bluuebunny/crossref_metadata_2025 huggingface dataset:
2008 Improving the documentation of Treatment Escalation Plans in patients >65yo admitted under the care of orthopaedics
Authors: Quarm M , Turnbull J , Stirzaker A G
Published: January 2024

Introduction

Treatment Escalation Plans (TEPs) are helpful tools that reduce un-necessary treatment burden, improve patient experience and follow the principles of realistic medicine. This is relevant in orthopaedics where a high percentage of the patients are frail, co-morbid, and would benefit from clear and realistic care plans. We aim to improve TEP completion to >50% of orthopaedic patients, over the age of 65yrs old, in three trauma wards at the Royal Infirmary of Edinburgh by August 2023.

Methods

We sampled three patient notes on each ward twice weekly from May – August 2023, noting whether TEPs were present, if it was consultant endorsed or provisional, and what key sections were completed (resuscitation, treatment goals and communication). To be included, the patient had to ≥65 and under orthopaedics. Process mapping demonstrated 2 key targets- admission clerk-in and registrar review. PDSA 1 involved creating a prompt for documenting TEPs on FY1 clerk-in which was added to the admission proforma folder and displayed as posters. PDSA 2 was a teaching session designed for orthopaedic registrars and other team members about TEP conversations.

Results

Pre-intervention data, demonstrated a median of 28% of orthopaedic patients ≥65yo have a TEP. Of the completed TEPs: 88% solely consisted of a resuscitation decision; 33% had treatment goals, 33% communication; and 0% of TEPs were endorsed. After PDSA 2; median TEP completion increased to 33%. Of the completed TEPs; none had only a resus decision, 100% have treatment goals; 100% communication, and 67% are endorsed.

Conclusions

Our studies have demonstrated that education and proforma changes have increased TEP documentation rate, although not to our projected target. However importantly, the percentage of TEPs that contain goals, document communication and consultant endorsement has improved significantly. This project is ongoing with planned further PDSA cycles.
1880 Improving physical activity in hospitalised older people: The Saints Foundation - University Hospital Southampton Partnership
Authors: Batchelor J , Hedges P , Gealer M , McCafferty R , Leli H , Draper P , Patel H P
Published: January 2024

Introduction

Deconditioning in the acute setting is associated with adverse outcomes, that cannot always be mitigated by increasingly stretched MDT workforce. We partnered with the Saints Foundation (SF), to test the feasibility and acceptability of a non-clinical Exercise Practitioner (EP) to work alongside therapies to promote physical activity (PA) of hospitalised older people.

Methods

Charity funded joint appointment of an NVQ3 EP with Postural stability Instructor (PSI) qualifications delivered quality education and rehabilitation programmes to hospitalised older patients. These took place in both one to one and gym-based group settings whilst working with the SF team to improve access to community-based exercise programmes.

Results

Between Sept 2022 and May 2023, the EP assessed 169 patients, mean age 86 yrs; male (62%), admitted after a fall. 105 patients (62%) underwent one to one rehabilitation consisting of falls education and individual exercise plans, 64 patients (38%) underwent gym-based rehabilitation, where strengthening and balance exercises were conducted in groups to improve overall function and increase confidence in functional ability. No adverse safety incidents were reported and a high level of satisfaction after interaction with the EP was conveyed. Initial focus was on patient feedback and satisfaction to ensure input o+- f an EP was well received and accepted.

Conclusion

Intervention by a non-clinical EP to improve the PA of hospitalised older people is acceptable, feasible, appears to be safe and is associated with increased patient satisfaction. By capitalising on SF expertise, we provided a clinical standard on exercise for older adults and built a strong relationship between our workforce to bridge community and acute services. Next steps are to increase the scope of interventions, evaluate quality of life pre and post hospitalisation, capture trust level metrics including length of stay, readmission rates and discharge destination to further evaluate the impact on service users.
1758 Front door frailty team reviews of care home residents in a North Wales District General Hospital
Authors: Speare C , Begum H , Mrittika S , Healy J , Abbott C
Published: January 2024

Introduction

Care home residents are increasingly presenting to hospitals. In October 2022, a frailty team was formed in our district general hospital, consisting of two SHOs, one SpR and one consultant, with support from pre-existing care home ANP and community resource team (CRT). Focusing on patients presenting to the Emergency Department, their aims were early identification of care home residents in order to optimise their care by facilitating discharge, tackling polypharmacy and seizing opportunities for advanced care planning.

Method

Care home residents were highlighted on the ED clinical system, using a unique icon, and reviewed by the frailty team. Anonymised patient statistics were logged into a bespoke e-database. This generated a dashboard of graphs showing trends in outcomes. The statistics from the first 8 months (3/10/22 to 5/6/23) were utilised to show patient demographics, number of reviews and rates of discharge.

Results

297 care home residents were reviewed. 83.8% of these patients had a Rockwood Clinical Frailty Score of ≥ 7. Delirium was present in 91 (30.6%) patients. 121 (40.7%) had at least 1 medication stopped. 165 (55.6%) were discharged after frailty review. Do not resuscitate forms were completed for 208 (70.0%) patients. Advanced Care Planning was discussed with 138 (46.5%) patients and 6 (2.0%) patients were not for re-admission. End of life care was commenced for 17 (5.7%) patients.

Conclusion

It is clear that patients attending the Emergency Department would benefit from an early comprehensive geriatric assessment. The benefits this has provided in one North Wales DGH are significant and have made strides in reducing unnecessary admissions, reducing polypharmacy and providing holistic, interdisciplinary and patient centred care including advanced care planning. Whilst the Emergency Department is not an ideal environment for this, the team have demonstrated the benefits to this model.
2042 Implementing the principles of Shared Decision Making into a Hospital at Home service, as part of a wider organisation adoption
Authors: Lewis L , Olden S , Waldon M , Loulaki M
Published: January 2024

Background

NICE (2023) Shared Decisions Making (SDM) Guidelines ensure Health Care professionals work together with a person to reach a decision about care based on their individual preferences, beliefs, and values. Local Problem. We conducted an Audit across our community services to assess NICE SDM, achieving 71% compliance. Results informed the project problem statement “Clinical Teams are not fully compliant to NICE SDM guidelines therefore a shared decision-making approach is not guaranteed”.

Methods

A fishbone diagram was applied to understand why SDM wasn’t routinely occurring in clinical practice. Our aim is to achieve organisation wide adherence to SDM. We propose a multi modal approach to increasing awareness of SDM across the organisation. We used a driver diagram working backwards from the goal, identifying the drivers and determining the project activities.

Interventions

Due to the enormity of rolling out a pan-organisational programme we decided to use the Frailty NHS@Home virtual ward to test and learn before greater adoption. We firstly processed mapped how the “What Matters to you?” question is embedded into our Comprehensive Geriatric Assessments. A decision support grid for treatment option decision making was created for dehydration or high risk of dehydration within the NHS@Home service, adapted from Marrin et al (2014). Three options are described underpinned by five questions. Feedback from Patient and public involvement ensured the language was appropriate. After the first PDSA cycle, the tool was reviewed by the project team and two further questions were added, “Did you understand the options which were explained to you?” and “What matters most to you as we decide together how best to treat your dehydration?”

Conclusion

A re audit and colleague survey will reveal increased knowledge and understanding of the SDM concept. We continually seek Feedback from individuals who use our services for their experience of SDM processes.
1941 Working as a multidisciplinary team to reduce weight loss - a quality improvement project to improve nutrition in older patients
Authors: Wright L , Newman C
Published: January 2024

Introduction

Weight loss is common during acute hospital admissions, and can be devastating to the older patient where weight loss is associated with an increase in mortality over a 12-month period. Patients who lack the ability to communicate their food preferences are at risk of receiving food they do not like, especially as food orders are often taken when family/carers are not present.

Methods

While working on a Department of Medicine for Older People and Stroke (DMOPS) ward, we worked with the Multidisciplinary team (MDT) with the aim of reducing weight loss. We implemented two interventions. The first being ‘MUST Mondays’, where patients were weighed and had a Malnutrition universal screening tool (MUST) completed on admission to the ward, and then weekly. We also implemented A3 Laminated menus - where patients and their families/carers were given food choices for the week in advance, and could use a marker to identify foods they did/did not like. These were then displayed above the bedspace. All patients were over the age of 65. We excluded patients who were actively dying, patients who were aiming for weight loss (Such as in fluid overload) and patients who were admitted for fewer than 8 days.

Results

Prior to putting the interventions in place, we audited 23 patients admitted over a 3-month period. 70% of patients lost weight over the course of their admission, and 48% had MUST assessments completed weekly. We re-audited 5 months after the interventions were implemented, we audited 20 patients over a 5-month period and found 55% lost weight over the course of their admission, and 80% had weekly MUST assessments.

Conclusion

Working as an MDT to put in place small interventions can have a meaningful impact on reducing weight loss in older patients during acute hospital admission.
1725 From care home to the emergency department; a snapshot of frailty admissions
Authors: Blackburn S , Sherif S Abou , Syed M , Hughes A , De Rohan C
Published: January 2024

Background

Care home residents form a large number of admissions to the Emergency Department (ED). Over an 8-month period, care home admissions to ED were reviewed, examining the nature of admissions to inform how to improve current pathways.

Method

Patients with a frailty score ≥6 (N=180), admitted from 34 care homes to Chelsea and Westminster Hospital ED over 6 months were included. Data was collected from medical and London Ambulance Service (LAS) records. Data collected included; Presenting Complaint (PC), LAS attendance times, prior discussion with a Health Care Professional (HCP), Length of Stay (LOS).

Results

LAS attendances during normal working hours (9am-5pm Monday- Friday) formed 34% (N=61) of admissions with only 43% (N=26) being discussed with an HCP prior to attendance. Of these, 30% (N=18) were discharged <24hrs and up to 39% (N=7) of these may not have required emergency admission. For all admissions, ‘fall’ was the most common PC, 33% (N=59) followed by ‘respiratory issue’ 21% (N=38). Overall, 24% (N=47) of total admissions were discharged <24hrs but total care home admissions accounted for a total of 454 bed stay days. Factors impacting discharge included COVID status, requiring care home re-assessment prior to discharge and no longer having a bed available.

Conclusion

This data demonstrates that there is an opportunity to improve care home support and admission pathways. Discussing patients with an HCP prior to contacting LAS may reduce requirement for ED attendance alongside access to rapid response community teams. Expanding an HCP accessible service out of hours (OOH) could facilitate this and implementing a frailty telephone service may also support with this initiative. Collaboration with care homes and community partners will form the next steps in this quality improvement work.
2038 Advanced care planning in severe frailty - quality improvement project two-year summary
Authors: Robinson S , Sawney P , Bethel S , Clarke E , Woods S , Alićehajić-Bečić Ð
Published: January 2024

Introduction

NICE guidance recommends that clinical teams should identify patients who are approaching their final year of life. It advises using tools such as the Clinical Frailty Score (CFS) to identify this cohort. Wigan has a significant proportion of severely frail patients would benefit from this conversation. The aim of this project was to increase the percentage of patients with severe frailty who have an advanced care planning (ACP) conversation during their hospital stay.

Method

Retrospective data collected from discharge letters was used to identify patients aged >65 years with a CFS ≥7 Astley ward. Exclusion criteria included patients <65 years old, patients who died during admission, patients who moved wards prior to discharge and re-admissions if within 30 days. The cohort was examined to see if firstly they had been highlighted as a patient who would benefit from ACP, and if an aspect of ACP had been completed during their admission.

Results

10 PDSA cycles were completed over the two years (2021-2023). Our data showed that teaching on ACP and dedicated Registrar sessions on the rota had the greatest impact on improving the completion of ACP discussions. While unified method of CFS assessment on admission and documentation of ACP on shared platforms did not change the ACP uptake significantly.

Conclusions

Systematic approach to improving ACP in severe frailty has the potential to improve patient experience and allow them to highlight their wishes at the end of life. Despite trialling multiple activities to increase ACP uptake it was clear whole multidisciplinary team engagement is required to maximise ACP. Therefore, future cycles will examine the impact of implementing a focused approach to ward rounds. Although we have progressed towards our goal, more work needs to be done to maximise uptake of ACP for severely frail patients during hospital admissions.
1871 Encouraging Mental Capacity Act assessments in cognitively impaired or delirious patients over 65 at an orthopaedic hospital
Authors: Fattahi A , Shah K
Published: January 2024

Introduction

The Mental Capacity Act (MCA) is designed to protect patients who may lack capacity to make decisions about their proposed treatment. At the Nuffield Orthopedic Centre (NOC), Oxford, nurses obtain a baseline abbreviated mental test score (AMTS) during the pre-operative assessment clinic. Post-operatively, the AMTS should be repeated with the 4AT to screen for delirium. If the AMTS is less than 8, or the patient is clinically believed to be delirious, then an MCA assessment should be undertaken and documented for the decision to accept treatment. The aim of this QI project was to widen this practice to all the junior doctors at the NOC.

Method

Baseline AMTS and MCA data were collected from one month of inpatients >64 years old at the NOC. Patients with post-op AMTS of <8 or those with delirium were identified and checked for documented MCA assessments. The results, teaching and training on capacity and consent were presented to the junior doctor team and a repeat audit cycle was performed to assess if the practice was being implemented.

Results

Data collected from 10/01/23 – 10/02/23 (n=125) showed that out of 10 patients meeting the AMTS criteria, only 4 had MCA assessments completed. Once the QI project was presented on 25/05/23, data collected from 12/06/23 – 15/07/23 showed that out of 5 eligible patients, 4 of them had MCA assessments documented.

Conclusion

Prior to this QI project, only 40% of patients with suspected cognitive impairment were undergoing an MCA assessment. Following the teaching and training to the junior doctors, the data collected shows that this figure had increased to 80%. In conclusion, this QI project has shown an improvement in appropriate application of the MCA. It should be repeated every 4 months to account for each new rotation of junior doctors.
1775 Delirium education and documentation - Quality improvement project in geriatric assessment unit
Authors: Zamir H , Shield L , Brodie L
Published: January 2024

Introduction

Delirium is a common presentation in older people (>65 Years age) and associated with falls risk, longer inpatient stay, post-discharge institutionalization, accelerated cognitive decline and higher mortality. While median duration of delirium is reported as 1 week but for one third patients, symptoms may persist 3 months or more, even a proportion of patients will never fully recover to their pre-delirium cognitive baseline. It is essential to educate patient and family that staying in the hospital can only make delirium worse and they will need extra support on discharge for usual daily activities to avoid falls and readmissions. Physicians should be aware that delirium sufferers often have an awareness of their experience and for affected person and their family, delirium can be a cause of significant distress. Identification of risk factors, education, and a systematic approach to management can improve the outcome and experience of the syndrome.

Aim

To provide delirium education and Improve documentation up to 95 % in GAU.

Method

• Prospective data collection

• Jan 2023 to March 2023

• Monthly data analysis of 20 patients in GAU with the confirm diagnosis of delirium.

• PDSA 1 Departmental teaching and delirium leaflet awareness and availability

• PDSA 2 Poster as Visual prompt

Results

After 2 PDSA cycles, we noticed significant improvement in delirium education and documentation up to 95%. Another QIP is ongoing to incorporate delirium time bundle in our practice to timely identify diagnosis, manage potential triggers and provide education to better understand its nature.

Conclusion

Along with prompt diagnosis and management, good educational approach and clear documentation will lead to improve understanding about delirium, reduce distress and facilitate safe early discharge. References https://www.sign.ac.uk/sign-157-delirium.
1971 Five years of the National Audit of Inpatient Falls
Authors: Whitney J , Sheshi N
Published: January 2024

Introduction

There are around 250,000 inpatient falls in English hospitals each year. Inpatient falls are associated with poor outcomes. Evidence suggests multifactorial assessment and intervention is the most effective way to prevent inpatient falls. There are National Institute of Health and Care Excellence (NICE) quality standards for safe post fall management. National audit supports improvement in the quality and safety of clinical care.

Methods

The National Audit of Inpatient Falls (NAIF) began collecting continuous data from all femoral fractures (as identified on the National Hip Fracture Database) in England and Wales from 2019. Prospective documentation review collects data on multifactorial falls risk assessment (MFRA) prior to the femoral fracture as well as immediate post fall management and presents performance indicators related to NICE guidelines/quality standards.

Results

There are around 2000 inpatient femoral fractures each year. Those with an inpatient fracture have double the 30-day mortality of those who fracture elsewhere, highlighting the vulnerability of this group of patients. There has been improvement in most aspects of MFRA and the proportion of patients checked for injury before moving from the floor has increased from 69 to 77%, use of flat lifting equipment from 22 to 29% and medical assessment within 30mins of the fall from 52 to 60%.

Conclusion

There have been steady improvements in guideline compliant inpatient fall-prevention and post-fall management, but there is more to do. The programme also produces improvement resources and activities and will be expanding the range injuries covered in the next 2 years.
1848 Risk of severe COVID-19 increases with the number of comorbidities in fully vaccinated individuals aged ≥65: results from INFORM
Authors: Dube S , McNulty R , Arnetorp S , Yokota R , Carty L , Taylor S , Peters J , Justo N , Lu Y , Evans K , Yates M , Nguyen H , Olson V , Quint J , Evans R
Published: January 2024

Objective

Ageing is associated with reduced vaccine efficacy due to immunosenescence. Severe COVID-19 outcomes are associated with comorbidities prevalent in older people. We report results from the INFORM study on severe COVID-19 outcomes in vaccinated older individuals with varying numbers of comorbidities.

Methods

A retrospective observational cohort study was conducted in England using a 25% random sample from NHS databases. COVID-19related outcomes (hospitalisations and mortality) in fully vaccinated (≥3 doses) older individuals from 1 Jan to 31 Dec 2022 are reported.

Results

Of a reference population of 7,180,205 fully vaccinated individuals ≥12 years, 2,232,140 were ≥65 years. The proportion of older people with ≥1 COVID-19 hospitalisation increased with age (≥65, 0.6%; ≥70, 0.7%; ≥75, 0.9%; ≥80, 1.2%) compared to overall population (OP, 0.2%). Incidence rates (IR) (95% CI) per 100 person years also increased with age for hospitalisation (≥65, 0.58 [0.57-0.59]; ≥70, 0.71 [0.69-0.73]; ≥75, 0.90 [0.88-0.92]; ≥80, 1.20 [1.18-1.22] versus OP, 0.22 [0.21-0.23]) and death (≥65, 0.16 [0.15-0.17]; ≥70, 0.20 [0.18-0.22]; ≥75, 0.28 [0.26-0.30]; ≥80, 0.42 [0.39-0.45] versus OP, 0.05 [0.04-0.06]). In those ≥65, 1,375,470 were not immunocompromised (IC) but had ≥1 high-risk comorbidity (no-IC/+Com), 586,155 had neither IC or comorbidity (noIC/noCom). An increased number of comorbidities was associated with increased hospitalisation and death IRs. In those ≥65 noIC/+Com, IRs (95% CI) were 0.63 (0.61-0.65), 0.88 (0.86-0.90) and 1.25 (1.22-1.28) for hospitalisation vs 0.20 (0.17-0.23) in noIC/noCom; and 0.16 (0.14-0.18), 0.23 (0.21-0.25) and 0.32 (0.29-0.09) vs 0.06 (0.03-0.09) for noIC/noCom for death where individuals had ≥1, ≥2 and ≥3 noIC/+Com, respectively.

Conclusions

Despite vaccination, older people are at increased risk for severe COVID-19 outcomes, with higher risk associated with more comorbidities. Even older patients with no-IC conditions have increased risk, especially those with other high-risk comorbidities. Additional interventions may be required to protect older people against severe COVID-19 outcomes.
1867 Efficacy and safety of metformin as a therapy for older people with sarcopenia and frailty - the MET-PREVENT randomised trial
Authors: Witham M D , McDonald C , Clegg A P , Hancock H , Hiu S , Nicholson K , Storey B , Simms L , Steves C J , von Zglinicki T , Wason J , Wilson N ,   on behalf of the MET-PREVENT study group, Sayer A A
Published: January 2024

Introduction

Metformin has pleiotropic biological effects which might improve muscle function in older people. The MET-PREVENT trial tested the efficacy and safety of metformin as a therapy for sarcopenia and frailty in older people.

Methods

Double blind, randomised, parallel-group, placebo-controlled trial. Participants aged ≥65 with walk speed <0.8m/s and low muscle strength (handgrip <16kg for women, <27kg for men, or 5x sit to stand >15s) were recruited from primary care and hospital clinics. Participants were randomised 1:1 using a web-based interactive system to receive 4 months of 500mg metformin or matching placebo 3x/day. The primary outcome, analysed by intention to treat, was the between-group difference in 4m walk speed at 4 months, adjusted for baseline values. Secondary outcomes included grip strength, short physical performance battery, six-minute walk distance, muscle mass by bioimpedance, quality of life and activities of daily living. All adverse events were recorded.

Results

Seventy-two participants were randomised, mean age 80 (SD 6) years. 42 (58%) were women, 42 (58%) were frail (Fried score ≥3); mean baseline 4m walk speed was 0.59 m/s (SD 0.22). 70 (97%) completed the trial (metformin 34/36, placebo 36/36). 14 (40%) discontinued metformin and 5 (14%) discontinued placebo. There was no difference in the primary outcome between the metformin (0.57 m/s [SD 0.19] m/s) and placebo group (0.58 m/s [SD 0.24]); adjusted treatment effect was 0.001 m/s (95%CI -0.06, 0.06); p=0.96. There was no significant effect on measures of muscle mass, physical performance, quality of life or activities of daily living. The metformin group had more adverse events (110 vs 77) and more hospital admissions (12 vs 3)

Conclusions

MET-PREVENT achieved successful recruitment with high retention rates, however metformin did not improve physical performance and was poorly tolerated with high rates of adverse events in older people with sarcopenia.
1878 Sarcopenia screening in older community-dwelling adults: findings from Southampton Longitudinal Study of Ageing (SaLSA)
Authors: Laskou F , Westbury L D , Bevilacqua G , Bloom I , Cooper C , Aggarwal P , Dennison E M , Patel H P
Published: January 2024

Introduction

The SARC-F questionnaire can be rapidly implemented by clinicians to identify patients with probable sarcopenia. A score ≥4 is predictive of sarcopenia and poor outcome. We sought to identify the prevalence and demographic correlates of probable sarcopenia (SARC-F score ≥4) in community-dwelling older adults.

Methods

480 participants (219 men, 261 women) identified from Primary Care completed a questionnaire ascertaining demographic, lifestyle factors, comorbidities, nutrition risk score (DETERMINE) and SARC-F score. Participant characteristics in relation to probable sarcopenia were examined using sex-stratified logistic regression. Age was included as a covariate.

Results

The median (lower quartile, upper quartile) age was 79.8 (76.9, 83.5) years. 12.8% of men and 23% of women had probable sarcopenia. Self-reported walking speed strongly associated with probable sarcopenia (men: odds ratio (OR) 10.39 (95% CI: 4.55, 23.72), p<0.001; women: 11.42 (5.98, 21.80), p<0.001 per lower band). Older age was associated with probable sarcopenia in both sexes (p=0.01) as was higher DETERMINE score (men: 1.30 (1.12, 1.51), p=0.001; women: 1.32 (1.17, 1.50), p<0.001 per unit increase). Among men, being married or in a civil partnership or cohabiting was protective against probable sarcopenia (0.39 (0.17, 0.89), p=0.03) as was reporting drinking any alcohol (0.34 (0.13, 0.92), p=0.03) while in women generally similar relationships were seen though these were weaker. Higher BMI (1.14 (1.07, 1.22), p<0.001 per unit increase) and presence of comorbidities (1.61 (1.34, 1.94), p<0.001 per extra medical condition) were also associated with probable sarcopenia in women. All associations were robust after adjustment for age.

Conclusions

Probable sarcopenia (SARC-F score ≥4) was common in older adults living in their own homes. As expected, self-reported walking speed was highly predictive of probable sarcopenia. In addition to advancing age and malnutrition, socio-demographic factors were also important. Identifying these factors in clinical practice should trigger sarcopenia screening in older adults.
1986 Hypoglycaemia in older people with diabetes and symptoms suggestive of hypoglycaemia - continuous glucose monitoring (CGM) study
Authors: Navaneetharaja N , Mattishent K , Loke Y
Published: January 2024

Introduction

Older people with diabetes are often admitted with falls, dizziness or confusion that may stem from undiagnosed episodes of hypoglycaemia. We examined the use of a 10-day period of round the clock glucose monitoring (CGM), to detect hypoglycaemia in older people with diabetes with symptoms potentially related to hypoglycaemia.

Methods

Population: Age 75 years and older, on sulfonylureas and/or insulin, presenting to hospital with a fall and/or symptoms suggestive of unrecognised hypoglycaemia.

Design

Single-centre, observational study (no change to standard diabetes care). Intervention: 10 days of CGM with Dexcom G6 sensor and Android app on smartphone to continuously transmit data.

Primary outcomes

Proportion of participants with captured hypoglycaemia; within that group, time spent in the hypoglycaemic range (Battelino T, Danne T, Biester T, et al. Diabetes Care. 2019;42(8):1593-603.).

Secondary outcomes

Overall time in range; emergency department re-attendances and/or hospital re-admissions for falls, fractures, heart attacks, ischaemic strokes and death within 30 days. REC IRAS project ID: 301286.

Results

26 eligible participants of which 13 consented to participate. At the time of writing, nine participants (mean age 81 years) completed the study. There were no reports of pain or skin reactions from the participants. Hypoglycaemic events were captured in 3 of 9 participants, with two participants suffering >1 hour below 3.9mmol/L. Only 3 participants achieved >50% time in range target (3.9-10.0mmol/L).

Discussion

We have detected significant hypoglycaemic episodes in our participants. CGM should be used more widely in older patients with diabetes who present with falls, dizziness or confusion. Limitations include issues around data capture due to participants struggling to navigate the mobile phone app. Despite this, all participants felt that CGM was better than finger-prick glucose testing. Future work is needed to explore how CGM can be deployed after acute admissions in this patient group.
2051 How representative are UK-based trials investigating lifestyle interventions for diabetes mellitus: a systematic review
Authors: Miles G , Smith R A
Published: January 2024

Background

Type 2 Diabetes mellitus (T2DM) is the most common long-term metabolic condition in older people. In the UK, half of all diabetic patients are over 65 and prevalence reaches 10% in over 75s. Lifestyle interventions reduce diabetic complications and can achieve remission, however, there are concerns over the generalisability of these findings to the diabetic population, particularly elderly, complex patients, and those from ethnic minorities. This systematic review quantifies the disparity between diabetes clinical trial cohorts and the UK diabetic population.

Method

This is a systematic review of UK-based randomised control trials (RCTs) of non-pharmaceutical interventions in adults with T2DM. Data was collected on characteristics of participants included in these studies, including age, sex, ethnicity, socioeconomic status and education of participants.

Results

Our search strategy identified 5437 results, of which 161 met the criteria for full-text screening. After full-text screening and de-duplication, 80 RCTs were included in our analysis. Of 80 studies, 60% (48/80) reported a mean participant age under 60. Only 40 (50%) reported participant age range; of these the maximum participant age was under 65 in 20% and under 75 in 60%. Where the mean age of participants was over 60, 56% (18/32) restricted participation by comorbidities. Almost all of these precluded anyone with pre-existing CVD (17/18), one third precluded any comorbidities, and 5/18 precluded hypertensive patients. Only 26% of studies reported the ethnicity of participants. These cohorts were not representative of the UK diabetic population, with underrepresentation of Asian ethnic groups in 90% of trials.

Conclusions

Representation of elderly patients with comorbidities and those belonging to ethnic minority groups is severely limited in UK based T2DM RCTs of lifestyle interventions. Failure to include a representative population in clinical trial cohorts risks guidance that is not generalisable to the UK diabetic population, potentially exacerbating existing health inequities.
1850 Dogs and Bones
Authors: Williams L , Nyunt N , Davies R , Adhiyaman V
Published: January 2024

Introduction

The health benefits of owning dogs include improved physical activity, mental well-being, companionship, and so forth. However, musculoskeletal injuries caused by dog-related activities might negate the aforementioned benefits. The aim of this study was to estimate the number of femoral fractures directly linked to dog-related activities in people above the age of 60.

Methods

In this observational study, we included all patients above the age of 60 with femoral fractures caused by dog-related activities, over a one-year period (June 2022 to May 2023). We chose to include people above the age of 60 because they are more likely to have a fragility fracture and are entered in the National Hip Fracture Database.

Results

387 patients (above the age of 60) were admitted with femoral fractures during the study period. Of these, 16 were directly related to dog-related activities. The common mechanisms of injuries include being tripped, pulled down and jumped over by a dog, and tangled and tripped by the dog leash.

Conclusion

4% of femoral fractures (1 in 25) in people above the age of 60 were caused by dog-related activities. This is probably an underestimate, because some owners may not have volunteered this information out of love for their dogs and inadequate history regarding the circumstances that led to the fall. Despite the injuries, all patients still loved their dogs and wanted to go home as soon as possible to be with them. There were more fractures in spring and summer (11) compared to autumn and winter (5) which reflects increased activity with better weather. Having a dog is a risk factor for falls and fractures. We recommend that dog owners carefully consider their choice of dogs and if there are issues with handling them, both dogs and their owners should receive appropriate training.
1866 The impact of patient and public involvement on partnership in the DREAM project
Authors: Morley N , Sanders T , Goodwin V A ,   on behalf of the DREAM team
Published: January 2024

Introduction

Patient and Public involvement is a cornerstone of the DREAM (Digital and Remote Enhancements for the Assessment and Management of older people) project. An advisory group of 10 diverse older people and carers was established to shape the research through regular discussions and explore inclusive involvement approaches for future work.

Methods

We conducted a reflective process evaluation to highlight the impact of the involvement process on the project and our public partners themselves. We collated impact logs, reflections and feedback from our public partners and an artist recorded the impacts using illustration.

Results

The advisory group:

• helped to lay the foundations of the project and steered its development with their views, knowledge and experiences

• shaped how evidence is captured and analysed so that it is usable, acceptable and makes sense to older people and carers

• provided insights to consider for implementation and shaped our dissemination strategy Our public partners and researchers also expressed relational impacts such as shared ownership. Public partners joined this project to improve health care for other people. They felt safe to share their experiences and be listened to. It gave them confidence in their health management, and they have built friendships. People also found comfort in the diversity of individuals and sharing common concerns.

Conclusion(s)

Public partners have been instrumental in the development of the DREAM project and supported the programme by being a critical friend beyond the remit of the research. Continued communication and feedback resulted in public partners feeling heard and their suggestions acted upon. Researchers and public partners felt gratitude, ownership and joy working on this project, and finding shared values. Our involvement approaches have shaped reciprocal relationships and had impact on our research culture, forming a foundation to the values of the people it is serving.
2009 Integrated physical-mental health care models for older people under specialist mental health services: a systematic review
Authors: Hickey B , Desai B , Chithiramohan T , Robinson T , Mukaetova-Ladinska E , Evley R , Dening T , Rajamani A , Subramaniam H , Tako A , Tarrant C , Beishon L
Published: January 2024

Background

Older people have complex health needs, with the inter-play between physical and mental health being a prominent issue. The ageing population has resulted in a large proportion of older people living with co-occurring physical and mental health disorders, which can prove challenging to manage simultaneously, particularly for serious mental illness. The aim of this systematic review was to explore models of integrated physical-mental health care available for older people, and whether these result in improved health outcomes. Sources of heterogeneity in the current evidence base alongside limitations were also explored.

Methods

Medline, Embase, CINAHL, PsycINFO and Scopus were searched with a predefined search strategy, generating 5257 articles. Studies were suitable for inclusion where an integrated physical-mental health care service model was utilised in a population of older people (aged >60 years) with a mental health diagnosis and at least one concomitant physical health condition requiring physical health care input. All studies were quality assessed for risk of bias and results were synthesised narratively.

Results

Ten studies met the inclusion criteria. All studies incorporated service models involving integrated and/or multidisciplinary care. These included joint medical-mental health wards as well as the implementation of multidisciplinary teams in hospital and care facilities. Overall, this enhanced the quality of care for elderly patients with benefits including but not limited to, enhanced patient experience, the expansion of multidisciplinary team practice, improved management of illness, and timely intervention.

Conclusions

Multidisciplinary and integrated care resulted in improvement of a range of health outcomes for older people with combined physical and mental health needs. Larger and more robust studies are needed to explore the development of these service models further, with cost-effectiveness analyses.
1970 How can health care professionals understand and incorporate spirituality into Comprehensive Geriatric Assessment?
Authors: Turner L
Published: January 2024

Introduction

Little is known about how Health Care Professionals (HCPs) conducting Comprehensive Geriatric Assessment (CGA) assess spiritual needs. The aim of this study was to better understand how UK HCPs understand and incorporate assessment of spirituality into CGA for community dwelling frail older people.

Methods

Semi-structured interviews were undertaken with HCPs who regularly undertake CGA in the community as well as Anna Chaplains (ACs) whose remit is to provide chaplaincy to community dwelling older people. An inductive approach was taken using a topic guide to structure the interviews. Thematic analysis was undertaken using NVIVO. Ethics approval was granted through St Augustine’s College of Theology.

Results

Three HCPs and two ACs were interviewed. Three themes emerged. Firstly, that spiritual assessment needs time, trust and skill and cannot be established using checklists. Assessment hinges on building a rapport between the patient and HCP. HCPs and ACs suggested potential questions that could support assessment of spiritual needs. Secondly, supporting spirituality is focused on sustaining identity, fostering hope and encouraging spiritual growth. Finally, health care professionals lacked confidence and understanding in how to recognise and meet spiritual needs. Several suggestions were made as to how to address this.

Conclusions

All participants agreed that incorporating assessment of spirituality into CGA was important but that doing so effectively requires understanding and skill. The questions suggested by participants mapped well onto existing models of spirituality in ageing and frailty. Study findings could be used to develop training for HCPs undertaking CGA.
1943 Thyroid dysfunction and its relationship with cardiometabolic risk in a South American cohort, cross-sectional study
Authors: Medina M , Amaya M , Dulcey L , Gomez J , Vargas J , Lizcano A , Teran J , Hernandez C , Ciliberti M , Blanco C
Published: January 2024

Introduction

A growing body of evidence suggests that metabolic syndrome is associated with endocrine disorders, including thyroid dysfunction. Thyroid dysfunction in patients with metabolic syndrome may further increase the risk of cardiovascular disease, thus increasing mortality. This study was conducted to assess thyroid function in patients with metabolic syndrome and to assess its relationship to components of metabolic syndrome.

Methods

A cross-sectional study was carried out among 170 geriatric patients. Anthropometric measurements (height, weight, waist circumference) and blood pressure were taken. Fasting blood samples were analysed for glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, and thyroid hormones (triiodothyronine, thyroxine, and thyroid-stimulating hormone).

Results

Thyroid dysfunction was observed in 31.9% (n = 54) of the patients with metabolic syndrome. Subclinical hypothyroidism (26.6%) was the main thyroid dysfunction, followed by overt hypothyroidism (3.5%) and subclinical hyperthyroidism (1.7%). Thyroid dysfunction was much more common in women (39.7%, n = 29) than in men (26%, n = 25), but not statistically significant (p = 0.068). The relative risk of having thyroid dysfunction in women was 1.525 (CI: 0.983-2.368) compared to men. Significant differences (p = 0.001) were observed in waist circumference between patients with and without thyroid dysfunction and HDL cholesterol that had a significant negative correlation with thyroid-stimulating hormone.

Conclusion

Thyroid dysfunction, particularly subclinical hypothyroidism, is common among patients with metabolic syndrome and is associated with some components of metabolic syndrome (waist circumference and HDL cholesterol). Keywords: metabolic syndrome, hypothyroidism, cardiovascular diseases.
1718 Co-Producing an Intervention to Reduce Sedentary Behaviour in Community-Dwelling Older Adults Through Behaviour Change Theory
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A
Published: January 2024

Background

Older adults are the fastest-growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research, and tailored strategies to reduce sedentary time may be warranted for this subset of older adults. The development of an intervention to reduce sedentary behaviour in adults aged ≥75 years using co-production and behaviour change theory is reported.

Methods

Four co-production workshops with community-dwelling older adults aged ≥75 years were held between October-December 2022. The intervention development process was informed by the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). Audio recordings and workshop notes were iteratively analysed, with findings used to inform subsequent workshops.

Results

The co-production group consisted of six community-dwelling older adults aged ≥75 years and two researchers. The developed intervention consists of four components (activity monitoring, educational material, group sessions and researcher follow-up), maps to 24 behaviour change techniques and targets barriers to reducing sedentary time. Participants were receptive of the co-production process.

Conclusions

Integrating co-production with the BCW can provide several benefits, with the BCW providing structure to the intervention development process, and co-production increasing the likelihood of the developed intervention being viewed as feasible by older adults. Furthermore, coding intervention components to the BCW may further our understanding of what approaches are successful or unsuccessful at influencing behavioural change. Transparent reporting of the intervention development process may benefit researchers developing interventions with older adults. Future research will pilot the co-produced intervention.
1717 Interventions to Reduce Sedentary Behaviour in Community-Dwelling Older Adults: A Mixed Method Review
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A
Published: January 2024

Introduction

Sedentary behaviour has been associated with several deleterious health outcomes and older adults are the fastest-growing and most sedentary group in society. This review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults.

Methods

This mixed-method systematic review (PROSPERO registration number: CRD42021264954) considered quantitative articles (randomised-controlled trials (RCTs) and cluster RCTs), qualitative articles (semi-structured interviews and focus groups) and mixed-method studies that explored interventions to reduce sedentary behaviour in community-dwelling older adults. Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus and PEDRO were searched from inception to March 2023. Articles were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed, qualitative evidence was thematically synthesised and both were combined in a mixed-method synthesis.

Results

Forty-one studies (15 RCTs, 21 qualitative and 5 mixed-method studies) were included. Interventions were somewhat effective at reducing sedentary time (-29.10 mins/day, 95% CI -51.74, -6.46). Three analytical themes were identified (what sitting means to older adults, expectations of ageing and social influence in older adults). The mixed-method synthesis identified that existing interventions have been limited by a recruited sample that is not representative of the wider population of older adults, and outcome measurement and intervention content that is not consistent with older adults’ priorities.

Conclusions

Future research should focus on inclusive recruitment strategies to recruit under-represented populations (such as adults aged 75 years and above), incorporate outcome measures that are valued by older adults, and incorporate older adults’ preferences in intervention content.