The edition · Geriatrics
Embolisation cuts the chronic subdural that comes back
Seven randomised trials and 1,889 patients: recurrence down by a third and reoperation by nearly two-thirds, with timing apparently not mattering; plus apathy and gait as the earliest dementia signs, what frequent napping predicts, and a physiotherapy model that reached more patients with the same staff.
The edition in brief
Today's geriatrics desk opens with an updated meta-analysis of seven randomised trials and 1,889 patients comparing middle meningeal artery embolisation plus standard treatment against standard treatment alone for chronic subdural haematoma. Recurrent or residual haematoma fell (relative risk 0.63, 95% CI 0.46 to 0.85) and reoperation fell sharply (0.39, 95% CI 0.28 to 0.56), with no increase in serious adverse events (0.87, 95% CI 0.72 to 1.06), mortality or poor functional outcome, and benefits apparently independent of when embolisation was performed. A review argues that apathy and gait slowing, together as motoric-cognitive risk syndrome, are observable markers that precede overt cognitive impairment and are already visible in routine clinics. In 995 older adults followed from 2013 to 2023 in the National Health and Aging Trends Study, frequent napping carried 1.48 times the hazard of incident dementia (95% CI 1.14 to 1.94) and unintentional napping 1.39 (1.06 to 1.81), with no association for infrequent or intentional napping. Among 13,343 Japanese community-dwelling adults aged 65 and over, the lowest quartile of estimated basal metabolic rate carried 2.8 times the risk of five-year incident disability (95% CI 2.4 to 3.1). A pearl covers measuring orthostatic blood pressure properly. The edition closes with a once-weekly group physiotherapy model on an acute geriatrics unit that delivered 37 sessions, reached 156 patient participations with no safety events, and raised therapist productivity by about 21%.
Embolisation for chronic subdural haematoma, now on seven trials
Ask about middle meningeal artery embolisation for chronic subdural haematoma — it cuts reoperation by nearly two-thirds without added harm, whenever it is done.
Apathy and a slowing walk arrive before the memory complaint
Record gait and ask about loss of initiative at every review; both precede the cognitive test becoming abnormal.
The nap you did not plan is the one that carries the signal
Ask whether daytime sleep is unintended — that is the question this study separates, and a yes warrants a medication review and a cognitive baseline.
A number you can calculate from height, weight and age predicted disability
Treat a low estimated basal metabolic rate as shorthand for anthropometric frailty and a prompt for geriatric assessment, not as a metabolic finding.
Most orthostatic blood pressures are measured wrongly, and the wrong ones are reassuring
Five minutes supine, then standing at one and three minutes — anything less and a negative result means nothing.
Group physiotherapy on an acute geriatrics ward reached more patients with the same staff
A once-weekly group physiotherapy session is feasible and safe on an acute geriatric ward and extends reach by about a fifth — measure patient outcomes as you introduce it.
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