European Geriatric Medicine最新文献

Purpose: To investigate whether hemoglobin two days after discharge and transferrin saturation two months after discharge for hip fracture (HF) were associated with mobility and functional outcomes.

Methods: We included patients ≥ 65 years, surgically treated for a hip fracture at Copenhagen University Hospital, Bispebjerg and Frederiksberg. Iron deficiency was defined as transferrin saturation (TSAT) below 20%. Mobility and physical function were measured two months after discharge in an orthogeriatric outpatient clinic using new mobility score (0-9 points, 9 best functional mobility), six-minute walk test, usual walking speed (10-m), 30-s Sit-to-Stand test, and handgrip strength. Associations between hemoglobin, transferrin saturation (per units of 10%) and outcomes were evaluated by multivariable linear regression, with age, sex, and type of fracture (intra- versus extracapsular) as covariates.

Results: 235 patients were included (69% women, age 80 ± 8 years, 55% had intra-capsular fractures). The average ± SD hemoglobin two days after discharge was 10.4 ± 1.5 g/dL, 91% had anemia according to the WHO definition. The average transferrin saturation two months after surgery was 0.21 ± 0.09, 51% had iron deficiency. High hemoglobin was associated with high new mobility score (B = 0.46, 95% CI 0.25-0.66, p < 0.001). High transferrin saturation was associated with high new mobility score (B = 0.74, 95% CI 0.17-1.31, p = 0.01), six-minute walk test (B = 47, 95% CI 16-78, p = 0.004), walking speed (B = 0.12, 95% CI 0.06-0.19, p < 0.001), 30-s Sit-to-Stand test (B = 1.56, 95% CI 0.30-2.85, p = 0.01), and hand grip strength (B = 2.1, 95% CI 0.0-4.2, p = 0.049).

Conclusions: High hemoglobin two days after discharge was associated with high new mobility score two months after surgery. Transferrin saturation was associated with mobility and all measured functional outcomes two months after hip fractures.

Purpose: The association between antidementia drugs (ADDs) use and the risk of nursing home placement (NHP) remains inconclusive. This study aimed to investigate the effects of ADDs, including cholinesterase inhibitors (CEIs) and memantine, on NHP among individuals with dementia.

Methods: A systematic search of PubMed, Embase, Cochrane Library and ClinicalTrials.gov was conducted up to 16 March 2024 and updated on 25 August 2025. Randomized controlled trials (RCTs) or observational studies investigating the use of ADDs and NHP were included. Hazard ratios (HRs) with 95% confidence intervals (CI) were pooled using the DerSimonian-Laird random-effects model.

Results: Of 1,373 records, three RCTs and nine observational studies were included, encompassing different comparators. Meta-analyses were conducted separately by study design. In RCT, the single trial comparing any ADDs versus non-use (N = 1; donepezil vs placebo) showed no significant difference in NHP. In head-to-head RCT comparisons, one trial suggested a non-significant trend toward higher NHP risk with memantine versus donepezil. Among observational studies, a meta-analysis of five observational studies suggested a lower NHP risk with any ADDs in Alzheimer's disease (pooled HR = 0.43, 95% CI: 0.32-0.58, I² = 40.39%, p < 0.001) and mixed dementia (pooled HR = 0.84, 95% CI: 0.72-0.97, I² = 0.00%, p = 0.019). Pooled observational head-to-head comparisons likewise showed no significant differences between donepezil and rivastigmine (n = 3), donepezil and galantamine (n = 2), or CEIs + memantine versus CEIs monotherapy (n = 2). These observational estimates may be affected by residual confounding and other biases and should be interpreted with caution. By GRADE, certainty was low for the RCTs evidence and very low for the pooled observational studies of ADDs or CEIs versus non-use, and for head-to-head and combination therapy comparisons.

Conclusions: RCTs, rated as low-certainty evidence, suggest that ADDs may have no effect on NHP, whereas observational studies, rated as very low-certainty evidence, suggest that ADDs may be associated with a reduced risk of NHP among individuals with dementia. Given the overall uncertainty, high-quality, adequately powered prospective trials with longer follow-up are required to clarify these associations and to assess whether a causal relationship exists.

Background: Falls are a major public health concern among older adults in India. While earlier studies using LASI data have identified some risk factors, they did not account for key geriatric syndromes, physical performance, and functional status. This study aims to comprehensively examine the determinants of falls among older adults using nationally representative LASI Wave 1 data.

Methods: We analysed data from 26,780 community-dwelling individuals aged ≥ 60 years from LASI Wave 1. Falls were self-reported. Covariates included socio-demographics, comorbidities, ADL/IADL, cognition, depressive symptoms, grip strength, gait speed, physical activity, and sensory impairments. Associations were assessed using univariate and stepwise multivariable logistic regression.

Results: Among 28,285 community-dwelling older adults from the LASI dataset, the median age of the participants was 67 years (interquartile range: 63-73), 51% of the individuals were male and 49% female. 11.56% individuals reported a history of falls, with a higher prevalence among women (56.97%) and increasing age groups. In multivariate analysis, female sex, underweight BMI, tobacco and alcohol use, chronic joint disease, high cholesterol, prior injury or fracture, sensory impairments, ADL limitations, depression, and physical performance deficits were independently associated with increased fall risk. Functional limitations, such as difficulty climbing stairs and pushing/pulling objects, were also significant predictors. Conversely, urban residence and heart disease were associated with a lower risk.

Conclusion: Falls in older Indian adults are linked to a complex interplay of sociodemographic, clinical, and functional factors. These findings highlight the need for integrated, targeted fall prevention strategies addressing modifiable risk factors within this population.

Aim: To evaluate the clinical profile, management, and outcomes of patients hospitalized with acute mesenteric ischemia (AMI). Secondary objectives were to identify factors associated with surgical intervention and in-hospital mortality in this patient population.

Methods: We conducted a retrospective multicenter study including 693 adult patients diagnosed with AMI across 10 hospitals in Southern Spain between 2010 and 2020. Data collected included demographics, comorbidities, functional status, treatment strategies, and outcomes.

Results: A total of 693 patients were studied, 360 (54.2%) were women. The median age was 77.8 years; 85.8% were aged ≥ 65 years, and 31.8% were ≥ 85 years. In-hospital mortality was 62.4%, increasing to 70.1% among the very old people. A total of 62.6% of patients were admitted to Internal Medicine departments; these patients were older, more functionally dependent (57.8%), and more likely to have dementia (24.9%) than those admitted elsewhere. Only 18.5% underwent surgery. Baseline functional (OR 4.54; 95% CI 1.45-14.22; p = 0.009) and male sex (OR 2.64; 95% CI 1.12-6.22; p = 0.027). were the strongest predictor of surgical intervention. Older age was the strongest independence variabile related to mortality (OR 1.70; 95% CI 1.09-2.64; p = 0.020).

Conclusions: AMI is a severe abdominal emergency that primarily affects older adults. Its nonspecific presentation often delays diagnosis, contributing to high mortality. Early detection and multidisciplinary management, involving internists and geriatricians, are key to improving prognosis and guiding treatment decisions aligned with patients' overall goals and functional status.

Background: Older patients living with frailty are particularly vulnerable to adverse outcomes during hospitalization and transitions in care. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes for these patients. To address the increasing demand for geriatric methodology and improve care quality, the nationwide quality database DANFRAIL was established with a cross-sectoral and interdisciplinary focus, first of its kind worldwide.

Methods: DANFRAIL aims to monitor and enhance quality of care for older patients with frailty across healthcare settings in Denmark. Thus, development involved a co-creation process with expert clinicians and patient representatives from all sectors, guided by a specialist team from the Danish Healthcare Quality Institute. The indicator set, derived from CGA domains, was refined through consensus meetings and public consultation.

Results: The initial indicator set includes 6 process indicators and 2 result indicators, focusing on key aspects of care for older patients living with frailty. The public consultation revealed concerns about implementation, workload, registration requirements, and data integration across sectors. Adjustments were made to address these issues and ensure the feasibility of data collection and use.

Conclusion: DANFRAIL represents a significant step towards improving the quality of care for older patients living with frailty in Denmark. Grounded in the principles of CGA, the database offers a structured, data-driven framework to monitor and enhance care delivery across sectors. By supporting continuous quality improvement and better health outcomes, DANFRAIL sets a national standard for caring for older people in vulnerable situations and may serve as an exemplary approach for international adoption.

Purpose: Delirium is a common complication in older adults hospitalised for acute heart failure (AHF), but its incidence, subtypes, and short-term outcomes remain poorly characterised in the very old population. This study aimed to determine the prevalence and incidence of delirium in patients admitted to an acute geriatric unit (AGU) with AHF, describe its subtypes, and assess their impact on 90-day post-discharge survival.

Methods: This prospective observational study included older adults hospitalised for AHF in an AGU between April 2022 and November 2024. Delirium was assessed using the 4AT and DSM-5 criteria and categorised as prevalent (on admission) or incident (during hospitalisation). Delirium psychomotor subtypes were classified as hyperactive, hypoactive, or mixed. Sociodemographic, clinical, and follow-up data were collected. Ninety-day survival was evaluated using Kaplan-Meier curves and Cox regression models.

Results: Among 399 patients (median age 87.4 years, 52% female), 132 (33%) experienced delirium, with 13.8% classified as prevalent and 19.2% as incident cases. Among those with delirium, 48% presented with the hyperactive, 31% with hypoactive, and 21% with the mixed subtype. In multivariable regression analysis, adjusted for relevant covariates, the hypoactive (adjusted HR 2.03, 95% CI 1.13-3.64) and mixed (adjusted HR 2.28, 95% CI 1.18-4.43) subtypes-but not the hyperactive subtype-were independently associated with an increased risk of death.

Conclusions: Delirium is common in very old patients hospitalised for AHF. Our findings indicate that the hypoactive and mixed subtypes are independently associated with poor 90-day post-discharge survival, highlighting the importance of their active identification and management.

Introduction: Geriatric syndromes are multifactorial ageing-related presentations. There is limited consensus regarding which presentations should be considered geriatric syndromes. Clinical codes generated following healthcare contacts are commonly used to identify diverse medical conditions. It is well demonstrated that geriatric syndromes are harder to identify using codes, possibly partly due to varying definitions, although identifying information is often located in unstructured text. Accurately identifying geriatric syndromes in healthcare records may therefore require different approaches compared to more firmly defined conditions. We review how studies using Electronic Health Records (EHRs) and derived databases align or differ in terms of geriatric syndromes selected for study, and how the syndromes are identified in the data sources.

Methods: The review was registered on the Open Science Framework ( https://osf.io/9ejhq ). Databases were searched in October 2024. Of 8086 titles screened, 74 studies had full text review, and 12 studies were included.

Results: Twelve studies from 7 countries identified 31 geriatric syndromes from primary databases (N = 6) or secondary databases (N = 6) using diagnostic codes, screening tools, or free text. The five most common geriatric syndromes were falls, functional decline, incontinence, delirium and malnutrition. Thirteen geriatric syndromes were included in two or more studies. Eight studies used more than one identification method. One study used two methods for all included syndromes.

Key conclusions: There is heterogeneity in what presentations studies include as geriatric syndromes, and how they identify them in EHRs. It is essential that researchers clearly describe their included geriatric syndromes, reason for selection, and identification methods.

Background: Wearable technologies focused on maintaining strength in older people are limited. A low-cost smart legging for daily use was developed, designed to stimulate the lower limbs through focal muscle vibration. The objective was to determine the effect of Myoviber® Smart Leggings with focal muscle vibration devices (MSLv) on knee extensor muscle strength in older people. The effect on participants with or without frailty was also determined.

Methods: Randomized, controlled experimental design. Healthy older people from the community (sample size analyzed, n = 52), distributed in an experimental group (EG, n = 29; 69 ± 4 years) treated with MSLv and a control group (CG, n = 23; 69 ± 4 years) treated with sham MSLv. Both groups used the respective MSLv at home for 30 days, for three continuous hours. Three 10 min doses of MSLv were administered along with the activities of daily living guide. Knee extensor strength was measured with a transducer before and after the intervention. Data were analyzed with two-way ANOVA and Bonferroni post hoc test.

Results: Muscle strength increased in both groups post-intervention, with a significant relative increase in the EG (p < 0.01) but not in the CG (p = 0.225). Participants classified as having pre-frailty or frailty conditions in the EG showed greater strength gains than their counterparts in the CG (p < 0.05).

Conclusion: The use of MSLv increases knee extensor muscle strength in older people, particularly those with pre-frailty or frailty conditions. MSLv is an innovative, practical solution that integrates health technologies for older adults.

Background: Older adults in inpatient rehabilitation often struggle to remain physically active, especially when restricted from bearing weight on a lower extremity. Given the negative consequences of inactivity, it is important to provide and encourage physical activities and include patients' and informal caregivers' input and views. This qualitative study explores the perspectives of patients receiving non-weight-bearing rehabilitation and their informal caregivers regarding the content and frequency of physical activities, and the motivational factors for performing such physical activities.

Methods: Semi-structured interviews were conducted with ten patients (8 female, aged 61-87) restricted from weight-bearing on a lower extremity, primarily due to fractures, and six informal caregivers (3 female, aged 58-86). The interviews were thematically analyzed using the framework method.

Results: Eleven themes emerged regarding physical activity during the non-weight-bearing period. The themes describe 1) the interpretation of physical activity during the non-weight-bearing period; 2) activity limitations; 3) frequency, duration, and 4) content of physical therapy; 5) patient-regulated exercise; 6) preferences for group versus individual therapy; 7) the healthcare providers, and 8) informal caregivers' role in facilitating and encouraging physical activity; 9) informing the patient and informal caregiver; 10 the rehabilitation location; and 11) intrinsic motivation.

Conclusion: Physical activity during the non-weight-bearing period should be tailored to the patient and their informal caregivers. It is important to inform and discuss the possibilities for being physically active with the patient. The most important goals for engaging in physical activity were regaining the ability to walk and returning home.

Aim: This study aimed to compare time to remission, glucocorticoid doses on the remission achieving regimen, and clinical characteristics between older and younger patients with polymyalgia rheumatica (PMR).

Methods: This retrospective cohort study included 157 patients with PMR at a tertiary center. Patients were stratified into older (≥ 65 years, n = 78) and younger (< 65 years, n = 79) groups. Baseline demographics, comorbidities, laboratory findings, and treatment outcomes were compared. The primary outcomes were time to remission and steroid doses at the time of remission.

Results: The mean age was 75.8 ± 8 years in the older group and 60.2 ± 3.3 years in the younger group. The majority of patients were female (82.1% in the older group and 79.7% in the younger group), with no significant difference between groups (P = 0.713). The older group showed a significantly longer time to remission (5.1 ± 1.9 months) compared with the younger group (4.0 ± 1.9 months, P < 0.001). Neutrophil counts were higher in older patients (7.0 ± 2.4 vs. 6.0 ± 2.0 × 10⁹/L, P = 0.004). Hyperlipidemia was more common in the older cohort (P = 0.023). Other comorbidities and inflammatory markers (ESR, CRP) did not differ significantly. Steroid doses required for remission were comparable across groups. Multivariable analysis identified age and neutrophil count as independent predictors of delayed remission.

Conclusions: Older PMR patients experience delayed remission despite similar glucocorticoid regimens. Elevated neutrophil counts may reflect an age-related pro-inflammatory state contributing to persistent disease activity. Tailored, age-adapted therapeutic strategies may improve outcomes in this population.