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Applicability of the electronic frailty index in younger and older adults in England: a population-based cohort study 电子衰弱指数在英国年轻人和老年人中的适用性：一项基于人群的队列研究。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100752
Daniel R Morales PhD , Prof Bruce Guthrie PhD , Thomas J Downes MPhil , Prof David A McAllister MD , Peter Hanlon PhD

Background

The electronic frailty index (eFI) was developed in older adults (aged ≥65 years). There are currently no validated frailty scores in clinical practice for younger adults (aged 18–64 years). The aim of this study was to examine whether the eFI score in younger adults had similar or different associations with adverse health outcomes compared with older adults.

Methods

In this population-based cohort study, electronic health records from the UK Clinical Practice Research Datalink GOLD database were analysed. We used a cross-section of patients on Nov 30, 2015, who were alive and had been registered with a general practice for at least 2 years before data capture. Patients were stratified into younger adults (aged 18–64 years, n=708 235; 49·4% female) and older adults (aged 65–95 years, n=231 819; 54·3% female). For all included patients, eFI score, prevalence of individual eFI deficits, and eFI frailty category were calculated. For the main outcomes, crude and age–sex adjusted hazard ratios (HRs) were calculated for 1-year and 3-year mortality and emergency hospitalisation for each group compared with adults defined by the eFI as fit.

Findings

The prevalence of eFI-defined frailty was higher in older adults than younger adults. Specifically, in older adults, 77 290 (33·3%) of 231 819 had mild frailty, 44 523 (19·2%) had moderate frailty, and 22 572 (9·7%) had severe frailty. For younger adults, 76 991 (10·9%) of 708 235 had mild frailty, 12 552 (1·8%) had moderate frailty, and 2088 (0·3%) had severe frailty. Adjusted HRs for both 1-year mortality and 1-year emergency hospitalisation in younger adults with mild, moderate, and severe frailty were greater than in older adults with equivalent frailty categorisation. Specifically, compared with fit older adults, age–sex adjusted 1-year mortality HRs were 1·94 (95% CI 1·80–2·09) in older adults with mild frailty, 2·99 (2·77–3·22) with moderate frailty, and 4·03 (3·72–4·36) with severe frailty. Compared with fit younger adults, age–sex adjusted 1-year mortality HRs were 3·15 (2·80–3·55) in younger adults with mild frailty, 5·88 (4·95–6·98) with moderate frailty, and 12·61 (9·76–16·30) with severe frailty (Z score p<0·001 for all comparisons). Compared with fit older adults, age–sex adjusted HRs for 1-year emergency hospitalisation were 2·30 (2·22–2·39) in older adults with mild frailty, 4·09 (3·94–4·25) with moderate frailty, and 6·76 (6·50–7·03) with severe frailty. Compared with fit younger adults, age–sex adjusted HRs for 1-year emergency hospitalisation were 3·16 (3·07–3·25) in younger adults with mild frailty, 6·64 (6·34–6·94) with moderate frailty, and 13·02 (12·04–14·09) with severe frailty (Z score p<0·001 for all comparisons). Similar associations were observed for 3-year mortality and emergency hospitalisation.

Interpretation

Similarly to older adults, the eFI identifies you
背景：电子衰弱指数（eFI）是在老年人（年龄≥65岁）中开发的。目前在临床实践中还没有针对年轻人（18-64岁）的有效虚弱评分。本研究的目的是研究与老年人相比，年轻人的eFI评分与不良健康结果是否有相似或不同的关联。方法：在这项基于人群的队列研究中，分析了来自英国临床实践研究数据链GOLD数据库的电子健康记录。我们使用了2015年11月30日的患者横截面，这些患者在数据采集前至少在全科诊所注册了2年。患者分为青壮年（18-64岁，n=708 235，女性49.4%）和老年（65-95岁，n=231 819，女性54.3%）。对于所有纳入的患者，计算eFI评分、个体eFI缺陷患病率和eFI虚弱类别。对于主要结局，计算各组1年和3年死亡率和紧急住院率的粗风险比（hr），并与eFI定义的成人进行比较。结果：efi定义的衰弱在老年人中的患病率高于年轻人。在老年人中，231 819人中有77 290人（33.3%）为轻度虚弱，44 523人（19.2%）为中度虚弱，22 572人（9.7%）为重度虚弱。在年轻人中，708 235人中有76 991人（10.9%）为轻度虚弱，12 552人（1.8%）为中度虚弱，2088人（0.3%）为重度虚弱。有轻度、中度和重度虚弱的年轻成人的1年死亡率和1年急诊住院的调整hr大于有相同虚弱分类的老年人。具体而言，与健康老年人相比，轻度虚弱老年人经年龄性别调整后的1年死亡率hr为1.94 (95% CI为1.8 -2·09)，中度虚弱老年人为2.99 (95% CI为2.77 - 3.22)，重度虚弱老年人为4.03 （95% CI为3.72 - 3.36）。与健康的年轻人相比，年龄性别调整后的1年死亡率hr为轻度虚弱的年轻人3.15(2.80 - 3.55)，中度虚弱的年轻人5.88(4.95 - 5.98)，严重虚弱的年轻人12.61 (9.76 - 16.30)（Z评分）。解释：与老年人相似，eFI识别出虚弱的年轻人具有高死亡率和急诊住院风险。eFI可能是一种识别个体以进行进一步评估和干预的工具。资助：惠康信托基金和首席科学家办公室。
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引用次数: 0
Advances in our understanding of how to prevent suicide in older men 我们对如何预防老年男性自杀的理解取得了进展。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100758
Stuart Leske , Kylie King
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引用次数: 0
Emulating target trials in older adults with multimorbidity 模拟多病老年人的靶试验。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100750
Changyuan Yang , Priya Vart
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引用次数: 0
Association between Hospital Frailty Risk Score and length of hospital stay, hospital mortality, and hospital costs for all adults in England: a nationally representative, retrospective, observational cohort study 英国所有成年人的住院时间、住院死亡率和住院费用与医院虚弱风险评分之间的关系：一项具有全国代表性的回顾性观察性队列研究
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100740
Prof Andrew Street PhD , Laia Maynou PhD , Joanna M Blodgett PhD , Prof Simon Conroy PhD

Background

Studies have shown that the Hospital Frailty Risk Score (HFRS) is significantly associated with length of stay, in-hospital mortality, and costs in people aged 75 years and older. However, its applicability to hospitalised adults of all ages is unclear. We aimed to examine the association between the HFRS and these three outcomes in a nationally representative sample of adults aged 18 years and older, admitted for emergency hospital care.

Methods

The analytical sample comprised 1 478 554 emergency hospital admissions for 653 294 patients—a 5% random sample of all emergency admissions for those aged 18 years and older to any English National Health Service acute hospital between April 1, 2011, and March 31, 2019. Admissions were categorised into zero (HFRS=0), low (0< HFRS <5), intermediate (5≤ HFRS ≤15), or high (HFRS >15) frailty risk categories. We analysed the association between these categories and three outcomes: length of stay (Poisson model), in-hospital death (probit model); and hospital costs (generalised linear model). Models controlled for patient characteristics and temporal effects and were run separately across nine age groups (18–24 years, 25–34 years, 35–44 years, 45–54 years, 55–64 years, 65–74 years, 75–84 years, 85–94 years, and ≥95 years).

Findings

The prevalence of high frailty risk increased with age, from 210 (0·2%) of 96 296 admissions for those aged 18–24 years to 9414 (42·0%) of 22 431 admissions for those aged 95 years and older. There were significant associations between frailty risk and both length of stay and costs across all age groups; the magnitude of the associations increased with age. For example, for those aged 18–24 years with high frailty risk, length of stay was 4·5 days (95% CI 3·8–5·3) longer and costs were £1217 higher (796–1638) than for someone with a zero frailty risk. For those aged 95 years and older with high frailty risk, length of stay was 15·3 days (13·5–17·1) longer and costs were £2557 higher (2234–2880) than for someone with a zero frailty risk. The association between frailty risk and in-hospital mortality increased up to age 65–74 years—those in this age group with high frailty risk had a probability of dying in hospital that was 2·3% greater (1·99–2·61) than those with zero frailty risk. This association decreased for older age groups.

Interpretation

Although designed for people aged 75 years and older, the HFRS was significantly associated with length of stay, in-hospital death, and hospital costs for all adults admitted to hospital, with a greater magnitude of effect with increasing age. Frailty dashboards that use the HFRS for older people could be extended to all people aged 18 years and older, offering the potential for holistic, frailty attuned interventions for younger people, such as earlier life course interventions to delay or prevent frailty and
背景：研究表明，医院虚弱风险评分（HFRS）与75岁及以上人群的住院时间、住院死亡率和费用显著相关。然而，它是否适用于所有年龄段的住院成年人尚不清楚。我们的目的是在全国代表性的18岁及以上接受紧急医院护理的成年人样本中检查HFRS与这三个结果之间的关系。方法：分析样本包括2011年4月1日至2019年3月31日期间所有18岁及以上的英国国家卫生服务急性医院急诊入院患者的5%，即1478 554例急诊入院患者，共653 294例患者。入院者被分为零（HFRS=0）、低（0< HFRS 15）虚弱风险组。我们分析了这些类别与三个结局之间的关系：住院时间（泊松模型）、院内死亡（probit模型）；医院费用（广义线性模型）。模型控制了患者特征和时间效应，分别在9个年龄组（18-24岁、25-34岁、35-44岁、45-54岁、55-64岁、65-74岁、75-84岁、85-94岁和≥95岁）中运行。结果：高衰弱风险患病率随年龄增长而增加，18-24岁住院患者96 296例中210例（0.2%），95岁及以上住院患者22 431例中9414例（42.0%）。在所有年龄组中，虚弱风险与住院时间和费用之间存在显著关联；这种关联的程度随着年龄的增长而增加。例如，对于那些年龄在18-24岁、脆弱风险高的人来说，住院时间比零脆弱风险的人长4.5天（95% CI 3.8 - 5.3），费用高出1217英镑（796-1638）。对于95岁及以上的高衰弱风险患者，住院时间比零衰弱风险患者长15.3天（13.5 - 17.1天），费用高出2557英镑（2234-2880英镑）。衰弱风险与院内死亡率之间的关联在65-74岁之间增加，该年龄组中衰弱风险高的患者在院内死亡的概率比无衰弱风险的患者高2.3%（1.99 - 2.61）。这种关联在年龄较大的群体中有所下降。解释：虽然是为75岁及以上的人群设计的，但HFRS与所有住院成年人的住院时间、住院死亡和住院费用显著相关，且随着年龄的增长，影响程度更大。使用老年人HFRS的脆弱性仪表板可以扩展到所有18岁及以上的人，从而为年轻人提供针对脆弱性的整体干预措施，例如早期生命过程干预措施，以延迟或预防脆弱性及相关后果。资助：国家卫生和保健研究所。
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引用次数: 0
Effectiveness of comprehensive geriatric assessment with extensive patient coaching for improving quality of life in older patients with solid tumours receiving systemic therapy (G-oncoCOACH): a multicentre randomised controlled trial 一项多中心随机对照试验：综合老年评估和广泛患者指导对改善接受全身治疗的老年实体瘤患者生活质量的有效性（G-oncoCOACH）
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100743
Cindy Kenis PhD , Lien Peeters MScN , Lore Laethem BSc , Jessie De Cock MSc , Nathalie Compté MD , Prof Johan Flamaing MD , Prof Koen Milisen PhD , Katleen Fagard MD , Jean-Pierre Lobelle MSc , Annouschka Laenen PhD , Prof Lore Decoster MD , Prof Hans Wildiers MD

Background

Comprehensive geriatric assessment (CGA) has demonstrated numerous benefits in older patients with cancer, and is internationally recommended, but more data are needed on its impact on quality of life (QoL). The aim of the G-oncoCOACH study is to evaluate the effectiveness of CGA on QoL in older patients with solid tumours receiving systemic therapy by integrating a geriatric team for implementing geriatric assessment (GA)-based recommendations and offering extensive patient coaching compared with standard of care in oncology.

Methods

The G-oncoCOACH study was a multicentre randomised controlled trial conducted in two academic hospitals in Belgium. Patients aged 70 years or older with solid tumours initiating systemic therapy with curative or non-curative intent, and physician-estimated life expectancy of at least 6 months, were randomly assigned (1:1) to either the control group (standard oncology care; receiving GA-based recommendations implemented by the oncology team) or the intervention group (receiving GA-based recommendations implemented by a geriatric team and intensive patient coaching). There was no masking of participants, physicians, or study personnel. The primary outcome was change in global health status (GHS) from baseline to 6 months, measured using the EORTC QLQ-C30 questionnaire (ie, QoL GHS). Linear mixed models were used for data analysis. Exploratory analyses evaluated predictors for change in QoL GHS. The trial is registered with ClinicalTrials.gov (NCT04069962), and is completed.

Findings

Between Oct 30, 2019, and Aug 5, 2021, 217 participants were enrolled and randomly assigned, of whom 212 had QoL GHS available at baseline (107 in the control group, 105 in the intervention group). Among these 212 participants, the mean age was 76·7 years; 111 (52%) were female and 101 (48%) male. The three most common tumour types were lung cancer (41 [19%]), colorectal cancer (31 [15%]), and breast cancer (22 [10%]). The mean difference in QoL GHS score between the intervention group and the control group at 6 months was 10·9 points (95% CI 3·7–18·0; p=0·0030) in favour of the intervention group, and confirmed by a sensitivity analysis. Adherence to GA-based recommendations was higher in the intervention group (71 [65%] of 110 recommendations implemented) than the control group (67 [45%] of 148 recommendations implemented). Exploratory analyses revealed significant predictors for change in QoL GHS, such as low baseline QoL GHS and high comorbidity.

Interpretation

The G-oncoCOACH study shows that CGA with the integration of a geriatric team for implementing GA-based recommendations and offering extensive patient coaching improves QoL GHS in older patients with cancer compared with standard of care in oncology.
背景：综合老年评估（Comprehensive geriatric assessment， CGA）已被证明对老年癌症患者有许多益处，并被国际上推荐，但其对生活质量（QoL）的影响还需要更多的数据。G-oncoCOACH研究的目的是评估CGA对接受全身治疗的老年实体瘤患者生活质量的有效性，通过整合老年团队实施基于老年评估（GA）的建议，并提供广泛的患者指导，与肿瘤学标准护理进行比较。方法：G-oncoCOACH研究是一项在比利时两所学术医院进行的多中心随机对照试验。年龄在70岁或以上的实体肿瘤患者开始接受系统性治疗，目的是治愈或不治愈，医生估计的预期寿命至少为6个月，随机（1:1）分配到对照组(标准肿瘤治疗；接受由肿瘤团队实施的基于ga的建议)或干预组（接受由老年团队实施的基于ga的建议和强化的患者指导）。没有对参与者、医生或研究人员进行伪装。主要结局是使用EORTC QLQ-C30问卷（即QoL GHS）测量的全球健康状况（GHS）从基线到6个月的变化。采用线性混合模型进行数据分析。探索性分析评估了生活质量GHS变化的预测因子。该试验已在ClinicalTrials.gov注册（NCT04069962），并已完成。研究结果：在2019年10月30日至2021年8月5日期间，217名参与者被招募并随机分配，其中212名参与者在基线时可获得生活质量GHS（对照组107人，干预组105人）。212名受试者的平均年龄为76.7岁；女性111例（52%），男性101例（48%）。三种最常见的肿瘤类型是肺癌（41例[19%]）、结直肠癌（31例[15%]）和乳腺癌（22例[10%]）。干预组与对照组6个月时生活质量GHS评分的平均差异为10.9分(95% CI 3.7 ~ 18.0；P =0·0030)支持干预组，并通过敏感性分析得到证实。干预组（实施110项建议中有71项[65%]）比对照组（实施148项建议中有67项[45%]）更坚持基于ga的建议。探索性分析揭示了生活质量GHS变化的重要预测因素，如低基线生活质量GHS和高合并症。解释：G-oncoCOACH研究表明，与肿瘤学标准护理相比，整合老年团队实施基于ga的建议并提供广泛的患者指导的CGA可改善老年癌症患者的生活质量GHS。资助：站起来对抗癌症（Kom op tegen Kanker）。
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引用次数: 0
Trends in mortality in people with heart failure and atrial fibrillation: a population-based cohort study 心力衰竭和心房颤动患者死亡率的趋势：一项基于人群的队列研究。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100734
Nicholas R Jones DPhil , Margaret Smith PhD , Yaling Yang PhD , Prof F D Richard Hobbs FMedSci , Prof Clare J Taylor PhD

Background

Atrial fibrillation and heart failure frequently coexist but the relative effect of atrial fibrillation on survival in people with heart failure, and vice versa, remains uncertain. We aimed to report contemporary estimates of mortality among people with atrial fibrillation and heart failure and analyse trends in mortality over time.

Methods

We did a retrospective cohort study of adults aged 45 years or older in England, using primary care data from the Clinical Practice Research Datalink GOLD dataset and linked secondary care data (Hospital Episode Statistics and Office for National Statistics datasets), for a total follow-up period from Jan 1, 2000, to Dec 31, 2018. We recorded incident cases of heart failure and atrial fibrillation in primary or secondary care during the study period, as well as pre-existing cases at the study index date. Individuals were categorised as having both heart failure and atrial fibrillation, atrial fibrillation only, heart failure only, or neither condition, with heart failure and atrial fibrillation included in analyses as time-varying covariates. The primary outcome was all-cause mortality, as recorded in primary or secondary care. We report the incidence and hazard ratios for all-cause mortality by diagnosis status, median overall survival following diagnosis, and the cumulative probability of all-cause mortality from 3 months to 10 years of follow-up and by year of diagnosis to assess trends over time. Estimates of median survival and the cumulative probability of overall mortality were restricted to incident diagnoses during the study period, and calculated overall as well as by sex, age, and Index of Multiple Deprivation quintile.

Findings

The cohort consisted of 2 381 941 people, including 100 132 initially diagnosed with heart failure only and 155 061 initially diagnosed with atrial fibrillation only by the study index date or during follow-up. By the end of follow-up, 74 470 people had been diagnosed with both conditions. 314 042 people died during follow-up, including 42 427 (57·0%) of those diagnosed with both heart failure and atrial fibrillation. In people diagnosed with both conditions during the study period (n=43 714), median overall survival was 3·15 years (95% CI 3·08–3·21), and the cumulative probability of mortality was 31·8% (95% CI 30·2–33·6) at 1 year, 61·4% (59·4–63·3) at 5 years, and 80·2% (78·3–82·1) at 10 years after both conditions had been diagnosed, representing significantly worse rates than for an initial diagnosis of either condition alone. Similarly, the risk-adjusted hazard of all-cause mortality was highest among people with both heart failure and atrial fibrillation. For the overall population, cumulative mortality probability estimates were unchanged over successive years of diagnosis for people with both heart failure and atrial fibrillation, while showing small improvements for people initia
背景：心房颤动和心力衰竭经常共存，但心房颤动对心力衰竭患者生存的相对影响，反之亦然，仍不确定。我们的目的是报告心房颤动和心力衰竭患者的当代死亡率估计，并分析死亡率随时间的趋势。方法：我们对英国45岁及以上的成年人进行了回顾性队列研究，使用临床实践研究数据链GOLD数据集的初级保健数据和相关的二级保健数据（医院事件统计和国家统计局数据集），总随访期为2000年1月1日至2018年12月31日。我们记录了在研究期间在初级或二级护理中发生的心力衰竭和心房颤动的病例，以及在研究索引日期已存在的病例。个体被归类为既有心力衰竭又有心房颤动，只有心房颤动，只有心力衰竭，或两者都没有，心力衰竭和心房颤动作为时变协变量包括在分析中。主要结局是记录在初级或二级保健中的全因死亡率。我们报告了全因死亡率的发生率和风险比，包括诊断状态、诊断后的中位总生存率，以及随访3个月至10年的全因死亡率累积概率和诊断年份，以评估随时间推移的趋势。中位生存期和总死亡率累积概率的估计仅限于研究期间的事件诊断，并根据总体以及性别、年龄和多重剥夺指数五分位数进行计算。研究结果：该队列包括2 381 941人，其中100132人最初诊断为心力衰竭，155 061人最初诊断为心房颤动，仅在研究索引日期或随访期间。到随访结束时，有74 470人被诊断出患有这两种疾病。随访期间死亡314042人，其中42427人（57.0%）同时诊断为心力衰竭和心房颤动。在研究期间（n=43 714）诊断为这两种疾病的患者中，中位总生存期为3.15年（95% CI 3.08 - 3.21），两种疾病诊断后1年的累积死亡率为31.8% (95% CI 30.2 - 33.6)， 5年的累积死亡率为64.1%(59.4 - 63.3)，10年的累积死亡率为80.2%(78.3 - 82.1)，明显低于单独诊断任何一种疾病的患者。同样，经风险调整后的全因死亡率在心力衰竭和心房颤动患者中最高。对于总体人群来说，对于心力衰竭和心房颤动患者的累积死亡率估计在连续几年的诊断中没有变化，而对于最初诊断为心力衰竭的患者（2000年至2008年诊断年期间10年累积概率中位数降低3.8% [95% CI 1.4 - 6.1]）或仅心房颤动（2000年至2017年诊断年期间1年累积死亡率中位数降低2.4%[0.5 - 4.2]），以及65岁之前诊断为两种疾病的患者的长期改善（10年累积死亡率中位数降低）2000年和2008年诊断年份之间的概率为14.5% [95% CI 3.8 - 25.2])。对于两种情况的患者，最贫困五分位数的中位总生存期明显更长(3.46年[95% CI 3.31 - 3.59]；N =9275)比最贫困五分位数（2.67岁[2.51 ~ 2.81]）多；n = 6302)。在年龄分层后，每个暴露组的中位总生存率在性别之间相似。解释：合并症心衰和房颤很常见，预后很差，随着时间的推移，诊断的死亡率估计没有改善，社会剥夺群体的生存率最差。资助：惠康信托基金会和国家健康与护理研究合作研究所，领导牛津大学的应用健康研究和护理。
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引用次数: 0
Prevalence of frailty and associated socioeconomic factors in people experiencing homelessness in England: cross-sectional secondary analysis of health needs survey data 英国无家可归者中虚弱的患病率和相关的社会经济因素：健康需求调查数据的横断面二级分析
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100745
Jo Dawes MPhil , Emmanouil Bagkeris PhD , Kate Walters PhD , Alexandra Burton PhD , Debra Hertzberg MSc , Rachael Frost PhD , Natasha Palipane MSc , Andrew Hayward MD

Background

Frailty is a complex health state affecting multiple body systems, resulting in increased vulnerability to health stressors. People experiencing homelessness (PEH) have poorer health, including higher prevalence of frailty, than the general population. This study aimed to calculate prevalence of frailty in PEH in England and explore associated sociodemographic characteristics.

Methods

This cross-sectional, secondary analysis study of health needs data collected from PEH in England created a frailty index by seeking expert input using a modified Delphi method and following published guidance for frailty index construction. Data were collected by Homeless Link in primarily urban areas through in-person, interviewer-administered surveys between 2012 and 2021 in three waves. Participants with data for at least 80% of frailty index variables were included. Descriptive statistics summarised the population. Among participants with sufficient frailty index data, the prevalence of frailty (frailty index scores of 0·25 or more) and pre-frailty (scores between 0·08 and 0·25) was calculated. Associations between frailty and sociodemographic characteristics were explored using multinomial logistic regression (adjusted for age; gender; accommodation at time of survey; engagement in employment, volunteering, and education; and immigration status).

Findings

The study sample included 2288 PEH (2156 [94·2%] aged 18–59 years). Frailty was prevalent in 949 (41·5%) of the study population and pre-frailty in 1001 (43·8%). Frailty was identified in 210 of 789 (26·6%) PEH aged 18–29 years. PEH aged 50–59 years had over eight times higher risk of frailty compared with PEH aged 18–29 years (adjusted risk ratio 8·30, 95% CI 4·86–14·16). Women experiencing homelessness (2·30, 1·57–3·37), and PEH who were not engaged in employment, volunteering, and education (3·05, 1·97–4·71) also had higher risk of frailty than men experiencing homelessness and PEH who were engaged in these activities, respectively. PEH who were not UK nationals had lower risk of frailty than those who were UK nationals (0·20, 0·12–0·33). Sleeping outside conferred a lower likelihood of frailty compared with people who were previously homeless but now housed (0·36, 0·17–0·76). Similar patterns were observed with pre-frailty.

Interpretation

To our knowledge, this is the largest study of frailty in PEH, offering valuable insights into the high levels of non-geriatric frailty in this vulnerable group, and can act as a starting point to guide service development and policy for this population.

Funding

National Institute for Health and Care Research.
背景：虚弱是一种影响多个身体系统的复杂健康状态，导致对健康压力源的易感性增加。与一般人群相比，无家可归者的健康状况较差，包括体弱多病的发生率较高。本研究旨在计算英格兰PEH患者的虚弱患病率，并探讨相关的社会人口学特征。方法：本研究对英国PEH的健康需求数据进行了横断面、二次分析研究，采用改进的德尔菲法寻求专家意见，并遵循已发表的脆弱性指数构建指南，创建了脆弱性指数。无家可归者链接在2012年至2021年期间，分三波通过访谈者亲自进行的调查收集了主要城市地区的数据。具有至少80%虚弱指数变量数据的参与者被纳入研究。描述性统计总结了人口情况。在虚弱指数数据充足的参与者中，计算虚弱患病率（虚弱指数得分在0.25及以上）和虚弱前患病率（虚弱指数得分在0.08至0.25之间）。使用多项逻辑回归（调整了年龄、性别、调查时的住宿、就业、志愿服务和教育的参与以及移民身份）探讨了虚弱和社会人口特征之间的关系。结果：研究样本包括2288例PEH（2156例[94.2%]，年龄18-59岁）。研究人群中有949人（41.5%）普遍虚弱，1001人（43.8%）处于虚弱前期。789例18-29岁PEH中有210例（26.6%）虚弱。50-59岁PEH的衰弱风险是18-29岁PEH的8倍以上（校正风险比8.30,95% CI 4.86 - 14.16）。经历过无家可归的女性（2.30,1.57 - 3.37）和不从事就业、志愿服务和教育的PEH（3.05, 1.97 - 4.71）也比经历过无家可归的男性和从事这些活动的PEH有更高的虚弱风险。非英国籍PEH患者的衰弱风险低于英国籍PEH患者（0.20,0.12 - 0.33）。与以前无家可归但现在有住所的人相比，睡在户外的人更容易虚弱（0.36,0.17 - 0.76）。类似的模式在虚弱前也被观察到。解释：据我们所知，这是PEH中最大规模的脆弱性研究，为这一弱势群体的非老年脆弱性高水平提供了有价值的见解，可以作为指导这一人群的服务开发和政策的起点。资助：国家卫生和保健研究所。
{"title":"Prevalence of frailty and associated socioeconomic factors in people experiencing homelessness in England: cross-sectional secondary analysis of health needs survey data","authors":"Jo Dawes MPhil ,&nbsp;Emmanouil Bagkeris PhD ,&nbsp;Kate Walters PhD ,&nbsp;Alexandra Burton PhD ,&nbsp;Debra Hertzberg MSc ,&nbsp;Rachael Frost PhD ,&nbsp;Natasha Palipane MSc ,&nbsp;Andrew Hayward MD","doi":"10.1016/j.lanhl.2025.100745","DOIUrl":"10.1016/j.lanhl.2025.100745","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a complex health state affecting multiple body systems, resulting in increased vulnerability to health stressors. People experiencing homelessness (PEH) have poorer health, including higher prevalence of frailty, than the general population. This study aimed to calculate prevalence of frailty in PEH in England and explore associated sociodemographic characteristics.</div></div><div><h3>Methods</h3><div>This cross-sectional, secondary analysis study of health needs data collected from PEH in England created a frailty index by seeking expert input using a modified Delphi method and following published guidance for frailty index construction. Data were collected by Homeless Link in primarily urban areas through in-person, interviewer-administered surveys between 2012 and 2021 in three waves. Participants with data for at least 80% of frailty index variables were included. Descriptive statistics summarised the population. Among participants with sufficient frailty index data, the prevalence of frailty (frailty index scores of 0·25 or more) and pre-frailty (scores between 0·08 and 0·25) was calculated. Associations between frailty and sociodemographic characteristics were explored using multinomial logistic regression (adjusted for age; gender; accommodation at time of survey; engagement in employment, volunteering, and education; and immigration status).</div></div><div><h3>Findings</h3><div>The study sample included 2288 PEH (2156 [94·2%] aged 18–59 years). Frailty was prevalent in 949 (41·5%) of the study population and pre-frailty in 1001 (43·8%). Frailty was identified in 210 of 789 (26·6%) PEH aged 18–29 years. PEH aged 50–59 years had over eight times higher risk of frailty compared with PEH aged 18–29 years (adjusted risk ratio 8·30, 95% CI 4·86–14·16). Women experiencing homelessness (2·30, 1·57–3·37), and PEH who were not engaged in employment, volunteering, and education (3·05, 1·97–4·71) also had higher risk of frailty than men experiencing homelessness and PEH who were engaged in these activities, respectively. PEH who were not UK nationals had lower risk of frailty than those who were UK nationals (0·20, 0·12–0·33). Sleeping outside conferred a lower likelihood of frailty compared with people who were previously homeless but now housed (0·36, 0·17–0·76). Similar patterns were observed with pre-frailty.</div></div><div><h3>Interpretation</h3><div>To our knowledge, this is the largest study of frailty in PEH, offering valuable insights into the high levels of non-geriatric frailty in this vulnerable group, and can act as a starting point to guide service development and policy for this population.</div></div><div><h3>Funding</h3><div>National Institute for Health and Care Research.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100745"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A geroscience response to cancellation of the UK’s Medicines Repurposing Programme: challenges and opportunities 对英国药品再利用计划取消的老年科学回应：挑战与机遇。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100744
Nicholas J W Rattray , Zahra Rattray , Ilaria Bellantuono , Jessica Lasky-Su , Lynne S Cox
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引用次数: 0
Capturing what counts in muscle failure: a critical appraisal of the current operational models of sarcopenia 捕捉肌肉衰竭：对当前肌肉减少症操作模型的关键评估。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100756
Hélio José Coelho-Júnior PhD , Emanuele Marzetti MD PhD
Sarcopenia was originally conceptualised to describe a neuromuscular condition that could help to explain, at least partly, the effect of unsuccessful ageing on the ability of older adults (ie, those aged 60 years and older) to maintain independent mobility. Over time, international committees have standardised the definition and operationalisation of sarcopenia. However, a key issue in diagnosing sarcopenia remains as the current definitions are primarily based on expert opinion, with no clear explanation or description of the method used to prioritise the diagnostic criteria for sarcopenia, rather than on the integration of subjective methods (eg, expert opinion) with hierarchical evidence and advanced statistical methodologies. This issue has led to considerable variability in the reported prevalence rates of sarcopenia, inconsistent findings regarding sarcopenia as a predictor of adverse outcomes, and major challenges in the development of effective non-pharmacological (eg, physical exercise, nutrition), pharmacological therapies, or reliable biomarkers of disease status. The ambiguity on what is being measured under the present definitions of sarcopenia raises the fundamental question of whether these models truly represent the most accurate and clinically useful constructs of age-related muscle failure. In this Personal View, we critically examine the current state of sarcopenia research and highlight the need for a revised approach that integrates physiological face validity and clinical applicability.
骨骼肌减少症最初的概念是描述一种神经肌肉状况，它可以帮助解释，至少部分地，不成功的衰老对老年人（即60岁及以上的人）保持独立活动能力的影响。随着时间的推移，国际委员会对肌肉减少症的定义和操作进行了标准化。然而，诊断肌少症的一个关键问题仍然存在，因为目前的定义主要基于专家意见，没有明确的解释或描述用于优先诊断肌少症的方法，而不是将主观方法（如专家意见）与分层证据和先进的统计方法相结合。这一问题导致报道的肌少症患病率存在相当大的差异，关于肌少症作为不良后果预测指标的研究结果不一致，并且在开发有效的非药物（如体育锻炼、营养）、药物治疗或可靠的疾病状态生物标志物方面面临重大挑战。在目前肌少症的定义下测量的内容的模糊性提出了一个基本问题，即这些模型是否真正代表了与年龄相关的肌肉衰竭的最准确和临床有用的结构。在本个人观点中，我们批判性地审视了肌少症研究的现状，并强调需要一种整合生理面部有效性和临床适用性的修订方法。
{"title":"Capturing what counts in muscle failure: a critical appraisal of the current operational models of sarcopenia","authors":"Hélio José Coelho-Júnior PhD ,&nbsp;Emanuele Marzetti MD PhD","doi":"10.1016/j.lanhl.2025.100756","DOIUrl":"10.1016/j.lanhl.2025.100756","url":null,"abstract":"<div><div>Sarcopenia was originally conceptualised to describe a neuromuscular condition that could help to explain, at least partly, the effect of unsuccessful ageing on the ability of older adults (ie, those aged 60 years and older) to maintain independent mobility. Over time, international committees have standardised the definition and operationalisation of sarcopenia. However, a key issue in diagnosing sarcopenia remains as the current definitions are primarily based on expert opinion, with no clear explanation or description of the method used to prioritise the diagnostic criteria for sarcopenia, rather than on the integration of subjective methods (eg, expert opinion) with hierarchical evidence and advanced statistical methodologies. This issue has led to considerable variability in the reported prevalence rates of sarcopenia, inconsistent findings regarding sarcopenia as a predictor of adverse outcomes, and major challenges in the development of effective non-pharmacological (eg, physical exercise, nutrition), pharmacological therapies, or reliable biomarkers of disease status. The ambiguity on what is being measured under the present definitions of sarcopenia raises the fundamental question of whether these models truly represent the most accurate and clinically useful constructs of age-related muscle failure. In this Personal View, we critically examine the current state of sarcopenia research and highlight the need for a revised approach that integrates physiological face validity and clinical applicability.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100756"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suicide prevention training in older men: a cluster randomised controlled trial of the Conversations about Suicide course in Australian Men’s Sheds 老年男性自杀预防训练：澳大利亚男性工棚自杀对话课程的随机对照试验。
IF 14.6 Q1 GERIATRICS & GERONTOLOGY
Lancet Healthy Longevity
Pub Date : 2025-08-01 DOI: 10.1016/j.lanhl.2025.100741
Amy J Morgan PhD , Anna M Ross PhD , Sanne Oostermeijer PhD , Claire M Kelly PhD , Angela Nicholas PhD , Prof Jane Pirkis PhD , Prof Nicola J Reavley PhD

Background

Older men (aged ≥65 years) have high suicide rates relative to other ages and there are major gaps in understanding how to improve suicide prevention knowledge and skills as a potential pathway to reduce suicide risk in this group. This study aimed to evaluate the effectiveness of a suicide prevention training course in a community sample of older men.

Methods

We conducted a cluster randomised controlled trial evaluating the Mental Health First Aid Conversations about Suicide course, which teaches community members to recognise when someone is experiencing suicidal thoughts and how to provide appropriate support. Australian Men’s Sheds(ie, community organisations that provide communal spaces for men to meet, socialise, learn new skills, and work on meaningful projects with other men) in the state of Victoria (from study onset) and additionally in New South Wales, Queensland, and Western Australia (from Oct 31 2022) were randomised (1:1) in clusters (single sheds or groups of sheds, if fewer than eight men per shed)with minimisation to the course or a waitlist control and all shed members who were men were eligible to participate. The primary outcome was participant intended actions (recommended or not recommended) towards a suicidal person, measured at baseline, 1-month follow-up and 7-month follow-up (primary timepoint), analysed by intention to treat. This trial is registered with ANZCTR, ACTRN12621000756820.

Findings

Between July 14, 2021 and Sept 27, 2023, ten clusters were allocated to the intervention and ten to the control, with 19 clusters analysed as one intervention cluster withdrew before baseline. Following exclusion of participants who did not provide data or withdrew consent, 261 participants were included: 92 in the intervention group and 169 in the control group. The mean age of participants was 71·6 years (SD 8·8). For the primary outcome of intended actions to support a suicidal person, the intervention group showed a larger improvement than the control group on recommended actions at 1-month follow-up (mean difference 4·42, 95% CI 3·19 to 5·64, p<0·0001) and 7-month follow-up (3·31, 2·06–4·57, p<0·0001). For non-recommended actions, the intervention group showed small, non-significant reductions at both timepoints relative to the control group (1-month follow-up: –0·48, –1·20 to 0·24, p<0·19; 7-month follow-up: –0·58, –1·32 to 0·16, p<0·12).

Interpretation

Delivering the Conversations about Suicide course in Men’s Sheds could improve the suicide prevention skills of older men in the community.

Funding

Australian Medical Research Future Fund.
背景：老年男性（≥65岁）相对于其他年龄段有较高的自杀率，在了解如何提高自杀预防知识和技能作为降低该群体自杀风险的潜在途径方面存在重大差距。本研究旨在评估自杀预防培训课程在社区老年男性样本中的有效性。方法：我们进行了一项随机对照试验，评估关于自杀的心理健康急救对话课程，该课程教导社区成员识别某人何时有自杀念头以及如何提供适当的支持。在维多利亚州（从研究开始）以及新南威尔士州、昆士兰州和西澳大利亚州（从2022年10月31日起）的澳大利亚男性棚屋（即为男性提供公共空间的社区组织，用于会面、社交、学习新技能和与其他男性一起从事有意义的项目）被随机分组（1:1）（单个棚屋或棚屋组），如果每个棚少于8人)，最小化课程或候补名单控制，所有棚成员都是男性，有资格参加。主要结局是参与者对自杀者的预期行动（推荐或不推荐），在基线、1个月随访和7个月随访（主要时间点）测量，并通过治疗意向进行分析。本试验已在ANZCTR注册，ACTRN12621000756820。研究结果：在2021年7月14日至2023年9月27日期间，10个组被分配到干预组，10个组被分配到对照组，其中19个组被分析为一个干预组在基线前退出。排除未提供数据或撤回同意的参与者后，共纳入261名参与者：干预组92名，对照组169名。参与者的平均年龄为71.6岁（标准差为8.8）。对于支持自杀者的预期行动的主要结果，干预组在1个月的随访中比对照组在推荐的行动方面显示出更大的改善（平均差4.42,95% CI 3.19至5.64）。解释：在男性棚里提供关于自杀的对话课程可以提高社区中老年男性的自杀预防技能。资助：澳大利亚医学研究未来基金。
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