Orexin antagonists for insomnia did not raise falls or fractures — but older-adult data are thin

The edition in brief

Today's geriatrics edition ends on insomnia and falls. A meta-analysis in JAGS (26 September) of 19 studies and 183,595 participants found dual orexin receptor antagonists did not increase falls (OR 0.76, 95% CI 0.56 to 1.04) or fractures (OR 1.05); the randomised trials alone suggested fewer falls (OR 0.59). Events were few and older-adult data limited, so the class looks like a safer option than benzodiazepines and Z-drugs, not a proven safe one; cognitive behavioural therapy for insomnia stays first. In the Health ABC cohort of 3,073 adults aged 70 to 79, poor appetite was linked to a 44% higher hazard of persistent mobility limitation, and poor appetite with raised inflammatory markers to the fastest decline. A US database study of 11.8 million older inpatients linked interhospital transfer to higher in-hospital mortality and readmission, although sicker patients are the ones transferred. A secondary analysis of the TALOS-AMI trial found that de-escalating from ticagrelor to clopidogrel after MI had no different effect by age, but the result in people over 75 remains uncertain. A network meta-analysis of caregiver interventions in dementia found only multicomponent programmes reduced burden. The pearl is tapering hypnotics slowly.