Housing needs for older people wishing to age in place and university students are different, yet both groups face unmet needs. To support older adults to remain in their homes longer, many countries have policies for ageing in place with in-home support. Housing affordability, a growing issue globally, leaves older adults and students vulnerable to homelessness or precarious housing. This scoping review aimed to explore the concept of intergenerational homesharing, where older adults share their home with a student. Using the JBI scoping review methodology, we searched peer-reviewed and grey literature describing homesharing arrangements between people aged 50+ and university students. Searches across six databases identified 1092 publications between 1985 to 2024. Of these 63 sources were eligible for inclusion. A range of programs have been developed internationally. Older adult participants were more often female, experiencing social isolation, and were apprehensive about the matching process, student behaviour, and financial impacts of programs. Interested students, also more often female, held concerns about loss of independence and differences in expectations. Homeshare participants reported decreased loneliness and isolation, and having enjoyed the experience more than anticipated. Of the few negative outcomes reported, students found support obligations higher than expected. Homeshare programs are one solution to housing concerns for older adults and university students. Recommendations for homeshare organisations include careful consideration of the matching and relationship development phases, establishing clear written agreements of boundaries and expectations, supporting participants throughout their agreement, and agreement-ending processes.
'Ri-Medi' is a pilot project implementation of a medication review and deprescribing (MRDP) service in the primary care setting, involving two health districts of the Local Health Authority Roma 1 (Rome, Italy). General practitioners (GPs) are supported in this activity by a multidisciplinary team consisting of epidemiologists, pharmacists, statisticians, pharmacologists, geriatricians, internists, and healthcare managers. Together with GPs, the team chooses specific therapeutic focuses for which updated evidence-based information and indications on the target population are provided. The focus is on the elderly population in hyper-polypharmacy (10+ drugs). For the pilot phase, the therapeutic focus was on potentially inappropriate statin use in primary prevention in patients aged 80+ years. For each GP, the number of patients at risk was estimated. In addition, a survey among a sample of voluntary GPs was launched to investigate their interest in participating in this activity, to collect potential critical issues and impressions, and to identify areas of interest for future MRDP campaigns of interest.
Preventing falls in older adults is a public health priority. The 2022 World Falls Guidelines (WGs) provide a validated algorithm to stratify fall risk (low, -intermediate, or high) and guide tailored prevention strategies. However, large-scale implementation of the WGs faces major barriers, including limited healthcare resources. A prescreening self-administered tool could optimize resource use by identifying individuals at potential moderate or high risk who warrant HCP assessment, while empowering older adults in their own care. To describe the development process of a self-administered questionnaire (APP-Chutes®) designed to pre-screen adults aged 65 and over for moderate or high fall risk, as defined by the WGs algorithm, with the aim of subsequent digitalization as a mobile application. A multidisciplinary expert group - including WGs contributors, geriatricians, a physiotherapist, a patient's representative, and methodologists - met over three days across six months. Inspired by the MASK-air® mHealth app model, the group defined the required qualities of the questionnaire, established an item development methodology, and designed a two-stage validation strategy (development and validation studies). For each WGs algorithm parameter, the group selected the most appropriate self-question(s) format - binary or visual analogue scale (VAS) - prioritizing simplicity, caregiver-assisted completion, and future digitalization. The group developed a self-questionnaire comprising binary questions and VAS items replacing WGs physical tests (walking speed, Timed Up and Go, grip strength). Key innovations include splitting ambiguous questions, applying VAS for subjective parameters (unsteadiness, fear of falling, fatigue, physical activity), and defining VAS thresholds to align with WGs binary outcomes. A two-stage prospective validation methodology, using weighted Gwet coefficient and ROC analyses, was defined. APP-Chutes® represents a novel, patient-centered pre-screening tool designed to facilitate the large-scale roll-out of the World Falls Guidelines. Validation studies will determine its accuracy and support its digitalization as a mobile application.
Geriatricians are aware that the clinical presentation of older people is often with 'atypical' symptoms of commonly encountered conditions. In this Commentary, we explore the emergence of this description as geriatric medicine developed during the era that the disease-diagnosis paradigm dominated medical discourse. We suggest that this recognition of atypicality may have increased the sensibility of non-experts to the more subtle clinical complexity of unwell older adults and added legitimacy to the role of specialist geriatrics, and therefore contributed to improvements in the access and quality of care of older people. Then, noting the growing understanding of the multidimensional nature of illness causation, with age-related frailty now widely appreciated, and insights emerging from geroscience, we offer a critique of its conceptual limitations. Finally, we suggest that holding to the notion of atypicality might be an obstacle to a more assertive reorientation to equitable and age-attuned healthcare, and that the time may be right to offer atypicality a well-deserved retirement.
Cognitive assessment in older adults with low educational attainment presents a diagnostic limitation. Conventional instruments may show reduced accuracy in populations with limited literacy. Therefore, we aimed to compare the diagnostic performance of four cognitive screening instruments for detecting mild cognitive impairment (MCI) in older adults with low education. In this prospective study, adults aged ≥65 years with educational attainment at or below the primary school level were recruited from a geriatric outpatient clinic. Participants underwent assessment with the RUDAS, QMCI-TR, S-MMSE, and DemTect. MCI was diagnosed according to Petersen criteria by geriatricians blinded to cognitive screening test results. Receiver operating characteristic analysis and multivariable logistic regression were performed. A total of 242 participants (mean age 74.0 ± 5.8 years; 62.0% female) were included, of whom 100 (41.3%) had MCI. RUDAS demonstrated comparatively better diagnostic accuracy (AUC 0.740, 95% CI 0.666-0.798), with a cut-off value of ≤23 yielding 83.0% sensitivity and 73.2% specificity. QMCI-TR and S-MMSE showed lower discriminative performance (AUCs 0.666 and 0.631, respectively), while DemTect showed no significant discriminative value (AUC 0.464). RUDAS remained the strongest independent predictor of MCI in multivariable analysis. Cognitive screening performance varied substantially across instruments in older adults with low educational backgrounds. While RUDAS showed the highest, albeit modest, diagnostic accuracy, other tools showed more limited or no diagnostic utility. Given that MCI represents a high-risk state for progression to dementia, these findings highlight the potential for misclassification, underscoring the need for appropriate test selection to improve early detection.
Amid growing concerns surrounding social isolation among older adults, AI chatbots have emerged as promising tools for providing digital companionship. While the intersection of aging and technology has been widely explored, there remains a gap in understanding the nuanced ways in which AI chatbots function as relational partners in older adults' daily lives. This study aimed to examine the roles of the AI chatbot in fostering digital companionship for adults in later life. Drawing on a qualitative research design, the study conducted in-depth, semi-structured interviews with individuals in later life who regularly engaged with AI chatbots. Thematic analysis method was used to synthesize the qualitative data. Participants described the AI chatbot as multifaceted relational agents-occupying roles such as human-like companions, supportive teachers, specialized consultants, practical assistants, and entertainment facilitators. These interactions were reported to support emotional well-being, enhance cognitive engagement, and promote a sense of self-efficacy in daily living. The findings illuminate the profound and diverse ways in which AI chatbots are integrated into the everyday lives of older users, extending far beyond utilitarian functions. As conversational AI continues to advance, designers and policymakers should acknowledge its potential to support aging in place by fostering connection, engagement, and autonomy among older populations.
To compare diagnostic and therapeutic approaches to delirium across European countries with well-established (WE) versus less-developed (LE) geriatric medicine (GM), to identify similarities, differences and potential gaps in care. A cross-sectional online survey was conducted among European geriatricians via the European Geriatric Medicine Society and professional networks from July 2023 to March 2024. Responses on delirium diagnosis and management were analyzed quantitatively, with comparisons between WE and LDGM countries. Of 196 hospital-based respondents, 79.1% were from WEGM countries and 20.9% from LDGM countries. Structured delirium screening was significantly more common in WEGM nations, especially in geriatric (88.4% vs 43.9%, p < 0.001) and orthopedic wards. Non-pharmacological strategies-such as hydration support (76.8% vs 52.5%, p = 0.002) and family involvement (81.5% vs 60.4%, p = 0.005)-were also more frequently used. Conversely, physical restraints were more commonly employed in LDGM countries (70.7% vs 41.4%, p < 0.001), as were pharmacological treatments, such as trazodone and quetiapine. Marked differences exist in delirium management across Europe, which may be linked at least in part to GM development, although confounding factors may exist, and causality cannot be assumed. WEGM countries appear to prioritize structured screening and non-pharmacological interventions, whereas LDGM countries rely more on pharmacological treatments. These findings highlight the need for standardized European guidelines to ensure equitable delirium care.
Older adults with cancer are at greater risk of experiencing drug therapy problems (DTPs), often related to multiple comorbidities, advanced age, and cancer treatments. Increasing evidence demonstrates the value of a pharmacist in geriatric oncology clinics, but little information exists on their practical integration. Our objective is to evaluate the logistics and impact of a pharmacist review of patients referred to a geriatric oncology clinic at an academic cancer centre. Starting January 2023, a one-year quality improvement pilot project integrated a pharmacist review of patients referred to the Older Adults with Cancer Clinic (OACC) at Princess Margaret Cancer Centre, Toronto, Canada. Eligibility criteria included: no existing best possible medication history (BPMH), taking ≥5 medications, plan for or undergoing systemic cancer therapy, or if requested by the OACC team. The BPMH, pharmacist assessment, and DTPs/recommendations were documented in the institution's electronic health record and flagged for the OACC team. Key outcomes included DTPs identified, time required by the pharmacists, and lessons learned. Interprofessional meetings were held every 2 to 3 months to review progress and provide constructive feedback. Descriptive and inferential analyses were performed. Over 49 weeks, the pharmacists reviewed 205 patients, averaging 4 patients per 7-h shift each week. Patients had a mean age of 81 years (SD = 6.6), 51.7% were male, were taking a mean 11.5 medications (SD = 4.8), and 73.7% patients were pre-treatment with a plan for systemic therapy. The mean pharmacist review time was 103.1 (SD = 60.3) minutes per patient. A total of 300 DTPs were identified during the one-year period and the most common DTP was adverse drug reaction. The majority of DTPs (65%) identified were accepted/acknowledged by the OACC geriatricians. Challenges that the pharmacists encountered included: determining which patients to prioritize, obtaining a BPMH remotely, and having only 1 day a week to complete review. This pilot project demonstrated that a pharmacist-integrated model for conducting BPMHs for a geriatric oncology clinic is feasible and clinically valuable. The pharmacists identified many DTPs, including those related to cancer therapies, contributing to safer and more informed treatment planning.
Demand for home-based care is growing, yet the attractiveness of this sector remains low due to poor working conditions. This threatens the sustainability of this service, which is often preferred by older adults. To address this issue, it is necessary to understand of the home care environment. Thus, the aim of this review is to develop a theory-informed framework that explains how multilevel conditions influence the well-being of home care workers. A mixed methods systematic review was conducted. The last updated search was conducted on April 8, 2026. Searches covered Jan 2000-April 2026. 2 reviewers independently coded the data, synthesized the findings using a convergent integrated approach, and integrated the evidence using the Job Demands-Resources and Work-Home Resources theories. Seventy-nine studies were included. High workload volume and intensity and, emotional demands with limited organizational resources were linked to strain, while adequate supervision, information flow, training, access to material resources, and supportive relationships mitigated harm and sustained motivation. The patterns were most pronounced among direct-hire and migrant workers. Negative consequences of the devaluation of care work and the crucial role of legal rights awareness emerged as novel contributions to the field. This theory-informed review addresses fragmented evidence on home care workers' well-being, identifies where demand rises and resources thin under efficiency pressures, and points decision-makers-especially in direct-hire and migrant-reliant systems-to specific practices for retaining the workforce and safeguarding care quality.
Primary hyperparathyroidism (PHPT) is a frequent endocrine disorder, with prevalence increasing with age, affecting approximately 1.5% of adults aged over 65. While management is well codified before the age of 50, with surgery being preferred, recommendations for older individuals are less clear. In this population, however, surgery is still the only curative option, and several studies demonstrated improvement in cognitive and neuropsychiatric symptoms, following parathyroidectomy. However, this indication must be weighed against the patient's co-morbidities, frailty and wishes. Drug-based alternatives are a valid option for patients unable or unwilling to undergo surgery. The fundamental question, however, is to evaluate the suitability of one treatment over another, depending on the patient's phenotype. A transdisciplinary approach involving endocrinologists, endocrine surgeons and geriatricians can ensure personalized care. A robust older patient may benefit from surgery, just like a younger patient, whereas a frail patient would benefit more from conservative management. In what are known as "pre-frail" patients, comprehensive geriatric assessment can optimize of the patient's general condition prior to surgery, and help anticipate postoperative complications. The present article firstly describes the clinical and biological specificities of PHPT in older adults, secondly compares the therapeutic strategies available, and thirdly identifies geriatric markers to guide the therapeutic decision.
In 2025, an Irish team developed the STOPPCog criteria to identify and support the deprescribing of potentially inappropriate medications (PIMs) in cognitively vulnerable older adults. The aim of this study was to provide a French adaptation of the STOPPCog criteria to facilitate their use by French healthcare professionals. The cross-cultural adaptation into French was conducted by two experts, confirmed through a forward-backward translation process, and finalized based on feedback from ten French reviewers (geriatricians and clinical pharmacists). Validation was performed by assessing inter-rater agreement using the intraclass correlation coefficient (ICC) after application of the STOPPCog criteria to five standardized clinical vignettes. The 23 criteria of the STOPPCog tool, organized into six sections, were retained with the same classification as in the original English version, while being adapted to French clinical practice. Back-translation confirmed preservation of the original clinical meaning, and good agreement among the ten reviewers was observed for the identification of PIMs (ICC = 0.791). The French adaptation of the STOPPCog criteria represents an important step toward facilitating their implementation in France. Adjustments based on recent French guidelines and the literature strengthen its relevance in the national context. Future work should focus on facilitating its implementation in clinical practice.
Osteoporosis is a major contributor to morbidity and mortality worldwide, yet underdiagnosis and undertreatment remain pervasive across diverse health systems, including Singapore's mixed public-private primary care landscape. In 2025, the Agency for Care Effectiveness (ACE), Ministry of Health, Singapore, updated its national clinical guideline 'Osteoporosis: Diagnosis and Management' to address these persistent gaps. This paper describes the development of the guideline and examines its implications for primary care using conceptual frameworks. The guideline was developed using a transparent, GRADE-aligned adaptation process that incorporated 10 high-quality international guidelines, local epidemiological and cost data, and formal RAND-UCLA consensus from a multidisciplinary Expert Group. Singapore's mixed public-private primary healthcare system. Oversight was provided by ACE's internal team, with content expertise drawn from a 21-member multidisciplinary expert group (EG), of whom 10 members (47.6%) were practising in public and private primary care settings. The panel included primary care physicians, specialists (ie, endocrinologists, rheumatologists, geriatricians, gynaecologists, orthopaedic surgeons), nurses and pharmacists, ensuring representation across care levels and disciplines. The updated guideline comprises six recommendations spanning risk assessment, lifestyle optimisation, diagnostic thresholds, pharmacologic treatment and referral for complex presentations. Key adaptations include earlier case finding in men, pragmatic vitamin D guidance, locally derived treatment thresholds for osteopenia and selective use of anabolic agents for patients at very high fracture risk. Conceptual analysis using Starfield's 4Cs (comprehensive, continuous, coordinated and first-contact care) and ACE's multilevel impact model, highlighted how the guideline may strengthen primary care functions and influence policy-level, organisational-level, clinician-level and patient-level pathways. Singapore's experience illustrates how mixed health systems can translate global evidence into concise, context-appropriate primary care guidance that supports system redesign and strengthens longitudinal management of chronic disease. Five transferable lessons emerge for similar systems: targeted adaptation of international evidence, pragmatic contextualisation of recommendations to local workflows and resources, strategic use of conditional recommendations, alignment of guideline implementation with broader system reforms and anchoring of chronic disease management in primary care.
This study identified latent domains and usage-breadth patterns of everyday digital technology (EDT) engagement among older adults and examined their concurrent and prospective associations with cognition. The analytic sample comprised 2,910 adults aged ≥65 who completed the 2020 Leave-Behind Questionnaire of the Health and Retirement Study. Exploratory and confirmatory factor analyses identified latent domains across 31 digital activities, and latent class analysis (LCA) identified subgroups differing in engagement breadth. Structural equation models and class-based models examined associations with concurrent (2020) and prospective (2022) cognition, adjusting for prior cognition (2018) and other covariates. Four domains-information access, routine tools, social engagement, and logistic tasks-were identified and confirmed. The domains were intercorrelated and loaded on a second-order general factor, reflecting a graded propensity toward digital engagement. LCA distinguished low-, moderate-, and broad-use groups, with engagement broadening in a patterned way in which the more demanding logistic tasks were endorsed least often, even among moderately engaged users. The general EDT factor, selected domain factors, engagement breadth, and digital gaming were positively associated with concurrent cognition, but none prospectively predicted cognition after adjustment for prior cognition. EDT engagement is best understood as a graded propensity that varies primarily in breadth. Its concurrent associations, absent prospective prediction over a two-year interval, are more consistent with cognitive status shaping EDT engagement than with short-term cognitive benefits of EDT engagement. These findings caution against strong claims that digital engagement preserves cognition, while supporting older adults' digital participation may remain valuable on other grounds.
Consumer-reported measures are important quality indicators for ensuring person-centeredness in home and community-based services (HCBS). However, administrative data commonly used to assess HCBS quality often lacks consumer-reported measures. To address this gap, we developed and validated novel consumer-reported quality indicators using data from the National Core Indicators-Aging and Disability (NCI-AD) Adult Consumer Survey. We conducted exploratory factor analyses using the 2018-2019 survey wave of NCI-AD (n = 5,572 community-dwellingolder consumers, age ≥65 years) and identified seven QIs. We then confirmed the validity of these seven new QIs in 2 ways: (a) qualitatively through a technical expert panel (for face validity and contextualization) and (b) quantitatively, using confirmatory factor analyses in the 2017-2018 survey wave (n = 9,145 community-dwelling consumers, age ≥65 years). The seven validated QIs were service satisfaction, staff quality, environmental safety, service decision-making, daily life decision-making, community inclusion, and overall health and quality of life. Internal consistency was strong across domains (Cronbach's alpha = 0.63-0.89; McDonald's omega = 0.70-0.90). Exploratory analyses also identified differences in selected QI scores by dementia status and age. These seven consumer-reported QIs provide a practical, validated framework for evaluating person-centered HCBS quality. They can support researchers, providers, and policymakers in monitoring service quality, identifying modifiable targets for improvement, and advancing quality measurement in publicly funded HCBS.
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.
Alzheimer's disease (AD), the most common form of dementia, is a neurodegenerative disorder that primarily affects older adults. Because the number of Americans 65 years of age and older living with AD is expected to increase and the availability of specialty physicians, such as neurologists and geriatricians, is limited, the role of primary care in diagnosing and managing patients with AD is expected to grow. Several guidelines for primary care providers are available for the evaluation, diagnosis, and treatment of patients with AD. However, there is no single concise and convenient reference tool for use in the primary care setting. In the primary care setting, clinicians are responsible for identifying patients at risk or demonstrating signs of cognitive impairment, administering cognitive tests, identifying appropriate referrals, and, in some cases, ordering blood-based biomarker testing. Although definitive testing and treatment identification may occur in the specialty care setting, in addition to serving as the hub to coordinate the multidisciplinary care team, primary care clinicians remain responsible for guiding patients and caregivers through shared decision-making regarding treatment, as well as the myriad responsibilities related to comorbidities, patient and caregiver psychological well-being, social support, and safety. This review aims to provide practical recommendations to primary care clinicians for the diagnosis, management, and long-term care of patients with AD.
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Studies suggest that interactions with animals may promote health and successful aging; however, the evidence remains mixed in community-dwelling older adults. This study assesses longitudinal evidence on the associations between pet ownership and successful aging and mortality among community-dwelling older adults. We conducted a systematic search across six databases for peer-reviewed studies and gray literature. After removing duplicates (1,214 of 3,615 records) 2,401 studies were independently screened by two authors using predefined eligibility criteria. Study quality was assessed using the 9-point Newcastle-Ottawa Scale for Cohort Studies. Of the remaining 26 studies from 21 countries and regions, 20 reported a positive association between pet ownership, successful aging, and lower all-cause mortality rates. Positive associations were found for physiological functioning (3/7), cognitive functioning (3/4), physical functioning (6/9), being actively engaged in life (2/3), being psychologically well adapted (3/7), lower all-cause mortality rates (2/6), cardiovascular disease (CVD) mortality rates (2/3), and cancer mortality rates (0/1). Negative associations were observed for physical functioning (1/9), being psychologically well adapted in later life (1/7), and having lower mortality rates (2/8). No associations were found for physiological function (5/7), cognitive functioning (4/4), physical functioning (4/9), being actively engaged in life (1/3), all-cause mortality (4/6), CVD mortality (2/3), and cancer mortality (1/1). Pet ownership may be a modifiable factor that supports healthy aging, though its impact is context-dependent. Therefore, future research should prioritize longitudinal, mixed-method designs to clarify causal mechanisms and optimize targeted interventions for diverse aging populations.
Social isolation is a contemporary public health crisis. However, we know little about trajectories of social isolation over time, and even less about early life precursors of these trajectories. Adverse childhood experiences (ACEs) are known predictors of a variety of poor economic, social, and health outcomes throughout adulthood. Informed by the life course perspective and stress process theory, we examine whether number of ACEs is an early life precursor of trajectories of social isolation throughout adulthood. We used longitudinal national data from both the Midlife in the United States (MIDUS) waves 1-3 (1995-2014) (ages 25-74 at baseline) and the Health and Retirement Study (HRS) waves 8-15 (2006-2020) (ages 51 and older). Growth curve modeling was used to examine the association between the number of ACEs and social isolation trajectories throughout adulthood. In both the MIDUS and HRS, social isolation increases over time among U.S. adults, with a steeper trajectory at older ages. A higher number of ACEs is associated with higher levels of social isolation throughout adulthood. However, in both datasets, there was no statistically significant interaction between ACEs and time-the association between ACEs and adult social isolation persists but does not accelerate throughout adulthood. Because the gap in social isolation between those with more and fewer ACEs is already pronounced at baseline among MIDUS and HRS adults, approaches to reducing adult social isolation need to address circumstances, such as ACEs, that launch trajectories earlier in the life course.