Scientific Research

Introduction

Globally, about one-third of community-dwelling older adults suffer from complex multimorbidity. Complex multimorbidity (three or more chronic diseases and affecting three or more different body systems) have worse outcomes than multimorbidity, such as more frequent hospitalizations, and premature mortality. The effect of sociodemographic factors in the progression of multimorbidity has been found, but the lifestyle and polypharmacy remain unclear. This study aims to explore impact of lifestyle and polypharmacy on the progression of multimorbidity among community-dwelling older adults.

Methods

The study used data from the health examination records of older adults residing in Southern China in 2017 and 2020 (n=3647). The outcome was occurrence of the status of the older adults changed from multimorbidity to complex multimorbidity after 3 years. Logistic regression model was used to analyze the influence of lifestyle (diet, physical activity, smoking and drinking) and polypharmacy of baseline on the progression of multimorbidity. Demographic variables were also included in the model as confounding variables.

Results

Totally 13.5% (n=491) of older adults with multimorbidity had developed into complex multimorbidity. The proportion of complex multimorbidity increased from 32.1% to 45.6%. The logistic regression analysis indicated that, compared with who exercise daily, those who don't exercise (OR=1.561, 95%CI:1.233-1.976, p<0.001) and those exercise occasionally (OR=1.670, 95%CI:1.328-2.100, p<0.001) are more possibly to have complex multimorbidity. The smokers have a higher risk than non-smokers (OR=1.636, 95%CI:1.137-2.353, p<0.01). Those widowed are more likely to developing complex multimorbidity than those married (OR=1.532, 95%CI:1.221-1.923, p<0.001). Diet, drinking and polypharmacy had no significant effect on the progression of multimorbidity.

Conclusions

Lack of exercise, smoking and loss of spouse can significantly increase risk of the progression of multimorbidity and developing into complex multimorbidity among community-dwelling older adults with multimorbidity. Future research could focus on developing and implementing exercise-based interventions to delay the progression of multimorbidity.

Introduction

Some people living with dementia have difficulties at mealtimes, with significant implications for physical and mental health (Abdelhamid et al., 2016). Care home staff provide direct care at mealtimes (Skills for Care, 2015), but there is a shortage of high-quality dementia care training focusing on mealtimes (Fetherstonhaugh et al., 2019). This study tested the feasibility and acceptability of an evidence-based training programme promoting better mealtime care for people living with dementia (Faraday et al, 2022).

Method

The study comprised a before-and-after design using multiple methods of data collection and analysis. The qualitative arm of the study is reported here. The training programme was delivered in three care homes in the UK, chosen for differences in context, size and ownership. Trainees were recruited from a range of different roles across the homes, including care staff, kitchen staff and management staff. After training, participants attended focus groups to elicit views on their experience of the training and suggestions for improvement. Data from the focus groups were analysed using reflexive thematic analysis (Braun & Clarke, 2022).

Results

Analysis to date has generated five themes: Need a mix of experience in the room; More dementia-specific content; Make the most of group discussions; Scenarios should be nuanced and complex; One-day delivery is easiest; Facilitator experience and skill outweighs profession. These themes will inform modification of the training programme’s content and format, to increase its acceptability and usefulness to care home staff, prior to wider roll-out and evaluation. At the same time, a short animation has been co-produced with experts by experience to convey key messages from the training as accessibly as possible (https://vimeo.com/1009856313).

Conclusion(s)

This study has reduced uncertainty about the training programme’s acceptability, so that it is more likely to become embedded in practice and improve mealtime care for people living with dementia. 

Introduction: Frailty and social vulnerability use deficit accumulation approaches to understand heterogeneity in older adult health outcomes. We examined sex differences in the effect of frailty and social vulnerability on 5-year mortality and long-term care home (LTCH) entry in Nova Scotia, Canada. Methods: We followed community-dwelling older adults 65 years and over who were assessed for public home care supports from 2005 to 2018 using data from the Resident Assessment Instrument. We conducted sex-stratified and sex-disaggregated Cox proportional hazards analyses, adjusting for age, Cognitive Performance Scale and cohort year of entry. Results: Of 5,520 home care clients, mean age was 80.5 (SD 7.5), frailty Index (FI) was 0.23 (SD 0.10) and Social Vulnerability Index (SVI) was 0.22 (SD 0.69). The cohort was 66.6% female who were significantly less frail, more socially vulnerable and more cognitively intact at baseline. At five years, 49.1% females and 63.0% males had died, and 36.3% females and 29.5% males required admission to LTCH. In sex-stratified models, higher SVI was associated with decreased 5-year mortality and increased LTCH entry; while higher FI was associated with increased 5-year mortality and LTCH entry. In sex-disaggregated analyses, higher SVI remained significantly associated with decreased 5-year mortality for females (aHR 0.92; CI: 0.86-0.99, p=0.02), but not for males (aHR 0.94; 0.86-1.02, p=0.11). There was a weaker association between FI and 5-year LTCH placement for males. Conclusion: Greater frailty was associated with LTCH placement and mortality across sexes, as we hypothesized. However, in sex-disaggregated analyses, the association between frailty and LTCH entry was weaker for males and higher social vulnerability was associated with decreased mortality only in female models. This raises the importance of evaluating these populations separately, as well as the question of how current LTCH placement policies may be inadvertently perpetuating the sex (and gendered) differences of aging.

Background 

Recent advances in skeletal muscle biology have identified multiple potential candidate therapeutic interventions for sarcopenia. A systematic approach is needed to prioritise the most promising interventions for early-phase clinical studies. 

Methods 

A multidisciplinary team with expertise in sarcopenia, early-phase clinical trials, and geriatric medicine sought to identify target product profile (TPP) and intervention selection tools for neuromuscular conditions. As none were identified for sarcopenia, the group then developed a sarcopenia TPP. An algorithm was created to select interventions most suitable for early-phase trials, combining "stop/go" criteria and traffic-light ratings. The tool was tested by evaluating outputs from a recent horizon scan and was adapted iteratively based on the findings. 

Results 

Key characteristics of an effective intervention for sarcopenia, as outlined by the Therapeutic Product Profile (TPP), include: - Improving strength and/or physical performance. - Safety for adults aged 65 and over. - Mild, reversible, infrequent, and/or transient side effects only. - Oral or intranasal administration twice a day or less; injectable forms once a month or less. - Minimal or no laboratory monitoring required. - No need for cold chain storage. The selection algorithm starts with two questions: “Is the drug contraindicated for older adults?” and “Is there already a Phase 2/3 clinical trial evaluating this or similar agents for sarcopenia?” The assessment considers evidence strength, mechanism of action, effective dose, safety in older adults, administration route and frequency, side effects, patent status, and availability. Examples of interventions include Alverine citrate (deprioritized as it is contraindicated in older adults), melatonin (prioritised for its safety and plausible mechanism), and angiotensin-receptor blockers (deprioritized due to previous Phase II testing). 

Conclusions 

The TPP and intervention selection tool show promise in enabling systematic evaluation of candidate sarcopenia interventions. They will now be used to select and prioritise interventions for future trials.

Introduction Hearing and vision impairment are associated with cognitive impairment and dementia in older adults. There is limited public understanding that modifying these risk factors can reduce the risk of dementia. In previous studies 36% of older adults have not had a vision assessment and hearing aids are thought to be underused. This study aimed to increase the understanding of patients attending a memory service of the link between cognition, vision and hearing impairment and encourage participants to have future eye and hearing assessments. Method A video was developed with patient and public involvement explaining the link between eyesight, hearing and cognitive impairment and the importance of regular vision and hearing assessments (https://vimeo.com/948705659 Password EMSAMS). All patients attending a memory clinic between 16/09/24 and 05/11/24 were asked to watch this short animated video. A questionnaire was performed after the video asking about previous hearing and vision assessments and whether it was more likely for participants to book a hearing or vision assessment after the video. Results 18 patients participated. 72% had a vision assessment in the past 2 years and 94% recalled at least 1 vision assessment. 66% of participants felt that this video made it more likely they would book a vision assessment in future. 33% of participants had a hearing assessment in the last 2 years. 44% felt that this video would make it more likely that they would book a hearing assessment in future. Free text comments about the video stated that the link between hearing, eyesight and memory was interesting and that the video was easy to understand. Conclusions This study shows that a video shown to patients at memory clinic explaining the link between hearing and vision impairment, and cognitive impairment and dementia can motivate patients to book future hearing and vision assessments.

Introduction: The Free-Cog is a brief cognitive test designed to capture decline in both general cognition and executive function. The Free-Cog has been validated by comparison with the Mini-Addenbrooke Cognitive Examination in a UK secondary care setting. Here, we compare Free-Cog to the routinely-used Mini-Mental State Examination (MMSE) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scales (PSMS). 

Methods: Patients from three memory clinics were recruited (n=318 records). The Free-Cog, MMSE, IADL and PSMS were administered in-person (n=288), via telephone (n=17), or virtually using video conferencing (n=12). The four tests were compared using Pearson correlation and ability to discriminate based on dementia diagnosis using binary logistic regression and area under receiver operator characteristic (AUROC) curves. 

Preliminary results: In-person Free-Cog score correlations ranged from strong (MMSE; r=0.86, 95% Confidence Interval [CI]: [0.83-0.89], p<0.001), to moderate (IADL; r= 0.57, 95% CI: [0.48-0.65], p<0.001) to weak with the PSMS (r=0.28, 95% CI: [0.16-0.39], p<0.001). The Telephone Free-Cog only correlated significantly with MMSE (r=0.73, 95% CI: [0.39-0.90], p<0.001) and virtual Free-Cog with MMSE (r=0.92, 95% CI: [0.74-0.98], p<0.001) and IADL (r= 0.63, 95% CI: [0.09-0.88], p=0.03). Each 1-point increase in Free-Cog (Odds ratio [OR]: 0.75, 95% CI: [0.69-0.82], p<0.001) decreased the odds of being diagnosed with dementia, as the MMSE (OR: 0.66, 95%CI: [0.57-0.76], p<0.001), and IADL (OR: 0.70, 95% CI: [0.60-0.83], p<0.001). The MMSE (AUROC=0.82) followed by the IADL (AUROC=0.80), then Free-Cog (AUROC=0.79) best discriminated between dementia and diagnosed otherwise, whereas the PSMS was inadequate (AUROC=0.60). 

Conclusion: The Free-Cog appears to be a free-of-cost, valid alternative to the routinely-used MMSE, and supplements the IADL scale in capturing cognitive and functional changes associated with neurodegenerative diseases of cognition.

Introduction: Parkinson's disease (PD) is an age-related neurological condition characterized by bradykinesia, tremor, and postural instability. Weight loss within the first year of diagnosis is associated with poor prognosis. Studies suggest that if older adults lose skeletal muscle, their risk of falls and related injuries increases. Therefore, measures of body composition (e.g. muscle, fat) are important in PD, where the risk of falls is high. Established body composition analysis equipment is bulky and only used in research settings. We tested the reliability of a portable SECA mBCA 525 device that has not been validated in PD. Method: We recruited 19 participants from Movement Disorder Clinics, with 11 household controls. Participants consented to body composition analysis using a SECA mBCA 525 device. It passes a mild electrical current between adhesive electrodes on the hands and feet to determine tissue impedance. Proprietary algorithms then use the impedance and manually collected data (weight, height, waist circumference and reported activity level) to estimate fat, lean, and water mass (kilograms). We performed this process at two visits a month apart to determine test-retest reliability. Results: We collected data from 24 participants: 10/11 control and 14/19 PD participants. All five PD participants with SECA data collection 'failures' had rest tremor. However, tremor amplitude was the same as the whole group average (mean 1.6, standard deviation 1.9 vs mean 1.6, standard deviation 1.2 for the whole group). There were no significant differences between estimates of lean- and fat mass between trials 1 and 2 (Bland-Altman plot and linear regression, p>0.05). Conclusions: The SECA mBCA 525 portable bio-impedance analysis device had good test-retest reliability for assessing lean- and fat mass in subjects with and without PD. However, data collection 'failures', which may be due to limb tremor, limit its usefulness in studies of people with PD

Background: Multimorbidity poses major healthcare challenges which contributes to a decline in quality of life and an increased mortality risk. There exists heterogeneity on the internal associations within multimorbidity. We aimed to explore multimorbidity patterns and construct networks, delving into the relationships among diseases. 

Methods: The data from the health examination records of adults residing in Southern China in 2020 were utilized. Individuals aged 65 and above were included. Fifteen diseases were extracted. Hierarchical cluster analysis was performed. The multimorbidity matrix was calculated and a heatmap was drawn by Python. Gephi was used to visualize the multimorbidity network. Subgroup analysis was performed based on the clustering results and gender. 

Results: This study included 54,829 individuals, with 30,872 females (56.3%). The average age was 75.9±7.1, and the prevalence of multimorbidity was 45.5%. The heatmap revealed the closest relationship between gout and osteoarthritis, with a correlation coefficient of 0.6. The cluster analysis revealed three multimorbidity patterns: the CAD-hypertension-cardiac failure cluster, the bronchical diseases-COPD-asthma cluster, the arrhymia-hyperlipidemia-osteoporosis cluster. The network analysis confirmed the strongest connection between gout and osteoarthritis, with a weight of 1.1. Subgroup analysis based on the clustering results indicated that within the arrhymia-hyperlipidemia-osteoporosis cluster, the relationship between hyperlipidemia and osteoporosis was the most tightly linked, with a weight of 0.1. In the bronchical diseases-COPD-asthma cluster, the connection between bronchial diseases and COPD was the closest, with a weight of 0.5. In the CAD-hypertension-cardiac failure cluster, the relationship between CAD and hypertension was the strongest, with a weight of 0.4. Gender-based subgroup analysis revealed that network density among females was higher at 0.83 compared to males at 0.78. 

Conclusions: Multimorbidity is prevalent and females exhibited greater complexity in their multimorbidity patterns. These can facilitate clinicians in identifying core diseases and providing targeted interventions to lower the risks of multimorbidity.

Introduction: Coronavirus disease 19 (COVID-19) has had lasting effects on the health of individuals, particularly older adults specially those with comorbidities, who are more vulnerable to severe and long term illness. Studying the post-COVID 19 period in the older population is relevant for understanding the long-term effects of the disease. There have been conflicting results on functional decline in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in post COVID 19 older adults compared to their pre-infection baseline. This study aimed to compare functionality in older people who have survived COVID 19 infection vs those who have never tested positive for COVID 19. Method: This study was a cross-sectional observational study. The primary objective was to compare functionality in the two groups, post COVID 19 and never tested positive for COVID 19. Both groups underwent detailed assessment via questionnaire which included socio-demographic details, functionality assessment, Comprehensive Geriatric Assessment (CGA) and details regarding COVID 19 infection in those who suffered from the infection. Results: Analysis showed that both groups had no significant differences in median ADL (20 vs 20, p-value = 0.684) or IADL scores (5 vs 5, p-value = 0.181). The COVID 19 group had a higher prevalence of mild cases(70%). Between the two groups, the COVID 19 group had higher BMI (25.90 +4.45 vs 23.32 +3.62, p-value = 0.002) and education status(56% vs 20% graduate p-value = 0.001). There were no significant differences in the various domains on Comprehensive Geriatric Assessment.
Conclusion: Functionality did not differ significantly in the COVID 19 survivors vs those who never suffered from COVID 19. Of all the variables, higher Body Mass Index (BMI) and higher education status were associated considerably with COVID 19 infection.

Practitioners’ Perspectives on Medicine Optimisation for Older People from Ethnic Minority Communities with Polypharmacy in Primary Care: A Realist evaluation

Introduction

Medicine optimisation (MO) is a person-centred approach to support the safe, effective, and appropriate use of medications, aligned with patients’ preferences and needs. MO in older people, particularly those from ethnic minority communities (EMCs), can be challenging due to cultural, communication, and systemic factors. These challenges are increased by polypharmacy, the use of multiple medications to manage multimorbidity, when medication errors, non-adherence, and adverse drug interactions are more likely.

This evaluation builds on a prior realist review that highlighted the complexities of MO for older people from EMCs. By exploring the perspectives of practitioners, this research aims to understand what works, for whom, why, and under what circumstances.

Methods

A realist evaluation was conducted using middle-range context-mechanism-outcome configurations (CMOCs) developed from a prior review. Semi-structured interviews were carried out with 15 purposively sampled primary care practitioners, including GPs and pharmacists. Interviews were audio-recorded, transcribed, and analysed using a realist framework.

Result

The earlier analysis revealed that older people from EMCs often faced barriers such as varying levels of health knowledge, language differences, and cultural stigmas, which limited their understanding of treatments and engagement in MO. These contexts triggered mechanisms of mistrust and disengagement.

However, when older people from EMCs encountered practitioners who demonstrated cultural understanding and adapted communication to their needs, mechanisms such as trust, understanding, sense of empowerment, and active participation were activated. This improved their confidence and adherence to medications. Systemic constraints, such as short consultation and reliance on remote tools, often disrupted continuity of care, leaving older people feeling unsupported.

The involvement of family members and interpreters helped bridge communication gaps, but inconsistencies in understanding or engagement sometimes introduced confusion, undermining trust, and clarity.

Conclusion

MO works best when tailored to the contexts of older people from EMCs, activating mechanisms such as trust, understanding, and empowerment.