The edition · Geriatrics
A five-question sarcopenia screen predicted who recovers after hip fracture; anaesthetic choice made no difference to older surgical patients' days at home
SARC-F outperformed grip strength and calf circumference in 430 older hip fracture patients, a 2,508-patient trial finds propofol and volatile anaesthesia equivalent for days alive at home, a South and Southeast Asian review shows dementia prevalence rising, an oral tau drug fails, and reactive balance training does not cut falls.
The edition in brief
In 430 adults aged 70 and over with hip fracture, a positive SARC-F questionnaire was associated with slower mobilisation on days 1 to 3 (odds ratios 1.99 to 7.56), worse walking to four months and a larger fall in Barthel Index (-17.5 vs -11.2 points), while handgrip strength and calf circumference were not consistently predictive. In a pragmatic trial of 2,508 patients aged 50 and over having major non-cardiac surgery in 49 UK hospitals, propofol-based total intravenous anaesthesia gave the same days alive and at home at 30 days as volatile anaesthesia (22.5 vs 22.4; IRR 1.00), with similar delirium, complications and mortality, but less nausea. A meta-analysis from South and Southeast Asia estimated dementia prevalence at 3.0% and Alzheimer disease at 2.0%, with Alzheimer prevalence in studies after 2010 at 8.0%, and literacy, sleep, periodontal care and cognitive stimulation associated with lower risk. The oral OGA inhibitor ceperognastat did not slow early Alzheimer disease in a phase 2 trial, and the higher dose was associated with faster decline and more serious adverse events. A reactive balance programme improved stepping but not laboratory or real-life falls. The practical message: ask the five SARC-F questions on admission with a hip fracture, and use the answer to plan rehabilitation.
Dementia prevalence in South and Southeast Asia is rising, with modifiable factors in reach
Dementia prevalence in South and Southeast Asia is rising; ask about memory routinely and address sleep, oral health and cognitive activity.
Propofol and volatile anaesthesia gave the same days alive and at home after major surgery
For older adults having major surgery, TIVA and volatile anaesthesia gave the same days at home and delirium rates.
Oral tau-targeting ceperognastat failed in early Alzheimer disease, and the higher dose did worse
The oral anti-tau drug ceperognastat did not slow early Alzheimer disease, and the higher dose was associated with harm.
Reactive balance training improved stepping but did not prevent falls
Reactive balance training improved stepping speed and length but did not reduce falls; stick with established strength and balance programmes.
Screen for delirium with the 4AT in two minutes
Use the 4AT on admission, after surgery and at any change in behaviour; 4 or more suggests delirium.
SARC-F predicted slow recovery after hip fracture better than grip strength or calf circumference
Ask the five SARC-F questions on admission with hip fracture; a positive screen identifies patients who will mobilise and recover more slowly.
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