Geriatrics最新文献

{"title":"Sensory Blurring in Nociplastic Pain: The Role of Descending Inhibitory Dysfunction and Gut-Brain Axis Alterations in Older Adults.","authors":"Takahiko Nagamine","doi":"10.3390/geriatrics11030071","DOIUrl":"10.3390/geriatrics11030071","url":null,"abstract":"<p><p><b>Background</b>: Inhibitory processes in the nervous system are traditionally conceptualized as suppressive mechanisms; however, their fundamental role is the refinement and optimization of sensory information. In nociception, this function is mediated by the descending pain inhibitory system (DPIS), which modulates nociceptive transmission at multiple hierarchical levels. Biological sex and gender-related factors significantly influence these inhibitory pathways, yet they are often overlooked in clinical frameworks. <b>Methods</b>: A narrative review was conducted using PubMed, MEDLINE, and Scopus databases, focusing on studies published between 2010 and 2025. Search terms included \"descending pain inhibitory system,\" \"nociplastic pain,\" \"aging,\" \"sex differences,\" \"gender,\" and \"gut-brain axis.\" Approximately 30 key references were synthesized. <b>Results</b>: The DPIS enhances the precision of nociceptive signals through mechanisms analogous to lateral inhibition. In chronic and nociplastic pain, this refinement process is impaired, leading to \"sensory blurring.\" Aging exacerbates these changes through neurochemical depletion and neuroinflammation. Crucially, this decline follows sex-specific trajectories; estrogen depletion in post-menopausal females accelerates the loss of monoaminergic inhibitory reserves, while gender-related sociocultural stressors can further disrupt top-down executive control. Additionally, alterations in the gut-brain axis signaling-modulated by sex-specific gut microbiota profiles-further disrupt inhibitory control. <b>Conclusions</b>: Chronic pain may be conceptualized as a disorder of sensory refinement rather than excessive nociceptive input. Inclusion of sex and gender as biological variables is essential for precision pain management. Therapeutic strategies should focus on restoring inhibitory precision through both central and systemic approaches, tailored to the patient's hormonal and physiological profile.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316859","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":"The Impact of General Anesthetics on Postoperative Delirium: A Narrative Review Based on Clinical Randomized Controlled Trials from the Last Five Years.","authors":"Jia-Ni Wu, Jia-Huan Xu, Jia-Yi Ge, Bo-Ran Deng, Xing-Jun Liu","doi":"10.3390/geriatrics11030070","DOIUrl":"10.3390/geriatrics11030070","url":null,"abstract":"<p><p>Postoperative delirium (POD) is an acute, reversible neurocognitive disorder characterized by confusion and altered consciousness. With the improvement in research methodologies and the introduction of innovative clinical drugs in recent years, a growing number of randomized controlled trials have been conducted. This article aims to conduct a comprehensive review of the efficacy of general anesthetics-including propofol, ciprofol, sevoflurane, ketamine, esketamine, dexmedetomidine, benzodiazepines, opioids, and lidocaine-in preventing and managing POD, based on randomized controlled trials published in the past five years. Propofol has advantages in preventing POD in pediatric patients. However, its efficacy compared with inhalational anesthetics still requires individualized evaluation in elderly patients. The novel drugs ciprofol and remimazolam exhibit favorable safety profiles and do not increase the risk of POD. The efficacy of dexmedetomidine shows variability across patient populations and surgical types. In addition, specific opioid drugs and lidocaine also demonstrate preventive potential when administered in a standardized manner.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316784","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":"Safety of Cholecystectomy in Nonagenarians: A Systematic Review and Meta-Analysis.","authors":"Dimitrios Vouros, Belen Conde Inarejos, James Fowler, Sarthak Jain, Vasileios Kotsarinis, Maaz Ullah, Awais Asif Chaudhary, Martyn Charles Stott, Ahmad Hassan, Shahin Hajibandeh, Shahab Hajibandeh, Jacob Kadamapuzha, Thomas Satyadas","doi":"10.3390/geriatrics11030069","DOIUrl":"10.3390/geriatrics11030069","url":null,"abstract":"<p><p><b>Background/Objectives</b>: To evaluate the safety of cholecystectomy in nonagenarians. <b>Methods</b>: In compliance with the PRISMA statement standards, a systematic review including random-effects meta-analysis and meta-regression models was conducted. All studies reporting postoperative outcomes in patients aged ≥90 undergoing cholecystectomy were included and analyzed. <b>Results</b>: Six studies (1223 patients) were included. The risk of 30-day mortality was 5.4% (95% CI 3.1-7.7); 30-day morbidity occurred in 22% (95% CI 11.3-32.8). The mean length of hospital stay was 11.5 days (95% CI 8.3-14.6). Postoperative mortality was not affected by male sex (coefficient: 0.028, <i>p</i> = 0.832), ASA status ≥ III (coefficient: 0.051, <i>p</i> = 0.309), cholecystitis as indication for cholecystectomy (coefficient: -0.166, <i>p</i> = 0.051), cholecystectomy in emergency setting (coefficient: -0.020, <i>p</i> = 0.425), laparoscopic (coefficient: -0.104, <i>p</i> = 0.09) or open approach (coefficient: 0.104, <i>p</i> = 0.09), and conversion to open surgery (coefficient: 0.043, <i>p</i> = 0.820). The GRADE certainty of evidence was low to moderate. <b>Conclusions</b>: Subject to selection bias and confounding by fitness, the available evidence suggests that cholecystectomy in highly selected nonagenarians with good performance status, who have passed robust preoperative fitness assessment tests, may be safe with an acceptable risk of morbidity and mortality.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316815","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":"Visual Hallucinations and Cognitive Impairment as the Initial Presentation of Severe Hypothyroidism in an Elderly Patient: A Case Report.","authors":"Hongyu Li, Chenxiang Cao, Xiaoyi Wang, Jing Zhang, Wenhui Zhao","doi":"10.3390/geriatrics11030068","DOIUrl":"10.3390/geriatrics11030068","url":null,"abstract":"<p><p><b>Background:</b> Hypothyroidism is a prevalent endocrine disorder capable of affecting multiple organ systems. While somatic symptoms are common, prominent neuropsychiatric manifestations such as visual hallucinations and cognitive deficits are exceptionally rare as an initial presentation. This atypical clinical picture frequently leads to misdiagnosis as primary psychiatric disorders or neurodegenerative conditions. <b>Case Presentation:</b> We report the case of a 75-year-old male who presented with a three-month history of complex visual hallucinations and progressive cognitive decline. The hallucinations were notably dependent on environmental light. Initial assessments raised concerns about the neurodegenerative process. However, laboratory investigations revealed severe autoimmune hypothyroidism with high titers of anti-thyroid antibodies. Following timely levothyroxine replacement therapy, the patient achieved complete remission of visual hallucinations and significant cognitive recovery. <b>Conclusions:</b> This case illustrates that severe hypothyroidism can manifest as a reversible metabolic encephalopathy mimicking dementia. It underscores the importance of screening for thyroid dysfunction in elderly patients presenting with unexplained acute neuropsychiatric symptoms to ensure appropriate management.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316843","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":"Outcomes of Curative Esophagectomy in Octogenarians vs. Non-Octogenarians with Esophageal Cancer: A Systematic Review and Meta-Analysis.","authors":"Liyang Xiao, Kai Siang Chan, Isaac Chan, Aung Myint Oo","doi":"10.3390/geriatrics11030067","DOIUrl":"10.3390/geriatrics11030067","url":null,"abstract":"<p><p><b>Background</b>: Esophageal cancer (EC) poses a growing global challenge in the context of an ageing population. Evidence on the role of curative esophagectomy in octogenarians is limited. This study aims to compare the long-term survival and post-operative mortality and morbidity in octogenarians undergoing curative esophagectomy for EC with those in non-octogenarians. <b>Methods</b>: A systematic search was performed on PubMed, Embase, Web of Science and Cochrane Library up to Jan 2026. The inclusion criteria were studies that compared outcomes of esophagectomy for EC between octogenarians and non-octogenarians. Exclusion criteria were single-arm studies and studies using different age cut-offs. <b>Results</b>: There were 18 studies with 73,776 patients (octogenarians <i>n</i> = 6234 and non-octogenarians patients <i>n</i> = 67,542), with smaller subsets of studies being analysed for individual outcomes. The overall incidence of open esophagectomy and minimally invasive esophagectomy (MIE) were 78.4% (<i>n</i> = 459/585) and 21.2% (<i>n</i> = 124/585), respectively, in octogenarians, and 69.8% (<i>n</i> = 3270/4688) and 29.4% (<i>n</i> = 1380/4688), respectively, in non-octogenarians. R0 resection was achieved in 85.2% (<i>n</i> = 1759/2064) of octogenarians and 91.9% (<i>n</i> = 30,764/33,480) of non-octogenarians. Pooled OS was inferior in the octogenarian group compared to the non-octogenarian group (<i>n</i> = 35,441, HR 2.29, 95% CI: 1.38-3.79). Pooled in-hospital mortality, 30-day mortality and 90-day mortality were higher in octogenarians. In terms of post-operative complications, pooled analysis demonstrated a higher overall complication rate in the octogenarian group (<i>n</i> = 6515, OR 1.40, 95% CI: 1.11-1.78), while rates of anastomosis leakage, chylothorax, respiratory complication, surgical site infection and recurrent laryngeal nerve injury were comparable between the two groups. <b>Conclusions</b>: Curative esophagectomy for EC is associated with worse overall survival, mortality and overall post-operative complication rate in octogenarians than non-octogenarians. Further research on the role of MIE in octogenarians should be conducted.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316807","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":"Kidney Transplantation over 65 Years: Clinical and Immunological Long-Term Outcomes-Single Center Experience.","authors":"Lucia Federica Stefanelli, Marianna Alessi, Martina Cacciapuoti, Rime Khalf, Dorella Del Prete, Francesca Katiana Martino, Lorenzo A Calò, Federico Nalesso","doi":"10.3390/geriatrics11030066","DOIUrl":"10.3390/geriatrics11030066","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Kidney transplantation (KT) in older recipients remains challenging due to age-related conditions such as frailty and comorbidities, as well as immunological changes related to immunosenescence, which expose older KTRs to a higher risk of infection and infection-related complications. The aim of this study was to evaluate clinical and immunological outcomes in older KTRs, analyzing the incidence of cardiovascular, infective, and neoplastic complications, as well as graft and patient survival and the associated risk factors. <b>Methods</b>: This monocentric study includes 157 KTRs aged over 65 years, followed at the Transplant Ambulatory of Padua University Hospital and transplanted between January 2013 and December 2023. Clinical and immunological outcomes were evaluated, including surgical complications, incidence of delayed graft function (DGF), and renal function at 1, 3, and 5 years after KT. <b>Results</b>: Patient survival rates were 96%, 91.5%, and 71.6% at 1, 3, and 5 years after KT, respectively, while graft survival rates were 94%, 87%, and 68%. Major complications were malignancies (40.1%), cardiovascular disease (33.1%), and bacterial infections (22%). In the multivariate analysis, donor age and history of malignancy were identified as independent risk factors for mortality (<i>p</i> = 0.048 and <i>p</i> = 0.056, respectively). Kaplan-Meier survival analysis confirmed donor age as the only significant risk factor for patient survival. Regarding graft survival, multivariate analysis identified hypertension as an independent risk factor for graft failure (<i>p</i> = 0.009), while Kaplan-Meier analysis showed diabetes (<i>p</i> = 0.040) and single-kidney transplantation (<i>p</i> = 0.003) as significant risk factors. <b>Conclusions</b>: KT in older recipients represents a safe and beneficial therapeutic option, offering favorable patient and graft survival outcomes. However, this epidemiological study highlights the need for personalized follow-up strategies and improved prognostic assessment in older KTRs.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13300480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316803","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":"Differential Effects of Cognitive vs. Motor Dual-Task Training in Stroke Rehabilitation: A Precision-Focused Meta-Analysis.","authors":"Hui Gao, Man Lang, Mustapha Mangdow, Wen Liu","doi":"10.3390/geriatrics11030065","DOIUrl":"10.3390/geriatrics11030065","url":null,"abstract":"<p><strong>Objectives: </strong>Stroke predominantly affects older adults and is accompanied by age-related declines in balance and mobility. Given the inter-individual variability in post-stroke functional capacity, identifying the most effective dual-task training modalities for specific patient profiles is essential for precision-based stroke rehabilitation. This systematic review and meta-analysis aimed to investigate the differential effectiveness of motor dual-task training (MDT) and cognitive dual-task training (CDT) on gait performance, balance control, and motor function while exploring other moderating factors.</p><p><strong>Methods: </strong>The study followed the PRISMA guidelines. A comprehensive search of six English databases (Web of Science, PubMed, Medline, Embase, Cochrane Library, CINAHL) and one Chinese database (CNKI) was conducted from November 2023 to June 2025. Randomized controlled trials involving adult stroke survivors were included. Outcomes included gait, balance, and lower-extremity motor function. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed to evaluate modality-specific effects and moderating factors.</p><p><strong>Results: </strong>Twenty-one RCTs (<i>n</i> = 786) were included. Dual-task training demonstrated moderate improvements in both temporal (SMD = 0.50, <i>p</i> = 0.03) and spatial (SMD = 0.5, <i>p</i> = 0.04) gait performance and balance control (SMD = 0.71, <i>p</i> = 0.02), but not motor function. MDT demonstrated superior effects on gait speed and stride length (SMD = 1.15, <i>p</i> = 0.01; SMD = 0.89, <i>p</i> < 0.01), whereas CDT showed greater benefits for balance (SMD = 0.59, <i>p</i> < 0.01). Greater balance improvements were observed in individuals at high fall risk, and subacute patients showed enhanced responsiveness.</p><p><strong>Conclusions: </strong>These findings provide guidance for tailoring dual-task modality and timing to individual patient profiles, though high heterogeneity and the lack of direct comparisons between MDT and CDT limit definitive conclusions.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13300573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316739","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 Health Literacy and One-Year Incidence of Pre-Frailty Among Older Adults Undergoing Frailty Health Checkups.","authors":"Yoshiharu Yokokawa, Keisuke Nakamura, Tomohiro Sasaki, Shinobu Yokouchi","doi":"10.3390/geriatrics11030064","DOIUrl":"10.3390/geriatrics11030064","url":null,"abstract":"<p><p><b>Objective</b>: We aimed to identify predictors of the transition to pre-frailty among older adults undergoing frailty health checkups and to evaluate their relative importance. <b>Methods:</b> A longitudinal analysis was conducted using data from a frailty health checkup project involving 830 older adults participating in community exercise classes in Matsumoto City, Nagano Prefecture, Japan. Among them, 502 individuals classified as robust (healthy) at baseline were followed for 1 year. Predictors of transition to pre-frailty were examined using multivariate logistic regression analysis. Given the low follow-up rate (43.4%), a sensitivity analysis using inverse probability weighting (IPW) was performed. Model performance was internally validated using bootstrap resampling and calibration assessment. <b>Results:</b> Of the 218 participants who completed the follow-up period, 45 (20.6%) transitioned to pre-frailty. Increasing age was a significant risk factor (OR = 1.13, 95% CI: 1.06-1.20), whereas higher health literacy was a protective factor (OR = 0.51, 95% CI: 0.29-0.86). In the IPW sensitivity analysis, the association with age remained stable, while health literacy demonstrated borderline significance (<i>p</i> = 0.08). The model showed acceptable discrimination (area under the curve [AUC] = 0.737; 0.728 after optimism correction) and good calibration (Hosmer-Lemeshow test, <i>p</i> = 0.124). <b>Conclusions:</b> Age and health literacy were independent predictors of transition to pre-frailty. As a modifiable factor, health literacy may represent a promising target for interventions aimed at preventing the progression to pre-frailty.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029373","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":"Influence of Age on the Effectiveness of Lee Silverman Voice Treatment^® BIG in Patients with Parkinson's Disease: A Retrospective Exploratory Observational Study.","authors":"Masanobu Iwai, Kazuya Takeda, Soichiro Koyama, Ikuo Motoya, Yuichi Hirakawa, Hiroaki Sakurai, Yoshikiyo Kanada, Nobutoshi Kawamura, Mami Kawamura, Shigeo Tanabe","doi":"10.3390/geriatrics11030063","DOIUrl":"10.3390/geriatrics11030063","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Advanced age in Parkinson's disease (PD) is linked to worse motor function, more severe symptoms, and impaired activities of daily living (ADLs). Lee Silverman Voice Treatment (LSVT)^® BIG may be suitable for older patients, as it can be adapted to individual abilities. This study evaluated whether age affects the effectiveness of LSVT^® BIG on gait speed, motor symptoms, ADLs, and quality of life (QoL) in PD. <b>Methods:</b> In this retrospective, single-center cohort study, 22 patients with PD were divided into an older group (≥65 years; <i>n</i> = 16) and a younger group (<65 years; <i>n</i> = 6). All participants completed 16 one-hour, face-to-face LSVT^® BIG sessions. Gait speed was assessed with the 10-m walk test; motor symptoms with Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III; ADLs with MDS-UPDRS Part II; and QoL with the Parkinson's Disease Questionnaire-39 Summary Index. Two-way mixed-design analysis of variance with aligned rank transformation was used for statistical analysis. <b>Results:</b> Significant improvements were observed for all outcomes (gait speed, motor symptoms, ADLs, and QoL) after the intervention. A significant effect of age group was found for gait speed, with younger patients walking faster overall. No significant interaction between timepoint and group was observed for any measure. <b>Conclusions:</b> LSVT^® BIG appears to improve gait speed, motor symptoms, ADLs, and QoL in patients with PD, regardless of age, suggesting it is an effective intervention for both older and younger patients.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029309","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":"Frailty Predicts Neurological Outcome in Chronic Subdural Hematoma: A Single-Center Prospective Cohort Study.","authors":"Tobias Philip Schmidt, Christian Jacquemain, Jule Rupprecht, Kerstin Jütten, Laura Schlager, Christian Blume, Michael Veldeman, Hans Clusmann, Anke Höllig, Catharina Conzen-Dilger","doi":"10.3390/geriatrics11030062","DOIUrl":"10.3390/geriatrics11030062","url":null,"abstract":"<p><strong>Objectives: </strong>Frailty, reflecting reduced physiological reserve, has emerged as a predictor of postoperative outcomes in neurosurgery and may provide greater prognostic value than age. In chronic subdural hematoma (cSDH), prospective data remain scarce. This study investigates the association between preoperative frailty, assessed using the Clinical Frailty Scale (CFS), and postoperative recovery in cSDH patients.</p><p><strong>Methods: </strong>In this ongoing prospective single-center cohort study, 78 consecutive patients (≥60 years) with cSDH were enrolled between August 2022 and October 2024. After exclusion of four conservatively managed patients, 74 surgically treated patients were included in the analysis. Frailty was defined as Clinical Frailty Scale (CFS) ≥ 5. The primary outcome was the Glasgow Outcome Scale-Extended at 6 months (GOSE6). Secondary outcomes included GOSE at discharge (GOSE0) and three months (GOSE3), revision surgery, intensive care unit (ICU) admission, and mortality after six months.</p><p><strong>Results: </strong>Higher CFS scores significantly correlated with poorer outcome at 6 months (r = -0.68, <i>p</i>_adj = 0.011). In regression analysis, frailty (<i>p</i> < 0.001), age (<i>p</i>_adj = 0.014), and revision surgery (p_adj = 0.009) were significant predictors of outcome. Frailty was associated with a reduced likelihood of a good neurological outcome (OR = 0.02, 95% CI: [0.004, 0.085]). Frail patients had significantly poorer outcomes at all timepoints (all <i>p</i>_adj = 0.014) and none achieved a favorable outcome (GOSE ≥ 6). Six-month mortality was significantly higher in frail patients compared to non-frail patients (32% vs. 4%, <i>p</i>_adj = 0.048, relative risk RR = 3.29, 95% CI [1.67, 5.78]).</p><p><strong>Conclusions: </strong>Our interim results suggest that preoperative frailty, as measured by the CFS, is strongly associated with poorer neurological recovery and higher mortality following surgical treatment of cSDH. Frailty assessment may facilitate individualized treatment strategies and improve risk stratification beyond age or comorbidity burden.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"11 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029343","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}