patients with fibromyalgia have many common clinical comorbidities, such as depression, anxiety, sleep disorders, chronic fatigue, chronic headaches, temporomandibular joint disorders, general numbness and tingling, irritable bowel syndrome, difficulty concentrating, and so on. The symptoms reduce the patient’s quality of life. Patients with fibromyalgia often have symptoms other than muscle pain. Thus, it is clinically referred to as fibromyalgia syndrome. Moreover, fibromyalgia is similar to the symptoms of many autoimmune diseases, such as rheumatoid arthritis, lupus erythematosus, polymyositis, and so on. Physicians should exclude these diseases to ensure accurate diagnosis.

According to the American Dental Association (ADA), diabetes can increase the risk of oral diseases and other symptoms in the oral cavity. About one-fifth of tooth loss can be attributed to diabetes. Periodontal diseases include gingivitis and periodontitis. Gingivitis is the acute or chronic inflammation of the gums, which is usually caused by dental plaques. Five major impacts on oral health by diabetes include gum disease, dry mouth or change in taste, infection, slow healing and periodontal disease. In addition, beside affecting blood sugar; periodontal disease is also closely related to cardiovascular disease. Omega-3 polyunsaturated fatty acids (PUFA) are not only beneficial to cardiovascular and metabolism, but also can inhibit inflammation and diabetic patients.

Acute mountain sickness (AMS) is the most common form of illness at high altitude; however, it is still unclear whether age is a protective factor or a risk factor for the development of AMS in travellers. The condition generally occurs at altitudes higher than 8,000 feet (ft), or 2,500 meters (m), and is usually due to a lack of oxygen. A person who is not used to high altitudes is most at risk of developing altitude sickness. Mountain sickness is also called high altitude sickness, referring to the impact of environment on the body health at high elevation. Altitude illness is divided into 3 syndromes: acute mountain sickness, high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). Mountain climbers are at risk of developing altitude sickness. Altitude sickness is caused by ascending too rapidly, which doesn't allow the body enough time to adjust to reduced oxygen and changes in air pressure. Symptoms include headache, vomiting, insomnia and reduced performance and coordination. Generally, it is classified into three categories based on the onset condition, namely acute mountain sickness, high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE). Hypoxic sleep disruption contributes to the symptoms of acute mountain sickness. Hypoxemia at high altitude is most severe during sleep. The sickness signifies that the human body has yet to adapt to the environment at 2500 meters or above in elevation, where low air pressure and oxygen will impair body functions. Mild cases can be treated according to symptoms (such as with painkillers for a headache), which usually go away on their own within a few days. Medicines specific for altitude sickness are also available. Acetazolamide is used to prevent and reduce the symptoms of altitude sickness. This medication can decrease headache, tiredness, nausea, dizziness, and shortness of breath that can occur when you climb quickly to high altitudes.

Abstract Oral lichen planus is a chronic inflammatory autoimmune disease affecting the oral mucous membrane. Its causes may include chronic medication use, metal denture friction, stress, and emotional disturbance. It is characterized by swelling and irritation with slight desquamation of the membrane, as well as Wickham striae under dermoscopy. Another common benign condition of skin hyperplasia is lichenoid keratosis, which involves an erythematous rash in the trunk or upper limbs triggered by friction. Although the two aforementioned conditions may occur separately, simultaneous sighting of two to three lesions in the skin has been reported.

Acute mountain sickness (AMS) refers to the impact of the environment on body health at high elevations. It is classified into three based on the onset condition, namely, AMS, high-altitude cerebral edema, and high-altitude pulmonary edema. This type of sickness is a signal that tells the human body to adapt to the environment at 2500 m or above elevation, wherein low air pressure and oxygen will impair bodily functions. The Lake Louise AMS scale was created to assess the condition in adults. It was first developed in 1991 and remains a useful scale to help diagnose the severity of AMS. It was updated in 2018, in which sleep disturbance was removed as an indicating symptom.

Oral lichen planus is a chronic inflammatory autoimmune disease affecting the oral mucous membrane. Its causes may include chronic medication use, metal denture friction, stress, and emotional disturbance. It is characterized by swelling and irritation with slight desquamation of the membrane, as well as Wickham striae under dermoscopy. Another common benign condition of skin hyperplasia is lichenoid keratosis, which involves an erythematous rash in the trunk or upper limbs triggered by friction. Although the two aforementioned conditions may occur separately, simultaneous sighting of two to three lesions in the skin has been reported.

Keratosis pilaris is a common dermatological condition and is sometimes considered as a normal variant of the skin. It is also referred to as follicular keratosis. It is multifactorial and innocuous, affecting the extensor surfaces of the proximal extremities. Keratosis pilaris first appears in early childhood and progresses to become extensive during the second decade of life. Keratosis pilaris is also associated with many other conditions, including atopic dermatitis, ichthyosis vulgaris, obesity, diabetes mellitus, and malnutrition, as well as in conjunction with syndromes like Down syndrome and Noonan syndrome. Although the disease may improve over time, there are still some treatments available, including emollients, exfoliants, anti-inflammatory medication, phototherapy, and laser therapy.

Most cases of intractable headaches are primary and functional in nature, and secondary headaches due to subarachnoid hemorrhage are not included in this category. Primary headache can be divided into the following two types: migraine and chronic tension-type headache. Moreover, if it is a chronic tension-type or an intractable headache, it is referred to as a refractory headache, which is more common in the elderly. This article aimed to describe the clinical differential diagnosis of intractable headache, latest management methods, risk factors associated with headaches, and other possible treatment options.

Vitiligo is a common depigmentation disorder and is mainly characterized by white patches of irregular shapes with clear boundaries on the skin. Although vitiligo is not a fatal disease and is not contagious, it can affect a person’s appearance and can cause great psychological distress. Approximately 1%–2% of the general population has vitiligo, and an estimated 20% has a family history of the disease. Vitiligo can be further classified into segmental and systemic vitiligo. Clinically, there are many skin depigmentation diseases that are easily confused with vitiligo, such as tinea versicolor, pityriasis alba, idiopathic guttate hypomelanosis, and chemical vitiligo, which need to be differentiated by a physician for correct diagnosis. The doctor will have to conduct a pathological examination of the skin to rule out any malignant diseases known to have reduced or absent melanocytes.