Alcohol-related hospital admissions are rising in England, particularly among individuals aged 65 and over. While alcohol intake and nutritional status are important factors in health outcomes, they are often overlooked. Loneliness, also common in this age group, is associated with poorer health and increased mortality. (1) To explore the clinical and sociodemographic characteristics, and nutritional status of older adults with alcohol use disorder (AUD) admitted to hospital. (2) Explore participants’ experiences of alcohol use in later life, perceptions of health and wellbeing, social relationships, and views on support following hospital admission. Participants were recruited from a UK tertiary teaching hospital and identified as drinking at increased risk using routine AUDIT-C alcohol screening. Measures including 6CIT (Six-item Cognitive Impairment Test), Depression and anxiety (HADS), 24-hour Dietary Recall, Social network composition, De Jong Loneliness Scale, and Meaning in life questionnaire were measured at baseline and 6 months. Qualitative telephone interviews were conducted at 6 months (n = 7). Qualitative data were analysed using reflexive thematic analysis. Thirty older adults (mean age 71) were recruited. Over half (53

INTRODUCTION:37%-48% of older patients receive anticholinergic medicines, increasing the risk for falls, delirium, dementia and death. Hospital admission may provide an opportunity for deprescribing to improve outcomes. This study evaluated the feasibility and acceptability of a digital tool to identify anticholinergic medicines and support deprescribing. METHODS:A pre-post feasibility study was conducted (May-September 2025). Patients aged ≥ 75 with an ACB score of ≥ 3, screened using a digital tool, were recruited. The identified medications were highlighted to the clinical team to prompt a medication review (stop, reduce or switch). Primary outcomes were recruitment and retention. Secondary outcomes included medication and patients' outcomes, healthcare use and acceptability from qualitative interviews. RESULTS:Recruitment was challenging; 65 out of 301 patients with ACB ≥ 3 (22%) were eligible, 21 participated, of which 15 (80%) completed follow-up. Mean age was 84.7 years, and intervention costs were £9.33 per patient. Interviews indicated technical and organisational challenges. Mean ACB scores were 3.85 (admission), 3.45 (discharge), 3.0 (1 month) and 3.44 (3 months), with slight changes in cognition and delirium but no changes in depressive symptoms or quality of life. CONCLUSIONS:Although acceptable, recruitment and technical challenges limited feasibility. Findings should be interpreted cautiously due to the small sample size, and further refinement is needed before implementation.

Polypharmacy (concomitant prescription of ≥ 5 medications) affects a third of older people, and evidence suggests an association with sarcopenia (loss of skeletal muscle mass/quality, muscle strength, and/or physical performance). As such, deprescribing has been recommended in routine management of sarcopenia, however it’s unknown whether deprescribing is beneficial. This systematic review aimed to understand effects of deprescribing on sarcopenia parameters in older adults. Medline, Embase, CINAHL, Web of Science, and the Cochrane Library databases were searched up to July 2023. All studies reporting effects of deprescribing interventions on sarcopenia parameters (primary outcomes) or nutritional intake (secondary outcomes) among older adults were included. Findings were summarised narratively, and study quality was assessed. A total of 4860 articles were identified and six were included (mean age range 67–87 years). Studies were heterogeneous in design, settings, follow-up periods, and outcomes. Deprescribing had no effect on skeletal muscle mass (n = 2). Positive effects were shown on handgrip strength with two studies reporting improvements following antihypertensive or benzodiazepines discontinuation and one showing no change between admission and discharge with general deprescribing. Outcomes of deprescribing on physical function outcomes varied based on the measures used. For example, one study showed no changes in timed up and go, Whereas effects on gait speed was contradictory in two studies, with preservation and deterioration reported. Two studies reported improvement between baseline and follow up in balance scores measured part of the Short physical performance battery or using the Short Berg’s Balance Scale among those who discontinued antihypertensive and/or benzodiazepines. Two studies reported improvements in nutritional outcomes following deprescribing at hospital discharge, whereas two other studies reported no change or increase in weight loss. There is limited research about the impact of deprescribing on sarcopenia parameters. This systematic review found no significant changes in muscle mass but there is some evidence in improvements in strength, physical performance, and nutritional status with deprescribing. The multidisciplinary implementation of nutrition and exercise therapies, as well as medication management to modify polypharmacy, may further promote improvement in sarcopenia. However, more high-quality research is needed to understand the effects of deprescribing on sarcopenia parameters among older people including those with confirmed diagnosis of sarcopenia. The review was registered on the international prospective register of systematic reviews (PROSPERO, CRD42023417997).

Background:Physical activity (PA) in older adults can prevent, treat, or offset symptoms and deterioration from various health conditions and help maintain independence. However, most older adults are insufficiently active. Digital interventions have the potential for high reach at low cost. Objective:This paper reports on the implementation of "Active Lives," a digital intervention developed specifically for older adults. Methods:This study had a qualitative design. The implementation team approached a range of National Health Service, public health, community, and third-sector organizations in the United Kingdom to offer Active Lives to as large and diverse groups of older adults as possible. Alongside real-world implementation activities, research was conducted to explore what supports and inhibits the implementation of a digital intervention for PA in older adults. Data collection involved interviews with implementation partners (n=15) and the implementation team (n=3) plus extensive field notes from stakeholder communications. Inductive thematic analysis was used to analyze the data. Results:Five broad themes were developed, capturing implementation barriers and facilitators. These were (1) complex and opaque networks and influencers, (2) forming an understanding of Active Lives and its fit, (3) a landscape of competition and conflicting interests, (4) navigating unclear approval processes, and (5) shifting strategies: small and effortful to high reach and passive. Identifying key decision makers proved arduous, consuming significant time and resources, and proposals from enthusiastic implementation partners often proved impractical or overly burdensome. Health care professionals demonstrated a comprehensive understanding of the potential benefits of digital interventions in alleviating operational burdens and improving patient care. However, stakeholders from disparate sectors held reservations about digital intervention and had different views on the best approaches to supporting PA among older adults. This discord was exacerbated by conflicts with existing local initiatives, such as group exercise programs, which occasionally hindered the implementation of Active Lives. Furthermore, bureaucratic hurdles within National Health Service trust approval processes acted as formidable obstacles, dampening progress and resolve, highlighting the need for guidance in identifying sustainable and scalable practices. Conclusions:The findings highlight important implementation challenges to digital PA interventions for older adults such as bureaucratic barriers and alignment with ongoing initiatives. This research emphasizes the necessity for strategic direction and multilevel guidance to efficiently implement digital interventions for PA among community-dwelling older adults.

Abstract Introduction Poor appetite affects 15–20% of community dwelling older adults. Studies link poor appetite with frailty and sarcopenia; however, lack of longitudinal evidence exists to inform potential causality. We aimed to determine if poor appetite predicts frailty or sarcopenia-related factors in community dwelling older adults. Methods Secondary data analysis on adults aged >60 years recruited from, syncope, fragility fracture and comprehensive geriatric assessment clinics with 2.5 year follow up. Appetite was assessed by Simplified Nutritional Appetite Questionnaire (SNAQ); a score of <14/20 defining poor appetite. Hand grip strength (HGS) was measured using a dynamometer, low HGS was defined by European criteria (<27 kg for males and < 16 kg for females). Frailty was measured using self-report of Fried phenotype. Results 86 participants, mean age of 78 years, 62% female. Sixty-two (72%) were followed up, of those 9 had died. Baseline mean SNAQ score was 15.2 (SD 8.1); 14 (16.3%) scored <14. Mean SNAQ score for the 53 participants at 2.5 year follow up was 14.9, 12 (14%) scored <14. Baseline and follow up SNAQ scores correlated moderately (Pearson’s r = 0.5; P = <.001). Fifteen (28%) individuals had low HGS at follow up, 12 had frailty (22%). Baseline SNAQ score < 14 was associated with increased odds of frailty (OR 18.00; 95% CI 2.92–111.00) and low HGS (OR 7.76; 95% CI 1.62–37.30) after 2.5 years. The association of baseline SNAQ <14 with presence of frailty was robust to adjustment for age and comorbidities (OR 13.50; 95% CI 1.14–160.03), while association with low HGS was attenuated (OR 2.29; 95% CI 0.27–19.39). Conclusion Poor appetite is predictive of presence of frailty and low HGS after 2.5 years in community dwelling older adults. This suggests poor appetite as causative in the development of poor health outcomes in older people and so a key intervention target to optimise healthy ageing.

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

BACKGROUND:Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years. METHODS:We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503). RESULTS:We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location. DISCUSSION:To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

Dehydration during hospital stays is a significant concern, particularly affecting older adults (1) . The ageing process associated with pathological changes and conditions such as dementia makes older adults especially vulnerable to both chronic and acute dehydration (1,2) . Recent studies indicate that conventional signs and symptoms of low-intake dehydration may not consistently indicate its presence in older inpatients, leading to missed or incorrect assessments. It can result in significant morbidity through falls, constipation, delirium, respiratory and urinary tract disorders, and even death (2,3) . Diagnosing low-intake dehydration at the early stage is challenging, leading to treatment delays which further compound the negative consequences of dehydration (1,3) . There is a need to determine the scope and practice of detecting and managing low-intake dehydration in ‘Medicine for Older People’ (MOP) wards at University Hospital Southampton (UHS). The primary aim of this study was to explore the current practices and challenges in detecting and managing low-intake dehydration in older inpatients within the MOP wards at UHS. Using a sequential, explanatory mixed-method design, a prospective chart review study (phase 1) was conducted at all the MOP wards at UHS over one month. The study included 50 adults aged 65 and above admitted to the medical wards for various reasons and now deemed ‘Medically Optimised for Discharge’ (MOFD). The quantitative aspect involved reviewing the completion of a local hydration assessment tool and the proper documentation of hydration and fluid balance charts for at-risk patients. The qualitative component (phase 2) consisted of semi-structured interviews with 10 participants—four doctors and six nurses with years of experience ranging from 4 to 12 years—to understand the perceptions of hospital staff on hydration care, its barriers and facilitators. The quantitative phase found that all patients were at risk for dehydration and underwent assessment through the hydration risk assessment, with hydration chart reviews during early, late, and night shifts. 20% did not have hydration assessment within 24h of admission and there were some missing reviews during various shifts. Most 24-hour fluid balance sheets were not completed for patients in the red category (start 24-hour fluid balance chart). Qualitative findings revealed that staff had ‘(1) experiential knowledge of hydration understanding the risks of dehydration in older adults’, ‘(2) difficulty in dehydration assessment and diagnosis due to resources’ and ‘(3) challenges related to staff levels and skills’ as well as (4) patient attributes contributing to difficulty in dehydration assessment. The mixed-methods study underscores the importance of addressing low-intake dehydration in older inpatients on MOP wards and highlights gaps in current practices. The findings emphasise the need for improved training, awareness, and standardised protocols to prioritise hydration care among healthcare professionals and provide optimal hydration care for older inpatients.

BACKGROUND:Despite the advantages of physical activity (PA), older adults are often insufficiently active to maximise health. Understanding factors that influence PA engagement will support well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adults' engagement in PA. METHODS:We searched six electronic databases for studies of community-dwelling older adults (≥70 years) including qualitative methods. We excluded studies of a single-disease group, individuals with cognitive impairment and care home residents. Methodological rigour was assessed with the Critical Appraisal Skills Programme, and framework synthesis was applied using the Capability Opportunity Motivation-Behaviour (COM-B) model, which hypothesises that behaviour is influenced by three factors: capability, opportunity and motivation. RESULTS:Twenty-five studies were included in the review (N = 4,978; mean 79 years) and 32 themes were identified. Older adults' capability was influenced by functional capacity (e.g. strength) and perceived risk of injury from PA (e.g. falls). Opportunity was impacted by the environment 'fit' (e.g. neighbourhood safety), the availability of social interaction and socio-cultural ageing stereotypes. PA was motivated by identifying as an 'exerciser', health gains and experiencing positive emotions (e.g. enjoyment), whereas negative sensations (e.g. pain) reduced motivation. CONCLUSIONS:The qualitative synthesis showcased a complex web of interacting factors influencing PA between the sub-domains of COM-B, pinpointing directions for intervention, including a focus on whole systems approaches. There was a lack of research exploring PA influences in the oldest old and in low-income countries. Future research should seek to involve under-served groups, including a wider diversity of older people.

Background Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs. Methods This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months. Results Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37–67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable. Conclusions Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff. Trials registration NCT04672200.

Abstract Introduction The health benefits of physical activity for older people are well recognised and include reduction in falls, improvement in frailty status and physical function. Nonetheless, physical inactivity remains a significant problem among older adults. This study aimed to determine the feasibility and acceptability of implementing online volunteer-led group exercise for community-dwelling older adults. Methods This pre-post mixed methods study was conducted among older adults attending community social clubs. Eligible participants were aged ≥ 65 years, able to walk independently, and able to provide written consent. The intervention consisted of a once weekly volunteer-led online group chair-based exercise. The primary outcomes were the feasibility and acceptability of the intervention. Secondary outcomes included physical activity levels measured using the Community Health Model Activities Program for Seniors (CHAMPS) questionnaire, functional status (Barthel Index), and health-related quality of life (EQ-5D-5L). Outcomes were measured at baseline and at 6 months. Trials registration: NCT04672200. Results Nineteen volunteers were recruited, 15 completed training and 9 were retained (mean age 68 years, 7 female). Thirty participants (mean age 77 years, 27 female) received the intervention and attended 54% (IQR 37-67) of exercise sessions. One minor adverse event was reported. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels. The intervention was acceptable to volunteers, participants, and staff. The seated exercises were perceived as safe, manageable and enjoyable. Volunteers were relatable role models providing positive vicarious experiences that improved participants confidence to exercise within a friendly, non-judgmental environment. Technological issues, or reluctance to learn how to use technology were barriers to the intervention. The social interactions and sense of belonging motivated participation. Conclusions Trained volunteers can safely deliver online group exercise for community-dwelling older adults and the intervention was feasible and acceptable to older adults, volunteers and club staff.

Introduction Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. In response to the COVID-19 pandemic, healthcare has increasingly turned to virtual modes of delivery and there is interest in the use of trained volunteers to deliver PA and nutrition interventions. We aim to evaluate the feasibility and acceptability of training hospital volunteers to deliver an online intervention, comprising exercise, behaviour change and nutrition support, to older people with frailty after discharge from hospital. Methods We will use a quasi-experimental mixed methods approach. Hospital volunteers (n=6) will be trained to deliver an online, 3-month, multimodal intervention to frail (Clinical Frailty Scale ≥5) adults ≥65 years (n=30) after discharge from hospital. Feasibility will be assessed by determining the number of volunteers recruited, trained and retained at the end of the study; the proportion of intervention sessions delivered; participant recruitment, retention and adherence to the intervention. To determine the acceptability of the intervention, interviews will be conducted among a purposive sample of older adults, and volunteers. Secondary outcomes will include physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy for managing chronic disease and PA. Outcomes will be measured at baseline, 3 months and 6 months. Analysis Descriptive statistics will be used to describe feasibility and adherence to the intervention. Secondary outcomes at baseline will be compared at 3 and 6 months. Interviews will be transcribed verbatim and analysed using thematic analysis. Ethics and dissemination Health Research Authority ethical approval was obtained on 30 May 2022 (reference: 22/WA/0155). Results will be disseminated through peer-reviewed journal articles, volunteer organisations, National Health Service communication systems and social media platforms. A toolkit will be developed to facilitate roll out of volunteer training. Trial registration number NCT05384730 .

The aim of the study was to determine the effectiveness of art therapy as prevention and therapeutical approach in geriatric patients with high risk for delirium. The study was not able to prove the hypothesis that a specific art therapy intervention was able to prevent delirium in patients of an acute geriatric ward, but it seemed to have a positive effect on the duration of delirium. No adverse events were registered in relation to art therapy. Art therapy might be an innovative additional non-pharmacological approach in the management of delirium. Delirium is common among older hospitalized patients and is regarded as a negative outcome parameter. Non-pharmacological strategies have been shown to be effective in the prevention and management of delirium. This study aimed to determine the effectiveness of art therapy as part of a multicomponent intervention in preventing and managing delirium in hospitalized older patients. 138 patients at risk of developing delirium were included and received art therapy twice daily for 25 min using a mobile atelier. 107 participants were included in the final analysis (N = 53 intervention, N = 54 control). The primary outcome was the effectiveness of art therapy in preventing delirium. The secondary outcome was to determine its impact on duration of delirium in patients with existing delirium. Delirium was assessed using the Nursing delirium Screening Scale (Nu-DESC). 8 patients (7.5

BACKGROUND:Dehydration is a frequent cause of excess morbidity and poor health outcomes, particularly in older adults who have an increased risk of fluid loss due to renal senescence, comorbidities, and polypharmacy. Detecting dehydration is key to instigating treatment to resolve the problem and prevent further adverse consequences; however, current approaches to diagnosis are unreliable and, as a result, under-detection remains a widespread problem. This systematic review sought to explore the value of bioelectrical impedance in detecting low-intake dehydration among older adults admitted to acute care settings.METHODS:A literature search using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane Library was undertaken from inception till May 2022 and led to the eventual evaluation of four studies. Risk of bias was assessed using the Cochrane tool for observational studies; three studies had a high risk of bias, and one had a low risk. Data were extracted using systematic proofs. Due to insufficient reporting, the data were analysed using narrative synthesis.RESULTS:One study showed that the sensitivity and specificity of bioelectrical impedance in detecting low-intake dehydration varied considerably depending on the total body water percentage threshold used to ascertain dehydration status. Other included studies supported the technique's utility when compared to conventional measures of hydration status.CONCLUSIONS:Given the scarcity of literature and inconsistency between findings, it is not possible to ascertain the value of bioelectrical impedance for detecting low-intake dehydration in older inpatients.

Introduction Physical activity is important for healthy ageing. Despite strong evidence on the benefits of physical activity for health and well-being, physical inactivity remains a significant problem among older adults. This study aims to determine the feasibility and acceptability of implementing an online volunteer-led group exercise for older adults. Methods A quasi-experimental mixed-methods approach will be used in this study. A training programme will be developed to train volunteers to deliver online group exercises to older adults aged >65 years (n=30). The primary outcome is the feasibility of implementing the intervention. This will be assessed by the number of volunteers recruited, trained, and retained at the end of the study, and the number of exercise sessions delivered and completed by participants. Secondary outcomes include physical activity levels measured using the Community Health Model Activities Programme for Seniors questionnaire, Barthel Index, EQ-5D-5L as a measure of health-related quality of life, SARC-F to determine sarcopenia status, and PRIMSA-7 to determine frailty status. Outcomes will be measured at baseline and at 6 months. Qualitative interviews will be conducted with volunteers(n=5), older adults (n=10) and family members (n=5) to explore their views on the intervention. Analysis Simple descriptive statistics will be used to describe participant characteristics, the feasibility of the study and the impact of the intervention on health outcomes. Parametric(t-test) or non-parametric(Mann-Whitney U test) statistics will be used to analyse continuous variables. χ2 test will be used for categorical variables. Qualitative data will be analysed using an inductive thematic analysis approach. Ethics and dissemination This study received ethical approval from the University of Southampton Faculty of Medicine Ethics Committee and Research Integrity and Governance committee (ID: 52 967 .A1). Study findings will be made available to service users, voluntary organisations and other researchers who may be interested in implementing the intervention. Trial registration number NCT04672200.

INTRODUCTION:Meaningful ageing research across the UK is dependent on a network of engaged geriatricians. The research in geriatric specialty training (RGST) survey aimed to establish current research opportunities available to geriatric medicine specialty trainees in the UK.METHODS:The RGST survey was disseminated to UK higher specialist trainees in geriatric medicine in 2019 via the Geriatric Medicine Research Collaborative network.RESULTS:Among the 36.9% (192/521) of respondents, 44% (83/188) reported previous research involvement and 7% (n=8) held a PhD or MD. Of the respondents with no research experience to date, 59.0% (n=49) reported a desire to undertake a period of research. One-third (31%) of geriatric registrars surveyed felt that they had gained sufficient research experience during their training. Perceived encouragement and support to undertake research was low (30.7%). Enablers and barriers to research engagement were identified.CONCLUSION:Research opportunity and engagement in geriatric medicine training is lacking. This could jeopardise the future workforce of research-active geriatricians in the UK and limit patient access to emerging research and innovation. Interventions to promote research engagement among geriatric medicine trainees are needed to facilitate integration of research into routine clinical practice to improve the health and care of older people.