Ageing & Dementia Publications

Yinusa G, Surr C, Thomas S, Fenge LA, Howdon D, Major J, Heward M, Taylor G, Knight H, Townson J, Murphy J. 

In the UK, over 980,000 people are living with dementia, and two-thirds of them live in their own homes. Up to 60% of this population is estimated to be at risk of or already experiencing malnutrition, with 45% facing significant weight loss. As dementia progresses, ensuring that people eat and drink well becomes challenging. 

Many families affected by dementia access home care services, with home care professionals playing a vital role in supporting and enhancing overall quality of life. Training in identifying nutritional problems and supporting family carers to prevent malnutrition is an identified research need; however, research on the contribution of home care professionals in this area is limited. This study aims to assess the feasibility and acceptability of a nutritional intervention for people living with dementia receiving home care from the perspectives of people with dementia, family carers (dyads), and home care professionals (including home care managers).

https://doi.org/10.1186/s40814-025-01722-5

November 2025

Andrews N, Brooks C, Amin J, Lim R, Board M, Latter S, Fraser S, Ibrahim K

Polypharmacy (taking five or more regular medications) is common in people with dementia or mild cognitive impairment (MCI) and is associated with poor outcomes such as decline in cognitive and physical functioning, falls and hospital admission. Reducing or stopping unnecessary medications (deprescribing) can help improve outcomes but limited research has been undertaken with people with dementia or MCI, especially in primary care. This study explored the perspectives and experiences of people with dementia or MCI, informal carers and healthcare professionals on deprescribing decision-making in this setting

https://doi.org/10.1177/14713012251376227

November 2025

O'Reilly T, Gómez Lemus J, Booth L, Clyne B, McCarthy C, Ibrahim K, Thompson W, McAuliffe C, Moriarty F

As certain medications increase risk of falls, it is important to review and optimise prescribing in those who have fallen to reduce risk of recurrent falls.

The obective of this study was to systematically review evidence on the prevalence and types of potentially inappropriate prescribing (PIP), including falls-risk increasing drug (FRID) use, in fallers.

A systematic search was conducted in July 2024 in MEDLINE, EMBASE, CINAHL and Google Scholar using keywords for fall events, inappropriate prescribing and FRIDs. Observational studies (cohort, case-control, cross-sectional, before-after) and randomised trials were included. Studies were eligible where participants had experienced a fall and PIP (including FRID use) was reported. Random-effects meta-analyses were conducted to pool prevalence of inappropriate prescribing and mean number of inappropriate prescriptions across studies.

https://doi.org/10.1093/ageing/afaf300

October 2025

Boxall C, Dennison L, Miller S, Joseph J, Morton K, Corser J, Kesten J, Electicwala A, Western MJ, Lim S, Grimmett C, Yardley L, Bradbury K

Physical activity (PA) in older adults can prevent, treat, or offset symptoms and deterioration from various health conditions and help maintain independence. However, most older adults are insufficiently active. Digital interventions have the potential for high reach at low cost.

This paper reports on the implementation of "Active Lives," a digital intervention developed specifically for older adults.

https://doi.org/10.2196/64953

October 2025

Meredith SJ, Holt L, Varkonyi-Sepp J, Bates A, Mackintosh KA, McNarry MA, Jack S, Murphy J, Grocott M, Lim S

Approximately 47 % of older people in hospital aged over 65 are affected by frailty. Frailty is characterised by a cumulative decline in biological reserves leading to impaired homoeostatic recovery following stressor events. It is associated with increased risk of post-hospitalisation, disability, and mortality.

Key interventions for frailty management and to address deconditioning post-hospitalisation include exercise, and nutrition support, underpinned by behaviour change strategies. However, in practice, access to models of care, such as multidisciplinary reablement services to support older people on discharge, is restricted by the health system’s capacity to deliver these services.

This study aimed to explore the feasibility and acceptability of training volunteers to deliver a remote multimodal intervention, including exercise, behaviour change and nutrition guidance, for older people living with frailty after hospital discharge.

https://doi.org/10.1016/j.tjfa.2025.100092

October 2025

Griffiths   R, Lim S, Lin J, Bates A, Jones L, Ibrahim K.

Anticholinergic medication use is increasing, particularly among older adults due to polypharmacy and comorbidities. High anticholinergic burden is linked to adverse outcomes such as reduced mobility and increased dementia risk. Acute hospital stays may offer an opportunity to address this often-overlooked issue.

The aim of this study was to examine the effects of deprescribing anticholinergic medications on outcomes in older hospitalised patients.

https://doi.org/10.1111/bcpt.70103

September 2025

See H, Gowling E, Boswell E, Aggarwal P, King K, Smith N, Lim S, Baxter M, Patel HP

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality.

An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. 

This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

https://doi.org/10.1007/s40266-025-01205-5

April 2025

Radcliffe E, Saucedo AR, Howard C, Sheikh C, Bradbury K, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Ibrahim K

Reducing polypharmacy and overprescribing in older people living with frailty is challenging. Evidence suggests that this could be facilitated by structured medication review (SMR) and deprescribing processes involving the multidisciplinary team (MDT). This study aimed to develop an MDT SMR and deprescribing intervention in primary care for older people living with frailty.

Intervention development was informed by the Medical Research Council framework for complex intervention and behaviour change and implementation theories. Intervention planning included: 1) a realist review of 28 papers that identified 33 context-mechanism-outcome configurations for successful MDT SMR and deprescribing in primary care, 2) a qualitative study with 26 healthcare professionals (HCPs), 13 older people with polypharmacy and their informal carers. The intervention's guiding principles were developed and intervention functions proposed, discussed and refined through an iterative process in four online co-design stakeholder workshops.

https://doi.org/10.1371/journal.pone.0319615

April 2025

Ventre JP, Manning F, Mahmoud A, Brough G, Timmons S, Hawley-Hague H, Skelton DA, Goodwin VA, Todd CJ, Kendrick D, Logan P, Orton E

Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape

The occurrence of falls in adults 65+ years remains a common and costly issue worldwide. There is current evidence to suggest that falls can be prevented using evidence-based strength and balance interventions, such as the six-month Falls Management Exercise (FaME) programme. Perspectives of multiple key partners and providers of the FaME programme could inform future implementation and fall prevention strategies.

Partners and providers involved in local community fall prevention pathways were purposefully recruited from three geographical areas across the UK. Semistructured interviews were conducted to gain a broad understanding of factors affecting the adoption, implementation and spread of FaME. Data were analysed using an inductive thematic approach and mapped to the Consolidated Framework for Implementation Research (CFIR).

https://doi.org/10.1093/ageing/afaf083

March 2025

Marshall J, Papavasiliou E, Fox C, Hawkes M, Irvine A, Moniz-Cook E, Pick A, Polley MJ, Reeve J, Robinson L, Rook G, Sadler E, Wolverson E, Walker S, Cross JL; SPLENDID Collaboration

Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how.

https://bmjopen.bmj.com/content/14/4/e080551

April 2024

Ledger L, Hope J, Schoonhoven L, Worsley PR

In the UK, over 700 000 patients are affected by pressure ulcers (PUs) each year, and 180 000 of those are newly acquired each year. Guest et al in a cohort study evaluating the burden of wounds in the UK, found that annual NHS cost of wound management was £8.3 billion. Whilst the cost to the patient and their families cannot be easily quantified, studies have shown that PUs result in reduced mental and physical function, social restrictions and increased pain. 

Increasingly the focus on prevention has become paramount, with core concepts of preventative interventions built into the national and international practice guidelines, which include PU risk assessment, skin care, nutrition, repositioning/mobilisation, and the use of appropriate pressure redistributing equipment. Central to a PU prevention approach is accurate risk assessment conducted by the health care professional. This involves using standardised risk assessment instruments, including skin assessment and inspection alongside discussion with the patient. However, a recent systematic review found that it was inconclusive whether risk assessment with a common tool makes a difference to pressure ulcer incidence, when compared with training and risk assessment using clinical judgement, or risk assessment using clinical judgement alone. 

In clinical practice, it has traditionally been the nurse who has been responsible for PU risk assessment and providing advice to be followed by the patient. However, increasingly there has been a policy shift in emphasis from nurses instructing patients what to do, to a partnership model with shared decision-making. This shift places increased responsibility on the patient to understand their own PU risk and carry out preventative measures. This is particularly important in community settings, where due to the limited time capacity and resource of healthcare workers, contact can be episodic, with patients and their families increasingly required to carry out advice and manage their own care. However, there are issues with patient non-adherence to PU advice, particularly in community settings that generate further risk to patients including further skin breakdown and other complications such as muscle wastage and reduced function. 

A recent systematic review of the psychosocial factors impacting community-based PU prevention identified several key influences that may affect the ability to achieve concordance between individuals and healthcare professionals, including social influences and beliefs about capabilities. The review found that a concordant relationship was facilitated by the healthcare professional's motivation to work alongside patients and their priorities and the interpersonal skills to build rapport and increase trust.

The few studies that have focused on the role of patients in PU prevention in the community setting have identified that patient engagement may be influenced by a range of factors which include the complexity of tasks, history of PU damage, and the quality of nurse-patient interactions. There are also other considerations for varying levels of patient involvement such as ill health and cognitive ability to participate in preventative strategies. However, currently there is a significant gap in the research around the patient's own understanding of PU risk, and how contextual factors such as environment and wider health status might play a role in risk perception. Indeed, most studies to date have focused on the professional nursing view. 

There is a lack of evidence around the type of nursing approach used and nurse-patient interactions within the setting itself and how PU risk is negotiated. It is important to understand this to determine the context in which PU risk information is communicated and the relationship of this to adherence behaviour.

The aims of the study were to identify potential factors affecting patient adherence to preventative advice and to explore how pressure ulcer risk is negotiated between nurse and patient in the community setting.

https://doi.org/10.1016/j.jtv.2025.100890

March 2025

Prieto J, Wilson J, Tingle A, Cooper E, Handley M, Rycroft-Malone J, Bostock J, Williams L, Loveday H

Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised.

This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances.

https://doi.org/10.3310/dadt3410

October 2024