ObjectiveTo examine whether wearing a pedometer was associated with higher objectively-measured physical activity (PA) among adolescents independent of other behavior change strategies, and whether this association differed by sex or day of wear.MethodIn a parallel-group population-based cohort study, 892 adolescents (43.4% male, mean ± SD age, 14.5 ± 0.5 years) from Eastern England were recruited. PA was measured (in 2005–2006) by accelerometry over four days; a sub-group (n = 345) wore a pedometer coterminously with the accelerometer. Three-level (individual, day of wear and school level) multiple linear regression was used to examine the association between accelerometry (counts/min, cpm) and pedometer wear, stratified by sex and adjusted for weekday/weekend.ResultsFor the entire cohort, there was a significant decline in cpm over four days (p < 0.01). Girls wearing pedometers had higher mean cpm than those not wearing a pedometer, independent of BMI z-score, socio-economic status, weekday/weekend, and school clustering (β = 5.1; 95% CI: 0.8 to 9.5, p = 0.02). This association was not seen in boys.ConclusionPedometer wear was associated with higher PA among adolescent girls, but not boys. Findings may support sex-specific intervention strategies. In addition to pedometer monitoring, additional strategies may be required to promote PA levels, especially among boys.

Background With increasing cost of healthcare in our aging society, a consistent pain point is that of end-of-life care. It is particularly difficult to prognosticate in non-cancer patients, leading to more healthcare utilisation without improving quality of life. Additionally, older adults do not age homogenously. Hence, we seek to characterise healthcare utilisation in young-old and old-old at the end-of-life. Methods We conducted a single-site retrospective review of decedents under department of Advanced Internal Medicine (AIM) over a year. Young-old is defined as 65–79 years; old-old as 80 years and above. Data collected was demographic characteristics; clinical data including Charlson Comorbidity Index (CCI), FRAIL-NH and advance care planning (ACP); healthcare utilisation including days spent in hospital, hospital admissions, length of stay of terminal admission and clinic visits; and quality of end-of-life care including investigations and symptomatic control. Documentation was individually reviewed for quality of communication. Results One hundred eighty-nine older adult decedents. Old-old decedents were mostly females (63% vs. 42%, p = 0.004), higher CCI scores (7.7 vs 6.6, p = 0.007), similarly frail with lower polypharmacy (62.9% vs 71.9%, p = 0.01). ACP uptake was low in both, old-old 15.9% vs. young-old 17.5%. Poor prognosis was conveyed to family, though conversation did not result in moderating extent of care. Old-old had less healthcare utilisation. Adjusting for sex, multimorbidity and frailty, old-old decedents had 7.3 ± 3.5 less hospital days in their final year. Further adjusting for cognition and residence, old-old had 0.5 ± 0.3 less hospital admissions. When accounted for home care services, old-old spent 2.7 ± 0.8 less hospital days in their last admission. Conclusion There was high healthcare utilisation in older adults, but especially young-old. Enhanced education and goal-setting are needed in the acute care setting. ACP needs to be reinforced in acute care with further research to evaluate if it reduces unnecessary utilisation at end-of-life.

Objectives: We aim to determine the prevalence of vision impairment (VI) and its cumulative impact on multimorbidity, frailty, physical and cognitive function, and quality of life. Method: In all, 780 community-dwelling older adults were interviewed for demographic data and a one-off physical activity screening. Covariate measurements include vision via Snellen chart, multimorbidity, five-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight) scale and Mini-Mental State Examination (MMSE). Outcome variables taken were Barthel Index, Lawton Instrumental Activities of Daily Living (IADL) scale, grip strength, Timed Up and Go (TUG), and EuroQol 5D (EQ-5D). Results: In all, 426 (54.6%) were female, mean age was 71.3 ± 0.2 years; 240 (30.8%) had VI. The interaction between VI, multimorbidity, and frailty significantly impacts grip strength, TUG, quality of life, and IADL. Discussion: Our study is the first to look at the interaction of VI, multimorbidity, frailty, and its combined impact on key domains of intrinsic capacity. Our results further support vision screening to enable aging in place and highlight importance of screening for frailty and cognition in those with VI.

IntroductionWhile hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams.Materials and MethodsA retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed.ResultsThe mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56–0.95) and extended cost (OR 0.69; 95% CI 0.54–0.95).ConclusionGeriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.