INTRODUCTION:Frailty is frequent among older adults with cancer and may affect treatment tolerance. Frailty screening is recommended to help guide clinical decision-making. This study evaluates the association between frailty, assessed with the Geriatric 8 (G8), and first-line oncologic treatment intensity, treatment tolerance within nine months, and one-year overall survival in older adults with various cancers. MATERIALS AND METHODS:This prospective cohort study at Odense University Hospital, Denmark included older adults age ≥ 70 years with solid cancers who underwent G8 screening at their initial oncology consultation between June 1, 2020-October 15, 2021. Clinical and survival data were extracted from medical records. Guideline treatment was defined as regimens consistent with national guidelines for first-line oncologic treatment, allowing add-on protocol treatment, while reduced-intensity treatment referred to regimens not among first choices. Treatment tolerance was defined as the absence of discontinuations, dose reductions after treatment initiation, or un-administered treatments (excluding delays). Associations between G8 frailty (G8 ≤ 14/17 points) and outcomes were analyzed using adjusted multivariate logistic regression and Cox proportional hazards regression. RESULTS:Among the 1398 patients screened, 65% were frail. Non-frail patients were more likely to receive guideline treatment (OR 1.98, 95%CI 1.28-3.06) and had better first-line treatment tolerance, irrespective of treatment intensity, compared to frail patients (OR 2.38, 95%CI 1.49-3.81), though this effect was more pronounced when receiving guideline treatment (OR 3.08, 95%CI 1.72-5.52). Frailty was associated with twice the risk of one-year mortality (HR 2.03, 95%CI 1.47-2.78), with an absolute mortality risk of 40%, compared to 10% for non-frail patients. Frail patients able to tolerate reduced-intensity treatment had a 68% lower mortality risk compared to frail patients who were unable to tolerate guideline treatment (HR 0.32, 95%CI 0.21-0.49). DISCUSSION:G8 screening identifies older adults at a higher risk of treatment intolerance and mortality. Our findings support the need for clinical trials investigating the effects of initially reduced-intensity treatments with potential escalation in frail older adults receiving systemic treatment. Study registration The study is registered at clinicaltrials.gov [NCT04644874].

AIMS:Care home admission often reflects frailty and limited life expectancy, potentially altering the benefit-harm balance of glucose-lowering drug (GLD) treatment for type 2 diabetes (T2D). Real-world data on treatment patterns in this setting remain limited. We examined GLD use for T2D among Danish care home residents. MATERIALS AND METHODS:We conducted a nationwide, population-based drug utilisation study of all individuals admitted to Danish care homes between 2018 and 2023, using linked national health registries. RESULTS:Among 88 658 residents (median age: 84 years [IQR: 78-90]; 60% women), 13% (n = 11 101) used GLDs for T2D at admission, with 84% continuing treatment beyond 2 years. Residents using GLDs at admission had long-standing diabetes (median duration: 12 years [IQR: 6.8-15]), relatively low glycated haemoglobin levels (median: 6.9% [IQR: 6.3-7.8]; 52 mmol/mol [45-62]) with little change around admission, and 43% used more than one GLD class, most commonly metformin (70%) and insulin (36%; basal: 30%; bolus: 16%). Use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors increased over time but remained limited (13% and 24%, respectively, in 2023), despite a high prevalence of cardiorenal disease (84%), and did not differ by cardiorenal disease status. Overall GLD use remained stable around admission, but initiation spiked 3 months before admission (36 initiators/10 000 residents), often following hospitalisation (63%) and primarily involved bolus insulin initiated by hospital physicians. CONCLUSIONS:GLD use for T2D among Danish care home residents is high and shows limited deintensification and potential misalignment with guideline recommendations.

BACKGROUND:Evidence on use of ultrasound to assess muscles in older adults, and its relation to clinically relevant measures is diverse and inconsistent. OBJECTIVE:To map and synthesize evidence on use of ultrasound-derived muscle variables and their associations with measures of physical function in older adults. METHODS:A scoping review was conducted in accordance with PRISMA-ScR and JBI guidance. MEDLINE, Cochrane, Embase, Scopus, CINAHL, and grey literature was searched. Eligible studies included adults ≥65 years, including frail cohorts, reporting association between ultrasound-derived muscle variables (muscle thickness (MT), cross-sectional area (CSA), echo intensity (EI), pennation angle (PA), fascicle length (FL), or shear-wave elastography (SWE)) and physical function measures (handgrip strength (HGS), sit-to-stand (STS), gait speed (GS), timed up-and-go (TUG), or short physical performance battery (SPPB)). RESULTS:Seventy studies met inclusion criteria. Mapping revealed that rectus femoris MT at mid-thigh was most frequently examined, with considerable protocol variation. Most studies used cross-sectional designs, and frail cohorts were underrepresented. MT and CSA showed weak to moderate associations with muscle strength-related measures (HGS and STS) and generally very weak to weak associations with physical performance-related measures (GS, TUG, SPPB). Evidence for EI, SWE, PA, and FL was limited and inconsistent. CONCLUSION:Current evidence provides limited support for ultrasound-derived muscle variables as markers of physical function in older adults. Muscle thickness and cross-sectional area capture aspects of muscle strength but insufficiently reflect physical performance. Establishing harmonized protocols and exploring responsiveness in frail populations, in longitudinal studies are critical steps for future research and clinical application.

Falls are among the most common and serious events in older adults and are closely associated with frailty. Falls frequently result in fractures, leading to substantial consequences for health, physical function, quality of life, independence, social isolation, and increased mortality. Although falls are often perceived as an inevitable part of ageing, this review finds that falls can be largely prevented through targeted exercise and their consequences mitigated through a systematic, multidisciplinary approach.

Introduction and Purpose:Hospitalised older patients are at high risk of functional decline due to prolonged inactivity. Gerontechnology, including robot-assisted physical exercise, may support early mobilisation, but its use in acute hospital settings remains underexplored. This case report provides an in-depth insight into robot-assisted physical exercise in an older patient admitted to a geriatric department, reflecting the clinical setting of geriatric care during acute hospitalisation and highlighting real-world challenges related to engagement and adherence. Method and Materials:As part of an ongoing randomised controlled trial (RCT), this case report includes a 98-year-old woman randomised to active robot-assisted physical exercise. The intervention was offered twice daily during hospital stay. A structured, semi-guided interview was conducted at discharge to explore the patient's experiences, motivation, and perceived impact of the exercise. This report presents a detailed description of the intervention including exercise, progression, adherence and the patient's experience. Results:The patient described the exercise as engaging, mood-lifting, and beneficial. However, fatigue impacted adherence, resulting in 50% adherence. Functionally, the patient demonstrated increased independence, reflected by an improvement in Barthel Index (0-100, higher scores indicate greater independence) from 57 at admission to 69 at discharge. Chair stand test performance did not change. Conclusion:Based on this single case, robot-assisted physical exercise was positively perceived, even by a frail, hospitalised older patient. However, fluctuating energy levels highlight the need for flexible, patient-centred strategies. This case provides early insight into feasibility, motivation, and real-world adherence, contributing to understanding how robotic rehabilitation may support early mobilisation. Further evidence from the ongoing RCT will clarify its effectiveness in improving outcomes in this population. Trial Registration:ClinicalTrials.gov NCT05782855.

A geriatric screening questionnaire was implemented in 2020 at the Department of Oncology, Gødstrup Hospital, Denmark, to identify frailty and individualize cancer care for all patients aged ≥ 60 years. However, not all patients answered. The primary aim of this study was to investigate the association between response status to the geriatric screening questionnaire and one-year survival. A secondary aim was to compare one-year survival according to the responders’ frailty status. We conducted a retrospective cohort study including all patients with cancer aged ≥ 60 who were enrolled in the geriatric screening between August 2020 and October 2023. The survival curves for responders and non-responders and across the patients’ frailty status were visualized using Kaplan–Meier plots. The associations were analyzed using logistic regression adjusted for potential confounders. In total, 702 patients were included. Among these, 28.1

BACKGROUND AND AIM:Falls in older adults are a major health concern. Risk factors include medications, but uncertainty remains about potential fall risk-increasing drugs (FRIDs). This nationwide cohort study examined whether non-selective beta-blocker eye drops (timolol) increase the risk of fall-related injuries compared to topical prostaglandin analogue (TPA) eye drops. METHODS:Using registry data from all Danish residents, we included individuals aged ≥65 years who initiated timolol (n = 52 019) or TPA (n = 72 885) between 1996 and 2023. Propensity score matching was applied to balance baseline characteristics. The primary outcome covered hospital-treated fall-related injuries while the secondary outcome was fall-related fractures specifically. RESULTS:No statistically significant differences were observed in the risk of fall-related injuries or fall-related fractures for timolol vs. TPA users at 14, 90 or 365 days of follow-up, before or after propensity score matching. Predefined subgroup analyses showed an increased risk of fall-related injuries among individuals aged ≥80 years [incidence rate ratio (IRR) 1.23, 95% CI 1.01-1.50] and among users of ≥3 FRIDs (IRR 1.20, 95% CI 1.01-1.44). CONCLUSION:Our findings suggest that timolol eye drops are not associated with a significantly increased risk of fall-related injuries in the overall population of older adults. However, a marginally significant increased risk of fall-related injuries was seen among the oldest individuals and those concurrently using multiple FRIDs. These findings underscore the importance of considering a patient-centred approach when prescribing medications that could be potentially harmful.

Acute hospitalization is a critical stressor that often leads to functional decline in older patients, highlighting the need for simple markers to identify at-risk individuals. Ultrasound is a feasible bedside tool for muscle mass assessment and has been proposed as a marker of physical function, but its prognostic value remains unclear. This study aimed to explore the association between ultrasound-derived muscle thickness (US-MT) and physical performance over time—gait speed (GS) and 30-s sit-to-stand (30s STS)—and selected clinical outcomes. In this prospective cohort study conducted in a geriatric department, adults aged ≥ 65 years with admission-related walking limitations were assessed at admission, discharge, 1 month, and 3 months. US-MT of the vastus lateralis was assessed at admission using ultrasonography. Longitudinal associations between US-MT and GS and 30s STS were examined using mixed-effects models. Associations with length of hospital stay (LOS), 3-month falls incidence, and 3-month mortality were examined using regression models. Among 243 participants, GS and 30s STS increased from admission to follow-up. Greater admission US-MT was modestly associated with faster GS in women (0.037 m/s; 95

Fragility fractures constitute a major global health burden and often result from falls. However, clinical care for fragility fractures is currently organized separately from fall prevention services leading to gaps in integrated care delivery. This joint position paper from the European Geriatric Medicine Society, the Fragility Fracture Network, the World Falls Prevention Society, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, the International Osteoporosis Foundation, the European Union of Medical Specialists-Geriatric Medicine Section, and the International Association of Gerontology and Geriatrics–European Region highlights the critical need for integrated falls and fracture prevention, with a focus on evidence-based clinical practice, knowledge dissemination, education, policy strategies, and research. We outline existing guidelines on fall and fracture prevention, with particular emphasis on how fracture risk assessment can be incorporated into fall prevention services and on integrating fall assessment into fracture prevention services. We advocate that future implementation guidelines place greater emphasis on fully integrated models of care. Moreover, training and education programs should be designed to encourage interdisciplinary collaboration among healthcare professionals. Integrated fall and fracture prevention services should be recognized as a public health priority and incorporated into national strategies for healthy aging, supported by adequate, dedicated, and sustainable resources including evidence-based exercise provision. Finally, future research should focus on evaluating the (cost) effectiveness of integrated care models and examining their practical implementation in real-world settings.

PURPOSE:To assess the 1-year risk of fall-related injuries among new users of opioids in Denmark. METHODS:Using Danish health registers, we identified all new adult users of opioids between 2010 and 2022 (first time use within 5 years). We performed logistic regression and applied marginal comparisons to estimate risk ratios (RRs) associating baseline risk factors to any fall-related injury and fall-related fractures specifically. Patients were followed after opioid initiation until fall-related injury, death, leaving the country, or 1-year follow-up, whichever occurred first. RESULTS:We identified 1 638 358 unique new users of opioids (54% women; median age 58 years). The 1-year risk of fall-related injuries and fall-related fractures was 8.6% and 3.6%, respectively. The risk of fall-related injuries was highest during the first weeks following opioid initiation. Increasing age, depression, Parkinson's disease, osteoporosis, and prior fall-related injuries were all associated with new fall-related injuries in the multivariable analysis. Prior fall-related injuries was a predictor of new fall-related injuries (RR 2.15; 95% CI: 2.12-2.18) and fall-related fractures (RR 1.35; 95% CI: 1.31-1.40). Prior fall-related fractures was a predictor of new fall-related injuries (RR 1.96; 95% CI: 1.93-1.99) and fall-related fractures (RR 6.47; 95% CI: 6.29-6.65). CONCLUSION:The 1-year risk for any fall-related injuries and fractures was 8.6% and 3.6%, respectively, and highest in the first weeks following opioid initiation. Several important risk factors associated with new fall-related injuries were identified. Physicians should be aware of patient characteristics related to fall risk when prescribing opioids.

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.

To explore the association between specific classes of fall-risk-increasing drugs and both one-time (1 fall) and recurrent (≥ 2) falls in community-dwelling adults aged 75 and older, utilizing prospective fall ascertainment and adjusting for relevant confounders. Benzodiazepine-related drugs, strong anticholinergics, and antiepileptics were each significantly associated with recurrent falls when adjusting for clinical and sociodemographic factors in this cohort of well-functioning community-dwelling older adults. Fall-risk-increasing drugs are an important modifiable risk factor for recurrent falls among older adults, and identifying individuals at risk is essential when conducting medication reviews or prescribing for this patient group. Fall-risk-increasing drugs (FRIDs) are a significant and modifiable risk factor for falls in older adults. However, prospective data using robust fall ascertainment on specific FRID classes are scarce in community-dwelling populations. We aimed to investigate the association between individual FRID classes and both single and recurrent falls in older community-dwelling adults. We analysed data from a Danish prospective cohort of 241 community-dwelling adults aged ≥ 75 years. Medication records were collected at baseline, and drugs were classified using the STOPPFall consensus FRIDs list. Falls were recorded prospectively for 1 year using monthly fall-calendars, verified using telephone follow-ups. Associations between FRIDs and one-time (1 fall) and recurrent falls (≥ 2 falls) were explored using Cox proportional hazards model, adjusting for clinical and sociodemographic factors. The median (IQR) age was 82 (80, 86) years, 66.4

Deprescribing is often challenged by differing attitudes of patients, relatives, and healthcare professionals. Such attitudes are summarised in this review. Patients may hold conflicting views, relatives influence decisions, and healthcare professionals face barriers such as a lack of guidance, uncertainty about benefits and harm, and resource constraints. Increasing awareness of these perspectives and integrating structured tools, clear guidance, and patient involvement in the deprescribing process can support shared decision-making and improve clinical practice and patient outcomes.

PURPOSE:To explore the challenges and opportunities for the implementation of falls preventive services across Europe. METHODS:An online cross-sectional survey among healthcare professionals was initiated by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Falls and Fractures containing a Likert scale and multiple-choice questions on education and knowledge, current practices, barriers, and facilitators for falls prevention. Survey participation for healthcare professionals was encouraged by the EuGMS through an email invitation, website banner, and social media. National representatives from 24 countries further promoted it via societies, local networks, and hospital channels. RESULTS:A total of 1669 multidisciplinary healthcare professionals participated from 34 European countries (median 47 years; 75% female; 40.6% physicians (73.3% geriatricians/trainees), 36% physiotherapists, 23.4% other healthcare professionals). Only 26.9% believed their undergraduate education adequately prepared them for clinical practice in this area. A total of 75.8% of respondents reported opportunistically screening older adults for fall risk often or always during consultations. Gait and balance assessment was considered the most important and was the most frequently performed component of the multifactorial fall risk assessment. The top-five barriers were staffing issues, lack of time, older adults' non-adherence to recommended strategies, workload related to falls prevention, and prioritizing other tasks. The top-five facilitators were more time, easy-to-use guidelines, sufficient resources, increased education and training on falls prevention, and increased collaboration. We observed regional and country-level variation in these top barriers and facilitators. CONCLUSION:This survey highlights the need for improved undergraduate education in falls prevention across Europe. It is essential to educate and engage governmental bodies and insurers to secure their support and prioritization of falls prevention initiatives. Furthermore, enhancing education, addressing older adults' nonadherence, interdisciplinary collaboration and providing easy-to-use guidelines seem crucial for effective implementation. The falls prevention strategy should be tailored to the local context.

Care home residents represent a frail population with limited life expectancy and are often prescribed multiple medications. As therapeutic goals shift in this population, certain treatments may become inappropriate. This study aims to describe potentially inappropriate medication use among Danish care home residents using the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) in a nationwide cohort of all Danish care home residents admitted 2015-2023, focusing on the time around admission and the last year of life. The cohort comprised 129 635 residents (61% women, median age 84 years). Around admission, 88% used at least one STOPPFrail medication, most commonly antihypertensives (58% before, 55% after), lipid-lowering therapies (31%, 27%) and proton-pump inhibitors (30%, 30%). The rate of new use increased from 2.6/100 residents/month 2 years before admission, peaking at 9.6/100 residents/month 2 months prior. Hospital physician prescribing increased as care home admission approached, after which general practitioners prescribed most prescriptions. Over 90% used at least one STOPPFrail medication during the last year of life, with increases in proton-pump inhibitors and antipsychotics, the latter most frequently initiated in the last 4 months. These findings underscore the importance of regular assessment and targeted efforts to improve prescribing appropriateness.

The World guidelines for falls prevention and management for older adults (WFG), from 2022, represent a global initiative to address the rising incidence of falls and related injury. WFG provides evidence-based recommendations across various settings, including community, hospital, and care home environments. A recent report highlighted a large variation in the implementation progress of the WFG across Europe. However, to date, a comprehensive global overview of the WFG implementation status has not been undertaken. To address this gap, we reached out to experts who took part in WFG to inquire about the implementation status of WFG in their countries. The responses from experts from 18 countries (one from Africa, six from Asia, one from Europe, three from North America, one from Oceania and six from South America) revealed that efforts to implement the WFG are underway in many of them, with differing degrees of progress varying from advanced integration into guidelines/policies to no/minimal actions. While the global implementation status of WFG is encouraging, significant barriers remain, including limited resources, competing health priorities, and cultural differences in care models. Adapting the WFG to diverse healthcare systems and integrating falls prevention into national policies and health priorities is essential to enable effective implementation. Furthermore, strengthening global collaboration, sharing best practices, prioritisation of the most effective and feasible falls prevention components in low resource settings, and advocating for falls prevention as a public health priority will help accelerate progress across the world for the benefit of older patients at risk of falling.

BACKGROUND:In older adults with ischemic heart disease, frailty status may better reflect biological than chronological age. The objective was to investigate the association between self-reported frailty status at discharge and a composite endpoint of 1-year mortality or all-cause readmission after percutaneous coronary intervention (PCI). METHODS:A multi-centre prospective cohort study of patients undergoing PCI. Self-reported frailty status was assessed using the Study of Osteoporotic Fractures (SOF) Frailty Index ("robust", "prefrail", and "frail"). The association between frailty status and the composite endpoint was investigated using Cox regression analysis in adjusted models (Model 1 sociodemographic, Model 2 + clinical variables), reported as hazard ratios (HR) and 95 % confidence intervals (CI). RESULTS:In total, 2831 patients (median age 66 years IQR 57-73, 21 % women) reported their frailty status post-PCI: 18 % were frail, 33 % prefrail, and 48 % robust. Among frail patients, a higher proportion (45 %) experienced the composite endpoint during the 1-year follow-up (vs robust 33 % and prefrail 35 %). Frailty status was not significantly associated with the composite endpoint. Post-hoc exploratory analyses showed that the SOF question about unintended weight loss was significantly associated with the composite endpoint among frail patients (adjHR 1.19 95 % CI 1.02-1.38 Model 1, adjHR 1.20 95 % CI 1.03-1.40 Model 2), driven by readmissions. Chair rise was associated with reduced mortality (Model 2 HR 0.32 95 % CI 0.11-0.92). CONCLUSION:Frailty status was not associated with the composite endpoint of 1-year mortality or readmission. However, unintended weight loss might be an important prognostic indicator for readmission and chair rise for mortality.