Year: 2025
Type: article
Abstract: Most cancer diagnoses occur in older adults. In a themed collection, O’Hanlon highlights challenges and opportunities in geriatric oncology [1]. The collection addresses key issues in geriatric oncology, including epidemiology, frailty assessment, trial participation barriers and the need for tailored care. The findings described in the collection underscore the urgent need for age-focused research and healthcare models that prioritise frailty-informed assessments, coordinated care and patient-centred interventions in oncology. The transition from hospital to home is a high-risk period for older adults, with frequent medication-related problems and unrecognised symptoms of deterioration. To address this, Murray et al. co-designed the 'Your Care Needs You' (YCNY) intervention with patients, carers and healthcare professionals to promote patient and family engagement during hospital stays [2]. A cluster randomised controlled trial across 39 wards (n = 5484) compared YCNY with usual care. The intervention focused on four key self-management activities: health and wellbeing, medications, daily living and escalating care needs. While YCNY did not significantly reduce unplanned hospital readmissions at 30 days, secondary outcomes showed promise. Notably, there were 13% fewer readmissions at 90 days and improved patient-reported experiences and safety at 30 days in the intervention group. Assessing daily function is essential in dementia screening, but existing questionnaires often have limitations, such as excessive length or lack of coverage of both cognitive and functional domains. Recently, the Standardised Assessment of Global Everyday Activities (SAGEA) was developed to address these issues, offering a concise 15-item tool spanning cognition, ADL, IADL, participation and mobility. In a retrospective analysis of prospectively collected data using data from the PROMPT and CAN-PROTECT registries, Phelps et al. validated SAGEA. SAGEA scores increased progressively across cognitive stages from subjective cognitive decline (SCD) to mild cognitive impairment (MCI) to dementia, confirming its sensitivity to clinical severity [3]. A predefined algorithm based on SAGEA questions identified dementia with excellent sensitivity (94.5%) and specificity (94.6%), although discrimination between MCI and dementia was less robust. Functioning in daily life of older adults living with dementia is also determined by behavioural and psychological symptoms (BPSD). BPSD contribute significantly to caregiver burden, institutionalisation and reduced quality of life. Virtual reality (VR), a 3D computer-generated simulation, has emerged as a potential non-pharmacological intervention to address these symptoms. In a systematic review, Wang et al. evaluated ten studies assessing the effectiveness, safety and acceptability of VR for reducing BPSD severity [4]. While the results were mixed, several studies reported reductions in aggression, depressive symptoms and apathy, with consistently high acceptability and minimal adverse effects across diverse clinical settings. Promising results, but further research is needed to determine the true potential of VR in managing BPSD and improving care for people living with dementia. Albeit more traditional, tailoring care to the individual needs and preferences of people with dementia (PWD) and their carers may be even more essential. Care delivery is however, complicated by the fact that dementia often impairs communication. In a mixed-methods review of 33 studies, Sunjaya et al. identified three key communication strategies for delivering personalised dementia care: understanding the person, their family and care context; using verbal, nonverbal and aided communication techniques; and ensuring adequate workforce support [5]. On another level, Bach-Mortensen et al. showed that for care home residents, their quality of life may also be dependent on the funding structure (self- or state-funded), with a nationwide retrospective observational analysis of care homes in England [6]. Using novel and population-level data, they found that self-funded residents are more likely to be in good-quality provision. Hypertension is an established modifiable risk factor for dementia. Nevertheless, previous randomised controlled trials and observational studies investigating the impact of antihypertensive drugs on dementia and Alzheimers disease risk have shown inconsistent findings. In a large multinational cohort study, using harmonised data from over 1.9 million individuals across Hong Kong, the UK, Sweden and Australia, Edmund et al. compared dementia risk among users of different antihypertensive classes [7]. Their findings suggest that (initiation of) ARBs -and not other antihypertensive classes- may offer a protective benefit against vascular dementia. Falls are common among older adults and are the main reason for injury-related emergency department visits. Medication use, particularly fall-risk-increasing drugs (FRIDs), is a key modifiable risk factor in falls prevention strategies. The STOPPFall screening tool, previously developed through expert consensus, identifies 14 classes of FRIDs that may contribute to fall risk [8]. In a longitudinal study using data from the Irish Longitudinal Study on Ageing (TILDA), Doyle et al. examined the association between STOPPFall medications and fall and fracture outcomes over a median follow-up of 8 years in 2898 community-dwelling older adults [9]. Prescription of ≥2 STOPPFall medications was independently associated with higher odds of all falls, unexplained and injurious falls and fractures, including hip fractures. These results underscore the importance of regular medication reviews and deprescribing where appropriate, supporting current international guidelines for fall prevention in older people. Approximately 30% of individuals aged 60 and older report experiencing loneliness, prompting the development of a wide range of interventions. Intuitively, one would expect social interventions to be the most successful approach. However, psychotherapy—especially reminiscence therapy—appears to be even more effective. This was examined by Yang et al. in a systematic review that examined 22 studies involving 1789 older adults, including 14 RCTs, and found that both simple reminiscence therapy and structured life review significantly reduced loneliness [10]. Reminiscence therapy works by helping older adults reflect on past experiences, enhancing their sense of identity and strengthening social connections. While the findings support the use of reminiscence therapy, variability across studies highlights the need for further research to refine intervention formats and better understand the factors influencing effectiveness in diverse settings. None declared. None declared.
Source: Age and Ageing
Author: Nathalie van der Velde
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411578586