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.
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.
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.
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.
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.
Recently, PCDHGB1 has been identified as a novel causative gene of dystonia predominantly affecting the cervical muscles. However, no large cohort study has been conducted to confirm the association. The objective of the study was to systematically evaluate the genetic associations of PCDHGB1 with dystonia in a large Chinese dystonia cohort. We analyzed rare variants of PCDHGB1 in a discovery cohort, including 878 dystonia patients, and a validation cohort, including 509 dystonia patients, using whole-exome sequencing. The overrepresentation of rare variants in patients was examined using Fisher's exact test at allele and gene levels. Twenty-seven rare variants of PCDHGB1 were identified in 55 individuals in the discovery cohort, including 3 frameshift variants (p.Leu177Valfs*7, p.Arg635Profs*24, p.Asp797Glufs*51) and 24 missense variants. Another 10 rare variants were detected in 12 patients in the validation cohort, including 1 frameshift variant (p.Leu709Argfs*13) and 9 missense variants. Fourteen patients carried the frameshift variant p.Leu177Valfs*7. Thirteen patients carried the p.Met111Val variant, including 3 patients from one family. At variant level, p.Pro773Ser and p.Arg408Gln were significantly associated with a higher risk of dystonia, whereas 15 variants (including p.Arg635Profs*24, p.Asp797Glufs*51, p.Leu709Argfs*13, and 12 missense variants) were nominally associated with a higher risk of dystonia. Gene-based burden analysis detected the enrichment of ultra-rare variants of PCDHGB1 in dystonia. Western blot experiments revealed that these four frameshift variants (p.Leu177Valfs*7, p.Arg635Profs*24, p.Asp797Glufs*51, p.Leu709Argfs*13) induced a truncated PCDHGB1 protein. Our study supplemented the evidence on the role of PCDHGB1 in dystonia and expanded the genotypic and phenotypic spectrum of PCDHGB1. © 2026 International Parkinson and Movement Disorder Society.
Textbook Outcome (TO) has been a useful tool to assess benchmark patient-centred surgical outcomes in elective abdominal surgery. This study aimed to evaluate the association of preoperative activities of daily living (ADL) status with TOs following major emergency abdominal surgery. This retrospective study included 301 consecutive patients who underwent major emergency abdominal surgery for high-risk acute abdominal conditions, including perforated peptic ulcer, intestinal ischemia, bowel obstruction, bowel perforation, and severe intraabdominal bleeding or infection, at Kumamoto Regional Medical Center between April 2019 and March 2025. Preoperative ADL was evaluated using the Barthel Index (range, 0 to 100), with higher scores indicating greater independence. Barthel Index ≤ 85 was defined as ADL impairment. According to a recent international consensus, TO was defined as discharge to "home" without major postoperative complications (Clavien-Dindo grade ≥ III). Multivariable logistic regression analysis was conducted to assess the association of preoperative ADL with TO achievement, adjusting for clinical features and surgery-related factors. Among the 301 patients, 90 (30%) had preoperative ADL impairment (Barthel Index ≤ 85) and 211 (70%) achieved TO. Multivariable analysis revealed that preoperative ADL impairment was independently associated with failure to achieve TO (odds ratio: 0.40; 95% confidence interval: 0.22-0.75; P = 0.004). Preoperative ADL impairment is associated with failure to achieve TO after major emergency abdominal surgery. These findings need to be validated by further study to improve patient-centred postoperative outcomes in high-risk abdominal emergencies.
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.
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.
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).
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.
Amid rapid population aging, declining fertility, and a shrinking workforce, employment in later life has become a critical issue in Japan. Older adults are no longer viewed solely as care recipients; many remain engaged in paid work, making employment a key form of social participation. This review synthesizes epidemiological evidence on the health benefits, challenges, and future directions of late-life employment, drawing on the authors' previous studies and domestic and international cohort research from a health and welfare policy perspective. Longitudinal evidence indicates that continued employment is associated with reduced mortality, better self-rated health, preserved cognitive function, and maintained activities of daily living. However, these benefits vary by sex, employment type, and frailty status. Notably, full-time employment may offer protective effects even among frail older adults, particularly in reducing risks related to dementia and physical decline, whereas irregular or sporadic work provides limited benefits. The motivation and meaning of work also play a crucial role. Employment driven solely by financial necessity is linked to poorer health outcomes and greater social isolation, while nonfinancial motivations-such as maintaining health, purpose in life, and social contribution-are associated with more favorable outcomes. Finally, the study underscores the importance of community-based intermediaries and emerging approaches such as social prescribing to connect older adults with meaningful, ability-appropriate work. Effective support requires integrating employment assistance with frailty assessment, safety management, and multidisciplinary coordination.
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.
Prostate cancer is the second most common malignant tumor among men worldwide. Its early diagnosis relies on screening. How to increase the detection rate of clinically significant prostate cancer, avoid overdiagnosis and over-treatment of low-risk tumors, while also considering economic benefits, has become a core issue in the field of screening. Currently, international prostate cancer screening strategies are moving from a single prostate-specific antigen (PSA) screening to individualized risk stratification, and exploring the roles of various stratification tools, such as magnetic resonance imaging (MRI), new biomarkers, and risk prediction models. However, there is no universally recognized unified approach. In recent years, although the incidence of prostate cancer in China has increased rapidly, the early diagnosis rate is still low. This is directly related to the insufficient prevalence of prostate cancer screening in China. Moreover, China also faces problems such as the lack of a reasonable screening model for elderly high-risk populations, insufficient public awareness, and the absence of a refined screening path. Future work involves building stratified screening strategies suitable for the Chinese population based on Chinese data, promoting the transition of screening from opportunistic to systematic, and is a task that needs to be carried out. 前列腺癌是全球男性发病率第二位的恶性肿瘤，其早期诊断依赖筛查。如何提高临床有意义前列腺癌的检出率，避免低危肿瘤的过度诊断与过度治疗，同时兼顾经济效益比，已成为前列腺癌筛查领域的核心问题。当前国际前列腺癌筛查策略正从单一的前列腺特异性抗原(prostate specific antigen, PSA)筛查走向个体化风险分层，并探索整合磁共振成像(magnetic resonance imaging, MRI)、新型生物标志物及风险预测模型等多种分层工具的作用，但尚无公认的统一路径。近年来，我国前列腺癌发病率虽快速上升，但早期诊断率仍较低，这与我国前列腺癌筛查普及率不足直接相关，而且我国还面临老年高危人群的合理筛查模式缺乏、公众认知不足、精细化筛查路径缺失等问题。未来需要基于中国人群数据，构建适合中国国情的分层筛查策略，以推动筛查从机会性向系统性转变。
Recent advances in Blood-Based Biomarkers (BBMs) are transforming the diagnostic landscape of Alzheimer Disease (AD), with plasma p-tau217 emerging as a highly accurate and scalable diagnostic marker of AD pathology. Across multiple analytical platforms, plasma p-tau217 has demonstrated consistently strong diagnostic performance for the detection of amyloid pathology. The interpretation of BBMs in older adults presents unique challenges due to the high prevalence of multimorbidity, chronic kidney disease, polypharmacy and frailty. Although these factors may influence absolute biomarker concentrations, current evidence suggests the diagnostic performance of p-tau217 remains largely preserved across diverse older populations when interpreted appropriately. Frailty may modify the relationship between AD pathology and clinical expression of mild cognitive impairment/dementia and may influence the absolute concentration of BBMs underscoring the importance of contextualising test results within a comprehensive assessment. Importantly, these factors should not preclude a clinical-biological diagnosis of AD. The clinical value of BBMs such as p-tau217 in older adults lies not in their use in isolation, but in their integration with a gerontologically attuned diagnostic pathway. Current evidence and international guidelines support the use of BBMs only in symptomatic older adults presenting to specialist services and not in asymptomatic individuals. This commentary reviews recent advances in BBM performance, emerging clinical guidelines, real-world evidence and potential diagnostic pitfalls relevant to older adults. We propose that incorporating BBMs within a Comprehensive Geriatric Assessment framework offers a pragmatic approach to achieving timely, accurate and equitable clinical-biological diagnosis whilst preserving the holistic, person centred principles of geriatric medicine.
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.
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.