Older Population Research Articles

Clinical perspective on innovative insulin delivery technologies in diabetes management.

The primary objective of this study is to report the results of an online questionnaire and the in-person discussion sessions of physicians specializing in diabetes care in which their opinions about current diabetes management was obtained. The Diabetes Innovation Summit 2023 drew attendance from a diverse group of specialized physicians from multiple countries. A comprehensive literature review was conducted to examine the technologies and medical needs associated with diabetes management. Using the results of the review, a questionnaire was developed by three experts from the steering committee to solicit feedback from specialized physicians. The online survey was made accessible between 10th December 2022 and 10th January 2023. Following the online survey, six structured in-person discussion sessions were conducted with specialized physicians from the Middle East, Central-Eastern Europe, and North Africa regions. The study revealed that about 59% of survey requests were answered, with many participants being pediatric endocrinologists from North Africa. Around 60% of diabetes patients followed Multiple Daily Injections (MDI) according to specialized physicians. Among MDI users, 62% employed Blood Glucose Monitors (BGM), 31% used intermittent-scanning Continuous Glucose Monitors (isCGM), and 23% used CGM. In North Africa, nearly 90% of patients used MDI due to financial constraints. While physicians focused on both Time in Range (TIR) and HbA1c for MDI-treated patients, satisfaction with TIR achieved was expressed by 31%, while 74·1% believed Real-Time CGM (rtCGM) was effective. Concerns arose about potentially misleading HbA1c results and the relatively low patient achievement of target TIR despite CGM usage. The Smart MDI System was seen favorably compared to other applications. The system's affordability was a significant barrier, particularly in the Middle East and Africa. The present study highlights that physicians are generally supportive of utilizing new technology. The questionnaires and the open discussion revealed the expectation that the Smart MDI technology provides better control, primarily by identifying missed boluses, while expressing concerns on the use of the technology by teenagers and children, who might forget the device and be reluctant to use in public, and by the older population, who might be challenged by the technology.

Efficacy of a single dose of cryopreserved human umbilical cord mesenchymal stromal cells for the treatment of knee osteoarthritis: a randomized, controlled, double-blind pilot study.

Knee osteoarthritis (OA) is the most prevalent degenerative musculoskeletal disorder, which is particularly common in older population. While conventional treatments have limited effectiveness, the development of more effective therapeutic strategies is necessary to address this primary source of pain and disability. Umbilical cord mesenchymal stromal cells (UC-MSCs) offer a promising therapeutic approach for treating knee OA.This randomized, prospective, double-blind and controlled pilot study was carried out to evaluate and compare the safety and therapeutic efficacy of a single intra-articular injection of a standardized product CellistemTMOA (5 × 106 ± 5 × 105 UC-MSCs), vs. triamcinolone (a synthetic corticosteroid) (10 mg/mL) in thirty patients with symptomatic knee OA (Kellgren-Lawrence grade II or III).The outcomes included changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores based on a Likert scale, numerical rating score (NRS) for pain, Magnetic Resonance Imaging (MRI), and quality of life (SF-36 questionnaire), from baseline and throughout 12-months of follow-up.Patients treated with CellistemTMOA showed significant improvement in WOMAC score (including the three subscale scores (pain, stiffness and function), NRS in pain, and SF-36 profile from baseline to 12 months (p < 0.05) compared to the triamcinolone group, and no severe adverse events were reported.There were no significant differences in MRI WORMS scores between the two groups. However, patients who received the cellular treatment experienced a significant improvement in their SF-36 profile (p < 0.05).This pilot study revealed that a single dose of CellistemTMOA is safe and superior to the active comparator in knee OA at 1-year of follow-up, making it a compelling therapeutic alternative to treat symptomatic OA patients.

Comprehensive Conservative Kidney Management among an Older Population Using a Large Administrative Claims Database

Comprehensive Conservative Kidney Management among an Older Population Using a Large Administrative Claims Database

Trends of Aged Population in Nepal

Population ageing is the dynamic process of demographic &amp; socio-economic transformation which reflects the increase in the share of the elderly on the total population, which is considered as natural phenomenon. There are 2.97 million older people in Nepal as of the 2021 census older population reached 10.21 percent population of Nepal. Average growth rate is 0.92 percent and the older population growth rate is 3.29 percent per year. Nepal’s total fertility is 1 percent below replacement level, infant mortality is around 23 per thousand live births and average life expectancy is now around 71 years. These indicators show ageing is increasing rapidly and the care giving burden may increase rapidly in the future due to the tendency of migration of the young population to foreign countries. In this context, the Nepal government needs to focus on how to manage the ageing population and provide quality services and social security for the growing older people of Nepal.

Elevating the patient voice: Understanding treatment preferences in patients with advanced prostate cancer.

262 Background: With multiple oral non-chemotherapy medications for prostate cancer patients, there is a need to explore the impact of pill burden on overall quality of life, patient experience, and adherence. This study aimed to understand medication preferences from patients with advanced prostate cancer. Methods: We conducted a cross-sectional, online survey of patients with advanced prostate cancer living in the United States. Inclusion criteria included: men with a self-reported diagnosis of prostate cancer that has spread beyond the prostate and are receiving any treatment for prostate cancer. This survey was conducted in January 2024. Patients were recruited through physician referral. Results: The survey enrolled 100 participants with a median age of 65 years (range 39-75). 53 (53%) patients identified as white, 31 (31%) identified as black, 15 (15%) were Hispanic. 81 (81%) stated that they had undergone previous chemotherapy and 80 (80%) patients reported taking oral medications for prostate cancer. Regarding overall pill burden, 48 (48%) took &gt;5 pills/day and 50 (50%) took &gt;3 pills/day including treatment for prostate cancer. Regarding treatment frequency, 63 (63%) patients reported difficulty remembering to take the pills multiple times per day and 92 (92%) patients said they would choose a 1 pill once daily option over a multi-pill regimen. 20 (20%) patients admitted to either having difficulty swallowing pills or being unsure about swallowing pills. Of these 20, 18 (95%) consider it important if a pill can be dispersed in water, or vehicles such as applesauce. 89 (89%) patients said they would prefer a non-chemotherapy treatment option compared to a chemotherapy-containing regimen. Conclusions: Most patients prefer the option of an oral treatment regimen compared with chemotherapy. Due to the challenges of polypharmacy as well as worsening memory, most patients also prefer a one pill once a day regimen. In an older population, therapies with formulations that allow for patient choice in administration schedule may avoid treatment interruptions. When discussing treatment options with patients, providers should take these factors into consideration.

Assessment of the Right Ventricle Function in Patients With Significant Tricuspid Regurgitation: A Review.

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function-a key prognostic factor in TR-remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes.

Development and Preliminary Psychometric Testing of a Brief Tool to Measure Medication Adherence in Older Populations.

Chronic diseases in older age are major sources of burden for healthcare systems. Compliance with medications is the key to treatment success for these patients, especially for frail individuals living in community settings. However, adherence to long-term medications in this population is not optimal, which leads to the need for frequent screening of compliance within large-scale public health surveys. In this context, a brief, simple and valid measure capturing medication adherence is not yet available. This study aims to develop and psychometrically test the Therapeutic Adherence Scale, a brief four-item tool that measures medication adherence in community-dwelling older adults affected by chronic diseases. We conducted a three-phase process of instrument development, content validity assessment and psychometric testing. Of the candidate nine items derived from a review of the literature, only four were deemed essential to capture intentional and nonintentional nonadherence. These items underwent structural validity, convergent and known-groups validity, and internal consistency on a sample of 269 participants (mean age = 7.91 years, SD = 7.26). Confirmatory factor analysis confirmed satisfactory fit indices (RMSEA = 0.000, CFI = 1.00, TLI = 1.00). Scores of the TAS were higher for those perceiving loneliness (ρ = 0.33, p < 0.001), those declaring memory loss in the last year (ρ = 0.29, p < 0.001), and those exhibiting worse mental quality of life (ρ = -0.15, p = 0.03) compared with the other groups. Cronbach's alpha and split-half reliability coefficients were acceptable, with values of 0.68 and 0.77, respectively. The Therapeutic Adherence Scale is a brief, valid and reliable self-report measure of medication adherence that can be used in practice and research to screen patients living in community settings. This tool is also free to use, which contributes to advancing knowledge on the field of medication adherence of older adults affected by chronic diseases.

Progress in Cardiac Magnetic Resonance Feature Tracking for Evaluating Myocardial Strain in Type-2 Diabetes Mellitus.

The global prevalence of type-2 diabetes mellitus (T2DM) has caused harm to human health and economies. Cardiovascular disease is one main cause of T2DM mortality. Increased prevalence of diabetes and associated heart failure (HF) is common in older populations, so accurately evaluating heart-related injury and T2DM risk factors and conducting early intervention are important. Quantitative cardiovascular system imaging assessments, including functional imaging during cardiovascular disease treatment, are also important. The left-ventricular ejection fraction (LVEF) has been traditionally used to monitor cardiac function; it is often preserved or increased in early T2DM, but subclinical heart deformation and dysfunction can occur. Myocardial strains are sensitive to global and regional heart dysfunction in subclinical T2DM. Cardiac magnetic resonance feature-tracking technology (CMR-FT) can visualize and quantify strain and identify subclinical myocardial injury for early management, especially with preserved LVEF. Meanwhile, CMR-FT can be used to evaluate the multiple cardiac chambers involvement mediated by T2DM and the coexistence of complications. This review discusses CMR-FT principles, clinical applications, and research progress in the evaluation of myocardial strain in T2DM.

Zircon Xenocrysts From Easter Island (Rapa Nui) Reveal Hotspot Activity Since the Middle Jurassic

AbstractWe report the finding of mantle‐derived zircon grains retrieved from red soils, regoliths, and beach sands from Easter Island, that are much older than the island volcanism (0–2.5 Ma) and its underlying lithosphere (Pliocene, 3–4.8 Ma). A large population of 0–165 Ma old zircons have coherent oxygen (δ18O 3.8–5.9‰) and hafnium (εHf(t)+3.5–+12.5) mantle isotopic signatures. These results are consistent with the crystallization of zircon from plume‐related melts. In addition, a chemically diverse population with ages from the Paleozoic to the Archean was found. These older populations are enigmatic but they could represent remnants of ancient subducted sediments. Meanwhile, the ∼0–165 Ma population is interpreted as plume‐derived, suggesting that the hotspot started at least ∼165 Ma ago. A spike of ∼164–160 Ma zircons could represent a Large Igneous Province (LIP) stage upon the first arrival of the plume. We use plate reconstructions to show that such a LIP would have formed on the Phoenix Plate and would have subducted below the Antarctic Peninsula around 100–105 Ma. There, LIP subduction would offer a solution for the enigmatic Palmer Land deformation event, previously proposed to result from a collision with an unknown indenter. The here‐reported “ghost” of a prolonged hotspot activity suggests that fragments of the Easter plume and of the ambient sub‐lithospheric mantle stored and re‐sampled zircon xenocrysts due to convective (re)circulation at the scale of the plume head. Our study demonstrates how zircon geochronology and geochemistry provide novel insights into global‐scale geodynamics, offering new perspectives on the dynamics of mantle plumes and hotspot activity.

Effect of group play therapy as holistic geriatric interventional modality on feelings of loneliness among older people: A randomized control trial.

Previous research has identified loneliness as a significant social stressor among the older adult population, and highlights the scarcity of empirical research on the efficacy of group play therapy as a method for addressing loneliness in this demographic. This study aimed to explore the impact of group play therapy on reducing feelings of loneliness among older individuals. A randomized clinical trial was carried out in 2018 on 60 older adult participants from two governmental health centers in Mashhad, Iran. The intervention group received adult-centered play therapy for 12 sessions over 6 weeks, with each session lasting 60 min. The therapy protocol combined traditional and modern games, structured into three stages: warm-up, working and closing. The University of California, Los Angeles (UCLA) scale was used to measure feelings of loneliness at baseline and after the intervention. Data analysis was carried out using SPSS version 21. There was a significant decrease in feelings of loneliness in the intervention group compared with the control group (P < 0.001). Additionally, a significant difference in feelings of loneliness was observed within the intervention group between baseline and follow up (P < 0.001). Group play therapy, involving a combination of traditional and modern games, can reduce feelings of loneliness among older adults. This method can promote healthy aging and improve mental health issues, such as loneliness, among older people. These findings can be utilized in healthcare centers and nursing homes for older adults. Geriatr Gerontol Int 2024; 24: 1067-1076.

The role of physical activity in falls prevention among older, actively treated cancer populations.

224 Background: Older cancer populations are at higher risks of falls and fall-related injuries undergoing formidable antineoplastic treatment, conditioned to greater physical and functional compromise. While passive risk surveillance and fall prevention strategies often render ineffective, emerging evidence has indicated the benefits of physical activity in reducing risk of falls. This study aimed to explore patient’s awareness and doctor’s advice regarding physical activity in relation to falls among older patients (&gt; 65) under active cancer treatment. Methods: This cross-sectional study was based on the public database from Medicare Health Outcome Survey (MHOS), which derived comprehensive patient-reported outcomes evaluating quality of care provided by Medicare health programs in the United States. Main exposures, including patient’s proactive consultation and doctor’s advice on promoting physical activity, were explored among beneficiaries sampled from 2018 to 2022 diagnosed with cancer and reported undergoing active treatment. Multivariable-adjusted logistic regressions were performed to calculate the risks of falls (Odds ratio, OR) associated with physical activity variables using the latest cohort (2022). Results: Among the total of 14937 (2018), 16927 (2019), 23027 (2020), 23512 (2021), and 21683 (2022) Medicare beneficiaries identified undergoing active cancer treatment, fall incidence sustained at around 30% (median: 30.54%, range 30.17% – 31.26%) of the target population. However, slightly over half of the target populations (median 56.81%, range 53.04% - 56.98%) had proactive consultations regarding physical activity, and even fewer reported receiving doctor’s advice to increase physical activity (median 51.35%, range 48.06% - 52.26%), without significant growth over the 5-year period. In addition, a 21.4% reduction in fall risk (OR=0.786, 95%CI=0.714-0.865) was noted among patients who had physical activity consultations with health professionals. Similarly, a 21.6% risk reduction (OR=0.784, 95%CI=0.713-0.863) was observed among those reported receiving doctor’s advice to increase physical activity level. Notably, the risk of falls associated with these physical variables remained significantly lower in lung (OR=0.667, 95%CI=0.45-0.948), colorectal (OR=0.642, 95%CI=0.436-0.944), and prostate cancer (OR=0.663, 95%CI=0.546-0.804) populations. Conclusions: The study showed an overall lower risk of falls among older cancer patients involved with physical activity, specifically those among lung, colorectal, and prostate cancer subpopulations. Future prospective trials are warranted to provide clinical validations and hence enhance public recognition as to promote the importance of physical activity in minimizing fall risks among older, actively treated cancer patients.

Prevalence and factors associated with sarcopenia among urban and rural Indian adults in middle age: A cross-sectional study from Western India.

Sarcopenia is the age-related loss of muscle mass and function. India has 8.6% of the global elderly (>60 years) population, and this is expected to increase to 20% by 2050. Around 70% of Indians live in rural areas where lifestyle factors like diet and physical activity differ from urban areas. Understanding age, sex and location-specific sarcopenia prevalence in India is crucial. Thus, our aim was to assess the prevalence and determinants of sarcopenia in urban and rural community-dwelling men and women aged 40 years and older, representing the next generation of older Indian adults. This cross-sectional study included 745 adults (400 women) from urban and rural areas near Pune, Western India. Assessments included socio-demography, diet by-24-hr recall, physical activity, anthropometry (height, weight), muscle mass measurement by dual-energy X-ray absorptiometry, muscle strength (hand grip) & muscle function by Short Physical Performance Battery (SPPB). Sarcopenia was defined by Asian Working Group on Sarcopenia-2019 guidelines Mean age of participants was 53±7.6yrs. Overall prevalence of sarcopenia was 10% and of severe sarcopenia was 4.2%. Sarcopenia prevalence was higher in rural (14.8%) than urban (6.8%) participants and in men (12.5%) than women (8%, all p<0.05). Muscle mass, grip strength and SPPB score were all higher in urban than rural participants (p<0.05). Older age, rural residence, inadequate protein intake, and lower socio-economic status were independently associated with sarcopenia. In this middle-aged group, sarcopenia prevalence was similar to that observed in older Western populations, over 100% higher among rural than urban participants, and higher amongst men than women. Age, location, protein intake and socioeconomic status were factors associated with sarcopenia. Given this rapidly increasing population of older adults in India there is an urgent need to plan strategies for early sarcopenia diagnosis and management, especially in rural populations.

A quantification of gastric and duodenal fluid volumes in older adults using MRI

Older adults are an inherently heterogeneous population with various underlying pathologies, medication use, and habits. In this study, the variability of this population was studied for the gastric and duodenal fluid volumes, as the amount of gastrointestinal volumes could play an essential role in the dissolution of drugs. The fluid volumes were retrospectively quantified by using magnetic resonance imaging (MRI). In 265 included fasted older individuals, the gastric fluid volume was 28.9 ± 21.1 mL (arithmetic mean ± standard deviation). No significant covariate-effect on stomach fluid volume was observed for various medication use, pathologies, and habits (e.g. hypertension, smoking, proton-pump inhibitors (PPIs), and aspirin). The gastric fluid volume remained constant with increasing age and had a high variability. The volumes and the variability were, however, not higher than the gastric values reported in healthy younger adults. The duodenal fluid volume was 16.6 ± 10.0 mL and a slight but statistically significant decrease with age was seen. In addition, cystic pancreas, obesity, diuretics, and PPI use demonstrated a moderate but significant correlation with the duodenal fluid volume. The findings of this study could be considered when developing and testing new drug candidates for the older adult population. For example, the volumes including their variability could be used as an input in physiologically based pharmacokinetic modelling approaches to predict drug exposure in this population.

Evaluation of "Age-Friendly City" Indicators in Golestan Province From the Perspective of the Older Adult Population

Objectives: To evaluate age-friendly city indicators from the perspective of the older adults in Golestan province in 2023. Design: A descriptive-analytical cross-sectional study. Setting(s): Golestan province, Iran. Participants: Individuals aged 60 years and above. Outcome measures: A sample of 310 participants was selected using proportional stratified sampling. Data were collected with a validated age-friendly city questionnaire. Results: The mean age of the participants in this study was 70.34±7.73 years (ranging from 60 to 99), with 64.5% being male. Among the three examined components, the component of respect and social security had the highest average among the older adults (4.65±17.72), followed by social participation (4.79±16.30) and civic engagement and employment (4.052±12.20). Agefriendly city indicators demonstrated statistically significant differences in variables such as city of residence (P=0.02), support source (P=0.009), income level (P=0.001), and marital status (P=0.05). Conclusions: None of the examined age-friendly city components in Golestan province met the necessary standards. Recommendations include enhancing efforts by service organizations to improve conditions for older adults.

Association of handgrip strength weakness and asymmetry with later life pain risk in middle-aged and older individuals: Results from four prospective cohorts.

The burden of pain in middle-aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts. This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk. We included 41,171 participants in the final analysis, with a mean follow-up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p-values for interaction >0.05). Our findings suggest that HGS can be used as an independent predictor of pain in middle-aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

Exploring the Origin of Cold Gas and Star Formation in a Rare Population of Strongly Bulge-dominated Early-type Galaxies

We analyze the properties of a rare population, the strongly bulge-dominated early-type galaxies (sBDEs) with significant H i gas, using the databases from the FAST All Sky H i survey (FASHI) and the Arecibo Legacy Fast ALFA (ALFALFA) survey. We select the sBDEs from the Sloan Digital Sky Survey and crossmatch with the FASHI-ALFALFA combined H i sample, resulting in 104 H i-rich sBDEs. These sBDEs tend to have extremely high H i reservoirs, which is rare in previous studies such as ATLAS3D. A total of 70% of the selected sBDEs are classified as quiescent galaxies, even though they have a large H i reservoir. We study the properties of these sBDEs from four main aspects: stellar population, gas-phase metallicity, stacked H i spectra, and environment. The majority of H i-rich sBDEs appear to show lower gas-phase metallicity and are located in significantly lower-density environments, suggesting an external origin for their H i gas. We find that star-forming sBDEs exhibit statistically higher star formation efficiency and slightly older stellar populations compared to normal star-forming galaxies, suggesting a recent star formation on the Gyr timescale. They also show narrower and more concentrated H i profiles compared to control star-forming galaxies, which may explain their higher star formation efficiency.

Trends in knee cartilage repair procedures in the United States, 2010 to 2020

IntroductionSurgical intervention of knee articular cartilage injuries may prevent degeneration in symptomatic patients. ObjectiveThis study aims to analyze trends, demographics, and yearly incidence of four different knee cartilage repair procedures in the U.S. from 2010 to 2020. MethodsThe PearlDiver database was queried for patients who underwent knee microfracture, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) procedures from 2010 to 2020. Student t and χ-square tests were used for statistical comparisons and analysis of data trends. Regression models and Compound Annual Growth Rates (CAGR) further assessed trends of each procedure. Results220,674 patients from 2010 to 2020 were included in this study. Microfracture incurred a 62.4% decrease in occurrence (P < 0.001). Incidence of OCA trended upwards (37.7%; P = 0.065) whilst OAT procedures significantly decline (53.9%; P < 0.001). ACI procedure numbers remained relatively stable (11.2% increase; P = 0.847). ConclusionsThe incidence of microfracture significantly decreased in the United States from 2010 to 2020. There was a positive trend in the incidence of OCA cases, whilst the number of OAT cases decreased significantly. The number of ACI cases performed per year did not change significantly over the study period with the exception of an increase from 2017-2019. Microfracture procedures were performed in an older patient population than the other cartilage procedures. Males were more likely to undergo the four cartilage preservation surgeries compared to females. Similar studies should be carried out in other large health databases to confirm the external validity of these trends across the United States.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: Geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. ObjectiveTo design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 92% felt they benefitted from attending. Additionally, 80% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Nutrient Intake in an At-risk Older Adult Population Who Attend Congregate Meal Centers

Nutrient Intake in an At-risk Older Adult Population Who Attend Congregate Meal Centers

Evaluating the Efficacy of Immune Checkpoint Inhibitors in Elderly Patients: A Systematic Review and Meta-analysis.

In this chapter, we outline the steps for designing and conducting a rigorous systematic review and meta-analysis, focusing on the efficacy of immune checkpoint inhibitors (ICIs) in elderly patients. ICIs have improved survival rates in advanced cancers, yet their effectiveness in older populations remains unclear. We detail the essential processes involved in both systematic reviews and meta-analyses. We can evaluate the efficacy of ICIs in elderly patients with advanced cancer, examining outcomes such as overall survival and progression-free survival.