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An introduction to the journal is presented in which the editor discusses the various topics within the issue, including subdural haematoma, an assessment of a special care acute hospital unit for people with dementia, and the epidemiology of deaths during emergency admission to hospitals.

Pain is common in people with dementia, and pain can exacerbate the behavioural and psychological symptoms of dementia. Effective pain management is challenging, not least in people with dementia. Impairments of cognition, communication and abstract thought can make communicating pain unreliable or impossible. It is unclear which biopsychosocial interventions for pain management are effective in people with dementia, and which interventions for behavioural and psychological symptoms of dementia are effective in people with pain. The result is that drugs, physical therapies and psychological therapies might be either underused or overused. People with dementia and pain could be helped by assessment processes that characterise an individual's pain experience and dementia behaviours in a mechanistic manner, phenotyping. Chronic pain management has moved from a 'one size fits all' approach, towards personalised medicine, where interventions recommended for an individual depend upon the key mechanisms underlying their pain, and the relative values they place on benefits and adverse effects. Mechanistic phenotyping through careful personalised evaluation would define the mechanisms driving pain and dementia behaviours in an individual, enabling the formulation of a personalised intervention strategy. Central pain processing mechanisms are particularly likely to be important in people with pain and dementia, and interventions to accommodate and address these may be particularly helpful, not only to relieve pain but also the symptoms of dementia. [ABSTRACT FROM AUTHOR]

The author discusses various studies on age and aging published in the journal. Topics include an overview of current thinking in Alzheimer's disease diagnosis and management, the use of routine electronic health data to derive electronic frailty indices, and a consensus process for introducing frailty screening in emergency departments.

The article presents summaries of several research on age, ageing, vascular disease, falls, cognition, frailty and pain. A randomized controlled trial evaluated a falls prevention bundle for hospitalised patients. Another study compared nebulised ketamine with intravenous morphine for moderate-to-severe acute musculoskeletal pain in emergency departments. Researchers examined outcomes for older patients with myocardial infarction using a prospective coronary reperfusion registry.

The article considers the concept of intrinsic capacity, the composite of physical and mental abilities that an individual can draw upon, as an opportunity to intervene to promote healthy ageing. It discusses the association of high-impact factors that describe the health status of individuals including locomotor, sensory, vitality, psychological and cognition domains to functional ability or loss in old age. It hypothesizes that changes in IC precede the process of disability development.

The author comments on the World Falls Guidelines that was developed to produce relevant and practical recommendations that could be applied to prevent falls throughout the world, specifically among geriatric patients. Topics covered include the potential of the guidelines in contributing to service development, improve quality of care, and promote education on falls, how the guidelines can support clinicians in their practice, and its role in the development of falls prevention services.

An introduction is presented in which the author discusses articles within the issue on topics including complex interventions for improving independent living and quality of life among community-dwelling older adults, risk of cardiovascular disease in cancer patients, and preferences of people living with dementia, their carers and clinicians when it comes to prescribing or deprescribing anti-hypertensive medication.

An introduction is presented to a series of commissioned commentaries within the issue on topics including current care for older people in Australia, care home research, structured advance care planning and end-of-life care in nursing homes, behavior in dementia care and trauma care.

In the article, the author discusses the challenges in the decision making and advance care planning on critical care admission of patients living with dementia. Also cited are the poor understanding of the public of critical care, the effectiveness of using natural language processing of unstructured records and machine learning to identify those at risk of subsequent falls, and the recommended fall prevention strategies like Tai Chi.

An introduction is presented in which the editor discusses papers within the issue on various topics, including new models for clinical decision making, the role of genomics in understanding disease mechanisms, and a falls prevention program for care homes.

An introduction is presented in which the author discusses articles within the issue on topics including innovations and developments in geriatric medicine, therapeutic and health benefits of sodium-glucose co-transporter-2 inhibitors, and telephone-based self-management support for older people at risk of hospital admission.

Clinicians who manage delirium must do so without key information required for evidence-based practice, not least lack of any clearly effective treatment for established delirium. Both the nature of delirium and the methods used to research it contribute to difficulties. Delirium is heterogeneous, with respect to motor subtype, aetiology, setting and the co-existence of dementia, and may be almost inevitable towards the end of life. Elements of assessment are subjective, so diagnosis can be uncertain or unreliable. Defining objectives of care and outcomes is sometimes unclear. Better identification and case definition, including seeking biomarkers, stratification by type, or aetiology, and application of more complex models of causation may help. This will likely require further observational epidemiology, imaging and laboratory-based research before further rounds of large-scale randomised controlled trials. Application of trial methodologies designed for drug treatments of better-defined conditions may have failed to take account of the complexities both of diagnosis and complex intervention in delirium. Both drug and complex intervention trials need sufficient preliminary work to ensure that the right dose, duration or intensity of treatment is delivered and a range of 'intermediate' and 'distal' outcome measures assessed. Re-purposing of established drugs may provide a source of investigational products. Greater use of alternative research methodologies (qualitative and realist), or adjuvants to trials (process evaluation), will help answer questions about focus, generalisability and why interventions succeed or fail. Delirium research will have to embrace both a 'back to basics' approach with increased breadth of methodologies to make progress. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented in which the editor discusses topics on the exergaming interventions in Parkinson's disease, the prevalence of frailty in patients with atrial fibrillation, and hip fracture.

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless, they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is an understanding of how to develop an intervention for people with mild cognitive impairment and dementia to promote their independence, stability, and physical activity. Introduction: Older adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective in this patient population potentially due to poor consideration of dementia-specific risk factors. An intervention is required that addresses the particular needs of older people with dementia in a community setting. Methods: We followed guidelines for the development of an intervention, which recommend a structured approach considering theory, evidence and practical issues. The process used 15 information sources. Data from literature reviews, clinician workshops, expert opinion meetings, patient-relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a pre-post intervention study and case studies were included. Data were synthesized using triangulation to produce an intervention suitable for feasibility testing. Practical consideration of how an intervention could be delivered and implemented were considered from the outset. Results: Elements of the intervention included individually tailored, dementia-appropriate, balance, strength and dual-task exercises, functional training, and activities aimed at improving environmental access, delivered using a motivational approach to support adherence and long-term continuation of activity. We focussed on promoting safe activity rather than risk or prevention of falls. Conclusion: We used a systematic process to develop a dementia-specific intervention to promote activity and independence while reducing falls risk in older adults with mild dementia. [ABSTRACT FROM AUTHOR]

Decision making with older people can be difficult because of medical complexity, uncertainty (about prognosis, treatment effectiveness and priorities), difficulties brought by cognitive and communication impairment and the multiple family and other stakeholders who may need to be involved. The usual approach, based on balancing benefits and burdens of a treatment, and then deciding on the basis of autonomy (or best interests for someone lacking mental capacity), within the constraints of resources and equity, remains valid, but is often inadequate. In addition, approaches relying on optimal communication and relationship building and professional virtues are important. Older people vary in their medical status, views and preferences more than younger people and these variations must be sought and accommodated, using a shared decision-making approach. This includes adapting to the increasing numbers of people from different cultures. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue, including falls prevention in older people, the threats to geriatric rehabilitation, and the decision-making process to antibiotic prescribing.

In the article, the editor discusses the various randomised clinical trials (RCT) on age and ageing that were published in the journal as of June 2022. Among the RCTs are the studies on the healthcare for older people in Central and South America, the effect of mid-life lifestyles like diet, exercise, and smoking on life expectancy, and the interventions to prevent falls in hospitals.

An introduction is presented in which the editor discusses the various topics within the issue, including geriatric medicine, the protective effects of vaccine against COVID-19, and hospital admission-based care.

An introduction is presented in which the editor discusses the various topics within the issue, including geriatric medicine, hypertension treatments, and mild cognitive impairment (MCI).

The author discusses articles to be published in the next issue of "Age & Ageing." Topics include the implementation of lateral flow device testing to identify COVID-19 infected care homes staff and visitors, role of designing and evaluating complex services for complex problems in scholarly geriatric medicine, and longitudinal associations between plasma fibroblast growth factor-21 and later muscle strength.

The author explores the impact factor of the journal "Age and Ageing" and the research articles it published for 2020. Topics discussed include the increase in the journal's impact factor, its research articles relating to COVID-19, studies published relating to service effectiveness in chronic obstructive pulmonary disease and anxiety and vascular surgery, and studies it published relating falls prevention guidelines.

An introduction is presented in which the editor discusses the various topics within the issue, including the effects of COVID-19 on care homes, hyponatraemia in older people, and a guideline on elder care.

An introduction is presented in which the editor discusses the various topics within the issue, including the effects of the COVID-19 pandemic to older people, dementia after delirium, and the effects of government policy on life expectancy.

An introduction to the journal is presented in which the editor discusses the various topics within the issue like geriatric medicine, polypharmacy, sarcopenia, and mapping of frailty.

Palliative sedation is a medical intervention to manage distress in dying patients, by reducing consciousness when symptom-directed therapies fail. Continuous deep sedation is ethically sensitive because it may shorten life and completely prevents communication. But sedation short of this is also common. There has been a steady increase in the use of sedation over recent decades. Sedation may have become a means to die while sleeping, rather than a method of last resort to alleviate suffering. Sedation may be requested or expected by patients, families or staff. The need for sedation may be being interpreted more loosely. The acceptance of a 'tolerable amount of discomfort' may have lost ground to a desire to get the final phase over with quickly. Sedation is not always a bad thing. Medical care is otherwise unable to completely control all distressing symptoms in every patient. Sedation may result from other necessary symptom control drugs. Dying when sedated can be seen by as 'peaceful'. We feel it is necessary, however, to highlight three caveats: the need to manage expectations, the cost in terms of loss of communication, and the grey area between continuous deep sedation and euthanasia. We conclude that there may be good grounds for sedation in palliative care, and in some cases, continuous deep sedation may be used as a last resort. But the criteria of necessary and proportionate drug treatment should remain. The normalisation of sedation into dying while sleeping should be resisted. [ABSTRACT FROM AUTHOR]

Background/Objectives: Older adults with dementia have at least a twofold increased risk of falls. Multi-factorial interventions have failed to demonstrate a reduction in falls in this group. Improved understanding of specific cognitive factors and their relationship to gait, balance and falls is required. Methods: Systematic searches of Medline, Embase, PsycInfo, and CINAHL databases from inception to April 2011 were conducted to identify prospective studies in older adults examining executive function and its relationship with falls, balance and gait abnormalities. Two independent reviewers extracted data on study populations, executive function measures and study outcomes. Results: Of 8,985 abstracts identified, 14 studies met inclusion criteria. Eleven studies examined executive function and falls. The remaining studies examined executive function and gait speed decline. Nine studies examining executive function and falls found a relationship between poor executive function and increased fall risk. All 3 studies examining executive function and gait found an association between poor executive function and declines in gait speed. Impaired executive function was associated with more serious falling patterns. Conclusions: Executive function was associated with falls and gait speed slowing in older adults. Future research should consider executive dysfunction as a training target for fall prevention, or as a factor mediating the failure of conventional fall prevention interventions. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the various topics tackled within the issue like the effects of COVID-19 on care homes, cardiopulmonary resuscitation (CPR) outcomes in older people, and cancer care for people living with dementia.

Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.Trial Registration Number: ClinicalTrials.gov: NCT01136148. [ABSTRACT FROM AUTHOR]

Background: people with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures. Aim: to investigate if balance tests, in conjunction with a falls history, can predict falls in older women with vertebral fractures. Methods: a cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180°), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured. Outcome Measure: fallers (at least one fall in a 12 month follow-up period) versus non-fallers. Results: one hundred and four women aged 63-91 years [mean = 78 ± 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR = 6.52; 95% CI = 1.69-25.22], 5 m-TUG test [OR = 1.03; 1.00-1.06], timed 10 m walk [OR = 1.07; 1.01-1.13] and the TURN180 test [OR = 1.22; 1.00-1.49] [P<0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR = 5.60; 1.40-22.45] and the 5 m-TUG test [OR = 1.04; 1.00-1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC = 60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR = 16.79, specificity = 100%, sensitivity = 13%]. Conclusions: a previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented on issues related to COVID-19 and geriatrics, including age-related anorexia and its drivers, a cohort study in which knee pain predicted loss of complex daily activities over a mean of six years of follow-up, and how frailty has been used as a public health tool to focus preventative and therapeutic activities through a range of health and social policy actions.

Common symptoms of pandemic coronavirus disease (COVID-19) include fever and cough. We describe a 94-year-old man with well-controlled schizoaffective disorder, who presented with non-specific and atypical symptoms: delirium, low-grade pyrexia and abdominal pain. He was given antibiotics for infection of unknown source, subsequently refined to treatment for community-acquired pneumonia. Despite active treatment, he deteriorated with oxygen desaturation and tachypnoea. A repeat chest X-ray showed widespread opacification. A postmortem throat swab identified COVID-19 infection. He was treated in three wards over 5 days with no infection control precautions. This has implications for the screening, assessment and isolation of frail older people to COVID-specific clinical facilities and highlights the potential for spread among healthcare professionals and other patients. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including health effects of alcohol, diagnosing osteoporosis, and nocturia.

Objective: first eye cataract surgery reduces the risk of falling. Most cataracts in elderly people are bilateral. Some binocular functions (e.g. stereopsis) are associated with falls. We aimed to determine if second eye cataract surgery reduces the risk of falling and to measure associated health gain. Study design and setting: we randomised 239 women over 70, who had been referred to a hospital ophthalmology department, with one unoperated cataract, to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow-up every 3 months for 12 months. We measured health status after 6 months. Results: visual function (especially stereopsis) improved in the operated group. Over 12 months follow-up, 48 (40%) operated participants fell at least once, 22 (18%) fell more than once. Forty-one (34%) unoperated participants fell at least once, 22 (18%) fell more than once. Rate of falling was reduced by 32% in the operated group, but this was not statistically significant (rate ratio 0.68, 95% CI 0.39, 1.19, P = 0.18). Confidence, visual disability and handicap all improved in the operated compared with the control group. Conclusion: second eye cataract surgery improves visual disability and general health status. The effect on rate of falling remains uncertain. [ABSTRACT FROM AUTHOR]

The author discusses several studies related to geriatric medicine as of September 2019. Topics covered include advances in radiotherapy that make treatments more effective while reducing adverse effects, an increase in the range of oral therapies for type 2 diabetes, and development of geriatric liaison services for older people attending various other specialties.

To estimate the number of people worldwide requiring daily assistance from another person in carrying out health, domestic or personal tasks. Data from the Global Burden of Disease Study were used to calculate the prevalence of severe levels of disability, and consequently, to estimate dependency. Population projections were used to forecast changes over the next 50 years. The greatest burden of dependency currently falls in sub-Saharan Africa, where the "dependency ratio"(ratioofdependent peopletothepopulationofworkingage)is about 10%, compared with 7– 8% elsewhere. Large increases in prevalence are predicted in sub-Saharan Africa, the Middle East, Asia and Latin America of up to 5-foldor6-fold in some cases.These increases will occur in the context of generally increasing populations,and dependency ratios will increase modestly to about 10%.The dependency ratio will increase more in China (14%) and India (12%) than in other areas with large prevalence increases. Established market economies, especially Europe and Japan,will experience modest increases in the prevalence of dependency (30%),and in the dependency ratio (up to 10%). Former Socialist economies of Europe will have static or declining numbers of dependent people, but will have large increases in the dependency ratio (up to 13%). Many countries will be greatly affected by the increasing number of dependent people and will need to identify the human and financial resources to support them. Much improved collection of data on disability and on the needs of caregivers is required.The prevention of disability and provision of support for caregivers needs greater priority. [ABSTRACT FROM AUTHOR]

Background: survivors of hip fracture are at 5- to 10-fold risk of a second hip fracture. There is little consensus about secondary prevention. Many are given calcium and vitamin D, but the evidence supporting this is circumstantial. Objective: to compare the effects of different calcium and vitamin D supplementation regimens on bone biochemical markers, bone mineral density and rate of falls in elderly women post-hip fracture. Design: randomised controlled trial. Setting: orthogeriatric rehabilitation ward. Methods: 150 previously independent elderly women, recruited following surgery for hip fracture, were assigned to receive a single injection of 300,000 units of vitamin D[sub2], injected vitamin D[sub2] plus 1 g/day oral calcium, 800 units/day oral vitamin D[sub3] plus 1 g/day calcium, or no treatment. Follow-up was one year, with measurement of 25-hydroxyvitamin D, parathyroid hormone, bone mineral density, and falls. Results: mean 25-hydroxyvitamin D increased and mean parathyroid hormone was suppressed in all the actively treated groups, more so in the group receiving combined oral vitamin D and calcium. Twenty per cent of participants injected with vitamin D were deficient in 25-hydroxyvitamin D a year later. Bone mineral density showed small but statistically significant dif- ferences of up to 4.6% between actively treated groups and placebo. Relative risk of falling in the groups supplemented with vitamin D was 0.48 (95% CI 0.26-0.90) compared with controls. Conclusion: Vitamin D supplementation, either orally or with injected vitamin D, suppresses parathyroid hormone, increases bone mineral density and reduces falls. Effects may be more marked with calcium co-supplementation. The 300,000 units of injected vitamin D may not last a whole year. [ABSTRACT FROM AUTHOR]

Evaluates the experiences of specialist nurses in evaluating elderly in-patients referred to a department of geriatric medicine at the Queen's Medical Centre in Nottingham, England. Methodology; Results; Conclusions.

The article explores the relationship between visual disorders and falls in older adults. The definitions for the terms visual acuity, contrast sensitivity and depth perception are presented. The intrinsic mechanisms of postural control and the extrinsic environmental factors, which are the two main influence on balance, are discussed. It is concluded that visual impairment is a risk factor for falls.

Presents information on a study which measured the prevalence of impairments, disabilities and handicaps in a geographically-defined elderly population. Methodology; Data collection and analysis; Results.

Presents the effectivity of audit packages regarding hospital care of elderly people. Methodology and goals of experiment; Results; Discussion.

Analyzes the feasibility of screening for prostate cancer. Criteria for justifying a cancer screening program; Data on prostate cancer in England and Wales; Incidence of prostate cancer; Risk factors; Survival rates; Pathophysiology; Estimated sensitivity and specificity of screening tests for detecting tumors of different volumes; Costs of a screening program; Unpredictability of the course of prostate cancer.

Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels. [ABSTRACT FROM AUTHOR]