Age and Ageing

Low mobility during hospitalisation poses risks of functional decline and other poor outcomes for older adults. Given the pervasiveness of this problem, low mobility during hospitalisation was first described as ‘dangerous’ in 1947 and later described as an epidemic. Hospitals have made considerable progress over the last half-century and the last two decades in particular, however, the COVID-19 pandemic presents serious new challenges that threaten to undermine recent efforts and progress towards a culture of mobility. In this special article, we address the question of how to confront an epidemic of immobility within a pandemic. We identify four specific problems for creating and advancing a culture of mobility posed by COVID-19: social distancing and policies restricting patient movement, personnel constraints, personal protective equipment shortages and increased patient hesitancy to ambulate. We also propose four specific solutions to address these problems. These approaches will help support a culture of healthy mobility during and after hospitalisation and help patients to keep moving during the pandemic and beyond.

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COVID-19 point-of-care testing in care homes: what are the lessons for policy and practice?

Peter Buckle, Massimo Micocci, John Tulloch, Patrick Kierkegaard, Paula Parvulescu, Carl Thompson, Karen Spilsbury, A Joy Allen, Richard Body, Gail Hayward, Iain Buchan, Adam L Gordon

doi : 10.1093/ageing/afab101

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1442–1444

COVID-19 has devastated care homes. Point-of-care tests (POCTs), mainly using lateral flow devices (LFDs), have been deployed hurriedly without much consideration of their usability or impact on care workflow. Even after the pandemic, POCTs, particularly multiplex tests, may be an important control against spread of SARS-CoV-2 and other respiratory infections in care homes by enabling identification of cases. They should not, however, replace other infection control measures such as barrier methods and quarantine. Adherence to LFDs as implemented among care home staff is suboptimal. Other tests—such as point-of-care polymerase chain reaction and automated antigen tests—would also need to be accommodated into care home workflows to improve adherence. The up-front costs of POCTs are straightforward but additional costs, including staffing preparation and reporting processes and the impacts of false positive and negative tests on absence rates and infection days, are more complex and as yet unquantified. A detailed appraisal is needed as the future of testing in care homes is considered.

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Prevalence, incidence and mortality of delirium in patients with COVID-19: a systematic review and meta-analysis

Shih-Chieh Shao, Chien-Cheng Lai, Yi-Hung Chen, Yung-Chang Chen, Ming-Jui Hung, Shu-Chen Liao

doi : 10.1093/ageing/afab103

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1445–1453

Attention should be paid to delirium in coronavirus disease 2019 (COVID-19) patients, especially older people, since advanced age poses increased risk of both delirium and COVID-19-related death.

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Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak

Judith H van den Besselaar, Reina S Sikkema, Fleur M H P A Koene, Laura W van Buul, Bas B Oude Munnink, Ine Frénay, René te Witt, Marion P G Koopmans, Cees M P M Hertogh, Bianca M Buurman

doi : 10.1093/ageing/afab081

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1454–1463

Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus.

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Is point-of-care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of a point-of-care polymerase chain reaction test for SARS-CoV-2

Massimo Micocci, Adam L Gordon, Mikyung Kelly Seo, A Joy Allen, Kerrie Davies, Dan Lasserson, Carl Thompson, Karen Spilsbury, Cyd Akrill, Ros Heath, Anita Astle, Claire Sharpe, Rafael Perera, Gail Hayward, Peter Buckle on behalf of the CONDOR Study Group

doi : 10.1093/ageing/afab072

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1464–1472

Reliable rapid testing for COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. This study aimed to examine the usability and test performance of a point of care polymerase chain reaction (PCR) test for detection of SARS-CoV-2 (POCKITTM Central) in care homes.

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Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study

Florence Canouï-Poitrine, Antoine Rachas, Martine Thomas, Laure Carcaillon-Bentata, Roméo Fontaine, Gaëtan Gavazzi, Marie Laurent, Jean-Marie Robine on behalf of the COMONH consortium

doi : 10.1093/ageing/afab098

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1473–1481

The objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement.

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Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis

Jennifer Kirsty Burton, Megan McMinn, James E Vaughan, Jacques Fleuriot, Bruce Guthrie

doi : 10.1093/ageing/afab099

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1482–1492

understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents.

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New horizons in understanding the experience of Chinese people living with dementia: a positive psychology approach

Wing Yin Tiffany Lau, Charlotte Stoner, Gloria Hoi-Yan Wong, Aimee Spector

doi : 10.1093/ageing/afab097

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1493–1498

As the global average age increases, the incidence of dementia is also rising. Given improvements in diagnosis and life expectancies, people now live longer with dementia. Thus, the wellbeing and quality of life among people living with dementia are increasingly important areas for research.

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New horizons in falls prevention and management for older adults: a global initiative

Manuel Montero-Odasso, Nathalie van der Velde, Neil B Alexander, Clemens Becker, Hubert Blain, Richard Camicioli, Jacqueline Close, Leilei Duan, Gustavo Duque, David A Ganz, Fernando G?mez, Jeffrey M Hausdorff, David B Hogan, Jose R Jauregui, Rose Anne Kenny, Lewis A Lipsitz, Pip A Logan, Stephen R Lord, Louise Mallet, David R Marsh, Finbarr C Martin, Koen Milisen, Alice Nieuwboer, Mirko Petrovic, Jesper Ryg, Ervin Sejdic, Cathie Sherrington, Dawn A Skelton, Mark Speechley, Maw Pin Tan, Chris Todd, Tischa van der Cammen, Joe Verghese, Nellie Kamkar, Yanina Sarquis-Adamson, Tahir Masud, the Task Force on Global Guidelines for Falls in Older Adults

doi : 10.1093/ageing/afab076

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1499–1507

falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries.

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HEARTS, minds and souls—it is time for geriatricians to bring more to continence management

Mathias Schl?gl, Adam Gordon

doi : 10.1093/ageing/afab088

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1508–1511

Urinary incontinence (UI), the involuntary loss of urine, is a common health condition that may decrease the quality of life and which increases in incidence and prevalence with age. Recent epidemiologic data suggest an overall prevalence of 38% in women older than 60 years, increasing to 77% in older women living in nursing homes. Despite this high prevalence, incontinence remains underdiagnosed and undertreated in this age group. In a representative population of 7,000 participants drawn from the Irish Longitudinal Study of Ageing, 750 had UI of whom 285 (38%) had not sought the help of a health care professional. The reasons that older people do not seek help for incontinence are complex and multiplex. Stigma surrounding diagnosis, a sense of futility coupled to a notion that incontinence is a part of normal ageing and the fact that incontinence simply gets ‘lost’ in the midst of multimorbidity and frailty have all been shown to play a role. Active case finding has therefore been highlighted as a cornerstone of effective care in serial international guidelines.

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Talking to multi-morbid patients about critical illness: an evolving conversation

Zudin A Puthucheary, Magda Osman, Dan J R Harvey, Angela S McNelly

doi : 10.1093/ageing/afab107

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1512–1515

Conversations around critical illness outcomes and benefits from intensive care unit (ICU) treatment have begun to shift away from binary discussions on living versus dying. Increasingly, the reality of survival with functional impairment versus survival with a late death is being recognised as relevant to patients.

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Appropriate deprescribing in older people: a challenging necessity Commentary to accompany themed collection on deprescribing

Nathalie van der Velde, Jatinder S Minhas

doi : 10.1093/ageing/afab142

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1516–1519

Older people are often taking several medications for a number of different medical conditions. Although physicians prescribe medications to treat diseases and symptoms, there may be also harmful side effects, especially so in older people taking several medications. Unfortunately, regular review of the benefits or risks of prescribed medications is as of yet not part of standard care. Also, data on how and in whom to stop medications in older people are scarce. The reason this is an important area of work is that medication related issues in older people are a common cause of harm, including both expected and unexpected effects of medications. Research to date tells us that to ensure successful implementation of structured and appropriate deprescribing, careful planning within hospital systems is needed. This includes involving different members of the team to ensure the patients truly benefit. The themed collection published on the Age and Ageing journal website offers key articles providing tools to assist decision-making, implementation strategies and multidisciplinary interventions—all with the aim of improving patient outcome and sustainability of deprescribing approaches.

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Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis

Jennifer Tran, Sarah L Hillebrand, Carel G M Meskers, Rebecca K Iseli, Andrea B Maier

doi : 10.1093/ageing/afab090

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1520–1528

Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults.

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Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review

Suzanne McIlroy, Edward Walsh, Christina Sothinathan, Elizabeth Stovold, Daniel Norwitz, Sam Norton, John Weinman, Lindsay Bearne

doi : 10.1093/ageing/afab150

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1529–1545

Lumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes.

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Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials

Eva Heilmann, Claudia Gregoriano, Djillali Annane, Konrad Reinhart, Lila Bouadma, Michel Wolff, Jean Chastre, Charles-Edouard Luyt, Florence Tubach, Angela R Branche, Matthias Briel, Mirjam Christ-Crain, Tobias Welte, Caspar Corti, Evelien de Jong, Maarten Nijsten, Dylan W de Lange, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Rodrigo O Deliberato, Stefan Schroeder, Kristina B Kristoffersen, Nathalie Layios, Pierre Damas, Stella S S Lima, Vandack Nobre, Long Wei, Carolina F Oliveira, Yahya Shehabi, Daiana Stolz, Michael Tamm, Alessia Verduri, Jin-Xiang Wang, Sabine Drevet, Gaetan Gavazzi, Beat Mueller, Philipp Schuetz

doi : 10.1093/ageing/afab078

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1546–1556

Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients.

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Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis

Fuzhong Li, Peter Harmer, Elizabeth Eckstrom, Barbara E Ainsworth, Kathleen Fitzgerald, Jan Voit, Li-Shan Chou, Fei Li Welker, Shana Needham

doi : 10.1093/ageing/afab110

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1557–1568

Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment.

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Frailty—a risk factor of global and domain-specific cognitive decline among a nationally representative sample of community-dwelling older adult U.S. Medicare beneficiaries

Nadia M Chu, Qian-Li Xue, Mara A McAdams-DeMarco, Michelle C Carlson, Karen Bandeen-Roche, Alden L Gross

doi : 10.1093/ageing/afab102

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1569–1577

frail older adults may be more vulnerable to stressors, resulting in steeper declines in cognitive function. Whether the frailty–cognition link differs by cognitive domain remains unclear; however, it could lend insight into underlying mechanisms.

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Differential risk of falls associated with pain medication among community-dwelling older adults by cognitive status

Aya Yoshikawa, Matthew Lee Smith, Marcia G Ory

doi : 10.1093/ageing/afab051

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1578–1585

Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status.

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Association between everyday walking activity, objective and perceived risk of falling in older adults

Carl-Philipp Jansen, Jochen Klenk, Corinna Nerz, Chris Todd, Sarah Labudek, Franziska Kramer-Gmeiner, Clemens Becker, Michael Schwenk

doi : 10.1093/ageing/afab037

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1586–1592

older persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into ‘vigorous’ (low ORF/PRF), ‘anxious’ (low ORF/high PRF), ‘stoic’ (high ORF/low PRF) and ‘aware’ (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet.

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The relationship between frailty and delirium: insights from the 2017 Delirium Day study

Paolo Mazzola, Elena Tassistro, Simona Di Santo, Emanuela Rossi, Anita Andreano, Maria Grazia Valsecchi, Antonio Cherubini, Alessandra Marengoni, Enrico Mossello, Mario Bo, Marco Inzitari, Mauro Di Bari, Cristina Udina, Nicola Latronico, Ciro Paolillo, Alessandro Morandi, Giuseppe Bellelli on behalf of the Italo-Catalan Study Group on Delirium (ICSGoD)

doi : 10.1093/ageing/afab042

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1593–1599

although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality.

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Hospital admission as a deprescribing triage point for patients discharged to Residential Aged Care Facilities

Greg Roberts, Matthew Pegoli, Luke Grzeskowiak, Sophie Benger, Heather Forbes, Kathryn Hunt, Shabnam Jafari, Ivanka Koeper, Cameron McDonald, Hanh Nguyen, Khadeeja Rawther, Lauren Taeuber, Evelyn Tran, Peter Vu, Alice Wisdom, Patrick Russell

doi : 10.1093/ageing/afab082

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1600–1606

Deprescribing may benefit older frail patients experiencing polypharmacy. We investigated the scope for deprescribing in acutely hospitalised patients and the long-term implications of continuation of medications that could potentially be deprescribed.

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Recent trends of invasive mechanical ventilation in older adults: a nationwide population-based study

Carmen Bouza, Gonzalo Mart?nez-Alés, Teresa L?pez-Cuadrado

doi : 10.1093/ageing/afab023

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1607–1615

Critical care demand for older people is increasing. However, there is scarce population-based information about the use of life-support measures such as invasive mechanical ventilation (IMV) in this population segment.

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Dynapenia, abdominal obesity or both: which accelerates the gait speed decline most?

Roberta de Oliveira M?ximo, Dayane Capra de Oliveira, Paula Camila Ram?rez, Mariane Marques Luiz, Aline Fernanda de Souza, Maicon Lu?s Bicigo Delinocente, Andrew Steptoe, Cesar de Oliveira, Tiago da Silva Alexandre

doi : 10.1093/ageing/afab093

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1616–1625

to investigate whether the combination of dynapenia and abdominal obesity is worse than these two conditions separately regarding gait speed decline over time.

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Neutrophil-to-lymphocyte ratio predicts delirium after stroke

Kaat Guldolf, Fenne Vandervorst, Robin Gens, Anissa Ourtani, Thomas Scheinok, Sylvie De Raedt

doi : 10.1093/ageing/afab133

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1626–1632

Delirium is an underdiagnosed and possibly preventable complication in acute stroke and is linked to poor outcome. Neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, is also associated with poor outcome after acute ischemic stroke.

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The rate by which mortality increase with age is the same for those who experienced chronic disease as for the general population

Marcus Ebeling, Roland Rau, H?kan Malmstr?m, Anders Ahlbom, Karin Modig

doi : 10.1093/ageing/afab085

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1633–1640

Mortality doubles approximately every 6–7 years during adulthood. This exponential increase in death risk with chronological age is the population-level manifestation of ageing, and often referred to as the rate-of-ageing.

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Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score

Yong Yong Tew, Juen Hao Chan, Polly Keeling, Susan D Shenkin, Alasdair MacLullich, Nicholas L Mills, Martin A Denvir, Atul Anand

doi : 10.1093/ageing/afab043

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1641–1648

frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.

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Factors associated with initiation of bone-health medication among older adults in primary care in Ireland

Mary E Walsh, Mari Nerdrum, Tom Fahey, Frank Moriarty

doi : 10.1093/ageing/afab033

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1649–1656

Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common.

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Association of life satisfaction with disability-free survival: role of chronic diseases and healthy lifestyle

Wei Wu, Ying Shang, Amaia Calder?n-Larra?aga, Debora Rizzuto, Marguerita Saadeh, Abigail Dove, Kuan-Yu Pan, Weili Xu

doi : 10.1093/ageing/afab086

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1657–1665

this article investigates the association between life satisfaction and disability-free survival, and explores the roles of chronic diseases and healthy lifestyle in this association.

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Individual changes in anthropometric measures after age 60 years: a 15-year longitudinal population-based study

Jie Guo, Ying Shang, Laura Fratiglioni, Kristina Johnell, Anna-Karin Welmer, Anna Marseglia, Weili Xu

doi : 10.1093/ageing/afab045

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1666–1674

weight loss is commonly observed with ageing. We explored the trajectory of body mass index (BMI) and two proxies of muscle mass—calf circumference (CC) and mid-arm circumference (MAC)—and identified their determinants.

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Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people—results from a nested, longitudinal cohort study

Sarah J Richardson, Rachael Lawson, Daniel H J Davis, Blossom C M Stephan, Louise Robinson, Fiona E Matthews, Carol Brayne, Linda E Barnes, John-Paul Taylor, Stuart G Parker, Louise M Allan

doi : 10.1093/ageing/afab068

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1675–1681

Acute hospitalisation and delirium have individually been shown to adversely affect trajectories of cognitive decline but have not previously been considered together. This work aimed to explore the impact on cognition of hospital admission with and without delirium, compared to a control group with no hospital admissions.

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Longitudinal trajectories of physical functioning among Chinese older adults: the role of depressive symptoms, cognitive functioning and subjective memory

Rumei Yang, Dongjuan Xu, Haocen Wang, Jiayun Xu

doi : 10.1093/ageing/afab135

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1682–1691

Maintaining physical functioning (i.e. mobility, activities of daily living [ADLs], instrumental activities of daily living [IADLs]) in older adults is essential for independent living. However, little is known about how longitudinal trajectories of physical functioning differ by varying levels of depressive symptoms, subjective memory impairment and cognitive functioning. We aimed to examine whether, and to what degree, the rate of change in physical functioning over time was associated with depressive symptoms, subjective memory and cognitive functioning.

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Cause-specific mortality prediction in older residents of S?o Paulo, Brazil: a machine learning approach

Carla Ferreira do Nascimento, Hellen Geremias dos Santos, André Filipe de Moraes Batista, Alejandra Andrea Roman Lay, Yeda Aparecida Oliveira Duarte, Alexandre Dias Porto Chiavegatto Filho

doi : 10.1093/ageing/afab067

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1692–1698

Populational ageing has been increasing in a remarkable rate in developing countries. In this scenario, preventive strategies could help to decrease the burden of higher demands for healthcare services. Machine learning algorithms have been increasingly applied for identifying priority candidates for preventive actions, presenting a better predictive performance than traditional parsimonious models.

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The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study

Malinee Neelamegam, Janice Zgibor, Henian Chen, Kathleen O’rourke, Chighaf Bakour, Lakshminarayan Rajaram, Kaarin J Anstey

doi : 10.1093/ageing/afab048

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1699–1708

chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population.

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Neuropsychiatric symptoms in early stage of Alzheimer’s and non-Alzheimer’s dementia, and the risk of progression to severe dementia

Tau Ming Liew

doi : 10.1093/ageing/afab044

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1709–1718

Neuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs.

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Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Lenneke E M Haas, Ariane Boumendil, Hans Flaatten, Bertrand Guidet, Mercedes Ibarz, Christian Jung, Rui Moreno, Alessandro Morandi, Finn H Andersen, Tilemachos Zafeiridis, Sten Walther, Sandra Oeyen, Susannah Leaver, Ximena Watson, Carole Boulanger, Wojciech Szczeklik, Joerg C Schefold, Maurizio Cecconi, Brian Marsh, Michael Joannidis, Yuriy Nalapko, Muhammed Elhadi, Jesper Fj?lner, Antonio Artigas, Dylan W de Lange, VIP2 study group

doi : 10.1093/ageing/afab036

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1719–1727

Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients???80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.

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Measuring the impact of a Chronic Obstructive Pulmonary Disease Community Respiratory Programme on emergency admissions to hospital: a controlled interrupted time series analysis

Kate A Levin, Marianne Milligan, Hannah K Bayes, Emilia Crighton, David Anderson

doi : 10.1093/ageing/afab104

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1728–1735

A community respiratory service was implemented in the North West of Glasgow (NW) in January 2013, as part of the Reshaping Care for Older People programme (RCOP). This study aimed to measure the impact of the service on older people’s emergency admissions (EAs) to hospital.

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Enrolment of older adults with cancer in early phase clinical trials—an observational study on the experience in the north west of England

Fabio Gomes, Tine Descamps, Jessica Lowe, Martin Little, Rosie Lauste, Matthew G Krebs, Donna Graham, Fiona Thistlethwaite, Louise Carter, Natalie Cook

doi : 10.1093/ageing/afab091

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1736–1743

older patients represent the majority of cancer patients but are under-represented in trials, particularly early phase clinical trials (EPCTs).

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Mortality in hip fracture patients after implementation of a nurse practitioner-led orthogeriatric care program: results of a 1-year follow-up

Jannic A A van Leendert, Aimée E M J H Linkens, Martijn Poeze, Evelien Pijpers, Fabienne Magdelijns, René H M ten Broeke, Bart Spaetgens

doi : 10.1093/ageing/afab031

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1744–1750

Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported.

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Acceptance and commitment therapy for late-life treatment-resistant generalised anxiety disorder: a feasibility study

Rebecca L Gould, Julie Loebach Wetherell, Kate Kimona, Marc A Serfaty, Rebecca Jones, Christopher D Graham, Vanessa Lawrence, Gill Livingston, Philip Wilkinson, Kate Walters, Marie Le Novere, Iracema Leroi, Robert Barber, Ellen Lee, Jo Cook, Viviana M Wuthrich, Robert J Howard on behalf of the FACTOID group

doi : 10.1093/ageing/afab059

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1751–1761

Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people.

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Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot

Miles D Witham, Philip Heslop, Richard M Dodds, Andrew P Clegg, Suzy V Hope, Claire McDonald, David Smithard, Bryony Storey, Ai Lyn Tan, Anna Thornhill, Avan A Sayer

doi : 10.1093/ageing/afab084

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1762–1769

sarcopenia registries are a potential method to meet the challenge of recruitment to sarcopenia trials. We tested the feasibility of setting up a UK sarcopenia registry, the feasibility of recruitment methods and sought to characterise the pilot registry population.

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Preoperative comprehensive geriatric assessment and optimisation prior to elective arterial vascular surgery: a health economic analysis

Judith S L Partridge, Andrew Healey, Bijan Modarai, Danielle Harari, Finbarr C Martin, Jugdeep K Dhesi

doi : 10.1093/ageing/afab094

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1770–1777

increasing numbers of older people are undergoing vascular surgery. Preoperative comprehensive geriatric assessment and optimisation (CGA) reduces postoperative complications and length of hospital stay. Establishing CGA-based perioperative services requires health economic evaluation prior to implementation. Through a modelling-based economic evaluation, using data from a single site clinical trial, this study evaluates whether CGA is a cost-effective alternative to standard preoperative assessment for older patients undergoing elective arterial surgery.

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Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data

Son Nghiem, Clifford Afoakwah, Paul Scuffham, Joshua Byrnes

doi : 10.1093/ageing/afab073

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1778–1784

Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD).

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Frailty is an outcome predictor in patients with acute ischemic stroke receiving endovascular treatment

Jo?o Pinho, Charlotte Küppers, Omid Nikoubashman, Martin Wiesmann, J?rg B Schulz, Arno Reich, Cornelius J Werner

doi : 10.1093/ageing/afab092

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1785–1791

Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST).

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Examining the role of specialist palliative care in geriatric care to inform collaborations: a survey on the knowledge, practice and attitudes of geriatricians in providing palliative care

Fiona Runacres, Peter Poon, Scott King, Julie Lustig, Anna Ugalde

doi : 10.1093/ageing/afab058

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1792–1801

The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant.

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The meaning of confidence from the perspective of older people living with frailty: a conceptual void within intermediate care services

Frazer Underwood, Jos M Latour, Bridie Kent

doi : 10.1093/ageing/afab109

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1802–1810

Confidence is a cornerstone concept within health and social care’s intermediate care policy in the UK for a population of older people living with frailty. However, these intermediate care services delivering the policy, tasked to promote and build confidence, do so within an evidence vacuum.

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Perspectives on ageing: a qualitative study of the expectations, priorities, needs and values of older people from two Canadian provinces

Rachel D Savage, Kate Hardacre, Aya Mahder Bashi, Susan E Bronskill, Colin Faulkner, Jim Grieve, Andrea Gruneir, Lisa M McCarthy, Stephanie A Chamberlain, Kenneth Lam, Nathan M Stall, Lynn Zhu, Paula A Rochon

doi : 10.1093/ageing/afab136

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1811–1819

Understanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples’ expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations’ age.

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How do people living with dementia perceive eating and drinking difficulties? A qualitative study

Kanthee Anantapong, Yolanda Barrado-Mart?n, Pushpa Nair, Greta Rait, Christina H Smith, Kirsten J Moore, Jill Manthorpe, Elizabeth L Sampson, Nathan Davies

doi : 10.1093/ageing/afab108

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1820–1828

Eating and drinking problems are common among people living with later-stage dementia, yet few studies have explored their perspectives.

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Changes in social, psychological and physical well-being in the last 5 years of life of older people with cancer: a longitudinal study

Lara Pivodic, Tine De Burghgraeve, Jos Twisk, Marjan van den Akker, Frank Buntinx, Lieve Van den Block

doi : 10.1093/ageing/afab125

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1829–1833

older people with cancer are at risk of complex and fluctuating health problems, but little is known about the extent to which their well-being changes in the last years of life.

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Feasibility of patient-reported outcome research in acute geriatric medicine: an approach to the ‘post-hospital syndrome’

Alexander D Franke

doi : 10.1093/ageing/afab074

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1834–1839

A patient’s self-reported health-related quality of life (HRQoL) can be quantified by a patient-reported outcome measure (PROM). A patient’s HRQoL can provide another avenue to understand the ‘post-hospital syndrome’, a period after hospital discharge that a patient remains vulnerable to subsequent re-admission. The purpose of the study was to establish the feasibility of collecting HRQoL of older inpatients treated for acute illnesses on medical ward. Feasibility of the PROM would be qualitatively judged upon completion time, response rate and sensitivity to change in HRQoL over time.

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Safety of oesophagogastroduodenoscopy in a nonagenarian population

Raphael Ellis, Dan Meir Livovsky, Dvorah Sara Shapiro, Reuven Friedmann, Asher Shafrir, Eran Goldin, Benjamin Koslowsky

doi : 10.1093/ageing/afab129

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1840–1844

invasive gastrointestinal (GI) procedures are increasingly performed on much older patients but data regarding oesophagogastroduodenoscopy (OGD) in this population are limited. We compared the indications, safety and benefits of OGD for nonagenarians compared to octogenarians.

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Burden of cardiovascular diseases in older adults using aged care services

Benjumin Hsu, Rosemary Korda, Vasi Naganathan, Peter Lewis, Sze-Yuan Ooi, David Brieger, Louisa Jorm

doi : 10.1093/ageing/afab083

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1845–1849

To quantify the burden of cardiovascular diseases (CVD) in older adults using community and residential care services.

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Learning from a successful process evaluation in care homes

Frances Allen, Janet Darby, Marie Cook, Rachel Evley, Maureen Godfrey, Jane Horne, Paul Leighton, Pip Logan, Katie Robinson

doi : 10.1093/ageing/afab139

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1850–1853

process evaluations (PE) are increasingly used in parallel with randomised controlled trials (RCT) to inform the implementation of complex health interventions. This paper explores the learning accrued from conducting a PE within the Falls in Care Homes Study (FinCH), a large UK RCT.

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Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis

Paul Bernard, Grace Corcoran, Lawrence Kenna, Claire O’Brien, Peter Ward, William Howard, Laura Hogan, Rebecca Mooney, Siobhan Masterson

doi : 10.1093/ageing/afab095

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1854–1858

many patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. Alternative care pathway models can reduce ED crowding and improve outcomes. Internationally, there is no consensus on which model is recommended.

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Diagnostic complexity in the older patient: an unusual presentation of advanced biliary disease

Jennifer Hosty, Ruth Narramore, Matthew Boothroyd, Rekha Ramanath

doi : 10.1093/ageing/afab123

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1859–1860

Biliary disease is common in the older population, and gallbladder dysfunction and increased bile lithogenicity predispose to calculi formation. This case demonstrates an unusual presentation of gallbladder empyema. A 90-year-old male with metastatic prostate cancer presented with hypoactive delirium. With no localising features, normal liver function tests but persistently raised inflammatory markers, he was initially managed as a urinary tract infection. Chest wall discomfort and swelling over the right costal margin later developed. Abdominal imaging demonstrated a massive gallbladder empyema invaginating through the lower right rib cage, causing the superficial swelling. Pre-morbid status prevented cholecystectomy and he was managed conservatively with percutaneous cholecystostomy and antibiotics. He was discharged to 24-h care 2 weeks after diagnosis with a long-term drain.

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Tetanus presenting as painful muscle spasms, dysphagia and delirium in an older adult

Minnie Merrick, Ipshita Scarrott

doi : 10.1093/ageing/afab124

Age and Ageing, Volume 50, Issue 5, September 2021, Pages 1861–1862

While tetanus is now a rare disease in the UK, it remains an important differential diagnosis for trismus and muscle spasms. Even more so in older adults, as this population is less likely to have received full vaccination. Hence, the highest incidence of tetanus in England is seen in older adults. Written informed consent for publication of their clinical details was obtained from the patient proxy.

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