Background: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions. Methods: The study included 160 community-dwelling individuals aged 60– 74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death. Results: Cohort characteristics: age 66.8± 4.2 years (mean±SD), 3.81± 2.23 diseases, 4.29± 3.60 medications or supplements, and good functional status (MMSE 29.0± 1.5, Barthel Index 98.1± 8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9− 27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41− 19.1), falls (9.38%; 95% CI=4.86− 13.9), death (0.63%; 95% CI=0− 1.85) and no institutionalization. A higher probability of CE was associated with age ≥ 70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤ 0.8 m/s (P=0.028) and TUG > 9 s (P< 0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07− 1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551− 0.766, P=0.004) and Youden’s J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643). Conclusion: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.

Background and Objectives: Anticholinergic drug use in the pharmacotherapy of elderly persons is common despite the increased risk of side effects. We examined the prevalence of anticholinergic drug use and total anticholinergic drug burden among patients admitted to an acute care geriatric ward in Poland. Materials and Methods: Cross-sectional study of 329 subjects hospitalized at the geriatric ward. Patient condition was assessed with a comprehensive geriatric assessment. The Anticholinergic Cognitive Burden (ACB) scale was used to estimate the total anticholinergic load. Results: Mean patient age was 79.61 ± 6.82 years. 40.73% of them were burdened with at least one anticholinergic drug. The clinically significant anticholinergic burden was observed in 13.98% of subjects. Patients with dementia, risk of falls, and severe disability had significantly higher total ACB scores compared to other groups. The receiver operating characteristics (ROC) curve revealed that the total ACB score ≥ 1 was significantly associated with dementia and the risk of falls. Total ACB score ≥ 2 was significantly associated with severe disability. Conclusions: Patients admitted to an acute care geriatric ward had an anticholinergic cognitive burden score comparable to other patient populations. We found associations at both low and elevated levels of anticholinergic burden with dementia and risk of falls. At elevated anticholinergic burden levels, we found associations with severe disability. Despite recommendations against the use of anticholinergics in older adults these medications are still commonly prescribed. Further study is necessary to define the characteristics of anticholinergic medication most closely associated with negative outcomes in elderly populations.

Background: Societal aging – as a global demographic phenomenon – shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60– 74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results: Mean study group age was 66.5 ± 4.1 years (<![CDATA[$\overline {\rm{X}} {\rm{ \pm SD}}$]]>) and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ± 1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age > 65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test < 432 m (P = 0.034), serum glucose > 120 mg/dL (P = 0.047), serum cortisol > 10 μg/dL (P = 0.011), leptin ≥ 15 ng/mL (P = 0.018), P-selectin ≥ 23 ng/mL (P = 0.006) and GDNF ≥ 20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53− 8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77− 0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02− 1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

This review evaluates the use of antidepressants in older patients for the treatment of nonspecific chronic lower back pain (LBP), emphasizing age-related physiological changes and common degenerative conditions in this age group. We conducted a comprehensive search targeting studies on antidepressant use in older patients with LBP. Selective serotonin reuptake inhibitors, while effective for mood regulation, show limited benefits for LBP. Serotonin-norepinephrine reuptake inhibitors, particularly duloxetine, demonstrate potential in managing LBP, though further research is needed to confirm these findings. Tricyclic antidepressants have shown potential for pain relief, with limited evidence for LBP, but have a substantial side effect profile, including cardiotoxicity, weight gain, and severe anticholinergic effects. The evidence for trazodone in the treatment of LBP is limited. When prescribing new medications for older adults, it is crucial to carefully consider the patient's overall health, potential drug interactions, and sensitivity to side effects, ensuring that the benefits of treatment outweigh the risks. This review underscores the need for further research to understand the long-term effects and benefits of antidepressants in older patients with LBP, aiming to balance pain relief, mood stabilization, and minimized side effects.

Background and Objectives: It is well established that patients with cognitive impairment are at a higher risk of falls. However, the impact of coexisting neuropsychiatric symptoms on the overall risk of falls in hospitalized geriatric individuals with and without dementia has not been extensively studied. This cross-sectional study will assess the association between neuropsychiatric symptoms and fall risk in geriatric individuals analyzed by sex. Materials and Methods: A total of 234 patients, both with and without dementia, admitted to the geriatric ward at Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, Poland, between January 2019 and January 2020 were included in this study. The Neuropsychiatric Inventory–Questionnaire was used to assess the presence of neuropsychiatric symptoms. Increased fall risk was defined by Berg scores of ≤40. Results: The mean age of the study group was 80.7 ± 6.6, and women accounted for 62.8% of the study population. Apathy was the most common neuropsychiatric symptom, affecting 58.1% of patients, and it was the most common symptom among people with dementia, affecting 67.80% of patients. The receiver operating characteristics curve analysis revealed that a high fall risk was significantly associated with the total number of neuropsychiatric symptoms (≥4) and the total intensity of these symptoms (≥6). For women, high fall risk was associated with three or more neuropsychiatric symptoms and a total neuropsychiatric symptom intensity score of at least 6. For men, the association of high fall risk with the total number of NPS was not significant; a total NPS intensity score of 10 or more was associated with high fall risk. Multivariate logistic regression analysis identified associations with fall risk for hallucinations. Conclusions: Our results suggest that the presence of neuropsychiatric symptoms, particularly hallucinations is associated with an increased risk of falls in geriatric inpatients. In addition, the cumulative total of NPS and their cumulative intensity are both independently associated with an increased risk of falls. These results suggest that fall prevention strategies should include the management of neuropsychiatric symptoms in hospitalized geriatric individuals.

Background: Circulating microRNAs have been proposed as minimally invasive markers of cognitive impairment and neurodegenerative disease, but evidence for individual miRNAs in heterogeneous older populations remains limited. Objective: We examined cross-sectional associations between eight circulating serum miRNAs and continuous cognitive performance in a mixed inpatient-outpatient geriatric cohort. Methods: This cross-sectional analysis included 65 enrolled participants from a single-center, non-consecutive, mixed inpatient-outpatient geriatric cohort; 63 formed the analytic cohort (32 inpatients, 31 outpatients). Eligibility required written informed consent, availability of a routine-care Mini-Mental State Examination (MMSE) score, administration of Addenbrooke’s Cognitive Examination III (ACE-III), fasting serum sampling, and structural brain MRI during the same visit or within 48 hours. Eight predefined serum miRNAs were quantified by RT-qPCR with exogenous spike-in controls, with cel-miR-39-3p used as the normalization reference. The primary outcome was continuous MMSE score. Secondary outcomes were ACE-III total score, the ACE-III attention/orientation subscale, and threshold-defined MMSE and ACE-III impairment categories. Multivariable linear or logistic regression models were adjusted for age, sex, years of education, and recruitment setting. The main analysis used adjusted linear regression for continuous MMSE with Benjamini-Hochberg false discovery rate correction across the eight individual-miRNA MMSE models. Bootstrap was used to assess the stability of the MMSE estimates. Sensitivity analyses for the three strongest MMSE associations included Huber robust regression and miRNA by setting interaction testing. Results: In multivariable models adjusted for age, sex, years of education, and recruitment setting, higher levels of miR-132, miR-545, and miR-34a were linked to lower MMSE scores. A 1-SD increase in each marker corresponded to an MMSE decrease of about 1.1–1.3 points. These were the strongest single-miRNA findings in the dataset and met the prespecified FDR threshold in the primary models, although bootstrap analyses showed limited precision. Robust regression gave the same negative pattern for all three markers, suggesting that the results were not driven by a small number of extreme observations. Evidence of between-setting differences was seen only for miR-132 and only at the nominal level. No individual miRNA showed a clear nominal association with ACE-III total, and the ACE-III attention/orientation and MRI-adjusted analyses were exploratory. In secondary threshold-based models, no single miRNA remained significant after FDR correction. Conclusions: In this cross-sectional pilot cohort, higher miR-132, miR-545, and miR-34a were associated with lower MMSE scores in adjusted analyses. However, effect sizes were small, bootstrap analysis showed considerable uncertainty, and the findings are exploratory and hypothesis-generating. These results require evaluation in larger consecutive cohorts and do not establish diagnostic, prognostic, or standalone clinical biomarker utility.