The edition · Geriatrics
Lifting weights for the ageing mind, and a safer sleeping pill for fall risk
Resistance training may sharpen some executive functions; a primary-care falls programme saved money while cutting falls in rural China; a crosswalk makes the brief AD8 usable for staging cognition; and orexin antagonists did not raise falls in older insomnia patients.
The edition in brief
Today's geriatrics edition is built around function and medication safety. A meta-analysis of resistance-training trials in community-dwelling older adults without cognitive impairment found modest gains in working memory (standardised mean difference 0.30) and cognitive flexibility (0.50), though with low certainty and no advantage over other forms of exercise. An economic evaluation alongside the FAMILY cluster trial in rural China showed a primary-healthcare-integrated balance and functional-exercise falls programme was dominant, cutting the absolute risk of falls by 8.6% while saving money, a scalable model for resource-limited settings. A crosswalk study gave the brief 8-item AD8 proxy tool empirically derived cutoffs for mild cognitive impairment (a score of 2) and dementia (a score of 4), aligning it with the longer IQCODE for baseline cognition in hospital. A clinic pearl restates structured deprescribing. The practice-changer: a meta-analysis of nearly 184,000 people found dual orexin receptor antagonists did not increase falls or fractures, and randomised data hinted at fewer falls, supporting them as a safer insomnia option than benzodiazepines and Z-drugs in older adults, with the caveat of limited data in the oldest patients.
Resistance training may help the ageing mind, modestly
Recommend regular resistance training to older adults for strength and falls; it may modestly aid working memory and cognitive flexibility, but is not proven better than other exercise for cognition.
A primary-care falls programme that saved money
A primary-care-integrated balance and exercise falls programme cut falls and saved money in rural China, offering a scalable model for low-resource settings.
Cutoffs that make the brief AD8 usable for staging cognition
Use the brief AD8 proxy interview with the new cutoffs, 2 or more for mild cognitive impairment and 4 or more for dementia, to estimate baseline cognition in hospitalised older adults.
Review and prune the medication list every visit
Review every older patient's full medication list at each visit, use STOPP/START, and deprescribe high-risk drugs one at a time against the patient's goals.
Orexin antagonists look safer than old sleeping pills for falls
When a hypnotic is genuinely needed in an older adult, prefer a dual orexin receptor antagonist over a benzodiazepine or Z-drug, as it did not raise falls or fractures.
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