bluuebunny/crossref_metadata_2025 huggingface dataset:
Microwave angular displacement sensor with wideband matching and impedance transforming
Authors: Zhu Hong‐Xu , Cheong Pedro , Tam Kam‐Weng , Chio Chi‐Hou , Teng Cheng , Zhang Wen‐Hai , Ngai Kong
Published: July 2023

This work proposes a microwave angular displacement sensor with wideband matching based on a wideband impedance transformer. According to the design requirement of the microstrip impedance transformer (load‐to‐source impedance of 250‐to‐50 Ω, centre frequency of 2.40 GHz) with Chebyshev frequency response, the proposed angular displacement sensor is explored for the high bandwidth sensitivity of 11.18 MHz/degree.
Effect of dual gating on electrical characteristics of amorphous indium‐tin‐gallium‐zinc‐oxide TFTs
Authors: Kong Heesung , Cho Kyoungah , Kang Mingu , Kim Jaybum , Lee Sunhee , Lim Junhyung , Kim Sangsig
Published: July 2023

In this study, the effect of dual gating on the electrical characteristics of amorphous indium‐tin‐gallium‐zinc‐oxide (a‐ITGZO) thin‐film transistors (TFTs) is investigated. The composition (In:Sn:Ga:Zn = 1.4:0.2:2.0:1.0 at.) of the a‐ITGZO channel layer sputtered at 20°C is close to that (In:Sn:Ga:Zn = 1.6:0.2:2.0:1.0 at.) of the ceramic target. The electrical characteristics of a dual‐gated TFT are superior to those of top‐ and bottom‐gated TFTs. This dual‐gating effect is analyzed with vertical electric fields, electron concentrations, and potential contours in the gated channels obtained by performing technology computer‐aided design (TCAD) simulations. The relatively higher mobility and on‐current are attributed to the reduction of a vertical electric field in the channel induced by the dual gating. Moreover, the relatively steeper subthreshold swing of the dual‐gated TFT is associated with bulk accumulation formed by the dual gating.
Ultrafast response of Ge2Sb2Te5 nanoparticles: The benefits of low energy amorphization switching with the same read/write speed of bulk memories
Authors: Caretta Antonio , Casarin Barbara , Chen Bin , Kooi Bart J. , Malvestuto Marco
Published: July 2023

We investigate the ultrafast response of crystalline Ge2Sb2Te5 nanoparticles (NPs) below the phase transformation threshold fluence. The observed rapid change of the optical response and the presence of coherent optical phonons are consistent with the relaxation dynamics in bulk Ge2Sb2Te5 films and, more importantly, occur within the same ultrafast timescales. We conclude that the benefit of the lower energy consumption of memories based on Ge-Sb-Te (GST) NPs aggregates, demonstrated by Casarin et al. (2018), occurs with no disadvantage, as the read/write speed can be as fast as in bulk GSTs.
1588 INTRODUCING ‘THE CARE TOOL’: A SIMPLE TOOL TO IMPROVE GENERAL SURGERY DOCUMENTATION AND UNDERSTANDING OF KEY ASPECTS OF FRAILTY
Authors: Tilley B , Macstay D , Valetopoulou A , Gathercole G , MacDonald L , Wright H , Sengupta I , Bertfield D
Published: July 2023

Introduction

Increased frailty is associated with increased post-operative morbidity and mortality in older patients undergoing emergency laparotomy. NELA recommend documentation of frailty in surgical patients over 652. Using QI methodology, we introduced a ‘CARE tool’ for surgical doctors aiming to improve their documentation of an older person’s medical history (including CFS and delirium).

Method

A collaborative team representing geriatric medicine, anaesthetics and surgery devised the acronym CARE (Cognition, Assistance at home, Record the CFS, Exercise tolerance). The tool was tested using QI methodology over 2 PDSA cycles. Cycle one introduced the tool into electronic patient records (EPR) and presented it at the surgical faculty meeting. Cycle two introduced the tool specifically to surgical FY1 doctors during induction. The EPR surgical clerkings of patients over 65 years old admitted to general surgery were sampled weekly over seven weeks to assess CARE tool completion. Post-intervention, we surveyed the surgical doctors assessing their understanding of frailty and perceived value of the CARE tool.

Results

At baseline: 12% of confusion, 92% dementia status, 0% CFS, 30% assistance at home, 8% exercise tolerance were documented. Following PDSA cycle one, use of the CARE tool was 40%. There was an increase in the documentation of confusion (40%) and CFS (40%). Dementia status and assistance at home were documented in similar frequency pre- and post-cycle. During cycle two, CFS documentation increased to 55% but identification of confusion dropped to 25%. The survey demonstrated that frailty, CFS scoring and delirium screening were better understood by junior doctors than Consultants and registrars.

Conclusions

Our project showed mixed success in improving documentation using the CARE tool. The survey demonstrated a good understanding and knowledge of frailty in surgical FY1s. Ongoing frailty teaching is planned for the surgical department.
1575 IMPROVING THE QUALITY OF COMPREHENSIVE GERIATRIC ASSESSMENT THROUGH INCORPORATION OF SKIN ASSESSMENT
Authors: Ali L , Kaneshamoorthy M , Haddadeen M , Salotun F , Krasniqi L
Published: July 2023

Introduction

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic method of recognising physical, psychosocial, and functional abilities & limitations of an elderly person. Assessment of the skin is an essential element of the physical domain of CGA as aging skin is more susceptible to loss of skin integrity. Common conditions including pressure sores, purpura from long term anticoagulation and steroid use, and venous stasis eczema put patients at high risk for developing infections. Therefore, it is essential to be cognizant of the condition of the elderly patients’ skin. We aimed to improve frequency of skin assessments performed by doctors working on the two geriatric wards of Southend University Hospital, over 6 weeks. Our baseline data illustrated that 15.8% skin assessments were documented by doctors on both wards and 80.7% by the nurses.

Method

Three bi-weekly interventions were carried out. PDSA 1 introduced a concept of regular skin assessments, highlighting its importance in elderly population, through informal teaching at morning meeting. PDSA 2 delivered formal teaching led by tissue viability nurse and finally, PDSA 3 presented a poster to act as reminder for regular skin assessments as well as provision of contact details to escalate positive findings.

Results

PDSA 1 showed improvement from 15.8% to 31.6% in frequency of performing skin assessments. PDSA 2 showed a decrease in number of skin assessments at 11.9%, which was less than baseline. PDSA 3 also showed a decrease at less than baseline and only resulted in 8.8% assessments completed.

Conclusion

The findings showed the first intervention as most impactful indicating benefit of teaching session focused on skin assessments in elderly patients. It is suggested that a regular teaching session is carried out in every rotation with regular audits for a more sustainable outcome.
1577 IMPROVING THE MULTIDISCIPLINARY TEAM MEETING IN A COMMUNITY HOSPITAL
Authors: Paterson A , Henderson L , Mathieson W
Published: July 2023

Introduction

Whitehills Health and Community Care Centre (WHCCC) is a 31-bed community hospital. Weekly multidisciplinary team (MDT) meetings occur to co-ordinate care and discharge planning. The format prior to this quality improvement project was meetings twice per week using Microsoft Teams. Errors were noted such as incorrect discharge dates and missed referrals.

Aims

improving information transfer during MDT meetings, reducing errors in communication, reducing meeting duration and improving staff satisfaction.

Methods

Data was collected in the format of surveys distributed to members of the MDT and meeting duration. There were three PDSA cycles: Introduction of chairperson and proforma Chairperson, Proforma and screensharing on Microsoft Teams. Reduction of MDT meetings to once weekly

Results

The initial survey found that 43% (n = 3/7) of staff found meetings to be effective. One hundred percent noted that information had been missed or not acted upon (n = 7). This improved with each cycle; cycle 3 data showed that 100% felt the meetings were effective and only 14% felt information was missed (n=1/7). Given the improvements, cycle 3 trialled a once weekly meeting. Average weekly time spent in meetings fell from 213 minutes to 130 minutes (39% reduction). 100% (n=7) said they were very satisfied or somewhat satisfied with the once weekly MDT.

Conclusions

Creating a standardised structure in the form of chaired meetings and MDT proforma was found to improve effectiveness of the meeting and reduce errors. These changes resulted in a more efficient and safe weekly meeting. This led to reduction in time away from clinical areas for MDT members. These changes have been adopted and maintained by the WHCCC team.

Areas of future development may include

The impact of blended or face to face meetings and further reduction in meeting times.
1607 MULTIDISCIPLINARY STRUCTURED MEDICATION REVIEW REDUCES INAPPROPRIATE POLYPHARMACY AND ASSOCIATED COSTS IN CARE HOMES
Authors: Marchant R , Thorman E , Page E , Worth C , Allcock D , Fraser H , McCracken S , Shipway D
Published: July 2023

Background

Person-centred structured medication review (SMR) is associated with reduced polypharmacy, adverse drug reactions (ADRs), admission to hospital and mortality. Our service development aimed to explore the cost-efficacy of a multi-disciplinary team (MDT) providing SMR as part of a comprehensive geriatric assessment for care home (CH) residents.

Method

We established an MDT consisting of a consultant geriatrician, specialist clinical pharmacist, two general practitioners, clinical fellow, physician associate and frailty paramedic practitioner. Training on SMR was given by the pharmacist to other team members, with further support offered through the pilot.

Results

A total of 785 residents were reviewed across 20 CH sites during the initial 6-month pilot. Overall, polypharmacy was reduced by an average of 1.33 medicines per resident (8.32 to 6.99). The drug classes most commonly deprescribed were laxatives, antidepressants, lipid lowering drugs, opioids, and nutritional supplements. Medicines altered included three classes known to cause 40% of avoidable hospital admissions due to ADRs (1): diuretics (stopped/changed for 42 residents), antiplatelets (stopped for 34 residents) and anticoagulants (stopped/changed for 26 residents). Annual projected medication savings totalled £131,462(net), with an average saving of £169 per resident (range £63- £367). Drg classes with the largest cost impact were nutritional supplements (40% total savings), laxatives (12%), opioids (12%) and anticoagulants (11%). Carbon footprint savings from the 12 inhalers stopped during this phase totalled 1,323,098 gCO2e per annum: equivalent to 4562 car miles.

Conclusion(s)

A multi-disciplinary approach to medication review was shown to reduce inappropriate polypharmacy in care home residents. This intervention was associated with significant projected cost savings. Future work should aim to target SMR to patients with the highest rates of inappropriate polypharmacy.

Reference

1. Howard, R. L. et al. Which drugs cause preventable admissions to hospital? A systematic review. British Journal of Clinical Pharmacology 2007; vol. 63 Preprint at. https://doi.org/10.1111/j.1365-2125.2006.02698.x.
1665 RECOGNISING FRAILTY IN NON-ELECTIVE GENERAL SURGICAL PATIENTS TO OPTIMISE THEIR CARE
Authors: Godfrey-Harris M , Connor J
Published: July 2023

Introduction

In 2021, there were 38,839 adults >65 years living in Brighton and Hove (1) (13% of the local population, compared to 18% in England (2)). However, 56% of emergency laparotomy procedures in the UK (3) are in the > 65s. At the Royal Sussex County Hospital, a consultant geriatrician was appointed to lead a Frailty Liaison Service to respond to the needs of frail older patients undergoing general surgery (GS). No process was in place for the early identification of these patients, so intervention decisions were being made without GS Frailty Liaison input, potentially leading to unnecessary procedures and adverse outcomes such as deconditioning (4), which could potentially be reduced by timely clinical frailty scoring (CFS) and comprehensive geriatric assessment (5).

Objective

This quality improvement project sought to identify all appropriate frail older patients over 70 within 1 week of admission to be seen by the Frailty Liaison Team on the general surgical ward.

Method

We used the Model for Improvement and diagnostic tools (fishbone; stakeholder mapping; driver diagrams) and PDSA cycles to test the impact of junior doctor education on CFS scoring and awareness raising primarily through a newsletter; measured by the number of frailty scores given to patients pre-intervention, remeasured at 3 months after the initial data set. We captured feedback following the education sessions to assess usefulness.

Results

100% of participants felt more confident in identifying frailty in GS patients. The average number of days from admission to identification and first review decreased from 8.29 to 6.36, possibly reducing adverse outcomes. The proportion of appropriate referrals increased, releasing time to care for those who needed it most.

Conclusion

Moving forward, we plan to promote the use of a CFS column on the handover list and continue our education sessions, incorporating real patient cases as requested in feedback.

References

1. Office for National Statistics. Local authority ageing statistics, based on annual mid-year population estimates. 2020. URL: https://www.ons.gov.uk/datasets/ageing-population-estimates/editions/time-series/versions/1.

2. Voices of our ageing population: Living longer lives. Office for National Statistics. 2022. URL: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/voicesofourageingpopulation/livinglongerlives.

3. NELA Project Team. Sixth Patient Report of the National Emergency Laparotomy Audit. London, 2020.

4. Eamer G, Taheri A, Chen SS, Daviduck Q, Chambers T, Shi X, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database of Systematic Reviews. 2018 Jan 31;2018(3).
1516 CAN AN ADVANCED CLINICAL PRACTITIONER (ACP) LEAD IN THE DEVELOPMENT OF A POPS SERVICE?
Authors: Cross J , Milton J , Boukadida K , Adeyemi T , Aitken E
Published: July 2023

Introduction

Perioperative medicine for the Older Patient undergoing Surgery (POPS) is an established, evidence based medically led service across many Trusts. However, with consultant workforce constraints, the aim was to determine if an alternative ACP led model of care, with consultant geriatrician oversight, delivered the same benefits.

Method

Results

Patient data analysed (n=404) from January to August 2022. Length of Stay (LOS) reduced for patients over 65 years of age living and with frailty by 4 days (17 to 13 days). Variation in LOS reduced from 46 to 26 days. Readmission rate was 6% (26/404). Average Trust rate of 11%. Introduction of POPS improved the National Emergency Laparotomy Audit geriatric specialist input from 10% in Q1 2020/2021 to 91% of patients in Q4 2021/22. Unmeasured benefits include upskilling of nursing staff on the wards identifying frailty and discharge planning. Shared decision making influencing non-surgical treatment for patients for better outcomes. Reduction in calls to medical registrar post POPS introduction.

Conclusion

This pilot successfully demonstrated the role of ACP in service design, care coordination and timely medical review to deliver a reduction in length of stay and readmission rate.
1572 A GREEN QUALITY IMPROVEMENT PROJECT: SUSTAINABLE WASTE DISPOSAL IN A GERIATRIC ADMISSIONS UNIT
Authors: Doak Z , Brodie L , Bostock C
Published: July 2023

Introduction

Following COP26, the NHS pledged a ‘Net Zero’ health service by 2040. Incineration of clinical waste has a negative impact on the environment whilst also being extremely costly. NHS Grampian spends over £1m annually on disposal of clinical waste, whilst 20% of the waste incinerated is unsuitable for that waste stream. An excess of clean plastic packaging from visors, used when managing respiratory viruses, was a particular contributor in our unit. To improve sustainability, the aim of this quality improvement project was to reduce unnecessary disposal of plastic packaging in clinical waste streams by 80% in our Geriatric Assessment Unit.

Method

Using PDSA methodology, data was collected regarding the number and location of clinical waste bins and how many contained plastic visor packaging or any form of ‘non-clinical’ waste. Qualitative data highlighted that staff were aware of disposing waste in the wrong stream, however, struggled to find alternative waste bins located nearby. Selected orange bins were removed and black bins introduced at convenient points. Further PDSA cycles focused on staff engagement and education.

Results

Following PDSA Cycle 1, a baseline median of 57% of orange bins contained clean plastic packaging and 64% contained any form of non-clinical waste. Following staff education, clinical waste bins containing single use plastic dropped to 0%, whilst the percentage containing any form of non-clinical waste remained averaging 35%.

Conclusion

Making clinical waste bins less readily available reduces the amount of unnecessary clean plastic packaging entering clinical waste. We must counteract this through increasing access to general and recyclable waste bins to ensure waste is disposed of correctly. This may be achieved through the creation of “waste stations” in preparation areas, to facilitate readily available access to all waste streams at a single point if required.
1609 IMPROVING STREAMING OF FRAIL OLDER ADULTS FROM THE EMERGENCY DEPARTMENT TO A FRAILTY UNIT
Authors: Connolly A , Oates R
Published: July 2023

Introduction

It is well recognised that frailty is increasing amongst the population and can impact outcomes for patients when admitted to hospital. Frail older adults are more vulnerable to developing complications form continued hospital admissions. National recommendations by GIRFT indicate CFS scores ought to be documented in the Emergency Department (ED) to facilitate early recognition of frailty and stream patient to the appropriate pathway and clinician. The aim of this is to ensure the correct Clinician reviews the frailer adult in the most appropriate setting and thereby reduce risk of deterioration and patient harm. In October 2022 an electronic patient record system (EPR). Bolton NHS Trust has created a dedicated frailty unit staffed by Geriatricians for older frail adults. Therefore, a method of identifying and streaming frailer older adults is crucial to effectiveness of the unit.

Methods

PDSA cycles were implemented. A retrospective audit was performed prior to the implementation of the CFS documentation. A robust education programme was introduced to all clinical staff in the Emergency Department. Online modules were also available. A second audit as part of PDSA cycle was then performed to assess the intervention.

Results

Pre-intervention and EPR documentation tool only 11% of patients had CFS score. Following the intervention, 88% of medical staff included the CFS score in their assessment prior to a Frailty team referral and review. The frailty team have observed an increase in referrals.

Conclusions

Early recognition and documentation has enabled improved streaming and review of the correct patients to the frailty unit. This has enabled Gold Standard of Comprehensive Geriatric Assessment for frailer adults to be completed. Further PDSA cycles to the effectiveness of the unit are ongoing. Initial data indicates with correct identification and recognition of frailty; the average length of stay has reduced.
1642 HOSPITAL FRAILTY RISK SCORE (HFRS) – IDENTIFYING FRAILTY IN THE EMERGENCY DEPARTMENT (ED)
Authors: Burgess A J , Hassan A , Burberry D J , Dorsett N , Bari A , Davies E A
Published: July 2023

Aim

We proposed that the Hospital Frailty Risk Score (HFRS) could identify patients attending the Emergency Department (ED) who would benefit from our Older Persons Assessment Service (OPAS). Identifying older people at risk of adverse outcomes in hospital can allow a system to provide frailty-specific interventions throughout their stay.

Methods

OPAS (ED-based) accepts patients with frailty syndromes aged >70 years. All patients receive a contemporaneous Clinical Frailty Score (CFS) following multidisciplinary assessment. A retrospective analysis of the OPAS databank was conducted using HFRS to divide patients in High/Intermediate and Low Frailty Risk. We considered Age, CFS, Postcode with Welsh index of multiple deprivation, length of stay (LOS) and 12-month mortality.

Results

700 consecutive admissions: 400 High/Intermediate and 300 Low HFRS. High/Intermediate HFRS vs Low HFRS had similar deaths (p=0.2) but significant difference in CFS (p<0.05). HFRS was able to detect frailty in those <75 years old (p<0.01) but not at ≥76 (p=0.08). There was no association between postcode with frailty or Death. HFRS Sensitivity: 0.44, Specificity: 0.83, Positive Predictive Value: 0.66, Negative Predictive value: 0.34, Area Under Curve: 0.39.

Conclusion

The HFRS identified 57% of the retrospective OPAS cohort, with the addition of >80yrs of age, the modified score identifies >85% of service users. Of those admitted, High/Intermediate Frail had median LOS of 28.11 days vs 21.26 days for not frail, with 30-day mortality 10.12% vs 8.90%; potentially suggesting the HFRS can identify a subpopulation of high-risk frail patients. We found socio-economic status, quality of discharge summaries and coding had no relationship to the screening efficacy of HFRS. We have developed an electronic, automated Frailty Flag that operates in real-time to signpost appropriate patients who would benefit from comprehensive geriatric assessment which we have tested in clinical practice. HFRS can be used to measure frailty-specific intervention system efficiency.
1571 A QUALITY IMPROVEMENT INITIATIVE ON ‘INDWELLING URINARY CATHETERISATIONS’ IN HOSPITALISED OLDER ADULTS
Authors: Giridharan K , Bradford D , Lim S , Feroz A , Naeem O
Published: July 2023

Introduction

Indwelling urinary catheters (IUC) are well-known to cause serious adverse outcomes in older adults such as catheter associated urinary tract infections (CAUTI), direct trauma, delirium, deconditioning, falls, restrain, prolonged length of stay etc. (Lee E., Malatt C, 2011). Removal of IUCs as soon as the indication is resolved, results in better outcomes (Dawson et al, 2017). We identified high rates of inappropriate catheterisations as a regular practice or part of sepsis protocol in our hospital. This QIP was designed to compare our practice against the standards set by NICE and Royal College of Nursing.

Methods

Two PDSA cycles of 30 patients each, were completed between 2021-2022 (4 months apart), in Acute Frailty Unit and two Elderly Care wards. New IUCs in patients above 65 years were included. Data were collected on, documentation of IUCs, indications, plans for Trial without catheters (TWOC), appropriate management plans and CAUTI. Interventions post first PDSA cycle were; organised teaching to the nurses and doctors, discussing catheters at by-daily board rounds (BR), displaying flowcharts and reviewing IUCs during ward rounds.

Results

Documentation of IUCs improved significantly from 17/30 to 24/30. There was a small reduction in inappropriate indications from 16/30 to 12/30. Documentation of TWOC plans improved from 4/30 to 11/30. Collection of urine samples for CAUTI’s improved from 11 to 18. Our interventions were shown to produce positive outcomes.

Conclusion

Despite continuous education and BR discussions, there’s still room for improvement. Better understanding of catheter associated harm by frailty teams resulted in positive outcomes. Next steps prior to the 3rd PDSA cycle include educating Emergency and medical teams through wider teaching platforms and integrating changes to hospital electronic systems on appropriate documentation and TWOC plans. Our study would be applicable in similar settings nationally and globally to achieve better catheter care in older adults.

Reference

1. Lee E., Malatt C (2011) Making the Hospital Safer for Older Adult Patients: A Focus on the Indwelling Urinary Catheter 15(1): 49–52.
1513 PRE-FRACTURE MOBILITY ENHANCES PREDICTION OF POST-OPERATIVE OUTCOMES IN HIP FRACTURE SURGERY
Authors: Stubbs T A , Doherty W J , Chaplin A , Langford S , Reed M R , Sayer A A , Witham M D , Sorial A K
Published: July 2023

Introduction

Predicting outcomes after hip fracture is important for identifying high-risk patients who may benefit from additional care and rehabilitation. Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture surgery.

Methods

We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30-days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC).

Results

1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7-5.5-fold higher 30-day mortality (p≤0.001), and 1.9-3.2-fold higher likelihood of prolonged LOS (p≤0.001). Worse mobility was associated with a 2.3-3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p<0.001) and a 1.3-2.0-fold higher likelihood of complications within 30-days (p≤0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733-0.777] to NHFS+mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557-0.611] to NHFS+mobility 0.616 [0.590–0.643].

Conclusions

Incorporating mobility assessment into risk scores may improve case mix adjustment, prognostication following hip fracture, and identify high-risk groups requiring enhanced pre, peri and post-operative care at admission. This implies that Information available at admission could facilitate prognostication, discharge planning, bed management and risk aversion, as well as informing discussions between clinical teams and patients about post-operative recovery.
1524 DRUG-INDUCED POSTURAL HYPOTENSION: CLUSTER ANALYSIS OF CO-PRESCRIPTION PATTERNS IN OLDER PEOPLE IN UK PRIMARY CARE
Authors: Bhanu C , Petersen I , Orlu M , Davis D , Sofat R , Bazo-Alvarez J C , Walters K
Published: July 2023

Introduction

Over 250 medications are reported to cause postural hypotension, associated with serious adverse outcomes in older adults. Studies in the literature and guidelines suggest a harmful cumulative risk of postural hypotension with multiple medication use. However, there is limited evidence on the potential for harm in practice, particularly which drugs are co-prescribed and may increase risk of postural hypotension.

Methods

Retrospective cohort study and cluster analysis using general practice data from IQVIA Medical Research Data (IMRD) in patients aged ≥50 contributing data between 1 Jan 2018 and 31 Dec 2018. Thirteen drug groups known to be associated with postural hypotension by mechanism were analysed and clusters generated by sex and age-band.

Results

602,713 individuals aged ≥50 with 283,912 (47%) men and 318,801 (53%) women were included. The most prevalent prescriptions that might contribute to postural hypotension were angiotensin converting enzyme (ACE) inhibitors, calcium-channel blockers, beta-blockers, selective serotonin reuptake inhibitors and uroselective alpha-blockers. We identified distinct clusters of cardiovascular system (CVS) drugs in men and women at all ages. CVS plus psychoactive drug clusters were common in women at all ages, and in men aged ≤70. CVS plus uroselective alpha-blockers were identified in men aged ≥70.

Conclusion

Distinct clusters of drugs associated with postural hypotension are commonly prescribed in practice, which change over the life course in men and women. Our findings highlight potentially harmful drug combinations that may cause a cumulative risk of postural hypotension in older people. This may guide clinicians about the potential of synergistic harm and to monitor for postural hypotension if using such combinations – particularly in patients aged ≥70 or at high-risk due to comorbidity.
1452 WHAT IS THE SOCIAL NETWORK OF THE MDTEA PODCAST (MULTIDISCIPLINARY TEAM EDUCATING ABOUT AGEING)?
Authors: Gill G , Wilkinson I , Collins S , Preston J
Published: July 2023

Background

The MDTea is a free open access medical education podcast designed for all healthcare professionals caring for older adults. To date there are 120 episodes.

Introduction/Method

The MDTea Podcast has CPD survey logs on its website where listeners who access the website can record their learning and receive a CPD certificate, Listeners provide their professional roles. Listener numbers for episodes were much higher than those recorded in the CPD log, so alternative measures were sought to understand who listens to the podcast. Series 11 was released in January to July 2022 and was themed around ‘A Day in the Life’ of health professionals working with older adults in the hospital environment. The MDTea Podcast Twitter account had 6333 followers before series 11 release and has good discussion and engagement with followers, and is regularly tagged in other geriatrics care from discussion by professionals. Measuring the followership and social network of the account may be useful to understand the MDTea’s place in the social network of UK care of older adults healthcare. Therefore with each episode release the new follower numbers and if available self-identified professional roles of each were recorded and counted.

Results

Over the course of the 11th series, the MDTea Podcast twitter account gained 432 new followers, from 22 different self-defined professional groups who engaged with our social media.121 followers did not identify their title. In contrast 12 self-identified professions were recorded in our series 11 CPD log results from 30 responses.

Conclusion

This work has demonstrated the wide range of professionals that engage with FOAMed resources produced by the MDTea. Given the breadth of professionals working in elderly care roles in both primary and secondary settings, having an understanding content users can enable authors to design content that is appropriate for their audience.
1615 RECOMMENDATIONS FOR THE ASSESSMENT AND MANAGEMENT OF CO-EXISTING DEMENTIA AND HEARING LOSS WITHIN UK AUDIOLOGY SERVICES
Authors: Langdon A , Heffernan E , Somerset S , Calvert S , Broome E , Dening T , Henshaw H
Published: July 2023

Introduction

Dementia and hearing loss (HL) are becoming increasingly prevalent in society and commonly co-exist. People living with concurrent conditions have complex needs and face additional barriers to diagnosis and management. There is a paucity of research regarding the current and optimal management of HL in people living with dementia. This research aimed to: (1) examine the current clinical provision for people living with HL and dementia within UK audiology services, and (2) explore recommendations for the management of co-existing HL and dementia from professionals and people living with these conditions.

Methods

This was an online, qualitative study with three stages: (1) open-ended survey of 37 audiologists, (2) semi-structured interviews with 13 audiologists, and (3) semi-structured workshops with seven people with lived experience of HL and/or dementia.

Results

Audiologists used various adapted and additional hearing assessments for people with dementia. Audiological interventions for people with dementia included adapted hearing aids, alternative interventions/devices, and involvement of other services/professions. Approaches to ongoing audiological care for people with dementia included providing frequent follow-ups and face-to-face, rather than remote, follow-ups. Overarching approaches to audiological care for this population involved patient-centredness, specialist training, increased carer involvement, and adjusted appointment duration. However, there are no standard procedures/guidelines relating to dementia in UK audiology services. Recommendations included enhanced training in dementia and HL across health and social care, improved multidisciplinary collaboration, appropriate carer involvement, and greater personalised care.

Conclusions

Currently, there is no standard practice for assessing and managing HL in people with dementia in UK audiology services. Although this study identified several beneficial strategies and approaches, there remain significant areas for improvement. The study results could be used in the future to produce national guidelines and training programmes for the assessment and management of HL in people with dementia, which would reduce disparities in care.
1435 THE BURDEN OF MULTIMORBIDITY AMONGST OLDER HOSPITALISED ADULTS IN NORTHERN TANZANIA: A MULTI-CENTRE STUDY
Authors: Davidson S L , Bickerstaff E , Emmence L , Motraghi-Nobes S M , Rayers G , Lyimo G , Kilasara J , Mitchell E , Urasa S , Walker R W , Dotchin C L
Published: July 2023

Background

Populations in sub-Saharan Africa are ageing rapidly and Tanzania is one country experiencing this acute demographic shift. Multimorbidity (the presence of two or more chronic conditions [1]) is common in the community and associated with greater risk of hospitalisation. To-date, the prevalence amongst older hospital inpatients is unknown.

Objective

To establish the prevalence of multimorbidity amongst older hospitalised adults in northern Tanzania.

Methods

For 6-months, adults aged ≥60 admitted to medical wards in four hospitals were invited to participate. A standardised questionnaire, structured around the Comprehensive Geriatric Assessment, was completed. This included items regarding health insurance and exemption from health user fees (granted based on age and low socioeconomic means). Multimorbidity was self-reported using a list of 16 conditions from the Study of Global Ageing and Adult Health Questionnaire, with additional screening for hypertension.

Results

Between March and August 2021, 540 adults aged ≥60 years were admitted and 308 (57%) underwent assessment. Reasons for non-participation included discharge (n=159) and death (n=34) prior to researcher attendance. Of 277 participants, 145 (52%) had self-reported multimorbidity. Data were unavailable for 31 participants who were unsure of their past medical history. Hypertension was reported by 146 (52%) and an additional 35 (11%) had mean readings ≥140/90 when screened. Mann-Whitney U revealed a significantly greater burden of multimorbidity in those with health insurance (p<0.001) or exemption from user fees (p=.34), compared with participants without.

Conclusion

Multimorbidity is common amongst hospitalised older adults in Tanzania. Higher rates amongst those with insurance or exemption are likely because of greater access to healthcare services and therefore diagnosis. Simple screening for hypertension identified further individuals with multimorbidity, demonstrating that it may remain underestimated. Widening access to healthcare is a government priority, but the impact of multimorbidity also poses a challenge to hospitals and policymakers.

Reference

1. Johnston MC et al. European Journal of Public Health 2018; 29: 182–9.
1454 THE CLINICAL UTILITY OF MUSCLE MASS ASSESSMENT IN PATIENTS WITH HIP FRACTURE: A SYSTEMATIC REVIEW
Authors: Prowse J , Jaiswal S , Sorial A K , Witham M D
Published: July 2023

Introduction

In the current European guidelines, sarcopenia is diagnosed on the basis of low muscle strength, with low muscle mass used to confirm diagnosis. The added value of measuring muscle mass is unclear. We performed a systematic review to assess whether muscle mass was independently associated with adverse outcomes in patients with hip fracture.

Method

The systematic review protocol was registered on the PROSPERO database (CRD42021274981). Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Clinicaltrials.gov) were searched for observational studies of patients with hip fracture aged ≥60 who had muscle mass or strength assessment perioperatively. Two reviewers independently screened titles/abstracts for inclusion. The association of muscle mass or strength with postoperative outcomes (mortality, Barthel Index, mobility, physical performance measures, length of stay, complications) was recorded. Risk-of-bias was assessed using the AXIS or ROBINS-I tool as appropriate. Due to the degree of study heterogeneity, data were analysed by narrative synthesis.

Results

The search strategy identified 3,007 records. Ten studies were included (n=2281 participants), containing 27 associations between muscle mass assessment and hip fracture postoperative outcomes. Four studies had intermediate risk of bias; 6 studies had high risk of bias. Lower muscle mass was associated with higher mortality and worse physical performance measures in univariate analyses but there was no significant association between muscle mass and mobility, length of stay and postoperative complication scores in any included study. Six studies assessed both muscle mass and strength. Muscle mass was not a significant independent predictor of any adverse outcome in any included study after adjustment for muscle strength and other predictor variables.

Conclusion

Data on the clinical utility of muscle mass measurement in patients with hip fracture are limited in volume and quality, but available studies suggest muscle mass does not offer additional prognostic benefit to muscle strength measures.
1547 PREFABRICATED ORTHOTICS WITH AND WITHOUT A METATARSAL PAD TO DECREASE PAIN AND FEAR OF FALLING IN OLDER ADULTS
Authors: LaCourse J , Sims J , Bharadwaj M , Ampat G
Published: July 2023

Background

Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability.

Objective

Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad. At baseline and 6-week follow-up, musculoskeletal pain was reported via Numerical Rating Scales (NRS), foot pain and functionality via the Foot Health Status Questionnaire (FHSQ), and fear of falling via the Short Falls Efficacy Scale International.

Results

Both groups reported significant improvements in pain in the back, hips, knees, ankles, and feet using the NRS (P < 0.001). Using the FHSQ, foot pain significantly improved in both the intervention (x-= 18.47 ±20.58, P < 0.001) and control group (x-= 17.21 ±18.74, P < 0.001). Function also improved significantly in both groups (x-= 18.35 ±20.67, P < 0.001 and x- = 15.07 ±20.15, P < 0.001, respectively), as did fear of falling (x-= 1.55 ±3.79, P < 0.001 and x-= 1.23 ±3.53, P < 0.001, respectively). No statistically significant difference was observed between groups for any outcome (P > 0.05).

Conclusion

Aetrex orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.
1508 OLDER PATIENTS’ ADHERENCE TO APPROPRIATE POLYPHARMACY: CHALLENGES, STRATEGIES AND OUTCOMES OF IMPORTANCE TO STAKEHOLDERS
Authors: Al Shaker H , Barry H , Hughes C
Published: July 2023

Introduction

Older patients often struggle to manage and take polypharmacy. Intervention studies have measured a variety of outcomes to improve adherence to polypharmacy. However, the scarcity of well-designed trials and inconsistencies in outcomes reported and measured have resulted in low-quality evidence. It is now recommended that researchers consider using a Core Outcome Set (COS); the minimum number of outcomes that should be measured and reported in all studies in a specific area. This study explored stakeholders’ perspectives regarding the challenges older patients face when taking polypharmacy, potential strategies to address such challenges, and outcomes of importance with a view to developing a COS for studies focusing on adherence to appropriate polypharmacy.

Method

Semi-structured virtual and telephone interviews were convened with relevant stakeholders, recruited through several approaches. Interview topic guides sought information on challenges and strategies associated with adherence to polypharmacy. A list of potential outcomes (n=7) associated with adherence research (derived from a previous Cochrane review and two other relevant studies) was presented to participants for comment. Content analysis of audio-recorded and transcribed interviews identified key themes on challenges, strategies and outcomes.

Results

Participants (15 academics, eight healthcare professionals, and six public participants) identified 11 challenges (encompassing medication, healthcare system, patient and socioeconomic issues) and 16 educational and behavioural strategies relevant to polypharmacy. They agreed that the seven outcomes presented to them were important and suggested six additional outcomes, generating a final list of 13 outcomes for potential use in trials focusing on adherence to appropriate polypharmacy.

Conclusion(s)

A range of challenges associated with polypharmacy was reported by participants, and a suite of strategies was suggested to address these challenges. The list of 13 outcomes will be used to inform the development of a COS for trials targeting interventions aiming to improve adherence to appropriate polypharmacy in older patients.
1540 YOGA FOR OLDER ADULTS WITH MULTIMORBIDITY: RANDOMISED CONTROLLED TRIAL WITH EMBEDDED ECONOMIC AND PROCESS EVALUATIONS
Authors: Tew G A , Wiley L , Ward L , Hugill-Jones J , Maturana C , Fairhurst C , Bell K , Bissell L , Booth A , Howsam J , Mount V , Rapley T , Ronaldson S , Rose F , Torgerson D J , Yates D , Hewitt C
Published: July 2023

Introduction

Older adults with multimorbidity can experience poor health-related quality of life (HRQOL). Yoga has the potential to improve HRQOL. The British Wheel of Yoga’s Gentle Years Yoga© (GYY) programme was developed for older adults with chronic conditions. We investigated the effectiveness and cost-effectiveness of the GYY programme in older adults with multimorbidity.

Method

This was a multi-site, individually randomised, open, superiority trial with embedded economic and process evaluations. Community-dwelling adults aged ≥65 years with ≥2 chronic conditions were recruited from general practices. All participants continued with usual care. Intervention participants were offered a 12-week GYY programme, which changed from face-to-face to online delivery during COVID-19. Most outcomes were participant reported. The primary outcome and endpoint was health-related utility measured using the EQ-5D-5L over 12 months. Secondary outcomes were HRQOL, depression, anxiety, loneliness, falls, adverse events and healthcare resource use.

Results

The mean age of the 454 participants was 73.5 years, 60.6% were female, and the median number of conditions was three. The primary analysis (n=422) showed no statistically or clinically significant difference in the EQ-5D-5L utility score over 12 months (adjusted mean difference of 0.020 favouring intervention; 95% CI -0.006 to 0.045, p=0.14). No statistically significant differences were observed in key secondary outcomes. No serious, related adverse events were reported. The intervention cost £80.85 more per participant (95% CI £76.73 to £84.97) than usual care, generated an additional 0.0178 quality-adjusted life years (QALYs) per participant (95% CI 0.0175 to 0.0180), and had a 79% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained.

Conclusion

The GYY programme showed no statistically significant benefits in terms of HRQOL, mental health, loneliness or falls. However, the intervention was safe, acceptable to most participants, and highly valued by some. The economic evaluation suggests that the intervention could be cost-effective.
1543 PROMOTING ACTIVITY, INDEPENDENCE AND STABILITY IN EARLY DEMENTIA AND MCI: THE PRAISED RANDOMISED CONTROLLED TRIAL
Authors: Harwood R H , Brand A , Goldberg S E , Masud T , Van Der Wardt V , Gladman J , Logan P , Hoare Z , Booth V , Howe L , Cowley A , Bajwa R , Burgon C , Di Lorito C , Godfrey M , Dunlop M , Welsh T
Published: July 2023

Introduction

People living with dementia and MCI progressively lose abilities, through increasing cognitive impairment, co-morbidities, inactivity, acute illnesses and injuries. Rehabilitation therapy may reduce disability and falls and increase resilience.

Methods

We co-produced a therapy intervention, comprising strength, balance and dual-task exercises, functional activity training and promoting community access, providing up to 50 therapy sessions, delivered over 12 months and underpinned by a behaviour change strategy. We evaluated the intervention in a 5-site multi-centred Randomised Controlled Trial, against a brief assessment control. Participants had a diagnosis of dementia or MCI, Montreal Cognitive Assessment (MoCA) between 13 and 25. Primary outcome was the Disability Assessment in Dementia (DAD), an ADL score, after 12 months, alongside a battery of other health status measures. The COVID-19 pandemic necessitated modifications.

Results

We recruited 365 participants, 42% female. Median age was 81 years (range 65-95), MoCA 20 (13-26), DAD 82 (5-100). Baseline balance between groups was good. Participants were predominantly white and socioeconomically advantaged. Intervention group participants received a median of 31 (IQR 22-40) session and undertook and additional mean 121 minutes of exercise per week. Assessed fidelity was good. 290 (79%) were followed up. There were no significant differences in DAD score (adjusted mean difference -1.3/100, 95% CI -5.2 to +2.6; effect size (d) -0.06; -0.26 to 0.15; p=0.5), physical activity, balance, quality of life, cognition or a range of other measures. Upper 95% confidence intervals excluded even small benefits. Rate of falling reduced by 22% (Rate Ratio=0.78; 0.46 to 1.3; p=0.3), but this was not statistically significant.

Conclusions

The intensive PrAISED intervention did not improve measured outcomes. It may be impossible to reduce the rate of functional decline in dementia. Alternatively, the pandemic may have distorted outcomes or participants may have been too advantaged to benefit. There may have been unmeasured psycho-social benefits.