Introduction: White coat hypertension in geriatric patients can complicate dental procedures in the presence of intense anxiety. Objective: To evaluate the effectiveness of a combined approach of psychological intervention and sedation for the control of the syndrome during multiple extractions. Case presentation: A 76-year-old woman with a diagnosis of white coat hypertension (WCH) and a history of dental anxiety. In two previous attempts, the surgery was suspended due to blood pressure elevation. The Dental Perception Reprogramming Protocol (DPRP) was applied along with conscious sedation (midazolam, fentanyl, dexmedetomidine) which allowed agitation, so deep sedation with propofol was used. Result: The patient had stable blood pressure (119/82 mmHg) and successfully completed the intervention without complications. Conclusions: The integration of psycho-behavioral and pharmacological techniques allowed effective hemodynamic control, and a key interdisciplinary approach is suggested for the management of the syndrome in older adults.

Objective: The non-verbal nature of the Clock Drawing Test (CDT) suggests it is a suitable cognitive screening instrument for populations with lower educational levels and/or language barriers. This study evaluates whether the CDT is a valid screening instrument for low-educated patients and includes a qualitative analysis of CDT errors. Method: A total of 503 participants were included, divided into four groups (dementia, MCI, no cognitive impairment, and other diagnosis), based on a clinical diagnosis by a geriatrician. Educational levels were categorized into four groups: no education and low, middle, and high education. CDT scores were assessed using the seven-point scoring system (Freedman), and two cutoff points were evaluated. Results: Results showed that in all education categories, the dementia group scored significantly lower on the CDT compared to the non-dementia group. The difference was smallest in participants with no education. Two cut-off points were assessed: <4 and <3. A cut-off of <4 showed better sensitivity versus <3, particularly for low-educated groups. A cut-off of <3 provided better specificity versus <4. Error analysis showed that errors made by low-educated participants without dementia were similar to those of patients with dementia. Conclusions: These findings show that the CDT (both total score and qualitative error analysis) has limited value in dementia case-finding in low-educated groups. The CDT is recommended primarily for middle- and high-educated groups.

Background/Objectives: The global aging population faces rising rates of cognitive decline and neurodegenerative disorders. This review explores how physical exercise influences brain health in aging, focusing on mechanisms, moderators, and personalized strategies to enhance cognitive resilience. Methods: A narrative review methodology was applied. Literature published between 2015 and 2025 was retrieved from PubMed, Scopus, and Web of Science using keywords and MeSH terms related to exercise, cognition, neuroplasticity, aging, and dementia. Inclusion criteria targeted peer-reviewed original studies in humans aged ≥60 years or aged animal models, examining exercise-induced cognitive or neurobiological outcomes. Results: Evidence shows that regular physical activity improves executive function, memory, and processing speed in older adults, including those with mild impairment or genetic risk (e.g., APOE ε4). Exercise promotes neuroplasticity through increased levels of BDNF, IGF-1, and irisin, and enhances brain structure and functional connectivity. It also improves glymphatic clearance and modulates inflammation and circadian rhythms. Myokines act as messengers between muscle and brain, mediating many of these effects. Cognitive benefits vary with exercise type, intensity, and individual factors such as age, sex, chronotype, and baseline fitness. Combined interventions—physical, cognitive, nutritional—show synergistic outcomes. Digital tools (e.g., tele-exercise, gamification) offer scalable ways to sustain engagement and cognitive function. Conclusions: Physical exercise is a key non-pharmacological strategy to support cognitive health in aging. It acts through diverse systemic, molecular, and neurofunctional pathways. Tailored exercise programs, informed by individual profiles and emerging technologies, hold promise for delaying or preventing cognitive decline.

Background/objectives: Aging is associated with a decline in physiological and cognitive functions. Periodontitis, a disease affecting the periodontal tissues, increases in prevalence with age. Bacteria and inflammatory mediators resulting from periodontitis can trigger neuroinflammation and potentially accelerate the progression of neurodegenerative diseases. This study aimed to evaluate the association between periodontal status, salivary flow rate, salivary cortisol levels, and cytokine levels with cognitive status in elderly Indonesian subjects. Methods: This cross-sectional study involved 70 participants aged ≥ 60 years from several social institutions in Jakarta and the Dental Hospital, Faculty of Dentistry, Universitas Indonesia. All participants provided written informed consent before the examination. Periodontal parameters, including plaque score, calculus index, bleeding on probing, number of remaining teeth, and functional tooth units, were assessed. Unstimulated salivary flow was collected over five minutes, and salivary cortisol levels were measured. Gingival crevicular fluid samples from the deepest periodontal pockets were collected to measure cytokine levels (TNF-α and IL-1β). Both cortisol and cytokine levels were analyzed using ELISA. Cognitive function was evaluated using the Hopkins Verbal Learning Test. Results: Plaque score, calculus index, and bleeding on probing were moderately associated with cognitive scores (p < 0.05). In contrast, the number of remaining teeth, functional tooth units, periodontitis severity, salivary flow rate, salivary cortisol, and cytokine levels were not significantly associated with cognitive scores (p > 0.05). Conclusions: These findings suggest that elderly individuals with cognitive impairment tend to have poorer periodontal health than those with normal cognitive function.

Background/Objectives: Falls are a major public health concern among older adults, often resulting in injury, mortality, and loss of independence. Understanding fall-related risk factors is essential for developing effective prevention strategies. This study examined the multifactorial risk assessment of falls among Thai community-dwelling older adults, aiming to identify and prioritize modifiable risk factors for targeted interventions in the Thai context. Methods: A cross-sectional study was conducted among 5694 adults aged ≥60 years who attended a comprehensive geriatric clinic in Bangkok, Thailand, between March 2019 and December 2023. All participants underwent a comprehensive geriatric assessment and fall history screening. Logistic regression analysis was performed to identify independent predictors of falls and recurrent falls. Results: Among the 5694 participants, 17.7% reported at least one fall in the past year, and 4.1% experienced recurrent falls. Independent risk factors for falls included female sex (OR = 1.74), unsteadiness (OR = 1.54), fear of falling (OR = 1.22), sedative drug use (OR = 1.38), and low gait speed (<1 m/s; OR = 1.70). Recurrent falls were additionally associated with urinary incontinence (OR = 1.78). Most falls occurred outdoors (58.5%), primarily due to environmental hazards such as slippery floors and uneven surfaces. The Clinical Test of Sensory Integration of Balance (CTSIB) showed no difference between fallers and non-fallers, except under the eyes-open on firm surface condition, where recurrent fallers exhibited significantly greater postural sway (p = 0.048). Conclusions: In community-dwelling Thai older adults with robust or pre-frail status, the three key questions for fall risk screening appear to be the most effective tool. Modifiable risk factors strongly associated with fallers and recurrent fallers include sedative use, urinary incontinence, and unsteadiness. Accordingly, medication review, urinary incontinence screening, and balance assessment may help prevent falls. The CTSIB may have only limited value in differentiating fall risk between fallers and non-fallers in this population.

Background: The biological mediators for the epidemiologic overlap between osteoporosis and dementia are unclear. We undertook a scoping review of clinical studies to identify genetic and biological factors linked with these degenerative conditions, exploring the mechanisms and pathways connecting both conditions. Methods: Studies selected (1) involved clinical research investigating genetic factors or biomarkers associated with dementia or osteoporosis, and (2) were published in English in a peer-reviewed journal between July 1993 and March 2025. We searched Medline Ovid, Embase, PsycINFO, the Cochrane Library, the Web of Science databases, Google Scholar, and the reference lists of studies following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Results: Twenty-three studies were included in this review. These explored the role of the APOE polymorphism (n = 2) and the APOE4 allele (n = 13), associations between TREM2 mutation and late onset AD (n = 1), and associations between amyloid beta and bone remodeling (n = 1); bone-related biomarkers like DKK1, OPG, and TRAIL as predictors of cognitive change (n = 2); extracellular vesicles as bone–brain communication pathways (1); and the role of dementia-related genes (n = 1), AD-related CSF biomarkers (n = 1), and parathyroid hormone (PTH) (n = 1) in osteoporosis–dementia pathophysiology. Conclusions: Bone-related biomarkers active in the Wnt/β-Catenin pathway (Dkk1 and sclerostin) and the RANKL/RANK/OPG pathway (OPG/TRAIL ratio) present consistent evidence of involvement in AD and osteoporosis development. Reports proposing APOE4 as a causal genetic link for both osteoporosis and AD in women are not corroborated by newer observational studies. The role of Aβ toxicity in osteoporosis development is unverified in a large clinical study.

Background: Pleural empyema remains a serious clinical condition with high morbidity and mortality, especially in elderly patients. As life expectancy increases, a growing number of older individuals require surgical treatment. This retrospective single-center study investigated age-related differences in clinical presentation, perioperative features, and postoperative outcomes in patients undergoing surgery for pleural empyema. Methods: We conducted this retrospective study at Helios University Hospital Wuppertal, Witten Herdecke University in Germany, from December 2019 to May 2024. We stratified the patients into two age groups: <65 and ≥65 years. We compared baseline characteristics, American Society of Anesthesiologists (ASA) physical status classification, empyema stage, hospital stay, drainage duration, complication rates, and in-hospital mortality. Results: A total of 103 patients were included, of whom 43 (41.7%) were aged ≥ 65 years. Older patients had significantly higher ASA scores and presented with more advanced empyema stages. Hospital stay was significantly longer in this group. However, complication rates (60.0% vs. 44.9%; p = 0.25), drainage duration, ICU admissions (91.4% vs. 83.7%; p = 0.48), and in-hospital mortality (0% in both groups) did not differ significantly. Conclusions: Although older patients had higher perioperative risks, their surgical outcomes were similar to those of younger patients. Chronological age alone should not be a limiting factor for surgical treatment of pleural empyema. Surgical decisions should be based on clinical condition rather than chronological age.

Well-being and social interaction are among the primary goals to be achieved for the elderly. Intergenerational physical activity (PA) has gained increasing attention due to its potential to encourage PA and social interaction, providing both social and physical benefits to both younger and older individuals. This review aimed to gain a deeper understanding of the potential roles of PA in facilitating intergenerational interactions and provide practical insights. Methods: Following PRISMA guidelines, the systematic review identified specific keywords to search for articles that met the chosen inclusion and exclusion criteria (n. 5 RCT articles, selected between 2009 and 2024), conducted by three independent reviewers. Scopus, PubMed, EBSCOhost, and Web of Science were consulted to identify relevant articles. Risk of bias was assessed using Cochrane RoB 2. For the narrative dissertation, articles were identified across three key areas of focus: types of PA, age groups, and intended goals. Results: Few studies have specifically implemented PA protocols in intergenerational relationships, and most have planned remote activities without monitoring outcomes. The main advantages of intergenerational PA are oriented towards the social and relational sphere rather than simple PA involvement. Conclusions: For the elderly, these programs may help mitigate age-related deficits, while children and adolescents, when adapting to their older counterparts, experience greater effectiveness when provided with clear guidance during shared activities. Considering the characteristics and needs of individuals of different ages, different activities must be proposed to obtain different results. The organization of workshops and preparatory sessions will help in facilitating relationships and interactions among participants.

Background/Objectives: An association between oral function and physical fitness, including walking capacity, has been reported. However, the association between masticatory behaviors and walking ability—both of which represent patterns of movement in daily life—has not been clarified. This study aimed to investigate the association between masticatory behaviors, oral function, and walking capacity in older people. Methods: One hundred community-dwelling older people (31 men, 69 women, mean age 75.7 ± 6.3 years) were selected to participate in this study. Age, sex, masticatory behaviors, oral functions (tongue pressure, tongue–lips motor function, occlusal force, and masticatory performance), and walking capacity were assessed. Masticatory behaviors were assessed during the consumption of one rice ball (100 g) using a wearable chewing counter, and the number of chews, chewing rate, the number of chews per bite, and meal time were recorded. Walking capacity was assessed using the timed up and go test (TUG). Spearman’s rank correlation coefficients were calculated to assess the strength and direction of the association. Results: Moderate negative correlations were observed between TUG time and tongue pressure and between TUG time and tongue–lips motor function (/ta/ and /ka/) (rs = −0.33, −0.21, −0.28, respectively). In addition, moderate negative correlations between TUG time and chewing rate (rs = −0.22) and between TUG time and meal time (rs = 0.33) were observed, suggesting that lower walking capacity was associated with slower chewing rate and longer meal times. Conclusions: In community-dwelling older people, declines in mastication speed and dexterity and tongue strength are associated with lower walking capacity.

Maximising the potential benefit of resistance exercise (RE) programs by ensuring optimal recovery is an important aim of exercise prescription. Despite this, research surrounding recovery from RE in older adults is limited and inconsistent. The following randomised controlled trial was designed to investigate the efficacy of milk consumption for improving recovery from RE in older adults. However, the study encountered various challenges that may be applicable to similar studies. These include recruitment issues, a lack of measurable perturbations in muscle function following RE, and potential learning effects amongst participants. Various considerations for exercise research have arisen from the data which could inform the design of future studies in this area. These include (i) recruitment—consider ways in which the study design could be altered to aid recruitment or allow a longer recruitment period; (ii) learning effects and familiarisation—consider potential learning effects of outcome measures and adjust familiarisation accordingly; (iii) identify, validate and optimise protocols for outcome measures that are applicable for the specific population; (iv) adjust the exercise protocol according to the specific aims of the study (e.g., are you replicating a usual exercise bout or is the intent to cause large amounts of muscle damage?).