Geriatric Medicine Updates

[Comment] Preparing for a dementia prevention era in the world we actually live in https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00060-7/fulltext?rss=yes Emma Nichols and colleagues published an ambitious multinational map of modifiable dementia risk factors in The Lancet Healthy Longevity,1 based on harmonised data from more than 214 000 adults aged 50 years and older across 14 regions, spanning high-income countries and low-income and middle-income countries. By moving beyond single-country estimates of population attributable fractions to a detailed description of the prevalence and co-occurrence of 12 modifiable risk factors identified in the recent Lancet Commission framework2 (low education, hearing loss, high LDL cholesterol, depression, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use, social isolation, and vision loss), the authors provide a pragmatic foundation for dementia prevention strategies that is globally informed yet locally realistic, aligned with the growing view of dementia prevention as a major public health platform.

[Articles] Differences in the prevalence and patterns of dementia risk factors across 14 countries and regions: a harmonised cross-national analysis https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00051-6/fulltext?rss=yes Differences in the prevalence and patterns of dementia risk factors highlight the need to tailor prevention strategies to specific contexts. However, findings also reveal consistent patterns in risk factor co-occurrence and clustering, which could guide the design of multidomain interventions and policy approaches to reduce dementia risk across settings. Overall, these findings support the use of both context-specific and shared approaches to reduce the burden of dementia.

[Editorial] Optimising health care for adults with Down syndrome https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00071-1/fulltext?rss=yes People with Down syndrome are living longer. In 2010, mean life expectancy for people with Down syndrome in the USA was 58 years, compared to just 26 years in 1950. These gains are due, in part, to health-care advances for conditions, such as congenital heart disease and respiratory infections, that disproportionally affect children with Down syndrome. However, while life expectancy has improved, many other aspects of health-care systems have not responded well to a growing number of individuals living—and ageing—with Down syndrome.

[Review] Population-level interventions for dementia prevention: a systematic review https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00053-X/fulltext?rss=yes Nearly half of dementia cases are potentially preventable through modifiable risk factors, yet few population-level interventions have been evaluated. This systematic review identified 12 studies from eight countries (Australia, Belgium, Chile, China, Denmark, the Netherlands, Puerto Rico, and the USA; sample size: 51–8360) evaluating population-level interventions focused on communicating dementia-specific risk reduction and prevention messaging. Intervention effectiveness varied. Mass media campaigns achieved broad reach but only marginal knowledge gains.

[Correspondence] Delirium: the missing link between severe infection and subsequent dementia? https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00057-7/fulltext?rss=yes We read with interest the Article by Pyry N Sipilä and colleagues,1 published in The Lancet Healthy Longevity. The findings are important and convincingly show that severe infections are associated with later dementia risk even after accounting for frailty status and comorbidity burden.

[Correspondence] Delirium: the missing link between severe infection and subsequent dementia? https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00058-9/fulltext?rss=yes We agree with Rose S Penfold and colleagues that delirium may have a role in the association between severe (hospital-treated) infections and an increased risk of subsequent dementia; however, whether delirium is a cause of later cognitive impairment, an accelerator of pre-existing neurodegenerative processes, or merely a symptom of evolving dementia and a marker of other insults and underlying vulnerabilities remains unclear.1 In a recent study by Penfold and colleagues, delirium was strongly associated with the risk of dementia, but most cases of dementia were diagnosed within a year from the diagnosis of delirium.

[Personal View] Conversion cascades for sensory and oral capability in primary care and community settings https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00048-6/fulltext?rss=yes Healthy ageing programmes increasingly incorporate functional checks and intrinsic capacity pathways in primary care and community settings. Yet, programme success is still often judged by the number of people screened, a metric that captures reach but not whether older adults receive usable follow-up, remain engaged, or achieve meaningful benefit. In this Personal View, we propose a conversion cascade as a staged framework for assessing whether people with eligible need progress from case finding to assessment, actionable planning, linkage to recommended intervention, sustained use or participation in the intervention, and patient-valued functional gain.

[Articles] Associations of testosterone, sex hormone-binding globulin, and related hormones with risks of cancer death, incident cancer, and incident prostate cancer in men: individual participant data meta-analyses https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00041-3/fulltext?rss=yes Lower total testosterone or dihydrotestosterone concentrations in men were associated with a higher risk of cancer death, and mid-range SHBG or luteinising hormone concentrations were associated with a lower risk. Men with lower SHBG or luteinising hormone concentrations had an associated higher risk of incident prostate cancer. Sex hormones could serve as biomarkers for cancer risk, warranting further investigation of these observed associations.

[Personal View] What is meant when we say we are clustering multimorbidity? https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00040-1/fulltext?rss=yes Clustering multimorbidity has been a global research priority of late. Existing studies usually identify these clusters using one of several popular clustering methods such as latent class analysis or hierarchical clustering and then explore various characteristics of these clusters (eg, their genetic underpinning or their sociodemographic drivers) as downstream analysis. These studies make several choices during clustering that are often not explicitly acknowledged in the literature, for example, whether they are clustering conditions or clustering individuals, and thus, lead to different clustering solutions.

[Review] Effectiveness of infection prevention and control interventions in reducing health-care-associated infections in long-term care facilities for older people: a systematic review https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00043-7/fulltext?rss=yes Existing infection prevention and control measures focus primarily on acute health-care settings; however, residents and staff in long-term care facilities are also at risk of acquiring health-care-associated infections. In this Review, we systematically evaluated the evidence on the effectiveness of infection prevention and control interventions for preventing health-care-associated infections and antimicrobial resistance in long-term care facilities for older people to inform WHO’s global guidelines.

[Corrections] Correction to Lancet Healthy Longev 2026; 7: 100837 https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00055-3/fulltext?rss=yes Joundi RA, Rangarajan S, Bangdiwala S, et al. Life-course trajectories and modifiable risk factors for incident walking limitation and mortality in 25 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet Healthy Longev 2026; 7: 100837—The appendix of this Article has been corrected as of June 5, 2026.

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[Articles] Pain and frailty progression in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort study https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00035-8/fulltext?rss=yes Pain that interferes with daily functioning is associated with frailty and frailty progression in survivors of childhood cancer, underscoring the need for interventions targeting pain and lifestyle factors to mitigate frailty risk and improve long-term health outcomes.

[Editorial] Prioritising cancer survivorship care https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00049-8/fulltext?rss=yes Cancer survivors are a growing population, driven by both increased incidence and improvements in survival rates. Estimates from the International Agency for Research on Cancer revealed global projections of more than 35 million new cancer cases by 2050, representing a 77% increase from the approximately 20 million cases in 2022. Though largely attributable to population ageing, given the higher prevalence of cancer in older people, the rise in incidence is also linked to increasing exposure to risk factors, including obesity and air pollution.

[Review] Stroke in older adults: exploring the intersections of comorbidity, disability, and frailty https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00037-1/fulltext?rss=yes Although the epidemiology of cerebrovascular disease is changing, stroke remains predominantly a disease of older adults. Clinicians, researchers, and policy makers should, therefore, be familiar with the key contextual factors of older age and how these factors might affect stroke care. Arguably, the three overarching manifestations of complexity in ageing are: comorbidity, disability, and frailty. These conditions are all common in stroke and, alone or in combination, have important consequences for stroke care and outcomes.

[Articles] Accelerated deficit accumulation in frailty and associations with adverse outcomes: a longitudinal population data analysis https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00032-2/fulltext?rss=yes In some individuals, accrual of frailty deficits includes episodes of accelerated accumulation, linked to specific deficits and signalling heightened vulnerability. Both the timing and rate of accumulation—not just the cumulative burden—might shape future health risks.

[Comment] Air pollution, population ageing, and dementia burden in China https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00028-0/fulltext?rss=yes Air pollution has recently been recognised as a major modifiable risk factor for dementia, with growing evidence linking long-term exposure to fine particulate matter (PM2.5) to cognitive decline and increased dementia incidence.1 Most research to date, however, has focused on establishing the exposure–response relationship rather than quantifying the attributable health burden of PM2.5 over time.2 Moreover, despite the strong age dependence of dementia, few studies have examined how demographic transitions—particularly rapid population ageing—interact with PM2.5 exposure to influence dementia burden.

[Articles] Physical activity and biological age measured by DNA methylation clocks: a systematic review and meta-analysis https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00019-X/fulltext?rss=yes Higher physical activity is significantly associated with lower biological age as measured by Horvath EAA and GrimAge EAA. However, evidence is predominantly from cross-sectional studies, limiting causal inference. Future longitudinal studies and clinical trials using standardised, objectively measured physical activity are warranted to clarify dose–response relationships, and to determine whether physical activity can causally modify ageing trajectories, thereby informing precision strategies for healthy longevity.

[Comment] Physical activity and biological ageing: the need for stronger causal evidence https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00029-2/fulltext?rss=yes DNA methylation (DNAm) is a widely studied epigenetic mechanism that regulates gene expression without altering the underlying DNA sequence itself. DNAm patterns are influenced by both genetic and environmental factors; DNAm-based measures to assess biological ageing, which are often referred to as epigenetic clocks, have been developed in the last two decades. The first-generation clocks, such as Horvath’s clock,1 are trained to predict chronological age using genome-wide DNAm levels, whereas second-generation clocks, such as DNAm GrimAge,2 use information on mortality and clinical biomarkers to better capture age-related health.