The edition · Geriatrics
Three or more brain-active drugs in nursing home residents with dementia, and in-hospital protein without short-term benefit
Nearly 30% of US nursing home residents with dementia took three or more CNS-active drugs; a protein-enriched diet after fragility fracture did not improve short-term recovery.
The edition in brief
A randomised trial of 100 malnourished older adults with fragility fractures found that a protein-enriched hospital diet did not reduce complications or improve mobility or discharge home; nutritional risk tracked frailty and multimorbidity. An Indian multicentre deprescribing trial team describes why removing fall risk-increasing drugs is hard to study and to do, from equipoise to hierarchical prescribing. A small Dutch trial of topical pilocarpine drops for dry mouth in frail or seriously ill patients missed its primary endpoint but was underpowered. The practice-changer comes from claims data on 485,251 long-stay US nursing home residents: those with dementia were more often exposed to potential drug interactions (58.0% vs 53.3%), and 29.6% took three or more CNS-active drugs against 21.2% without dementia, a combination that is a known falls risk and a clear target for review.
Protein-enriched hospital diet after fragility fracture: no short-term benefit
Treat malnutrition after fragility fracture as a frailty marker, and extend nutritional support into rehabilitation rather than relying on the hospital stay.
Why deprescribing fall-risk drugs is hard: lessons from an Indian trial
Make one clinician responsible for reviewing the whole medication list of an older patient who falls.
Pilocarpine drops for dry mouth in frailty: a negative but underpowered trial
Start with mouth care and drug review for dry mouth in frail patients; pilocarpine drops are a well-tolerated but unproven option.
Measuring orthostatic hypotension properly after a fall
Check lying and standing blood pressure at one and three minutes when an older patient falls.
Nearly 30% of nursing home residents with dementia took three or more CNS-active drugs
Review and try to reduce regimens with three or more CNS-active drugs in care home residents with dementia.
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