At the end of the first month of anti-tuberculosis treatment, researchers assessed 17 symptoms using the Pulmonary Tuberculosis Patient Symptom Cluster Assessment Scale. Latent class analysis identified a low symptom burden subtype in 128 patients, or 42.7%; a high psychogastrointestinal symptoms subtype in 92 patients, or 30.7%; and a high respiratory symptoms-dominant subtype in 80 patients, or 26.6%. The psychogastrointestinal subtype was characterized by the co-occurrence and high burden of depression, anxiety, nausea and vomiting, while the respiratory subtype was characterized by a high burden of respiratory symptoms.

Medication adherence was assessed in the third month of treatment among 285 patients who completed follow-up, using the researchers’ self-developed and validated Treatment Adherence Scale for Tuberculosis. A score above 36 points was classified as good adherence. The good-adherence rate was 45.7% in the high psychogastrointestinal symptoms group, 60.0% in the high respiratory symptoms-dominant group and 77.3% in the low symptom burden group; the difference among the three groups was significant at P<0.001. Univariate and multivariable logistic regression analyses examined associations between symptom subtype and good adherence.

After adjustment for confounding factors, the high psychogastrointestinal symptoms subtype had the strongest reported association with poor adherence. Its adjusted odds ratio for good adherence was 0.24, with a 95% confidence interval of 0.13–0.45 and P<0.001, indicating lower odds of good adherence than in the low symptom burden group. Coexisting diabetes mellitus was also independently associated with lower odds of good adherence, with an adjusted odds ratio of 0.52, a 95% confidence interval of 0.28–0.97 and P=0.037. These results show associations, not causal effects. The study was limited to newly diagnosed older inpatients with pulmonary tuberculosis in four wards at two hospitals, and adherence was assessed once during the first three months of treatment. Fifteen enrolled patients did not complete the adherence follow-up, leaving 285 participants in that analysis. The reported findings do not establish that symptom patterns cause nonadherence or that the associations will generalize to other populations and settings.

Subject of Research: Symptom subtypes and medication adherence among older patients with pulmonary tuberculosis

Article Title: Classification of older pulmonary tuberculosis patients based on symptom clusters and differences in medication adherence: a latent class analysis

Article References: Cai, Y., Cheng, X., & Rui, Y. (2026). Classification of older pulmonary tuberculosis patients based on symptom clusters and differences in medication adherence: a latent class analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14486-x

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14486-x

Keywords: pulmonary tuberculosis, older patients, medication adherence, symptom clusters, latent class analysis, psychogastrointestinal symptoms, respiratory symptoms, observational cohort, multicenter study, Classification, older, pulmonary

The study team, led by Xue Wang, Xu Zhang, and Yingchun Gao with corresponding author Yan Liu, recruited 210 family caregivers of older patients with gynecological malignant tumors from the gynecological tumor center of a Beijing hospital between July and December 2024. Participants were enrolled through convenience sampling and completed a battery of standardized instruments: a general information questionnaire, the Caregiver Burden Scale, a health-related quality of life measure based on the SF-12 framework, and the Simple Coping Style Scale. The design allowed the researchers to quantify three variables for each caregiver—the perceived burden of care, the dominant coping strategies, and self-reported physical and mental health status—and then to test statistically whether coping styles transmit part of the effect of burden onto quality of life.

The headline numbers are sobering. The mean caregiver burden score was 48.71, with a standard deviation of 17.56, indicating a substantial and widely varying load across the sample. Meanwhile, the mean scores for physical and mental health-related quality of life—the Physical Component Summary (PCS) and Mental Component Summary (MCS)—were 43.07 and 42.60 respectively, both below the general population norm of 50, suggesting that these caregivers’ health was already compromised on average. Positive coping strategies, such as seeking social support and reframing problems, scored a mean of 17.73, while negative coping strategies, such as avoidance and emotional venting, averaged 13.70. The spread in these scores would prove central to the study’s central finding.

Correlation analysis revealed a consistent and statistically significant pattern. Care burden was negatively associated with positive coping (r = −0.301), with physical quality of life (r = −0.495), and with mental quality of life (r = −0.443), all at P < 0.01. In other words, the heavier the perceived burden, the less likely caregivers were to adopt adaptive strategies and the worse their self-rated health. Burden also correlated positively with negative coping (r = 0.362), meaning that overwhelmed caregivers tended to lean more heavily on avoidance and other maladaptive responses. These bivariate relationships set the stage for the study’s more sophisticated question: does coping merely accompany poor outcomes, or does it actively carry the effect of burden into health?

To answer that question, the researchers built mediation models, a statistical technique that decomposes the total effect of one variable on another into a direct pathway and an indirect pathway routed through a third variable. Here, the indirect pathway ran from care burden through coping style to quality of life. The results showed that both positive and negative coping styles partially mediated the association between burden and both dimensions of health-related quality of life. For the physical health dimension, positive coping accounted for 13.85 percent of the total effect and negative coping for 14.95 percent. For the mental health dimension, the mediating shares were larger: 17.37 percent through positive coping and 28.81 percent through negative coping.

That asymmetry is one of the most striking technical findings in the paper. The mental component of caregivers’ quality of life appears substantially more sensitive to coping style than the physical component, with negative coping in particular transmitting nearly three in ten of the total effect of burden onto mental health. The interpretation, consistent with stress and coping theory, is that burden does not act on wellbeing in a single straight line. A heavy caregiving load erodes health partly on its own—through exhaustion, disrupted sleep, and financial strain—but also indirectly, by pushing caregivers toward strategies such as avoidance, self-blame, or emotional discharge, which in turn deepen psychological distress. Conversely, caregivers who maintain problem-focused, socially engaged strategies retain a buffer even under heavy load.

The clinical context matters for understanding why this population deserves specific attention. Gynecological malignancies—cancers of the cervix, uterus, ovary, and related organs—are increasing in the population, and because many are diagnosed in midlife and beyond, a growing number of older patients depend on family members for daily support. Treatment trajectories are long and demanding, involving surgery, chemotherapy, and surveillance, and the intimate nature of these cancers can add communication and emotional burdens that caregivers of patients with other malignancies may not face. Yet family caregivers are rarely the focus of clinical care; they are the infrastructure that keeps oncology functioning, and their health is a quiet casualty when that infrastructure is overloaded.

The authors emphasize that the partial nature of the mediation is itself informative. Because coping styles accounted for only a fraction of the total effect—between roughly 14 and 29 percent depending on the pathway—most of the harm of care burden operates directly, independent of coping. That means teaching coping skills alone cannot substitute for reducing the burden itself through respite care, financial support, and better coordination of services. At the same time, the significant mediating shares indicate that coping-focused interventions are a genuine lever, not a cosmetic one. Nursing staff, the authors argue, should design and implement targeted interventions that encourage positive coping strategies, potentially screening caregivers for maladaptive patterns at the start of the treatment journey.

The study’s limitations, which the authors acknowledge, are typical of cross-sectional survey research. All data were collected at a single point in time from a convenience sample at one hospital, which limits causal inference and generalizability. It is entirely possible that poor quality of life worsens coping and increases perceived burden, rather than the reverse, or that the relationships are bidirectional and mutually reinforcing. The authors explicitly call for longitudinal and intervention studies to establish the temporal ordering of these relationships and to determine whether coping-focused support actually improves quality of life when tested prospectively. The sample size of 210, while adequate for the mediation models fitted, is modest relative to the diversity of caregiving situations across regions and healthcare systems.

Even with those caveats, the research adds a precise and actionable piece to a rapidly growing picture of caregiver science. It confirms with specific effect estimates that the psychological strategies caregivers use are not merely personality traits but measurable pathways through which the stress of care translates into bodily and mental harm. For clinicians, the practical message is that a caregiver’s coping style is a modifiable risk factor that can be assessed and addressed alongside the patient’s treatment plan. For the millions of families navigating gynecological cancer in an aging population, the study offers a measure of scientific validation: the exhaustion they feel is real, quantifiable, and—partly, at least—something that the right psychological support could soften.

Subject of Research: The mediating role of coping styles in the relationship between caregiving burden and quality of life among family caregivers of older patients with gynecological cancers.

Article Title: Influence of the care burden on quality of life among family caregivers of older patients with gynecological malignant tumors: the mediating role of coping styles

Article References: Wang, X., Zhang, X., Gao, Y., Huang, A., Jin, H., Zhao, C., Zhang, P., Zhai, H., Xu, Y., & Liu, Y. (2026). Influence of the care burden on quality of life among family caregivers of older patients with gynecological malignant tumors: the mediating role of coping styles. BMC Nursing. https://doi.org/10.1186/s12912-026-05489-9

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05489-9

Keywords: caregiver burden, coping styles, quality of life, gynecological cancer, family caregivers, mediation analysis, nursing, older patients, oncology, mental health, SF-12, Beijing

Delirium is defined as an acute disturbance in attention, awareness, and cognition that arises as a direct consequence of a physiological event such as an acute illness or infection. It affects roughly one in four older acute medical inpatients, a figure that has remained stubbornly stable across four decades of research. Far from being a benign and transient confusion, delirium is a red flag of underlying vulnerability. It is associated with increased mortality, longer hospital admissions, long-term cognitive decline, poorer functional status, and higher rates of institutionalisation. Crucially, it is also partially preventable: studies suggest that up to a third of new delirium cases in hospitalised patients could be avoided through multicomponent interventions such as reorientation, sleep protection, early mobilisation, and ensuring patients have their glasses and hearing aids. But prevention depends on knowing who is at risk, and that is where the system frequently breaks down.

The Groningen team, led by geriatric medicine researcher Maaike A. Pouw, set out to compare three distinct approaches to delirium identification in the same cohort of patients. The first was a retrospective extraction of documented prehospital indicators: researchers combed through the free-text referral notes and handovers written by general practitioners and ambulance professionals, marking a case as positive when the notes contained an explicit suspicion of delirium or descriptions consistent with it, such as a patient being progressively confused, disoriented, or incoherent. The second was the VMS delirium risk score, a three-question tool used across Dutch hospitals since 2012 that asks about memory problems, need for help with self-care, and any previous episode of delirium. The third was the 4AT, a widely validated four-item screening instrument that assesses alertness, abbreviated mental test performance, attention, and acute mental status change, and can be administered without special training even to drowsy or agitated patients.

The study drew on Acutelines, a hospital-based data and biobank that enrols patients with acute conditions arriving at the emergency department of the University Medical Center Groningen. From September 2020 to February 2024, the researchers included patients aged 70 and older who were admitted for at least one night after their emergency visit and who had a completed 4AT assessment at admission. In total, 655 patients entered the analysis, with a median age of 76 years and 62 percent male. To establish whether patients actually experienced delirium during hospitalisation, the team performed a careful chart-based review using DSM-5 criteria, supplemented by a check for new antipsychotic prescriptions or elevated scores on the Delirium Observation Screening Scale. Uncertain cases were discussed in consensus meetings, a process that applied to 20 percent of all records.

The headline finding was stark. Delirium occurred in 146 of the 655 patients, or 22 percent, consistent with the well-documented burden of the syndrome in older inpatients. When the researchers calculated positive likelihood ratios, a statistical measure of how strongly a positive result points toward the condition, the documented prehospital indicators scored 5.54, the 4AT scored 2.39, and the VMS risk assessment scored just 1.55. In practical terms, when a general practitioner or ambulance medic had written down a suspicion of delirium, that observation was by far the strongest early predictor that the patient would indeed be delirious during the admission. The positive predictive value of the prehospital documentation was 0.64, meaning nearly two-thirds of flagged patients were confirmed cases, and the 4AT achieved an even higher positive predictive value of 0.83, although it flagged only 22 percent of patients as positive.

Each tool, however, told only part of the story. The documented prehospital indicators had a low sensitivity of 0.34, meaning most patients who went on to develop delirium had no such note in their referral documentation. The researchers caution that this may partly reflect documentation gaps rather than a true absence of symptoms at the time of prehospital contact, since emergency crews understandably prioritise physical stabilisation and may not record or convey observations of confusion during a hectic transfer. Among patients with negative prehospital indicators, 16 percent still developed delirium, a figure similar to the 13 percent false-negative rate of the 4AT. The VMS score behaved differently altogether: as a risk-factor-based tool rather than a feature-based one, it generated many false positives, 231 patients or 38 percent of the cohort, but relatively few false negatives, suggesting it is better suited to casting a wide preventive net than to confirming diagnosis.

The study also revealed troubling inconsistencies in routine screening practice. Although compliance with VMS screening was high at 94 percent, exceeding expectations from prior literature, discrepancies appeared in 12 percent of cases. Some patients had been screened twice at different time points with contradictory answers, and in other instances the screening indicated the patient had never experienced delirium even though a previous episode was clearly documented in their medical history. The authors suggest this may reflect the tool’s reliance on patient self-report, since patients may not recall a previous delirium episode, particularly when it occurred on top of underlying dementia. These reliability concerns matter because the VMS score drives decisions about preventive care across Dutch hospitals.

Another striking observation was the limited overlap between the two feature-based approaches. Both the prehospital documentation and the 4AT aim to capture the actual clinical features of delirium at roughly the same point in the care pathway, yet their positive classifications diverged substantially. The authors attribute this to the inherently fluctuating course of delirium, differences in assessment timing, and the possibility that early symptoms resolve quickly after simple interventions such as intravenous fluids or oxygen. They also note that research settings tend to yield higher detection rates than routine care, and that the 4AT in this study was administered partly by trained researchers rather than solely by clinical staff.

The implications reach beyond the emergency department. The authors argue that it would be beneficial to mandate the documentation of cognitive functioning in referral letters and ambulance reports for older patients conveyed to the emergency department, potentially enabling earlier identification and faster intervention, such as involving family members or placing the patient in a calmer environment. They point to emerging technologies that could help, including targeted training for emergency medical services personnel, clinical decision support systems, and natural language processing tools capable of extracting relevant information from clinical narratives automatically. The Institute for Healthcare Improvement recommends delirium screening at least every 12 hours in acute care, but the Groningen team suggests assessment may need to begin even earlier, at the first point of contact at home or in the ambulance.

The study has limitations that the authors acknowledge candidly. It was a single-centre cohort, the medical records were not independently assessed by two reviewers, and the retrospective design meant outcome parameters were restricted to what could be extracted from electronic records. Verbal observations communicated at handover may never have been written down, and chart-based delirium detection depends on the recognition skills of the initial care provider. The interval between early assessment and the occurrence of delirium during a long hospital stay also complicates interpretation, since an initially negative assessment may have been accurate at the time. Nevertheless, the large sample size, multi-year data collection, and realistic representation of routine emergency practice give the findings weight. As the researchers conclude, all three approaches were associated with delirium during hospitalisation, but the humble prehospital note, often scribbled under pressure in the back of an ambulance, may be an underused and valuable asset in protecting older patients from one of medicine’s most consequential syndromes.

Subject of Research: Comparison of three delirium identification approaches in older emergency department patients

Article Title: Comparing three approaches to delirium identification in older patients presenting to the emergency department

Article References: Pouw, M. A., Haan, E. G., Jansen, C. J., Trzpis, M., & van Munster, B. C. (2026). Comparing three approaches to delirium identification in older patients presenting to the emergency department. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01612-w

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01612-w

Keywords: delirium, emergency department, older patients, 4AT screening, VMS risk score, prehospital care, geriatric medicine, screening tools, likelihood ratio, hospitalisation, cognitive impairment, ambulance notes

Researchers at Tampere University Hospital set out to answer a question that had not been addressed before: whether temporal muscle thickness, or TMT, measured on ordinary computed tomography scans, could predict survival in patients aged 70 or older who received brain radiotherapy for metastatic cancer. The question matters because prognostication in this population is exceptionally difficult and exceptionally important. Brain metastases affect an estimated 10 to 40 percent of patients with solid tumors, and population studies place the incidence between 8.3 and 14.3 per 100,000 people, a figure that almost certainly underestimates the true burden because not all cases are registered. Median survival across the field ranges from as little as two months to 21 months depending on the primary cancer, and for patients over 65, Surveillance, Epidemiology, and End Results data indicate a median survival of four months or less for nearly all common malignancies, including breast, colorectal, esophageal, renal, and lung cancer and melanoma.

Accurate prognostic tools would allow clinicians to tailor treatment intensity intelligently. Patients with a favorable outlook might benefit from more aggressive interventions, while those expected to survive only weeks could be spared the burdens of hospitalization, repeated radiotherapy sessions, or chemotherapy in the final weeks of life, interventions that may degrade quality of life without meaningfully extending it. Honest prognostic information also underpins shared decision-making, giving patients and families a realistic basis on which to weigh intensive treatment against palliative care. The Tampere team reasoned that if a simple measurement already embedded in the treatment-planning scan could sharpen these predictions, it would be a genuinely useful clinical instrument.

The study, published in Cancer Reports, took the form of a retrospective cohort analysis of consecutive patients aged 70 years or older who underwent brain radiotherapy, with or without prior surgical resection, for brain metastases between 2014 and 2022. From the hospital’s electronic radiotherapy database, 249 patients met the inclusion criteria: 136 men with a mean age of 76.0 years and 113 women with a mean age of 76.4 years. Lung cancer dominated the cohort, accounting for 113 patients or 45.4 percent, followed by breast cancer with 29 patients and melanoma with 27. Most participants, 226 in total, received radiotherapy alone, split between whole-brain radiotherapy, given to 151 patients, and stereotactic radiotherapy, delivered to 98, while 23 patients underwent surgical resection followed by postoperative radiation.

Measuring the temporalis muscle requires surprising methodological care. A single observer, blinded to patient outcomes, assessed TMT on each patient’s first radiotherapy planning head CT, or on a diagnostic CT performed within the preceding month. The measurement plane had to be oriented parallel to the falx cerebri, the membrane dividing the brain’s hemispheres, and tangential to the floor of the middle cranial fossa, with the image windowed to a narrow setting of 80 Hounsfield units width and 40 length to sharpen the muscle’s boundaries. On the first axial slice above the bony orbit, a tangent line was drawn from the muscle’s anterior attachment to the skull, and thickness was recorded at the muscle’s thickest point perpendicular to that line, deliberately excluding fat, fascia, and blood vessels. The average of left and right measurements was used in the analyses. To confirm the technique’s reliability, a second observer independently measured a random sub-cohort of 19 patients, and the agreement between readers was excellent, with an intraclass correlation coefficient of 0.942 for single measurements and 0.970 for averages—figures indicating that the measurement itself is robust and reproducible.

Because men naturally have thicker temporal muscles than women, the researchers derived sex-specific thresholds for low TMT by maximizing Youden’s index, a statistical measure balancing sensitivity and specificity, for three-month survival. The resulting cut-offs were 4.3 millimeters for men, with 46.7 percent sensitivity and 74.6 percent specificity, and 3.975 millimeters for women, with 64.6 percent sensitivity and 49.2 percent specificity. These thresholds are notably lower than those reported in earlier studies of younger patients, a difference the authors attribute to the advanced age of their cohort, in which temporal muscle wasting is already widespread. By these criteria, 35.3 percent of the men and 56.6 percent of the women had low temporal muscle thickness.

The survival picture in the cohort was stark. Median overall survival was just 90 days, or roughly three months, and by the one-year mark 86.7 percent of the patients had died. Patients with normal TMT did live somewhat longer on average than those with low TMT, with a median of 103 days versus 75 days, and in univariate analyses low TMT was significantly associated with worse survival at three months, with a hazard ratio of 1.54, and at six months, with a hazard ratio of 1.41. At one month and twelve months, no association reached statistical significance. But the crucial test came when the researchers adjusted their models for other clinical variables: age, body mass index, surgical treatment, and type of radiotherapy. Once these factors were accounted for, the relationship between TMT and survival evaporated entirely at every time horizon, with the adjusted three-month hazard ratio falling to 1.40 and losing significance.

What did predict survival, independently, were other clinical variables. Receiving whole-brain radiotherapy rather than stereotactic radiotherapy carried a substantially higher risk of death at every time point, with an adjusted hazard ratio of 5.98 for one-month survival and approximately 2.3 at the longer horizons. This likely reflects treatment selection rather than harm: whole-brain radiotherapy is generally reserved for patients with multiple metastases and poorer prognosis, while stereotactic techniques are favored for those with limited, more favorable disease. Similarly, patients who did not undergo surgical resection had markedly higher mortality across all time frames, since surgery is typically offered only to younger patients with solitary lesions and better expected outcomes. Higher body mass index was protective for one-month survival, with a hazard ratio of 0.31, and advancing age independently worsened six- and twelve-month survival. The authors are candid that these patterns largely mirror the realities of clinical decision-making.

The contrast with previous research is instructive. Of six earlier studies evaluating TMT in patients with brain metastases, three found that low thickness predicted shorter survival, while others found no association once confounders were considered. Crucially, those studies examined patients on average more than a decade younger, with median survival extending from three to eleven months, and several included only surgically treated patients. The Tampere cohort, by contrast, was older, sicker, and predominantly managed with radiotherapy alone. The researchers also tested whether TMT predicted survival within their largest tumor subgroup, the 113 lung cancer patients, and found no significant association at any time point, which discouraged further subgroup analyses. Additional limitations deserve mention: performance status, number of brain lesions, intracranial tumor volume, extracranial disease status, and systemic therapy were not incorporated into the models, and the derived sex-specific cut-offs may risk overfitting, making external replication essential.

The study’s conclusion is refreshingly direct: temporal muscle thickness should not be regarded as a prognostic factor in patients aged 70 or older with brain metastases treated with radiotherapy. The finding is a valuable corrective to a growing enthusiasm for imaging-derived body-composition markers, reminding clinicians and researchers that a measurement can be technically reliable, easily obtained, and biologically plausible yet still fail to add independent predictive value in the population that matters. In very old, profoundly ill patients whose median survival is measured in weeks, disease aggressiveness and treatment selection appear to overwhelm any signal carried by skeletal muscle reserves. For this vulnerable group, prognostic conversations must continue to rest on established clinical variables, while the search for better tools goes on.

Subject of Research: Temporal muscle thickness as a prognostic marker for survival in older patients with brain metastases treated with radiotherapy

Article Title: Association Between Temporal Muscle Thickness and Survival in Older Patients With Brain Metastases Undergoing Radiation Therapy

Article References: Pikkarainen, L., Korhonen, T. K., Tolonen, A., Pesonen, E. K., Hernandez, N., Skyttä, T., & Arponen, O. (2026). Association Between Temporal Muscle Thickness and Survival in Older Patients With Brain Metastases Undergoing Radiation Therapy. Cancer Reports, 9(9), Article e70671. https://doi.org/10.1002/cnr2.70671

Image Credits: AI Generated

DOI: 10.1002/cnr2.70671

Keywords: temporal muscle thickness, brain metastases, radiotherapy, survival, sarcopenia, cachexia, prognostication, computed tomography, whole-brain radiotherapy, stereotactic radiotherapy, older patients, Cancer Reports