Search Results (1,013)

Background/Objectives: Tinea capitis is traditionally a childhood infection, yet recent reports describe its emergence among older adults. In this population, hormonal changes, comorbidities, and frequent corticosteroid use may modify clinical presentation and delay diagnosis. This systematic review aimed to consolidate current evidence on Tinea capitis in individuals aged 65 years or older, focusing on epidemiologic, clinical, and mycological characteristics as well as therapeutic outcomes. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in the PubMed, Scopus, and SciELO databases for studies published between 1978 and February 2025. Eligible articles included case reports, case series, and clinical studies involving patients ≥65 years with confirmed Tinea capitis. Two independent reviewers screened and extracted data on demographics, comorbidities, risk factors, clinical manifestations, diagnostic methods, etiologic agents, and treatment response. Results: Sixty-three studies comprising 91 patients from 19 countries were included. Most cases originated from Spain (n = 27) and the United States (n = 12). Females accounted for 90.1% of cases. The leading comorbidities were diabetes mellitus (37.5%) and hypertension (21.9%). Topical corticosteroid use (40.7%) and pet exposure (27.8%) were frequent risk factors. Misdiagnosis occurred in 37.4% of patients, commonly as seborrheic dermatitis or erosive pustular dermatosis. The inflammatory variant predominated (65.9%), with kerion reported in 42.9%. Microsporum canis was the predominant agent (26.9%, n = 24), while Trichophyton rubrum and Trichophyton tonsurans were equally frequent (both 19.1%, n = 17). Systemic antifungal therapy achieved clinical cure in 91.2% of cases. Conclusions: Tinea capitis in the elderly is an underrecognized and often misidentified scalp infection. Awareness of its variable presentation and systematic mycological assessment are crucial to ensure timely therapy and prevent scarring alopecia. Full article

Background: Kidney transplantation activity at the University Hospital of Guadeloupe was briefly interrupted at the onset of the COVID-19 pandemic, reflecting the global impact of this health crisis on organ transplantation. This study assessed patient and graft recovery in 335 recipients transplanted between 2013 and 2023, comparing those transplanted before 2020 and after the resumption of activity. The objective was to evaluate changes in recipient profiles, surgical parameters, and post-transplant outcomes following this disruption. Methods: This retrospective cohort included all kidney transplants performed at the University Hospital of Guadeloupe over a ten-year period. Most patients (70%) received transplants before 2020, with 30% afterward. All grafts were ABO-compatible, and 98.2% were from deceased donors. Trends in transplant activity were analyzed to identify variations over time, with a peak observed in 2018, followed by a decline until 2021 and a progressive recovery from 2022. Comparative analyses were performed to examine disparities in donor and recipient characteristics, ischemia durations, and outcomes between the two periods. Results: After 2020, recipients were more likely to be elderly (≥70 years), immunized, obese, have heterozygous sickle cell disease, or have polycystic kidney disease (p < 0.05). Mean cold ischemia time decreased (p = 0.009), while warm ischemia time increased (p < 0.001), reflecting procedural and logistical adaptations. Graft survival remained stable, with 97.5% at 6 months and 89.8% at 4 years for transplants before 2020, versus 100% and 96.9%, respectively, after 2020 (p = 0.160). Patient survival did not differ significantly between periods (p = 0.199). Independent factors associated with mortality included recipient age ≥ 60 years, diabetes, graft failure, transplantation before 2020, cold ischemia time ≥ 1200 min, and graft pyelonephritis. Conclusions: Despite the temporary suspension of activity and an increased proportion of transplants with expanded criteria after 2020, graft recovery and patient survival were not adversely affected. These findings suggest that kidney transplantation in Guadeloupe demonstrated strong resilience and capacity for adaptation during and after the COVID-19 crisis, maintaining outcomes comparable to the pre-pandemic period. Full article

Polypharmacy and the use of potentially inappropriate medications (PIM) are prevalent issues among institutionalized older adults, contributing to adverse drug events and decreased quality of life. This study aimed to describe the sociodemographic and clinical characteristics associated with polypharmacy and the use of PIM in elderly people in nursing homes. A cross-sectional descriptive study was conducted among 151 residents aged ≥ 65 years. Data was extracted from institutional records. The mean age of participants was 86.48 ± 8.00 years; 71.5% were female. Excessive polypharmacy was observed in 49.7% of residents. The mean number of medications was 9.66 ± 4.18, with nervous system drugs being the most prescribed (3.73 ± 2.31). PDDIs were detected in 94% of the sample and PIMs were present in 82.8% of residents. The most common PIMs were proton pump inhibitors (ATC A) and anxiolytics (ATC N). Binary logistic regression identified two independent predictors for PIMs: the total number of medications (AOR = 1.259) and the use of ATC A (Alimentary tract and metabolism) medications (AOR = 2.315). Conversely, age and sex were not significant predictors. The study reveals a critical prevalence of excessive polypharmacy, PIM use, and PDDIs among institutionalized elderly in the Algarve. These findings underscore the urgent need for systematic, multidisciplinary medication reviews in Portuguese nursing homes to promote safer and more rational prescribing practices. Full article

Frailty has emerged as a critical determinant of clinical outcomes in elderly patients, shaping postoperative recovery in crucial orthopedic events, such as hip fractures. The purpose of the present study is to examine the impact of frailty syndrome on muscle strength and joint range of motion in the non-fractured lower extremity and upper extremities of hospitalized older adults following hip fracture surgery. The sample consisted of 60 elderly patients recovering from either intracapsular or extracapsular hip fractures. Participants were categorized into either a frail or non-frail group, determined by the Clinical Frailty Scale. The outcome measures of muscle strength and range of motion of the upper and lower extremities were assessed by valid instruments, including a hand-held dynamometer, the Medical Research Council scale, and a digital goniometer. Statistical comparisons between groups were conducted using the independent samples t-test and the Mann–Whitney U test. The results showed that the non-frail group demonstrated greater active range of motion in the shoulder bilaterally (right: t = −2.85, left: U = 628.00, p < 0.05), elbow flexion bilaterally (right: U = 589.50, left: U = 592.50, p < 0.05), hip flexion (U = 679.50, p < 0.01), knee extension (t = −3.07, p < 0.05), and ankle dorsiflexion (t = −2.36, p < 0.05). Regarding the muscle strength, the non-frail group showed significantly higher grip strength bilaterally (right: U = 754.50, left: U = 713.50, p < 0.001), as well as greater strength in hip flexion (U = 641.00, p < 0.01) and ankle dorsiflexion (U = 619.50, p < 0.01). Frailty may negatively influence the muscle strength and joint mobility in non-fractured extremities, thereby hindering postoperative physical recovery in older adults with hip fractures. Further research involving a larger and more homogeneous sample may predict falls in elderly patients after hip or knee surgery using the Clinical Frailty Scale. Full article

Background: Diabetic neuropathy (DN) may impair balance and gait, increasing the risk of falls in elderly patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate whether the presence and severity of DN are associated with balance and mobility impairment as well as with increased fear of falling in patients with T2DM. Methods: A total of 124 adults with T2DM underwent neuropathy assessment with the Michigan Neuropathy Screening Instrument (MNSI) and sudomotor testing (SUDOSCAN). Balance and fall risk were evaluated using the Berg Balance Scale (BBS), Timed Up and Go (TUG), Falls Efficacy Scale—International (FES-I), and Fear of Falling Questionnaire—Revised (FFQ-R). Comparison of parameters between patients with vs. without DN, correlations, and multivariable linear regressions (DN components as predictors) were performed. Results: Compared with those without DN, participants with DN had higher FES-I (31.0 vs. 21.0) and FFQ-R (56.0 vs. 42.0) scores and lower BBS (42.0 vs. 46.0). TUG did not differ significantly (11.8 vs. 11.25 s). In multivariable models, higher MNSI questionnaire and objective scores independently predicted lower BBS (β = −0.74 and −1.1, respectively) while only the MNSI questionnaire predicted higher TUG (β = 0.43). For fear of falling, the MNSI questionnaire predicted higher FES-I (β = 1.66) and both MNSI components predicted higher FFQ-R (β = 2.31 and 1.7, respectively). Leg SUDOSCAN values were not associated with BBS, TUG, FES-I, or FFQ-R. Conclusions: DN is associated with impaired balance and greater fear of falling. Neuropathy burden, particularly patient-reported symptoms, relates to worse performance and confidence, whereas sudomotor impairment alone does not. Full article

Background: Colorectal cancer (CRC) mainly affects older adults, yet elderly patients are underrepresented in outcomes research. Accurate risk stratification tools, such as the Charlson Comorbidity Index (CCI), are essential for guiding surgical decisions in this group. Methods: We conducted a retrospective review of patients aged 75 years or older who underwent colorectal cancer resection at a tertiary centre between January 2019 and September 2024. Clinical, pathological, and molecular data were analyzed. The primary outcome was a composite of major postoperative complications (Clavien–Dindo grade 3 or higher) or 30-day mortality, stratified by CCI (5 or higher vs. less than 5). Statistical tests included chi-square, Fisher’s exact, and Mann–Whitney U as appropriate. Results: The median age was 81 years (range 75–97), with 59.7% male. CCI ≥ 5 was observed in 24.6% (51/211). The primary composite outcome of major postoperative complications or 30-day mortality occurred in 15/51 (29.4%) patients with a CCI ≥ 5 compared to 19/160 (11.9%) with a CCI < 5 (p = 0.04). Major complications occurred in 18.5% (39/211) of cases, and the 30-day mortality rate was 3.3% (7/211). Laparoscopic resection was independently protective in multivariate analysis (adjusted OR 0.37, p = 0.048), while age ≥85 and emergency presentation were not statistically significant predictors. Conclusions: Colorectal resection in patients aged ≥75 is linked with acceptable morbidity and low short-term death rates. A CCI ≥ 5 significantly predicts adverse outcomes and should be included in preoperative assessments. Minimally invasive surgery seems advantageous and should be considered, when possible, to enhance results in this high-risk group. Full article

Background: Transcranial pulse stimulation (TPS) is an innovative non-invasive brain stimulation technique using ultrasonic waves. Despite its application in first clinical trials, so far, no systematic overview of its effects across different patient populations has been conducted. Objectives: This systematic review and meta-analysis examines the effects of TPS on cognitive, motor, and mental health outcomes as well as on patient safety in neurological and psychiatric disorders. Methods: We conducted a literature search in MEDLINE, PsycINFO & PsycArticles, CENTRAL, Web of Science, and Google Scholar, covering the period from January 2013 to December 2024. Two independent reviewers conducted the study selection, data extraction, and quality assessment. To evaluate the risk of bias, the RoB2 tool was used for randomized studies and the ROBINS-I tool for non-randomized studies. Results: A total of fifteen studies (five randomized controlled trials and ten non-blinded, single-arm trials) including both adolescent and adult and elderly patient populations (Alzheimer’s disease, mild cognitive impairment, Parkinson’s disease, major depressive disorder, autism spectrum disorder, attention-deficit hyperactivity disorder) were included. Positive effects of TPS intervention on cognitive, motor, and mental health outcomes, as well as a high safety profile, were demonstrated in a majority of the studies and outcome parameters. However, limitations of the included studies persist due to small sample sizes, lack of control groups, retrospective analyses, and heterogeneity of study protocols and measurements. Conclusions: TPS is a safe and promising method for treating neurological and psychiatric disorders. To better assess the potential of this innovative technique, standardized protocol procedures and larger, sham-controlled trials are needed. Full article

Background: Influenza vaccination reduces morbidity and mortality in older adults. This study identifies characteristics and reasons for vaccination uptake among the elderly to inform strategies to improve coverage. Methods: We conducted a cross-sectional survey in December 2024 among community-dwelling adults aged ≥ 60 years across six Chinese cities. Data collected included socio-demographic and health characteristics, influenza vaccine awareness and uptake, reasons for vaccination or non-vaccination, and intentions for future vaccination. Univariate and multivariable logistic regression were used to identify factors associated with vaccination. To explore motivation patterns, co-occurrence networks of vaccination reasons were constructed, and k-medoids clustering was applied. Results: Among 13,363 adults aged ≥ 60 years, influenza vaccination coverage was 34.0%. Higher education and income, being married, having health insurance, poor self-care ability, and chronic obstructive pulmonary disease were independently associated with vaccination. Vaccinated individuals reported more positive attitudes and were mainly motivated by family and doctor recommendations as well as perceived vaccine effectiveness, with four motivation profiles discovered: social recommendation, comprehensive confidence, clinician-guided, and self-reliant confidence. Among unvaccinated participants, the main reasons for non-vaccination were mild influenza symptoms and the influence of family and friends, forming four motivation profiles: safety concern, low-perceived risk, social influence, and perceived ineffectiveness. Conclusions: Influenza vaccination among older Chinese adults remains suboptimal. Tailored interventions leveraging healthcare provider endorsement, family and social support, and policy-driven strategies such as free or subsidized vaccination are needed, particularly for high-risk populations. Full article

Periprosthetic joint infection (PJI) remains one of the most serious complications after total joint arthroplasty. This retrospective 1:1 matched case–control study investigated preoperative predictors and patient phenotypes associated with PJI in 182 patients (91 cases, 91 controls) undergoing hip or knee arthroplasty between 2013 and 2024. Variables with skewed distributions were log-transformed, and multivariable logistic regression with LASSO regularization identified independent risk factors. Unsupervised K-means clustering was applied to perioperative features to explore data-driven patient phenotypes. Preoperative anemia (OR 5.91, p = 0.026), higher ASA score (OR 1.77, p = 0.033), and surgical delay (OR 1.67, p = 0.024) independently predicted infection, while age and CRP showed non-significant trends. The resulting five-variable preoperative model achieved an AUC of 0.718 (optimism-corrected AUC of 0.661) for infection prediction. Clustering analysis revealed three phenotypes: anemia-dominated, elderly but short-procedure, and high surgery duration with significantly different infection rates (χ² = 23.5, p < 0.001) but similar mortality (p = 0.068). This integrative approach combining regression-based prediction and phenotype discovery enables clinically interpretable, preoperatively applicable risk stratification. The findings identify anemia, comorbidity burden, and surgical delay as key modifiable targets for preventive optimization before arthroplasty. External validation and recalibration to population-level incidence are warranted before clinical implementation. Full article

Sarcopenic obesity (SO) is a syndrome characterized by a gradual reduction in skeletal muscle mass, strength, and function coupled with excessive fat accumulation, which considerably increases the risk of metabolic disorders and atherosclerotic cardiovascular disease. Owing to its extensive influence on the health of elderly individuals and distinct pathophysiological mechanisms, SO should be considered an independent clinical condition. Atherosclerosis, the fundamental pathophysiological underpinning of atherosclerotic cardiovascular disease, has garnered increased interest because of its association with SO. Existing research indicates that SO may synergistically promote atherosclerosis development through multiple pathways, including hormonal dysregulation, adipo-myokine imbalance, insulin resistance, chronic low-grade inflammation, and lipid metabolic abnormalities. The current literature gaps predominantly encompass the absence of standardized diagnostic criteria for SO, inconsistent results in studies investigating the relationship between SO and atherosclerosis, and inadequate causal validation. Studies indicate associations between SO and carotid atherosclerosis, coronary atherosclerosis, arterial stiffness, and 10-year atherosclerotic cardiovascular disease risk; however, conclusions remain inconsistent, and most studies are cross-sectional. Additionally, this field has insufficient focus on peripheral atherosclerosis, such as in the lower extremities. Moreover, the pathophysiological mechanisms remain unclear. A complex vicious cycle potentially exists among decreased muscle mass and function, fat accumulation, and atherosclerosis, a relationship that has not received sufficient attention. Therefore, this review aims to integrate existing evidence, summarize advances in diagnostic criteria for SO, review the epidemiological association between sarcopenic obesity and atherosclerosis, and analyze the reasons for heterogeneity in conclusions. It further explores potential pathophysiological mechanisms, delving into the vicious cycle among declining muscle mass and function, fat accumulation, and atherosclerosis. Finally, this review proposes future research directions, including diagnostic standardization, in-depth mechanism exploration, conducting prospective cohort studies to validate causal relationships, and developing intervention targets for SO–Atherosclerosis comorbidity. Full article

Background/Objectives: This study aimed to comprehensively characterize the prevalence and patterns of drug-induced hospitalizations and death and to identify predictors strongly associated with drug-induced death. Methods: This study analyzed 29,438 serious adverse event (SAE) reports submitted to the Korea Adverse Event Reporting System (KIDS KAERS DB) database between January 2019 and December 2023. Disproportionality analysis was conducted to detect drug–event associations, and multiple logistic regression was performed to identify independent predictors of mortality. Results: Mortality accounted for 7.53% (n = 2217) and hospitalization for 93.53% (n = 27,532). The strong signals for drug-induced death were observed with steroids (ROR 3.81, 95% CI 3.39–4.27), antidotes (ROR 3.65, 95% CI 2.15–6.18), and anticoagulants (ROR 2.01, 95% CI 1.73–2.34). Immunosuppressants (ROR 9.17, 95% CI 4.75–17.70), diuretics (ROR 3.83, 95% CI 1.42–10.31), and antihyperlipidemics (ROR 3.65, 95% CI 1.72–7.69) were strongly associated with hospitalizations. In multivariate regression, men, aging (OR 1.02, 95% CI 1.02–1.03), use of antidotes (OR 11.37, 95% CI 6.59–19.62), steroids (OR 5.78, 95% CI 4.71–7.08), and anticoagulants (OR 3.60, 95% CI 2.90–4.46) were independent predictors of drug-induced mortality. Conclusions: This study emphasizes the need for targeted surveillance and risk-mitigation strategies focusing on anticoagulants, steroids and immunosuppressants, particularly among elderly and multimorbid populations. Full article

Background/Objectives: Maintaining independent mobility among older adults requires complex cognitive and physical health and is influenced by various health-related factors. This study sought to examine the relationship between health-related factors and driving among community-dwelling older adults by comparing the health status of currently driving individuals and those who have ceased driving. Methods: A secondary data analysis was conducted using the 2023 Korean Elderly Survey, collected between 4 September and 12 November 2023. A total of 4114 individuals aged 65 years or older were included. Statistical analyses were performed using chi-square tests, independent t-tests, and weighted binary logistic regressions via IBM SPSS for Windows. Results: Significant health-related factors for driving cessation included having ≥2 chronic diseases (OR = 1.22, p = 0.041), diagnosed depression (OR = 3.64, p = 0.030), Instrumental Activities of Daily Living dependency (OR = 1.67, p = 0.001), visual discomfort (OR = 1.18, p = 0.048), depression risk (OR = 1.34, p = 0.015), suspected cognitive impairment (OR = 1.73, p < 0.001), and poor self-rated health (OR = 1.21, p = 0.029). None of the participants with Parkinson’s were currently driving, whereas polypharmacy (≥5 medications) was not statistically significant (OR = 0.77, p = 0.222). Chronic diseases that may affect driving were also not statistically significant. Conclusions: This study highlights the fact that older drivers may have difficulty recognizing health-related risks that affect driving. To support safe mobility, it is essential to implement a health-centered assessment of driving fitness, including an appropriate evaluation cycle, and promote continuous education to raise awareness among older adults. Full article

Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of short-term mortality, particularly in elderly patients with multimorbidity and frailty. Conventional models such as the GRACE score provide robust prognostication but do not incorporate comorbidity or frailty burden. This study investigated the prognostic value of combining the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and Clinical Frailty Score (CFS) with GRACE in predicting one-month mortality in older ACS patients. Methods: A single-center, retrospective cohort study was conducted including 90 patients aged ≥65 years admitted with ACS. Demographic, clinical, echocardiographic, and laboratory data were collected. CIRS-G, CFS, and GRACE scores were calculated at admission. The primary endpoint was one-month all-cause mortality. Statistical analyses included group comparisons, correlation tests, logistic regression, and ROC curve analysis. Results: The mean age was 74.8 ± 6.6 years, and 73.3% were male. At one month, mortality was 8.9% (n = 8). Non-survivors had significantly higher CIRS-G (median 18.5 vs. 14.0, p = 0.006), CFS (6.0 vs. 4.0, p = 0.008), and GRACE scores (183 vs. 122, p < 0.001), and lower ejection fraction (32.5 vs. 50.0, p < 0.001) compared with survivors. Logistic regression identified GRACE as the only independent predictor of mortality (OR = 1.081 per 10-point increase, p = 0.044). ROC analysis showed GRACE had the highest discriminative performance (AUC = 0.919), while CIRS-G (AUC = 0.796) and CFS (AUC = 0.777) also demonstrated significant predictive value. The combined CIRS-G + CFS model provided comparable discrimination (AUC = 0.785; sensitivity 75%, specificity 87%). Conclusions: GRACE remains the strongest independent predictor of one-month mortality in elderly ACS patients; however, comorbidity and frailty scores also contribute meaningful prognostic information. Integrating these geriatric assessments with traditional risk models may improve individualized risk stratification and management. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity, disability, and loss of independence in the elderly population. The optimal management of these fractures remains debated, especially regarding the balance between conservative treatment and minimally invasive surgical techniques such as percutaneous vertebroplasty (VP). This study aimed to compare clinical and radiological outcomes of VP and conservative management in patients with acute OVCFs. Materials and methods: A retrospective observational cohort study was conducted on 120 patients with acute OVCFs treated either conservatively or through percutaneous VP using polymethylmethacrylate (PMMA) cement. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Roland–Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Evaluations were performed at baseline and at 1, 3, 6, and 12 months post-treatment. Radiological follow-up assessed fracture healing and new vertebral fractures. Results: Patients treated with VP experienced significantly faster pain relief and functional improvement than those managed conservatively, with marked differences in VAS, RMDQ, and ODI scores within the first month (p < 0.01). By 12 months, outcomes converged between groups, with comparable pain and functional levels. No major complications were reported; cement leakage was asymptomatic, and no neurological or systemic adverse events occurred. Radiological healing was satisfactory in both groups, without increased risk of adjacent fractures in the VP group. Conclusions: Percutaneous vertebroplasty resulted in faster short-term improvement compared with conservative treatment, while functional outcomes converged over time. The retrospective, non-randomized design limits causal inference. Full article

Obesity in elderly individuals is associated with increased levels of inflammatory biomarkers, indicating a state of chronic low-grade inflammation, which has been recently termed as adipaging. Several studies have demonstrated this relationship: overweight and obese middle-aged and elderly individuals show elevated levels of inflammatory markers like CXCL-16, IL-6, and adipokines compared to normal weight counterparts. These markers positively correlate with anthropometric parameters indicating increased cardiovascular risk. C-reactive protein (CRP) and fibrinogen levels increase progressively with higher obesity classes in the general population, including the elderly. For instance, CRP levels nearly double with each increase in weight class compared to normal weight individuals. Additionally, the presence of obesity-related comorbidities like hypertension or diabetes further elevates these inflammatory markers. In conclusion, obesity in the elderly is characterized by elevated levels of various inflammatory biomarkers, reflecting a state of chronic low-grade inflammation. This inflammatory state may contribute to the development of obesity-related comorbidities. The clarification of the complementary or independent role of these biomarkers in aging and obesity could lead to targeted therapeutic interventions in this vulnerable population group. Full article