The edition · Geriatrics
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.
The edition in brief
PROMED-EX randomised 105 community-dwelling older adults at risk of undernutrition and cognitive decline to personalised protein-enriched Mediterranean dietary counselling with home exercise, counselling alone, or a healthy eating leaflet. At six months, Mini Nutritional Assessment scores improved by 2.7 points with counselling alone and 2.9 with counselling plus exercise against control, both p<0.001. Neurocognitive test battery z-scores improved by 0.3 and 0.2 respectively. Exercise adherence was low, and the counselling-only arm did as well as the combined arm on the primary outcome. In 2,612 veterans with dementia hospitalised for at least two days, median stay was 6 days and 5.3% stayed 21 days or longer. Social vulnerability (OR 1.74, 95% CI 1.16-2.61), chronic disease burden (1.06 per unit, 1.01-1.10) and delirium present at admission (1.55, 1.07-2.26) predicted a prolonged stay. Greater clinical frailty predicted a shorter one, which the authors flag as needing explanation rather than acting on. Across 4,018 Health and Retirement Study participants with DNA methylation data and up to 12 years of follow-up, older epigenetic age by DNAmGrimAge was associated with faster decline in cognition, grip strength and walking speed after adjusting for chronological age. Effect sizes per unit are very small and the analysis is retrospective. A randomised trial of a user-centred dementia caregiver app in 75 analysed caregivers improved overall and psychological quality of life at eight weeks but did not change caregiver burden, neuropsychiatric symptom severity or caregiver distress.
Delirium at the front door predicts a three-week admission
In people with dementia, delirium at admission and social vulnerability predict a stay of three weeks or more, so start discharge planning on day one rather than at medical fitness.
An app for dementia carers improved how they felt, and not what they were carrying
A carer-designed dementia app improved caregivers' quality of life over eight weeks but did not reduce caregiver burden or neuropsychiatric symptoms, so it complements practical support rather than replacing it.
Epigenetic clocks track functional decline, at effect sizes nobody can use yet
DNAmGrimAge was associated with faster decline in cognition, grip strength and gait speed independent of chronological age, but the effect sizes are far too small to inform any decision about an individual patient.
The Mini Nutritional Assessment takes four minutes and nobody does it
Score the short-form Mini Nutritional Assessment at the first visit and repeat it - the numerical score is what makes a change in nutritional status visible at all.
Dietary counselling alone improved nutrition and cognition, and the exercise arm added nothing to it
Personalised protein-enriched Mediterranean dietary counselling improved nutritional status by nearly 3 points on the Mini Nutritional Assessment and modestly improved cognition, and adding home-based exercise added nothing to that.
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