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Editor’s view—advancing care in geriatrics
Nathalie van der Velde
doi : 10.1093/ageing/afae230
Volume 53, Issue 10, October 2024, afae230
Advance care planning is closely tied to uncertainty, yet this relationship is often overlooked and underexplored. The papers in the collection curated by P. Collins et al examine this dynamic in the context of frailty. While uncertainty is typically viewed as a barrier to advance care planning, it can also be an opportunity to help individuals navigate and live well with uncertainty. Paradoxically, despite being a challenge, advance care planning plays a key role in supporting people to live well amidst an unpredictable future. Approaches to uncertainty vary depending on whether it can be reduced or remains unresolved. P. Collins et al thoughtfully summarise the evidence and dilemmas surrounding advance care planning in frail older adults in their accompanying commentary accompanying the themed collection: Advance care planning in older adults with frailty
Facilitating equitable research access for people living in care homes
Maria Drummond, Kirsty Cartin, Susan D Shenkin, Jennifer Kirsty Burton
doi : 10.1093/ageing/afae220
Volume 53, Issue 10, October 2024, afae220,
Editorial to accompany ‘Research happens a lot in other settings—so why not here?’ A qualitative interview study of stakeholders’ views about advance planning for care home residents’ research participation
The challenge of predicting frailty in geriatric oncology: insights from the hospital frailty risk score (HFRS) and the geriatric 8 (G8) screening tools
Betuel Gomes, Juliana Fernandes
doi : 10.1093/ageing/afae236
Volume 53, Issue 10, October 2024, afae236
To accompany: Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer
Geriatric medicine and Olympic elite sports—parallels and philosophies
Claire McDonald, Avan A Sayer, Miles D Witham
doi : 10.1093/ageing/afae212
Volume 53, Issue 10, October 2024, afae212,
The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course—important for healthy ageing
Realising the right to rehabilitation—commentary on ‘reablement, rehabilitation, recovery: everyone’s business
Anne Hendry
doi : 10.1093/ageing/afae228
Volume 53, Issue 10, October 2024, afae228,
Rehabilitation is a core component of comprehensive geriatric assessment and should be central to integrated care and support across the whole system. Yet access barriers and ageist practices still prevail within many rehabilitation services. This commentary reflects on a report and recommendations published by the British Geriatrics Society in May 2024. As lead author for the report, I share my personal reflection on the key messages and take this opportunity to thank the multidisciplinary contributors
Reimagining and rebranding advance care planning
Chetna Malhotra
doi : 10.1093/ageing/afae233
Volume 53, Issue 10, October 2024, afae233,
Advance care planning (ACP) has traditionally aimed at ensuring that patients’ end-of-life (EOL) wishes are understood and respected. However, recent literature raises concerns about its effectiveness, with many trials indicating that ACP does not significantly improve goal-concordant care, enhance quality of life or reduce healthcare costs. This is because patients’ future decisions are influenced by their transient preferences due to projection bias. To remain relevant, ACP requires a radical shift in perspective, implementation and branding. First, ACP’s mission must be redefined with a focus on: Educate, Share and Prepare. This perspective emphasises ongoing conversations about patient health and illness, sharing of patients’ current values and goals of care and preparation for the future, rather than making definitive future decisions. Second, ACP should be integrated into routine care, normalising these discussions. Simplifying ACP processes and shifting incentives to support shared responsibility among stakeholders can enhance integration. Last, rebranding ACP as ‘Advance Care Preparation’ can clarify its purpose, distinguishing it from EOL planning and increasing its uptake. This rebranding ensures that ACP meets the evolving needs of patients and their families, ultimately enhancing the quality of care and patient satisfaction. These changes in perspective, implementation and branding can transform ACP into a valuable tool for delivering compassionate, patient-centred healthcare, making it relevant to all individuals
New horizons in systems engineering and thinking to improve health and social care for older people
Navneet Aujla, Tricia Tooman, Stella Arakelyan, Tim Kerby, Louise Hartley, Amy O’Donnell, Bruce Guthrie, Ian Underwood, Julie A Jacko, Atul Anand
doi : 10.1093/ageing/afae238
Volume 53, Issue 10, October 2024, afae238,
Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people
Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose–response meta-analyses
Shudong Tian, Zhide Liang, Mengmeng Tian, Fanghui Qiu, Yingdanni Yu, Hong Mou, Yan Gao
doi : 10.1093/ageing/afae211
Volume 53, Issue 10, October 2024, afae211
We assessed the effects of different exercise modalities and doses on depression levels in older adults
Associations between amyloid-? load and cognition in cerebrovascular disease beyond cerebral amyloid angiopathy: a systematic review and meta-analysis of positron emission tomography studies
Jie Zhang, Cathy J Price, Ke Zhao, Yuanyuan Tang, Shuchang Zhong, Jingjing Lou, Xiangming Ye, Feng Liang
doi : 10.1093/ageing/afae240
Volume 53, Issue 10, October 2024, afae240
To investigate the association between VCI and amyloid-? deposition in non-CAA CVD patients.
Effects of exercise referral schemes enhanced with behavioural self-management strategies on functional capacity and self-reported disability in community-dwelling older adults. Secondary results from the SITLESS multi-country, three-armed randomized controlled trial
Pia Ø Olsen, Mark A Tully, Borja del Pozo Cruz, Maria Giné-Garriga, Laura Coll-Planas, Marta Roqué, Dietrich Rothenbacher, Dhayana Dallmeier, Oriol Sansano-Nadal, Nicole E Blackburn
doi : 10.1093/ageing/afae225
Volume 53, Issue 10, October 2024, afae225,
Exercise referral schemes (ERS) are an effective strategy for increasing physical activity (PA) in older adults. Behavioural self-management strategies (SMS) may augment the maintenance of PA and associated benefits in this population, resulting in preservation of the functional capacity and prevention of disability over the long-term
Two simple modifications to the World Falls Guidelines algorithm improves its ability to stratify older people into low, intermediate and high fall risk groups
Cameron Hicks, Jasmine Menant, Kim Delbaere, Daina L Sturnieks, Henry Brodaty, Perminder S Sachdev, Stephen R Lord
doi : 10.1093/ageing/afae192
Volume 53, Issue 10, October 2024, afae192
We conducted a secondary analysis of a cohort study to examine the World Falls Guidelines algorithm’s ability to stratify older people into sizable fall risk groups or whether minor modifications were necessary to achieve this.
The temporal sequence and reciprocal relationships of frailty, social isolation and loneliness in older adults across 21 years
Fereshteh Mehrabi, Mary Louise Pomeroy, Thomas K M Cudjoe, Emerald Jenkins, Elsa Dent, Emiel O Hoogendijk
doi : 10.1093/ageing/afae215
Volume 53, Issue 10, October 2024, afae215,
It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years.
Care trajectories and transitions at the end of life: a population-based cohort study
Isabelle Dufour, Josiane Courteau, Véronique Legault, Claire Godard-Sebillotte, Pasquale Roberge, Catherine Hudon, the TorSaDE Cohort Working Group
doi : 10.1093/ageing/afae218
Volume 53, Issue 10, October 2024, afae218
To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death.
Feasibility and acceptability of the HOLObalance telerehabilitation system compared with standard care for older adults at risk of falls: the HOLOBalance assessor blinded pilot randomised controlled study
Marousa Pavlou, Carol Ann Flavell, Fariba Mostajeran Gourtani, Christos Nikitas, Dimitris Kikidis, Athanasios Bibas, Dimitris Gatsios, Vassilis Tsakanikas
doi : 10.1093/ageing/afae214
Volume 53, Issue 10, October 2024, afae214,
To determine the platform’s safety, acceptability and feasibility, investigate functional gait and dynamic balance benefits and provide data for a definitive trial
The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study
Lizhen Ye, Esmee Bally, Sophie A Korenhof, Irene Fierloos, Tamara Alhambra Borrás, Gary Clough, Hein Raat, Amy van Grieken
doi : 10.1093/ageing/afae210
Volume 53, Issue 10, October 2024, afae210,
This study aims to examine the bidirectional association between loneliness and frailty across the different domains.
Influence of intergenerational social mobility on brain structure and global cognition: findings from the Whitehall II study across 20 years
Yingxu Liu, Benjamin Thyreau, Yuehua Cui, Ye Zhang, Yasuko Tatewaki, Yasuyuki Taki
doi : 10.1093/ageing/afae221
Volume 53, Issue 10, October 2024, afae221,
To examine the association of social mobility, brain grey matter structure and global cognition
Effects of controlled supramaximal high-intensity interval training on muscle capacities and physical functions for older adults: analysis of secondary outcomes from the Umeå HIT study—a randomised controlled trial
Erik Frykholm, Mattias Hedlund, Clemens Becker, Henrik Holmberg, Bengt Johansson, Jochen Klenk, Nina Lindelöf, Ulrich Lindemann, Emma Simonsson, Carl-Johan Boraxbekk
doi : 10.1093/ageing/afae226
Volume 53, Issue 10, October 2024, afae226
This study investigated the effectiveness of supramaximal high-intensity interval training (supramaximal HIT) on muscle capacities and physical function compared to moderate-intensity training (MIT) for older adults
Core outcome set for studies evaluating interventions to prevent or treat delirium in long-term care older residents: international key stakeholder informed consensus study
Gregor Russell, Namrata Rana, Siobhan T Reilly, Anas Shehadeh, Valerie Page, Najma Siddiqi, Louise Rose
doi : 10.1093/ageing/afae227
Volume 53, Issue 10, October 2024, afae227
Trials of interventions to prevent or treat delirium in older adults resident in long-term care settings (LTC) report heterogenous outcomes, hampering the identification of effective management strategies for this important condition. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in this population
Social isolation, loneliness and low dietary micronutrient intake amongst older people in England
Andrew Steptoe, Hoi Lam Fong, Camille Lassale
doi : 10.1093/ageing/afae223
Volume 53, Issue 10, October 2024, afae223
Social isolation and loneliness are associated with increased risk of adverse health outcomes at older ages. This study evaluated whether isolation and loneliness are related to inadequate intake of micronutrients in the diet.
Retrospective evaluation of the world falls guidelines-algorithm in older adults
Bob van de Loo, Martijn W Heymans, Stephanie Medlock, Ameen Abu-Hanna, Nathalie van der Velde, Natasja M van Schoor
doi : 10.1093/ageing/afae229
Volume 53, Issue 10, October 2024, afae229
The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own
Real-world mobility recovery after hip fracture: secondary analyses of digital mobility outcomes from four randomized controlled trials
Monika Engdal, Kristin Taraldsen, Carl-Philipp Jansen, Raphael Simon Peter, Beatrix Vereijken, Clemens Becker, Jorunn Laegdheim Helbostad, Jochen Klenk
doi : 10.1093/ageing/afae234
Volume 53, Issue 10, October 2024, afae234
To estimate the progression of real-world mobility the first year after hip fracture using digital mobility outcomes
Assessing 1-year sodium-glucose co-transporter-2 inhibitor tolerance in older adults
Stephanie M Schafer, Marcia C Zeithamel, Nancee V Waterbury, Brian C Lund
doi : 10.1093/ageing/afae237
Volume 53, Issue 10, October 2024, afae237,
Evidence concerning tolerability of sodium-glucose co-transporter-2 (SGLT2) inhibitors in older adults is limited due to under-representation in clinical trials. Our study aimed to determine the extent to which SGLT2 inhibitor intolerance increases with age and explore additional factors associated with intolerance.
Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study
Charlotte McLennan, Catherine Sherrington, Wendy Tilden, Matthew Jennings, Bethan Richards, Anne-Marie Hill, Greg Fairbrother, Francis Ling, Vasi Naganathan, Abby Haynes
doi : 10.1093/ageing/afae208
Volume 53, Issue 10, October 2024, afae208,
Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies
Intersection between person-centred practice and Montessori for dementia and ageing in residential aged care
Marta Woolford, Lauren Bruce, Daniella Rigoni, Hannah Gulline, Phillipa Horsman, Ann MacRae, Danielle Berkovic, Niluksha Morawaka, Silvia Alberti, Helen Skouteris ... Show more
doi : 10.1093/ageing/afae217
Volume 53, Issue 10, October 2024, afae217,
Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC.
Exploring the lack of continuity of care in older cancer patients under China's ‘integrated health system’ reform
Jiawei Geng, Ran Li, Xinyu Wang, Rongfang Xu, Jibing Liu, Dixi Zhu, Gaoren Wang, Therese Hesketh
doi : 10.1093/ageing/afae213
Volume 53, Issue 10, October 2024, afae213
Continuity of care is essential to older patients’ health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused.
“Research happens a lot in other settings—so why not here?” A qualitative interview study of stakeholders’ views about advance planning for care home residents’ research participation
Brittany Nocivelli, Fiona Wood, Kerenza Hood, Carolyn Wallace, Victoria Shepherd
doi : 10.1093/ageing/afae235
Volume 53, Issue 10, October 2024, afae235
Underrepresentation of care home residents in research has resulted in a poorer evidence base for health care in care homes. Fewer opportunities to take part in research, as well as assumptions made by others about their interest or wishes, creates challenges for residents’ inclusion in research. Early discussions about research preferences and wishes may be beneficial. This qualitative study aimed to explore stakeholders’ views about how care home residents can be supported to communicate their wishes about research participation
Navigating dementia feeding decisions in Asia: a mixed methods study of caregivers
Ellie B Andres, Isha Chaudhry, Ishwarya Balasubramanian, Louisa Poco, Philip Yap, Chetna Malhotra
doi : 10.1093/ageing/afae232
Volume 53, Issue 10, October 2024, afae232,
Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate
Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before–after analysis based on a quality improvement project
Benjamin T Dodsworth, Kelly A Reeve, Martin Zozman, Philipp Meier, Felix Buddeberg, Marius Möller, Simone Pascale Wildhaber, Mary-Anne Kedda, Sönke Böttger
doi : 10.1093/ageing/afae219
Volume 53, Issue 10, October 2024, afae219
To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time
