Marco Salvi

Purpose To synthesise the principal scientific advances and professional development opportunities presented at the 21st EuGMS Congress, with a focus on findings likely to influence future geriatric practice and research priorities. Methods Members of the EuGMS-Early-Career Geriatricians Initiative (ECGI) attended and reviewed congress sessions, including all plenary lectures, joint symposia with major European and international societies, ECGI-organised sessions, and selected Special Interest Group (SIG) meetings. A narrative, non-systematic synthesis was developed through collaborative discussion, guided by the congress theme of 'New Landscapes in Geriatric Medicine' and informed by on-demand access to recorded sessions. Results Key scientific contributions included advances in the management of multimorbidity, hypertension, osteoporosis, nutrition-related disorders, frailty, and sarcopenia. Emerging trial and cohort data emphasised the importance of refined assessment tools and improved risk stratification to support individualised care. Sessions consistently highlighted the value of multidisciplinary models integrating geriatrics with cardiology, endocrinology, oncology, and surgical care. Congress activities also facilitated research capacity-building through peer exchange, SIG engagement, and structured early-career initiatives, supporting methodological skill development and fostering cross-national collaborations. Conclusion The scientific advances marked a pivotal moment for geriatric medicine in Europe, with biological diagnostics, personalised treatment strategies, and cross-specialty collaboration rapidly reshaping comprehensive care for older people. Translating these advances equitably will require sustained investment in geriatric workforce development and research infrastructure and represents a call to align health policy with the growing complexity of an ageing population.

Background: Adverse drug reactions (ADRs) represent a major and often underestimated source of morbidity, hospitalization, and functional decline in older adults. The convergence of age-related pharmacokinetic and pharmacodynamic changes, multimorbidity, polypharmacy, and frailty creates a clinical environment in which ADR risk is not static but evolves along progressive trajectories—from mild, early manifestations toward severe, potentially irreversible outcomes. Understanding these trajectories is essential for rational geriatric prescribing. Methods: This narrative review synthesizes evidence from epidemiological studies, systematic reviews, Cochrane analyses, and clinical trials published between 2000 and 2025, focusing on adults aged 65 years and older with two or more chronic conditions. Sources were identified through a structured, non-systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus using the terms ‘adverse drug reactions’, ‘polypharmacy’, ‘multimorbidity’, ‘frailty’, ‘deprescribing’, and ‘pharmacokinetics’ in older adults, alone and in combination. Evidence quality was assessed narratively, distinguishing trial evidence from observational and expert consensus data. Results: ADRs in older adults are best classified using complementary frameworks—the augmented Type A to withdrawal Type E and failure-of-therapy Type F taxonomy (Types A–F), the Dose-Time-Susceptibility (DoTS) classification, and the EIDOS mechanistic scheme—which together capture the heterogeneity of drug-related harm in this population. Age-related pharmacokinetic changes (altered absorption, increased volume of distribution of lipophilic drugs, reduced hepatic and renal clearance) and pharmacodynamic shifts (heightened receptor sensitivity, baroreflex impairment, increased blood–brain barrier permeability) interact with polypharmacy and frailty to amplify ADR trajectories from mild to severe. Anticholinergic burden, prescribing cascades, and inappropriate polypharmacy function as structural accelerators of these trajectories. Medication review and deprescribing improve prescribing quality but evidence for hard outcome benefits remains of low to very low certainty. Emerging AI-enabled digital tools show promising accuracy for identifying frailty and pharmacological vulnerability, but this performance relates to frailty classification and has not yet been shown to prevent ADR trajectories; they require validation for routine clinical use. Conclusions: Recognizing ADRs in older adults as dynamic trajectories rather than isolated events repositions prescribing review and deprescribing from optional to essential clinical acts. An integrated approach combining pharmacological vigilance, comprehensive geriatric assessment, structured deprescribing, and emerging digital decision-support tools offers the most realistic pathway to reduce the trajectory-related burden of drug-related harm in complex older patients.

Background: Sarcopenia, altered bone and systemic metabolism, physical frailty and cognitive decline are age-dependent and interrelated phenomena. Sleep disorders which are erroneously considered as part of the aging process might be the unifying underlying mechanism of accelerated aging. It is well-known that impaired sleep health could predict neurodegeneration and functional decline. However, in current clinical practice, sleep disorders are not routinely screened and only a minority of cases require second-tier specialist techniques. The delay of their assessment, without a comprehensive evaluation, results in higher healthcare costs. The aim of SOMNUS-DARE project is to detect, in a translational manner, the role of sleep disorders in the genesis of physical frailty, sarcopenia, mild cognitive impairment, and to measure their contribution to the progression of these phenomena towards mobility-disability and dementia. Methods: SOMNUS-DARE project will evaluate a sample of 300 community-dwelling healthy active and physically frail sarcopenic subjects, aged 65 years or older, free of cognitive impairment and self-sufficient in basic activities of daily living. The effect of sleep disorders on physical, cognitive and cardiovascular function, systemic, bone and muscle metabolism and body composition will be prospectively assessed by performing: comprehensive geriatric assessment; sleep analysis and environmental monitoring; brain MRI, amyloid positron emission tomography; bone densitometry; radiofrequency echographic multi spectrometry; muscle ultrasound; bioimpedance analysis; cardiac ultrasound; dynamic blood pressure monitoring; blood and saliva measurements. Discussion: The project will make it possible to analyse an extremely relevant public health problem which is still underestimated in the current clinical practice. The combination of traditional diagnostics and innovative digital health techniques, will allow a translational and multidimensional analysis of sleep disorders and to weigh their impact on physical and cognitive decline and quality-of-life trajectories. The expected results will highlight the importance of sleep as a fundamental determinant of health and will contribute to the activation of clinical diagnostic and therapeutic pathways in older individuals where the tailored approach might contribute to substantial benefit. Trial registration: Clinical Trial Number: NCT06944600; Clinical Trial Registry: ClinicalTrials.gov; Registration Date: April 17th, 2025.

Background: The relationship between sleep and healthy aging is complex, involving changes in sleep patterns, architecture, and disturbances. Recognizing these changes is crucial for maintaining physical, cognitive, social, and psychological well-being in older adults. However, links between sleep parameters and aging outcomes remain unclear. Objective: This review synthesizes current knowledge on associations between sleep parameters (duration, continuity, architecture, quality) and healthy aging outcomes, including physical health, cognitive function, psychological well-being, and social engagement. Methods: Following the Arksey and O’Malley framework and Joanna Briggs Institute guidelines, this scoping review analyzed observational studies on healthy older adults. Sleep-related measures were examined without confounders from mental or physical illnesses. Results: Twenty studies were included. Across cohorts, older adults consistently exhibited advanced sleep phases (bedtime ≈39 minutes earlier, wake time ≈76 minutes earlier) and reduced total sleep time (by approximately 2.4 hours vs younger adults). Both short and long sleep durations were associated with poorer aging outcomes, supporting a U-shaped relationship between sleep length and healthy aging. Sleep efficiency decreased by 13% and wake after sleep onset increased fourfold with age, particularly among women. Age-related reductions in slow-wave and REM sleep were linked to lower cognitive performance and altered mood regulation. Moderate daytime napping (< 60 min/day) was generally associated with better sleep quality, whereas excessive napping correlated with reduced odds of “successful aging”. Discrepancies between subjective and objective sleep assessments emerged, indicating that older adults may underreport sleep disturbances. Conclusion: Gaps in understanding longitudinal sleep data, the mechanisms of sleep’s impact on aging, and napping’s role need further exploration. Future research could inform interventions for promoting healthy aging.

Global healthcare systems are under increasing strain to ensure long-term sustainability, necessitating a fundamental transition towards proactive, preventive healthcare strategies. Wearable sensor technologies are uniquely positioned to facilitate this paradigm shift by enabling continuous physiological and behavioral monitoring, facilitating early risk stratification, and enabling timely interventions. DigitAl lifelong pREvention (DARE) is a nationwide initiative conceived in Italy to develop and evaluate novel digital tools and services aimed at fostering innovative health promotion and disease prevention pathways, with wearable devices identified as a critical enabling technology. Herein, we present a comprehensive overview of 16 pilot investigations designed in DARE to rigorously assess the utility of wearable devices in the continuous monitoring of physical activity, joint mobility, sleep architecture, heart rate variability, nutrition, and glucose homeostasis across diverse health domains, including healthy aging, chronic disease prevention, and lifestyle modification programs targeting over 20000 participants. We meticulously detail the methodological characteristics of these study protocols, explicitly outlining the technical specifications, functional capabilities, and inherent limitations of the 18 distinct wearable devices (sourced from 12 different manufacturers) employed across these clinical trials. The breadth of applications and the heterogeneity of the target populations underscore the significant potential of wearable devices as an integral component of future digital health prevention strategies.

Atrial Fibrillation can be considered a geriatric syndrome for its prevalence and incidence, its impact on patients’ quality of life, and Health Systems’ economy. The European Society of Cardiology 2024 guidelines introduce a recommendation for maintaining vitamin K antagonist therapy over switching to direct oral anticoagulants in clinically stable elderly patients with atrial fibrillation. This article explores the implications of this indication for the geriatric clinical context. The focus will also be devoted to the need for the stratification of older patients with atrial fibrillation, making an appropriate distinction between frailty and disability.

Purpose Frail and sarcopenic older individuals are high-risk population of cardiovascular events requiring multidomain intervention. The cross-talk between cardiac and skeletal muscle mass is crucial to maintain physical independence in this specific population. The aim of the study was to evaluate, in a selected sample of frail and sarcopenic older adults, the influence of two-year exercise program and nutritional counseling (MCI group) compared to lifestyle education (HALE group) on echocardiographic parameters and on the relationship between cardiac and skeletal muscle mass. Methods One-hundred subjects, among those enrolled in the SPRINTT trial at Frailty Clinic of University-Hospital of Parma site, underwent cardiological examination as part of the ancillary protocol (CARDIOSPRINTT). 82 participants (46 MCI and 36 HALE) completed the protocol and attended the final visit after approximately 25 months. Results We did not find not significant changes in the intervention group compared with HALE group. However, we captured the longitudinal effects of CV aging, including the reduction of left ventricular volume and an impairment of systolic and diastolic function of both ventricles. We found, as in the baseline, a significant relationship between LVM and SMM (r=0.571, p<0.001) suggesting the existence of cardiac muscle-skeletal muscle axis. This relationship was not independent of age, BMI or systolic blood pressure. ConclusionOur findings suggest that among frail patients with different degree of mobility impairment a personalized exercise protocol is necessary to improve cardiac health and counteract the cardiovascular aging. The modulation of cardiac-muscle axis, is an intriguing target for preventing or delaying the cardio-sarcopenia.

Background: Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to improve the prognosis and reduce surgical complications. The aim of this research was to innovatively explore whether the preoperative period could be the appropriate timeframe to empower surgical resilience, through prehabilitation and dietary supplementation, in older sarcopenic patients undergoing knee arthroplasty. Methods: The current literature concerning the effectiveness of prehabilitation and dietary supplementation before knee arthroplasty in sarcopenic older individuals was reviewed, following the SANRA criteria, between December 2023 and February 2024. The study inclusion criteria were as follows: (1) prehabilitation and/or dietary supplementation interventions; (2) human participants aged 65 years and older; (3) relevant outcome reporting (functional status, postoperative complications, and patient-reported outcomes); and (4) articles written in English The extracted information included study characteristics, demographics, intervention details, outcomes, and the main findings. Results: Merged prehabilitation and dietary supplementation strategies extrapolated from the current literature and involving strength, resistance, balance, and flexibility training, as well as essential amino acids, iron, vitamin D, adenosine triphosphate, and glucosamine sulphate supplementation, could improve the functional capacity, ability to withstand the upcoming surgical stressors, and postoperative outcomes in older people undergoing knee arthroplasty. Conclusions: Addressing complex links between knee osteoarthritis and sarcopenia in older individuals undergoing knee arthroplasty requires a multidimensional approach. Prehabilitation emerges as a crucial preliminary step, allowing the optimization of surgical outcomes. Nutraceutical integration, included in a comprehensive care plan, could have a synergic effect in achieving prehabilitation goals. Those interventions are essential for surgical resilience, in terms of muscle function preservation, recovery acceleration, and overall quality of life enhancement. Intensive collaboration among specialists could advance knowledge and the sharable consensus concerning the critical and evolutive field of perioperative care.

Dopamine is a key neurotransmitter involved in physiological processes such as motor control, motivation, reward, cognitive function, and maternal and reproductive behaviors. Therefore, dysfunctions of the dopaminergic system are related to a plethora of human diseases. Dopamine, via different circuitries implicated in compulsive behavior, reward, and habit formation, also represents a key player in substance use disorder and the formation and perpetuation of mechanisms leading to addiction. Here, we propose dopamine as a model not only of neurotransmission but also of neuromodulation capable of modifying neuronal architecture. Abuse of substances like methamphetamine, cocaine, and alcohol and their consumption over time can induce changes in neuronal activities. These modifications lead to synaptic plasticity and finally to morphological and functional changes, starting from maladaptive neuro-modulation and ending in neurodegeneration.