Wellness
Electronic Frailty Index predicts older patients’ risks of living with frailty

GPs can more accurately identify older people’s frailty and intervene earlier as a result of NIHR-funded research led by the University of Leeds.
Researchers have successfully improved the Electronic Frailty Index (eFI) – a tool that uses data to predict older patients’ risks of living with frailty – so medical professionals can provide holistic care, help to prevent falls, reduce burdensome medications and provide targeted exercise programmes to maximise independence.
The groundbreaking eFI was first developed by Leeds academics and introduced in 2016 across the UK.
In just one year of use by NHS England, more than 25,000 people with frailty were referred to a falls service, with an estimated prevention of around 2,300 future falls. Researchers estimate that in 2018 alone, these interventions saved the NHS nearly £7m.
The world-first eFI system also influenced similar approaches in the US, Canada, Spain and Australia.
Now, a new eFI2 system will improve the accuracy of the service by integrating data on 36 health problems including dementia, falls and fractures, weight loss and the number of regular prescriptions people have.
The research confirms that the eFI2 can more accurately predict older people’s need for home care, risk of falls, care home admission or death.
The authors hope that the eFI2, which is now available to three in five GPs in England through Optum (formerly known as EMIS) software, will help more older people stay independent for longer.
Andrew Clegg, who led the study, is NIHR Research Professor and Head of Ageing and Stroke Research at the University of Leeds School of Medicine, and Honorary Consultant Geriatrician at Bradford Royal Infirmary.
Professor Clegg said: “This landmark health data study, funded by the National Institute for Health and Care Research (NIHR), is a major step forward in transforming health and social care services for older people with frailty.
“The eFI2 is a significant improvement on the original eFI and will be extremely valuable for helping GPs identify older people living with frailty so that they can be provided with personalised treatments to prevent costly loss of independence and falls in older age.
“We are delighted that the eFI2 has already been made available to 60% of GPs and is an exemplar of the planned NHS ‘analogue to digital’ shift.”
Professor Marian Knight, Scientific Director for NIHR Infrastructure, said: “The eFI has already proven that it can improve patient outcomes and save the NHS millions of pounds.
“This evolution of the tool is extremely exciting, enabling people to receive personalised treatments from their GPs and maintain their independence for longer, bringing crucial cost savings to the health system.”
Frailty is identified when older people have a high risk of a range of adverse outcomes such as requirement for home care services, falls and admission to a hospital or care home. It is estimated that frailty costs the NHS £6bn every year.
The eFI2 algorithm is based on routine data from Connected Bradford and the Welsh Secure Anonymised Information Linkage dataset, drawing on 750,000 linked records across medical, community and social care data to assign categories of frailty to older people.
It uses 36 variables, including dementia, falls and fractures, weight loss and the number of regular prescriptions people have to predict which groups of people are more likely to be living with frailty. GPs are then encouraged to use their clinical judgement to apply a personalised approach to each patient. The accuracy of the eFI2 has significantly improved from the first model.
Kate Walters, Professor of Primary Care & Epidemiology at UCL, a GP and one of the paper authors, said: “The eFI2 has great potential as a simple tool to support GPs in identifying people living with frailty who may benefit from further support to help them stay independent.”
News
Study reveals link between cheese and dementia

A 25-year Swedish study links higher cheese intake to lower Alzheimer’s risk in people without known genetic risk, with cream also tied to lower dementia risk.
However, researchers emphasise that the results should be interpreted with caution.
The study tracked 27,670 people over 25 years.
During that time, 3,208 participants were diagnosed with dementia.
Among individuals without a known genetic risk for Alzheimer’s disease, those who consumed more than 50 grams of full-fat cheese per day showed a 13 to 17 per cent lower risk of developing Alzheimer’s.
This association did not appear in participants who carried genetic risk factors for the disease.
People who consumed more than 20 grams of full-fat cream per day also showed a lower risk of dementia overall, ranging from 16 to 24 per cent.
No meaningful links were found for low-fat or high-fat milk, fermented or non-fermented milk, or low-fat cream.
The results stand out because public health guidance has long encouraged people to choose low-fat dairy to protect heart health.
This connection matters because cardiovascular disease (conditions affecting the heart and blood vessels) and dementia share many underlying risk factors, including high blood pressure, diabetes and obesity.
When evidence from previous studies is combined, analyses suggest that cheese consumption may also be linked to a lower risk of heart disease, and that full-fat dairy does not necessarily increase cardiovascular risk.
Several other studies have explored whether similar patterns apply to brain health, but the results are mixed.
Evidence overall suggests that studies conducted in Asian populations are more likely to report benefits of dairy consumption for cognitive health (the ability to think, remember and reason), while many European studies do not.
One possible explanation is that average dairy intake tends to be much lower in Asian countries, meaning modest consumption may have different effects than higher intakes.
For example, one Japanese study reported a reduced dementia risk among people who ate cheese, but overall consumption levels were very low and the research was sponsored by a cheese producer.
In contrast, another Japanese study funded by government grants found no protective effect of cheese.
Some long-term European studies have also reported benefits.
In a Finnish study of 2,497 middle-aged men followed for 22 years, cheese was the only food associated with a lower dementia risk, reduced by 28 per cent.
Other dietary factors also appear to matter.
Higher consumption of milk and processed red meat was associated with worse performance on cognitive tests, while fish intake was linked to better results.
A large study in the UK that followed nearly 250,000 people found lower dementia risk among those who ate fish two to four times a week, fruit daily and cheese once a week.
However, these studies have important limitations.
What people eat is usually self-reported, and changes in memory can affect both eating habits and how accurately people remember what they have eaten. To deal with this, the Swedish researchers took two extra steps.
First, they excluded anyone who already had dementia when the study began.
Then they repeated the same calculations after removing people who went on to develop dementia within the first ten years of the study.
This did not mean starting the study again or recruiting new participants. It simply meant re-checking the results using a smaller group of people who remained dementia-free for longer.
The reason for doing this is that the early stages of dementia can subtly change behaviour long before diagnosis.
People may eat differently, lose appetite or struggle to recall their usual diet. By focusing on participants who stayed cognitively healthy for many years, the researchers reduced the chance that these early changes were influencing the results.
Another important question is whether substitution played a role.
Some of the apparent benefits may reflect replacing red or processed meat with cheese or cream, rather than an effect of dairy itself.
Supporting this idea, the Swedish study found no association between full-fat dairy and dementia risk among participants whose diets remained stable over five years.
Most importantly, foods should not be considered in isolation.
Dietary patterns matter more than individual ingredients. Diets such as the Mediterranean diet, which is consistently associated with lower risks of both dementia and heart disease, include cheese alongside vegetables, fish, whole grains and fruit.
In the Swedish study, people who consumed more full-fat cheese and cream were also more educated, less likely to be overweight and had lower rates of conditions linked to dementia, including heart disease, stroke, high blood pressure and diabetes.
All of these factors independently reduce dementia risk.
This suggests that higher cheese intake tended to occur within healthier overall lifestyles, rather than alongside excess calorie consumption or poor metabolic health.
Overall, the evidence does not support the idea that full-fat dairy causes dementia, nor that fermented milk products reliably protect against it.
Full-fat cheese contains several nutrients relevant to brain health, including fat-soluble vitamins A, D and K2, as well as vitamin B12, folate, iodine, zinc and selenium.
These nutrients play roles in neurological function and may help support cognitive health.
That said, the data do not justify eating large amounts of cheese or cream as protective foods against dementia or heart disease.
The most consistent message remains that balanced diets, moderation and overall lifestyle matter far more than any single item on the cheese board.
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ATW’s research round-up: new Alzheimer trigger identified, UK university targets longevity. fibre not protein?…and more

A UK university will become one of the first in the country to make improving the health and well-being of the elderly one of its six ‘mission-led’ research priorities.
Bournemouth University’s choice to focus on pensioners is partly the result of the Labour Government’s wish for universities to specialise, whilst also reflecting the area’s demographics – the south-coast city has one of the one of the oldest populations in the world.
“Our demographics are much older than other places – about 10 years older on average compared to the rest of the UK,” explained Tom Wainwright, professor of orthopaedics at Bournemouth.
Vary your exercise
The university’s Orthopaedic Research Institute is already heavily involved in work with the surrounding area and its recently published study, in The Lancet, showed that over-65s with osteoarthritis who undertook group-based cycle classes enjoyed much better outcomes than those receiving one-to-one physiotherapy.
Research published in leading British doctors’ publication the BMJ Journal, which tracked 100,000 people over the last 30 years, has shown that mixed exercise routines can have a significant impact on overall health and longevity.
The study tracked the cohorts exercise habits over three decades and found that participants who engaged in the highest variety of exercises had a 19% lower risk of death, compared to those who engaged in the lowest variety.
Benefits were even bigger when looking at specific causes like heart disease, cancer, and respiratory illness, with risk reductions ranging from 13 to 41 percent.
“People naturally choose different activities over time based on their preferences and health conditions,” says Yang Hu, corresponding author and research scientist in the Harvard TH Chan Department of Nutrition.
“When deciding how to exercise, keep in mind that there may be extra health benefits to engaging in multiple types of physical activity, rather than relying on a single type alone.”
US researchers have identified over five dozen new potential blood-based metabolites which could predict a Type 2 diabetes risk, years in advance.
Key Alzheimer trigger identified
Scientists at Mass General Brigham and Albert Einstein College of Medicine, followed 23,634 participants for up to 26 years and over that time analysed 469 metabolites in blood samples, alongside additional genetic, diet and lifestyle data.
In doing so they identified 235 metabolites associated with higher or lower diabetes risk, including 67 new molecules previously unreported.
The researchers say their work supports a shift toward precision prevention strategies which are more reliable than current indicators such as BMI or family history.
Further research into the Alzheimer’s predicting APOE (apolipoprotein E) gene has left UK researchers with renewed conviction of their ability to develop preventive measures, earlier in life.
Researchers at University College London analysed nearly 470,000 people across four major studies, focusing on participants aged 60 and older with confirmed Alzheimer’s diagnoses and genetic data.
Whilst previous studies had identified the ε4 allele of APOE as the one most predictive of Alzheimer’s development the UCL researchers also highlighted how allele ε3 may also carry a significant risk
Dr Dylan Williams, the study’s lead author, explained that the APOE gene’s contribution to the prevalence of Alzheimer’s has been significantly underestimated for a long time, and that the ε3 allele has historically been misunderstood as having a neutral effect on risk.
He said: “Intervening on the APOE gene, or the molecular pathway between the gene and Alzheimer’s, could have huge potential for preventing or treating a large majority of cases.”
Fibre first
Researchers say that fibre – found in beans, lentils, chia seeds, oats, bran, and certain fruits – is emerging as the ‘new hero’ of nutrition science.
Longevity expert Dr Vassily Eliopoulos, MD, who trained at Cornell, highlights how protein has ruled diet trends for years, but says fibre is now stepping into the spotlight.
“Everyone’s chasing protein, but the next big longevity macro is fibre. And fibre might be the most under-appreciated longevity nutrient that you’re missing daily.”
Explaining why fibre plays such a crucial role, he highlights the connection between gut health and overall well-being.
“Here’s the secret, your gut microbes eat what you don’t digest. These microbes convert fibre into powerful compounds that protect the body. They turn fibre into short-chain fatty acids, which act as your body’s natural anti-inflammatory molecules,”
Dr Eliopoulos highlights how chronic inflammation is closely linked to ageing and disease and he recommends aiming for 30 to 40 grams of fibre a day.
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