News in brief
Authors: Jack Williamson
Journal: The Lancet Healthy Longevity (2021)

Polypharmacy, the taking of multiple medications a day, is linked to an increased likelihood of severe or life-threatening side-effects as a result of drug—drug interactions, increased patient anxiety, and high financial burden in some health-care systems. It has also been criticised as being an integral aspect of what many perceive to be the over-medicalisation of some conditions, such as prediabetes, that are closely associated with increased age. However, the question of whether the harms of polypharmacy outweigh the harms of prediabetes in older adults has so far remained unanswered. In a 6-year prospective cohort analysis of 3412 adults (mean age 75·6 years, none of whom had diabetes and 1462 [59%] of whom had prediabetes [fasting blood glucose levels 100–126 mg/dL]), Mary R Rooney (Johns Hopkins Bloomberg School of Public Health, MD, USA) and colleagues showed that fewer patients in their study had progressed from prediabetes to diabetes (112 [8%] participants) than regressed to normoglycaemia (647 [44%] participants) or died (236 [16%] participants). Although the prevalence of prediabetes was high in the sample, this study provides evidence that progression from prediabetes to diabetes in older adults is uncommon. On the basis of this evidence, the authors suggest that pharmacological interventions or other aggressive approaches to prevent diabetes in older adults are unlikely to confer meaningful benefits and that lifestyle improvements (when feasible and safe) should instead be prioritised. Several lifestyle factors (eg, increased sedentarism) and biological factors (eg, poor dermal perfusion, skin frailty, and loss of skin elasticity and firmness) contribute to a greater likelihood of developing pressure injuries (PIs) in older adults. Although preventive measures are still the first line of defence against PIs, it is known that techniques to prevent PIs in patients who are hospitalised are often underused, meaning there is a great need for treatments for early stage PIs. Using several murine models of PI, Christopher T Turner (University of British Columbia, Vancouver, BC, Canada) and colleagues investigated the role of the serine protease Granzyme B (GzmB) in mice and human tissue. Their results showed that GzmB, normally involved in intracellular lymphocyte-mediated apoptosis in healthy tissue, was significantly elevated in mouse and human PI tissues. Moreover, their study indicated that extracellular GzmB is an important contributor to age-dependent impaired PI healing by increasing inflammation, vascular micro-haemorrhaging, extracellular matrix degradation, and fibrotic activity, implicating extracellular GzmB as a possible key therapeutic target for treating older adults with PIs. With no definitive biomarker diagnostic test to detect Parkinson's disease (PD) before it presents as a degenerative neurological condition, novel efforts have been directed towards identifying non-motor symptoms of PD, including the detection of seborrhoea, the overproduction of sebum that occurs in around 60% of patients with PD. Building on previous findings of a putative distinct volatiles-associated signature (VAS) of PD, Eleanor Sinclair (The University of Manchester, Manchester, UK) and colleagues used dynamic head space thermal desorption gas chromatography–mass spectrometry to measure sebum composition in swabs sampled from the upper back region of 100 patients with PD and 29 control participants. Their study showed that 84% of patients with PD were correctly classified using this novel diagnostic technique, with the authors identifying several VAS features that are significantly associated with the presence of PD, irrespective of sex, body-mass index, alcohol intake, smoking status, or age. Future studies should use these results to explore more targeted analyses of the PD-specific VOS to better inform diagnostic techniques for patients with PD. Published on Feb 26, 2021, the Final Report of the Royal Commission into Aged Care Quality and Safety assessed the quality and safety of aged care services in Australia, concluding that at least one in three older people using aged care facilities receive substandard care. The Commission, developed by Tony Pagone and Lynelle Briggs, contains 148 recommendations for change, organised around five key themes, including the extent of substandard health care (eg, shortage of staff and distressing evidence of physical and sexual abuse), the causes of systemic failures that inhibit older people from dignified ageing, and remedial actions needed. Recommendations include a new Aged Care Act that prioritises the needs of older people, fairer approaches to means testing for aged care funding, and the appointing of a Commissioner of Aboriginal and Torres Strait Islander Aged Care to deliver culturally flexible and safe care for indigenous Australians. The Royal Commissioners have recommended that the Australian Government report to Parliament by May 31, 2021, in response to their recommendations.