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The editors of BMC Geriatrics would like to thank all our reviewers who have contributed to the journal in Volume 14 (2014).
The editors of BMC Geriatrics would like to thank all our reviewers who have contributed to the journal in Volume 15 (2015).
In the era of technological revolution in healthcare, the integration of Artificial Intelligence (AI) stands out as a potentially transformative force (1). Clinicians often view the promises of AI with a healthy degree of skepticism (2), understanding the complexities of aging and the heterogeneity of physical and cognitive functions in older adults (3). This skepticism is necessary and healthy. AI engineers, on the other hand, sometimes struggle to fully grasp the expectations of clinicians and the intricate nature of aging (4). The future will require multidisciplinary collaboration among clinicians, AI engineers, and key stakeholders, including patient advocacy groups and older adults, to develop solutions that effectively address the complex nature of aging. As a geriatrician (P.A.) and an AI researcher (R.C.), we aim to provide insight into this burgeoning field, highlighting how AI can redefine, revitalize, and revolutionize care for older adults. In this editorial, we are also charting a course for an upcoming special issue in The Journals of Gerontology on AI-enabled wearables and sensors for older adults. This upcoming issue will aim to explore innovative ways these technologies enhance care for older adults, with a focus on practical applications and real-world impact. Geriatrics, with its focus on the health and care of older adults, presents unique challenges, including managing multiple chronic diseases, cognitive decline, and end-of-life care (5). AI’s role in geriatrics is not limited to clinical applications. It extends to enhancing the everyday lives of older adults through AI-powered assistive technologies, enabling better management of chronic conditions, and providing companionship through advanced robotics and virtual assistants (1). These innovations are crucial in addressing the psychological and social aspects of aging, thus contributing to a holistic approach to care for older adults. The future of geriatrics care is inherently collaborative, demanding a synergy among healthcare professionals, technologists, ethicists, and AI developers. The goal is to foster an environment where AI not only coexists with traditional healthcare practices but also enhances them, always keeping the well-being and dignity of older adults at the forefront. In that realm, the National Institute on Aging has allocated $60 million to establish 3 Artificial Intelligence and Technology Collaboratories for Aging Research at Johns Hopkins University, University of Pennsylvania, and a University of Massachusetts-led consortium. This initiative aims to accelerate the development of AI technologies tailored for older adults. The project brings together experts across various fields, including medicine, engineering, and business, alongside patient advocacy groups and older adults. These collaboratories seek to integrate AI into geriatric care effectively, enhancing healthcare practices while focusing on the well-being and dignity of older adults (6,7). AI has already made significant strides in the healthcare of older adults, particularly in predictive analytics and diagnostics. A notable example is Stanford Hospital’s AI algorithm (8), which assesses mortality risk. This deep-learning algorithm, trained on 2 million patient records, flags patients with a 75% or higher risk of dying within 3–12 months (9,10). This information prompts physicians to initiate advance care planning conversations, though the specific mortality risk is not disclosed to the patient or attending physician. This algorithm is intended as a tool for facilitating critical end-of-life discussions, often neglected due to busy clinical schedules and the discomfort of the topic (8,11). The utility of this algorithm extends beyond physicians to other healthcare staff. Therapists, for example, use it to guide conversations about end-of-life care, focusing on what is important to the patient in their final months. This broader involvement of nonphysician staff in such discussions represents a significant shift in the approach to terminal care (8,11). Likewise, the University of Pennsylvania Health System’s AI algorithm, which evaluates over 500 patient variables, has quadrupled the number of advance care conversations (8). This algorithm has also helped address potential biases in patient care, particularly in conversations about death among different ethnic or minority groups (12). AI’s impact on healthcare is not limited to predictive analytics. Google’s AI system for lung cancer detection, for instance, has shown promising results, outperforming radiologists in some aspects (13). The FDA has approved over 160 AI-driven products in recent years, mostly in medical imaging, reflecting AI’s growing role in this field (8). A recent project by computer scientists at the University of California, San Diego, CA, exemplifies this evolution. Funded by an Amazon Research Award, they are developing a voice assistant tailored to understand and respond to medical questions from adults over age 65 (8,14). This demographic often struggles with current voice assistants due to their conversational speech patterns. This initiative underscores the necessity to adapt AI to the user, emphasizing inclusivity in technology design. In terms of patient outcomes, AI is also helping with surgical decision making. A team from Johns Hopkins University (8) has developed an AI algorithm that uses imaging data to predict the best candidates for spinal surgery. This model, which considers spinal morphology, is potentially more accurate than traditional assessment methods based solely on general health indicators (15). The coronavirus disease 2019 (COVID-19) pandemic has further highlighted the importance of AI in healthcare. BlueDot’s AI methodologies were instrumental in tracking early cases of the outbreak. The Severe COVID-19 Adaptive Risk Predictor developed by Johns Hopkins researchers provided valuable insights for patient management during the pandemic, although challenges in data consistency and validation were noted (8). AI has also been pivotal in sepsis detection and management. Suchi Saria’s work at Johns Hopkins led to the development of an AI system that integrates patient data for early sepsis detection, potentially saving lives and reducing healthcare costs. Her startup, Bayesian Health, has made this technology accessible to thousands of healthcare providers (16). One of the emerging applications of AI in healthcare is its utility for clinicians, including geriatricians, in their day-to-day patient interactions. AI systems are increasingly being developed to review patient messages and analyze them in the context of past encounters and medical records. This capability allows for the preparation of a thorough analysis and assists doctors in crafting responses, enhancing the efficiency and effectiveness of patient communication. Additionally, AI is being employed to listen to patient encounters and prepare detailed encounter notes. This not only saves time for healthcare professionals but also ensures accuracy in medical documentation, which is critical for patient care continuity. AI’s potential in diagnosing rare syndromes and diseases is another promising application. By analyzing vast datasets and identifying patterns that might be overlooked by human clinicians, AI can aid in the early detection and diagnosis of rare conditions, significantly affecting patient outcomes (8). However, AI in healthcare faces challenges, including algorithmic biases and data quality issues. Studies have shown that AI tools can unintentionally perpetuate racial and gender biases present in healthcare data (17,18). Addressing these biases is crucial for the equitable application of AI in healthcare. The integration of AI for older adults is also not without challenges. Existing systems often reflect societal biases, particularly ageism, neglecting the needs and preferences of older adults. This issue is evident in the way older adults interact with technologies like voice assistants. In addition, and specifically in the older adult’s domain, there is a narrow focus on accessibility, often conflating aging with disability, which inadvertently excludes older adults from the wider benefits of technology (19). This perspective sidelines the rich life experiences, wisdom, and potential contributions of older adults in the realm of digital technology. There is a need for technologies that are not only usable by older adults with age-related limitations but are also useful and acceptable to the broader spectrum of older adults, many of whom do not have such limitations. There is a critical need to involve older adults as full stakeholders in digital society, and enable them to be active participants and co-designers in technology development. This inclusion can lead to innovations that better align with the varied needs and preferences of older adults, and help dispel stereotypes that often lead to the marginalization of this demographic in the tech industry. By embracing the diverse experiences and insights of older adults, we can develop AI technologies that truly enhance the lives of older adults, making the digital world more inclusive and beneficial for all age groups. Despite these challenges, AI’s role in healthcare is rapidly expanding. Big tech firms and startups are investing heavily in AI-driven healthcare solutions, anticipating significant growth in this sector. The future of AI in healthcare, particularly geriatrics care, lies in addressing these challenges and ensuring equitable access to AI tools across all patient demographics (1). In addressing the future of geriatrics and healthcare, a common concern arises: will AI replace physicians, and scientists? The reality, however, reveals a different narrative. The truth is, AI will not replace clinicians, including geriatricians, or scientists. These roles, steeped in years of training, experience, and human understanding, remain irreplaceable. What AI does is enhance these roles, offering tools and insights that were previously unimaginable. It brings a level of precision, efficiency, and predictive power to healthcare, changing how we approach diagnosis, treatment, and patient care. This power of AI does not diminish the value of healthcare professionals; rather, it elevates it. Those who embrace AI and integrate it into their practice will find themselves at the forefront of modern medicine, especially in the field of geriatrics where the complexities of care are manifold. Thus, as we navigate the inevitable tide of integrating AI into geriatrics and healthcare at large, it’s not a question of replacement but of enhancement and evolution. The key lies in harnessing AI as a powerful ally in our quest to provide the best possible care for older adults. Those who adapt, learn, and grow with these technological advancements will be the ones shaping the future of geriatrics care. They are the ones who will not be replaced, but will instead become irreplaceable. This work was supported by grants from the National Institute on Aging, part of the National Institutes of Health (P30AG073104 to Johns Hopkins University). None.
OBJECTIVES: To provide an ethical analysis of the implications of the usage of artificial intelligence-supported clinical decision support systems (AI-CDSS) in geriatrics. DESIGN: Ethical analysis based on the normative arguments regarding the use of AI-CDSS in geriatrics using a principle-based ethical framework. SETTING AND PARTICIPANTS: Normative arguments identified in 29 articles on AI-CDSS in geriatrics. METHODS: Our analysis is based on a literature search that was done to determine ethical arguments that are currently discussed regarding AI-CDSS. The relevant articles were subjected to a detailed qualitative analysis regarding the ethical considerations Supplementary Datamentioned therein. We then discussed the identified arguments within the frame of the 4 principles of medical ethics according to Beauchamp and Childress and with respect to the needs of frail older adults. RESULTS: We found a total of 5089 articles; 29 articles met the inclusion criteria and were subsequently subjected to a detailed qualitative analysis. We could not identify any systematic analysis of the ethical implications of AI-CDSS in geriatrics. The ethical considerations are very unsystematic and scattered, and the existing literature has a predominantly technical focus emphasizing the technology's utility. In an extensive ethical analysis, we systematically discuss the ethical implications of the usage of AI-CDSS in geriatrics. CONCLUSIONS AND IMPLICATIONS: AI-CDSS in geriatrics can be a great asset, especially when dealing with patients with cognitive disorders; however, from an ethical perspective, we see the need for further research. By using AI-CDSS, older patients' values and beliefs might be overlooked, and the quality of the doctor-patient relationship might be altered, endangering compliance to the 4 ethical principles of Beauchamp and Childress.
The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.
Despite the introduction of a diagnostic code and acceptance of a diagnostic process for sarcopenia as a new health technology in Korea, many practitioners remain unfamiliar with the evaluation of sarcopenia. Thus, the Korean Working Group on Sarcopenia (KWGS) developed clinical practice guidelines for the diagnosis of sarcopenia in older Korean adults. A two-phase Delphi interview comprising 19 questions was conducted with 40 expert panelists, 22 of whom participated in the first round between June and August 2022. The second round of the Delphi interview included the remaining 11 questions that were not agreed upon in the first round. The screening process for sarcopenia includes various questionnaires and examinations used in different research and clinical settings. The diagnostic process for sarcopenia was simplified by combining the steps of case finding and assessment. The Short Physical Performance Battery test was given particular emphasis owing to its multifaceted nature. Regardless of muscle mass, having low muscle strength with low physical performance is considered clinically relevant and newly defined as "functional sarcopenia." Comprehensive geriatric assessment is important for diagnosing sarcopenia. The KWGS's clinical guideline aims to facilitate the early detection of sarcopenia by allowing various screening tools to be used in a unified process and reducing confusion about which tools to use for diagnosis. This recommendation expands the conceptual definition of sarcopenia as a complex pathophysiological state in line with the concept of frailty and aims to stimulate further research on the diagnosis and management of sarcopenia in clinical settings.
The increasing elderly population globally presents challenges in geriatric healthcare, including better resources, unmet healthcare needs, and sustainability of health and social security systems. Artificial intelligence (AI) is being used to address these challenges, with studies focusing on socially assistive robots, humanoid robots, and robotic pets in elderly care. This review aims to provide a comprehensive overview of the roles of artificial intelligence (AI) technologies in elderly healthcare by identifying the potential benefits and challenges in geriatric healthcare services. AI technologies can potentially improve care and health outcomes for older adults, promote healthy aging, and alleviate the burden on the healthcare system. Moreover, AI systems can assist healthcare providers in assessing potential drug interactions, identifying medication errors, and optimizing medication regimens to minimize side effects and enhance overall patient safety. In addition, AI-supported robots can provide caregivers personalized and efficient care while providing rehabilitation and mobility support for the elderly. Collaboration between healthcare professionals and artificial intelligence holds significant potential to facilitate more effective delivery of care, improve patient outcomes, and optimize health resources for the increasingly aging population. Keywords: Aging; Geriatrics; Artificial Intelligence; Healthcare.
BACKGROUND: A care gap exists between recommendations and practice regarding the diagnosis and treatment of osteoporosis in fracture patients. The current study was designed to determine rates and predictors of in-hospital diagnosis and treatment of osteoporosis in patients admitted with fragility hip fractures, and to assess differences in these rates since the outset of the multipronged "Fracture? Think Osteoporosis" (FTOP) Program, which includes education of geriatrics and rehabilitation teams. METHODS: This is a retrospective cohort study conducted with data from two Hamilton, Ontario, university-based tertiary-care hospitals, and represents a follow-up to a previous study conducted 8 years earlier. Data pertaining to all 354 patients, age > or = 50, admitted between March 2003 and April 2004, inclusive, with a diagnosis of fragility hip fracture were evaluated. Twelve patients were excluded leaving 342 patients for analysis, with 75% female, mean age 81.Outcomes included: Primary -- In-hospital diagnosis of osteoporosis and/or initiation of anti-resorptive treatment ("new osteoporosis diagnosis/treatment"). Secondary -- In-hospital mortality, BMD referrals, pre-admission osteoporosis diagnosis and treatment. RESULTS: At admission, 27.8% of patients had a pre-existing diagnosis of osteoporosis and/or were taking anti-resorptive treatment. Among patients with no previous osteoporosis diagnosis/treatment: 35.7% received a new diagnosis of osteoporosis, 21% were initiated on anti-resorptive treatment, and 14.3% received a BMD referral. The greatest predictor of new osteoporosis diagnosis/treatment was transfer to a rehabilitation or geriatrics unit: 79.5% of rehabilitation/geriatrics versus 18.5% of patients receiving only orthopedics care met this outcome (p < 0.001). CONCLUSION: New diagnosis of osteoporosis among patients admitted with hip fracture has improved from 1.8% in the mid 1990's to 35.7%. Initiation of bisphosphonate therapy has likewise improved from 0% to 21%. Although multiple factors have likely contributed, the differential response between rehabilitation/geriatrics versus orthopedics patients suggests that education of the geriatric and rehabilitation teams, including one-on-one and group-based sessions, implemented as part of the FTOP Program, has played a role in this improvement. A significant care gap still exists for patients discharged directly from orthopedic units. The application of targeted inpatient and post-discharge initiatives, such as those that comprise the entire FTOP Program, may be of particular value in this setting.
Abstract Background Considering the importance of health behaviors in health outcomes, it is necessary to assess health behaviors precisely. This study aimed to develop and validate The Geriatrics Health Behavior Questionnaire among Iranian older adults. Methods This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The initial questionnaire has been developed with 22 items and seven subscales based on an extensive literature review, evaluation of related questionnaires, and experts’ opinions. Face and content validity were evaluated by interviewing 10 older adults and 18 specialists. The construct validity was evaluated via Known-groups validity and convergent validity. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability. Results The face validity was conducted by using interviews with older adults and gathering the specialists’ opinions. The items were grammatically and lexically corrected accordingly. Two items were deleted due to CVR < 0.44. Modified Kappa statistic (K*) and I-CVI for all items were higher than 0.88. The average content validity index (S-CVI/Ave) value was 0.94. Three items were deleted to improve the internal consistency; the final GHBQ consisted of 17 items with Cronbach α = 0.72. Acceptable convergent validity was approved by a significant correlation between GHBQ and SF8™ health survey ( r = 0.613, P value< 0.001). Independent t-test showed that older adults with education level ≥ high school have significantly higher health behavior scores than those with education level < high school (11.93 ± 2.27 vs. 9.87 ± 2.35, t = − 9.08, p < 0.001). Intra-class correlation coefficient (ICC) for the total questionnaire was 0.92 (95% CI =0.84 to 0.96). Standard Error Measurement (SEM) and Minimal Detectable Change (MDC 95 ) were 0.71 and 1.98, respectively. Conclusion The present study results showed that the Geriatrics Health Behavior Questionnaire had suitable validity and reliability among Iranian older adults. It is recommended to consider its comprehensiveness and yet its briefness in other populations after passing validation.
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The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.
BACKGROUND: Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. METHODS AND FINDINGS: We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. RESULTS: A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05). We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001). Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001) was predicted. CONCLUSION: We concluded that patients with a higher level of knowledge are more adherent to their medications and that better understanding of socio-demographic factors has a clear influence on the level of knowledge and adherence to medications and thus contributes to the development of guidelines for treatment and may consequently lead to favourable clinical outcomes and savings of health care costs.
Background: Aging presents both challenges and opportunities. It will increase demand for health care to restore function or enhance residual functional capability and improving the quality of life in older people. The objective of the present investigation was to offer perspectives into the worldwide research production concerning the geriatric rehabilitation. Methods: A bibliometric analysis was conducted utilizing the Scopus database covering the period of 1948 through 2022. Several methods and instruments were employed to scrutinize and illustrate the data. Results: The search strategy found 6630 articles. The United States was the most active country with the highest number of coauthors. VA Medical Center was the most active organization with Becker the most active author in Geriatric Rehabilitation research with 40 articles from Germany, followed by Hauer and Trabucchi with 39 and 37 articles, respectively. The most frequent words in this field were “rehabilitation, elderly, geriatrics, stroke, hip fracture, aged, dementia and activities of daily living.” The most influential articles were specified. In terms of journals, BMC Geriatrics was the most active, while the most cited article was “Gait Variability and Fall Risk in Community-Living Older Adults: A 1-Year Prospective Study” by Hausdorff in 2001. Conclusions: Geriatric rehabilitation has received special attention in the last decade. Current studies highlight the importance and understanding of the unique needs of older adults. The core for this area that includes impairment related to physical, cognitive, and functional needs is considered. Hence, health care practitioners and scholars must prioritize geriatric rehabilitation as a specialty and comprehend the optimal strategy for supporting elderly individuals to maintain their independence as much as feasible.
This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal-) nutrition, muscle strength and function, cardiovascular (de-) conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and geriatrics (Geriatrics meets spaceflight!). In particular, such integration can lead to procedures that address the morbidity and the mortality associated with bedrest immobilization and in the rising health care costs associated with an aging population demographic.
Aim: The aim of the current work was to develop vardenafil hydrochloride (VRD)-loaded ethosome-derived invasomes as a possible transdermal system which could be used for patients suffering from pulmonary arterial hypertension. Methods: VRD-loaded ethosomes were developed at three concentrations of phosphatidylcholine (5, 10 and 15 mg/mL) and three percentages of ethanol (20%, 30% and 40%, v/v). The best achieved VRD-loaded ethosomes (ETH9) were optimized to invasomes via incorporation of terpenes (limonene, cineole and a 1:1 mixture) at three concentrations (0.5%, 1% and 2%, v/v). All systems were evaluated for vesicle size, zeta potential, drug entrapment efficiency (EE%), cumulative drug permeated percentages after 0.5hrs (Q 0.5h ) and 12hrs (Q 12h ) and steady-state flux (J ss ). The optimized system (ETH9-INV8) was further characterized for morphology, histopathology and confocal laser scanning microscopy (CLSM). Physiologically based pharmacokinetic (PBPK) modeling was employed to estimate VRD pharmacokinetic parameters from the optimized transdermal system and an oral aqueous drug dispersion, in adults and geriatrics. Results: The optimized invasomal system (ETH9-INV8) was characterized with spherical vesicles (159.9 nm) possessing negative zeta potential (− 20.3 mV), promising EE% (81.3%), low Q 0.5h (25.4%), high Q 12h (85.3%) and the largest steady-state flux (6.4 μg.cm − 2 h − 1 ). Following a leave-on period of 12hrs in rats, it showed minor histopathologic changes. CLSM studies proved its ability to deeply permeate rat skin. Lower C max values, delayed T max estimates and greater AUC 0-24h folds in adults and geriatrics (≈ 2.18 and 1.69, respectively) were estimated following the transdermal application of ETH9-INV8 system. Conclusion: ETH9-INV8 is a promising transdermal system for VRD. Keywords: vardenafil hydrochloride, ethosomes, invasomes, transdermal, physiologically based pharmacokinetic modeling
multimorbidity; guiding principles; comorbidity; older adults One of the greatest challenges in geriatrics is the provision of optimal care for older adults with multiple chronic conditions, or "multimorbidity." 1-3 More than 50% of older adults have three or more chronic diseases, with distinctive cumulative effects for each individual. ltimorbidity is associated with higher rates of death, disability, adverse effects, institutionalization, use of healthcare resources, and poorer quality of life. 1 Comprehensive strategies and interventions for common syndromes and organization of care in this population show promise, but what the best clinical management approaches are remains unclear. st clinical practice guidelines (CPGs) focus on the management of a single disease, but CPG-based care may be cumulatively impractical, irrelevant, or even harmful for such individuals. CPG deficiencies are not based solely on shortcomings of guideline development and implementation. Older adults with multimorbidity are regularly excluded or underrepresented in trials and observational studies, which translates to less focus on older adults in meta-analyses, systematic reviews, and guidelines and affects appropriate interpretation of results.
South Korea became an aged society in 2017 and is predicted to become a super-aged society by 2025. Therefore, knowing the trends among older adults and identifying the geriatric burden are crucial for both healthcare professionals and policymakers. We previously summarized the general health and socioeconomic profiles of Korean older adults from the 2017 National Survey of Living Conditions and Welfare Needs of Older Koreans. In this update, we briefly summarized the results of the 2020 National Survey of Living Conditions and Welfare Needs of Older Koreans by categorizing them according to their general aging profile, socioeconomic status, lifestyle, and health status. In addition, we reviewed recent updates in the field of frailty and sarcopenia from population-based community cohorts in Korea. We hope this study will serve as a current reference for nationwide statistical data on common clinical and social parameters used in geriatrics and gerontology.
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BACKGROUND: Optimal blood pressure targets in older adults are controversial. OBJECTIVE: to investigate whether the relation of blood pressure with mortality in older adults varies by age, functional and cognitive status. DESIGN: longitudinal geriatric outpatient cohort. SETTING: Milan Geriatrics 75+ Cohort Study. SUBJECTS: One thousand five hundred and eighty-seven outpatients aged 75 years and over. METHODS: The relations of systolic (SBP) and diastolic blood pressure (DBP) with mortality risk were analysed using Cox proportional hazards models. Blood pressure, Mini-Mental State Examination (MMSE) and Basic Activities of Daily Living (ADL) were assessed at baseline. All analyses were adjusted for socio-demographic factors, co-morbidities and medications. RESULTS: One thousand and forty-six patients died during 10-year follow-up. The relationships of SBP and DBP with mortality risk were U-shaped; SBP of 165 mmHg and DBP of 85 mmHg were associated with the lowest mortality. Patients with SBP < 120 mmHg and patients with SBP 120-139 mmHg had 1.64-fold (95% confidence intervals, CI 1.21-2.23) and 1.32-fold (95% CI 1.10-1.60) higher mortality risk than patients with SBP 160-179 mmHg (P values 0.001 and 0.004, respectively). In patients with SBP below 180 mmHg, higher SBP was associated with lower mortality in patients with impaired ADL and MMSE but not in those with preserved ADL and/or MMSE (P for interaction 0.033). Age did not modify the correlation of SBP with mortality. CONCLUSIONS: The correlations of SBP and DBP with mortality were U-shaped. Higher SBP is related to lower mortality in subjects with impaired ADL and MMSE. ADL and MMSE may identify older subjects who benefit from higher blood pressure.
South Korea is the fastest aging country in the world, having become an aged society in 2017, with over 14% of its population aged 65 years or older. This Korean Geriatrics Fact Sheet 2018 aimed to overview and clarify the current geriatric burden and its trends in South Korea. Using nationwide surveys and public reports from government or related organizations, especially the 2017 Survey of the Living Conditions and Welfare Needs of Korean Older Persons from the Korea Institute for Health and Social Affairs, our committee has summarized the profile, socioeconomic status, health-related lifestyles, geriatric syndromes with major comorbidities, and use of healthcare services in the aging population. We hope that this review will publicize the social burden and seriousness of the aging problem in Korea.