Geriatrics最新文献

{"title":"Burning Questions: Oral Ulceration Secondary to Improper Bisphosphonate Administration in Advanced Dementia.","authors":"Kate Murphy, Eleanor Marks, Kieran O'Connor, Elizabeth Moloney","doi":"10.3390/geriatrics11050128","DOIUrl":"10.3390/geriatrics11050128","url":null,"abstract":"<p><p><b>Background:</b> Oral bisphosphonates are first-line osteoporosis therapy but can cause mucosal chemical injury when tablets are retained rather than swallowed correctly. This risk is heightened in cognitively impaired older adults with dysphagia or difficulty complying with medication administration guidelines. <b>Case Presentation:</b> A 73-year-old female nursing home resident with advanced vascular dementia presented with 24 h of oral pain, reduced intake, lethargy and new facial swelling. She had received monthly ibandronic acid 150 mg for two years, with documented difficulty swallowing tablets but no formal swallowing assessment. Examination showed ulceration of the left lower lip and anterior tongue with mild vestibular swelling. Clinical investigations excluded haematinic deficiency and osteonecrosis; traumatic, lichenoid, vesiculobullous and neoplastic causes were considered unlikely based on distribution, clinical features and temporal association with the recent dose. Bisphosphonate-associated chemical mucosal injury was diagnosed by hospital dental services. Ibandronic acid was discontinued, topical treatment initiated, and ulcers resolved by three weeks. Denosumab was substituted in view of the patient's dysphagia and cognitive status. <b>Discussion:</b> This case supports the existing literature identifying inappropriate administration-often linked to dysphagia or physical impairment-as a leading cause of oral bisphosphonate-associated ulceration, typically affecting the tongue and lower lip. Ibandronate-related cases are rarely reported, likely reflecting prescribing frequency rather than lower risk. Current guidelines lack explicit recommendations addressing dysphagia or cognition in prescribing decisions. <b>Conclusions:</b> Presence of dysphagia and cognitive status should be assessed before and during oral bisphosphonate therapy. New oral pain, ulceration or facial swelling should prompt oral examination and medication review, with alternative antiresorptive agents considered when oral administration is impaired.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Views on Ageing and Loneliness in Older Patients Undergoing Geriatric Treatment.","authors":"Luise Umfermann, Aline Schönenberg, Tino Prell","doi":"10.3390/geriatrics11050125","DOIUrl":"10.3390/geriatrics11050125","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Loneliness is a clinically relevant psychosocial factor in later life and has been associated with adverse mental, cognitive, and physical health outcomes. Views on ageing may shape social engagement, coping, and perceived belonging, but evidence from geriatric patient populations remains limited. This study examined whether views on ageing are associated with loneliness in geriatric patients. Secondary analyses explored subjective age, including felt age and the perceived onset of old age. <b>Methods</b>: This cross-sectional analysis used baseline data from two prospective observational studies in geriatric patients (N = 459). Loneliness was assessed with the three-item UCLA Loneliness Scale. Views on ageing were measured using five items from the German Ageing Survey. Associations were examined using Spearman correlations, non-parametric group comparisons, and multiple linear regression. <b>Results</b>: Participants had a mean age of 83.1 years and 65.6% were female. The mean UCLA loneliness score was 1.54 ± 2.07, and the mean views on ageing sum score was 13.21 ± 2.72. More negative views on ageing were associated with higher loneliness (ρ = 0.122, <i>p</i> = 0.009). In the fully adjusted regression model, views on ageing remained independently associated with loneliness after adjustment for chronological age, sex, and depressive symptoms (β = 0.117, <i>p</i> = 0.014; adjusted R² = 0.051). Depressive symptoms were also independently associated with loneliness (β = 0.182, <i>p</i> < 0.001), whereas chronological age and sex were not. At the item level, associations with loneliness were mainly driven by reduced positive ageing-related beliefs. Higher felt age was associated with higher loneliness (ρ = 0.151, <i>p</i> = 0.003), while a later perceived onset of old age was associated with lower loneliness (ρ = -0.136, <i>p</i> = 0.017). <b>Conclusions</b>: In geriatric patients, more negative views on ageing were weakly associated with higher loneliness independent of depressive symptoms. The small effect size suggests that views on ageing should be interpreted as one modest component within a broader biopsychosocial understanding of loneliness in geriatric care.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coaching-Driven Digital Literacy for Older Adults: Results from AGAPE Ecosystem Pilot Study.","authors":"Matei Teodorescu, Chiara Pedrini, Ileana Ciobanu, Andreea Georgiana Marin, Emanuela Elena Mihai, Sabrina Tazzari, Maria Luigia Del Vicario, Jensen Selwyn Joymangul, Ana Goreti Oliveira, Elena Tamburini, Francesco Agnoloni, Francesca Cecchi, Mihai Berteanu","doi":"10.3390/geriatrics11050124","DOIUrl":"10.3390/geriatrics11050124","url":null,"abstract":"<p><p><b>Introduction:</b> Rapid technological development requires continuous learning and adaptation, yet many older adults (OAs) face difficulties using digital technologies. The AGAPE project (Active aGeing And Personalised service Ecosystem) aimed to promote active and healthy ageing (AHA) among adults aged 65+ by supporting independent functioning reducing caregiver burden, and improving eHealth literacy through personalized, user-friendly digital services co-created and tested in Italy, Portugal, and Romania. <b>Objective:</b> AGAPE pilot phase evaluated the effectiveness and usability of innovation adoption strategies designed to improve technology acceptance, digital literacy, and behavioural change among older adults and caregivers. This study examined participants' perceptions of digital technologies and self-reported digital efficacy during a multicomponent intervention combining repeated technology use, personalized coaching, digital literacy and health education, technical assistance, and support from informal and formal caregivers. <b>Material and Methods:</b> The multiple-sites uncontrolled pilot study combined home-based use of the AGAPE digital technologies with long-term combined personalized support. Data were collected at baseline (T0), intermediate (T1), and final (T2) assessments using the System Usability Scale (SUS), technostress questionnaire, digital adoption questionnaire (TAM-derived), EQ-5D-5L, CarerQoL-7D, and the UCLA Loneliness Scale, complemented by participant feedback, technology usage, and activity data. <b>Results:</b> The study included 217 participants, of whom 146 were OAs. Over the course of the intervention, participants showed reductions in technostress and improvements in perceived digital efficacy, although the magnitude and direction of change varied across pilot sites. The findings also indicated that contextual and social factors contributed to technology adoption and engagement. <b>Conclusions:</b> Participation in the multicomponent AGAPE intervention was associated with positive longitudinal changes in technology-related perceptions, technostress, and digital self-efficacy. The findings support the feasibility and potential of combining digital technologies with personalized coaching and broader interpersonal support to facilitate technology adoption among older adults. However, given the uncontrolled study design and the integrated nature of the intervention, the observed changes cannot be attributed independently to coaching or to any single intervention component.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialized Delirium Care Environments in Hospitalized Older Adults: A Systematic Review.","authors":"Henri Perrin, Giulio Mastria, Alberto Garcia Manjon, Patrizia D'Amelio","doi":"10.3390/geriatrics11050122","DOIUrl":"10.3390/geriatrics11050122","url":null,"abstract":"<p><p><b>Purpose:</b> Delirium is a frequent and serious condition in older patients, associated with severe adverse outcomes and lacking proven pharmacological treatments. Non-pharmacological multicomponent strategies are recommended, and specialized delirium care environments (e.g., delirium room, delirium unit, psychogeriatric unit) have been proposed as a potential strategy to improve the management of delirium in hospitalized older adults. Our objective was to provide the first systematic review and pooled analysis on the subject, synthesizing the characteristics of specialized delirium environments in the care of delirium and their association with clinical outcomes. <b>Methods:</b> A systematic search of MEDLINE, Cochrane, and EMBASE identified studies on patients aged 65 years and older with delirium or related acute confusional states admitted to specialized delirium care environments. Study quality was assessed using Cochrane's risk of bias tools, and exploratory pooled analyses were conducted when at least three studies reported the same outcome. <b>Results:</b> Nine studies, reported across 15 publications and including 2226 patients, met the inclusion criteria. Interventions were heterogeneous in structure and content, but most combined delirium-oriented staff training, enhanced surveillance, environmental adaptation, and multicomponent non-pharmacological care. Comparator groups were also diverse and included standard wards, earlier versions of specialized care models, indirect admission pathways, and non-delirious controls. The narrative synthesis suggested that specialized delirium care environments were most consistently associated with shorter delirium duration, more favorable discharge outcomes, lower physical restraint use, and better functional recovery, while findings for length of stay, falls, psychotropic drug use, and mortality were less consistent. Exploratory pooled analyses suggested a favorable direction of effect for several outcomes, particularly discharge destination and mortality, but pooled estimates were not statistically significant and should not be interpreted as definitive evidence of efficacy. All included studies were judged to be at a high or critical risk of bias. <b>Conclusions:</b> Specialized delirium care environments appear promising for the management of delirium in hospitalized older adults, particularly for outcomes closely related to day-to-day delirium care. However, the current evidence base is limited by substantial heterogeneity in intervention models, comparator groups, and outcome definitions, as well as by a high risk of bias across studies. These findings support further evaluation of specialized delirium care models, but do not yet allow firm conclusions regarding their effectiveness.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very Late-Onset Myasthenia Gravis in a Very Elderly Patient: Diagnostic Challenges and Importance of Early Recognition.","authors":"Nermina Polimac Gorana, Almedina Spiljak","doi":"10.3390/geriatrics11050121","DOIUrl":"10.3390/geriatrics11050121","url":null,"abstract":"<p><p><b>Background:</b> Myasthenia gravis is an autoimmune disorder of the neuromuscular junction characterized by fluctuating skeletal muscle weakness. Late-onset MG (onset ≥ 50 and <65 years) and very late-onset MG (VLOMG; onset ≥ 65 years) are increasingly recognized subgroups, and diagnosis in very elderly patients remains challenging because symptoms frequently overlap with age-related conditions and comorbidities. <b>Case Presentation:</b> An 88-year-old man with very late-onset myasthenia gravis (symptom onset at approximately age 85) was urgently referred because of a several-day history of rapidly worsening dysphagia and dysarthria, superimposed on fluctuating diplopia, dysphagia, dysarthria, and fatigable bulbar symptoms that had progressively worsened over the preceding three years. Initial diagnostic evaluation was challenging because of advanced age, previous lacunar infarctions, and multiple comorbidities, including pulmonary thromboembolism, chronic kidney disease, and permanent pacemaker implantation (which precluded brain MRI). Neurological examination and the characteristic fluctuation of symptoms raised suspicion of myasthenia gravis. Serological testing confirmed markedly elevated acetylcholine receptor antibodies, whereas MuSK antibodies were negative. Repetitive nerve stimulation was not performed given the high antibody titer and unambiguous clinical presentation. Thoracic computed tomography excluded thymoma. Treatment with pyridostigmine, azathioprine (maintenance dose kept lower than standard due to chronic kidney disease stage IIIB), and low-dose prednisone (selected due to age and comorbidity profile) resulted in early, patient-reported clinical improvement (approximately 60% in speech and swallowing) over eight weeks of follow-up; a validated severity scale (MG-ADL) showed a score of six (scoring range 0-24). <b>Conclusions:</b> Myasthenia gravis should remain an important differential diagnosis in very elderly patients presenting with fluctuating ocular and bulbar symptoms, even in the presence of multiple comorbidities that may obscure the diagnosis. In this patient, early recognition, antibody testing, and individualised initiation of therapy were followed by meaningful short-term improvement; a single case with eight weeks of follow-up cannot establish that such therapy prevents disease progression or myasthenic crisis, and longer follow-up and additional cases are needed.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Subjective Symptoms, Psychological Stress and Quality of Life Among Older Japanese Adults.","authors":"Sachie Ono, Akira Komatsuzaki, Yukika Enoki, Takeshi Kamoda, Chikage Kato, Kiyoka Arashi","doi":"10.3390/geriatrics11050123","DOIUrl":"10.3390/geriatrics11050123","url":null,"abstract":"<p><p><b>Background/Objectives</b>: A crucial issue in Japan, as a rapidly aging society, is supporting the quality of life (QOL) of older adults to ensure they do not require long-term care. This study aims to examine the association between subjective symptoms and psychological stress and QOL decline using a large-scale Japanese national statistics database. <b>Methods</b>: Anonymized data were analyzed from 23,649 adults aged ≥ 65 years, obtained from the Comprehensive Survey of Living Conditions carried out in 2019 in Japan. The degree of association of different factors with QOL decline was analyzed using univariate symptom analysis and adjusted odds ratios (ORs) obtained through binary logistic regression. We also compared the reported frequency and mean number of symptoms in a group with poor QOL and one with good/regular QOL. <b>Results</b>: In the group with poor QOL, significantly more individuals were aged ≥ 75 years, had high levels of psychological stress (Kessler Psychological Distress Scale [K6]), and reported subjective symptoms (<i>p</i> < 0.01). The mean number of symptoms was significantly higher in this group (5.77) than in the good/regular QOL group (3.34, <i>p</i> < 0.01). In the binary logistic regression, the variables with the highest adjusted ORs were the K6 group (4.49), impaired limb movement (2.81), and numbness of the limbs (2.01). <b>Conclusions:</b> These findings indicate that different symptoms, including stress, have varying impacts on QOL in older adults. Addressing symptoms associated with reduced QOL in community-dwelling older adults may help promote continued aging in place.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral Interventions to Increase Physical Activity Among Dementia Caregivers: A Narrative Review of Behavior Theory, Behavior Change Techniques, and Mechanisms of Behavior Change.","authors":"Ashley M Goodwin, Alex Makhnevich, Karina W Davidson, Liron Sinvani, Mark J Butler","doi":"10.3390/geriatrics11050120","DOIUrl":"10.3390/geriatrics11050120","url":null,"abstract":"<p><p><b>Background:</b> Due to the rise in Alzheimer disease (AD) and AD-related dementias (AD/ADRD) in an aging population, millions of caregivers will be at risk for physical and mental health decline. As those they care for already have physical and cognitive impairment, it is crucial that caregivers maintain health-promoting behaviors. Because regular physical activity (PA) prevents functional loss and improves physical health and well-being, understanding how to help caregivers adopt and sustain PA despite unique time, caregiving, and self-efficacy barriers is a pressing public-health priority. Existing health-promoting interventions among dementia caregivers, including PA, have demonstrated limited success. To overcome the fragmentation and slow synthesis of behavioral science evidence, the Human Behavior-Change Project advocates theoretical grounding, systematic mapping of intervention components (e.g., behavior change techniques [BCTs]) using standardized taxonomies, and explicit specification of mechanisms of behavior change (MoBCs). <b>Objective:</b> To examine the limited success of health-promotion interventions among dementia caregivers we aimed to conduct a narrative review to synthesize evidence from interventions that evaluated PA in dementia caregivers across three domains: (1) use of behavioral theory to inform intervention design, (2) specification of BCTs, and (3) identification and measurement of MoBCs. <b>Methods:</b> Two scientific databases were searched to identify representative studies and reviews, using key terms including \"physical activity\", \"intervention\", \"dementia\", and \"caregiver\" from inception to July 2025. <b>Results:</b> Seven primary intervention trials and six reviews were selected for inclusion. Gaps across the domains were identified to inform priority areas for future research. <b>Conclusions:</b> There is a need to develop tailored, theory-driven PA interventions that target empirically supported BCTs and MoBCs to improve dementia caregivers' health and well-being.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Survival of Very Elderly Patients with Heart Failure Managed in a Comprehensive Heart Failure Management Unit.","authors":"Sonia González-Sosa, Alba Rodríguez-Quintana, Pablo Santana-Vega, Jose A Rodríguez-González, José M García-Vallejo, Jorge Arencibia-Borrego, Alicia Conde-Martel","doi":"10.3390/geriatrics11050119","DOIUrl":"10.3390/geriatrics11050119","url":null,"abstract":"<p><p><b>Background</b>: Heart failure (HF) is the leading cause of hospitalisation in older adults, with incidence increasing markedly with age. However, long-term outcome data in patients aged ≥85 years remain limited. We evaluated survival and predictors of mortality in this very elderly HF population enrolled in a structured outpatient programme. <b>Methods</b>: A retrospective observational study was conducted, including patients aged ≥85 years assessed at a Comprehensive HF Management Unit between 2012-2023. Demographic characteristics, comorbidities, functional (Barthel) and cognitive (Pfeifer) status, laboratory parameters, hospitalisations, and survival status were collected. Long-term survival was estimated using the Kaplan-Meier method, and predictors of mortality were analysed using Cox regression models. <b>Results</b>: A total of 514 patients were included (mean age 88.4 ± 3 years, 46.1% male); 340 (66.1%) died during follow-up. Survival was 77% at 1 year, 50% at 2.5 years, and 25% at 5 years. Mortality was associated with diabetes (<i>p</i> = 0.038), advanced chronic kidney disease (<i>p</i> = 0.008), dementia (<i>p</i> < 0.001), neoplasia (<i>p</i> = 0.007), ischaemic heart disease (<i>p</i> < 0.001), history of HF (<i>p</i> = 0.043), NYHA III-IV (<i>p</i> < 0.001) and elevated NT-proBNP (<i>p</i> < 0.001). Worse functional and cognitive status, higher comorbidity according to the Charlson Comorbidity Index and readmission at one year (all <i>p</i> < 0.001) were also related to mortality. In the first multivariable model, worse cognitive and functional status, a higher Charlson comorbidity index, NYHA class III-IV, and high NT-proBNP were independent predictors of mortality. When 1-year HF readmission was added to the model, the Charlson index (HR:1.10; 95%CI 1.01-1.19), high NT-proBNP (HR:1.76; 95%CI 1.30-2.38) and HF readmissions within 1 year (HR:2.68; 95%CI 1.72-4.16) remained independently associated with mortality. <b>Conclusions</b>: In patients aged ≥85 years with HF, survival was poor, with only half alive at 2.5 years and 25% at 5 years. Comorbidity burden, high natriuretic peptides, and early readmission independently predicted mortality, underscoring the importance of comprehensive assessment in this population.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient- and Function-Centric Model/Approach for Hypoglycemia Management in Older Adults.","authors":"Kannayiram Alagiakrishnan, Laurie Mereu, Gulelala Rahim, Mahua Ghosh, Albert Vu","doi":"10.3390/geriatrics11050118","DOIUrl":"10.3390/geriatrics11050118","url":null,"abstract":"<p><p>Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients' health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Implant Rehabilitation in Geriatric Patients: A Comprehensive Narrative Review of Contemporary Strategies to Avoid Extensive Bone Augmentation Procedures.","authors":"Angelo Aliberti, Wien Cirine Ben Amor, Mauro Mariniello, Gilberto Sammartino, Oreste Trosino, Francesco Giordano","doi":"10.3390/geriatrics11050117","DOIUrl":"10.3390/geriatrics11050117","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The management of edentulism and severe alveolar bone loss in older adults remains a significant challenge in implant dentistry. Given the potential biological and therapeutic burden associated with extensive regenerative procedures, increasing interest has been directed toward treatment strategies that utilize available anatomy and reduce surgical complexity. This narrative review examined contemporary augmentation-avoidance approaches for implant rehabilitation in geriatric patients. <b>Methods</b>: A structured narrative literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, including studies published up to 30 May 2026. Clinical studies, systematic, umbrella and narrative reviews, meta-analyses that evaluate augmentation-avoidance approaches in implant dentistry were considered. The review examined evidence relevant to older adults, including clinical, prosthetic, functional, and patient-centered outcomes. <b>Results</b>: The available literature describes multiple strategies for managing reduced bone availability, including short and ultra-short implants, narrow-diameter implants, tilted implant concepts, pterygoid and trans-sinus implants, zygomatic implants, immediate loading protocols, flapless and computer-guided surgery, and implant-retained overdentures. These approaches have broadened the range of treatment options available for patients with reduced bone availability and may reduce the need for extensive regenerative procedures in selected clinical situations. In addition to implant and prosthetic outcomes, increasing attention has been directed toward oral health-related quality of life, masticatory function, treatment satisfaction, and maintenance requirements. However, evidence specifically focused on geriatric populations remains limited. <b>Conclusions</b>: Contemporary implant dentistry offers several alternatives to extensive bone regeneration in carefully selected geriatric patients, although current evidence is largely extrapolated from mixed adult populations. Treatment planning should integrate anatomical conditions with systemic health, functional status, frailty-related factors, and long-term maintenance considerations. Further geriatric-focused research is needed to support patient-centered decision-making and optimize long-term rehabilitation outcomes in aging populations.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}