The edition · Geriatrics
Regular paracetamol did not ease pain in care-home residents with advanced dementia
A meta-analysis of four randomised trials in 482 residents found no meaningful pain reduction from scheduled paracetamol. Also: the SARC-F questionnaire predicted recovery after hip fracture, a stroke follow-up programme linked to worse function in the over-80s, and mind-body exercise for balance.
The edition in brief
A meta-analysis of four randomised trials in 482 long-term care residents with moderate to severe dementia and mild to moderate pain found regularly scheduled paracetamol (2.5 to 3 g/day for 4 to 13 weeks) did not significantly reduce observed pain compared with placebo or usual care (SMD −0.14, 95% CI −0.39 to 0.11; moderate certainty). In 430 adults aged 70 or over with hip fracture, the five-item SARC-F questionnaire, unlike grip strength or calf circumference, consistently predicted poor early mobilisation and worse walking and function up to four months. A subgroup analysis of the Norwegian LAST-long trial found an 18-month stroke coordinator programme was associated with fewer favourable functional outcomes in people aged 80 or over (23.4% vs 57.0%), while frailty did not modify the effect. A meta-analysis of 31 trials found tai chi and Baduanjin improved balance and fall-risk test scores, with low certainty and no data on actual falls. The pearl covers assessing pain in people who cannot report it.
Five SARC-F questions predicted who would struggle after hip fracture
Use the five-question SARC-F screen on admission with hip fracture to identify older patients likely to recover poorly and target rehabilitation early.
A stroke follow-up programme was linked to worse function in the over-80s
Be cautious about applying structured community stroke programmes to people over 80 without tailoring, since this trial raised a possible signal of worse function.
Tai chi and Baduanjin improved balance scores in older adults, with no falls data
Tai chi and similar exercises may improve balance in older adults and are a reasonable option, but evidence that they cut falls was not shown here.
When a resident cannot tell you about pain, watch for it
In residents with advanced dementia, assess pain with an observational scale during care before treating behaviour change with sedatives.
Scheduled paracetamol did not reduce pain in care-home residents with advanced dementia
Review standing regular paracetamol in care-home residents with advanced dementia, as four trials found no measurable pain benefit, and target treatment to a specific cause.
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