Sepsis is a core cause of infection-related mortality in the elderly. This article describes the epidemiological characteristics of sepsis in the elderly. Globally, the incidence and mortality rates of sepsis in the elderly increase significantly with age, and there are significant regional differences; Etiologically, Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae) are predominant, and the risk of infection with drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus is increasing; Common sites of infection are lung, urinary tract and abdomen, and the mortality rate of central nervous system infection is the highest; Risk factors include age, comorbidities (cardiovascular diseases, metabolic diseases, chronic organ dysfunction), immunosenescence, and iatrogenic factors. These suggest that we need to strengthen early diagnosis, optimize antibiotic strategies, and implement individualized treatment to reduce the burden of sepsis in the elderly in the future.

Sepsis remains a formidable clinical challenge in the field of critical care medicine worldwide, particularly exacerbated by the aging population due to high incidence and mortality rates. Elderly patients exhibit heightened susceptibility to sepsis and more multiple comorbidities, which synergistically amplify risks of adverse outcomes and impose substantial economic strain on healthcare systems. Therefore, focusing on the pathophysiological mechanisms and clinical complexities specific to sepsis in the elderly, implementing early diagnosis and targeted interventions have important value. The exosomes play the regulatory role as intercellular communicators in sepsis-associated immune dysregulation, endothelial barrier disruption and multi-organ injury. These nanovesicles demonstrate dual potential as both novel diagnostic biomarkers and precision therapeutic vehicles for targeted drug delivery. This article reviews the distinctive pathophysiological and clinical characteristics of sepsis in the elderly patients, systematically elaborates the roles of exosomes in disease progression and clinical outcomes, and explores the promising diagnostic and therapeutic applications of exosome-based strategies, which can provide theoretical foundation to overcome current challenges in precision medicine for sepsis in the elderly.

The gut is the second most common source of sepsis, and age-related pathophysiological alterations in the gut may serve as potential contributors to the susceptibility and vulnerability in the elderly patients with enterogenic sepsis. This article analyzes the relationship between gut immune function, mucosal barrier integrity, gut microbiota composition and the pathogenesis of sepsis in the elderly. It further reviews recent advances in prevention and therapeutic strategies, and suggests that future research should focus on elucidating the dynamic interactions between aging and the intestinal microenvironment, developing novel therapies targeting gut barrier restoration and immunomodulation, and optimizing existing clinical interventions through large-scale trials, with the ultimate aim of reducing the incidence and mortality of enterogenic sepsis in the elderly.

Sepsis exhibits high morbidity and mortality among the elderly population, posing a significant public health challenge. Timely and effective anti-infective therapy is the cornerstone of sepsis management. Elderly patients, due to the decline in organ function, multiple comorbidities, complex baseline conditions and high individual heterogeneity, need clear pathogen identification and a grasping of the overall characteristics of sepsis to achieve effective and precise antimicrobial therapy. Furthermore,appropriate therapeutic agents should be selected according to individual circumstances with dynamic monitoring and adjustments, and strict medication management should be implemented. Currently, there is no unified standard antimicrobial therapy regimen for sepsis, so the development of new technologies and medicines in the future is necessary to improve patients’ outcomes.

With the accelerating pace of global aging, the incidence rate and mortality rate of sepsis among the elderly have risen significantly, posing a serious threat to public health. The elderly patients with sepsis exhibit distinct age-related characteristics in their endocrine stress responses, which not only influence the progression of sepsis but also present challenges to clinical management.This review systematically summarizes the dysfunction and underlying mechanisms of hypothalamic-pituitary-adrenal (HPA) axis, hypothalamic-pituitary-thyroid (HPT) axis, hypothalamic-pituitary-gonadal (HPG) axis and renin angiotensin-aldosterone system (RAAS) in the elderly patients with sepsis, and comprehensively analyzes the risks and benefits of hormone replacement therapy, providing a theoretical foundation for optimizing treatment strategies in the elderly patients with sepsis.

Objective To develop a simple delirium screening scale, and to investigate its reliability and validity. Methods The Diagnostic and Statistical Manual of Mental Disorders-fifth edition(DSM-V) was used as the gold standard for delirium. The item response theory(IRT) method was used to accurately portray and analyze the characteristics of each entry of the survey data, and the opinions of the expert panel were combined to form an ultra-simplified scale, which could be used to rapidly screen delirium for multiple. Finally, 359 patients who were admitted to the Geriatrics Center of West China Hospital from January to December 2023 were enrolled in this study to verify the reliability and validity of the scale. Results The completion rate of this study was 100%. According to DSM-V standard, the sensitivity of the Chinese Delirium Screen-Ultra Brief Scale(CDScreen-UBS) was 95.9%, the specificity was 83.5%, the positive predictive value was 48.0%, the negative predictive value was 99.2%, the positive likelihood ratio was 5.81, the negative likelihood ratio was 0.04, and the area under the receiver operating characteristic (ROC) curve was 0.897. Conclusions CDScreen-UBS is extremely sensitive in rapidly screening delirium in the elderly population.

Objective To systematically analyze the relationship between health literacy level and the risk of frailty/pre-frailty in the elderly. Methods The observational studies on association between health literacy level and frailty/pre-frailty in the elderly were retrieved from the databases such as PubMed,Scopus, Web of Science, Cochrane Library, EMbase, China Biology Medicine Database,CNKI, VIP and Wanfang data. The retrieval time was from the establishment of the database to May 13, 2024. The literatures were screened according to inclusion and exclusion criteria, and the methodological quality of the literatures was evaluated. Stata 17.0 software was used to analyze the data. Results A total of 6 literatures related to the level of health literacy and the risk of frailty in the elderly were enrolled, and 3 of them also reported the risk of pre-frailty period. The total sample size was 13 120 patients, including 1 528/4 910 patients presenting with frailty/pre-frailty and 6 682 patients with non-frailty. The Results of meta-analysis showed that the low level of health literacy increased the risk of frailty(OR=2.18,95%CI:1.45-3.29, P<0.01) and pre-frailty(OR=2.30,95%CI:1.66-3.19, P<0.01). Conclusions Current Results suggest that low health literacy level may be a risk factor for the occurrence of frailty.However, due to the limitations of literatures quality and research methods, this result needs to be further confirmed.

Objective To investigate the impact of different doses of salmon calcitonin on the levels of osteocalcin(OST), N-terminal propeptide of type I procollagen(PINP) and bone pain, and the safety in the elderly patients with osteoporosis. Methods A total of 106 elderly patients with osteoporosis at Xinjiang Production and Construction Corps Hospital from August 2021 to July 2023 were enrolled in this study. These patients were randomly divided into the low-dose group(n=53) and the high-dose group(n=53) according to the dosage of salmon calcitonin. All patients received alendronate as the standard treatment.The low-dose group received injection of salmon calcitonin, 50 IU every two days in the first 2 weeks of treatment, and 50 IU once a week from the 3rd week. The high-dose group received injection of salmon calcitonin, 50 IU/d for the first 2 weeks of treatment, and 100 IU once a week from the 3rd week. All patients were treated continuously for 3 months. The general clinical characteristics, the levels of OST, PINP, beta-isomer of the C-terminal telopeptides of type Ⅰ collagen(β-CTx) and bone mineral density (BMD) before and after the treatment were compared between the two groups. The improvement in bone pain was assessed using the visual analogue score(VAS), and the clinical effectiveness and the incidence of adverse reactions were compared between the two groups. Results After treatment, the levels of serum OST and β-CTx were significantly decreased, and the level of PINP was significantly increased in both groups, especially in the high-dose group(P<0.05). After treatment, the levels of BMD at femoral neck, lumbar spine and hip were significantly increased in both groups, especially in the high-dose group(P<0.05). After treatment, the VAS score was significantly decreased in both groups, especially in the high-dose group(P<0.05). There were no significant differences in the total effective rate and the incidence rate of adverse between the two groups(P>0.05). Conclusions An increased dosage of salmon calcitonin could enhance the therapeutic effectiveness in treating osteoporosis among the elderly patients, and improve bone metabolism, BMD and bone pain with safety.

Objective To investigate the incidence of skin-immune-related adverse events(s-irAE) in the elderly patients with non-small cell lung cancer(NSCLC) undergoing treatment with programmed cell death 1 receptor(PD-1) inhibitors, and to investigate the correlation of s-irAE with survival prognosis and clinical indictors. Methods The clinical data of the elderly patients with NSCLC were collected from the Affiliated Hospital of Inner Mongolia Medical University from March 2020 to March 2023. These patients received first-line treatment with PD-1 inhibitor monotherapy. The patients were divided into s-irAE group and non-s-irAE group according to whether they presented with s-irAE. The levels of progression-free survival(PFS), overall survival(OS), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and prognostic nutritional index(PNI) were compared between the two groups. Results A total of 40 patients were enrolled. The incidence rate of s-irAE was 52.5%(21/40), and the incidence rate of grade ≥3 s-irAE was 5.0%(2/40). The median occurrence treatment cycle of s-irAE was 4.0 (3.0, 5.0), and the main types of s-irAE were rash with pruritus and capillary hyperplasia. Compared with the non-s-irAE group, the s-irAE group had longer median PFS, OS (not reach vs 9.0 months, HR=0.211, 95% CI: 0.073-0.606, P=0.004), (not reach vs 12.0 months, HR=0.233, 95% CI: 0.073-0.748, P=0.014). The levels of PNI, NLR and PLR showed no significant differences between s-irAE group and non-s-irAE group(all P＞0.05). Conclusions The incidence rate of s-irAE is high in the elderly NSCLC patients receiving first-line treatment with PD-1 inhibitor monotherapy. However, the occurrence of s-irAE predicts a better survival prognosis, and predictors for the s-irAE need further study.

Objective To compare the predicting value of the obesity-related indices for the risk of cardiovascular disease(CVD) in the postmenopausal women, and to determine the optimal cut off point for the best indicators. Methods This cross-sectional study surveyed 1 702 postmenopausal women aged over 60 years old living in the urban area of Nanjing, China. Eight obesity-related anthropometric indices were studied, including body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, abdominal volume index, body obesity index, body roundness index and body shape index. Logistic regression analysis was used to evaluate the correlation between 10-year CVD risk and all indicators. The receiver operating characteristic(ROC) curve and the area under the curve(AUC)were used to evaluate the predictive value of all indicators for CVD risk. Results Among these postmenopausal women, 691(40.6%) cases presented with medium risk of CVD, and 406(23.9%) with high risk of CVD. People with moderate to high CVD risk had higher levels of body measurement indices. Logistic regression analysis showed that all anthropometric indices were statistically correlated with CVD risk except for body shape index. ROC analysis showed that body roundness index and waist-to-height ratio had higher predicting value for CVD risk, with optimal cut-off value as 3.85 and 0.52, respectively. Conclusions Body roundness index and waist-to-height ratio are the best anthropometric indicators for assessing CVD risk in postmenopausal women.

Objective To investigate the cognitive function and the ability of the elderly in nursing institutions, and to analyze the correlation between cognitive function and ability. Methods A total of 593 elderly people living in nursing institution were enrolled in this study.The cognitive function was evaluated with Mini-Mental State Examination(MMSE), and the ability of the elderly was assessed using the elderly Ability Assessment Scale(GB/T42195-2022). The ability of the elderly with different severity degrees of cognitive impairment were compared. Spearman correlation analysis was used to test the correlation between cognitive function and ability. Results The average score of MMSE was 14.69±10.44. There were 452 cases (76.2%) with MMSE score ≤24. The total average score of ability assessment in the elderly was 50.30±27.28, and only 17 cases (2.9%) presented with good ability. There was no significant difference in the ability between mild cognitive impairment group and normal cognitive function group, while the ability in severe cognitive impairment group and moderate cognitive impairment group was significantly lower than that in the other groups. There was a positive correlation between ability and cognitive function(r=0.724,P＜0.01). Conclusions The cognitive impairment of the elderly in nursing institution is prominent. When the elderly have cognitive impairment, especially severe cognitive dysfunction, the ability of the elderly decreases significantly.

Objective To explore the effects of low-dose glucocorticoids on the prognosis of the elderly patients with septic shock combined with immunosuppression. Methods A total of 54 elderly patients with sepsis shock combined with immunosuppression admitted to Intensive Care Unit (ICU) and Emergency Intensive Care Unit (EICU) of Nanjing First Hospital from October 2020 to December 2023 were enrolled in this study. The patients were divided into glucocorticoids group (n=26) and non-glucocorticoids group (n=28) based on whether low-dose glucocorticoid treatment was used.The efficacy and treatment safety were analyzed and compared between the two groups. Results After 24 hours of hormone therapy, the oxygenation index and the change of vasoactive drug score (ΔVIS) in glucocorticoids group were significantly higher than those in non-glucocorticoids group (P<0.05). There were no statistically significant differences in median survival time, incidence rate of hospital infections, duration of mechanical ventilation, ICU and hospital stay between the two groups (P>0.05). The levels of interleukin (IL)-6, IL-10, Treg cell, CD4, and CD56 showed no significant differences between the two groups on the first and fifth day of ICU admission (all P>0.05). On the 5th day of admission at ICU, the levels of DCreg cell and CD8 in glucocorticoids group were significantly higher than those in non-glucocorticoids group (P<0.05). Conclusions Early use of low-dose glucocorticoids in the elderly patients with sepsis shock and immunosuppression can improve the oxygenation function and reduce the dosage of vasoactive drugs, without increasing the incidence of hospital infections and hospitalization stay.

Objective To explore the relationship between pan-immune-inflammation index (PIV) and the severity of macular edema in the elderly with diabetic retinopathy. Methods A total of 98 elderly patients with diabetic retinopathy admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from January 2021 to January 2024 were enrolled in this study. The patients without macular oedema were enrolled in the control group (n=20), and the patients with macular edema were enrolled in the observation group (n=78). According to the severity of macular edema, the patients in the observation group were divided into mild group (n=23), moderate group (n=39) and severe group (n=16). The baseline data were compared among the groups. Logistic regression analysis was used to analyze the influencing factors of macular edema in the elderly patients with diabetic retinopathy. Results There were significant differences in the duration of diabetes, the levels of hemoglobin A1c (HbA1c), interleukin-6 (IL-6) and PIV between the observation group and the control group (P<0.01). Logistic regression analysis showed that the duration of diabetes, the levels of HbA1c, IL-6 and PIV were independent influencing factors for macular edema in the elderly patients with diabetic retinopathy (P<0.05). There were significant differences in the levels of PIV, HbA1c and IL-6 among mild group, moderate group and severe group (P<0.05). PIV was positively correlated with the levels of HbA1c and IL-6 (r=0.611, P<0.01; r=0.653, P<0.01). Conclusions PIV is closely related to the severity of macular edema in the elderly patients with diabetic retinopathy, which can be used as an important indicator to evaluate the severity of macular edema in the elderly patients with diabetic retinopathy, and to provide reference for clinical diagnosis and treatment.

Objective To investigate the predictive value of serum laminin (LN) level for the prognosis of acute heart failure (AHF) in the elderly. Methods A total of 238 elderly patients with AHF admitted to Nantong First People’s Hospital from July 2019 to November 2020 were enrolled in this study. The baseline data and the occurrence of major adverse cardiovascular event (MACE) were recorded and collected. Based on the occurrence of MACE, the patients were divided into event group and non-event group.The differences in the baseline data between the two groups were analyzed. Multiple logistic regression analysis was used to investigate the influencing factors of MACE. Receiver operating characteristic (ROC) curve analysis was used to investigate the predictive value of LN for prognosis. Results There were 53 patients presenting with MACE. The levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), LN, hyaluronic acid, aminoterminal propeptide of type Ⅲ procollagen, creatinine, C-reactive protein (CRP), left ventricular end-diastolic diameter, left ventricular end-systolic diameter, systolic blood pressure, glycocholic acid and left ventricular ejection fraction (LVEF), and the proportion of acute decompensated heart failure showed significant differences between event group and non-event group (P<0.05).The levels of LN and LVEF were the independent influencing factors of MACE.The area under the ROC curve of LN in predicting in-hospital MACE in the elderly patients with AHF was 0.742,with cut-off point of 92.5 ng/mL, sensitivity of 59.6%, specificity of 77.1%(P<0.001). Conclusions LN may serve as a potential biomarker to predict the in-hospital prognosis in the elderly patients with AHF.

Objective To investigate the expression and clinical significance of peripheral blood C-X-C motif chemokine ligand 9 (CXCL9) and C-X3-C motif chemokine receptor 1 (CX3CR1) in the elderly patients with chronic obstructive pulmonary disease (COPD)-related pulmonary hypertension (PH). Methods A total of 177 elderly patients with COPD-related PH treated at Xingtai Central Hospital from January 2021 to February 2023 were enrolled in this prospective study. The patients were divided into mild group(21 cases), moderate group(51 cases), severe group(84 cases) and very severe group(21 cases) according to pulmonary function classification, and were divided into poor prognosis group (81 cases) and good prognosis group(96 cases) based on one-year outcomes. The levels of peripheral blood CXCL9 and CX3CR1 were measured using enzyme-linked immunosorbent assay. A multivariate unconditional logistic regression model was applied to identify risk factors for poor prognosis in the elderly COPD-related PH patients, and receiver operating characteristic (ROC) curve was used to assess the predictive value of peripheral blood CXCL9 and CX3CR1 for poor prognosis. Results The levels of peripheral blood CXCL9 and CX3CR1 increased progressively from mild group to very severe group (P＜0.05). After a one year of follow-up, the incidence rate of poor prognosis was 45.76% (81/177). Elevated levels of N-terminal pro-B-type natriuretic peptide, CXCL9 and CX3CR1 were independent risk factors for poor prognosis in the elderly patients with COPD-related PH, while longer 6-minute walk distance (6MWD) and higher cardiac index were independent protective factors (P＜0.05). The area under the curve (AUC) of combined CXCL9 and CX3CR1 for predicting poor prognosis in the elderly patients with COPD-related PH was 0.897 (95%CI: 0.843-0.938), which was higher than that of CXCL9 (0.796, 95%CI: 0.729-0.853) or CX3CR1 (0.785, 95%CI: 0.717-0.843) alone. Conclusions Elevated peripheral blood CXCL9 and CX3CR1 levels in the elderly patients with COPD-related PH are closely associated with reduced lung function and poor prognosis. Combined measurement of peripheral blood CXCL9 and CX3CR1 has a high predictive value for poor prognosis in the elderly patients with COPD-related PH.

Objective To study the effects of different light intensity of phototherapy on the sleep quality of the elderly patients with Parkinson’s disease and insomnia. Methods A total of 136 elderly patients with Parkinson’s disease and insomnia at the First Affiliated Hospital with Nanjing Medical University from July 2022 to January 2024 were enrolled in this study. They were randomly divided into high-intensity light group, moderate-intensity light group, low-intensity light group and control group. The control group received routine treatment and nursing, and the three phototherapy groups received 10 000 Lux, 5 000 Lux and 1 000 Lux phototherapy from 16:30 to 17:00 every day additionally. The score of Parkinson’s Disease Sleep Scale(PDSS) and the polysomnography(PSG) parameters were compared among the four groups 1 week, 2 weeks and 1 month after intervention. Results After one week of intervention, there was no significant difference in PDSS score and PSG paramenters between the high-intensity light group and the moderate-intensity light group(P>0.05), but the PDSS scores and the sleep efficiency, wake time and wake frequency were significantly different compared with the low-intensity light group and the control group(P<0.05). There was no significant difference in PDSS score and PSG parameters between the low-intensity light group and the control group(P>0.05). After two weeks of intervention, there was no significant difference in PDSS score and PSG parameters between the moderate-intensity light group and the low-intensity light group(P>0.05), but the PDSS scores and the sleep efficiency, wake time and wake frequency were different compared with the control group(P<0.05); The PDSS scores and the sleep efficiency, wake time of the high-intensity light group were significant different compared with the moderate-intensity light group, the low-intensity light group and the control group(P<0.05). One month after intervention, there was no significant difference in PDSS scores and PSG among the three phototherapy groups(P>0.05),but the sleep efficiency, wake time and wake frequency were significant different compared with the control group (P<0.05). Conclusions Phototherapy with higher intensity(5 000 Lux and above) can achieve good therapeutic effect in the elderly patients with Parkinson’s disease and insomnia in a short period of time(1 week), and the greater the light intensity in the short term, the greater the effect size. Long-term adherence to 30 min daily phototherapy, 1 000 Lux and above light intensity can improve sleep quality.

Objective To investigate the association between sleep duration with glycemic control among community elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 688 elderly patients with T2DM were randomly selected from communities with multi-stage stratified cluster random sampling method.Multivariable logistic regression models were used to analyze the association of sleep duration with glycemic control. Results Of the elderly patients with T2DM,327(47.5%) cases presented with normal sleep, 136(19.8%) presenting with short sleep, and 225(32.7%) presenting with long sleep, respectively.After adjustment for potential confounders, long sleep duration was an independent influencing factor of glycemic under control(OR=0.70, 95%CI: 0.49-0.97 for glycated hemoglobin; OR=0.72, 95%CI: 0.49-0.95 for fasting plasma glucose). Conclusions Long duration of sleep could influence the glucose metabolism in the community elderly patients with T2DM, and decrease the rate of glycemic control.

Objective To investigate the accuracy of virtual non-calcium technique based on dual energy CT for the diagnosis of fresh osteoporotic vertebral compression fractures(OVCF) in the elderly, and to evaluate the possibility of an alternative examination for magnetic resonance imaging (MRI). Methods The imaging data from the patients who met the inclusion criteria were retrospectively collected from January 2022 to March 2024. A total of 133 elderly patients with a mean age of 75.3±7.2 years were enrolled in this study,with 48 males and 85 females. All patients underwent virtual non-calcium technique based on dual energy CT examination and MRI. The diagnosis was performed by senior imaging physicians. Spearman correlation analysis was used to evaluate the consistency of diagnosis among MRI, dual energy CT and virtual non-calcium technique based on dual energy CT, and then chi-square test was adopted to evaluate the differences in diagnostic accuracy.Finally,the reasons for misdiagnosis of dual energy CT and virtual non-calcium technique based on dual energy CT was analyzed. Results The sensitivity, specificity and accuracry of dual energy CT in diagnosing fresh OVCF were 89.0%, 62.7% and 77.4%, compared with 97.3%, 74.7% and 89.5% of virtual non-calcium technique. The virtual non-calcium technique group had significantly less misdiagnosis cases due to old vertebral fractures and osteophytes than dual energy CT group(P<0.05). Conclusions Virtual non-calcium technique based on dual energy CT is a novel imaging technique that can replace MRI in diagnosing fresh osteoporotic vertebral compression thoracolumbar fractures, especially for the patients with MRI-related contraindications. However, this examination should be carefully prescribed for the patients with bone cement injection and metal fixation history.

Alzheimer’s disease(AD) is an age-associated neurodegenerative disorder, and its pathogenesis has been extensively studied. The mainstream theory shows AD is associated with amyloid-beta(Aβ) and tau protein. However, studies show that abnormal fatty acid metabolism may play a role throughout the progression of AD, with specific physiological and pathological connections. This article summarizes the associations and recent advances on fatty acid transport, degradation and synthesis in relation to AD, aiming to provide new insights for identifying potential therapeutic targets.

Alzheimer’s disease (AD) is a neurodegenerative disorder that exhibits gender differences in epidemiology, clinical symptoms, neuroimaging and biomarkers. The underlying mechanisms contributing to these differences remain unclear. Current research suggests that sex chromosomes, sex hormones, apolipoprotein E, inflammatory and immune factors, and vascular disease-related factors may be involved in the gender-specific mechanisms of AD susceptibility. However, more research evidence is needed to support these findings and to identify new intervention targets, thereby promoting precision diagnosis and treatment for AD.

The training of geriatric professionals has been classified as a critical talent training project in China, which aims to significantly expand the geriatric medicine workforce and improve the overall quality and expertise of these professionals. The National Health Commission has been implementing the National Geriatrics Talent Training Program since 2021. In this study, taking the National Geriatric Medicine Talent Training Base at the First Affiliated Hospital of Nanjing Medical University as an example, we explored the teaching reforms and innovations within the program, and analyzed the strengths and weaknesses encountered during its implementation, in order to further strengthen the capacity building of geriatric professionals in Jiangsu Province and provide valuable insights for future training work.