Background: Sickle cell disease (SCD) is a hematologic disorder that affects approximately 100,000 Black individuals in the United States. Although extensive literature describes fall risk factors in adults 65 years and older, evidence regarding fall risk in older adults with SCD remains limited and largely anecdotal. Risk factors for falls in adults aged 50 years and older with SCD overlap with those observed in the general geriatric population aged 65 years and older. Objective: The objective of this study was to describe factors associated with increased fall risk in older patients with SCD. Data Sources: A literature search of PubMed and MEDLINE was performed using the following search terms: "sickle cell disease", "falls", "risk factors", "older adults", "management," and "prevention," as well as combinations of these terms. Data Synthesis: Fifteen studies were identified. Reduced physical functioning, dizziness/imbalance, cognitive impairment, visual deficits, vitamin D deficiency, osteoporosis, polypharmacy, and silent cerebral ischemia (SCI) were identified as risk factors for SCD-related falls. Discussion: Fall risk factors, prevention, and management strategies in patients are understudied and complex. Fall-prevention strategies used for older adults are also important for patients with SCD. Conclusion: Falls in older adults with SCD appear to reflect a convergence of neuromusculoskeletal complications, sensory deficits, cognitive vulnerability, and medication-related effects; however, the evidence base remains limited, and SCD-specific guidance is lacking. Clinicians should evaluate older adults with SCD for the aforementioned fall risk factors.
Older adults have unique experiences after a disaster in that they are a vulnerable social group due to their specific problems and multiple needs. This study aimed to examine in depth the experiences of older adults after the great Kahramanmaraş earthquake in Türkiye on February 6, 2023. The study's data were collected through in-depth face-to-face interviews between 20 and 30 March 2023, right after the earthquake disaster. The study group consisted of 15 older adult earthquake survivors. The descriptive phenomenological approach and thematic analysis were used in this study to reveal the subjective experiences of older adults in their post-earthquake lives. According to the findings, post-earthquake experiences of older adults were evaluated under three themes: "Changes in life routine", "Post-earthquake challenges", and "Coping methods". Health and social care service providers can alleviate the multiple challenges experienced by older adults through addressing their needs during the acute phase and examining their coping strategies.
Emergency departments (EDs) face significant challenges in delivering high-quality care for older patients. Identifying barriers and developing stakeholder-informed interventions are essential to improve ED care. This study aimed to identify nurses' perceived barriers to caring for older ED patients and to develop and evaluate a targeted intervention to improve care quality. This multicenter quality improvement project (QIP) was conducted across EDs in four western European countries (2024-2025) using three iterative Plan-Do-Study-Act (PDSA) cycles. Cycle 1 involved a needs assessment among nurses to identify barriers. Cycle 2 focused on developing and evaluating the perceived helpfulness and feasibility of three proposed interventions. Cycle 3 implemented and evaluated the selected intervention. Nurses provided feedback throughout all PDSA cycles. In Cycle 1, 82 nurses from eight EDs in Belgium (n = 22), Germany (n = 20), Switzerland (n = 30), and Iceland (n = 10) identified time constraints (n = 92; 39%), behavioral disorders (n = 30; 13%), and communication difficulties (n = 25; 11%) as key barriers. In Cycle 2, three interventions were proposed: (1) a QR-code leaflet to facilitate geriatric anamnesis through relatives, (2) educational sessions for nurses, and (3) an informative poster promoting family involvement. The QR-code and poster were evaluated as most helpful and feasible. In Cycle 3, a combined poster-QR-code intervention was developed and implemented across all sites and was well received, though with no measurable effect at this stage. Iterative PDSA cycles provided a structured framework to identify barriers, co-develop, and refine a context-specific intervention for geriatric ED care. The absence of an immediate effect underscores that continuous iteration and stakeholder engagement are essential to further enhance geriatric care within the complex ED setting.
To examine whether frailty moderates associations between intrinsic capacity (IC) losses and health-related outcomes among community-dwelling older adults. Secondary analysis of a longitudinal cohort study. Community in Singapore. Adults aged ≥55 years from the Individual Physical Proficiency Test for Seniors cohort. IC was assessed using the Integrated Care for Older People Step One questions, and frailty using Clinical Frailty Scale (CFS). Outcomes included ADL and iADL, Life Space Assessment, self-rated health (SRH), EQ-5D-5L, hospitalizations, A&E visits, and falls. Linear mixed and Cox proportional hazard models were used, with multiple imputation and sensitivity analyses for missing data. Among 1109 participants (mean age 67.7(SD 6.8) years; 73% female; 86% Chinese), 308(28%) were frail (CFS > 3). Higher cumulative IC losses were associated with iADL decline over time (IC losses × Year2 β = -0.305; 95%CI -0.50 to -0.11; p < 0.01), poorer SRH (β = -1.624; 95%CI -2.593 to -0.654; p = 0.001), lower EQ-5D-5L scores (β = -0.00689; 95%CI -0.012 to -0.001; p < 0.05), and higher hospitalization risk (HR = 1.47; 95%CI 1.08-2.01; p < 0.05). Significant IC losses × frailty interactions were observed for iADL and EQ-5D-5 L, which remained significant in imputation and sensitivity analyses. In subgroup analyses, IC losses remained associated with poorer quality-of-life measures and iADL decline among both non-frail and frail participants. The effect of IC on health-related outcomes is influenced by frailty status. The sub-group analysis supported the detrimental effect of IC loss even among non-frail older adults. These findings support IC assessment alongside frailty evaluation.
Extramammary Paget disease (EMPD) involving the genital and anogenital region is difficult to manage when lesions are extensive, chronic, or located across functionally sensitive sites. In older patients with diabetes, cardiovascular disease, or advanced local involvement, wide excision may lead to considerable perioperative burden, delayed healing, and anatomical impairment. To describe the short-term clinical outcomes and symptom relief associated with aminolevulinic acid photodynamic therapy (ALA-PDT) in older patients with extensive EMPD who were unsuitable for disfiguring surgery or declined surgical treatment. We retrospectively reviewed three histologically confirmed EMPD cases affecting the mons pubis, penile root or foreskin, scrotum, inguinal region, and adjacent proximal thigh. All patients received lesion preparation by debridement followed by topical 10% ALA-PDT using a standardized illumination regimen. At the 3-month evaluation, erosive and exudative areas had re-epithelialized, and nodular lesions showed marked reduction or flattening. Pruritus and local pain improved rapidly and had resolved within 2 weeks after treatment initiation. Mild transient erythema was the only treatment-related reaction. No clinically apparent regrowth or progression was observed during the 12-month clinical and dermoscopic follow-up. In this small retrospective series, ALA-PDT was associated with short-term clinical control and palliative benefit in older patients with extensive genital EMPD, while preserving genital anatomy without creating large surgical defects. These preliminary findings support further evaluation of optimized PDT-based conservative strategies for difficult-to-treat EMPD.
Emergency room (ER) visits in older adults are associated with increased morbidity and mortality. The World Health Organization's Integrated Care for Older People (ICOPE) framework assesses intrinsic capacity (IC), but the association between IC impairments and ER visit risk remains underexplored. This study examined whether IC impairments were associated with ER visits among community-dwelling older adults. This retrospective cohort study used Taiwan's Integrated Care for Older People (ICOPE) database linked to National Health Insurance claims and the Death Registry. A total of 244,899 adults aged ≥65 years were followed from 2022 to 2023. Six IC domains (cognition, mobility, vitality, vision, hearing, and psychological well-being) were assessed. IC impairment severity was categorized as low (0 impairments), moderate (1-2 impairments), or high (≥3 impairments). Latent class analysis (LCA) identified IC impairment patterns. Poisson regression estimated rate ratios (RRs), adjusting for confounders. Over 213,528 person-years, 96,889 ER visits occurred (453.75/1,000 person-years). Impairments in all six IC domains were significantly associated with higher ER visit risk, with malnutrition showing the strongest association (aRR = 1.27, 95% CI: 1.24-1.31). Greater IC impairment severity was associated with higher ER visit risk. Five IC impairment patterns were identified, and the "impairments in all domains" group had the highest risk (aRR = 1.47, 95% CI: 1.41-1.54). IC impairments, particularly greater impairment severity, were associated with a higher risk of ER visits. Routine ICOPE assessment in community and primary care settings may help identify at-risk older adults early and guide targeted, integrated interventions, with closer follow-up for those with multiple impairments.
Sarcopenia in older adults with diabetes may encompass clinically distinct phenotypes. We examined whether body composition-defined phenotypes differed in diabetes complications, insulin resistance-related metabolic features, and continuous glucose monitoring (CGM)-derived glycemic profiles. This cross-sectional study included 109 adults aged 70 years or older with diabetes and frailty. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2 criteria; adiposity was defined using body mass index, body fat percentage, and central obesity. Analyses were mainly descriptive; exploratory logistic regression assessed poor CGM time in range (TIR), defined as TIR below 70%. Sarcopenia was identified in 86 participants (78.9%). After exclusion of 2 participants in a small non-sarcopenic with adiposity subgroup, 107 participants formed three phenotypes. Sarcopenic obesity showed an insulin resistance-related cluster comprising greater central adiposity, higher triglycerides and TyG index, metabolic syndrome in all participants, and greater insulin requirements. Sarcopenia without adiposity showed more neuropathy, albuminuria, cerebrovascular disease, and lower TIR despite similar glycated hemoglobin. Glycated hemoglobin was the only independent correlate of poor TIR; phenotype was not significant overall. Phenotypes showed distinct clinical, insulin resistance-related, and CGM profiles. These preliminary findings support phenotype-aware assessment but require confirmation in larger longitudinal studies before informing management.
Transparent reporting of user-centered design (UCD) in mobile health (mHealth) interventions remains limited and poorly standardized, hindering replicability and equity. Existing frameworks, such as ISO 9241-210, FRAME, and TIDieR, provide partial guidance but do not capture completely the UCD cycle. To propose an operational blueprint and a practical checklist for reporting UCD in mHealth interventions, and to conduct a pilot content validation of the checklist with application to older adults in Brazil. Elements from ISO 9241-210, FRAME, and TIDieR were integrated into the iterative development of an mHealth app ("Viva"). Twenty older adults (mean age 65.0 (3.5) years; 70% high school, 15% elementary, 15% bachelor's degree) participated in focus groups, usability testing, and iterative prototyping. Usability was assessed with the System Usability Scale (SUS) and the Suitability Assessment of Materials (SAM). Adaptations were documented with FRAME. After two prototyping cycles, mean SUS scores increased from 71.2 (SD 4.7) to 87.1 (SD 5.9), representing a statistically significant improvement of +15.9 points (95%CI: +12.1 to +19.6; p<0.001; d=1.10). SAM scores improved from 34.9% (SD 5.7) to 70.7% (SD 13.0), an increase of +35.8 percentage points (95%CI: +27.4 to +44.2; p<0.001; d=0.90). Attrition was zero, with all participants completing testing. FRAME analysis documented 18 adaptations, mainly related to navigation, terminology, and layout. The final reporting checklist included 13 items organized into eight domains: context, stakeholder involvement, design process, adaptations, outcomes, integration, equity & inclusion, and transparency. The proposed blueprint and checklist address critical gaps in UCD reporting by making design processes auditable and replicable. Although further multicenter validation is required, these tools provide a preliminary step toward harmonized reporting practices, with potential to improve transparency, equity, and clinical relevance in digital health, pending broader external validation.
To investigate the associations of the Short Physical Performance Battery (SPPB) and the Chair Stand Test (CST) with all-cause mortality risk among high-functioning older adults over a 15-year follow-up. Longitudinal cohort study using data from the English Longitudinal Study of Ageing (ELSA) with a 15-year follow-up. General community in England. A population-based sample of 2747 individuals with baseline high physical function (gait speed > 0.8 m/s or > 1.0 m/s). Poor lower extremity function was defined as SPPB ≤ 10 points and CST > 15 s. All-cause mortality during the follow-up. Cox proportional hazards models, adjusted for sociodemographic, behavioural, and clinical factors were used to estimate hazard ratios (HRs). Mortality rates were 19.6 and 39.7 per 1000 person-years for SPPB > 10 and ≤ 10 points, and 21.9 and 41.4 per 1000 person-years for CST ≤ 15 and > 15 s, respectively. The risk of mortality was 31% higher for SPPB ≤ 10 points (HR 1.31; 95% CI 1.12-1.54) and 36% higher for CST > 15 s (HR 1.36; 95% CI 1.13-1.62). In a sensitivity analysis (gait speed > 1.0 m/s), the risk of mortality was 43% higher for SPPB ≤ 10 (HR 1.43; 95% CI 1.11-1.83) and 75% higher for CST > 15 s (HR 1.75; 95% CI 1.30-2.36). Both the SPPB and the CST were associated with mortality risk among high-functioning older adults. However, given its quick, easy application, CST may be preferable in clinical settings.
Deficient muscle-specific strength has been recognized as a key component of sarcopenia. However, the impact of various interventions on muscle-specific strength has not been systematically reviewed. This study aims to provide a systematic summary of research examining the effects of exercise, nutrition, and other interventions on muscle-specific strength in older adults. Randomized controlled trials (RCTs) were identified through comprehensive searches of major databases. Eligible studies included adults aged 60 years or older, with interventions lasting at least 8 weeks. Studies were required to assess muscle strength normalized by muscle mass. Standardized mean differences (SMDs) were calculated using random-effects meta-analyses, and heterogeneity was evaluated using I² statistics. A total of 41 RCTs with 3,141 participants were included in the analysis. Interventions included resistance exercise, nutritional supplementation, aerobic exercise, concurrent training, combined exercise and nutrition, caloric restriction, and other therapies. Resistance exercise significantly improved muscle-specific strength (SMD = 0.61, 95% confidence interval: 0.27 to 0.94), although heterogeneity was observed (I² = 81%). In contrast, interventions such as aerobic exercise, concurrent training, combined exercise and nutrition, and nutritional supplementation did not lead to significant improvements in muscle-specific strength. High heterogeneity was observed across all included studies. Resistance exercise is the most effective intervention for improving muscle-specific strength in older adults. The effects of other interventions, such as nutritional supplementation and aerobic exercise, remain inconclusive. Further well-designed RCTs exploring diverse exercise regimens and nutritional interventions are needed to confirm these findings and identify the most effective strategies for enhancing muscle-specific strength in older populations.
Herpes zoster (HZ) has been linked to elevated cardiovascular risk, but the mechanisms remain unclear. Depressive symptoms, particularly specific domains of symptoms, may show statistical mediation in this association. This study examined the longitudinal association between HZ and heart disease, assessed whether depressive symptoms showed statistical mediation, and conducted exploratory internal prediction analyses using machine-learning survival models. Based on the data from the Health and Retirement Study (HRS), we used Cox proportional hazards models to estimate the association between HZ and heart disease and mediation analyses to evaluate the role of total, cognitive-affective, and somatic depressive symptoms in middle-aged and older adults. In addition, five survival prediction models, including Cox, RSF, GBM, LASSO-Cox, and XGBoost, were evaluated using the concordance index (C-index). Among 16,195 participants, HZ was associated with an increased risk of heart disease (adjusted HR 1.22, 95% CI 1.09-1.38, P = 0.001). Significant statistical indirect effects were observed for total (P = 0.003) and somatic depressive symptoms (P = 0.001), whereas no significant indirect effect was observed for cognitive-affective symptoms. Among the evaluated models, Cox and LASSO-Cox showed the highest discrimination, with C-indices of approximately 0.67. HZ was associated with an increased risk of incident heart disease. Statistical indirect effects were observed through depressive symptoms, particularly somatic symptoms, under the assumed temporal ordering. HZ and depressive symptoms provided modest additional predictive information in exploratory internal analyses.
This study determined the relative strength of the association between fall risk factors and falls among community-dwelling older adults. Ninety-four older adults participated in this cross-sectional study. Their fall history in the past year and four categories of fall risk factors, including sensory (foot tactile sensation), motor (muscle strength and power), physical (balance, mobility, ankle range of motion, and physical activity level), and mental (fear of falling and cognitive functions), were collected. Logistic regression indicated that sensation, leg muscle power, and knee extensor strength collectively reached the highest faller status classification accuracy (70.7%). The Relative Weight Analysis results revealed that sensation accounts for 62.51% of the observed variation in faller status, followed by leg muscle power (32.49%) and knee extensor strength (5%). Our findings implied that foot sensation and leg muscle power could be used to assess one's risk of falls. Interventions targeting them may reduce falls for older adults.
Fragmented care in older adults often results in duplicated testing, delayed decision-making and unclear clinical responsibility. These challenges are particularly pronounced in community and home-based primary care settings, where multiple providers contribute to care without formal coordination structures. Although comprehensive multidimensional geriatric evaluation is recommended, its complexity limits routine implementation. This article proposes a pragmatic framework integrating assessment of daily functioning, cognitive screening, mood assessment and mobility evaluation with targeted laboratory testing guided by clinical findings. A central principle of this model is clinical accountability, defined as the responsibility of the clinician who performs assessment and interprets findings to integrate diagnostic results into patient management and follow-up. In this framework, accountability refers specifically to responsibility for documenting findings, initiating appropriate follow-up evaluation and ensuring communication of clinically significant results. By linking brief multidimensional assessment, problem-oriented testing and explicit responsibility for follow-up, this practice-informed communication offers a pragmatic, adaptable approach for family physicians and community-based clinicians working in fragmented care environments. It is presented as a practice-informed proposal rather than a validated framework, consensus statement or guideline.
Vascular depression (VaD) is a subtype of late-life depression (LLD) associated with cerebrovascular disease, cognitive impairment, and poor response to standard antidepressants. Despite its clinical relevance and association with increased risk of dementia, no specific treatment guidelines currently exist. To systematically review randomised controlled trials (RCTs) on the clinical efficacy of pharmacological and non-pharmacological interventions for VaD in older adults. A systematic search of MEDLINE, EMBASE, Web of Science and ClinicalTrials.gov registry identified 7994 records, of which 8 RCTs met inclusion criteria. Studies included participants with late-life VaD. Interventions comprised pharmacological treatments (augmentation with tandospirone and nimodipine) and neuromodulation techniques (rTMS and tDCS). Outcomes included treatment response and remission, change in depressive symptoms, and other clinical outcomes. Augmentation with tandospirone was associated with faster early symptom improvement in three of four trials. Nimodipine improved remission at 2 months and reduced recurrence in one of two trials. Neuromodulation interventions showed promising antidepressant effects and cognitive benefits (based on two trials). Treatments were generally well tolerated. However, study heterogeneity, small sample sizes, and short follow-up durations limited comparability and precluded meta-analysis. The overall certainty of evidence was low to very low. Evidence on treatment for VaD remains limited, highlighting the need for large, well-designed RCTs and integrated approaches combining vascular risk management with targeted therapies.
Gabapentin and duloxetine are common treatments for neuropathic pain in adults over 65, but data on their gastrointestinal (GI) bleeding risk are limited. We compared GI bleeding risk after starting gabapentin or duloxetine in this population. We used the TriNetX US Collaborative Network to conduct an active-comparator cohort study using target trial emulation. Patients aged 65 years and above with neuropathic pain diagnosed between January 2020 and December 2024 were included, excluding those with prior GI bleeding, major depressive disorder, or thrombocytopenia. Propensity score matching balanced key covariates. The main outcome was GI bleeding within 24 months, analyzed with Cox regression; secondary analyses included upper/lower GI bleeding, mortality, and hospitalization. Negative controls assessed confounding. The study analyzed 62,926 patients (55,236 gabapentin; 7,690 duloxetine) and matched 7,599 pairs. GI bleeding was less common with gabapentin initiators (1.22%) than duloxetine initiators (2.49%), showing an absolute risk reduction of 1.27% (HR 0.86, 95% CI 0.84-0.89, p < 0.0001), mainly for upper GI bleeding (HR 0.39, 95% CI 0.29-0.53). Lower GI bleeding results were not significant. Gabapentin also showed slightly lower all-cause mortality (HR 0.87, 95% CI 0.84-0.90). Negative control outcomes revealed no notable associations. In older adults with neuropathic pain, gabapentin initiation was associated with a lower risk of GI bleeding than duloxetine, especially for upper GI bleeding. As both drugs offer comparable analgesic efficacy, GI bleeding risk may be a relevant consideration when choosing between them. These findings are hypothesis-generating and should be confirmed in independent datasets and prospective comparative studies will confirm the data.
Plasma proteomics detect multi-pathway biological changes preceding dementia onset. The Dementia SomaSignal Test (dSST) is a validated 25-protein score predicting 5- and 20-year all-cause dementia risk. Preclinical and clinical data suggest glucagon-like peptide-1 receptor agonists may have neuroprotective effects. In a post hoc analysis of the Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity (SELECT) trial, adults ≥ 65 years with overweight/obesity and cardiovascular disease without diabetes (n = 2970) were randomized to semaglutide 2.4 mg or placebo. Non-fasted serum samples at baseline and week 104 were analyzed using the dSST. Semaglutide reduced increases in predicted dementia risk versus placebo: 2.5-fold less increase in 5-year risk (26.0% lower predicted event rate; odds ratio [OR] 0.74, 95% confidence interval [CI] 0.65-0.85) and 1.67-fold less increase in 20-year risk (8.8% lower; OR 0.91, 95% CI 0.88-0.94). It also reduced odds of higher dementia risk classification by 36% (β -0.44; P < 0.001). Semaglutide slowed progression of a validated proteomics-based dementia risk signature.
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Poor sleep is linked to adverse health outcomes. Animal studies suggest the gut microbiome may influence sleep, but human findings remain inconsistent. We examined associations of self-reported insomnia symptoms, daytime sleepiness, and actigraphy-measured sleep with gut microbiome diversity and composition in older adults. We studied 869 Baltimore Longitudinal Study of Aging participants with self-reported sleep and shotgun metagenomic sequencing; 332 also had actigraphy. We tested associations of sleep with alpha diversity, beta diversity, and species composition using regression, PERMANOVA, and ANCOM-BC2, adjusting for age, sex, BMI, physical activity, education, and depressive symptoms. Participants had mean age 70.7 years; 54.8% were female and 66.9% White. Trouble falling asleep ≥5 times/week was associated with higher Shannon diversity (β=0.41 SD; 95% CI: 0.09, 0.73) and Pielou's evenness, but not richness metrics. No actigraphy-measured sleep variables were associated with alpha or beta diversity. Beta diversity analyses suggested excessive sleepiness (1-2 o 3-4 times/week) was associated with different microbial composition, though variance explained was small. In species-level analyses, frequent insomnia symptoms or excessive sleepiness were associated with depleted or undetected Eubacterium sp. CAG:251. In exploratory actigraphy models, each doubling of sleep efficiency was associated with higher Eubacterium sp. CAG:251 prevalence (PR=2.15; 95% CI: 1.47, 3.14), while each 30-minute increase in wake after sleep onset was associated with lower prevalence (PR=0.49; 95% CI: 0.29, 0.81). Global diversity findings were limited and inconsistent, whereas subjective and objective sleep disturbances converged on Eubacterium sp. CAG:251. Findings are exploratory and require longitudinal replication.
The emergence of agentic artificial intelligence (AI), such as Anthropic's Claude Mythos, challenges the conventional understanding of human agency. This paper explores differences between computational intelligence and human aging and discusses how advanced AI can intersect with the lived experience and mental health of older adults. Unlike the data-driven, simulation-based, nonconscious functions of AI, consciousness is embodied, relational, and historically evolved. Aging changes the brain, the body, and the body-brain communication. Despite cognitive compensation by recruitment of supplemental neural networks, neural aging changes human experience. Along with neurobiology, consciousness is shaped by the older person's identity, which integrates experiences of successes, reversals, love, loss, suffering, and mortality into a coherent life story. Applying the frameworks of poetic naturalism and "hybrid reason," this paper discusses the possibility of a symbiotic AI-human relationship. In this paradigm, AI manages analytical tasks and offers cognitive support (the "how"), while the aging individual provides intentionality, ethical boundaries, and historical perspective (the "why"). Appropriately managed, the human-AI interaction will be a relationship not of subordination but of mutual optimization. As the natural advocates for older adults, geriatric mental health professionals must steward the integration of AI in aging care, ensuring a synergy in which technology scaffolds and augments human function while it preserves the person's agency and dignity. Advocacy should focus both on minimizing the AI risks of manipulation, over-dependence, and privacy loss and on promoting user-centered designs that can make technology accessible and welcoming for older adults.