Fragility fractures of the hip can be occult and undetected on plain radiographs.This results in delayed or missed diagnosis and treatment and thus poorer outcomes.We describe a case of 3-day delay in hip fracture treatment in an 85-year-old woman who presented with severe right hip pain without a history of trauma.Initial plain radiographs and computed tomography did not detect a hip fracture, but subsequent magnetic resonance imaging on day 3 detected an insufficiency fracture of the femoral neck.This case highlights the importance of using magnetic resonance imaging as the first-line investigation for hip pain in patients with clinical suspicion of fracture but with normal radiographs.

Between 2020 and 2022, the coronavirus disease 2019 (COVID-19) pandemic had devastating impacts worldwide. Countries adopted various policies to curtail these impacts: ranging from full lockdown with "dynamic zero" policy in China to policy of living with the virus in Western countries. Strategies were selected based on geopolitical situations. Nonetheless, older adults universally experienced the most adverse effects, with worse functional recovery and higher case fatality rates. In Hong Kong, the overall case fatality rate among older patients (16.8%) was associated with baseline Clinical Frailty Scale (CFS) score; the highest rate was 40% among patients with a CFS score ≥7. 1 In the current issue of the Asian Journal of Gerontology and Geriatrics, Chen et al 2 shared their experience from Singapore. They found that patients with greater frailty or more functional limitations had higher mortality rates, worse functional recovery, and longer hospital stays. They suggested that risk factors for longer length of stay should be identified to guide medical decisions and optimise healthcare resource utilisation. However, resources should not be the primary determinant of clinical management decisions, and ageism should be avoided. Optimal clinical care and management should consider biological status or frailty status. For robust individuals with adequate functional recovery, the goal of intervention should be restorative to achieve good health-related quality of life. For individuals near the end of life, the goal of intervention may be to achieve good quality of dying through an end-of-life care programme, 3 which is cost-effective without shortening the median survival. Nonetheless, the challenge is to identify older adults who are near the end of life and would benefit from optimised quality of dying (rather than restorative intervention). Mo et al 4 suggested possible solutions for this challenge. The use of Hospital Admission Risk Reduction Program for the Elderly score and/or CFS score can help guide management, not for medical resource allocation, but for optimising care towards restoration/maintenance of health-related quality of life or towards quality of dying. Although the impact of COVID-19 has diminished, its resurgence or the emergence of new infectious diseases will inevitably occur. It is time to plan ahead and initiate studies that can guide future clinical practice.

Older patients are vulnerable to complications from hospitalisation, particularly during the COVID-19 pandemic.We report four cases of complications (psychological distress, deconditioning and pressure injuries, delirium, and poor feeding) that occurred during the stay in the community treatment facility.These complications are common and tend to be overlooked during the pandemic because of the isolation policy with decreased contact between healthcare workers and patients, increased patient load, and shortage of healthcare manpower.The usual preventive measure should be implemented despite the difficulties during the pandemic.Early mobilisation with decreased bedrest and early discharge arrangement should be considered once medical condition stabilised and isolation period completed.

Objective.To evaluate the effect of mental practice (MP), mirror therapy (MT), and MP+MT on upper extremity function and activities of daily living performance in patients with stroke.Methods: A total of 25 participants were randomly assigned to receive MP (n=8), MT (n=8), or MP+MT (n=9).Outcomes were assessed before, during, and after intervention using the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT) for upper extremity function as well as the Korean version of the modified Barthel Index (K-MBI) and the Motor Activity Log (MAL) for activities of daily living performance.Results: After intervention, MP, MT, and MP+MT groups had significant improvement in scores of FMA, ARAT, MBI, MAL (all p<0.05).The improvement in scores of FMA, ARAT, MBI, MAL did not differ significantly among the three groups.Nonetheless, the improvement in scores was largest in the MP+MT group. Conclusion:MP, MT, and MP+MT can improve upper extremity function and activities of daily living performance in patients with stroke.The improvement is largest after MP+MT.

Objective.To determine the association between depression and quality of sleep in older people in Qazvin, Iran.Methods.Older people aged 60 years who were referred to urban health centres in Qazvin, Iran between 2018 and 2019 were randomly selected via multistage cluster sampling.Inclusion criteria were ability to communicate and no history of cognitive, psychiatric, or neurological disorders (according to medical records).Depression and sleep quality of participants were assessed by two trained nurses.Depression was assessed using the validated Iranian version of the 15-item Geriatric Depression Scale (GDS-15).Sleep quality and its problems over a 1-month period was measured using the self-report Pittsburgh Sleep Quality Index (PSQI).A cut-off score of >5 is considered poor sleep quality.Results.194 men and 206 women aged 60 to 87 years were recruited.The mean GDS score was 7.04; 255 (63.8%) had no depression and 145 (36.3%) had depression.The two groups differed significantly in terms of education (p=0.021),chronic disease (p=0.015), and economic status (p=0.026).80% of participants had poor sleep quality (PSQI score of >5).The mean PSQI score was higher in those with depression than in those without depression (7.82 vs 6.71, P<0.001).Participants with depression also had higher subscores in sleep latency (p=0.021),sleep disturbances (p=0.047),use of sleeping medication (p=0.011), and daytime dysfunction (p=0.003).In the logistic regression analysis, poor sleep quality (PSQI score of >5) was associated with 2.55-fold increased risk of depression after adjusting for age, sex, disease, and economic status.Discussion.The prevalence of poor sleep quality and depression in Iranian older people is high.Poor sleep quality is associated with depression in older people.Interventions should be provided to improve sleep quality of older people.Measures to attract social participation, promote health status, and provide consulting services for older people are warranted.

In Hong Kong, the fifth wave of the COVID-19 pandemic has resulted in >9000 deaths, of which >87% involved older adults aged 70 years, and more than half of these older adults were living in residential care homes for the elderly. 1 Frailty is a major risk factor for the high mortality in older adults. In this issue, Miu 2 reports that 70% of community-dwelling older adults are frail or prefrail and that pain management may help to prevent progression of frailty.

Background.Frailty is a multidimensional syndrome.Sarcopenia plays an essential role in the early diagnosis and prevention of frailty syndrome.Therefore, we examined the association of frailty syndrome with sarcopenia among community-dwelling rural older adults in West Bengal.Methods: This cross-sectional survey was conducted between October 2018 and January 2020 in 510 (230 men and 280 women) older adults aged ≥60 years who had lived for >10 years in the selected villages of Pancharul Gram Panchayat, Udaynarayanpur Block of Howrah District, West Bengal, India.Participants were assessed for frailty syndrome and sarcopenia as well as cognitive impairment, social support, history of fall, and nutritional status by a single investigator.Frailty syndrome was assessed using the modified Physical Frailty Phenotype Scale.Frailty is defined as a display of ≥3 of five physiological deficits: low weight, low gait speed, reduced muscle strength, exhaustion, and low physical activity.Sarcopenia was assessed using the Asian Working Group on Sarcopenia 2014 consensus by measuring dominant hand grip strength, gait speed, and skeletal muscle mass index.Results: Of the 510 participants, 44 (8.6%) were both frail and sarcopenic, 88 (17.3%) were frail only, 16 (3.1%)were sarcopenic only, and 362 (71.0%) were non-frail and non-sarcopenic.The prevalence of frailty syndrome was 25.9%, whereas the prevalence of sarcopenia was 11.8%.Compared with non-frail participants, frail participants were six times (adjusted OR=6.42, p<0.01) more likely to be sarcopenic after adjusting for age, marital status, educational level, occupational work, cognitive impairment, social support, history of fall, and nutritional status.

Frailty and sarcopenia are important syndromes in older people and are associated with poor outcomes.Assessment and prevention of frailty and sarcopenia are of particular importance during the COVID-19 pandemic.Since 2020, the pandemic has been a new risk factor for frailty and sarcopenia.Strict lockdown measures to protect frail older adults may worsen the frailty and sarcopenia and lead to social isolation, depression, malnutrition, and reduced access to care. 1 In the present issue, Das et al 2 investigate the association between frailty and sarcopenia in West Benga, India.Frail participants are six times more likely to be sarcopenic than non-frail people.Further study on Asian populations is warranted to determine the best management strategies.

Introduction. Depression is the most common mental disorder. Older adults are more vulnerable to depression and are usually underdiagnosed and untreated. This study aims to determine the prevalence of depression among older adults in Bali and identify its risk factors.

Taking multiple medications for the treatment of chronic diseases may lead to medication-related problems or adverse effects. Physiological changes with age affect drug absorption and clearance and hence have implications on drug doses. Hospitalised older people are at risk of prescribing errors. Medication reconciliation should be performed at all interfaces of care, including admission, transfer, and discharge. Polypharmacy and inappropriate medications are also common in older people, for whom deprescribing should be initiated, taking into account their life expectancy and applying a holistic approach to achieve individualised care.