Geriatric respiratory medicine 2026: from artificial intelligence to personalised management of the multimorbid patient

: The profound demographic shift toward an ageing population has decisively moved the burden of chronic and acute lung diseases towards older adults, necessitating a transition from organ-centred models to integrated, multidimensional care. This review outlines a pragmatic framework for managing the complex interplay of immunosenescence, frailty and multimorbidity. In acute care, "pneumonia-associated sarcopenia" is identified as a critical driver of recurrent infections and functional decline, requiring a shift towards aspiration prevention and the aid of diagnostic tools such as lung ultrasound. The selection of noninvasive respiratory support, including high-flow nasal cannulas and noninvasive ventilation, must balance physiological efficacy with the risks of delirium and patient self-inflicted lung injury. Preventive strategies have evolved with the introduction of 20-valent pneumococcal and respiratory syncytial virus vaccines, alongside proactive screening for ɑ1-antitrypsin deficiency to enable precision interventions. Chronic disease management emphasises a "device-centric" inhalation therapy approach, tailoring delivery systems to impaired peak inspiratory flows and cognitive status rather than to pharmacology alone. The advent of biological therapies, particularly the use of dupilumab and mepolizumab in eosinophilic COPD, offers a transformative "steroid-sparing" effect, aiming for clinical stability and preserved independence. Finally, the integration of artificial intelligence as "augmented intelligence" and the "4Ms" multidisciplinary model (mentation, medication, mobility, morbidities) provide the necessary tools to navigate clinical complexity. This holistic strategy ensures that technological innovation remains anchored in patient-centred goals.