Chronic kidney disease (CKD) is one of the most common and highly harmful chronic non-communicable diseases in China, posing a direct and significant threat to the health of the elderly population. Chronic renal fibrosis in the elderly is the most definitive and important pathological basis for the progression of CKD. In the elderly, renal fibrosis is often the result of various CKD progressing to an advanced stage, and is commonly seen in hypertensive nephrosclerosis, diabetic nephropathy, ischemic nephropathy, chronic glomerulonephritis, hyperuricemic nephropathy, drug-induced kidney injury, and obstructive nephropathy. More critically, current clinical diagnosis and treatment face multiple challenges: traditional diagnostic methods cannot accurately and early reflect the extent of renal interstitial fibrosis; existing fibrosis cannot be effectively reversed; and elderly patients often suffer from multiple comorbidities and polypharmacy. These factors collectively compound the difficulties. Therefore, exploring new diagnostic technologies and therapeutic strategies are keys to breaking through the bottlenecks in this field. This article systematically reviews the core mechanisms of the aforementioned common elderly renal fibrotic diseases, summarizes recent advances in diagnostic technologies and therapeutic strategies, and aims to provide a reference for clinical practice and future research.

Pancreatic fibrosis is a hallmark pathological feature of chronic pancreatitis (CP) and pancreatic cancer, severely affecting the health of the elderly population and imposing a heavy medical burden. While imaging examination serves as an important noninvasive approach for evaluating pancreatic fibrosis, conventional imaging modalities remain limited in accurately diagnosing fibrosis severity and comprehensively assessing disease status. In recent years, the advancement of radiomics has emerged as a novel technical avenue to facilitate precision diagnosis and personalized intervention for pancreatic fibrosis. This review systematically summarizes radiomics research in the context of pancreatic fibrosis diagnosis and management, with particular emphasis on its role in enhancing diagnostic performance for CP, optimizing prognostic prediction for patients with pancreatic ductal adenocarcinoma, and informing individualized therapeutic decision-making, thereby elucidating the potential value of radiomics in improving pancreatic health among the elderly population.

A complex bidirectional regulatory relationship exists between aging and liver fibrosis. Elderly patients with liver fibrosis demonstrate distinct features in etiology, pathophysiology, comorbidity patterns, and treatment tolerance. This paper systematicly reviews current knowledge on the common causes and clinical characteristics of geriatric liver fibrosis, the mechanisms underlying the aging-fibrosis interplay, progress in diagnostic modalities, and emerging anti-fibrotic therapies. The review highlights the urgent need to refine non-invasive diagnostic approaches and to develop individualized, multifaceted anti-fibrotic management strategies tailored to the elderly population.

From an etiological perspective, chronic pulmonary fibrotic diseases (pulmonary fibrosis) are categorized into idiopathic pulmonary fibrosis and secondary pulmonary fibrosis, with treatment principles varying among different disease subtypes. Older adults, being a high-incidence population for pulmonary fibrosis, encounter multiple unique challenges in disease management. This article systematically reviews the pathogenesis, diagnostic evaluation, classification system, and progress in individualized treatment of pulmonary fibrosis in the elderly, aiming to provide references for improving the clinical outcomes of elderly patients.

Myocardial fibrosis is an important pathological basis for the occurrence and development of various cardiovascular diseases in the elderly, and is closely related to heart failure, arrhythmia and poor prognosis. With the development of imaging technology, non-invasive methods such as echocardiography, computed tomography and cardiac magnetic resonance have played important roles in the assessment of myocardial fibrosis. However, traditional image analysis mostly has the limitations of relying on visual assessment or having limited parameter measurement, and still has deficiencies in the identification of diffuse and microscopic heterogeneous fibrosis. Radiomics, by mining a large number of quantitative features from medical image data and combining statistical and machine learning methods for modeling and analysis, provides a new technical path for non-invasive and precise assessment of myocardial fibrosis. This article reviews the pathological basis of myocardial fibrosis in the elderly, the current status of imaging assessment and the progress of radiomics research. It points out that future efforts should focus on establishing standardized radiomics workflows to improve feature stability and reproducibility, conducting multicenter studies, and integrating multimodal imaging with multi-omics data to comprehensively characterize the disease phenotype of myocardial fibrosis from macroscopic morphology to microscopic molecular level.

Objective To investigate gender differences in affective prosody comprehension (APC) and their associations with dysfunctional attitudes and cognitive function among cognitively healthy older adults. Methods Using the Mandarin Auditory Emotion Stimulus Database, we assessed the APC ability for seven emotions (happiness, surprise, sadness, anger, fear, disgust, and neutral) in 199 community-dwelling older adults without cognitive impairment. Dysfunctional attitudes were evaluated using the Dysfunctional Attitudes Scale, and cognitive function was assessed using the Montreal Cognitive Assessment scale. Partial Least Squares regression was used to analyze the relationships among the variables. Results Older women showed higher accuracy and shorter reaction times in APC, with particularly significant advantages in recognizing happiness, fear, and disgust. Older men were more likely to misclassify negative emotions as neutral or positive emotions. The gender differences in APC accuracy among older adults were associated with the gender differences in dysfunctional attitudes, while the gender differences in APC reaction time were associated with the gender difference in visuospatial ability. Furthermore, APC accuracy in older adults was correlated with scores in visuospatial function, language ability, delayed memory, attention, abstract thinking, and naming dimensions. Conclusions There are significant gender differences in both accuracy and reaction time of APC among older adults, and APC accuracy is positively correlated with cognitive function. Older men exhibit poorer APC performance and a higher rate of misjudgment of negative emotions, which may be related to their lower scores in dysfunctional attitudes.

Objective To systematically analyze the association between multi-dimensional mental health factors (cognition, emotion, adaptation, personality, and interpersonal relationship) and common psychological problems among community-dwelling elderly people, and quantify the influence intensity of each factor, so as to provide a theoretical basis for targeted mental health interventions. Methods A stratified multistage sampling method was used to select 570 elderly individuals from 8 communities in Shandong Province from January to June 2023. The revised Eysenck Emotional Stability Scale, the 3rd edition of the UCLA Loneliness Scale, and the Mental Health Scale for the Elderly were used for evaluation. Spearman rank correlation was used to screen factors significantly associated with psychological problems, and a stepwise multiple linear regression model was established to analyze the association characteristics and influence intensity between mental health factors and common psychological problems in the elderly. Results The detection rates of common psychological problems in the community-dwelling elderly were as follows: hypochondriasis (91.93%), guilt (90.88%), dependence (89.30%), obsessiveness (78.95%), depression (73.68%), inferiority (60.70%), and anxiety (38.95%). A total of 84.21% of the participants had moderate to high loneliness. Multiple linear regression showed that interpersonal factor was the only significant predictor for anxiety, guilt and obsessiveness (β=-0.23, -0.20, -0.14, all P<0.001), and also had significant protective effects on depression, hypochondriasis, inferiority and loneliness. Adaptation factor had the strongest effects on hypochondriasis (β=-0.20, P<0.001) and inferiority (β=-0.20, P<0.001), and could effectively alleviate loneliness. Emotional and personality factors significantly reduced dependence (β=0.15, 0.19, both P<0.001), and improved depression and inferiority. Cognitive factor was not included in any regression model and had no independent significant effect. Conclusions Psychological problems of community-dwelling elderly people are mainly characterized by health anxiety, self-deprecation, dependence and loneliness. Interpersonal factor is the core protective factor against negative psychological problems, and adaptation, emotion and personality factors also play important roles. A targeted and multi-level mental health intervention system should be constructed with interpersonal support as the core, adaptation training as the focus, and emotional and personality cultivation as the basis, so as to strengthen the balanced supply of urban and rural services and comprehensively improve the mental health of community-dwelling elderly people.

Objective To identify latent profiles of dyspnea beliefs in elderly patients with severe bronchial asthma and analyze the influencing factors of different latent profiles, in order to provide a basis for implementing individualized psychological interventions. Methods A convenience sampling method was used to select elderly patients with severe bronchial asthma admitted to Shanghai Changzheng Hospital from June 2024 to June 2025 as the study subjects. Data were collected using a general information questionnaire, the Breathlessness Beliefs Questionnaire, the Self-Rating Anxiety Scale (SAS), and the modified British Medical Research Council Dyspnea Scale. Latent profile analysis was employed to identify potential categories of dyspnea beliefs, and multivariate logistic regression analysis was used to explore the influencing factors. Results A total of 306 patients were included, with an effective response rate of 98.37% (301/306). Latent profile analysis revealed that the dyspnea beliefs of elderly patients with severe bronchial asthma could be categorized into three distinct profiles: a low-beliefs group (18.9%), a moderate-beliefs-avoidance group (40.9%), and a high-beliefs-fear group (40.2%). Multivariate logistic regression analysis indicated that monthly household income per capita, dyspnea severity, regular physical exercise, combined with chronic obstructive pulmonary disease, regular follow-up, and SAS score were independent influencing factors for different dyspnea belief profiles. Conclusions Dyspnea beliefs among elderly patients with severe bronchial asthma exhibit significant heterogeneity and are influenced by a combination of physiological, psychological, and social factors. Healthcare providers should recognize the characteristic differences among patients with different profiles, with a particular focus on those with multiple risk factors, to develop targeted intervention strategies.

Objective To investigate the association between serum free fatty acid (FFA) level measured at admission and 90-day mortality in elderly patients with spontaneous intracerebral hemorrhage (sICH). Methods A retrospective study was conducted on 564 patients aged >60 years with sICH. Baseline data, including sex, age, smoking history, alcohol consumption history, blood pressure, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, FFA, blood lipid profile, blood routine index, hematoma volume, and activated partial thromboplastin time (APTT), were collected from all enrolled patients. Patients were divided into a low FFA group (FFA≤0.40 mmol/L, n=293) and a high FFA group (FFA>0.40 mmol/L, n=271) based on median serum FFA level. All patients were followed up for 90 days following discharge, with the outcome defined as all-cause mortality. Univariate and multivariate Cox proportional hazards regression models were employed to analyze the association between serum FFA level and the risk of 90-day all-cause mortality in elderly patients with sICH. Pearson correlation analysis was performed to examine the relationship between FFA level and hematoma volume. Mediation analysis was conducted via the bootstrap method, with FFA as the independent variable, hematoma volume as the mediator, and 90-day mortality as the dependent variable. Results Significant differences were observed in systolic blood pressure, hematoma volume, high-density lipoprotein cholesterol, lipoprotein(a), apolipoprotein B, and mortality rate between elderly sICH patients with different FFA levels (P<0.05). The log-rank test demonstrated that elderly sICH patients with different FFA levels exhibited significant differences in 90-day mortality risk (P<0.05). Univariate Cox proportional hazards regression analysis indicated that age, FFA, hematoma volume, NIHSS score, white blood cell count, hypertension, smoking, and APTT might be associated with 90-day all-cause mortality in elderly sICH patients (P<0.05). In the multivariate Cox proportional hazards regression model, after adjusting for hematoma volume, NIHSS score, APTT, white blood cell count, age, and diastolic blood pressure, FFA remained an independent influencing factor for 90-day all-cause mortality in elderly patients with sICH (HR=2.803, 95%CI: 1.032-7.611). Pearson correlation analysis indicated a positive correlation between FFA level and hematoma volume (r=0.161, P<0.001). Mediation analysis revealed that the indirect effect of FFA on 90-day mortality through hematoma volume was 0.351 (95%CI: 0.123-0.663). Conclusions FFA level at admission is significantly associated with the 90-day mortality risk in elderly sICH patients, and it may influence the 90-day mortality through hematoma volume.

Objective To evaluate the effect of virtual reality-assisted three-level language instruction training on rehabilitation in the elderly patients with post-stroke aphasia. Methods A retrospective analysis was conducted on 98 elderly patients with post-stroke aphasia who received rehabilitation training at Department of Rehabilitation Medicine, West Hospital, Sichuan University from July 2022 to March 2025. The patients were divided into the observation group (n=49) and the control group (n=49) based on different intervention measures. The control group received conventional language training and virtual reality training, while the observation group received three-level language instruction training on the base of the control group. Both groups received 8 weeks of training. The scores of each dimension of Western Aphasia Battery (WAB), aphasia quotient (AQ), National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), Barthel index, and Hospital Version Aphasia Depression Questionnaire (SADQ-H) were compared before and after the intervention in both groups. Results After the intervention, the scores of each dimension of WAB, AQ, MMSE, and Barthel index in both groups were higher than those before the intervention, while the NIHSS score and SADQ-H score were lower than those before the intervention in two groups. The improvements of the above indicators in the observation group were more significant than those in the control group(P<0.01). Conclusions Compared with virtual reality training alone, the combined application of three-level language instruction training can lead to greater improvements in language function, neurological function, cognitive function, activities of daily living, and psychological well-being among the elderly patients with post-stroke aphasia.

Objective To construct and validate of a 3-year recurrent stroke prediction model for elderly patients with acute ischemic stroke (AIS) involving the anterior circulation. Methods A total of 281 patients with anterior circulation AIS admitted to the Second Affiliated Hospital of Guangdong Medical University from January 2021 to June 2022 were retrospectively included as the research subjects. Based on the 36-month follow-up data, the patients were divided into the recurrence group and the non-recurrence group. Univariate and multivariate logistic regression analysis were used to investigate the independent risk factors for recurrent stroke in elderly patients within 3 years, and a nomogram prediction model was constructed. Subsequently, internal validation was conducted through calibration curves, area under the curve (AUC), and decision curve analysis (DCA). Results Among 281 patients, 93 (33.09%) elderly patients with anterior circulation AIS experienced recurrent stroke within 3 years. The results of multivariate logistic regression analysis showed that the time from onset to admission, modified Barthel index(MBI), high-sensitivity C-reactive protein and malondialdehyde (MDA) were independent risk factors for the risk of recurrent stroke within 3 years in patients with anterior circulation AIS (P<0.05), while end-distolic velocity (Vd) and superoxide dismutase (SOD) were independent protective factors (P<0.05). The internal performance evaluation results of the model showed that the Brier score of this model was 0.0146, the calibration slope was 1.0073, and the calibration intercept was -0.0024. The receiver operating characteristic curve indicated that the AUC value of this model for the risk of recurrent stroke within 3 years in elderly patients with anterior circulation AIS was 0.978 (95%CI:0.956-0.983). After 1000 internal validations by Bootstrap, the corrected AUC of this nomogram model was 0.942 (95%CI:0.921-0.965). DCA further confirmed that the model demonstrated good clinical net benefits over a wide range of threshold probabilities. Conclusions The nomogram model based on the time from onset to admission, MBI scores, MDA, hs-CRP, Vd, and SOD accurately assesses the risk of recurrent stroke within 3 years in elderly patients with anterior ciculation AIS, demonstrating good predictive efficacy and clinical utility.

Objective To investigate the efficacy of a single session of extracorporeal shock wave therapy (ESWT) in alleviating triceps surae muscle tone and improving lower limb motor function in elderly patients with Parkinson’s disease. Methods From December 2024 to December 2025, 50 elderly patients with Parkinson’s disease and elevated triceps surae muscle tone at the First Affiliated Hospital of Nanjing Medical University were enrolled in this study. They were randomly allocated into a research group (n=25) and a control group (n=25). The research group received a single session of ESWT applied to the bilateral triceps surae muscles, while the control group received a single session of sham stimulation. Before the intervention and within 10 minutes after intervention, the Modified Ashworth Scale (MAS) for ankle dorsiflexion, the 10-Meter Walk Test (10MWT), and the Timed Up and Go test (TUGT) were assessed. Simultaneously, surface electromyography signals were recorded. The root mean square (RMS) value of the triceps surae at rest was used to evaluate changes in electrophysiological muscle activity. Results The MAS grade for ankle dorsiflexion, 10MWT speed, and TUGT time significantly improved in the research group than those in the control group (P＜0.001). Furthermore, the resting RMS of the medial gastrocnemius (P=0.026), lateral gastrocnemius (P=0.008), and soleus muscles (P=0.003) significantly reduced. Conclusions A single session of ESWT demonstrates an immediate effect in alleviating triceps surae muscle tone in elderly patients with Parkinson’s disease. It can effectively improve peri-ankle muscle tone and enhance functional mobility related to sit-to-stand and walking.

Objective To investigate the incidence and risk factors of atrial high-rate episodes (AHREs) following dual-chamber pacemaker implantation in elderly patients. Methods This study retrospectively collected the clinical data of 107 patients aged ≥65 years who underwent dual-chamber pacemaker implantation at Department of Cardiovascular Medicine, the Third Affiliated Hospital of Soochow University from April 2018 to September 2024. The patients were divided into AHREs group and non-AHREs group based on the presence of AHREs during follow-up. The incidence and risk factors of AHREs were analyzed. Results During a median follow-up of 12 (8,15) months, AHREs occurred in 24 patients (22.4%). The proportion of sick sinus node syndrome (SSS), left atrial volume, percentage of atrial pacing and P-wave sensing amplitude showed significant differences between AHREs group and non-AHREs group (P<0.01).Multivariable logistic regression analysis revealed that SSS (OR=4.065, P=0.015) was an independent risk factor for AHREs, whereas a higher P-wave sensing amplitude (OR=0.372, P<0.01) served as an independent protective factor.Receiver operating characteristic curve analysis showed that the area under the curve of P-wave sensing amplitude in predicting AHREs was 0.834 (P<0.01), with an optimal diagnostic cut-off of 3.85 mV. Conclusions The elderly patients exhibit a high incidence rate of AHREs following dual-chamber pacemaker implantation; SSS and P-wave sensing amplitude are independent predictors of AHREs; A P-wave sensing amplitude ≤3.85 mV is associated with an increased risk of AHREs.

Objective To analyze the clinical, endoscopic and pathological characteristics of fundic gland type neoplasms in the elderly. Methods A retrospective analysis was conducted on 19 patients diagnosed with fundic gland type neoplasms from January 2020 to June 2025 at Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University. Results A total of 19 patients aged 60-86 years were enrolled in this study, including 8 cases of oxyntic gland adenoma, 11 cases of gastric adenocarcinoma of the fundic gland type. All 19 cases were single gastric fundic gland-type tumors, and 8 cases were complicated with gastric diseases such as multiple gastric polyps and gastric stromal tumors. Digestive endoscopy showed that 17 cases had lesions located at the upper 1/3 of the stomach, and 2 cases had lesions located at the middle 1/3 of the stomach. Under white-light endoscopy, most of the lesions showed polypoid or submucosal tumor-like changes. The main Paris classification was type 0-Ⅱa or 0-Ⅱb. Among them, 14 cases had a reddish surface color, and 5 cases showed a faded color change. After endoscopic submucosal dissection (ESD), endoscopic mucosal resection or biopsy forceps resection, no recurrence or metastasis was found in all patients. One patient received additional surgical treatment after ESD. No recurrence or metastasis was observed postoperatively. Immunohistochemistry showed diffuse expression of mucin 6 (MUC6) and synaptophysin (Syn), sporadic expression of chromogranin A (CgA), and a low Ki-67 proliferation index. Conclusions Fundic gland type neoplasm, is a rare and special type of tumor, for which endoscopic treatment is safe and effective, and the prognosis is relatively good. However, there is currently insufficient understanding of it, and it is very easy to be missed or misdiagnosed. Therefore, it is still necessary to improve the understanding, diagnosis and treatment of fundic gland type neoplasms.

Falls are prevalent among the elderly, making fall prevention an undeniable public health challenge. In recent years, virtual reality (VR) technology has been increasingly applied in fall prevention for older adults. This paper reviews the positive role of VR technology in fall prevention, its implementation strategies, and the acceptance among both elderly individuals and healthcare professionals. The study emphasizes the need to further strengthen the theoretical foundation of VR-based interventions for fall prevention, explore age-friendly and context-specific adaptations of VR technologies, and address the personalized and psychological needs of older adults.

Calcific aortic valve disease (CAVD) is currently the third most common cardiovascular disease in developed countries, following coronary heart disease and hypertension, with a high incidence rate and fatality rate among the elderly population aged ≥65 years old. Recent studies have shown that macrophages play a key role in the progression of CAVD. This article summarizes the research progress on the macrophage-to-mesenchymal transition in CAVD, bidirectional communication between macrophages and valve mesenchymal cells, the initiation mechanism of macrophages in autologous valve calcification and bioprosthetic valve failure, as well as the regulatory target of macrophage polarization in calcified valves. Finally, this article proposes that valvular calcification is a stereoscopic and regulatable process, future research should be strengthened on the mechanisms by which macrophages influence valvular calcification, aiming to identify non-surgical therapeutic targets for CAVD and explore new directions for the development of anti-degeneration bioprosthetic valve materials.

Objective To standardize an expert consensus on the nursing management of toenail onychomycosis in elderly patients with diabetes mellitus, so as to guide clinical nursing practice. Methods A consensus development group was established. Relevant clinical decisions, practice guidelines, evidence summaries, expert consensuses, systematic reviews and group standards addressing the nursing management of toenail onychomycosis in elderly patients with diabetes mellitus were systematically retrieved from domestic and international databases and relevant websites. The search timeframe was from the inception of each database to April 2025. After literature screening and quality evaluation, 27 publications were finally included, consisting of 14 guidelines, 6 evidence summaries, 3 systematic review, 3 expert consensuses and 1 group standard. Evidence was synthesized to formulate the initial draft of the consensus. From October to December 2025, 15 experts and 10 experts in medical care for diabetes, onychomycosis, and geriatrics were invited to participate in a round of expert consultation and an expert panel meeting respectively. Through these processes, the initial draft items were revised and refined, and the level of evidence and strength of recommendations were determined. Subsequently, the final version of the consensus was established. Results The consensus comprised 35 items covering 4 themes: assessment, management, health education, and professional training for toenail onychomycosis in elderly patients with diabetes mellitus, thereby establishing a nursing framework for this condition. Conclusions This consensus provides practical guidance for clinical healthcare professionals to effectively manage toenail onychomycosis in elderly patients with diabetes mellitus, and to effectively prevent the occurrence and progression of diabetic foot.