A most challenging task for scientists that are involved in the study of ageing is the development of a measure to quantify health status across populations and over time. In the present study, a Bayesian multilevel Item Response Theory approach is used to create a health score that can be compared across different waves in a longitudinal study, using anchor items and items that vary across waves. The same approach can be applied to compare health scores across different longitudinal studies, using items that vary across studies. Data from the English Longitudinal Study of Ageing (ELSA) are employed. Mixed-effects multilevel regression and Machine Learning methods were used to identify relationships between socio-demographics and the health score created. The metric of health was created for 17,886 subjects (54.6% of women) participating in at least one of the first six ELSA waves and correlated well with already known conditions that affect health. Future efforts will implement this approach in a harmonised data set comprising several longitudinal studies of ageing. This will enable valid comparisons between clinical and community dwelling populations and help to generate norms that could be useful in day-to-day clinical practice.

Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.

Unbalanced diets and stressful situations disrupt energy homeostasis and are implicated in the development of severe pathologies. The present study investigated the effects of a 7-day diet, enriched in corn oil (20%) and proportionally lower in protein and carbohydrate, on the major regulators of energy expenditure and stress response of adult male Wistar rats exposed to acute swimming stress at the end of the dietary treatment. Food intake and body weight gain were lower in diet-fed as compared with normal-chow-fed controls. The circulating leptin levels were elevated in both nonstressed and stressed diet-fed rats, while the glucose levels were significantly increased only in the diet-fed group subjected to stress. The plasma insulin levels were not affected by the diet, but were significantly reduced in acutely stressed rats. Acute swimming increased corticosterone levels both in chow-fed and diet-fed rats. No significant effect of diet was observed on corticosterone levels. Northern blot analysis showed increased glucocorticoid receptor mRNA levels in the hypothalamus of normally fed rats subjected to stress. This increase was not observed in the diet-fed stressed group, which on the contrary showed reduced glucocorticoid receptor mRNA levels following stress. The data presented indicate that even a moderately unbalanced, fat-enriched diet can within a short time disrupt the metabolic neuroendocrine balance and the stress response, rendering the organism more vulnerable to potential stressful insults.

1. High-fat diets disrupt metabolic equilibrium and hypothalamic-pituitary-adrenal axis function and may lead to the development of metabolic and endocrine dysfunctions. The early neuroendocrine responses elicited by a combination of short-term metabolic and emotional stressors is not fully elucidated. 2. The purpose of the present study was to determine the impact on female rats, of a short-term enriched in fat diet, combined with an acute stressor. 3. Adult female Wistar rats were fed a fat diet for 7 days and subsequently exposed to 5 min swimming stress. Plasma leptin, insulin, glucose, luteinizing hormone (LH) and corticosterone, along with brain corticosteroid receptors' mRNAs were measured at 1 h post stress. 4. Diet, compared to chow, reduced food intake and body weight gain, increased leptin and LH, and decreased glucose in the periphery. The diet increased plasma corticosterone and reduced GR mRNA in the hippocampus, similarly to swim stress. 5. The diet significantly modified the animals' response to the subsequent swim stress, by blocking further corticosterone rise and GR mRNA reduction. In addition, exposure of diet-fed rats to stress, altered their endocrine response, in terms of leptin and LH. 6. These observations suggest that even short, moderately unbalanced diets can affect peripheral and central components of energy balance, reproduction and stress response.

Aim: We aimed to evaluate the feasibility and efficacy of a short training course on frailty destined for primary health care (PHC) professionals Findings: PHC professionals applied frailty screening strategies more frequently three months following the workshop compared to baseline and reported improvements in a) their familiarization with the frailty syndrome, b) self-perception of knowledge and skills to detect and manage frailty and c) the attitude that frailty is an inevitable consequence of ageing. Time restrictions was reported to be the main barrier to the application of frailty screening and management strategies.Message: A short skill-oriented training course can significantly and sustainably improve PHC professionals' attitudes and practices regarding frailty.

Purpose Although frailty can be delayed or prevented by appropriate interventions, these are often not available in countries lacking formal education and infrastructure in geriatrics. The aim of this study was to: (a) explore ideas, perceptions and attitudes of primary health care (PHC) professionals towards frailty in a country where geriatrics is not recognised as a specialty; (b) explore PHC professionals’ training needs in frailty; and (c) define components of a frailty educational programme in PHC. Methods Qualitative design, using two focus groups with PHC professionals conducted in Thessaloniki, Greece. Focus groups were audio recorded and transcribed. Data were analysed with thematic analysis. Results In total 31 PHC professionals (mean age: 46 years; gender distribution: 27 females, 4 males) participated in the study (physicians n = 17; nurses n = 12; health visitors n = 2). Four main themes were identified: (1) Perceptions and understanding of frailty; (2) Facilitators and barriers to frailty identification and management; (3) Motivation to participate in a frailty training programme; (4) Education and training. The main barriers for the identification and management of frailty were associated with the healthcare system, including duration of appointments, a focus on prescribing, and problems with staffing of allied health professionals, but also a lack of education. Training opportunities were scarce and entirely based on personal incentive. Professionals were receptive to training either face-to-face or online. A focus on learning practical skills was key. Conclusion Education and training of professionals and interdisciplinary collaboration are essential and much needed for the delivery of person-centred care for people with frailty living in the community.

ObjectivesBy the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands.MethodsFrom 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity.ResultsOlder Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001).ConclusionsA shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level.

Background Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. Methods A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. Results Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. Conclusion So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.