The global rise in aging populations has introduced challenges such as increased social isolation and weakened intergenerational relationships. Intergenerational programs (IGPs) offer some promising strategies to address these issues by encouraging interactions between the older and younger generations by fostering mutual learning, support, and understanding. This study evaluated the feasibility and impact of a community-based intergenerational program in rural Maharashtra, India, with a particular focus on improving the overall well-being of the elderly individuals. A mixed-methods approach was used to evaluate the implementation of community-driven IGP strategies in 18 villages via qualitative methods (in-depth interviews, focus group discussions, force field analysis, spider web analysis, and most significant change stories) and quantitative assessments (quality of Life, generativity, social capital and self-care assessment tools) across 3 years. Stratified random sampling was used to recruit 520 participants across two elderly age groups (60-70 years and > 70 years). The qualitative data revealed that IGPs improved intergenerational relationships, enhanced communication and appreciation for joint family structures. The key facilitators included community engagement, peer trainers, cultural events, and active involvement from local leaders. Barriers included conflicting agricultural responsibilities, health issues, and limited intergenerational interaction due to mobile use. In the 60-70 years age group, the quality of Life scores was 70.6 at baseline and 68.5 by year 3, the generativity scores was 32.3 at baseline and 28 by year 3, and the social capital scores was 48.3 at baseline to 48.4 by year 3. In the > 70 years age group, the quality of Life score ranged from 66.9 at baseline to 65.4 by year 3, and the generativity scores was 31.8 at baseline and 26.1 at year 3. The social capital score was 45.2 at baseline and 45.5 by year 3. The self-care score was 127 for the 60-70 years age group and 125 for the > 70 years age group at baseline, and 106 for the 60-70 years age group and 103 for the > 70-years age group by year 3. Child-caregiver interactions for the 60 to 70 year-old age group (8.61 at baseline and 9.13 by year 3) and for the > 70-year-old group (9.23 at baseline to 7.74 by year 3). Community based intergenerational project offer a promising approach to address social isolation and promote well-being in elderly individuals while also enhancing intergenerational connections and community resilience.

Anemia is highly prevalent among hospitalized older adults and is associated with increased morbidity and mortality. Hepcidin is a liver-derived hormone that reduces iron availability and contributes to anemia. As the key regulator of iron metabolism, hepcidin is hypothesized to promote anemia development through inflammation-mediated pathways. However, the role of hepcidin in different types of anemia among frail, acutely hospitalized older patients remains poorly understood. The present study aimed to investigate the relationship between circulating hepcidin levels and markers of inflammation, anemia, frailty, comorbidity, and kidney function in a cohort of acutely hospitalized older patients. Data from 1,030 patients aged ≥ 65 years from the Copenhagen PROTECT study were analyzed. Plasma hepcidin and interleukin-6 (IL-6) were measured using immunoassays, while standard biochemical markers, including hemoglobin and C-reactive protein (CRP), were assessed by routine clinical platforms. Anemia was defined according to WHO criteria. Frailty and comorbidity were evaluated using the Clinical Frailty Scale and the age-adjusted Charlson Comorbidity Index (CCI), respectively. Kidney function was determined by estimated glomerular filtration rate (eGFR). Correlations were examined using Pearson or Spearman methods depending on distribution and post hoc analyses included subgroup comparisons stratified by frailty and CCI strata. In exploratory multivariable analyses, hemoglobin was associated with hepcidin, inflammation, renal function, frailty, and comorbidity. Anemia was present in 48% of patients, with 10% of these displaying moderate-to-severe anemia. Hepcidin levels were significantly lower in patients with severe anemia compared to non-anemic patients. Notably, no consistent correlation was found between hepcidin and hemoglobin overall. Median hepcidin was 60.1 ng/mL [IQR 21.8-126.2] and showed moderate positive correlations with CRP (r = 0.48) and IL-6 (r = 0.47) (both p < 0.001). Hepcidin levels were lower in frail patients and varied modestly across comorbidity strata. In this cohort of acutely admitted older medical patients, hepcidin was moderately associated with inflammation and showed modest associations with frailty, comorbidity, and anemia severity. Although no overall correlation was found between hepcidin and hemoglobin, patients with more severe anemia showed lower hepcidin levels. These findings suggest that inflammation is the primary driver of hepcidin regulation in this population. The study was approved by the Regional Ethics Committee of Copenhagen and Frederiksberg (H19039214) and the Danish Data Protection Agency (P2019239).

Global surgical volumes continue to rise, yet postoperative morbidity and mortality remain substantial, particularly among geriatric patients. The scarcity of multi-center prospective perioperative cohorts with active follow-up and large-scale, high-quality data limits the understanding of risk profiles and hinders individualized perioperative management in this population. To address this gap, the PeRiOperative sTress risk assEssment and Clinical decision cohorT (PROTECT) was established by creating a dedicated perioperative data platform for geriatric patients. This cohort profile specifically describes the study design, recruitment strategy, data structure, and current status of PROTECT. PROTECT is an ongoing, ambispective, real-world observational cohort across three tertiary medical centers. The study continuously enrolls inpatients aged ≥ 65years undergoing surgery under anesthesia. Preoperatively, standardized pre-anesthesia assessments are conducted to collect comprehensive medical information. Intraoperatively, anesthetic and surgical data, along with high-frequency biosignals are recorded. Postoperative outcomes are evaluated at 48hours, 7days, and 30days. Descriptive analyses were performed to summarize baseline characteristics and postoperative outcomes. The first participant was enrolled in August 2019. As of May 2025, 61,289 participants aged 65-100years have been included. The median age is 71years, and 44.4% are female. 52.2% are classified as American Society of Anesthesiologists physical status III or higher. The most common surgeries are abdominal (42.8%) and orthopedic (19.9%). Since October 2023, postoperative follow-up response rates have reached 96.5% at 48hours, 77.7% at 7days, and 72.1% at 30days. The 30-day all-cause mortality rate is 0.7%. The most frequent postoperative adverse outcomes are pulmonary infection (13.0%), nausea (11.9%), hepatic dysfunction (9.9%), and intensive care unit admission (8.6%). Leveraging the PROTECT dataset, several prediction models for major postoperative complications have already been developed and implemented in clinical practice. PROTECT provides one of the largest and most comprehensive perioperative datasets for geriatric population. It enables detailed characterization of risk profiles, morbidity, and mortality in geriatric patients, supports identification of contributors to adverse outcomes, and offers a robust platform for developing perioperative risk assessment tools and multivariable models to support clinical decision-making. Future expansions will include extending follow-up to 90, 180, and 365days and recruiting additional participating centers. Registered at chictr.org.cn on 15/10/2025 (ChiCTR2500110517).

Japan faces an unprecedented demographic shift, characterized by the world's most rapidly aging population and a projected surge in annual deaths, leading to a "frequent death society." This trend places substantial fiscal pressure on national healthcare and long-term care (LTC) systems, with expenditures already representing a significant share of gross domestic product (GDP) and continuing to rise. To support sustainability, accurate and proactive cost-prediction models are needed for resource allocation and policy planning. Japan's Long-Term Care Insurance (LTCI) system, established in 2000, provides services based on a seven-level care needs certification, which directly determines monthly benefit limits and strongly influences overall LTC expenditures. Ongoing revisions to the certification system underscore the need to understand how changes in care levels relate to future costs. Traditional cost-prediction models often rely on static, short-term aggregates and may miss dynamic spending patterns. In contrast, data-driven approaches (e.g., trajectory-based methods and machine learning) can identify evolving patterns over longer periods and leverage routinely collected data to enable earlier risk stratification and targeted interventions. This preliminary study addresses a specific research gap by uniquely focusing on estimating lifetime LTC costs based on "changes in care levels," utilizing only initial (first three months) service utilization data and associated costs, without requiring extensive patient background information. Although we refer to "lifetime cost estimation," the present analysis is based on observed service utilization and expenditures over a 12-36-month observation window; therefore, findings should be interpreted as an estimation of longer-term cost trajectories rather than directly observed lifetime costs. We analyzed data from 5,925 LTC users who initiated services at one of 91 home care service centers operated nationwide by a single company in Japan in June 2015 or later, continued service use for 12-36months, and were certified at Care Levels 1-4. The provider is a privately held (non-listed) corporation; therefore, publicly available audited financial statements and dividend policies are limited. As supplementary context, we referenced publicly available Official Gazette (Kanpo)-derived corporate information (Kanpo-derived database; CATR) [1]. The outcome was monthly average LTC service cost. Predictors included initial care level, first-month costs, binary indicators for seven LTC service types used in the first month, binary indicators for changes in costs for each service type during the first three months, and interruption of LTC service use during the first three months. We constructed prediction models using random forest and multivariable linear regression, with an 80/20 split for training/validation. For cost comparisons, users were categorized into a Maintenance/Improvement Group (final care level unchanged or improved from baseline) and a Deterioration Group (final care level worsened from baseline). The Deterioration Group showed significantly higher costs from the first month, particularly among users with higher independence (Care Level 1 or 2), which may reflect early anticipation of deterioration by care providers. Predictive performance was high for both random forest (R2 = 0.677 in the preliminary study) and linear regression models. The linear regression model performed best primarily in the stable Care Level 1 Maintenance Group, whereas the random forest model performed better across most other cohorts, particularly at higher Care Levels (3 and 4). High predictive accuracy was achieved without requiring basic patient attributes (e.g., age, sex) or underlying disease information. In contrast, predictive performance was relatively low in the Care Level 1 Deterioration Group, suggesting greater heterogeneity in cost trajectories among users who are mild at baseline but subsequently deteriorate. This preliminary study demonstrates the feasibility of estimating longer-term LTC cost trajectories based on early service utilization patterns, highlighting the potential role of care managers in shaping future cost trajectories. These findings may inform efforts to enhance the fiscal sustainability and quality of Japan's LTCI system.

Age-related hearing loss (ARHL) or presbycusis is a bilateral sensorineural hearing impairment associated with aging of the structures of the inner ear and auditory pathways and is the most common cause of acquired hearing loss in older adults. Presbycusis is a disabling condition that affects communication and quality of life, and has been associated with poorer cognitive performance. This study aimed to examine the association between ARHL, cognitive screening performance, and hearing-related quality of life in older adults. This single-center prospective observational study with cross-sectional analysis included 60 participants aged 60 years and older: 40 patients with presbycusis and 20 control participants with normal hearing or mild hearing loss. Hearing threshold was examined using pure-tone audiometry and expressed as the Pure Tone Average (PTA). Cognitive function was screened using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), and quality of life was evaluated using the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) questionnaire. On cognitive screening, most patients with age-related hearing loss scored in the range suggestive of cognitive impairment, and 90% reported reduced hearing-related quality of life. Statistically significant correlations were observed between PTA and both MoCA and MMSE scores, suggesting that hearing threshold is strongly associated with cognitive status. Exploratory analyses also suggested an association between self-reported duration of hearing loss and cognitive screening results, although this finding should be interpreted cautiously. In this sample of older adults, worse hearing thresholds were associated with poorer performance on cognitive screening instruments and with lower hearing-related quality of life. These findings support further investigation of early hearing assessment and rehabilitation in older adults, and indicate the necessity of effective and timely auditory amplification, even in individuals with moderate hearing loss.

Intrinsic capacity (IC) is a comprehensive index composed of cognition, locomotion, vitality, and sensory and psychological domains. This study explores the use of IC as a predictor of fall incidence and functional decline over 5 years. Data were obtained from 2476 participants aged 60 years and older from Wave 3 (2015) and Wave 5 (2020) of the China Health and Retirement Longitudinal Study. IC was assessed via the WHO's Integrated Care for Older People tool. Functional decline was defined as the inability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) independently. Falls were self-reported at follow-up. Multivariable logistic regression models were used to explore the association between IC and adverse outcomes. A total of 2476 participants were included in this study, including 1382 males (55.82%) and 1094 females (44.18%), with a mean age of 67.1 ± 5.6 years. The mean total IC score was 4.25 ± 1.78. More depressive symptoms were associated with increased fall risk (OR = 1.410; 95% CI: 1.138-1.747) and decreased ability to perform IADLs (OR = 1.772; 95% CI: 1.451-2.163). Visual impairment was associated with increased fall risk (OR = 1.371; 95% CI: 1.110-1.693) and decreased ability to perform ADLs (OR = 1.281; 95% CI: 1.050-1.563). Poor chair rise test results (OR = 1.351; 95% CI: 1.006-1.814) and hearing impairment (OR = 1.283; 95% CI: 1.020-1.614) were associated with decreased ability to perform IADLs. Furthermore, greater IC was associated with decreased risks of falls and functional decline. The total IC score and components of each domain were associated with the risk of falls and functional decline after 5 years.

After hospital care, older people with dementia often require further health and social care services. Hospital discharge is a complex process in which such support is planned and coordinated. This typically requires collaboration between professionals with different responsibilities representing various authorities to ensure integrated care. In Sweden, the decentralised organisation of health and social care services may lead to variation in discharge procedures and in how collaboration across care providers and authorities is organised. Politicians and civil servants play a central role in shaping discharge practices and in organising collaboration and coordination of services within regions and municipalities. However, their perspectives remain relatively underrepresented in previous research on hospital discharges for older people with dementia. Maximum variation strategy was used to recruit four politicians and eleven local government officials. Semi-structured interviews were conducted and analysed using reflexive thematic analysis. Our findings suggest that the discharge process from inpatient hospital care is governed by formal agreements outlining responsibilities between care providers. This process involves both a physical relocation and an administrative handover of responsibilities. Strategic workforce planning is essential to ensure sustained staff competence, and particular attention must be given to safeguarding the individual's representation throughout the discharge process. Politicians and local government officials highlight the need for clearly defined procedures and guidelines, governed by formal agreements between care providers and care authorities. The findings problematize frequent staff turnover, which undermines the development of a stable organizational culture in relation to hospital discharges. Furthermore, there is a need for experienced professionals committed to working with people with dementia, applying a person-centred approach throughout discharges.

The world population is aging rapidly. Fractures are more frequent in older people are associated with high rates of mortality and morbidity. Several studies have implemented various nursing care interventions to improve health outcomes in older patients following fractures. The current systematic review and meta-analysis aimed to study the effects of various nursing care interventions on the rehabilitation of older patients following fractures. A comprehensive search was conducted across the seven reputable databases (Epistemonikos, Cochrane, Scopus, PubMed, Medline, Embase, and Web of Science) employing four sets of keywords up to April 2025, following the PRISMA approach. The PICOS framework was developed to elucidate the research question, and studies that did not meet the specified criteria were excluded. 94 articles were included in the current review. Among the interventions, multidisciplinary intervention programs, evidence-based nursing, and comprehensive nursing programs demonstrated the highest effectiveness. Nevertheless, educational nursing interventions, exercise programs, discharge programs, family-centered care programs, and pain management programs, despite their low cost, also had a significant positive impact on patient rehabilitation. It was found that nursing interventions in the observational group, compared to the control group, significantly improved satisfaction rates and alleviate complication rates. These findings suggest that various nursing intervention programs can effectively enhance rehabilitation outcomes in older patients following fractures.

Studies suggest delirium is associated with neuronal injury, which may further raise mortality risk. Neuronal injury can be assessed by measuring neurofilament light chain (NFL) concentrations in cerebrospinal fluid (CSF). This study aimed to investigate the association of CSF-NfL with delirium and mortality in patients with hip fracture. The study comprised two prospective cohorts of 548 hip fracture patients with per-operative CSF samples. CSF-NfL concentrations were measured using a commercial ELISA. Delirium was assessed daily from admission until the fifth postoperative day and survival censored at one year. The multivariable analyses (Logistic and Cox regression) were adjusted for age, sex, glomerular filtration rate, dementia status, comorbidity, and Activities of Daily Living. Additionally, Cox regression was adjusted for delirium. In total, 259 (52%) patients developed delirium. In univariate analysis, CSF-NfL was higher among patients with delirium (2116 pg/ml versus 1366 pg/ml, odds ratio (OR) 2.21, (95% confidence interval (CI) [1.75,2,78], P < 0.001). In adjusted analysis, CSF-NfL was not significant (OR 1.29, [0.92,1.81], P = 0.128) and only remained significantly associated with delirium in the subgroup of patients without dementia (OR 1.84, [1.17, 2.89], P = 0.007). In unadjusted analysis of mortality, CSF-NfL was significantly associated with death at one year (hazard ratio (HR) 1.60, [1.37, 1.87], P < 0.001) but not in adjusted analysis (HR 1.03 [0.84, 1.26], P = 0.736). Our findings show that CSF-NfL concentrations were associated with delirium in patients without pre-existing dementia, suggesting possible undiagnosed dementia or, less likely, delirium-related neuronal injury. The CSF-NfL-associated mortality hazard was non-significant after adjustment, mainly for delirium. Thus, the clinical context must be considered when studying CSF-NfL and delirium.

With the continuous increase in morbidity among older adults and the rapid progression of population aging, the demand for healthcare services and older adults care services has grown rapidly. However, the traditional model characterized by the separation of healthcare and older adults care has become increasingly inadequate in meeting the diverse and expanding needs of the aging population. Therefore, promoting the coordinated development of healthcare services and older adults care services has emerged as an urgent and critical issue. Based on panel data from 31 provinces (including municipalities and autonomous regions) in China from 2014 to 2023, this study employs the entropy method, the coupling coordination degree model, and the geographic detector model to analyze the level of coordinated development and its key influencing factors between community-level healthcare services and older adults care services at the provincial scale. Specifically, the entropy method is used to determine indicator weights, the coupling coordination degree model is applied to evaluate the coordination level, and the geographic detector model is utilized to identify the main influencing factors. (1)The coupling coordination level between community healthcare services and older adults care services in China shows an overall upward trend, although the growth rate is uneven, exhibiting a dynamic evolution characterized by "rapid development-gradual slowdown-bottoming out and rebound-fluctuating advancement."(2)Significant spatial disparities are observed in the coupling coordination level, gradually forming a diversified spatial pattern in which coastal regions take the lead, inland regions rise rapidly, and remote regions demonstrate substantial development potential.(3)The coupling coordination development of community healthcare services and older adults care services in China is jointly influenced by infrastructure, workforce, and service capacity. Among these factors, the number of healthcare institutions, the number of technical staff, the number of outpatient visits, the number of older adults care institutions, the number of certified social workers, and the number of community-based daytime care recipients play a dominant promoting role. Based on the findings, this study recommends implementing dynamic regulatory strategies aligned with different development stages, formulating region-specific policies that account for spatial heterogeneity, and adopting targeted interventions focusing on key influencing factors, in order to systematically promote the high-quality coordinated development of healthcare services and older adults care services in China.