Expanding the clinical implications of biomarkers and physiological indicators in geriatric institutionalization

The recent study by Maeda (2025) provides a multifaceted investigation of geriatric health through estimated telomere length (eTL), oral status, body temperature and disease history among institutionalized aged individuals. Capitalizing on this significant research, our letter examines understated inferences and suggests new applications of these data to aging research and geriatric care planning. We emphasize eTL as a promising non-invasive biomarker for the prediction of loss of independent living, suggesting its incorporation into frailty tests and screening tools at the population level. The observation by this study of asymmetric, left-dominant tooth loss prompts questions regarding neuromuscular aging and hemispheric control of oral function, and a new "tooth loss laterality" index is proposed for clinical application. Moreover, we further explore body temperature as a disease-specific marker, highlighting its particular significance in cancer survivorship and stroke outcome. These temperature signatures potentially could act as early indicators of metabolic or inflammatory dysregulation. Furthermore, we explore the disproportionate care requirements in post-COVID-19 female patients in accordance with global trends in long COVID and highlight the necessity for gender-sensitive geriatric guidelines. Ultimately, we suggest that disease-specific patterns of telomere shortening particularly in stroke, cancer and fracture, capture distinct biological aging processes that are worthy of longitudinal genomic and epigenetic investigation. Taken as a whole, these findings extend Maeda's work through encouraging a systems biology perspective toward aging that emphasizes predictive biomarkers, asymmetrical decline, and sex-differentiated vulnerabilities. This vision can contribute to preventive intervention and personalized care planning in the super-aged society of Japan. Keywords: Telomere length, geriatric care, tooth loss asymmetry, body temperature biomarkers, post-covid syndrome, institutionalization risk, biological aging