In the article by Yong et al. entitled "Impact of Informal Caregiving at Older Ages on Loneliness and Social Networks in Singapore" [Gerontology. 2025;71:990-1002; https://doi.org/10.1159/000548267], there is an error in the Results section. The word "effective" should read "effect." The corrected sentence is: "The average treatment effect represents an additive effect; i.e., if all older adults were informal caregivers, the loneliness score would be different (higher) by 0.31 points."
Introduction: Sarcopenia is an age-related condition characterised by low muscle mass and function, associated with poorer outcomes. Its prevalence and prognostic role in multiple myeloma (MM) remain unclear, as most studies only consider muscle mass defined by computed tomography (CT) scan and disregard muscle function. This study aimed to describe the prevalence of sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) definition in older patients with MM and to analyse its associations with other geriatric syndromes and survival outcomes.
Methods: This is a prospective study of patients aged ≥65 years with newly diagnosed MM who underwent a Comprehensive Geriatric Assessment (CGA), including handgrip strength and gait speed. Their initial positron emission tomography-computed tomography images were evaluated in terms of muscle mass, subcutaneous and visceral adipose tissue at the third lumbar vertebral level (L3). Medical records were reviewed in January 2025 to collect mortality and follow-up data.
Results: Of 52 patients included (55.1% women; median age 77.6 ± 5.9 years), 32 (61.5%) had probable sarcopenia (low muscle strength), and four (12.5%) had confirmed sarcopenia (low muscle strength and low muscle mass). No significant differences were found in frailty or malnutrition between sarcopenic and non-sarcopenic participants. Sarcopenic patients had significantly shorter overall survival (OS) compared with non-sarcopenic patients (43.1 vs. 18.0 months, p = 0.001), and low muscle mass was independently associated with poorer survival outcomes (hazard ratio [HR]: 46.8; 95% confidence interval [CI]: 1.9-1,146.9). In contrast, no significant differences were observed for progression-free survival (PFS), although low muscle mass remained significantly associated with an increased risk of progression (HR: 25.34; 95% CI: 1.72-374.27).
Conclusion: This is the first study to include both muscle quantity (muscle mass) and function (muscle strength) as the correct approach for sarcopenia evaluation in older patients with MM. Patients with sarcopenia may have reduced OS, and low skeletal muscle mass index was also associated with shorter PFS, but further studies with larger cohorts are needed to confirm its prognostic value.
.Introduction: Falls occur in all age-groups and represent a significant public health concern. Previous studies have implemented artificial intelligence, including machine learning (ML) and deep learning (DL) algorithms for fall risk prediction, but the comparative performance between models and the applicability for younger populations remains unclear. This study aims to develop and compare different ML/DL models and identify key predictive features across age-groups.
Methods: We enrolled 1,441 community-dwelling adults aged over 20 years in southern Taiwan and collected demographic, clinical, and physical performance data. Participants were categorized based on fall history. Five ML models (KNN, RF, GBDT, XGBoost, and CatBoost) and two DL models (GRU, AGRU) were trained and evaluated using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (AUROC). Feature importance was interpreted using SHapley Additive exPlanations values in the best-performing model. Age-stratified subgroup analyses were conducted for groups aged 20-45, 46-65, and >65 years.
Results: The AGRU model achieved the highest accuracy (91.39%) and AUROC (0.934) in the overall group and outperformed other models across all subgroups. Feature importance analysis revealed pulse rate, living alone, systolic blood pressure, 5-times Sit-to-Stand test, and sex as major predictors of falls in the overall group. The top five predictive factors varied across age-groups.
Conclusion: We developed a robust and interpretable DL model to identify fall risk across different age-groups. Age-specific risk factors highlight the need for tailored preventive strategies. External validation using an independent dataset demonstrated moderate generalizability. Validating the model on larger, more diverse datasets and integration of sequential or sensor-based data are essential for practical applications.
Introduction: Older adults with mild cognitive impairment (MCI) are at elevated risk for falls and related complications. However, longitudinal data on fall incidence and functional recovery in high-risk individuals following a severe fall remain limited. This study aimed to compare 12-month fall incidence, cognitive and physical function, and physical activity in older adults with and without probable MCI who presented to the emergency department (ED) after a severe fall but were not hospitalized.
Methods: Data were collected from the SeFallED study, a prospective observational study of community-dwelling older adults (≥60 years) presenting to the ED due to a fall and discharged within 72 h of a fall. Participants were classified into older adults with and without probable MCI based on Montreal Cognitive Assessment scores (cut-off ≤24). Primary outcomes were recurrent falls and those demanding medical attention, assessed monthly via telephone interviews over 12 months. Secondary outcomes included cognitive performance, physical function (Short Physical Performance Battery, gait speed, postural sway), life-space mobility, and physical activity (accelerometry, self-report).
Results: Older adults with probable MCI (n = 116) were significantly more likely to experience a recurrent fall (52.6% vs. 36.5%; p = 0.012) and a fall requiring medical attention (33.6% vs. 11.9%; p < 0.001) than older adults without MCI (n = 126), as shown by chi-square tests. RM-ANCOVA indicated that cognitive performance improved in older adults with probable MCI over time, but no significant group differences emerged in physical function or physical activity. Life-space mobility remained consistently lower in older adults with probable MCI.
Conclusion: Despite comparable physical function, older adults with probable MCI are at substantially higher risk of experiencing recurrent falls, including falls requiring medical attention. Further research should investigate whether incorporating a cognitive screening in the ED and initiating secondary falls prevention strategies at the earliest opportunity can reduce fall incidence, particularly among older adults with MCI.
Introduction: Foot-related factors such as plantar foot muscle weakness, hallux valgus, hammer toe, excessive pronation, and foot pain are known causes of falls in older adults (ages > 65). Minimally cushioned footwear may naturally strengthen and provide enhanced sensory awareness to the feet, leading to reduced fall risk. The purpose of this study was to analyze the effects of long-term minimal footwear use on fall risk and fall incidence in older adults with established fall risk.
Methods: Adult volunteers ages > 65 were screened for fall risk and randomized into minimal footwear (n=33) and control (sham intervention, n=32) groups. Participants performed intervention or control activities 5x/week for 16 weeks and then at least 2x/week for the remainder of the 1-year study. They were measured for fall risk using the Mini Balance Evaluation Systems Test (Mini-BESTest) at baseline, 16 weeks, and 1 year. Participants kept written journals of intervention adherence and falls, and were contacted bimonthly to collect details on falls. A mixed-effects linear model analysis was used to measure change in fall risk. The minimimal detectable change (MDC) of > 3.5 points defined "meaningful change". Fall incidence was analyzed with number of falls per participant, proportion of fallers in each group, and fall rates per person-year. Time-to-first-fall analyses using Kaplan-Meier survival curves were used to visualize the cumulative probability of remaining fall-free over the 1-year period. The log-rank test was used to evaluate differences between groups.
Results: Minimal footwear group made significant improvements in Mini-BESTest scores at both follow-up time points (16 weeks: 2.24 points, p < 0.001; 1 year: 2.62 points, p < 0.001) compared to no improvements made by control group (16 weeks: 0.108 points, p=0.794; 1 year: 0.119 points, p=0.797). At 16 weeks, 28.6% of minimal footwear group and 3.3% of control group achieved the MDC (p =0.005). At 1 year, 23.1% of minimal footwear group and 7.4% of control group achieved the MDC (p=0.111). Fall incidence was not significantly different between groups at 1 year; however, minimal footwear group had fewer falls, a smaller proportion of fallers, and longer time to first fall. For the 1-year study duration, 76.9% of minimal footwear group and 51.9% of control group remained fall-free.
Conclusion: Long-term minimal footwear use resulted in meaningful improvements in balance and reduced fall risk in older adults. This type of footwear can be gradually incorporated into daily activities using our progressive schedule, or could be included in existing fall-prevention programs. This study was underpowered to detect fall incidence, and we did not see a difference in falls incidence between groups.
Introduction: Depressive moods can lead to a decline in physical function and the development of dementia, resulting in negative outcomes such as the need for long-term care and increased mortality. Similarly, oral frailty highlights the relationship between aging and oral health issues. Depressive moods and oral frailty contribute to the detrimental cycle of frailty and significantly affect the overall health of older adults. Early assessment of these problems and the implementation of appropriate interventions may help prevent and mitigate functional decline. However, the relationship between these two factors in older outpatients has not been sufficiently investigated. We hypothesized that a higher percentage of patients with oral frailty in a medical outpatient clinic would experience depressive moods and aimed to investigate the relationship between these two factors.
Methods: This was a cross-sectional study. Patients aged ≥65 years who visited a frailty outpatient clinic were included in this study. Depressive moods were assessed using the Geriatric Depression Scale-15 (GDS-15). Oral frailty was assessed using the Oral Frailty Five-item Checklist (OF-5). The associations between depressive moods (GDS-15 ≥5), oral frailty (OF-5 ≥2), and OF-5 sub-items were analyzed using the chi-square test and logistic regression analysis.
Results: A total of 337 patients (mean age: 78.4 ± 6.4 years old) were included. Of these, 126 (37%) had depressive moods, and 168 (50%) had oral frailty. A significantly higher proportion of patients with depressive moods had oral dysfunction, including chewing ability, swallowing function, and dryness, as well as oral frailty. The logistic regression analysis showed that oral frailty was associated with depressive moods with an adjusted odds ratio of 2.13 (95% confidence interval: 1.27-3.55).
Conclusion: There was an association between depressive moods and oral frailty. In addition, a relationship between depressive moods and subjective oral dysfunction, such as chewing ability and dryness, was observed. A longitudinal study is required to address the causal effects of oral frailty on depressive moods.
Introduction: Balance on the Brain is a balance-focused multi-modal community-based exercise intervention aimed at reducing falls and improving health outcomes for people living with mild cognitive impairment (MCI). This study completed an important step when conducting randomised controlled trials (RCTs) by evaluating the barriers and facilitators of the program from the perspective of the intervention participants and the exercise providers delivering the intervention. This study also explored the perspective of the main informal support people (MISP) of intervention participants living with MCI.
Methods: This was a qualitative study using face-to-face semi-structured interviews. Interviews were audio-recorded to enable verbatim transcriptions. Braun and Clarke's 6-step thematic analysis process was used to analyse the data.
Results: A total of 26 RCT intervention participants, 4 physiotherapists, and 14 MISPs were interviewed at the end of the 6-month intervention. There was moderate diversity in the overall experiences; for example, what may have been a barrier for some was a facilitator for others. Overall, lack of motivation and other health issues were the most identified barriers across the Balance on the Brain intervention. Key facilitators for the intervention participant were the guidance provided by the physiotherapists delivering the program and the ease of adding the intervention into their daily routine. The MISPs had varying levels of involvement and support throughout the intervention; some completed the intervention exercises with the intervention participant, others were supportive and encouraged participation, and some had no input into the intervention participant's involvement in the Balance on the Brain intervention.
Conclusion: The Balance on the Brain RCT was largely accepted by intervention participants, physiotherapists delivering the intervention, and the MISPs. Exercise interventions that can be tailored to each participant's needs are likely to be viewed more favourably. Future interventions for this population may be improved by adding opportunities for the MISPs to be more involved.
Introduction: Polypharmacy might be clinically appropriate if it improves health outcomes of people with dementia. However, polypharmacy was associated with higher risks of impairment in cognitive, physical, and emotional abilities. Several studies on polypharmacy among people with dementia were performed globally but not in Vietnam. This study aimed to investigate the epidemiology of polypharmacy among people with dementia in Vietnam.
Methods: This retrospective cohort study included outpatient individuals who were diagnosed with dementia between January 1, 2023, and April 15, 2024, in the Vietnam National Geriatric Hospital. Data were extracted from medical records, including dementia diagnosis, drug utilization, medical history before dementia diagnosis, comorbidities, and sociodemographic. The monthly quantity of drugs used was categorized as "no polypharmacy" 0-4 drugs, "polypharmacy" ≥5 drugs, and "hyperpolypharmacy" ≥10 drugs. The primary outcome was the incidence of polypharmacy following dementia diagnosis. The prescription of potentially inappropriate medications in people with dementia, identified using the American Geriatrics Society Beers criteria, was also evaluated. Multivariable logistic regression was employed to find associated risk factors of polypharmacy.
Results: During the follow-up from dementia diagnosis to June 30, 2024, there were 64 people having polypharmacy (median age at dementia diagnosis 73.5, 68.8% females) and 342 people without polypharmacy (median age at dementia diagnosis 74.0, 64.0% females). Age at dementia diagnosis, sex, regions of residence, and education were not associated with having polypharmacy in people with dementia. Compared to people with Alzheimer's disease, significantly higher probabilities of having polypharmacy were seen in people with vascular dementia (odds ratio [OR] 4.63, 95% confidence interval [CI] 2.16-9.92) and other dementias (OR 4.61, 95% CI 2.31-9.18). People with dementia at severe stage were at lower chance of having polypharmacy (OR 0.19, 95% CI 0.05-0.63). Potentially inappropriate medications were more frequent in the polypharmacy group (n = 27, 42.2%), compared to the non-polypharmacy group (n = 59, 17.3%). Prescribing antipsychotics in the polypharmacy group doubled that in the non-polypharmacy group (34.4% versus 16.1%).
Conclusion: Lower incidence of polypharmacy among people with dementia compared to previous studies might either imply the improvement in managing the prescription of potentially inappropriate medications or be underestimated by not including inpatient individuals. Future studies are necessary to clarify the impact of polypharmacy on health outcomes of people with dementia.
Introduction: Perceived balance confidence may influence stability of gait among older adults and be pronounced in varied environments. This cross-sectional study investigated associations between balance confidence and outdoor walking parameters in various environments as well as differences in these parameters among older adults with varying levels of balance confidence.
Methods: Older adults (N = 39, women 67%, mean age 76) walked outdoors on level, uphill, and downhill with their self-selected normal speed. Walking parameters (stride, stance, and swing durations and cadence) and their variance were assessed using inertial measurement units on the lower back and shanks. Balance confidence was evaluated using the activities-specific balance confidence scale (ABC). Additionally, physical activity, self-rated health, falls in past year, anthropometrics, walking speed on level, short physical performance test (SPPB), and Timed Up and Go (TUG) were recorded.
Results: Balance confidence positively correlated with cadence on level (rs = 0.439, p = 0.005) and uphill (rs = 0.336, p = 0.049), negatively with cadence variability downhill (rs = -0.424, p = 0.007) and stride duration on level (rs = -0.436, p = 0.006) and uphill (rs = -0.335, p = 0.049). The high balance confidence group (ABC ≥80, n = 32) had 7-8% higher cadence in all environments, 7-8% shorter stride duration uphill and downhill, walked 0.14 m/s faster on level and showed less variability in walking parameters uphill compared to the lower balance confidence group (ABC <80, n = 7).
Conclusion: In older adults, differences in walking parameters can be seen when using the balance confidence as a differentiating factor. Self-rated balance confidence combined with an uphill walking test may give an indication of varying walking patterns in older adults.
Introduction: This study assessed the association between thyroid-stimulating hormone (TSH) levels and the risk of tooth loss.
Methods: From 2005 to 2013, 56,743 community-dwelling individuals aged ≥65 years underwent biennial physical examinations in Taipei. Dental evaluations documented tooth count and TSH levels were measured using a third-generation assay. Participants averaged 3.4 follow-ups over 4.9 years and were categorized into four groups based on plasma TSH concentrations. A generalized estimating equation model analyzed the longitudinal relationship between tooth loss and TSH levels.
Results: Participants' mean age was 73.1 years (standard deviation, 6.3), being highest in the clinical hypothyroidism group (74.6 years) and lowest in the euthyroid group (73.0 years). Hypertension and diabetes were more prevalent in the clinical hypothyroidism group. Periodontitis rates were consistent across TSH categories, and 81.5% of participants retained ≥20 teeth, 12.0% had 10-19 teeth, and 6.5% had 1-9 teeth. Severe tooth loss (1-9 teeth) was slightly more frequent in the clinical hypothyroidism group (6.7%), suggesting a potential link between thyroid function and tooth retention. Multivariable-adjusted models found no significant association between subclinical hypothyroidism and tooth loss, whereas clinical hypothyroidism reduced risk (odd ratio [OR] = 0.82, 95% confidence interval: 0.74-0.92). Stratified analysis showed this protective effect in those with ≥20 teeth and in individuals aged 65-75 years (OR = 0.79). Conversely, subclinical hypothyroidism increased tooth loss risk in participants aged ≥75 years (OR = 1.12). Sex-stratified analysis revealed 26% lower risk in females with clinical hypothyroidism (OR = 0.74), suggesting age- and sex-specific influences of thyroid function on oral health.
Conclusion: This study suggests a link between clinical hypothyroidism and reduced tooth loss, particularly in women and individuals aged 65-75 years. Conversely, subclinical hypothyroidism in persons ≥75 years correlates with greater risk, underscoring the role of thyroid function in geriatric oral health.
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