Nutrition plays a fundamental role in the management of frail elderly patients. Indeed, effective management can reduce common pathological situations, such as malnutrition, refeeding syndrome, and aspiration pneumonia, which can increase morbidity and mortality in intensive care unit settings. To optimize this management, it is essential to have knowledge of basic aspects such as timing, route, and composition of nutrition, as well as the prevention and management of the most common adverse events.

Heart failure (HF) represents a growing public health challenge, particularly among older adults. Its prevalence increases with age and is frequently complicated by frailty, multimorbidity, and functional decline, all of which worsen prognosis and complicate management. The relationship between HF and frailty is bidirectional: HF promotes sarcopenia, cachexia, and inflammation, while frailty reduces resilience and tolerance to therapy. The objective of the paper is to summarize current evidence on the management of HF in frail older adults, highlighting recent pharmacological advances, geriatric considerations, and emerging multidisciplinary strategies.A narrative synthesis has been performed, including the most recent European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, position papers, and randomized controlled trials focusing on drug therapy, non-pharmacological interventions, and comprehensive geriatric care in older adults with HF. Guideline-directed medical therapy for HF with reduced ejection fraction—comprising sodium-glucose co-transporter 2 (SGLT2) inhibitors, angiotensin receptor-neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists—remains the cornerstone of treatment. Evidence for HF with mildly reduced ejection fraction and HF with preserved ejection fraction supports SGLT2 inhibitors and individualized management of comorbidities. Multidimensional interventions, including nutritional support, tailored physical rehabilitation, cognitive and psychological care, and telemonitoring, significantly improve outcomes. Structured transitional care and early palliative integration reduce readmissions and enhance quality of life. Effective management of HF in frail older adults requires combining evidence-based pharmacological therapy with a holistic, geriatric, and multidisciplinary approach spanning hospital, transitional, and community settings. Strengthening randomized evidence and integrating comprehensive care models are essential to improving prognosis and functional independence in this vulnerable population.

Pulmonary embolism (PE) represents one of the main causes of acute respiratory failure in geriatric patients. In the older population, critical issues in PE management are multiple: reduced specificity of clinical signs and symptoms (with symptoms common to other pathologies, such as chest pain, dyspnea, and tachypnea), frequent late diagnosis (delay in diagnosis or misdiagnosis), the difficulty in the diagnostic algorithm, the need for a rapid prognostic assessment, and consequent timely treatment. Optimal PE management is patient-centered, includes all treatment options available, and aims at optimizing clinical outcomes in the short, medium, and long term with a multidisciplinary approach.

Syncope in older adults is common, heterogeneous, and frequently misclassified as an unexplained fall, leading to injury, fear of recurrence, and costly, low-yield testing and hospitalization. The 2018 European Society of Cardiology (ESC) Guidelines emphasize structured initial evaluation (history with witnesses, orthostatic blood pressure, and 12-lead ECG), risk-feature-guided disposition, and targeted second-line investigations rather than routine neuroimaging or carotid duplex ultrasound. We performed a structured narrative review anchored to the ESC 2018 Guidelines, searching MEDLINE/PubMed up to February 2026 for randomized trials, observational cohorts, and systematic reviews with substantial representation of adults aged ≥65 years and extracting geriatric-relevant outcomes including injury, falls, admission, arrhythmic diagnoses, and short-term serious events. Evidence since 2018 supports the enduring value of the ESC 2018 Guidelines’ framework but highlights the need for geriatric adaptation: repeated orthostatic phenotyping (including post-prandial and delayed hypotension), systematic deprescribing, and explicit integration of frailty, cognition, and trauma risk into disposition decisions. Post-2018 data strengthen mechanism-based strategies, including earlier implantable loop recorders with remote monitoring and selective pacing for tilt-induced asystolic reflex syncope, while cardioneuroablation remains investigational for most elders. We propose a pragmatic pathway prioritizing diagnostic yield, minimizing low-value testing, and aligning interventions with patient goals and functional outcomes to reduce recurrences and support safer transitions.