Alzheimer’s disease (AD) accounts for 60–80% of all dementia cases. Recent advances in diagnostic biomarkers of early symptomatic AD (ie, mild cognitive impairment and mild dementia due to AD) and amyloid-targeting therapies (ATTs) have the potential to improve outcomes for patients with AD. Two ATTs (donanemab and lecanemab) are currently approved and available for use in the US. Both ATTs can slow disease progression as well as cognitive and functional decline in patients with early symptomatic AD. Treatment with ATTs is associated with specific safety concerns such as amyloid-related imaging abnormalities. Therefore, the benefit versus risk profile needs to be carefully considered when deciding whether to treat a patient with ATTs. This review aims to educate geriatric-trained health professionals regarding advances in the diagnosis and treatment of early symptomatic AD, including the optimal duration of treatment, management of adverse reactions, and patient counseling. It also discusses key considerations in care transitions and patient management in multidisciplinary settings to ensure continuous patient-centered care.

PurposeVery old adults with heart failure (HF) experience high rehospitalisation rates related to multimorbidity, functional vulnerability, and complex care transitions. Empirical evidence on factors associated with rehospitalisation in very old adults with HF managed within integrated post-discharge care pathways remains limited. This study aimed to describe rehospitalisation patterns and associated clinical markers in very old patients with HF managed within an integrated cardiogeriatric post-discharge pathway.Patients and methodsThis retrospective single-centre cohort included patients aged ≥65 years hospitalised for acute HF and enrolled at discharge in an integrated cardiogeriatric pathway combining structured remote monitoring, rapid-access day-hospital services and coordinated outpatient follow-up (April 2023–August 2025). Analyses were restricted to patients who survived the early post-discharge period and had available 12-month follow-up data, in order to assess rehospitalisation status at predefined post-discharge time points. The primary outcome was unplanned HF rehospitalisation at 12 months; secondary outcomes included rehospitalisation at 3 and 6 months, predictors of rehospitalisation and hospital length of stay. Exploratory multivariable logistic regression analyses were performed.ResultsAmong 255 very old patients with available 12-month follow-up data (median age 87 years), rehospitalisation rates were 9.8% at 3 months, 16.1% at 6 months and 24.7% at 12 months. Higher loop diuretic dose was associated with rehospitalisation at 3 months. At 6 months, moderate-to-severe mitral regurgitation, higher diuretic dose and absolute iron deficiency were independently associated with rehospitalisation. At 12 months, moderate-to-severe mitral regurgitation, iron deficiency and chronic obstructive pulmonary disease were independently associated. These findings apply to patients who survived the early post-discharge period and had sufficient follow-up data, rather than to an unselected acute HF population.ConclusionIn very old patients with HF and available longitudinal follow-up, higher loop diuretic dose, iron deficiency, moderate-to-severe mitral regurgitation, and COPD were associated with rehospitalisation status at predefined time horizons. These exploratory findings suggest that routinely available clinical markers may help support risk-stratified follow-up in advanced-age HF populations.

To describe the status of home medication behaviors and medication literacy among older patients with chronic diseases in China and to identify factors influencing medication literacy levels to inform improvement strategies. A national cross-sectional study was conducted from October 2022 to the end of June 2023 across 31 provinces using a multi-center, quota-based convenience sampling approach. Trained pharmacists collected data via face-to-face interviews using a validated Knowledge, Attitude, and Practice (KAP) questionnaire. Medication literacy was dichotomized into adequate (score ≥186) and inadequate (<186). Multivariable logistic regression was employed to identify associated determinants. Among the 10,363 eligible participants, 48.31% demonstrated adequate medication literacy. Prevalent suboptimal home medication behaviors were observed: 57.05% failed to completely retain original medication packaging, and 74.25% could not fully understand package inserts. Through multivariable logistic regression, several key factors were identified as significant predictors of medication literacy. Higher educational attainment (college degree and above: OR = 2.185, 95% CI: 1.744 to 2.738) was identified as a strong predictor of adequate literacy. Conversely, discarding medication package inserts (OR = 0.697, 95% CI: 0.588 to 0.828) and the inability to comprehend package inserts (OR = 0.265, 95% CI: 0.226 to 0.311) were found to be negatively associated with literacy levels. Furthermore, 93.60% of the cohort reported the presence of somatic symptoms, which were frequently misattributed to normal aging rather than potentially modifiable medication-related causes. Medication literacy among older Chinese adults with chronic diseases remains suboptimal, with nearly half failing to achieve adequate levels. Independent self-management is significantly associated with socioeconomic factors and specific behavioral gaps. A home-based pharmaceutical care system should be implemented to prioritize vulnerable groups, advocate for the retention of original packaging, and promote the development of simplified medication instructions.

Aging involves declines in cognitive and physical functions, raising risks of falls, loss of independence, and poorer quality of life. Dual-task training, integrating cognitive and motor activities, has shown benefits, but direct comparisons of additional dual-task training (ADT), which embeds cognitive demands within motor tasks, and incorporated dual-task training (IDT), which requires concurrent yet independent cognitive tasks, are limited. This study compared the effects of ADT and IDT on cognitive function, physical performance, instrumental activities of daily living (IADL), and quality of life in community-dwelling older adults. Seventy-four participants (≥60 years) were randomized to ADT (n = 34) or IDT (n = 40) and completed a 12-week group program. Cognitive outcomes were measured with the Montreal Cognitive Assessment, Digit Symbol Substitution Test, Wechsler Memory Scale-III Word List, and Stroop Color Word Test; motor outcomes with the Box and Block Test, Timed Up and Go, and dual-task indices (BBT-SST, BBT-FD); functional outcomes with the Lawton IADL and Community Integration Questionnaire (CIQ). A significant group × time effect was found for BBT-SST number scores (p =0.002), with IDT yielding greater dual-task cognitive gains. Both groups improved in global cognition, processing speed, and working memory, while only IDT enhanced motor performance and motor-cognitive coordination. No significant changes were observed in TUG, dual-task cost, IADL, or CIQ. IDT showed superior benefits for dual-task cognition and coordination, suggesting greater ecological validity, more efficient resource allocation, and closer alignment with real-world demands. Future studies should investigate electroencephalography (EEG) based neural mechanisms and develop VR approaches for at-risk older adults.

BackgroundSarcopenia, an age-related syndrome marked by progressive loss of skeletal muscle mass and function, is associated with frailty, disability, falls, and increased mortality among older adults. However, existing diagnostic methods, such as dual-energy X-ray absorptiometry (DXA) and physical performance tests, are often inaccessible in routine clinical practice due to equipment and time constraints.ObjectiveThis study aimed to develop and validated a multimodal, explainable AI model for identifying sarcopenia using routinely available chest CT scans and outpatient clinical data in older adults.MethodsA total of 290 participants (mean age 67.6 ± 5.8 years; 38.9% female) were included. A weakly supervised segmentation framework combining the Segment Anything Model (SAM) and Contrastive Language-Image Pretraining (CLIP) was employed to extract muscle features at the T12 level. Clinical variables, including anthropometric indices, lifestyle behaviors, and biochemical markers, were encoded and fused with imaging-derived features. A multi-layer perceptron (MLP) was trained to classify sarcopenia based on 2019 AWGS criteria. Model interpretability was assessed using SHAP (Shapley Additive Explanations) values.ResultsThe model achieved an AUC of 0.88 (95% CI: 0.83–0.92), accuracy of 0.85 (95% CI 0.82–0.89), sensitivity of 0.79 (95% CI: 0.70–0.987), and specificity of 0.88 (95% CI: 0.83–0.92). SHAP analysis revealed that gender, total triiodothyronine, creatine kinase, body mass index and creatinine were the most influential predictors. The fusion of weakly supervised learning and multimodal data enabled effective muscle region segmentation and improved diagnostic performance.ConclusionIn summary, we developed and internally validated an explainable multimodal AI model that integrates chest CT–derived muscle features with routine outpatient clinical variables for sarcopenia detection in older adults. The model demonstrated strong diagnostic performance and interpretability, highlighting its potential for opportunistic risk stratification in routine clinical workflows. Future multi-center validation and prospective studies are warranted to confirm its generalizability and long-term clinical utility.

Surgical management of lumbar degenerative diseases (LDD) in octogenarians requires balancing effective neural decompression against diminishing physiological reserves. While general anesthesia (GA)-based endoscopic techniques (ENDO-GA) are highly effective, they often impose excessive systemic stress on frail patients. Conversely, percutaneous endoscopic lumbar discectomy under local anesthesia (PELD-LA) provides targeted decompression while mitigating these GA-associated risks. Given the scarcity of direct comparisons in this fragile population, this study evaluates the safety and efficacy of PELD-LA versus ENDO-GA. We retrospectively analyzed 100 consecutive octogenarians treated for LDD between January 2021 and December 2024. Patients were stratified into two specific surgical strategy groups: targeted decompression via PELD-LA (n=54) and extensive decompression via ENDO-GA (utilizing UBE or Delta techniques, n=46). To minimize selection bias, a 1:1 Propensity Score Matching (PSM) was conducted using specific covariates (age, sex, comorbidities, and ASA classification), yielding 39 matched pairs (n=78). Primary outcomes assessed perioperative safety and recovery efficiency (complications, PONV, ambulation time, and length of hospital stay).Secondary outcomes evaluated postoperative clinical efficacy (VAS and ODI at 3 months, and modified MacNab criteria at 12 months postoperatively). After propensity score matching, baseline characteristics were well-balanced between the two groups. Perioperatively, the PELD-LA group exhibited significantly shorter operative times (97 vs 150 min, P<0.001), earlier ambulation (48 vs 72h, P<0.001), and reduced length of hospital stay (9 vs 14 days, P<0.001) compared to the ENDO-GA group. Clinically, despite a smaller "targeted" decompression range, PELD-LA achieved long-term efficacy (MacNab criteria: 94.9% vs 94.9%, P=1.000) comparable to extensive decompression, while demonstrating superior early pain relief and functional improvement (VAS and ODI) at 3 months postoperatively (P<0.01). Crucially, the overall complication rate was significantly lower in the PELD-LA group (30.8% vs 82.1%, P<0.001), primarily driven by a marked reduction in postoperative nausea and vomiting (PONV) (23.1% vs 66.7%, P<0.001). Within our short-to-medium-term observation period, PELD-LA delivered clinical efficacy comparable to GA-based endoscopic procedures for octogenarians, while significantly reducing perioperative complications and accelerating recovery. Crucially, we do not assert that PELD-LA is universally superior; rather, we emphasize the importance of tailored patient selection. For frail patients with limited physiological reserve, PELD-LA serves as a physiologically rational strategy, balancing targeted decompression with the preservation of systemic stability.

Enhanced Recovery After Surgery (ERAS) pathways have been adapted for open and lower extremity vascular surgery and increasingly guide perioperative care for older adults. However, little is known about how perioperative nurses implement ERAS-consistent and geriatric-focused practices for older patients undergoing open and hybrid aortic procedures, particularly in hybrid operating room settings and in Chinese hospitals, where pathway maturity and geriatric integration may vary across centres. To describe perioperative nurses' implementation of ERAS-consistent and geriatric-focused nursing practices for older adults undergoing open and hybrid aortic vascular surgery in China, and to identify nurse- and organisation-level factors associated with higher implementation, with attention to modifiable determinants (training, ERAS pathways, staffing). Registered nurses working in operating theatres/hybrid operating rooms, post-anaesthesia care units, intensive care/high-dependency units, vascular surgical wards and pre-assessment clinics in eight tertiary general hospitals in Shanxi Province, China, were surveyed between March and July 2024. The Geriatric-Focused Vascular ERAS Nursing Practices Questionnaire, developed from ERAS/SVS guidelines and geriatric surgery literature, measured nurse-reported implementation across perioperative domains, geriatric-focused elements, attitudes and perceived barriers. The instrument underwent expert review, pilot testing and internal consistency assessment, while more advanced psychometric testing was beyond the scope of this initial multicentre study. Data were analysed using descriptive statistics, group comparisons and multivariable linear regression; free-text responses were examined using inductive qualitative content analysis. The study was conceptually informed by a Donabedian structure-process-outcome framework and a capability-opportunity-motivation perspective on behaviour change. Of 640 eligible nurses, 428 provided analysable responses (usable response rate 66.9%). The global ERAS implementation score (1-5) was 3.41 (SD 0.49). Implementation was highest for intraoperative/post-anaesthesia practices (3.82, SD 0.61) and preoperative education/optimisation (3.63, SD 0.72), and lowest for frailty and cognitive/delirium assessment (2.71, SD 0.81). Routine frailty assessment was reported by 23.4% and routine use of structured delirium screening tools by 30.8%. Higher implementation was independently associated with ERAS-specific training (B = 0.28, p < 0.001), geriatric/frailty training (B = 0.12, p = 0.008), working in hospitals with a formal ERAS pathway (B = 0.24, p < 0.001), higher perceived staffing adequacy (B = 0.09, p = 0.004), and greater experience (B = 0.04 per 5 years, p = 0.012) (adjusted R2 = 0.38). Qualitative findings highlighted ERAS as an "ideal rather than daily reality", challenges in technology-dense environments, fragmented responsibilities, and the need for leadership and tailored education. Perioperative nurses in these tertiary hospitals reported moderate implementation of ERAS-consistent care for older adults undergoing open and hybrid aortic vascular surgery, with substantial gaps in frailty assessment, delirium screening and geriatric-tailored practices. These gaps are clinically important because they may limit timely risk recognition and tailoring of perioperative care in a high-risk older surgical population. ERAS-specific and geriatric training, hospital-level ERAS pathways, perceived staffing adequacy and experience were associated with higher implementation and represent important modifiable targets, although causal relationships cannot be inferred from this cross-sectional survey.

To investigate the clinical characteristics of postoperative subacromial impingement syndrome (SIS) in elderly patients undergoing arthroscopic rotator cuff repair (RCR) and to analyze its association with mid- to long-term postoperative functional recovery. A retrospective analysis was conducted on the clinical data of 150 elderly patients who underwent RCR between January 2023 and January 2025. Patients were stratified into an impingement group (n = 32) and a non-impingement group (n = 118) based on the presence of SIS at 3 months postoperatively. Preoperative baseline characteristics, surgery-related variables, and postoperative outcomes including the Constant-Murley Shoulder Score (CMS), the University of California, Los Angeles Shoulder Score (UCLA), and the Visual Analog Scale for pain (VAS) were compared between the two groups at 3, 6, and 12 months after surgery. At 3 months postoperatively, the incidence of SIS was 21.33% (32/150). The affected patients mainly presented with aggravated shoulder pain during abduction and forward flexion, with 100% positive Neer impingement test and 90.63% positive Hawkins impingement test, and some patients had audible clicking during shoulder movement. At 3, 6, and 12 months after surgery, CMS and UCLA scores were significantly lower in the impingement group than in the non-impingement group, while VAS scores were significantly higher (all P < 0.05), Cohen's d values for CMS at 0.55, 0.35, 0.59; for UCLA at 1.21, 0.41, 0.48; and for VAS at 0.42, 0.81, 0.63 (moderate to large effect sizes) indicating a substantial magnitude of intergroup differences. Although CMS and UCLA scores demonstrated a progressive improvement over time and VAS scores showed a continuous decline in both groups, the overall recovery level in the impingement group remained consistently inferior to that of the non-impingement group throughout the follow-up period. The incidence of SIS after RCR in elderly patients is relatively high, and the postoperative SIS in this population is characterized by aggravated shoulder pain during abduction and forward flexion, positive Neer and Hawkins impingement tests, and occasional audible clicking during shoulder movement. Postoperative SIS was significantly associated with poorer shoulder functional recovery and delayed pain relief in elderly patients undergoing arthroscopic rotator cuff repair.

Non-alcoholic fatty liver disease (NAFLD), the most prevalent chronic liver disease globally, is closely linked to obesity and metabolic dysregulation. However, the relative contributions of overall adiposity versus body fat distribution patterns to NAFLD pathogenesis, particularly in the elderly population, remain incompletely understood. This study aimed to investigate the association between cluster-derived body composition phenotypes and NAFLD risk, and identify independent risk factors for NAFLD. This cross-sectional study enrolled 239 elderly participants. Body composition parameters (whole-body and regional fat percentages, visceral adipose tissue (VAT) area, fat-free mass) were measured via dual-energy X-ray absorptiometry (DXA). Participants were divided into NAFLD and non-NAFLD groups by abdominal ultrasonography. Inter-group comparisons were performed with Student's t-tests and chi-square tests. Cluster analysis was applied to identify distinct body composition phenotypes. Univariate and multivariate logistic regression were used to screen independent NAFLD risk factors, and ROC curve analysis evaluated the model's predictive performance. The NAFLD group showed more prominent central obesity (P<0.001) and higher fat-free mass (P<0.001) than the non-NAFLD group, with no difference in total body fat percentage. Three phenotypes were identified: high total fat with limb-dominant distribution (C1), high visceral fat with central obesity (C2), and low total fat with symmetrical distribution (C3). C2had the worst metabolic profile and highest NAFLD prevalence (60.5%), significantly higher than C1 (27.5%) and C3 (30.3%). Multivariate analysis identified lower HDL-C, higher BMI, elevated trunk-to-leg fat ratio, and higher albumin as independent NAFLD predictors; the four-indicator combined model had optimal predictive performance (AUC=0.803). In the elderly, visceral fat accumulation and central fat distribution, rather than overall adiposity itself, are key body composition features linked to NAFLD. The high visceral fat central obesity phenotype correlates with the highest metabolic risk and NAFLD prevalence, and the trunk-to-leg fat ratio is a robust NAFLD predictor.