2026-03-04
Maria Paula B. D’Elia, Melissa K. Andrew, Henrique Pott
Background Herpes zoster (HZ) and its complications, postherpetic neuralgia (PHN), are common in adults, particularly the frail. Frailty may affect infection outcomes and vaccine efficacy. This study evaluated the association between frailty and HZ/PHN risk, and examined vaccine uptake, immunogenicity, and efficacy in frail versus non-frail individuals. Methods We systematically reviewed PubMed/MEDLINE, the Cochrane Library, Embase, and grey literature for studies published from January 2015 to January 2025. Eligible studies included observational and randomized controlled trials evaluating frailty in adults aged ≥50 years and reporting HZ incidence, severity, PHN, or vaccination. Two reviewers independently selected studies, extracted data using a standardized form, and assessed quality using JBI tools. Due to heterogeneity, data were synthesized narratively. Results Eight studies met the inclusion criteria, with a sample size exceeding 15,000 participants. Two studies identified an association between frailty and an increased incidence of HZ, while two others indicated an elevated risk of PHN among frail individuals. One study highlighted low vaccine uptake in a frail Italian cohort. Three studies assessed the immunogenicity of the zoster vaccine, suggesting that although absolute immune responses may be diminished in frail individuals, relative responses are often maintained. A pooled analysis of recombinant zoster vaccine trials demonstrated consistently high efficacy (exceeding 90%) across all frailty levels. Conclusions Frailty may increase vulnerability to HZ and PHN. Routine frailty assessment may improve vaccine uptake and prevention. Further longitudinal studies using standardized frailty measures are needed to understand the causal pathways and optimize care.
2026-03-04
Erin D Davis, Prangad Gupta, Chantelle R Zimmer, Caitlin McClurg, Jayna Holroyd-Leduc
Background As ethnically diverse populations increasingly access long-term care (LTC) and residential care facilities (RCF), mealtimes emerge as vital opportunities to preserve cultural identity, foster social connections, and support well-being. However, systemic barriers and institutional limitations often prevent culturally inclusive mealtimes, marginalizing minority populations and perpetuating inequities in mealtime delivery. This review explores the state of knowledge on cultural and ethnically diverse mealtime practices and menu options within LTC and RCF. Methods Using the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines, a comprehensive scoping review was conducted. Databases and grey literature sources were systematically screened, with data extracted and analyzed using a hybrid thematic analysis. Findings were organized by the socioecological model, exploring influences at intrapersonal, interpersonal, community, institutional, and societal levels. Results A total of 126 full-text manuscripts were reviewed and 42 were included in the final analysis. Key themes emphasized food’s role in cultural identity, and highlighted best practices in ethnic-specific facilities, which tailored menus and rituals to residents’ needs. Barriers included budget constraints, limited access to culturally specific ingredients, insufficient staff training, and standardized menus. Families often bridged these gaps, straining their resources. Promising practices included flexible meal schedules, resident-centred menu planning, staff training, and partnerships with cultural organizations. Recommendations focused on increasing funding, implementing flexible policies, and studying the long-term impacts of inclusive practices. Conclusions Culturally inclusive mealtime practices have the potential to transform LTC and RCF by promoting dignity, enhancing quality of life, and addressing systemic inequities. Ethnic-specific facilities provide effective models, but broader adoption of best practices is necessary for mainstream care settings.
2026-03-04
Shailesh Nadkarni, Samin Barakati, Neil Dattani, Sudip Saha
Emotion-focused model of care delivery creates a supportive environment for persons with dementia. There is a lack of certainty regarding one such emotion-focused model’s effectiveness (Butterfly) in an acute care environment, primarily because prior research has been confined to long-term care (LTC) facilities. Studies have demonstrated reduced neuro-psychiatric symptoms (NPS) when person-centred dementia care models are deployed for persons living with dementia (PLWD). A multi-site cross-sectional design assessed NPS in PLWD using the NPI-Q scale in hospitalized patients on a Emotion-focused unit for 7–21 days. We identified 177 PLWD (88 from an acute care for elderly unit, 89 from general medicine units). The two cohorts had 40 female and 48 male patients in the ACE unit and 35 female and 54 male patients in the general medicine unit. The average age between the two groups was 83 and 84 yrs, respectively. NPI-Q symptom severity was lower on the ACE unit in comparison to the general medicine unit. Mean improvement for motor behaviours and sleep were significant. Caregiver distress scores were significantly lower for delusions, agitation, anxiety, irritability, motor behaviour and sleep. Emotion-focused care made a statistically significant change in NPS severity and caregiver distress when compared to care provided in general medicine units.
2026-03-04
Karla J. Faig, Aidan E. Steeves, Chris A. McGibbon, Molly A. Gallibois, Alanna K. Bohnsack, Josée S. Haché, Grant A. Handrigan, Carole C. Tranchant, Andrew M. Sexton, Samantha M. Knill, Pamela G. Jarrett
Background SYNchronizing Exercises, Remedies in GaIt and Cognition @Home (SYNERGIC@Home/SYNERGIE~Chez soi) is a home-based, double-blind, randomized controlled trial. Sixty community dwelling older adults (aged 60–90 years), living in New Brunswick, Canada, who were at risk of dementia participated remotely using secure videoconferencing. Participants underwent 16 weeks (three sessions/week) of cognitive and physical interventions. This research aimed to determine the frequency, severity, and relationship of adverse events (AEs) that occurred during the physical and cognitive intervention phase of the SYNERGIC@Home study. This study addressed a critical question: Whether AEs occurring during a remote exercise and cognitive intervention for older adults at risk of dementia can be managed safely and effectively to optimize participation. Methods All AEs were recorded, including type, severity, and their relatedness to the intervention. Intervention modifications due to AEs were also recorded. Results Participant’s mean age was 69.5 years (SD=6.47), 76.7% were female, and 58.4% were living in suburban or urban communities. A total of 88 AEs affected 42 (70.0%) participants. Most AEs (71.6%) were unrelated to the intervention, and 69.3% were classified as mild, with musculoskeletal issues being the most common AE (39.8%). One unrelated serious AE was recorded. Modifications to the physical intervention were made for 31 participants, and two discontinued due to unrelated medical issues. Conclusions When delivered remotely, physical and cognitive interventions resulted in no serious related AEs and the few related, mostly mild AEs, were safely managed through modifications to the physical interventions.
2026-03-04
Sara Pishdadian, Jacky Jin
Psychosocial interventions targeting cognition improve objective cognitive test performance, strategy use, emotional well-being, and quality of life in individuals with mild cognitive impairment and early dementia. These interventions have been labeled as cognitive training, cognitive remediation, cognitive rehabilitation, cognitive stimulation, and overlap with cognitive (psycho)therapy. The inconsistent labeling of the interventions has resulted in ambiguity of what a cognitive intervention entails and limits the translation of interventions into clinical practice. To address this, we propose a new frame-work, “PICC-M”, that classifies cognitive interventions based on five active ingredients or the mechanisms resulting in clinically significant change. These ingredients are psychotherapeutic support (P), individualized patient goals (I), cognitive exercises (C), compensatory strategies (C), and metacognitive strategies (M). We examine three intervention programs to illustrate how this framework clarifies each intervention’s active ingredients and their relation to cognitive, psychological, and functional outcomes. The PICC-M framework lays the foundation for dismantling studies to isolate and test the effectiveness of specific active ingredients and ultimately support clinical delivery of evidence-based interventions for older individuals with neurocognitive deficits.