Geriatrics
Community-dwelling people with dementia spent most of the year at home after STEMI catheterisation
A national Medicare study argues against letting a dementia diagnosis alone rule out STEMI care, while nursing home residents fared much worse. Motivational interviewing reduced psychological aggression and neglect in a Hong Kong elder abuse trial.
In spinal stenosis, a group programme cut use of controlled painkillers (opioids and gabapentinoids), and that helped explain fewer falls
A BOOST trial analysis linked early reduction in controlled pain drugs to the programme's fall reduction; perioperative esketamine was associated with less delirium in older surgical patients; and trouble chewing or swallowing predicted death in 50 000 Japanese older adults.
A primary-care balance and exercise programme cut falls and likely saved money in rural older adults
The FAMILY trial's economic evaluation finds falls prevention was cheaper and better than usual care; orexin antagonists show no excess falls or fractures; and older adults in behavioural emergencies are sedated more often, mostly with benzodiazepines.
Heart failure drugs were associated with 31% lower mortality after 65 — yet frail patients are the least likely to get them
A 92,916-patient meta-analysis argues against withholding guideline therapy on age, one older inpatient in four leaves hospital less able than they arrived, and an AD8 score now separates MCI from dementia.
A five-question sarcopenia screen predicted who recovers after hip fracture; anaesthetic choice made no difference to older surgical patients' days at home
SARC-F outperformed grip strength and calf circumference in 430 older hip fracture patients, a 2,508-patient trial finds propofol and volatile anaesthesia equivalent for days alive at home, a South and Southeast Asian review shows dementia prevalence rising, an oral tau drug fails, and reactive balance training does not cut falls.
Four in ten older adults seen in ED after a fall were back within a year
A meta-analysis tracks acute care use after a fall presentation; a multicomponent programme for fear of falling did no better than sham; improvements in frailty score were linked to lower hospitalisation and death; and pilocarpine drops for dry mouth in frailty fell short in an underpowered trial.
Not every fall-risk drug is equal: SSRIs, older antiepileptics and anticholinergics marked the older adults most likely to be admitted after a fall
A German cohort of 120,867 older adults on fall-risk drugs shows which classes to review first, a BMJ network meta-analysis puts a dose on exercise for bone, and anticholinergic burden tracks with falls and cognitive impairment in frail people with orthostatic hypotension.
Falls clinics beat usual care, but not falls advice
The updated Cochrane review — 110 trials, 48,919 people — finds multifactorial assessment cuts the falls rate against usual care and adds nothing over education. Plus prehabilitation in frail cardiac surgery, and what culturally adapted dementia support actually consists of.
Embolisation cuts the chronic subdural that comes back
Seven randomised trials and 1,889 patients: recurrence down by a third and reoperation by nearly two-thirds, with timing apparently not mattering; plus apathy and gait as the earliest dementia signs, what frequent napping predicts, and a physiotherapy model that reached more patients with the same staff.
Getting older people off controlled analgesics is how a rehabilitation programme prevented falls
A mediation analysis of the BOOST trial finds the falls reduction ran through medication, not just through better walking — which makes deprescribing the active ingredient. Plus intranasal dexmedetomidine the night before surgery, an esketamine delirium signal at low certainty, and why two claims-based frailty scores disagree by fivefold.
Dementia is not a reason to withhold the cath lab
Among 117,318 Medicare beneficiaries catheterised for STEMI, community-dwelling patients with dementia spent 225 days at home in the following year against 299 without — and more than half spent over 300. Plus three questions that predict mortality, what EMS gives older people for agitation, and frailty screening from two mornings of wear.
Over a quarter of older inpatients leave hospital less able than they arrived
A 439,406-patient pooled estimate of hospitalisation-associated disability, an eyeball frailty judgement that excludes frailty but cannot confirm it, and anticholinergic burden in Parkinson's disease raising fracture risk by half.
A five-question SARC-F screen predicted who would recover poorly after hip fracture better than grip strength or calf size
A Finnish hip fracture cohort closes the edition. Before it: cannabinoids fail for agitation in dementia, reactive balance training that improved stepping but not falls, a health check-up for over-75s, and the updated Cochrane review of long-term hormone therapy.
A Canadian guideline says keep statins in older adults unless they are near the end of life
GRADE-based deprescribing guidance rejects stopping statins on age alone; four in ten older adults return to the emergency department within a year of a fall; bed and chair alarms do not prevent inpatient falls; and one in three Indians studied had sarcopenia.
A two-minute cognitive score predicts a year of a patient's life after head injury
In 14,395 older adults discharged to a nursing facility after traumatic brain injury, severe cognitive impairment on a brief bedside test meant 36% fewer days at home over the next year. Plus a third of older cannabis users met criteria for cannabis use disorder.
Six years after a hip fracture, function has not come back
A nine-year Chinese cohort shows daily-living difficulty still a quarter above baseline at six years, with the over-80s getting worse rather than better; four weeks of resistance-focused prehabilitation shifts frailty before cardiac surgery; and a dose arrives for the exercise we prescribe for bone.
Hearing loss and multimorbidity together, not either alone
In 874 US adults over 70 followed for a median 9.3 years, hearing loss alone carried a 1.4-fold mortality risk and three or more conditions 1.7-fold - neither interval excluding 1. The two together carried 2.3-fold, and the interaction was significant. Plus what education does for everyday function, when disability actually begins before death, statins and frailty in HIV, and the vaccine almost nobody gives on admission.
Disease keeps accumulating at 95, and the frailty index does not care which deficits you count
Swedish register data follow a whole birth cohort from 70 to 100; a machine-learning test confirms that frailty index items are genuinely interchangeable; vitamin D tracks with longer measured sleep; and an Aboriginal co-designed falls programme improves mobility where a social programme does not.
Fatigability predicts falls, and a mouth-care programme that improved everything except pneumonia
A two-question scale identified fallers prospectively over five years; estimated basal metabolic rate stratified five-year disability in 13,343 Japanese elders; and an augmented-reality version of an old exercise beat video instruction in care homes.
Middle meningeal embolisation cuts reoperation for chronic subdural haematoma by 60 per cent
Seven randomised trials and 1,889 patients show recurrence and reoperation both fall without any rise in serious adverse events; Japanese claims data reveal cholinesterase inhibitors running for a mean of 1.5 years in people with severe Alzheimer's disease; and a communication tool designed to improve dialysis decisions made things measurably worse.
In frail patients with a postural drop, the drug list is the treatable part
Among 1,465 older adults assessed for frailty, any anticholinergic burden in frail people with orthostatic hypotension more than doubled the odds of falls and more than tripled the odds of cognitive impairment. Plus a five-question sarcopenia screen that outperformed grip strength after hip fracture, and cannabinoids failing again in dementia.
Apathy and a slowing gait are the two signs already in front of you
A synthesis argues that motivation and walking speed change before cognition does, and both are observable in any routine consultation. Also: what a 61,000-person pooled cohort says about which risks still matter at 90, and why intensity relative to a patient's own capacity beats counting ten-minute bouts.
Correcting undernutrition improved cognition as well as weight, and delirium on admission predicts a three-week stay
A three-arm trial finds dietary counselling alone improved nutritional status and neurocognitive scores in older adults at risk, epigenetic clocks track functional decline retrospectively, and a caregiver app moved quality of life without touching burden.
More than one in three older adults in India has sarcopenia
A meta-analysis of 44 Indian studies puts confirmed sarcopenia at 35.4% and finds nearly half of studies using non-standard diagnostic criteria, while cognitive frailty — potentially reversible — affects 12.2% of community-dwelling older adults worldwide.
Not all activity protects the ageing brain — leisure helps, work may harm
A 4.2-million-person analysis finds leisure-time activity linked to less dementia while occupational activity is linked to more, a randomised trial shows a self-selected vegan diet strips muscle from healthy older adults unless they lift weights, and frailty on admission predicts who will lose independence.