The edition · Geriatrics
Brisk walking reversed frailty in more older adults than walking at a comfortable pace
A blinded cluster trial in 14 retirement communities found high-intensity walking moved 70% of frail and prefrail participants down a frailty category, against 46% with casual walking. Plus what follows an emergency visit for a fall, which fall-risk drugs matter most, sarcopenia and cancer treatment toxicity, and why comorbidity counts stop predicting decline in the frail.
The edition in brief
In a cluster-randomised, assessor- and participant-blinded trial across 14 US retirement communities, prefrail and frail adults (mean age 79) walked under supervision three times a week for 16 weeks at either about 70% of maximum heart rate or a comfortable pace. Frailty improved by at least one category in 69.6% of the high-intensity group against 46.4% (OR 2.91), with better gait speed and six-minute walk distance; attendance was similar. A meta-analysis of 19 studies found that after an emergency visit for a fall, 15% of older adults returned to the emergency department within 30 days and about 41% within a year, with readmission 10% at 30 days and about 31% by six months. In 120,867 adults over 65 taking fall-risk-increasing drugs, SSRIs, older antiepileptics and moderately anticholinergic drugs marked those at highest risk of a fall-related admission. In 161 adults over 70 starting treatment for advanced cancer, sarcopenia defined by strength as well as muscle mass was associated with severe non-haematological toxicity (OR 2.24) and worse one-year survival; muscle mass alone was not. In 1,299 hospitalised older Japanese adults, comorbidity burden predicted hospital-associated disability only in those who were not frail. The pearl covers a chair-stand test in clinic.
After an emergency visit for a fall, four in ten older adults were back within a year
An emergency visit for a fall marks a high-risk year; arrange a falls and frailty assessment soon after.
SSRIs, older antiepileptics and anticholinergic drugs marked the highest fall risk among fall-risk drugs
When reviewing fall-risk drugs in older adults, look first at SSRIs, older antiepileptics and anticholinergic drugs.
Sarcopenia measured by strength, not muscle mass alone, flagged older adults likely to suffer severe cancer treatment toxicity
In older adults starting cancer treatment, a slow chair-stand test plus low muscle mass flagged higher toxicity risk; muscle mass alone did not.
In frail inpatients, the comorbidity count stopped predicting loss of function in hospital
Score frailty on admission; in frail older inpatients, comorbidity counts no longer predicted functional decline.
Time five chair stands in clinic
Time five chair stands at review; a slow result flags weakness that predicts falls, disability and treatment harm.
High-intensity walking reversed frailty more often than casual walking
Advise frail and prefrail older adults to walk briskly, about 45 minutes three times a week; intensity mattered.
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