Geriatrics

Cumulative geriatric syndromes on admission strongly stratify 90‑day mortality risk

In this 43-hospital cohort of 2,556 patients ≥65 years admitted to geriatric services, the median burden was 5 geriatric syndromes at admission. Disability, polypharmacy, frailty, and sensory impairment were the most prevalent syndromes, each affecting over half of patients. Ninety-day mortality increased stepwise from about 8% with 0–2 syndromes to nearly 50% with ≥11 syndromes. Each additional geriatric syndrome was independently associated with higher 90‑day mortality (adjusted HR 1.22; 95% CI 1.15–1.30). These findings support routine, standardized counting of geriatric syndromes on admission to identify high-risk inpatients and prioritize interventions. 1

Blood pressure trajectories after 85 predict later IADL and cognitive changes

Among 429 participants from the Leiden 85-plus study, annual BP, functional status, and MMSE were tracked over 5 years from age 85. Rising blood pressure over time was followed by subsequent IADL decline, whereas BP decreases preceded later IADL improvement. Changes in diastolic BP predicted concordant changes in MMSE: falling diastolic BP foreshadowed MMSE decline, rising diastolic BP foreshadowed MMSE improvement. These temporal patterns suggest BP trends, rather than single readings, may signal impending functional or cognitive deterioration in the oldest old. For very old adults, aggressive BP lowering should be weighed against potential downstream functional and cognitive effects. 2

Step length independently predicts incident frailty beyond gait speed

This prospective cohort followed 1,898 community-dwelling adults aged 65–92 who were nonfrail at baseline for 3 years. Incident frailty, defined as transition to pre-frail or frail by the Kihon Checklist, occurred in 32.2% of participants. Slower gait speed, shorter step length, and lower cadence each predicted incident frailty in multivariable logistic models. Step length remained significantly associated with frailty onset even after adjusting for gait speed and other covariates (OR 0.945; 95% CI 0.909–0.982). Incorporating step length into routine gait assessment may improve early identification of older adults at risk for frailty. 3

Specific CGA domains influence kidney transplant listing and receipt in older adults

In 164 older adults with advanced CKD evaluated for kidney transplant, 84.8% were listed and 17.3% of those listed received a transplant. Better basic ADL function was associated with higher likelihood of being listed for transplantation. Instrumental ADL performance and faster gait speed were more strongly associated with ultimately receiving a transplant. Higher cognitive performance on clinical evaluation and MoCA independently favored both listing and transplantation, even after age adjustment. Nutritional status, adjusted for age, also independently influenced listing eligibility, highlighting the value of focused CGA in transplant pathways. 4