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Background Molnupiravir and nirmatrelvir-ritonavir are orally administered pharmacotherapies for mild to moderate COVID-19. However, the effectiveness of these drugs among very old (≥80 years), hospitalised patients remains unclear, limiting the risk–benefit assessment of these antivirals in this specific group. This study investigates the effectiveness of these antivirals in reducing mortality among this group of hospitalised patients with COVID-19. Methods Using a territory-wide public healthcare database in Hong Kong, a target trial emulation study was conducted with data from 13 642 eligible participants for the molnupiravir trial and 9553 for the nirmatrelvir-ritonavir trial. The primary outcome was all-cause mortality. Immortal time and confounding bias was minimised using cloning-censoring-weighting approach. Mortality odds ratios were estimated by pooled logistic regression after adjusting confounding biases by stabilised inverse probability weights. Results Both molnupiravir (HR: 0.895, 95% CI: 0.826–0.970) and nirmatrelvir-ritonavir (HR: 0.804, 95% CI: 0.678–0.955) demonstrated moderate mortality risk reduction among oldest-old hospitalised patients. No significant interaction was observed between oral antiviral treatment and vaccination status. The 28-day risk of mortality was lower in initiators than non-initiators for both molnupiravir (risk difference: −1.09%, 95% CI: −2.29, 0.11) and nirmatrelvir-ritonavir (risk difference: −1.71%, 95% CI: −3.30, −0.16) trials. The effectiveness of these medications was observed regardless of the patients' prior vaccination status. Conclusions Molnupiravir and nirmatrelvir-ritonavir are moderately effective in reducing mortality risk among hospitalised oldest-old patients with COVID-19, regardless of their vaccination status. [ABSTRACT FROM AUTHOR]

Background and objectives Dementia prevalence continues to rise. It is therefore essential to provide feasible and effective recommendations to encourage healthy brain ageing and reduce dementia risk across the population. Appropriate nutrition represents a potential strategy to mitigate dementia risk and could be recommended by clinicians as part of mid-life health checks and other health initiatives to reduce dementia prevalence. The purpose of this review is to provide a clinician-focused update on the current state of the knowledge on nutrition and dementia prevention. Methods Narrative review. Results Strong evidence exists to support the consumption of healthy, plant-based dietary patterns (e.g. Mediterranean, MIND or Nordic diet) for maintaining cognitive function and reducing dementia risk in later life and is supported by dementia prevention guideline from leading public health bodies (e.g. World Health Organization). Emerging evidence suggests potential cognitive benefits of consuming specific nutrients/foods (e.g. n-3 fatty acids or fish, flavonols and B-vitamins) and multi-nutrient compounds (e.g. Fortasyn Connect). Challenges and opportunities for integrating nutritional/dietary interventions for dementia prevention into clinical practice are explored in this review. Conclusions Appropriate nutrition represents an important factor to help facilitate healthy cognitive ageing and allay dementia risk. The information provided in this article can help clinicians provide informed opinions on appropriate nutritional strategies as part of mid-life Health Checks and other risk reduction initiatives. [ABSTRACT FROM AUTHOR]

Background Substantial evidence supports the inverse association between adherence to healthy dietary patterns and frailty risk. However, the role of plant-based diets, particularly their quality, is poorly known. Objective To examine the association of two plant-based diets with incidence of physical frailty in middle-aged and older adults. Design Prospective cohort. Setting United Kingdom Subjects 24,996 individuals aged 40–70 years, followed from 2009–12 to 2019–22. Methods Based on at least two 24-h diet assessments, we built two diet indices: (i) the healthful Plant-based Diet Index (hPDI) and (ii) the unhealthful Plant-based Diet Index (uPDI). Incident frailty was defined as developing ≥3 out of 5 of the Fried criteria. We used Cox models to estimate relative risks (RR), and their 95% confidence interval (CI), of incident frailty adjusted for the main potential confounders. Results After a median follow-up of 6.72 years, 428 cases of frailty were ascertained. The RR (95% CI) of frailty was 0.62 (0.48–0.80) for the highest versus lowest tertile of the hPDI and 1.61 (1.26–2.05) for the uPDI. The consumption of healthy plant foods was associated with lower frailty risk (RR per serving 0.93 (0.90–0.96)). The hPDI was directly, and the uPDI inversely, associated with higher risk of low physical activity, slow walking speed and weak hand grip, and the uPDI with higher risk of exhaustion. Conclusions In British middle-age and older adults, greater adherence to the hPDI was associated with lower risk of frailty, whereas greater adherence to the uPDI was associated with higher risk. [ABSTRACT FROM AUTHOR]

Background Data about the clinical benefit from initial low-density lipoprotein cholesterol (LDL-C) reduction with lipid lowering treatment for secondary prevention and risk of major vascular events amongst older as compared with younger individuals treated during routine clinical care are limited. We investigated this in a nationwide cohort. Methods Individuals aged ≥ 50 years with a first-time hospitalisation for a cardiovascular event (index event, including acute coronary syndrome, non-haemorrhagic stroke, transient ischaemic attack and coronary revascularisation), 1 January 2008 to 31 October 2018, who subsequently used lipid lowering treatment, and had an LDL-C measurement before and after the event were included. Hazard ratios (HRs) for major vascular events per 1 mmol/L reduction in LDL-C were estimated for the included 21,751 older and 22,681 younger individuals (≥/<70 years old) using Cox regression. Results LDL-C lowering was associated with a 12% lower risk of major vascular events in older individuals per 1 mmol/L reduction in LDL-C (HR 0.88, 95% confidence interval [CI] 0.84–0.93), with no significant difference compared with the risk reduction amongst younger individuals (HR 0.88, 95% CI 0.83–0.93; P -value for difference between age groups: 0.86). The risk reduction was more pronounced when post hoc restricting, as a proxy for compliance, to new users with an LDL-C reduction above the lowest decile for both older (0.81, 95% CI 0.73–0.90) and younger (0.81, 95% CI 0.72–0.91) individuals. Conclusions This study strongly supports a similar relative clinical benefit of LDL-C reduction with lipid lowering treatment for secondary prevention of major vascular events amongst individuals aged ≥70 and <70 years. [ABSTRACT FROM AUTHOR]

Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer's disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI. [ABSTRACT FROM AUTHOR]

Background Strokes due to cardio embolism are generally more severe and prone to early and long term recurrence. All forms of anticoagulant therapy are associated with a two thirds risk reduction in acute ischaemic stroke associated with atrial fibrillation. Establishing a diagnosis of paroxysmal atrial fibrillation can be a challenging one. Our study will attempt to answer the question as to what duration of extended cardiac monitoring is required when screening for atrial fibrillation in cryptogenic stroke. Methods We examined the time of atrial fibrillation initial diagnosis in 50 patients with an original working diagnosis of cryptogenic stroke but later have atrial fibrillation confirmed on extended monitoring. All patients wore the external loop recorder from 1 day to 3 weeks' duration. On return of the device, data from the external loop recorder was downloaded, and reviewed by a consultant cardiologist. The total duration of monitoring using the external loop recorder was recorded. The time to first episode of algorithm detected atrial fibrillation was recorded. Results The mean duration of extended cardiac monitoring using the external loop recorder was 120.1days By seven days, atrial fibrillation had been detected in 94% of patients. By 72 hours, atrial fibrillation had been detected in 78% of patients. The mean age of participants was 58.3 years. 54.4% were female. The mean time to detection of atrial fibrillation was 52.9 hours. The median time to detection of atrial fibrillation was 34.2 hours. Conclusion External loop recorders present an opportunity for detection of paroxysmal atrial fibrillation in high risk individuals. Our study shows the feasibility and accuracy of a screening duration of seven days in the high risk post ischaemic stroke population. A one week screening timeframe allows us to screen twice as many patients for paroxysmal atrial fibrillation. Successful screening for atrial fibrillation in this high risk group allows the commencement of acceptable and safe anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Background Dementia Understand Together is a public support, awareness and stigma reduction campaign aimed at inspiring people from all sections of society to stand together with the 55,000 Irish people living with dementia. Led by the HSE working with The Alzheimer Society of Ireland and Genio it is supported by over 40 partner organisations and 230+ community champions, who are creating communities that actively embrace and include those living with dementia and their families. Methods The campaign uses personal testimonial TV commercials, radio advertising, social media and national and local news stories to build understanding among the general public about dementia. At a local level the campaign is growing a movement of people who are taking action to creative inclusive communities across Ireland. Extensive research using national biennial public surveys (2016 and 2018) (N=1003) and campaign evaluation tools has and continues to inform the development and progression of the campaign. Results 33% of respondents described themselves as knowing a lot about dementia, up from 24% in January 2016. There was a significant difference in attitudes between those who were aware of the campaign and those who were not. Dementia risk reduction is a key message of the national campaign and 52% of respondents were aware that there are things they can do to potentially reduce their risk – up from 46% in 2016. 59% who saw the TV campaign said they were impacted in some way as a result of the personal stories featured and stated that they took some action, such as calling into a friend. Conclusion The development and implementation of the campaign is a partnership approach between the leading organisations working in the area of dementia. Findings show that the campaign is creating better understanding of dementia among the general public, increasing awareness of the condition and risk reduction, and is inspiring people to take actions. [ABSTRACT FROM AUTHOR]

Background Falls are a common cause of morbidity and mortality in older adults, with most being caused by identifiable risk factors. This study aimed to assess demographics and clinical characteristics of patients who had recurrent falls attending the medicine for the older person (MFTOP) outpatient department at a tertiary centre. Methods Retrospective analysis of patients seen at MFTOP OPD between January 2018 and December 2018. Data were obtained from clinical notes. Age, gender, blood pressure, cognitive tests, blood tests, diagnoses and medications that could contribute to falls were recorded. Results 100 patients were reviewed. 60% were female (60). Mean and median ages were 83. Causes of falls included; gait/balance disorders or weakness 36.0%, environment-related/'accident' 19.0%, alcohol 5.0%, dizziness/vertigo 5.0%, visual disorder 4.0%, confusion 4.0%, others 3.0%, drop attack 1.0%, unknown 5.0%. 18.4% (18/98) had orthostatic hypotension (OH), of which 44.4% (8/18) had low standing systolic BP <120 P=0.0205 compared to the non-OH group. Median HbA1c was 39 (30 - 83) for 80 patients 95% CI 39.5-43.4. 11.9% (11/92) had low serum sodium (<135) (95% CI 137.7-139.3). 29.0% (29/100) had impaired cognition of which 13.4% (4/29) were at risk of vitamin D deficiency P=0.5767. Other medical conditions potentially contributing to falls included; arthritis 16.0%, Parkinson's disease 7% and incontinence 3.0%. Medications that can contribute to falls included; antihypertensive agents 67 (66.3%), tricyclic antidepressants 19 (18.8%), antianxiety agents 15 (14.9%), opiates 12 (11.9%), hypnotics/ tranquilizers 27(26.7%) and diuretics 28 (27.7%). Conclusion There is a high prevalence of co-morbidities and polypharmacy in patients with recurrent falls. Identifying modifiable causes may reduce the risk of falls in the future. Tighter glycaemic control was observed and relaxed glucose control in high-risk older adults are recommended. [ABSTRACT FROM AUTHOR]

Background The patient profile in a 160-bed rehabilitation hospital is evolving with increasing numbers of older adults admitted with falls and frailty. In 2018 a snapshot audit revealed over 60% of patients obtained scores indicative of cognitive impairment. Traditional falls prevention education delivered in a group format relies on attendees having an adequate level of sensory registration and cognitive abilities to comprehend and recall information given. The Occupational Therapists (OTs) proposed greater benefits from caregiver inclusion in such education to enhance understanding for both patients and caregivers on falls prevention and home environment modifications to facilitate safer home discharges. Methods A mixed-methods design was used. Quantitative data was gathered using a pre and post education 10-point Likert scale to assess attendees' perceived knowledge in four domains: (1) Falls risk factors (2) Modifiable environmental factors (3) Managing falls (4) Accessing support/information to reduce risk of falls Qualitative data was gathered through written feedback. Referrals were generated by OTs. Evening sessions facilitated increased caregiver attendance. OTs delivered a 45 minute PowerPoint presentation, demonstrated adaptive equipment and engaged in discussion with attendees. Information packs were provided to caregivers including a Home Safety Assessment Tool to aid with home environment modification. Results Data from April 2018-2019 was analysed using Microsoft Excel. 21 groups were facilitated with 385 attendees overall. Average percentage increase in knowledge in each of the four domains was 30%. Overall knowledge increased by 32%. Conclusion Increased knowledge of modifiable falls risk factors and supporting persons at risk of falls in the home was demonstrated. OTs reported reduced caregiver concerns regarding home environment modification. Home assessments completed after group attendance found caregivers had implemented recommendations made in the presentation. Further data could be collected to measure the degree of environmental modification completed prior to OT home assessments. Additional qualitative data is required to fully assess benefits to both patients and caregivers. [ABSTRACT FROM AUTHOR]

The article discusses the Scottish Intercollegiate Guidelines Network (SIGN) for risk reduction and management of delirium. Other topics include the importance of the 4 'A's Test (4AT) in delirium diagnosis, the effectiveness of non-pharmacological management of cognitive disorder spectrums in hospitals, as well as the advances in delirium research, practice, education and policy in Great Britain.

In the article, the author discusses issues in using the term 'risk feeding' and risk feeding policies in the care of people with dysphagia and older people. Other topics include the possibility that misperceptions on the relationship between aspiration and pneumonia may worsen due to said policies, the adverse effects of the policies in individualised and flexible decision making, as well as the nil-by-mouth (NBM) designation.

Background: frailty is an indicator of late-life decline marked by higher rates of disability and healthcare utilisation. Research has linked health benefits with moderate alcohol use, including frailty risk reduction. Past work suggests inflammation, measured by C-reactive protein (CRP), as one candidate mechanism for this effect. Objective: this study aims to elucidate a possible mechanism - CRP modulation - by which moderate alcohol consumption may protect against frailty. Methods: a cross-sectional study using data from the 2008 wave of the Health and Retirement Study (HRS) conducted by the University of Michigan. The HRS is a cohort study on health, retirement and aging on adults aged 50 and older living in the USA. A final sample of 3,229 stroke-free participants, over the age of 65 years and with complete data, was identified from the 2008 wave. Alcohol use was measured via self-report. Frailty was measured using the Paulson-Lichtenberg Frailty Index. CRP was collected through the HRS protocol. Results: results from structural equation modelling support the hypothesised model that moderate alcohol use is associated with less frailty and lower CRP levels. Furthermore, the indirect relationship from moderate alcohol use to frailty through CRP was statistically significant. Conclusions: overall findings suggest that inflammation measured by CRP is one mechanism by which moderate alcohol use may confer protective effects for frailty. These findings inform future research relating alcohol use and frailty, and suggest inflammation as a possible mechanism in the relationship between moderate alcohol use and other beneficial health outcomes. [ABSTRACT FROM AUTHOR]