Geriatrics最新文献

Background: Ageing profoundly alters endocrine regulation and nutrient metabolism, predisposing older adults to thyroid dysfunction. Iodine, an essential micronutrient, lies at the center of this vulnerability due to its narrow physiological range and multiple interactions with nutrition, medications, renal function, and, presumably, gut microbiota. Objective: This narrative review integrates evidence on how ageing modifies iodine-thyroid homeostasis, emphasizing the roles of dietary intake, pharmacologic exposures, microbiota composition, and age-related metabolic alterations that influence iodine handling and thyroid hormone economy. Main Findings: Physiological ageing reduces renal iodine clearance, thyroidal reserve, and peripheral hormone conversion, while chronic inflammation and multimorbidity increase susceptibility to both iodine deficiency and excess. Polypharmacy, including amiodarone, lithium, and proton pump inhibitors, further destabilizes thyroid function. Age-related dysbiosis may impair micronutrient absorption and immune tolerance, linking gut ecology to thyroid autoimmunity. The gut microbiota may influence thyroid function through immune and metabolic pathways, although current evidence in older adults remains limited. Together, these factors shift the balance between iodine intake and utilization, heightening the risk of subclinical or overt hypothyroidism in older adults. Conclusions: Overall, variations in iodine intake emerge as one of the main determinants of thyroid dysfunction in ageing with nutritional, pharmacologic, and other modifiers primarily influencing iodine-related thyroid vulnerability. The adoption of age-adjusted thyroid reference ranges and preventive monitoring can reduce overtreatment and improve metabolic resilience in later life.

Background: Late-onset depression (LOD) represents a distinct clinical and biological phenotype emerging in the context of global population ageing. This study aims to synthesize current evidence on the epidemiology, risk factors, mechanistic pathways, and therapeutic approaches of LOD, integrating biological, psychological, and social dimensions. Methods: This narrative review synthesizes recent evidence across epidemiology, clinical symptomatology, neurobiology, and treatment. Where conceptually appropriate or empirically overlapping, we incorporate findings from the broader late-life depression (LLD) literature. Results: LOD emerges (as a distinct clinical and biological entity in later life) as a clinically and biologically meaningful presentation of depression in later life, representing a minority of depressive cases. It is defined by prominent apathy, psychomotor slowing, and cognitive impairment, and is closely linked to frailty, medical comorbidity, and heightened dementia risk. Pathophysiological mechanisms converge on vascular, inflammatory, oxidative, and neuroplasticity pathways, while psychosocial adversity further shapes onset and course. Treatment prioritizes efficacy and tolerability amid multiple morbidity; SSRIs and SNRIs are first-line, with pro-dopaminergic or dual-action agents addressing anhedonia and apathy, and neuromodulation or augmentation strategies reserved for resistance. Integrative approaches combining pharmacotherapy, psychotherapy, and lifestyle interventions are essential to optimize outcomes in aging populations. Conclusions: Late-onset depression (is a distinct, biologically and psychosocially driven disorder) represents a biologically and psychosocially enriched subtype in its own within the spectrum of late-life depression, requiring integrated, personalized care. Addressing neurovascular mechanisms, psychosocial adversity, and prevention through coordinated geriatric and psychiatric strategies may improve outcomes in aging populations.

Background: This study examined whether adverse drug reaction (ADR)-related hospital admissions or adverse drug events (ADE) in primary care are associated with changes in health-related quality of life (HRQOL), functional decline, and A&E visits, over time, in two separate prospective cohort studies of older adults in Ireland. Methods: The Adverse Drug reactions in an Ageing PopulaTion (ADAPT) (Study 1: N = 230) and the Centre for Primary Care Research (CPCR) (Study 2: N = 605) prospective cohorts were used. Participants completed health outcome questionnaires at baseline and again at 3 months (Study 1) and at 24 months (Study 2). ADR-related admissions and ADEs were assessed at baseline. Multivariable linear, logistic, and ordinal logistic regressions were used to examine associations between ADR-related admissions/ADEs and changes in HRQOL (EQ-5D-5L/3L), functional decline, and A&E visits, adjusting for age, sex, comorbidity, and polypharmacy. Results: In Study 1 (ADAPT cohort), frailty increased and A&E visits decreased over 3 months in both ADR/non-ADR groups (p < 0.01). In Study 2 (CPCR cohort), HRQOL decreased, and functional decline and A&E visits increased for both ADE/non-ADE groups over 24 months (p < 0.05). Individuals with ADEs had lower HRQOL and greater functional decline at both time points (p < 0.001). However, experiencing an ADR or an ADE was not significantly associated with changes in HRQOL, functional decline, or A&E visits over time, after adjustments. Conclusions: There were no substantial differences in the short-term healthcare burden of ADRs, while ADEs had poorer long-term outcomes.

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the "Geriatric Delirium Pass (GeDePa)", a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023-2024). Results: Healthcare professionals confirmed the GeDePa's practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.

Background/objectives: Current studies have shown that caregiving anxiety is associated with an individual's dysfunctional thoughts. The aim of this study was to assess the mediating effect of caregivers' forgiveness (benevolence, lack of avoidance and lack of revenge) on the relationship between dysfunctional thoughts and anxiety in the informal caregivers of dependent older adults.

Methods: Participants were 222 family caregivers. We conducted path analysis to test the hypothesized model.

Results: We found a model that showed a good fit (χ² = 3.410; χ²/gL = 5; p = 0.63; GFI = 0.994; CFI = 0.999; RMSEA = 0.001). It showed a direct and negative association between dysfunctional thoughts and lack of revenge, and this variable was related positively with both benevolence and lack of avoidance. In turn, benevolence was associated with lower levels of anxiety. The associations between dysfunctional thoughts and anxiety were mediated by caregiver forgiveness.

Conclusions: Our research suggests the importance of health workers seeking to understand how individuals judge their avoidance, revenge and lack of benevolence, which affect individuals' anxiety, for change. This study demonstrates the relevance of forgiving strategies in developing and testing informal caregiving assessments. It is necessary to detect and reduce avoidance and revenge related to caregivers. It is also necessary to detect and improve benevolence.

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues-including depression, anxiety, cognitive decline, and the use of psychotropic medications-reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth-mind connection promotes holistic health rather than functional decline.

Background: Sarcopenia is highly prevalent among hospitalized older adults and is associated with poor clinical outcomes. Multiple diagnostic criteria exist, but the comparative implications of different handgrip strength (HGS) thresholds and measurement tools are less explored.

Objectives: This study aimed to assess the prevalence of sarcopenia, comparing the diagnostic yield of different HGS thresholds using two measurement instruments (dynamometer and vigorimeter) in hospitalized older adults.

Design: This was a cross-sectional observational study.

Setting: A tertiary geriatric hospital with acute, rehabilitation, and long-term care wards was included.

Participants: A total of 376 hospitalized older adults with complete HGS and bioelectrical impedance analysis (BIA) data were recruited.

Measurements: HGS was measured using both a hydraulic dynamometer and a pneumatic vigorimeter. Sarcopenia was defined using cut-offs from EWGSOP2, SDOC, and two DO-HEALTH-derived thresholds. Low muscle mass was identified using the fat-free mass index (FFMI) by BIA. Multivariate logistic regression was used to identify predictors of sarcopenia.

Results: The prevalence of probable sarcopenia ranged from 68.1% to 89.4%, and confirmed sarcopenia from 39.6% to 50.3%, depending on the thresholds applied. Sarcopenic patients were older (86.1 ± 9.8 vs. 80.4 ± 11.0 years; p < 0.001), had lower BMI (20.7 ± 2.9 vs. 26.1 ± 4.8 kg/m²; p < 0.001), and were more frequently in long-term care (p = 0.014-0.043). Older age (OR 1.03-1.07 per year; p < 0.05) and lower BMI (OR 0.59-0.68 per kg/m²; p < 0.001) were independently associated with sarcopenia; sex and fall history were not.

Conclusions: Sarcopenia prevalence was high and varied widely across diagnostic definitions and measurement tools, reflecting both methodological variability and the high vulnerability of hospitalized older adults. These findings highlight the need for standardized, context-adapted diagnostic strategies to guide timely intervention in high-risk hospitalized older adults.

Background/Objectives: This study aimed to assess the impact of a physio-feedback exercise program (PEER) on the static balance of community-dwelling older adults. Methods: A clustered randomized controlled trial involving community-dwelling older adults (≥60 years of age) in the Central Florida area was conducted. Participants were randomized by research site into either (1) an 8-week exercise intervention program consisting of group-based and at-home exercises, along with a discussion with a researcher regarding their physiological health before and after the intervention period, or (2) a control group. Static balance outcomes included anterior-posterior root mean square (AP RMS), medial-lateral RMS (ML RMS), sway speed variability, and sway area measured using the Balance Tracking System (BTrackS) at baseline (T1), post-intervention (T2), one-month post-intervention (T3), and three months post-intervention (T4). Results: Among 373 community-dwelling older adults (mean age = 74.3 ± 7.1 years), a trend towards short-term improvement of sway area was observed for the intervention group, as seen through a small, marginally significant reduction in sway area at T2 (standardized β = -0.07; p = 0.050). However, the trend dissipated during post-intervention follow-up periods (T3 and T4). Sway speed variability significantly increased for the intervention group at T4 (standardized β = 0.10; p = 0.014). Conclusions: The PEER intervention may need to increase the total duration of the intervention, the frequency of the weekly exercise sessions, and the amount of standing stance exercises during the group-based and at-home exercise sessions to elicit improvements in static balance among older community-dwelling adults.

Background: Depression in older adults is a multifactorial condition influenced by health status, functional capacity, and lifestyle factors. This study aimed to investigate the individual and combined associations of these factors with late-life depression.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), this study evaluated the associations of general health, chronic conditions, functioning, and lifestyle behaviors (including physical activity, sleep, diet quality, smoking, and alcohol use) with depressive symptoms among U.S. adults 65 years and older. Weighted logistic regression models, accounting for the complex survey design of NHANES, were used to examine the factors both individually and in combination.

Results: Depressive symptoms were more prevalent among individuals with poor self-rated health, physical and cognitive functional limitations, hypertension, obesity, current smoking, physical inactivity, and alcohol abstinence. A clear cumulative risk gradient was observed with increasing numbers of risk factors: older adults with six or more risk factors had at least 20-fold higher likelihood of depressive symptoms compared with those with one or no risk factors.

Conclusions: These findings highlight the interdependent influences of health, function, and lifestyle on late-life depressive symptoms and underscore the need for integrative prevention and intervention strategies to promote mental well-being in aging populations.

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