Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex. Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1–2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0–4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression. Of 382 examined patients, 256 (mean age 84 ± 7 years, 70

Objectives Hypertension remains poorly controlled globally, highlighting the need for scalable community-based strategies. Although community health worker (CHW)-facilitated interventions show promise, implementation evidence from low- and middle-income countries remains limited. This study assessed the implementation processes, mechanisms of impact and contextual factors influencing a CHW-facilitated home visit intervention for hypertension management.Design Mixed-methods process evaluation nested within a randomised cluster trial.Setting An urban municipality in Nepal.Participants Individuals with hypertension were surveyed at baseline (n=1252) and follow-up (n=1098). CHWs completed routine monitoring forms and home visits were observed (n=47). In-depth interviews were conducted with individuals with hypertension (n=20), spouses (n=7), adult children (n=13), CHWs (n=8) and public primary healthcare providers (n=5).Results Overall, 86% of participants completed all six planned home visits. Visits were generally delivered with fidelity, with minor adaptations to fit participant and family contexts. Participants reported high satisfaction and perceived benefits, including improved knowledge, family support and uptake of self-blood pressure monitoring. However, developed behavioural action plans often lacked specificity, limiting progress follow-up and accountability. Weak public primary care capacity, medication stockouts and preference for higher-level or private facilities constrained care linkage.Conclusion CHW-facilitated home visits addressed key individual and family-level barriers to hypertension management, but impact was limited by uneven behaviour uptake and constrained public primary healthcare capacity for medication supply and titration. Strengthened CHW training and mentorship are needed to support effective behaviour change. Integration of community interventions with functional primary care systems is essential for sustained hypertension control in low-resource urban settings.Trial Registration number NCT05292469; date of registration: 22 March 2022; URL: https://clinicaltrials.gov/ct2/show/NCT05292469?cntry=NP&draw=2&rank=6.

BACKGROUND:Polypharmacy in older adults is associated with inappropriate prescribing and adverse drug events. In a previous trial, we demonstrated improved Health-Related Quality of Life (HRQoL) following medication reviews by geriatricians and general practitioners in home-dwelling older adults. Whether similar benefits can be achieved during acute admissions in primary care remains unclear. OBJECTIVE:To assess the effect of collaborative medication reviews during acute admissions to a Municipal Inpatient Acute Care (MIPAC) unit. METHODS:In this single-blind, parallel-group, randomised controlled trial, patients ≥70 years using ≥6 regular medications admitted to a MIPAC unit in Oslo, Norway, were randomised 1:1 to receive either a structured medication review or usual care. The intervention involved assessment by MIPAC physicians specialised in general practice, geriatric supervision and discussion with the patient's general practitioner. The primary outcome was HRQoL measured with the 15D instrument at 16 weeks. Secondary outcomes included physical and cognitive function, oral health, healthcare utilisation and mortality. RESULTS:We included 137 participants (mean age 85 years, 69% women; 67 intervention, 70 control). At 16 weeks, there was no significant difference in 15D scores between groups (mean difference 0.009; 95% CI, -0.063 to 0.079; P = .8). The intervention group had more medication changes during admission, but differences diminished post-discharge. No differences were observed in secondary outcomes. CONCLUSION:Collaborative medication reviews during acute primary care admissions did not improve HRQoL. The findings underscore the need for longitudinal, patient-centred strategies initiated in clinically stable phases.

Background A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions. Methods This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox' proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups. Findings For the total cohort (N = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2-6.7). ECOG 2-4, uncontrolled extracranial metastases, and >= 5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3-4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3-3.5]; ECOG 3-4: 2.1 [1.5-2.7]). Patients surviving <6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving >6 months reported stable scores over time. Interpretation Patients with ECOG 2-4, especially those with uncontrolled extracranial metastases and >= 5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival <6 months and specifically advise against WBRT.

BACKGROUND AND PURPOSE:Chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) results in favorable survival. However, treatment intensity must be balanced against late side effects. The aim of this current study was to prospectively investigate patient-reported outcomes (PROs) before CRT and up to 5 years after completed CRT for SCCA. Patient/material and methods: This prospective study included 120 patients with SCCA receiving CRT to total doses of 54-58 Gy with concomitant mitomycin and 5-fluorouracil. Patients completed PRO questionnaires before CRT, and at 3 months, 1-, 3-, and 5 years after completed CRT. The questionnaires were the EORTC QLQ-C30 and QLQ-CR29, St. Marks incontinence score, Fatigue Questionnaire, the Hospital Anxiety and Depression Scale, and a scoring for neuroticism. RESULTS:Patients reported a high burden of symptoms and impaired functional outcomes prior to treatment. Tumor-related symptoms, such as buttock pain, improved (difference 11.1, p = 0.002) at a clinically relevant level 3 months after CRT, consistent with tumor response. Other functional outcomes and symptoms, such as body image (difference 11.5, p < 0.001), worsened. While some outcomes, such as anxiety (difference 10.4, p = 0.001), improved over time, several were persistently impaired, in particular anorectal and sexual function, where symptom burden remained high 5 years after CRT. Chronic fatigue (CF) was reported by 28% of patients at 5-year follow-up. INTERPRETATION:Five years after CRT for SCCA, patients report a persistently high symptom burden regarding anorectal and sexual function, and one-third report CF, demonstrating the long-term impact of treatment.

Introduction: Radiotherapy (RT) is a frequently offered treatment option for brain metastases (BMs) in patients with non-small-cell lung cancer (NSCLC). This study presents patient-reported outcomes (PROs) in a cohort of NSCLC with BMs treated with RT. This study researched how PRO scores at the start of RT may be useful in survival estimates and how PROs change over time after RT. Methods: NSCLC patients with first-time BMs treated with RT were identified in a prospective observational study. PROs were collected at the start of RT and monthly for up to 1 year. Differences in PRO mean scores at the start of RT (M0) and at month 2 (M2) after treatment are reported. Prognostic values of PROs were analyzed in a stepwise adjusted Cox model. Results: Of 294 patients identified, 239 (81%) responded at M0; 105/239 (44%) responded at both M0 and M2. High scores for weakness of legs at M0 were associated with short survival when adjusting for performance status and status of extracranial metastases. Those responding at M0 only had worse mean scores for overall QoL and PF but similar scores for fatigue and dyspnea compared to patients responding over time. At M2, patients with <6 months survival after RT reported worse scores for overall QoL, PF, fatigue, and dyspnea; long-term survivors reported stable scores. Conclusions: NSCLC patients diagnosed with BMs and expected survival < 6 months should be offered optimal palliative care rather than RT.

Background:Cognition and frailty are sparsely studied in patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to describe the preoperative cognitive function compared with normative data and frailty profile in iNPH patients accepted for shunt surgery. Methods:All patients were diagnosed according to international guidelines and underwent a standardized cognitive and physical examination and a geriatric assessment prior to surgery. Z-scores for the cognitive tests were calculated based on age and education adjusted population norms. Results:The study cohort included 276 iNPH patients accepted for shunt surgery. Mean ± SD age was 73.1 ± 5.7 years, education 12.5 ± 3.8 years, and 61% were male. The median (IQR) score on the Mini-Mental State Evaluation was 27 (24-29), and the median (IQR) Clock Drawing test score was 4 (3-5). Mean (SD) z-score for immediate verbal recall was -1.74 (0.98), for delayed recall -1.66 (1.01), for figure copying -0.85 (1.35) for Trail Making Test A -1.50 (1.09), for Trail Making Test B -1.88 (1.03), for phonemic fluency -1.46 (1.10), and for semantic fluency -1.59 (1.20). Cluster analysis identified three groups, mainly differing regarding visuospatial function. The mean (SD) Frailty Index score was 0.23 (0.13), indicating mild frailty. The frailty domain most affected was physical function. Conclusion:iNPH patients showed reduced cognitive function across all domains. The patient group is rather heterogeneous regarding cognitive symptoms, and no specific cognitive profile was identified. Cognitive assessment offers limited utility for diagnosing a typical pattern specific for iNPH but is important due to the complex needs for this patient group. Whether cognitive and frailty profile can be used to identify shunt responders, must be assessed in longitudinal studies.

Domestic violence and food insecurity are significant global health challenges, particularly during pregnancy, when both can adversely affect maternal and child health. Food insecurity may occur independently or as a consequence of domestic violence, yet their relationship remains underexplored. This study aims to investigate the association between exposure to domestic violence perpetrated by intimate partners or by family members and food insecurity during pregnancy. This cross-sectional study used baseline data from 2129 pregnant women attending routine antenatal care as part of an ongoing randomized controlled trial. Inclusion criteria were age ≥ 18 years, gestational age between 12 and 22 weeks, and consent to participate. Colour-Coded Audio Computer-Assisted Self-Interview method was administered via a computer tablet for data collection. Domestic violence was assessed using the Nepalese Abuse Assessment Screen and food insecurity using a modified Household Food Insecurity Access Scale. Of the participants, 12.9

AIMS:Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals. METHODS AND RESULTS:Using Norwegian national registries (2011-18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18-44 years (8%) and 45-54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively. CONCLUSION:New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.

[This corrects the article DOI: 10.3389/fneur.2025.1644507.].

Objectives Important risk factors for mortality include frailty and illness severity. The National Early Warning Score 2 (NEWS2) is widely used to assess acute illness severity and mortality risk, but age and frailty's impact on the association between NEWS2 and mortality is less understood, particularly in nonhospital settings. This study aimed to examine the associations between frailty, NEWS2, and 1-year postdischarge mortality in older adults admitted to the Oslo Municipal In-Patient Acute Care (MipAC) unit. Design Prospective observational study. Setting and Participants Patients admitted to the MipAC unit with 1-year follow-up for all-cause mortality. Methods Frailty was assessed using the Clinical Frailty Scale (CFS). The maximum registered NEWS2 during admission was obtained from patient records. Associations with 1-year mortality were analyzed using a Cox model and Kaplan-Meier survival analysis. Results Among 382 patients (mean age, 84.3 years; 72% female), 58 died during the 1-year follow-up period. Both CFS and NEWS2 were independently associated with 1-year mortality in an age-adjusted Cox proportional hazards model. The adjusted hazard ratios were 1.33 (95% CI, 1.07-1.66) per unit increase in CFS and 1.26 (95% CI, 1.14-1.39) per unit increase in NEWS2. A supplementary analysis of the vital signs contributing to NEWS2 revealed that elevated respiratory rate and hypotension were independently associated with increased 1-year mortality, with adjusted hazards ratios being 2.71 (95% CI, 1.35-5.46) and 3.05 (95% CI, 1.54-6.01), respectively. When combining CFS and NEWS2, moderately to severely frail patients (CFS ≥6) with low NEWS2 (0-4) showed a tendency toward increased mortality, whereas among those with high NEWS2 (≥5), frailty did not appear to further influence mortality risk. Conclusions and Implications CFS, NEWS2, and the vital signs elevated respiratory rate and hypotension are associated with 1-year mortality in patients admitted to a MipAC unit.

BACKGROUND:Oral health is an essential part of overall health and well-being in older adults and may be influenced by medications and frailty. This study aimed to describe the prevalence of xerostomia and hyposalivation and examine their associations with xerogenic medications and frailty in acutely ill older adults. METHODS:This cross-sectional study included patients aged ≥ 70 years admitted to the Municipal In-Patient Acute Care unit in Oslo, Norway. General xerostomia was defined as a score ≥ 3 on the General Xerostomia Question (GXQ). Specific xerostomia was measured with the Summated Xerostomia Inventory (SXI). Objective dry mouth measures included unstimulated whole saliva (UWS) secretion rate and the Clinical Oral Dryness Score (CODS), with hyposalivation defined as UWS ≤ 0.1 mL/min. Examination of dentition included numbers of missing teeth and posterior occluding pairs of teeth. Medication data included total drug burden and number of xerogenic medications. Frailty was assessed using the Clinical Frailty Scale (CFS). Associations were analyzed using logistic regression models. RESULTS:Among 382 patients (mean age 84 years, 72% women), general xerostomia was present in 30% and hyposalivation in 56%. Mean number (SD) of xerogenic medications was 3.7 (±2.2). The number of xerogenic medications used was significantly associated with general xerostomia in both unadjusted (OR: 1.17, 95% CI: 1.05-1.29) and adjusted models (OR: 1.13, 95% CI: 1.01-1.26). Median UWS declined numerically with increasing number of xerogenic medications. Higher CFS scores were associated with increased subjective xerostomia scores (GXQ and SXI), elevated CODS, more missing teeth, and reduced occlusion, but not with general xerostomia or hyposalivation when predefined cut-off values were applied. CONCLUSION:Xerostomia and hyposalivation were common among acutely ill older adults. General xerostomia was associated with xerogenic medication use and frailty. Our findings highlight the need to incorporate oral health assessments into routine geriatric care and emphasize the importance of interdisciplinary collaborations.

Background: The rate of locally recurrent rectal cancer (LRRC) in Norway has decreased due to advancements in surgical techniques and preoperative treatments. Despite this, LRRC continues to present significant morbidity and mortality challenges. This study aims to analyze survival outcomes following different treatment modalities for LRRC in Norway and assess the impact of changes in treatment strategies over time. Methods: This retrospective study utilized data from the Cancer Registry of Norway, focusing on patients with stage I-III primary rectal cancer treated between 1997 and 2016, who subsequently developed LRRC. Treatment modalities, including surgery, radiotherapy (RT), and re-irradiation (reRT), were analyzed, and the impact of various factors on overall survival (OS) was assessed. Results: Of the 13,480 patients who underwent surgery for rectal cancer, 827 (6.1%) developed LRRC. For all patients, the median survival from LRRC diagnosis was 18 months, with a 3-year OS of 29%. For patients who underwent surgical resection of LRRC, the 3-year OS was 55% for those who received pre-operative RT, 50% for those who received reRT, and 35% for those without any radiation therapy. For non-operated patients, 3-year OS rates were 22% with RT, 21% with reRT, and 15% for patients without radiation therapy. Patients diagnosed after 2006, patients with early-stage primary cancer, younger age (<75), extended recurrence interval, or well-differentiated tumors had better survival outcomes. Interpretation: This study describes the outcomes after multimodal treatment approaches for LRRC on a national level over a 20-year period. Patients who underwent surgical resection combined with RT or reRT had the best survival outcomes; however, this group represents a highly selected patient population.

Background:One in 3 patients with advanced cancer develops brain metastases. Surgical resection of brain metastases is done in 15%-20% of these patients. While gross total resection (GTR) is believed to extend overall survival (OS), concerns exist regarding increased morbidity. This study examines the impact of surgical resection, particularly GTR, on self-reported symptoms, focusing on quality of life (QoL) and motor dysfunction. Methods:We conducted a prospective cohort study involving adult patients undergoing surgical resection for brain metastases from solid tumors in a defined region of Norway between 2017 and 2021. Clinical data were collected at inclusion prior to surgery and every 3 months the first year. Patients completed monthly questionnaires assessing QoL and motor dysfunction. QoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL, while motor dysfunction was evaluated using the EORTC QLQ-BN20. Results:A total of 155 patients were included and median OS was 13 months. GTR was achieved in 69 (44%) patients and was associated with longer median OS compared to subtotal resection (17.7 vs. 10.9 months, P = .04). Mean QoL remained stable throughout the follow-up period. Improved motor dysfunction 1 month after surgery was reported by 23% of the patients, while 25% reported worse motor dysfunction. Factors associated with a high motor dysfunction score at 1 month were age >70 years, higher baseline motor dysfunction, and multiple brain metastases. Neither GTR nor location of metastases in motor-associated areas were associated with worsened motor dysfunction. Conclusion:Self-reported QoL is maintained after surgery for brain metastases. Complete resection is associated with extended OS without compromising self-reported motor function.

Background and purpose: This large population-based, retrospective, single-center study aimed to identify predictive factors in patients with brain metastases (BM) from gynecological cancers. Material and methods: 144 patients with BM from gynecological cancer treated with radiotherapy were identified. Primary cancer diagnosis, age, performance status, number of BM, presence of extracranial disease and type of BM treatment were assessed. Overall survival (OS) was calculated using the Kaplan-Meier method and Cox proportional hazards regression model was used for multivariable analysis. A prognostic index was developed based on scores from independent predictors of OS. Results: Median OS for the entire study population was 6.2 months. Forty percent of patients died within 3 months after start of radiotherapy. Primary cancer with the origin in cervix or vulva (p=0.001), ECOG 3-4 (p<0.001) and the presence of extracranial disease (p=0.001) were associated with significantly shorter OS. The developed prognostic index based on these factors, categorized patients into three risk groups with a median OS of 13.5, 4.0 and 2.4 months for the good, intermediate and poor prognosis group, respectively. Conclusion: Patients with BM from gynecological cancers carry a poor prognosis. We identified predictive factors for survival and developed a scoring tool to help differentiate patients with better or worse prognosis. Patients in the high-risk group have a particular poor prognosis, and omission of radiotherapy should be considered.

OBJECTIVE:To develop and externally validate a prognostic model built on important factors predisposing multimorbid patients to all-cause readmission and/or death. In addition to identify patients who may benefit most from a comprehensive clinical pharmacist intervention. METHODS:A multivariable prognostic model was developed based on data from a randomised controlled trial investigating the effect of pharmacist-led medicines management on readmission rate in multimorbid, hospitalised patients. The derivation set comprised 386 patients randomised in a 1:1 manner to the intervention group, i.e. with a pharmacist included in their multidisciplinary treatment team, or the control group receiving standard care at the ward. External validation of the model was performed using data from an independent cohort, in which 100 patients were randomised to the same intervention, or standard care. The setting was an internal medicines ward at a university hospital in Norway. RESULTS:The number of patients who were readmitted or had died within 18 months after discharge was 297 (76.9 %) in the derivation set, i.e. the randomized controlled trial, and 69 (71.1 %) in the validation set, i.e. the independent cohort. Charlson comorbidity index (CCI; low, moderate or high), previous hospital admissions within the previous six months and heart failure were the strongest prognostic factors and were included in the final model. The efficacy of the pharmaceutical intervention did not prove significant in the model. A prognostic index (PI) was constructed to estimate the hazard of readmission or death (low, intermediate or high-risk groups). Overall, the external validation replicated the result. We were unable to identify a subgroup of the multimorbid patients with better efficacy of the intervention. CONCLUSIONS:A prognostic model including CCI, previous admissions and heart failure can be used to obtain valid estimates of risk of readmission and death in patients with multimorbidity.

Background and Aims The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF.Methods A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011-18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]).Results Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37-0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88-1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16-1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51-0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17-2.81]).Conclusions In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile.

Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (n = 141), and 7.5 months after SRT (n = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival.