bluuebunny/crossref_metadata_2025_split huggingface dataset:
534 ADVANCED COMMUNICATION SKILLS: TEACHING DURING A PANDEMIC
Authors: Pedersen A , Greenhalgh M , Tan M , Terry R , Royle C , Royles K 
Published: June 2021

Abstract

Introduction
In the first wave of the COVID-19 pandemic, it was recognised there would be an increased demand on clinicians to provide patients and relatives with bad news. The national ban on hospital visiting rapidly changed the way in which this news would be delivered. In recognition of these new challenges, our team sought to design a teaching course that could be implemented quickly and cost effectively, with the aim of improving clinician’s confidence around these difficult skills.

Methods
A teaching programme was created using senior geriatric and palliative care clinicians as simulated patients, open to any grade and speciality. Learners were required to break bad news (BBN) without any visual feedback, to simulate skills required when using the telephone. Surveys were collected to determine self–assessed confidence across four domains (Table 1) before, immediately after and 4–20 weeks after the course. Participants were asked to rank their confidence for each skill on a 5 point scale with 1 being very unsure and 5 being very confident.

Results
Pre-teaching scores showed an average of 3 (neither confident nor unsure) across all domains. After the course all domains improved, most notably around discussing end of life (EoL) care and discussing information over the phone.

Conclusion
This project has highlighted a lack of confidence across all skill levels when it comes to BBN. This confidence is easily improved by a short, cost-effective teaching course. It remains to be seen if this improved confidence translates to better communication with relatives.
548 FRAILTY ANALYSIS ACROSS POPULATIONS: THE USE OF THE HOSPITAL FRAILTY RISK SCORE IN SPECIALISED SERVICES USING NHS NATIONAL DATA
Authors: Imam T , Konstant-Hambling R , Fluck R , Hall N , Palmer J , Conroy S 
Published: June 2021

Abstract

Introduction
Frailty is increasingly used to risk stratify older people, but across specialised services there is no standardised approach. The aim of this study was to answer the question posed by NHS England to assess frailty could be measured and related to outcomes across Specialsed Services. The Hospital Frailty Risk Score (HFRS) was used and the data published in Age and Ageing in 2020.

Method
A retrospective cohort study was performed using the Secondary Uses Service (SUS) electronic database for people aged 75 or older admitted between April 2017 and March 2018. Based on HFRS, the populations were risk stratified into mild, moderate and severe frailty risk. The relationships with length of stay, readmission rate, mortality and some selected condition specific treatment complications were quantified using descriptive statistics.

Results
Frailty was differentially distributed across the specialties; around one-third had mild frailty; another third had moderate frailty and one-quarter severe frailty. Increasing frailty risk was associated with increased length of stay for the index admission, more days in hospital in the year following intervention and increased risk of dying in hospital. Severe frailty was a powerful discriminator of the risk of death; between 25 and 40% of those with severe frailty risk died at 30 months across all specialties.

Conclusions
This study demonstrates the first application of the HFRS to a national dataset to describe service outcomes and mortality for older people undergoing a range of specialised interventions. This information was used to identify those that might benefit from holistic assessment, aid prognostication, commissioning and service planning. It informed the promotion of quality improvement work in this area via the Specialised Clinical Frailty Network. By implementing the HFRS, changes in outcomes can be plotted across years to assess improvements, performance and benchmarking.
426 PREVALENCE OF, AND RISK FACTORS FOR, DEMENTIA IN ADULT OUTPATIENT REFERRALS TO A REGIONAL REFERRAL HOSPITAL IN ARUSHA, TANZANIA
Authors: Roe C , Safic S , Mwaipopo L , Dotchin C , Klaptocz J , Gray K , Joseph M , Walker R 
Published: June 2021

Abstract

Introduction
The global burden of dementia is increasing, with the greatest increase predicted to occur in sub-Saharan Africa (SSA). Despite this there are limited previous data on the prevalence of, and risk factors for, dementia in SSA. This study aimed to estimate the prevalence of dementia, and investigate its associations, in those aged 60 years and older attending the outpatient department of Mount Meru Hospital in northern Tanzania. This is the first hospital-based outpatient dementia prevalence and risk factors study to be conducted in an east African population.

Methods
This was a one-phase cross-sectional study. Adults aged 60 years and over attending medical outpatients were screened for dementia using The Identification and Intervention for Dementia in Elderly Africans cognitive screening tool. Those who scored ≤9 were clinically assessed using the DSM-IV criteria. Demographic, medical comorbidity and lifestyle information were collected during a clinical assessment.

Results
Prevalence of dementia was 5.0% (95% confidence interval: 3.7–6.3). Binary logistic regression found female sex (odds ratio (OR) = 2.778), having no formal education (OR = 6.088), quantity of alcohol consumption (units/week) (OR = 1.080), uncorrected visual impairment (OR = 4.260), body mass index &lt;18.5 kg/m2 (OR = 6.588) and stroke (OR = 15.790 with wide 95% confidence interval (3.48–74.475)) to be significantly, independently associated with dementia.

Conclusions
The prevalence of dementia in this population is lower than previously reported community-based rates in Tanzania, and similar to those in high-income countries. This is the first time the association between uncorrected visual impairment and dementia has been reported in SSA. Other associations identified are in keeping with previous literature. Further research on the management of dementia and its risk factors, and the support and education of carers and patients in east African populations is required.
451 THE BEST MARKER FOR COGNITION—RELATIVE HANDGRIP STRENGTH, ASYMMETRY OR WEAKNESS?
Authors: Ho V , Chen C , Merchant R A 
Published: June 2021

Abstract

Introduction
Handgrip strength (HGS) is increasingly used to estimate overall muscle strength. Association between low HGS and cognitive decline has been well documented. Recently, McGrath’s team elucidated a new dimension of HGS asymmetry with important implications on physical and cognitive limitations. It is unclear if these effects can be generalised. The Asian working group for sarcopenia (AWGS) has called for ‘special considerations’ due to ‘anthropometric and cultural or lifestyle-related differences’6. Hence, we aim to investigate if HGS asymmetry is associated with cognition in Asians.

Methodology
We defined sarcopenia by AWGS consensus: HGS &lt;28 kg for men; &lt;18 kg for women. Asymmetry was HGS &gt;10% stronger on either hand; relative HGS was HGS adjusted for BMI. Low cognitive function was defined as MMSE&lt;26. We compared weakness alone, any HGS asymmetry or relative HGS alone and combination of weakness and HGS asymmetry or relative HGS asymmetry. Each model was adjusted for demographic characteristics, hand dominance, obesity, frailty, physical activity, depression and perceived health status.

Results
738 Asian subjects participated. Mean age 70.8 ± 0.2 years, 45.1% males, 82.5% Chinese. More than 50% have multimorbidity. 5.4% were frail. Mean BMI 24.4 ± 0.1 kg/m2. Mean HGS 22.6 ± 0.3. 93 (12.7%) had symmetrical HGS and not weak, 59 (7.8%) asymmetrical and not weak, 321 (43.6%) symmetrical and weak, 265 (35.9%) asymmetrical and weak. Mean MMSE scores for weakness alone, asymmetry alone and combined weakness and asymmetry are 26.6 ± 0.1, 26.8 ± 0.2 and 26.5 ± 0.2 respectively. HGS asymmetry alone was not associated with better cognitive function OR 0.66 (95%CI: 0.30–1.44). Combined asymmetry and weakness was non-significantly linked to worse cognition OR 2.14 (95%CI: 0.79–5.82). We found relative HGS to be protective for cognitive decline, OR 0.31 (95%CI: 0.12–0.78, p = 0.012).

Conclusion
Our study highlights the impact of ethnicity in sarcopenia research. Our population shows association of relative HGS with cognition. Further longitudinal studies are needed.
514 FRAILTY IN OSTEOARTHRITIS AND THE INFLUENCE OF CO-MORBIDITY
Authors: Cook M J , Verstappen S M M , Lunt M , O’Neill T W 
Published: June 2021

Abstract

Introduction
Risk factors for frailty, including low physical activity and chronic pain, are common among people with osteoarthritis. The aim of this analysis was to determine the association between osteoarthritis and frailty and to determine whether comorbidities interact additively with OA to increase the likelihood of frailty.

Methods
Men and women aged 40-69 years who contributed to the UK Biobank were analysed. Data about self-reported physician-diagnosed diseases was collected, as well physical measurements, including hand-grip strength. Frailty (robust, pre-frail, frail) was assessed using a modified frailty phenotype, comprising five components: low grip strength, slow walking speed, weight loss, low physical activity, and exhaustion. The association between osteoarthritis and the frailty phenotype was determined using negative binomial regression, adjusting for age, sex, body mass index, smoking status, and Townsend deprivation score. We calculated the attributable proportion of risk of frailty due to additive interaction between osteoarthritis and common co-morbidities (cardiovascular disease, diabetes, COPD, and depression).

Results
457,561 people were included, 35,884 (7.8%) had osteoarthritis. The adjusted relative risk ratio (95% CI) for pre-frailty and frailty (versus robust), respectively was higher among people with (versus without) osteoarthritis: 1.58 (1.54, 1.62) and 3.41 (3.26, 3.56). There was significant additive interaction between the presence of osteoarthritis and each of the co-morbidities considered in increasing risk of frailty, particularly diabetes (attributable proportion of risk due to additive interaction with osteoarthritis (95% CI)), 0.49 (0.42, 0.55), coronary heart disease 0.48 (0.41, 0.55), and depression 0.47 (0.41, 0.53).

Conclusions
Our results suggest that people with OA are at increased risk of pre-frailty and frailty. The mechanisms are not fully understood, though co-morbidity appears to contribute to the risk of frailty beyond the expected additivity of risk due to OA and co-morbidity. Early diagnosis and optimal management of co-morbidities in people with OA may be beneficial.
529 ASSESSING DISCOMFORT AND DISTRESS IN OLDER INPATIENTS WITH DEMENTIA
Authors: West E , Sampson E L , Davies N 
Published: June 2021

Abstract

Introduction
Up to 42% of acute hospital inpatients have dementia. This can make it more difficult for patients to communicate their needs, this in turn may lead to distress and agitation. The aim of this study is to explore the prevalence of distress and discomfort in inpatients with dementia in acute hospitals who may not be able to communicate their needs.

Methods
A series of existing clinical and observational methods were used to measure various aspects of the experience of hospitalised in patients with dementia, and staff working with these patients on wards. These measures looked to identify sources of discomfort, observe the effect of the environment, understand how staff currently identify discomfort and explore associations with behaviours that challenge.

Results
94 patients and their next of kin have been approached; 79 consented to being included in the study, and 67 have been fully assessed. Almost 20% of patients assessed have severe psychiatric problems. ~70% of patients were severely disoriented at assessment. Patients assessed were often sleepy (62%), hadn’t moved for a long period of time (48%) and reported agitation (60%), anxiety (60%) and depression (70%). Staff reported agitation and aggression in 56% of patients, with high frequencies of incidents per patient.

Conclusions
Signs of distress and agitation are common in hospitalised persons with dementia. Patients are often disoriented, which impedes communication of needs. This also has a high burden on staff, as many behavioural and psychiatric symptoms of dementia are experienced daily on wards.
433 SAME SPECIALITY, DIFFERENT REALITY?
Authors: Gomez A , Capon-Saez A , Gomez-Mosquera A , Parada-DeFreitas Y , Arechaderra-Calderon J J , Hoyos E , Jackson H , Ramon-Espinoza F , Vilches-Moraga A 
Published: June 2021

Abstract

Introduction
The United Kingdom and Spain run government-funded social and health care services, free for the user at the point of delivery. Acute Geriatric Units (AGU) carrying out Comprehensive Geriatric Assessments improve the clinical outcomes of older patients. Little is known about the similarities and differences between countries, and how these may impact on clinical outcomes.

Methods
Prospective observational study of consecutive patients admitted to AGU of 2 hospitals in the UK and 4 hospitals in Spain between the 1st to the 30th of October 2019 and from the 1st to the 29th of February 2020. We followed up the patients for a 90 day period.

Conclusions
Frailty, multimorbidity and polypharmacy were prevalent in both cohorts. English patients were younger, with shorter hospital stay, mortality and use of antipsychotic medication but higher readmission rates. Involvement from Allied health care professionals was higher in UK hospitals.
455 PROSPECTIVE EVALUATION OF FRAILTY IN INDIVIDUALS WITH KNEE PAIN IN MALAYSIAN ELDERS LONGITUDINAL RESEARCH (MELOR) STUDY
Authors: Chiew C L , Mat S , Hui K S , Tan M P 
Published: June 2021

Abstract

Introduction
Osteoarthritis (OA) is a major cause of physical impairment in older persons. Few studies have determined the relationship between the presence of OA and frailty. We evaluated the prospective relationship between knee pain and frailty in a Malaysian longitudinal cohort.

Method
Data from Malaysian Elders Longitudinal Research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted questionnaires and hospital-based health-checks from 2013–2015. The presence of knee pain was determined with the single question, ‘do you have pain in your knee(s)?’. Frailty status was determined at follow-up in 2019 using SARC-F.

Results
Data from 1,226 individuals, mean age (SD) = 68.97 (7.48), range = 54–97 years and 56.6% women at baseline, were included. 408 (33.3%) had knee pain. Individuals with knee pain were significantly more likely to be female (66.2% vs 51.8%, p &lt; 0.001). Ethnic differences existed in the presence of knee pain (Malay 43.4% vs Chinese 24.8% vs Indian 31.9%, p &lt; 0.001). Individuals with knee pain was more likely to have diabetes (40.1% vs 29.9%, p &lt; 0.001), hypertension (38.3% vs 27.0%, p &lt; 0.001), dyslipidaemia (38.4% vs 26.5%, p &lt; 0.001) and obesity (52.6% vs 30.2%, p &lt; 0.001). After adjustment for confounders, individuals with knee pain were more significantly to develop frailty at follow-up [odds ratio (95% confidence interval) =2.71(1.61–4.58)].

Conclusion
Knee pain was associated with an increased risk of frailty with 5-years follow-up in an urban population in Kuala Lumpur. More detailed evaluation using imaging and clinical diagnosis of osteoarthritis is now indicated. Future studies should also seek to identify modifiable risk factors for the development of frailty in individuals with knee OA and develop strategies to prevent frailty.
466 PREVALENCE AND IMPACT OF FRAILTY IN PATIENTS HOSPITALISED WITH COVID-19. THE SALFORD EXPERIENCE IN WAVES 1 AND 2
Authors: Khan A , Espinoza F R , Kneen T , Dafnis A , Allafi H , Carter B , Narro-Vidal M , Short R , Price A , Upton R , Vilches-Moraga A 
Published: June 2021

Abstract

Introduction
The COVID-19 pandemic has had an extensive impact on the frail older population, with significant rates of COVID-related hospital admissions and deaths amongst this vulnerable group. There is little evidence comparing the prevalence and impact of frailty amongst patients hospitalised with COVID-19 in wave 1 vs wave 2 of the pandemic.

Methods
Prospective observational study of all consecutive patients admitted to Salford Royal NHS Foundation Trust (SRFT) between 27th February and 28th of April 2020 (wave 1), and 1st October to 10th November 2020 (wave 2) with a diagnosis of COVID-19. The primary endpoint was in-hospital mortality. Patient demographics, co-morbidities, biochemical parameters, and frailty (using the Clinical Frailty Scale, score 1–4 = not frail, score 5–9 = frail) were collected. A Cox proportional hazards model associating wave and frailty with mortality was used. A logistic regression model was used to associate patient characteristics with wave. Both models adjusted for patient characteristics.

Results
A total of 700 patients were included (N = 429, wave 1; N = 271, wave 2). In wave 1, 42% (N = 180) were female; median age was 72; 37% (N = 160) were non-survivors, 49% (N = 212) were frail (CFS 5–9). In wave 2, 38% (N = 104) were female; median age was 73; 30% (N = 80) were non-survivors, 39% (N = 106) were frail. There was a reduction in mortality in wave 2, aHR = 0.71 (95% CI 0.53–0.94). Frailty was associated with increased mortality, after adjustment for age, wave and other patient characteristics. Patients were more frail in wave 1, and the effect of frailty was more pronounced in wave 1 vs wave 2.

Conclusion
Frailty is highly prevalent amongst patients of all ages admitted to SRFT with COVID-19. Higher scores of frailty are associated with increased mortality.
483 IMPROVING THE PROVISION OF REGIONAL GERIATRIC MEDICINE TEACHING DURING THE COVID-19 PANDEMIC
Authors: Smith N , Owen C , Mankelow T 
Published: June 2021

Abstract

Introduction
In Wessex Deanery, prior to the COVID-19 pandemic, Geriatric Medicine trainees from 10 NHS trusts attended face-to-face regional teaching sessions. In response to the pandemic, this teaching was suspended to reduce disruption in service provision and support social distancing. There was a clear need to reintroduce teaching for continued professional development and trainee progression.

Methods
In July 2020, Geriatric Medicine trainees in Wessex completed a questionnaire survey to identify their desire for socially distanced teaching and an acceptable format for delivery. Two half-day pilot teaching sessions via MS Teams were organised in September and October 2020. Trainees provided feedback via a questionnaire survey about the relevance and quality of teaching, and to identify any barriers to attendance. Subsequently, a monthly full-day virtual teaching programme was implemented. We reported reflections of our experiences on our trainee website to support future sessions.

Results
All trainees (n = 15) were eager for regional teaching to recommence through socially distanced education. Trainees had a preference for MS Teams, which can support interactive teaching. Attendance to the pilot sessions exceeded previous face-to-face sessions. 19 trainees attended the first session; 17 provided feedback. 28 trainees attended the second session; 12 provided feedback. Feedback was overwhelmingly positive; all reported the sessions were interesting and 82% (n = 14) that they would lead to changes in their practice. Some trainees expressed that full-day sessions would enhance curriculum coverage. 94% (n = 16) were positive of the virtual platform; it reduced travel and sessions could be recorded. Local trainees attended the second session in-person, which enhanced interactivity.

Conclusion
Virtual teaching has been successful in Wessex Deanery, with high attendance and positive feedback. Trainees can engage remotely without the need for travel and disruption. After the pandemic we hope to develop a regional teaching programme integrating virtual and face-to-face sessions to improve attendance and accessibility.
499 DEVELOPING A NOVEL TEACHING PROGRAMME FOR PHYSICIAN ASSOCIATE STUDENTS WITHIN ELDERLY MEDICINE
Authors: Mottaghi-Taromsari S , Wileman L 
Published: June 2021

Abstract

Introduction
The Physician Associate course has been running in the North West since 2016. As such, the format and layout of clinical placements for its students are still in their relative infancy. First year students, similar to third year medical students, begin clinical placement after an intensive lecture series at the University. Placements at Wythenshawe hospital typically involved an initial and closing meeting with their supervisor with little teaching activity organised specifically for them. We therefore set out to devise a formal teaching programme within their elderly care attachment to better address their learning needs.

Methods
We devised a programme for the placement involving a formal induction, orientation and then rotation through different elements of the elderly medicine faculty. The students spent 4 weeks in total in 3 different clinical areas to obtain different experiences. Formal teaching was arranged once per week with a clinician to cover topics relevant to geriatrics and general medicine. Feedback forms were used to assess the students’ views on the quality of the induction and teaching. A pre-placement questionnaire was used at the start to assess understanding of frailty and confidence with assessing falls. This was then repeated at the end of the placement to evaluate progression.

Results
From the initial pilot involving 3 cohorts (10 students total), 90% of the students rated the placement positively as a learning opportunity with 100% commending the organisation and structure of the programme. 100% of students rated the content and delivery as good for the organised teaching sessions. Understanding of frailty and confidence in assessing falls also saw marked improvements over the course of the placement.

Conclusion
We have demonstrated how a better structured teaching programme is valued by the physician associate students and will now proceed to develop and expand this model in elderly medicine and beyond.
502 OUTCOMES OF HOSPITALISED PATIENTS WITH COVID-19 SIX MONTHS AFTER INDEX ADMISSION
Authors: Tullo E , Dotchin C , Jaiswal S 
Published: June 2021

Abstract

Introduction
Early outcomes for hospitalised patients with covid-19, including admissions to critical care and mortality have been widely published. Less is known about the longer-term patient outcomes such as readmissions, deaths after discharge and level of care required on discharge.

Methods
Following an audit of 360 consecutive admissions of patients with covid-19 requiring level 1 inpatient care in spring 2020, we collated data about mortality, readmissions, and residential status for the same cohort at six months after index admission.

Results
The cohort had a median age of 78: 70% survived to discharge. Median length of stay was nine days (range 1–90). Of 252 patients discharged, a further 35 (14%) had died by six-month follow-up. 95 patients (38%) required at least one further hospital admission in the following six-month period. 40 (16%) of discharged patient required increased support, defined as new or increased package of care or an alternative interim or permanent change of residence. (Table 1). Table 1 emailed separately as will not transfer into this space Of the 40 patients requiring increased support on discharge, 7 (18%) died, 15 (38%) returned to their preadmission residential status, and 17 (43%) still required increased support.

Conclusions
Covid-19 has a high mortality rate in those admitted to hospital. Patients receiving level 1 care in hospital and surviving to discharge have a high risk of readmission or death in the following six-months. For those requiring increased support on discharge, the majority do not return to their pre-admission residential status.