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Falls are very serious health concerns among older adults. Providing additional cutaneous and proprioceptive feedback to older adults may enhance their balance control and therefore reduce the incidents of falls. This study aimed to investigate the acute and acclimated effect of wearing waist-to-above-ankle compression garments (CGs) on balance control in community-dwelling older adults. Thirty-one older adults participated in the study. The Timed Up and Go, Berg Balance Scale, and the Fall Risk Test of the Biodex Balance System were used in a random order to examine balance control in three testing sessions 1 week apart. Results indicated wearing CGs had a significant impact on the Timed Up and Go test (p <.001), Berg Balance Scale (p =.001), and the Fall Risk Test (p =.001). For the Timed Up and Go test, participants exhibited significant improvement in both the acute (8.68 vs. 7.91 s) and acclimated effect (7.91 vs. 7.41 s) of wearing CGs. For the Berg Balance Scale, participants showed significant improvement after wearing CGs for 1 week in comparison to the no CGs condition (55.77 vs. 55.39 points). For the Fall Risk Test, participants showed a significant improvement in the acute effect of wearing CGs in comparison to the no CGs condition (1.55° vs. 1.31°). This exploratory study showed that wearing waist-to-above-ankle CGs provided a positive impact on balance control in healthy community-dwelling older adults. It lays the foundation for future studies with a larger sample size to investigate the potential benefits of wearing CGs in individuals with balance control deficits and/or other comorbidities. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective, multicenter, international, observational study. OBJECTIVE: Identify independent prognostic factors associated with achieving the minimal clinically important difference (MCID) in patient reported outcome measures (PROMs) among adult spinal deformity (ASD) patients ≥60 years of age undergoing primary reconstructive surgery. METHODS: Patients ≥60 years undergoing primary spinal deformity surgery having ≥5 levels fused were recruited for this study. Three approaches were used to assess MCID: (1) absolute change:0.5 point increase in the SRS-22r sub-total score/0.18 point increase in the EQ-5D index; (2) relative change: 15% increase in the SRS-22r sub-total/EQ-5D index; (3) relative change with a cut-off in the outcome at baseline: similar to the relative change with an imposed baseline score of ≤3.2/0.7 for the SRS-22r/EQ-5D, respectively. RESULTS: 171 patients completed the SRS-22r and 170 patients completed the EQ-5D at baseline and at 2 years postoperative. Patients who reached MCID in the SRS-22r self-reported more pain and worse health at baseline in both approaches (1) and (2). Lower baseline PROMs ((1) - OR: .01 [.00-.12]; (2)- OR: .00 [.00-.07]) and number of severe adverse events (AEs) ((1) - OR: .48 [.28-.82]; (2)- OR: .39 [.23-.69]) were the only identified risk factors. Patients who reached MCID in the EQ-5D demonstrated similar characteristics regarding pain and health at baseline as the SRS-22r using approaches (1) and (2). Higher baseline ODI ((1) - OR: 1.05 [1.02-1.07]) and number of severe AEs (OR: .58 [.38-.89]) were identified as predictive variables. Patients who reached MCID in the SRS22r experienced worse health at baseline using approach (3). The number of AEs (OR: .44 [.25-.77]) and baseline PROMs (OR: .01 [.00-.22] were the only identified predictive factors. Patients who reached MCID in the EQ-5D experienced less AEs and a lower number of actions taken due to the occurrence of AEs using approach (3). The number of actions taken due to AEs (OR: .50 [.35-.73]) was found to be the only predictive variable factor. No surgical, clinical, or radiographic variables were identified as risk factors using either of the aforementioned approaches. CONCLUSION: In this large multicenter prospective cohort of elderly patients undergoing primary reconstructive surgery for ASD, baseline health status, AEs, and severity of AEs were predictive of reaching MCID. No clinical, radiological, or surgical parameters were identified as factors that can be prognostic for reaching MCID.

BACKGROUND: Pharmacologic treatments are available to treat insomnia, a common and burdensome sleep disorder, but may be contraindicated in older adults who are prone to side effects from sleep-promoting drugs. These analyses of sleep diary data from Study E2006-G000-303 (Study 303) investigated the benefits of lemborexant 5 mg (LEM5) and 10 mg (LEM10) in the subgroup age ≥ 65 years with insomnia. METHOD: Study 303, a 12-month, double-blind study of LEM5 and LEM10 in adults (age ≥ 18 years) with insomnia disorder (sleep onset and/or maintenance difficulties) assessed subject-reported (subjective) sleep-onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), and total sleep time (sTST). Morning sleepiness/alertness, insomnia severity (Insomnia Severity Index [ISI]), fatigue (Fatigue Severity Scale [FSS]), perceptions of sleep-related medication effects (Patient Global Impression-Insomnia [PGI-I] questionnaire), and safety were also evaluated. RESULTS: In this subgroup of older adults (≥ 65 years; n = 262), there were significantly larger changes from baseline for sSOL, sSE, sTST, and sWASO with LEM5 and LEM10 versus placebo through month 6 (except sWASO month 1), indicating improvement; these improvements were sustained through month 12. Subject-reported increases in morning alertness were significantly greater with one or both LEM doses versus placebo through month 6 and sustained through month 12. There were significantly larger ISI total and daytime functioning score decreases (improvement) from baseline with LEM versus placebo at months 1, 3, and 6 (total score: both doses; daytime functioning: LEM5 month 1 and both doses months 3 and 6) and decreases from baseline FSS at months 1 and 3 (LEM5) and month 6 (both doses), sustained to month 12. Compared with placebo, more subjects reported that LEM (both doses) positively impacted ability to sleep, time to fall asleep, and TST through month 6, sustained to month 12, with no rebound after drug withdrawal. LEM was well tolerated to month 12; mild somnolence was the most common treatment-emergent adverse event. CONCLUSIONS: Improvements in subject-reported efficacy in LEM-treated adults age ≥ 65 years with insomnia were observed as early as the first week of treatment and sustained through end of month 12. LEM was well tolerated. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT02952820: E2006-G000-303; Study 303; SUNRISE-2 (First posted: October 2016); EudraCT 2015-001463-39 (First posted: November 2016).

Resistance exercise training (RET) can be applied effectively to increase muscle mass and function in older adults (65–75 years). However, it has been speculated that older adults above 85 years are less responsive to the benefits of RET. This study compares the impact of RET on muscle mass and function in healthy older adults 65–75 years versus older adults above 85 years. We subjected 17 healthy older adults 65–75 years (OLDER 65–75, n = 13/4 [female/male]; 68 ± 2 years; 26.9 ± 2.3 kg/m2) and 12 healthy older adults above 85 years (OLDER 85+, n = 7/5 [female/male]; 87 ± 3 years; 26.0 ± 3.6 kg/m2) to 12 weeks of whole-body RET (three times per week). Prior to, and after 6 and 12 weeks of training, quadriceps and lumbar spine vertebra 3 muscle cross-sectional area (computed tomography scan), whole-body lean mass (dual-energy X-ray absorptiometry scan), strength (one-repetition maximum test), and physical performance (timed up and go and short physical performance battery) were assessed. Twelve weeks of RET resulted in a 10% ± 4% and 11% ± 5% increase in quadriceps cross-sectional area (from 46.5 ± 10.7 to 51.1 ± 12.1 cm2, and from 38.9 ± 6.1 to 43.1 ± 8.0 cm2, respectively; p <.001; η2 =.67); a 2% ± 3% and 2% ± 3% increase in whole-body lean mass (p =.001; η2 =.22); and a 38% ± 20% and 46% ± 14% increase in one-repetition maximum leg extension strength (p <.001; η2 =.77) in the OLDER 65–75 and OLDER 85+ groups, respectively. No differences in the responses to RET were observed between groups (Time × Group, all p >.60; all η2 ≤.012). Physical performance on the short physical performance battery and timed up and go improved (both p <.01; η2 ≥.22), with no differences between groups (Time × Group, p >.015; η2 ≤.07). Prolonged RET increases muscle mass, strength, and physical performance in the aging population, with no differences between 65–75 years and 85+ years older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Concerns about the efficacy and safety of intensive low-density lipoprotein cholesterol lowering in older patients have led to weaker recommendations in the U.S. guidelines for patients ≥75 years of age compared to younger patients. Data are sparse on long-term benefits of proprotein convertase subtilisin/kexin type 9 inhibition in older patients. This study aims to assess the long-term benefit of evolocumab among patients aged ≥75 years. The FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) trial randomized 27,564 patients who were 18 to 85 years of age with atherosclerotic cardiovascular disease to evolocumab vs placebo with 2.2 years of median follow-up. In the open-label extension (FOURIER-OLE), 6,635 participants were transitioned to open-label evolocumab for an additional 5-year median follow-up. The primary endpoint (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization) was compared based on the original allocation to evolocumab vs placebo stratified by age (<75 vs ≥75 years). Analyses were underpowered for individual components of the composite endpoint. The annualized incidence rates for adverse events of interest were calculated for the OLE population across age groups during the parent FOURIER trial by randomized treatment arm and during the combined parent and FOURIER-OLE studies for patients originally allocated to evolocumab. Of 27,564 patients, 2,526 (9%) were ≥75 years of age at entry into FOURIER (median age: 77 years [Q1-Q3: 76-79 years]). The median follow-up in FOURIER and FOURIER-OLE was 7.1 years (Q1-Q3: 6.7-7.6 years), with a maximum of 8.7 years. Earlier initiation of evolocumab reduced the rate of the primary endpoint at least as well in older (HR: 0.79; 95% CI: 0.64-0.97) as in younger patients (HR: 0.86; 95% CI: 0.80-0.92; P interaction = 0.43). The absolute risk reductions were 5.4% (95% CI: –2.0% to 12.8%) in older and 2.3% (95% CI: 0.1%-4.5%) in younger patients, leading to numbers needed to treat of 19 and 44, respectively. The annualized incidence rates of safety events generally appeared similar across treatment arms in both age groups. Early initiation of long-term evolocumab provides older patients with atherosclerotic cardiovascular disease cardiovascular benefits at least as good as those observed in younger patients, with a more favorable number needed to treat in older patients for reducing a composite endpoint and no significant safety concerns. These findings may be helpful in guiding future recommendations. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Birdshot chorioretinitis (BSCR) is an ocular HLA-related disease with variable clinical progression. We examine the quality of life (QOL) of BSCR individuals aged ≥80 years, providing insights into the long-term disease impact. Methods: We utilized data from the CO-BIRD cohort (ClinicalTrials.gov Identifier: NCT05153057) conducted at Hôpital Cochin in Paris, France, focusing on BSCR patients aged ≥80. The main outcome was vision-related QOL using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). We used Spearman correlation to explore the impact of better BCVA and MD on the composite score, and the Wilcoxon test to evaluate specific visual symptoms' effects. Results: The study included 35 patients with a mean age of 83.9 ± 3.7 years, 74.3% of whom received systemic immunosuppression. The mean composite score was 58 ± 30, with a median of 75 (23–79). The lowest subscores were driving capacity (38 ± 38), mental health (49 ± 33), and role difficulties (50 ± 35), while the highest were for ocular pain (70 ± 25) and social function (70 ± 38). Decimal BCVA below 0.5 and MD below −6 dB were associated with lower subscores. BCVA and MD were strongly correlated with the composite score (R = 0.67). Symptoms of poor color and blurry vision were significantly associated with lower composite score (p < 0.005). Conclusion: Most BSCR patients over 80 in our cohort maintained sufficient vision for daily activities. The high standard deviation and wide range of VFQ-25 results reflect the heterogeneity of visual outcomes among elderly BSCR patients. [ABSTRACT FROM AUTHOR]

Background: The potential of the application of artificial intelligence and biochemical markers of oxidative stress to predict the prognosis of older patients with gastric cancer (GC) remains unclear. Methods: This retrospective multicenter study included consecutive patients with GC aged ≥ 65 years treated between January 2012 and April 2018. The patients were allocated into three cohorts (training, internal, and external validation). The GC-Integrated Oxidative Stress Score (GIOSS) was developed using Cox regression to correlate biochemical markers with patient prognosis. Predictive models for five-year overall survival (OS) were constructed using random forest (RF), decision tree (DT), and support vector machine (SVM) methods, and validated using area under the curve (AUC) and calibration plots. The SHapley Additive exPlanations (SHAP) method was used for model interpretation. Results: This study included a total of 1,859 older patients. The results demonstrated that a low GIOSS was a predictor of poor prognosis. RF was the most efficient method, with AUCs of 0.999, 0.869, and 0.796 in the training, internal validation, and external validation sets, respectively. The DT and SVM models showed low AUC values. Calibration and decision curve analyses demonstrated the considerable clinical usefulness of the RF model. The SHAP results identified pN, pT, perineural invasion, tumor size, and GIOSS as key predictive features. An online web calculator was constructed based on the best model. Conclusions: Incorporating the GIOSS, the RF model effectively predicts postoperative OS in older patients with GC and is a robust prognostic tool. Our findings emphasize the importance of oxidative stress in cancer prognosis and provide a pathway for improved management of GC. Trial registration: Retrospectively registered at ClinicalTrials.gov (trial registration number: NCT06208046, date of registration: 2024–05-01). [ABSTRACT FROM AUTHOR]

Background: This single center-based prospective cohort study was conducted, on 157 patients over 60 years old patients requiring major orthopedic surgery, from June 2019 to June 2021. Frailty was assessed using the Edmonton Frailty Scale pre-operatively. Post-operative complications, ambulatory status, readmission rates, and mortality were monitored up to three months post-surgery, and statistical analysis was performed. Materials and Methods: With India's elderly population projected to reach 324 million by 2050, the prevalence of orthopedic surgeries among this demographic is increasing. frailty, a measure of decreased strength, endurance, and physiological function with aging, may significantly affect surgical outcomes. This study aimed to evaluate the correlation between frailty, as measured by the Edmonton Frailty Scale, and postoperative outcomes in elderly patients undergoing major orthopedic surgeries. Results: The study found that 60% of patients were categorized as either vulnerable or frail. Surgical site infection (15.9%) was the most common postoperative complication across all frailty levels. Cardiac complications and deep vein thrombosis were significantly associated with higher frailty levels. At discharge, 78% of patients were ambulatory, improving to over 91% at the three-month follow-up. However, frailty significantly delayed recovery to ambulatory status. The incidence of death during the study was 3.2%, and readmission within 30 days post-surgery was 3.8%. Statistical analysis revealed significant differences between frailty levels and post-operative complications, ambulatory status, and, to a lesser extent, readmission, and mortality rates. Conclusion: The study demonstrates a significant correlation between frailty and adverse postoperative outcomes in elderly patients undergoing major orthopedic surgeries. It underscores the necessity of incorporating frailty assessment into preoperative evaluations to tailor care plans and improve surgical outcomes. Tailored rehabilitation programs and preoperative optimization may mitigate the risks associated with frailty, enhancing recovery and reducing the burden of postoperative complications and readmission [ABSTRACT FROM AUTHOR]

As the global trend of population ageing intensifies, the health management needs of the elderly are becoming increasingly urgent, while the existing pension system and medical resources are ill-equipped to cope with this realistic challenge. In this context, smart health wearables, as a major innovation in the field of health technology. integrate advanced technologies such as sensors, mobile technology and artificial intelligence to efficiently collect and analyze users' physiological data, provide real-time feedback on health conditions and provide early warnings, and help users realize self-health management. These products demonstrate considerable potential for application among the elderly population, offering efficient and convenient health management services that are expected to significantly enhance their quality of life and optimize the allocation of medical resources. In recent years, the rapid development of this field has triggered extensive research in the academic community. However, the majority of existing studies focus on technology development and application scenarios, and lack a systematic overview of the field and a comprehensive comparison of domestic and international studies. To address this gap, the study employed bibliometric methods to systematically review and evaluate the research conducted over the past decade on smart health wearables for the elderly, both domestically and internationally. The aim is to reveal the current research status, hotspots, and trends in this field, and to explore potential research directions, providing valuable insights for academic research, technological innovation, and practical applications. Using the CNKI and Web of Science core databases as data sources, the study selected relevant literature on elderly smart health wearables published between 2013 and 2023. A total of 339 domestic and 649 international papers were chosen, and the data were visualized using VOSviewer and CiteSpace software. First, descriptive statistical analysis was conducted on the annual publication volume, as well as the contributions of countries and institutions. Second, co-occurrence and clustering analyses of keywords were performed to identify research hotspots domestically and internationally. Additionally, keyword time-zone and burst detection were used to reveal the evolution of research frontiers. Finally, co-citation analysis was employed to present the foundational knowledge structure of international research and identify influential classic works. This study is the first to conduct a bibliometric analysis of research on elderly smart health wearables both domestically and internationally. This study has constructed knowledge maps providing a clear framework for the existing research in this field. The study reveals the current research status and trends in the field of smart health wearables for the elderly from four dimensions: spatiotemporal distribution, research hotspots, frontier evolution, and knowledge foundations. The results show that the USA and China dominate international research in this field, with particularly close academic collaboration between the two countries. Although domestic and international research have different focuses, domestic studies mainly concentrate on the integration of wearable technology and elderly care systems, while international research focuses more on technological innovation in health management and its practical applications, as well as elderly technology acceptance. Domestic research has evolved from product development and the optimization of elderly care systems to smart health management applications. Meanwhile, international research has shifted from technology development and system integration to in-depth exploration of elderly technology acceptance and adoption. Additionally, geriatric technology adoption assessment, health monitoring technology innovation, and smart health management applications form the foundational knowledge of this field. Future research should strengthen interdisciplinary collaboration between engineering and medical fields, so as to explore user experience and needs to optimize elderly-centered product design. Long-term efficacy validation is necessary to ensure the practical application of smart health wearables. These studies will drive the further development of smart health wearables for the elderly, and offer effective support in addressing the global health challenges posed by aging. [ABSTRACT FROM AUTHOR]

Background: There is a need for comprehensive programs that address both the physical and psychosocial aspects of fall prevention for the elderly. Objective: This study assessed the efficacy of the exercise regimen on various health metrics for elderly community dwellers. Methods: Forty-four participants were divided into experimental and control groups. The experimental group adhered to a 9-step core exercise regimen for fall prevention, practicing three times a week for 30 minutes across 10 weeks, while the control group maintained their regular daily activities without any specific exercise program. Before and after the intervention, participants underwent the timed up-and-go t est to evaluate the physical function, the berg balance scale (BBS) and one-legged stance test (OLST) for balance assessment, the activity-specific balance confidence scale for fall-related self-efficacy, and measures for health-related quality of life. Results: Participants in the experimental group showed significant improvements in physical function (p =.04, Cohen's effect size (d) = 0.2). and balance ability on BBS (p <.01, d = 0.2) and OLST (p <.01, d = 1.3) compared to the control group. Furthermore, there was a notable enhancement in the quality of life indicators for this group, especially in areas such as physical function (p =.04, d = 0.2), physical-role limitation (p =.04, d = 0.2), mental health (p =.01, d = 0.3), vitality (p =.02, d = 0.4), body pain (p =.04, d = 0.5), and general health (p =.04, d = 0.4). Conclusion: These findings highlight the potential of the fall prevention exercise program in improving physical health aspects, but its influence on specific psychosocial elements remains to be determined. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate and compare the swallow-related muscles and bones movement patterns during swallowing quantitatively by B+M-mode ultrasound, and to investigate its application value in dysphagia. Sixty elderly stroke patients with dysphagia (patient group) and sixty healthy elderly individuals (control group) were enrolled in this study. M-mode ultrasound was utilized to measure the radial displacement and duration of tongue and geniohyoid muscle movements. B-mode ultrasound was employed to assess hyoid bone displacement and the distance of hyoid-larynx approximation. Ultrasound parameters were compared between the two groups. Logistic regression was used to identify the optimal parameters with independent predictive value. The predictive efficacy of each parameter for dysphagia was evaluated using ROC curve analysis. Both intraindividual and interindividual variations were observed in the B+M-mode imaging traces during the three swallows. Significant differences were found in the average radial displacement and duration of tongue and geniohyoid muscle movements, hyoid bone displacement, and hyoid-larynx approximation distance between the two groups (all p < 0.001). The radial displacement of the tongue and geniohyoid muscle, hyoid bone displacement, and hyoid-larynx approximation distance were lower in the patient group compared to the control group, while the duration of tongue and geniohyoid muscle movements was higher in the patient group. Logistic regression selected the radial displacement of the tongue, the duration of geniohyoid muscle movement, and the hyoid-larynx approximation distance as significant predictors. The combined model demonstrated excellent predictive performance with an AUC of 0.994 and good model fit (p < 0.001). The B+M-mode ultrasound offers a rapid and safe technique for the preliminary evaluation of swallowing movements. It can serve as a quantitative and noninvasive method for the clinical screening of dysphagia. [ABSTRACT FROM AUTHOR]

Background: With ageing of the population, there is an increasing likelihood that elderly people will seek employment, with a resultant increase in the incidence of hand injuries, including digital amputations. However, the surgical indication for replantation of an amputated digit in elderly patients is controversial. The purpose of this study was to compare functional outcomes after single-digit replantation of the thumb to long finger in older (≥65 years old) and younger (<65 years old) patients to assess the feasibility of digit replantation in the elderly population. Methods: A retrospective cohort study was performed in 25 patients (12 elderly and 13 younger) with successful replantation of the thumb, index or long finger at our hospital. All patients were followed up for more than 1 year. Key pinch strength, Semmes–Weinstein (S–W) test, % total active motion (TAM), Purdue Pegboard Test score (hand dexterity) and Disabilities of the Arm, Shoulder and Hand (DASH) score were investigated. Results: Elderly patients showed significantly worse results for the S–W test and Purdue Pegboard Test score. The % TAM, key-pinch strength and DASH scores were similar in the two groups. Conclusions: Replantation surgery in elderly patients results in similar postoperative hand function (finger mobility and pinch strength) and activities of daily living to those in younger patients. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

The study examined the glycaemic response to pasta made from three different wheat varieties in individuals with type 2 diabetes. The research found that there were no significant advantages in post-prandial glucose control when using ancient wheat varieties like Khorasan or Senatore Cappelli compared to the modern wheat variety Claudio. The macronutrient composition of the pasta was similar across all three varieties, and the differences in post-prandial glucose response were clinically trivial. The study suggests that individuals with type 2 diabetes can choose pasta based on personal taste preferences without worrying about minor differences in glucose levels. [Extracted from the article]

Objectives: Older spouses are a significant part of family caregivers of patients with Alzheimer's disease (AD) and need support. Evidence suggests that different factors influence the support of older spousal caregivers. However, there is little evidence about these factors in developing countries like Iran. This study aimed to identify the factors affecting the support of Iranian older spousal caregivers of people with AD. Method: This qualitative study used Graneheim and Lundman's conventional content analysis approach. Through purposive sampling, 10 caregivers, three family members, and three professionals were recruited from various cognitive clinics and centers. In-depth and semi-structured interviews were used to collect data and continued until conceptual saturation was achieved. Results: Two themes were derived from the data as factors affecting support, which included (1) caregiver's support-seeking (complexity of the patient's condition, caregiver's geriatric health, the burden of caring for a spouse with AD, marital bond quality, caregiver's support-phobic beliefs, caregiver's awareness of care) and (2) capacities of support resources (supportive family, supportiveness of society, formal systems' capability to provide support services). Conclusion: The present study provided practical information about the factors influencing the support of older spousal caregivers. Healthcare providers and policymakers can use these concepts to improve the support process by strengthening caregivers' support-seeking motivation and enhancing capacities in support resources. [ABSTRACT FROM AUTHOR]

This study examines gender differences in economic independence and health status among elderly people in India, using 2017–8 data from the National Sample Survey Organisation (NSSO). It explores these aspects in relation to factors like residence, age, literacy, marital status and principal activity. The findings show that elderly women are more economically dependent than men, with age, lack of education and widowhood increasing dependency. Married individuals tend to enjoy better health, while higher literacy and economic engagement improve male health. The study calls for revamping social security schemes and implementing female-centric measures to address the gender disparities among India's elderly. [ABSTRACT FROM AUTHOR]

Introduction: The administration of intravenous (IV) contrast media during computed tomography (CT) examinations is essential to enhance diagnostic accuracy in various clinical scenarios. Traditionally, older age is considered a risk factor for the development of post-contrast Acute Kidney Injury (PC-AKI); however, there is limited information available for the super-elderly population (aged ≥ 85). This study aims to investigate the incidence and risk factors associated with PC-AKI in individuals aged 85 and older undergoing CT scans with IV contrast. Methods: A retrospective cohort study, including all hospitalized patients aged 85 or older who underwent CT scans between the years 2005 and 2021. Patients were categorized into IV contrast and non-IV contrast groups. Baseline demographic and clinical data, along with kidney function parameters, were collected. Results: The final cohort included 7,078 patients who underwent CT scans, with 40% receiving IV contrast. The overall AKI occurrence within 72 h post-CT was 5.72%, slightly elevated in the non-IV contrast group (6.25% vs. 4.94%, p = 0.02). However, multivariate analysis revealed no significant difference between the groups (OR 1, CI 0.8–1.2, p = 0.92), even after stratifying by kidney function. A secondary analysis, using a less strict AKI definition, supported these findings. Baseline creatinine levels emerged as prominent risk factor associated with PC- AKI. Conclusion: The current study provides reassurance regarding the safety of contrast-enhanced CT scans in super-elderly patients, particularly those with baseline normal to mild kidney dysfunction. These findings may contribute to the ongoing discussion on the risk–benefit balance of contrast-enhanced CT scans in the super-elderly population. [ABSTRACT FROM AUTHOR]

Background: As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians. Methods: Women (≥ 80 years) with invasive breast cancer were identified in 2004–2020 NCDB. To facilitate comparison, only non-Hispanic Black and non-Hispanic White patients were included; patients of Hispanic ethnicity were excluded. Demographics, tumor characteristics, and treatments were assessed by race. Overall survival was compared using the logrank test. Multivariable logistic and Cox proportional hazard regression models were developed to evaluate the independent association of race with outcomes of interest. Results: Of 222,897 patients, 19,059 (8.6%) were Black. Most patients had stage I ER + HER2- invasive ductal carcinoma. Black patients more frequently had greater comorbidities, low income and education, and advanced stage (p < 0.001 each; ref: White). Following adjustment, Black women had increased likelihood of Stage III/IV over time, as well as increased odds of chemotherapy (AOR 1.22, 95% CI 1.15 – 1.29) and non-operative management (AOR 1.82, 95% CI 1.72 – 1.92; ref: White). Although Black patients had lower survival rates compared to White, race was not associated with 5-year mortality following adjustment for stage, receipt of surgery, and adjuvant treatments (p = 0.34). Conclusions: Inferior survival among elderly Black patients appears be driven by advanced stage at presentation. While such disparities are narrowing in the present era, future work must consider upstream interventions to ensure equitable outcomes for all races. [ABSTRACT FROM AUTHOR]

Introduction: Recent trial-level meta-analyses have established disease-free survival (DFS) as a valid surrogate for overall survival (OS) in human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC), irrespective of disease stage, and in early-stage hormone receptor-positive (HR+)/HER2− BC. To advance the understanding of the association between additional DFS endpoints and OS, this study assessed the patient-level correlations between DFS and OS, invasive DFS (IDFS) and OS, and distant DFS (DDFS) and OS in Medicare beneficiaries with early-stage HER2− BC, overall and in subgroups of patients with HR+/HER2− BC and triple-negative BC (TNBC). Methods: Patients with stages I–III HER2− BC aged ≥ 66 years were identified from SEER-Medicare data (2010–2019). DFS, IDFS, DDFS, and OS were assessed using Kaplan–Meier analyses. Normal scores rank correlation was estimated between each DFS endpoint and OS, overall and separately in patients with HR+/HER2− BC and TNBC. Results: Of 28,655 patients, 90.4% had HR+/HER2− BC and 9.6% had TNBC (median follow-up 4 years). Median DFS, IDFS, and DDFS were 4.5, 5.9, and 6.3 years, respectively, in HR+/HER2− BC and 3.0, 3.8, and 4.4 years, respectively, in TNBC. Median OS was not reached (5-year OS, HR+/HER2− BC 83.7%; TNBC 67.7%). A significant positive correlation was observed between each DFS endpoint and OS across cohorts, with the strongest correlation observed between DDFS and OS in HR+/HER2− BC (correlation coefficient 0.60; 95% confidence interval 0.57–0.62; p < 0.001) and in TNBC (0.69; 0.65–0.71; p < 0.001). Conclusion: We observed significant positive patient-level correlations between DFS and OS, IDFS and OS, and DDFS and OS in early-stage HER2− BC. Our IDFS and DDFS findings advance the understanding of the role of these DFS endpoints as predictors of OS, and their potential utility as surrogate endpoints in clinical trials of early-stage HER2− BC, given additional validation in trial-level meta-analyses. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis catheter migration, a common complication in patients undergoing peritoneal dialysis, often leads to poor dialysate drainage, infection, and abdominal pain. Timely and effective treatment of catheter migration is essential to ensure uninterrupted dialysis. Case presentation: This study presents three cases of peritoneal dialysis (PD) catheter displacement in patients with end-stage renal disease (ESRD), involving three elderly individuals aged 80, 81, and 76 years. All instances of catheter displacement were primarily localized to the upper abdominal region. Following unsuccessful attempts with traditional repositioning methods (such as positional adjustments, ambulation, and saline infusion), a two-person collaborative repositioning technique was employed, combining external manual pressure with rapid saline injection. Consequently, all catheters were successfully repositioned to the pelvic area and remained stable throughout the follow-up period. Conclusions: This re-port preliminarily demonstrated the feasibility and effectiveness of two-person collaborative repositioning approach in elderly patients with PD catheter displacement. Although the results have potential application value, further studies are needed to verify their generality and long-term efficacy in larger samples. [ABSTRACT FROM AUTHOR]

Background: Using a validated tool, we explored the prevalence, risk factors, and predictors of longer hospitalization among hospitalized geriatric patients. Methods: Retrospective and comparative analyses of age groups (55–64 vs. ≥ 65 years), gender, survival status, and frailty index categories were performed. The Modified 5-Item Frailty Index was assessed, and multivariable logistic regression analysis was performed to predict prolonged hospitalization (> 7 days). Results: There were 17,600 trauma hospitalizations with a mean age of 32 ± 15 years between 2010 and 2021; of them, 9.2% were geriatrics at ≥ 55–64 years (n = 935) and ≥ 65 years (n = 691). The female/male ratio was 17.5%/82.5%, and the mean injury severity score was 13 ± 9. The injury rate for age ≥ 65 was 24 per 10,000 compared to 10 per 10,000 in the younger group age (≥ 55–64). 35% of injuries occurred at home due to falls. Overall mortality was 8%, with a higher rate among males than females (9% vs. 4%). The deceased were three years older at the time of death compared to the survivors. Higher frailty grades were associated with home-related falls and head injuries. Patients 65 years or older were likely to have higher frailty scores, as indicated by higher percentages in the mFI-5. Among the older group, 25% were moderately frail, and 18% severely frail. In the younger group, 50% were frail. Higher frailty scores correlated with increased acute kidney injury, pneumonia, urinary tract infections, and longer hospital stays. Severe frailty significantly predicted longer hospitalization (odds ratio 1.83, p = 0.007). Conclusion: One out of eleven trauma admissions was aged > 55. Head injury and bleeding were the leading causes of mortality in the study cohort. There was a significant decrease in the trend of geriatric trauma over the years. The modified FI-5 performs well as a predictive tool of prolonged hospitalizaion in trauma patients with different age groups. [ABSTRACT FROM AUTHOR]

We investigated the influence of sarcopenia on treatment outcomes in elderly patients receiving medical therapy for lower urinary tract symptoms (LUTS). We included male patients with LUTS aged ≥ 75 years who had not changed their medication for 1 year. Current conditions were estimated using IPSS, overactive bladder symptoms score (OABSS), and screening tool for sarcopenia (SARC-F). We also evaluated prostatic volume (PV), serum testosterone level, grip strength, and nutrition status. SARC-F score of ≧4 was defined as sarcopenia. We included 59 patients in this study, including 16 patients (27.1%) with sarcopenia. The mean grip strength was significantly lower in the sarcopenia group than the non-sarcopenia group (25.5 vs. 30 kg, p < 0.01). IPSS total score, voiding symptom score of IPSS, and IPSS-QOL were significantly higher in the sarcopenia group than the non-sarcopenia group. The non-sarcopenia group had significantly larger PV (40 vs. 20 ml, p < 0.01) and higher testosterone levels (497.5 vs. 369 ng/ml, p = 0.03) compared with the sarcopenia group, whereas the percentage of patients taking dutasteride tended to be higher in the non-sarcopenia group than the sarcopenia group (58.1% vs. 31.3%, p = 0.07). Moderate and severe LUTS (IPSS total ≥ 8) persisted in 34 patients (57.6%) after medical treatment. Multivariate analysis showed that only SARC-F was a significant factor affecting the IPSS total ≥ 8 despite medical treatment for 1 year (OR 1.67, 95%CI: 1.13–2.46, p = 0.01). Sarcopenia defined by using SARC-F is a significant factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥ 75 years. [ABSTRACT FROM AUTHOR]

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Background: The incidence of glioblastoma in the elderly population is increasing as the worldwide population ages. The differential and poorer survival in the elderly population compared to younger patients is partially explained. The present study aimed to investigate the clinical impact of epidermal growth factor receptor EGFR-altered glioblastoma in a real-life elderly glioblastoma population. Patients and Methods: A bicentric and retrospective study was conducted. Patients were 70 years or older and suffering from histomolecularly confirmed glioblastoma. Single nucleotide variants (SNV), amplification, or chromosome 7 polysomy were sought. The primary endpoint was the comparison of overall survival (OS) in patients with or without EGFR alteration. Secondary objectives were to determine other clinical parameters correlated with EGFR alteration status. Results: Seventy-three patients were analyzed: 41.1% had at least one EGFR alteration. The presence of EGFR alteration did not impact overall survival: HR 0.97 [0.6–1.57], p = 0.9; the median overall survival was 6.5 months [5.3–9.3] in the EGFR-altered group versus 7 months [4.5–10] in the EGFR wild-type group, p = 0.75. In multivariate analysis, tumor resection was associated with a significant overall survival improvement: the median OS in the resected group (n = 20) was 11 months [95% CI 7.8–22] versus a median OS of 5.5 months [4.6–7.8] in the unresected group (n = 53), without correlation to EGFR alteration status. Conclusion: In the modern era of molecular characterization and improved treatment modalities, the presence of at least one EGFR alteration did not influence survival outcomes in an elderly population of glioblastoma patients. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) is a prevalent condition among older adults and may be linked to cognitive health. This study explored a relationship between OAB and cognitive health among adults aged 60 ≥ years in the United States, using NHANES 2011–2014. A cross-sectional analysis was conducted using a nationally representative sample of 2,324 (45.95% male, 54.05% female), within 755 individuals have OAB. Cognitive health was assessed using the Consortium to Establish a Registry for Alzheimer's Disease-Word Learning (CERAD W-L), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). OAB was defined by a score more than 3 on the Overactive Bladder Syndrome Symptom Score (OABSS). Depression incidence was also recorded. Weighted linear regression models adjusted for demographic, behavioral factors, and comorbidities (e.g., diabetes, kidney disease etc.), were employed to examine the independent association between cognitive health and OAB. The results indicated that cognitive scores were significantly lower in the OAB group compared to the non-OAB group across all cognitive tests (p<0.001). The incidence of depression was significantly higher in the OAB group (15%) compared to the non-OAB group (6.05%) (p<0.001). Regression analysis revealed that a 14% decrease in cognitive health z-scores in patients with OAB (β=-0.14, CI (95%) [-0.22, -0.06]). Furthermore, depression was found to mediate 34.56% of the association between OAB and cognitive health relationship [CI (95%): 0.20, 0.69]. This negative association was robust in subgroups by demographics, behavioral factors, and comorbidities. This study's findings, supported by mediation analysis, smoothed curve analysis, and sensitivity analysis, suggest that lower cognitive health is significantly associated with OAB, and depression plays an important mediating role in this association. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the distribution of bacteremia pathogens in elderly patients, examine the impact of gender on pathogen distribution, and evaluate the predictive value of routine blood parameters for diagnosing bacteremia. Methods: A retrospective analysis was conducted on 151 elderly patients (≥60 years old) admitted to Fuding Hospital, Fujian University of Traditional Chinese Medicine between October 2022 and June 2023. Comprehensive routine blood tests and blood cultures were performed. The diagnostic efficacy of routine blood parameters, including white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red blood cell distribution width (RDW), was evaluated using receive operating characteristic (ROC) curve analysis. Patients were categorized into either the culture-positive group (82 cases) or the culture-negative group (69 cases) according to blood culture results. Results: No significant differences in age and gender were found between the culture-positive and culture-negative groups. The primary bacterial pathogens of bacteremia in the elderly were Escherichia coli , Klebsiella pneumoniae and Streptococcus. Elderly female patients demonstrated a significantly higher culture positivity rate for E. coli compared to their male counterparts (P = 0.021). The areas under the ROC curve (AUC) for the four parameters were as follows: WBC, 0.851 (95% confidence interval (CI) 0.790 - 0.912); NLR, 0.919 (95% CI 0.875 - 0.963); PLR, 0.609 (95% CI 0.518 - 0.700); and RDW was 0.626 (95% CI 0.563 - 0.717). Conclusions: E. coli was identified as the predominant pathogenic microorganism causing bacteremia in the elderly, with a significantly higher culture positivity rate among female patients. Routine blood parameters (WBC, NLR, PLR, and RDW) demonstrated a predictive potential for diagnosing bacteremia in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Stromal-cell-derived factor 1 (SDF-1) plays a crucial role in hematopoiesis and has been implicated in acute myeloid leukemia (AML) pathogenesis. Understanding its relationship with chemotherapy outcomes could lead to improved therapeutic approaches for elderly AML patients. Methods: This study retrospectively analyzed the medical records of elderly AML patients (n = 187) and compared serum SDF-1α levels with age-matched controls (n = 120). Patients received CAG (cytarabine, aclarubicin, and G‐CSF)-based chemotherapy, and serum SDF-1α levels were assessed using ELISA. Results: Serum SDF-1α levels were significantly elevated in elderly AML patients compared to controls (p < 0.001). Receiver operating characteristic (ROC) analysis confirmed its diagnostic relevance, revealing the area under the ROC curve (AUC) of 0.76. Factors such as age, French-American-British (FAB) classification, Eastern Cooperative Oncology Group (ECOG) performance status, primary AML status, white blood cell count, and bone marrow blast cell ratio, were confirmed to be prognostically relevant. Serum SDF-1α levels were elevated in patients who did not achieve complete remission (NCR) compared to those in complete remission (CR). ROC analysis further highlighted the predictive capability of serum SDF-1α for chemotherapy responsiveness. Independent predictors of treatment failure included age, FAB classification, ECOG status, and serum SDF-1α levels. Following chemotherapy, serum SDF-1α levels decreased in patients in CR but remained unchanged in those in NCR. Higher baseline levels of SDF-1α were associated with shorter overall survival. Conclusions: Elevated serum SDF-1α levels in elderly AML patients are associated with poor chemotherapy response and shorter survival. Baseline serum SDF-1α levels could serve as a prognostic marker for CAG-based treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led governments worldwide to make ethically controversial decisions. As a result, healthcare professionals are facing several ethical dilemmas, especially in terms of healthcare services provided to senior citizens. Thus, the aim of this review is to identify and categorize ethical dilemmas as well as propose solutions regarding health care services for elderly individuals. Methods: A qualitative systematic review of the literature was undertaken in the first tier of the pandemic. All identified scientific and editorial articles published in English or French between December 2019 and October 2021 were included. An article was excluded if it was commercial, did not address an issue in the care of the elderly or present any qualitative data. Article eligibility was determined through a process of triangulation among three independent reviewers. Results: Initially, 69 articles met our inclusion criteria and were selected for this review. These studies can be divided into 2 distinct categories: scientific articles (17 studies) and expert opinion articles (52 articles). However, due to the large quantity of qualitative data that was extracted, only the results from the scientific literature are presented here. The analysis of the data of 17 studies has allowed the emergence of 2 main themes of ethical dilemmas: 1) access to care (3 subthemes: A) triage decisions for admission, B) access to the intensive care unit and C) vaccine allocation) and 2) infection control decisions (2 subthemes: (D) isolation and E) autonomy). Our results also revealed 4 categories of potential solutions to the encountered ethical dilemmas, namely, optimal protocols, enhanced communication, caregiver support and technological assistance (virtual team-based, AI). Conclusions: The ethical dilemmas that emerged from our results highlight the interest of a serious international discussion around the phenomena of ageism and its potential ethical implications for health care workers (be it under normal circumstances or exceptional circumstances such as those of a pandemic). We highly recommend that future research be undertaken to test the efficacy of the proposed solutions in providing age-friendly, dilemma-free health care and environments. [ABSTRACT FROM AUTHOR]

Objective: To construct a recurrence prediction model for Elderly Schizophrenia Patients (ESCZP) and validate the model's spatial external applicability. Methods: The modeling cohort consisted of 365 ESCZP cases from the Seventh People's Hospital of Dalian, admitted between May 2022 and April 2024. Variables were selected using Lasso-Logistic regression to construct the recurrence prediction model, with a nomogram plotted using the "RMS" package in R 4.3.3 software. Model validation was performed using 1,000 bootstrap resamples. Spatial external validation was conducted using 172 cases ESCZP from the Fourth Affiliated Hospital of Qiqihar Medical College during the same period. The model's discrimination, accuracy, and clinical utility were assessed using Receiver Operating Characteristic (ROC) curves, Area Under the Curve (AUC), calibration curves, and Decision Curve Analysis (DCA). The Hosmer-Lemeshow test was used to evaluate model fit. Results: A total of 537 cases ESCZP were included based on inclusion and exclusion criteria, with 150 recurrences within two years and 387 non-recurrences. Lasso-Logistic regression analysis identified Medication status, Premorbid personality, Exercise frequency, Drug adverse reactions, Family care, Social support, and Life events as predictors of ESCZP recurrence. The AUC for the modeling cohort was 0.877 (95% CI: 0.837–0.917). For the external validation cohort, the AUC was 0.838 (95% CI: 0.776–0.899). Calibration curves indicated that the fit was close to the reference line, demonstrating high model stability. DCA results showed good net benefit at a threshold probability of 80%. Conclusion: The nomogram prediction model developed based on Lasso-Logistic regression shows potential in identifying the risk of recurrence in ESCZP. However, further validation and refinement are needed before it can be applied in routine clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk factors for ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus. Methods: A total of 112 elderly patients with hypertension and type 2 diabetes, treated at Jiangmen Central Hospital from January 2023 to December 2023, were selected and categorized into a stroke group and a non-stroke group, each comprising 56 patients. The two groups were examined for demographic data, risk variables were evaluated by multifactorial logistic regression analysis, and the predictive value was determined using ROC curves. Results: The comparison of hyperhomocysteinemia (HHcy), fibrinogen (FIB), and high-density lipoprotein cholesterol (HDL-C) between the non-stroke and stroke groups revealed statistically significant differences (P < 0.05). Logistic regression analysis indicated that HHcy (OR 16.936; 95% CI 1.946–146.071; P = 0.010), FIB (OR 1.773; 95% CI 1.238–2.540; P = 0.002), and HDL-C (OR 0.182; 95% CI 0.043–0.775; P = 0.021) were significant factors in the onset of ischemic stroke among elderly patients with hypertension and type 2 diabetes. ROC curve analysis revealed that the area under the curve (AUC) for FIB, HDL-C, and HHcy in diagnosing stroke associated with hypertension and type 2 diabetes mellitus in the elderly were 0.704, 0.640, and 0.598, respectively, while the AUC for the combined diagnosis of all three was 0.784. Conclusions: HHcy, FIB, and HDL-C independently influence the occurrence of ischemic stroke in elderly patients with hypertension combined with type 2 diabetes mellitus, and their combined enhanced predictive capability for ischemic stroke occurrence. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusion\nPlain Language SummaryVentricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature review explores the changes in VAC with aging and various cardiovascular diseases (CVDs).This literature review covers studies on changes in VAC with age and common CVDs such as arterial hypertension, atrial fibrillation, heart failure with preserved and reduced ejection fraction and aortic stenosis. The review discusses traditional measures of VAC, including arterial elastance (Ea) and ventricular elastance (Ees), as well as emerging parameters such as global longitudinal strain (GLS) and pulse wave velocity (PWV). The review introduces the PWV/GLS ratio as a novel method for assessing VAC.With aging, both Ea and Ees increase, while the Ea/Ees ratio remains relatively stable, reflecting balanced arterial and ventricular adaptations. Novel measures, such as PWV/GLS ratio, show greater impairment in older adults and provide a comprehensive evaluation of VAC.Aging disrupts VAC through arterial stiffening and reduced heart function, often exacerbated by CVDs. Novel metrics like PWV/GLS may improve VAC assessment, helping clinicians manage age-related cardiovascular issues by identifying risks earlier and guiding treatment to support efficient heart-artery interaction.Ventricular-Arterial Coupling (VAC) is a key concept in cardiovascular health, showing how the heart and arteries work together.Key VAC measurements include arterial elastance (Ea) and ventricular elastance (Ees), which help assess heart efficiency and risk for diseases.Understanding these VAC changes may help in managing conditions like atrial fibrillation, arterial hypertension, heart failure and aortic stenosis.Aging generally increases Ea and Ees, but the VAC ratio (Ea/Ees) often remains stable due to compensatory heart changes.Novel parameter like pulse wave velocity (PWV) to global longitudinal strain (GLS) ratio offers more precise assessments of arterial stiffness and heart function, revealing declines in VAC as people age. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is prevalent in older adults with chronic pain, making early detection crucial for dementia prevention and healthy aging. This study aimed to determine MCI risk factors in older patients with chronic pain and to develop 9 machine learning models to identify MCI risk. Methods: A total of 612 older patients with chronic pain were recruited between October 2023 and July 2024. Data collected included patients' general information, cognitive function, pain level, depression, and sleep quality. The dataset was randomly divided into training set and testing set, and processed by Min-Max Normalization and SMOTETomek comprehensive sampling. SVM-RFE and LASSO regression were used for variable selection. We then developed machine learning models and interpreted them by SHAP. Results: Age, education level, number of pain sites, pain duration, pain level, depression and sleep quality were risk factors of MCI in older patients with chronic pain. The Extreme Gradient Boosting (XGBoost) model performed best (AUC 0.925), with pain level, age, and depression as the most important variables. Conclusions: We successfully developed 9 machine learning models to identify MCI risk. These models provide a tool for nurses to detect MCI risk early. We recommend that nurses integrate machine learning techniques into clinical nursing practice for managing MCI. However, these findings require validation with longitudinal data to confirm predictive validity for MCI progression. [ABSTRACT FROM AUTHOR]

Objective: To understand the impact of both frailty and chronologic age on outcomes of weaning from invasive mechanical ventilation (MV). Methods: The study population consisted of patients enrolled in the 'WorldwidE. AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. We defined 4 non-overlapping groups, namely: 'frail' (clinical frailty scale [CFS] score > 4; age < 80 years); 'elderly' (CFS ≤ 4; age ≥ 80y), 'frail \elderly' (CFS > 4; age ≥ 80 years), and a 'not frail or elderly' population. The primary outcome was the impact of frailty and older age on delayed weaning and failed weaning from invasive MV. Secondary outcomes included the impact of frailty and age on ICU and hospital survival. Results: In the study population, 760 (17%) were frail, while 360 (8%) were elderly, 197 (4%) were frail and elderly, while 3,176 (70%) were not frail or elderly. The frail and elderly cohorts were more likely to be female, had hypoxemic/hypercapnic respiratory failure or sepsis, and had more comorbidities. The proportion of delayed weaning and of failed weaning from invasive MV was significantly higher in the frail (28 and 23%), the elderly (25 and 19%), and the frail and elderly groups (22% and 25%), compared to the not frail or elderly population (12% and 13%, P < 0.01). ICU and hospital mortality was higher in the frail (21 and 33%), the elderly (19 and 31%), and the frail and elderly groups (26 and 46%), compared to the not frail or elderly population (12% and 18%, P < 0.001). In multivariate analyses, there was an independent association between frailty and delayed weaning initiation and weaning failure. Old age was independently associated with risk of weaning failure. Conclusions: Frailty status had a more consistent impact than older age on weaning outcomes. However, overall outcomes in these cohorts are encouraging once separation attempts have been initiated. [ABSTRACT FROM AUTHOR]

Background: Identifying high risk factors and predicting lung cancer incidence risk are essential to prevention and intervention of lung cancer for the elderly. We aim to develop lung cancer incidence risk prediction model in the elderly to facilitate early intervention and prevention of lung cancer. Methods: We stratified the population into six subgroups according to age and gender. For each subgroup, random forest, extreme gradient boosting, deep neural networks, support vector machine, multiple logistic regression and deep Q network (DQN) models were developed and validated. Models were trained and tested using samples from 2000 to 2015 and independent external validated through those from 2016 to 2019. The suitable model for lung cancer risk prediction and high risk factors identification was chosen based on internal validation and independent external validation. Results: The DQN model achieved the optimal prediction performance in stratified subgroups, with AUROC ranging from 0.937 to 0.953, recall ranging from 0.932 to 0.943, F2-score ranging from 0.929 to 0.946, precision ranging from 0.926 to 0.952, F1-score ranging from 0.933 to 0.963 and RMSE ranging from 0.21 to 0.27. SHAP values were supplied for model interpretability. High risk factors of lung cancer incidence were identified in the elderly. Men ≥ 65 carrying C > A/G > T mutation had the highest lung cancer incidence decrease of 39.5% after five years quitting in stratified elderly groups, which were 1.83 times more than women ≥ 65 not carrying C > A/G > T mutation. Conclusions: The DQN model may be suitable for identifying high risk factors and predicting lung cancer risk with high performance. The proposed intervention and diagnosis pathways could be used for early screening and intervention before the occurrence of lung cancer, which could help oncologists develop targeted intervention strategies for the stratified elderly to reduce lung cancer incidence and improve therapeutic effect. Proposed method could also be used in predicting the risk of other chronic diseases to help conduct intervention and reduce incidence. [ABSTRACT FROM AUTHOR]