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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 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 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.

Hospitalisation frequently leads to hospital-acquired disability in older adults, with subsequent functional decline and loss of independence. However, the potential role of multidomain interventions (MDIs) integrating physical, nutritional and cognitive components, supported by digital technologies, remains largely unexplored in the acute care setting. OPTIMAge-IT therefore aims to evaluate the effect of a technology-supported MDI on motor function at hospital discharge and its feasibility in the post-discharge phase among frail older adults. OPTIMAge-IT is an ongoing, pragmatic, multicentre, cluster-randomised controlled trial conducted in eight Italian Acute Geriatric Units. Adults aged ≥ 70 years admitted from the Emergency Department with mild-to-moderate frailty are enrolled consecutively and allocated by centre to usual care or a structured, multidisciplinary, technology-supported MDI. The intervention starts after clinical stabilisation and continues for 12 weeks post-discharge, supported by a tracker and a tablet. The MDI includes Vivifrail-based physical exercise, computerised cognitive training (BrainHQ), nutritional counselling, health education, medication review, and promotion of social engagement. The primary endpoint is change in Short Physical Performance Battery at hospital discharge. Secondary endpoints include feasibility of the intervention and its home continuation (adherence, usability and retention), as well as the effect of the MDI on in-hospital and post-discharge outcomes. Follow-up assessments are performed at 3 and 6 months in the intervention arm and at 6 months in the control arm; blood biomarkers are collected at discharge and at 6 months. OPTIMAge-IT will provide evidence on the feasibility and clinical value of a technology-supported MDI to prevent hospital-acquired disability and promote functional status in frail older adults. Findings may inform the development of scalable, person-centred post-hospital care models. NCT06611228 (https://clinicaltrials.gov/study/NCT06611228; 2025-01-08).

Palliative care is traditionally associated with hospice and cancer care, yet older adults admitted to hospitals and long-term care facilities (LTCF) frequently experience multimorbidity, frailty, and high symptom burden. We aimed to estimate the prevalence and characteristics of palliative care needs in Internal Medicine and Geriatrics hospital wards and LTCF in Italy. We conducted a national cross-sectional point-prevalence study. Adults aged ≥ 18 years hospitalized in participating wards or residing in LTCF were eligible. NECPAL 4.0 tool was used to identify patients and residents with palliative care needs. Additional indicators included functional and nutritional decline, repeated hospitalizations, dysphagia, pressure ulcers, delirium, and pain. A total of 5,389 participants were included (3,303 hospital patients, median age 81 years; 2,086 LTCF residents, median age 86 years) from 235 facilities. Overall, 58.3% of hospitalized patients and 48.1% of LTCF residents had a positive NECPAL assessment. Prevalence was higher among patients with cancer (77.2% in hospital; 61.5% in LTCF), but remained substantial among those without cancer (50.8% in hospital; 46.8% in LTCF). Functional decline (56.2% hospital; 48.7% LTCF), nutritional decline (36.6%; 23.9%), dysphagia (17.6%; 28.8%), delirium (19.2%; 36.4%), and moderate-to-severe pain (25.9%; 20.3%) were common across settings. Palliative care needs are highly prevalent among hospitalized patients and LTCF residents and are not limited to oncology. These findings support systematic screening and integration of a needs-based palliative care approach within hospital and long-term care systems.

The age-related muscle strength decline is a major impediment to the achievement of healthy aging. This study aimed to investigate the association between a panel of Alzheimer’s disease (AD) blood biomarkers and longitudinal trajectories of muscle strength. This 12-year population-based cohort study included 2011 dementia-free participants from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Muscle strength was measured through the grip strength and chair stand tests, while baseline levels of AD biomarkers (total tau [t-tau], phosphorylated tau181 [p-tau181], neurofilament light chain [NfL], glial fibrillary acid protein [GFAP], and amyloid-β [Aβ] 42/40 ratio) were assessed by Quanterix Single Molecule Arrays. Linear mixed models, adjusted for socio-demographics and clinical factors, were used to estimate the association between AD biomarkers and muscle strength decline. Higher baseline levels of p-Tau181 (β 0.94, 95%CI 0.72;1.16), NfL (β 0.79, 95%CI 0.59;0.99), and GFAP (β 0.38, 95% CI 0.22;0.54) were associated with an accelerated worsening of the chair stand test over the follow-up. The adjustment for Mini-Mental State Examination (MMSE) led to an attenuation of these associations. Higher baseline levels of p-Tau181 (β -0.11, 95%CI -0.16;-0.06), and NfL (β -0.05, 95%CI -0.09;-0.003) were associated with a faster decline in the grip strength test over the follow-up; no attenuation was observed after adjusting for MMSE. Several blood biomarkers implicated in AD pathophysiology are associated with distinct trajectories of muscle strength. Cognitive function appears to influence this association, mostly concerning muscle strength as measured by the chair stand test.

Individuals experiencing simultaneous decline in cognitive and motor performances (i.e., dual decliners) face an increased risk of dementia and other adverse health outcomes. While the underlying pathophysiology remains largely unknown, this study aims to explore the association between serum biomarkers of Alzheimer’s disease (AD) and various patterns of cognitive/motor decline. Data are drawn from the Swedish National Study on Aging and Care in Kungsholmen. The rates of cognitive and motor decline were assessed over a 15-year period using linear mixed models, with Mini-Mental State Examination and gait speed as the respective measures. Participants were categorized into slow/non-decliners (reference group, n=1115), fast motor decliners (n=162), fast cognitive decliners (n=162), and dual decliners (n=264). The association between serum AD markers levels and the four decline patterns was analyzed using multinomial logistic regressions. Phosphorylated tau181 (OR = 1.77, 95% CI: 1.60;1.97), neurofilament light chain (OR = 1.44, 95% CI: 1.31;1.57) and phosphorylated tau181/amyloid-β42 ratio (OR = 1.18, 95% CI: 1.12;1.25) were associated with the highest risk of a dual decline pattern among study participants. In isolated cognitive decliners, robust associations were observed for amyloid-β42, amyloid-β42/40 ratio and glial fibrillary acidic protein, whereas no significant association emerged for those exhibiting only motor decline. Dual decliners present distinct profiles of serum AD biomarkers. The extensive involvement of tau pathology and neurodegeneration suggests an intrinsic biological complexity that necessitates further research, encompassing vascular and neuroinflammatory pathways.

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