Geriatrics

Potentially inappropriate CNS-active prescribing remains common in older adults, including those with cognitive impairment

This large JAMA cohort examined use of potentially inappropriate CNS-active medications in older adults with and without cognitive impairment. High-risk agents remained frequently prescribed despite known associations with falls, delirium, and accelerated cognitive decline. Older adults with established cognitive impairment were still commonly exposed, indicating missed opportunities for deprescribing. Findings support routine CNS-active medication review, especially in dementia, and prioritizing safer nonpharmacologic or non–CNS-active alternatives. 1

Vision and motor impairments independently predict incident dementia in community-dwelling Medicare beneficiaries

In 3,847 cognitively unimpaired NHATS participants ≥65 years, baseline sensorimotor impairments predicted subsequent dementia over a mean 5.2 years. Vision difficulty, impaired standing balance, slow gait, poor chair stands, and weak grip each carried independent dementia hazard ratios above 1.2. Having three or more sensorimotor impairments raised dementia risk substantially compared with no impairments (HRs up to about 2). Results support incorporating simple vision and mobility measures into dementia risk stratification and targeting these domains for early intervention. 2

Hearing aid prescription may reduce 7-year dementia risk, with little effect on overall cognitive trajectory

This Neurology target trial emulation used ASPREE data to compare hearing aid prescription versus no prescription in older adults with moderate hearing impairment. Estimated 7-year dementia risk was 5.0% with hearing aid prescription versus 7.5% without (RR 0.67; 95% CI 0.37–0.97). Cognitive impairment risk was also lower with hearing aids, and dementia risk decreased as reported use frequency increased. Mean overall cognitive scores among survivors were similar between strategies, and residual confounding cannot be excluded. Clinically, findings support counseling on hearing aids as a potential dementia risk–modifying tool while awaiting randomized trials. 3

Ward transfers prolong hospital stay disproportionately for patients with dementia

This UK service evaluation analyzed 27,140 admissions of adults ≥65 years across four hospitals, including 2,760 individuals with dementia. Each ward change was associated with longer length of stay (β 5.2 days), with an additional 1.7 days in those with dementia. Dementia increased inpatient mortality and care-home discharge risk, but ward changes did not modify these outcomes. Minimizing ward transfers, particularly in people with dementia, may reduce prolonged hospitalization and associated inpatient harms. 4