Dana Pourzinal,Deborah Brooks,Deepa Sriram,Emily Mccann,James M King,Nancy A Pachana,Kirstine Shrubsole,Brian Wood,Alexander Lehn,Rodney Marsh,Jacki Liddle,Leander K Mitchell,John D O'Sullivan,Edwin C K Tan,Neil Page,Elton H Lobo,Martie-Louise Verreynne,Sabrina Lenzen,Nadeeka Dissanayaka
Although cognitive impairment is prevalent in people living with Parkinson's disease (PD), the clinical approach to cognitive disorders in PD varies significantly across health services. Here, we present updated best practice guidelines to standardise the diagnosis, evaluation, and management of cognitive disorders in PD across clinical contexts. Guideline development followed a two-phase process incorporating both expert and lived-experience perspectives. In Phase 1, preparatory research (literature reviews and a national survey) generated 58 preliminary recommendations. These were refined through a modified Delphi process with 29 clinician and research experts, resulting in 51 evidence-based and expert-endorsed recommendations. In Phase 2, perspectives of people with lived experience of cognitive disorders in PD (n = 15) were attained through focus groups, which produced 25 recommendations. A subsequent national survey (n = 81) demonstrated consensus on 24 of the 25 recommendations. Overall, the guideline development process yielded 58 unique recommendations, including recommendations for a tailored neuropsychological toolkit sensitive to cognitive decline in PD. These are the first best practice guidelines for the diagnosis, evaluation and management of cognitive disorders in PD informed by empirical evidence, expert consensus, and insights from people with lived experience. Clinical adoption of these guidelines will improve the quality of care, diagnostic accuracy, and early detection of cognitive disorders in PD. Future service models should consider incorporating these guidelines to optimise cognitive care in PD and promote evidence-based and patient-centred standards of practice.
{"title":"Best practice guidelines for the diagnosis, evaluation, and management of cognitive disorders in Parkinson's disease.","authors":"Dana Pourzinal,Deborah Brooks,Deepa Sriram,Emily Mccann,James M King,Nancy A Pachana,Kirstine Shrubsole,Brian Wood,Alexander Lehn,Rodney Marsh,Jacki Liddle,Leander K Mitchell,John D O'Sullivan,Edwin C K Tan,Neil Page,Elton H Lobo,Martie-Louise Verreynne,Sabrina Lenzen,Nadeeka Dissanayaka","doi":"10.1093/ageing/afag063","DOIUrl":"https://doi.org/10.1093/ageing/afag063","url":null,"abstract":"Although cognitive impairment is prevalent in people living with Parkinson's disease (PD), the clinical approach to cognitive disorders in PD varies significantly across health services. Here, we present updated best practice guidelines to standardise the diagnosis, evaluation, and management of cognitive disorders in PD across clinical contexts. Guideline development followed a two-phase process incorporating both expert and lived-experience perspectives. In Phase 1, preparatory research (literature reviews and a national survey) generated 58 preliminary recommendations. These were refined through a modified Delphi process with 29 clinician and research experts, resulting in 51 evidence-based and expert-endorsed recommendations. In Phase 2, perspectives of people with lived experience of cognitive disorders in PD (n = 15) were attained through focus groups, which produced 25 recommendations. A subsequent national survey (n = 81) demonstrated consensus on 24 of the 25 recommendations. Overall, the guideline development process yielded 58 unique recommendations, including recommendations for a tailored neuropsychological toolkit sensitive to cognitive decline in PD. These are the first best practice guidelines for the diagnosis, evaluation and management of cognitive disorders in PD informed by empirical evidence, expert consensus, and insights from people with lived experience. Clinical adoption of these guidelines will improve the quality of care, diagnostic accuracy, and early detection of cognitive disorders in PD. Future service models should consider incorporating these guidelines to optimise cognitive care in PD and promote evidence-based and patient-centred standards of practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seasonal variation and indoor environmental factors play important roles in shaping frailty risk among old adults. A recent study conducted by Yin et al. (Association between home environment characteristics, indoor dust microbiota and frailty among community-dwelling older adult couples. Age Ageing 2025;54:afaf321.) provided new evidences for the relationships between home conditions and indoor dust microbiota and frailty in older couples. However, this commentary highlights two key methodological challenges that may affect the interpretation of the findings of the study. First is seasonal confounding, given the seasonal variation of wet-bulb globe temperature (WBGT), particulate levels and indoor microbiota; and the limited temporal and spatial representativeness of single-time environmental and microbiological measurements, which may reduce the accuracy and interpretability of the results. Addressing these issues can promote causal inference and generalizability of the relationship between environmental factors and frailty among older adults. Furthermore, incorporating measurements of fine airborne particulate matter in future studies is recommended to better elucidate the role of indoor air quality in the frailty development pathway.
{"title":"Seasonal and spatial considerations in assessing home environment characteristics, indoor dust microbiota and frailty","authors":"Ziyu Wang, Yufang Guo","doi":"10.1093/ageing/afag040","DOIUrl":"https://doi.org/10.1093/ageing/afag040","url":null,"abstract":"Seasonal variation and indoor environmental factors play important roles in shaping frailty risk among old adults. A recent study conducted by Yin et al. (Association between home environment characteristics, indoor dust microbiota and frailty among community-dwelling older adult couples. Age Ageing 2025;54:afaf321.) provided new evidences for the relationships between home conditions and indoor dust microbiota and frailty in older couples. However, this commentary highlights two key methodological challenges that may affect the interpretation of the findings of the study. First is seasonal confounding, given the seasonal variation of wet-bulb globe temperature (WBGT), particulate levels and indoor microbiota; and the limited temporal and spatial representativeness of single-time environmental and microbiological measurements, which may reduce the accuracy and interpretability of the results. Addressing these issues can promote causal inference and generalizability of the relationship between environmental factors and frailty among older adults. Furthermore, incorporating measurements of fine airborne particulate matter in future studies is recommended to better elucidate the role of indoor air quality in the frailty development pathway.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delirium is a highly prevalent neuropsychiatric syndrome characterised by acute inattention, altered arousal and impaired cognition. Cerebral energy insufficiency is hypothesised to drive delirium and both hypoglycaemia and hypoxia can directly precipitate functional deficits and EEG slowing. Here we review the evidence that disrupted energy metabolism may play a causative role in delirium across multiple settings. Neuromonitoring methods including near infrared resonance spectroscopy and Transcranial Doppler suggest an association between altered cerebral perfusion and delirium, albeit with a minority of studies demonstrating associations with hyperoxia or low brain oxygen extraction. Hyperglycaemia, hypoglycaemia, relative hypoglycaemia and large fluctuations in glucose show associations with delirium, dependent on the setting. Functional neuroimaging methodologies such as functional MRI and fluorodeoxyglucose-positron emission tomography, demonstrate regional rather than global changes in functional hyperaemia and hypometabolism and the networks across which these changes occur may be key drivers of the delirium phenotype. Whether those changes reflect regulated changes in activity, the development of insulin resistance or an impairment of neurovascular coupling in those circuits requires further research. Availability of glucose, the ability to take it up and use it are all important in maintaining normal brain function and the disruption of any or all of these could impair energy metabolism in the brain during acute illness and delirium. Optimising brain glucose utilisation is a rational goal towards reducing delirium. Clinical trials with intranasal insulin offer tentative indication that this might be tractable and alternative fuels also might mitigate delirium. Systematic experiments and clinical trials are necessary to assess whether restoring normal metabolism can protect against delirium in different clinical environments.
{"title":"New horizons: disrupted brain energy metabolism as a driver of delirium","authors":"Meher Sabharwal, Gordon Boyd, Colm Cunningham","doi":"10.1093/ageing/afag024","DOIUrl":"https://doi.org/10.1093/ageing/afag024","url":null,"abstract":"Delirium is a highly prevalent neuropsychiatric syndrome characterised by acute inattention, altered arousal and impaired cognition. Cerebral energy insufficiency is hypothesised to drive delirium and both hypoglycaemia and hypoxia can directly precipitate functional deficits and EEG slowing. Here we review the evidence that disrupted energy metabolism may play a causative role in delirium across multiple settings. Neuromonitoring methods including near infrared resonance spectroscopy and Transcranial Doppler suggest an association between altered cerebral perfusion and delirium, albeit with a minority of studies demonstrating associations with hyperoxia or low brain oxygen extraction. Hyperglycaemia, hypoglycaemia, relative hypoglycaemia and large fluctuations in glucose show associations with delirium, dependent on the setting. Functional neuroimaging methodologies such as functional MRI and fluorodeoxyglucose-positron emission tomography, demonstrate regional rather than global changes in functional hyperaemia and hypometabolism and the networks across which these changes occur may be key drivers of the delirium phenotype. Whether those changes reflect regulated changes in activity, the development of insulin resistance or an impairment of neurovascular coupling in those circuits requires further research. Availability of glucose, the ability to take it up and use it are all important in maintaining normal brain function and the disruption of any or all of these could impair energy metabolism in the brain during acute illness and delirium. Optimising brain glucose utilisation is a rational goal towards reducing delirium. Clinical trials with intranasal insulin offer tentative indication that this might be tractable and alternative fuels also might mitigate delirium. Systematic experiments and clinical trials are necessary to assess whether restoring normal metabolism can protect against delirium in different clinical environments.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"20 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146210351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.175
Robert Murphy, Roisin Heffernan, Emma Doyle, Tara Ramsbottom, Kishen Radhakrishna, Nichola Boyle, Warren Connolly
Background Discharge summaries are a vital method of communication and critical for safe patient transitions. We sought to improve the quality of our discharge summaries through continual departmental audit against the National Standard for Discharge Summary Information (HIQA, 2013). We compared results across four audit cycles since 2022. Methods In each audit, 20 patients were selected at random from the preceding three months. Their electronic discharge summary and paper based medical notes were compared against the HIQA standards. Five key elements were examined: clinical course, complications, primary diagnosis, discharge medications and follow-up. Post Cycle1 interventions included creating an NCHD-designed flowchart, targeted education sessions and weekly reports on outstanding summaries to consultants. Data was analysed using Stata V15. Binary outcomes were compared between Cycle 1 and Cycles 2–4 using Pearson’s Chi-square test (p < 0.05). A composite outcome (5 key elements) was analysed using logistic regression. Results Significant improvements were made and sustained in documentation of the clinical course (40%-75%, p = 0.004), primary diagnosis (85%-100%, p = 0.002), and stopped medications (40%-70%, p = 0.016). Communication of future-plans (85%-97%, p = 0.062) and ideal summaries (20%-40%, p = 0.104) showed positive trends but did not reach statistical significance. Documentation of new or changed medications (85%-75%, p = 0.354), complications (80%-85%, p = 0.600), and complete discharge medications (57%-60%, p = 0.794) remained stable across cycles. Discharge summary quality improved significantly across cycles, with Cycles 2–4 scoring 0.63 points higher on a 5-point composite scale than Cycle 1 (p = 0.022). Conclusion NCHD-led continual audit, education sessions, a targeted flowchart and weekly reports resulted in significant and sustained improvements in the quality of discharge summaries. In addition to these interventions, we recommend the implementation of end-to-end electronic patient records to improve the accuracy of medication documentation.
{"title":"Bridging the Gap: The Impact of a 4-cycle, 3-year Departmental Audit on Discharge Summary Quality in a Geriatric Medicine Service","authors":"Robert Murphy, Roisin Heffernan, Emma Doyle, Tara Ramsbottom, Kishen Radhakrishna, Nichola Boyle, Warren Connolly","doi":"10.1093/ageing/afaf318.175","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.175","url":null,"abstract":"Background Discharge summaries are a vital method of communication and critical for safe patient transitions. We sought to improve the quality of our discharge summaries through continual departmental audit against the National Standard for Discharge Summary Information (HIQA, 2013). We compared results across four audit cycles since 2022. Methods In each audit, 20 patients were selected at random from the preceding three months. Their electronic discharge summary and paper based medical notes were compared against the HIQA standards. Five key elements were examined: clinical course, complications, primary diagnosis, discharge medications and follow-up. Post Cycle1 interventions included creating an NCHD-designed flowchart, targeted education sessions and weekly reports on outstanding summaries to consultants. Data was analysed using Stata V15. Binary outcomes were compared between Cycle 1 and Cycles 2–4 using Pearson’s Chi-square test (p &lt; 0.05). A composite outcome (5 key elements) was analysed using logistic regression. Results Significant improvements were made and sustained in documentation of the clinical course (40%-75%, p = 0.004), primary diagnosis (85%-100%, p = 0.002), and stopped medications (40%-70%, p = 0.016). Communication of future-plans (85%-97%, p = 0.062) and ideal summaries (20%-40%, p = 0.104) showed positive trends but did not reach statistical significance. Documentation of new or changed medications (85%-75%, p = 0.354), complications (80%-85%, p = 0.600), and complete discharge medications (57%-60%, p = 0.794) remained stable across cycles. Discharge summary quality improved significantly across cycles, with Cycles 2–4 scoring 0.63 points higher on a 5-point composite scale than Cycle 1 (p = 0.022). Conclusion NCHD-led continual audit, education sessions, a targeted flowchart and weekly reports resulted in significant and sustained improvements in the quality of discharge summaries. In addition to these interventions, we recommend the implementation of end-to-end electronic patient records to improve the accuracy of medication documentation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"52 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.207
Colm Ryan, Mary Doyle, Dan Ryan
Background Blood pressure (BP) is a highly important inpatient vital sign. However, its variability poses a challenge to the clinician attempting to conclude ward mean and minimum values - often from two readings per day. In this study we compared BP readings from 24-hour ambulatory BP monitors (ABPMs with that of 5 days of twice daily ward based BP readings (WBRs). The aim of the study was to test the accuracy of ward BP in clarifying mean and minimum values. Methods We performed a retrospective cohort study, gathering data on inpatients in an off-site rehabilitation unit between April 2023 and October 2024. Included patients had undergone an 24-hour ABPM assessment during their inpatient stay. Chart review was performed to collect data on ABPM, daytime WBRs (five day average, five day minimum), demographics, comorbidities, and clinical frailty score. Univariate analysis compared the relationships between ABPMsand WBRs. Results 72 patients were included; 45 were male (63%), mean age 79.92 years (6.744), mean clinical frailty score 5.056 (0.948). ABPMsdiffered significantly from five-day WBRs. Mean Systolic WBRs differing from ABPMsby an average of 6.4mmHg (p-value 0.03, Pearson 0.79). WBRs overestimated systolic blood pressure in 50 patients (69%), by an average of 12.01mmHg (p-value 0.001, Pearson 0.9). Regarding minimum Systolic BP, WBRs overestimated minimum BP by more than 10mmHg in 35 (49%) patients. Of note 29 (40%) of our cohort reported a history of falls in the last year with comorbid orthostatic hypotension. Conclusion In this frail, frequent-faller group, five-day average ward systolic BP overestimated mean systolic BP by approximately 1 BP tablet (6mmHg). Moreover, in half of patients ward BP overestimated minimum BP by more than 10mmHg. While treating hypertension is an essential component of medical care, more accurate BP assessment tools should be considered to prevent over-zealous treatment of BP in older, frailer inpatients.
{"title":"Testing five-day average ward based BP accuracy by comparing versus inpatient Ambulatory Blood Pressure Monitoring– A ward-based, retrospective cohort study","authors":"Colm Ryan, Mary Doyle, Dan Ryan","doi":"10.1093/ageing/afaf318.207","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.207","url":null,"abstract":"Background Blood pressure (BP) is a highly important inpatient vital sign. However, its variability poses a challenge to the clinician attempting to conclude ward mean and minimum values - often from two readings per day. In this study we compared BP readings from 24-hour ambulatory BP monitors (ABPMs with that of 5 days of twice daily ward based BP readings (WBRs). The aim of the study was to test the accuracy of ward BP in clarifying mean and minimum values. Methods We performed a retrospective cohort study, gathering data on inpatients in an off-site rehabilitation unit between April 2023 and October 2024. Included patients had undergone an 24-hour ABPM assessment during their inpatient stay. Chart review was performed to collect data on ABPM, daytime WBRs (five day average, five day minimum), demographics, comorbidities, and clinical frailty score. Univariate analysis compared the relationships between ABPMsand WBRs. Results 72 patients were included; 45 were male (63%), mean age 79.92 years (6.744), mean clinical frailty score 5.056 (0.948). ABPMsdiffered significantly from five-day WBRs. Mean Systolic WBRs differing from ABPMsby an average of 6.4mmHg (p-value 0.03, Pearson 0.79). WBRs overestimated systolic blood pressure in 50 patients (69%), by an average of 12.01mmHg (p-value 0.001, Pearson 0.9). Regarding minimum Systolic BP, WBRs overestimated minimum BP by more than 10mmHg in 35 (49%) patients. Of note 29 (40%) of our cohort reported a history of falls in the last year with comorbid orthostatic hypotension. Conclusion In this frail, frequent-faller group, five-day average ward systolic BP overestimated mean systolic BP by approximately 1 BP tablet (6mmHg). Moreover, in half of patients ward BP overestimated minimum BP by more than 10mmHg. While treating hypertension is an essential component of medical care, more accurate BP assessment tools should be considered to prevent over-zealous treatment of BP in older, frailer inpatients.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.188
Sarah O'Loughlin, Agnes Jonsson, Colin Mazen
Background Subdural haematoma (SDH) is a potentially life-threatening form of traumatic brain injury, occurring in both younger and older adults. This study aimed to identify which clinical and radiological severity markers best predict patient outcomes and whether these predictors differ by age group. Methods A retrospective review was conducted on SDH-related admissions to the National Trauma Centre between July 2023 and September 2024. Radiological severity was assessed using maximum SDH depth and midline shift, while clinical severity was measured via the Glasgow Coma Scale (GCS). Outcome measures included hospital length of stay and 30-day all-cause mortality. Statistical analysis was performed using Minitab. Results Isolated SDH accounted for 38.9% of all traumatic brain injuries admitted during the study period (n=203). The mean age was 68.4 ±18.7 years; 59.5% were aged ≥65 years and 67% were male. Mean SDH depth was 8.5 ±7.3 mm; midline shift, 1.62 ±3.9 mm; and GCS, 14 ±2.2. Across all ages, SDH depth demonstrated a moderate correlation (r = 0.343, p = 0.015) with length of stay, while GCS and midline shift showed a weak correlation with length of stay (r = -0.257, p = 0.039, r = 0.288, p = 0.87, respectively). In older adults, GCS had a stronger, and significant, correlation with length of stay (r = -0.428, p < 0.001), while in younger adults, SDH depth and midline shift were more strongly associated with length of stay (r = 0.572, p = 0.070; r = 0.493, p = 0.78, respectively). Thirty-day mortality was 2.08% in older and 6.35% in younger patients, with no significant difference or correlation to predictors. Conclusion Clinical and radiological predictors of outcome in SDH vary by age. GCS is a stronger prognostic indicator in older adults, whereas radiological markers have greater predictive value in younger patients.
硬膜下血肿（SDH）是一种可能危及生命的外伤性脑损伤，发生在年轻人和老年人中。本研究旨在确定哪些临床和放射学严重程度标记最能预测患者预后，以及这些预测指标是否因年龄组而异。方法回顾性分析2023年7月至2024年9月国家创伤中心收治的sdh相关患者。放射学严重程度通过最大SDH深度和中线移位进行评估，而临床严重程度通过格拉斯哥昏迷量表（GCS）进行测量。结果测量包括住院时间和30天全因死亡率。采用Minitab进行统计学分析。结果孤立性SDH占研究期间收治的所有外伤性脑损伤的38.9% （n=203）。平均年龄68.4±18.7岁；年龄≥65岁者占59.5%，男性占67%。平均SDH深度为8.5±7.3 mm；中线位移，1.62±3.9 mm；GCS为14±2.2。各年龄段SDH深度与住院时间呈中等相关性（r = 0.343, p = 0.015），而GCS和中线移位与住院时间呈弱相关性（r = -0.257, p = 0.039, r = 0.288, p = 0.87）。在老年人中，GCS与住院时间的相关性更强且显著（r = -0.428, p < 0.001），而在年轻人中，SDH深度和中线移位与住院时间的相关性更强（r = 0.572, p = 0.070; r = 0.493, p = 0.78）。老年患者30天死亡率为2.08%，年轻患者为6.35%，与预测因子无显著差异或相关性。结论SDH预后的临床和放射学预测因素因年龄而异。GCS在老年人中是一个更强的预后指标，而放射学标记在年轻患者中具有更大的预测价值。
{"title":"Age-Related Predictors of Outcomes for Subdural Haematoma","authors":"Sarah O'Loughlin, Agnes Jonsson, Colin Mazen","doi":"10.1093/ageing/afaf318.188","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.188","url":null,"abstract":"Background Subdural haematoma (SDH) is a potentially life-threatening form of traumatic brain injury, occurring in both younger and older adults. This study aimed to identify which clinical and radiological severity markers best predict patient outcomes and whether these predictors differ by age group. Methods A retrospective review was conducted on SDH-related admissions to the National Trauma Centre between July 2023 and September 2024. Radiological severity was assessed using maximum SDH depth and midline shift, while clinical severity was measured via the Glasgow Coma Scale (GCS). Outcome measures included hospital length of stay and 30-day all-cause mortality. Statistical analysis was performed using Minitab. Results Isolated SDH accounted for 38.9% of all traumatic brain injuries admitted during the study period (n=203). The mean age was 68.4 ±18.7 years; 59.5% were aged ≥65 years and 67% were male. Mean SDH depth was 8.5 ±7.3 mm; midline shift, 1.62 ±3.9 mm; and GCS, 14 ±2.2. Across all ages, SDH depth demonstrated a moderate correlation (r = 0.343, p = 0.015) with length of stay, while GCS and midline shift showed a weak correlation with length of stay (r = -0.257, p = 0.039, r = 0.288, p = 0.87, respectively). In older adults, GCS had a stronger, and significant, correlation with length of stay (r = -0.428, p &lt; 0.001), while in younger adults, SDH depth and midline shift were more strongly associated with length of stay (r = 0.572, p = 0.070; r = 0.493, p = 0.78, respectively). Thirty-day mortality was 2.08% in older and 6.35% in younger patients, with no significant difference or correlation to predictors. Conclusion Clinical and radiological predictors of outcome in SDH vary by age. GCS is a stronger prognostic indicator in older adults, whereas radiological markers have greater predictive value in younger patients.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"3 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.132
Nur Atikah Mohd Asri, Hadeel Abdalla, Sara Mirghni, Luke Walsh, Azrin Muslim, Mark Rogan, Kashif Rana
Background Chronic obstructive pulmonary disease (COPD) is closely linked to osteoporosis and fragility fractures due to factors like chronic inflammation, glucocorticoid use, and vitamin D deficiency. Despite NOGG guidelines, FRAX® assessments and bone-protective therapies are underutilized in this population. This study aims to evaluate bone health and identify treatment gaps in osteoporosis management among COPD patients. Methods An observational, prospective study was conducted on all medical admission ≥ 60 years old (n=50) with COPD in an Irish University Hospital for a period of 4 weeks in February 2025. Data analysis was performed using WEKA Explorer 3.8.6. Chi2 test was utilised to check for significance (p<0.05). Results 50% of patients sustained some form of fracture with vertebral fractures predominated (24%), followed by rib (12%), wrist (12%), hip (6%) and others (50%). 24% of patients had ≥2 fractures, with 38% sustaining major fractures. Only 58% of patients had vitamin D level tested. Of these, 58.9% were deficient (≤20 ng/mL) and 13.7% receiving no Vitamin D supplementation. 4% had calcium deficiency, yet none received calcium supplementation. Using NOGG criteria, 20% of patients were deemed high and very high risk of Major osteoporotic fracture, but only 30% received anti-osteoporotic treatment (p = .005). Conclusion The high vertebral fracture prevalence aligns with COPD’s systemic inflammation and muscle-bone crosstalk dysfunction, which accelerate bone resorption. The low rate of osteoporosis therapy indicates under-recognition of fracture risk, highlighting actionable gaps in osteoporosis care for COPD patients while emphasizing the need for guideline-driven interventions to reduce fracture-related morbidity.
慢性阻塞性肺疾病（COPD）与骨质疏松和脆性骨折密切相关，原因包括慢性炎症、糖皮质激素的使用和维生素D缺乏。尽管有NOGG指南，但FRAX®评估和骨保护疗法在这一人群中未得到充分利用。本研究旨在评估COPD患者的骨骼健康状况，并确定骨质疏松症管理的治疗差距。方法对2025年2月在爱尔兰大学医院住院的所有≥60岁COPD患者（n=50）进行为期4周的观察性前瞻性研究。使用WEKA Explorer 3.8.6进行数据分析。采用Chi2检验检验显著性（p<0.05）。结果50%的患者存在某种形式的骨折，以椎体骨折为主（24%），其次是肋骨骨折（12%）、手腕骨折（12%）、髋部骨折（6%）和其他骨折（50%）。24%的患者骨折≥2处，38%的患者骨折严重。只有58%的患者进行了维生素D水平检测。其中，58.9%缺乏维生素D(≤20 ng/mL)， 13.7%没有补充维生素D。4%的人缺钙，但没有人补充钙。使用NOGG标准，20%的患者被认为是严重骨质疏松性骨折的高风险和非常高风险，但只有30%的患者接受了抗骨质疏松治疗（p = 0.005）。结论慢性阻塞性肺疾病椎体骨折的高发生率与慢性阻塞性肺疾病的全身性炎症和骨骼肌串扰功能紊乱相一致，促进骨吸收。骨质疏松治疗的低率表明对骨折风险的认识不足，这突出了COPD患者骨质疏松治疗的可操作差距，同时强调了指南驱动的干预措施的必要性，以减少骨折相关的发病率。
{"title":"Breaking Bad: The Shocking Gap in Osteoporosis Care for Chronic Obstructive Pulmonary Disease Patients","authors":"Nur Atikah Mohd Asri, Hadeel Abdalla, Sara Mirghni, Luke Walsh, Azrin Muslim, Mark Rogan, Kashif Rana","doi":"10.1093/ageing/afaf318.132","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.132","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) is closely linked to osteoporosis and fragility fractures due to factors like chronic inflammation, glucocorticoid use, and vitamin D deficiency. Despite NOGG guidelines, FRAX® assessments and bone-protective therapies are underutilized in this population. This study aims to evaluate bone health and identify treatment gaps in osteoporosis management among COPD patients. Methods An observational, prospective study was conducted on all medical admission ≥ 60 years old (n=50) with COPD in an Irish University Hospital for a period of 4 weeks in February 2025. Data analysis was performed using WEKA Explorer 3.8.6. Chi2 test was utilised to check for significance (p&lt;0.05). Results 50% of patients sustained some form of fracture with vertebral fractures predominated (24%), followed by rib (12%), wrist (12%), hip (6%) and others (50%). 24% of patients had ≥2 fractures, with 38% sustaining major fractures. Only 58% of patients had vitamin D level tested. Of these, 58.9% were deficient (≤20 ng/mL) and 13.7% receiving no Vitamin D supplementation. 4% had calcium deficiency, yet none received calcium supplementation. Using NOGG criteria, 20% of patients were deemed high and very high risk of Major osteoporotic fracture, but only 30% received anti-osteoporotic treatment (p = .005). Conclusion The high vertebral fracture prevalence aligns with COPD’s systemic inflammation and muscle-bone crosstalk dysfunction, which accelerate bone resorption. The low rate of osteoporosis therapy indicates under-recognition of fracture risk, highlighting actionable gaps in osteoporosis care for COPD patients while emphasizing the need for guideline-driven interventions to reduce fracture-related morbidity.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"303 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.029
Kara Mc Loughlin, Katie Robinson
Background The number of older adult Emergency Department (ED) attendances is rising in line with population ageing. These ED visits are associated with adverse outcomes. Consequently, intervention studies with older adults in the ED aiming to mitigate adverse outcomes are increasing. However, there is currently no agreement on what outcomes to measure in these studies. This outcome heterogeneity has negative implications for synthesising evidence and for policy implications. To address this issue, we plan to develop a Core Outcome Set (COS) for use in studies with older adults in the ED setting. The first step in this process is to generate a long list of potential outcomes to include in the COS via a scoping review. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological guidance and reported with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An international trial register and 3 electronic databases were searched to locate experimental studies that recruited a population of older adults (aged 65yrs+) or in the ED. Searches and screening were completed independently by two researchers. Data was extracted using a custom data extraction template, the study design, outcomes measured, outcome tools, and measurement timepoints were recorded. Results Over 23,000 papers were screened with a full text review of 363 papers and a final inclusion of 106 papers. Outcomes were split into primary and secondary with a total of 217 in total reported across included studies (93 primary and 124 secondary outcomes). The modified Dodd taxonomy for Core Outcome Sets was utilised with 38 outcome domains used to categorise the outcomes reported. Conclusion This scoping review has highlighted the large variety of outcomes. Mapping these outcomes will inform the development of a Core Outcome Set which will have the potential to enhance future trials with this population.
{"title":"Scoping review of outcomes reported in studies with older adults in the Emergency Department","authors":"Kara Mc Loughlin, Katie Robinson","doi":"10.1093/ageing/afaf318.029","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.029","url":null,"abstract":"Background The number of older adult Emergency Department (ED) attendances is rising in line with population ageing. These ED visits are associated with adverse outcomes. Consequently, intervention studies with older adults in the ED aiming to mitigate adverse outcomes are increasing. However, there is currently no agreement on what outcomes to measure in these studies. This outcome heterogeneity has negative implications for synthesising evidence and for policy implications. To address this issue, we plan to develop a Core Outcome Set (COS) for use in studies with older adults in the ED setting. The first step in this process is to generate a long list of potential outcomes to include in the COS via a scoping review. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological guidance and reported with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An international trial register and 3 electronic databases were searched to locate experimental studies that recruited a population of older adults (aged 65yrs+) or in the ED. Searches and screening were completed independently by two researchers. Data was extracted using a custom data extraction template, the study design, outcomes measured, outcome tools, and measurement timepoints were recorded. Results Over 23,000 papers were screened with a full text review of 363 papers and a final inclusion of 106 papers. Outcomes were split into primary and secondary with a total of 217 in total reported across included studies (93 primary and 124 secondary outcomes). The modified Dodd taxonomy for Core Outcome Sets was utilised with 38 outcome domains used to categorise the outcomes reported. Conclusion This scoping review has highlighted the large variety of outcomes. Mapping these outcomes will inform the development of a Core Outcome Set which will have the potential to enhance future trials with this population.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"59 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background A prescribing cascade occurs when a new drug is prescribed to manage an adverse effect of another medication. Prescribing cascades are clinically important as they can result in potentially avoidable harm to patients. Older adults are particularly vulnerable to prescribing cascades due to multimorbidity and polypharmacy. This study aimed to utilise the Theoretical Domains Framework (TDF), a validated theory-informed framework to explore behavioural factors influencing hospital physicians’ recognition of prescribing cascades. Methods Between May and July 2024 fourteen semi-structured interviews were conducted with hospital physicians of all grades. Interviews were audio-recorded and transcribed verbatim. Transcripts underwent content analysis to identify themes and Theoretical Domains Framework (TDF) domains. Results Four key TDF domains were identified: (i) Environmental context and resources: time pressures, staffing shortages, difficulty accessing accurate medication lists, and insufficient information technology (IT) infrastructure are barriers to recognition; (ii) Knowledge: many physicians were unfamiliar with the term ‘prescribing cascade’, and those who could define it acknowledged knowing only a limited number of specific examples. Physicians reported minimal education and training at undergraduate and postgraduate level; (iii) Skills: physicians typically develop the skill to recognise prescribing cascades through experiential learning (particularly while working with geriatric medicine consultants); (iv) Social/professional role and identity: participants identified themselves (the prescriber) as being primarily responsible for prescribing cascade recognition. Pharmacists provide a crucial role through obtaining accurate medication lists, medication review, and ward round participation. Some interviewees expressed greater confidence in recognising prescribing cascades that occurred within their own specialty. Conclusion This study reveals significant gaps in hospital physicians’ knowledge and understanding of prescribing cascades. Potential initiatives to address this include targeted education, improved IT infrastructure, improved access to accurate up-to-date medication lists and a collaborative physician-pharmacist approach. These interventions would likely improve prescribing cascade recognition, particularly in older people with multimorbidity and polypharmacy.
{"title":"Barriers and Facilitators to Hospital Physicians’ Recognition of Prescribing Cascades: A Qualitative Interview Study","authors":"Ruth Daunt, Kieran Dalton, Denis Curtin, Denis O'Mahony","doi":"10.1093/ageing/afaf318.104","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.104","url":null,"abstract":"Background A prescribing cascade occurs when a new drug is prescribed to manage an adverse effect of another medication. Prescribing cascades are clinically important as they can result in potentially avoidable harm to patients. Older adults are particularly vulnerable to prescribing cascades due to multimorbidity and polypharmacy. This study aimed to utilise the Theoretical Domains Framework (TDF), a validated theory-informed framework to explore behavioural factors influencing hospital physicians’ recognition of prescribing cascades. Methods Between May and July 2024 fourteen semi-structured interviews were conducted with hospital physicians of all grades. Interviews were audio-recorded and transcribed verbatim. Transcripts underwent content analysis to identify themes and Theoretical Domains Framework (TDF) domains. Results Four key TDF domains were identified: (i) Environmental context and resources: time pressures, staffing shortages, difficulty accessing accurate medication lists, and insufficient information technology (IT) infrastructure are barriers to recognition; (ii) Knowledge: many physicians were unfamiliar with the term ‘prescribing cascade’, and those who could define it acknowledged knowing only a limited number of specific examples. Physicians reported minimal education and training at undergraduate and postgraduate level; (iii) Skills: physicians typically develop the skill to recognise prescribing cascades through experiential learning (particularly while working with geriatric medicine consultants); (iv) Social/professional role and identity: participants identified themselves (the prescriber) as being primarily responsible for prescribing cascade recognition. Pharmacists provide a crucial role through obtaining accurate medication lists, medication review, and ward round participation. Some interviewees expressed greater confidence in recognising prescribing cascades that occurred within their own specialty. Conclusion This study reveals significant gaps in hospital physicians’ knowledge and understanding of prescribing cascades. Potential initiatives to address this include targeted education, improved IT infrastructure, improved access to accurate up-to-date medication lists and a collaborative physician-pharmacist approach. These interventions would likely improve prescribing cascade recognition, particularly in older people with multimorbidity and polypharmacy.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"10 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.006
Ruth McCullagh, Dawn Skelton, N Frances Horgan, Eidin Ni She, Katherine Thackeray, Caroline Eldridge, Leanne Ahern, Eibhlis Cahalane, Vanda Cummins, Edel Brennan
Background The Falls Management Exercise (FaME) programme is a group-based strength and balance intervention shown to reduce falls and support physical activity and independence in older adults, with lasting effects. A key component is teaching participants how to get up from the floor, reducing fear and ambulance calls. Although UK studies highlight implementation challenges, FaME remains effective across populations. With Ireland’s over-65 population projected to exceed one million within a decade and injury costs set to surpass €2 billion, community-based falls prevention is urgently needed. In 2022, the AFFINITY project funded the training of 120 instructors to deliver FaME nationally. FaME Ireland now aims to assess early adoption, focusing on service integration, programme acceptability, and sustainability. Methods To evaluate early adoption, all FaME-trained instructors were surveyed on their delivery experiences. The HSE Change Guide, an experience-based co-design and action research approach, is being applied at three early-adopter sites reflecting varied contexts. Interviews, observations, and co-design workshops explored delivery, access, sustainability, and post-programme physical activity. Results Survey response rate was 67% (n=103), with good geographic coverage. Just over half reported delivering FaME, though some faced long waiting lists. Strong demand and positive participant feedback enabled uptake, but barriers included funding, venue shortages, and limited referral systems. Participants valued improved confidence and social connection, but access, awareness, and follow-on options were limited. Instructor job insecurity and short-term funding threatened sustainability. Local workshops proposed solutions including increased awareness, better referral pathways, and stronger networks. Conclusion FaME is valued and impactful, but early implementation reveals service gaps. To scale effectively, improved referral systems, long-term funding, and workforce support are needed. Upcoming HSE restructuring presents an opportunity to embed FaME nationally and enhance older adults’ independence and wellbeing.
{"title":"Learning from the early adoption of an evidence-based Falls Management Exercise Programme (FaME) in Ireland","authors":"Ruth McCullagh, Dawn Skelton, N Frances Horgan, Eidin Ni She, Katherine Thackeray, Caroline Eldridge, Leanne Ahern, Eibhlis Cahalane, Vanda Cummins, Edel Brennan","doi":"10.1093/ageing/afaf318.006","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.006","url":null,"abstract":"Background The Falls Management Exercise (FaME) programme is a group-based strength and balance intervention shown to reduce falls and support physical activity and independence in older adults, with lasting effects. A key component is teaching participants how to get up from the floor, reducing fear and ambulance calls. Although UK studies highlight implementation challenges, FaME remains effective across populations. With Ireland’s over-65 population projected to exceed one million within a decade and injury costs set to surpass €2 billion, community-based falls prevention is urgently needed. In 2022, the AFFINITY project funded the training of 120 instructors to deliver FaME nationally. FaME Ireland now aims to assess early adoption, focusing on service integration, programme acceptability, and sustainability. Methods To evaluate early adoption, all FaME-trained instructors were surveyed on their delivery experiences. The HSE Change Guide, an experience-based co-design and action research approach, is being applied at three early-adopter sites reflecting varied contexts. Interviews, observations, and co-design workshops explored delivery, access, sustainability, and post-programme physical activity. Results Survey response rate was 67% (n=103), with good geographic coverage. Just over half reported delivering FaME, though some faced long waiting lists. Strong demand and positive participant feedback enabled uptake, but barriers included funding, venue shortages, and limited referral systems. Participants valued improved confidence and social connection, but access, awareness, and follow-on options were limited. Instructor job insecurity and short-term funding threatened sustainability. Local workshops proposed solutions including increased awareness, better referral pathways, and stronger networks. Conclusion FaME is valued and impactful, but early implementation reveals service gaps. To scale effectively, improved referral systems, long-term funding, and workforce support are needed. Upcoming HSE restructuring presents an opportunity to embed FaME nationally and enhance older adults’ independence and wellbeing.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"11 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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