European Geriatric Medicine最新文献

{"title":"Effectiveness and safety of chronic diuretic use in older adults: an umbrella review of recently published systematic reviews and meta-analyses of randomized-controlled trials.","authors":"Eveline van Poelgeest, Konstantinos Prokopidis, Tuğba Erdogan, Min Ji Kwak, Karolina Piotrowicz, Luca Paoletti, Annette Eidam, Fatma Özge Kayhan Koçak, Birkan Ilhan, Alessia Beccacece, George Soulis, Serdar Özkök, Gulistan Bahat, Eva Topinková, Joost Daams, M Louis Handoko, Parag Goyal, Jerzy Gąsowski, Antonio Cherubini, Nicola Veronese, Giuseppe Dario Testa, Wade Thompson, Nathalie van der Velde","doi":"10.1007/s41999-025-01229-5","DOIUrl":"10.1007/s41999-025-01229-5","url":null,"abstract":"<p><strong>Background: </strong>Healthcare providers should balance the potential risks and benefits of chronic diuretic use, particularly in older adults, as with age, diuretic benefits may decline and risks increase. A comprehensive synthesis and critical evaluation of the available evidence on chronic diuretic treatment effects is currently lacking.</p><p><strong>Methods: </strong>We conducted an umbrella review of systematic reviews and meta-analyses published since 2018 on health outcomes associated with diuretic use in randomized-controlled trials (RCTs). We conducted random-effects meta-analysis for pooled effect estimates and narratively summarized data that could not be pooled.</p><p><strong>Results: </strong>We included 741 effect estimations from 117 systematic reviews (SRs) on 1566 RCTs in individuals aged 62 ± 6 years. Of our 33 meta-analyses, 11 provided convincing, high-quality evidence: finerenone reduced the risk of cardiovascular (CV) mortality and end-stage kidney disease in individuals with chronic kidney disease (CKD) and/or type 2 diabetes (T2D). Torasemide reduced the risk of heart failure-related hospitalization (HFH) more than furosemide in individuals with HF. Thiazides reduced CV events in individuals with hypertension. Mineralocorticoid receptor antagonists (MRAs) reduced HFH, but also increased hyperkalemia risk in individuals with HF. MRAs also reduced the risk of atrial fibrillation in those with HF or CVD, and reduced HFH, major adverse cardiovascular events (MACEs), > 40% eGFR decrease, and composite kidney outcomes in individuals with CKD and/or T2D. Lower quality evidence suggests that in older (≥ 65 years), but not in younger adults, diuretics may reduce CV mortality, but also increase adverse event (AE) risk.</p><p><strong>Conclusions: </strong>Our umbrella review offers a comprehensive and up-to-date evaluation of the benefits and harms of diuretics. However, further research is needed to establish their efficacy and safety in populations commonly seen in clinical practice, especially older adults living with multimorbidity and frailty.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1353-1387"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Falls prevention in community-dwelling older adults and implementation of world falls guidelines: a call for action across Europe by the European Geriatric Medicine Society Special Interest Group on Falls and Fractures.","authors":"Nathalie van der Velde, Lotta J Seppala, Alvaro Casas Herrero, Cedric Annweiler, Anna Björg Jónsdóttir, Hubert Blain, Yannis Dionyssiotis, Sofia Duque, James Frith, Bahaa N Francis, Tomasz Grodzicki, Alison Hay, Luisa Alejandra Hernández-Sánchez, Roope Jaatinen, Christof J Kadane, Marko Kolsek, Tomasz Kostka, Lisa McGarrigle, Stany Perkisas, Christoph Pertinatsch, Beatrice Pettersson, Jean-Yves Reginster, Carmelinda Ruggiero, Opinder Sahota, François-Xavier Sibille, Balamrit Singh Sokhal, Dawn A Skelton, Joke Spildooren, Emma Stanmore, Hana Vankova, Ellen Vlaeyen, Yelda Ozturk, Ozlem Yilmaz, Chris Todd, Caterina Trevisan, Hanna Willems, Manuel Montero-Odasso, Finbarr C Martin, Jesper Ryg, Tahir Masud","doi":"10.1007/s41999-025-01206-y","DOIUrl":"10.1007/s41999-025-01206-y","url":null,"abstract":"<p><p>Falls among older adults represent a significant public health challenge due to their consequences, including serious injuries, increased morbidity and mortality, decreased quality of life, and heightened healthcare costs. The World Falls Guidelines (WFG), published in 2022, offer a robust framework for evidence-based interventions; however, the uptake of these guidelines into clinical practice across Europe remains inconsistent. Key barriers to implementation include insufficient resources, a lack of trained healthcare professionals, and limited integration into existing healthcare systems. This position paper by the EuGMS Special Interest Group (SIG) on Falls and Fractures addresses the implementation of the WFG among community-dwelling older adults and falls prevention across Europe by providing an overview of the current status of WFG adoption in Europe and discusses the challenges and opportunities for implementation. We provide an overview of the current resources to support the clinical practice of falls prevention, implementation guides, and educational programs. Additionally, we discuss what is necessary for the future development of these resources and for advancing research. The EuGMS SIG on Falls and Fractures advocates for a commitment of healthcare providers as well as insurers, policymakers, and other stakeholders to collaborative European initiatives-such as developing a standardised falls prevention strategy, promoting evidence-based implementation plans, establishing a European-wide research agenda, and creating under- and postgraduate curricula-which are essential for advancing falls prevention efforts across Europe.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1249-1268"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An umbrella review and meta-meta-analysis on the effectiveness of digital health interventions for cognitive function improvement in the elderly.","authors":"Yi Deng, Minqi Wang, Can Li, Hong Wu","doi":"10.1007/s41999-025-01257-1","DOIUrl":"https://doi.org/10.1007/s41999-025-01257-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to systematically evaluate the effectiveness of DHIs in improving cognitive function among older adults and to explore whether participant characteristics moderate these effects.</p><p><strong>Methods: </strong>An umbrella review and meta-meta-analysis were conducted in accordance with PRISMA guidelines, with the study pre-registered on the PROSPERO database (CRD420251003146). The eligibility criteria were clearly defined using the PICOS framework. A comprehensive literature search was performed across multiple databases including Web of Science, PubMed, CINAHL, Scopus, and the Cochrane Library. Methodological quality was assessed with the AMSTAR 2 tool and the corrected covered area (CCA) was calculated to evaluate overlap between studies, ensuring the reliability of the meta-meta-analysis.</p><p><strong>Results: </strong>A total of 31 systematic reviews and meta-analyses involving 31,093 older adults were included. The findings indicated that DHIs had a significant positive impact on global cognitive function (SMD = 0.50, 95% CI: 0.40-0.60, p < 0.001). The positive effects were also found across specific cognitive domains, including attention (SMD = 0.41), memory (SMD = 0.37), executive function (SMD = 0.35), and processing speed (SMD = 0.21). Furthermore, the subgroup analyses demonstrated that individuals with MCI and dementia experienced greater cognitive improvements from the interventions.</p><p><strong>Conclusion: </strong>The results suggest that DHIs hold substantial potential for enhancing cognitive function in the elderly population. By providing timely and personalized interventions, they can effectively improve cognitive outcomes, offering practical utility in clinical settings, and informing the development of policies aimed at expanding access to cognitive health services.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitation discussion practices: a survey of European geriatricians.","authors":"Johannes Trabert, Caterina Trevisan, Nienke Golüke, Guillaume Chapelet, Elisabet Sanchez-Garcia, Mary Ni Lochlainn","doi":"10.1007/s41999-025-01218-8","DOIUrl":"10.1007/s41999-025-01218-8","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiopulmonary resuscitation (CPR) is a life-saving treatment, yet outcomes in frail older adults are poor. Despite this, decision-making around resuscitation remains complex, influenced by misperceptions among patients, families, and physicians. We aimed to describe current practices, identify difficulties and barriers regarding do-not-resuscitate (DNR) decisions, and to assess differences across Europe.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted between September and December 2023, targeting geriatricians across Europe. The survey, disseminated via professional networks, assessed frequency and confidence in discussing DNR orders, barriers to discussions, and inter-country differences. Sociodemographic data and responses were analysed using descriptive statistics and logistic regression to identify factors influencing resuscitation discussions.</p><p><strong>Results: </strong>A total of 473 geriatricians participated across 22 countries (65% female, mean age 41.8 years, mean experience 10.5 years). Discussions of DNR orders occurred with ≥ 60% of hospitalised patients for 40% of respondents, with confidence discussing DNR orders reported by 80%. Reported barriers included time constraints (50%), cultural beliefs (25%), and lack of training (41%). Patients were kept 'for resuscitation' despite medical futility in an estimated 38% of cases at the request of patients or next of kin. Western European geriatricians discussed DNR orders more frequently and confidently than peers in other regions. Experience (> 20 years) was strongly associated with confidence (OR 7.53, 95% CI 1.93-32.35).</p><p><strong>Conclusion: </strong>Significant variability exists in resuscitation discussions among European geriatricians, influenced by region, gender, and experience. Enhanced physician training, societal awareness, and standardised protocols could improve resuscitation decision-making and reduce inappropriate resuscitation attempts.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1527-1536"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between multimorbidity and intrinsic capacity among older Chinese adults: evidence from the CHARLS 2011-2015.","authors":"Mengyuan Zhang, Yanlong Xu, Yan Xing, Hongqi Li","doi":"10.1007/s41999-025-01232-w","DOIUrl":"10.1007/s41999-025-01232-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the relationships between multimorbidity, patterns, and intrinsic capacity (IC) transitions in older Chinese adults.</p><p><strong>Methods: </strong>The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. IC evaluations were conducted in 2011 and 2015, encompassing cognition capacity, locomotion capacity, vitality capacity, psychological capacity, and sensory capacity. Based on the IC status in 2011 and 2015, four distinct IC transitions were defined. Multimorbidity patterns were determined at baseline through latent class analysis involving 14 chronic conditions. The associations between multimorbidity patterns and IC transitions were examined using multinomial logistic regression.</p><p><strong>Results: </strong>Among 3569 participants aged 60 and above, 53.0% were male, with a median age of 65 years. Regarding their condition counts, 10.9% had no disease, 24.3% had only one disease, and 64.8% had multimorbidity. Within the group with multimorbidity, 58.0% experienced sustained impairment in IC, a notably higher percentage compared to those with no disease (45.6%) and those with only one disease (50.6%). Compared to those with no disease, multimorbidity was significantly associated with IC sustained impairment after adjusting for all covariates (OR = 1.64; 95%CI = 1.20-2.23). Among the 2314 participants with multimorbidity, three multimorbidity patterns were identified: metabolic pattern (27.1%), arthritis-stomach pattern (64.5%), and respiratory pattern (8.4%). Compared to the metabolic pattern, the arthritis-stomach and respiratory patterns exhibited a higher risk of sustained impairment in IC; however, there was no significant difference observed between the latter two multimorbidity patterns.</p><p><strong>Conclusions: </strong>Multimorbidity was associated with sustained impairment IC among older Chinese adults. Compared to the metabolic pattern, both the arthritis-stomach and respiratory patterns exhibited a notably elevated risk of sustained impairment IC.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1207-1216"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of antibiotic use in nursing homes for suspected urinary tract infections: comparison across five European countries.","authors":"Matilde Bøgelund Hansen, Jesper Lykkegaard, Malene Plejdrup Hansen, Carl Llor, Ana Garcia Sangenis, Pia Touboul-Lundgren, Pascale Bruno, Ruta Radzeviciene, Lina Jaruseviciene, Marilena Anastasaki, Christos Lionis, Anna Kowalczyk, Maciek Godycki-Ćwirko, Beatriz Gonzalez Lopez-Valcárcel, Fabiana Raynal Floriano, Athina Chalkidou, Lars Bjerrum, Jette Nygaard Jensen","doi":"10.1007/s41999-025-01185-0","DOIUrl":"10.1007/s41999-025-01185-0","url":null,"abstract":"<p><strong>Purpose: </strong>Antibiotic use is the main driver of bacterial antimicrobial resistance. Urinary tract infections (UTIs), for which antibiotics are often prescribed, are among the most common infections among residents in nursing homes. This study aimed to estimate and compare the appropriateness of antibiotic use for suspected UTIs among nursing home residents across five European countries. Both the decision to treat and the choice of antibiotics used were explored.</p><p><strong>Methods: </strong>This cross-sectional study used the Audit Project Odense (APO) method. The appropriateness of the treatment decision for UTIs was evaluated according to symptom presentation in residents without indwelling urinary catheters. The choice of antibiotic used for treatment was evaluated according to the first-line antibiotic recommended for the treatment of UTIs in the respective countries. Data were collected through an institutional sign-up questionnaire and a clinical case registration chart. All residents in new or ongoing treatment with systemic antibiotics were registered during a 6-week period between February and April 2022.</p><p><strong>Results: </strong>A total of 70 nursing homes or wards registered 508 antibiotic treatments for suspected UTIs. The proportion of antibiotics prescribed for UTIs to nursing home residents with no specific UTI symptoms varied from 10% in Poland to 68% in Spain. The proportion of treatments with the first-line choice of antibiotics for UTIs also varied from 28% in France and Poland to 55% in Spain.</p><p><strong>Conclusion: </strong>There was a substantial proportion of potentially inappropriate antibiotic treatments, with notable variation among the countries studied.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1453-1464"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using electronic health records to understand multimorbidity in older people: a scoping review.","authors":"Lucy Smith, Glenn Simpson, Neil Singh, Lucy Wells, Hajira Dambha-Miller","doi":"10.1007/s41999-025-01231-x","DOIUrl":"10.1007/s41999-025-01231-x","url":null,"abstract":"<p><strong>Purpose: </strong>The increasing availability of electronic health records (EHR), encompassing routinely collected general practice, hospital, and linked national census data, presents significant opportunities to enhance our understanding of multimorbidity at scale. However, the utility and clinical impact of EHR in advancing multimorbidity research, particularly concerning older adults who are disproportionately affected, remain unclear. This study aims to synthesise the literature on the use of EHR to investigate multimorbidity in individuals aged 65 years and older.</p><p><strong>Method: </strong>We conducted a scoping review, performing literature searches across Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies published from the inception of these databases until September 2024 were included if they investigated multimorbidity using EHR in individuals aged 65 years and older. The extracted data were synthesised using an iterative descriptive process.</p><p><strong>Results: </strong>A total of 753 studies were identified, with 46 meeting the eligibility criteria for inclusion. All studies originated from high-income countries, primarily the USA and Spain. Research focused on areas such as healthcare utilisation and costs, predictive modelling based on patient disease profiles, specific clustering models, relationships between multimorbidity and particular disease categories, aetiology, polypharmacy, and the accuracy of EHR. Reporting on data completeness, sociodemographic characteristics, and the inclusion of ethnic and social diversity within EHR datasets was notably limited.</p><p><strong>Conclusions: </strong>The use of EHR to elucidate multimorbidity is expanding and holds substantial promise. However, enhanced reporting of data completeness and sociodemographic characteristics is essential to facilitate the effective translation of findings into real-world populations. Neglecting these aspects, risks exacerbating inequality gaps for individuals 65 years and older with multimorbidity.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1163-1206"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beneficial outcomes of medication review in patients with hip fractures: a systematic review.","authors":"Dina Aprillia Ariestine, Taro Kojima, Fakhriza Hidayati Siregar, Alvin Ivander","doi":"10.1007/s41999-025-01252-6","DOIUrl":"10.1007/s41999-025-01252-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to analyze medication review efficacy toward clinical outcomes in older adults with hip fractures.</p><p><strong>Methods: </strong>A systematic search was conducted using the modified keywords \"medication review,\" \"polypharmacy,\" and \"hip fractures\" to find relevant studies. Following the PRISMA guidelines, we reviewed published studies from 2014 to 2024. A total of 21 studies have been identified, six of which reported medication reviews for older adults with hip fractures.</p><p><strong>Results: </strong>The findings highlight the critical need for a multi-faceted strategy to address the challenges of polypharmacy in older adults with hip fractures. A higher number of medications is associated with some adverse outcomes, such as increased hospitalization rates, longer recovery times, and a greater incidence of pressure ulcers. Although minimizing inappropriate medications may show some positive results, focusing solely on medication management is insufficient in this vulnerable population.</p><p><strong>Conclusion: </strong>Medication reviews have substantially mitigated medication-related issues, including costs, drug efficacy, and patient discomfort. Nevertheless, clinical outcomes have yet to exhibit significant improvement, which presents an opportunity for further research to explore the potential benefits of medication reviews in enhancing the care of patients with hip fractures. A holistic approach, which consists of medication review, patient education, and tailored rehabilitation programs, may be essential to improve recovery, decrease hospitalization rates, and prevent adverse events.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1341-1352"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes.","authors":"Virginia Boccardi, Gülistan Bahat, Cafer Balci, Isabelle Bourdel-Marchasson, Antoine Christiaens, Lorenzo Maria Donini, Sibel Cavdar, Stefania Maggi, Serdar Özkök, Tajana Pavic, Stany Perkisas, Stefano Volpato, Muhammad Shoaib Zaidi, Andrej Zeyfang, Alan J Sinclair","doi":"10.1007/s41999-025-01168-1","DOIUrl":"10.1007/s41999-025-01168-1","url":null,"abstract":"<p><strong>Purpose: </strong>This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population?</p><p><strong>Methods: </strong>The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes.</p><p><strong>Results: </strong>The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group.</p><p><strong>Conclusion: </strong>This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1231-1247"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and enablers to general practitioner referral of older adults to hearing care: a systematic review using the theoretical domains framework.","authors":"E C Davine, P A Busby, S Peters, J J Francis, J Z Sarant","doi":"10.1007/s41999-024-01124-5","DOIUrl":"10.1007/s41999-024-01124-5","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to identify and synthesise the literature regarding barriers and enablers affecting general practitioner (GP) referral to hearing care for their older patients (50 years and over).</p><p><strong>Methods: </strong>A search of peer-reviewed articles reporting primary empirical studies was conducted across CINAHL, Ovid Medline and Scopus, with search terms relating to the search domains \"General Practitioner\", \"Referral\", \"Hearing loss\", and \"adults aged 50 and older\". Qualitative and quantitative studies were included if they reported barriers or enablers to referral. A mixed-methods approach was used to synthesise the findings of the included studies, firstly into the Theoretical Domains Framework of behaviour change, and then into more granular sub-themes.</p><p><strong>Results: </strong>The initial search yielded 859 unique studies. Title and abstract screening identified 21 studies of possible relevance, and full text review identified seven studies for inclusion in this review. A total of 19 unique themes were identified and coded to 10 of the 14 domains of the Theoretical Domains Framework; however thematic overlap between studies was low and fewer than half of these themes were consistently identified as either a barrier or enabler. Four main barriers to referral to hearing care were identified: Lack of time, lack of familiarity with diagnostic criteria and tools, lack of knowledge of treatments and higher relative importance of other health conditions.</p><p><strong>Conclusion: </strong>The minimal overlap of themes and low agreement on which of these constitute barriers and enablers for referral indicates a need for further research to provide greater clarity in this area and explain the heterogeneity of these results.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1507-1518"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}