Background Coronary artery bypass grafting is the most commonly performed major surgical procedure worldwide. The prognostic value of preoperative functional status measures, including self‐perceived health, the physical domain of the MacNew heart‐related quality of life score, and estimated maximum oxygen consumption for long‐term mortality remains unclear. Methods We included 1146 patients undergoing coronary artery bypass grafting across 7 hospitals in Israel. Three functional status indicators were assessed: self‐perceived health, MacNew physical domain score, and estimated maximum oxygen consumption. Associations with all‐cause mortality were examined using multivariable Cox regression. Results Participants had a mean age of 65.6 ± 10 years, and 260 (23%) were female. Over a median follow‐up of 15.4 years (interquartile range, 10), 687 (59.6%) patients died. Multivariable Cox regression identified all functional status indicators to associate with mortality. Impaired self‐perceived health was the strongest predictor of mortality (hazard ratio [HR], 1.43 [95% CI, 1.2–1.7], P <0.001), followed by low baseline maximum oxygen consumption (HR, 1.2 [95% CI, 1.0–1.5], P =0.05) and poor MacNew physical domain score (HR, 1.2 [95% CI, 1.0–1.4], P =0.02). Discrimination, according to Harrell's C statistic was highest for self‐perceived health (C‐index, 0.729 [95% CI, 0.7–0.8], P <0.001). Net reclassification improvement analysis confirmed that self‐perceived health provided the greatest incremental value, correctly reclassifying 30% of participants (95% CI, 0.2–0.5; P <0.001) for mortality. Conclusions Self‐perceived health demonstrated better prognostic value, exceeding the functional status measures examined. Self‐perceived health, a single question indicator, should be considered a key measure for risk stratification and prognosis following coronary artery bypass grafting. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT00356863.

Background & Aims Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revolutionized the treatment of type 2 diabetes mellitus and obesity in recent years. While gastrointestinal adverse events are common, their association with nutritional deficiencies, including thiamine, has not been comprehensively investigated. This study aimed to evaluate whether treatment with GLP-1 RAs is associated with the occurrence of Wernicke encephalopathy (WE). Methods We conducted a pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) and a narrative literature review. Disproportionality analysis assessed WE reporting following GLP-1 RA treatment using the reporting odds ratio (ROR) and the lower bound of the information component (IC) 95% credibility interval. Results We identified 15 cases of GLP-1 RA-associated WE: 13 from FAERS, 1 from published literature, and 1 from our medical center. Most cases occurred with semaglutide (n=8/15) or tirzepatide (6/15), and were reported in 2023-2024 (14/15). Most patients (13/15) reported gastrointestinal manifestations of either weight loss, vomiting, loss of appetite, or malnutrition. Classic WE symptoms were reported in 11 patients, and the full clinical triad in 2 patients. Long-term neurological sequelae were noted in 7 of 11 patients with follow-up data. Disproportionality analysis showed increased reporting of WE with GLP-1 RAs compared with other medications (ROR=2.35 [95%CI, 1.38-4.01]; IC025=0.29). Conclusions WE is a potentially rare but severe adverse event of GLP-1 RA treatment, mainly with semaglutide or tirzepatide. As early detection may prevent neurological sequelae, increased clinical awareness is warranted, especially in individuals experiencing severe gastrointestinal symptoms.

BACKGROUND:The association of body fat distribution markers with cardiovascular (CV) outcomes is not established among older adults. METHODS:939 adults from the Glucose Intolerance, Obesity, and Hypertension study, were followed for a mean follow-up of 13 years (IQR 8). Nine fat-distribution markers were evaluated for their association with ischemic changes on ECG, and mortality. Multivariable regression models were used, and their performance was assessed using receiver operating characteristic (ROC) curves and net reclassification improvement (NRI) analysis. RESULTS:Mean baseline age was 72.3 ± 7 years and 471 (49%) were females. Upper quintiles (Q4-5) of weight-adjusted waist index (WWI) were associated with 1.8 (95%CI: 1.1-2.9, P = .01) greater odds for ischemic ECG changes. During follow-up, 466 (48.4%) participants died, 179 (38.4%) from CV causes. The WWI was the strongest predictor of both all-cause (HR = 1.4, 95%CI: 1.1-1.7, P = .002) and CV mortality (HR = 1.7, 95%CI: 1.2-2.3, P = .0031). ROC analysis showed better predictive ability for WWI (AUC = 0.442, 95%CI: 0.4-0.5, P = .003), and NRI analysis revealed that WWI outperformed other markers, correctly reclassifying 36% (95%CI: 0. 2-0.5, P = .01) and 32% (95%CI: 0.1-0.5, P < .001) of participants for all-cause and CV mortality respectively, compared with Body mass index (BMI)-based model. CONCLUSIONS:WWI showed the strongest association with mortality and should be considered the preferred marker for identifying abnormal fat distribution, potentially replacing BMI. Key messages What is already known on this topic: Body mass index (BMI) correlates poorly with visceral fat yet data on which body fat distribution markers is the strongest predictor of cardiovascular (CV) morbidity and mortality is lacking among older adults. What this study adds: Weight adjusted waist index (WWI) was the strongest predictor of ischemic ECG changes, all-cause and CV mortality, outperforming BMI. How this study might affect research, practice or policy: WWI should be considered the preferred marker for identifying abnormal fat distribution, screening individuals at risk and guide medical intervention for weight reduction, potentially replacing BMI.

To determine whether indirect calorimetry (IC)-guided nutritional prescriptions improve weaning success and time to liberation from prolonged mechanical ventilation (PMV) compared with predictive-equation-guided feeding. In this double-blind randomized controlled trial conducted at Reuth Tel-Aviv Rehabilitation Hospital (Nov 2019-Apr 2023), with 1-year follow-up, adults ventilated ≥ 21 days were randomized to receive IC-guided energy targets or predictive-equation-guided feeding. Primary outcomes were successful weaning (≥ 7 consecutive days of spontaneous breathing) and time to successful weaning. Secondary outcomes included number of weaning cycles and 1-year mortality. Metabolic/nutritional safety parameters were recorded. Analyses followed the intention-to-treat principle, with additional per-protocol analyses. Time-to-event outcomes were evaluated using Kaplan–Meier estimates and Cox proportional hazards models. Among 211 randomized patients (111 IC; 100 control), successful weaning was achieved in 58

BACKGROUND:Potentially inappropriate prescribing (PIP), encompassing potentially inappropriate medications (PIMs) and prescribing omissions (PPOs), is prevalent among older adults and consistently associated with adverse health outcomes. However, evidence on its impact on mortality remains limited. We examined the associations of PIMs and PPOs with long-term mortality in a cohort of community-dwelling older adults. METHODS:One thousand two hundred and ten participants from the third follow-up (1999-2007) of a longitudinal prospective cohort study were followed for mortality until 03/2022. PIMs and PPOs were identified using the 2023 Beers and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) v3 criteria. Cox proportional hazards and Fine-Gray subdistribution hazard models assessed associations between PIP and all-cause and non-cancer mortality, respectively, adjusting for sociodemographic, lifestyle, and health-related factors. RESULTS:Overall, 81.2% of participants were exposed to > 1 problem: 52.6% and 45.0% to PIMs based on Beers and STOPP criteria, respectively, and 59.3% to PPOs. In multivariable analysis, exposure to ≥ 2 PIMs was associated with increased all-cause mortality for Beers (HR = 1.31, 95% CI: 1.04-1.69) and STOPP (HR = 1.25, 95% CI: 1.00-1.55) criteria. An interaction between PIMs (Beers criteria) and self-rated health (SRH) indicated stronger associations for those with "excellent/good" baseline SRH, compared to those with "poor/very poor" SRH (p-for-interaction = 0.030). Use of ≥ 2 PIMs was also associated with a 1.4-fold increased non-cancer mortality risk for both tools. Exposure to ≥ 2 PPOs was associated with a 1.8-fold increase in all-cause mortality risk (HR = 1.84, 95% CI: 1.24-2.72), while associations were stronger in men (p-for-interaction = 0.012). Exposure to 1 or ≥ 2 PPOs was also associated with 1.3 and 2.0-fold increased non-cancer mortality risk, respectively. CONCLUSIONS:PIP is prevalent and is associated with increased long-term mortality among community-dwelling older adults. Addressing PIMs in healthier older individuals and reducing PPOs in clinical practice is critical. Sex-specific pharmaceutical guidelines are warranted.

BACKGROUND:Data on drug safety in multimorbid older-adults are limited, as clinical trials often apply upper age limits and focus on individual drugs or specific combinations. We aimed to explore high-risk drug patterns in community-dwelling older-adults, and their associations with long-term mortality. METHODS:We included 1,048 participants from a longitudinal population-based cohort, all taking at least one medication. Participants were examined in 1999-2007 and followed for mortality through March 2022. Individuals with similar profiles of high-risk drugs, identified using Beers criteria as potentially inappropriate for most older adults or requiring caution, were grouped using agglomerative hierarchical clustering. Cox and competing-risk regressions were used to examine the associations of the high-risk drug patterns with all-cause and non-cancer mortality. RESULTS:The most prevalent morbidities among participants (mean age 73.3 ± 7.3 years, 55.9% women) were hypertension (55.3%) and cardiovascular diseases (45.5%), and 77.7% took at least one high-risk drug. Five distinct patterns were identified: 'None' cluster (no dominant high-risk drug); 'Calcium channel blockers' (CCBs) cluster, with high nonsteroidal anti-inflammatory drug (NSAID) prevalence; 'Renin-angiotensin-aldosterone system (RAAS) inhibitors' cluster, with a high concomitant use of sulfonylureas compared to other clusters; 'Diuretics' cluster, with a relatively high prevalence of antithrombotics and proton pump inhibitors; and 'Benzodiazepines' cluster, with a relatively high antidepressant prevalence. Clusters differed by age, sex, ethnicity, and health characteristics. In multivariable analysis, the 'Diuretics' cluster was associated with increased all-cause (HR = 1.33, 95%CI: 1.03-1.72) and non-cancer (HR = 1.41, 95%CI: 1.03-1.93) mortality compared to the 'None' cluster. The 'CCBs' cluster was associated with a greater risk for non-cancer mortality. Several drug combinations were identified as potential contributors to the increased risk observed in these clusters, including the concomitant use of NSAIDs and antihypertensives and a possible CCB-diuretic prescribing cascade. CONCLUSIONS:Examining high-risk drug patterns offers a patient-centered approach to improving evidence-based medication guidelines and facilitating early interventions for vulnerable older-adults.

We propose a procedure for imputing missing values of time-dependent covariates in a survival model using fully conditional specification. Specifically, we focus on imputing missing values of a longitudinal marker in joint modeling of the marker and time-to-event data, but the procedure can be easily applied to a time-varying covariate survival model as well. First, missing marker values are imputed via fully conditional specification multiple imputation, and then joint modeling is applied for estimating the association between the marker and the event. This procedure is recommended since in joint modeling marker measurements that are missing not-at-random can lead to bias (e.g. when patients with higher marker values tend to miss visits). Specifically, in cohort studies such a bias can occur since patients for whom all marker measurements during follow-up are missing are excluded from the analysis. Our procedure enables to include these patients by imputing their missing values using a modified version of fully conditional specification multiple imputation. The imputation model includes a special indicator for the subgroup with missing marker values during follow-up, and can be easily implemented in various software: R, SAS, Stata etc. Using simulations we show that the proposed procedure performs better than standard joint modeling in the missing not-at-random scenario with respect to bias, coverage and Type I error rate of the test, and as good as standard joint modeling in the completely missing at random scenario. Finally we apply the procedure on real data on glucose control and cancer in diabetic patients.

An easy-to-use and reliable tool is essential for gait assessment of people with gait pathologies. This study aimed to assess the reliability and validity of the OneStep smartphone application compared to the C-Mill-VR+ treadmill (Motek, Nederlands), among patients undergoing rehabilitation for unilateral lower extremity disability. Spatiotemporal gait parameters were extracted from the treadmill and from two smartphones, one on each leg. Inter-device reliability was evaluated using Pearson correlation, intra-cluster correlation coefficient (ICC), and Cohen’s d, comparing the application’s readings from the two phones. Validity was assessed by comparing readings from each phone to the treadmill. Twenty-eight patients completed the study; the median age was 45.5 years, and 61% were males. The ICC between the phones showed a high correlation (r = 0.89–1) and good-to-excellent reliability (ICC range, 0.77–1) for all the gait parameters examined. The correlations between the phones and the treadmill were mostly above 0.8. The ICC between each phone and the treadmill demonstrated moderate-to-excellent validity for all the gait parameters (range, 0.58–1). Only ‘step length of the impaired leg’ showed poor-to-good validity (range, 0.37–0.84). Cohen’s d effect size was small (d < 0.5) for all the parameters. The studied application demonstrated good reliability and validity for spatiotemporal gait assessment in patients with unilateral lower limb disability.

ImportanceConcerns have been raised that glucagon-like peptide-1 receptor agonists (GLP-1RA) may increase the risk of pancreatic cancer.ObjectiveTo investigate the association of GLP-1RA treatment with pancreatic cancer incidence over 9 years of follow-up.Design, Setting, and ParticipantsIn this population-based historical cohort study, adult patients (aged 21 to 89 years) with type 2 diabetes insured by Clalit Healthcare Services, the largest state-mandated health organization in Israel, were followed up from 2009, when GLP-1RA became available in Israel, until pancreatic cancer diagnosis, death, reaching age 90 years, or end of follow-up (December 2017). Data were analyzed from June 2022 to November 2023.ExposuresTreatment with GLP-1RA was compared with basal insulin.Main Outcome and MeasuresPancreatic cancer incidence was compared according to weighted cumulative exposures to GLP-1RA and to basal insulin in a Cox model implemented in discrete time, with time origin at 2 years after diabetes diagnosis, adjusting for confounding. In sensitivity analyses, propensity score–matched pair new-user design and prevalent new-user design were used for the comparison. Because of risk for reverse-causation bias, results in the fifth to seventh year after medication were emphasized.ResultsDuring a cumulative follow-up of 3 290 439 person-years of 543 595 adults with a mean (SD) age of 59.9 (12.8) years (277 502 women [51%]) with incident diabetes, 1665 patients received pancreatic cancer diagnoses. In total, 33 377 patients (6.1%) used GLP-1RA and 106 849 (19.7%) used basal insulin. The estimated hazard ratio (HR) for pancreatic cancer associated with incremental use of 1 defined daily dose per day of GLP-1RA compared with basal insulin in the fifth to seventh year previously (all other characteristics, including age, sex, ethnic background, sociodemographic status, baseline body mass index, smoking history, history of pancreatitis, other glucose-lowering medications treatment history, and length of diabetes, being equal) was 0.50 (95% CI, 0.15-1.71). The new-user and prevalent new-user designs showed HRs from the fifth year onwards following initiation of GLP-1RA vs basal insulin of 0.52 (95 % CI, 0.19-1.41) and 0.75 (95 % CI, 0.37-1.53), respectively.Conclusions and RelevanceIn this historical cohort study of adults with type 2 diabetes, no support for an increased pancreatic cancer incidence over 7 years following start of GLP-1RA treatment was found. However, monitoring for pancreatic cancer risk beyond 7 years following initiation of therapy is still required.Trial RegistrationClinicalTrials.gov Identifier: NCT02072902

Objectives: While several biomarkers were previously associated with frailty and mortality, data are still contradicting. We aimed to evaluate the association between novel biomarkers and frailty among community-dwelling older adults to enhance understanding of the pathophysiology of frailty. Methods: Nine hundred and sixty-three older adults were screened during the third phase (1999-2008) of the Israel study on Glucose Intolerance, Obesity, and Hypertension (GOH). Frailty was defined as sedentary individuals, past 10 years hospitalizations, or at least one of the following: body mass index (BMI) <21 kg/m(2); albumin <3.2 g/dl; >= 2 major baseline diseases. Biomarkers were evaluated for their association with frailty, all-cause, and cardiovascular mortality. Results: Mean baseline age was 72 +/- 7 years, 471 (49%) were women, and 195 (20%) were classified as frail. Median follow-up for cardiovascular and all-cause mortality was 11 and 13 years, with 179 (18.6%) and 466 (48.4%) deaths recorded, respectively. Multivariable logistic regression showed greater odds for frailty with lower quartile of alanine aminotransferase (ALT) (OR = 1.8, 95%CI: 1.2-2.8, p = 0.01), and for each 5 mu mol/L increment in homocysteine levels (OR = 1.3, 95%CI: 1.1-1.5, p = 0.001). Multivariate Cox regression showed greater all-cause and cardiovascular mortality risk for individuals with low ALT (HR = 1.6, 95%CI: 1.3-2.0, p < 0.001 and HR = 1.5, 95% CI: 1.0-2.2, p = 0.03, respectively), and high homocysteine (HR = 1.1, 95%CI: 1.1-1.3, p = 0.003 and HR = 1.2, 95%CI: 1.0-1.3, p = 0.04, respectively). Homocysteine association with mortality was more pronounced in those with baseline ischemic heart disease (IHD) compared with subjects free of IHD (P for interaction = 0.01). Conclusions: Lower ALT and higher homocysteine were associated with frailty, all-cause and cardiovascular mortality. These available and low-cost biomarkers underscore the nutritional and metabolic aspects of frailty when screening high-risk older adults, especially those with IHD, and may be considered as preferable screening biomarkers to be tested among these individuals for frailty and mortality risk.

BACKGROUND:Collection of detailed dietary data is labor intensive and expensive, harmonization of existing data sets has been proposed as an effective tool for research questions in which individual studies are underpowered. METHODS:In this paper, we describe the methodology used to retrospectively harmonize nutritional data from multiple sources, based on the individual participant data of all available studies, which collected nutritional data in Israel between 1963 and 2014. This collaboration was established in order to study the association of red and processed meat with colorectal cancer. Two types of nutritional questionnaires, the Food Frequency Questionnaires (FFQ) and the 24-h dietary recall (24HR recall), and different food composition tables, were used by the participating studies. The main exposure of interest included type of meat (total meat, red meat, and poultry) and level of processing. RESULTS:A total of 29,560 Israeli men and women were enrolled. In studies using FFQ,the weighted mean intakes of total, red, processed meat, and poultry were 95, 27, 37 and 58 gr/day and 92, 25, 10, and 66 gr/day in studies using 24HR recall, respectively.. Despite several methodological challenges, we successfully harmonized nutritional data from the different studies. CONCLUSIONS:This paper emphasizes the significance and feasibility of harmonization of previously collected nutritional data, offering an opportunity to examine associations between a range of dietary exposures and the outcome of interest, while minimizing costs and time in epidemiological studies.

In order to explore the association between meat consumption and gastrointestinal/colorectal cancer (CRC) risk and to estimate the Israeli population attributable fraction (PAF), we conducted a collaborative historical cohort study using the individual participant data of seven nutritional studies from the past 6 decades. We included healthy adult men and women who underwent a nutritional interview. Dietary assessment data, using food‐frequency or 24‐h recall questionnaires, were harmonized. The study file was linked to the National Cancer and death registries. Among 27,754 participants, 1216 (4.4%) were diagnosed with gastrointestinal cancers and 839 (3.0%) with CRC by the end of 2016. Using meta‐analysis methods applied to Cox proportional hazard models (adjusted for daily energy intake, sex, age, ethnic origin, education and smoking),100 g/day increments in beef, red meat and poultry consumption, and 50 g/day increment in processed meat consumption were associated with hazard ratios (HRs) and 95% confidence intervals of 1.46 (1.06–2.02), 1.15 (0.87–1.52), 1.06 (0.89–1.26), and 0.93 (0.76–1.12), respectively, for CRC. Similar results were obtained for gastrointestinal cancer, although red meat consumption reached statistical significance (HR = 1.27; 95%CI: 1.02–1.58). The PAFs associated with a reduction to a maximum of 50 g/day in the consumption of red meat were 2.7% (95%CI: −1.9 to 12.0) and 5.2% (0.3–13.9) for CRC and gastrointestinal cancers, respectively. Reduction of beef consumption to a maximum of 50 g/day will result in a CRC PAF reduction of 7.5% (0.7%–24.3%). While beef consumption was associated with gastrointestinal/CRC excess risk, poultry consumption was not. A substantial part of processed meat consumption in Israel is processed poultry, perhaps explaining the lack of association with CRC.

A direct comparison between glycemic-based and lipid-based insulin sensitivity indices (ISIs) for ECG findings and all-cause and cardiovascular mortality is lacking. 963 community-dwelling older adults, examined as part of the third phase of the Glucose intolerance, Obesity, and Hypertension study between 1999 and 2008, were followed until December 2016 and December 2019 for cardiovascular and all-cause mortality, respectively. Eleven different ISIs were calculated and evaluated against ECG findings, all-cause, and cardiovascular mortality with multivariable regression models. The area under the receiver operating curve (AUC) and net reclassification improvement (NRI) analysis were implemented to compare ISIs performance. Mean age was 72.3 ± 7 years and 471 (49

BackgroundWe followed prolonged mechanically ventilated (PMV) patients for weaning attempts and explored factors associated with successful weaning and long-term survival.MethodsThis historical cohort study included all adult PMV patients admitted to a single rehabilitation hospital during 2015-2018 and followed for survival according to weaning success up to 3 years or the end of 2021.ResultsThe study included 223 PMV patients. Of them, 124(55.6%) underwent weaning attempts, with 69(55.6%) successfully weaned, 55(44.4%) unsuccessfully weaned, and 99 patients with no weaning attempts.The mean age was 67±20 years, with 39% female patients. Age, sex distributions and albumin levels at admission were not significantly different among the groups. The successful weaning group had a 6% higher proportion of conscious patients than the failed weaning group (55% vs. 49%, respectively, p=0.45). Patients successfully weaned were less frequently treated with antibiotics for 5 days or more than those unsuccessfully weaned (74% vs 80%, respectively, p=0.07). They also had a lower proportion of time from intubation to tracheostomy greater than 14 days (45% vs 66%, p=0.02). The age, sex, antibiotic treatment, time to tracheostomy exceeding 14 days and time from admission to first weaning attempt adjusted one-year mortality risk of successful vs. failed weaning was somewhat lower, HR=0.75, 95%CI: 0.33-1.60, p=0.45, with the same trend by the end of 3 years, HR=0.77, 95%CI: 0.42-1.39, p=0.38.ConclusionSuccessful weaning from PMV may be associated with better survival and allows chronically ventilated patients to become independent on a ventilator. A larger study is needed to further validate our findings.

OBJECTIVES:To explore admission and discharge prescription rates of guideline-directed medical therapy (GDMT), defined as aggregate antiplatelet agents, statins, and β-blockers, after coronary artery bypass graft (CABG) surgery and to reveal its association with long-term survival. PATIENTS AND METHODS:This is a prospective cohort study-based emulated trial of patients undergoing elective or semi-elective isolated CABG surgery in 7 cardiothoracic units in Israel from January 1, 2004, to December 31, 2007, and followed up until December 31, 2020, for all-cause mortality. RESULTS:Only 59.2% of 968 patients (n=573) were discharged on GDMT after CABG surgery. Admission GDMT use conferred a 7 times greater likelihood of discharge GDMT prescription (odds ratio, 7.07; 95% CI, 5.04 to 9.91; P<.001), with no sex differences observed. After applying inverse probability of treatment weighting, baseline characteristics were well balanced between groups. During a median follow-up of 13.7 years, a Cox regression model with propensity score-adjusted inverse probability of treatment weighting revealed lower mortality in patients with discharge GDMT prescription who underwent CABG surgery than in their counterparts (hazard ratio, 0.75; 95% CI, 0.60 to 0.93; P=.008). CONCLUSION:The use of aggregate GDMT before surgery conferred a greater likelihood of GDMT prescription upon discharge, which, in turn, is associated with better long-term survival. Educational efforts of pertinent medical professionals are needed to minimize preventive treatment gaps. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00356863.

Background: Delirium is a common neuropsychiatric syndrome characterized by the acute and fluctuating impairment of cognition, attention, and consciousness, which is prevalent in older adults following surgical procedures. Despite the recognized impact of delirium on recovery, its specific effects on motor rehabilitation outcomes in the geriatric population remain underexplored. This historical cohort study aimed to evaluate the association between the presence of delirium upon admission to a rehabilitation hospital and the motor functional gain at discharge among older patients following hip fracture surgery. Methods: The collected data included socio-demographic characteristics, comorbidities, medications, Mini-Mental State Examination (MMSE) scores, and the Functional Independence Measure (FIM). Motor rehabilitation outcomes were assessed using Motor Absolute Functional Gain (mAFG), the Montebello Rehabilitation Factor Score (mMRFS), and Rehabilitation Efficiency (mRE). Results: Of the 143 hip fracture patients admitted for rehabilitation, 38 (26.6%) were diagnosed with delirium. Patients with delirium had lower MMSE scores (18.1 ± 5.8 vs. 22.4 ± 6.0, p < 0.001), higher benzodiazepine prescription rates (50.0% vs. 14.3%, p < 0.001), and longer lengths of stay in acute care and rehabilitation (42.7 ± 10.4 vs. 37.3 ± 11.2 days, p = 0.01). Despite significant improvements in the FIM scores for both groups (p < 0.001), patients with delirium had lower mAFG (11.87 ± 7.26 vs. 15.91 ± 8.73, p = 0.01), mMRFS (0.22 ± 0.14 vs. 0.31 ± 0.15, p = 0.001), and mRE (0.28 ± 0.17 vs. 0.44 ± 0.25, p < 0.001). However, the multivariate regression models showed no association between delirium and functional improvement after adjusting for confounders. Conclusions: While both patients with and without delirium showed improvement in their motor functions by the time they were discharged from a rehabilitation hospital, patients with delirium showed lower absolute and relative improvements. Tailored programs addressing the special needs of patients with delirium after hip fracture surgery may enhance outcomes for this vulnerable population. A specialized, multidisciplinary approach tailored to the patient’s cognitive status and overall condition is key to maximizing the recovery of older hip fracture patients with delirium.

Purpose: Physical activity was previously associated with decreased mortality. Current guidelines recommend >150 min/week or >75 min/week of moderate or high-intensity exercise to maintain a healthy lifestyle; however, exercise properties most strongly associated with low mortality among the elderly may still be explored. Methods: A total of 1210 community-dwelling older adults, from the third phase (1999-2004) of the Israel Study on Glucose Intolerance, Obesity, and Hypertension, were followed until 2016 and 2019 for cardiovascular and all-cause mortality, respectively. Physical activity properties were recorded and evaluated against all-cause and cardiovascular mortality. Results: Mean age at baseline was 73 +/- 7 years, with 638 (53%) females, and 585 (48%) reported habitual exercise. When compared to sedentary individuals, multivariable Cox regressions showed a significantly lower risk for all-cause mortality among currently active individuals [hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.59-0.88, P = .002], those engaging in light-moderate activity (HR = 0.72, 95% CI: 0.57-0.89, P = .003), those with diverse exercise types (HR = 0.59, 95% CI: 0.44-0.80, P = .001), more sessions/week (HR = 0.94, 95% CI: 0.92-0.97, P < .001), those meeting current exercise recommendations (HR = 0.79, 95% CI: 0.58-0.89, P = .03), those who engaged in walking (HR = 0.58, 95% CI: 0.45-0.76, P < .001), and swimming (HR = 0.66, 95% CI: 0.45-0.96, P = .03). Similar HRs were found for cardiovascular mortality, although a somewhat stronger protective association was observed for swimming (HR = 0.48, 95% CI: 0.24-0.95, P = .04) compared to a sedentary lifestyle. Conclusion: The study further supports current exercise guidelines among the elderly. It also underscores the importance of physical activity in older individuals while prioritizing a greater number of sessions/week in addition to the total duration, and highlights specific activity features associated with lower long-term mortality among older adults.