Pain practice : the official journal of World Institute of PainAlexandre Meurant, Vincent Bonnet, Clément Gakuba, Cédric Villain, Gilles Loggia
BACKGROUND: Optimal perioperative pain management in older adults challenges anesthesiologists due to increased drug sensitivity, altered pharmacokinetics, and limitations of pain assessment tools in cognitively impaired patients. This study evaluated whether a single 60-min structured collaborative training session between a geriatrician and a clinical pharmacist is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by increased concordance with expert opinion on a script concordance test (SCT). METHODS: SCT assessed 20 clinical vignettes covering pain assessment, analgesic selection, and adverse effect management domains. These were submitted to anesthesiologists before and after training. A panel of 13 geriatricians established scoring criteria. Internal consistency was measured using Cronbach's alpha. Paired t-tests and Wilcoxon signed-rank tests compared pre- and post-training scores, with the 95% confidence interval (CI) for the overall change estimated by bootstrap resampling. RESULTS: Seventeen anesthesiologists completed both assessments. Mean SCT scores increased from 45.8 ± 7.4 to 59.5 ± 8.5 post-training (p < 0.001), showing a 29.7% improvement (95% CI, 18.7%-41.7%). Analysis revealed improvements in analgesic prescription (+47.9%; 95% CI, 10.0-28.1 points) and adverse effect management (+26.8%; 95% CI, 9.1-19.0 points), while the change in pain assessment was not statistically significant (-11.6%; 95% CI, -16.6-9.4 points). Internal consistency improved from 0.542 to 0.704. Most participants (89.5%) lacked prior training in prescribing analgesics to older adults, and 73.7% were unfamiliar with clinical guidelines. CONCLUSION: This study suggests that collaborative geriatrician-pharmacist training is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by greater concordance with expert opinion on a script concordance test. The varying effects across domains suggest that distinct competencies may require distinct educational approaches. These findings support further investigation of interprofessional education into anesthesiology training to enhance clinical reasoning in the care of older surgical patients.
The journal of nutrition, health & agingEmanuele Marzetti, Anna Picca
Population aging has intensified the search for biological measures that can explain why individuals of the same chronological age differ so markedly in health, function, resilience, and disease burden. Geroscience has provided a powerful framework by linking shared mechanisms of aging to multiple age-related conditions, but translation to clinical practice remains incomplete. Aging clocks and circulating biomarkers have improved biological-age estimation, yet prediction alone does not establish biological meaning or clinical utility. Emerging evidence instead supports a view of aging as a heterogeneous and multidimensional process shaped by organ-specific vulnerability, cumulative stress, multimorbidity, and declining resilience. The field should therefore move beyond single biomarkers and universal aging clocks toward gerodiagnostic approaches that characterize individual aging trajectories and their modifiability. Progress in gerotherapeutics will similarly require closer integration of mechanism, measurement, and intervention. The ultimate goal is not merely to quantify aging, but to identify actionable biological processes whose modification may preserve function, delay multimorbidity, and extend healthspan.
Medicina (Kaunas, Lithuania)Beyza Ünlü, Hacer Demir, Sena Ece Davarcı, Yaşar Culha, Meltem Baykara
Background and Objectives: Functional impairment is common in older adults with cancer and may influence treatment outcomes. This study aimed to evaluate the prognostic value of objectively measured functional mobility, with gait speed as the primary analytical variable, for survival, treatment response, and chemotherapy-related toxicity in geriatric cancer patients. Materials and Methods: In this single-center prospective study, 102 patients aged 65 years and older who were chemotherapy-naive were enrolled. Before treatment initiation, functional mobility was assessed using a 3-m gait-speed test at the patient's usual pace. Gait speed was analyzed primarily as a continuous variable; the sample-median cutoff was retained for secondary descriptive analyses, and 0.8 m/s was evaluated in a sensitivity analysis. Associations with survival, treatment response, and toxicity were evaluated using survival and regression analyses. Results: The mean gait speed was 0.481 ± 0.176 m/s. Among patients with metastatic disease, higher continuous gait speed was associated with lower mortality in univariable analysis (HR = 0.752, 95% CI: 0.605-0.934, p = 0.010) and after adjustment for age, sex, and ECOG performance status (adjusted HR = 0.647, 95% CI: 0.490-0.853, p = 0.002). Gait speed was not significantly associated with metastatic PFS, non-metastatic OS or DFS, or grade ≥ 3 toxicity. The 0.8 m/s sensitivity analysis was limited by marked group imbalance. Conclusions: Higher baseline gait speed was associated with lower mortality in metastatic geriatric cancer patients, whereas statistically significant associations were not detected for PFS, non-metastatic survival outcomes, or grade ≥ 3 toxicity. These exploratory findings require validation in larger and more homogeneous cohorts.
Geriatrie et psychologie neuropsychiatrie du vieillissementCédric Annweiler, Jacques Boddaert, Jean-Pierre Aquino, Gaëtan Gavazzi, Sylvie Bonin-Guillaume
Extreme heat disproportionately affects frail older adults and may simultaneously disrupt hospital capacity, working conditions, and geriatric care pathways. We aimed to describe thermal conditions, capacity strain, and organizational adaptations in acute geriatric units (AGUs) during a heatwave and one week later, and to describe conditions in medical rehabilitation units (MRUs). PUGG FLASH-HEATWAVE was a repeated national observational, non-interventional service-level survey. Phase 1 surveyed AGUs on 25-26 June 2026; phase 2 surveyed AGUs and MRUs on 2-3 July 2026. Data were aggregated at the service level. Because no stable unit identifier was available, AGU data from the two survey waves were compared as independent samples using chi-square or Fisher's exact tests. Exploratory Mann-Whitney tests assessed the association between room cooling and reported events in phase 1. One hundred and twelve AGUs, representing 4,268 usual beds, participated in phase 1; phase 2 included 30 AGUs (1,007 beds) and 26 MRUs (1,490 beds). In phase 1, 45.5% of AGUs considered patient-room temperatures to be intolerable, 71.4% reported excessive room temperatures as an operational difficulty, and 88.4% reported staff fatigue. Major or critical emergency-department strain affected 57.1% of units, while 64.3% reported capacity strain with consequences for admissions. Downstream rehabilitation and other care capacity was considered insufficient by 87.5% of AGUs. One week later, the proportion of AGUs reporting at least partly tolerable room temperatures had increased from 53.6% to 100.0% (p < 0.001), while at least moderate emergency-department strain decreased from 91.1% to 63.3% (p < 0.001), capacity strain with operational consequences from 64.3% to 40.0% (p = 0.016), and staff fatigue from 88.4% to 50.0% (p < 0.001). Downstream capacity insufficiency remained unchanged (87.5% versus 86.7%; p = 0.903). Among MRUs, 65.4% reported patient rooms that were intolerable or only partly tolerable, 73.1% had postponed or refused admissions, and 88.5% had adapted rehabilitation activities. In phase 1, units with at least partly cooled rooms reported fewer heat-related complications and heatstroke events in unadjusted exploratory analyses. The heatwave acted as a stress test for an already fragile system. Improvements in several indicators of acute strain did not resolve the persistent downstream bottleneck. A national multi-year policy should integrate thermal adaptation of healthcare facilities, protected seasonal capacity, adequate workforce resources, and regional coordination across geriatric care pathways.
In France, nearly one third of breast cancers occur after the age of 70, yet these patients have long been underrepresented in the clinical trials that inform treatment decisions. This exclusion, rarely made explicit, became embedded in clinical practice. The ASTER 70s trial, published in The Lancet in 2025, provides new evidence. It shows that adjuvant chemotherapy does not improve overall survival in women aged 70 and older, while exposing them to significant toxicity and potential loss of autonomy. This seemingly negative result constitutes a decisive finding: it demonstrates that it is both possible and necessary to generate evidence for populations long excluded from clinical research. It calls for a rethinking of health equity.
Aging cellStefano Donega, Kenneth W Fishbein, Paolo Dominelli, Allison B Herman, Rafael de Cabo, Myriam Gorospe, Luigi Ferrucci
The stepwise movement of oxygen from the atmosphere to the mitochondria, the "oxygen cascade", is one of the most tightly regulated systems in physiology. Despite decades of mechanistic study, it has remained quite unexplored in Geroscience. This oversight should be reconsidered. In young organisms, hypoxic stress (whether environmental or tissue-specific) activates a complex adaptive response to preserve energetic stability via restraining anabolic pathways, optimizing mitochondrial performance, and reinforcing cellular quality control systems. With advancing age, angiostatic signaling increases, endothelial metabolism becomes dysregulated, and overall alveolar ventilation and pulmonary gas exchange (ventilation-perfusion matching and diffusion capacity) become less efficient. These changes promote microvascular rarefaction and low-grade but persistent mismatches between oxygen delivery and demand at the tissue level, ultimately destabilizing cellular function. In this review, we propose that the gradual erosion of oxygen homeostasis is not simply a byproduct of aging, but also a driver of molecular damage and functional decline. We examine the aging oxygen cascade through the framework of resilience biology, focusing on mechanisms such as mitochondrial electron leaks, oxidative stress amplification, iron dyshomeostasis, ferroptosis, and epigenetic remodeling. We also discuss interventions that alter oxygen availability, such as intermittent hypoxia, hyperbaric oxygen therapy, and hypoxic-hyperoxic training. These approaches demonstrate adaptive potential, but they also highlight the narrow margin between beneficial stress and injury. We propose "Oxygenaging" as a unifying framework in which aging associates with the progressive loss of equilibrium across the oxygen cascade, linking systemic oxygen transport to mitochondrial function, genomic stability, and cellular resilience.
VASA. Zeitschrift fur GefasskrankheitenGerald Kolb, Farzin Adili, Michael Denkinger, Gesine Dörr, Ursula Müller-Werdan, Oliver J Müller, Christoph Ploenes, Alexander Oberhuber, Barbara Rantner, Mark…
The patient population treated by vascular medicine is becoming older, which goes along with an increasing number of patients presenting with frailty syndrome. The level of frailty determines the outcomes after vascular surgery or interventions. This position paper written by the German Society for Vascular Surgery and Vascular Medicine, the German Society for Geriatrics, and the German Society for Angiology - Society for Vascular Medicine summarizes the current evidence on the impact of frailty on the outcome after treatment for vascular diseases, and calls for a closer collaboration between geriatrics and vascular medicine and an integration of geriatric assessment in the preoperative or preinterventional evaluation of patients. Concrete and practical demands and tasks are formulated aiming at increasing awareness of geriatrization of the patient population, promoting research on the impact of frailty on the treatment of vascular patients and improving patients' safety, reducing complications and enhancing quality of care of older vascular patients.
Longevity science has advanced faster than the public's capacity to interpret it. Biological age tests, longevity clinics, and consumer wearables now reach millions of people, yet no shared framework exists to tell an individual what those numbers mean or what to do about them. Cardiovascular medicine encountered a comparable problem and resolved it not with a new therapeutic but with a communication instrument: Life's Essential 8, which distilled a contested risk landscape into eight components scored from 0 to 100, and which has since been shown to track biological aging itself. This Perspective argues that geroscience has assembled much of the material for an equivalent instrument, even while the field continues to disagree about foundational questions. Expert panels have converged on which biomarkers are worth tracking as outcomes in aging intervention trials, and have concluded that no single biomarker suffices, which leaves a composite as the only viable path. What has not happened is the translation of that research-level agreement into a public-facing instrument. A candidate structure is proposed, comprising four behavioral and four biological pillars with explicit scoring thresholds, designed for administration by clinicians in primary care rather than by longevity clinics only, and constructed so that seven of the eight components require only a questionnaire, a bedside test, and routine bloods.
AIM: To design, implement, and evaluate a consultant-led Comprehensive Geriatric Assessment (CGA) service within an Irish private acute hospital, where structured geriatric models are not routinely embedded. The study examined the early operational and clinical impact of the service on care delivery for hospitalised adults aged ≥75 years. METHODS: A retrospective service-improvement audit was conducted involving 50 consecutive inpatients aged ≥75 years admitted to acute medical wards following introduction of a consultant-led geriatric service. Data were extracted from electronic health records using a structured audit tool aligned with the Health Service Executive (HSE) Model of Care for Older People, National Clinical Programme for Older People (NCPOP) quality standards, and the British Geriatrics Society Silver Book II. Primary outcomes were (1) time to first geriatric review and (2) proportion of patients reviewed within 48 hours. Secondary outcomes included multidisciplinary team (MDT) involvement, length of stay (LOS), discharge destination, and 30‑day readmission. Post‑implementation outcomes were descriptively compared with aggregated hospital activity data from the 12 months preceding service introduction. RESULTS: The mean age of patients was 82.6 years (SD 5.1), and 29 (58%) were female. The median time to first geriatric review was 29 hours, with 42 (84%) patients assessed within 48 hours of admission. MDT involvement was documented in 35 (70%) patients, compared with an estimated pre-implementation baseline of 22 (45%). The mean length of stay was 6.8 days, compared with a historical institutional estimate of 8.7 days derived from pre-service hospital activity data, representing an approximate 22% reduction. Discharge directly home occurred in 33 (66%) patients, while 5 (10%) were readmitted within 30 days. Staff survey responses (50) demonstrated high awareness of the service among 44 (88%) respondents and a perceived improvement in discharge coordination in 41 (82%). CONCLUSIONS: Introduction of a dedicated geriatric service in a private acute Irish hospital was associated with earlier specialist review, high multidisciplinary engagement, and favourable discharge outcomes. These findings support further development of CGA-aligned services within the private healthcare sector.
BACKGROUND: Thailand is undergoing a rapid demographic transition, with an estimated 28% of the population expected to be aged 60 years or older by 2030. This shift creates an urgent demand for technology-enhanced solutions for older adults. Despite growing interest in Internet of Things (IoT) sensor networks and machine learning applications for older adult care, the patterns of technology acceptance and implementation readiness in Thai older adult care facilities remain underexplored. OBJECTIVE: This study aimed to assess the readiness and adoption patterns of sensor network and machine learning technologies among older adults and care stakeholders in Thai older adult care facilities, guided by the Gerontechnology Acceptance Model (GTAM) and Service Exchange Value Creation Logic. METHODS: A sequential explanatory mixed methods design was used. Phase 1 (quantitative) involved structured technology assessments by 12 health care technology specialists and survey administration to 120 consumer representatives (older adults, n=70; adult family members, n=50), stratified across Bangkok and Chiang Mai. Phase 2 (qualitative) comprised 20 semistructured interviews and 3 purposively selected focus groups from phase 1 participants to elaborate on the quantitative findings. The primary theoretical framework was GTAM, mapping 5 constructs (perceived usefulness, ease of use, social influence, facilitating conditions, and behavioral intention) to corresponding survey items. This study was approved by the Assumption University Institutional Review Board (AU-IRB 80/2024) and is registered under a noninterventional observational design; formal clinical trial registration was not applicable. RESULTS: IoT fall detection systems received the highest clinical efficacy ratings from specialists (mean 4.5, SD 0.3 on a 5-point scale) and achieved 89% user acceptance. Artificial intelligence-driven early warning systems demonstrated the highest perceived clinical impact (mean 4.7, SD 0.2) but also the greatest implementation complexity (mean 4.2, SD 0.5). The consumer survey findings revealed that digital literacy level was the strongest predictor of behavioral adoption intention (β=.62; P<.001), with high-confidence participants showing 2.3 times higher acceptance rates than low-confidence participants. Significant geographic differences emerged: Bangkok respondents showed higher acceptance of medical IoT technologies (mean 4.3, SD 0.3; t119=1.98; P=.05), while Chiang Mai respondents reported a stronger preference for environmental digital health solutions (mean 4.5, SD 0.3; t119=4.12; P<.001) and elevated privacy concerns (mean 4.2, SD 0.4; P=.005). Qualitative analysis identified 5 themes: surveillance anxiety, family-mediated adoption, regional digital trust, training needs, and dignity-preserving technology design. CONCLUSIONS: Smart technology integration in Thai older adult care facilities is feasible and accepted across demographic groups when implemented in phases, culturally adapted, and supported by digital literacy training. Key adoption enablers were digital confidence, family involvement, and privacy-respecting design. The GTAM-derived findings offer an evidence-based framework for deploying gerontechnology in health care contexts in developing nations. Longitudinal outcome studies are needed to validate clinical and economic projections from prior literature.
Frontiers in cellular and infection microbiologyPuyu Liang, Zhaoyi Tan, Beibei Liang, Yuxi Xu, Tianlin Wang, Zhijian Zhang, Yun Cai
BACKGROUND: As global population aging accelerates, infectious diseases in older adults have emerged as a growing public health burden with substantial clinical, economic, and societal implications. The rapid advancement of artificial intelligence (AI) offers a transformative opportunity to enhance the management of infections in this vulnerable population. METHODS: This review delineates key determinants specific to geriatrics that influence infection susceptibility and atypical presentation, including age-related organ dysfunction, immunosenescence, inflammaging, chronic comorbidities, and psychosocial factors, and summarizes the recent advances in AI applications across the management for infectious diseases in older adults. RESULTS: AI has made significant progress in the prevention, diagnosis, and treatment of infectious diseases in older adults: early detection of clinical deterioration, rapid and etiologically precise diagnosis, individualized therapeutic optimization, AI-facilitated antimicrobial stewardship, and accelerated discovery of novel antimicrobial strategies. CONCLUSION: AI shows great potential in helping prevent, diagnose, and treat infections in older adults, and represents a promising complement to traditional care approaches.
Deutsche medizinische Wochenschrift (1946)Nina Rosa Neuendorff, Valentin Goede
The incidence of many cancers increases with age. Because of the frequent presence of comorbidity, the prognosis is usually significantly worse in these cases. Furthermore, there is little evidence on how cancer treatments can be adapted in the presence of comorbidity. This article discusses key aspects of comorbidity in older cancer patients and provides practical management recommendations.
Israel journal of health policy researchZorian Radomyslsky, Dor Atias, Bar Cohen, Ali Abu-Raya, Sara Kivity, Reuma Kurz, Eduardo Schejter, Jacob Segal, Ilan Yehoshua, Ori Liran, Miri Mizrahi Reuveni,…
BACKGROUND: As populations age, changing living conditions and declining self-advocacy often create barriers to essential care. Mobile Geriatric Teams (MGTs) offer a potential solution by providing assessments within a patient's regular environment, potentially reaching underdiagnosed and undertreated individuals who struggle to access routine healthcare. The aim of this study was to evaluate the clinical impact and reach of MGTs in the Northern District of Israel. Specifically, we aimed to assess the extent of MGT-initiated Comprehensive Geriatric Assessments and compare therapeutic and diagnostic outcomes between patients seen by MGTs and those receiving standard community-based geriatric consultations. METHODS: This is a retrospective, data-based study serving as a proof-of-concept evaluation for MGT implementation in Israel. The intervention was implemented in MHS between January 1, 2020, and December 31, 2023, and data were collected 3 and 6 months after the MGT appointment. Group comparisons were conducted using chi-square tests, Fisher's exact tests, and Wilcoxon rank-sum tests. In addition, we performed matched logistic regression models. RESULTS: A total of 8,152 individuals were included in the study; 4,348 were assessed by MGTs. The MGT group participants were slightly older and had a higher proportion of males and a lower SES category than the comparison group. The MGTs group had fewer diagnoses of mild cognitive impairment, dementia, and depression, compared to the comparison group. They also had more diagnoses of orthostatic hypotension, and they were more likely to be assessed for fall risk. The MGT group was also prescribed fewer medications in the months following the assessment. After the MGT intervention, we report an increase in primary care visits in the relevant population in the district where it was implemented, while the comparison group did not have a corresponding trend. CONCLUSIONS: In this study, we demonstrated that MGTs can reach a specific subpopulation of the elderly who might not otherwise undergo a geriatric assessment, primarily males, those of low SES, and possibly those with less urgent health concerns. These findings highlight the complementary role of MGTs in increasing accessibility, promoting equity, and addressing unmet needs in populations less likely to seek care on their own.
Within the emerging field of nutritional neuroscience, omega-3 fatty acids are among the most extensively investigated dietary bioactive compounds with potential relevance to cognitive aging. As populations continue to age worldwide, identifying modifiable nutritional factors that support cognitive health has become an important public health priority. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), obtained primarily from marine sources, are integral components of neuronal membranes and serve as precursors of specialized pro-resolving lipid mediators. This narrative review integrates concepts from nutritional neuroscience and geroscience to examine how dietary omega-3 fatty acids may influence biological pathways involved in age-related cognitive decline. Current evidence suggests that DHA and EPA affect multiple processes linked to brain aging, including neuroinflammation, synaptic plasticity, mitochondrial function, oxidative stress, cerebrovascular integrity, cellular senescence, and gut-brain axis signaling. These mechanisms overlap with several hallmarks of aging and may contribute to the maintenance of cognitive function during later life. Observational studies generally associate higher dietary intake or circulating omega-3 status with better cognitive performance and a lower risk of cognitive decline and dementia. Findings from randomized controlled trials are less consistent, although benefits appear more likely in individuals with low baseline omega-3 status, mild cognitive impairment, or increased biological vulnerability. Beyond their established anti-inflammatory effects, omega-3 fatty acids may influence multiple aging-related pathways, particularly inflammaging, vascular aging, and mitochondrial dysfunction. Although heterogeneity in study design, dosage, intervention timing, and participant characteristics precludes firm conclusions, viewing omega-3 fatty acids through a geroscience lens offers a useful framework for interpreting existing evidence and informing future research. Overall, omega-3 fatty acids represent a promising nutritional strategy for supporting cognitive health across the lifespan, warranting further investigation in well-characterized populations and precision nutrition approaches.
NutrientsAgata Kryczyk-Poprawa, Elżbieta Rząsa-Duran, János Tamás Varga, Andrea Lehoczki, Virág Zábó, Vince Fazekas-Pongor, Dávid Major, Tamás Csípő, Ágnes Szappanos, Á…
Age-related alterations in the gut microbiota contribute to chronic low-grade inflammation, immune dysregulation, metabolic dysfunction, frailty, sarcopenia, and cognitive decline. Dietary polyphenols and fermentable fiber modulate microbial composition and metabolism, promoting the production of bioactive metabolites, including short-chain fatty acids, secondary bile acids, indole derivatives, and urolithins, which regulate intestinal barrier integrity, immune homeostasis, mitochondrial function, and gut-organ communication. This narrative review critically synthesizes evidence from experimental studies, observational cohorts, randomized controlled trials, systematic reviews, and meta-analyses to examine microbiota-mediated mechanisms linking these dietary components to healthy aging within the geroscience framework. Although mechanistic evidence is compelling, translation into clinically meaningful aging outcomes remains limited because most intervention studies are small and heterogeneous and primarily rely on surrogate biomarkers. Current evidence supports polyphenol- and fiber-rich dietary patterns as biologically plausible strategies for promoting healthy aging through modulation of the gut microbiota; however, establishing causal relationships will require standardized microbiome methodologies, validated microbiome-derived biomarkers, integrated multi-omics approaches, and adequately powered longitudinal studies and randomized controlled trials.
Revista da Associacao Medica Brasileira (1992)Zeynep Irmak Kaya
OBJECTIVE: The aim of this study was to analyze the thematic and methodological evolution, alignment with global literature, and publication conversion rates of medical specialty theses in clinical nutrition in Turkey between 1990 and 2025. METHODS: A total of 750 theses were retrospectively analyzed from the Turkish National Thesis Center database. Data were evaluated for thematic content, diagnostic tools, and interdisciplinary distribution using Callon's centrality/density metrics and segmented regression models. RESULTS: The dominant research themes were sarcopenia and muscle health (36.5%), nutritional support (28.0%), and malnutrition scores (26.4%). A strong thematic association was found between sarcopenia and frailty, primarily concentrated in geriatrics. Geriatrics exhibited the highest statistical density for sarcopenia and frailty themes (Adjusted Residual: +6.1). Objective muscle measurements were included in 48.2% of theses, with 65% of these utilizing computed tomography-based "opportunistic imaging." Segmented regression identified 2015 as a significant structural breakpoint in thesis production (p<0.001). The overall publication rate was 28.4%, with the highest conversion observed in sarcopenia-focused theses (42.0%; 95%CI 36.2-47.8). Conversely, cachexia was the least represented area (1.2%). CONCLUSION: Clinical nutrition research in Türkiye has evolved into a muscle-focused, phenotype-based paradigm, with geriatrics serving as the primary driver. While sarcopenia has become central to clinical research, complex wasting syndromes like cachexia remain academically neglected. These findings demonstrate that geriatric nutrition plays a decisive role in national academic output, though more holistic and multidisciplinary research strategies are needed for future academic training.
Even critical approaches in ageing and technology that aim at better inclusion of older people and their perspectives have shortcomings. In socio-gerontechnology research this can be seen as a reliance on the third age paradigm. Although concepts stemming from this paradigm, such as early adoption and innosumerism, have been useful in untangling ageism that is central to gerontechnology, they have simultaneously enforced the ideal of active ageing. This conceptual article incorporates the concept of ailment into socio-gerontechnology literature for a deeper understanding of gerontechnology. The article suggests that this integration can help in gaining a better understanding of agency, the market and needs in gerontechnology practices. Through this discussion, the paper paves the way for more inclusive research in the nexus of ageing, care and technology studies.
Zeitschrift fur Gerontologie und GeriatrieMarkus Gosch, J Bauer, C Bollheimer, R Dodel, M Gollasch, H J Heppner, L Hofbauer, H J Lakomek, U Müller-Werdan, M C Polidori, T Prell, S Schütze, C Sieber, K …
Geriatric medicine is becoming increasingly more important in the context of demographic change. Older people frequently suffer from multimorbidity, functional impairments and complex psychosocial conditions that are often insufficiently addressed by a purely diagnosis-oriented medical approach. The primary aim of geriatrics is therefore not only the treatment of diseases but also with respect to individual goals, the preservation of independence, quality of life and social participation.This expert paper outlines the current state of geriatric care in Germany, its scientific evidence base and key challenges and future perspectives. Central elements of geriatric complexity medicine include comprehensive geriatric assessment, multiprofessional treatment concepts and cross-sectoral models of care. Numerous studies demonstrate that this approach improves functional outcomes, reduces the risk of long-term care dependency and reduces or shortens hospital stays.Despite established acute geriatric and rehabilitation structures, substantial deficits remain in nationwide access to care, financing, academic integration, research and professional training. Workforce shortages, insufficient outpatient services and the limited integration of geriatric principles into other medical specialties weaken the great opportunity that modern geriatric medicine offers for preventing the need for long-term care. At the same time, digitalization, telemedicine and innovative cross-sectoral care models offer new opportunities for patient-centered geriatric medicine.The authors advocate stronger structural and political support for geriatrics, the expansion of outpatient geriatric centers, financing systems that adequately reflect patient complexity and a stronger integration of geriatrics into research, teaching and medical education including a German Center for Geriatric Medicine with substantial involvement of geriatrics. In this way, geriatrics can make a major contribution to a sustainable, patient-centered and future-oriented healthcare system.
Demographic aging is leading to an increase in the number of elderly patients admitted to intensive care units, where they are at risk of geriatric syndromes. This prospective, single-center pilot study shows that targeted training significantly improves the knowledge of staff, primarily nurses and paramedical personnel. These results support the value of continuing education in geriatrics, a finding that should be confirmed by multicenter studies.
Journal of aging studiesChris Gilleard, Paul Higgs
This paper outlines a critique of the use of post-humanist epistemologies in the study of age and ageing which we argue makes age more a matter of human imagination than of human mattering. The 'decentring' of what is human that is associated with post-humanism creates a set of phenomena that we feel obfuscates rather than illuminates the place of age and ageing in human life, human relations and human society. Applied to the study of ageing, post-humanism claims to establish a new materialist gerontology that challenges the ontological basis applied in most ageing studies. Both the species-being of humanity, the individual experience of age and ageing and the social relations in which the processes of ageing are embedded, are sidelined in favour of a view of ageing conceived as an entanglement of objects, organs and organisations. Rather than a human or social reality, age appears to dissolve into a complex, contingent set of networks and processes extending beyond the merely human. These post-humanist developments are seen as offering new and alternative perspectives to those associated with more conventional ageing studies, which have focused on change in the individual experience, cultural representations and social relations of ageing. Such post-humanist epistemological frameworks, we suggest, risk acting as a set of mirrors through which age is endlessly refracted. In the process, age and ageing lose much of their human understandability to become a seemingly infinite flux of diffusely distributed, and ultimately directionless quasi-vitalities.
Perspectives on medical educationMaarten van der Ven, Isa Wijnands, Natasja Looman, Esther de Groot, Cornelia Fluit, Wietske Kuijer-Siebelink, Dieneke van Asselt
INTRODUCTION: Intraprofessional collaboration (IntraPC) competencies are invaluable in the care for older adults with complex care needs, but these competencies are not acquired automatically. IntraPC learning requires explicit attention in postgraduate training, where learning usually occurs in the workplace. However, both residents and supervisors struggle with how to incorporate IntraPC learning into daily practice. This study explored how and to what extent current resident-supervisor dialogues (RSDs) provide opportunities for IntraPC learning and explored barriers to IntraPC workplace learning. METHODS: In this focused ethnography, we observed RSDs in the geriatric medicine department of a Dutch university medical center, focusing on opportunities for learning about IntraPC in the workplace. After each observation, both the resident and supervisor participated in in-depth interviews to reflect on the observed behavior. Data were then analyzed through inductive coding followed by thematic analysis. Subsequently, themes were discussed during two focus groups to enable collective reflection with research participants. RESULTS: Although ample IntraPC learning opportunities were observed in the current RSDs, they remained underutilized. Participants reported dynamics between residents and supervisors that could obstruct IntraPC learning, including perceived time constraints, feedback misalignment between resident and supervisor, monitoring-focus, and the struggle for entrustment. DISCUSSION: IntraPC learning opportunities in RSDs often remain implicit, even though addressing IntraPC learning does not necessarily require additional supervision time. This implicit learning limits reflection on current collaborative practices. Moreover, dynamics between residents and supervisors may hinder the explicit development of IntraPC competencies. To support improvements in IntraPC learning, supervisors and residents are encouraged to regard IntraPC practices as an important learning topic within RSDs.
Danish medical journalKristoffer K Brockhattingen, Søren Kabell Nissen, Signe Høi Rasmussen, Siri Aas Smedemark, Astrid Heath, Karen Andersen-Ranberg, Lone Winther Lietzen
INTRODUCTION: Acute geriatric care models provide short, time-limited care for patients aged ≥ 65 years with acute medical illness, typically within 48 hours of presentation, in both hospital and community settings. These models have gained international interest; yet national coverage and organisation in Denmark have not been mapped. We aimed to identify all active acute geriatric care models across Denmark and to describe their core functions and the frequency with which these functions are deployed. METHODS: A questionnaire from the Special Interest Group in Acute and Cross-sectoral Geriatrics (Danish Geriatrics Society), distributed in 2025, captured geography, team composition and routine assessment elements. Descriptive analyses summarised active sites and assessment components. RESULTS: All hospital-based geriatric units (20/20) answered the questionnaire. Across regions, 12 of 20 hospital-based geriatric units reported having an active acute geriatric function. All care models (12/12) performed diagnostic assessment, patient-centred evaluation and treatment elements of comprehensive geriatric assessment, physical examination and laboratory testing. Other elements, such as ECG, ultrasound, frailty assessment, interdisciplinary review and community care coordination, were reported variably (n = 4-10/12). CONCLUSIONS: Acute geriatric care models are present nationwide but vary widely in visitation, team composition, assessments and follow-up. Establishing common guidelines may promote consistent and equitable care and reduce unwarranted variation in quality of care. FUNDING: None. TRIAL REGISTRATION: Not relevant.
Age and ageingSean Ninan, Katherine Howick, Finbarr C Martin
Geriatricians are aware that the clinical presentation of older people is often with 'atypical' symptoms of commonly encountered conditions. In this Commentary, we explore the emergence of this description as geriatric medicine developed during the era that the disease-diagnosis paradigm dominated medical discourse. We suggest that this recognition of atypicality may have increased the sensibility of non-experts to the more subtle clinical complexity of unwell older adults and added legitimacy to the role of specialist geriatrics, and therefore contributed to improvements in the access and quality of care of older people. Then, noting the growing understanding of the multidimensional nature of illness causation, with age-related frailty now widely appreciated, and insights emerging from geroscience, we offer a critique of its conceptual limitations. Finally, we suggest that holding to the notion of atypicality might be an obstacle to a more assertive reorientation to equitable and age-attuned healthcare, and that the time may be right to offer atypicality a well-deserved retirement.
Geriatrics & gerontology internationalCGA and 5Ms Working Group of the Japan Geriatrics Society, Tomomichi Sakai, Taku Fujimoto, Yuji Yamada, Tatsuya Hosoi, Naoki Tomita, Hiroyuki Kadoya, Yumi Chib…
BACKGROUND: Japan faces unprecedented demographic challenges as the world's most rapidly aging country, with 29.4% of the population aged ≥ 65 (2025) and projections estimating 38% by 2065. While Comprehensive Geriatric Assessment (CGA) is the gold standard for geriatric care, its implementation in Japan remains limited to geriatric specialists, creating a significant gap in delivering optimal care to Japan's growing older adult population. OBJECTIVE: To propose an integrated model that combines the 5Ms framework (Mind, Mobility, Medications, Multicomplexity, Matters Most) with CGA to enhance accessibility, practicality, and continuity of geriatric care in Japanese healthcare systems. METHODS: This position statement synthesizes evidence on CGA effectiveness and the educational and clinical utility of the 5Ms, evaluates cultural considerations in Japan, and proposes a three-tiered implementation model. RESULTS: The integration of CGA and the 5Ms framework creates a tiered assessment continuum that adapts to clinical contexts, facilitates team-based care, and improves quality and continuity across settings. The model supports education, quality improvement, and culturally sensitive care planning. CONCLUSIONS: The integration of the 5Ms and CGA offers a practical framework to formalize, connect, and strengthen geriatric care already being delivered across Japanese healthcare settings. The Japan Geriatrics Society supports this model as a guiding structure for phased implementation, workforce development, and ongoing evaluation to enhance the delivery of person-centered geriatric care in Japan.
BACKGROUND: Oncogeriatrics is a sensitive medical specialty dealing with malignant neoplastic diseases in elderly patients. Ethical challenges have emerged due to both the specific characteristics of the affected population and the severity of the disease. AIM: To report and analyze the ethical issues raised in oncogeriatrics. RESULTS: Oncogeriatrics is an emerging specialty that has developed in response to two major epidemiological observations: the aging population and the increasing number of cancer patients. Assessing these patients using specific scoring tools is essential to identify their particular needs. The unique characteristics of this population give rise to several ethical dilemmas, including end-of-life issues (such as therapeutic obstinacy and euthanasia) and those related to the patient's capacity for discernment and informed consent. The main ethical concerns discussed in this paper include access to care, research, consent and the right to information, and end-of-life issues. Addressing these challenges involves applying the four fundamental principles of medical ethics: respect for autonomy, non-maleficence, beneficence, and justice. CONCLUSION: Adhering to the four principles of ethics provides a framework for managing ethical issues. However, in oncogeriatrics, applying these principles must be carefully evaluated due to the specific characteristics of the elderly population.