Costas Glavas

Background: Home-based reablement programs have improved everyday functioning for people living with early-stage dementia or mild cognitive impairment (MCI), but the substantial time commitment required for delivery by health professionals has created a barrier to widespread implementation. Digital technology could facilitate delivery, but traditional devices such as smartphones and tablets present usability challenges for this population. We have co-designed a cognitive reablement program, VOICE-COG, that can deliver personalized interventions broadcast via voice-controlled digital voice assistants (DVAs). Objective: This pilot nonblinded randomized controlled trial examined the feasibility and potential effectiveness of VOICE-COG for older adults living with dementia or MCI to guide the design of a full-scale trial. Methods: Older adults (aged 60‐85 years) with a self-reported diagnosis of dementia or MCI (N=30) were recruited via Facebook or the StepUp-for Dementia Research database and randomized to either a DVA intervention (n=15) or control (n=15) group for 12 weeks. Each participant randomized to the intervention group and their care partner met with a psychologist via Zoom to select 2 or 3 personalized goals from the VOICE-COG program. The personalized program was input into the software (BuddyLink) by researchers for broadcast via a DVA (Amazon Alexa Show 8). Participants in the control group received enhanced usual care, consisting of treatment as usual, plus weekly informational emails. Primary feasibility outcomes were recruitment, retention, device-recorded adherence, and the System Usability Scale (SUS). Secondary outcomes were self-reported by the participant and care partner via web-based Qualtrics forms and included the Goal Attainment Scale–Light (GAS), changes in participant mood, cognition, and everyday functioning, and carer burden. Results: The recruitment rate was 86% (30/35) and the retention rate was 97% (29/30), with 1 participant in the intervention group lost to follow-up. Adherence to the VOICE-COG program ranged from 29% to 100% (mean 70%, SD 17%). The VOICE-COG program was rated as marginally acceptable (mean SUS score 56.3, SD 18.1). After 12 weeks, 60% (9/15) of the intervention group reported having met or exceeded their goals (GAS-Light t-score ≥50; mean 57.6, SD 15.4). The intervention group had a significantly higher increase in Multifactorial Memory Questionnaire–Strategy subscale score compared with control, mean difference 5.0 (95% CI 0.03-10.1, P =.049), representing a medium effect size ( d =0.55). There were no other significant differences between groups. Conclusions: This co-designed VOICE-COG program, delivered via DVAs, was feasible for older adults living with early-stage dementia or MCI, resulting in most participants meeting their reablement goals and increases in the use of memory strategies. System usability issues should be addressed in future adequately powered trials.

It is unclear whether comorbid low bone mineral density (BMD) and sarcopenia, known as 'osteosarcopenia', synergistically increase fall and fracture risk. This review aims to determine whether osteosarcopenia confers a greater risk for incident falls and fractures than low BMD or sarcopenia alone. Relevant databases were searched from inception to 2025 for prospective studies in populations aged ≥ 50 years comparing fall and fracture risk in osteosarcopenia to low BMD (T-Score < -1.0) or sarcopenia alone. Meta-analyses calculated risk ratios (RR) and measures of interaction on additive (relative excess risk due to interaction; RERI) and multiplicative (multiplicative interaction ratio; MR) scales. Seven records (n = 813) were included. Osteosarcopenia was associated with similar fracture risk as low BMD (RR 1.22; 95% CI 0.96, 1.56; k = 6, I² = 0%), but higher risk than sarcopenia (RR 2.12; 95% CI 1.42, 3.15; k = 5; I² = 0%). Falls risk did not differ for osteosarcopenia compared to low BMD (RR 1.15; 95% CI 0.44, 2.97; k = 3; I² = 72.9%) or sarcopenia (RR 1.06; 95% CI 0.70, 1.59; k = 3; I² = 1.1%). Synergy analyses showed pooled RERI of 0.35 (95% CI - 0.22, 0.91; k = 5) for fractures and - 0.16 (95% CI - 0.60, 0.28; k = 3) for falls, with MR estimates of 1.21 (95% CI 0.90 to 1.62) and 0.83 (95% CI, 0.64 to 1.09), respectively. Risk of incident fracture in osteosarcopenia is similar to that of low BMD, but higher than sarcopenia, and falls risk does not differ between conditions. The absence of significant additive or multiplicative interactions suggests there is insufficient evidence to support the promotion of osteosarcopenia as a distinct diagnostic entity.

Background: Osteoporosis self-management requires scalable support, and digital health platforms may meet this need. This study aimed to characterise the experiences and perspectives of postmenopausal women who participated in a digital voice assistant (DVA) delivered osteoporosis self-management intervention, and to assess key implementation outcomes.Methods: This was a qualitative analysis of interviews with postmenopausal women from the intervention arm (DVA group) of a 12-month randomised controlled trial. The DVA program broadcast education videos, medication reminders, home-based exercise, nutrition advice and monthly quizzes through a DVA device. Semi-structured interviews were recorded, transcribed and managed in NVivo through reflexive thematic analysis, guided by the Practical Planning for Implementation and Scale-Up and Proctor’s implementation outcome taxonomy frameworks. Evidence weighting summarised participant coverage and code density.Results: Twenty-two of 25 (88%) DVA group participants completed semi-structured interviews. Thematic analysis identified seven themes mapped to Proctor’s implementation outcomes. Evidence weighting indicated strong support for the intervention’s appropriateness and acceptability, moderate support for its adoption, fidelity, feasibility and sustainability, and limited support for costs. Participants valued clear audiovisual guidance, conversation-based interactions with natural language, and flexible home-based access to self-management.Conclusion: Implementation of digital health platforms for osteoporosis self-management appears feasible, acceptable and sustainable among postmenopausal women. Scale-up will depend on streamlined content, reliable delivery modalities, accessible user support, clear privacy regulations and pragmatic pricing models to promote uptake, sustained engagement and healthcare system integration.

Managing blood glucose levels and adhering to exercise is challenging for older adults with obesity and type 2 diabetes mellitus (T2DM). Digital voice assistants (DVAs) utilising conversation-based interactions and natural language may overcome barriers to accessing home-based lifestyle programs, but end-user perspectives are essential for implementation. This analysis investigated end-user perspectives on implementation outcomes of a DVA-delivered lifestyle program nested within a randomised controlled trial of 50 older adults (aged 50–75 years) with obesity and T2DM (DVA n = 25; control n = 25). Following trial completion, 10 DVA participants (mean ± SD age 67 ± 4 years) completed semi-structured interviews guided by the Practical Planning for Implementations and Scale-up guide and Proctor’s implementation outcome taxonomy. Over half (60%) were willing to pay for the DVA-delivered program, indicating perceived value. DVA audiovisual and conversation-based modalities enhanced engagement and acceptability. Most end-users found the DVA program feasible as a modality for delivering lifestyle programs, but suggested greater personalisation to bolster sustainability. Overall, the intervention was identified as acceptable and appropriate, suggesting digitally delivered programs may be feasible and sustainable for long-term use. Findings should be interpreted cautiously, given the small sample size and short intervention period. Nevertheless, end-users’ suggestions could inform the implementation of digital health interventions into healthcare systems.

Sarcopenic obesity is the confluence of low skeletal muscle mass and function with excess adiposity. Sarcopenic obesity is becoming increasingly prevalent among older adults and may contribute to greater risk of functional decline, falls, fractures and mortality than sarcopenia or obesity alone. This narrative expert review, based on targeted literature searches and the authors' personal libraries, outlines the current understanding of sarcopenic obesity, including its multifactorial pathophysiology. We also describe the current operational definition and estimated prevalence in older populations, and its impact on musculoskeletal and cardiometabolic health. Evidence from interventional studies exploring the use of targeted multimodal lifestyle behavior interventions, with a focus on the primary role of exercise and caloric restriction, to address sarcopenic obesity and its consequences is presented. Finally, we discuss recommendations for clinical practice and future research aimed at optimizing body composition and physical function in older adults. Despite a lack of consistent evidence on its prevalence, it is clear that sarcopenic obesity conveys serious health consequences. Further research is required to determine the optimal approaches to its diagnosis and management, but this should not act as a barrier to assessment and intervention in clinical settings.

Background: Supervised gym-based high-intensity resistance and impact training (HiRIT) can enhance physical function and muscle strength, but older adults may face challenges affecting adherence to HiRIT, such limited access to facilities and lack of transportation, necessitating a shift towards unsupervised home-based exercise. The aim of this study was to explore experiences and perspectives of older adults with obesity who were required to transition from supervised gym-based HiRIT to unsupervised home-based resistance training (RT) and aerobic training (AT) during COVID-19 lockdowns. Secondary aims were to compare changes in body composition and physical function after 12 weeks between participants required to transition to home-based exercise (“HOME”) and those who were able to continue gym-based exercise (“GYM”). Methods: Thirty older adults (60–89 years) with obesity were enrolled from the gym-based HiRIT intervention arm of a 12-week exercise and dietary weight loss trial. Thirteen (43%) participants were transitioned to HOME due to COVID-19 lockdowns. HOME participants were prescribed bodyweight RT and AT exercises, while maintaining the weight loss intervention. Eight HOME participants completed semi-structured interviews post-intervention. Quantitative outcomes including exercise adherence, body composition and physical function were compared to GYM participants. Results: Participants’ experiences and perspectives regarding the HOME program encompassed various elements including accessibility, accountability, maintaining physical activity levels, motivation, support from health care professionals, openness to telehealth videoconferencing for support, engagement, lack of equipment, supervision and a structured routine. Both groups had significant reductions in body mass (mean ± SD; GYM: -4.4 ± 0.4 kg, HOME: -6.2 ± 1.2 kg), but HOME demonstrated greater losses in fat mass (mean difference: -3.1 kg, 95% CI: -6.0, -0.3) compared with GYM represented by a large effect size (d = 0.8). Physical function outcomes improved only in GYM (all P < 0.05). Conclusions: Older adults with obesity transitioning from supervised gym-based to unsupervised home-based exercise face both supportive and challenging experiences. While accessibility and accountability enhanced their engagement, some participants faced difficulties related to limited equipment and digital support, emphasising areas for improvement in home-based exercise interventions. Home-based exercise may be effective for supporting dietary weight loss, but further research is needed to determine if there are any beneficial effects on physical function. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001146280; date of registration: 12/07/2018.