The edition · Geriatrics
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.
The edition in brief
In 223 community-dwelling adults aged 60 and over followed with monthly telephone contact from 2019 to 2025, higher baseline Pittsburgh Fatigability Scale scores predicted falls after adjustment including prior falls - physical fatigability odds ratio 1.54 (95% CI 1.25-1.91) and mental fatigability 1.41 (1.12-1.77), with physical fatigability holding at 1.37 (1.09-1.71) after accounting for multiple sclerosis status. A five-year prospective cohort of 13,343 community-dwelling Japanese adults aged 65 and over found that those in the lowest quartile of basal metabolic rate estimated from the Harris-Benedict equation had 2.8 times the risk of incident disability (95% CI 2.4-3.1) compared with the highest quartile, with the authors interpreting it as an integrated anthropometric risk marker rather than a metabolic measurement. A three-arm single-blind trial in 117 long-term care residents in Chongqing found augmented-reality-assisted Baduanjin improved the Fried frailty phenotype more than control at 12 weeks, with adherence of 91%, and outperformed video-guided exercise on physical function, activities of daily living, nutrition, cognition and mood. A 12-month follow-up of the RESILIENT trial of three months of mobile health cardiac rehabilitation in older adults with ischaemic heart disease found no difference in time to first all-cause readmission (log-rank P=0.26). And a 60-month quality improvement evaluation across 33,155 hospitalised older adults nearly doubled oral care documentation, from around 30% to around 57%, while non-ventilator hospital-acquired pneumonia rates did not fall (2.1% before, 2.4% after).
How tired an activity makes someone predicted their falls better than asking about fatigue
Ask how tired a specific activity would make the patient, not whether they feel tired - fatigability predicted falls over five years even after accounting for previous falls.
An equation using height, weight, age and sex stratified five-year disability risk
Height, weight, age and sex alone identify older adults at nearly three times the five-year disability risk - the marker is body size, so act on nutrition and muscle rather than on metabolism.
Adding real-time feedback to an old exercise beat showing residents a video
Supervised, corrected exercise beat video-guided exercise on frailty and every functional domain - the resource that matters is someone watching, not the technology.
Mobile cardiac rehabilitation did not reduce readmissions at a year
Offer mobile cardiac rehabilitation for function, not for readmissions - a three-month programme made no difference to time to first readmission over a year.
Look in the mouth on the post-take round
Look in the mouth and write what you find - dentures, thrush, dry mucosa and decay are four findings in ten seconds that change eating, drinking and aspiration risk.
Oral care documentation nearly doubled and hospital-acquired pneumonia did not move
Doubling documentation of oral care changed nothing about pneumonia rates - audit whether mouths are clean rather than whether the box is ticked, and decide your outcome measure before you start.
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