Geriatrics

Education-focused medication management reduces hospitalisations and ED visits in dementia

Systematic review and meta-analysis of people with dementia found physician plus patient/carer education reduced all-cause hospitalisation (RR 0.92) and ED visits (RR 0.92). Seven RCTs and five nonrandomised studies evaluated physician education, prescribing reminders, and multidisciplinary teams. Multidisciplinary team interventions reduced drug-related readmissions (HR 0.49). Authors conclude tailored education for clinicians and carers is the most promising strategy to lower healthcare utilisation. 1

CGA-based individualized program reverses frailty in older nondialysis CKD

Randomized trial of 242 frail patients with nondialysis CKD found frailty reversion at 12 months was 30.6% vs 7.4% (OR 5.22). Intervention was a 12-month individualized, CGA-driven multidomain program including nutrition, psychological, and physical-function components. There were no clear differences in unplanned hospitalization or all-cause mortality. Findings apply mainly to older patients with stage 3 CKD and may not generalize to more advanced disease. 2

Single outpatient CGA did not improve goal attainment in frail CKD outpatients

Cluster RCT across 15 centers assigned frail CKD outpatients to one-off outpatient CGA plus usual care or usual care alone. At three months, goal attainment scores were similar (mean difference 1.54; 95% CI -3.13 to 6.20) and secondary outcomes showed no benefit. No significant effects were seen for quality of life, frailty status, mortality, hospitalizations, or residential care admission. Authors advise against routine single-episode outpatient CGA and suggest integrated or repeated models may be needed. 3