Search

Background In recent years, physical impairment (PI) combined with cognitive impairment (CI) is a common comorbidity in the elderly. An early detection of PI combined with CI in the elderly and timely interventions may help to improve the quality of life of the elderly and reduce the burden on their families and society. However, relevant studies on the comorbidity of PI and CI in the elderly and its influencing factors have been rarely reported. Objective To observe the clinical characteristics of the comorbidity of PI and CI in the elderly and the influencing factors. Methods Elderly patients hospitalized in Peking University People's Hospital from September 2018 to November 2019 were selected. A total of eligible 244 subjects meeting the inclusion criteria were surveyed for the physical function and cognitive function using the Short Physical Performance Battery (SPPB) and the Mini-mental State Examination (MMSE), respectively. PI was diagnosed with lower than 10 points of the SPPB, and CI was diagnosed with lower than 27 points of the MMSE. Patients were divided into non-PI+non-CI, PI+non-CI, non-PI+CI, PI+CI. Social demographic, anthropometric, laboratory examination and other indicators of patients were collected, and Logistic regression analysis was used to explore the influencing factors for PI combined with CI in the elderly. Results Among the 244 patients, there were 102 (41.80%), 64 (26.23%), 26 (10.66%) and 52 (21.31%) cases of non-PI+non-CI, PI+non-CI, non-PI+CI and PI+CI, respectively. Multivariate binary Logistic regression analysis showed that compared with non-PI+non-CI cases, age (P

Abstract Background The mortality of pneumonia in older adults surpasses that of other populations, especially with the prevalence of coronavirus disease 2019 (COVID-19). Under the influence of multiple factors, a series of geriatric syndromes brought on by age is one of the main reasons for the poor prognosis of pneumonia. This study attempts to analyze the impact of geriatric syndrome on the prognosis of pneumonia. Methods This is a prospective cross-sectional study. Patients over 65 years old with COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative community-acquired pneumonia (SN-CAP) were included in the research. General characteristics, laboratory tests, length of stay (LOS), and comprehensive geriatric assessment (CGA) were collected. Multivariate regression analysis to determine the independent predictors of the severity, mortality, and LOS of COVID-19. At the same time, the enrolled subjects were divided into three categories by clustering analysis of 10 CGA indicators, and their clinical characteristics and prognoses were analyzed. Results A total of 792 subjects were included in the study, including 204 subjects of SN-CAP (25.8%) and 588 subjects (74.2%) of COVID-19. There was no significant difference between non-severe COVID-19 and SN-CAP regarding mortality, LOS, and CGA (P > 0.05), while severe COVID-19 is significantly higher than both (P

We aimed to examine the association between the use of specific types of dietary supplements and frailty using cross-sectional, nationally representative survey data. Adults aged ≥50 years in the Korea National Health and Nutrition Examination Survey 2018–2020 were included. We calculated a 46-item frailty index to assess frailty. In total, 27,384 older adults were included (mean age: 62.47 years; median frailty index: 0.12). Among them, 72% used at least one dietary supplement. The prevalence of dietary supplement use was higher among women than among men and in participants with higher socioeconomic status. Compared to non-users, users of dietary supplements had a healthier diet and nutrient intake, and lower levels of frailty. After adjusting for socioeconomic and dietary factors, users of vitamin C, red ginseng or calcium were found to be significantly less frail. Our findings indicate promising results concerning dietary supplement intake in managing frailty among older Korean adults. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine whether the frequency of eating together is associated with the incidence of functional disability in older adults who live alone. Methods This 6-year observational prospective cohort study utilised self-reported questionnaires. Data were drawn from the participants of the Japan Gerontological Evaluation Study project between 2016 and 2022. The participants were independent older adults aged ≥65 years living alone in Japan. The primary outcome was the incidence of functional disability during the follow-up period, with the self-reported frequency of eating together serving as the explanatory variable. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models after adjusting for confounders associated with incident functional disability. Results Among the 7167 participants, the mean age at baseline was 75.3 ± 6.5 years and 69.2% were female. About, 12.8% of participants (n  = 917) developed functional disabilities during the observation period. The incidence rates were 11.7% for 'every day', 11.3% for 'several times a week', 11.5% for 'several times a month', 12.7% for 'several times a year' and 19.0% for 'seldom'. The frequency of eating together 'seldom' was significantly associated with an increased incidence of functional disability (HR: 1.55, 95% CI: 1.10–2.18). Conclusion Among older adults living alone, infrequent eating together ('seldom') was identified as a risk factor for developing functional disability. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the relationship between sarcopenia and frailty and examine factors associated with frailty among older patients with and without sarcopenia. Methods: This cross‐sectional study was conducted on older inpatients and outpatients in Vietnam. Participants aged 60 years or older were consecutively enrolled in the study. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Fried's frailty phenotype was applied to define frailty. Logistic regression models with frailty as the dependent variable were applied. Results: A total of 835 patients (mean age: 71.3 years, SD 8.4) were recruited. The overall prevalence of frailty was 17%. Among participants with and without frailty, 92% and 47% had sarcopenia, respectively. In unadjusted analysis, sarcopenia was significantly associated with increased frailty (OR 12.3, 95% CI 6.7–22.6) and remained significant after adjustment for sociodemographic factors (OR 6.3, 95% CI: 3.0–12.6) and for both sociodemographic and clinical factors (OR 5.4, 95% CI: 2.4–12.2). Among participants with sarcopenia, older age, inpatient status, having a high risk for falls, malnutrition and a history of hospitalisation in the last year were significantly associated with frailty. Among participants without sarcopenia, the factors associated with frailty were older age, inpatient status, low educational level, high risk of falls and malnutrition. Conclusions: Our study results highlighted that sarcopenia and frailty are two related but distinct geriatric syndromes. [ABSTRACT FROM AUTHOR]

Elderly and senile people often suffer from cognitive impairment. One of the significant issues that develop as the severity of cognitive impairment increases is dysphagia. The article addresses various causes of dysphagia and ways to manage it. Due to the high prevalence of dysphagia in cognitively reduced patients, selecting therapy for cognitive disorders is often challenging. Since patients with dysphagia have difficulties taking solid dosage forms (DF) – tablets and capsules, alternative DFs are being discussed. In particular, studies of the positive effect on the cognitive status of Cereton and the use of its different DFs are presented, allowing for optimal therapy in various situations. The novel DF of Cereton, an oral solution, is convenient for use in patients with dysphagia.

Background: The elderly population is increasing every year, especially in developing countries. Geriatric syndrome is a condition where there is a disturbance in the multifactorial system in the elderly due to decreased function. Case: Woman, 85 years old, came with the main complaint of weakness, accompanied by not wanting to eat and drink since 3 days. The patient could not sleep for 2 days, coughed up phlegm since 1 month ago, accompanied by shortness of breath. One week ago the patient complained of liquid bowel movements accompanied by mucus and dregs. The patient has a history of high blood pressure and was diagnosed with stage III heart failure. From physical examination, GCS E4V4M5, blood pressure 130/80, pulse 72x/m, respiration 20x/m, temperature 37 C, oxygen saturation 94%, anemic conjunctiva, rhonchi in both lung fields, epigastric tenderness, non-pitting upper leg edema. Laboratory examination, Hb 8.0 gr/dL on the second day to 6.7 gr/dL, LED 72 mm/hour. AP chest photo shows consolidation in the middle zone of the right lung and left lower zone, increased vascular pattern with chepalization, CTR 72%. The patient was given initial management of 40 mg omeprazole injection and 4 mg ondansetron. Discussion and conclusion: Based on the results of the anamnesis, physical examination, and support examination, the patient's complaints constitute a geriatric syndrome. The management provided includes medical management to deal with systemic complaints as well as educating the family about the patient's condition. Keywords: Elderly, geriatric syndrome

Abstract Background This study aimed to investigate the actual application, knowledge, and training needs of comprehensive geriatric assessment (CGA) among geriatric practitioners in China. Methods A total of 225 geriatric practitioners attending the geriatric medicine or geriatric nursing training were recruited for this cross-sectional study. The questionnaire included demographics, healthcare institution characteristics, the actual application, knowledge, training needs, and barriers to CGA and geriatric syndromes (GS). Results Physicians and nurses were 57.3% and 42.7%, respectively. 71.1% were female, with a median age was 35 years. Almost two-thirds (140/225) of geriatric practitioners reported exposure to CGA in their clinical practice. The top five CGA evaluation items currently used were malnutrition risk (49.8%), fall risk (49.8%), activity of daily living (48.0%), pain (44.4%), and cognitive function (42.7%). Median knowledge scores for the management procedures of GS ranged from 2 to 6. Physicians identified medical insurance payment issues (29.5%) and a lack of systematic specialist knowledge and technology (21.7%) as the two biggest barriers to practicing geriatrics. Nurses cited a lack of systematic specialist knowledge and technology (52.1%) as the primary barrier. In addition, physicians and nurses exhibited significant differences in their knowledge of CGA-specific evaluation items and management procedures for GS (all P

Abstract Background Data taken from tertiary referral hospitals in Indonesia suggested readmission rate in older population ranging between 18.1 and 36.3%. Thus, it is crucial to identify high risk patients who were readmitted. Our previous study found several important predictors, despite unsatisfactory discrimination value. Methods We aimed to investigate whether comprehensive geriatric assessment (CGA) -based modification to the published seven-point scoring system may increase the discrimination value. We conducted a prospective cohort study in July–September 2022 and recruited patients aged 60 years and older admitted to the non-surgical ward and intensive coronary care unit. The ROC curve was made based on the four variables included in the prior study. We conducted bivariate and multivariate analyses, and derived a new scoring system with its discrimination value. Results Of 235 subjects, the incidence of readmission was 32.3% (95% CI 26–38%). We established a new scoring system consisting of 4 components. The scoring system had maximum score of 21 and incorporated malignancy (6 points), delirium (4 points), length of stay ≥ 10 days (4 points), and being at risk of malnutrition or malnourished (7 points), with a good calibration test. The C-statistic value was 0.835 (95% CI 0.781–0.880). The optimal cut-off point was ≥ 8 with a sensitivity of 90.8% and a specificity of 54.7%. Conclusions Malignancy, delirium, length of stay ≥ 10 days, and being at risk of malnutrition or malnourished are predictors for 30-day all-cause unplanned readmission. The sensitive scoring system is a strong model to identify whether an individual is at higher risk for readmission. The new CGA-based scoring system had higher discrimination value than that of the previous seven-point scoring system.

As the Japanese population continues to age steadily, the number of older adults requiring healthcare has increased. Evidence demonstrates that hospitalization for acute care has a negative impact on the health outcomes of older adults. Frail older adults tend to have multifactorial conditions collectively known as "geriatric syndromes." When those with these premorbid conditions are hospitalized for acute care, they tend to develop new problems such as delirium and new functional impairments. Adverse consequences of hospitalization include the risk of loss of functional independence and chronic disability. In 2019, the new concept of "hospital-associated complications" (HACs) was proposed to describe these new problems. HACs comprise five conditions: hospital-associated falls, delirium, functional decline, incontinence, and pressure injuries. This review discusses the important issues of HACs in relation to their classification, prevalence, risk factors, prevention, and management in older adults hospitalized for acute care. Robust prevention and management are imperative to address the serious consequences and escalating medical costs associated with HACs, and a multidimensional and multidisciplinary approach is key to achieving this goal. Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine and offers a holistic approach involving multidisciplinary and multidimensional assessments. Considerable evidence is accumulating regarding how CGA and coordinated care can improve the prognosis of hospitalized older adults. Further research is needed to understand the occurrence of HACs in this population and to develop effective preventive measures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the actual application, knowledge, and training needs of comprehensive geriatric assessment (CGA) among geriatric practitioners in China. Methods: A total of 225 geriatric practitioners attending the geriatric medicine or geriatric nursing training were recruited for this cross-sectional study. The questionnaire included demographics, healthcare institution characteristics, the actual application, knowledge, training needs, and barriers to CGA and geriatric syndromes (GS). Results: Physicians and nurses were 57.3% and 42.7%, respectively. 71.1% were female, with a median age was 35 years. Almost two-thirds (140/225) of geriatric practitioners reported exposure to CGA in their clinical practice. The top five CGA evaluation items currently used were malnutrition risk (49.8%), fall risk (49.8%), activity of daily living (48.0%), pain (44.4%), and cognitive function (42.7%). Median knowledge scores for the management procedures of GS ranged from 2 to 6. Physicians identified medical insurance payment issues (29.5%) and a lack of systematic specialist knowledge and technology (21.7%) as the two biggest barriers to practicing geriatrics. Nurses cited a lack of systematic specialist knowledge and technology (52.1%) as the primary barrier. In addition, physicians and nurses exhibited significant differences in their knowledge of CGA-specific evaluation items and management procedures for GS (all P < 0.05). However, there were no significant differences in their training needs, except for polypharmacy. Conclusions: The rate of CGA application at the individual level, as well as the overall knowledge among geriatric practitioners, was not adequate. Geriatric education and continuous training should be tailored to address the specific roles of physicians and nurses, as well as the practical knowledge reserves, barriers, and training needs they face. [ABSTRACT FROM AUTHOR]

Background: The relationship between functional and nutritional status in the geriatric population remains an issue of debate and there is a gap in the knowledge regarding this field in long-lived individuals. Aim: The main aim of this study was to assess the association between selected blood parameters of nutritional status and functional status in extreme longevity. Methods: The inclusion criteria were centenarians above 100 years of age who were examined at their homes, and blood samples were collected. The study group consisted of 170 individuals (25 men and 145 women, median age 100.75 years [100.29–101.58]). Results: Total protein and albumin serum concentration was significantly lower in long-lived individuals with severe functional decline compared to individuals with preserved functional status, p = 0.000001 and p = 0.0000, respectively. Iron serum level was significantly higher in the group with preserved functional status, p = 0.04. Preserved functional status was positively correlated with total protein serum concentration (p = 0.000), albumin concentration (p = 0.000), and iron serum level (p = 0.029). A negative correlation was stated between c-reactive protein (CRP) and functional status (p = 0.032). Univariable logistic regression analysis showed that the functional status of long-lived individuals depends on total protein (OR 2.89, CI 95% [1.67–5.0]) and albumin concentrations (OR 2.34, CI 95% [1.39–3.92]). Multivariable backward stepwise logistic regression analysis showed that a total protein concentration was the only variable independently related to the preserved functional status (OR 3.2, 95% Cl [1.8–5.67]). Conclusions: In long-lived individuals, the total serum protein and albumin levels are lower in centenarians with severe functional decline, and they correlate with functional status. Total protein serum concentration is the only factor independently related to the preserved functional status in extreme longevity. [ABSTRACT FROM AUTHOR]

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation. [ABSTRACT FROM AUTHOR]

Objective: Urinary incontinence (UI) is a common condition with a substantial negative impact on older adults' quality of life. This study examines whether individual differences in behavioral, cognitive, and emotional traits assessed by the five major dimensions of personality are related to the risk of concurrent and incident UI. Methods: Participants were older women and men (N > 26,000) from the Midlife in the United States Survey, the Health and Retirement Study, and the English Longitudinal Study of Aging. In each cohort, personality traits (measured with the Midlife Development Inventory) and demographic (age, sex, education, and race), clinical (body mass index, diabetes, blood pressure), and behavioral (smoking) factors were assessed at baseline. UI was assessed at baseline and again 8–20 years later. Results for each cohort were combined in random‐effect meta‐analyses. Results: Consistently across cohorts, higher neuroticism and lower conscientiousness were related to a higher risk of concurrent and incident UI. To a lesser extent, extraversion, openness, and agreeableness were also related to lower risk of concurrent and incident UI. BMI, diabetes, blood pressure, and smoking partially accounted for these associations. There was little evidence that age or sex moderated the associations. Conclusions: The present study provides novel, robust, and replicable evidence linking personality traits to UI. The higher vulnerability for UI for individuals who score higher on neuroticism and lower on conscientiousness is consistent with findings for other multifactorial geriatric syndromes. Personality traits can help identify individuals at risk and may help contextualize the clinical presentation of comorbid emotional, cognitive, and behavioral symptoms. Key points: In three large samples of middle‐aged and older adults and a meta‐analysis, the present study provides replicable evidence for an association between personality traits and risk of Urinary incontinence (UI)Higher neuroticism was related to a higher risk of concurrent and incident UIHigher extraversion, openness, agreeableness, and conscientiousness were related to lower risk of concurrent and incident UI [ABSTRACT FROM AUTHOR]

Objectives: To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. Methods: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. Results: A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P <.001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P <.001). Conclusions: A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation. [ABSTRACT FROM AUTHOR]

Background: Data taken from tertiary referral hospitals in Indonesia suggested readmission rate in older population ranging between 18.1 and 36.3%. Thus, it is crucial to identify high risk patients who were readmitted. Our previous study found several important predictors, despite unsatisfactory discrimination value. Methods: We aimed to investigate whether comprehensive geriatric assessment (CGA) -based modification to the published seven-point scoring system may increase the discrimination value. We conducted a prospective cohort study in July–September 2022 and recruited patients aged 60 years and older admitted to the non-surgical ward and intensive coronary care unit. The ROC curve was made based on the four variables included in the prior study. We conducted bivariate and multivariate analyses, and derived a new scoring system with its discrimination value. Results: Of 235 subjects, the incidence of readmission was 32.3% (95% CI 26–38%). We established a new scoring system consisting of 4 components. The scoring system had maximum score of 21 and incorporated malignancy (6 points), delirium (4 points), length of stay ≥ 10 days (4 points), and being at risk of malnutrition or malnourished (7 points), with a good calibration test. The C-statistic value was 0.835 (95% CI 0.781–0.880). The optimal cut-off point was ≥ 8 with a sensitivity of 90.8% and a specificity of 54.7%. Conclusions: Malignancy, delirium, length of stay ≥ 10 days, and being at risk of malnutrition or malnourished are predictors for 30-day all-cause unplanned readmission. The sensitive scoring system is a strong model to identify whether an individual is at higher risk for readmission. The new CGA-based scoring system had higher discrimination value than that of the previous seven-point scoring system. [ABSTRACT FROM AUTHOR]

Abstract This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome.

This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome. [ABSTRACT FROM AUTHOR]

This study aimed to assess the main clinical and anamnestic characteristics of adult Cystic Fibrosis (CF) patients and to evaluate the association of frailty with the CF genotyping classification. In an observational cross-sectional study, all ambulatory CF patients over 18 years old who received a diagnosis at the Regional Cystic Fibrosis Center for adults were enrolled and assessed by spirometry for respiratory function, by ADL and IADL for functional status, and by the Study of Osteoporotic Fractures (SOF) Index for frailty. The study population consisted of 139 CF patients (mean age 32.89 ± 10.94 years old, 46% women). Most of the subjects were robust (60.4%). The pre-frail/frail group was more frequently females (p = 0.020), had a lower BMI (p = 0.001), worse respiratory function, a higher number of pulmonary exacerbations/years, cycles of antibiotic therapy, and hospitalization (all p < 0.001) with respect to robust patients. The pre-frail/frail subjects used more drugs and were affected by more CF-related diseases (all p < 0.001). In relation to logistic regression, the best predictor of the pre-frail/frail status was a low FEV1 level. The CF patients show similarities to older pre-frail/frail subjects, suggesting that CF might be considered an early expression of this geriatric syndrome. This finding could help to better define the possible progression of CF, but overall, it could also suggest the usefulness employing of some tools used in the management and therapy of frailty subjects to identify the more severe CF subjects. [ABSTRACT FROM AUTHOR]

Geriatric syndromes associated with medications have been a social problem in Japan due to a rapid growing aging population in recent years. The aim of this study was to extract outpatients complaining of geriatric syndromes associated with medications at a pharmacy in Japan. We interviewed 206 outpatients individually by asking whether there were any symptoms labeled as geriatric syndromes they were conscious of after explaining about polypharmacy including typical symptoms such as drowsiness, depression, forgetfulness, reduced appetite, lightheadedness/dizziness, difficulty urinating and constipation with the use of a polypharmacy leaflet. The results showed that the prevalence of geriatric syndromes associated with medications was 7.8%, and moreover that the more medications patients take, the more they are likely to complain about their health problems. Especially, five or more medications were found to be associated with the increased frequency of geriatric syndromes in the outpatients. The present study suggests a simple screening method using active intervention and structured interview techniques for extraction of outpatients complaining of geriatric syndromes associated with medications at pharmacies. [ABSTRACT FROM AUTHOR]

Aim: Multiple risk factors are involved in geriatric syndrome (GS) occurring in older adults. Although drug therapy often contributes to GS, the specific causes among older adults in Japan remain unclear. In this study, we examined the possible prescribing cascade rate among older outpatients eligible for Late‐stage Elderly Health Insurance and elucidated the differences between GS and GS associated with medication (GSAM) trends. Methods: This retrospective study enrolled patients from health insurance claims data in Japan between October 2018 and March 2019; hospitalized patients were excluded. Two groups were identified among the participants with GS: GS (no use of GS‐causing medications) and possible‐GSAM (p‐GSAM; use of GS‐causing medications). The collected data were analyzed using the Bell Curve for Excel, and statistical significance was set at P < 0.05. Results: In total, 137 781 outpatients were enrolled. Of the 32 259 outpatients who did not use GS‐causing medications, 7342 were classified into the GS group. Among 105 522 outpatients who used GS‐causing medications, 8347 were classified as having p‐GSAM. The mean number of prescriptions was significantly higher in the p‐GSAM group than in the GS group (P < 0.01). Furthermore, all GS symptoms showed significant differences, with impaired appetite being the most prevalent in the p‐GSAM group than in the GS group (P < 0.01). A possible prescribing cascade was suspected in 2826 (33.9%) of 8347 outpatients in the p‐GSAM group. Conclusion: Impaired appetite in patients taking GS‐causing medications might lead to prescribing cascades. Further studies are needed to prevent such prescribing cascades. Geriatr Gerontol Int 2024; 24: 61–67. [ABSTRACT FROM AUTHOR]

Geriatric syndromes involving instability are associated with a higher risk of further complications in patients with trauma requiring subsequent surgery. Acute stroke symptoms require prompt recognition and initiation of reperfusion treatment. This case study describes the patient's stroke symptoms in a timeline and explores the benefit of objective assessment using screening tests and their importance in the differential diagnosis in nursing. Dysphagia is one of the stroke symptoms that can lead to aspiration pneumonia and increase the risk of mortality. This article aims to inform general nurses about the importance of early recognition of dysphagia and other stroke symptoms using adequate screening tests to ensure quality care. Geriatric syndromes encompass instability, resulting in a higher risk of complications, especially in trauma patients. This case study describes a patient with acute ischemic stroke with vague and unrecognized symptoms of dysphagia and explores the rationale for objective screening tests in nursing care. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. Methods A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non‐fall group. Data were collected from the We‐Chat applet of comprehensive geriatric assessment. A t test and chi‐square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. Results (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non‐fall group. The average calf circumference in the fall group was significantly lower than that in the non‐fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non‐fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non‐fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non‐fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). Conclusions The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients.

BackgroundGeriatric syndromes may be more common in older cancer patients than in those without cancer. Geriatric syndromes can cause poor clinical outcomes. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is often used as a clinically reported functional status score in oncology practice.MethodsOur study was designed as a cross-sectional study and included 218 older cancer patients. This study aimed to determine the prevalence and relationship of geriatric syndromes according to the ECOG-PS in older cancer patients.ResultsThe mean age of 218 participants was 73.0 ± 5.6 years, with 47.7% being women and 52.3% men in our study. ECOG-PS 0, 1, and 2 groups contained 51, 39, and 10% of the patients, respectively. The mean number of geriatric syndromes in the ECOG 0, 1, and 2 groups was 2.3 ± 2.2, 4.3 ± 2.4, and 5.7 ± 2.1, respectively (p

Introduction: Patients who should benefit from anti-amyloid therapies (AAT) are found across all geriatric settings. Yet, it remains unclear how the use of AAT in patients with geriatric syndromes, such as frailty and polypharmacy, has so far been discussed in the literature. Methods: Articles on aducanumab, gantenerumab, lecanemab, donanemab, crenezumab, solanezumab were retrieved in MEDLINE from inception to July 2023. For each article, identified geriatric relevant terms were assigned to five discussion contexts (eligibility of AAT study population, safety, prescription, patient clinical profile, alternative outcomes measurement). Article type and the involvement of geriatric healthcare professionals as an author were further extracted. Results: Out of 538 articles, 23 (4.27%) were published in journals from the geriatric category, 44 (8.18%) included an author affiliated with a geriatric institution. One hundred and sixteen (21.56%) articles included at least one geriatric relevant term, which were mostly discussed in the context of safety and eligibility. Articles mentioning geriatric syndromes were more frequently authored by a geriatric healthcare professional (p = 0.044). Discussion: The use of AAT in patients with geriatric syndromes has so far received poor attention in the literature raising concerns on their use in this patient group. The involvement of geriatric healthcare professionals in future studies may increase the relevance of AAT research in patients with geriatric syndromes. [ABSTRACT FROM AUTHOR]

Background The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people's lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. Methods The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. Results Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from −59% for incontinence to −13% for femoral neck fractures). A dose–response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. Conclusions In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults' health. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. Methods: A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non‐fall group. Data were collected from the We‐Chat applet of comprehensive geriatric assessment. A t test and chi‐square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. Results: (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non‐fall group. The average calf circumference in the fall group was significantly lower than that in the non‐fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non‐fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non‐fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non‐fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). Conclusions: The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of cognitive dysfunction among inpatients in Geriatrics Depart- ment of a hospital in Yunnan Province, and to analyze the influencing factors of cognitive dysfunction of the elderly.Methods A total of 2 216 admitted patients(≥60 years old) in the Department of Geriatrics of a hospital in Yunnan Province from September 2018 to August 2021 were recruited as the subjects. General data of the patients were collected. Comprehensive geriatric assessment was conducted by an internet-based platform of the Comprehensive Geriatric Assessment developed by the Department of Geriatrics of Yunnan First People's Hospital, among which cognitive function was assessed by the Mini-Mental State Examination(MMSE)phenotype. Results Among 2 216 patients, 1 087(49.1%) had normal cognitive function, 639(28.8%) had mild cognitive impairment, 285 (12.9%) had moderate cognitive impairment and 205 (9.3%) had severe cognitive impairment. According to multivariate Logistic regression analysis, increased age [OR=1.026,95% CI(1.015, 1.037),P＜ 0.001], vision decline[OR=1.290,95% CI(1.002, 1.662),P＜ 0.05], empty nest[OR=1.433,95% CI(1.009, 2.034),P＜ 0.05], family support disorder[OR=1.436,95% CI(1.120, 1.842),P＜ 0.05], insomnia [OR=1.380,95% CI(1.095, 1.740),P＜ 0.05] and suffered chronic obstructive pulmonary disease [OR=1.234,95% CI(1.008, 1.512),P＜ 0.05) were the risk factors for cognitive function in the elderly, while the individuals mainly engaged in mental activities[OR=0.678,95% CI(0.540,P＜ 0.05).0.852, P＜ 0.001], education experience of primary school[OR=0.613,95% CI(0.485,0.776,P＜0.001], secondary school[OR=0.670,95% CI(0.534, 0.839), P＜ 0.001) and university degree or above [OR=0.555,95% CI(0.410, 0.751),P＜ 0.001] were protective factors. Conclusions The prevalence of cognitive dysfunction in elderly hospitalized patients is high and closely related to a variety of factors. Specific intervention of related factors is of great significance for the early prevention of cognitive impairment in the elderly.

Abstract Objective Syncope is a common clinical condition in the elderly, associated with significant morbidity and risk of recurrence. Recurrent syncope causing a repeated reduction in the cerebral blood flow can predispose to progressive neurodegeneration, a decline in overall health and functionality. Hence, this study was conducted to study the common causes of recurrent syncope and its association with various geriatric syndromes. Methodology This case–control study recruited 50 cases of recurrent syncope and 50 controls, aged 75 years and older. A detailed history and sequential evaluation for aetiologies of recurrent syncope were done. Cognition, frailty, activities of daily living, depression, and nutrition were assessed using various scales. Results Most (80%, 80/100) of the participants were males and the mean age was 80.04 ± 4.3 years. In the syncope group, 42% (21/50) of patients had arrhythmia, and 30% (15/30) had valvular heart disease. Recurrent syncope was significantly associated with lower scores on Montreal cognitive assessment scale (OR: 6.47 P

Abstract Background Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS. Case presentation We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home. Conclusions To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.

Background/objectivesTo estimate associations between lower urinary tract symptoms (LUTS) and phenotypic frailty in older men.DesignCross-sectional study.SettingCommunity-dwelling men recruited from 2000 to 2002 from six U.S. academic centers for the Osteoporotic Fractures in Men Study.ParticipantsA total of 5,979 men aged 65 and older.MeasurementsThe independent variable was LUTS severity (none/mild, moderate, or severe) assessed with the American Urologic Association Symptom Index. Participants were categorized as frail, intermediate stage, or robust using an adapted Cardiovascular Health Study index (components: low lean mass, weakness, exhaustion, slowness, and low physical activity). Associations were estimated with odds ratios and 95% confidence intervals (CIs) from multivariable multinomial logistic regression models adjusted for potential confounders of age, other demographics, health-related behaviors, and comorbidities.ResultsThe prevalence of frailty was 7%, 11%, and 18% among men with none/mild, moderate, and severe LUTS, respectively. Moderate and severe LUTS, overall and by storage and voiding subscores, were associated with higher odds of both intermediate stage and frailty in all models. After adjustment for confounders, the odds of frailty was 1.41 times higher among men with moderate LUTS (95% CI = 1.14-1.74) and 2.51 times higher among men with severe LUTS (95% CI = 1.76-3.55), compared with none/mild LUTS. Severe LUTS was associated with a greater odds of individual frailty components exhaustion and low physical activity.ConclusionThe prevalence of phenotypic frailty is higher among older community-dwelling men with moderate or severe LUTS compared with those with mild or no LUTS. The positive association between LUTS severity and frailty among older men appears independent of age and known frailty risk factors. Although the temporal direction of this association and the utility of LUTS or frailty interventions in this population remain unclear, the high co-occurrence of these conditions could lead to earlier identification of frailty when clinically appropriate.

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.

IntroductionPatients who should benefit from anti-amyloid therapies (AAT) are found across all geriatric settings. Yet, it remains unclear how the use of AAT in patients with geriatric syndromes, such as frailty and polypharmacy, has so far been discussed in the literature.MethodsArticles on aducanumab, gantenerumab, lecanemab, donanemab, crenezumab, solanezumab were retrieved in MEDLINE from inception to July 2023. For each article, identified geriatric relevant terms were assigned to five discussion contexts (eligibility of AAT study population, safety, prescription, patient clinical profile, alternative outcomes measurement). Article type and the involvement of geriatric healthcare professionals as an author were further extracted.ResultsOut of 538 articles, 23 (4.27%) were published in journals from the geriatric category, 44 (8.18%) included an author affiliated with a geriatric institution. One hundred and sixteen (21.56%) articles included at least one geriatric relevant term, which were mostly discussed in the context of safety and eligibility. Articles mentioning geriatric syndromes were more frequently authored by a geriatric healthcare professional (p = 0.044).DiscussionThe use of AAT in patients with geriatric syndromes has so far received poor attention in the literature raising concerns on their use in this patient group. The involvement of geriatric healthcare professionals in future studies may increase the relevance of AAT research in patients with geriatric syndromes.

Multidimensional assessments are important in evaluating the overall health of older adults. The comprehensive geriatric assessment (CGA) is a representative framework; however, the burden associated with the CGA has led to the development of simplified multidimensional tools. Comparing these tools to the CGA can help utilize them effectively. However, a direct comparison is challenging owing to the conceptual nature of the CGA. In this study, we conducted a web-based survey to identify essential CGA components by linking International Classification of Functioning, Disability, and Health (ICF) category level 2 items and "not defined/not covered" (nd/nc) items. Healthcare professionals and individuals aged >65 years participated in a two-stage Delphi study. In total, 182 respondents (7 geriatricians, 22 nurses, 20 therapists, and 4 case managers) completed the survey. Sixty-one essential components for CGA were identified, including 55 ICF categories. Additionally, personal factors (i.e., proactiveness) and nd/nc items (i.e., subjective perceptions) were aggregated. The results suggest that the CGA includes objective conditions of intrinsic capacity, functional ability, and environment as well as subjective perceptions and proactiveness toward those conditions. Thus, CGA is not merely expected to assess geriatric syndrome but also to estimate broader concepts, such as interoception, resilience, and quality of life. [ABSTRACT FROM AUTHOR]

A geriatric syndrome manifests itself as a group of signs and symptoms such as functional decline or cognitive problems leading to a vulnerable or frail phenotype. Here we present the case of an older woman with primary hyperparathyroidism masked by a frail phenotype detected during the geriatric consultation at the emergency department. A 75-year-old woman with a history of hypertension, hypercholesterolemia, diabetes mellitus type 2, morbid obesity, non-alcoholic fatty liver disease, and secondary hyperparathyroidism due to vitamin D deficiency, presented at the emergency department with progressive fatigue, weakness, confusion, and cognitive decline over the last weeks. Previous consultation at the emergency department of another hospital a week earlier had not yielded a clear diagnosis. Geriatric assessment revealed severe frailty, functional dependence and neurocognitive decline. Blood tests revealed severe hypercalcemia (3.71 mmol/L), hypophosphatemia (0.35 mmol/L), and elevated PTH (492 ng/L). Parathyroid 4D scintigraphy and CT scan showed a possible parathyroid adenoma and multiple thyroid nodules. The patient underwent parathyroidectomy and subtotal thyroidectomy. Pathology revealed a parathyroid adenoma confirming the diagnosis of primary hyperparathyroidism, and papillary thyroid carcinoma. She was discharged after 22 days, and full functional and neurocognitive recovery was confirmed after 12 months. Geriatric consultation on the emergency ward is of key importance. Clinical decisions in older people are indeed complex and require multidisciplinary input where experience of geriatricians provides important added value. [ABSTRACT FROM AUTHOR]

Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio‐respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi‐system age‐related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system‐based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi‐factorial mechanisms of breathlessness in community‐dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi‐modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence‐based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults. [ABSTRACT FROM AUTHOR]

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind–body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind–body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population. [ABSTRACT FROM AUTHOR]

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 infrastructure 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 sarcopenia 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, reducemuscle synthesis and increasemuscle breakdown, resulting in an increase in the prevalence of sarcopenic obesity in the elderly. Studies have shown that sarcopenia increases the risk of falls in the elderly, and also causes obese elderly people to easily losemuscle 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 common event among older adults and are associated with increased morbidity and disability. [ABSTRACT FROM AUTHOR]

Lucille B Brunker,1 Christina S Boncyk,1,2 Kimberly F Rengel,1,2 Christopher G Hughes1,2 1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Lucille B Brunker, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building &num;422, Nashville, TN, 37212, USA, Tel +1 615-936-2857, Email lucille.brunker@vumc.orgAbstract: There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.Keywords: geriatric syndrome, critical illness, organ dysfunction, shock, respiratory failure

Chilaiditi’s syndrome is a rare disease with an incidence of 0.025-0.28% cases, where it shows colon interposition between diaphragm and right lobe of liver. Usually related to congenital malformation include the absence, weakness, or elongation of suspensory ligaments of transversal colon or falciform ligaments. The 83-year-old woman was admitted with 1-week history of fatigue, lacked the will to eat and drink. Nausea and vomiting were sometimes accompanied with abdominal pain. Patient often had difficulty in defecating even though she had been eating fruits, she often needed laxatives. Patient had a history of osteoarthritis and hypertension. Physical examination appeared moderately-ill, with gasglow coma scale (GCS) 14 and blood pressure 150/90 mmHg. From abdomen epigastric tenderness (+). From thoracic X-ray found visible interposition of colon at right-upper quadrant of abdomen. Geriatric index fall risk assessment = 11 and mini mental state examination (MMSE) = 22. This patient was a geriatric patient with multiple diagnosis and frailty. Patient had a history of osteoarthritis contributes to patient’s instability. Chronic constipation was also quite disturbing cause an interposition of colon. Patient had coincidence with COVID-19 with comorbidity and geriatric syndrome. Thorough care, close monitoring, and optimal management should be applied.

Objective: Folates are essential for healthy cell division, growth and function. With the discovery that folate provides the proliferation and differentiation of muscle cells, the relationship between folate and sarcopenia has attracted the curiosity of researchers. Geriatric syndromes may have a common pathogenesis, as they are considered clinical conditions with common risk factors. Our aim in this study was to investigate the relationship of sarcopenia with geriatric syndromes and serum folate level. Materials and Methods: The study population consisted of 287 patients (202 female) who were admitted to our geriatrics outpatient clinic for the first time and underwent a comprehensive geriatric assessment (CGA) during the one year between January 2018 and January 2019. Demographic information, chronic diseases, drugs used by the participants and their current chronic diseases, CGA results and laboratory findings of patients were recorded. Diagnosis of sarcopenia was made under the guidance of the European working group on sarcopenia in older people 2. Results: Eighty-eight (31%) of the 287 patients were sarcopenic. While age, number of drugs, the frequency of chronic kidney disease and malnutrition were statistically significantly higher in patients with sarcopenia, mini-mental state examination score and serum folate levels were significantly lower (p=0.001, p<0.001, p=0.040, p<0.001, p=0.001, p=0.028; respectively). The result of univariate logistic regression analysis showed that sarcopenia was independently associated with folate [odds ratio: 0.926 (95%) confidence interval: 0.864-0.993, p=0.031]. Serum folate level in patients with malnutrition was also significantly lower (7.12±4.39, p=0.008). Conclusion: Since sarcopenia is associated with malnutrition, they should be evaluated together. As we found that serum folate levels were lower in patients with both sarcopenia and malnutrition, we recommend that risky groups be supported with folate-rich foods or folic acid supplementation. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of cognitive dysfunction among inpatients in Geriatrics Depart-ment of a hospital in Yunnan Province, and to analyze the influencing factors of cognitive dysfunction of the elderly.Methods A total of 2 216 admitted patients (≥60 years old) in the Department of Geriatrics of a hospital in Yunnan Province from September 2018 to August 2021 were recruited as the subjects. General data of the patients were collected. Comprehensive geriatric assessment was conducted by an internet-based platform of the Comprehensive Geriatric Assessment developed by the Department of Geriatrics of Yunnan First People’s Hospital, among which cognitive function was assessed by the Mini-Mental State Examination (MMSE)phenotype. Results Among 2 216 patients, 1 087 (49.1%) had normal cognitive function, 639 (28.8%) had mild cognitive impairment, 285 (12.9%) had moderate cognitive impairment and 205 (9.3%) had severe cognitive impairment. According to multivariate Logistic regression analysis, increased age [OR=1.026,95% CI (1.015, 1.037),P＜ 0.001], vision decline[OR=1.290,95% CI (1.002, 1.662),P＜ 0.05], empty nest[OR=1.433,95% CI (1.009, 2.034),P＜ 0.05], family support disorder[OR=1.436,95% CI (1.120, 1.842),P＜ 0.05], insomnia [OR=1.380,95% CI (1.095, 1.740),P＜ 0.05] and suffered chronic obstructive pulmonary disease [OR=1.234,95% CI (1.008, 1.512),P＜ 0.05) were the risk factors for cognitive function in the elderly, while the individuals mainly engaged in mental activities[OR=0.678,95% CI (0.540,P＜ 0.05).0.852, P＜ 0.001], education experience of primary school[OR=0.613,95% CI (0.485,0.776,P＜0.001], secondary school[OR=0.670,95% CI (0.534, 0.839), P＜ 0.001) and university degree or above [OR=0.555,95% CI (0.410, 0.751),P＜ 0.001] were protective factors. Conclusions The prevalence of cognitive dysfunction in elderly hospitalized patients is high and closely related to a variety of factors. Specific intervention of related factors is of great significance for the early prevention of cognitive impairment in the elderly. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS. Case presentation: We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home. Conclusions: To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients. [ABSTRACT FROM AUTHOR]

Objective: Syncope is a common clinical condition in the elderly, associated with significant morbidity and risk of recurrence. Recurrent syncope causing a repeated reduction in the cerebral blood flow can predispose to progressive neurodegeneration, a decline in overall health and functionality. Hence, this study was conducted to study the common causes of recurrent syncope and its association with various geriatric syndromes. Methodology: This case–control study recruited 50 cases of recurrent syncope and 50 controls, aged 75 years and older. A detailed history and sequential evaluation for aetiologies of recurrent syncope were done. Cognition, frailty, activities of daily living, depression, and nutrition were assessed using various scales. Results: Most (80%, 80/100) of the participants were males and the mean age was 80.04 ± 4.3 years. In the syncope group, 42% (21/50) of patients had arrhythmia, and 30% (15/30) had valvular heart disease. Recurrent syncope was significantly associated with lower scores on Montreal cognitive assessment scale (OR: 6.47 P < 0.001), four or more comorbidities (OR: 6.29 P < 0.001), and hearing impairment (OR: 6.21 P < 0.004) on multivariate logistic regression analysis. Conclusion: Recurrent syncope is significantly associated with cognitive impairment, the presence of four or more comorbidities, and hearing impairment. Conduction abnormality was the most common etiology of recurrent cardiovascular syncope. Structured evaluation and appropriate management of recurrent syncope might reduce the decline in physical, cognitive, and psychological reserve. A follow‐up longitudinal study is needed to establish this. [ABSTRACT FROM AUTHOR]

Frailty is a common geriatric syndrome characterized by increased vulnerability and is associated with adverse clinical events such as falls, hospitalization, and death. Early diagnosis and early intervention can delay or reverse frailty and ensure the healthy aging of older individuals. At present, there are no gold standard biomarkers for the diagnosis of frailty, which mainly relies on the scale to assess frailty, and the scale has shortcomings such as lagging assessment, subjectivity, and poor consistency. Frailty biomarkers help in early diagnosis and intervention in frailty. The purpose of this review is to summarize the existing inflammatory markers of frailty and focus on novel inflammatory biomarkers of frailty that can be used to help identify frailty early and explore potential intervention targets.