The edition · Geriatrics
Cutting controlled pain drugs helped explain fewer falls in older adults with spinal stenosis
A secondary analysis of the BOOST trial found its exercise-and-psychology programme reduced controlled analgesic use at six months, and that reduction partly explained fewer falls by a year. Plus eyeballing frailty, SARC-F after hip fracture and motivational interviewing for elder abuse.
The edition in brief
In the BOOST trial of 435 older adults with neurogenic claudication, a third were taking at least one controlled pain medicine at baseline. A group physical and psychological programme reduced controlled-drug use at six months compared with best-practice advice (OR 0.62, 0.40 to 0.96), and mediation analysis suggested that reduction contributed to the fewer falls seen at 12 months. The effect narrowed by a year. In 200 adults aged 70 or over referred for coronary angiography, a cardiologist's quick visual judgement of frailty had 94% sensitivity and a 98.5% negative predictive value against the Fried test, but only 49% positive predictive value — good for ruling frailty out, not in. In 430 older adults after hip fracture, the SARC-F questionnaire predicted slower early mobilisation and poorer walking and function at four months, while grip strength and calf circumference did not. A Hong Kong trial of 198 older adults at risk of abuse found four sessions of motivational interviewing reduced minor psychological aggression and caregiver neglect and improved self-efficacy, compared with a waiting list. The pearl covers the falls-focused medication review.
Eyeballing frailty is good at ruling it out, poor at ruling it in
A quick clinical impression reliably excludes frailty, but confirm it with a structured tool before acting on a suspicion.
After hip fracture, five SARC-F questions predicted recovery better than grip or calf measurements
Use the SARC-F questionnaire on admission after hip fracture to identify patients likely to recover slowly.
Motivational interviewing reduced some forms of elder abuse in a Hong Kong trial
Motivational interviewing reduced psychological aggression and neglect in older adults at risk of abuse; ask privately and work with the person's ambivalence.
After any fall, review the medicines that cause them
Review falls-risk-increasing medicines and check orthostatic blood pressure after every fall in an older adult.
Spinal stenosis in older adults: reducing controlled pain drugs helped explain fewer falls
In older adults with spinal stenosis, pair rehabilitation with tapering of opioids and gabapentinoids; the reduction helped explain fewer falls.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free