Background: Frailty is associated with mortality in the elderly. We aimed to determine the appropriate time and frailty index (FI) threshold for frailty intervention in Chinese community-dwelling older adults.
Methods: In this prospective cohort study, we used data from the 2011 wave of the Chinese Longitudinal Healthy Longevity Study. Follow-up was performed for 7 years from baseline. Using the FI to evaluate frailty and define frailty status, we explored the best time point and FI score for frailty intervention, by comparing the relationships of FI and frailty status with mortality.
Results: From 2011 to 2018, 8642 participants were included and followed up. A total of 4458 participants died during the study period. After adjusting for variables such as age, sex, marital status, education level, and living conditions, the hazard ratio (HR) of mortality risk based on the FI at baseline was 37.484 (95% confidence interval [CI]: 30.217-46.498; P<0.001); female sex, living in the city, being married, and living with spouse were found to be protective factors, whereas ageing was a risk factor of frailty. The mortality risk was higher in pre-frail than in frail participants (HR: 3.588, 95% CI: 3.212-4.009, P<0.001). Piecewise linear regression analysis revealed an FI score threshold of 0.5. When the FI score was >0.5, the HR of mortality based on the FI was 15.758 (95% CI: 3.656-67.924; P<0.001); when the FI score was ≤0.5, the HR of mortality based on the FI was 48.944 (95% CI: 36.162-66.244; P<0.001).
Conclusion: The FI is a stronger predictor for mortality than the frailty status. The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients, and an FI score of 0.5 was found to be the threshold for mortality prediction using the FI.

1.The mortality risk was higher in pre-frail than in frail older adults.
2.The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients.
3.The FI score of 0.5 was found to be the threshold for mortality prediction using the FI.

Objective.
As sociodemographic shifts have occurred over the past few decades and affected the health care system in many nations, Indonesia has gradually become an aging society. A new challenge has been an increased hospital readmission rate and prolonged hospitalization in elderly patients due to chronic illness. Improved long-term management requires a comprehensive plan to guarantee coordination and continuity of care following hospital discharge.

Methods.
For this review, literature was searched using the keywords transitional care, geriatric, and chronic disease in the electronic databases PubMed, ScienceDirect, and Cochrane. RCT, systematic review, or meta-analysis studies that implemented transitional care intervention (TCis) for people over 60 with chronic diseases met the inclusion criteria. Studies were limited to those published in the last ten years and in Bahasa/English. The PRISMA guidelines were used to evaluate critical appraisal.

Results.
We found 107 records. The inclusion criteria were met by seven articles. From one to twelve months after discharge, outcome assessments were performed. TCis were divided into three categories: before discharge, at home after discharge, and throughout the entire period. Most studies (n=7) measured readmission, mortality (n=4), and emergency department visits (n=3). The majority of the studies found that intervention groups (IG) outperformed control groups (CG).

Conclusion.
Transitional care benefits geriatrics with chronic diseases by lowering hospital readmission rates, mortality rates, and emergency department visits. To provide effective transitional care, five domains must be addressed: comprehensive assessment, planning and communication, self-care and caregiver support, access facilitation, and a competent healthcare team.

1. Transitional care is beneficial for geriatrics with chronic disease
2. Transitional care reduces hospital readmission rates, mortality, and emergency department visit.
3. Comprehensive assessment, planning and communication, support for self-care and the caregiver, access facilitation, and a competent healthcare team are the key's factor

Background: Falls in the elderly are an increasingly common public health issue due to the aging population with devastating consequences of injury, disability and mortality. Dwelling adjustment and continuous home care is proposed to help reduce the incidence of falls and improve the quality of life in elderlies and their family members.
Rationale: to compare the incidence of falls in elderlies with and without the support of home visit and dwelling adjustment.
Methods: a prospective randomized controlled interventional study consisting of patients above 70 years of age living in Surin province between 1st of January and 30th of June 2022.
Measurements and outcomes: 40 patients from each district were chosen by random sampling and were assessed for baseline fall risk scores. These patients were then centrally randomized to receive 2 home visits with a dwelling adjustment-based protocol with follow up monitoring of falls within 6 months.
Results: Six-hundred and thirty-eight patients were studied, with an average age of 79 years. Of which, the 319 patients that received dwelling-adjustment home visits had a lower incidence of falls (P<0.001). The number of patients needed to treat was 8 to prevent a fall in 1 patient. (95%= CI 6-12 patients).
Conclusions: Physicians should consider providing dwelling adjustment-based home visits for patients above the age of 70 to significantly reduce the risk of falls.
Keywords: Home Visit, Dwelling Adjustment, Fall, Elderly, Home Environment

1.adjustment-based home visits
2.home environment for elderly
3.how to reduce the risk of fall

Introduction
Grip strength and walking speed influence the physical performance in elderly. The risk of obesity for mortality is controversial. The study aims to determine the association between grip strength, walking speed and all-cause mortality elderly.

Objectives
The objective of this study was to determine the risk of all-cause mortality in different physical performance of elderly.

Methods
We included elderly above 65-year-old in 2009 and followed up until 2021 from a community cohort group. The demographic data, clinical parameter, physical performance, and outcome were recorded, including age, gender, body height and weight, baseline disease, grip strength, 5-meter-walking-speed, the date of inclusion and mortality. We defined the normal grip strength(NG) as ≥ 28 kilogram in male and 18 kilogram in female, the normal walking speed(NW) as ≤1 meter per second. We defined the participants with poor grip strength (PG) and poor walking speed (PW) on the contrary. Participants with body mass index ≥ 25 kg/m² was defined obese (O) and non-obese (NO) on the contrary. Continuous and categorical variables were analyzed with student t-test, logistic regression and chi-square test respectively. Cox regression was used for survival analysis, adjusting for age, sex, physical activity and baseline disease.

Results
Among 1029 participants, mean age was 73.4-year-old and male is predominant (52.1%). The percentages in non-obese and obese groups were 60.3% and 39.7%. The all-cause mortality in PG and NG groups were 60.3% and 29.8% (p<0.005) and the all-cause mortality in PW and NW groups were 40.0% and 19.6% (p<0.005), respectively. The all-cause mortality of non-obese and obese groups were 38.3% and 34.6% (p=0.220). The hazard ratio of all-cause mortality of PG and PW groups were 1.71 (95% CI: 1.344-2.176; p<0.005) and 1.402 (95% CI: 0.956-2.055; p=0.084), respectively.

Conclusion
Poor grip strength and poor walking speed increased the risk of all-cause mortality in elderly.

1. Poor physical performance, such as weak grip strength and slow walking speed increase the risk of all-cause mortality in elderly.
2. The risk of obesity for all-cause mortality in elderly had no strong evidence currently.
3. Early physical rehabilitation should improve geriatric long term outcome in clinical practice.

Aim: The Nursing Home Support Team’s (NHST) project is a collaboration between SLH and various nursing home (NH) providers to improve care within NHs so as to achieve and maintain an average yearly reduction in the number of NH resident admissions to Acute Hospitals (AH) of at least 10% measured from a baseline to minimise unnecessary readmissions to acute hospitals (AHs) and optimise care within the NHs.

Content: Various initiatives (On-site medical coverage, Tele-medicine coverage, After-office hours telemedicine service, Speech Therapist (ST) Services, Transfer out (TO) reviews, and Training and Education) were implemented to avoid unnecessary and readmissions to the AHs. NHST has successfully reduced the admissions to AHs by an average of 17.0%.

Goals: This project highlighted the importance of customised delivery of care. The uniqueness of each NH required that NHST care delivery be tailored to suit specific needs and work cultures. Across the three partners, there were preferential care delivery approaches to the residents. NHST doctor and speech therapist administered their interventions in view of the nursing home’s practices and model of care. The project also emphasized the importance of goals of care discussions. CPs and PPCs are conversations that featured strongly in many NH interactions. However, family members and caregivers were uncomfortable and unwilling to talk about end-of-life discussions concerning the residents. In order to overcome this challenge, perspective and understanding of ageing in the long-term care setting within Singapore’s healthcare need to be changed to better support successful ageing in the long-term care setting as well as promote quality of life for individuals in their end-of-life phase. Potentially, this may attract more people to join the long-term care workforce, remove the stigma of ACP, PPC, and end-of-life, and secure a healthy understanding on ageing in Singapore.

1. Customised delivery of care to suit specific needs and work cultures
2. Goals of care discussion with residents’ family members and caregivers
3. Enhance value-added staff time: value added services were facilitated by providing nurse training to equip to make ground decisions regarding medical conditions of the residents through care pathways.