Life Extension Should Come with Wisdom: Reflections and Questions for the Geroscience and Longevity Community.

Geroscience, or longevity biotechnology, has made impressive advances in recent years that have led to the founding of dozens of start-ups, nonprofits and advocacy organizations, and the formation of a global movement to defeat aging. The community envisions changes at the regulatory and policy levels and calls for increased funding for research. Nevertheless, progress in the field has not been matched by discussions about ethical, legal, and social implications, as longevity advocates assume that seeking to expand lifespan or health span is inherently desirable and permissible. In this article, I make the case for the importance of putting ethics and society back into geroscience, along with three considerations for the longevity community. First, it should seek to understand the needs and attitudes of the public. Second, the community needs to define whether the field is primarily striving for healthy aging (increasing health span) or for extending years of life (lifespan). Third, it needs to define the role of investors and tech millionaires in shaping the field's priorities and direction. This last point raises the question of who is setting the direction of a field that can reshape the meaning of being human.

Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians.

BACKGROUND: Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS: This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS: The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION: There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.

Navigating the Landscape of Translational Geroscience in Canada: A Comprehensive Evaluation of Current Progress and Future Directions.

The inaugural Canadian Conferences on Translational Geroscience were held as 2 complementary sessions in October and November 2023. The conferences explored the profound interplay between the biology of aging, social determinants of health, the potential societal impact of geroscience, and the maintenance of health in aging individuals. Although topics such as cellular senescence, molecular and genetic determinants of aging, and prevention of chronic disease were addressed, the conferences went on to emphasize practical applications for enhancing older people's quality of life. This article summarizes the proceeding and underscores the synergy between clinical and fundamental studies. Future directions highlight national and global collaborations and the crucial integration of early-career investigators. This work charts a course for a national framework for continued innovation and advancement in translational geroscience in Canada.

The Paradoxical Decline of Geriatric Medicine as a Profession.

In this Viewpoint, author Jerry Gurwitz discusses the attrition of geriatric medicine as a profession, attributing it in part to societal attitudes about aging and compounded by the negative effects of lower compensation and lack of career prestige.

La importancia de la geriatría transversal en la cirugía abdominal oncológica / The importance of cross-speciality geriatrics in abdominal oncologic surgery

Introducción. El paciente de edad avanzada es el usuario más frecuente en los centros sanitarios. La Geriatría transversal comparteel proceso asistencial con el cirujano atendiendo la esfera cognitiva, funcional y social del paciente, con el objetivo de optimizar loscuidados (tales como mantenimiento de la independencia funcional, nutrición, detección del deterioro cognitivo…) ofreciendo unacobertura integral y reduciendo complicaciones, costes y estancia hospitalaria de manera sobreañadida. El objetivo del trabajo esdar visibilidad a la contribución que el geriatra puede llevar acabo en los servicios de Cirugía General. Material y métodos. Seriede casos mediante estudio descriptivo retrospectivo en el que se analizaron los pacientes mayores de 75 años intervenidos de cáncerde colón durante el año 2021 en el Hospital Central de la Cruz Roja mediante cirugía programada y su evolución clínica posteriora los 6 meses. Resultados: 10 pacientes (80% mujeres), edad media 76,4 años (±3,2), Escala Cruz Roja Funcional media de 1/5(±0,9), con índice de Barthel modificado 80/100 (±15,2), Escala Cruz Roja Mental de 0/5 (±0,6). Índice de Charlson medio de 4,3puntos (±2,2) con 60% enfermedades cardiovasculares, 20% insuficiencia renal crónica y 20% neumopatías. Destacó la elevadapolifarmacia (100%) y desnutrición (60%) previo a la cirugía. El 50% presentó delirium y el 40% padeció insuficiencia cardiacadescompensada. Conclusiones. La Geriatría transversal ayuda a detectar necesidades silentes y debe participar en la atenciónmulticomponente tanto previa a la cirugía (prehabilitación) como en la hospitalización y seguimiento posterior, colaborando con el cirujano en la atención al paciente crónico complejo geriátrico. (AU)

Introduction. The older patient is the most frequent user in healthcare centers. Cross-speciality geriatrics shares the care processwith the surgeon attending the cognitive, functional and social sphere of the patient, with the aim of optimizing care (such asmaintenance of functional independence, nutrition, detection of cognitive deterioration...) offering a comprehensive coverage andreducing complications, costs and hospital stay in a superadded way. The aim of this study is to give visibility to the contributionthat geriatricians can make in general surgery services. Material and methods. Case series by retrospective descriptive study inwhich patients over 75 years of age operated on for colon cancer during the year 2021 in the Central Hospital of the Red Cross byscheduled surgery and their clinical evolution after 6 months were analyzed. Results: 10 patients (80% women), mean age 76.4years (±3.2), mean Functional Red Cross Scale of 1/5 (±0.9), with modified Barthel index 80/100 (±15.2), Mental Red Cross Scaleof 0/5 (±0.6). Mean Charlson index of 4.3 points (±2.2) with 60% cardiovascular disease, 20% chronic renal failure and 20% pneumopathies. The high polypharmacy (100%) and malnutrition (60%) prior to surgery stood out. Fifty percent presented deliriumand 40% suffered from decompensated heart failure. Conclusions. Cross-speciality geriatrics helps to detect silent needs and shouldparticipate in multicomponent care both prior to surgery, during hospitalization and subsequent follow-up, collaborating with thesurgeon in the care of the geriatric complex chronic patient. (AU)

National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity.

Importance: Declining primary care visit rates and increasing specialist visit rates among older adults with multimorbidity raise questions about the presence, specialty, and outcomes associated with usual clinicians of care for these adults. Objective: To examine trends in the presence and specialty of usual clinicians and the association with preventive care receipt and spending. Design, Setting, and Participants: This survey study used repeated cross-sectional analyses of Medicare Current Beneficiary Survey data from 2010, 2013, and 2016. Participants were community-dwelling Medicare Advantage and traditional Medicare members with at least 2 chronic conditions. Data were analyzed from March 1, 2020, to February 5, 2021. Main Outcomes and Measures: Trends and factors associated with self-reported usual clinician presence and specialty. Multivariable regression was used to examine associations between usual clinician presence and specialty with preventive care receipt and spending, controlling for respondent sociodemographic and clinical characteristics. Results: A total of 25 490 unweighted respondent-years were examined, representing 90 324 639 respondent-years across the United States. Overall, 58.4% of respondent-years belonged to women, and the mean (SD) age of respondents was 77.5 (7.5) years. From 2010 to 2016, those reporting usual clinicians dropped from 94.2% to 91.0% (P < .001). Across study years, respondents were more likely to report a usual clinician if they were women (adjusted marginal difference [AMD], 2.5 percentage points; 95% CI, 1.5-3.5 percentage points) or had higher income (≥$50 000 vs <$15 000: AMD, 2.2 percentage points; 95% CI, 1.1-3.4 percentage points) and less likely if they were Black beneficiaries (vs White: AMD, -2.8 percentage points; 95% CI, -4.3 to -1.3 percentage points) or had traditional Medicare (vs Medicare Advantage: AMD, -3.2 percentage points; 95% CI. -4.1 to -2.3 percentage points). Among 23 279 respondents with usual clinicians, those reporting specialists as their usual clinicians decreased from 5.3% to 4.1% (P < .001). Across the study period, respondents were more likely to report specialists as their usual clinicians if they had traditional Medicare (vs Medicare Advantage: AMD, 2.3 percentage points; 95% CI, 1.6 to 2.9 percentage points), were Black or non-White Hispanic (Black vs White: AMD, 1.5 percentage points; 95% CI, 0.2 to 2.8 percentage points; non-White Hispanic vs White: AMD, 3.8 percentage points; 95% CI, 1.9 to 5.7 percentage points), or lived in the Northeast (vs Midwest: AMD, 3.6 percentage points; 95% CI, 2.1 to 5.2 percentage points). Compared with those without usual clinicians, respondents with usual clinicians were more likely to receive all examined preventive services, such as cholesterol screening (AMD, 6.7 percentage points; 95% CI, 5.4 to 8.1 percentage points) and influenza vaccines (AMD, 11.6 percentage points; 95% CI, 9.2 to 14.0 percentage points). Among respondents with usual clinicians, those reporting specialist usual clinicians (vs primary care) were less likely to receive influenza vaccines (AMD, -5.6 percentage points; 95% CI, -9.2 to -2.1). Conclusions and Relevance: In this study, older adults with multimorbidity were less likely to have a usual clinician over the study period, with potential implications for preventive care receipt. Our results suggest a key role for usual clinicians, especially primary care clinicians, in vaccination uptake for this population.

Risk factors and management of pulmonary infection in elderly patients with heart failure: A retrospective analysis.

ABSTRACT: Pulmonary infection is common in patients with heart failure, yet the risk factors remain unclear. We aimed to evaluate the clinical characteristics and risk factors of pulmonary infection in elderly patients with heart failure, to provide reference to the prevention of pulmonary infection.This study was a retrospective study design. We included elderly heart failure patient admitted to our hospital from April 1, 2018 to August 31, 2020. The characteristics and clinical data of pulmonary infection and no infection patients were assessed. Logistic regression analyses were conducted to identify the risk factors of pulmonary infections in patients with heart failure.A total of 201 patients were included. The incidence of pulmonary infection in patients with heart failure was 23.88%. There were significant differences in the age, diabetes, New York Heart Association (NYHA) grade, left ventricular ejection fraction (LVEF), C-reactive protein (CRP) between infection and no infection group (all P < .05), and there were not differences in the sex, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, length of hospital stay between 2 groups (all P > .05). Logistic regression analyses indicated that age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L were the independent risk factors of pulmonary infections in patients with heart failure (all P < .05). Pseudomonas aeruginosa (34.48%), Staphylococcus aureus (19.57%), and Klebsiella pneumoniae (15.22%) were the most common 3 pathogens in patients with pulmonary infection.Heart failure patients with age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L have higher risks of pulmonary infections, preventive measures targeted on those risk factors are needed to reduce pulmonary infections.

[Update 2021: Coronavirus pandemic - challenges for geriatrics]. / Update 2021: Corona-Pandemie ­ Herausforderungen für die Geriatrie.

Nobody supposed that after one year of the pandemia, the SARS-CoV-2 Virus and its emerging mutants dominates the press, our lives and the health system as a whole. As for Geriatric Medicine, many things have also changed: The majority of COVID-19 patients are no more the (oldest) old and mortality is less observed in multimorbid persons, as most of them have been vaccinated. (Oldest) old persons are still especially vulnerable to die due to a COVD-19 infection. In longterm care, a significant higher mortality was seen in the former waves, but now, some longterm care facilities have more places that they can fill. This is a situation that many European countries would never have anticipated.Ressource allocationin stormy times is now more openly discussed, especially who should be admitted to intensive care units. This has led to more detailed and new guidelines which may help even when the pandemia is over. Here, some thoughts regarding the care of older adults in times of the pandemia are discussed.

Ageism in COVID-Related Newspaper Coverage: The First Month of a Pandemic.

OBJECTIVES: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic. METHOD: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers. RESULTS: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life. DISCUSSION: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media.

Brain training using cognitive apps can improve cognitive performance and processing speed in older adults.

Managing age-related decrease of cognitive function is an important public health challenge, especially in the context of the global aging of the population. Over the last years several Cognitive Mobile Games (CMG) have been developed to train and challenge the brain. However, currently the level of evidence supporting the benefits of using CMG in real-life use is limited in older adults, especially at a late age. In this study we analyzed game scores and the processing speed obtained over the course of 100 sessions in 12,000 subjects aged 60 to over 80 years. Users who trained with the games improved regardless of age in terms of scores and processing speed throughout the 100 sessions, suggesting that old and very old adults can improve their cognitive performance using CMG in real-life use.