Abstract Background In rapidly ageing societies, promoting healthy ageing is essential. Japan launched a nationwide policy using questionnaire-based frailty screening to help older adults recognise their risk and engage in preventive care. This study evaluated whether this policy was associated with changes in long-term care (LTC) need. Methods The intervention was a health guidance programme initiated through frailty screening and delivered at the municipal level from April 2022. We conducted this single-city study in Sukagawa City, Japan. We extracted monthly data on LTC certifications and population from January 2015 to December 2025. We analysed these data using an interrupted time-series design with segmented regression. The outcome was the monthly age-standardised LTC certification rate among adults aged ≥75 years. We assumed a slope change occurring 12 months after the intervention and fitted Poisson regression models with a log link and an offset for population. Results Following the intervention, the trend in the LTC certification rate among adults aged ≥75 years declined relative to the pre-intervention trend (annualised RR for the change in trend, 0.974; 95% CI, 0.963–0.983). At the end of follow-up, the model-estimated age-standardised LTC certification rate was 6.8% lower than the counterfactual rate projected from continuation of the pre-intervention trend (95% CI, 4.4%–10.0%). Conclusion The frailty screening–based preventive care initiative for older adults was associated with a reduction in LTC certification rates. These findings suggest the potential value of linking frailty screening with broad preventive guidance as a municipal approach to addressing population-level LTC need.
Abstract Background Chronic subdural haematoma (cSDH) is common in older adults, and medication exposures may influence postoperative outcomes. We assessed whether pre-surgery statin use is associated with short- and long-term outcomes. Methods We conducted a nationwide registry study of adults undergoing surgical evacuation of traumatic or non-traumatic cSDH (6/2004–12/2018) in Finnish university hospitals. Pre-surgery statin use was defined from national prescription records using a pill-counting approach. The primary outcome was 30-day all-cause mortality. Secondary outcomes were 30-day reoperation and length of hospital stay. Tertiary outcomes were 1-year mortality and reoperation. Mortality was analysed using Cox regression; reoperation with Fine–Gray models accounting for competing risk of death. Results The cohort included 9001 patients, of whom 2450 (27.2%) used statins. Thirty-day mortality was 3.3% in statin users and 4.5% in non-users, with lower adjusted mortality among statin users (HR 0.57; 95% CI 0.44–0.73). Reoperation within 30 days (n = 897) was similar between groups (sub-distribution HR 1.08; 95% CI 0.97–1.21). Hospital stay was shorter in statin users (22.1 ± 62.7 vs 26.3 ± 77.5 days; adjusted P = .002). At 1 year, mortality remained lower in statin users (13.3% vs 15.4%; HR 0.66; 95% CI 0.58–0.75), with no difference in reoperation (sub-distribution HR 1.09; 95% CI 0.96–1.22). Conclusion In this nationwide cohort of surgically treated cSDH patients, pre-surgery statin use was associated with lower short- and long-term mortality and shorter hospital stay, while reoperation rates were similar between statin users and non-users.
Abstract Background Frailty is associated with greater healthcare use. Still, cost estimates can be biased when shorter survival among severely frail patients is not considered. This study estimated physician service costs across frailty levels, assessing how differential survival influenced expenditures. Methods In this retrospective cohort study, 944 older adults received comprehensive geriatric assessment following emergency department (ED) referral to internal medicine. Frailty was measured using the Clinical Frailty Scale (CFS) and categorised as well, mildly frail, moderately frail and severely frail. Publicly funded physician service costs (2015 Canadian dollars[$]) during the subsequent year were obtained from provincial claims. A three-part regression model adjusted for age, sex and illness acuity separated differences attributable to service intensity from those attributable to survival. Results Participants were ED patients (Mage 80.8 years; 521 women [55%]) referred to Internal Medicine; 41.6% died within 1 year. Physician costs were concentrated in the months immediately following ED presentation. Costs for mildly and moderately frail patients were ~ $300–$400 higher than for well patients, although differences were estimated imprecisely. Severely frail patients incurred $704 less than well patients over 1 year, primarily reflecting shorter survival. During periods patients were alive, all frailty groups incurred higher costs than the well group. Conclusions Physician service costs varied non-linearly with frailty severity. Lower cumulative expenditure among severely frail patients does not necessarily imply lower healthcare need. Clinical pathways and health-system planning should consider differential survival and use frailty assessment to identify individuals who may benefit from proactive multidisciplinary, supportive or palliative care.
Abstract Objective Plant-based dietary patterns may influence healthy ageing, but their longitudinal and multidimensional associations with frailty remain unclear. We examined these associations across three primary ageing cohorts and explored links between dietary components and frailty domains. Methods The primary sample included 8628 older adults from Chinese Longitudinal Healthy Longevity Survey (CLHLS), Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA). Overall, healthful and unhealthful plant-based diet indices (PDIs, hPDIs and uPDIs) were derived from cohort-specific food-group data. A supplementary analysis of 10 821 SHARE participants used a two-component plant–animal contrast. Frailty was assessed using a multidomain deficit-accumulation index. Generalised linear mixed models examined diet–frailty associations, and Mundlak decomposition separated between-person differences from within-person changes where repeated diet data were available. Spline and network analyses examined non-linearity and component-level associations. Results Higher PDI was associated with lower frailty risk across all three primary cohorts (ORs = 0.71–0.80), whereas higher uPDI was associated with higher risk (ORs = 1.24–1.41). hPDI was inversely associated only in ELSA and was null in CLHLS and HRS. In CLHLS, between-person dietary differences showed stronger associations than within-person changes. Spline analysis provided limited evidence of non-linearity. Network analyses highlighted nuts, vegetables and plant oils as showing predominantly inverse associations with several frailty domains. SHARE analysis showed an inverse between-person association, no within-person association, with the plant-based component also showing predominantly inverse links with frailty domains. Conclusion Higher overall plant-based diet scores were associated with lower frailty risk, whereas unhealthful plant-based diets were associated with higher risk, underscoring the importance of diet quality.
Abstract Background Dementia is a global challenge, but benefits from local, context-specific evidence. With finite resource, and numerous potential research directions, formal priority setting can help develop equitable and relevant research agendas. We used this approach to establish dementia and brain health research priority questions for Scotland. Methods A steering board of professionals and experts through lived experience guided the process, following established research prioritisation frameworks. Research questions were collected through surveys and refined to create an interim list. This was further rationalised through Delphi-style ranking involving cross-disciplinary, cross-sectoral interest-holders. After reaching consensus, each research question was assessed for potential impact. Results Between April and July 2025, 706 participants submitted 2677 questions. These were consolidated into an interim list of 142 questions. Two ranking rounds (n = 242, n = 252) reduced the list to 20 questions (10 brain health, 10 dementia). Interest-holders included people living with cognitive impairment (n = 48, 6·8%), current or previous caregivers (n = 217, 30·7%), public contributors (n = 261, 37·0%), and professionals (n = 134, 19·0%). Risk reduction was a leading brain health priority, while early diagnosis was a top dementia priority. Research around brain resilience and improving dementia care pathways was selected as having greatest potential impact. Conclusion We established Scotland-specific research priorities for brain health and dementia, which we advocate to researchers, funders and decision-makers. Our national research prioritisation exercise received engagement from diverse interest-holders, ensuring a range of voices will inform future research.
