Weekend warriors and preventing crises

The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery recently published their updated the guidelines on Management of Atrial Fibrillation (AF), in their commentary Kaba et al. underscore AF as a prototypical age-related condition with major implications for geriatric practice [1]. The introduction of the AF-CARE framework represents a decisive move towards comprehensive, patient-centred and multidisciplinary management, particularly suited to the heterogeneity of older adults with AF. The guidelines reinforce that assessment and mitigation of modifiable bleeding risks, alongside shared decision-making, should underpin anticoagulation, while neither advanced age nor fall risk alone should preclude treatment in those at high stroke risk. Treatment selection between DOACs and warfarin should be individualised, with renal function monitoring as a core component of safe long-term therapy in older patients. Crucially, the emphasis on frailty rather than chronological age to guide rate versus rhythm control reflects a geriatric-informed approach and highlights priorities for future trials and guideline development in an increasingly diverse ageing population. Mobility has become a central integrative marker of ageing, health trajectories and healthcare utilisation. In a best practice paper, Beauchamp et al. present the outcomes of an international consensus meeting on the minimum standards for the use of wearables in measuring late-life mobility [2]. The big bonus of capturing real-world mobility over prolonged periods in comparison to the limitations of clinic-based or self-reported assessments that inadequately reflect daily function. Currently, there is a lack of standardised methods across studies, making interpretation of results challenging. The group identified 20 core device-derived mobility measures across six subdomains of mobility. Thirty guiding principles were developed to inform the selection, protocols and interpretation of wearable data in older adults as well as 16 research priorities. The articulation of core measures, guiding principles and research priorities provides a structured foundation for harmonising studies, supporting regulatory alignment and improving cross-study comparability. Results can be used to guide wearable mobility assessments in older adults and promote consistent research practices. The applicability of wrist-worn accelometry data was assessed by Liu et al. in a large prospective cohort study, examining whether concentrating guideline-recommended physical activity into 1 or 2 days per week—the so-called ‘weekend warrior’ pattern—confers similar benefits to activity spread more evenly across the week [3]. Over a median 7.8-year follow-up, both active weekend warriors and regularly active individuals had substantially lower risks of incident probable sarcopenia, confirmed sarcopenia and falls compared with inactive participants. Notably, the magnitude of risk reduction for sarcopenia and falls was comparable, and in some analyses greater, among weekend warriors than among those with a regular activity pattern. These findings challenge the primacy of frequency over total volume in current physical activity messaging and provide reassurance for older adults unable to exercise most days. The study offers important public health implications, suggesting that even activity or resistance training concentrated into 1 to 2 days per week may be a pragmatic and effective strategy to reduce sarcopenia and fall risk in ageing populations. Since age-associated cognitive decline and dementia are significant public health concerns without cure prevention is key. Exercise can benefit cognition in older adults. With their cluster randomised controlled trial, Tait et al. add to the evolving evidence on dual-task exercise as a cognitive intervention in later life [4]. The findings suggest modest but domain-specific gains—particularly in attention, reaction time, and aspects of learning and working memory—that emerge early and, for some outcomes, are sustained or evolve over longer follow-up. Benefits for visual learning and working memory emerged after 12 months. Genotype may influence effects, based on findings in brain-derived neurotrophic factor Met-carriers. Overall, this study supports dual-task exercise as a promising, functionally relevant approach, while underscoring the need for longer, adherence-focused interventions. Besides targeted exercise, stimulating and supporting physical and social activities is of high importance for the well-being of older adults living with cognitive disorders and dementia. In a qualitative, narrative review Kwok et al. synthesised existing evidence on the lived experiences and preferences of people with dementia, carers and professionals concerning strategies to support safe walking and prevent missing episodes [5]. They concluded that personalised safe walking plans are vital to both prevent and manage missing incidents in dementia care and that there is an urgent need for interventions that assess the effectiveness of care plans to support safe walking. Common strategies include familiar wayfinding strategies, use of technological devices and live tracking as well as support from health care professionals, family, neighbours, community alert systems and—as last resort—police. As the global prevalence of dementia continues to rise sharply, crises in community-based dementia care are becoming an increasingly frequent and consequential challenge in geriatric practice. In a qualitative systematic review and meta-ethnography, Thissen et al. provide a nuanced understanding of how such crises emerge and are managed, identifying ‘balancing between safety and autonomy’ as the central underlying mechanism [6]. Disruptions in the living situation of persons with dementia, leading to heightened risks, trigger this delicate balancing process for patients, informal caregivers and healthcare professionals. The findings highlight that crisis resolution is facilitated when professionals adopt proactive, collaborative approaches that attend to the needs and perspectives of both the person with dementia and their caregiver. Conversely, fragmented healthcare systems that operate as reactive ‘push’ systems often hinder timely and appropriate responses, underscoring the need for practice innovation and policy reform to strengthen continuity of care and prevent avoidable crises. Considering its high prevalence and its negative effects on older persons and society at large, the World Health Organisation (WHO) has embarked on a global campaign to combat ageism. Besides being underrecognised, importantly, ageism is enacted both towards and by older adults. In their paper, Ayalon et al. share the preliminary validation of the WHO Ageism Towards Older Persons Scale (WHO-A-TOPS) in 1778 participants [7]. WHO-A-TOPS is a 10-item measure designed to comprehensively assess ageism, while capturing its three dimensions, e.g. stereotypes, prejudices and discrimination. Drawing on data from four countries and across the full adult lifespan, the scale the authors validated demonstrated strong psychometric properties and measurement invariance across age groups and cultural contexts. By providing a reliable, valid and cross-nationally applicable instrument, this study establishes a new benchmark for ageism research and offers a much-needed tool to support comparative studies, intervention evaluation and policy-relevant research in ageing. Orthostatic hypotension (OH) is common in older person with prevalences between 20% and 50% depending on the setting. Both over- and undertreatment of hypertension may lead to symptomatic OH, with possible negative health effects as a result. In a post hoc analysis of the SPRINT trial, Wang et al. address a clinically salient dilemma in geriatric hypertension management: whether the cognitive benefits of intensive blood pressure lowering extend to patients who develop OH during treatment [8]. In this analyses, they showed that among older adults without OH at baseline, intensive systolic blood pressure control was associated with a lower risk of incident dementia. However, in participants who developed new-onset OH during follow-up, intensive treatment was linked to a markedly higher risk of dementia, raising concern about potential cerebral hypoperfusion in this subgroup. These divergent findings underscore OH as a key modifier of treatment benefit and harm, rather than a benign side effect. The study highlights the need for vigilant monitoring of postural blood pressure changes and a more individualised approach to blood pressure targets in older adults, alongside calls for prospective validation to inform future guidelines. Adding to the granularity, using a novel analytical approach (dynamic time warping), Duin et al. showed in a 5-year prospective study of 85 year olds that changes in blood pressure are temporally associated with subsequent changes in functional status and cognitive function in adults aged 85 years and older [9]. Rising blood pressure leads to worsening functional status and falling diastolic pressure predicted later cognitive decline. They concluded that both increases and decreases in blood pressure, particularly in diastolic blood pressure, can precede functional and cognitive decline. These findings suggest that stability in blood pressure may be more important than absolute values in this age group. It underscores the importance of careful and individualised blood pressure management in the oldest old. In a population-based study, Claffey et al. provide mechanistic insight into the well-established association between OH and falls by directly linking postural blood pressure drops to impaired cerebral perfusion in 2478 older adults [10]. Using portable near-infrared spectroscopy during active standing, the authors demonstrate that community-dwelling individuals with OH experience significantly greater and more sustained reductions in cerebral oxygenation than those without OH. Interestingly, the risk of future unexplained falls was not uniformly elevated in all participants with OH, but was substantially higher only among those with marked cerebral hypoperfusion. These findings support cerebral hypoperfusion as a key pathophysiological pathway underpinning falls in OH, rather than blood pressure change alone. It highlights the potential clinical value of integrating cerebral perfusion assessment into OH in geriatric care. None declared. None declared.