Ageing & Dementia Publications

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

Andrews N, Brooks C, Board M, Fraser S, Latter S, Aplin K, McCausland B, Radcliffe E, Amin J, Lim R, Van Leeuwen E, Ibrahim K

Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy is considered feasible, safe and can lead to improved health. However, for those living with dementia or MCI, this can be challenging. This systematic review aimed to summarise the evidence on the outcomes of medicine optimisation and deprescribing interventions for older people with dementia or MCI.

https://doi.org/10.1007/s40266-025-01189-2

March 2025

Ibrahim K, Cox NJ, Lim SER, Radcliffe E, Lundby C, Prokopidis K, Thompson W, Moriarty F

Polypharmacy (concomitant prescription of ≥ 5 medications) affects a third of older people, and evidence suggests an association with sarcopenia (loss of skeletal muscle mass/quality, muscle strength, and/or physical performance). As such, deprescribing has been recommended in routine management of sarcopenia, however it’s unknown whether deprescribing is beneficial. This systematic review aimed to understand effects of deprescribing on sarcopenia parameters in older adults.

https://doi.org/10.1186/s12877-025-05819-7

March 2025

Frankland J, Lee K, Bridges J

People living with a dementia are an increasing proportion of those residing in long term care settings. A person-centred approach is widely accepted practice for this group, but there is evidence that this is not universally applied. Material Citizenship™ is a novel delivery of person-centred dementia care and training which promotes the importance of functional objects to enhance choice, control and agency.

This evaluation of Material Citizenship™ assessed mode of training delivery, perceived impact of the training on care delivery, and implementation challenges.

https://doi.org/10.31389/jltc.321

February 2025

Corbett T, Meier N, Bridges J

The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.

This paper presents findings from a qualitative study of how HCWs conceptualise and navigate the temporal aspects of delivering personalised care to older people living with multimorbidity. Building on research from organisation studies and the sociology of time, we interviewed 19 UK HCWs about their experiences of delivering care to this patient group.

https://doi.org/10.1108/jhom-07-2024-0295

February 2025

Collins P, Hopkins S, Milbourn H, Etkind SN

Older people often live with multiple serious illnesses and frailty with a reduced biological reserve. People living with frailty face an inherently uncertain future with the unpredictable dying trajectory of frailty being widely recognised. Uncertainty can also result from healthcare systems, from fragmented care due to multiple illnesses, or patchy communication between services. It can leave patients, carers and health professionals distressed and overwhelmed.

Advance care planning seeks to help individuals articulate their preferences and priorities for care in the face of an uncertain future . Advance care planning is thus intertwined with and inseparable from uncertainty, yet the relationship between the two is relatively under-recognised and under-investigated. The papers in this themed collection explore aspects of this relationship in the context of frailty. 

https://doi.org/10.1093/ageing/afae146

September 2024

Christie R, Sadler E, Sait M, Light K, Cox C, Board M, Thomas S, Walker DM, Allen-Pick M, Bradbury K, Murphy J

Globally, the prevalence of long-term conditions (LTCs) continues to rise. The impact of LTCs presents significant challenges for international health and social care systems and continues to be a leading cause of mortality. Despite this, digital health coaching interventions (DHCIs) appear to be a promising strategy for managing chronic disease. The aims of this systematic review and narrative synthesis were to explore the barriers and enablers for the use of DHCIs and to gather valuable information to inform the development of a new DHCI for LTC management.

https://doi.org/10.1177/20552076241302230

December 2024