Getting older people off controlled analgesics is how a rehabilitation programme prevented falls

The edition in brief

A secondary and mediation analysis of the BOOST randomised trial in 435 older people with neurogenic claudication found that 63 per cent were taking at least one pain medication at baseline and 34 per cent at least one controlled medication. At six months, the physical and psychological group intervention had reduced controlled medication use compared with best practice advice (OR 0.62, 95% CI 0.40 to 0.96), a difference that narrowed by twelve months. Mediation analysis found that the reduction in controlled analgesics during the first six months was a notable contributor to the falls reduction seen at twelve months. In a single-centre non-inferiority trial, 316 older patients having knee or hip arthroplasty received either intranasal dexmedetomidine the night before surgery or intravenous dexmedetomidine before induction; delirium within three days occurred in 9.5 and 7.6 per cent respectively, a rate difference of 0.02 (95% CI −0.04 to 0.08) meeting the non-inferiority margin, with better preoperative sleep, less anxiety and fewer adverse events in the intranasal arm. A meta-analysis of 17 trials and 2,914 patients aged 60 and over found perioperative esketamine associated with lower postoperative delirium (OR 0.57, 95% CI 0.40 to 0.82, I-squared 45.8 per cent) and less nausea and vomiting, with no excess psychiatric adverse events, but limited certainty. And a comparison of three claims-based frailty indices in Medicare data found they classified between 10 and 71 per cent of the same population as frail depending on which index and threshold was used.