The edition · Geriatrics
In frail inpatients, comorbidity counts stopped predicting loss of function
In 1,299 older Japanese inpatients, the Charlson index predicted hospital-associated disability only in the non-frail. Plus moderate exercise doses in mild cognitive impairment, and opioids after hip fracture.
The edition in brief
A retrospective multicentre cohort of 1,299 adults aged 65 and over admitted to acute hospitals in Japan found that a higher Charlson Comorbidity Index was associated with hospital-associated disability in non-frail patients (OR 1.44 per point) but not in the frail (OR 0.98), so frailty, not comorbidity count, carried the risk signal in the most vulnerable. A Bayesian dose-response network meta-analysis of 38 trials in older adults with mild cognitive impairment found the most reliable executive-function gains at moderate exercise doses of about 300–1,000 MET-minutes per week, with plateaus above that; certainty was low to moderate. A 16-year Ontario cohort of 114,055 older adults with hip fracture found benzodiazepine dispensing fell from 34% to 13% while opioid dispensing stayed near 45%. In two Spanish cohorts, closer adherence to a plant-based planetary health diet was associated with lower odds of frailty (pooled OR 0.52). The pearl covers benzodiazepine review after a fall.
Moderate exercise doses gave the most reliable cognitive gains in MCI
Recommend moderate, regular exercise of about 75–250 minutes a week for older adults with mild cognitive impairment.
After hip fracture, benzodiazepine use fell sharply but opioid use stayed high
Discharge hip fracture patients with an opioid stop date and avoid new benzodiazepines.
A plant-forward planetary health diet was linked to lower odds of frailty
Encourage plant-rich diets in older adults while making sure protein intake stays adequate.
After a fall, review the benzodiazepine
Review and gradually taper benzodiazepines and Z-drugs after a fall in an older adult.
Comorbidity count predicted hospital disability only in the non-frail
Score frailty on admission and treat every frail older inpatient as at high risk of functional decline.
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