Geriatrics & Palliative Care Clinical Practice Updates
We summarize recent practice-changing research in geriatrics and palliative care from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application.
The cluster-randomized MedSafer trial showed that electronic decision support during hospitalization safely increased deprescribing of potentially inappropriate medications, although it did not significantly reduce 30-day adverse drug events versus usual care.
A cluster-randomized trial of a Goals-of-Care decision aid for nursing home residents with advanced dementia improved end-of-life communication and palliative care plans and was associated with fewer hospital transfers.
Statistical Robustness
Cluster RCT (n=302) with prespecified outcomes; effect on hospital transfers observed alongside communication gains.
Strengths
Caregiver-centered; scalable tools; improves documentation of preferences.
Pitfalls
Implementation resources vary; benefits depend on clinician engagement.
Clinical Implication
Trigger early palliative consultation and structured GOC discussions during hospitalization or SNF transition.
Practical Example
For an 85-year-old with advanced dementia admitted for aspiration pneumonia, initiate GOC discussion, consider hospice eligibility, and document POST/MOST orders.
Reference: Hanson LC, et al. Goals-of-Care intervention for advanced dementia: randomized clinical trial. JAMA Intern Med. 2017;177:24-31.
The Clinical Frailty Scale (CFS) predicts short-term mortality and adverse outcomes in emergency and inpatient settings and can augment triage risk scores when assessed reliably.
Statistical Robustness
Multiple prospective cohorts and meta-analyses; validation for 30-day mortality prediction in ED patients; consistent findings across settings.
Subjective elements require rater training; avoid using as sole basis for limiting care.
Clinical Implication
Incorporate CFS into admission assessments to guide mobility, discharge planning, and goals-of-care conversations.
Practical Example
ED patient aged 79 with CHF: CFS 6 (moderately frail) → early PT/OT, delirium prevention bundle, discuss realistic discharge goals.
Reference: Kaeppeli T, et al. Validation of CFS for 30-day mortality prediction in the ED. Ann Emerg Med. 2020;76:291-300. Related cohort: Javadzadeh D, et al. BMC Geriatr. 2024.
The PAL-HF randomized trial demonstrated that a multidisciplinary palliative care intervention improved heart-failure–related quality of life, anxiety/depression, and spiritual well-being compared with usual care.
Statistical Robustness
Single-center RCT (n=150) with validated patient-reported outcomes; not powered for mortality/ICU utilization endpoints.
Strengths
Structured ACP integrated with specialty palliative care; reproducible care model.
Pitfalls
Resource intensity; generalizability across systems requires adaptation.
Clinical Implication
Embed ACP and symptom management early for advanced HF admissions; align inpatient plans with outpatient follow-up.
Practical Example
For a 70-year-old with recurrent HF admissions, initiate palliative consult to address dyspnea/fatigue and document preferences before discharge.
Reference: Rogers JG, et al. Palliative care in heart failure (PAL-HF) randomized clinical trial. JACC: Heart Fail. 2017;5:318-326.
Recent randomized trials show that 12-week resistance-focused, home-based or hybrid exercise programs improve strength and physical performance in community-dwelling older adults with sarcopenia.
Statistical Robustness
Prospective RCTs with objective strength/performance endpoints; meta-analytic synthesis supports benefit.
Strengths
Low-risk, scalable interventions; aligns with mobility-first inpatient care.
Pitfalls
Adherence and supervision needs; body composition changes may lag behind functional gains.
Clinical Implication
Prescribe simple, progressive resistance circuits at discharge with PT follow-up for sarcopenic patients.
Practical Example
For an 82-year-old with low grip strength, start a graded home program (sit-to-stands, step-ups, bands) and reassess in 4–6 weeks.
Reference: Liu M, et al. 12-week graded home-based resistance+cardio program in older adults with sarcopenia. Clin Interv Aging. 2024.
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