“Failure To Thrive” in Older Adults

The long-term impact of different non-cancer pain management strategies in older adults remains poorly understood. This population-based retrospective cohort study aimed to identify distinct trajectories of chronic non-cancer pain management and examine their associations with adverse clinical outcomes in older adults, stratified by frailty status. Using Taiwan's National Health Insurance database, we included older adults (≥65 years) who initiated non-steroidal anti-inflammatory drugs (NSAIDs) in 2010 and followed them for 8years. Participants were stratified by frailty status using the multimorbidity frailty index. Group-based multi-trajectory modelling and Cox proportional hazards models were employed to identify distinct trajectories of chronic non-cancer pain management (including medications [i.e., NSAIDs, paracetamol, muscle relaxants and psychotropic agents] and non-pharmacological physical therapy) and to assess the associations between trajectory groups and subsequent clinical outcomes. Among 24 539 participants (mean age 72.7, 58.9% female), four distinct trajectories were identified: short-term (27.6%), mild (31.9%), moderate (21.7%) and extensive (18.9%) utilization. Compared to the short-term group, the extensive utilization group were significantly associated with higher risks of unplanned hospitalization (adjusted hazard ratio [aHR]: 1.36, 95% confidence interval [CI] 1.24-1.48), all-cause hospitalization (aHR: 1.43, 95% CI 1.35-1.52) and incident dementia (aHR: 1.27, 95% CI 1.04-1.54). For dialysis, only the extensive group was associated with higher risk in the age-sex adjusted model (HR: 2.06, 95% CI: 1.00-4.22), but significance was attenuated after frailty adjustment. No significant differences in all-cause mortality were observed after full adjustment. These findings highlight that extensive long-term utilization of pain management strategies in older adults is associated with increased risks of adverse outcomes, particularly hospitalizations and incident dementia, especially among fit older adults, emphasizing the need for careful monitoring and personalized approaches to pain management in older populations, balancing effective pain control with minimization of potential long-term risks.

12053 Background: Polypharmacy (PP) is common in older adults starting cancer treatment and associated with increased risk of potential drug-drug interactions (PDI). PP and PDI may affect treatment-related outcomes in older patients. This study evaluates the association of PP and PDI with systemic treatment adverse outcomes in older adults with advanced cancer. Methods: This secondary analysis of prospectively collected data from the GAP 70+ Trial (NCT02054741; PI: Mohile) enrolled patients aged 70+ with advanced (i.e. incurable) cancer; had ≥1 geriatric assessment domain impairment; and planned to start a new chemotherapy regimen or another regimen with high risk of toxicity. PP was assessed prior to initiation of treatment and defined as concurrent use of ≥8 medications (meds). PDI among all drugs were reviewed prior to initiation of treatment using Lexi-Interact® Online with category D and X considered “major PDI”. Study outcomes were assessed within 3 months of treatment initiation and included: 1) total number of Grade ≥2 toxicities according to National Cancer Institute Common Toxicity Criteria; 2) total number of Grade ≥3 toxicities; and 3) early treatment discontinuation due to toxicity. Multivariable linear and logistic regression models were used to examine the association of PP and PDI with treatment adverse-outcomes adjusted for age, gender, cancer type, comorbidity, physical function, social support, and study arm. Results: Among 718 participants, the mean age was 77 (range 70-96); 43% were females; and 57% had lung or gastrointestinal cancers. The median number of meds was 5 (range 0-24); 28% received ≥8 concurrent meds; and 25% had ≥1 major PDI. The mean number of Grade ≥2 toxicities for patients with PP was 9.8 versus 7.7 in patients without PP (adjusted β=1.87, standard error [SE]=0.71, P<0.01). The mean number of Grade ≥3 toxicities for patients with PP was 2.9 versus 2.2 in patients without PP (adjusted β=0.59, SE=0.29, P=0.04). Patients with ≥1 major PDI had 59% higher odds of early treatment discontinuation versus those without major PDI (adjusted odds ratio 1.59, 95% confidence interval=1.03-2.46, P=0.03). There was no significant association between PP and early treatment discontinuation. Major PDI were not significantly associated with toxicity (Ps>0.05). Conclusions: In a cohort of vulnerable older adults with advanced cancer, PP and PDI are associated with increased risk of systemic treatment adverse outcomes. Providing meaningful screening and interventional tools to optimize medication use may improve treatment outcomes in these patients. Funding:UG1CA18996, U01CA233167.

Frailty and leucocyte count are predictors of all-cause mortality and hospitalization length in non-demented institutionalized older women

Spatiotemporal parameters such as gait velocity and stride length are simple indicators of functional status and can be used to predict major adverse outcomes in older adults. A smartphone can be used for gait analysis by providing spatiotemporal parameters useful for improving the diagnosis and rehabilitation processes in frail people. The aim of this study was to review articles published in the last 20 years (from 2004 to 2024) concerning the application of smartphones to assess the spatiotemporal parameters of gait in older adults. This systematic review was performed in line with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), and original articles were identified by searching seven electronic databases: SciVerse (ScienceDirect), Excerpta Medica Database (EMBASE), Medline, Scopus, PubMed, Web of Science and the Cochrane Library. Studies were rigorously screened using the inclusion criteria of smartphones and mobile apps, older adults and spatiotemporal gait parameters, and results were narratively synthesized. Seventy-three articles were initially identified while searching the scientific literature regarding this topic. Eleven articles were selected and included in this review. Analysis of these studies covered information about gait assessment using mobile apps recorded in 723 older adults and 164 control cases. Analysis of data related to the application of smartphones to assess spatiotemporal parameters of gait in older adults showed moderate-to-excellent test-retest reliability and validity (ICCs around 0.9) of gait speed, the most common parameter reported. Additionally, gait speeds recorded with mobile apps showed excellent agreement when compared to gold standard systems. Smartphones and mobile apps are useful, non-invasive, low-cost and objective tools that are being extensively used to perform gait analysis in older adults. Smartphones and mobile apps can reliably identify spatiotemporal parameters related to adverse outcomes, such as a slow gait speed, as predictors and outcomes in clinical practice and research involving older adults.

Frailty is a progressive, dynamic clinical syndrome characterized by reduced physiological reserves and increased vulnerability to stressors, leading to adverse outcomes in older adults. Despite its clinical significance, routine detection of frailty remains challenging owing to subtle presentations and time constraints during assessments. Longitudinal studies are essential for capturing its biological trajectory and identifying early biomarkers. This scoping review aims to systematically identify and map biomarkers-including inflammatory, hormonal, metabolic, genetic, and imaging-based markers-investigated for their longitudinal associations with frailty in older adults. Studies involving older adults with comorbid conditions (eg, cancer, infectious diseases, cardiovascular diseases) will also be included when frailty is assessed as an outcome. We will conduct a comprehensive literature search in 6 databases (PubMed, CINAHL, Cochrane Library, Scopus, Web of Science, and Embase). We will include longitudinal studies that examine the association between objectively measured biomarkers and frailty, as assessed with validated tools, in older adults. Studies published in English, Korean, or Chinese will be considered, with no restriction on publication date. We identified 3315 records after duplicate removal in an exploratory search conducted in July 2024, indicating a substantial body of literature for review. We plan to complete this review by December 2026. This review will identify and describe longitudinal biomarkers that precede frailty in older adults, highlighting their potential for personalized clinical application. Anticipated limitations include reliance on observational study designs, methodological heterogeneity, and limited causal inference. PRR1-10.2196/83312.

Hospitalization due to adverse drug events in older adults with cancer: A retrospective analysis

<sec> <title>BACKGROUND</title> Frailty is a progressive, dynamic clinical syndrome characterized by reduced physiological reserves and increased vulnerability to stressors, leading to adverse outcomes in older adults. Despite its clinical significance, routine detection of frailty remains challenging owing to subtle presentations and time constraints during assessments. Longitudinal studies are essential for capturing its biological trajectory and identifying early biomarkers. </sec> <sec> <title>OBJECTIVE</title> This scoping review aims to systematically identify and map biomarkers—including inflammatory, hormonal, metabolic, genetic, and imaging-based markers—investigated for their longitudinal associations with frailty in older adults. Studies involving older adults with comorbid conditions (eg, cancer, infectious diseases, cardiovascular diseases) will also be included when frailty is assessed as an outcome. </sec> <sec> <title>METHODS</title> We will conduct a comprehensive literature search in 6 databases (PubMed, CINAHL, Cochrane Library, Scopus, Web of Science, and Embase). We will include longitudinal studies that examine the association between objectively measured biomarkers and frailty, as assessed with validated tools, in older adults. Studies published in English, Korean, or Chinese will be considered, with no restriction on publication date. </sec> <sec> <title>RESULTS</title> We identified 3315 records after duplicate removal in an exploratory search conducted in July 2024, indicating a substantial body of literature for review. We plan to complete this review by December 2026. </sec> <sec> <title>CONCLUSIONS</title> This review will identify and describe longitudinal biomarkers that precede frailty in older adults, highlighting their potential for personalized clinical application. Anticipated limitations include reliance on observational study designs, methodological heterogeneity, and limited causal inference. </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> PRR1-10.2196/83312 </sec>

Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population. We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3-2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies. Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.

Cardiovascular diseases (CVDs) represent a significant cause of morbidity and mortality among older adults in China, exerting a substantial influence on their quality of life and life expectancy. The country’s ageing population is predicted to intensify this burden, underscoring the need for the development of innovative and effective management strategies. The prospective cohort study will recruit older patients with cardiometabolic diseases from multiple community health service centres in Shanghai. Participants will be comprehensively assessed for CVD risk factors, medications, functional status, and multi-omics data, along with continuous sign monitoring data from wearable bracelets and their electronic health records. The primary objective of the study is twofold: firstly, to explore the independent and joint predictive power of digital biomarkers and clinical indicators for cardiovascular events (new incident/recurrent), dementia, death and other adverse outcomes in older adults; and secondly, to establish a digital twin platform for precision medicine. The study proposes a novel integration of digital intelligence into cardiometabolic health management for older adults. The utilisation of comprehensive data collection and advanced analytical methods is anticipated to generate valuable insights into the intricate interplay of risk factors and outcomes. The development of personalised risk assessment models and intelligent alert systems has the potential to enhance the prevention and treatment of CVDs, thereby improving health outcomes and quality of life for older adults. ChiCTR2500096478 (Chinese Clinical Trial Registry). Registered 24 January 2025 - Prospectively registered.

The objective of this study was to assess the predictive ability of the Triage Risk Stratification Tool (TRST) in identifying older adults at risk of adverse outcomes [return to emergency department (ED), hospitalization, or a composite outcome] within 30 and 120 days following discharge from ED. A systematic search was conducted to identify studies validating the TRST in older adults aged at least 65 years discharged from ED. The methodological quality of selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A score of at least 2 was used to identify high-risk patients. A bivariate random effects model was applied to generate pooled estimates of sensitivity and specificity. The discriminative ability of the tool was assessed using the c statistic. Heterogeneity was assessed graphically and statistically using the variance of the logit-transformed sensitivity and specificity. Six studies (3233 patients) were included. With a cutoff of at least 2, the pooled sensitivity of the TRST for a composite outcome at 30 days was 0.58 (95% confidence interval 0.52-0.65), the specificity was 0.61 (95% confidence interval 0.58-0.64). Similar values were obtained for the composite outcome at 120 days and the individual outcomes at both timepoints. The c statistic was consistently low across the outcomes and timepoints. There was little heterogeneity across studies. In conclusion, the TRST is limited in its ability to discriminate between older adults with or without an adverse outcome following discharge from ED. The low levels of heterogeneity gives us confidence that the pooled estimates reflect the predictive ability of the TRST in clinical practice.

BackgroundFrailty contributes to adverse outcomes in older adults and places a heavy burden on healthcare resources. Dysphagia is associated with frailty, but the mechanisms by which dysphagia affects frailty in older adults are unclear. This study aimed to investigate a serial mediating effect of self-perceived oral health and self-reported nutritional status in the relationship between dysphagia and frailty among hospitalized older patients in China.MethodsThis cross-sectional study included 1200 patients aged ≥ 65 years in the Department of Geriatrics, Shaanxi Provincial People’s Hospital. A structured face-to-face interview was used to survey the following questionnaires: General Information Questionnaire, Tilburg Frailty Indicators (TFI), Eating Assessment Tool-10 (EAT-10), 30mL Water Swallow Test (WST), Geriatric Oral Health Assessment Index (GOHAI), and Short-Form Mini-Nutritional Assessment (MNA-SF). A total of 980 participants with complete data were included in the analysis. Statistical analysis was performed using SPSS 26.0 and Amos 28.0 software. Spearman’s correlation analysis was used for correlation analysis of study variables. The results of the multivariate linear regression analysis for frailty were used as covariates in the mediation analysis, and the structural equation model (SEM) was used to analyze the mediating effects among the study variables.ResultsDysphagia, self-perceived oral health, self-reported nutritional status, and frailty were significantly correlated (P<0.001). Dysphagia was found to directly affect frailty (β = 0.161, 95%CI = 0.089 to 0.235) and through three significant mediation pathways: (1) the path through self-perceived oral health (β = 0.169, 95%CI = 0.120 to 0.221), accounting for 36.98% of the total effect; (2) the path through self-reported nutritional status (β = 0.050, 95%CI = 0.023 to 0.082), accounting for 10.94% of the total effect; (3) the path through self-perceived oral health and self-reported nutritional status (β = 0.077, 95%CI = 0.058 to 0.102), accounting for 16.85% of the total effect. The total mediation effect was 64.77%.ConclusionsThis study indicated that dysphagia was significantly associated with frailty. Self-perceived oral health and self-reported nutritional status were serial mediators of this relationship. Improving the oral health and nutritional status of hospitalized older patients may prevent or delay the frailty caused by dysphagia.

Sarcopenia contributes to functional decline and adverse outcomes in older adults, yet little is known about nurses' knowledge and practices regarding this condition. This study described nurses' self-perceived knowledge, perceptions, and practices related to sarcopenia. A descriptive, online survey was used to assess 109 nurses regarding sarcopenia. Over half of the nurses reported limited knowledge of sarcopenia and were unsure whether it is preventable; 15.6% believed it was not preventable. Most had not received recent sarcopenia education (94.5%), were unfamiliar with diagnostic criteria (95.4%), and did not use objective assessment tools (96.3%). Nearly half overestimated the age at which muscle mass and strength begin to decline, and only 4.6% correctly identified sex-specific grip strength cut-offs. Confusion with frailty criteria was common (23.8%). Findings reveal substantial gaps in nurses' knowledge and practice regarding sarcopenia in older adults. Enhanced education, clinical guidelines, and standardized assessment processes are needed to support timely recognition and management.

Limited data exists regarding risk factors for adverse outcomes in older adults hospitalized with Community-Acquired Pneumonia (CAP) in low- and middle-income countries such as India. This multisite study aimed to assess outcomes and associated risk factors among adults aged ≥60 years hospitalized with pneumonia. Between December 2018 and March 2020, we enrolled ≥60-year-old adults admitted within 48 hours for CAP treatment across 16 public and private facilities in four sites. Clinical data and nasal/oropharyngeal specimens were collected by trained nurses and tested for influenza, respiratory syncytial virus (RSV), and other respiratory viruses (ORV) using the qPCR. Participants were evaluated regularly until discharge, as well as on the 7th and 30th days post-discharge. Outcomes included ICU admission and in-hospital or 30-day post-discharge mortality. A hierarchical framework for multivariable logistic regression and Cox proportional hazard models identified risk factors (e.g., demographics, clinical features, etiologic agents) associated with critical care or death. Of 1,090 CAP patients, the median age was 69 years; 38.4% were female. Influenza viruses were detected in 12.3%, RSV in 2.2%, and ORV in 6.3% of participants. Critical care was required for 39.4%, with 9.9% in-hospital mortality and 5% 30-day post-discharge mortality. Only 41% of influenza CAP patients received antiviral treatment. Admission factors independently associated with ICU admission included respiratory rate >30/min, blood urea nitrogen>19mg/dl, altered sensorium, anemia, oxygen saturation <90%, prior cardiovascular diseases, chronic respiratory diseases, and private hospital admission. Diabetes, anemia, low oxygen saturation at admission, ICU admission, and mechanical ventilation were associated with 30-day mortality. High ICU admission and 30-day mortality rates were observed among older adults with pneumonia, with a significant proportion linked to influenza and RSV infections. Comprehensive guidelines for CAP prevention and management in older adults are needed, especially with the co-circulation of SARS-CoV-2.

The role of frailty in explaining the association between the metabolic syndrome and mortality in older adults

ObjectiveTo investigate the association of normal BMI with central obesity (CO), high BMI with CO, high BMI without CO, and normal BMI without CO, with function and cognition in older adults.MethodsCross-sectional study involving 754 participants ≥ 65 years. Data collected include demographics, cognition, and physical measurements.ResultsFemales had a higher prevalence of high BMI with CO and a lower prevalence of high BMI without CO than males (61.0% vs 44.6% and 4.6% vs 15.0%, respectively). Within gender, CO groups, regardless of BMI, had lower mini-mental state examination (MMSE), handgrip strength (HGS), and longer timed-up-and-go (TUG) scores. Overall, the high BMI without CO group had the highest MMSE scores, HGS, and shortest TUG. Amongst males, HGS was significantly lower in the normal BMI with CO group (B −3.28, 95% CI −6.32 to −0.23, P = 0.04). CO, regardless of normal/high BMI, had significantly longer TUG time (B 2.65, 95% CI 0.45 to 4.84, P = 0.02; B 1.07, 95% CI 0.25 to 1.88, P = 0.01, respectively) than normal BMI without CO group. CO was associated with lower MMSE scores in both genders but significant only in males with normal BMI and CO (B −1.60, 95% CI −3.15 to −0.06, P = 0.04).ConclusionCO may be a better predictor of obesity and adverse outcomes in older adults. High BMI without CO was associated with better outcomes especially in males but require further validation. Prospective longitudinal studies are needed to ascertain the impact of BMI and/or CO on function, cognition, mortality, and gender differences.