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Background Sarcopenia is a complex and multifactorial condition, and recent studies have explored the role of neurological markers in its diagnosis and prediction. Although associations have been identified between reduced muscle strength, slow walking speed and elevated neurofilament levels (NfL), long‐term evidence and sex‐based differences in muscle health and sarcopenia remain underexplored. This study investigates the relationship between baseline blood biomarkers of Alzheimer's disease (AD) and long‐term sarcopenia trajectories in a Swedish cohort of older adults, while also examining potential sex‐based differences. Methods The study analysed 2291 participants aged ≥ 60 years (61.5% females) over a 12‐year follow‐up, classifying sarcopenia into three stages (no, probable and confirmed sarcopenia) using modified EWGSOP2 criteria. Muscle strength was assessed via handgrip or chair stand tests and muscle mass via calf circumference. Baseline data on AD biomarkers were collected. Latent class mixed models identified two sarcopenia trajectories: one with early progression accelerating around age 70 years and another with later progression accelerating after age 80 years, observed in both sexes. Regression analyses examined the associations between AD biomarkers, sarcopenia progression speed and incidence. Results Probable and confirmed sarcopenia were more prevalent in females (28.2% vs. 14.1% and 7.6% vs. 6.1%, respectively; p < 0.001). All AD biomarkers showed significantly different distributions across the three sarcopenia stages. Analysis revealed that only p‐tau181 (OR 1.24 [1.09; 1.42], p = 0.002) and NfL (OR 1.56 [1.30; 1.91], p < 0.001) were independently associated with worse sarcopenia trajectories. These associations remained significant in individuals over 78 years (p‐tau181: OR 1.32 [1.11; 1.59], p = 0.003; NfL: OR 1.77 [1.40; 2.28], p < 0.001) and in males (p‐tau181: OR 1.39 [1.14; 1.73], p = 0.003; NfL: OR 1.38 [1.11; 1.82], p < 0.001). In females, only NfL remained significantly associated. NfL was significantly linked to sarcopenia development (HR 1.20 [1.10; 1.30], p < 0.001), with similar findings for females (HR 1.40 [1.20; 1.63], p < 0.001) and older individuals (HR 1.35 [1.15; 1.58], p < 0.001). Notably, both NfL and p‐tau181 were significantly associated with sarcopenia incidence in younger participants (< 78 years) and in males, independent of dietary patterns. Conclusions Our study, unique for its long follow‐up duration, explores the relationship between sarcopenia and neurodegeneration biomarkers, highlighting the role of p‐tau181 and NfL in the progression of the condition. These biomarkers could potentially serve as indicators for the early detection of sarcopenia, particularly in older adults and males, offering insights that may contribute to personalized screening and targeted interventions.

Background Type 2 diabetes mellitus (T2DM) is a common chronic disease in older adults and a leading cause of death and disability worldwide. While recent diabetes guidelines introduce the Comprehensive Geriatric Assessment (CGA) as a key tool for managing diabetes treatments, evidence of its effectiveness in delaying functional impairment and achieving patient-reported outcomes (PROs) remains lacking. This article describes the protocol of a randomized parallel-group controlled trial aimed at evaluating the effect of a CGA-guided plan of care on physical performance changes over time as compared with a usual-care group. Methods Three centers will participate in this study, each recruiting 60 older adults with T2DM from their outpatient clinics. Eligible patients will be randomized into either the usual-care or intervention group in a 1:1 allocation ratio. All patients will receive standard care according to current diabetes guidelines and undergo CGA. For the intervention group, the CGA will guide a multidimensional intervention. Follow-up visits will be scheduled at 6 and 12 months. The primary outcome will be the change in physical performance at the end of the follow-up, as assessed by the Short Physical Performance Battery score, with a comparison between the control and intervention groups. Discussion From this study, we will contribute to the growing evidence of the impact of CGA on the assessment and management of older patients with T2DM and its complications. Results will be disseminated through a peer-reviewed journal and presentations at conferences. Final results will be shared with a broader audience through collaborations with patients with diabetes and their caregiver association at local and national levels. The findings will inform the extent to which a CGA-driven care plan may significantly reduce functional impairment and improve patient and caregiver satisfaction. Trial registration ClinicalTrials.gov ID: NCT06842459 – registered February 24, 2025 – retrospectively registered.

Background The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older. Methods An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023. The questionnaire covered hospital profiles, geriatric consultation practices, risk assessment tools, discharge processes and perspectives on geriatric emergency care. Results In this mixed method research, 219 structured interviews were collected. The majority of physicians were employed in hospitals, with 54.7% being geriatricians. Critical gaps in older patient’s care were identified, including the absence of dedicated care pathways, insufficient awareness of screening tools, and a need for enhanced professional training. Conclusions Tailored protocols and geriatric educational programs are crucial for improving the quality of emergency care provided to older individuals. These measures might also help relieve the burden on the Emergency Departments, thereby potentially enhancing overall efficiency and ensuring better outcomes.

Background: The blood-cerebrospinal fluid barrier (BCSFB) regulates substance exchange between the blood and cerebrospinal fluid (CSF). Objectives: This study investigated sex-related differences in the CSF/blood quotient of albumin (QAlb), a BCSFB function biomarker, in older patients undergoing spinal anesthesia for hip fracture (HF) surgery. Design: Seventy-eight patients aged ⩾65 years (18 males, 60 females) undergoing HF repair were enrolled. Methods: Baseline variables, including age, sex, diagnosis of dementia, were collected. The BCSFB function was assessed using the CSF/blood quotient of albumin (QAlb). Results: Dementia prevalence was similar in men (22.2%) and women (17.6%), as was postoperative delirium (POD) (men 27.8%, women 33.3%). Despite similar demographics, men exhibited significantly higher CSF albumin concentrations (P = .031) and QAlb values (P = .023) compared to women. No differences were found in QAlb value between patients with or without dementia in male (P = .645) and female (P = .102) subgroups. Moreover, no differences in QAlb value emerged between those with or without POD in males (P = .173) and females (P = .225). Conclusion: Despite sample size and sex imbalance, our analyses highlight a sex-related discrepancy in BCSFB function in older patients underscoring the need for sex-specific QAlb reference ranges. Normalization of QAlb values by sex may be essential to prevent over- or underestimation of BCSFB dysfunction in the 2 sexes. Future studies with larger, balanced cohorts may clarify these differences. Plain Language Summary When someone has a hip fracture and needs surgery, doctors often use spinal anesthesia. This study looked at the fluid around the brain and spinal cord (called cerebrospinal fluid or CSF) and compared it to the blood in older patients who had this type of surgery. The wall between the blood and the CSF, called the blood-CSF barrier, controls what goes in and out of the brain fluid. We measured a specific marker, called QAlb, to see how well this barrier was working. We wanted to know if there were any differences between older men and women. We studied 78 patients aged 65 and older who had hip fracture surgery. We noted whether they were male or female and if they had dementia. We also checked if they developed confusion after surgery (delirium). We found that even though the men and women in our study were similar in age and how many had dementia or delirium, the men had higher levels of a protein called albumin in their CSF and higher QAlb values compared to the women. This suggests that the barrier between their blood and brain fluid might work differently. We didn’t find a clear link between the QAlb levels and whether someone had dementia or developed delirium, in either men or women. Our findings suggest that there might be important differences in how the blood-CSF barrier functions in older men and women. This means that the normal ranges for the QAlb marker might need to be different for men and women. We need more research with a larger and more equal number of men and women to better understand these differences. This could help us improve care for older patients after hip fracture surgery.

Background Prognostic stratification in older patients with sepsis is challenging due to frailty and the role of multidrug-resistant (MDR) infections. Aims To test the predictive accuracy of different frailty measures, blood routine tests and MDR infection status for in-hospital mortality among older patients with sepsis. Methods Consecutive patients aged ≥ 65 years with qSOFA ≥ 2 and positive cultures admitted to a tertiary care hospital were enrolled. Frailty was assessed using the Clinical Frailty Scale (CFS), the Primary Care–Frailty Index (PC-FI), and a 50-item FI. A base logistic regression model including age, sex, WBC count, platelets, creatinine, hs-CRP, and lactate predicted mortality. Frailty indices and MDR status were sequentially added, and model performance was compared using the area under the Receiver Operating Characteristics (AUROC). A nomogram was developed to visualize mortality probabilities. Results Among 93 patients (median age 80, IQR [72–84] years, 63.4% males), in-hospital mortality was 16.1%. Deceased patients were frailer and had a higher number of comorbidities. By logistic multivariable regression, the base model achieved an AUROC of 0.771 for predicting in-hospital mortality. Adding frailty indices improved model performance to 0.800 (PC-FI), 0.817 (CFS), and 0.823 (FI). Incorporating MDR status further increased AUROC to 0.890 (PC-FI + MDR), 0.907 (CFS + MDR), and 0.922 (FI + MDR), outperforming the base model ( p  < 0.05 for all). Conclusions Incorporating frailty indices and MDR status of culture isolates into traditional prognostic parameters improves mortality prediction in older patients admitted with sepsis, enabling more accurate risk stratification and personalized treatment strategies.

Background Geriatric Short-Stay Observation Units (G-SSU) are specialized units designed to improve care for older adults within the emergency department (ED). At our hospital, the Osservazione Breve Intensiva Geriatrica (OBI-GER) was established as a dedicated G-SSU. Aims This study aims to characterize the clinical profile of older adults admitted to OBI-GER and identify factors associated with hospitalization within the first 24 h of admission. Methods Retrospective, single-center study including individuals aged ≥ 75 years, admitted to OBI-GER between August 2023 and August 2024, with frailty and/or delirium during ED stay. Multivariable logistic regression model with stepwise selection was used to assess associations between hospitalization and clinical, functional, laboratory, and organizational variables. Results Overall, 353 patients (mean age 86.8  ±  5.5 years, 47.9% male) were included, of whom 109 (30.8%) required hospitalization. The cohort exhibited moderate frailty (median Clinical Frailty Scale = 6, IQR 6–7) and a considerable comorbidity burden (median Charlson Comorbidity Index [CCI] = 6, IQR 5–8), along with a high prevalence of dementia (45%) and polypharmacy (mean 7.1  ±  3.4 medications). Independent risk factors for hospitalization included higher CCI (OR 1.19, 95% CI 1.05–1.35), delirium on the first day of OBI-GER (OR 2.03, 95% CI 1.13–3.64), frequent faller profile (OR 2.66; 95% CI 1.38–5.12), and lower hemoglobin levels at ED admission (OR 0.89, 95% CI 0.79–0.99). Conclusions Despite their clinical complexity, only one-third of patients admitted to OBI-GER required hospitalization. CCI, delirium, fall history, and hemoglobin levels may serve to stratify hospitalization risk and optimize patient selection for G-SSU.

This study aimed to investigate the psychological impact of the COVID-19 pandemic on healthcare workers (HCWs) in geriatric settings. Online cross-sectional survey. 394 geriatric HCWs in Italy. The survey was developed by a multidisciplinary team and disseminated in April 2022 to the members of two geriatric scientific societies (Italian Society of Geriatrics and Gerontology and Italian Association of Psychogeriatrics). The survey examined the experiences related to the COVID-19 pandemic, as well as psychological burden and support. Work-related anxiety and distress related to the pandemic were studied using the SAVE-9 scale (Stress and Anxiety to Viral Epidemics). Three hundred sixty-four participants (92.4%) changed their job activity during the pandemic and about half (50.9%) failed to cope with this change, 58 (14.7%) had increased work-related anxiety, and 39 (9.9%) work-related stress levels. Three hundred forty (86.3%) participants reported acute stress reaction symptoms, including irritability, depressed mood, headache, anxiety, and insomnia, and 262 (66.5%) required psychological support, mainly from friends/relatives (57.9%) and/or colleagues (32.5%). Furthermore, 342 participants (86.8%) recognized they would benefit from informal and formal psychological support in case of future similar emergencies. This study highlights the high psychological burden experienced by geriatric HCWs in Italy during the COVID-19 pandemic and emphasizes the need for supportive interventions.

Key summary points Aim To conduct an updated systematic review of the literature and proportional meta-analysis to assess prevalence and incidence of delirium in older adults with COVID-19. Findings Delirium is a prevalent feature of COVID-19 in older adults, especially those living with frailty. Delirium may be the only sign or symptom of COVID-19 in this population. Message Delirium is common in older adults with COVID-19 and a formal inclusion as a COVID-19 feature is advisable. Purpose Delirium has been recognized as an atypical presenting feature of COVID-19 in older adults and is independently associated with mortality. We aimed to perform an updated systematic review of the literature and proportional meta-analysis to assess prevalence and incidence of delirium in older adults with COVID-19, addressing differences according to sex, frailty status, and settings. Methods We searched databases for English-language articles on prevalence and incidence of delirium in older adults with COVID-19, published between March 2020 and January 2023. Results Of the 1171 articles identified, 66 met selection criteria and were included in the meta-analysis ( n = 35,035 participants, age-range 66–90 years old, 46.6% females). We observed similar pooled prevalence (20.6% [95% Confidence Interval (CI) 17.8–23.8%]) and incidence (21.3% [95% CI 14.7–30%]) of delirium. Pooled occurrence (both prevalence and incidence) of delirium was similar according to sex (females 21.3% [95% CI 16–27.5%] vs. males 23.8%% [95% CI 18.2–30.4%], p -value = 0.55) and study setting (nursing homes 22.5% [95% CI 14.2–33.6%] vs. hospital 20.3% [95% CI 17–24%], p = 0.68), but it was significantly higher in frail versus non-frail patients (37% [95% CI 26.6–48.8%] vs. 12.5% [95% CI 7.8–19.6%], p -value < 0.01). Delirium definitions and assessment tools largely varied across studies. Conclusion This review delineates delirium as a common feature of COVID-19, particularly in frail older adults, and supports its formal inclusion among COVID-19 symptoms. The considerable heterogeneity in delirium assessment highlights the need for an operational strategy to standardize definitions and tools utilization in the management of frail older adults.

The R package MixMashNet provides an integrated framework for estimating and analyzing single and multilayer networks using Mixed Graphical Models (MGMs), accommodating continuous, count, and categorical variables. In the multilayer setting, layers may comprise different types and numbers of variables, and users can explicitly impose a predefined multilayer topology. Bootstrap procedures are implemented to quantify sampling uncertainty for edge weights and node-level centrality indices. In addition, the package includes tools to assess the stability of node community membership and to compute community scores that summarize the latent dimensions identified through network clustering. MixMashNet also offers interactive Shiny applications to support exploration, visualization, and interpretation of the estimated networks.