Jemima T. Collins

Introduction: Intrinsic capacity (IC) is the composite of an individual’s physical and mental capacities which maintain functional ability. We aimed to develop and validate an IC scale that was ready for clinical use, and to explore the interaction between pain, IC, and functional outcomes. Methods: Confirmatory factor analysis was used to test the construct validity of the model drawing on items from the English Longitudinal Study of Ageing (ELSA). The final Derby Scale of Intrinsic Capacity (DSIC) included mobility (Short Physical Performance Battery), cognition (orientation and 10-word recall), vitality (body mass index), sensory (self-reported vision and hearing), and psychology (Satisfaction with Life). Logistic regression, repeated-measures ANOVA, and structural equation modeling were used to explore interactions between pain, IC, and outcomes. Results: 2486 (wave 6) out of 4052 (wave 4) people aged ≥ 60 years had complete data for analysis. A higher (better) baseline DSIC was associated with decreased risk of basic and instrumental activities of daily living [OR 0.73, 95% CI 0.67–0.80], informal help [OR 0.69, 95% CI 0.62–0.78], formal help [OR 0.66, 95% CI 0.53–0.82], and falls [OR 0.90, 95% CI 0.83–0.97]. People with pain at baseline and follow-up had a lower (poorer) DSIC than those with no pain. The model we created accounted for 36% of variability of ADL difficulties. Pain reduced DSIC by 12% and in turn ADL difficulties by a further 12%. Conclusion: The DSIC is a validated, clinically user-ready tool for measuring IC in older people. Pain was associated with poorer IC and mediated the relationship between IC and ADL difficulties.

Background: Pain may be linked to neuropsychiatric symptoms in dementia but the nature of these associations is unclear. The aims of this study were to examine the concurrent validity of pain scales and to investigate the relationship between pain and neuropsychiatric symptoms in community-dwelling people with dementia. Methods: This study recruited dyads of people with dementia and their caregivers. Questionnaires measuring pain (Numeric Rating Scale, Brief Pain Inventory Short Form, EQ5D3L) and cognition (Mini- Addenbrookes Cognition Examination) were completed by people with dementia. Dyad partners completed the Neuropsychiatric Inventory Questionnaire (NPI-Q). We examined the degree of agreement between different measures of pain and compared the NPI-Q score and items between people with dementia with and without troublesome pain (NRS ≥ 4, NRS < 4), and between those with single and multisite pain. Results: The study recruited 35 individuals with dementia (49% female, mean age 80 with a range of 65–91 years, mean Mini-ACE 13.6/30) and 35 dyad partners. 66% of people with dementia had troublesome pain and compared to those without troublesome pain they were not significantly different in terms of age, sex, frailty, or other demographic variables, but were more likely to take regular paracetamol. Agreement between the NRS and EQ5D3L pain score was good (Cohen’s kappa 0.70, p p <0.05). Conclusion: Community-dwelling people living with dementia can self-report pain using a range of pain scales. Certain neuropsychiatric symptoms may be more common in the presence of pain but requires further study with larger cohorts.

Intrinsic capacity (IC) is the composite of an individual’s physical and mental capacities which maintain functional ability. We aimed to develop and validate an IC scale that was ready for clinical use, and to explore the interaction between pain, IC and functional outcomes. Methods Confirmatory factor analysis was used to test the construct validity of the model drawing on items from the English Longitudinal Study of Ageing (ELSA). The final Derby Scale for Intrinsic Capacity (DSIC) included mobility (Short Physical Performance Battery), cognition (orientation and 10-word recall), vitality (body mass index), sensory (self-reported vision and hearing) and psychology (Satisfaction with Life). Logistic regression, repeated measures ANOVA, and structural equation modelling were used to explore interactions between pain, IC and outcomes. Results 2486 (wave 6) out of 4052 (wave 4) people aged ≥60 years had complete data for analysis. A higher (better) baseline DSIC was associated with decreased risk of basic and instrumental activities of daily living [OR = 0.73, 95%CI 0.67–0.80], informal help [OR = 0.69, 95%CI 0.62–0.78], formal help [OR = 0.66, 95%CI 0.53–0.82] and falls [OR = 0.90, 95%CI 0.83–0.97]. People with pain at baseline and follow-up had a lower (poorer) DSIC than those with no pain. The model we created accounted for 36% of variability of ADL difficulties. Pain reduced DSIC by 12% and in turn ADL difficulties by a further 12%. Conclusion The DSIC is a validated, clinically user-ready tool for measuring IC in older people. Pain was associated with poorer IC and mediated the relationship between IC and ADL difficulties.

Background: Sleep problems are highly prevalent in the older population, with associated physical and mental health effects. They should be identified within a Comprehensive Geriatric Assessment (CGA), a multidimensional evaluation of an older person’s health. However, the extent to which sleep is routinely assessed within CGAs and the methods used, remain unclear. Objectives: The aim of the review was to describe the assessment tools, practitioners involved and the settings in which sleep assessments were conducted within CGAs. Methods: A systematic search was conducted across five electronic databases and grey literature sources between January 1993 and June 2025. Relevant data including healthcare setting, practitioners involved, sleep assessment tool(s) and questions used were extracted. Results: Of 1842 identified references, 136 were included for review. Across 54.4% sources, 28 different assessment tools were identified, with the Pittsburgh Sleep Quality Index being most used (21.3%). General screening questions were utilised in 42.6% sources, most often (81.6%), in place of an assessment tool. The most frequent question related to difficulty falling asleep. Sleep assessments were commonly conducted by nurse/nurse practitioners and geriatricians. They were predominantly performed in secondary care (55.9%), particularly within outpatient geriatric clinics. Conclusions: Sleep assessment within CGAs varies globally. Incorporating screening questions regarding sleep problems could prompt a more holistic assessment of health and wellbeing in the older person, which could feasibly be performed within a CGA by any practitioner. Guidance defining the standards for assessing sleep within a CGA is needed.

Benefits of supplemental protein in older people in different health states and settings are uncertain. This review aimed to determine the effects of supplemental protein on health outcomes in older people. An overview of reviews. Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost) and Google Scholar were searched from January 1990 to August 2024. Systematic reviews with meta-analyses reporting protein intake's effect on health outcomes were included. Methodological quality was assessed using the Assessing Methodological Quality of Systematic Reviews 2 critical appraisal tool. Inconsistency between results from different reviews was explored by examining effects by population type [healthy people, living with long-term conditions (LTCs), hospital inpatients] and whether supplementation was given with or without concomitant exercise. Thirty-three reviews with meta-analyses collating data from 441 unique studies were included. There was no increase in muscle mass, strength or physical performance from protein supplementation in older people in general, nor in healthy older people. There was medium-certainty evidence of at least small increases in muscle mass and strength in older people with LTCs, and the benefits of protein supplementation were more certain with concomitant exercise. Evidence suggests that protein supplementation in hospital patients with hip fractures reduced the number of medical complications. Protein supplementation is effective for improving muscle mass and strength in older people with LTCs and medical complications in older hospitalised patients with hip fractures. The evidence does not support its routine use in other groups of healthy older people.

Background: People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation.Objectives: (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL.Methods: This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use.Results: In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications.Conclusion: Many care home residents live with pain, anxiety and depression. Addressing residents’ pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.

Background: With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. Methods: Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. Results: A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. Conclusion: Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.

Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug–drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences (“phenotyping”) may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of “digital phenotyping” in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.

Purpose: To investigate the longitudinal associations between pain and depressive symptoms in adults. Methods: Prospective cohort study on data from 28,515 community-dwelling adults ≥ 50 years, free from depression at baseline (Wave 5), with follow-up in Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Significant depressive symptoms were defined by a EURO-D score ≥ 4. The longitudinal association between baseline pain intensity and significant depressive symptoms at follow-up was analysed using logistic regression models; odds ratios (ORs) and confidence intervals (CI) were calculated, adjusting for socio-demographic and clinical factors, physical inactivity, loneliness, mobility and functional impairments. Results: Mean age was 65.4 years (standard deviation 9.0, range 50–99); 14,360 (50.4%) participants were women. Mean follow-up was 23.4 (standard deviation 3.4) months. At baseline, 2803 (9.8%) participants reported mild pain, 5253 (18.4%) moderate pain and 1431 (5.0%) severe pain. At follow-up, 3868 (13.6%) participants—1451 (10.3%) men and 2417 (16.8%) women—reported significant depressive symptoms. After adjustment, mild, moderate and severe baseline pain, versus no pain, were associated with an increased likelihood of significant depressive symptoms at follow-up: ORs (95% CI) were 1.20 (1.06–1.35), 1.32 (1.20–1.46) and 1.39 (1.19–1.63), respectively. These associations were more pronounced in men compared to women, and consistent in participants aged 50–64 years, those without mobility or functional impairment, and those without loneliness at baseline. Conclusion: Higher baseline pain intensity was longitudinally associated with a greater risk of significant depressive symptoms at 2-year follow-up, in community-dwelling adults without baseline depression.

Care homes are central to the COVID-19 story. Care home residents comprised the bulk of those who died during the first wave of the pandemic in most countries. Failures to protect residents in the early stages were multiple. Inadequate testing procedures meant asymptomatic cases went undetected [ 1]. Lack of access controls led to infections being seeded from the community and hospitals [ 2]. Poor availability of effective personal protective equipment in many countries compounded these deficiencies [ 3].