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Introduction Half of older people are prescribed unnecessary or harmful medication that are not routinely deprescribed in hospital. There is a need for trials of deprescribing interventions, and for these to adopt consistent measurement and reporting of outcomes(1). Aim To develop a Core Outcome Set (COS) for use in hospital deprescribing trials for older people under the care of a geriatrician. Methods We developed a list of potentially relevant outcomes from the literature. We sought representation from four stakeholder groups: older people and carers, hospital clinicians, hospital managers, and ageing/deprescribing researchers. A gatekeeper at 15 hospitals in England identified and provided study information to hospital staff by email; and older people taking ≥5 medicines, and their carers received printed study information. Academics were recruited worldwide. The number approached was not captured. Using a two-round Delphi survey of participants from all four stakeholder groups scored , each outcome according to Grading of Recommendations Assessment, Development and Evaluation (GRADE)(2). This was followed by two consensus workshops to finalise the COS by discussing the importance, feasibility and acceptability of outcomes. Results In the Delphi survey, 200 people completed Round 1 and 114 completed Round 2. Representing all stakeholder groups, 10 people participated in Workshop 1 and 10 people in Workshop 2. Six outcomes were identified as most important, feasible and acceptable to collect in a trial and were included in the COS for hospital deprescribing trials with older people under the care of a geriatrician. These outcomes were: number of prescribed medicines stopped; number of prescribed medicines with dosage reduced; quality of life; mortality; adverse drug events and number of hospital stays. Three other outcomes were identified as important, but not currently feasible to collect: number of potentially inappropriate medicines prescribed; burden to the patient from their medication; and medication-related admissions to hospital. Conclusion The COS provides the minimum outcomes that should be collected and reported in all hospital deprescribing trials for older people under the care of a geriatrician. This COS builds on three existing COS for: medication reviews in older people with polypharmacy; addressing polypharmacy in older people in primary care; and optimising prescribing in older people in nursing homes. However, it is important when developing a COS to involve all relevant stakeholders that will be affected by a COS, which in this case was older people under the care of a geriatrician and relevant hospital staff. The six outcomes in the COS were agreed as being the most important to be implemented in all hospital deprescribing trials for older people under the care of a geriatrician. The value of considering the feasibility of outcome data collection is demonstrated by the removal of three outcomes that may have compromised COS uptake. Adoption of the COS by hospital deprescribing trials for older people under the care of a geriatrician will enable results from trials to be compared and also allow future aggregation of trial data. References 1. Lundby C, Pottegård A. Considerations regarding choice of primary outcome in clinical trials in deprescribing. British Journal of Clinical Pharmacology. 2022;88(7):3032–4. 2. Williamson PR, Altman DG, Blazeby JM, Clarke M, Devane D, Gargon E, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13(1):1–8.

Background Oral sodium bicarbonate is often used to treat metabolic acidosis in older people with advanced chronic kidney disease, but evidence is lacking on whether this provides a net gain in health or quality of life. Methods We conducted a multicentre, parallel group, double-blind, placebo-controlled randomised trial. Adults aged 60 years and over with category 4 or 5 chronic kidney disease, not on dialysis, with serum bicarbonate concentrations Results We randomised 300 participants, mean age 74 years; 86 (29%) were female. Mean baseline estimated GFR was 19 ml/min/1.73m2. Study medication adherence was 73% in both groups. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery at 12 months (-0.4 points; 95% CI -0.9 to 0.1, p=0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 versus 400). Time to commencing renal replacement therapy was similar in both groups (HR 1.22, 95% CI 0.74 to 2.02, p=0.43). Health economic analysis showed lower quality of life and higher costs in the bicarbonate arm at one year (£1234 vs £807); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness. Conclusions Oral sodium bicarbonate did not improve a wide range of health measures in this trial, and is unlikely to be cost-effective for use in the UK NHS in this patient group.

than in 2002 (41%), P= 0.027. ABPM recordings showed significantly fewer undiagnosed hypertensive individuals in 2012 (14%) that in 2002 (28%), P< 0.001. Significantly more hypertensive individuals were optimally treated in 2012, (44%) versus (19%), P < 0.001. Minimum and mean systolic BP were significantly lower in the 2012 cohort, but maximum systolic BP and diastolic BP did not differ. Use of ACE inhibitor, angiotensin receptor blockers and diuretics had significantly increased over the 10-year interval. Patient reported rates of falls, dizziness and syncope had not risen significantly. Ischaemic heart disease was significantly less common in the 2012 cohort, P< 0.05. Conclusion: Hypertension in older people is better recognised and more effectively managed now than 10 years ago. This has not been associated with a significant change in rates of falls, dizziness or syncope.

To systematically review the evidence for the effect of vitamin D supplementation on glycaemia, insulin resistance, progression to diabetes and complications of diabetes.Systematic review and meta-analysis. We searched databases including MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on fasting glucose, glycaemic control, insulin resistance, insulin/C-peptide levels, micro- and macrovascular outcomes and progression from non-diabetes to diabetes. Studies were assessed independently by two reviewers according to a pre-specified protocol.Fifteen trials were included in the systematic review. Trial reporting was of moderate, variable quality. Combining all studies, no significant improvement was seen in fasting glucose, HbA(1c) or insulin resistance in those treated with vitamin D compared with placebo. For patients with diabetes or impaired glucose tolerance, meta-analysis showed a small effect on fasting glucose (-0.32 mmol/l, 95%CI -0.57 to -0.07) and a small improvement in insulin resistance (standard mean difference -0.25, 95%CI -0.48 to -0.03). No effect was seen on glycated haemoglobin in patients with diabetes and no differences were seen for any outcome in patients with normal fasting glucose. Insufficient data were available to draw conclusions regarding micro- or macrovascular events; two trials failed to show a reduction in new cases of diabetes in patients treated with vitamin D.There is currently insufficient evidence of beneficial effect to recommend vitamin D supplementation as a means of improving glycaemia or insulin resistance in patients with diabetes, normal fasting glucose or impaired glucose tolerance.

Scope: Sedentary behaviour and bed rest in hospital are associated with multiple complications and worse health outcomes in older people. There is evidence that early mobilisation of those patients improves not only health outcomes but also general wellbeing and satisfaction with healthcare. This aspect of care is frequently compromised due to the time pressures experienced by clinical staff. We undertook a systematic literature review of studies that included volunteers helping mobilise older inpatients. Search methods: We searched Cochrane, Medline, Embase, CINNAHL, Amed and Google databases using MeSH headings and keywords within six key themes: inpatients, older, exercise, delirium, falls and volunteers. The abstracts were screened first independently then jointly by two reviewers. Full texts of relevant articles were retrieved. Reference lists were reviewed. Hospital based studies, projects or programmes in which volunteers (+/staff members) were used to assist mobilisation in medical inpatients aged over 65 were included. Multi – intervention trials were included if mobilisation was part of the protocol. We excluded studies limited to a single disease such as stroke or Parkinson’s disease. Results: 1677 papers were identified and the titles and abstracts were screened. Only four studies fulfilled the search criteria and were included in the final review. Multiple scientific abstracts related to one controlled study which included volunteer assisted mobilisation as part of the delirium prevention multi-intervention (HELP).Three observational studies were identified only on Google but were poorly evaluated or still on-going. The data available indicated a positive effect of volunteers on patient and staff satisfaction with care. Conclusions: There is a lack of randomised controlled trials of volunteer assisted mobilisation of older inpatients. When adopted as part of delirium prevention programme volunteers contributed to improved outcomes. There is insufficient evidence to provide guidance on the use of volunteers specifically to deliver mobility assistance to older inpatients.