The World Health Organization published the 2019 Integrated Care for Older People (ICOPE) framework to guide, assess, and promote the intrinsic capacity of older adults, referring to their physical and mental health. This study aims to investigate the relationship between intrinsic capacity (IC) and frailty among older adults. This cross-sectional study was conducted in a medical center in Taiwan in 2021. Two hundred ten patients over 65 admitted to the geriatric ward were invited to participate. The questionnaire included an IC measure, Fried's frailty scale, and demographic items. The IC measure was ascertained using the six domains of ICOPE (cognition, mobility, nutrition, visual, hearing, and depressive symptoms). The Fried's frailty scale was used to categorize participants as robust (Fried's frailty scale=0), prefrail (Fried's frailty scale=1-2), or frail (Fried's frailty scale ≥3). Multinomial logistic regression was used to analyze the association between individual ICOPE domains and frailty stages, while adjusting for confounders. 39.0% were prefrail, and 28.6% were frail. Mobility loss and depressive symptoms were significantly associated with prefrail (adjusted odds ratio (aOR): 4.44, 95% CI: 1.82-10.82; aOR: 8.41, 95% CI: 1.75-40.37) and frail (aOR: 11.57, 95% CI: 3.63-36.93; aOR: 13.77, 95% CI: 2.62-72.49) individuals, respectively. Malnutrition (aOR: 4.01, 95% CI: 1.18-13.62) and hearing loss (aOR: 4.37, 95% CI: 1.09-19.66) were significantly associated with frail older adults. Mobility loss and depressive symptoms occurring at the prefrail stage could be used as assessment items for early detection of prefrail.

The AD8 is a validated informant-based interview for early dementia detection. Research suggests the utility of self-rated AD8 to identify milder dementia forms in research settings. This study compares the factor structure, reliability, and diagnostic performance between AD8-self and AD8-informant for early cognitive impairment (ECI) in a clinical setting. 515 patient-informant dyads [43 cognitively intact and 472 ECI] from a tertiary memory clinic completed both self-reported and informant AD8. We conducted exploratory factor analysis to determine the factor structure, Cronbach's alpha for internal consistency, and receiver operating characteristic (ROC) curve analysis for ECI, including a subgroup analysis for mild cognitive impairment (MCI). The mean age and education of ECI participants were 75.61 years (range, 51-95) and 5.6 years (range, 0-20), respectively, and 72.6 years (range, 51-89) and 6.8 years (range, 0-16) in the MCI subgroup. Unlike AD8-informant's one-factor structure, AD8-self had a two-factor structure corresponding to memory and non-memory domains. AD8-self demonstrated lower reliability (Cronbach's Alpha: ECI 0.666 vs. 0.764; MCI 0.663 vs. 0.709). In ECI, AD8-informant (cut-off ≥3) showed better diagnostic performance (Sensitivity: 89%, Specificity: 79%) than AD8-self (cut-off ≥4) (Sensitivity: 27.1%, Specificity: 95.3%) (AUC: 0.915 vs. 0.593, p<0.001). Similar results were found in MCI (Sensitivity: 64.7% vs 26.5%; Specificity:79.1% vs 95.3%; AUC:0.745 vs 0.600, p=0.002). AD8-self has a distinct factor structure, lower reliability, and inferior diagnostic performance compared to AD8-informant for ECI/MCI detection. Our result do not support AD8-self as a standalone tool for detecting ECI or MCI.

Microscopic polyangiitis (MPA) is a rare ANCA-associated vasculitis that poses unique diagnostic and therapeutic challenges in seniors. We describe a 90-year-old female with diabetes, hypertension and heart failure who presented with anasarca and rapid renal failure. Evaluation revealed MPO-ANCA positivity, and renal biopsy confirmed pauci-immune crescentic glomerulonephritis. Her course was complicated by anemia and deep vein thrombosis. She was managed with high-dose corticosteroids, rituximab, and supportive hemodialysis, achieving improvement in renal function. This case highlights how comorbidities may obscure recognition of vasculitis and how assessment of frailty and baseline function are essential in weighing risks of immunosuppression in the seniors. Clinicians should maintain vigilance for ANCA-associated vasculitis in older adults with unexplained renal decline and tailor therapy to balance disease control with vulnerability to treatment toxicity.

Phase angle (PhA) reflects cellular integrity and muscle quality. However, evidence is limited regarding whether an increase in PhA is associated with improvements in activities of daily living (ADL) and skeletal muscle mass. This study aimed to investigate the association between change in PhA and prognosis in terms of ADL and skeletal muscle mass in post-stroke patients undergoing rehabilitation. This retrospective cohort study was conducted at a convalescent rehabilitation hospital in Japan. Patients with a PhA at admission below the cutoff values (4.76° for males and 4.11° for females) were included. Patients were categorized into a PhA-increase group (>0) and a non-increase group (≤0). Outcomes included the Functional Independence Measure (FIM)-motor score and skeletal muscle mass index (SMI) at discharge. Multivariate regression was used to assess associations. A total of 253 patients were included (mean age 78.0 ± 10.9 years; 51% women). The median [IQR] PhA at admission was 3.70° [3.20, 4.10], and the median change during hospitalization was 0.00° [-0.20, 0.30]. Of these, 119 patients had increased PhA and 134 did not. Change in PhA was independently associated with higher FIM-motor scores (β = 0.078, P = 0.040) and greater SMI (β = 0.454, P < 0.001) at discharge. In post-stroke patients, an increase in PhA during hospitalization was associated with better functional and muscular outcomes. PhA may therefore serve as a valuable biomarker for assessing the efficacy of rehabilitation.

BackgroundWith increasing life expectancy, the number of older adults with multiple chronic conditions requiring complex medication regimens is growing, raising concerns about polypharmacy and potentially inappropriate medication (PIM) use. This study investigated trends in polypharmacy and PIM use among 66-year-olds in South Korea from 2012 to 2021, considering participant characteristics, to inform interventions and policies.MethodsA repeated cross-sectional study was conducted using the National Health Insurance Services database covering approximately 97% of Koreans. We included 3,397,044 individuals aged 66 who underwent the National Screening Program for Transitional Ages between 2012 and 2021. Polypharmacy was defined as the use of ≥5 medications for ≥90 days annually, hyper-polypharmacy as ≥10 medications, and PIM use as ≥1 PIM for ≥28 days. Trends were analyzed by sex, frailty, comorbidity, income, insurance type, and residence.ResultsPolypharmacy prevalence increased from 32.0% in 2012 to 35.4% in 2021, and hyper-polypharmacy also rose. PIM use slightly decreased from 55.7% to 53.7%. Higher rates of polypharmacy and PIM use were observed among rural residents, medical aid beneficiaries, and those with lower income. Despite improvements in comorbidity and frailty, socioeconomic disparities widened, particularly among medical aid beneficiaries. Frequently prescribed PIMs included NSAIDs, PPIs, muscle relaxants, and anxiolytics/hypnotics.ConclusionWhile PIM use slightly decreased over the study period, it remained above 50%, and polypharmacy prevalence increased among older adults in Korea. Socioeconomic disparities in medication use persist, highlighting the need for targeted interventions and policies to promote safe medication use among vulnerable groups.

Renal function declines with age as the kidneys become more vulnerable to inflammation and cellular senescence. This study examined gene expression changes linked to renal aging and assessed whether short-term calorie restriction (CR), a known anti-aging intervention, could reverse these alterations. Using RNA-seq data, we applied bioinformatics, systems biology, and molecular biology approaches to identify differentially expressed genes during aging and under CR. Gene Ontology and pathway analyses revealed that both aging and CR altered the expression of key senescence-associated secretory phenotype (SASP) genes, including cytokines and chemokines (Il1b, Ccl3, Ccl5, Il19, and Il24) and growth factors (Timp1 and Mmp12). Renal aging is also associated with an increased expression of cell cycle arrest markers (P15INK4B (Cdkn2b), P16INK4A (Cdkn2a), and P21 (Cdkn1a)), which are suppressed by CR, suggesting a link to cellular senescence. Quantitative analysis of renal tissue samples confirmed the age-associated upregulation of these genes at the transcriptional level, and CR effectively attenuated these changes. Among these genes, we focused on the members of the IL-20 family, particularly Il19 and Il24. Furthermore, experimental induction of cellular senescence using H₂O resulted in elevated Il19 and Il24 expression alongside other senescence markers. These findings suggest that aging and short-term CR regulate the IL-20 family expression, potentially influencing cellular senescence. Our study suggests that Il19 and Il24 are associated with age-related renal decline and may represent hypothesis-generating candidates, highlighting potential molecular targets for future mechanistic and therapeutic investigations.

Elderly patients visiting the emergency department (ED) are at increased risk of adverse outcomes, including ED revisits and mortality. Sarcopenia quantification by point-of-care ultrasound (POCUS) may be a useful bedside screening tool, especially when traditional frailty screening instruments, reliant on history taking, cannot be used. This study evaluated whether POCUS measurement of rectus femoris cross-sectional area (RFcsa) can predict adverse outcomes in elderly patients visiting the ED. In this single-centre prospective study, patients aged ≥70 years presenting to the ED of a Dutch university hospital and enrolled in the Acutelines data and biobank were included. RFcsa was measured using POCUS. ROC-analysis assessed the overall accuracy of RFcsa for prediction of the primary outcome, which was defined as the composite of ED revisit or death within 3 months. Logistic regression determined the added value of RFcsa to Karnofsky Performance Score (KPS). During the study period, a total of 68 patients were included. 26 patients (38%) met the primary endpoint. RFcsa showed excellent intra-rater reliability (ICC = 0.98). However, the accuracy to predict the composite endpoint was low, with an area under the curves (AUC) of 0.53 (0.39-0.66) for unadjusted RFcsa and, 0.51 (0.36-0.66) for sex-adjusted RFcsa and 0.53 (0.37-0.68) for height-adjusted RFcsa. The addition of RFcsa in a multivariate logistic regression model with KPS did not increase the overall explained variance in the primary endpoint. In elderly patients presenting in the ED, POCUS-measured RFcsa does not predict ED revisits or death within 3 months.

BackgroundTrauma remains a leading cause of death and disability. With the rapidly growing aging population, geriatric patients face heightened trauma risks due to physiological decline and comorbidities. Despite the growing burden, data on the clinical characteristics, injury mechanisms, patterns, and healthcare utilization in this group remain limited. This study analyzed trauma outcomes and associated factors in geriatric patients.MethodsWe conducted a retrospective cohort study using data from a Level I trauma center. Patients aged ≥65 years were compared with younger adults (<65 years). Variables included demographics, injury mechanism, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury SeverityScore (ISS), clinical outcomes, and medical costs. Multivariate logistic regression identified mortality predictors.ResultsAmong 10,358 trauma patients with mean age of 54.2 years, 61.9% of younger patients were male, compared to 37.7% in the geriatric group (p<0.001). Geriatric patients exhibited lower male predominance, higher costs, and greater mortality (p<0.001). Multivariable analysis revealed that, among geriatric groups, male sex, older age, lower GCS, lower RTS, burns injuries, and severe injuries (AIS ≥3) to head, thoracic, extremity, and appearance were significant mortality predictors. Undergoing orthopedic and thoracic surgeries was associated with lower mortality in geriatric patients.ConclusionGeriatric trauma patients experience higher mortality risks and demands. Timely interventions, critical care management, appropriate triage, and age-adapted assessment tools are essential for improving clinical outcomes. These findings underscore the importance of interdisciplinary care strategies to optimize geriatric trauma management and resource utilization.