Objectives.To investigate the occurrence of fragility fractures or fallrelated admissions in severely frail older patients after deprescription of denosumab.Methods.Medical records of patients who were prescribed denosumab for osteoporosis and subsequently deprescribed it due to either advanced frailty with a Clinical Frailty Scale (CFS) score of 7 or terminal illness with an estimated survival of <1 year were retrospectively reviewed.Primary outcomes were the occurrence of any clinical fragility fracture and fall-related admission within 3 years of deprescription of denosumab.Secondary outcomes were 1-year and 3-year mortality rates after deprescription.Results.In total, 23 women and four men (median age, 87 years; median weight, 43.3 kg; median CFS score, 7) were included in the analysis; 25 (92.6%)patients had a history of fragility fracture.Their median T-scores were -2.9 at the total hip, -3.7 at the femoral neck, and -2.3 at the lumbar spine.All patients had at least one comorbid chronic illness.The median duration of denosumab treatment was 24 months.Reasons for deprescription of denosumab were advanced frailty with poor mobility and functional status (n=24), end-stage renal failure (n=2), and advanced malignancy (n=1).Within 3 years of deprescription of denosumab, none of the patients experienced any fracture or fallrelated admission.At 3 years, 19 (70.4%) patients had died, mostly due to pneumonia (68.4%). Conclusions.Fragility fractures and injurious falls did not increase after deprescribing denosumab in older patients with advanced frailty or lifelimiting disease during the next 3 years.Deprescription of denosumab may be justifiable in these patients, given the limited benefits.

the diagnosis of primary hyperparathyroidism.She received intravenous fluids and 4 mg of zoledronic acid, which led to symptomatic improvement.However, serum calcium remained elevated at 2.73 mmol/L.Vitamin D concentration was not assessed because the test required out-of-pocket payment.Cinacalcet was initiated at a dose of 50 mg twice daily, and she was discharged with plans for outpatient follow-up.Computed tomography identified a right parathyroid adenoma measuring 1.71.12.4 cm, along with multiple old rib fractures bilaterally and a left inferior pubic ramus fracture with callus formation.Ultrasonography of the parathyroid glands revealed a well-defined hypoechoic nodule with a central cystic component posterior to the right thyroid gland and increased vascularity (Figure).Technetium-99m sestamibi parathyroid scintigraphy showed predominant tracer uptake in the upper right neck, confirming a right superior parathyroid adenoma (Figure).Bone mineral density T-scores at the spine and hip were both -3.1.The patient was deemed to be at high risk for parathyroidectomy due to a difficult airway, frailty, and low metabolic equivalent of task.She opted for medical management, which included oral cinacalcet, increased oral fluid intake, and regular monitoring of serum calcium concentrations.However, dose escalation of cinacalcet resulted in light-headedness and general malaise.To manage her secondary osteoporosis and hypercalcaemia, subcutaneous denosumab (60 mg) was administered

Delirium superimposed on dementia (DSD) is a frequent but underrecognised condition that complicates care in older adults.Although delirium and dementia share overlapping features, their clinical courses and management differ substantially.Failure to distinguish between the two can delay appropriate treatment and worsen outcomes, including prolonged hospitalisation, accelerated cognitive decline, and increased mortality.This review outlines the clinical features, challenges, and management strategies for DSD, highlighting the importance of recognising acute changes in behaviour and cognition.We emphasise the role of early identification, nonpharmacological interventions, and cautious medication use in patients with underlying cognitive impairment.The emerging view of delirium as a potential contributor to neurodegeneration was discussed, highlighting the importance of post-delirium follow-up and long-term cognitive monitoring.Increased awareness and the use of a structured, multidisciplinary approach enable clinicians to better manage DSD and reduce its long-term impacts on patients and caregivers.

Objectives.This study aimed to implement a fall prevention intervention for postoperative older adults at a private hospital in Hong Kong. Methods.A Plan-Do-Study-Act approach was used to develop and implement a fall prevention intervention.Interventions (including protocol-based use of fall alarm pads (FAP), staff training, patient and caregiver education, and shared decision-making) were implemented for postoperative patients aged >70 years or those aged 65 years with a preoperative Morse Fall Scale score of 45 or prescribed 7 oral medications.The numbers of fall incidents among the targeted patients in surgical wards before and after intervention were compared.Additionally, qualitative analysis of frontline nurses' perceptions of FAP use and effectiveness in preventing patient falls was conducted before intervention and 1 month after intervention.Patient satisfaction and feedback from patients and caregivers were assessed after 2 days of FAP use. Results.The fall prevention intervention programme received mixed feedback regarding continuation and effectiveness of routine application of FAPs but achieved high adherence among patients and caregivers.Of 122 patients responded, 119 were satisfied or very satisfied with the FAP application.Frontline staff noted increased awareness of fall prevention strategies and greater confidence in engaging patients effectively.However, many preferred selective rather than routine use of FAPs. Conclusions.Our fall prevention programme for postoperative older adults highlights the integration of protocol-based interventions with active stakeholder engagement.The programme improved patient safety and satisfaction.

Objectives.This study aimed to assess the effect of the Elderly-Toddlers Intergenerational Programme on the health status and social interactions of older adults in two Indonesian cities.Methods.Older adults in East Jakarta and Bogor City aged 60 years who were capable of performing activities, free of visual and hearing impairments, and residing with toddlers and family (caregivers) were invited to participate between April and November 2022.Participants were randomly assigned to the Elderly-Toddlers Intergenerational Programme or to an elderly programme at a community health centre.The intervention group received training for older adults and caregivers on the growth and development of toddlers, communication and playing with toddlers, and storytelling, followed by conducting activities to foster meaningful engagement between older adults and toddlers (one session per week for 8 weeks).The control group received standard services at the community health centre.Results.In total, 136 older adults from East Jakarta (n=68) and Bogor City (n=68) were equally assigned to the Elderly-Toddlers Intergenerational Programme (n=34) or an elderly programme (n=34) in each city.Health status and social interaction among older adults significantly improved after intervention, whereas no significant improvement was observed in the control groups.In the multiple linear regression analysis, higher education level was a predictor of better health status (=3.67,R 2 =0.087, p=0.047), whereas greater family support was a predictor of better social interaction (=0.29,R 2 =0.210, p<0.001).Improvements in older adults' health status and social interaction were influenced by education level and family support, in addition to participation in the programme. Conclusion.The Elderly-Toddlers Intergenerational Programme was effective for improving the health status and social interaction of older adults.

Dermatomyositiswithin normal limits.He appeared thin, with generalised xerosis on the face and the dorsal aspects of his hands.Cardiovascular, respiratory, and abdominal results were unremarkable.Cranial nerve function was intact.No focal asymmetrical neurological findings were observed to suggest an overt neurological cause of the dysphagia.Laboratory results were unremarkable.There was no evidence of anaemia.Renal function was within normal limits.Computed tomography of the brain revealed no abnormalities.The patient was treated presumptively for a cerebrovascular accident and prescribed antiplatelets and statins.Magnetic resonance imaging of the brain performed 2 weeks later also failed to demonstrate any changes consistent with a cerebrovascular accident.However, the dysphagia worsened, leading to aspiration pneumonia.Given the worsening dysphagia and the normal neuroimaging findings, an alternative diagnosis was considered.Closer examination of the face and hand skin revealed features of Gottron's papules.The patient also exhibited macules over the face consistent with a heliotrope rash (Figure).Repeated neurological assessment revealed subtle, symmetrical, proximal muscle weakness.Serum creatine kinase was elevated at 885 mmol/L.Antinuclear antibody results were negative.A myositis-specific antibody panel revealed a strongly positive anti-TIF (transcriptional intermediary factor) 1 antibody signal.Muscle biopsy demonstrated chronic myopathic changes with perifascicular atrophy, characteristic of dermatomyositis.The patient was diagnosed with anti-TIF1 dermatomyositis and treated with high-dose corticosteroids and methotrexate.Unfortunately, he developed complications related

Objective.This study aimed to evaluate the prevalence and distribution of oral cancer and potentially malignant disorders among older adults in each region of Thailand, based on screening data between 2020 and 2024.Methods.Oral cancer screening data of patients aged 60 years between October 2020 and July 2024 were obtained from (1) the Health Data Center (community screening) and ( 2) Cancer Registry reports and Thai Cancer Base (hospital screening).Descriptive statistics were provided, and spatial analysis was performed.Results.Of 1 614 549 older adults screened, 540 (0.03%) had signs suggestive of oral cancer or potentially malignant disorders.The highest prevalence was observed among individuals aged 60 to 65 years.The incidence of oral cancer reached 8 per 100 000 among men and 4 per 100 000 among women.Tongue cancer was the most prevalent, followed by cancer of the floor of the mouth and lip cancer.The highest incidences of oral cancer were reported in the central and southern regions. Conclusions.Although the prevalence of oral cancer and potentially malignant disorders was low, the screening programme facilitates early intervention.Dental health education, regular oral evaluation, and effective referral may reduce late-stage diagnoses, while region-specific surveillance and data-informed planning support efficient resource allocation.

The increased susceptibility of older people to infection, together with population ageing, presents a major challenge to the healthcare system.Immunosenescence, characterised by the decline of both innate and adaptive immunity due to ageing, increases the risks of infection and disease severity and complications, resulting in substantial morbidity and mortality among older people.Vaccination has long been recommended as the most effective measure to prevent infectious diseases.However, immunosenescence decreases vaccine-induced immune responses, leading to lower efficacy in older people for the three most commonly recommended vaccines: influenza, pneumococcal, and herpes zoster vaccines.Provided that the impact of infectious diseases is great among older people and the threat of infection is likely to increase with the relaxation of infection control measures, vaccination remains a crucial measure to reduce infection, hospitalisation, and mortality.Despite these benefits, vaccination coverage among older people in Hong Kong remains suboptimal.In addition to strategies to enhance vaccination coverage among older people, other strategies such as promotion among healthcare workers and caregivers, measures to improve immune responsiveness, co-administration of vaccines, and selection of more immunogenic vaccine formulations should be considered to improve the effectiveness of vaccination as a means of primary prevention for older people in the community.

Objectives.To explore the perspectives of healthcare providers in an emergency department (ED) in Hong Kong who deliver care to older people.Methods.Healthcare providers at the ED of United Christian Hospital who delivered direct care to older people or were involved in leading geriatric emergency care practice were invited to participate.Participants were interviewed in person or via web conferencing between May 2022 and February 2023 by a nurse consultant with training in qualitative research.The views and perspectives of participants were explored, and additional issues were identified.Interviews were transcribed verbatim, and the transcripts were coded and grouped according to patterns and themes that emerged from the data.Results.In total, 30 participants were interviewed.They included two senior emergency physicians, three residents, 18 registered nurses, five advanced practice nurses, and two patient care assistants.Two themes emerged: 'challenges of caring for older people in the ED' and 'strategies for providing the best possible care'.In theme 1, the challenges were categorised as follows: 'limitations of the ED in providing geriatric care', 'challenges to the provision of direct care', and 'problems related to community resources in geriatric emergency care'.In theme 2, the strategies were categorised as: 'building a geriatricfriendly environment', 'identifying care needs actively', 'engaging family members and carers in the care process', 'valuing compassion in caring for older people', and 'forming a multidisciplinary team'. Conclusions.Older people are a fast-growing population that presents challenges to clinical services in ED, which can be tackled by creating a geriatric-friendly environment, proactively identifying care needs, and working with families and healthcare teams.The results indicate a need to educate healthcare providers regarding care transitions and available community resources.An information platform should be established to facilitate the referral of older patients to appropriate services.