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Adverse events in exercise interventions among older adults with frailty: a study protocol of systematic review and meta-analysis

Por: Kurita · S. · Suo · R. · Maruo · K. · Nishimoto · J. · Tsujimoto · T. · Sasai · H. · Shigematsu · R. · Nakata · Y. · Osuka · Y.
Introduction

Although several systematic reviews and meta-analyses have demonstrated the benefits of exercise interventions in older adults with frailty, the potential harm associated with these interventions has not been systematically synthesised. This systematic review aims to examine the adverse events reported in exercise intervention trials involving older adults with frailty and to compare the risk of adverse events between the intervention and control groups.

Methods and analysis

Searches will be performed in four electronic databases (PubMed, Cochrane Library, Web of Science and SPORTDiscus) for published trials. Eligible studies will be randomised controlled trials of exercise interventions, including older adults with frailty aged ≥60 years, with frailty identified using a validated method. Five reviewers and three referees, all with expertise in exercise interventions, will be assigned to three independent review teams to ensure efficient screening. Reviewers will independently screen titles, abstracts and full texts using Rayyan, and then extract trial and adverse event data into an Excel spreadsheet. The risk of bias in eligible trials will be assessed using the Cochrane Risk of Bias 2 (RoB-2) tool. The referees will resolve any disagreements between the two reviewers throughout the screening, data extraction and risk-of-bias assessment processes. The primary outcome is adverse events, defined as any unfavourable, unintended signs, symptoms or disease that occurred during the study period. An independent biostatistician will perform a random-effects meta-analysis using a generalised linear mixed model with a binomial likelihood and a logit link to estimate the pooled risk ratios (RRs) for adverse events in the intervention group relative to the control group. Publication bias will be evaluated using funnel plots and Egger’s regression test. Depending on the number of available studies, subgroup analyses will be conducted to examine differences in RRs according to the study quality, duration of intervention, exercise frequency, setting and supervision.

Ethics and dissemination

Ethical approval was not required because we did not use specific patient data. The findings of the systematic review and meta-analysis will be disseminated through publication in a peer-reviewed journal and presentation at appropriate conferences.

PROSPERO registration number

CRD420251180645.

Fun Exercise for Older Adults (FEXO): study protocol for a randomised controlled trial on intrinsic capacity, adherence and motivation

Introduction

Ageing is associated with declines in physical and cognitive function that increase the risk of disability and dependence. Intrinsic capacity (IC), proposed by the WHO, provides a multidimensional framework to assess health in older adults. This study aims to evaluate whether a multicomponent recreational exercise programme (Fun Exercise for Older Adults (FEXO)) improves IC, motivation and adherence compared with a conventional programme (OTAGO).

Methods and analysis

A randomised controlled trial with two groups (2:1 ratio) will be conducted among 120 community-dwelling older adults (≥60 years). Participants will be randomly assigned to FEXO (intervention) or OTAGO (control). Both programmes will consist of 3 weekly sessions for 14 weeks. Primary outcomes: IC, assessed through validated measures (Short Physical Performance Battery, Mini Nutritional Assessment, Mini-Mental State Examination, Cornell Scale for Depression in Dementia and sensory evaluation), motivation (BREQ-3) and adherence rate. Secondary outcomes include body composition, cardiovascular parameters, frailty, cognition and resilience (PRIFOR). Data will be analysed using two-way ANOVA (groupxtime) under an intention-to-treat approach. Effect sizes (p²) and 95% CIs will be reported. Additional analyses (correlation, regression, mediation and moderation) will explore associations and intervention effects.

Ethics and dissemination

Approved by the Ethics Committee of Universidad CEU Cardenal Herrera (Ref. CEEI23/487 and CEEI25/639). Results will be disseminated through peer-reviewed journals and scientific conferences. The findings of this study will contribute to improving evidence-based strategies for promoting healthy ageing and will support the development of more engaging and effective exercise interventions for older adults.

Trial registration number

This study has been prospectively registered at ClinicalTrials.gov (identifier: NCT07133568).

Dual versus single implant fixation for geriatric distal femur fractures: protocol for a randomised, controlled pilot study at five US level 1 trauma centres

Por: Haller · J. · Achebe · C. C. · Oman · G. · Konda · S. · Garner · M. · Yuan · B. · Marchand · L. S. · DeKeyser · G. J.
Introduction

Geriatric distal femur fractures are associated with mortality rates exceeding 20%, comparable to hip fractures. Traditional single implant fixation often requires weight-bearing restrictions that delay recovery. This pilot study aims to assess the feasibility of conducting a multicentre randomised controlled trial comparing dual vs single implant fixation for geriatric distal femur fractures.

Methods and analysis

This multicentre, prospective, randomised controlled pilot trial will enrol 80 participants aged 60 years or older with displaced distal femur fractures at five US level 1 trauma centres. Patients will be randomly allocated 1:1 to receive either single implant (lateral plate or retrograde nail) or dual implant (nail-plate or dual plate) fixation. All patients will be permitted immediate weight-bearing. The primary outcome is feasibility assessed through enrolment rate (80 patients in 12 months), protocol adherence (≥90%) and follow-up retention (≥85% at 12 months). Secondary outcomes include post-surgical mobility (AM-PAC, TUG), patient-reported outcomes (PROMIS-PF, PROMIS-29), mortality (90-day and 1 year) and complication rates. Analyses will be on an intention-to-treat basis.

Ethics and dissemination

The protocol was approved by the University of Utah Institutional Review Board (IRB_00149119) and IRBs at all participating centres. Written informed consent will be obtained from participants or legally authorised representatives. Findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

NCT05292313.

Healthcare utilisation patterns among frail individuals aged 50+ years: results from the Lolland-Falster Population Study (LOFUS)

Por: Jacobsen · K. K. · Christensen · M. G. · Nilsson · C. · Jepsen · R. · Thygesen · L. · Suetta · C. · Holm · E. A.
Objectives

Frailty is a clinical syndrome characterised by impaired homeostatic mechanisms and reduced physiological reserve. Hospital admissions for ambulatory care sensitive conditions (ACSCs) are commonly used as indicators of quality in primary healthcare. We aimed to examine the association between frailty and the use of healthcare resources, including unplanned hospital visits due to ACSCs and non-ACSCs and visits to general practitioners (GPs) and medical specialists (MSs) in primary care. We hypothesised that frail individuals would have similar odds of hospital visits due to ACSCs and non-ACSCs.

Design

Registry-based epidemiological study.

Setting

Data from the Danish Lolland-Falster Health Study and national health registers. Data were collected in a rural region of Denmark between February 2016 and February 2020.

Participants

10 154 randomly selected individuals aged ≥50 years participating in the Lolland-Falster Health Study with valid frailty measurements.

Outcome measures

Hospital visits due to any diagnosis, hospital visits due to ACSCs and non-ACSCs, and visits to GPs and MSs in the primary care sector.

Results

After adjustment for age, sex, comorbidity and socioeconomic factors, frail participants had higher odds of hospital visits due to any diagnosis (OR 1.27, 95% CI 1.02 to 1.57; p=0.03). The odds of hospital visits due to ACSCs (OR 1.42, 95% CI 0.97 to 2.08; p=0.07) and non-ACSCs (OR 1.16, 95% CI 0.91 to 1.47; p=0.22) were not significantly different. Frail individuals had higher odds of visiting their GP (OR 1.21, 95% CI 1.00 to 1.46; p=0.047) but not a medical specialist (OR 0.82, 95% CI 0.62 to 1.07; p=0.15).

Conclusions

Among frail individuals, the distinction between unplanned hospital visits due to ACSCs and non-ACSCs is not meaningful. This finding is consistent with the understanding of frailty as a state of reduced physiological reserve, in which minor stressors may lead to hospital care regardless of diagnostic category.

Use of wipes with emollient and barrier properties for the prevention of pressure injuries: a multicentre randomised controlled trial

Por: Ryan · H. · Tehan · P. E. · Gumuskaya · O. · Hutton · A. · Mitchell · B.
Objective

To evaluate the effectiveness of a twice-daily application of a wipe impregnated with emollient and barrier ingredients in reducing incidence of pressure injury (PI) in aged care consumers.

Design

A single-blinded, multicentre randomised controlled trial. Randomisation was stratified by facility, using simple 1:1 randomisation within each stratum.

Setting

20 residential aged care facilities in Rural and Metropolitan New South Wales and the Australian Capital Territory, Australia.

Participants

858 aged care consumers aged ≥65 years at risk of developing a PI.

Intervention

Participants were randomised 1:1 to receive either standard hygiene practices, repositioning and use of pressure redistribution surfaces (standard care) or twice-daily applications of a pre-packaged wipe impregnated with emollient and barrier ingredients (Contiplan) to the sacrum, buttocks and heels in addition to standard care for the study duration.

Primary outcome and analysis

The primary outcome was the incidence of PIs per 1000 consumer days. Treatment effects were estimated using an intention-to-treat approach, with the absolute difference and 95% CI estimated using the Wald method. The relative difference in the incidence of PIs was estimated using a negative binomial regression model (with log link).

Results

858 participants were included in the study. There was a 50% relative reduction in the incidence of PI in the intervention compared with the control (95% CI 0.31 to 0.81, p=0.005), with an absolute rate difference of 0.31 fewer PIs per 1000 consumer days (95% CI 0.11 to 0.51).

Conclusion

The use of wipes with emollient and barrier properties significantly reduced the incidence of PIs and prolonged the time to first PI, demonstrating efficacy as a PI preventive strategy in aged care.

Trial registration

Australian and New Zealand Clinical Trials Registry, ACTRN12622001360707.

Incidence and associated factors of inadequate emergence in elderly patients undergoing elective major abdominal surgery: a prospective cohort study in Northwest Ethiopia

Por: Bayable · S. D. · Debas · S. A. · Aligaz · E. M. · Endeshaw · A. S. · Ale · Y. F. · Amberbir · W. D. · Fetene · M. B. · Yetneberk · T. · Zegeye · S. T.
Background

Inadequate emergence is a common postoperative complication in elderly patients following major abdominal surgery. This study was designed to determine its incidence, identify associated risk factors and characterise its clinical subtypes within this high-risk cohort.

Design and setting

This prospective single-centre cohort study was conducted at a comprehensive specialised tertiary care hospital in Northwest Ethiopia. Consecutive patients aged 65 years and older scheduled for elective major abdominal surgery under general anaesthesia were enrolled.

Primary outcome measure

The primary outcome was the proportion of patients experiencing inadequate emergence.

Results

A total of 388 patients were analysed. Inadequate emergence occurred in 21.9% of participants (95% CI 14.3% to 31.6%), with hypoactive emergence observed in 10.7% and emergence delirium in 11.2%. Multivariable logistic regression identified several independent predictors, including advanced age (adjusted OR (AOR)=1.9; 95% CI 1.5 to 8.2), preoperative anxiety (AOR=2.7; 95% CI 1.2 to 7.2), prolonged preoperative fasting (AOR=2.1; 95% CI 1.8 to 9.1), non-ketofol-based induction (AOR=3.4; 95% CI 1.6 to 6.3), absence of abdominal field block (AOR=4.2; 95% CI 4.0 to 9.6), substantial intraoperative blood loss (>1000 mL; AOR=1.9; 95% CI 1.2 to 7.6), postoperative nausea and vomiting requiring antiemetics (AOR=2.2; 95% CI 2.1 to 7.1) and presence of an indwelling urinary catheter (AOR=2.4; 95% CI 1.8 to 7.9).

Conclusions

Inadequate emergence occurred in approximately one in five elderly patients undergoing elective major abdominal surgery. Independent predictors included advanced age, major intraoperative blood loss, postoperative nausea/vomiting requiring antiemetics, non-ketofol-based induction, preoperative anxiety, absence of abdominal field block, presence of an indwelling urinary catheter and prolonged preoperative fasting.

Rehabilitation intervention to improve Recovery after an Episode of Delirium in adults over 65 years (RecoverED): a multicentre, single-arm feasibility study in NHS acute hospitals in the UK

Por: Allan · L. · Um · J. · OConnell · A. · Raghuraman · S. · Bingham · A. · Laberick · A. · Chandler · K. · Connors · J. · Mahmoud · A. · Hawton · A. · Goodwin · E. · Morgan-Trimmer · S. · Goodwin · V. A. · Ukoumunne · O. C. · Jackson · T. A. · Richardson · S. J. · Collier · L. · Glasby · J.
Objectives

To test a theory-informed, person-centred rehabilitation intervention for older adults following a hospital admission complicated by delirium, developed in line with the Medical Research Council framework for complex interventions, to determine whether: (a) the intervention is acceptable to individuals with delirium and (b) a definitive trial and parallel economic evaluation of the intervention are feasible.

Design

Multicentre, single-arm feasibility study.

Participants

19 patient (aged >65 years old) and carer pairs were recruited from six National Health Service acute hospitals across the UK.

Intervention

Home-based rehabilitation programme designed to support recovery after hospital discharge, addressing cognitive, physical, physiological and psychosocial needs. Delivered by a trained team of occupational therapists, physiotherapists and rehabilitation support workers, the intervention included a comprehensive home assessment, collaborative goal setting, up to 10 personalised sessions over 12 weeks and the use of a recovery record to guide progress, education and psychosocial support.

Outcome measures

Examined aspects of feasibility including eligibility, recruitment, data collection, attrition, acceptability of the rehabilitation intervention and potential to calculate cost-effectiveness.

Results

In total, 419 patients were identified as having delirium and 36 met the full eligibility. 19 patient and carer pairs agreed to participate in the study (consent rate 53%; 95% CI 35% to 70%) with 13 participants going on to start the intervention (68%; 95% CI 43% to 87%) and 10 participants completing final follow-up (53%; 95% CI 29% to 76%). Baseline assessments were conducted either during hospitalisation or postdischarge, with initial assessments occurring a mean of 18 days (SD=13.0) postdischarge, and 77% completed within 14 days. Participants completed a mean of eight sessions (SD=2.9). 19 participants completed the primary outcome at baseline, while 10 participants completed it at 6-month follow-up. The economic evaluation indicated a total cost of £1249.29 per participant, covering assessments, intervention sessions and training costs.

Conclusions

The intervention showed feasibility among older adults recovering from delirium, as evidenced by the trial processes for participants who entered the study. However, recruitment challenges indicate a need for better strategies and further research through a definitive randomised controlled trial to demonstrate the effectiveness and cost-effectiveness of the intervention.

Trial registration number

ISRCTN15676570

Biopsychosocial trajectories in older adults with planned intensive care: a protocol for a prospective observational study (GeriICU)

Por: Schumann · J. · Köhring · W. · Simm · A. · Grosskopf · A. · Szabo · G. · Schneider · T. · Prell · T.
Background

Older adults admitted to intensive care units (ICUs) following elective surgery face heterogeneous trajectories of recovery spanning the physical, cognitive and social domains. Biological ageing processes, including cellular senescence, may modulate these outcomes. Here, we present the protocol for an analytic prospective observational cohort study integrating biopsychosocial assessments and senescence-associated biomarkers to identify predictors of health-related quality of life (HRQoL) and post-ICU recovery.

Methods and analysis

Single-centre, prospective cohort study at the University Hospital Halle (Saale), Germany. Adults aged 60 years or older scheduled to undergo elective surgery and who have a planned postoperative stay in the ICU of at least 24 hours and who are able to provide consent will be enrolled. Baseline pre-ICU data will include the following: medical history, comorbidity, medications, routine laboratory values and a comprehensive geriatric assessment (eg, frailty, mobility, handgrip strength, Timed Up & Go, cognition, mood, loneliness, social status and EuroQol 5-Dimension 5-Level, EQ-5D-5L). A 5 mL serum sample will be collected for a senescence-associated secretory phenotype panel and additional ageing biomarkers. Skin autofluorescence will be used to estimate advanced glycation end-products. Telephone follow-ups at 3 and 6 months ascertain HRQoL, functional outcomes, psychosocial outcomes, rehospitalisations and institutionalisation. The primary endpoint is defined as a stable or improved HRQoL (EQ-5D-5L) at 3/6 months vs baseline. We intend to use multivariable predictive modelling with elastic-net regularisation and conduct internal validation using bootstrap resampling and cross-validation.

Ethics and dissemination

This study has been approved by the Ethics Committee of the Medical Faculty, Martin-Luther-University Halle-Wittenberg (No. 2025-112). Written informed consent is obtained from all participants. The results of this study will be reported in a peer-reviewed journal.

Trial registration number

DRKS00037969.

Seasonal and temporal trends in leading causes of hospitalisation among older adults in Hong Kong: a retrospective study across community and institutional care settings

Por: Qian · X. X. · Chau · P. H. · Lai · E. T. C. · Wong · G. L.-H. · Woo · J.
Objectives

With an ageing population, understanding leading causes of hospitalisation in older adults is critical for care strategies. These leading causes may vary across residential settings and by seasonal patterns. This study examines the temporal trends of leading causes of hospitalisation among older adults in community-dwelling and nursing home settings, specifically comparing patterns during winter and summer seasons.

Design, setting, participants and main outcome measures

A retrospective analysis of electronic medical records from Hong Kong public hospitals (2012–2018) was conducted for three million adults aged ≥65. Age-standardised and sex-standardised monthly hospitalisation rates and average annual percentage change (AAPC, representing the average yearly percentage change in rates) were examined for leading causes during summer and winter across settings.

Results

Among community-dwelling individuals, the top five causes in 2018 were symptoms, signs and abnormalities not classified elsewhere (NEC), neoplasms, genitourinary, circulatory and respiratory diseases in winter, with digestive diseases replacing respiratory diseases in summer. Symptoms, signs and abnormalities NEC (AAPC: 2.7% (95% CI 1.8% to 3.6%) in winter; 3.4% (2.8% to 4.0%) in summer), neoplasms (2.4% (1.4% to 3.4%) in winter; 2.5% (1.6% to 3.4%) in summer), genitourinary (2.5% (2.1% to 2.9%) in winter; 2.4% (1.8% to 3.0%) in summer) and digestive diseases (2.5% (1.6% to 3.3%) in winter; 2.6% (1.7% to 3.5%) in summer) increased, while circulatory diseases decreased in winter. In nursing home residents, the top five causes in 2018 were respiratory diseases, symptoms, signs and abnormalities NEC, genitourinary, circulatory and digestive diseases in winter and summer. Symptoms, signs and abnormalities NEC increased (2.9% (0.9% to 5.0%) in winter; 2.9% (0.8% to 5.1%) in summer), while circulatory diseases declined across seasons. Genitourinary diseases remained stable across seasons, whereas digestive diseases declined in winter.

Conclusions

In Hong Kong’s ageing population, seasonal and temporal shifts in hospitalisation causes were observed. Symptoms, signs and abnormalities NEC emerged as the top two causes across settings, highlighting challenges for primary care and hospital management and need for enhanced prevention and care strategies.

Global prevalence and risk factors of probable sarcopenia in older adults: a protocol for systematic review and meta-analysis

Por: Ye · Y. · Shi · Y. · Deng · T. · Gu · C.
Introduction

With the acceleration of the global ageing trend, sarcopenia has become a major public health problem. Probable sarcopenia, characterised primarily by decreased muscle strength, represents an early, potentially reversible stage. However, epidemiological evidence on the prevalence and risk factors of probable sarcopenia in older populations remains limited, scattered, and methodologically inconsistent. Therefore, systematic reviews and meta-analyses are needed to synthesise current data, quantify global and regional prevalence, identify associated risk factors, and explore sources of heterogeneity.

Methods and analysis

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2020 and Joanna Briggs Institute (JBI) methodologies, this review will include observational studies that define probable sarcopenia according to recognised consensus criteria (European Working Group on Sarcopenia in Older People 2 and Asian Working Group for Sarcopenia 2). Comprehensive searches of eleven English and Chinese databases (Web of Science, PubMed, MEDLINE, Embase, Scopus, CENTRAL, CINAHL, CBM, CNKI, WANFANG, and VIP) will be conducted from inception to January 2026. Two reviewers will independently screen, extract, and appraise studies using JBI tools. Random-effects meta-analyses will be used to estimate global and regional prevalence and to synthesise the available evidence on associated risk factors. Pre-specified subgroup and meta-regression analyses will be undertaken to explore potential sources of heterogeneity across diagnostic criteria, geographical regions, and population characteristics.

Ethics and dissemination

Ethical approval was not required for this protocol. The results of the final review will be disseminated in a peer-reviewed journal.

PROSPERO registration number

CRD420251153142.

Characteristics and functionalities of digital tools supporting motivation and adherence to physical activity in older adults with health conditions: a protocol for a scoping review

Por: Burin-Chu · S. · Agbangla · N. F. · Caby · I. · Bossede · F.
Introduction

Regular physical activity declines with age, particularly among older adults with health conditions. Digital tools, including wearable devices, mobile applications, virtual reality systems and tele-exercise platforms, offer promising ways to promote physical activity. However, the technological components of these tools and their reported associations with motivation, adherence and physical activity levels remain underexplored. This scoping review aims to map the characteristics and functionalities of digital tools used to promote physical activity among older adults with health conditions and to examine how these components are described in relation to psychobehavioural outcomes.

Methods and analysis

This review will follow the Joanna Briggs Institute methodological guidance. Searches will be conducted in PubMed, Web of Science, PsycInfo and SportDiscus. The reference lists of included studies will also be screened to identify additional relevant articles. Eligible studies will include adults aged 60 years or older with health conditions using digital tools for physical activity. Two reviewers will independently select studies and extract data on the components of digital tools. A descriptive synthesis will summarise the key technological characteristics, and a content analysis will identify and categorise tool components, describing how they are reported in relation to psychobehavioural outcomes and theoretical constructs.

Ethics and dissemination

This review does not involve human participants, so ethical approval is not required. Findings will be disseminated through peer-reviewed publications, conference presentations and stakeholder summaries.

Supported implementation of tailored hospital fall prevention interventions: a protocol for the PROTECT stepped wedge type I hybrid effectiveness-implementation trial

Por: McLennan · C. · Hassett · L. · Tilden · W. · Naganathan · V. · Haynes · A. · Jennings · M. · Ni Chroinin · D. · Richards · B. · Hallahan · A. · Biswas · R. K. · Kwok · W. · McVeigh · T. · Heppleston · E. · Jackson · D. · Nayak · V. · Delaney · S. · Howard · K. · Pinheiro · M. · Macpherson
Introduction

Patient falls in hospitals lead to patient harm, staff distress and economic burden on health systems. There are few strategies with robust evidence demonstrating benefit for the prevention of falls, especially in acute hospital settings. Education and multicomponent fall prevention approaches are promising. Rigorous systematic measurement of implementation has been lacking in most hospital fall prevention trials. This paper describes the protocol for a trial that will evaluate the impact of supported implementation of tailored multicomponent fall prevention interventions on patient falls in hospital.

Methods and analysis

A stepped-wedge hybrid type I effectiveness implementation cluster randomised trial will be conducted. Twelve inpatient wards across four metropolitan hospitals will be enrolled in the trial, clustered into groups of four and randomised to commence the intervention at one of three time periods. Patients and ward staff will be recruited to complete pre-implementation surveys, which, combined with analysis of routinely collected local falls data and staff brainstorming, will inform tailored multicomponent fall prevention interventions for each ward. Wards will receive quality improvement training, clinical facilitation and staff education for at least 4 months to support implementation of their fall prevention interventions. The primary outcome—rate of falls—will be measured using routinely collected hospital falls data from the incident management system and medical records. Pre-implementation and post-implementation patient and staff surveys, qualitative interviews and bedside audits will measure secondary effectiveness and implementation outcomes. Healthcare utilisation from hospital data will inform the cost-effectiveness analysis.

Ethics and dissemination

The Sydney Local Health District Human Research Ethics Committee (RPAH Zone) approved this trial (protocol number X24-0087 and 2024/ETH00583). The trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572). Data collection commenced in October 2024, due for completion in May 2026. Results will be published in reputable international journals and presented at relevant conferences.

Trial registration number

Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572).

A multicentre, prospective, observational study on detecting medication discrepancies using medication reconciliation as a tool at the emergency department among geriatric patients in northwest Ethiopia

Por: Moges · T. A. · Zewdu · W. S. · Yazie · T. S. · Sema · F. D. · Dagnew · F. N. · Tarekegn · G. Y. · Wondm · S. A. · Kiflu · M. · Zeleke · T. K. · Tamene · F. B. · Ferede · Y. A. · Dagnew · S. B.
Objective

Geriatric patients often face issues related to polypharmacy and adverse drug events. Re-evaluating prescribed medications and considering deprescribing is critical. Medication discrepancies (MDs) during care transitions can compromise patient safety, as over 60% of medication errors occur at these points. This study aimed to assess the magnitude of MDs and their contributing factors through the medication reconciliation (MedRec) process among geriatric patients in emergency departments of comprehensive specialised hospitals in northwest Ethiopia, as well as to determine the acceptance of pharmaceutical interventions.

Design

In this multicentre prospective observational study, the best possible medication history (BPMH) was obtained within 24 hours of emergency department admission from at least two sources. A comparison of the BPMH list with medication orders from treating physicians revealed discrepancies. Data were analysed using STATA V.17.0, using multivariable logistic regression to assess variable associations.

Setting

Adult emergency departments of comprehensive specialised hospitals in northwest Ethiopia.

Participants

Overall, 384 geriatric patients with chronic conditions and current medication use who visited the adult emergency department of the hospital from 10 January 2025 to 30 March 2025 were involved in this study.

Outcome measures

Magnitude and types of MDs, acceptance of pharmacist interventions, and factors associated with MDs.

Results

In total, 384 patients with chronic diseases visiting the hospital emergency department were recruited in the present study. Out of 384 patients involved in the study, 218 (56.77%) had encountered at least one MD. Omission error 190 (45.24%) was the most common type of MD, followed by wrong dose 82 (19.50%). Among 420 interventions, 80.48% of the total cases were accepted. Number of previous/home medications (≥5 medicines; adjusted OR (AOR)=3.12; 95% CI 1.190 to 8.151), older age (≥75 years; AOR=1.62; 95% CI 1.054 to 2.495), and number of comorbidities (≥3; AOR=1.65; 95% CI 1.066 to 2.546) were associated factors with MDs.

Conclusion

This study revealed a high prevalence of MDs in the emergency department. Polypharmacy, comorbidities and older age were factors associated with MDs. The study findings show the need for a clinical pharmacist-led MedRec implementation to enhance patient safety.

ReFIT study (reversing frailty in transplantation): protocol for a longitudinal study to assess clinical and biomedical changes in frailty through kidney transplantation

Por: Payne · T. · Shaw · A. · Hanjani · L. S. · Homes · R. · Giddens · F. · Ravuri · H. G. · Yap · C. X. · Walsh · J. · Kumar · V. · Garton · F. C. · Rhee · H. · Huang · A. · Francis · R. S. · Reid · N. · McAdams-DeMarco · M. · Gordon · E. · Midwinter · M. · Hubbard · R.
Introduction

Losses of functional reserve across multiple physiological systems have been identified in frail patients, yet the exact aetiology of frailty remains unclear. Although strongly associated with chronological age, frailty often develops at a younger age in patients with organ failure. Frailty is prevalent in patients with kidney failure; however, individuals experience improvements in physical frailty measures following kidney transplantation. This makes younger patients with kidney failure a unique population for studying both the accelerated onset of frailty and its reversal. This research project aims to test the hypothesis that frailty secondary to organ failure and age-related frailty are associated with similar molecular and physiological measures.

Methods and analysis

This longitudinal study will recruit 150 patients in three groups. Group A (kidney transplant recipients aged ≥40 years; n=50) and Group B (patients aged ≥40 years active on the kidney transplant waitlist; n=50) will comprise younger adults with frailty from organ failure. Group C (adults aged ≥65 years (or ≥55 years for Aboriginal and Torres Strait Islander patients); n=50) will comprise older community dwellers. The primary outcome is the Frailty Index (FI). Secondary outcomes include the change in FI over time, and at baseline when considering various clinical metadata, immune parameters, kidney function and nutrition intake which will be measured at baseline and 12-month time points. Longitudinal changes in frailty will be analysed using linear mixed models with multiple testing corrections for false discovery rates.

Endocrine profiles and metabolomics, measures of immune function and microcirculatory dysfunction, will be measured by liquid chromatography-mass spectrometry and/or gas chromatography-mass spectrometry. The gut microbiome will be sequenced via shotgun metagenomics (Illumina NextSeq500, 150 bp paired-end, 3Gbp/sample). Circulating cell-free DNA/mitochondrial DNA will be quantified through droplet digital PCR. Microcirculation will be assessed via sublingual dark field videomicroscopy with glycocalyx markers measured by ELISA.

Ethics and dissemination

This study will be conducted with all stipulations of this protocol, and the conditions of the ethics committee approval. Ethical principles have their origin in the Declaration of Helsinki, all Australian and local regulations and in the spirit of the standard of Good Clinical Practice (as defined by the International Conference on Harmonisation). Organs/tissues will be sourced ethically and will not be sourced from executed prisoners or prisoners of conscience or other vulnerable groups.

Ethics approval was received by the Metro South Health Research Ethics Committee (HREC/2023/QMS/95392) and ratified by the University of Queensland.

Results will be disseminated through peer-reviewed publications, academic conferences, participant newsletters and health organisation collaboration.

Knowledge, attitudes and perceptions of geriatric nursing care among nurses at specialised hospitals in North-West Ethiopia: a facility-based, mixed-methods, cross-sectional survey

Por: Abawa · E. D. · Amlak · B. T. · Bewket · B. · Alem · G.
Objectives

To assess the level of knowledge, attitudes and perceptions of nurses regarding geriatric nursing care, and to identify factors associated with these outcomes among nurses working in specialised hospitals in North-West Ethiopia.

Design

Facility-based, mixed-methods study, consisting of a cross-sectional survey and qualitative interviews.

Setting

Specialised hospitals in the Gojjam area, North-West Ethiopia. The study was conducted from 25 October to 30 November 2024.

Participants

For the survey component, 424 nurses were selected using simple random sampling. Twelve nurses were purposively selected for the qualitative in-depth interviews.

Outcome measures

Knowledge and attitudes towards geriatric nursing care were measured using the Knowledge of Participants Questionnaire and the Older People in Acute Care Survey. Logistic regression identified factors associated with knowledge and attitudes. Qualitative data were analysed thematically.

Results

44.6% (95% CI 39.8% to 49.4%) of nurses had good knowledge and 45.3% (95% CI 40.5% to 50.2%) had a favourable attitude towards geriatric nursing care. Knowledge was significantly associated with being female (AOR 1.61; 95% CI 1.02 to 2.43), holding a diploma (AOR 0.40; 95% CI 0.17 to 0.93), holding a degree (AOR 0.32; 95% CI 0.16 to 0.65), having 6–10 years of experience (AOR 0.48; 95% CI 0.31 to 0.74) and room adequacy (AOR 0.63; 95% CI 0.42 to 0.95). Attitude was associated with 6–10 years of work experience (AOR 0.65; 95% CI 0.43 to 0.99) and working in academic hospitals (AOR 0.34; 95% CI 0.21 to 0.53). Qualitative findings highlighted gaps in training, workload challenges and environmental limitations.

Conclusion

Less than half of nurses had good knowledge or favourable attitudes towards geriatric nursing care. Gender, educational level, experience and room adequacy were associated with knowledge, while experience and hospital type were associated with differing attitudes. Integrating geriatric nursing into the curriculum and allocating adequate resources are recommended.

Continence care quality from the perspective of older adults in long-term care or in receipt of home care: a scoping review

Por: Silverglow · A. · Milsom · I. · Kennedy · M. · Wijk · H. · Wagg · A.
Objectives

To assess the state of the research literature addressing what is known about the quality of continence care from the perspective of older adults in long-term care or in receipt of home care.

Design

Scoping review of the literature according to the Joanna Briggs Institute method, reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Participant: older adults (>65 years of age), either in receipt of home health or social care services or older adult residents of long-term care (nursing homes). Concept: older adult perspectives on quality of continence care (access, care to meet needs, continuity, goals, expectations, delivery, experiences, personalised care, partnerships in care, well-being and social support). Context: older adults in long-term care or in receipt of home care.

Results

We identified 14 articles from the academic literature. Sources originated from the USA (7), Australia (4), Canada (2) and 1 from Italy. Long-term care residents were the focus of 12 of the articles. Older adults reported limited access and information regarding continence care and services and variable abilities of care staff to deliver care. Older adults wanted to be actively involved in decisions about their care, preserve their autonomy and independence and wanted care to enhance their well-being.

Conclusions

Studies examining the perspectives of older adults regarding the quality of their continence care are few. Older adults value person-centredness, expert advice regarding their condition, allowing preservation of self-determination and independence where possible. Older people value meaningful relationships with empathetic care providers. There remains a need for education of care providers in continence care and for policies and practices to support continence in a dignity-preserving framework.

Registration

Open Science Framework (https://osf.io/bprq9/).

Update of the Novara Cohort Study (NCS): protocol evolution of a population-based longitudinal study on ageing in Northern Italy - cohort profile

Por: Cracas · S. V. · Garro · G. · Venetucci · J. · Martorana · M. · Antona · A. · Bettio · V. · Rossato · D. · Briacca · L. · Viola · E. · Caristia · S. · Colombo · V. · Capuzzi · L. · Roveda · C. · Varalda · M. · Rolla · R. · Sacchetti · S. · Tillio · P. A. · Capello · D. · Faggiano · F.
Purpose

The Novara Cohort Study (NCS) was established to investigate the biological, psychological and social factors that influence ageing in the general population. The study aims to identify early risk factors for frailty, allostatic load and cognitive decline, and to uncover molecular and functional markers of accelerated biological ageing. NCS addresses the need for detailed life-course data from Southern Europe to support personalised prevention and early diagnosis, and to promote healthy longevity.

Participants

NCS is a population-based, longitudinal cohort in the Novara province (Northern Italy), originally enrolling adults aged 35 and older. The inclusion criteria were later expanded to encompass all residents aged 18 and over, facilitating the study of ageing trajectories from early adulthood onward. As of mid-2025, about 1000 participants have been enrolled, and recruitment is ongoing. The cohort’s diversity in age, employment status and health conditions enhances its value for life-course analysis.

Findings to date

Following a pilot phase in 2022–2023, the whole study protocol now includes detailed demographic, clinical, behavioural, cognitive and psychosocial data, along with biological samples stored in the UPO Biobank. The protocol incorporates validated tools, comprehensive physical and cognitive assessments, and over 90 laboratory biomarkers covering inflammation, metabolism, hormonal function and coagulation. Additionally, a subset of participants underwent advanced inflammatory profiling by simultaneous measurement of 92 immune-related proteins and comprehensive genomic profiling using Illumina Single Nucleotide Polymorphism (SNP) arrays, capturing common genetic variation across multiple biological domains. Preliminary results demonstrate the feasibility of integrating deep phenotyping, reveal the roles of frailty in ageing and show initial evidence of age-related changes in inflammatory proteins.

Future plans

NCS plans to enrol at least 10 000 participants and will conduct long-term follow-up using both passive methods, such as linking with clinical records and administrative health databases, and active in-person reassessments. Future phases will integrate clinical, behavioural and cognitive data with large-scale omics analyses, including genomics, proteomics, metabolomics and transcriptomics. Machine learning techniques will be employed to model biological age, identify early signs of age-related decline and develop personalised prevention strategies. By combining high-resolution phenotyping with multidimensional data, NCS aims to find modifiable risk factors and molecular signatures of ageing, supporting national and European research efforts and encouraging collaborative studies through open data-sharing frameworks.

Determining the burden of falls amongst community-dwelling older people in Ireland to inform falls care delivery: secondary data analysis from the Irish longitudinal study on ageing - the defined study

Por: Briggs · R. · Ward · M. · Scarlett · S. · van der Velde · N. · Hernandez · B. · Romero-Ortuno · R. · Tysinger · B. · May · P. · Ahern · E. · Kenny · R. A.
Objective

Falls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland.

Design

Population-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.

Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates.

Participants/Setting

Population-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years.

Results

Almost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago).

Conclusions

The burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.

Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.

Functional decline and social support in older patients during hospitalisation: a cross-sectional study of some determinants of care in a poor resource setting, Southeast Nigeria

Por: Anyigor-Ogah · C. S. · Ekechi · A. N. · Chukwuonye · M. E. · Nweke · I. C. · Idika · I. M. · Ovuoba · C. M.
Introduction

There is a high level of older people neglect in Nigeria, especially in the rural setting, and they did not receive much attention in terms of their overall health and well-being. Government social interventions are usually geared towards the children, adolescents, pregnant women and lactating mothers. Evaluating the level of functional decline and social support among these groups and how it affects their overall well-being will enable policy formulations geared towards holistic care for them. This study aimed to determine the level of functional dependence in some basic activities of daily living (ADLs: mobility, dressing, grasp and bathing) and social support in older people to enhance evidence-based advocacy to all stakeholders in older people care.

Methods

This was a hospital-based cross-sectional study of 160 (75 males and 85 females) older people aged 65–98 years selected through systematic random sampling. The 2 test, t-test and logistic regression were used for analysis.

Results

The response rate was 100%. The mean age of male respondents was 76.31±8.34 years and that of the female respondents was 76.87±7.47 years. A statistically significant association was found between age >75 years, absence of a spouse, low education level and functional dependence in all ADLs studied. Although age independently predicted dependence in all studied ADLs, except dressing and grasp, marital status predicted dependence in dressing and bathing, and availability of care also predicted dependence in mobility.

Conclusion

Age is an independent risk factor for functional dependence in mobility and bathing, and marital status independently predicted dependence in dressing and bathing. Not receiving care also independently predicted dependence in mobility. Thus, improvements in the biopsychosocial, biomedical and economic well-being of older people will ameliorate the impact of poor care on functional status and ADLs.

Prevalence and determinants of assistive device use among older adults in India: a cross-sectional analysis of a nationally representative survey

Por: Ravi · R. · Olickal · J. J. · Adoor · A. · Sireesha · V. N. · Devasia · J. · Thankappan · K. R.
Objectives

To estimate the prevalence and identify the determinants of assistive device usage in daily life among older adults in India.

Design

Cross-sectional analysis of nationally representative survey data.

Setting

India

Participants

A total of 66 316 adults aged ≥45 years with complete information on assistive device use from Wave 1 of the Longitudinal Ageing Study in India, 2017–2018.

Primary and secondary outcome measures

The primary outcome was self-reported use of any assistive device, including visual, hearing, mobility or other assistive devices. There were no predefined secondary outcome measures. Sociodemographic and health-related variables were analysed as covariates to assess factors associated with assistive device use.

Results

The prevalence of assistive device use was 38.61% (95% CI: 37.73% to 39.50%). Use increased with age, from 34.48% among adults aged 45–59 years to 52.07% among those aged ≥75 years (adjusted prevalence ratios (aPR) 1.30; 95% CI: 1.25 to 1.35). Prevalence was higher among men (40.94%) than women (37.51%) (aPR 1.06; 95% CI: 1.03 to 1.09), among individuals with education above primary level (54.28%) compared with those with up to primary education (28.35%) (aPR 1.42; 95% CI: 1.36 to 1.48), and among urban residents (53.88%) vs rural residents (31.16%) (aPR 1.18; 95% CI: 1.14 to 1.22). A clear socioeconomic gradient was observed, with prevalence increasing from 27.65% in the poorest to 50.66% in the richest wealth quintile (aPR 1.32; 95% CI: 1.25 to 1.39). Assistive device use was higher among participants with chronic conditions (47.30%) than those without (28.16%) (aPR 1.15; 95% CI: 1.11 to 1.19) and was markedly higher among those with a prior eye or vision diagnosis (64.93%) compared with those without (14.61%) (aPR 3.94; 95% CI: 3.78 to 4.11). Among users, spectacles or contact lenses were most common (89.26%), followed by walking sticks or walkers (11.62%) and dentures (6.15%). State-level prevalence varied widely, ranging from 71.27% in Goa to 13.44% in Arunachal Pradesh.

Conclusion

Assistive device use was reported by less than half of Indian adults aged ≥45 years. The findings reveal clear socioeconomic and geographic inequities in access to assistive devices, with substantially lower use among older adults with less education, those in poorer wealth quintiles and rural residents. These disparities highlight the need for equity-focused interventions that improve accessibility to assistive devices, particularly for socially and economically disadvantaged groups and individuals with chronic conditions.

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