UNASSIGNED: Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients.
UNASSIGNED: Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD.
UNASSIGNED: One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804).
UNASSIGNED: Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.

OBJECTIVE: Few studies have investigated the factors associated with ambulation and survival over one year. Therefore, this study aimed to examine the factors that influence ambulation and survival rates in elderly patients who have undergone conservative management for hip fractures.
METHODS: This retrospective study included 74 ambulatory individuals aged 65 years or older prior to their injuries. One-year mortality and ambulatory status were assessed. Statistical comparisons of background and medical characteristics between groups of independent and non-independent walkers, as well as between survivors and mortalities, were performed using the Pearson chi-squared, Fisher exact, and Mann-Whitney U tests.
RESULTS: The numbers of older patients able to walk independently, those not able to walk independently, and those with mortality at one-year post-injury after conservative management of hip fractures were 13 (18.3%), 35 (49.3%), and 23 (32.4%), respectively. Independent walkers one year after conservative treatment for hip fracture were younger (p=0.04) and less likely to have cognitive impairment (p=0.04) than non-independent walkers. The proportion of individuals with cognitive impairment was found to be lower among survivors than among mortalities (p=0.0098).
CONCLUSIONS: Cognitive decline may contribute to difficulties in walking independently and mortality at one year post-injury in this population.

BACKGROUND: Calf circumference is currently recommended as a case-finding marker for sarcopenia, but its usefulness has not been determined in chronic pain conditions. Therefore, the present study aimed to evaluate the predictive performance of calf circumference in diagnosing sarcopenia in older patients with chronic low back pain.
METHODS: Ambulatory adult patients aged ≥ 65 years with chronic low back pain were enrolled. A diagnosis of sarcopenia was established based on the criteria outlined by the Asian Working Group for Sarcopenia in 2019. Patient demographics, pain-related factors, clinical factors, and sarcopenia-related measurements were compared between non-sarcopenic and sarcopenic patients. Linear regression analysis was used to evaluate the correlation of calf circumference with muscle mass, strength, and physical performance. Also, a receiver operating characteristic curve analysis for calf circumference in predicting sarcopenia was conducted; and area under the curve (AUC) values, along with their corresponding 95% confidence intervals (CI), were calculated.
RESULTS: Data from 592 patients were included in the analysis. Eighty-five patients were diagnosed with sarcopenia (14.3%), 71 of whom had severe sarcopenia (11.9%). A higher prevalence of sarcopenia was observed in female patients (9.0% vs. 16.7%, p = 0.016). After adjusting for age, BMI, and comorbidities, calf circumference correlated positively with muscle mass but not with muscle strength and physical performance. The AUC values for sarcopenia were 0.754 (95% CI = 0.636-0.871, p = 0.001) in males and 0.721 (95% CI = 0.657-0.786, p < 0.001) in females. The cut-offs for calf circumference in predicting sarcopenia were 34 cm (sensitivity 67.1%, specificity 70.6%) in males, and 31 cm (sensitivity 82.5%, specificity 51.5%) in females.
CONCLUSIONS: Even though sex differences in its predictive value for sarcopenia should be considered, our findings suggest that calf circumference can be used as an indicator for predicting muscle mass and may serve as a potential marker for identifying sarcopenia in older patients with chronic low back pain.

Background: Approximately 50% of older patients hospitalized for hip fractures are admitted to a geriatric rehabilitation department at a skilled nursing home. Given the wide variation in rehabilitation stay lengths, predicting the length of stay upon hospital discharge would help manage patients\' recovery expectations and create appropriate therapy schedules. Existing literature on length of stay predictors included both acute hospital and in-hospital rehabilitation phases or involved small sample sizes. The present study aims to identify predictors for the length of geriatric rehabilitation stay in skilled nursing homes for older patients after hip fracture surgery upon hospital discharge. Methods: This retrospective cohort study was conducted from 1 October 2017 to 1 July 2023, including 561 patients. Potential predictors of the length of geriatric rehabilitation stay were first tested univariately, with variables showing p < 0.15 entered into a multivariate forward linear regression model. Results: This model identified the following independent predictors of a longer length of geriatric rehabilitation stay: Functional Ambulation Categories (FACs) 0 (B = 29.9, 95% CI 24.1-35.7), 1 (B = 18.0, 95% CI 11.8-24.2), 2 (B = 12.0, 95% CI 7.1-17.0), or 3 (B = 3.6, 95% CI -1.2-9.4) at hospital discharge vs. FAC 4, living independently with home care services (B = 5.9, 95% CI 2.5-9.3) or in a residential home prior to the hip fracture (B = 0.2, 95% CI -7.4-7.8) vs. living independently without home care services, non- or partial weight-bearing mobilization vs. full weight-bearing mobilization (B = 15.4, 95% CI 8.5-22.2), internal fixation vs. hemiarthroplasty (B = 4.7, 95% CI 1.4-7.9), in-hospital delirium (B = 7.0, 95% CI 2.2-11.7), and in-hospital heart failure (B = 7.9, 95% CI 0.5-15.3). The explained variance was 32.0%. Conclusions: This study identified FAC at hospital discharge, premorbid living situation, postoperative weight-bearing protocol, surgery type, in-hospital delirium, and in-hospital heart failure as independent predictors of the length of geriatric rehabilitation stay. Future investigations are needed to identify additional predictors, such as cognitive functioning, to better predict the length of geriatric rehabilitation stay upon hospital discharge.

OBJECTIVE: This study assessed the characteristics, management, and outcomes of dysphagia rehabilitation in older patients with CVD in a super-aged society, highlighting the need for comprehensive management strategies in community hospital settings. It aimed to uncover valuable insights into the benefits of integrating dysphagia rehabilitation with cardiac care in patient management.
METHODS: We conducted a retrospective review of patients with CVD aged ≥ 65 years who were admitted to Niigata Minami Hospital between January 2019 and December 2021. We focused on patients requiring dysphagia rehabilitation and assessing the effects of these interventions on recovery.
RESULTS: The study included 732 participants with an average age of 86.0 ± 7.8 years, of whom 41.9% were male. Approximately 55.1% required dysphagia rehabilitation. Dysphagia rehabilitation significantly improved oral caloric intake and BMI in patients who underwent rehabilitation, and these improvements were comparable to those in patients who did not require dysphagia rehabilitation. Significant enhancement in the ADL of patients was observed at discharge. Patients who required dysphagia rehabilitation also had longer hospital stays and were more likely to be discharged to nursing facilities.
CONCLUSIONS: Dysphagia is common in older patients with CVD, and dysphagia rehabilitation positively affects the maintenance of nutritional status and helps patients achieve ADL independence at discharge. This study highlights the importance of integrating dysphagia rehabilitation into ordinary cardiac rehabilitation programs for older patients with CVD to improve their QOL.

In Europe, CRC is the second most common cause of cancer death, and surgery remains the mainstay curative treatment. Age and frailty are associated with an increased risk of postoperative morbidity and 1-year mortality. Chronological age is not sufficient to assess the risk of postoperative complications. The CGA has been developed to better identify frail patients. Geriatric co-management have been developed to optimize the post-operative outcomes. We analyzed the real-life of geriatric co-management within an ERAS program on surgical outcomes at 90 days and oncologic outcomes at 1 year in patients aged 70 years or older after surgery for CRC. This was a retrospective study based on a prospective cohort. Fifty-one patients with a G8 score ≤ 14 were referred to geriatricians for preoperative CGA (Frail Group). They were compared with 151 patients with a G8 score ≥ 15 (Robust Group). In the Frail Group, patients were significantly older with more comorbidities than the patients in the Robust Group. Oncologic characteristics, treatments and global post-operative outcomes were comparable between the two groups. One year after surgery mortality and recurrence rates were similar between the two groups. Our study suggests that geriatric co-management is feasible and contributes to the reduction of postoperative morbimortality. Moreover, performing the CGA after G8 score screening and completion of geriatric interventions resulted in similar 90-day postoperative outcomes, in frail patients than in robust patients. Our results confirmed the benefit of geriatric co-management, involving G8 screening, CGA, and ERAS, for frail older patients undergoing surgery for CRC.

BACKGROUND: This study evaluated the association between the risk factors and prognosis for metachronous esophageal squamous cell carcinoma (ESCC) after endoscopic resection (ER) of esophageal cancer in older patients.
METHODS: We conducted a retrospective observational study of 127 patients with ESCC who underwent ER from 2015 to 2020. Patients were classified as non-older (≤ 64 years), early older (65-74 years), and late older (≥ 75 years). We analyzed factors associated with poor overall survival and metachronous ESCC after ER using multivariate Cox regression analysis. A metachronous ESCC prediction scoring system was examined to validate the surveillance endoscopy program.
RESULTS: Body mass index (BMI) and Charlson Comorbidity Index (CCI) were significant risk factors for poor overall survival in the multivariate analysis (p = 0.050 and p = 0.037, respectively). Multivariate analysis revealed that age of < 64 years, Lugol-voiding lesions (grade B/C), and head and neck cancer were significantly related to metachronous ESCC (p = 0.035, p = 0.035, and p = 0.014, respectively). In the development cohort, BMI < 18.5 kg/m2, CCI > 2, age < 64 years, Lugol-voiding lesions (grade B/C), and head and neck cancer were significantly related to metachronous ESCC, and each case was assigned 1 point. Patients were classified into low (0, 1, and 2) and high (> 3) score groups based on total scores. According to Kaplan-Meier curves, the 3-year overall survival was significantly lower in the high-score group than in the low-score group (91.5% vs. 100%, p = 0.012).
CONCLUSIONS: We proposed an endoscopic surveillance scoring system for metachronous ESCC considering BMI and CCI in older patients.

Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment landscape of lymphoma and is now approved by the FDA for multiple indications. Given that the indications for CAR T-cell therapy are expanding, a larger patient population will be eligible to receive this treatment in the coming years. Pivotal clinical trials leading to FDA approval of CAR T-cell products required patients to have adequate organ function and good performance status. In the real world, however, the patient population eligible for CAR T-cell therapy includes patients who are older, frail, have poor performance status, and have multiple comorbidities. Studies have shown that CAR T-cell therapy is relatively safe and tolerable in such frail patients, however, there is no agreed upon consensus or guidelines to assess eligibility for CAR T-cell therapy at this moment. Gaining further insight into such patient populations will be vital in order to safely provide and expand access to CAR T-cell therapy.

UNASSIGNED: Early postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems.
UNASSIGNED: Eighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups.
UNASSIGNED: Patients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups.
UNASSIGNED: Revision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.

OBJECTIVE: To determine the utilization rate of a home-based rehabilitation program following an inpatient rehabilitation stay, and to investigate the profile of users.
METHODS: Observational study SETTING: Inpatient rehabilitation facility in a tertiary hospital PARTICIPANTS: Older patients (N=1,913) discharged home between June 2018 and May 2021, after an inpatient rehabilitation stay.
METHODS: N/A MAIN OUTCOME MEASURE: Discharge to home-based rehabilitation RESULTS: Over the study period, 296 (15.5%) patients were discharged to home-based rehabilitation. Compared to the others, home-based rehabilitation patients were more frequently women (69.6% vs 61.5%, p=.008), and admitted after orthopedic surgery (elective or for fracture) (30.1% vs 16.1%, p<.001). They had worse functional performance at admission (mean FIM self-care score: 27.8±7.3 vs 30.8±6.7, p<.001), but greater gain in self-care during their inpatient stay (5.0±4.8 vs 4.4±4.7, p=.038). In multivariable analysis, being a woman (adjOR 1.36; 95%CI 1.01-1.82, p=.040), being admitted after orthopedic surgery (adjOR 2.32; 95%CI 1.64-3.27, p<.001), being admitted for gait disorders or falls (adjOR 1.38; 95%CI 1.01-1.88, p=.039), and showing greater gain in mobility during the inpatient stay (adjOR 1.12; 95%CI 1.07-1.17, p<.001) remained associated with discharge to home-based rehabilitation. In contrast, higher mobility at discharge decreased the odds of discharge to home-based rehabilitation (adjOR 0.87; 95%CI 0.83-0.91, p<.001).
CONCLUSIONS: One in six patients benefited from home-based rehabilitation after their inpatient stay. Although these patients had poorer functional performance at admission and discharge, they showed greater mobility improvement during their inpatient stay, suggesting that their good recovery potential was a key determinant of their orientation toward home-based rehabilitation.