Background: Frailty is commonly considered as a syndrome with several symptoms, including weight loss, exhaustion, weakness, slow walking speed and physical inactivity. It has been suggested that cognitive impairment should be included in the frailty index, however the association between frailty and cognition has not yet been fully established. Objective: To investigate cross-sectionally whether frailty is associated with cognitive impairment or clinically diagnosed dementia in older people. Methods: The study included a total of654 persons aged 76-100 years (mean 82 ± 4.6).Frailty status of the participants was assessed using the Cardiovascular Health Study criteria. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Clinically diagnosed dementia was assessed by specialists using diagnostic criteria. The associations between frailty and cognition were investigated using logistic regression. Results: A total of 93 (14%) participants were classified as frail. Cognitive impairment (MMSE score <25) was observed among 171 (26%) persons and 134 (21%) persons had clinically diagnosed dementia. 97 (15%) persons had Alzheimer's disease, 19 (3%) had vascular dementia, 12 (2%) had dementia with Lewy bodies and 8 persons (1%) had some other type of dementia. Multivariate logistic regression models showed that frail persons were almost 8 times more likely to have cognitive impairment (OR 7.8, 95% CI 4.0-15.0), 8 times more likely to have some kind of dementia (OR 8.0, 95% CI 4.0-15.9), almost 6 times more likely to have vascular dementia (OR 5.6, 95% CI 1.2-25.8) and over 4 times more likely to have Alzheimer's disease (OR 4.5, 95% CI 2.1-9.6) than persons who were robust. Conclusion: Frailty is strongly associated with cognitive impairment and clinically diagnosed dementia among persons aged 76 and older. It is possible that cognitive impairment is a clinical feature of frailty and therefore should be included in the frailty definition.

Physical activity after a hip fracture : effect of a multicomponent home-based rehabilitation program -a secondary analysis of a randomized controlled trial Turunen, Katri; Salpakoski, Anu; Edgren, Johanna; Törmäkangas, Timo; Arkela, Marja; Kallinen, Mauri; Pesola, Maija; Hartikainen, Sirpa; Nikander, Riku; Sipilä, Sarianna Turunen, K., Salpakoski, A., Edgren, J., Törmäkangas, T., Arkela, M., Kallinen, M., . . . Sipilä, S. (2017). Physical activity after a hip fracture : effect of a multicomponent home-based rehabilitation program -a secondary analysis of a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 98 (5), 981-988. doi:10.1016/j.apmr.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT ACKNOWLEDGMENTSWe thank the physiotherapists at the Central Finland Health Care District for the valuable work in the recruitment of the participants and data collection. We are also thankful to all those persons who assisted in data collection. follow-up among older people recovering from a recent hip fracture. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT7 DESIGN: Secondary analysis of a randomized, controlled, parallel-group trial.8 SETTING: Home-based rehabilitation; measurements in university laboratory.9 PARTICIPANTS: Community-dwelling people aged 60+ recovering from a hip fracture. 10Participants were randomly assigned into an intervention (n=40) or control (n=41) group on 11 average 42±23 days after discharge from hospital. 12 MEASUREMENTS:The outcome was the level of PA, which was assessed with the 13 questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12 and 24 months after baseline.14 Three PA categories were defined: inactivity, light PA and moderate to heavy PA. Physical increased PA among older hip fracture patients. The increase was found to be maintained at the 26 one-year follow-up.

Theoretical risks posed by alcohol use are not minimal in the older elderly, though the quantity of alcohol use is not considerable. Physicians and nurses should pay attention to chronic diseases and medications when counselling aged people about alcohol consumption. The question of clinical importance of alcohol-medication interactions needs to be studied further.

IMPORTANCEWith the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking.OBJECTIVES To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. EVIDENCE REVIEW A systematic review following Preferred Reporting Items for SystematicReviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence-and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. FINDINGSOf 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (Ն11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations.

Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly.