This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.

This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and...

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Background: Physical activity and sedentary behaviour are modifiable risk factors for noncommunicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital behaviour change interventions have the potential to reach many older adults to promote physical activity and reduce sedentary time. Methods: A systematic review of major databases from inception to 03/2018 was undertaken. Randomised controlled trials (RCT) or pre-post interventions assessing effects of digital behaviour change interventions on physical activity and/or sedentary behaviour in older adults (≥50 years) were included. Random effects meta-analyses were carried out. Results: Twenty-two studies were included, including 1757 older adults (mean age=67 years, %male=41). Random effects model meta-analyses suggested that digital behaviour change interventions increased total physical activity among RCT studies (SMD=0.28; 95%CI 0.01, 0.56; p=0.04) and pre-post studies (SMD=0.25; 95%CI 0.09, 0.41; p=0.002), increased moderate-to-vigorous physical activity (SMD=0.47; 95%CI 0.32, 0.62, p<0.001; MD=52min/week) and reduced sedentary time (SMD=-0.45; 95%CI-0.69,-0.19; p<0.001; MD=58min/day). Reductions in systolic blood pressure (-11bpm; p=0.04) and improvements in physical functioning (p=0.03) were also observed. Conclusions: Digital behaviour change interventions may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults.

Highlights There is a lack of clarity around the relationship between oxidative stress and frailty.  Our review provides some cross sectional evidence of increased oxidative stress among frail older people.  There is some preliminary evidence of lower anti-oxidant parameters (vitamin C, E, α-tocopherol, biological anti-oxidant potential, total thiol levels) in frailty. ABSTRACT (250/250)Objective: Oxidative stress (OS) is associated with accelerated aging. Previous studies have suggested a possible relationship between OS and frailty but this association remains unclear.We conducted a systematic review to investigate potential interactions between OS and frailty.Methods: A systematic literature search of original reports providing data on 'OS and antioxidant' parameters and frailty was carried out across major electronic databases from inception until May 2016. Cross-sectional/case control and longitudinal studies reporting data on the association between frailty and anti-oxidants-OS biomarkers were considered for inclusion. Results were summarized with a best-evidence based synthesis.Results: From 1,856 hits, 8 studies (cross-sectional/case control) were included (N=6,349; mean age of 75±12 years; 56.4% females). Overall, there were 588 (=9.3%) frail, 3,036 prefrail (=47.8%), 40 (=0.6%) pre-frail/robust, and 2,685 (=42.3%) robust subjects. Six crosssectional/case control studies demonstrated that frailty was associated with an increase in peripheral OS biomarkers including lipoprotein phospholipase A2 (studies=1), isoprostanes (studies=2), Malonaldehyde (studies=2), 8-hydroxy-20-deoxyguanosine (studies=2), derivate of reactive oxygen metabolites (studies=2), oxidized Glutathione/ Glutathione (studies=1), 4-hydroxy-2,3-nonenal (studies=1), and protein carbonylation levels (study=1). In addition, preliminary evidence points to lower anti-oxidant parameters (vitamin C, E, α-tocopherol, biological anti-oxidant potential, total thiol levels) in frailty. Conclusion:Frailty and pre-frailty appear to be associated with higher OS and possibly lower anti-oxidant parameters. However, due to the cross sectional design, it is not possible to disentangle the directionality of the relationships observed. Thus, future high quality and in particular longitudinal research is required to confirm/refute these relationships and to further elucidate pathophysiological mechanisms.