BACKGROUND:The frailty index (FI) assumes that deficits are interchangeable; the type of individual items matters less than the total count. Machine learning is increasingly used to create shorter FIs, often motivated by perceived barriers to collecting many items in clinical settings despite availability of electronic health records. We explored whether FI item selection matters when predicting mortality in adults living with cardiovascular disease (CVD). METHODS:We analysed 3669 adults living with CVD from the National Health and Nutrition Examination Survey (1999-2018) with a 46-item FI. Cox and random survival forest models predicted all-cause and CVD-specific mortality using individual items or composite FI scores. Items were ranked by permutation importance. At each item count k (1-46), we compared the top k items as individual predictors, the top k items combined into a single FI and 200 FIs each built from randomly selected k items. RESULTS:Models using 46 individual items outperformed composite FI approaches for both outcomes (C-index: 0.71 [0.69-0.74] vs 0.64-0.67). Importance-ranked FI performance peaked at ~10 items then declined. Randomly built FIs improved steadily, converging with the importance-ranked composites by ~35 items (all-cause) and 20 items (CVD). Analyses using imputation produced consistent results. CONCLUSIONS:When enough items are included, which specific items make up the FI has negligible influence on prediction. Combining items into a single score discards some prognostic information, but this trade-off maintains the generalisability that makes the FI practical. Short importance-ranked FIs benefit from avoiding dilution rather than capturing an optimal item set, and any such selection is outcome-specific and sample-dependent.
PURPOSE:Benzodiazepine use is prevalent among older adults despite its recognised negative effects, including increased risk of falls, fractures and decline in functional status. Lifestyle interventions can preserve physical function and reduce the risk of disability. This study investigates whether benzodiazepine use reduces the effectiveness of lifestyle-based interventions on mobility disability. METHODS:We performed a secondary analysis of the 'Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies' trial. The lifestyle intervention consisted of physical exercise and nutritional counselling. Benzodiazepine use was assessed based on baseline or longitudinal exposure (defined as use at baseline plus use at two or more additional time points). Cox regression models were used to ascertain the association between benzodiazepine use and mobility disability incidence. A separate analysis was conducted among participants with a Short Physical Performance Battery (SPPB) score 3 to 7. RESULTS:Among the 1506 participants included (mean age 78.9 years; 71.5% female; 753 intervention vs. 753 control), 211 (14.0%) reported benzodiazepine use at baseline. Overall, 55.0% of baseline benzodiazepine users and 43.6% of non-users developed mobility disability during the follow-up (P = .003). When baseline benzodiazepine use was considered, no significant effect associated with multicomponent intervention (MCI) was shown among non-users (Hazard Ratio (HR) = 0.86; 95% Confidence Interval (CI) 0.72-1.03) and users (HR = 1.04; CI 0.67-1.62). In the subgroup of participants with SPPB scores 3 to 7, a significant effect of the MCI was observed only among non-users (HR = 0.80, 95% CI 0.66-0.97), while no 'association' was detected among users (HR = 1.06; 95% CI 0.65-1.71, P for interaction = .035). When longitudinal benzodiazepine exposure was considered, similar results were observed. In particular, in the SPPB score 3 to 7 subgroup, the beneficial effect of the MCI was observed only among non-users (HR = 0.79; 95% CI 0.64-0.96), while no 'association' was detected among users (HR = 1.13; 95% CI 0.60-2.13, P for interaction = .035). CONCLUSION:In frail older adults, benzodiazepine use significantly blunts the effectiveness of lifestyle interventions for preventing mobility disability. These findings support a prudent approach to benzodiazepine use in frail older patients.
BACKGROUND:Fragility fractures cause disability in older adults. Although frailty determines adverse outcomes, the relationship between anatomical fracture site and functional status remains unclear. Clarifying these associations may improve geriatric assessment and secondary prevention strategies. METHODS:We conducted a population-based retrospective cohort study using the Shizuoka Kokuho Database, which integrates medical and long-term care insurance claims in Japan. Individuals aged ≥65 years with a first-time, single-site fragility fracture (proximal humerus, distal radius, hip, distal femur, vertebrae or pelvis) were included. Frailty was assessed using long-term care insurance (LTCI) certification levels and the electronic frailty index (eFI). Fracture distribution was compared across frailty strata, and crude and age- and sex-adjusted odds ratios (ORs) were estimated using separate logistic regression models for each fracture site. RESULTS:Among 146 052 fractures (mean age 81.5 years; 78.2% women), distal radius fractures occurred predominantly in individuals without LTCI certification (86%), whereas 47% of hip fractures occurred in this group, showing a functional gradient. Distal femur fractures were associated with severe frailty (OR 10.55, 95% CI 9.61-11.57). Age- and sex-adjusted analyses attenuated these associations, but key patterns for distal radius, hip and distal femur fractures remained. Similar gradients were observed across eFI categories. CONCLUSIONS:Fracture site was associated with differences in care needs and frailty among older adults. Distal radius fractures were more common among individuals with lower care needs, whereas pelvic and distal femur fractures were more common among those with advanced frailty. Anatomical fracture location may provide context in geriatric assessment and prevention strategies. Trial Registration (if applicable): Not applicable.
BACKGROUND:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes, but evidence in adults aged ≥75 years remains limited, particularly compared with dipeptidyl peptidase-4 inhibitors (DPP-4i). METHODS:We conducted a target trial emulation using linked administrative claims and health examination data in Japan. Individuals aged ≥75 years with type 2 diabetes who newly initiated an SGLT2i or DPP-4i were identified. Intention-to-treat (ITT) effects were estimated using inverse probability weighting, with a 1-month induction period for mortality, cardiovascular and renal outcomes. RESULTS:The study included 8486 individuals (2204 SGLT2i users, 6282 DPP-4i users). After a 1-month induction period, SGLT2i initiation was associated with lower all-cause mortality (hazard ratio [HR] 0.677, 95% confidence interval [CI] 0.500-0.916) and lower risk of end-stage renal disease or dialysis (HR 0.374, 95% CI 0.157-0.890). No clear differences were observed for heart failure hospitalisation (HR 1.103, 95% CI 0.854-1.426) or myocardial infarction (HR 1.015, 95% CI 0.768-1.341) in the ITT analysis. Stroke occurred more frequently among SGLT2i users (HR 1.420, 95% CI 1.165-1.828), although this finding should be interpreted cautiously. CONCLUSIONS:Among adults aged ≥75 years with type 2 diabetes, SGLT2i initiation was associated with lower all-cause mortality and renal risk compared with DPP-4i initiation. The higher observed stroke risk requires cautious interpretation because residual confounding, competing mortality and heterogeneity in vulnerable older adults may contribute to this signal.
Polypharmacy is highly prevalent among older adults and is associated with adverse outcomes. While comprehensive medication review is widely promoted to address potentially inappropriate prescribing, it is resource intensive. Focused deprescribing-defined as the targeted withdrawal or dose reduction of specific drug classes-has emerged as a potentially more scalable strategy. This umbrella review synthesised evidence on the effectiveness and safety of drug class-specific focused deprescribing interventions in older adults. We conducted an umbrella review of systematic reviews evaluating focused deprescribing interventions targeting specific pharmacological classes. MEDLINE, Embase, the Cochrane Library and Web of Science were searched from inception to March 2025. Study selection, data extraction and methodological quality assessment (AMSTAR-2) were performed independently by two reviewers. Findings were synthesised narratively by drug class and outcome domain, and overlap was assessed using the Corrected Covered Area. Twenty-seven systematic reviews were included. Most focused on psychotropics, particularly benzodiazepines, and anticholinergics, with fewer assessing antidiabetics or fall-risk increasing drugs. Reductions in medication use were most consistent for benzodiazepines and other psychotropics, especially when interventions included psychotherapy or multifaceted components. Evidence for antidiabetics suggested feasibility and safety, whereas effects on anticholinergics and fall-risk increasing drugs were limited. Clinical outcomes, including mortality, falls and cognition, were inconsistently reported and rarely improved. Most reviews were rated as critically low quality, and certainty of evidence was generally low or very low. Focused deprescribing appears feasible and generally safe for reducing selected potentially inappropriate medications in older adults; however, its clinical benefits are drug class-dependent and remain uncertain.
BACKGROUND:Falls are a major cause of morbidity and mortality in older adults. The World Falls Guidelines (WFG) propose a risk stratification algorithm using fall history, three key questions (3KQ), mobility tests and clinical criteria, but it has yet to be systematically evaluated. OBJECTIVE:To assess whether the WFG algorithm, in original or modified form, effectively stratifies community-dwelling older adults into low, intermediate or high risk of future falls; whether it has been prospectively validated; and whether it has been adequately operationalised. METHODS:We conducted a systematic review (PROSPERO CRD420251151506) by searching MEDLINE, Embase and Google Scholar. Two reviewers independently screened studies and extracted data on cohort characteristics, algorithm adaptations, baseline risk distribution and prospective falls outcomes over ≥6 months. Given the heterogeneity of the studies included, quantitative meta-analysis was not conducted. RESULTS:Eight cohort studies (n = 25 027; mean age range 61-82 years) met the inclusion criteria. No study implemented the WFG algorithm as published; two used minor modifications and six had major adaptations due to dataset limitations. Common modifications included rephrasing the 3KQ, replacing 'subjective unsteadiness' question with objective measures, applying mobility test universally, adjusting mobility tests thresholds and omitting fall severity definition components. Across studies, 7.9%-82.6% of participants were classified as low risk, 0.4%-18.3% as intermediate risk and 10.5%-88.7% as high risk. High-risk classification showed modest sensitivity (26.5%-52.3%) and moderate-to-high specificity (34.2%-88.9%) for future falls (1-2 years), with an overall accuracy of 61.2%-74.2%. High-risk groups consistently had a two- to three-fold higher incidence of falls than low-risk groups, while intermediate-risk groups only showed a slightly elevated risk. Use of 3KQ alongside fall history and universal mobility testing improved discrimination and increased the proportion in the intermediate-risk category. CONCLUSION:The operationalised versions of the WFG algorithm identify older adults at high falls risk with high specificity but limited sensitivity. Proposed pragmatic modifications improve stratification accuracy for intermediate risk group but require prospective validation.
BACKGROUND:Vaccine hesitancy among older adults has increasingly raised public concern and warrants global actions in the post-COVID-19 era. This systematic review aimed to synthesise determinants of vaccine hesitancy and related mitigation strategies toward routine vaccinations recommended for older adults (influenza, pneumococcal and shingles vaccines), which is important for promoting healthy ageing and fighting against infectious diseases during both pandemic and non-pandemic periods. METHODS:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search was conducted between November 2024 and June 2025 across Web of Science, PubMed and MEDLINE. The data were analysed by narrative synthesis guided by two theoretical frameworks. RESULTS:A total of 72 studies were included. Most of them were conducted in developed countries, with a surge since the COVID-19 pandemic. Determinants of vaccine hesitancy were summarised from 49 studies into 3 levels, 8 themes and 24 sub-themes: individual level (sociodemographics, personal perceptions, previous experiences), group and social level (interpersonal influence, community influence, media/cultural influence) and practical issues level (willingness to pay, convenience of access). The intervention strategies were categorised from 23 studies into five types, including dialogue-based intervention, reminder/recall-based intervention, incentive-based intervention, passive intervention and multi-component intervention. Notably, this review identified a lack of conceptual clarity in distinguishing vaccine hesitancy from actual vaccination behaviours and a shortage of comprehensive interventions tailored to older adults. CONCLUSION:Vaccine hesitancy toward routine immunisations among older adults is driven by multilayer determinants, underscoring the need for comprehensive, theory-informed and tailored interventions that address the diverse determinants.
BACKGROUND:Hip fractures (HF) are a major cause of morbidity and mortality and account for substantial health and social care costs. We report the incidence and characteristics of older patients (≥60 years) presenting with hip fractures (HFs) in England, Wales and Northern Ireland. METHODS:We conducted a national cohort study of HF events recorded in the National Hip Fracture Database (NHFD) between May 2011 and September 2023. HF incidence was derived using sex and age-banded mid-year population estimates from the Office for National Statistics to calculate at-risk population incidence for the whole cohort and by sex and age strata. RESULTS:735 436 HF events were included (71% female, mean age 82.9 years). Annual NHFD HF numbers increased across the study period from 55 832 to 63 341 (13.5%). However, overall incidence declined from 422.8 to 412.8 per 100 000 population. Divergence was observed between sexes, with falling incidence in females but rising in males. HF patients are presenting with greater systemic disease burden, with the proportion graded American Society of Anaesthesiologists ≥3 increasing in both females (66.4% to 80.4%) and males (73.4% to 84.3%). CONCLUSION:Despite modest declines in overall incidence in women, absolute HF numbers continue to rise. The divergent sex-specific trends and substantial increase in patient comorbidity represent important shifts in HF epidemiology with implications for service capacity, risk stratification and secondary prevention strategies. This mandates urgent realignment of care resources to minimise the impact on patient mortality and economic health burden.
OBJECTIVE:To compare health and health service use in female live-in caregivers along multiple timepoints with population-based controls over a 20-year period. METHODS:Data from 6000 women aged 50-77 caring for someone who was ill, disabled or frail, were collected over eight waves of Australian Longitudinal Study on Women's Health 1946-51 cohort (from 2001 to 2022). Physical functioning (PF), general mental health (MH), depressive symptoms, stress and general practitioner (GP) and medical specialist visits were compared between caregivers and time-matched controls, before, during and after caregiving. Fully adjusted mixed linear models or logistic regression, including sensitivity analyses by caregiving intensity, were conducted. RESULTS:In adjusted results, caregivers and controls had similar initial levels of PF, but caregivers had significantly poorer PF over time including during [2.39 (-3.68, -1.10)] and after stopping caregiving [-2.19 (-3.51, -0.87)]. Caregivers had poorer MH on all three measures [eg, -5.56 (-6.61, -4.51) on SF-36 MH] and more GP visits across the study than controls, with the poorest scores in the period before stopping caregiving. Accessing medical specialists did not differ between caregivers and controls until after stopping caregiving, when caregivers had higher odds [1.22 (1.06, 1.40)]. Associations were stronger in caregivers providing higher intensity care. CONCLUSIONS:Caregiver physical and MH was poorest and GP visits highest prior to stopping caregiving, while specialist visits increased after stopping caregiving. Interventions to assist caregivers manage their own health needs, particularly in the period before stopping caregiving, and assisting them maintain health service use throughout and following caregiving cessation should be tested.
INTRODUCTION:Health and social care systems face rising pressures due to population ageing, rising frailty, multimorbidity and complex care needs. Traditional hospital-based care is increasingly recognised as unsustainable, and may be inappropriate for older adults living in care homes. In England, policy promotes shifting care from acute hospitals to community and residential settings. Hospital at Home (HaH) delivers hospital-level care in a person's usual residence; however, little is known about its delivery and experience within care homes. METHODS:This study reports qualitative findings from semi-structured interviews with care home staff, supported by descriptive survey data and open-ended survey responses. Care home staff were recruited from several localities in the South of England. Quantitative survey data were analysed descriptively and qualitative data, thematically. RESULTS:Fifty participants completed the survey and 20 participated in interviews. Hospital admission remained necessary for some residents, particularly for fractures and acute emergencies. However, hospitalisation was frequently associated with distress, communication breakdowns and hospital-associated decline. In contrast, HaH was perceived to offer benefits including collaborative working, improved continuity, preservation of dignity and comfort and reduced exposure to hospital-related risks. Key barriers included workforce capacity, geographical coverage, limited opening hours and inconsistent referral pathways, restricting timely and equitable access. CONCLUSION:Hospital at Home was perceived by care home staff as a valuable and often preferable alternative to hospitalisation for many residents. However, structural and organisational barriers must be addressed to realise its full potential within care home settings. Future research should examine how HaH can be more widely implemented in care homes.
BACKGROUND:Older adults with cardiovascular disease (CVD) have a high risk of falls, yet evidence for scalable fall-prevention programs in this population is limited. METHODS:This secondary analysis of the Fall Prevention for Rural Community-Dwelling Elderly open-label cluster randomised trial included rural Chinese adults aged 60 years or older with self-reported physician-diagnosed hypertension or heart disease at baseline from 128 villages. Villages were randomised 1:1 to a 12-month village doctor-led intervention comprising balance and functional exercise and health education, or to usual care. The primary outcome was reporting at least one fall over 12 months. Secondary outcomes included falls rate, fall-related injury, functional mobility and health-related quality of life. RESULTS:Participants were recruited between 19 September 2023 and 15 November 2023. Compared with usual care, the intervention reduced the proportion reporting at least one fall [31.6% vs 42.7%; OR, 0.60; 95% confidence interval (CI), 0.43 to 0.84], falls rate (0.9 vs 1.6 per person-year; RR, 0.62; 95% CI, 0.43 to 0.89) and fall-related injury (15.9% vs 24.9%; OR, 0.57; 95% CI, 0.42 to 0.78). The intervention also improved chair stand performance, balance performance and health-related quality of life score, but not Timed Up and Go. Benefits were generally consistent across subgroups, with a greater effect in men. CONCLUSIONS:A village doctor-led fall-prevention program integrated into rural primary care reduced falls and fall-related injuries and improved functional outcomes among older adults with CVD. These findings support integrating scalable nonpharmacological fall-prevention strategies into routine cardiovascular management in rural primary care.
INTRODUCTION:Persons with dementia and their caregivers are more physically inactive than cognitively healthy peers or non-caregivers, yet little is known about their views on dyadic physical activities. This study explored the perceptions, facilitators, barriers and expectations related to dyadic physical activity among persons with dementia and their caregivers. METHODS:An exploratory dyadic qualitative study was conducted with 24 community-dwelling dyads in Hong Kong SAR, China. Semi-structured dyadic interviews were analysed using inductive thematic analysis. RESULTS:Four themes comprising 22 subthemes were identified. Dyads recognised mutual physical, psychological and relational benefits and valued activities that fostered shared enjoyment and relational resonance, though some questioned dyadic activity's relevance. Engagement was facilitated by clear rewards, established habits, everyday collaborative activities, culturally meaningful incentives and strong social and professional support in a facilitative environment. Participation was hindered by limited shared understanding of physical activity, negative emotions in partner, mismatched fitness levels and activity rhythms, social withdrawal by the person with dementia, time pressures and conflicting family attitudes. Dyads expected interventions to yield tangible health and fitness gains, be tailored to both partners' capacities and interests, provide appropriate challenge and ensure safety through explicit risk management strategies. CONCLUSION:Dyadic physical activity is not simply 'doing it together'. Instead, interventions should be tailored, health-oriented and relationally attuned, with explicit consideration of the practical and emotional challenges faced by both dyad members. Psychoeducation regarding the significance of physical activity may need to extend beyond the dyadic members to the wider family to promote 'doing it together'.
BACKGROUND:The global prevalence of dementia is rising rapidly, placing increasing pressure on health and social care systems to deliver coordinated and equitable post-diagnostic support. In England, service fragmentation and workforce constraints limit the delivery of recommended care models. Non-clinical dementia navigator (DN) models have emerged as a potentially scalable approach to improve care coordination and access, yet evidence on their system-level impact remains limited. METHODS:We estimated the population of people with diagnosed dementia in England eligible for DN support between 2025 and 2030 using NHS data and projected prevalence trends. Eligibility was adjusted for undiagnosed cases, care home residents, and expected uptake. Costs of delivering DN-led care were derived from existing UK service models and unit costs, while potential savings were based on reductions in health-care utilisation observed in the US Care Ecosystem trial. Probabilistic sensitivity analyses were conducted to assess uncertainty. RESULTS:The number of eligible individuals receiving DN support is projected to increase from 300 000 in 2025 to 360 000 in 2030. Delivering this model would require ~940 to 1120 link workers. Annual costs are estimated at £224 million in 2025, rising to £343 million in 2030. These are offset by estimated savings of £1140 million and £1750 million, respectively. Even under conservative assumptions, DN models generate net savings. CONCLUSIONS:Scaling up DN-led care in England could support large numbers of people with dementia while generating substantial health system savings. These findings suggest that navigator-based models offer a feasible and cost-saving approach to delivering coordinated post-diagnostic dementia care at scale.
BACKGROUND:Social isolation, loneliness and frailty commonly emerge in later life, yet understanding of how their interrelationships relate to all-cause death remains limited. This longitudinal study aimed to examine the associations between social isolation and loneliness and risk of all-cause death and to examine the mediating role of frailty in these associations. METHODS:This study analysed data from four large international cohorts (Health and Retirement Study, China Health and Retirement Longitudinal Study, Survey of Health, Ageing and Retirement in Europe and Mexican Health and Ageing Study) covering 31 countries. Cox proportional hazards models were used to estimate the associations of social isolation and loneliness with frailty and all-cause death. A random-effects meta-analytic model was used to pool cohort-specific estimates. Finally, mediation analysis was conducted to quantify the mediating effect of frailty in the associations between social isolation, loneliness and all-cause death. RESULTS:Over a mean follow-up of 7.07 years, there were 20 504 (25.61%) participants who developed frailty and 6212 (7.76%) all-cause death among total of 80 050 participants. Social isolation was associated with increased risks of frailty (pooled HR = 1.26, 95% CI: 1.09-1.44) and all-cause death (pooled HR = 1.33, 95% CI: 1.12-1.56). Loneliness was associated with an increased risk of frailty (pooled HR = 1.19, 95% CI: 1.00-1.41) and all-cause death (pooled HR = 1.25, 95% CI: 1.10-1.41). Frailty mediated 24.43% (17.35%-34.43%) of the association between social isolation and all-cause death and 55.18% (47.12%-64.43%) of the association between loneliness and all-cause death. CONCLUSION:In later life, social isolation and loneliness increased risks of all-cause death and frailty served as a key mediator. These findings underscore the urgent need for public health policies and clinical practice to prioritise systematic identification and intervention targeting social isolation and loneliness, while integrating frailty screening and management into healthy ageing strategies.
BACKGROUND:Statins, renin-angiotensin system inhibitors (RASIs) and beta-blockers are guideline-recommended cardiovascular medications post-myocardial infarction (MI) for secondary prevention, but evidence for people with dementia is scarce. OBJECTIVE:To evaluate the association between post-MI cardiovascular medication use and the risk of cardiovascular outcomes and mortality, focusing on people with dementia. DESIGN:Large retrospective cohort study using data from Australia, Finland, Taiwan, the UK and the USA. SUBJECTS:People with and without dementia. METHODS:Seven exposure groups were assigned using one or combinations of the three guideline-recommended medication classes-(i) statin, RASI and beta-blocker, (ii) statin and beta-blocker, (iii) statin and RASI, (iv) RASI and beta-blocker, (v) statin only, (vi) beta-blocker only and (vii) RASI only, based on medication records during a 60-day landmark period post-MI. Recurrent MI, major adverse cardiovascular event (MACE) and all-cause mortality were evaluated as outcomes. Jurisdiction-specific results were pooled together using meta-analyses. RESULTS:A total of 28 122 people with dementia and 260 360 people without dementia were included. Among people with dementia, using any single or two medications carried a similar risk of recurrent MI and MACE as using all three guideline-recommended medications, except that using RASI and a beta-blocker without a statin was associated with a lower risk of recurrent MI (HR 0.85; 95% CI, 0.75-0.96). Using a statin and RASI without beta-blockers resulted in similar all-cause mortality to using all three (HR 1.16; 95% CI, 0.97-1.39), while all the remaining single- or dual-medication regimens were associated with higher risks of all-cause mortality. CONCLUSIONS:For people with dementia, using one or two guideline-recommended medications appeared sufficient to protect against recurrent MI and MACE. Beta-blockers may not provide additional survival benefits over statins and RASIs.
BACKGROUND:Sarcopenia, the age-related loss of muscle mass and strength, contributes to frailty and disability. Ultra-processed foods (UPFs) may increase risk via metabolic and inflammatory pathways. This study examined the association between UPF intake and sarcopenia in older Iranian adults. METHODS:This cross-sectional study used data from the second phase of the Birjand Longitudinal Aging Study (BLAS). Sarcopenia was defined using EWGSOP2 criteria. Dietary intake was assessed with a validated food frequency questionnaire, and UPF consumption was categorised into quartiles based on energy contribution (NOVA classification). Logistic and multinomial regression models were applied, adjusting for demographic, behavioural, nutritional and clinical factors. RESULTS:Among 1006 participants (mean age 72.4 ± 6.5 years; 48.2% women), 29.1% had no sarcopenia, 54.4% probable sarcopenia, 8.7% confirmed sarcopenia and 7.7% severe sarcopenia. Higher UPF intake was associated with greater odds of sarcopenia in a dose-dependent manner. In fully adjusted logistic regression models, participants in the third and fourth quartiles of UPF consumption had significantly higher odds of sarcopenia compared with the lowest quartile (Q3: OR = 2.23, 95% CI: 1.17-4.23; P = .014; Q4: OR = 2.50, 95% CI: 1.32-4.74; P = .05). Multinomial analyses further demonstrated that high UPF intake was specifically associated with advanced sarcopenia stages (Q4 vs Q1: Coeff = 2.10, 95% CI: 1.05-4.18; P = .036). CONCLUSION:Higher UPF consumption was independently associated with both the presence and severity of sarcopenia. Reducing UPF intake may help preserve muscle health and lower disability risk in ageing populations.
INTRODUCTION:People with dementia are often hospitalised due to comorbidities and superimposed delirium and have poorer outcomes in hospital compared to people without dementia, especially among under-served groups. Hospital at Home (HaH) schemes could reduce these inequalities by facilitating care in a familiar home environment that offers similar outcomes to acute hospital care with lower risks of harms. AIMS:We aimed to investigate how dementia and cognitive impairment are considered within English health policy documents informing HaH implementation; considering potential impact on health inequalities and implications for future policy development. METHODS:We searched websites, including UK governmental, NHS, social care and professional organisation sources, from 2015; and reference lists of included documents. We thematically analysed documents. RESULTS:We included 17 documents, comprising clinical guidelines (n = 5), government guidance (n = 4), policy papers (n = 3), service evaluations (n = 3), a strategy document (n = 1) and case study (n = 1). We developed three themes: (i) benefits of HaH for people with dementia, including more person-centred care and familiar treatment environments; (ii) how HaH can be inclusively designed for people with dementia, accommodating needs and mitigating concerns over digital exclusion and safety; and (iii) the critical role of family carers in enabling HaH, including potential carer burden. DISCUSSION:HaH models have potential to reduce health inequalities for people with dementia, but current implementation policies risk reinforcing inequalities, particularly among those without digital proficiency or carer support. Future policies should drive consistent inclusive eligibility criteria and processes for ensuring continuity with primary care, dementia care as a HaH staff core competency.
BACKGROUND:Evidence for non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy for older patients with atrial fibrillation (AF) and drug-eluting stents is lacking. OBJECTIVES:We aimed to evaluate the safety and efficacy of NOAC monotherapy in older AF patients with drug-eluting stents. METHODS:This is a secondary analysis of the ADAPT AF-DES randomised trial comparing NOAC monotherapy with combination therapy with NOAC plus clopidogrel in patients with AF and drug-eluting stents. Patients were stratified by age (≥75 years and <75 years). Apixaban or rivaroxaban was used as the NOAC. The primary endpoint was a net adverse clinical event at 1 year after randomisation, defined as a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism or major or clinically relevant non-major bleeding defined by the International Society on Thrombosis and Haemostasis criteria. RESULTS:Among 960 patients included in the ADAPT AF-DES trial, 376 (39.2%) patients were aged ≥75 years. In patients aged ≥75 years, the incidence of the primary endpoint was lower in the NOAC monotherapy group (9.8% vs. 22.3%; adjusted hazard ratio, 0.37; 95% confidence interval, 0.21-0.66; P < .001) than in the combination therapy group. In contrast, the incidences did not differ between treatment strategies in patients aged <75 years. The interaction between age groups and strategy groups did not reach statistical significance (P for interaction = .095). The reduction in major or clinically relevant non-major bleeding with NOAC monotherapy was consistent across age groups. In contrast, the benefit of NOAC monotherapy in major adverse cardiac and cerebrovascular events was more pronounced in patients aged ≥75 years, with a statistically significant interaction. CONCLUSIONS:In this post hoc analysis, NOAC monotherapy was associated with a lower risk of net adverse clinical events, specifically within the older age subgroup. Tailored approach regarding age and individual ischaemic risk may be needed.
BACKGROUND:Older adults presenting to the emergency department (ED) following a fall are at high risk for recurrent falls, injuries and increased healthcare utilisation. This systematic review and meta-analysis evaluated the effectiveness of interventions initiated upon ED presentation in reducing falls (primary outcome) and fall-related outcomes (secondary outcomes) among older adults. METHODS:A comprehensive search was performed in Ovid Medline, Embase, CINAHL, PEDro, Web of Science, and Scopus up to June 2025, following PRISMA guidelines. This yielded 9624 references, of which 4811 records remained after deduplication and were screened for eligibility. Meta-analyses and descriptive methods, including vote counting, were applied where appropriate. Sensitivity and subgroup analyses were conducted. RESULTS:Thirty articles were included. Interventions were associated with a significant reduction in fall incidence (rate ratio 0.69; 95% CI 0.54-0.88; I2 = 95%), supported by vote counting. While reductions were also observed in the proportion of fallers (odds ratio 0.87; 95% CI 0.71-1.07; I2 = 61%), fall-related and all-cause ED revisits, hospital admissions, recurrent falls and mortality, these trends did not reach statistical significance. Sensitivity analysis excluding studies with modified usual care showed a significant reduction in fall-related ED revisits and people sustaining an injurious fall. Secondary outcomes including quality of life, fear of falling and physical functioning generally showed trends favouring the intervention group. Considerable heterogeneity and variation in intervention characteristics were noted across studies. CONCLUSION:Interventions for older adults presenting to the ED after a fall suggest a favourable effect on fall rate. Non-significant trends favouring the intervention group were observed for several other outcomes, but heterogeneity and methodological limitations preclude definitive conclusions.
