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The Apollonion Private Hospital is an ultra-modern Hospital purposely built to offer the best medical care to its patients.
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Al Zahra Hospital Sharjah is the first and the largest private general hospital in the UAE with both inpatient and outpatient treatment at an international standard,
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UT Health East Texas is passionate about delivering the highest quality care with unmatched compassion, outstanding service and innovative technology.
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<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Transitions from hospital to home are risky for older people. The role of patient involvement in supporting safe transitions is unclear.<div class="boxTitle">Objective</div>To assess the clinical effectiveness of an intervention to improve the safety and experience of care transitions for older people.<div class="boxTitle">Trial design</div>Cluster randomised controlled trial.<div class="boxTitle">Participants</div>Eleven National Health Service acute hospital trusts and 42 wards (clusters) routinely providing care for older people (aged 75 years and older) planning to transition back home.<div class="boxTitle">Intervention</div>Patient involvement ward-level intervention—Your Care Needs You (YCNY).<div class="boxTitle">Outcomes</div>Unplanned hospital readmission rates within 30 days of discharge (primary outcome). Secondary outcomes included readmissions at 60 and 90 days post-discharge, experience of transitions and safety events.<div class="boxTitle">Randomisation</div>Ward as the unit of randomisation from varying medical specialities randomised to YCNY or care-as-usual on a 1:1 basis.<div class="boxTitle">Blinding</div>Ward staff, research nurses and researchers were unblinded. Patients were unaware of treatment allocation. Statisticians were blinded to the primary outcome data until statistical analysis plan sign-off.<div class="boxTitle">Results</div>Using a mixed effects logistic regression we saw no significant difference in unplanned 30-day readmission rates (OR 0.93; 95% CI, 0.78 to 1.10; <span style="font-style:italic;">P</span> = .372) between intervention (17%) and control (19%). At all timepoints, rates were lower in the intervention group. The total number of readmissions was lower in the intervention group (all timepoints) reaching statistical significance across 90-days with 13% fewer readmissions (IRR: 0.87; 95% CI 0.76 to 0.99) than the control. At 30-days only, intervention group patients reported better experiences of transitions and significantly fewer safety events. Serious adverse events were similarly observed in both groups [YCNY: 26 (52.0%), Care-as-usual: 24 (48.0%)]. None related to treatment.<div class="boxTitle">Conclusions</div>YCNY did not significantly impact on unplanned hospital readmissions at 30 days but in some secondary outcomes we did find evidence of clinical benefit.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Falls and fractures are common among older people. The Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall) provides a comprehensive list of fall-risk-increasing drugs (FRIDs). This study assesses the association between STOPPFall medications and future falls/fractures among a large cohort of community-dwelling people ≥65 years using The Irish Longitudinal Study on Ageing (TILDA) Waves 1–6, collected from 2009 to 2021.<div class="boxTitle">Methods</div>STOPPFall medications were recorded at Wave 1 and Wave 3. Falls/fractures were self-reported. Logistic regression models reporting odds ratios (ORs) assessed the association between STOPPFall medications and falls (including injurious/unexplained falls) and fractures at follow-up, adjusted for relevant covariates.<div class="boxTitle">Results</div>Over one in four participants (777/2898, 27%) were prescribed one STOPPFall medication, and 15% (421/2898) were prescribed ≥2 STOPPFall medications. Over half of participants fell during follow-up, with 1/5 sustaining any fracture. Prescription of ≥2 STOPPFall medications was independently associated with all falls [OR 1.67 (95%CI 1.28–2.18); <span style="font-style:italic;">P</span> < 0.001], injurious falls [OR 1.53 (95%CI 1.19–1.97); <span style="font-style:italic;">P</span> = 0.001], unexplained falls [OR 1.86 (95%CI 1.43–2.42); <span style="font-style:italic;">P</span> < 0.001], all fractures [OR 1.59 (95%CI 1.20–2.12); <span style="font-style:italic;">P</span> = 0.001] and hip fractures [OR 1.75 (95%CI 1.00–3.05); <span style="font-style:italic;">P</span> = 0.048]. Increasing prescription of ≥2 STOPPFall medications at Wave 3 was associated with increased likelihood of all falls and injurious falls.<div class="boxTitle">Conclusion</div>Prescription of ≥2 STOPPFall medications is independently associated with an increased likelihood of all falls and all fractures. This is a potentially modifiable risk factor for falls, and an increased falls risk should be considered when prescribing these medications.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>We investigated the association between mobile phone use characteristics and Parkinson’s disease (PD) risk and whether genetic predisposition modified these associations, utilising data from the UK Biobank. Participants using mobile phones for at least one hour weekly had a lower risk of PD compared to those using less than five minutes weekly (HR: 0.75, 95% CI: 0.65–0.87). Long-term users of mobile phones over eight years had an 18% reduced risk compared to participants with a length of mobile phone use ≤1 year (HR: 0.82, 95% CI: 0.68–1.00), and increased frequency of mobile phone use over two years was associated with a 12% lower risk than those who did not change (HR: 0.88, 95% CI: 0.79–0.98). No interaction between mobile phone use characteristics and PD-PRS was detected. Total brain volume, grey matter and white matter were positively associated with mobile phone use, while white matter hyperintensity was negatively associated.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Loneliness has detrimental effects on the mental well-being of senior citizens. Reminiscence therapies have emerged as a potential intervention to alleviate loneliness. This study aimed to systematically review and quantitatively analyse the effects of reminiscence therapy on loneliness among older adults.<div class="boxTitle">Methods</div>A comprehensive search was performed across 11 electronic databases, meta-analyses were used to explore the effectiveness of reminiscence therapy on loneliness among older adults, while multiple subgroup analyses were conducted to explore differences in the effectiveness of different types of reminiscence therapy. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.<div class="boxTitle">Results</div>Twenty-two studies were included in the systematic review meta-analysis. The meta-analysis indicated that reminiscence therapy significantly reduced loneliness in older adults (standard mean difference = −1.52, 95% CI [−2.11, −0.93], <span style="font-style:italic;">P</span> < .01). Subgroup analyses showed significant effects for both simple reminiscence and life review therapy. Group reminiscence therapy was more effective than individual reminiscence therapy, and that reminiscence therapy conducted by professional facilitators was more effective than that led by non-professionals.<div class="boxTitle">Conclusions</div>Reminiscence therapy is an effective intervention for reducing loneliness among older adults, highlighting its importance in clinical practice. Future research should explore the best practices for different types of reminiscence therapies, tailored to the personal needs and backgrounds of older adults.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>It is unknown whether the relationship between ageing of different organs and cognitive decline varies in older adults.<div class="boxTitle">Objectives</div>This study investigated the association of body ageing and organ-specific ageing with cognitive decline, and whether this relationship was strengthened by hearing loss.<div class="boxTitle">Methods</div>The study included older adults free from cognitive impairment, drawn from the Chinese Longitudinal Healthy Longevity Survey. Organ-specific ages were estimated using the support vector machines. The age gap and ageing rate were calculated. Cognitive function was assessed at each visit using the Mini-mental State Examination, and a linear mixed-effects model was employed for analysis.<div class="boxTitle">Results</div>Over a median follow-up period of 6 years, of 1003 older adults (mean age 80.8 ± 10.9 years, 47.7% female) included, 187 (18.6%) experienced cognitive impairment. Compared to individuals with biological younger for body, musculoskeletal system and immune system, biological older (age gap > 0) was associated with faster cognitive decline (<span style="font-style:italic;">β</span><sub>body</sub> = −0.229, 95% confidence interval [CI]: −0.435, −0.023; <span style="font-style:italic;">β</span><sub>muscle</sub> = −0.294, 95% CI: −0.500, −0.088; <span style="font-style:italic;">β</span><sub>immune</sub> = −0.246, 95% CI: −0.452, −0.041), but not for cardiometabolic and renal systems. A linear positive dose–response association between age gap and cognitive impairment was uniquely observed for musculoskeletal system, whereas null associations for other organ systems. Moreover, higher ageing rates of body and musculoskeletal system were associated with faster cognitive decline. In the joint exposure analysis, hearing loss significantly strengthened the body age gap/ageing rate–cognitive decline association.<div class="boxTitle">Conclusions</div>Advanced biological ageing of the body, musculoskeletal system and immune system, particularly in the presence of hearing loss, accelerates cognitive decline.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Research in long-term residential care settings (or care homes) for older people should address questions and uncertainties that matter most for those receiving and delivering care. Whether research does this effectively is unclear. In part, because the uncertainties and questions of key stakeholders are unmapped.<div class="boxTitle">Objective</div>To capture and prioritise the uncertainties of older people living in care homes, their relatives and staff.<div class="boxTitle">Methods</div>A three-phase mixed-methods study: (i) gathering uncertainties, (ii) data analysis and (iii) prioritisation. Phase 1 used interviews to gather uncertainties from residents (<span style="font-style:italic;">n</span> = 14), relatives (<span style="font-style:italic;">n</span> = 10) and staff (<span style="font-style:italic;">n</span> = 44). In phase 2, uncertainties were coded using thematic inductive analysis, represented as ‘foreground’ (necessitating research) or ‘background’ (not needing research) questions, and a prioritisation tool developed. The tool included optional open-text responses, capturing new questions fitting (and additional detail around) the existing subthemes. During phase 3, the prioritisation tool was completed by residents (<span style="font-style:italic;">n</span> = 95), relatives (<span style="font-style:italic;">n</span> = 85) and staff (<span style="font-style:italic;">n</span> = 158).<div class="boxTitle">Results</div>319 uncertainties were identified: 274 foreground (research-based) and 45 background (fact-based) questions. Six broad and 38 subthemes were developed. Broad themes included (i) communal living, (ii) health and care services, (iii) resident care, (iv) residents’ health and well-being, (v) residents’ daily life and (vi) care home staff. Priority subthemes included enjoy living with others, dignity and respect, support with emotions, meaningful activities, and staff recruitment and retention.<div class="boxTitle">Conclusion</div>This is the first study of care home prioritised uncertainties informed by residents, relatives and staff. The uncertainty-based questions represent important targets for care home research and practice improvement.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The relationship between body mass index (BMI) changes across the lifespan and cognitive health in later life remains unclear. This study evaluated the association between BMI changes from midlife to late-life and subsequent subjective cognitive complaints (SCCs) in women.<div class="boxTitle">Methods</div>We analysed data from 5160 women in the New York University Women’s Health Study, a prospective cohort with over 30 years of follow-up. BMI was calculated using self-reported height and weight at baseline and follow-up. SCCs were assessed using a validated questionnaire in 2018–2020. Odds ratios (ORs) for reporting ≥2 SCCs were estimated using unconditional logistic regression.<div class="boxTitle">Results</div>BMI at specific life stages was not significantly associated with SCC risk. BMI changes from midlife to late-life were associated with SCC risk. Compared to women with stable BMI (≤5% change), moderate BMI loss (5.1–10% decrease) was associated with higher odds of ≥2 SCCs (OR: 1.23, 95% CI: 1.02–1.48), large BMI gain (>10% increase) was associated with lower odds of ≥2 SCCs (OR: 0.81, 95% CI: 0.67–0.97). These findings were consistent across sensitivity analyses, including varying age cut-offs and excluding BMI changes occurring 5–10 years before late-life.<div class="boxTitle">Conclusions</div>Our findings emphasize the importance of considering lifelong weight changes in assessing cognitive health risks. In particular, significant weight loss from midlife to late-life may serve as a potential indicator of cognitive decline in older adults. Further research is needed to elucidate the underlying mechanisms of this association and to explore effective interventions for mitigating cognitive health risks.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) are first-line antihypertensive drugs for many patients, and influencing angiotensin systems may play a role in dementia risk. This study aimed to investigate whether exposure to different antihypertensive drug classes compared with ACEI affects the risk of dementia and pathological dementia subtypes in a large multinational database study.<div class="boxTitle">Methods</div>This was a multinational population-based cohort study using electronic health databases in Hong Kong, the UK, Sweden and Australia. A common protocol was used to harmonise the study design. An active comparator, a new user design, was applied to compare the risk of all-cause dementia between different antihypertensive drug classes, with secondary outcomes of Alzheimer’s disease (AD) and vascular dementia (VaD). Adjusted Cox proportional hazards models with inverse probability of treatment weighting were used to generate results in each study site and were pooled in meta-analysis.<div class="boxTitle">Results</div>One million nine hundred twenty-five thousand, five hundred sixty-three individuals were included across the four databases with a median follow-up ranging from 5.6 to 8.4 years. Compared to ACEI, initiation with ARB was associated with a reduced risk of incident all-cause dementia [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.89–0.94] and VaD (HR 0.87, 95% CI 0.78–0.96) but not AD.<div class="boxTitle">Conclusions</div>This is the largest multinational cohort study conducted to date investigating different classes of antihypertensive drugs and the risk of incident dementia. When initiating antihypertensives, physicians and patients should consider the reduced risk of all-cause dementia and VaD with ARB compared with ACEI in their risk–benefit assessment.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Older adults, as a vulnerable population, typically show lower engagement with eHealth technologies. Limited internet access and low use for health information may contribute to poorer health outcomes.<div class="boxTitle">Objectives</div>The purposes of this study were to examine differences in socio-demographics and compare healthy lifestyles, health statuses and attitudes toward online health information among different groups of internet access and use for health information.<div class="boxTitle">Design</div>This cross-sectional study utilised secondary data from the International Social Survey Programme.<div class="boxTitle">Methods</div>A structured questionnaire was used for data collection from May 2023 to April 2024. Respondents were divided into three groups: 22.02% in a No-Access group (no internet access), 28.75% in a Non-User group (have access but do not use it for health information), and 49.22% in a User group (have access and use it for health information). In total, 14 008 respondents aged over 60 years from 30 countries were selected.<div class="boxTitle">Results</div>Groups were significantly associated with most sociodemographic factors, with the educational level showing the strongest effect size in both access/no-access and users/non-users comparisons. Older adults in the No-Access group had lower frequencies of healthy lifestyles and worse health statuses, while those in the User group had higher frequencies of healthy lifestyles, better health statuses, and positive attitudes toward online health information.<div class="boxTitle">Conclusions</div>Promoting a digitally inclusive environment is essential for enhancing internet access and use among older adults to support healthier lifestyles and improved health statuses.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Sarcopenia, a progressive loss of muscle mass and function, increases health risks in older adults, especially in rapidly ageing populations like Korea. Computed tomography (CT) imaging at the third lumbar vertebra (L3) level is a gold standard for assessing skeletal muscle area (SMA) and indices (SMIs), yet age- and sex-specific reference values are limited. This multicentre study aimed to establish these values for improved sarcopenia diagnosis.<div class="boxTitle">Methods</div>We conducted a retrospective study with 2637 healthy Korean adults (1366 men, 1271 women) aged 20 and older, using abdominal CT scans from routine health check-ups at four centres. SMA and SMIs were measured at L3, and T-scores were calculated by comparing participants’ values with a healthy young reference group (ages 20–39). Sarcopenia was classified into Classes I and II using standardised cutoffs.<div class="boxTitle">Results</div>An age-related SMA decline was observed in both sexes, with a more significant reduction in men. Sarcopenia prevalence was higher in men based on the SMA index, while SMA/body mass index (BMI) was more sensitive in women. Class I sarcopenia ranged from 10.1% to 21.3% in men and 10.6% to 23.6% in women, with Class II prevalence between 1.0% and 5.5% in men and 1.3% and 8.3% in women.<div class="boxTitle">Conclusion</div>This study establishes CT-based reference values for SMA and SMIs, supporting early sarcopenia detection, with the SMA/BMI index proving valuable for both men and women.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Environmental air pollution is increasingly recognised as a potential contributor to frailty. This systematic review and meta-analysis aimed to synthesise existing evidence on the associations between environmental air pollution and frailty in middle-aged and older adults, providing insights into the impact of air pollution on public health.<div class="boxTitle">Methods</div>The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement 2020. Four electronic databases were searched without restrictions on language, publication status, or year of publication.<div class="boxTitle">Results</div>Of the 145 publications identified through the systematic search, 18 were included. Meta-analyses indicated a 19% increased risk of frailty due to air pollution (fine particulate matter ≤2.5 microns) [n = 9 studies; pooled odds ratio (OR) 1.19; 95% confidence interval (CI) 1.10–1.27], a 28% increase with exposure to household solid fuels (n = 4 studies; OR 1.28; 95% CI 1.16–1.40) and a 59% increase due to exposure to secondhand smoke (n = 3 studies; OR 1.59; 95% CI 0.46–2.72). Except for the meta-analysis on air pollution, no heterogeneity or risk of publication bias was observed amongst the included studies. The Joanna Briggs Institute checklist confirmed high methodological quality across all included studies.<div class="boxTitle">Conclusions</div>Environmental exposures, including air pollution, the use of unclean household fuels and exposure to secondhand smoke, significantly increase the risk of frailty. These findings underscore the urgent need to raise awareness and establish effective public health strategies to reduce these environmental risks and associated frailty, particularly in light of population ageing.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Ambulance services are commonly used by older adults. The scope of services continues to adapt in response to more non–life-threatening calls, often due to the acute consequences of chronic illness. Frailty increases with increasing age, but it is not known how common or severe it is within patients conveyed to hospital by ambulance.<div class="boxTitle">Methods</div>Open cohort of people aged ≥50 living in Wales between 2010 and 2017. Routinely collected electronic data on ambulance attendances resulting in conveyance were linked to primary care data within the Secure Anonymised Information Linkage databank, and the electronic Frailty Index was calculated. The prevalence and severity of frailty according to patient and incident characteristics was described.<div class="boxTitle">Results</div>Of 1 264 094 individuals within the cohort, 23.8% were taken to hospital between 2010 and 2017, of which frailty was present in 84.3% of patients. There was an upward trend in the number of conveyances for patients with moderate and severe frailty across the years in all age groups. The distribution of frailty was similar across call categories, deprivation quintiles and out-of-hours incidents. Patients conveyed from residential homes had a higher level of frailty and comprised 8.7% of the total conveyances.<div class="boxTitle">Conclusions</div>The high prevalence of frailty within adults aged ≥50 with emergency conveyances suggests upskilling ambulance crews with frailty training to enhance their assessment and decision making may improve patient outcomes. The high proportion of conveyances from residential homes indicates scope for increasing integration of community services to provide more patient-centred care pathways.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Allied health professionals provide essential healthcare services to older adults with chronic health conditions. However, there are challenges to access and utilisation of these services for rural communities and limited scope of the existing literature.<div class="boxTitle">Objective</div>To conduct a scoping review of the literature related to access and utilisation of allied health services for older adults living in rural areas.<div class="boxTitle">Design</div>Scoping review.<div class="boxTitle">Methods</div>Four databases were searched. Articles were included based on pre-determined criteria and were limited to articles published between 2010 and 2023. Data were extracted with a focus on access and utilisation factors, enablers and barriers related to care recipients, care providers, other stakeholders and the healthcare system.<div class="boxTitle">Results</div>Thirty four studies met the inclusion criteria. The majority of studies focussed on accessibility from the perspective of the consumer (<span style="font-style:italic;">n</span> = 31), whilst few studies focussed on the perspective of the care providers (<span style="font-style:italic;">n</span> = 3). ‘Availability and accommodation’ was the most frequently explored dimension of accessibility in the included papers, from the consumers’ perspective (<span style="font-style:italic;">n</span> = 18) and from the health system (<span style="font-style:italic;">n</span> = 15).<div class="boxTitle">Conclusion</div>This is the first scoping review to improve understanding of older adults’ access to and utilisation of allied health services in rural areas. Understanding the most impactful accessibility dimensions can enhance strategies for improving access and utilisation of allied health services, especially when tailored to the local context. More studies are needed to understand accessibility of allied health services in rural areas from the perspective of care providers.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Given the significant burden and rising prevalence of dementia, it is essential that personalised care is available to people with dementia (PWD) and their family carers. This involves tailoring support to meet individuals’ unique needs and preferences. Effective communication is fundamental to delivering such care, yet dementia impacts communication, posing challenges in meeting individuals’ needs.<div class="boxTitle">Aim</div>To understand key communication strategies used by healthcare professionals (HCPs) in delivering personalised dementia care.<div class="boxTitle">Methods</div>A systematic search across MEDLINE, EMBASE, EMCare, PsycINFO, CINAHL, Scopus, and Web of Science was conducted (April 2024) without limits on care setting, country or publication date. We identified studies examining communication strategies, barriers, and facilitators for delivering personalised care for PWD and their carers. Study quality was assessed using Joanna Briggs Institute critical appraisal tools and the Mixed Methods Appraisal Tool. Using codebook thematic analysis, a narrative synthesis of findings was developed.<div class="boxTitle">Results and Conclusion</div>The review included 33 studies, encompassing qualitative, quantitative and mixed-methods research conducted in hospitals, care homes and community settings. Most studies originate from high-income countries and care homes, limiting generalisability. Three themes on communication strategies for delivering personalised dementia care were developed: understanding the person, their family and their care context; communication techniques (verbal, nonverbal and use of external aids); and support for the workforce. The review underscores the importance of combining practical, emotional and relational approaches while highlighting current gaps, such as the need for better workforce support and more research in primary care and culturally diverse contexts.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Mental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation in care homes for older adults in the United Kingdom.<div class="boxTitle">Methods</div>A systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000. Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model and Theoretical Domains Framework.<div class="boxTitle">Results</div>Barriers included poor access to training, low staff confidence and a lack of understanding about using legislation in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff (n = 18) to interpret findings in the context of current practice.<div class="boxTitle">Conclusions</div>This review presents complex and multi-faceted barriers preventing the implementation of mental capacity legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law. Future research should explore how staff are trained about legislation and identify best practices.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Postoperative delirium (POD) arises among older surgical patients. Screening followed by prevention efforts are recommended. A risk prediction tool called PIPRA plus has been developed, yet its performance and whether adoption into health services is cost-effective are unknown.<div class="boxTitle">Objective</div>To estimate the expected change to ‘total costs’ and ‘health benefits’ measured by quality adjusted life years (QALYs) from a decision to adopt PIPRA plus for screening purpose to find at-risk individuals who are then offered nonpharmacological interventions to reduce risks of POD.<div class="boxTitle">Design</div>Cost-effectiveness modelling study that draws on a range of relevant data sources.<div class="boxTitle">Setting</div>Swiss healthcare system.<div class="boxTitle">Subjects</div>Surgical inpatients aged 60 or older, excluding cardiac and intracranial surgeries.<div class="boxTitle">Methods</div>A decision tree model was used to capture the events likely to impact on cost and health outcomes. Information was harvested from a prospective before–after study done in Switzerland and augmented with other data. Probabilistic sensitivity analysis was undertaken to reveal the probability that adoption was cost-effective against a stated maximum willingness to pay threshold for decision-making in Switzerland.<div class="boxTitle">Results</div>Patients in both phases of the study were similar. Costs were lower by 2898 CHF (SD 1050) per patient with the adoption of the risk screening tool and there was a modest gain to health benefits of 0.01 QALY (SD 0.026). There was a 99.7% probability that adoption would be cost-saving and 91% probability that adoption would be cost-effective.<div class="boxTitle">Conclusions</div>We provide early-stage evidence that a decision to adopt the risk screening tool and offer risk-reducing interventions could be cost-effective.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Standardised questionnaires of cognitive symptoms and cognitive-related function can assist in diagnosing dementia. The Standardised Assessment of Global Everyday Activities (SAGEA) is a 15-item questionnaire, developed to measure functional status by capturing cognitive symptoms, basic and instrumental activities of daily living, participation in activites, and mobility.<div class="boxTitle">Objective</div>The aim of this study was to validate the SAGEA as a tool for assessing cognitive dysfunction in dementia.<div class="boxTitle">Methods</div>Participants with dementia, mild cognitive impairment (MCI) or subjective cognitive decline (SCD) were selected from the clinic-based Prospective Registry for Persons with Memory Symptoms (PROMPT), and cognitively asymptomatic, unimpaired controls were selected from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function and Caregiving in Ageing study.<div class="boxTitle">Results</div>SAGEA scores correlated well with the Lawton-Brody scale for instrumental activities of daily living (<span style="font-style:italic;">r</span> = −0.68, <span style="font-style:italic;">P</span> < 0.0001). SAGEA scores differed significantly across participant groups, highest for individuals with dementia (17.7 ± 8.59) followed by MCI (10.8 ± 9.10), SCD (8.07 ± 7.06) and controls (1.60 ± 2.07). The SAGEA classified dementia with an AUC of 0.97, sensitivity of 94.5% and specificity of 94.6% at a cut-off point of ≥6 points based on Youden’s index. A dementia diagnosis algorithm based on the SAGEA distinguished dementia from controls with a sensitivity of 68% and specificity of 100%.<div class="boxTitle">Conclusions</div>This study supports the utility of the SAGEA as an adjunct to diagnosing dementia and a potentially useful screening tool.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Time to surgery (TTS) increases mortality risk in old patients with proximal femur fractures (PFFs). Orthogeriatric care pathways reduce mortality and length of stay, but the interaction between TTS and geriatric intervention remains unclear.<div class="boxTitle">Objective</div>To identify organisational variables—including geriatric intervention—that are predictive of 90-day mortality and explore their interactions with TTS.<div class="boxTitle">Materials and Methods</div>This retrospective study included 7756 PFFs aged over 60 who underwent surgery between 2005 and 2017. Organisational factors influencing 90-day mortality (main outcome) were identified in an administrative database using log-rank tests. Variables such as a mobile geriatric team (MGT) intervening in the emergency department were screened. Selected variables were included in a Cox model alongside TTS and the AtoG score, a validated multidimensional prognostic tool (from 0 no comorbidity to ≥5). Statistical interactions between TTS and organisational variables were calculated.<div class="boxTitle">Results</div>MGT was one of the rare organisational variables with a protective effect: hazard ratio (HR) = 0.81, CI 95% [0.68–0.98], <span style="font-style:italic;">P</span> = 0.03. MGT’s strongest effect was for TTS up to 1 day (HR = 0.70, CI95% [0.53–0.92], <span style="font-style:italic;">P</span> = 0.01) and then decreased beyond 2 days (HR = 0.97, CI95% [0.73–1.3], <span style="font-style:italic;">P</span> = 0.08). In patients with an AtoG score ≤ 2, MGT was the strongest parameter: HR = 0.76, CI95% [0.60–0.93], <span style="font-style:italic;">P</span> = 0.03, while the HR for TTS was 1.01 CI 95% [0.99; 1.02], <span style="font-style:italic;">P</span> = 0.15. In patients with an AtoG>2, there was a synergic interaction between MGT and reduced TTS (<span style="font-style:italic;">P</span> = 0.05).<div class="boxTitle">Conclusion</div>Geriatric intervention modulated the effect of TTS on 90-day mortality up to a TTS of 2 days. MGT had a positive impact on both vulnerable and earthier patients.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Behavioural and psychological symptoms of dementia (BPSD) are complex neuropsychiatric symptoms that contribute to caregiver strain, increased rates of institutionalisation and reduced quality of life. Virtual reality (VR) has gained interest as a non-pharmacological approach to potentially reduce BPSD severity.<div class="boxTitle">Objective</div>This review sought to synthesise evidence on the effectiveness of VR in reducing BPSD severity, while exploring its acceptability, safety, and optimal dosage in dementia care.<div class="boxTitle">Methods</div>MEDLINE, EMBASE, CINAHL and SCOPUS were searched for randomised and quasi-experimental trials assessing VR’s effect on BPSD. JBI critical appraisal checklists were used to assess methodological quality. Findings were presented narratively, with meta-analysis performed on a subset of BPSD symptoms where data were available.<div class="boxTitle">Results</div>Of the ten included studies, four found no significant change in overall BPSD. Mixed findings were observed for individual BPSD symptoms. Meta-analysis showed a significant reduction in depressive symptoms (mean diff −0.38, <span style="font-style:italic;">P</span>= .026) and no reduction in agitation (mean diff 1.87, <span style="font-style:italic;">P</span> = .2). Two studies reported reduced aggression and mixed findings were found for anxiety. Reduced apathy was observed in one study following each VR session and during the session in another. VR was generally well-accepted with few side effects reported.<div class="boxTitle">Conclusion</div>VR appears to be an acceptable non-pharmacological intervention for BPSD reduction. However, the limited available studies, methodological variations and quality issues suggest the need for future larger-scale research to confirm its efficacy and effectiveness.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Cognitive impairment, dementia and sarcopenia significantly reduce the quality of life in middle-aged and older adults by impairing daily functioning, making cognitive decline a major concern for healthcare professionals.<div class="boxTitle">Objective</div>To estimate the prevalence of sarcopenia and probable sarcopenia in middle-aged and older adults with cognitive impairment.<div class="boxTitle">Methods</div>Six databases—Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus and Web of Science was conducted through February 2025. Cohort and cross-sectional studies included, and a random-effects model was used for pooled prevalence analysis. Cognitive impairment is a decline in cognitive functions, including memory, attention and executive function, covering mild cognitive impairment and dementia. Sarcopenia is decreased skeletal muscle mass and function, assessed by muscle strength or physical performance.<div class="boxTitle">Results</div>A total of 67 studies involving 23 532 participants revealed a pooled sarcopenia prevalence of 30.1% and a probable sarcopenia prevalence of 40.5%. Additionally, amongst adults aged 65 and older, the prevalence of sarcopenia was 32.7%. The prevalence of sarcopenia varied by setting: 25.3% in community-dwelling populations, 35.5% in hospitals and 41.5% in institutional settings. Moderating factors included age, female, body mass index, comorbidities and risk factors such as depression, diabetes, hypertension, malnutrition, osteoarthritis, alcohol consumption and smoking.<div class="boxTitle">Conclusions</div>Approximately one-third of middle-aged and older adults with cognitive impairment demonstrate to have sarcopenia. Early detection and tailored interventions by public health professionals are crucial, particularly for individuals with mild cognitive impairment and dementia. Enhanced preventive strategies are essential to improving outcomes and reducing healthcare costs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Cancer disproportionately affects older adults, who account for the majority of diagnoses and deaths globally. However, research and clinical care often fail to adequately address their unique needs. <a href="https://academic.oup.com/ageing/pages/cancer-and-older-people">This collection of studies in Age and Ageing</a> highlights challenges and opportunities in geriatric oncology. The rising incidence of cancer in the older population, driven by demographic shifts and socioeconomic factors, underscores the need for targeted prevention and control strategies. Despite this, older adults remain underrepresented in clinical trials, with barriers including social isolation, healthcare professionals’ biases and a lack of dedicated studies. Frailty assessment is gaining ground as a key tool in geriatric oncology. Studies on frailty scores such as the Hospital Frailty Risk Score, and comprehensive geriatric assessment (CGA), show their ability to predict outcomes and guide interventions. CGA-based care has been shown to reduce treatment toxicity without compromising survival, yet its integration into routine practice remains limited. Treatment challenges are common, particularly with novel therapies like immune checkpoint inhibitors, which carry age-specific risks of adverse events. Tailored services are essential to address the diverse needs of older cancer patients. Research highlights the importance of improving communication around cancer screening for older adults and developing specialised care pathways for vulnerable populations, such as those with dementia. Continuity of care remains a significant challenge, requiring better coordination across healthcare providers. These findings emphasise the urgent need for age-attuned research, frailty-informed care models and tailored interventions to improve outcomes for older adults with cancer.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Adult social care in England operates in a two-tier system of self-funded and state-funded residents. It is unclear, however, whether resident funding source impacts care home quality.<div class="boxTitle">Methods</div>We conducted a nationwide retrospective observational analysis of care homes in England (<span style="font-style:italic;">n</span> = 28 239 Provider Information Return entries for 14 444 care homes, representing ~367 653 residents), 2021–23, to examine the relationship between resident funding (self- or state-funded) and care home quality (inspection ratings by the industry regulator). We linked data from the Care Quality Commission’s Provider Information Return to inspection ratings, area deprivation, and care home and resident characteristics. We modelled a series of logistic regressions, incorporating interaction terms to investigate the interrelationships between ownership (for-profit, third sector, public) and area deprivation.<div class="boxTitle">Findings</div>Care homes with more self-funded residents were more likely to have better inspection ratings [odds ratio for each percentage of self-funded residents: 1.01, 95% confidence interval (CI) 1.008–1.012, <span style="font-style:italic;">P</span> < .001]. The effect of self-funded residents on care quality was largest amongst for-profit homes and not statistically significant for third sector and public homes. For homes without self-funders, third sector and public providers were 14.0 (95% CI: 10.1–17.8, <span style="font-style:italic;">P</span> < .001) and 6.9 (95% CI: 4.1–9.7, <span style="font-style:italic;">P</span> < .001) percentage points more likely to be rated higher than for-profit homes.<div class="boxTitle">Conclusions</div>The quality of for-profit care homes is strongly influenced by the proportion of self-funded residents, whilst third and public sector homes provide consistent care regardless of resident funding source. This strongly impacts care equity for residents nationwide, as the concentration of self-funders is largely determined by area wealth.</span>
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