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Effectiveness and safety of focused deprescribing interventions targeting specific drug classes in older adults across clinical settings: an umbrella systematic literature review. 针对老年人临床环境中特定药物类别的集中处方解除干预措施的有效性和安全性:一项综合性系统文献综述。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag243
Ángel García Álvarez, Pau Riera Serra, Ignacio Ricci-Cabello, David Morales Hernández, Roberto Santa Cruz, Narges Malih, Daniela C Gonçalves-Bradley, Laura Gallardo-Alfaro, Maria Jesús Serrano Ripoll, Catalina Calafat Villalonga, Bárbara Ana Ferrer Jaillard, Manuel Pinteño-Blanco, David Medina Bombardó, Maria Angela Doronzo, Sebastián Jaume Gayá, Maria Antònia Fiol-deRoque
{"title":"Effectiveness and safety of focused deprescribing interventions targeting specific drug classes in older adults across clinical settings: an umbrella systematic literature review.","authors":"Ángel García Álvarez, Pau Riera Serra, Ignacio Ricci-Cabello, David Morales Hernández, Roberto Santa Cruz, Narges Malih, Daniela C Gonçalves-Bradley, Laura Gallardo-Alfaro, Maria Jesús Serrano Ripoll, Catalina Calafat Villalonga, Bárbara Ana Ferrer Jaillard, Manuel Pinteño-Blanco, David Medina Bombardó, Maria Angela Doronzo, Sebastián Jaume Gayá, Maria Antònia Fiol-deRoque","doi":"10.1093/ageing/afag243","DOIUrl":"10.1093/ageing/afag243","url":null,"abstract":"<p><p>Polypharmacy is highly prevalent among older adults and is associated with adverse outcomes. While comprehensive medication review is widely promoted to address potentially inappropriate prescribing, it is resource intensive. Focused deprescribing-defined as the targeted withdrawal or dose reduction of specific drug classes-has emerged as a potentially more scalable strategy. This umbrella review synthesised evidence on the effectiveness and safety of drug class-specific focused deprescribing interventions in older adults. We conducted an umbrella review of systematic reviews evaluating focused deprescribing interventions targeting specific pharmacological classes. MEDLINE, Embase, the Cochrane Library and Web of Science were searched from inception to March 2025. Study selection, data extraction and methodological quality assessment (AMSTAR-2) were performed independently by two reviewers. Findings were synthesised narratively by drug class and outcome domain, and overlap was assessed using the Corrected Covered Area. Twenty-seven systematic reviews were included. Most focused on psychotropics, particularly benzodiazepines, and anticholinergics, with fewer assessing antidiabetics or fall-risk increasing drugs. Reductions in medication use were most consistent for benzodiazepines and other psychotropics, especially when interventions included psychotherapy or multifaceted components. Evidence for antidiabetics suggested feasibility and safety, whereas effects on anticholinergics and fall-risk increasing drugs were limited. Clinical outcomes, including mortality, falls and cognition, were inconsistently reported and rarely improved. Most reviews were rated as critically low quality, and certainty of evidence was generally low or very low. Focused deprescribing appears feasible and generally safe for reducing selected potentially inappropriate medications in older adults; however, its clinical benefits are drug class-dependent and remain uncertain.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787038","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}
引用次数: 0
Comparative effectiveness of high-dose versus standard-dose influenza vaccines in nursing home residents aged 65 and older in France: a nationwide cohort study on the French health data system from the 2022-2023 season. 高剂量与标准剂量流感疫苗在法国65岁及以上养老院居民中的比较有效性:一项关于法国2022-2023年健康数据系统的全国性队列研究。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag238
Helene Bricout, Marie-Cecile Levant, Pascal Crépey, Gaëtan Gavazzi, Jacques Gaillat, Marine Dufournet, Nada Assi, Benjamin Grenier, Fanny Raguideau, Camille Salamand, Anne Mosnier, Laurence Watier, Odile Launay, Matthew Loiacono
{"title":"Comparative effectiveness of high-dose versus standard-dose influenza vaccines in nursing home residents aged 65 and older in France: a nationwide cohort study on the French health data system from the 2022-2023 season.","authors":"Helene Bricout, Marie-Cecile Levant, Pascal Crépey, Gaëtan Gavazzi, Jacques Gaillat, Marine Dufournet, Nada Assi, Benjamin Grenier, Fanny Raguideau, Camille Salamand, Anne Mosnier, Laurence Watier, Odile Launay, Matthew Loiacono","doi":"10.1093/ageing/afag238","DOIUrl":"10.1093/ageing/afag238","url":null,"abstract":"<p><strong>Background: </strong>Older adults in nursing homes face high influenza-related morbidity and mortality due to immunosenescence and comorbidities, which may reduce vaccine effectiveness. High-dose (HD) influenza vaccine, containing four times more antigen than standard-dose (SD) formulations, aim to compensate for this impaired immune response.</p><p><strong>Objectives: </strong>To compare the Relative Vaccine Effectiveness (rVE) of HD versus SD influenza vaccines against influenza-related hospitalisations (primary), and hospitalisations due to pneumonia or combined influenza/pneumonia (secondary) in nursing home residents aged ≥65 years.</p><p><strong>Study design: </strong>Nationwide retrospective cohort (French SNDS). Residents vaccinated between 1 September 2022, and 31 March 2023, were followed until 30 June 2023, discharge or death. Facilities with in-house pharmacies were excluded.</p><p><strong>Exposures/outcomes: </strong>HD vs. SD influenza vaccine (pharmacy dispensing codes). Hospitalisations identified by ICD-10 discharge codes.</p><p><strong>Methods: </strong>HD and SD recipients were matched 1:1 using propensity scores with exact matching on sex, age group, region and vaccination week. Incidence rate ratios (IRR) were estimated using Poisson/negative binomial models. rVE = (1-IRR) × 100.</p><p><strong>Results: </strong>Among 315 239 residents (123 720 HD; 191 519 SD), 76 858 pairs were matched (mean age 88 years; 75% women). Influenza hospitalisation rates were 302 vs. 438 per 100 000 person-years, corresponding to an rVE of 30.8% (95% CI: 11.8-45.7; P = .0029). No significant rVE was observed for pneumonia or combined outcomes.</p><p><strong>Conclusions and relevance: </strong>HD vaccine was associated with a significant reduction in influenza-related hospitalisations in French nursing home residents, supporting preferential HD use in this high-risk population. Residual confounding cannot be excluded, and vaccine safety was not assessed in the present analysis.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Validation of the World Falls Guidelines risk stratification algorithm. A systematic review. 世界瀑布指南风险分层算法的验证。系统回顾。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag231
Frederico Pieruccini-Faria, Surim Son, Kim Delbaere, Nathalie van der Velde, Stephen R Lord, Finbarr C Martin, Jesper Ryg, Maw Pin Tan, Teresa Liu-Ambrose, Diana Amaris, Cameron Hicks, Tahir Masud, Manuel Montero-Odasso
{"title":"Validation of the World Falls Guidelines risk stratification algorithm. A systematic review.","authors":"Frederico Pieruccini-Faria, Surim Son, Kim Delbaere, Nathalie van der Velde, Stephen R Lord, Finbarr C Martin, Jesper Ryg, Maw Pin Tan, Teresa Liu-Ambrose, Diana Amaris, Cameron Hicks, Tahir Masud, Manuel Montero-Odasso","doi":"10.1093/ageing/afag231","DOIUrl":"10.1093/ageing/afag231","url":null,"abstract":"<p><strong>Background: </strong>Falls are a major cause of morbidity and mortality in older adults. The World Falls Guidelines (WFG) propose a risk stratification algorithm using fall history, three key questions (3KQ), mobility tests and clinical criteria, but it has yet to be systematically evaluated.</p><p><strong>Objective: </strong>To assess whether the WFG algorithm, in original or modified form, effectively stratifies community-dwelling older adults into low, intermediate or high risk of future falls; whether it has been prospectively validated; and whether it has been adequately operationalised.</p><p><strong>Methods: </strong>We conducted a systematic review (PROSPERO CRD420251151506) by searching MEDLINE, Embase and Google Scholar. Two reviewers independently screened studies and extracted data on cohort characteristics, algorithm adaptations, baseline risk distribution and prospective falls outcomes over ≥6 months. Given the heterogeneity of the studies included, quantitative meta-analysis was not conducted.</p><p><strong>Results: </strong>Eight cohort studies (n = 25 027; mean age range 61-82 years) met the inclusion criteria. No study implemented the WFG algorithm as published; two used minor modifications and six had major adaptations due to dataset limitations. Common modifications included rephrasing the 3KQ, replacing 'subjective unsteadiness' question with objective measures, applying mobility test universally, adjusting mobility tests thresholds and omitting fall severity definition components. Across studies, 7.9%-82.6% of participants were classified as low risk, 0.4%-18.3% as intermediate risk and 10.5%-88.7% as high risk. High-risk classification showed modest sensitivity (26.5%-52.3%) and moderate-to-high specificity (34.2%-88.9%) for future falls (1-2 years), with an overall accuracy of 61.2%-74.2%. High-risk groups consistently had a two- to three-fold higher incidence of falls than low-risk groups, while intermediate-risk groups only showed a slightly elevated risk. Use of 3KQ alongside fall history and universal mobility testing improved discrimination and increased the proportion in the intermediate-risk category.</p><p><strong>Conclusion: </strong>The operationalised versions of the WFG algorithm identify older adults at high falls risk with high specificity but limited sensitivity. Proposed pragmatic modifications improve stratification accuracy for intermediate risk group but require prospective validation.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A policy scoping review of how 'Hospitals at Home' can and could support people with dementia. 对“家庭医院”如何能够和能够支持痴呆症患者的政策范围进行审查。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag229
Anthony Zheng Wang, Anita Wong, Nathan Davies, Sevim Hodge, Elizabeth L Sampson, Victoria Vickerstaff, Kate Walters, Catherine J Evans, Mark James Rawle, Jane Ward, Simon Conroy, Bastien Genet, Claudia Cooper
{"title":"A policy scoping review of how 'Hospitals at Home' can and could support people with dementia.","authors":"Anthony Zheng Wang, Anita Wong, Nathan Davies, Sevim Hodge, Elizabeth L Sampson, Victoria Vickerstaff, Kate Walters, Catherine J Evans, Mark James Rawle, Jane Ward, Simon Conroy, Bastien Genet, Claudia Cooper","doi":"10.1093/ageing/afag229","DOIUrl":"10.1093/ageing/afag229","url":null,"abstract":"<p><strong>Introduction: </strong>People with dementia are often hospitalised due to comorbidities and superimposed delirium and have poorer outcomes in hospital compared to people without dementia, especially among under-served groups. Hospital at Home (HaH) schemes could reduce these inequalities by facilitating care in a familiar home environment that offers similar outcomes to acute hospital care with lower risks of harms.</p><p><strong>Aims: </strong>We aimed to investigate how dementia and cognitive impairment are considered within English health policy documents informing HaH implementation; considering potential impact on health inequalities and implications for future policy development.</p><p><strong>Methods: </strong>We searched websites, including UK governmental, NHS, social care and professional organisation sources, from 2015; and reference lists of included documents. We thematically analysed documents.</p><p><strong>Results: </strong>We included 17 documents, comprising clinical guidelines (n = 5), government guidance (n = 4), policy papers (n = 3), service evaluations (n = 3), a strategy document (n = 1) and case study (n = 1). We developed three themes: (i) benefits of HaH for people with dementia, including more person-centred care and familiar treatment environments; (ii) how HaH can be inclusively designed for people with dementia, accommodating needs and mitigating concerns over digital exclusion and safety; and (iii) the critical role of family carers in enabling HaH, including potential carer burden.</p><p><strong>Discussion: </strong>HaH models have potential to reduce health inequalities for people with dementia, but current implementation policies risk reinforcing inequalities, particularly among those without digital proficiency or carer support. Future policies should drive consistent inclusive eligibility criteria and processes for ensuring continuity with primary care, dementia care as a HaH staff core competency.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular thrombectomy versus medical management in patients with dementia and acute ischaemic stroke. 痴呆合并急性缺血性脑卒中患者血管内血栓切除术与药物治疗的比较
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag241
Huanwen Chen, Matthew K Mcintyre, Sinan Aktay, Matthew Yen, Shivanthi Gunawardane, Dhairya A Lakhani, Ajay Malhotra, Marco Colasurdo, Dheeraj Gandhi
{"title":"Endovascular thrombectomy versus medical management in patients with dementia and acute ischaemic stroke.","authors":"Huanwen Chen, Matthew K Mcintyre, Sinan Aktay, Matthew Yen, Shivanthi Gunawardane, Dhairya A Lakhani, Ajay Malhotra, Marco Colasurdo, Dheeraj Gandhi","doi":"10.1093/ageing/afag241","DOIUrl":"10.1093/ageing/afag241","url":null,"abstract":"<p><strong>Objective: </strong>While pre-existing dementia is a known negative predictor for good endovascular thrombectomy (EVT) outcomes, comparative efficacy and safety data of EVT versus best medical management (BMM) for large vessel occlusion (LVO) patients with dementia are limited. This study compares hospitalisation outcomes of EVT versus BMM for LVO patients with underlying dementia.</p><p><strong>Methods: </strong>Using the US Nationwide Readmissions Database from 2016 to 2022, we retrospectively identified adult patients with dementia who presented with LVO stroke. The primary outcome was discharge to home. Secondary outcomes included in-hospital mortality, length-of-stay and complications. Patients who underwent EVT were compared to those who received BMM after propensity score matching. Interaction and subgroup analyses assessed treatment effect heterogeneity associated with age and dementia type.</p><p><strong>Results: </strong>Among 37 298 patients included, 6618 EVT and 13 092 BMM patients remained after propensity score matching. Home discharge rates were similar between groups (27.1% vs 26.4%, P = .51). EVT was associated with longer length-of-stay (median 7 vs 6 days, P < .001) and increased intracranial haemorrhage (23.9% vs 11.1%, P < .001), with no significant difference in mortality (15.0% vs 14.9%, P = .87). Patient age significantly moderated EVT effectiveness (interaction P < .001), and EVT among patients <75 years old was significantly associated with higher rates of home discharge (36.7% vs 26.8%, P < .001). Additionally, EVT appeared more effective for patients with vascular dementia (vs Alzheimer's disease, interaction, P = .014), among whom EVT was associated with significantly higher rates of home discharge (32.7% vs 25.2%, P = .007).</p><p><strong>Interpretation: </strong>Treatment response to EVT among LVO stroke patients with dementia was heterogeneous, and EVT was beneficial for patients <75 years old and those with vascular dementia.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811802","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}
引用次数: 0
Acupuncture for older adults with dementia in residential care homes: an assessor-blinded, randomised controlled trial. 针刺治疗老年痴呆患者:一项评估盲、随机对照试验。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag298
Mei Yan Chan, Jiahui Yin, Man Tik Cheung, Xinjing Yang, Kwai Ching Lo, Choi Fai Yu, Sichang Yang, Shi Qi Huang, Wing Yan Tsui, Chik Fung Ng, Pui Yan Chan, Wai Chi Chan, Wai Chung Clara Chan, Lei Li, Chun Yuan Chiang, Zhang-Jin Zhang
{"title":"Acupuncture for older adults with dementia in residential care homes: an assessor-blinded, randomised controlled trial.","authors":"Mei Yan Chan, Jiahui Yin, Man Tik Cheung, Xinjing Yang, Kwai Ching Lo, Choi Fai Yu, Sichang Yang, Shi Qi Huang, Wing Yan Tsui, Chik Fung Ng, Pui Yan Chan, Wai Chi Chan, Wai Chung Clara Chan, Lei Li, Chun Yuan Chiang, Zhang-Jin Zhang","doi":"10.1093/ageing/afag298","DOIUrl":"10.1093/ageing/afag298","url":null,"abstract":"<p><strong>Background: </strong>Dementia harms the mental health of older adults and poses a significant caregiver burden. This study aimed to evaluate the effectiveness and safety of acupuncture in managing cognitive decline and related symptoms in older adults with dementia.</p><p><strong>Methods: </strong>Eligible participants were recruited from 19 local residential care homes for older people in Hong Kong, China, from 5 October 2021 to 27 August 2024, in an assessor-blinded, randomised controlled trial. 118 participants were randomised to acupuncture and care-as-usual control (n=59 in each group) for 12 weeks. The analyses were on the intention-to-treat population. The primary outcome was the mean baseline-to-endpoint change of the Montreal Cognitive Assessment (MoCA) score. Secondary outcomes included the functional independence, pain, depressive and sleep symptoms.</p><p><strong>Results: </strong>85.6% (101/118) of participants completed the study. The primary outcome, MoCA, was not significantly improved in week 12. Subgroup analyses showed that the treatment effect on MoCA appeared to differ across dementia severity strata. Acupuncture was superior over control in improving functional independence (the Chinese version of the Modified Barthel Index, mean difference=4.12, 95% confidence interval=0.81, 7.44, P=0.015; standardised effect size=0.29). All treatment-related adverse events were mild, and 2 nontreatment-related death cases were reported.</p><p><strong>Conclusions: </strong>While no significant effect in cognitive function was observed, acupuncture was associated with an improvement in functional independence, and the treatment effect on cognition might differ across dementia severity strata. This warrants further validation of the exploratory results, identifying a subpopulation of older adults with dementia who could gain more benefits from acupuncture in improving cognitive function.</p><p><strong>Trial registration: </strong>www.ClinicalTrials.gov: NCT04305951, date of registration: 10/03/2020.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 10","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antidepressants at the threshold: what is really driving prescribing around dementia diagnosis? 抗抑郁药的门槛:围绕痴呆症诊断开处方的真正驱动力是什么?
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag252
Chengjun Liu, Katharine A Wallis
{"title":"Antidepressants at the threshold: what is really driving prescribing around dementia diagnosis?","authors":"Chengjun Liu, Katharine A Wallis","doi":"10.1093/ageing/afag252","DOIUrl":"https://doi.org/10.1093/ageing/afag252","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786966","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}
引用次数: 0
Fragility fracture site is associated with frailty in older adults: a population-based cohort study in Japan. 脆性骨折部位与老年人虚弱相关:日本一项基于人群的队列研究
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag244
Ryutaro Shibata, Yoko Sato, Shinsuke Takeda, Shota Nakagawa, Takuya Usami, Philip Hawke, Yoshihiro Tanaka
{"title":"Fragility fracture site is associated with frailty in older adults: a population-based cohort study in Japan.","authors":"Ryutaro Shibata, Yoko Sato, Shinsuke Takeda, Shota Nakagawa, Takuya Usami, Philip Hawke, Yoshihiro Tanaka","doi":"10.1093/ageing/afag244","DOIUrl":"10.1093/ageing/afag244","url":null,"abstract":"<p><strong>Background: </strong>Fragility fractures cause disability in older adults. Although frailty determines adverse outcomes, the relationship between anatomical fracture site and functional status remains unclear. Clarifying these associations may improve geriatric assessment and secondary prevention strategies.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study using the Shizuoka Kokuho Database, which integrates medical and long-term care insurance claims in Japan. Individuals aged ≥65 years with a first-time, single-site fragility fracture (proximal humerus, distal radius, hip, distal femur, vertebrae or pelvis) were included. Frailty was assessed using long-term care insurance (LTCI) certification levels and the electronic frailty index (eFI). Fracture distribution was compared across frailty strata, and crude and age- and sex-adjusted odds ratios (ORs) were estimated using separate logistic regression models for each fracture site.</p><p><strong>Results: </strong>Among 146 052 fractures (mean age 81.5 years; 78.2% women), distal radius fractures occurred predominantly in individuals without LTCI certification (86%), whereas 47% of hip fractures occurred in this group, showing a functional gradient. Distal femur fractures were associated with severe frailty (OR 10.55, 95% CI 9.61-11.57). Age- and sex-adjusted analyses attenuated these associations, but key patterns for distal radius, hip and distal femur fractures remained. Similar gradients were observed across eFI categories.</p><p><strong>Conclusions: </strong>Fracture site was associated with differences in care needs and frailty among older adults. Distal radius fractures were more common among individuals with lower care needs, whereas pelvic and distal femur fractures were more common among those with advanced frailty. Anatomical fracture location may provide context in geriatric assessment and prevention strategies. Trial Registration (if applicable): Not applicable.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787045","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}
引用次数: 0
Intrinsic capacity trajectories and health outcomes in home care settings: a Canadian population-based cohort study. 家庭护理环境中的内在能力轨迹和健康结果:加拿大基于人群的队列研究
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag255
Bonaventure Amandi Egbujie, Hein van Hout, George Heckman, Leon Geffen, John N Morris, John P Hirdes
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引用次数: 0
Editor's View - Blood-based markers for diagnosis of Alzheimer's disease. 编者观点-诊断阿尔茨海默病的血液标志物。
IF 7.4 2区 医学
Age and ageing Pub Date : 2026-08-03 DOI: 10.1093/ageing/afag253
Roy L Soiza
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引用次数: 0
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