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Purpose: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty., Methods: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics., Results: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %)., Conclusions: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm., Competing Interests: Declaration of competing interest A.J.C. has received grant or consulting funds from the Medical Research Future Fund, Dementia Australia Research Foundation and the Pharmaceutical Society of Australia. All these funds were paid to the administering University. A.J.C. is also a national board director for the Pharmaceutical Society of Australia. S.H. belongs to an endowed chair funded by donations from Hakue technology, PROUMED, Japan Bio Products, Towa Pharmaceutical, Yellow Eight and Sugi Holdings and received research funding from SOMPO Care Inc. outside of this work. N.M.V. has received grant or consulting funds from UCB Biopharma, Nestlé and Vegenat. R.V. was previously on the board of Resthaven and the board governance committee. Visvanathan is co-founder and chair of the clinical advisory group for a wearable sensor technology start-up HealthVibes.ai. J.S.B. has received grant or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Australian Commission on Safety and Quality in Health Care, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations. All these funds were paid to the administering University. All other authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: Depression is common amongst Australian residential aged care services (RACS) residents. This study aimed to estimate the risk of depression amongst residents and identify factors associated with this risk. In care settings such as RACS, time-efficient screening tools to identify depression risk may be a preferred tool., Methods: The two-item Patient Health Questionnaire (PHQ-2), derived from the nine-item PHQ-9 used commonly in the United States (US), was employed in this study. A resident was identified as being at risk of depression where the score was ≥3. Multivariable logistic regression analysis was used to identify independent factors associated with being at risk of depression., Results: Residents' mean age was 87.7 (standard deviation: 7.3) years and 73% were female. One-fifth of residents (n = 108 or 20%) were at risk of depression. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99); Pain Assessment in Advanced Dementia (PAINAD) score (OR 1.55, 95% CI 1.11-2.16); Epworth Sleepiness Scale (ESS) score (OR 1.08, 95% CI 1.03-1.13); and 38-item Frailty Index (FI) score (OR 1.07, 95% CI 1.03-1.10) were significantly associated with being at risk of depression, whilst sex, urinary incontinence, polypharmacy, Dementia Severity Rating Scale (DSRS) and Nursing Home Life Space Diameter (NHLSD) score were not., Conclusions: One in five residents were at risk of depression. Younger age, higher pain, higher daytime sleepiness and higher frailty status were associated with depressive risk. Future studies focusing on interventions targeting these factors may contribute to improved health outcomes., (© 2024 The Author(s). Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Objective: Deprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain., Design: Secondary cross-sectional analyses of data from 4 cohort studies., Setting and Participants: A total of 1142 residents in 31 nursing homes., Methods: Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts., Results: In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06-1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45-2.18), aspirin (PR, 1.31; 95% CI, 1.04-1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00-1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan., Conclusions and Implications: There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing., Competing Interests: Disclosure Australia: J.S.B. has received grant funding or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations unrelated to this work. All grants and consulting funds were paid to the employing institution. R.V. was previously a board member and part of the clinical governance committee of Resthaven Incorporated. R.V. is co-founder and chair of the clinical advisory group for a wearable sensor technology start-up HealthyVibes.ai. China: None. Japan: S.H. belongs to an endowed chair funded by donations from Hakue technology, PROUMED, Japan Bio Products, Towa Pharmaceutical, Yellow Eight and Sugi Holdings. S.H. received research funding from SOMPO Care Incorporated outside of this work. Spain: N.M.V. has received grants and consulting funds from UCB Biopharma and Vegenta., (Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes., Aims: To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use., Methods: Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing., Results: Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes., Conclusion: Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Objectives: This study aimed to explore the feasibility (including recruitment, safety and adherence) and the effects of a twice weekly supervised Judo-based exercise program over eight weeks on mobility, balance, physical performance, quality of life, fear of falling and physical activity (including by frailty status) in community-dwelling older people aged ≥65 years., Design: Pre-post study., Participants: A total of 17 participants (mean age 74.3±6.2; range 66-87 years; 76.5% female)., Intervention: A Judo-based exercise program conducted twice weekly for 60 minutes per session over eight weeks., Measurements: Pre and post assessments included the Timed Up and Go (TUG); the Berg Balance Scale (BBS); the Short Physical Performance Battery (SPPB); the Short Form Health Survey-36 (SF-36); the Falls Efficiency Scale International (FES-I); and an ActivPal accelerometer to measure participants' physical activity., Results: Most participants had low (≤3) Charlson's Comorbidity Index scores (n=17, 100%), were well nourished (n=16, 94.1%), not sarcopenic (n=16, 94.1%), and not cognitively impaired (n=13, 76.5%), anxious or depressed (n=14, 82.4%). Ten participants (58.8%) were non-frail and seven were pre-frail (41.2%). Significant improvements (p<0.05) were seen for mobility (TUG), balance (BBS) and physical performance (SPPB). Pre-frail participants showed greater improvement in mobility (TUG) than non-frail participants (p=0.020). No changes (p≥0.05) were seen in quality of life, fear of falling, or physical activity. Participants' adherence (i.e., attending sessions) was high (i.e., ≥81.2%). No serious adverse events or withdrawals were reported., Conclusion: Findings suggest that the eight week Judo-based exercise program can be delivered safely to older adults aged ≥65 years, including those at-risk of frailty, as long as there is close supervision with individualisation of the program in response to emergent health symptoms and the program is conducted on requisite Judo mats. This Judo-based exercise program is effective in improving physical function with potential to prevent falls and frailty risk., Competing Interests: ADJ, GT and RV report no conflict of interest in relation to this project. MV and MH are Judo coaches at the AUJC who developed and delivered the eight week Judo-based exercise program. MV and MH were not involved in assessing participants or collecting data.

Objective: To investigate symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes (NHs)., Methods: Secondary cross-sectional analyses of two prospective cohort studies involving 12 Australian NHs and four Japanese NHs. Frailty was measured using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Regular medications were classified as symptomatic or preventive based on published lists and expert consensus. Descriptive statistics were used to compare the prevalence and ratio of symptomatic to preventive medications., Results: Overall, 550 Australian residents (87.7 ± 7.3 years; 73.3% females) and 333 Japanese residents (86.5 ± 7.0 years; 73.3% females) were included. Australian residents used a higher mean number of medications than Japanese residents (9.8 ± 4.0 vs 7.7 ± 3.7, p < 0.0001). Australian residents used more preventive than symptomatic medications (5.5 ± 2.5 vs 4.3 ± 2.6, p < 0.0001), while Japanese residents used more symptomatic than preventive medications (4.7 ± 2.6 vs 3.0 ± 2.2, p < 0.0001). In Australia, symptomatic medications were more prevalent with increasing frailty (non-frail 3.4 ± 2.6; frail 4.0 ± 2.6; most-frail 4.8 ± 2.6, p < 0.0001) but less prevalent with age (< 80 years 5.0 ± 2.9; 80-89 years 4.4 ± 2.6; ≥ 90 years 3.9 ± 2.5, p = 0.0042); while preventive medications remained similar across age and frailty groups. In Japan, there was no significant difference in the mean number of symptomatic and preventive medications irrespective of age and frailty., Conclusions: The ratio of symptomatic to preventive medications was higher with increasing frailty but lower with age in Australia; whereas in Japan, the ratio remained consistent across age and frailty groups. Preventive medications remained prevalent in most-frail residents in both cohorts, albeit at lower levels in Japan., (© 2023. The Author(s).)

Objectives: Excessive daytime sleepiness is an increasingly frequent condition among older adults with comorbidities and living in nursing homes (NHs). This study investigated associations between participants' characteristics and excessive daytime sleepiness (EDS); the ability of the Epworth Sleepiness Scale (ESS) scores, EDS, and EDS severity levels to predict mortality at 12 months of follow-up; and the optimal cut-off for ESS to predict mortality among NH residents., Design: Prospective and cross-sectional analysis in a prospective study., Setting and Participants: Older adults permanently residing in 12 NHs from South Australia., Methods: Baseline characteristics including the ESS were collected and mortality at 12 months was assessed. Logistic regression analyzed associations between participants' characteristics and EDS (ESS >10). Kaplan-Meier cumulative survival estimates followed by log-rank and adjusted Cox proportional hazards models explored associations of ESS scores, EDS, and EDS severity levels with time-to-incident death. Receiver operator curve analysis assessed the best cut-off for ESS to predict mortality risk., Results: A total of 550 participants [mean (SD) age, 87.7 (7.2) years; 968 (50.9%) female]. Malnutrition [adjusted odds ratio (aOR) 2.02, 95% confidence interval (CI) 1.13‒3.61], myocardial infarction (aOR 1.91, 95% CI 1.20‒3.03), heart failure (aOR 2.85, 95% CI 1.68‒4.83), Parkinson's disease (aOR 2.16, 95% CI 1.04‒4.47) and severe dementia (aOR 8.57, 95% CI 5.25‒14.0) were associated with EDS. Kaplan-Meier analyses showed reduced survival among participants with EDS (log-rank test: χ 2  = 25.25, P < .001). EDS predicted increased mortality risk (HR 1.63, 95% CI 1.07-2.51, P = .023). ESS score of 10.5 (>10) was the best cut point predicting mortality risk (area under the curve = 0.62)., Conclusions and Implications: EDS predicts mortality risk and is associated with age-related comorbidities in NH residents. Screening for EDS is a simple strategy to identify NH residents at higher risk of adverse outcomes, triggering an assessment for reversibility or conversations about end-of-life care., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs)., Objective: The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline., Methods: Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review., Results: Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20-2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12-2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29-0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators., Conclusions: Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions., (© 2023. The Author(s).)

The practice of judo appears to impact positively on physical performance, muscle strength and flexibility in older people, while also benefiting bone mineral density in middle-aged adults. This scoping review aimed to map the range, scope and type of relevant studies conducted to examine the safety, feasibility and effects of judo interventions on various health-related outcomes designed for middle-aged and older adults (≥45 years) with no previous experience in judo. Six databases as well as gray literature were searched using a developed search strategy. Two independent reviewers screened the titles and abstracts, as well as full-texts of relevant articles using data extraction tools developed for the purpose of this study. Fifteen original studies were included, comprising 648 participants (mean age 45-77.8 years). All 15 studies reported significant positive results of ≥1 health-related outcome. Quality of life and bone mineral density seemed to improve only after longer interventions (≥9 or ≥12 months, respectively), while results regarding fear of falling and physical activity levels were mixed. Five studies showed improvements in fear of falling while four studies reported no change. Similarly, two studies showed improvements in physical activity, while another study showed no change. Five studies reported on safety and deemed their intervention to be safe (no adverse events), with two studies confirming feasibility. Findings suggest that judo interventions can positively impact health-related outcomes in middle-aged and older adults. However, studies had small sample sizes and more research is needed to confirm these findings. Geriatr Gerontol Int 2023; 23: 163-178., (© 2023 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Objective: Despite growing research on sedentary behaviour and physical activity among hospitalised older people, there is little evidence of effective intervention strategies. This study sought input from clinical staff from various health professions on strategies to increase physical activity and reduce sedentariness for hospitalised older people., Methods: A 60-minute focus group discussion involving two physiotherapists, two occupational therapists, one doctor, one nurse and one social worker was conducted. Participants were recruited from a subacute geriatric ward and an acute orthopaedic ward with an orthogeriatric service at a general hospital. Data were thematically analysed., Results: Six strategies to reduce sedentary behaviour and increase physical activity were identified: clear and positive communication for patients and family/carers; educating patients and family/carers; involving family/carers and volunteers; setting physical activity goals; utilising group activities and activities of daily living (ADL); and making the hospital environment activity-friendly., Conclusions: This research has revealed novel strategies to increase physical activity and reduce sedentary behaviour in hospital. The next step is to design interventions for testing., (© 2022 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Background: Frailty is common among residential aged care services (RACS) residents; however, little is known about how frailty changes over time in this population. This study aimed to estimate minimally important difference (MID) in frailty to then describe: frailty change over 12 months; and factors associated with worsening frailty., Methods: Prospective cohort study across 12 RACS sites of a single aged care organisation in South Australia (n = 548 residents, mean age 87.7 ± 7.2 years, 72.6% female). Frailty was measured using a frailty index (FI) with 12 months between baseline and follow-up. MID was calculated cross-sectionally (anchor-based using self-reported health, and ½SD for distribution-based)., Results: Between-person MID for the FI was identified as 0.037 (anchor-based) and 0.063 (distribution-based). Using the conservative value of 0.063 as the basis for change, 32.3% (n = 177) of residents remained stable, 13.7% (n = 75) improved, 33.0% (n = 181) worsened and 21.0% (n = 115) died over 12 months. In a multivariable analysis, significant predictors of the dichotomous outcome of worsening and death at 12 months were: being malnourished (odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.23, 3.75), at risk of malnutrition (OR = 1.98, 95%CI = 1.34, 2.91) and diabetes (OR = 1.61, 95%CI = 1.06, 2.42) compared to those who remained stable or improved., Conclusions: A 6.3% change in frailty for RACS residents is a conservative MID. Frailty is dynamic in RACS residents, and stability or improvement was possible even for the most-frail. Treatments such as nutritional interventions, exercise and diabetes management are likely to benefit frailty., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Life-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1 year., Design: Prospective cohort study., Setting and Participants: Twelve nursing homes including 556 residents, mean age 87.73 ± 7.25 years, 73.0% female., Methods: Life-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale., Results: NHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n = 527) and wing (86.4%, n = 485). One-half of the residents left their wing daily (51.0%, n = 284), and over one-quarter (26.4%, n = 147) ventured outside their nursing home at least weekly. Significant associations (P &lt; .05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P &lt; .05) of lower mortality, lower falls rate, and higher QoL at 1 year when compared with moderate or low mobility., Conclusions and Implications: Given the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: Sarcopenia is a common disorder of loss of muscle mass and function among older adults; however, few studies have examined screening instruments for sarcopenia risk in residential aged care services (RACS). The aims of this study were to measure sarcopenia risk in RACS residents using the SARC-F, describe factors associated with sarcopenia risk and examine the predictive validity of the SARC-F for 12-month mortality., Methods: This was a prospective cohort study carried out in South Australian RACS across 12 sites. In total, 541 residents (mean age 87.7 [7.3] years, 72.6% women) were included in the study. Sarcopenia risk was measured using a modified SARC-F (≥4 point cut point)., Results: We identified 89.5% (n = 484) of residents at risk of sarcopenia. Significant (P > 0.05) predictors of sarcopenia risk in multivariable analysis included the presence of diabetes (relative risk [RR] = 1.08), classification as most-frail (RR = 1.06) and smaller Nursing Home Life Space Diameter (NHLSD) score (RR = 0.99). Mortality was observed in 20.9% (n = 113) of residents over a 12-month follow-up. Classification as at-risk of sarcopenia was a significant predictor of 12-month mortality; however, it had a poor area under the receiver operator curve (0.56), and a low positive predictive value (23.1%). The best performing cut-point of ≥7 also had poor discriminative ability (under the receiver operator curve = 0.66, positive predictive value = 30.8%)., Conclusions: Sarcopenia risk is extremely common among RACS residents and its presence is a significant contributor to 12-month mortality. Low discriminative ability for the SARC-F was noted across multiple cut-off scores for predicting mortality at 12 months. Diabetes management and promoting physical activity and nutrition among RACS residents are likely to influence sarcopenia risk positively. Geriatr Gerontol Int 2022; 22: 206-212., (© 2022 Japan Geriatrics Society.)

Background: The Frailty In Residential Sector over Time (FIRST) Study is a 3-year prospective cohort study investigating the health of residents living in residential aged care services (RACS) in South Australia. The study aims to examine the change in frailty status and associated health outcomes., Methods: This interim report presents data from March 2019-October 2020. The study setting is 12 RACS from one organisation across metropolitan and rural South Australia involving 1243 residents. All permanent (i.e. respite or transition care program excluded) residents living in the RACS for at least 8 weeks were invited to participate. Residents who were deemed to be medically unstable (e.g. experiencing delirium), have less than 3 months to live, or not fluent in English were excluded. Data collected included frailty status, medical diagnoses, medicines, pain, nutrition, sarcopenia, falls, dementia, anxiety and depression, sleep quality, quality of life, satisfaction with care, activities of daily living, and life space use at baseline and 12-months. Data Linkage will occur over the 3 years from baseline., Results: A total of 561 permanent residents (mean age 87.69 ± 7.25) were included. The majority of residents were female (n = 411, 73.3%) with 95.3% (n = 527) being classified as either frail (n = 377, 68.2%) or most-frail (n = 150, 27.1%) according to the Frailty Index (FI). Most residents were severely impaired in their basic activities of daily living (n = 554, 98.8%), and were at-risk of malnutrition (n = 305, 55.0%) and at-risk of sarcopenia (n = 492, 89.5%). Most residents did not experience pain (n = 475, 85.4%), had normal daytime sleepiness (n = 385, 69.7%), and low anxiety and depression scores (n = 327, 58.9%)., Conclusion: This study provides valuable information on the health and frailty levels of residents living in RACS in South Australia. The results will assist in developing interventions that can help to improve the health and wellbeing of residents in aged care services., Trial Registration: Prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12619000500156 ).

This pilot study aimed to examine the feasibility and effectiveness of a 6-months multi-component exercise program combined with twice daily consumption of either rice (RicePro) or whey-based (WheyPro) protein supplements (2 × 20 g of protein) on gait speed, grip strength and physical performance in community-dwelling pre-frail and frail older adults. Secondary outcomes included: frailty score, muscle mass, quality of life, nutritional intake, cognitive performance, depression and physical activity levels. A total of 70 participants (mean age 73.34 ± 6.85 years) were randomly allocated to either RicePro ( n  = 36) or WheyPro ( n  = 34). No adverse events were reported in regards to the exercise, however, several gastrointestinal symptoms were noted with the whey protein causing two-fold more symptoms compared to the rice protein. No differences were found between the groups ( p  > 0.05), except the total consumed energy (kJ) ( p  = 0.014) and fat (g) ( p  = 0.012) which was significantly lower in WheyPro. The results indicate that the quality of protein may not be as important as long as a sufficient amount is consumed.

Background: Sedentary behaviour (SB) can delay hospitalised older adults' recovery from acute illness and injuries. Currently, there is no synthesis of evidence on SB among hospitalised older people. This scoping review aimed to identify and map existing literature on key aspects of SB among hospitalised older adults, including the prevalence, measurement and intervention strategies for SB and sedentary behaviour bouts (SBBs) as well as healthcare professionals, patients and carers' perspectives on interventions. Methods and analysis: Several electronic databases were searched between January 2001 and September 2020. The Joanna Briggs Institute (JBI) framework was used to conduct this scoping review. Results: Out of 1824 articles, 21 were included comprising 16 observational studies, 3 randomised controlled trials, 1 comparative study, and 1 phase-1 dose-response study. The sample size ranged from 13 to 393, with all 1435 participants community-dwelling before hospitalisation. Only two studies focused on measuring SB and SBBs as a primary outcome, with others (n = 19) reporting SB and SBB as a sub-set of physical activity (PA). Older adults spent an average of 86.5%/day (20.8 h) sedentary. Most studies (n = 15 out of 21) measured SB and SBB using objective tools. Conclusion: Hospitalised older people spent most of their waking hours sedentary. Studies explicitly focused on SB and SBB are lacking, and the perspectives of patients, carers and healthcare professionals are not clarified. Future hospital-based studies should focus on interventions to reduce SB and SBB, and the perspectives of healthcare professionals, patients and carers' taken into account.

Objective: To assess the changes in fifth-year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty after a 4.5-week geriatric medicine course., Methods: Students' perceived importance and competence was assessed before and after the course using a 26-item Likert scale questionnaire with scores ranging from 1 to 6., Results: Students' perceptions of the importance of defining frailty (P = .01), explaining what frailty is (P = .03), advising on nutritional needs (P = .001) and exercise (P = .001) and prescribing an exercise program (P < .001) significantly improved after the course. Medical students' perceived competence in assessing, diagnosing and managing frailty was low to moderate precourse and increased significantly postcourse (2.3 [1.2] 4.9 [2.9], mean [IQR], P < .001) across all items., Conclusion: An appropriate curriculum focusing on geriatric health conditions such as frailty can improve senior medical students' perceived importance and competence in assessing, diagnosing and managing frailty., (© 2020 AJA Inc.)

Background: Older adults spend up to 23 h daily sitting or lying while in hospital. Sedentary behaviour (SB) within a hospital setting is often associated with poor health outcomes including physical and cognitive decline, reduced quality of life and death as well as hospital readmissions. Conversely, replacing SB with mild to moderate levels of physical activity such as walking can significantly reduce hospital readmission risk by 30 days. Given the potentially harmful effects of SB in hospitalised older adults, it is vital to identify current literature by broadly exploring different aspects of SB among older people in hospital. The overall aim of this scoping review is to produce a literature map of current evidence on key domains of sedentary behaviour in hospitalised older people., Method: A search for relevant publications will be undertaken in Pedro, MEDLINE Ovid, Cochrane, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, Embase, Ageline, Joanna Briggs Institute (JBI) and clinical trials registries. Publications in English and those where the author can provide the full text in English will be included. Studies conducted in hospitals (including in-patient rehabilitation facilities) or acute and subacute care settings and in people aged ≥ 65 will be included. A three-stage method will be used to identify relevant articles, consisting of database search using keywords, keywords and index words across all databases, and reference searching. Articles will be selected following screening of titles/abstracts succeeded by a full-text appraisal utilising a standardised selection form. Two independent reviewers will extract data using the standardised form that will be tested on two articles. A narrative summary will accompany results presented in tables and figures.

The study aimed to examine the sustained impact of a 1.5-hour medical school-based physical activity (PA) module on interns' perceived competence and importance in advising older adults about exercise. The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered in 2017 (CG: control group) and 2018 (IG: intervention group) two years post-course. The perceived competence of both, CG (n=23) and IG (n=18), decreased significantly over two years (p≤0.05) with no difference between the groups (p>0.05). However, 72.2% (n=13) of the interns who attended the PA module still felt competent in advising older adults about exercise (4.21±0.66) compared to 47.8% (n=11) of the CG (3.89±0.67). The perceived importance decreased significantly in both groups (p≤0.05) with no difference between the groups (p>0.05). However, both groups still perceived exercise for older people as important (CG:4.55±0.61; IG:4.83±0.47). Subsequently, continued professional development is likely to be a key requirement for ensuring sustainability over time., Competing Interests: The authors declare no conflicts of interest.

The anorexia of aging affects approximately a quarter of older people and is a major contributor to the development of under-nutrition and many other adverse health outcomes in older people. Despite the high prevalence, the anorexia of aging is frequently overlooked by clinicians and, of even more concern, it is commonly accepted as inevitable and a part of 'normal' aging. Early identification of risk coupled with efforts to mitigate these risks through appropriate interventions might stem the deleterious consequences of the anorexia of aging. This review aims to provide an update on the current knowledge base whilst making some practical suggestions that may be of use in clinical practice. Interventions such as exercise and good nutrition remain the preferred treatment while pharmacological options, whilst they continue to be trialed, are not currently recommended for routine clinical use., Competing Interests: R Visvanathan has received honorarium, speakers fee and travel support from Nutricia and Abbott. Nestle Australia has also provided grant support to the National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Aging.

Background: Exercise is considered to be the most effective strategy to treat, prevent and delay frailty, a prevalent geriatric syndrome observed in clinical practice. Encouraging frail older people to take up exercise is crucial in the management of this condition. The study aimed to explore pre-frail and frail older peoples' perspectives in relation to being advised about exercise and their perceptions of the general practitioners' (GPs) role in promoting exercise for older people., Methods: Semi-structured interviews were conducted with 12 community-dwelling older (median age 83 years) participants screened pre-frail or frail using the FRAIL Screen. Their attitudes towards exercise, the advice received, their access to relevant information and their perceptions of the GP's role in promoting exercise were explored. Thematic analysis was conducted to analyse data., Results: The majority of participants had a positive attitude towards exercise, and many participants indicated a preference for being advised firstly by their GPs and then other healthcare professionals. Participants living in the community reported difficulties in accessing information on exercise and indicated that local governments and GP practices should promote exercise for older people more actively. Participants living in retirement villages, however, reported having access to relevant information and being encouraged to participate in exercise., Conclusion: This research identified a gap in current practice, demonstrating that GPs, healthcare providers and local governments should promote exercise for older people more actively. Convincing health professionals to encourage regular exercise among their older patients would provide an opportunity to avoid and manage frailty in this population.

Objectives: This umbrella review aimed to determine the effectiveness of exercise interventions, alone or in combination with other interventions, in improving physical function in community-dwelling older people identified as pre-frail or frail., Introduction: Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty. Several systematic reviews discuss the effects of exercise interventions on physical function parameters, such as strength, mobility, gait, balance and physical performance, and indicate that multi-component exercise, including resistance, aerobic, balance and flexibility training, appears to be the best way in which to improve physical function parameters in frail older people. However, there is still uncertainty as to which exercise characteristics (type, frequency, intensity, duration and combinations) are the most effective and sustainable over the long-term., Inclusion Criteria: Participants were adults, 60 years or over, living in the community and identified as pre-frail or frail. Quantitative systematic reviews, with or without meta-analysis that examined the effectiveness of exercise interventions of any form, duration, frequency and intensity, alone or in combination with other interventions designed to alter physical function parameters in frail older people, were considered. The quantitative outcome measures were physical function, including muscular strength, gait, balance, mobility and physical performance., Methods: An iterative search strategy for ten bibliometric databases and gray literature was developed. Critical appraisal of seven systematic reviews was conducted independently by two reviewers using a standard Joanna Briggs Institute tool. Data was extracted independently by two reviewers using a standard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach., Results: Seven systematic reviews were included in this umbrella review, with a total of 58 relevant randomized controlled trials and 6927 participants. Five systematic reviews examined the effects of exercise only, while two systematic reviews reported on exercise in combination with a nutritional approach, including protein supplementations, as well as fruit and dairy products. The average exercise frequency was 2-3 times per week (mean 3.0 ± 1.5 times per week; range 1-7 weekly) for 10-90 minutes per session (mean of 52.0 ± 16.5 mins) and a total duration of 5-72 weeks with the majority lasting a minimum of 2.5 months (mean 22.7 ± 17.7 weeks). Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength, gait speed, balance and physical performance, including resistance, aerobic, balance and flexibility tasks. Resistance training alone also appeared to be beneficial, in particular for improving muscular strength, gait speed and physical performance. Other types of exercise were not sufficiently studied and their effectiveness is yet to be established., Conclusions: Interventions for pre-frail and frail older adults should include multi-component exercises, including in particular resistance training, as well as aerobic, balance and flexibility tasks. Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made.

Background: Exercise courses during medical school contribute to medical students' confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise., Objective: To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students' perceptions of the importance of exercise and their perceived competence in advising older people about exercise., Design: Pre-post survey., Setting: University campus., Participants: 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group)., Measurement: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group., Results: Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students' perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001)., Conclusion: A 1.5-hour physical activity module improves senior medical students' perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students' exercise counselling abilities., Competing Interests: None declared by the authors

Objective: To determine the effects of a 4.5-week geriatric medicine course on fifth year medical students' perception of the importance of and their competence in prescribing exercise to older people., Methods: The modified Exercise and Physical Activity Competence Questionnaire was administered to 81 students before and after the course. Scores ranged from 0 to 6. One open-ended question about perceived barriers to exercise prescription was asked., Results: Students' perceptions of the importance of designing an exercise prescription (P = 0.038), determining the training heart rate (P = 0.021), determining the body mass index (P > 0.001), referring an older person to an exercise program (P > 0.001) and identifying age-related limitations (P = 0.029) improved significantly after the course. Students' self-perceived competence improved significantly across all items (P > 0.001). Barriers to exercise prescription included lack of: knowledge (57%), patient compliance (39%) and time (33%)., Conclusion: A geriatric medicine course contributes to improved senior medical students' perceptions of importance of and their competence in prescribing exercise to older people., (© 2017 AJA Inc.)

Background: Research has repeatedly demonstrated that exercise has a positive impact on physical function and is beneficial in the treatment of physical frailty. However, an even more effective strategy for managing physical frailty might be the combination of multicomponent exercise with the intake of high-quality protein supplements, but the efficacy remains unclear for older adults who are already pre-frail and frail. The aim is to examine the feasibility of recruiting frail older adults to participate in a trial designed to determine the potential effects of a 6-month exercise and nutrition intervention on physical function. The feasibility objectives will include frail older peoples' compliance, the safety and tolerability of the trial, the estimation of estimates to aid sample size calculation, and the potential efficacy. Primary outcomes for the main trial will include gait speed, grip strength and physical performance. Secondary outcomes will include frailty status, muscle mass, nutritional intake, physical activity levels, cognitive performance and quality of life., Methods/design: A randomised, parallel, control pilot and feasibility study will be conducted. All participants will be randomly assigned to either (a) an exercise program + high-quality protein supplement or (b) an exercise program + low-quality protein supplement. Both protein supplements will be matched closely in colour, flavour and packaging so that both the participants and the research staff are blinded. The exercise program will be the same in both groups. Assessments will be conducted at baseline and at 3 and 6 months and include gait speed, grip strength, the Short Physical Performance Battery, Timed Up and Go Test, FRAIL Screen, bioelectrical impedance analyses, 24-h dietary recall, Katz Activities of Daily Living, Lawton Instrumental Activities of Daily Living, the Trail Making Test, Short Form Health Survey-36, and 1 week accelerometer quantification. The data will be analysed using an ANCOVA model., Discussion: This study is expected to provide much needed insight into the feasibility of recruiting and retaining frail older adults into community-based intervention programs, while providing knowledge relating to the safety, tolerability and benefits of a combined exercise and protein supplement program designed to halt or reverse the transition of physical frailty in the community. If shown to be effective, this strategy could be included in the best practice clinical guidelines for community-dwelling older adults who are pre-frail or frail., Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12616000521426.

Geriatric assessment tools are applicable to the general geriatric population; however, their feasibility in frail older adults is yet to be determined. The study aimed to determine the feasibility of standardised geriatric assessment tools and physical exercises in hospitalised frail older adults. Various assessment tools including the FRAIL Screen, the Charlson Comorbidity Index, the SF-36, the Trail Making Test (TMT), the Rapid Cognitive Screen, the Self Mini Nutritional Assessment (MNA-SF) and the Lawton iADL as well as standard physical exercises were assessed using observational protocols. The FRAIL Screen, MNA-SF, Rapid Cognitive Screen, Lawton iADL and the physical exercises were deemed to be feasible with only minor comprehension, execution and safety issues. The TMT was not considered to be feasible and the SF-36 should be replaced by its shorter form, the SF-12. In order to ensure the validity of these findings a study with a larger sample size should be undertaken., Competing Interests: The authors report no conflicts of interest

Review Question/objective: The objectives of this umbrella review are to determine the effectiveness of exercise interventions, alone or in combination with other interventions, for improving physical function in community-dwelling older people who are identified as frail or at risk of frailty, and to identify if any particular intervention type or characteristic is the most effective.Specifically, the review question is: What is the effectiveness of exercise interventions, alone or in combination with other interventions, for improving physical function in community-dwelling older people identified as frail or at risk of frailty?

Sarcopenia, an age-related decline in muscle mass and function, is affecting the older population worldwide. Sarcopenia is associated with poor health outcomes, such as falls, disability, loss of independence, and mortality; however it is potentially treatable if recognized and intervened early. Over the last two decades, there has been significant expansion of research in this area. Currently there is international recognition of a need to identify the condition early for intervention and prevention of the disastrous consequences of sarcopenia if left untreated. There are currently various screening tools proposed. As yet, there is no consensus on the best tool. Effective interventions of sarcopenia include physical exercise and nutrition supplementation. This review paper examined the screening tools and interventions for sarcopenia.