The edition · Geriatrics
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.
The edition in brief
Deprescribing has a target today. A cross-sectional analysis of 1,465 community-dwelling adults aged 65 and over undergoing comprehensive geriatric assessment measured frailty by Fried phenotype, anticholinergic burden by the Anticholinergic Cognitive Burden Scale, and orthostatic hypotension as a fall of 20 mmHg systolic or 10 diastolic within three minutes of standing. Orthostatic hypotension rose across frailty stages: 6.6% robust, 12.1% prefrail, 14.5% frail. Among the 181 with orthostatic hypotension, any anticholinergic burden was independently associated with dependency in prefrail people (odds ratio 3.50, 95% CI 1.30 to 9.41) and with falls (2.39, 1.13 to 5.05) and cognitive impairment (3.63, 1.63 to 8.07) in frail people. A prospective cohort of 430 adults aged 70 and over with hip fracture found that the five-question SARC-F questionnaire, not handgrip strength or calf circumference, consistently predicted poor early mobilisation and worse walking and functional outcomes to four months, with neither group improving between four and 12 months. A meta-analysis of nine trials and 334 participants found cannabinoids did not improve agitation, neuropsychiatric symptoms or cognition in dementia, and doubled somnolence. A randomised trial of reactive balance training improved step length and stepping reaction time but did not reduce laboratory-induced or real-world falls over a year. The regulatory sweep found no new drug or device action for this desk.
A postural drop plus an anticholinergic is the combination to break
In frail older adults with orthostatic hypotension, any anticholinergic burden more than doubled the odds of falls and more than tripled the odds of cognitive impairment — measure standing blood pressure, then review the drug list.
After a hip fracture, five questions beat a dynamometer
The five-question SARC-F predicted poor mobilisation and functional decline after hip fracture where grip strength and calf circumference did not — ask it on admission and escalate rehabilitation immediately for high scorers.
Cannabinoids failed again in dementia, and made people sleepier
Across nine trials and 334 patients, cannabinoids improved neither agitation nor cognition in dementia and doubled somnolence — the sedation is the effect families mistake for benefit.
Reactive balance training made people step better and did not stop them falling
Six weeks of low-cost reactive balance training improved step length and stepping reaction time but did not reduce laboratory or real-world falls over 12 months.
No new drug or device action; a review of where frailty sits in assisted dying law
No new regulatory action for this desk today; a review of assisted dying jurisdictions found frailty eligibility unclear in 14 of them, reflecting how poorly legal frameworks built around named terminal illness handle a trajectory.
Measure the standing blood pressure yourself, and measure it late
Five minutes lying, then standing readings at one, two and three minutes, and record the actual numbers with symptoms — the drop that explains the falls is usually the late one nobody waited for.
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