Geriatrics最新文献

Background: Older adults with Alzheimer's disease (AD) face a heightened risk of adverse hospital outcomes, including mortality. However, early identification of high-risk patients remains a challenge. While regression models provide interpretable associations, they may miss non-linear interactions that machine learning can uncover.

Objective: To identify key predictors of in-hospital mortality among AD patients using both survey-weighted logistic regression and explainable machine learning.

Methods: We analyzed hospitalizations among AD patients aged ≥60 in the 2017 Nationwide Inpatient Sample (NIS). The outcome was in-hospital death. Predictors included demographics, hospital variables, and 15 comorbidities. Logistic regression used survey weighting to generate nationally representative inference; XGBoost incorporated NIS discharge weights as sample weights during 5-fold hospital-grouped cross-validation and used the same weights in performance evaluation. Missing-value imputation and feature scaling were performed within the cross-validation pipelines to prevent data leakage. Model performance was assessed using AUROC, AUPRC, Brier score, and log loss. Feature importance was assessed using adjusted odds ratios and SHapley Additive exPlanations (SHAP). A sensitivity analysis excluded palliative care and DNR status and was re-evaluated under the same grouped cross-validation.

Results: In the full model, logistic regression achieved AUROC 0.879 and AUPRC 0.310, while XGBoost achieved AUROC 0.887 and AUPRC 0.324. Palliative care (aOR 6.19), acute respiratory failure (aOR 5.15), DNR status (aOR 2.20), and sepsis (aOR 2.26) were the strongest logistic predictors. SHAP analysis corroborated these findings and additionally emphasized dysphagia, malnutrition, and pressure ulcers. In sensitivity analysis excluding palliative care and DNR status, logistic regression performance declined (AUROC 0.806; AUPRC 0.206), while XGBoost performed similarly (AUROC 0.811; AUPRC 0.206). SHAP corroborated the dominant signals from end-of-life documentation and acute organ failure in the full model; in the restricted model (excluding DNR and palliative care), SHAP highlighted physiologic and frailty-related features (e.g., dysphagia, malnutrition, aspiration risk) that may be more actionable when end-of-life documentation is absent.

Conclusions: Combining regression with explainable machine learning enables robust mortality risk stratification in hospitalized AD patients. Restricted models excluding end-of-life indicators provide actionable risk signals when such documentation is absent, while the full model may better support resource allocation and goals-of-care workflows.

Oral health in older adults is a critical component of overall well-being requiring integrated, interdisciplinary approaches to address its complex interplay of medical, functional, and psychosocial challenges. The aim of this is to examine strategies to enhance interdisciplinary collaboration among dental professionals, physicians, nurses, nutritionists, and caregivers to improve oral health outcomes in aging populations. Older adults commonly face dental problems such as periodontal disease which can be exacerbated by polypharmacy, systemic diseases, and barriers to accessing care. These multifaceted needs necessitate coordinated efforts across dentistry, geriatric medicine, nursing, and social support systems. Strategies of effective interdisciplinary care include: (1) Medical-dental integration, enabling physicians to screen for oral health issues during routine assessments; (2) Nursing and caregiver engagement in daily oral hygiene support and early problem identification; (3) Nutritional interventions tailored to address chewing difficulties and prevent malnutrition; (4) Social support systems to improve access to affordable care; and (5) Technology-driven solutions such as tele-dentistry to enhance communication, early detection, and care coordination. Despite these opportunities, systemic barriers persist, including fragmented healthcare systems, financial constraints, workforce shortages, cultural biases, and technological gaps. Progress requires commitment from policymakers, healthcare institutions, and health care professionals to prioritize geriatric oral health as a public health imperative. In conclusion, interdisciplinary collaboration enhances older adults' oral-systemic health via cross-sector policies and healthcare workforce education. Implementing these strategies can mitigate oral health disparities, reduce the burden of chronic diseases, and improve quality of life for aging populations through holistic, patient-centered care.

Background/Objectives: Acute heart failure (AHF) is a common cause of hospitalization in older adults, associated with high morbidity and mortality. In this population, frailty, comorbidity, and functional variability significantly influence prognosis. This study evaluated short-term (30-day) and long-term (1-year) mortality predictors in elderly patients with AHF treated in the emergency department (HED), considering clinical variables, comorbidities, and precipitating factors (PFs). Materials and Methods: An observational cohort study was conducted based on a secondary analysis of older patients with AHF included in the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry, treated at Hospital Universitario Marqués de Valdecilla (HUMV) between 2007 and 2022. Clinical, laboratory, and PF-related variables were collected. The primary outcome was all-cause mortality at 30 days and 1 year. Univariate and multivariate logistic regression analyses were performed. Results: A total of 548 patients were included (mean age: 80.7 years), of whom 78.6% required hospitalization, mainly in the Internal Medicine department. Mortality was 11.1% at 30 days and 29.9% at 1 year. Age, valvular heart disease, dementia, and elevated creatinine levels were independently associated with higher mortality. Hypoxemia and low-output symptoms were linked to short-term mortality, while NYHA class III and anemia were associated with long-term mortality. Among PFs, acute coronary syndrome (ACS) was related to worse short-term outcomes, whereas rapid atrial fibrillation (AF) was inversely associated with long-term mortality. Conclusions: The prognostic relevance of risk factors differs between short- and long-term outcomes in older patients with AHF. Incorporating clinical characteristics and PFs into risk stratification models may support individualized management and guide follow-up strategies tailored to the geriatric profile. This multidimensional approach is essential to improve clinical decision-making and outcomes in a highly vulnerable population.

Objectives: This study investigated the impact of age on the diagnostic accuracy and patient acceptance of two chewing efficiency tests: the digital Mini Dental Assessment (MDA) using carrots and the CHEW test by Slavicek using fruit gum, applied in both clinical and nursing home settings. Methods: Seventy participants aged 18 to 99 years from dental clinics and nursing homes were included. All participants received a standardized dental examination (reference standard) and performed the MDA and CHEW tests. Sensitivity, specificity, and AUC values were calculated using ROC analysis. Participants rated both tests in terms of taste, consistency, comprehensibility, required time, and subjective chewing sensation. Acceptance was analyzed across age groups and prosthesis types. Results: Both chewing efficiency tests showed good agreement with the clinical reference standard. The AUC was 0.72 for the MDA and 0.78 for the CHEW test (p = 0.192). Sensitivity was higher for the CHEW test (100%) compared to the MDA (83.3%), while the MDA demonstrated slightly higher specificity (59.6% vs. 55.8%). Age significantly influenced both diagnostic outcomes and test acceptance (p < 0.05). Younger participants (<70 years) were more often correctly classified as healthy and tended to prefer the MDA, whereas older participants (≥70 years) preferred the CHEW test, primarily due to taste. Misclassifications occurred most frequently among participants with complete dentures. Conclusions: Both the digital MDA and the CHEW chewing test demonstrated good diagnostic performance in identifying treatment need. Acceptance varied significantly with age, suggesting that test selection may be optimized based on patient characteristics. These simple and rapid assessments may support early detection of dental treatment needs in clinical and nursing home settings.

Background/Objectives: To evaluate short-term postoperative outcomes in octogenarians undergoing robotic pancreaticoduodenectomy. Methods: In compliance with the PRISMA statement standards, a systematic review and random-effects meta-analysis was conducted. All studies reporting short-term postoperative outcomes in patients aged ≥ 80 undergoing robotic pancreaticoduodenectomy were included and analyzed. Results: A total of 321 octogenarians from five studies were included. The mean operative time was 459.7 min (95% CI 398.6-520.8) and the estimated intraoperative blood loss was 216.1 mL (95% CI 147.4-284.8). Conversion to open occurred in 3.8% (95% CI 0.0-7.7). The risk of postoperative mortality was 4.5% (95% CI 1.7-7.2) and Clavien-Dindo grade ≥ III (major) complications occurred in 28.0% (95% CI 22.9-33.1). The risk of grade B or C postoperative pancreatic fistula was 10% (95% CI 6.5-13.5). The hospital stay was 14.9 days (95% CI 10.2-19.5). The risk of reoperation and readmission were 8.0% (95% CI 4.4-11.7) and 25.6% (95% CI 16.9-34.3), respectively. Compared to patients aged <80, the risk of major complications was higher (OR: 1.81, p = 0.010) and hospital stay was longer (MD: 5.19 days, p = 0.030) in octogenarians. Compared to the open approach, robotic approach was associated with longer operative time (MD: 137.08 min, p = 0.0009), less intraoperative blood loss (MD: -246.00 mL, p = 0.010), and lower major complications (OR: 0.62, p = 0.020). Conclusions: Subject to selection and confounding bias, robotic pancreaticoduodenectomy may be safe with acceptable postoperative mortality and morbidity in highly selected octogenarians with good performance status. The results of the current study can be used for hypothesis synthesis and power analysis in future comparative studies.

Background: Susception to cardio-reno-metabolic disorders increases markedly with age; however, the dominant contributors to risk may differ across the adult life course. While metabolic abnormalities often predominate at younger ages, vascular and renal alterations become more prominent in older populations. Understanding how these risk components reconfigure with aging may inform age-tailored prevention strategies. Methods: This cross-sectional observational study included 287 adults undergoing clinical and biochemical evaluation for cardio-metabolic risk. Participants were stratified into three age categories: <65 years (n = 175), 65-75 years (n = 84), and >75 years (n = 28). Anthropometric measurements, blood pressure, metabolic parameters, liver enzymes, inflammatory markers, and renal function indices were assessed. Insulin resistance was estimated using the triglyceride-glucose (TyG) index, and renal function was evaluated by estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Comparisons across age groups were performed using one-way analysis of variance (ANOVA). Results: Younger participants (<65 years) exhibited a predominantly metabolic risk profile, characterized by higher body mass index, waist circumference, fasting plasma glucose, triglycerides, and TyG index (all p < 0.05). In contrast, advancing age was associated with a progressive vascular-renal phenotype, including higher systolic blood pressure, lower diastolic blood pressure, and a marked decline in eGFR (p < 0.001). Liver enzymes decreased with age, while the FIB-4 index increased. UACR and C-reactive protein levels did not differ significantly between age groups. Despite these differences in individual risk markers, the composite risk category score was similar across age strata. Conclusions: Cardio-reno-metabolic risk profiles show distinct age-stratified patterns in dominant risk markers, with metabolic predominance more evident at younger ages and vascular-renal vulnerability more prominent in older adults. These findings support a life-course perspective on risk assessment and highlight the potential importance of early detection of vascular and microvascular risk in metabolically burdened younger individuals, prior to the development of overt renal dysfunction and advanced vascular aging.

Background: Advancing age is frequently associated with balance impairment, increased fall risk, and psychological distress, which together contribute to loss of independence and reduced quality of life. Yoga, as a mind-body practice, has the potential to enhance physical stability as well as mental well-being in older adults. Therefore, the objective of this study was to evaluate the effects of a structured yoga program on balance, fear of falling, mobility, and mental health outcomes among older adults. Methods: A quasi-experimental pretest-post-test study was conducted at Nagpur, India. A total of 64 eligible participants (65-85 years) were purposively assigned to a yoga intervention group (n = 32) or a waitlist control group (n = 32). The 12-week intervention comprised preparatory exercises, yoga postures, breathing practices, and meditation. Outcomes assessed at baseline and post-intervention included balance, fear of falling, mobility, depression, and anxiety. Results: Data from 50 participants (yoga: n = 26; control: n = 24) were analyzed. The yoga group showed significant improvements in balance (p < 0.001) and functional mobility (p < 0.001), with significant reductions in fear of falling (p = 0.009), anxiety (p = 0.0003), and depression (p = 0.004). In contrast, the control group exhibited deterioration in functional mobility (p = 0.001) and anxiety (p = 0.009), with no significant gains in other measures. Between-group comparisons confirmed significantly greater improvements in the yoga group across all outcomes. Conclusions: A 12-week yoga program was feasible and effective in improving balance, functional mobility, and mental health, while reducing fear of falling among older adults. Yoga may serve as a safe, non-pharmacological intervention to promote healthy aging in institutionalized populations. Trial registration: This study was prospectively registered with the Clinical Trial Registry of India (Registration No: CTRI/2023/10/058682; Registered on: 16 October 2023).

Background/Objectives: Chronic kidney disease (CKD) in older adults is frequently accompanied by substantial medication burden, increasing risks of adverse drug events and poor adherence. The Planetary Health Diet Index (PHDI), emphasizing plant-based foods and sustainable dietary patterns, may improve cardiometabolic health and reduce medication requirements. This study examined the association between PHD adherence as measured by the PHDI and medication burden among older adults with CKD. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018 cycles. Older individuals aged ≥ 65 years with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m² or albumin-to-creatinine ratio > 30 mg/g) at the baseline visit were included (n = 3161). PHDI scores (0-150) were calculated from two consecutive 24 h dietary recalls. Medication burden was assessed as the total prescription medication count and frequency of individual classes. Multivariable Poisson regression models evaluated associations between PHDI score and number of prescribed medications, adjusting for sociodemographic, lifestyle, and clinical covariates; logistic regression models were used to evaluate the association between PHDI score and specific medication classes. Results: Mean (SD) age was 75.0 (5.5) years; mean PHDI score was 62.4 (18.7). Participants in the highest PHDI tertile had significantly lower medication burden compared to the lowest tertile. In fully adjusted Poisson regression models, each 10-point increase in PHDI score was associated with 3% fewer medications (RR: 0.97, 95% CI: 0.96-0.99, p = 0.011). Participants in the highest PHDI tertile had 8% fewer medications compared to the lowest tertile (RR: 0.92, 95% CI: 0.87-0.98, p = 0.013). Higher PHDI scores were significantly associated with lower odds of proton pump inhibitor use (OR: 0.86, 95% CI: 0.79-0.94 per 10-point increase) and nonsteroidal anti-inflammatory drug prescription (OR: 0.86, 95% CI: 0.76-0.97 per 10-point increase). Participants in the highest PHDI tertile had 34% lower odds of PPI use (OR: 0.66, 95% CI: 0.49-0.89) and nonsignificant lower odds of NSAID use (OR: 0.67, 95% CI: 0.40-1.11) compared to those in the lowest tertile. Conclusions: Higher PHDI adherence was independently associated with lower medication burden in older adults with CKD. These findings suggest that plant-forward, sustainable dietary patterns may reduce pharmacological complexity in this vulnerable population. Prospective studies are needed to assess causality and clinical implementation strategies.

Background/Objectives: This pilot study aimed to evaluate the feasibility of applying the Beers criteria in the community pharmacy setting and aid pharmacists in identifying and emphasizing adverse effects from potentially inappropriate medications (PIMs) for older adults. Methods: We applied a single-center retrospective study to collect demographic and outcome data in order to analyze dispensed PIMs for older adults. We used an evaluation tool to compare warnings between pharmacy dispensing software and the Beers criteria. Descriptive statistics were computed via standard statistical software. Results: Culled from a random selection of 215 patients, the medical records from 50 subjects ≥65 years old were reviewed, including 440 of their medications. Our data demonstrated that 96% of subjects were dispensed at least one PIM, with a total of 34 different PIMs distributed at varying frequencies. A comparative analysis indicated that 74% of dispensed medications had similar, but not identical, warning profiles presented in the dispensing software and Beers criteria. Anticholinergic burden of dispensed PIMs indicated that older adults were at risk of falls and delirium. By supplementing the dispensing software with Beers criteria, we were able to create clinical communication notes for providers, patients, and pharmacy students to emphasize the role pharmacists can play to minimize PIM's adverse effects on older adults. Conclusions: Our data indicates the feasibility of implementing the Beers criteria in the community pharmacy setting. Integrating the dispensing software warnings with Beers criteria created a structured intervention strategy to prevent potential adverse effects and develop clinical communication notes to emphasize a more engaging role that the community pharmacy setting can play to optimize therapeutic outcomes for older adults.

Lung cancer is one of the most common malignant tumors and is associated with a high mortality rate, especially in aged patients. Immunotherapy is an effective method for treating lung cancer, particularly when used in combination with other treatments like chemotherapy. One of the types of immunotherapy is the use of autologous immune cells that are pre-activated before injection back to a patient. The effectiveness of this type of immunotherapy is determined by the specificity of its action on cancer cells through the activation of immune cell, e.g., lymphocytes. However, this treatment is not extensively used in elder patients due to higher risk of complications. On the other hand, in those aged patients who suffer from late stage cancer, the immune-cell based immunotherapy may come as a last resort. In this study, we present a clinical case of a 63-year-old patient with advanced-stage lung cancer and CT-confirmed infiltration of the left main bronchus. Treatment of the patient with immunotherapy using autologous activated lymphocytes combined with tomotherapy resulted in prominent improvement and decreased size of the malignancy. This positive effect was accompanied by a decrease in the number of circulating tumor cells in the blood. The patient was treated in May-June 2024 and is still alive with good condition as of August 2025. We conclude that combined treatment is a reliable option for selected aged patients with advanced-stage lung cancer.