Explore the vast range of titles available.

Background Chronic pain, defined as pain persisting for ≥ 3 months, is associated with frailty, falls, and reduced quality of life. Falls remain a major cause of morbidity and mortality in older adults, yet the value of integrating pain severity into falls risk assessment is underexplored. This study examined associations between chronic pain severity and subsequent falls, frailty, physical performance, and perceived health in older adults at risk of falls. Methods In this cross-sectional study, baseline data from 143 community-dwelling adults aged ≥ 60 years at risk of falls were analysed. Participants were recruited from community and primary care centres in Singapore. Pain severity was assessed using the Wong–Baker Faces Pain Rating Scale (0–10) and classified as no pain, mild pain (< 3), or at least moderate pain (≥ 3). Data on demographics, frailty, sarcopenia (SARC-F ≥ 2), nutrition, cognition, fear of falling, and perceived health (EuroQol Visual Analogue Scale [EQ-VAS] and EuroQoL 5-Dimensions [EQ-5D]) were collected. Physical performance tests included handgrip strength, gait speed, 5-times sit-to-stand, and Timed-Up-and-Go (TUG). Logistic and linear regression models examined associations between pain severity and outcomes, adjusting for demographic and clinical covariates. Results Chronic pain was prevalent in 37.1%. Compared with no pain, at least moderate pain was associated with higher odds of future falls (adjusted odds ratio (aOR) 3.54, 95% CI 1.53–8.19), moderate/high falls risk (aOR 4.78, 95% CI 1.65–10.77), frailty (aOR 4.17, 95% CI 1.42–8.26), sarcopenia (aOR 4.99, 95% CI 1.63–7.28), slower gait speed (aOR 3.87, 95% CI 1.18–8.67), longer TUG (aOR 4.52, 95% CI 1.36–10.01), and poor physical performance (aOR 12.50, 95% CI 3.94–17.17). Pain severity was associated with EQ-VAS (β = − 4.07, 95% CI − 7.67 to − 1.47) and EQ-5D index (β = − 0.11, 95% CI − 0.15 to − 0.07). Conclusion Higher chronic pain severity was associated with future falls, frailty, poor physical performance and lower perceived health in at-risk older adults. Incorporating pain severity assessment into falls risk stratification could support earlier, targeted interventions to prevent injurious falls. Longitudinal studies are needed to determine the causal impact of pain management on falls, frailty, and quality of life. Clinical relevance Chronic pain in older adults is significantly associated with an increased risk of future falls, frailty, poor physical performance, and lower perceived health, highlighting the importance of evaluating chronic pain in fall risk assessments and vice versa. Implementing targeted prevention measures for individuals with chronic pain can potentially mitigate the risk of falls and improve overall health outcomes in this population.

Introduction. Growth differentiation factor 15 (GDF-15) has been shown to be a metabolic and appetite regulator in diabetes mellitus (DM) and obesity. We aimed to investigate (i) the association between GDF-15 and DM with and without poor physical function independent of inflammation and (ii) the prediction model for poor physical function in prefrail older adults. Methods. A cross-sectional study of 108-prefrail participants ≥60 years recruited for multidomain interventions. Data was collected for demographics, cognition, function, frailty, nutrition, handgrip strength (HGS), short physical performance battery (SPPB), and gait speed. Serum concentrations of GDF-15, IL-6, and TNF-α were measured. GDF-15 was classified into tertiles (T1, T2, and T3), and its association was studied with DM and physical function (DM poor physical function, DM no poor physical function, no DM poor physical function, and no DM no poor physical function). Results. Compared with T1, participants in T3 were significantly older, had a lower education level, had almost three times higher prevalence of DM, slower gait speed, longer chair-stand time, and lower SPPB scores. On multivariate analysis, the odds of having both DM and poor physical performance compared to having no DM and no poor physical performance were significantly higher in GDF-15 T3 vs. GDF-15 T1 (aOR 9.7, 95% CI 1.4-67.7; p=0.021), and the odds of having DM no poor physical function compared to having no DM and no poor physical performance were significantly higher in GDF-15 T2 (aOR 12.7, 95% CI 1.1-143.7; p=0.040) independent of BMI, IL-6, TNF-α, nutrition, physical function, education, age, and gender. Conclusion. The association of GDF-15 with DM-associated poor physical function is independent of inflammation in prefrail older adults. Its causal-association link needs to be determined in longitudinal studies.

Background The Ginkgo biloba special extract, EGb 761® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer’s disease (AD). Methods To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence‐based consensus recommendations regarding the use of EGb 761® in neurocognitive disorders with/without cerebrovascular disease. Results Key randomized trials and robust meta‐analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761®versus placebo in patients with mild‐to‐moderate dementia. In those with mild cognitive impairment (MCI), EGb 761® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761® with the same strength of evidence as acetylcholinesterase inhibitors and N‐methyl‐D‐aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761® to have a positive risk‐benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta‐analyses have not supported this association. Conclusions The Expert Group foresee an important role for EGb 761®, used alone or as an add‐on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761® should be used in alignment with local clinical practice guidelines.

Motoric cognitive risk syndrome (MCR) is defined by the presence of slow gait and subjective cognitive decline. It is well recognized as a prodrome for dementia, but the biological mechanism and trajectory for MCR are still lacking. The objective of this study was to explore the association of MCR with body composition, including sarcopenia and systemic inflammation, in pre-frail older adults in a cross-sectional study of 397 pre-frail community-dwelling older adults. Data on demographics, physical function, frailty, cognition (Montreal Cognitive Assessment (MoCA)), perceived health and depression were collected. Body composition was measured using a bioelectrical impedance analyzer. Systemic inflammatory biomarkers, such as progranulin, growth differentiation factor-15 (GDF-15), interleukin-10 (IL-10), interleukin-6 and tumor necrosis factor-α (TNF-α), were collected. Univariate and multivariate logistic regression were used to analyze the association between MCR, body composition, sarcopenia and systemic inflammatory biomarkers. The prevalence of MCR was 14.9%. They were significantly older and there were more females, depression, functional impairment, lower education, physical activity and MoCA scores. Body fat percentage (BF%), fat mass index, fat to fat free mass ratio (FM/FFM) and sarcopenia prevalence were significantly higher in MCR. Serum GDF-15 and TNF-α levels were highest with progranulin/TNF-α and IL-10/TNF-α ratio lowest in MCR. Compared to healthy patients, MCR was significantly associated with sarcopenia (aOR 2.62; 95% CI 1.46–3.17), BF% (aOR 1.06; 95% CI 1.01–1.12), FMI (aOR 1.16; 95% CI 1.02–1.30) and FM/FFM (aOR 6.38; 95% CI 1.20–33.98). The association of IL-10 to TNF-α ratio (aOR 0.98, 95% CI 0.97–0.99) and IL-10 (aOR 2.22, 95% CI 0.05–0.98) with MCR were independent of sarcopenia and BF%. Longitudinal population studies are needed to understand the role of body fat indices and IL-10 in pre-frail older adults with MCR and trajectory to dementia.

Decline in intrinsic capacity (IC) has been shown to accelerate progression to disability. The study aims to explore association of IC composite score with functional ability, sarcopenia and systemic inflammation in pre-frail older adults. Cross-sectional study of pre-frail older adults ≥60 years old recruited from the community and primary care centers. Composite scores of four domains of IC were measured: locomotion, vitality, cognition and psychological. FRAIL scale was used to define pre-frailty. Muscle mass was measured using the bioelectrical impedance analysis. Systemic inflammation biomarkers [Interleukin-6 (IL-6), Interleukin-10 (IL-10), Tumor Necrosis Factor Alpha (TNF-α), and Growth differentiated factor 15 (GDF-15)] were measured. Participants in the lowest tertile (T1) exhibited greater decline in IC. A total of 398 pre-frail older adults were recruited, mean age was 72.7 ± 5.8 years, 60.1% female, education level 7.8 years, and 85.2% were of Chinese ethnicity. A total of 75.1% had decline in locomotion, 40.5% in vitality, 53.2% in cognition and 41.7% in psychological domain. A total of 95% had decline in at least one domain. T1 was significantly associated with ADL impairment (aOR 3.36, 95% CI 1.78-6.32), IADL impairment (aOR 2.37, 95% CI 1.36-4.13), poor perceived health (aOR 0.96, 95% CI 0.95-0.98), fall (aOR 1.63, 95% CI 1.05-2.84), cognitive impairment (aOR 8.21, 95% CI 4.69-14.39), depression (aOR 101.82, 95% CI 33.62-308.37), and sarcopenia (aOR 2.40, 95% CI 1.60-5.45). T1 had significant associations with GDF-15, IL-10, and IL-10 to TNF-α ratio. Decline in IC composite score among pre-frail older adults was associated with functional limitation, sarcopenia, and systemic inflammation.

Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

Background With increasing cost of healthcare in our aging society, a consistent pain point is that of end-of-life care. It is particularly difficult to prognosticate in non-cancer patients, leading to more healthcare utilisation without improving quality of life. Additionally, older adults do not age homogenously. Hence, we seek to characterise healthcare utilisation in young-old and old-old at the end-of-life. Methods We conducted a single-site retrospective review of decedents under department of Advanced Internal Medicine (AIM) over a year. Young-old is defined as 65–79 years; old-old as 80 years and above. Data collected was demographic characteristics; clinical data including Charlson Comorbidity Index (CCI), FRAIL-NH and advance care planning (ACP); healthcare utilisation including days spent in hospital, hospital admissions, length of stay of terminal admission and clinic visits; and quality of end-of-life care including investigations and symptomatic control. Documentation was individually reviewed for quality of communication. Results One hundred eighty-nine older adult decedents. Old-old decedents were mostly females (63% vs. 42%, p  = 0.004), higher CCI scores (7.7 vs 6.6, p  = 0.007), similarly frail with lower polypharmacy (62.9% vs 71.9%, p  = 0.01). ACP uptake was low in both, old-old 15.9% vs. young-old 17.5%. Poor prognosis was conveyed to family, though conversation did not result in moderating extent of care. Old-old had less healthcare utilisation. Adjusting for sex, multimorbidity and frailty, old-old decedents had 7.3 ± 3.5 less hospital days in their final year. Further adjusting for cognition and residence, old-old had 0.5 ± 0.3 less hospital admissions. When accounted for home care services, old-old spent 2.7 ± 0.8 less hospital days in their last admission. Conclusion There was high healthcare utilisation in older adults, but especially young-old. Enhanced education and goal-setting are needed in the acute care setting. ACP needs to be reinforced in acute care with further research to evaluate if it reduces unnecessary utilisation at end-of-life.

With aging populations, the prevalence of dementia, frailty and malnutrition will increase. The aim of this study is twofold (a) to determine the demographic data, including frailty and malnutrition prevalence in older patients with diagnosis of dementia and/or cognitive impairment and (b) to determine its impact on outcomes such as length of stay (LOS), readmission and mortality stratified by frailty status. Retrospective single-center cohort study conducted using hospital database on older patients ≥65 yrs. admitted to a tertiary hospital between March 2022 and Dec 2023 and discharged with either primary or secondary diagnosis of dementia or cognitive impairment. Data on age, gender, ethnicity, comorbidities, discharge diagnoses, Hospital Frailty Risk Score (HFRS), Clinical Frailty Scale (CFS), activity of daily living (ADL), 3-Minute Nutrition Screening and outcomes such as LOS, readmission, mortality and cost of hospitalization were extracted. Those aged between 65 to 74 years old were categorized as \"young-old,\" and ≥75 years old as \"old-old.\" Dementia or cognitive impairment diagnosis was prevalent in 8.6% (3090) older patients, and 33.7% were malnourished. 54.5% were female with a mean age of 82.0 years. Almost one fourth were dependent on ADL. Based on frailty defined by (i) HFRS-26.0% had intermediate and 18.2% high frailty (ii) CFS-41.0% were mild/moderately frail, and 32.2% severely frail. Median LOS was 8 days. 30 and 90-days readmission rates were 23.2 and 35.4%, respectively. In-hospital mortality was 7.8% and 30-day mortality 14.0%. High HFRS (aOR 1.511, 95% CI: 1.089-2.097;  = 0.013), severe frailty (aOR 4.325, 95% CI: 0.960-2.684;  < 0.001) and terminal frailty (aOR 39.762, 95% CI: 18.311-86.344;  < 0.001) were significantly associated with inpatient mortality. Intermediate HFRS (aOR 1.682, 95% CI: 1.380-2.050;  < 0.001), mild/moderate frailty (1.609, 95% CI: 1.254-2.065;  < 0.01), high HFRS (aOR 2.178, 95% CI: 1.756-2.702;  < 0.001) and severe frailty (2.333, 95% CI: 1.804-3.017;  < 0.01) were significantly associated with 30-days readmission. The impact of malnutrition on healthcare utilization was highest in the old-old with high HFRS and severe frailty. Frailty and malnutrition have significant impact on healthcare utilization, readmission rates, and mortality among older adults with dementia and/or cognitive impairment.

To determine the prevalence of metabolic syndrome (MetS) in older adults and assess the association of MetS and adverse outcomes with handgrip strength (HGS), HGS/body weight (BWT), and HGS/body mass index (BMI). A cross-sectional population study in Singapore. Data were collected on demographics, HGS, Timed-Up and Go (TUG), fasting glucose, lipid profile, blood pressure, waist circumference, frailty status, and cognition in 722 older adults ≥65 years old. MetS was defined using the Modified ATP III for Asians where at least three of the following conditions must be fulfilled, central obesity, high blood glucose (or diagnosed diabetes mellitus), high blood pressure (or diagnosed hypertension), low high-density lipoprotein, and high triglycerides. The waist circumference in the Modified ATP III for Asians is ≥90 cm for males or ≥80 cm for females. HGS and HGS normalized by BWT or BMI were used for the association. The prevalence of MetS in older adults was 41.0%, and those ≥85 years old 50.0%. The prevalence was higher in females ≥70 years old, with 8 in 10 females ≥85 years having MetS. After adjusting for age, years of education, physical exercise, as well as history of smoking and alcohol consumption, higher HGS normalized by BWT or BMI was significantly associated with lower odds of having MetS (OR: 0.51,95% CI 0.43-0.61, <0.01) and (OR: 0.13, 95% CI 0.07-0.24, <0.01). Almost 1 in 2 older adults had MetS, with the prevalence in females much higher than that in males over 70 years old. Our findings suggest that both HGS/BWT and HGS/BMI had a significant negative association with MetS, its components, and adverse effects. Further studies are needed to validate the association and to determine optimal cutoffs of HGS/BWT and HGS/BMI for MetS, and the effectiveness of interventions in averting the risk.

With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.