Long-term benzodiazepine use for insomnia remains a patient-safety concern, while deprescribing is frequently hindered by fear of poor sleep, limited confidence in non-pharmacological alternatives, and difficulty translating general sleep advice into daily practice. This review examines current evidence on behavioural sleep determinants, patient education, health literacy, and visual communication in relation to benzodiazepine deprescribing. Particular attention is given to older adults, for whom long-term use, polypharmacy, falls risk, and differences in health literacy may complicate deprescribing. Successful deprescribing extends beyond dose reduction and requires attention to medication beliefs, withdrawal concerns, self-efficacy, and access to effective behavioural support. Cognitive behavioural therapy for insomnia and other non-pharmacological approaches can facilitate discontinuation, but their availability remains limited. Visual educational resources may improve comprehension, reduce cognitive burden, and help patients recognise the relationship between daytime behaviours, circadian regulation, sleep environment, pre-sleep routines, and sleep-related thoughts. However, visual sleep-health communication has rarely been examined specifically within benzodiazepine deprescribing. Integrating visual sleep-health education into deprescribing conversations may provide a practical framework for explaining insomnia mechanisms, identifying modifiable behaviours, and supporting shared goal setting. A proposed visual framework is presented as an adjunct to clinician-guided tapering and evidence-based insomnia treatment. Its acceptability, feasibility, and effectiveness should be evaluated before routine clinical implementation.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are most well known for their effects on body weight and glucose homeostasis. However, the functional impacts of GLP-1RAs are understudied in aging adults, a population at increased risk of functional decline. Further, there is a lack of data on the impact of personal and sociocultural factors on GLP-1RA effects or prescription rates. While there currently is a modest amount of research in this area, studies indicate that GLP-1RA therapy may enhance overall mobility function, likely due to weight loss as opposed to improved muscle function. Similarly, use of some newer GLP-1RAs is associated with greater perceived quality of life, but also with reduced handgrip strength or lower body function in certain populations. Finally, recent data suggest that age, sex, race/ethnicity, and socioeconomic status may influence GLP-1RA prescription rates and, in some cases, responses to treatment The current review summarizes the effects of GLP-1RAs on physical function and quality of life in aging adults, while considering personal characteristics and social determinants of health, particularly in regard to effects on prescription rates
Sarcopenia, characterized by progressive loss of skeletal muscle mass, strength, and physical performance, is increasingly recognized as a relevant comorbidity in patients with heart failure (HF). Multiple systematic reviews and meta-analyses have explored this relationship, yet a comprehensive synthesis of existing evidence is lacking. This umbrella review aimed to summarize and critically appraise the evidence from published systematic reviews and meta-analyses investigating the prevalence, prognostic impact, and outcomes associated with sarcopenia in HF populations. Eight systematic reviews and meta-analyses, including between 38 and 21 primary studies encompassing 1,594 to 68,556 participants, were identified. The prevalence of sarcopenia among HF patients ranged from 31
Emergency medicine physicians (EMP) are routinely called upon to assist patients and their families in making serious, often life altering, medical decisions. These decisions are regularly made with limited information and during times of crisis. With patient autonomy at the forefront of EMPs minds, this review provides both background and pragmatic approaches to the evaluation of the older adult patient’s capacity to participate in this medical decision-making process. It is important for the reader to recognize this article is meant to provide an overview of the literature in an effort to educate clinicians who care for older adult patients. It should be viewed as a medical reference. As the clinical care of patients can be impacted by many variables, this article should not be seen as an effort to strictly define the standard of care for all medical providers in all settings. The landscape of emergency medicine (EM) continues to evolve in the post-COVID era. With recent increased focus on high-value, often ambulatory based care and continued emphasis on patient autonomy, medical decision-making capacity evaluations are being considered within contemporary contexts. This article aims to summarize the approach to these evaluations within the modern-day practice environment of EM. Caring for older adults in the emergency department (ED) is common and becoming more so. As such, there is a need for EMPs to be well versed in capacity evaluations among this cohort. The T.A.S.K approach, establishing trust, asking about the key capacity elements, considering said elements within the context of the sliding scale principle and keeping an accurate and concise record of the evaluation is one method EMPs might employ when conducting such assessments. It is further important for the EMP to recognize the unique biopsychosocial aspects among older adults that can influence the process and results of this capacity evaluation.
Transitions of care from the emergency department (ED) represent a period of heightened vulnerability for older adults, driven by medical complexity, functional impairment, and social factors. This review examines ED-based geriatric models and interventions aimed at improving transitions of care, with a focus on how outcomes are defined and measured. Geriatric emergency department (GED) models emphasize multidisciplinary assessment, targeted screening, and care coordination to address risks during ED transitions. While a growing body of literature describes promising interventions including screening linked to services, care management, medication review, and post-ED follow-up, evidence remains heterogeneous. Outcomes are frequently measured using utilization-based metrics, which may inadequately capture patient-centered goals such as function, symptom burden, and care continuity. GED models provide a valuable framework for identifying risks related to transitions of care for older adults, but current evidence is limited by inconsistent outcome definitions and system-level constraints. Future research should prioritize patient-centered outcomes, pragmatic implementation strategies, and alignment with post-acute care capacity to meaningfully improve transitions from the ED for older adults. Older adults are especially vulnerable during transitions of care, and this may be especially true after an ED visit. Risks for geriatric patients encompass many elements of care, including medication changes and interactions, unrecognized cognitive and functional decline, inadequate social support, and ability to coordinate needed follow-up. The broad scope of transitional needs makes pinpointing sustainable and scalable interventions challenging. GED models can help standardize processes targeting elder-specific vulnerabilities and identify the resources needed to improve safety for older patients. Data remain limited regarding what is most impactful on older patients transitioning from the ED, but multidisciplinary interventions offering support such as targeted care management, thorough medication reconciliation, PT/OT evaluation, and scheduling assistance show promise. Gaps in existing literature include the lack of a shared framework regarding meaningful, patient-centered outcomes and little exploration to date regarding scalability and equity. Additionally, post-acute care bottlenecks pose real challenges to ED transitions of care that cannot be addressed directly with ED-initiated interventions.
