In patients living with advanced dementia, the intensity of care during life-threatening infections remains controversial and marked by wide variation in practice. This international survey investigated physicians' and physicians-in-training's management choices for individuals with advanced dementia and the factors associated with those choices. Vignette-based survey. Twelve countries across five continents. We administered our vignette-based survey to medical students, residents and physicians. The survey elicited participants' views on whether antibiotics should be administered to an elderly patient with advanced dementia and very poor quality of life, presenting with bacterial pneumonia. We explored factors associated with treatment choices using univariable analysis and multiple logistic regression models. Of the 785 participants (age, mean (SD): 31.1 (11.5) years), one-third (31.2%) resided in the Region of the Americas, 21.9% in Europe, 16.2% in the Eastern Mediterranean region and 17.1% in China. In the univariable analysis, choice to treat was associated with younger age, country/WHO region (African region highest overall, European region lowest overall), stage of medical training (medical student most inclined to treat) and absence of medical assistance in dying (MAiD) legislation. Multivariable analyses provided evidence that country was the variable most strongly associated with the choice to treat with antibiotics (Cameroon, China, Saudi Arabia highest; Norway, Switzerland, Spain lowest), with the presence of MAiD legislation also strongly associated (OR 0.35, 95% CI 0.23 to 0.51). Age (OR 0.82, 95% CI 0.66 to 1.00) and religiosity level (OR 0.93, 95% CI 0.87 to 0.99) showed weaker associations with treatment decisions. Inclination to treat individuals with advanced dementia who develop pneumonia varies greatly between and within jurisdictions. Social factors (in particular country but also presence of MAiD legislation) proved the most prominent associations, with individual characteristics much less influential. These findings underscore the importance of contextual and cultural factors in value-sensitive clinical decisions. We registered the protocol at Open Science Framework (osf.io/6kfbt).
Cancer survivors face unique and persistent health-related quality of life (HRQoL) challenges. Existing HRQoL questionnaires for survivors lack content regarding chronic physical issues and have typically included limited cancer types and languages/cultures, affecting breadth of content and generalisability. We developed and validated the EORTC QLQ-SURV100, a questionnaire to assess HRQoL in disease-free survivors of diverse cancers. A conceptual framework of HRQoL in cancer survivors, developed in previous study phases and conceptualised as survivors' self-reported physical, mental and social functioning and well-being, formed the basis for questionnaire content. The QLQ-SURV100 was administered to 1480 participants across 46 centres in 21 countries (31% breast cancer, 23% colorectal, 22% prostate, 24% other cancers), who had completed primary treatment 1-10 years earlier and had no evidence of active disease. Structural validity of the 21 multi-item questionnaire scales was assessed via confirmatory factor analysis; test-retest reliability via intraclass correlation coefficients (ICCs); construct validity through known-group comparisons; and cross-cultural validity and sex invariance through differential item functioning (DIF). Item response theory (IRT) analyses evaluated item redundancy and performance. The QLQ-SURV100 showed strong structural validity (Comparative Fit Index = 0.951; Tucker-Lewis Index = 0.944; Root Mean Square Error of Approximation = 0.046), with most standardised factor loadings > 0.7. Test-retest ICCs exceeded 0.7 for 27 of 35 scales and 0.6 for 34 scales. Known-groups analyses supported most hypotheses, confirming sensitivity to treatment, comorbidity, age, sex, and education. DIF analysis indicated minor cross-cultural item bias, but no sex-related DIF. IRT analysis found no redundant items. The EORTC QLQ-SURV100 showed satisfactory structural validity, test-retest reliability and construct validity; limited item redundancy; and measurement invariance across the sex and language groups examined.
Acute geriatric care models provide short, time-limited care for patients aged ≥ 65 years with acute medical illness, typically within 48 hours of presentation, in both hospital and community settings. These models have gained international interest; yet national coverage and organisation in Denmark have not been mapped. We aimed to identify all active acute geriatric care models across Denmark and to describe their core functions and the frequency with which these functions are deployed. A questionnaire from the Special Interest Group in Acute and Cross-sectoral Geriatrics (Danish Geriatrics Society), distributed in 2025, captured geography, team composition and routine assessment elements. Descriptive analyses summarised active sites and assessment components. All hospital-based geriatric units (20/20) answered the questionnaire. Across regions, 12 of 20 hospital-based geriatric units reported having an active acute geriatric function. All care models (12/12) performed diagnostic assessment, patient-centred evaluation and treatment elements of comprehensive geriatric assessment, physical examination and laboratory testing. Other elements, such as ECG, ultrasound, frailty assessment, interdisciplinary review and community care coordination, were reported variably (n = 4-10/12). Acute geriatric care models are present nationwide but vary widely in visitation, team composition, assessments and follow-up. Establishing common guidelines may promote consistent and equitable care and reduce unwarranted variation in quality of care. None. Not relevant.
In super-aged societies such as Japan, achieving "healthy longevity with well-being" requires not only medical and long-term care services but also a seamless continuum that integrates health promotion, frailty prevention, and community-based support, along with age-friendly physical and social environments that support functional ability, social participation, and independent living. Within this framework, oral frailty (OF)-defined as the accumulation of slight declines in oral function, including tooth loss, chewing and swallowing difficulties, oral dryness, and low articulatory oral motor skills-has emerged as a key indicator linking oral health to systemic frailty, disability, and mortality. Originating in Japan, the concept of OF emphasizes early detection and reversibility through multidisciplinary collaboration. The 2024 Consensus Statement issued by three academic societies (the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty) proposed a definition, conceptual model, and assessment using the Oral Frailty 5-item Checklist (OF-5). This review summarizes the development of OF initiatives within Japan's Community-Based Integrated Care System and discusses recent international trends, including the WHO Global Oral Health Action Plan (2023-2030), the FDI policy statement "Oral Health for Healthy Ageing," and emerging global research evidence. Practical examples, such as a community-wide campaign in Hiratsuka City, illustrate multisectoral collaboration to prevent and raise awareness of OF. Finally, we highlight future directions, including integration of oral health into community development, strengthening interprofessional collaboration, and leveraging digital technologies for monitoring and education. By integrating clinical, community, and policy perspectives, the Japanese concept of OF offers a promising, implementable model for global healthy aging.
To synthesise the principal scientific advances and professional development opportunities presented at the 21st EuGMS Congress, with a focus on findings likely to influence future geriatric practice and research priorities. Members of the EuGMS-Early-Career Geriatricians Initiative (ECGI) attended and reviewed congress sessions, including all plenary lectures, joint symposia with major European and international societies, ECGI-organised sessions, and selected Special Interest Group (SIG) meetings. A narrative, non-systematic synthesis was developed through collaborative discussion, guided by the congress theme of 'New Landscapes in Geriatric Medicine' and informed by on-demand access to recorded sessions. Key scientific contributions included advances in the management of multimorbidity, hypertension, osteoporosis, nutrition-related disorders, frailty, and sarcopenia. Emerging trial and cohort data emphasised the importance of refined assessment tools and improved risk stratification to support individualised care. Sessions consistently highlighted the value of multidisciplinary models integrating geriatrics with cardiology, endocrinology, oncology, and surgical care. Congress activities also facilitated research capacity-building through peer exchange, SIG engagement, and structured early-career initiatives, supporting methodological skill development and fostering cross-national collaborations. The scientific advances marked a pivotal moment for geriatric medicine in Europe, with biological diagnostics, personalised treatment strategies, and cross-specialty collaboration rapidly reshaping comprehensive care for older people. Translating these advances equitably will require sustained investment in geriatric workforce development and research infrastructure and represents a call to align health policy with the growing complexity of an ageing population.
Chronic limb threatening ischemia (CLTI) in older adults is associated with severe morbidity and high mortality. The rising prevalence is largely driven by the aging population and confronts healthcare systems with challenges like increasing demand for chronic care, staff shortage and rising healthcare costs. To improve post-operative outcomes and reduce the burden on healthcare systems, multimodal prehabilitation has gained interest and has the potential to improve post operative outcomes. However, evidence of the effect in older adults with CLTI remains scarce. The aim of this study is to determine whether a multimodal multicomponent prehabilitation program (MMPP) reduces length of stay and improves clinical, patient-reported and economic outcomes of older adults with CLTI. We developed a multicenter randomized controlled trial, with embedded cost-effectiveness analyses.. CLTI-patients aged 65 years or older, planned for revascularization, and their primary informal caregiver (IC) will be eligible. A total of 300 patients will be randomized to receive either standard preoperative care or a 2-week MMPP. All patients receive a general health screening. The MMPP includes physiotherapy and, if indicated, referral to a geriatrician, dietician or smoking-cessation coach, ferric carboxymaltose infusion or pre-arranged homecare. The primary outcome is length of stay. Exploratory secondary outcomes include minor complications, quality of life of patient and IC and health related quality of life. Descriptive secondary outcomes include 30-day and 6-month mortality, major complications, readmissions, burden on the IC, cost-effectiveness; and experiences and preferences regarding shared decision making. To the best of our knowledge, this is the first randomized controlled trial to evaluate the effect of an MMPP within older CLTI-patients. Findings will inform healthcare professionals whether an MMPP should be implemented in routine vascular surgical practice to reduce length of stay and improve clinical and patient-centered outcomes. The study is registered at the International Clinical Trials Registry Platform (NL-OMON58069).
Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.
For slowly progressive ultra-rare diseases, hard clinical endpoints such as mortality or sustained functional decline are often impractical within feasible trial timeframes. Surrogate biomarkers, including fluid and imaging analytes, offer a pathway to accelerate drug development. Achieving cross-jurisdictional regulatory acceptance for these surrogates remains a profound scientific and policy challenge. We conducted a narrative synthesis incorporating regulatory guidance documents from the FDA, EMA, and NMPA, alongside PubMed-indexed literature on surrogate endpoint validation, orphan drug approval, and biomarker qualification programs published up to early 2026. The FDA's Accelerated Approval pathway and the EMA's Conditional Marketing Authorization represent the primary regulatory vehicles for surrogate-based approvals. A four-tier validation model is proposed, incorporating mechanistic plausibility, epidemiological association, quantitative surrogacy statistics, and confirmatory post-approval requirements. Case studies from neurology (spinal muscular atrophy) and metabolic disorders (lysosomal storage diseases) illustrate the context-of-use dependency of these surrogates. Cross-jurisdictional divergence in evidentiary standards and the absence of a dedicated ICH guideline for rare disease surrogate endpoints constitute major structural gaps. A globally harmonized evidentiary framework for surrogate endpoint qualification in ultra-rare diseases is urgently needed. Validating this framework in the ultra-rare space could serve as a stepping stone for broader rare disease drug development. Bayesian adaptive designs, international consortium registries, and real-world evidence frameworks are key enabling strategies for addressing the inherent sample-size constraints of this research.
Frail older patients are at high risk of both thromboembolism and bleeding, making anticoagulant therapy challenging. Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists because of comparable efficacy and lower bleeding risk. However, evidence supporting their use in frail older patients remains limited. Recent studies have demonstrated that a substantial proportion of frail older patients have DOAC plasma levels outside the expected on-therapy range, which may be associated with an increased risk of bleeding or thromboembolic events. The DOAC-FRAIL randomized controlled trial (RCT) aims to determine whether adjustment of DOAC therapy based on peak plasma concentrations improves the safety and efficacy of anticoagulant treatment compared with standard care in frail older patients. The DOAC-FRAIL study is an international, multicenter, randomized controlled trial including frail older patients aged ≥70 years with a Clinical Frailty Scale score >3 receiving DOAC therapy. Participants are randomized to either a Single Cycle Measurement and Adjustment Strategy based on peak DOAC plasma concentrations or standard care. Patients with a life expectancy of less than 3 months or previous DOAC dose adjustment based on plasma level measurements are excluded. The primary outcome is the composite of bleeding events, including clinically relevant non-major bleeding, and thromboembolic events during 2 years of follow-up. Secondary outcomes include feasibility, determinants of deviant peak DOAC plasma concentrations, quality of life, cost-effectiveness, and all-cause mortality. The DOAC-FRAIL trial is currently ongoing. Participant recruitment has been initiated, and study results are expected after completion of follow-up. The DOAC-FRAIL RCT will provide evidence on whether a plasma concentration-guided DOAC dosing strategy improves clinical outcomes compared with standard care in frail older patients. The findings may contribute to more personalized anticoagulant therapy in this vulnerable population. EU CT-2025-521362-10-00.
Diaphragm ultrasound, as a convenient and non-invasive bedside visual monitoring technique, has gradually become a vital tool for assessing the morphology and function of the diaphragm in critically ill patients. By real-time monitoring of key indicators including diaphragmatic excursion, thickness, and thickening fraction, diaphragm ultrasound allows the early identification of diaphragmatic dysfunction, providing crucial evidence for respiratory monitoring and support for critically ill patients. In the formulation and implementation of mechanical ventilation management and weaning strategies, diaphragm ultrasound helps improve the weaning success rates and optimize the prognosis of critically ill patients. Currently, diaphragm ultrasound is in a critical stage of rapid popularization and continuous improvement, while standardized operational protocols and evaluation criteria for clinical practice remain lacking. To address this gap, the Critical Rehabilitation Branch of Guangzhou Rehabilitation Medicine Association and the Critical Care Medicine Branch of Guangdong Medical Association jointly organized a multidisciplinary consensus writing committee composed of domestic frontline clinical experts covering critical care medicine, ultrasound medicine, respiratory therapy and other related disciplines. In strict accordance with the principles of evidence-based medicine, the writing committee systematically retrieved and comprehensively evaluated the latest domestic and international guidelines, expert consensuses and high-quality clinical research evidence on diaphragm ultrasound. Combined with the characteristics of clinical practice in China and senior clinical experience of participating experts, the consensus was finalized through evidence-based demonstration and multiple rounds of seminars, namely the Expert consensus on the clinical application of diaphragm ultrasound in critically ill patients (2026 edition). A total of 21 recommendations have been formulated in this consensus, covering multiple aspects including the indications, technical specifications, examination procedures, clinical applications and multidisciplinary collaboration of diaphragm ultrasound, aiming to promote the standardized application of diaphragm ultrasound technology in the management of critically ill patients.
Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim's home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study's detection rate (<1%) falls critically short of international benchmarks (3-5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments.
Poisonings are a global public health challenge, especially for older adults with dementia. This study examined the incidence, types and medications involved at the time of poisoning among older people with and without dementia in Sweden. Using linked Swedish national registries, we conducted a matched cohort study of individuals ≥65 years with dementia diagnosed between 2014 and 2018, matched 1:3 to controls by age and sex, and followed until December 2019. Poisonings were identified via International Classification of Disease-10 codes. Incidence rates (IR) and hazard ratios (HR) were estimated using survival models. Among 415 016 participants, dementia was associated with higher poisoning incidence (IR 100.3 vs 76.4 per 100 000 person-months; HR at 6 months 1.48). Risks were greatest for unintentional poisonings, toxic pharmaceutical effects and adverse drug reactions within 6 months postdiagnosis. Psychotropics, antithrombotics and cardiovascular medications were the most commonly used. Dementia is associated with poisoning risk, warranting cautious prescribing and prevention strategies.
Gamified digital training may support long-term engagement in aging populations, yet randomized evidence linking behavioral effects to convergent neuroimaging outcomes remains limited. This study tested whether a home-based digital mahjong-based cognitive engagement intervention enhanced cognition in community-dwelling older adults and explored brain changes using multimodal magnetic resonance imaging (MRI). We conducted a single-blind, parallel-group randomized controlled trial in Taipei, Taiwan (July 2020-November 2021). Community-dwelling adults aged 55 years and older were randomized (1:1) to a 6-month digital mahjong-based intervention (two 30-minute sessions per week via an iPad app) with an incentivized walking component (Mi Band step tracking with in-game tokens) or no intervention. Primary MRI outcomes were gray matter volume, regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuations (fALFF), and global brain connectivity. Secondary outcomes included cognition (Montreal Cognitive Assessment), physical activity (International Physical Activity Questionnaire), mental health (Brief Resilience Scale and Mandarin version of the Demoralization Scale), quality of life (EQ-5D with a visual analog scale), physical fitness and body composition, and blood biomarkers. Per-protocol analyses were performed. Voxel-wise imaging analyses used analysis of covariance in SPM12 with family-wise error (FWE) correction at the cluster level (P<.05). Sensitivity analyses controlling for MRI delay duration were conducted to assess robustness of findings. In total, 60 participants were enrolled (n=30, 50% per group); 96.7% (29/30) in the intervention group and 90% (27/30) in the control group completed primary assessments. Compared with controls, the intervention group showed a greater improvement in Montreal Cognitive Assessment delayed recall (between-group difference=-0.79 points, 95% CI -1.538 to -0.042; P=.04). Neuroimaging revealed increased ReHo in the right insula (FWE-corrected P<.05) and decreased gray matter volume in the left frontal pole and orbitofrontal cortex, with reduced fALFF in the left frontal pole. Changes in delayed recall were positively associated with right insular ReHo and also showed significant associations with the right anterior cingulate gyrus (ReHo), left inferior frontal gyrus, and right paracingulate gyrus (fALFF; FWE-corrected P<.05 in all cases). In exploratory dose analyses, right insular ReHo correlated with total practice sessions (r=0.48; P=.009). Among physiological outcomes, the intervention group had a larger reduction in diastolic blood pressure (-3.50 mm Hg, 95% CI -6.911 to -0.091; P=.04), whereas the thyroid-stimulating hormone decreased but remained within the normal range. Sensitivity analyses confirmed that primary findings remained stable after controlling for MRI delay duration. This 6-month home-based digital mahjong intervention improved delayed recall and increased right insular ReHo. Integrating culturally familiar cognitive challenges with lifestyle engagement may be a feasible strategy associated with salience network-related functional changes and memory performance. Future large-scale trials should use active control conditions and factorial designs to rigorously isolate component-specific mechanisms. ClinicalTrials.gov NCT05808426; https://clinicaltrials.gov/study/NCT05808426.
Multidisciplinary collaboration between traumatologists and geriatricians has gained international recognition for improving outcomes for older patients after fragility fractures through various models of care delivery. To inform decisions about harmonizing existing models, a deeper understanding of their delivery and impact on patient-relevant and health-economic outcomes is needed. We analyzed health insurance claims data from patients aged ≥ 80 years hospitalized with hip fractures between 2014 and 2019 at 121 certified German orthogeriatric centers. We defined hospital-level orthogeriatric care models by the geriatricians' integration into the surgical wards (geriatric consult service (GCS) vs. integrated care model (ICM)), their weekly patient visit frequency in hospitals with GCS (> 2 (high) vs. 2 (low)), and the network structure between hospitals (single-site institution vs. multisite network cooperation). Outcomes included survival time, direct inpatient medical costs, length of stay (LOS), delivery of early complex geriatric rehabilitation (EGR), and transfer patterns. The four care models observed in [Formula: see text] hospitals were low-frequency GCS (26 hospitals, 1479 patients), high-frequency GCS (46 hospitals, 3451 patients), hospital networks (42 hospitals, 1832 patients), and ICM (7 hospitals, 457 patients). Covariate-adjusted death hazards revealed the lowest 30-day hazard in ICM hospitals and the lowest 30-to-180-day hazard in hospital networks. Statistically significant differences were found when comparing these hazards with those in low-frequency GCS hospitals, showing respective reductions of 28% and 20%. Although the care models involved different individual treatment paths, such as varying timings and rates of EGR or transfers to external wards or subacute facilities, their overall costs remained similar. Our findings indicate that health outcomes in orthogeriatric care models depend not only on the availability of geriatricians but also on the extent of their involvement in patient management, whereas mean costs were similar across all models.
Pulmonary function and skeletal muscle strength are key indicators of physiological health, yet evidence describing their relationship in young, healthy populations remains underexplored in Saudi Arabia. This study aimed to examine the association between pulmonary function and handgrip strength (HGS) in healthy young adults while controlling demographic, anthropometric and lifestyle factors. In this cross-sectional study, 71 healthy young adults (18-25 years) were recruited from the central region of Saudi Arabia. Pulmonary function test (PFT) was assessed using spirometry, including forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC ratio, and peak expiratory flow (PEF). HGS was measured using a Jamar dynamometer. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Unadjusted associations were examined using Spearman's correlation coefficients. Hierarchical multiple linear regression was performed to evaluate the independent association between pulmonary function parameters and HGS, adjusting for age, sex, height, weight, physical activity, and smoking status. Unadjusted analyses showed moderate positive correlations between HGS and absolute spirometry indices, including FVC (r = 0.53), FEV₁ (r = 0.54), and PEF (r = 0.53; all p < 0.001). Associations with percentage-predicted spirometry values were weak and nonsignificant. In hierarchical multiple linear regression analysis, age, sex, height, weight, physical activity, and smoking status explained 34.3% of the variance in HGS (p < 0.001). After adjustment for these covariates, the addition of FVC (ΔR2 = 0.003, p = 0.597), FEV₁ (ΔR2 = 0.019, p = 0.203), and PEF (ΔR2 = 0.002, p = 0.702) did not significantly improve model fit. The final model explained 36.7% of the variance in HGS. Pulmonary function was positively associated with HGS in unadjusted analyses; however, this association was attenuated after adjustment for demographic, anthropometric, and lifestyle factors. These findings suggest that factors, such as sex and body size, may partially account for the association between pulmonary function and HGS in healthy young adults.
Apathy, defined as a significant and sustained reduction in goal-directed behavior associated with impaired daily functioning, is a common and clinically important syndrome in mild and major neurocognitive disorders (NCDs) and is associated with poorer outcomes for patients and carers. Despite growing research, important gaps in knowledge continue to hinder accurate recognition and effective treatment. This International Psychogeriatric Association (IPA) white paper summarizes key scientific and clinical insights from a multidisciplinary Apathy Task Force, with the aim of providing a narrative overview of current knowledge on nomenclature, biomarkers, treatments, and prevention, and of identifying gaps to inform global priorities in research and clinical care, and inform policy. The IPA convened a multidisciplinary task force of apathy researchers during the 2024 and 2025 IPA Congress meetings. Through structured discussions informed by targeted literature review, the group identified key themes and critical gaps across domains relevant to apathy in NCDs. Apathy is highly prevalent across NCDs and evidence demonstrates that it has substantial functional, emotional, and societal impact. Although diagnostic criteria have recently been refined, clinical identification remains challenging. Multiple scales exist to assess apathy, yet inconsistent use across settings and misalignment with updated diagnostic criteria limit comparability. Neuroimaging studies consistently implicate fronto-subcortical network involvement, but no reliable peripheral biomarkers have been established. While select non-pharmacological, pharmacological and neuromodulatory interventions show promising evidence, non-pharmacological are considered central to current management. Clinical guidelines and policy efforts remain limited despite the substantial burden of apathy. Emerging evidence highlights opportunities to improve diagnosis, deepen mechanistic understanding, and develop more treatments that are targeted and scalable. Key priorities identified include increasing awareness of and education around apathy, incorporating apathy into national dementia strategies, improving implementation of effective non-pharmacological interventions, and advancing the development of interventions and biomarkers aligned with contemporary diagnostic criteria. By integrating evidence across clinical, biological, and care domains, this white paper provides a structured framework to guide future research, clinical practice, and policy.
Integrative oncology (IO) modalities aim to improve the quality of life of persons with cancer, including strategies to manage treatment and disease-related symptoms. As evidence increases to include IO in supportive care, interest grows globally. Understanding barriers to IO recommendation is key to facilitating its uptake. Members of the Multinational Association of Supportive Care in Cancer (MASCC) and the Society for Integrative Oncology (SIO) were invited to complete an online survey in Fall 2023 assessing barriers to IO recommendation on a 5-point scale. Descriptive statistics assessed demographic data and general counts of scaled agreement, while logistic regression analysis evaluated perceived barriers in relation to relevant covariates. Over 80% of respondents believed that healthcare professionals' (HCP) lack of knowledge with IO and lack of insurance/out-of-pocket costs were barriers to recommending IO. Approximately 80% agreed that lack of referral pathways was a logistical barrier and 85% reported lack of confidence in IO as an individual-level barrier. Respondents from Europe were 2.2 times more likely to agree with the perceived barrier of HCP knowledge, compared to respondents from North America (OR 2.22, 95% CI 1.05-4.67, p = 0.036). Lastly, compared to general physicians, integrative professionals were more likely to report perceptions that IO would delay conventional care delivery (OR 3.62, 95% CI 1.56-8.43, p = 0.0003). Results of this study highlight important barriers and facilitators of IO integration into standard supportive care globally. These findings represent perspectives from an international sample of MASCC and SIO members and may not apply to all oncology professionals. Further research is necessary to understand the global roadblocks that exist among practitioners interested in IO use.
Hypertension is prevalent and is influenced by modifiable factors. Increasing attention has focused on community-based health promotion. However, studies on the relationship between neighborhood characteristics and hypertension prevalence are limited. This study combined medical claims and geographic information system data to identify neighborhood characteristics associated with hypertension. The study population included participants enrolled in the National Health Insurance or Medical Care System for the Elderly in both 2017 and 2021, and their 2021 data were aggregated at the elementary school district level. Hypertension was defined using the International Statistical Classification of Diseases and Related Health Problems-10 codes I10-I15. Neighborhoods were defined by elementary school districts. For each school district, hypertension prevalence, the proportions of participants aged <65 years, 65-74 years, and ≥75 years, and the proportion of men were calculated. Neighborhood characteristics included college graduation rate, area deprivation index, annual average temperature, annual total precipitation, average slope angle, number of destination types, and densities of public places. Quasi-Poisson regression analyses were conducted with the number of hypertension cases as the dependent variable, neighborhood characteristics as explanatory variables, the proportions of participants aged 65-74 years and ≥75 years, and the proportion of men (in the overall analysis) as covariates, and the number of participants as an offset term. For the quasi-Poisson regression analyses, a Bonferroni-adjusted p-value < 0.05 was considered statistically significant. The study covered 424 elementary school districts across 14 municipalities in five prefectures in western Japan. The mean number of participants per district was 2,248 (men: 946, women: 1,302), with an average age of 67 years (men: 66; women: 68). The mean hypertension prevalence was 51% (men: 53%; women: 50%). In the combined and female-only analyses, the neighborhood proportion of university graduates and green space coverage were significantly negatively associated with hypertension prevalence. In the male-only analysis, the proportion of university graduates, green space coverage, and park density showed significant negative associations. Neighborhood socioeconomic and physical environmental characteristics were associated with hypertension prevalence in Japan, particularly educational attainment and green space coverage, suggesting that social and physical environmental attributes may contribute to community-level cardiovascular health.
To investigate the effects of square-step exercise on fall fear, balance ability, activities of daily living, and fall risk in older patients with ischemic stroke. Sixty-two older ischemic stroke patients hospitalized in the Department of Neurology from January to September 2024 were enrolled. The subjects who met the inclusion criteria were divided into two groups according to the unit (n1 = n2 = 31). The control group received routine care, while the intervention group, in addition to routine care, underwent square-step exercise training. The scores of Short Falls Efficacy Scale-International, Berg Balance Scale, Modified Barthel Index, and Morse Fall Scale in older patients with ischemic stroke were assessed and analyzed before and after the intervention. After a 12-week intervention, the intervention group demonstrated superior improvements in fall efficacy (SFES-I score), balance ability (BBS score), and fall risk (MFS score) compared with the control group (P < 0.05). Regarding activities of daily living (MBI score), both groups showed improvement compared to baseline after the intervention; however, the difference between the intervention and control groups was not statistically significant (P = 0.250). Square-step exercise enhances fall efficacy levels and alleviates fear of falling in older ischemic stroke patients. It also demonstrates efficacy in improving balance ability and reducing fall risk. ChiCTR2600127548, Date:02/07/2026. (Retrospectively registered).
A significant proportion of healthcare costs is incurred in hospitals at the end of life (EoL), with a small group of patients accounting for most of the costs. Scarce resources should be allocated based on cost-effectiveness. High costs and low satisfaction with care suggest low-value care at EoL; however, there is little evidence regarding which patients receive such care. To identify the characteristics of older patients who experience high-cost care but report low satisfaction with care at EoL. Secondary data analysis of mortality follow-back surveys: International Access, Rights, and Empowerment (IARE) studies. We surveyed the next of kin of older patients who received palliative care or died in hospital in England. Satisfaction with care at EoL and cost of hospital care calculated with quantity of services and unit costs. We used multinomial logistic regression to analyse factors associated with potentially low-value care. 404 patients were included (mean [SD] age: 80.4 [8.5] years). During the last three months of life, 53.8% of the total hospital care costs were incurred by 20% of the patients. 36.6% of the respondents reported low satisfaction. Compared to patients with low-cost care and reporting satisfaction, patients who were 65-74 years old (relative risk ratio [RRR] = 3.2, 95% CI: 1.09 to 9.42), had low income (RRR = 4.12, 95% CI: 1.29 to 13.15) and with an illness duration of 1-12 months (RRR = 3.93, 95% CI: 1.37 to 11.21) were more likely to receive high-cost hospital care and report low satisfaction. Being younger, on low incomes and with short illness duration are associated with high-cost, low-satisfaction hospital care at EoL. Identifying underlying mechanisms may enable targeted interventions to reduce high-cost, low-value care. Further investigation is needed to change the care trajectories of patients with these risk factors. Most healthcare costs at the end of life go toward hospital care, and a small group of patients accounts for the largest share of these costs. However, receiving high-cost care does not necessarily mean better outcomes. When patients experience both high costs and low satisfaction, it suggests care that is not good value and should be avoided if possible. But there has been little evidence about which patients tend to receive this type of care. The research team analyzed data from two surveys of bereaved family members or carers of older patients who potentially had palliative care needs or died in hospitals in England. They aimed to identify the characteristics of older patients who were most likely to receive high-cost, low-satisfaction hospital care at the end of life. The study included 404 older patients. Those who were aged 65 to 74 years, had lower incomes, or had an illness lasting between one month and one year were more likely to receive high-cost hospital care and to have low satisfaction with that care. The findings suggest that the oldest patients, those with higher incomes, and those with longer-term chronic illnesses may be more likely to receive better-value hospital care. These differences point to possible inequities in healthcare, which can also affect how efficiently hospital resources are used. Having realistic expectations about care may also play a role. The study highlights specific targets that could be the focus of future efforts to improve trajectories of care.