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One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

Aims To describe the degree of disability and nursing need of people living with diabetes resident in nursing homes in one Primary Care Trust in the UK. \ud \ud Methods A retrospective case notes review of 75 people with known diabetes who were resident in the 11 nursing homes in Coventry Teaching Primary Care Trust. \ud \ud Results Very significant levels of disability and nursing need were documented in areas of continence, feeding, mobility and communication. Each individual had a mean of four co-morbidities (range 1-8), excluding diabetes. Using the definition of terminal illness based on a negative answer to the question 'would I be surprised if my patient were to die in the next 12 months' it is likely that the majority of individuals described in this study would be classified as being terminally ill. \ud \ud Conclusion Using four practical clinical measures, this study has shown very significant levels of disability and nursing care need in this population of mainly elderly people resident in nursing homes in Coventry. In addition, it has demonstrated that a large proportion of nursing home residents with diabetes can be considered to be in the terminal phase of life, a period where many other factors interplay in how care should be delivered and what outcomes are appropriate. In fact, residents in this category may well be candidates for a considered withdrawal of treatments, but not of care.

Aims To describe the numbers and costs of medications prescribed to people living with diabetes resident in nursing homes in one primary care trust in the UK. Methods A retrospective case notes review of 75 people with known diabetes who were resident in the 11 nursing homes in the Coventry teaching primary care trust. Results Sixty-three residents (84%) were being prescribed four or more medications. Forty-four residents (59%) were prescribed anti-platelet drugs for prevention of cardiovascular disease, including aspirin, clopidogrel and dipyridamole, and 31 residents (41%) were on statin therapy. Eighteen (24%) residents had a monthly medication cost that was above 101 pound per month. On detailed review, these were largely residents who were being prescribed special order liquid preparations, usually for secondary cardiovascular disease prevention. Conclusion Polypharmacy, defined as taking four or more drugs per day per resident, is highly prevalent within this population of care home residents with diabetes. A high proportion of residents are prescribed drugs for cardiovascular disease prevention, which may be entirely inappropriate in this population with limited life expectancy. Regular medication review of care home residents with diabetes should be undertaken as it has the potential to reduce costs, minimize adverse drug reactions and increase health gain.