Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise.

Objective: Hospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients. Design: In this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control or intervention (exercise) group, and were assessed at baseline, admission, discharge, and 3 months thereafter. Setting and participants: 268 patients (mean age 88 years, range 75 to 102) admitted to an acute care for elders (ACE) unit of a Public Hospital were randomized to a control (n=125) or intervention (exercise) group (n=143). Methods: Both groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total daily duration of ~20 min). We measured incident HAD at discharge and after 3 months (primary outcome); and Short Physical Performance Battery (SPPB), ambulatory capacity, number of falls, re-hospitalisation and death during a 3-month follow-up (secondary outcomes). Results: Median duration of hospitalisation was 7 days (interquartile range 4 days). Compared with admission, the intervention group had a lower risk of HAD at discharge (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.11, 0.92) and at 3-months follow-up (OR 0.24; 95% CI: 0.08, 0.74) than controls during follow-up. No intervention effect was noted for the other secondary endpoints (all p>0.05), although a trend towards a lower mortality risk was observed in the intervention group (p=0.078). Conclusion and implications: These findings demonstrate that a simple inpatient exercise programme significantly decreases the risk of HAD in acutely hospitalised, very old patients.

This case highlights the findings on 18F-FDG PET/CT in a nursing home physician suspected of COVID-19, raises a number of clinical dilemmas, and points to the potential use of PET/CT in studying the pathophysiology of COVID-19 as follows: 1. Our patient had two negative RT-PCR tests for SARS-CoV-2, confirming the high false-negative rate when compared with CT imaging. A review of seven previously published studies of both inpatients and outpatients with SARS-CoV-2 infection reported a wide variation in sensitivity of RT-PCR, depending on the time the test was taken after symptom onset. Specifically, the false-negative rate of RT-PCR tests was 38% on the day of symptom onset, 20% 3 to 4 days after symptom onset, and 66% 2 weeks after symptom onset. Other factors that could contribute to the two negative RT-PCR tests include sampling, storage, and processing errors and different viral loads, depending on stage of the disease. Most important, the sensitivity of chest CT for diagnosing COVID-19 has been shown to be 98% compared with 71% for RT-PCR. 5 2. The 18F-FDG PET/CT findings in this patient are consistent with past studies showing multiple, bilateral FDGpositive GGOs, multilobar consolidations, and evidence of lymph node involvement. 6 3. GGOs are often unperceivable on chest radiography, particularly in patients with few symptoms or low severity. Although we are not suggesting that routine 18F-FDG PET/CT scans be done on patients suspected of COVID-19, we believe the standard of care should be that patients with a clinical syndrome including respiratory symptoms and/or signs consistent with COVID-19, a negative chest X-ray, and neoplastic comorbidities have a chest CT scan. 7 Bilateral GGOs or consolidation on chest CT scan in the proper clinical situation should prompt the radiologist to suggest COVID-19 as a possible diagnosis. 8 4.Findings consistent with COVID-19 will be found in patients having 18F-FDG PET/CT for either staging or recurrence of malignancies. Consequently, nuclear medicine departments and staff need to assume that all patients undergoing 18F-FDG PET/CT need to be screened before scanning, personnel properly gowned and masked, the facility properly cleaned and disinfected afterwards, and lung nodule evaluation be modified. 9 5. FDG PET/CT is highly sensitive for detecting inflammatory disease and is a potential modality to study the inflammatory components of SARS-CoV-2 infections, monitoring disease progression and treatment effects and potentially improving patient management. In addition, FDG PET/CT may elucidate cytokine storm, focusing not only on pulmonary inflammation but also other organs that have been reported to be involved (i.e., myocardium, pericardium, and intestine). 10

Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.