The edition · Geriatrics
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.
The edition in brief
In 430 adults aged 70 or over with hip fracture, a positive SARC-F questionnaire was consistently associated with poor early mobilisation (OR 7.56 for impaired mobility on day 3), worse walking at 1–4 months and greater functional decline (Barthel change −17.5 vs −11.2), while handgrip strength and calf circumference were not. Function did not improve between 4 and 12 months in either group, so the early months are the window for rehabilitation. A meta-analysis of nine trials in 334 people with dementia found cannabinoids did not improve agitation (SMD −0.58, −1.71 to 0.55), neuropsychiatric symptoms or cognition, and doubled somnolence (RR 2.03). A 6-week reactive balance programme in 88 older adults improved step length and stepping reaction time but did not reduce laboratory or daily-life falls over a year. In a Japanese target trial emulation, attending a first health check-up at 75–84 was associated with a lower 5-year risk of disability or death (20.6% vs 26.7%), but the interval included no effect. The updated Cochrane review of long-term hormone therapy, mostly from the Women's Health Initiative with women over 60, found oestrogen-only therapy probably increased stroke (RR 1.33) and combined therapy probably increased breast cancer (RR 1.27), while both reduced fractures. The pearl: count anticholinergic burden at every medication review.
Cannabinoids did not reduce agitation in dementia and doubled drowsiness
Do not use or recommend cannabinoids for agitation in dementia; they did not help and increased drowsiness.
Reactive balance training improved stepping but did not prevent falls
Keep using established balance and strength programmes for falls prevention; this reactive stepping programme improved stepping tests but not falls.
A first health check-up at 75–84 was associated with less disability or death, but the result was uncertain
Health check-ups for over-75s may modestly reduce disability, but the evidence is uncertain; make any check-up target actionable geriatric problems.
Cochrane update: long-term hormone therapy reduced fractures but raised stroke and, when combined, breast cancer
In older women still on hormone therapy, review whether the benefits continue to outweigh raised stroke and thrombosis risk.
Count anticholinergic burden at every medication review
At every medication review in an older adult, total the anticholinergic burden and deprescribe the drug contributing most.
SARC-F on admission identified hip fracture patients likely to mobilise and recover poorly
Ask SARC-F on admission for every older patient with hip fracture, and direct intensive early rehabilitation to those who screen positive.
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