Objective To explore the association between frailty and the risk of benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) in elderly men aged≥60 years old in China. Methods The demographic information, health-related data, and examination data of elderly men aged ≥60 years old in the China Health and Retirement Longitudinal Study in 2011 were collected. Baseline characteristics of the BPH/LUTS group and non-BPH/LUTS group were compared. The correlation between frailty and the risk of BPH/LUTS was evaluated using univariable and multivariate logistic regression models. Subgroup analysis based on three variables including metabolic syndrome, obesity, and sarcopenia, was conducted to explore the potential variations of the association between frailty and BPH/LUTS in each subgroup. Results A total of 1453 subjects were included in this study. The prevalence of BPH/LUTS was 14.66%. After adjusting for all covariates, pre-frailty (OR=1.947, 95%CI: 1.279-2.964, P=0.002) and frailty (OR=1.820, 95%CI: 1.100-3.012, P=0.020) were associated with a higher risk of BPH/LUTS. Subgroup analysis indicated that in the population without metabolic syndrome, pre-frailty and frailty were significantly associated with a higher risk of BPH/LUTS. Conclusions In elderly men aged ≥60 years old in China, frailty is significantly associated with a higher risk of BPH/LUTS, and this association is more obvious in the population without metabolic syndrome.   

Objective To investigate the association between C-reactive protein-triglyceride-glucose index (CTI) and the risk of developing lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). Methods This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) longitudinal cohort from 2011 to 2018, which included 3610 middle-aged and older participants. Multivariable Cox proportional hazards regression models, Kaplan-Meier survival analysis, and restricted cubic splines (RCS) were used to explore the relationship between CTI level and the risk of BPH/LUTS. The predictive performance of CTI was assessed using receiver operating characteristic (ROC) curve analysis. Additionally, subgroup analysis and sensitivity analysis were conducted to evaluate the robustness of the findings. Results During the follow-up period, 630 participants (17.5%) developed BPH/LUTS. After adjusting for potential confounders, each one-unit increase in CTI level was associated with an 8% increased risk of BPH/LUTS (HR=1.08, 95%CI: 1.03-1.25). Compared to the lowest quartile, higher quartiles of CTI were associated with progressively increasing risks of BPH/LUTS (HRs=1.23, 1.29, 1.38, P for trend=0.018). Subgroup analysis indicated that the association between CTI level and BPH/LUTS risk was stronger among participants with a body mass index (BMI) ≥24. RCS analysis further supported an overall linear relationship between CTI level and BPH/LUTS risk. Furthermore, ROC analysis showed that CTI had a stronger predictive performance for BPH/LUTS risk compared to triglyceride-glucose index (TyG) and C-reaction protein alone. Sensitivity analysis confirmed the robustness of these primary findings. Conclusions This study indicates that CTI level are significantly and positively associated with the risk of BPH/LUTS in middle-aged and older men. Moreover, this association varies across different BMI populations. Maintaining lower CTI level may help reduce the risk of BPH/LUTS in middle-aged and older men.   

Objective To investigate the influencing factors of the stage Ⅱ conversion rate of sacral nerve modulation (SNM) in the elderly patients with neurogenic lower urinary tract dysfunction(NLUTD). Methods A retrospective analysis was performed on the clinical data of 123 elderly NLUTD patients aged over 60 years who underwent stage Ⅰ SNM testing in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2017 to December 2025. According to the efficiency and whether they received stage Ⅱ permanent implantation, the patients were divided into the successful conversion group (n=85) and the failed conversion group (n=38). Potential influencing factors were collected, including age, gender, disease course, body mass index (BMI), symptom classification and post-void residual urine. Univariate analysis and multivariable logistic regression analysis were conducted to investigate the influening factors. Results Univariate analysis showed no statistically significant differences in age, gender, and BMI (all P>0.05), while significant differences were observed in disease duration, post-void residual urine, and symptom type between the two groups (all P<0.05). Further multivariable logistic regression analysis revealed that, after adjusting for age, gender, and BMI, longer disease duration (OR=0.785, 95%CI: 0.650-0.947, P=0.012) and voiding-phase dysfunction (with storage-phase dysfunction as reference, OR=0.243, 95%CI: 0.086-0.691, P=0.008) were independent risk factors of successful stage Ⅱ conversion. Conclusions Longer disease course and predominant clinical manifestations of voiding-phase dysfunction (such as dysuria and urinary retention) are independent risk factors for decreased stage Ⅱ conversion rate of SNM in elderly NLUTD patients. It is recommended that potential beneficial patients be evaluated and screened earlier in clinical decision-making.

Diabetic bladder dysfunction (DBD) is the most common chronic complication of diabetes mellitus in urology. Approximately 40%-60% of diabetic patients are troubled by DBD, presenting with varying degrees of lower urinary tract symptoms, mainly including reduced bladder filling sensation, detrusor contractile dysfunction, increased bladder capacity and elevated post-void residual urine volume, which seriously affect patients’ quality of life. The pathophysiology of DBD involves abnormal detrusor status, urothelial dysfunction, and neuropathy. As the structural basis for bladder emptying, changes in the structure and function of the detrusor are key to the occurrence and development of DBD. This review focuses on the time-dependent changes of the detrusor during the course of DBD, systematically expounds the dynamic evolution law from compensatory hyperactivity to decompensated hypoactivity, and deeply analyzes the core mechanisms driving the transition. In the early stage, compensation is dominated by increased neurotransmitter release, sensitization of purinergic signaling pathways and enhancement of calcium signaling pathways; With the progression of the disease, insulin signaling pathway disorders and lipid metabolism disorders drive smooth muscle phenotype transformation; Ultimately, comprehensive activation of oxidative stress leads to irreversible structural damage and functional failure of the detrusor.

Obstructive sleep apnea (OSA) and nocturia/nocturnal enuresis frequently co-occur in the elderly population, significantly impairing quality of life and elevating risks such as falls and fractures. This article aims to systematically review the underlying mechanisms and therapeutic strategies for this comorbidity from an integrated Traditional Chinese and Western Medicine perspective. From a pathophysiological perspective, intermittent hypoxia and intrathoracic pressure fluctuations induced by OSA collectively contribute to nocturnal polyuria and abnormal bladder storage function through multiple pathways. These include dysregulation of the neuro-humoral axis, direct renal injury, and bladder dysfunction. Traditional Chinese Medicine (TCM) posits that the core pathogenesis involves a root deficiency with superficial excess. This encompasses impaired transformation and transportation functions of the triple energizer (Sanjiao), deficiency of the lung, spleen, and kidney leading to water metabolism disorder, as well as malnourishment of the heart-spirit and emptiness of the marrow-sea, resulting in the loss of "mental control" over urination. In terms of treatment, Western medicine employs methods such as continuous positive airway pressure, pharmacotherapy, and surgery, while TCM utilizes approaches including herbal medicine and acupuncture for holistic regulation. This article emphasizes the critical importance of screening for OSA in elderly patients presenting with nocturia and suggests that future efforts should focus on establishing an integrated diagnostic and therapeutic model combining TCM and Western medicine to optimize patient management.   

Objective To explore the effect of Fibulin-1 on the senescence of vascular smooth muscle cells (VSMC) and its possible mechanisms. Methods VSMCs of rat cultured in vitro were divided into three groups for the experiment. The control group was DMEM culture medium without D-galactose, the D-galactose group was DMEM culture medium containing D-galactose, and the experimental group was DMEM culture medium with Fibulin-1 recombinant protein and D-galactose. β-galactosidase staining was used to analyze the cell senescence among each group, transmission electron microscopy was used to observe the ultrastructural changes of cells, and Western blot method was used to detect the protein expressions of P16, P21 and P53. Results β-galactosidase staining analysis showed that the number of senescent cells in the D-galactose group and the experimental group was significantly increased compared with the control group, especially in the expermental group(P<0.05). Through the transmission electron microscopy, we found that the nuclei and extranuclear organelles of the cells in the experimental group showed more obvious senescence changes. The expressions of P16, P21 and P53 proteins in the D-galactose group and the experimental group were significantly increased than those in the control group, especially in the experimental group (P<0.05). Conclusions The Fibulin-1 recombinant protein promotes the aging signs of VSMC at both cellular and sub-cellular levels, and its mechanism may be related to Fibulin-1 upregulating the expressions of cell cycle inhibitory proteins P16, P21 and P53.   

Objective To explore the risk factors of cognitive dysfunction in the elderly patients with Parkinson’s disease (PD) based on quantitative parameters of magnetic resonance imaging (MRI). Methods A retrospective study was conducted, enrolling 150 elderly PD patients admitted to Xi’an International Medical Center Hospital from September 2021 to January 2025. These patients were divided into an observation group (n=52) and a control group (n=98) based on the occurrence of cognitive dysfunction. The MRI parameters, general clinical data, and laboratory indicators of the two groups were collected and compared. Logistic regression analysis was used to investigate the factors influencing the occurrence of cognitive dysfunction in elderly PD patients. ROC curve and calibration curve were used to verify the model. Results Compared with the control group, the observation group showed increased apparent diffusion coefficient (ADC) and H-Y grading, prolonged disease course, decreased gray matter fractional anisotropy (FA) and uric acid (UA) levels (P<0.05). Logistic regression analysis revealed that substantia nigra ADC (OR=2.192), substantia nigra FA (OR=0.464), disease duration (OR=1.893), H-Y grading (OR=1.923), and UA (OR=0.488) were independent predictors of cognitive dysfunction in elderly PD patients (P<0.05). A risk prediction model for cognitive dysfunction in PD patients was constructed based on the influencing factors. The ROC curve results showed that the area under the curve (AUC) of this prediction model for cognitive dysfunction in PD patients was 0.910 (95%CI: 0.852-0.950), with a sensitivity of 90.54% and a specificity of 83.65%, and the Youden index was 0.729. The calibration curve demonstrated that the predictive model exhibited good fit (Hosmer-Lemeshow χ²=0.83, P=0.437). Conclusions The substantia nigra ADC, FA, disease duration, H-Y grading, and UA levels are influencing factors for cognitive dysfunction in elderly PD patients. The risk prediction model for cognitive dysfunction constructed based on these factors in elderly PD patients, demonstrates significant assessment value.   

Objective To investigate the effect of individualized dosing regimen of dexmedetomidine based on multimodal anesthetic depth monitoring in preventing postoperative cognitive dysfunction (POCD) in the elderly patients undergoing non-cardiac surgery. Methods This prospective randomized controlled study enrolled 240 elderly patients undergoing non-cardiac surgery. All the patients were randomly assigned to group A (individualized dexmedetomidine administration guided by multimodal monitoring), group B (conventional anesthesia guided by multimodal monitoring), and group C (conventional anesthesia with routine monitoring), with 80 cases in each group. Mini-Mental State Examination (MMSE) was assessed and serum levels of S100β, neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) were measured to evaluate neuronal injury and oxidative stress before and 1, 3, 7 d after the operation. Meanwhile, adverse events in the three groups were also recorded. Results Compared with group B and group C, group A showed a significantly lower incidence of POCD 3 d and 7 d after operation (P<0.05), with a faster recovery of MMSE scores. At all postoperative time points, the serum levels of S100β, NSE, GFAP, MDA and GSH-Px were significantly lower while the level of SOD was higher in group A than those in group B and group C (P<0.01). The incidence rates of excessive sedation/somnolence, hypotension, and bradycardia were significantly lower in group A than those in group C(P<0.05). Conclusions The individualized dosing regimen of dexmedetomidine based on multimodal anesthetic depth monitoring has significant advantages in preventing POCD in the elderly patients undergoing non-cardiac surgery.    

Objective To explore the association between a body shape index (ABSI) and the risk of age-related macular degeneration (AMD). Methods Based on the cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, a multivariable logistic regression model considering the complex sampling design of NHANES was used to analyze the association between ABSI and AMD. The restricted cubic spline (RCS) analysis was conducted to explore the dose-response relationship between ABSI and AMD. Results A total of 4 874 participants (365 cases of AMD) were included. After adjusting for all variables in the multivariable logistic regression model, ABSI remained significantly positively associated with AMD within the range of (7.95-8.28)×10^-2, the risk of AMD increased in the second quartile than that in the first quartile (OR=1.49,95%CI:1.01-2.20). RCS analysis showed that when ABSI was less than 8.28×10^-2, it is positively associated with AMD risk. Conclusions ABSI is independently associated with the risk of AMD within a certain range and may serve as a potential indicator for risk assessment and early screening, which suggesting that obesity management is significant for the prevention and control of AMD.   

Objective To explore the influence of sleep duration and social isolation on cognitive frailty in elderly patients with chronic heart failure(CHF). Methods From January 2024 to January 2025, a total of 302 elderly patients with CHF in Nanjing First Hospital were investigated by the general information questionnaire, sleep duration assessment, Lubben Social Network Scale-6, Frailty scale, Montreal Cognitive Assessment scale, and Clinical Dementia Rating scale. LASSO regression was used to screen variables and logistic regression was used to analyze the relationship of sleep duration,social isolation with cognitive frailty. Results There were 145(48.0%) elderly CHF patients presenting with cognitive impairment. Multivariable logistic regression analysis showed that after adjusting for confounding factors, the risk of cognitive frailty in patients with sleep duration >8 hours was 3.606 times higher than that in patients with sleep time of 6 to 8 hours (P<0.05). The risk of cognitive frailty in patients with social isolation was 3.360 times higher than that in patients without social isolation (P<0.05). Conclusions Prolonged sleep duration (>8 hours) and social isolation both increase the risk of cognitive frailty in elderly patients with CHF.   

Objective To investigate the relationship between preoperative T cell mitochondrial dysfunction and postoperative delirium (POD) in elderly patients undergoing thoracic surgery. Methods A total of 133 elderly patients scheduled for elective thoracic surgery under general anesthesia at the Second Affiliated Hospital of Nanjing Medical University from January to November 2024 were enrolled. Preoperative venous blood samples were collected for T cell exhaustion and mitochondrial dysfunction assessment. Postoperative delirium (POD) was evaluated within 1-3 days after surgery using the 3-Minutes Delirium Diagnostic Scale (3D-CAM). Patients were divided into POD group and non-POD (NPOD) group based on POD occurrence within 3 days. Multivariable logistic regression was employed to analyze the relationship between T cell exhaustion, mitochondrial dysfunction, and POD. Results Among 133 patients, 31 patients developed POD. Compared with the NPOD group, the patients in the POD group had significantly higher age, postoperative hospital stay duration, total hospital stay duration, preoperative neutrophil percentage, neutrophil count, white blood cell count, and C-reactive protein, while body mass index(BMI), preoperative lymphocyte percentage, and albumin were significantly lower in the POD group (P<0.05). Regarding T cell and mitochondrial dysfunction, patients in the POD group showed significantly increased levels of percentage of CD3⁺CD4⁺PD-1⁺ T cells and decreased levels of percentage of CD45⁺ lymphocytes, percentage of CD3⁺MMP-Low T cells, percentage of CD3⁺CD4⁺MMP-Low T cells and percentage of CD3⁺CD8⁺MMP-Low T cells (P<0.05). After adjusting for confounding factors, age was identified as an independent risk factor for POD (OR=1.110, 95%CI:1.004-1.229), whereas CD3⁺CD4⁺MMP-Low T cell percentage(OR=0.762,95%CI: 0.608-0.956), CD3⁺CD8⁺MMP-Low T cell percentage (OR=0.857,95%CI: 0.737-0.997)and BMI(OR=0.818,95%CI: 0.672-0.996)served as independent protective factors. Conclusions Among elderly patients undergoing thoracic surgery, age, BMI, preoperative percentage of CD3⁺CD4⁺MMP-low T cells, and percentage of CD3⁺CD8⁺MMP-low T cells were identified as independent factors associated with POD.   

Objective To explore the symptom experiences and coping strategies of elderly patients with esophageal cancer complicated with tracheoesophageal fistula (TEF), and to provide references for the development of clinical interventions. Methods Using the phenomenological research method, 17 patients with esophageal cancer complicated with TEF, were recruited from January to December 2024. Semi-structured in-depth interviews were conducted, and the Colaizzi 7-step analysis method was used to analyze, summarize and refine the themes of interview data. Results Four themes were extracted, including symptom experience (respiratory symptoms, sleep deprivation, fatigue, enteral nutrition-related discomfort), emotional and cognitive experience (psychological distress, illness cognition restructuring, perceived social support), coping strategies (active coping, social isolation), unmet support needs (disease-related information, transitional care). Conclusions Elderly patients with TEF experience multiple burdens and needs, suggesting that medical staff should optimize symptom management strategies, address negative emotions proactively, cultivate positive psychological resources, and strengthen information support and transitional care to alleviate symptoms, enhance disease coping capacities and promote physical and mental well-being.    

Objective To investigate the effect of multi-dimensional collaborative management based on frailty risk assessment on blood glucose control and health promotion behavior in elderly patients with type 2 diabetes mellitus(T2DM) complicated with frailty risk. Methods A total of 128 elderly T2DM patients with frailty risk who were treated in the Department of Endocrinology, General Hospital of Eastern Theater Command of Chinese People’s Liberation Army from January to December 2024 were selected as the research subjects. The patients were divided into intervention group (n=64) and control group (n=64) by randomized methods.The 2-hour postprandial plasma glucose (2hPG), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), total score of frailty score (FP), pace, grip strength, health promotion behavior scale (HPLP-Ⅱ) score, diabetes distress scale (DDS) and diabetes self-management behavior scale (SDSCA) were compared between the two groups before intervention and 3 months after intervention. Results There were no significant differences in 2hPG, FPG and HbA1c between the two groups before intervention (P>0.05). After intervention, the levels of 2hPG and FPG decreased in both groups, especially in the intervention group(P<0.05). There were no significant differences in total score of FP, grip strength and pace between the two groups before intervention (P>0.05). After intervention, the total score of FP, grip strength and pace of the two groups were improved compared with those before intervention, especially in the intervention group (P<0.05). There were no significant differences in the scores of each dimensions of HPLP-Ⅱ between the two groups before intervention (P>0.05). The scores of each dimensions of HPLP-Ⅱ in the two groups after intervention were higher than those before intervention, especially in the intervention group (P<0.05). There were no significant differences in DDS and SDSCA scores between the two groups before intervention (P>0.05). After intervention, the DDS scores of the two groups decreased, the SDSCA scores increased, especially in the intervention group (P<0.05). Conclusions The multi-dimensional collaborative management based on frailty risk assessment can effectively improve blood glucose control, reduce diabetes-related psychological pain, enhance self-management ability, and promote the comprehensive optimization of health behaviors in elderly patients with T2DM complicated with frailty risk.   

Objective To evaluate the efficacy of high tibial osteotomy (HTO) combined with platelet-rich plasma (PRP) in the treatment of medial compartment osteoarthritis in the elderly patients. Methods In this double-blind, randomized controlled trial, 50 patients were randomly assigned into group A (HTO + intra-articular PRP injection) and group B (HTO + intra-articular saline injection) via computer-generated randomization. PRP was prepared preoperatively from autologous blood and administered during surgery and 14 d after operation. Follow-ups were conducted for 3 months, with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) scores recorded at each visit. The differences were compared between the two groups. Results 3 months after operation, the total WOMAC scores and VAS scores were significantly lower in both groups compared with those before operation, especially in group A(P＜0.05). Conclusions HTO combined with PRP may represent a more rational treatment option for alleviating knee pain and improving knee joint function of medial compartment osteoarthritis in elderly patients.

Objective To investigate the clinical efficacy of total hip arthroplasty (THA) via the direct anterior approach(DAA) in elderly patients with femoral neck fractures and ipsilateral lower limb muscle weakness. Methods A total of 65 patients with weak lower limb muscle strength and femoral neck fractures admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2020 to September 2025 were enrolled as study subjects. Among them, 35 patients underwent DAA-THA(observation group), and 30 patients underwent posterolateral approach total hip arthroplasty (PLA-THA, control group). Operative time, intraoperative blood loss, incision length, complication rates, and postoperative Harris Hip Score between the two groups were compared. Results All patients successfully completed the surgery and were followed up for 12 weeks. The observation group had a longer operative time, shorter incision length, and less blood loss compared to the control group, with statistically significant differences (P<0.05). In the observation group, there was only one case of hip joint posterior dislocation. In contrast, the control group had one case of surgical site infection and four cases of hip joint posterior dislocation, with no statistically significant difference (P＞0.05). The Harris Hip Scores of the observation group were higher than those of the control group 1 week, 4 weeks, and 12 weeks after operation, with statistically significant differences (P<0.05). Conclusions The DAA-THA in elderly patients with femoral neck fractures on the lower limb muscle side demonstrates favorable early outcomes, including reduced risk of prosthetic dislocation, accelerated recovery of pre-injury mobility, improved quality of life, and with high safety.

Objective To construct a nomogram risk prediction model for delayed neurocognitive recovery (dNCR) in elderly patients with Parkinson’s disease (PD) after subthalamic nucleus (STN) deep brain stimulation (DBS). Methods A retrospective analysis was conducted on 291 elderly PD patients who underwent STN-DBS treatment at Nanjing Brain Hospital from 2016 to 2024. The characteristic variables were selected based on the data of patients with or without dNCR after STN-DBS. Fifteen characteristics, including prior repetitive transcranial magnetic stimulation(rTMS), disease duration, years of education, levodopa-equivalent daily dose (LEDD), scores of Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment(MoCA), total cholesterol, and histories of hypertension, diabetes, cerebral infarction, and brain atrophy were enrolled in multivariable logistic regression analysis to construct a prediction nomogram model, and a calibration curve was drawn to evaluate the accuracy of the model. Results There were 89(30.58%) patients presenting with dNCR after STN-DBS. Multivariable logistic regression model identified LEDD, baseline MMSE score, years of education, rMST history, and brain atrophy as the influencing factors for dNCR after STN-DBS (all P<0.05). The model demonstrated good discriminative ability and calibration upon bootstrap validation (500 replicates), and showed consistency between the actual probability and the predicted probability. Conclusions Higher MMSE score, longer education duration, and previous rTMS treatment independently reduce the risk of post-operative dNCR, whereas elevated LEDD and brain atrophy are the risk factors. The constructed nomogram model showed robust discrimination and calibration, providing a clinically useful tool for individualized risk assessment before STN-DBS in elderly PD patients.   

With the acceleration of global aging, emotional health issues among the elderly have become increasingly prominent. Traditional intervention methods have limitations such as strong reliance on drugs and significant side effects. Artificial intelligence (AI) technology, through emotion recognition, dynamic prediction, and personalized intervention, offers innovative solutions for elderly emotional care. This article systematically reviews the current application status, core scenarios, challenges, and future directions of AI in elderly emotional care management, aiming to provide theoretical references and practical guidance for the development of related fields in China. The future development urgently requires a multi-dimensional approach including aging-friendly technological transformation, data and algorithm governance, and policy coordination to truly make AI a partner in elderly emotional care.

Type 2 diabetic osteoporosis (T2DOP) is a chronic bone metabolic disorder occurring in the context of disordered glucose metabolism, characterized by a unique“high bone density, low bone quality”phenotype and significantly increase fracture risk. Recently, the follicle-stimulating hormone (FSH) and its receptor (FSHR) signaling pathway has attracted increasing attention for its role in the pathogenesis of T2DOP. In addition to regulating gonadal function, FSH can also participate in the bidirectional regulation of glucose metabolism and bone metabolism through FSHR distributed in the pancreas, liver, adipose tissue, and bone tissue. This article systematically reviews the mechanism of action of the FSH-FSHR signaling pathway in T2DOP and explores therapeutic strategies targeting this pathway, providing novel insights for the prevention and treatment of T2DOP.

Objective To summarize the best evidence for polypharmacy management in elderly patients with chronic heart failure(CHF), and to provide a basis for healthcare professionals to assess polypharmacy in this population and standardize medication management practices. Methods Following the 6S model, evidences on polypharmacy management were retrieved from databases including UpToDate, BMJ Best Practice, JBI Evidence-Based Practice Database, the National Institute for Health and Care Excellence (NICE) guidelines website, Medlive, Cochrane Library, Embase, PubMed, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, and the Chinese Biomedical Literature Database. The search timeframe spanned from the inception of each database to March 2025. The PIPOST model was adopted to clarify evidence-based questions, and the included literature types comprised clinical guidelines, evidence summaries, systematic reviews, expert consensus statements, and clinical decision-making documents. Two researchers independently conducted literature screening, quality assessment, and evidence extraction, with any discrepancies resolved through consultation with a third researcher. Finally, the extracteds evidences were thematically categorized and synthesized, and the JBI Evidence Pre-grading System (2014 version) was applied to grade the levels of evidences. Results A total of 11 articles were included, from which 29 best-practice recommendations were synthesized. The innovation of this summary lies in the development of a comprehensive management framework encompassing assessment, prescribing, intervention, follow-up, and education of the patients. Central to this framework is the proposal of a “tiered collaborative” implementation pathway tailored to China’s current healthcare resource landscape. The evidence particularly highlights the value of interprofessional collaboration, the development of locally adapted assessment tools, and the pivotal coordinating role of nurses in continuity of care. Conclusions The evidence synthesized in this study can be applied in clinical practice by selecting the most appropriate evidence in combination with hospital context, clinical scenarios, and individual patient characteristics. This approach aims to standardize polypharmacy management practices and ensure medication safety.   

Adrenal aging refers to the progressive structural and functional changes of the adrenal glands that occur with advancing age, particularly characterized by a remodeling of the adrenal cortical secretory profile with a marked decline in dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), a decrease in average aldosterone levels, and overall cortisol levels that remain relatively stable or are mildly elevated, with attenuation of circadian rhythms and secretory pulse amplitudes. These hormonal changes are associated with adverse outcomes across multiple systems, including sarcopenia/osteopenia, metabolic syndrome, blood pressure abnormalities, impaired immune function, mood and cognitive disorders, frailty, and reduced rehabilitation capacity, indicating that adrenal aging is a clinical issue warranting attention. However, there has been no unified national consensus or guideline in China on adrenal aging/adrenocortical aging to date. Based on a systematic review of the evidence and aligned with domestic clinical practice, this consensus for the first time proposes the definition of adrenal aging, pathways for diagnostic evaluation, recommendations for laboratory and imaging tests, key points for differential diagnosis, stratified management and intervention strategies, and follow-up standards, with the goal of standardizing clinical diagnosis, treatment, and research practice related to adrenal aging in China and promoting healthy aging.