Ana María

Defective proteostasis is a hallmark of aging cells and tissues. Among the different components of the proteostasis network, in this study, we focu...

by Ana María Montserrat Gala and Nursing Department, Escola Universitària Gimbernat, Adscrita a Universitat Autònoma de Barcelona, 08174 Sant Cugat del Vallès, Spain

Department of Medical Oncology, Ramon y Cajal University Hospital, 28034 Madrid, Spain Department of Medical Oncology, Vithas La Milagrosa University Hospital, 28010 Madrid, Spain

Background Frailty is a multidimensional syndrome associated with increased vulnerability to stressors, chronic disease exacerbations, hospitalizations, and disability. Polypharmacy, often defined as the chronic use of five or more medications, is closely and bidirectionally related to frailty. In this context, medication review is a potential strategy to improve health outcomes and slow down the frailty process by optimizing pharmacological treatments. This study aims to evaluate the impact of a geriatrician-led medication review, integrated within primary care (+ AGIL Barcelona program) on polypharmacy and medication adequacy in older adults. Methods We evaluated the effect of the + AGIL Barcelona program on medication adequacy. The + AGIL is a multidisciplinary and multicomponent intervention aimed at promoting healthy aging, based on a comprehensive geriatric assessment and a 10–week structured exercise program, nutritional counseling, medication review, and healthy lifestyle promotion tailored to the individual's needs. Based on patient’s frailty status, comorbidities, and preferences, geriatricians revised the medications, and the modifications were discussed with the participants’ primary care physician, and in selected cases, with a clinical pharmacist. Baseline and three-month follow-up data were collected, including quantitative polypharmacy prevalence, and potentially inappropriate medications (PIMs), according to the EU(7)-PIM list. Subgroup analyses were based on Clinical Frailty Scale scores. Results The study included 173 community-dwelling older adults (mean age: 81.2 years – SD: 5.7; 68.8% women). At baseline, polypharmacy was prevalent (84.4%), with 59.5% of participants receiving at least one PIM. After three months, a slight reduction in the mean number of medications per patient was observed (7.6 to 7.4, p = 0.051). Reduction of number of PIMs was also observed (1.0 to 0.9 per patient, p = 0.011), particularly in those medications affecting the nervous (from 30.1% to 24.3% in the sample, p = 0.025) and genitourinary (from 6.9% to 4.6%, p = 0.046) systems. After stratifying by frailty, a consistent trend was observed overall and especially among non-frail and vulnerable groups. Conclusions While the + AGIL Barcelona program had a limited quantitative impact on polypharmacy, it significantly reduced PIMs’ use, particularly in nervous system-acting medications, which are involved in increased risk of falling and cognitive impairment in older adults. The study highlights the importance of medication review in multidimensional frailty management, although future research with larger samples and standardized medication review protocols is needed.

Aleida Rosquete-Estevez Júlia Crespin Luis Yubero Ana María Mancho and Marta Umbert

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The reduction of the perinatal and late neonatal mortality ratio (PNR) is a universal indicator of development.

Non-acute subdural hematomas (naSDH), encompassing subacute and chronic subdural hematomas, are a common neurosurgical condition in older adults with substantial recurrence rates after treatment. Management has become increasingly multimodal, combining surgical and endovascular strategies; however, the influence of clinical, radiological, surgical and technical factors on recurrence and reintervention remains under investigation. We conducted a retrospective multicenter cohort study including patients from six high-complexity neurosurgical and neurointerventional referral centers in Colombia between January 2023 and June 2025. Adult patients with symptomatic non-acute subdural hematoma confirmed by CT were included. Hematomas were managed with surgery alone, combined surgery and middle meningeal artery embolization, or embolization alone. Recurrence and reintervention were evaluated as outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors associated with the primary outcomes. A total of 247 naSDH were analyzed. Recurrence occurred in 51 hematomas (20.6%) and reintervention in 44 (17.8%). In multivariable analysis, smoking (OR 9.59, 95% CI 1.93–47.52), hypertension (OR 5.23, 95% CI 1.14–23.93), increasing age (OR 1.07, 95% CI 1.00–1.16), and greater hematoma thickness (OR 1.20, 95% CI 1.05–1.37) were independently associated with recurrence. Combined surgery with embolization was associated with reduced recurrence (OR 0.44, 95% CI 0.22–0.88). Among surgical variables, post-drain pneumocephalus significantly increased recurrence risk (OR 13.32, 95% CI 2.83–62.65), whereas longer durostomy drainage duration reduced the recurrence (OR 0.51, 95% CI 0.30–0.85). Endovascular technical factors were not independently associated with recurrence. Clinical factors showed the strongest association with recurrence. Combined surgery and embolization showed a protective association, while postoperative pneumocephalus and drainage duration significantly influenced possible outcomes.