Ageing & Dementia Publications

Radcliffe E, Kandala N, Sach T, Mccloskey S, Howard C, Sheikh C, Bradbury K, Latter S, Recio Saucedo A, Lown M, Brad L, Fraser SD, Ibrahim K

Polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice.

Polypharmacy (taking five or more regular medications on daily basis) affects nearly  half of people in England aged 65 and over. Polypharmacy in older people is  associated with increased potentially inappropriate medications (PIMs)  leading to  increased risk of falls, cognitive impairment, functional decline, hospital admission and  death. In older people living with frailty medications harm can be amplified and  can outweigh benefits or the known time to benefit exceeds projected life expectancy  e.g. statins. Additionally, the goals of drug treatment in this population may change  from reducing the risk of disease and prolonging life to reducing the burden of  treatment and maintaining quality of life. 

Frailty may influence factors such as drug  pharmacokinetics and pharmacodynamics, toxicity, and therapeutic efficacy. In turn,  these factors may be involved in the development of frailty.   Therefore, it has been recommended that people living with frailty and those with  complex and problematic polypharmacy should receive a structured medication  review (SMR) annually by their general practice team, specifically a clinical  pharmacist  referred to throughout as a ‘pharmacist’. 

An important aspect of  SMR is deprescribing which involves tapering /dose reduction, stopping, or switching  drugs with the goal of improving outcomes. Deprescribing has been shown to be  feasible and safe across a wide range of conditions, medications, settings and with  the use of different deprescribing tools. Deprescribing can lead to a reduction  in polypharmacy and PIMs and for those living with frailty, can result in important  benefits in relation to depression, function and frailty status. 

Implementing deprescribing in primary care can be challenging, but several facilitating  factors have been identified. These include collaboration within well-integrated  multidisciplinary teams (MDTs) with clear roles, where pharmacists lead with input  from other professionals as needed. Effective digital and face-to-face communication,  co-location, access to patient records, systems to identify high-risk patients, and use  of tools to support SMRs further facilitate deprescribing. Face-to-face  consultations are particularly valuable for discussing deprescribing, although  communication should be tailored to patient and carer needs. Patient and carer  education, shared decision-making, and trust in HCPs are also key facilitators.  Clear plans for monitoring and follow-up after SMRs support continuity of care. 

Despite this growing evidence, no intervention has yet been developed  and tested that integrates these facilitators and is feasible for implementation in routine  primary care.  To address this, a complex intervention to support medication review and  deprescribing in primary care for older people living with frailty and polypharmacy was  co-developed with key stakeholders, including patients, carers and health care  professionals (HCPs) (MODIFY). This was achieved through three iterative stages of:  reviewing the evidence; collecting and analysing primary qualitative data; and  collaborating with stakeholders, guided by the principles of realist synthesis and the  person-based approach. 

This paper presents the research conducted which  aimed to assess the feasibility and acceptability of implementing the intervention in  general practice among older people living with frailty, to inform a future substantive  trial.

https://doi.org/10.3399/bjgpo.2025.0175

Krohn JN, Barrett J, Heeren P, Lim S, Moloney E, Nickel CH, van Oppen J, Sandig N, Ünlü L, Singler K.

Older emergency patients currently account for most European emergency medical service dispatches. Due to demographic changes and increasing comorbidities in advanced age, this number is expected to rise substantially in the coming years. Prehospital professionals require specialised training to provide high-quality care for complex, multimorbid patients. The aim of this study is to define minimum competencies for paramedic education in Europe on the management of emergencies in older adults.

https://doi.org/10.1186/s13049-026-01550-3

January 2026

Cox NJ,   Jones L, Lim SE.

Undernutrition is common amongst older people and can lead to adverse health outcomes and increased dependence. 

This review focuses on an aspect of undernutrition that is often overlooked, namely loss of appetite, and will discuss the challenges in this under-researched field from the perspective of geriatric medicine. Appetite decline is common in later life and predicts undernutrition in older populations. As such, timely identification and intervention on poor appetite could delay onset or progression of undernutrition to optimise healthy ageing and maintain independence. In addition, management of undernutrition ultimately requires the individual to meet their nutritional requirements. However, unless attention is paid to mitigating appetite decline, strategies to improve intake are likely to be ineffective. Treatment for appetite decline is challenging due to the multiple and complex underlying mechanisms. Current evidence is limited to a few trials targeting older people including flavour enhancement and fortification or supplementation, lifestyle measures such as increasing physical activity and social interaction, and medications, all with mixed results. Progress on treatments for appetite decline has been hampered by a lack of distinction from undernutrition, but also perhaps the approach to it as a concept. 

Categorising appetite decline in ageing as a geriatric syndrome could aid progress in the unification of approaches to mechanistic research, assessment and management strategies, which are likely to be most effective when in multi-component form and underpinned by the principles of Comprehensive Geriatric Assessment (CGA).

https://doi.org/10.1017/s0029665125102115

January 2026

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