搜索结果：Annals of geriatric medicine and research

For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.

Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

Renal function declines with age as the kidneys become more vulnerable to inflammation and cellular senescence. This study examined gene expression changes linked to renal aging and assessed whether short-term calorie restriction (CR), a known anti-aging intervention, could reverse these alterations. Using RNA-seq data, we applied bioinformatics, systems biology, and molecular biology approaches to identify differentially expressed genes during aging and under CR. Gene Ontology and pathway analyses revealed that both aging and CR altered the expression of key senescence-associated secretory phenotype (SASP) genes, including cytokines and chemokines (Il1b, Ccl3, Ccl5, Il19, and Il24) and growth factors (Timp1 and Mmp12). Renal aging is also associated with an increased expression of cell cycle arrest markers (p15INK4B (Cdkn2b), p16INK4A (Cdkn2a), and p21 (Cdkn1a)), which are suppressed by CR, suggesting a link to cellular senescence. Quantitative analysis of renal tissue samples confirmed the age-associated upregulation of these genes at the transcriptional level, and CR effectively attenuated these changes. Among these genes, we focused on the members of the interleukin 20 (IL-20) family, particularly Il19 and Il24. Furthermore, experimental induction of cellular senescence using H2O2 resulted in elevated Il19 and Il24 expression alongside other senescence markers. These findings suggest that aging and short-term CR regulate the IL-20 family expression, potentially influencing cellular senescence. Our study suggests that Il19 and Il24 are associated with age-related renal decline and may represent hypothesis-generating candidates, highlighting potential molecular targets for future mechanistic and therapeutic investigations.

Although older adults are statistically less likely to be exposed to crime, they tend to worry more about it compared to younger adults. Fear of crime (FOC) has been associated with lower life satisfaction, dependence in activities of daily living, poorer mental health, and reduced self-reported physical health. Few studies have compared different age groups among older adults or examined its relationship with various symptoms of common diseases. This study aimed to improve understanding of the association between behavioral FOC and symptom burden. This cross-sectional study comprised 5,832 participants aged 60-96 years from the Swedish "Good Aging in Skåne" general population study. Data were collected through questionnaires, medical examinations, and patient journal reviews. Linear and logistic regression models, adjusted for age, gender, sociodemographic and health factors, were used to examine associations between FOC, the number of perceived symptoms, and prevalence of different symptom domains. Overall, 34.7% of participants reported refraining from going out in the evening at least occasionally due to fear of crime or threats during the past year, with higher prevalence among women and individuals aged 70 years and older. Statistically significant associations were found between FOC and both the number of reported symptoms and several symptom domains. Fear of crime is common among older adults, particularly in women, and is associated with an increased total number of symptoms and certain symptom domains. FOC should be recognized as a crucial factor influencing older adults' lives, with extensive health consequences.

Trauma remains a leading cause of death and disability. With the rapidly growing aging population, geriatric patients face heightened trauma risks due to physiological decline and comorbidities. Despite the growing burden, data on the clinical characteristics, injury mechanisms, patterns, and healthcare utilization in this group remain limited. This study analyzed trauma outcomes and associated factors in geriatric patients. We conducted a retrospective cohort study using data from a Level I trauma center. Patients aged &#x2265;65 years were compared with younger adults (<65 years). Variables included demographics, injury mechanism, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score, clinical outcomes, and medical costs. Multivariate logistic regression identified mortality predictors. Among 10,358 trauma patients with mean age of 54.2 years, 61.9% of younger patients were male, compared to 37.7% in the geriatric group (p<0.001). Geriatric patients exhibited lower male predominance, higher costs, and greater mortality (p<0.001). Multivariable analysis revealed that, among geriatric groups, male sex, older age, lower GCS, lower RTS, burns injuries, and severe injuries (AIS &#x2265;3) to head, thoracic, extremity, and appearance were significant mortality predictors. Undergoing orthopedic and thoracic surgeries was associated with lower mortality in geriatric patients. Geriatric trauma patients experience higher mortality risks and demands. Timely interventions, critical care management, appropriate triage, and age-adapted assessment tools are essential for improving clinical outcomes. These findings underscore the importance of interdisciplinary care strategies to optimize geriatric trauma management and resource utilization.

To develop and apply a multidimensional Social Frailty Index (SFI) to estimate the prevalence of social frailty among older adults in four departments of Colombia. A cross-sectional, analytical study was conducted using secondary data from the 2016 Survey on Health, Well-being, and Aging (SABE Colombia). The study included 3,506 individuals aged 60 years and older residing in Antioquia, Caldas, Risaralda, and Quind&#xed;o. Variables from demographic, health, and social domains were analyzed using principal component analysis to construct the SFI. Individuals scoring above the 75th percentile were classified as socially frail. The prevalence of social frailty was 25.3% (95% confidence interval, 23.8-26.7), with higher rates observed among men (29.2%) and individuals aged 75 years and older (32.4%), as well as among residents of Antioquia. Four latent components were identified: functional dependence; social engagement and participation; social and emotional isolation; and perceived health and healthcare quality. The index showed consistency with theoretical frameworks and international tools. This multidimensional index allows for early identification of vulnerable older adults, supporting targeted interventions and public health planning. Further research is needed to standardize measurement criteria and to evaluate the predictive value of social frailty in relation to outcomes such as disability, multimorbidity, mortality, and quality of life.

Decision-making about systemic therapy in older adults with cancer is complex due to frailty, clinical uncertainty, and competing treatment goals. Limited evidence exists synthesizing how healthcare professionals support decision-making in geriatric oncology. This qualitative systematic review searched four databases through November 2025 and conducted citation tracking. Thematic synthesis was performed, and confidence in findings was assessed using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). Twelve studies involving 212 healthcare professionals were included. Two analytical and six descriptive themes were identified. Healthcare professionals sought to minimize treatment-related harm while respecting patients' values and life perspectives. Decision-making was shaped by clinical judgment integrating geriatric assessment findings, healthcare professionals' perspectives, ethical considerations regarding beneficence and autonomy, and structural factors such as resource limitations and interprofessional collaboration. These findings highlight the need for clinical expertise, collaboration across oncology, primary care, and geriatric care providers, and system-level support for geriatric-informed care.

This study examined the validity and reliability of two smartphone-based tasks, the Symbol Search Task (SST-SP) and the Dot Memory Task (DMT-SP), in cognitively healthy older adults. Sixty participants (32 older and 28 younger adults) completed two sessions approximately one week apart. In the first session, participants performed standardized cognitive tests (Symbol Digit Substitution Test and Visual Digit Span Test) on a personal computer (PC), PCbased Symbol Search Task (SST-PC), and Dot Memory Task (DMT-PC), followed by the SST-SP and DMT-SP. The second session included only SST-SP and DMT-SP. In older adults, the correlation between the SST-SP and SST-PC was very strong (r=0.83). In addition, the SST-SP showed a moderate correlation with the Symbol Digit Substitution Test (r=0.50). A very strong correlation was observed between DMT-SP and DMT-PC (r=0.86). The DMT-SP also showed a moderate correlation with the Visual Digit Span Test (r=-0.47). The SST-SP demonstrated good test-retest reliability and high split-half reliability, whereas the DMT-SP showed moderate test- retest reliability and acceptable-to-good split-half reliability. Older adults scored lower than younger adults on both the SST-SP and DMT-SP. The SST-SP and DMT-SP are valid and reliable tools for assessing processing speed and working memory, respectively, in cognitively healthy older adults. These tools may provide new strategies for assessing the cognitive performance and/or ability in older adults in both research and clinical settings.

In this study, we aimed to investigate the association between the presence of pressure ulcers and body composition parameters in older residents of long-term care facilities and identified the most relevant indicators. This cross-sectional observational study assessed 156 residents. Body composition was measured, including body mass index (BMI) and phase angle (PhA). Functional assessments included the Barthel index (BI), and Clinical Frailty Scale. The participants were classified into two groups based on the presence or absence of pressure ulcers. Group comparisons and receiver operating characteristic analyses were used to determine the area under the curve (AUC) and cutoff values. The diagnostic performance of the combined cutoff values was also examined. Binary logistic regression was used to evaluate the association between PhA and the presence of pressure ulcers. Twenty (12.8%) participants had pressure ulcers, 90% of which were mild-stage. PhA was lower in the pressure ulcer group (p < 0.001), with an optimal cutoff value of 3.1&#xb0; (AUC 0.72). Using the cutoff values derived from each assessment, the combination of PhA with BI or BMI improved the AUC to a maximum of 0.78. Logistic regression demonstrated a significant association between PhA and the presence of pressure ulcers (p < 0.05). Phase angle may serve as a complementary biomarker for pressure ulcer risk assessment and may be more useful when combined with functional and nutritional indicators. The use of body composition parameters for noninvasive risk assessment could play an important role in future pressure ulcer prevention strategies.

Japan's rapidly aging population has increased the urgency of addressing frailty among older adults. Oral hypofunction and malnutrition are recognized as key contributors to frailty, and both are considered reversible through early interventions. However, little is known about the effectiveness of integrating nutritional guidance and oral function training in community dental clinics. This study aimed to examine the association between dietary variety, oral function, and body composition among outpatients aged 50 years and older, and to evaluate the effects of targeted interventions over a 1-year period. A total of 74 outpatients (mean age 72.3&#xb1;9.6 years) were assessed at baseline and after 1 year. Dietary variety was evaluated using the Dietary Variety Score (DVS), and oral function was assessed using seven standardized parameters. Body composition, including weight, body fat percentage, and muscle mass, was assessed using a bioelectrical impedance analyzer. Based on DVS results, registered dietitians provided nutritional counseling, while dental hygienists delivered tailored oral function training. Statistical analyses included the Wilcoxon signed-rank and McNemar's tests. Significant improvements were observed in eight of the ten DVS food groups, resulting in a higher total DVS score. Tongue coating index and tongue pressure also improved significantly, and the prevalence of oral hypofunction declined. No significant changes were found in body composition. Integrating nutritional guidance and oral function training in a community dental setting improved dietary variety and oral function in older adults. These findings suggest that multidisciplinary care in community dental clinics may contribute to health promotion and frailty prevention.

This study aimed to clarify the association between the co-existence of possible sarcopenia (PS) and dysphagia in patients with acute stroke and the functional outcomes 12 months after stroke. This multicenter retrospective cohort study was conducted on patients with stroke admitted to two acute care hospitals in Japan between November 2020 and October 2023. PS was defined based on grip strength (males <28 kg, females <18 kg) and calf circumference (males <34 cm, females <33 cm) on admission. Dysphagia was defined as a Functional Oral Intake Scale score of less than 4. The outcome was defined as a composite of either poor functional outcome (modified Rankin Scale [mRS] score of 3-6) or failure to recover to the premorbid mRS at 12 months after stroke onset. Modified Poisson regression analysis was used to examine the association between the co-existence of PS and dysphagia and poor functional outcomes. This study included 604 patients (median age 76 years; 367 men). Compared with the non-PS and non-dysphagia group, the PS and dysphagia group had a higher proportion of poor functional outcomes. Subsequently, modified Poisson regression analysis was performed. The interaction between PS and dysphagia was significantly associated with poor functional outcomes (risk ratio=4.348, 95% confidence interval 2.683-7.046). In patients with acute stroke, the co-existence of PS and dysphagia was associated with poor functional outcomes 12 months after stroke. Future multicenter prospective interventional studies are required to clarify the effectiveness of multifaceted intervention programs in high-risk patients.

Phase angle (PhA) reflects cellular integrity and muscle quality. However, evidence is limited regarding whether an increase in PhA is associated with improvements in activities of daily living (ADL) and skeletal muscle mass. This study aimed to investigate the association between change in PhA and prognosis in terms of ADL and skeletal muscle mass in post-stroke patients undergoing rehabilitation. This retrospective cohort study was conducted at a convalescent rehabilitation hospital in Japan. Patients with a PhA at admission below the cutoff values (4.76&#xb0; for male and 4.11&#xb0; for female) were included. Patients were categorized into a PhA-increase group (>0) and a non-increase group (&#x2264;0). Outcomes included the Functional Independence Measure (FIM)-motor score and skeletal muscle mass index (SMI) at discharge. Multivariate regression was used to assess associations. A total of 253 patients were included (mean age 78.0&#xb1;10.9 years; 51% females). The median PhA at admission was 3.70&#xb0; (interquartile range [IQR], 3.20-4.10), and the median change during hospitalization was 0.00&#xb0; (IQR, -0.20- 0.30). Of these, 119 patients had increased PhA and 134 did not. Change in PhA was independently associated with higher FIM-motor scores (&#x3b2;=0.078, p=0.040) and greater SMI (&#x3b2;=0.454, p<0.001) at discharge. In post-stroke patients, an increase in PhA during hospitalization was associated with better functional and muscular outcomes. PhA may therefore serve as a valuable biomarker for assessing the efficacy of rehabilitation.

Postoperative hypokalemia is a common electrolyte disturbance associated with adverse outcomes, particularly in older adults. This study aimed to identify risk factors and develop predictive models for hypokalemia within 24 hours after carotid endarterectomy (CEA) for severe carotid artery stenosis, a condition that primarily affects older patient populations. A retrospective cohort of 1,076 CEA patients (October 2021 to May 2023) was analyzed. Risk factors were identified using univariate and multivariate logistic regression. A predictive nomogram was developed and internally validated via bootstrapping. Machine learning models (Random Forest and XGBoost) were developed and interpreted using SHAP (SHapley Additive exPlanations) analysis. Subgroup analyses were performed in patients aged &#x2265;70 years and by comparing postoperative potassium levels >4.0 mmol/L versus 3.5-4.0 mmol/L. The cohort had a median age of 65 years. Multivariate analysis identified preoperative potassium (odds ratio [OR]=0.60, 95% confidence interval [CI] 0.50-0.72), hemoglobin (OR=0.74, 95% CI 0.63-0.88), BMI (OR=0.74, 95% CI 0.63-0.88), and postoperative visual analogue scale score (OR=1.28, 95% CI 1.09-1.51) as independent predictors. Frailty showed borderline significance (OR=1.56, 95% CI 1.00-2.44, p=0.05). The nomogram achieved an area under the curve (AUC) of 0.710, demonstrating good discrimination and calibration. Machine learning models similarly performed well (AUC 0.707-0.709). We developed a validated tool to predict postoperative hypokalemia after CEA. The model highlights that in addition to biochemical and surgical factors, geriatric syndromes like frailty and nutritional status are pivotal risk determinants. This facilitates early, individualized management, including tailored potassium supplementation, nutritional support, and pain control, especially for vulnerable older adults, to mitigate complications and promote recovery.

To evaluate the accuracy of arm circumference (AC) compared with other anthropometric and functional indicators as a predictor of sarcopenia risk in community-dwelling older adults. This was a cross-sectional, analytical, population-based study derived from a household survey involving individuals aged 60 years or older. Measurements of AC, calf circumference (CC), and variables related to muscle strength, muscle mass, and functional performance were collected, including the Timed Up and Go test, sit-to-stand test, and gait speed. The sample comprised 708 older adults, predominantly female (64.7%), aged between 60 and 94 years. The prevalence of sarcopenia was 14.7%, with 4.9% classified as severe. AC showed a negative association with sarcopenia (&#x3b2;=-0.01, 95% confidence interval [CI] 0.75-0.92, p<0.01) and reduced the odds of sarcopenia by 17% for each additional centimeter (odds ratio=0.83, 95% CI 0.75-0.92). The comparison of the areas under the receiver operating characteristic curves (AUC) indicated similar performance between AC and CC (z=0.24, p=0.81). The diagnostic accuracy of AC was slightly higher than that of CC in male (27.1% vs. 26.6%) and female (43.0% vs. 37.6%). Both AC and CC demonstrated high discriminative capacity for sarcopenia, with cutoff points that balanced sensitivity and specificity. AC stands out as a viable, simple, and effective alternative for sarcopenia screening in community-dwelling older adults.

Cardiovascular disease (CVD) in older adults is compounded by malnutrition and chronic inflammation. We compared the long-term prognostic performance of three categories of routinely available indices: nutritional (Prognostic Nutritional Index [PNI], Geriatric Nutritional Risk Index [GNRI], Controlling Nutritional Status [CONUT]); immune-inflammatory (Systemic Immune-Inflammation Index [SII]); and anthropometric (Weight-Adjusted Waist Index [WWI]). We analyzed 1,804 NHANES 2009-2018 participants aged &#x2265;60 years with established CVD, linked to the National Death Index. Survey-weighted Cox models with restricted cubic splines estimated associations with cardiovascular and all-cause mortality, adjusted for demographic, socioeconomic, behavioral, and comorbid covariates. Sensitivity analyses included landmark exclusion of early deaths (6, 12, 24 months), a complete-case analysis, and additional adjustment for total energy and protein intake. The nutritional indices (PNI, GNRI, CONUT) showed L-shaped associations with cardiovascular mortality that persisted after sequential exclusion of early deaths and after additional adjustment for total energy and protein intake. Each 1-point increase in PNI corresponded to an adjusted hazard ratio (aHR) of 0.91 (95% CI 0.87-0.95) for cardiovascular mortality; moderate-to-severe malnutrition by PNI carried a 4.61-fold higher hazard. PNI yielded the best model fit (lowest AIC/BIC); CONUT had the highest discrimination. The SII association attenuated when deaths within 24 months were excluded. The WWI predicted all-cause but not cardiovascular mortality. The nutritional indices (PNI, GNRI, CONUT) showed durable associations with cardiovascular mortality, whereas the SII signal was acute and the WWI predicted only all-cause mortality. These findings are hypothesis-generating; prospective external validation is required before routine clinical use.

This study examined how the frequency of in-person, telephone, text-based communication, and video interactions with non-cohabiting family and friends relates to loneliness among older adults in Japan. We analyzed data from 6,786 adults aged &#x2265;65 in the 2024 Japan COVID-19 and Society Internet Survey (JACSIS) study. Interaction frequency with non-cohabiting family and friends was categorized into none (reference), monthly, and weekly or more. Loneliness was measured using the 3-item UCLA Loneliness Scale and dichotomized at &#x2265;4, indicating loneliness; a &#x2265;7 cut-off was used in sensitivity analyses. Logistic regression models adjusted for sociodemographic, lifestyle, and health-related factors. For family, significant associations with lower loneliness were observed only at weekly frequencies-in-person (adjusted odds ratio [aOR]=0.764, 95% confidence interval [CI] 0.664-0.879), text (aOR=0.747, 95% CI 0.659-0.846), and telephone (aOR=0.624, 95% CI 0.543-0.718), whereas for friends, significant associations were observed at monthly frequencies-in-person (aOR=0.621, 95% CI 0.549-0.701), text (aOR=0.881, 95% CI 0.778-0.997), and telephone (aOR=0.734, 95% CI 0.659-0.819). Video calls were associated with lower odds of severe loneliness (score &#x2265;7) in sensitivity analyses-weekly calls with family (aOR=0.736, 95% CI 0.547-0.991) and monthly calls with friends (aOR=0.656, 95% CI 0.470-0.917). Interactions with friends show associations with lower levels of loneliness at lower frequencies than family contact. While text and phone calls are broadly associated with reduced loneliness, video calls showed an association specifically with a lower prevalence of severe loneliness, underscoring the potential for tailored communication strategies.

Population aging is increasing the prevalence of type 2 diabetes mellitus (T2DM) and hip fractures, which are major contributors to morbidity, mortality, and healthcare costs among older adults. The coexistence of both conditions further worsens clinical outcomes and quality of life. This study analyzes the association between T2DM and 30-day outcomes after hip fracture. Observational, longitudinal study with a 1-month follow-up after hospital discharge, including a total of 1,164 patients aged &#x2265;65 years with hip fracture treated at a public university hospital between 2017 and 2022. The main variable was the presence of T2DM. Sociodemographic, clinical, and surgical variables, along with 30-day outcomes (mortality, readmission, reoperation, functional change, and change of residence), were collected. Patients with insulin-treated diabetes showed a higher percentage of 30-day hospital readmission (11.4%) compared with patients without diabetes (3.3%) and those with non-insulin-treated diabetes (2.9%). Insulin-treated diabetes was associated with an increased risk of 30-day hospital readmission (hazard ratio=3.36; 95% confidence interval 1.59-7.08). No statistically significant differences were observed in the remaining outcomes analyzed. Individuals with insulin-treated diabetes exhibit an increased risk of hospital readmission following hip fracture. These findings highlight the need for targeted perioperative management, closer post-discharge monitoring, and diabetes-specific care pathways for this high-risk subgroup. Implementing individualized follow-up and optimizing glycemic control may help reduce early readmissions and improve short-term clinical outcomes in patients with type 2 diabetes, particularly those treated with insulin.