The edition · Geriatrics
Orexin antagonists show no fall signal, and a poor appetite flags mobility loss within a year and a half
A 19-study meta-analysis finds dual orexin receptor antagonists did not raise falls or fractures, though data in older adults are thin; a Health ABC analysis links poor appetite and inflammation to rapid mobility loss; and eccentric training builds leg strength in older adults.
The edition in brief
A meta-analysis of 19 studies (10 randomised trials, 9 observational; 183,595 participants) found that dual orexin receptor antagonists for insomnia were not associated with more falls (OR 0.76, 95% CI 0.56 to 1.04) or fractures (OR 1.05); randomised trials suggested fewer falls (OR 0.59), but event rates were low, the optimal information size was not reached and data in older adults were limited. In 3,073 adults aged 70 to 79 in the Health, Aging and Body Composition study, the 12.6% who reported poor appetite were more likely to develop persistent difficulty walking a quarter mile or climbing ten steps (adjusted HR 1.44), with 40% affected by 18 months versus 20% of those with a good appetite; those who also had raised inflammatory markers declined fastest. A meta-analysis of 15 small randomised trials (438 older adults) found eccentric overload training improved lower-limb strength (SMD 0.50) and explosive power (SMD 0.39), with longer programmes doing better. A systematic review of 11 studies of non-drug delirium recovery interventions found the evidence limited and heterogeneous, mostly confined to hospital, with emotional recovery and long-term outcomes largely unstudied. The pearl: ask about appetite as a vital sign of function in older adults.
Poor appetite in older adults predicts mobility loss, fastest when inflammation is also raised
Ask about appetite in older adults, and treat a poor appetite as a signal to review nutrition, medicines and mobility before decline.
Eccentric overload training builds leg strength and power in older adults
Consider eccentric strength exercises for older adults, sustained for at least eight weeks, to improve leg strength and power.
Delirium recovery: little evidence on helping people recover after the episode
Plan follow-up after hospital delirium, including cognitive and emotional review, while recognising that the evidence for specific recovery interventions is weak.
Treat insomnia in older adults without reaching first for a hypnotic
Use behavioural treatment first for insomnia in older adults, and taper rather than stop existing sedative-hypnotics.
Dual orexin receptor antagonists: no increase in falls or fractures, but thin data in older adults
When a hypnotic is unavoidable in an older adult, an orexin antagonist may carry less fall risk than older agents, but the evidence in this age group is thin.
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