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BACKGROUND: With demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers. METHODS: A cross-sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut-off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression. RESULTS: Most dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge. CONCLUSION: Implementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

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INTRODUCTION: Older adults are at risk of adverse effects during chemotherapy including nausea and fatigue, but many also suffer from dizziness and peripheral neuropathy. This may lead to balance and walking impairments and increased risk of falls and affect health-related quality of life. Moreover, these symptoms are often underreported with inadequate awareness among health professionals leading to deficient focus on the need for targeted assessment and rehabilitation. We aimed to examine the prevalence of dizziness, impaired walking balance, and neuropathy and falls in older adults ≥65 years with gastrointestinal cancer receiving chemotherapy and the associations between these symptoms. Further, we aimed to examine the quantity of patients reporting these symptoms to the oncologist. MATERIALS AND METHODS: This is a cross-sectional study among patients ≥65 years with gastrointestinal cancers who have completed three or more series of chemotherapy. The prevalence of dizziness, impaired walking balance, neuropathy, and reporting of these adverse effects was examined through structured questionnaires. RESULTS: Of two hundred patients (57 % male, mean age 74.4 years) the prevalence of dizziness was 54 % and the prevalence of patients experiencing impaired walking balance was 48 %. Symptoms of neuropathy was present in 32 % of patients and 11 % experienced falls during chemotherapy. Symptoms of neuropathy was associated with experiencing dizziness: odds ratio (OR) 1.98 (95 % confidence interval [CI]: 1.06; 3.71) and impaired balance: OR 3.61 (95 % CI: 1.87; 6.96). Less than half the patients (48 %) told the oncologist about these symptoms. DISCUSSION: Dizziness and impaired walking balance during chemotherapy are underreported yet profound symptoms among older patients with cancer. Dizziness and impaired balance should be systematically assessed during chemotherapy among older patients.

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BACKGROUND: Recognizing functional deficits early and counteracting them with a multimodal treatment concept is one of the most important tasks of general practitioners, who are usually the primary medical contact for geriatric patients. AIM: Illustration of strategies for a biopsychosocial assessment of geriatric patients and for the creation of individually adapted prevention concepts in general practice. MATERIAL AND METHODS: Literature research on the theoretical background of the most important prevention approaches for geriatric patients as well as considerations on their relevance and implementation in daily practice. RESULTS: For geriatric patients prevention measures should be implemented simultaneously on all four prevention levels. The main objective is promoting physical and mental exercise. The risks of immobility, depression, cognitive decline, malnutrition and, last but not least, polypharmacy are of particular importance. CONCLUSION: Geriatric patients represent a very heterogeneous group. In order to be able to take individual preventive action, a multidimensional assessment of key factors for maintaining functionality and relative health is required, even though chronic conditions may already exist.

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Introduction This study evaluates the effectiveness of a comprehensive hip fracture protocol, with a focus on specific readmission reasons. Methods A retrospective cohort study of hip fracture patients aged 60 and older who underwent surgery before (control) and after (intervention) implementation of a comprehensive hip fracture program. Objectives included identifying readmission reasons and rates, time to operating room (TOR), length of stay (LOS), reoperation, and mortality rates. Logistic regression was utilized to determine significance. Results One hundred and sixty-three patients (control) vs. 238 patients (intervention) were identified. The intervention group had higher odds of 90-day readmission for a medical reason (OR = 1.735, p = 0.028). Thirty-three out of forty-two patients (79%) in the control group and 68/78 patients (87%) in the intervention group were readmitted secondary to a medical reason (pulmonary etiology being the most common). Surgical-related readmissions (surgical site infections and dislocations are most common) were lower in the intervention group compared with the control group, with 10/78 patients (13%) and 9/42 patients (21%), respectively. Twenty-four-hour TOR was achieved in 125 patients (52.5%) in the intervention group vs. 70 patients (42.9%) in the control group. LOS was shorter by 1.1 days for the intervention group (p = 0.010). Mortality was lower in the intervention group. Discussion A comprehensive hip fracture protocol can reduce LOS, TOR, mortality rate, and even surgical-related readmissions. Readmission rates are mainly due to medical problems, which may be unavoidable and thus may not be an adequate hip fracture effectiveness metric. Potential areas of improvement and additional study may include closer internal medicine oversight and primary care follow-up after discharge.

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Background: There is ongoing debate regarding prostate cancer (PCa) screening in advanced age males, leading to treatment decisions often based on tumor staging and life expectancy. A critical gap in clinical evidence and tailored guidelines for the advanced age with PCa persists. This study aims to compare survival outcomes of various treatment approaches in this demographic. Methods: We analyzed data from a large urological center for advanced age patients suspected of having PCa between 2012 and 2022. We collected clinical and pathological characteristics and evaluated treatment modalities, including palliative therapy and definitive therapy. Propensity score matching (PSM) analysis was implemented to reduce bias between treatment modalities. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were conducted to evaluate progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Results: Out of 4,333 suspected patients, 376 individuals aged 80 years and older underwent prostate biopsy. The overall detection rate of PCa was 78.7%, with a high prevalence of high-grade tumors [International Society of Urological Pathology (ISUP) grade ≥2]. Most patients (86.5%) received palliative therapy, while 13.5% underwent definitive therapy. Patients in the definitive therapy group had lower prostate-specific antigen (PSA) values, lower tumor stage, and Charlson Comorbidity Index (CCI), longer life expectancy, and a higher Geriatric 8 (G8) score compared to the palliative therapy group. The median OS for the entire cohort was 72.0 months, with 70.0 months for palliative therapy and 96.0 months for definitive therapy. Multivariable analyses identified lymphatic and bone metastasis, as well as definitive therapy, as independent prognostic factors for PFS, CSS, and OS. Conclusions: Advanced age patients, although a small group, have distinct characteristics, including higher PSA levels, positive biopsy rates, and pathological grading and staging. In medically fit elderly patients, especially those with localized PCa and a life expectancy of ≥5 years, definitive therapy could improve survival outcomes.

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The prevalence of diabetic retinopathy (DR) among the geriatric population poses significant challenges for early detection and management. Optical Coherence Tomography Angiography (OCTA) combined with Deep Learning presents a promising avenue for improving diagnostic accuracy in this vulnerable demographic. In this method, we propose an innovative approach utilizing OCTA images and Deep Learning algorithms to detect diabetic retinopathy in geriatric patients. We have collected 262 OCTA scans of 179 elderly individuals, both with and without diabetes, and trained a deep-learning model to classify retinopathy severity levels. Convolutional Neural Network (CNN) models: Inception V3, ResNet-50, ResNet50V2, VggNet-16, VggNet-19, DenseNet121, DenseNet201, EfficientNetV2B0, are trained to extract features and further classify them. Here we demonstrate:•The potential of OCTA and Deep Learning in enhancing geriatric eye care at the very initial stage.•The importance of technological advancements in addressing age-related ocular diseases and providing reliable assistance to clinicians for DR classification.•The efficacy of this approach in accurately identifying diabetic retinopathy stages, thereby facilitating timely interventions, and preventing vision loss in the elderly population.

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Introduction: Anogenital warts (AGW) are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV), particularly types 6 and 11. The highest incidence of AGW occurs in the age group of 15-24 years. However, as life expectancy increases, there is a significant rise in the geriatric population worldwide. This demographic shift is directly proportional to the increasing number of STIs cases within the geriatric group. Cases: A case of AGW was reported in a 75-year-old man who had a history of erectile dysfunction medication use and recent sexual contact. During the physical examination, a hyperpigmented plaque with a verrucous surface was observed at the base of the penis. The results of the histopathological examination were consistent with the characteristics of AGW. In addition, HPV genotyping, through polymerase chain reaction (PCR) showed the presence of HPV type 6. Discussion: The aging process leads to a decline in immune function among geriatric individuals, which causes susceptibility to infections, including STIs. Moreover, the geriatric population has a different level of susceptibility to STIs compared to younger individuals. Factors such as physiological changes, decreased sexual function, low awareness of STIs, and having multiple sexual partners further increase the risk of STIs in this age group. Conclusion: Sexual intercourse is an important component of the human life. However, the natural decline in sexual function due to the aging process often occurs with advancing age. As a result, many geriatrics seek various solutions in order to maintain sexual function and activity in old age. Since STIs can occur at any age, early detection and education are essential, particularly for the geriatric population.

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INTRODUCTION: Periampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high-risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery. METHODS: This prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality. RESULTS: Of the 88 patients included, 87 had a complete CGA. Sixty-five patients (75%) were frail and 22 (25%) were non-frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% p = 0.004). Fifty-seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, p = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43-7.89, p = 0.006). CONCLUSION: Frailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all-cause mortality. CGA can contribute to shared decision-making and optimize perioperative care in older patients.

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Introduction: Deprescribing serves as a pivotal measure to mitigate the drug-related problem due to polypharmacy. This study aimed to map the factors influencing healthcare providers' deprescribing decision using the Behaviour Change Wheel framework and develop an innovative conceptual model to support deprescribing practice. Methods: A cross-sectional online survey targeting doctors and pharmacists was conducted to assess the influence of various factors on healthcare providers' comfort in recommending deprescribing. The conceptual model was formulated, based on the existing deprescribing framework and the Behaviour Change Wheel. The model's robustness was scrutinised through Partial Least Squares Structural Equation Modeling (PLS-SEM), and model-fitting indices were employed to obtain the best-fit model. Results: A total of 736 responses were analysed with the final best-fit model consisting of 24 items in 5 constructs (R 2: 0.163; SRMR: 0.064; rho_c: 0.750-0.862; AVE: 0.509-0.627) and three independent factors. Based on the results, we proposed that deprescribing could be promoted through strategies aimed at enhancing healthcare providers internal capabilities such as knowledge levels, when patients' condition deteriorated and previous experiences with adverse events of drugs. Organisational support in providing such educational opportunities is important, with the empowerment of patient and healthcare providers through policy enhancements, guideline development, and effective communication. Conclusion: The deprescribing behaviours of healthcare professionals are influenced by an intricate interplay of patient, prescriber, and system factors. Enhancing deprescribing practices necessitates a comprehensive strategy that encompasses providers and patients' education, the development of structured deprescribing guidelines, the implementation of deprescribing support tools, and the enhancement of communication between healthcare providers.

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Aging is a complex, multifactorial, and inevitable process, which begins before birth and continues throughout the life. Multimorbidity prevailing among the geriatric population is an important health challenge for most of the developing countries. To examine the effect of gender and increasing age on the survival of the geriatric population suffering from multimorbidity. A cross-sectional study was conducted among the geriatric population of the Jammu district, J and K, using multistage sampling procedure, and the analysis was conducted using the Kaplan-Meier method and survival analysis using software IBM SPSS version 24.0. Our study included 1150 study subjects, of whom 610 (53%) were males and 540 (47%) were females, respectively. It was indicated that the probability for the survival of the study population suffering from morbidity belonging to 60-64 years was higher than the survival of the geriatric population belonging to other age-groups or we can say that survival probability of the geriatric population suffering from morbidities decreases with the increase in age. Also, it was reported that probability for the survival of the female geriatric population suffering from morbidity was slightly higher than the survival of the male geriatric population. Gender had no significant effect on survival of the geriatric population suffering from morbidities, whereas baseline age had a significant effect on the survival of the geriatric population suffering from morbidities as their survival probability decreases with the increase in age.

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BACKGROUND: The nurse's ability to accurately identify urgent conditions and triage this vulnerable population tends to be complex and challenging. Little is known about the reliability and validity of common triage tools in geriatric patients. AIM: To determine the reliability and validity of triage tools in geriatric emergency care and summarize the specific content of current triage tools for geriatric patients. METHODS: The eligible literature was searched from the MEDLINE, CINAHL, EMBASE, and Cochrane Database using targeted search strategies. We defined the objectives and questions, set standards for article inclusion criteria, and conducted literature searching and screening. The mixed methods assessment tool (MMAT) appraised the article's quality. Finally, we extracted and analyzed the data from the included articles, summarizing the results. Endnote X9 was used for data extraction and collation. RESULTS: Nine articles were eligible. These included six triage tools: CTAS, JTAS, KTAS, MTS, SETS, and ESI. The reliability of the CTAS was good when applied to triage geriatric patients. The SETS performed well in prehospital simulated triage. The ESI has moderate to excellent reliability. The CTAS has good to excellent validity, while the JTAS, KTAS, MTS, and ESI have fair to good results. CONCLUSION: Several triage tools are useful in geriatrics, but the reliability and validity of these tools have mixed results. Applying triage tools to triage geriatric patients still has limitations.

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OBJECTIVES: Approximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MEASUREMENTS: Themes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. RESULTS: The authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. CONCLUSIONS: The study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

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Background: Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. Objectives: To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Review design: Systematic review and network meta-analysis. Eligibility criteria: Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Main outcomes: Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. Data sources: We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Review methods: Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). Results: We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. Limitations: High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Conclusions: Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence. Future work: Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further. Study registration: This study is registered as PROSPERO CRD42019162195. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.

Due to a lack of robust evidence, the benefits and risks of most types of community services for older people are unclear. Individualised care planning, where medication is adjusted and there are regular follow-ups, probably helps people stay living at home. There are many kinds of community services for older people. For example, in some services, everyone is given exercise and dietary advice or an individualised care plan. These often aim to help older people age independently. Maintaining independence is important in later life. We wanted to find out which community services work best: to help people stay living at home, and to do day-to-day activities independently. We reviewed findings from previous studies that have tested different community services for older people. We combined these findings and compared different types of service with one another. We rated our confidence in the evidence. We found 129 studies with 74,946 people. We found 63 different kinds of service have been studied. The studies were carried out in diverse populations around the world. Individualised care planning, where medication is adjusted and there are regular follow-ups, may help people age independently. It probably increases the chance of staying at home slightly. It may also help with doing day-to-day activities very slightly. Exercise and dietary advice may also help people stay living at home. However, there was some evidence that some services may reduce independence. We do not know what effect most services have. We generally had little confidence in the evidence because studies were small, and information was missing. The evidence is up to date to August 2021.

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INTRODUCTION: Stress-induced hyperglycemia (SIH) and malnutrition are common in trauma patients and are linked to worse outcomes. This study examined the influence of nutritional status, determined by the Geriatric Nutritional Risk Index (GNRI), on the incidence of SIH in trauma patients. METHODS: A retrospective analysis was conducted on adult trauma patients admitted to a Level I trauma center from 1 January 2009 to December 31, 2021. Patients were categorized into four groups: SIH, diabetic hyperglycemia (DH), diabetic normoglycemia (DN), and non-diabetic normoglycemia (NDN). Nutritional status was assessed using GNRI: high risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI ≤ 98), and no risk (GNRI > 98). Incidence of SIH and outcomes were analyzed across GNRI groups. RESULTS: SIH was associated with higher mortality across all GNRI groups compared to NDN, with the highest rate (45.7%) in the high-risk group. Mortality decreased as GNRI increased in all glucose groups. NDN patients had the lowest mortality rates across GNRI groups. There was no correlation between GNRI and SIH incidence (p = 0.259). CONCLUSION: SIH significantly influenced mortality across all nutritional status groups, with the highest impact in malnourished patients. Although malnutrition did not affect SIH incidence, both SIH and poor nutritional status independently contributed to worse trauma outcomes. Targeted management of hyperglycemia and nutritional deficiencies is crucial for improving survival.

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Nurses play a critical role in caring for elderly patients; however, the emphasis on aging care in undergraduate programs may be insufficient. The present study aims at identifying the relevance given to theoretical and/or practical gerontological and geriatric contents in undergraduate study plans in Portugal and Spain. Presenting a two-part investigation, an integrative review approach examines nursing education on a global scale and a comparative analysis, using Bereday's comparative method, to assess the nursing curricula between Portugal and Spain. The search found 117 documents, with 16 being included. Studies covered diverse educational practices in geriatric and gerontological nursing, emphasizing curriculum development, faculty expertise, practical training, attitudes towards elderly care, and future directions. The comparative analysis of nursing curricula revealed that Portugal places a priority on building foundational theoretical knowledge in the first year and then gradually integrating practical training. In contrast, Spain emphasizes an extensive and integrated approach with a strong focus on practical skills and comprehensive assessments. Our research emphasizes the need to incorporate aging-focused education into nursing curricula and update the curriculum, providing hands-on training with early exposure to these environments. Additionally, simulation classes can enhance critical thinking by allowing students to experience aging effects firsthand.

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INTRODUCTION: The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. METHODS: This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. RESULTS: No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). CONCLUSIONS: The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.

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The aim of this study was to investigate whether interventions to discontinue or down-titrate heart failure (HF) pharmacotherapy are feasible and associated with risks in older people. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Electronic databases were searched from inception to 8 March 2023. Randomized controlled trials (RCTs) and observational studies included people with HF, aged ≥50 years and who discontinued or down-titrated HF pharmacotherapy. Outcomes were feasibility (whether discontinuation or down-titration of HF pharmacotherapy was sustained at follow-up) and associated risks (mortality, hospitalization, adverse drug withdrawal effects [ADWE]). Random-effects meta-analysis was performed when heterogeneity was not substantial (Higgins I2 < 70%). Sub-analysis by frailty status was conducted. Six RCTs (536 participants) and 27 observational studies (810 499 participants) across six therapeutic classes were included, for 3-260 weeks follow-up. RCTs were conducted in patients presenting with stable chronic HF. Down-titrating a renin-angiotensin system inhibitor (RASI) in patients with chronic kidney disease was 76% more likely than continuation (risk ratio [RR] 1.76, 95% confidence interval [CI] 1.14-2.73), with no difference in mortality (RR 0.64, 95% CI 0.30-1.64). Discontinuation of beta-blockers were feasible compared to continuation in preserved ejection fraction (RR 1.00, 95% CI 0.68-1.47). Participants were 25% more likely to re-initiate discontinued diuretics (RR 0.75, 95% CI 0.66-0.86). Digoxin discontinuation was associated with 5.5-fold risk of hospitalization compared to continuation. Worsening HF was the most common ADWE. One observational study measured frailty but did not report outcomes by frailty status. The appropriateness and associated risks of down-titrating or discontinuing HF pharmacotherapy in people aged ≥75 years is uncertain. Evaluation of outcomes by frailty status necessitates investigation.

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OBJECTIVES: Previous studies have reported that tooth loss is associated with an increased risk of dementia; however, few have explored the association between number of teeth and dementia-free and total life expectancies. We investigated whether having more teeth is associated with longer dementia-free and total life expectancies. DESIGN: A 10-year follow-up prospective cohort study from 2010 to 2020. SETTING AND PARTICIPANTS: Functionally independent older adults aged ≥65 years living in 9 municipalities in Japan. METHODS: The exposure was the number of teeth (≥20, 10-19, 1-9, and 0). Dementia onset and mortality within the 10-year follow-up were used as the outcome. Dementia-free and total life expectancies according to the number of teeth were derived from multistate modeling estimates. RESULTS: A total of 44,083 participants were included (men: 46.8%). The mean age was 73.7 years (standard deviation [SD] = 6.0). During follow-up, 17.3% and 21.4% of the participants experienced the onset of dementia and death, respectively. Having fewer teeth was associated with dementia (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.07-1.22, 10-19 teeth; HR, 1.15; 95% CI, 1.08-1.22, 1-9 teeth; HR, 1.13; 95% CI, 1.05-1.21, 0 teeth) and death (HR, 1.13; 95% CI, 1.05-1.22, 10-19 teeth; HR, 1.27; 95% CI, 1.19-1.37, 1-9 teeth; HR, 1.47; 95% CI, 1.36-1.59, 0 teeth) compared with having ≥20 teeth. Dementia-free life expectancies at the age of 65 years were 16.43 years and 18.88 years with ≥20 teeth, and 14.40 years and 17.12 years with 0 teeth for men and women, respectively. The total life expectancies at the age of 65 were 17.84 years and 22.03 years with ≥20 teeth, and 15.42 years and 19.79 years with 0 teeth for men and women, respectively. CONCLUSIONS AND IMPLICATIONS: Having more teeth was associated with longer dementia-free and total life expectancies.

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PURPOSE OF REVIEW: This paper summarizes the prevalence, impact, and presentation of ageism across multiple mental health care settings including inpatient, outpatient, long-term care, and criminal justice. Strategies for combating ageism are described. RECENT FINDINGS: Ageism is a common form of bias that has deleterious medical and psychosocial consequences for older adults. Ageism manifests in a variety of ways in mental health settings. Clinical, educational, and public policy strategies are recommended to combat ageism in mental health settings. Ageism remains pervasive in society and in mental health care settings. Ageism impacts healthcare trainees, healthcare providers, healthcare systems, and older adults themselves. Age-friendly practices and strategies for combating ageism exist and need broader dissemination.

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INTRODUCTION: A substantial majority of patients diagnosed with metastatic breast cancer consists of individuals 65-year-old or above. Emerging treatment approaches, which utilize genomics-guided therapy and innovative biomarkers, are currently in development. Given the numerous choices in the metastatic context, it is necessary to adopt a personalized approach to decision-making for these patients. AREAS COVERED: The authors provide a comprehensive analysis of the existing literature on the use of systemic anticancer treatments in older women, specifically those aged 65 and above, who have metastatic breast cancer, focusing on the reported effectiveness and adverse effects of these treatments in this population. EXPERT OPINION: The evidence to treat older patients with metastatic breast cancer primarily relies on subgroup analyses, whose interpretation should be approached with caution. In several clinical trials subgroup analysis, it has been observed that this population seem to have comparable benefits and toxicities to younger patients, but real-world data have showed older women exhibit worse rates of survival compared to younger women. Multiple factors are likely involved in this, but we postulate this is related to lower rates of guideline concordant, and factors such as comorbidity, lack of social supports, malnutrition, and geriatric factors like frailty and/or vulnerability. This underscores the importance of a broader assessment for patients with a geriatric perspective and involvement of multi-disciplinary team.