bluuebunny/crossref_metadata_2025_split huggingface dataset:
471 LET’S TALK DEMENTIA
Authors: Ashraf M , Mahmood A , Honney K 
Published: June 2021

Abstract

Introduction
By 2021 over one million people will be living with dementia (1) costing the government an estimated £30bn a year (2). However, cognitive decline is often misdiagnosed or missed completely in hospital admissions, resulting in delays in detection and treatment for patients. Quick and simple screening tools such as the Abbreviated Mental Test Score (AMTS) could help provide early detection and faster treatment times for such patients. Data from Queen Elizabeth Hospital Kings Lynn showed that only 56.8% of patients over the age of 75 were being assessed for cognitive function on admission, while the national targets are set at 90%.

Methods
A multi-cycle, trust wide, quality improvement project was used to improve screening outcomes for dementia in QEHKL. A baseline measure of screening was taken by QEHKL coding department. Five PDSA (Plan Do Study Act) cycles were undertaken, implementing interventions to aid screening at each stage. Examples include improved medical clerking booklets, trust wide education and allocated ward ‘Dementia Champions’. Performance was assessed by auditors, through patient notes and discharge letters.

Results
Over a 4-month period, 432 patient notes were inspected on six medical wards. Results after interventions showed a significant rise in Dementia Screening from 58.7% to 89.8%. AMTS completion was 70.7% in September 2020 on medical wards which improved to 85.7% in November 2020. Results were collected during the COVID-19 pandemic however, COVID wards were excluded.

Conclusion
The QI project has highlighted that education and accessible tools can improve cognitive screening numbers. An important note is, due to increased pressures during the COVID pandemic it is plausible that screening rates were adversely affected. Despite this, our figures still show positive improvement. The next cycle of our project includes surgical wards and we expect by the time of presentation to have this data to show.
547 QUALITY IMPROVEMENT PROJECT IN PRESCRIBING THICKENERS POST STROKE
Authors: Abubacker S , Attia A , Alcock C 
Published: June 2021

Abstract

Introduction
One of the therapies that Speech and Language Therapy SALT) provide is a level to which fluids must be thickened to ensure a safe swallow. The thickening agent should be supplied by the hospital to the patient on discharge. This requires the thickening agent to be added to the electronic discharge letter (EDL) and, ‘To Take Out’ (TTO) medication list by ward doctors.

Method
samples of 10-20 EDLs, taken from SALT list of stroke patients between interventions. Cycle 1: SALT were initially attempting to contact the physicians responsible for writing the EDL Cycle 2: SALT kept a register of patients that they had seen the recommended thickener prescription. This list was kept in the doctor’s office. This list was mentioned in handover every morning for doctors to update EDL Cycle 3: The aforementioned list was continued, and responsibility for transfer onto EDLs was delegated to the on call Senior House Officer (SHO) Cycle 4: In addition to the above measures, custom made stickers were added to the prescription chart as an indicator to add thickener to the TTO.

Results
Cycle 1: 20% Prescribed (n = 10) Cycle 2: 78% Prescribed n = 18) Cycle 3: 93% Prescribed (n = 14) Cycle 4: 100% Prescribed (n = 10).

Conclusion
This project has built up a multidisciplinary system to a multidisciplinary problem. Through repeated cycles and system improvement, we have seen and demonstrated a collaborative effort resulting in consistent and improving results.
462 COUNSELLING IN CARE HOMES
Authors: Pybis J , Chigariro N , Bacon J 
Published: June 2021

Abstract

Introduction
Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern & Mental Health Foundation, 2006) and 40% suffer from depression (The Royal College of General Practitioners, 2014). Antidepressant prescribing has been reported to be nearly four times greater in care homes than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas, Malouf, McCleery & Dening, 2018). With two-thirds of care home residents having some form of dementia, there is a need to find alternative interventions. Talking therapies, such as counselling, may be a useful alternative.

Method
Adopting a qualitative approach using semi-structured interviews and focus groups with counsellors (N = 12) who have experience of working in this context and with care home managers (N = 3) and care teams (N = 6), this study aimed to explore the feasibility of implementing counselling in a care home setting. We explored the views of care home staff towards counselling and identify barriers to service implementation, alongside the experience of counsellors who have delivered counselling in care homes to understand what service delivery models are currently adopted. Data were analysed thematically.

Results
Findings fell under the following key themes: The funding and referral process for counselling in a care home; skills and competences required; training needs; adaptations to practice; barriers to implementing counselling in a care home.

Conclusions
It is timely to consider the role of psychological therapy in supporting the mental health of care home residents. There is a need for further research to explore a service delivery model of counselling in care homes.
484 CHANGING PRACTICES OF DECISION MAKING REGARDING DO-NOT-ATTEMPT-CARDIOPULMONARY-RESUSCITATION ORDERS AMID THE COVID-19 PANDEMIC
Authors: Connellan D , Diffley K , McCabe J , Cotter A , McGinty T , Sheehan G , Ryan K , Cullen W , Lambert J , Callaly E , Kyne L 
Published: June 2021

Abstract

Introduction
The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation into focus. This study aims to analyse Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic.

Methods
This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31 s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period. Pre-COVID-19 pandemic DNACPR documentation rates were also examined. Factors associated with DNACPR order instatement during the first wave of the COVID-19 pandemic were identified.

Results
Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. 50% of DNAR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of 131 patients aged 65 years or over within the cohort admitted with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 patients ≥65 without COVID-19 (p &lt; 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p &lt; 0.0001). Independent associations with DNACPR order documentation included increasing age (Odds Ratio [O.R.] 1.12; 95% CI 1.05-1.21); nursing home resident status (O.R. 3.57; 95% CI 1.02-12.50); frailty (O.R. 3.34; 95% CI 1.16-9.61) and chronic renal impairment (O.R. 5.49; 1.34-22.47). The case-fatality-rate of older patients with COVID-19 was 29.8% versus 5.4% without COVID-19. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived.

Conclusion
The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain clinical practice despite the pandemic.
527 FRAILTY AND MULTIMORBIDITY IN TYPE 2 DIABETES: A UK BIOBANK ANALYSIS
Authors: Hanlon P , Jani B D , Butterly E , Nicholl B , Lewsey J , McAllister D A , Mair F S 
Published: June 2021

Abstract

Introduction
Frailty and multimorbidity are common in type 2 diabetes (T2D), including people &lt;65 years. Guidelines recommend adjustment of treatment targets in people with frailty or multimorbidity, however guidelines do not differentiate these two related states. It is unclear how recommendations to adjust treatment targets in people with frailty or multimorbidity should be applied to different ages. It is also not known if the relationship between HbA1c and outcomes is similar in people with and without frailty. We assess implications of frailty/multimorbidity in middle/older-aged people with T2D.

Methods
Analysis of UK Biobank participants (n = 20,566) with T2D aged 40-72 years comparing two frailty measures (frailty phenotype and frailty index) and two multimorbidity measures (Charlson comorbidity index and a simply count of 40 long-term conditions (LTCs)). Outomes: mortality (all-cause, cardiovascular- and cancer-related mortality), Major Adverse Cardiovascular Event (MACE), hospitalization with hypoglycaemia or fall/fracture.

Results
Measure choice influenced the population identified: 42% of participants were identified as frail/multimorbid by at least one measure; only 2.2% were identified by all four measures. Both frailty and multimorbidity, by all measures, were prevalent throughout the age range studied. Each measure was associated with mortality, MACE, hypoglycaemia and falls. The absolute 5-year mortality risk was higher in older versus younger participants with a given level of frailty (e.g. 1.9%, and 9.9% in men aged 45 and 65, respectively, using frailty phenotype) or multimorbidity (e.g. 1.3%, and 7.8% in men with 4 LTCs aged 45 and 65, respectively). Using frailty phenotype, the relationship between higher HbA1c and mortality was stronger in frail compared with pre-frail or robust participants.

Conclusion
Assessment of frailty/multimorbidity should be embedded within routine management of middle-aged and older people with T2D. Method of identification as well as features such as age impact baseline risk and should influence clinical decisions (e.g. glycaemic control).
536 NEGOTIATING INDIVIDUALLY TAILORED URGENT CARE PLANS FOR OLDER PEOPLE IN AMBULATORY EMERGENCY CARE
Authors: Mckelvie S 
Published: June 2021

Abstract

Introduction
Ambulatory emergency care (AEC) provides hospital-equivalent medical care in out-of-hospital settings for acutely unwell complex older patients. This ethnography aimed to understand the cognitive work of the senior clinicians in the AEC environment.

Methods
Three AEC sites were purposively sampled to recruit twelve clinicians with backgrounds in Geriatrics, General Practice, Emergency and Acute Medicine. This qualitative investigation used focused ethnography within a case study approach to understand the decision-making processes in the context of the AEC environment. Participant-observation during an AEC shift was complemented by informant interviews. A framework approach to thematic analysis used a priori and data derived codes to develop explanatory themes. Ethnographic principles of constant comparison and cognitive task analysis were used to evaluate the clinicians’ decision-making processes for index patient cases.

Results
This ethnographic case study showed that AEC clinicians tailored their management plans to the individual patient based on their clinical assessment and needs, using creative problem solving and reflexivity. The AEC clinicians personalised their interventions based on the patient assessment, the patients’ wishes and disease severity. The individual tailoring of the AEC plan was negotiated with the patient, their next-of-kin and the multidisciplinary team (MDT). The discussions with patient and families allowed discussion of the differing priorities and facilitated compromise. AEC plans were also negotiated with the MDT to build a shared understanding of the patients’ needs. The MDT also provided cognitive and emotional support by challenging and validating the senior decision-makers clinical plans.

Conclusion
This tailored approach allowed the flexible delivery of AEC to meet the patients’ needs. It is hoped that by characterising the work of AEC clinician that this study will aid the development of medical training curricula, interdisciplinary working and health service design. Further research is needed on team-based decision-making for individually tailored care in urgent care settings.
454 ASSOCIATION BETWEEN STATINS AND MAJOR ADVERSE CARDIAC EVENTS AMONG OLDER ADULTS WITH FRAILTY: A SYSTEMATIC REVIEW
Authors: Hale M , Zaman H , Mehdizadeh D , Todd O , Callaghan H , Gale C P , Clegg A 
Published: June 2021

Abstract

Background
Statins reduce the risk of major adverse cardiovascular events (MACE), however, their clinical benefit for primary and secondary prevention among older adults with frailty is uncertain. This review investigates whether statins prescribed for primary and secondary prevention are associated with reduced MACE among adults aged ≥65 years with frailty.

Methods
Systematic review of studies published between 01.01.1952 and 01.01.2019 in MEDLINE, Embase, Scopus, Web of Science, Cochrane Library and the International Pharmaceutical Abstracts. Studies that investigated the effect of statins on MACE among adults ≥65 years with a validated frailty assessment were included. Data were extracted from the papers as per a pre-published protocol, PROSPERO: CRD42019127486. Risk of bias was assessed using the Cochrane Risk of Bias in non-randomised studies of interventions.

Finding
18794 abstracts were identified for screening. From these, six cohort studies fulfilled the inclusion criteria. There were no randomised clinical trials. Of studies involving statins for primary and secondary prevention (n = 6), one found statins were associated with reduced mortality (hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.37–0.93) and another found they were not (p = 0.73). One study of statins used for secondary prevention found they were associated with reduced mortality (HR 0.28, 95%CI 0.21–0.39). No studies investigated the effect of statins for primary prevention or the effect of statins on the frequency of MACE.

Discussion
This review summarizes the existing available evidence for decision making for statin prescribing for older adults with frailty. This study identified only observational evidence that, among older people with frailty, statins are associated with reduced mortality when prescribed for secondary prevention, and an absence of evidence evaluating statin therapy for primary prevention. The findings of this study highlight that randomised trial data are urgently needed to better inform the use of statins among older adults living with frailty.
488 GRIP STRENGTH FROM MIDLIFE AS AN INDICATOR OF LATER-LIFE COGNITION AND BRAIN HEALTH: EVIDENCE FROM A BRITISH BIRTH COHORT
Authors: Dercon Q , Nicholas J , James S-N , Schott J , Richards M 
Published: June 2021

Abstract

Introduction
Grip strength is an objective measure of physical function with potential predictive value for health in ageing populations. We aimed to assess whether levels and changes in grip strength from midlife predicted later-life brain health and cognition.

Methods
446 participants in an ongoing British birth cohort study, the MRC National Survey of Health and Development (NSHD), had their maximum grip strength measured at ages 53, 60–64, and 69, and underwent neuroimaging as part of its neuroscience sub-study, Insight 46, at 69–71. A group-based trajectory model identified latent groups of individuals in the whole NSHD cohort with below- and above-average grip strength over time, plus a reference group. Trajectory group membership, plus standardised grip strength levels and change from age 53, were each related to MRI-derived measures of whole-brain volume (WBV) and white-matter hyperintensity volume (WMHV), plus several cognitive tests. Models were adjusted for sex, body size, head size (where appropriate), sociodemographics, and behavioural and vascular risk factors.

Results
Consistently below-average grip strength from midlife was associated with lower WBV and non-verbal reasoning ability at age 69–71 (e.g. low group WBV vs. reference group β = −13.38 cm^3; 95% CI = (−24.12 cm^3, −2.64 cm^3); p = 0.015). There was some accompanying evidence that above-average maximum grip strength showed a positive association with WBV, which was more pronounced in female participants (high group female WBV vs. reference group β = 18.30 cm^3; 95% CI = (1.34 cm^3, 35.29 cm^3); p = 0.034). Steeper than average declines in grip strength between 53 and 69 were additionally weakly associated with an estimated 10% higher WMHV at age 69–71 (β = 1.10, 95% CI = (1.00, 1.22); p = 0.053).

Conclusion
This study provides preliminary evidence that tests of maximum grip strength may have value in predicting brain health. Future work should assess how these observed differences relate to later-life negative health outcomes, and whether changes in grip strength reflect concurrent changes in brain structure and connectivity.
495 CONVERSATIONS ON LIVING & DYING: AN INTERVENTION TO INCREASE COGNITIVELY-ABLE, COMMUNITY-BASED FRAIL ELDERS’ ENGAGEMENT WITH ACP
Authors: Combes S , Gillett K , Norton C , Nicholson C J 
Published: June 2021

Abstract

Introduction
Advance care planning (ACP) can support person-centred end-of-life care by helping individuals articulate their end-of-life preferences. Frail elders’ vulnerability to deterioration makes ACP engagement particularly relevant; however, their engagement with ACP is uncommon. This study aimed to develop an intervention to increase ACP engagement with cognitively-able, community-dwelling frail elders.

Methods
Multiple methods were used to establish ACP barriers and facilitators: a systematic integrative review, modified e-Delphi survey (multidisciplinary health and social care professionals (H&SCPs) n = 73), and semi-structured interviews (frail elders n = 10, family members n = 8). A conceptual model, developed from the integrative review, underpinned data collection for the e-Delphi and interviews. Triangulation, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change and decide intervention content and implementation. The intervention was developed using behavioural change theory. Prototype refinement consisted of pre and post questionnaires, use of the intervention in practice, and focus groups (H&SCPs n = 26).

Results
The prototype intervention consists of a 3.5-hour training and education session for H&SCPs, supported by a toolkit. The intervention focuses on the relevance and experience of ACP for frail elders and ACP strategies H&SCP can use to encourage frail elders’ ACP engagement. Strategies include recognising the importance of decision-making in relationships and living well now, starting early, using an honest but gentle approach, and helping frail elders prepare for ACP conversations. Participants report that the intervention helps them think differently about ACP and encourages them to engage frail elders with ACP.

Conclusions
To our knowledge this is the first intervention underpinned by behaviour theory that focuses on supporting H&SCPs to engage community-dwelling, cognitively-able frail elders with ACP. Refinements, such as additions to the toolkit, have been suggested. However, H&SCPs appear to find the intervention acceptable, feasible, engaging, and useful in their practice.
496 NON-RANDOMISED FEASIBILITY STUDY OF THE REHABILITATION POTENTIAL ASSESSMENT TOOL (REPAT) IN FRAIL OLDER PEOPLE IN ACUTE SETTING
Authors: Cowley A , Goldberg S E , Gordon A L , Logan P A 
Published: June 2021

Abstract

Introduction
Clinicians are often required to decide about patients’ potential to respond to rehabilitation. ‘Rehabilitation potential’ can determine what services patients can access. In acute hospitals clinicians have limited time to assess and deliver rehabilitation which takes into account the complexities of frailty and ageing. We set out to evaluate whether the Rehabilitation Potential Assessment Tool (RePAT)—a 15 item assessment tool and training package which emphasises person-centred approaches—was feasible and could aid rehabilitation decisions.

Method
A non-randomised feasibility study with nested semi-structured interviews, set in the acute hospital, explored whether RePAT was deliverable and acceptable to staff, patient and carers. A maximum variation sample of physiotherapists and occupational therapists was recruited. Patient and carer participants were recruited from Healthcare of Older People wards. Staff and patient characteristics were summarised using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed on how closely they matched tool guidance by two reviewers. Mean values of the two scores were calculated.

Results
Six staff participants were recruited and trained, and assessed a total of 26 patient participants using RePAT. Mean patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean time to complete RePAT was 32.7 (±9.6) minutes. 13 out of 15 RePAT items achieved fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider the complex and dynamic nature of rehabilitation decisions in a more structured and consistent way.

Conclusion
RePAT was found to be acceptable and tolerated by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation potential decision-making and encouraged them to become more cognisant of ethical dilemmas and biases.