bluuebunny/crossref_metadata_2025_split huggingface dataset:
2236 Emergency department attendance stratified by cause and frailty status: a national cohort study of over 155 million patients
Authors: Sokhal BS , Matetić A , Protheroe J , Helliwell T , Myint PK , Paul T , Mallen C , Mamas M 
Published: August 2024

Abstract

Introduction
Data are limited on whether the causes of Emergency Department (ED) attendance and clinical outcomes vary by frailty status.

Methods
Using data from the Nationwide Emergency Department Sample, all ED attendances from 2016 to 2018 were stratified by the cause of attendance and Hospital Frailty Risk Score (HFRS) category. Logistic regression was used to determine adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of ED and overall mortality.

Results
A total of 155,497,048 ED attendances were included, of which 125,809,960 (80.9%) had a low HFRS (&lt;5), 27,205,257 (17.5%) had an intermediate HFRS (5–15) and 2,481,831 (1.6%) had a high HFRS (&gt;15). The most common cause of ED attendance in the high HFRS group was infectious diseases (43.0%), followed by cardiovascular diseases (CVD) (24.0%) and respiratory diseases (10.2%). Musculoskeletal diseases were the most common cause of admission for the low HFRS group (21.2%), followed by respiratory diseases (20.6%), and gastrointestinal diseases (18.5%). On adjusted analysis, high HFRS patients had increased overall mortality (combined ED and in-hospital) across most attendance causes, compared to their low HFRS counterparts (p &lt; 0.001). High HFRS patients with infectious diseases (aOR 23.88 95% CI 23.42–24.34), CVD (aOR 2.58 95% CI 2.55–2.61) and respiratory diseases (aOR 36.90 95% CI 36.18–37.62) had an increased risk of overall mortality, compared to their low-risk counterparts (p &lt; 0.001).

Conclusions
A significant proportion of patients attending the ED are frail, with the cause of attendance varying by frailty status. Frailty is associated with increased overall mortality across most attendance causes.
2243 Modification effect of disability profiles on the association of blood pressure and mortality among older long-term care people
Authors: Zhong Y , Feng C , Hou L , Yang M , Zhang X , Wu J , Dong B , Jia P , Yang S , Dou Q 
Published: August 2024

Abstract

Introduction
Evidence of the optimal blood pressure target for older people with disability in long-term care is limited. We aim to estimate the associations of blood pressure with all-cause and cause-specific mortality in older people with different profiles of disability.

Methods
This prospective cohort study was based on the government-led long-term care program in Chengdu, China, including 41,004 consecutive disabled adults aged ≥60 years. The association between blood pressure and mortality was analysed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.

Results
The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild–moderate disability group (Barthel index ≥40), and a reversed J-shaped in severe disability group (Barthel index &lt;40). In mild–moderate disability group, SBP &lt; 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10–1.33), compared to SBP between 135–150 mmHg. In severe disability group, SBP &lt;150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16–1.27), compared to SBP between 150–170 mmHg. The associations were robust in subgroup analyses in terms of age, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) &lt; 67 mmHg (HR 1.29, 95% CI, 1.18–1.42) in mild–moderate disability group and &lt; 79 mmHg (HR 1.15, 95% CI, 1.11–1.20) in severe disability group both demonstrated an increased all-cause mortality risk.

Conclusion
The optimal blood pressure range was higher in older long-term care people with severe disability than those with mild–moderate disability. This study provides new evidence for optimal individualised management of blood pressure in disabled older people in long-term care settings.
2239 Making frailty practice robust – using e-learning to facilitate frailty education
Authors: McKeown W , Bhatt K , Collingridge G , Gyimah C 
Published: August 2024

Abstract

Introduction
Frailty is a condition with increasing prevalence in the UK and significantly impacts the lives of those affected and their families. Frailty is a condition best managed by teams of skilled multi-disciplinary health and social care professionals (HSCPs). It is therefore essential that all HSCPs working with older people living with frailty are equipped with the appropriate knowledge and attitudes to look after affected persons.

Methods
In 2023, The British Geriatric Society (BGS) and NHS England (NHSE) collaborated to produce an online e-learning programme aligned to tier three of the NHS Skills for Health Frailty framework of core capabilities. The e-learning programme was launched in September 2023 and was made available for free to all who signed up. It contained four modules: Understanding and Communicating Frailty, Identifying Frailty, Supporting People Living with Frailty and Building Systems Fit for Frailty. Learning was provided through case-based discussions, best practice examples and input from the full range of HSCPs who now deliver frailty care.

Results
Between September 2023 and January 2024, over 4000 HSCPs registered for the online module. A wide range of HSCPs signed up for the module with nursing staff, advanced clinical practitioners, consultant geriatricians and physiotherapists, being the groups most commonly represented. 92% of those who completed the module agreed or strongly agreed that the course helped develop knowledge, understanding and confidence in frailty. 91% of those who completed the module said completion of the course would help them to further improve patient care and clinical practice. Areas identified to enhance the module further included addition of more case studies and making the resource more adaptable to all UK regions.

Conclusions
e-Learning can be an effective facilitator of frailty education for a wide range of HSCPs. Ongoing review of learner feedback should be undertaken to inform future programme updates.
2241 ‘You learn by doing, and by falling over’: a simulation-based approach to frailty, falls and fractures.
Authors: Price A , Robbins B , Hettle D , Pearson GME 
Published: August 2024

Abstract

Background
Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people, despite older people occupying two thirds of inpatient beds [1,2]. Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine [3]. We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’ and using de-escalation strategies in the management of delirium.

Methods
Using quality improvement methodology, we developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students’ ‘preparedness for F1’.

Results
Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation.

Conclusion
Our work highlights the merits of using simulation in geriatric medicine to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

References
1. Monrouxe LV, Grundy L, Mann M et al. BMJ Open. 2017;7(1). 2. British Geriatrics Society. Protecting the rights of older people to Health and Social Care [Internet] 2023. 3. Fisher JM, Walker RW. Age and Ageing. 2013 Dec 18;43(3):424–8.
2284 NHS staff experiences of racism from patients and carers: survey from a London older persons service
Authors: Parker CH , Ali S , Sampson EL , Sivapathasuntharam D 
Published: August 2024

Abstract

Introduction
There is growing awareness of the harms caused by racial abuse and discrimination from patients towards healthcare professionals, including anecdotal reports of patients ‘requesting a white doctor’ (Kline, BMJ Opinion, 2020); yet there is limited understanding of the impact in Geriatric settings. We conducted a survey in an inpatient Older Persons Service (OPS) on the prevalence, impact and actions taken in response to patient racism towards staff.

Methods
A cross-sectional survey (Total N = 47; Black and Minority Ethnic (BME) staff: N = 32; White staff: N = 15) of staff experiences of racist behaviour from patients and carers (July 2021) in a tertiary level inpatient OPS in an ethnically diverse London borough, both in terms of patients and staff, in the United Kingdom. The survey was developed in collaboration with OPS staff and the BME network. The anonymous survey was offered to all nurses, doctors, allied healthcare professionals and non-clinical staff on two 26-bed wards.

Results
Sixty-nine percent (22/32) of BME staff had personally experienced racist behaviour from older patients, while witnessing racism towards colleagues was reported by 62% (18/29) of BME staff and 80% (12/15) of White Staff. Sixty-seven percent (30/45) of respondents had witnessed a patient request a different ethnicity of healthcare professional. The majority of racist incidents went unchallenged and unreported with only 39.1% challenging the patient or carer, 21.7% reporting to a senior and 8.7% reporting via the electronic incident reporting system. The impact of such incidents on staff well-being included self-reported depression (56%, n = 11/21), anxiety about work (28%, n = 6/21) and insomnia (14%, n = 3/21).

Conclusion
With an ageing population, staff recruitment and retention in Geriatrics is critical. Comprehensive policies that have a zero-tolerance approach to racism, support staff and encourage reporting are crucial. Future research that considers the impact of mental capacity and cognitive impairment would be beneficial.
2263 Learning geriatric syndromes through case-based discussion (CBD)
Authors: Karpageshwary KS 
Published: August 2024

Abstract

Introduction
Geriatric syndromes are traditionally taught through didactic teaching and bed side tutorials. However, these do not consider the science of learning and the strategies needed for a novice learner. It is prudent to manage cognitive load, create associations through testing and enforce deliberate practice for a novice as opposed to an advanced learner. Case- Based discussions (CBD) serve as an apt tool to deliver knowledge covering geriatric syndromes; aimed at testing learner’s understanding through its application to a simulated patient profile. This pilot aimed to test the applicability of CBD to teach geriatric syndromes to novice learners.

Method
A scoping review was completed by medical officers starting on their geriatric medicine rotation in a Singapore tertiary hospital to determine syndromes which they request dedicated teaching for within curriculum. Learners ranked Incontinence and Falls with Osteoporosis management as the top 2 geriatric syndromes of interest. Focus group discussion using Rogers’s theory of diffusion principle was undertaken to understand both the advantages and challenges of CBD. Clinical scenarios were curated specific to the 2 topics with learner’s completing a pre session quiz beforehand to determine their baseline knowledge. The topic specific CBD was done via zoom platform with questions applied in a graded fashion; components include that of diagnosis, evaluation, and management of select syndrome. Learners completed a post session quiz 1 week after the CBD to determine retention of knowledge.

Results
Quantitative Feedback received from the learners highlighted that more than 90% would want CBD to be implemented for other geriatric syndromes. There was an improvement in the average score obtained in post session quiz for Osteoporosis from 6.09 to 6.75. However, there was notably poor participation in the post session quiz.

Conclusion
This pilot highlights that CBD should be utilised to enhance teaching of clinical concepts in geriatric medicine.
2198 Evidence of systematic missingness in frailty data: a European cohort study
Authors: Eagleton G , Güven R , Thorsteinsdottir T , van Oppen J ,   on behalf of the European Taskforce on Geriatric Emergency Medicine
Published: August 2024

Abstract

Introduction
Emergency department (ED) frailty screening is recommended in guidelines for its potential to trigger earlier and more appropriate comprehensive evaluation and intervention for the most vulnerable patients. Post-implementation studies of the Clinical Frailty Scale (CFS) typically observe around 50% concordance with screening. Little is known regarding the characteristics of those people omitted.

Methods
The Frailty in European Emergency Departments (FEED) cohort study observed prevalence of frailty, administering the CFS to consecutive attenders over twenty-four hours. Retrospective ‘normal day’ data from two weeks prior were also collected, where sites used retrievable electronic health records. Age, sex, ethnic group, mode and time of arrival and departure, NEWS2 score, and use of resuscitation areas were recorded. CFS missingness was assessed for distribution and dependency with other variables using chi-squared tests. The frailty distributions in prospective and retrospective data were compared with the Kruskal-Wallis test.

Results
Only five of sixty-two sites collected CFS scores in retrievable electronic records. The cohorts included 368 individuals prospectively and 399 retrospectively. At these sites, 14% prospective and 55% retrospective CFS observations were missing. CFS entries were more frequently missing in people with non-white ethnic group (p = 0.007) and self-presentation (p &lt; 0.001). The distributions of CFS differed significantly (p = 0.009); on the retrospective day, no individuals were assigned CFS scores 1 or 9, and CFS scores 4 and 6 were over-represented.

Conclusion
Acknowledging the limited participation and use of snapshot data, these findings alert the presence of systematic, non-random missing data in routine CFS screening. Systematic missingness in frailty data has critical implications for research in geriatric emergency medicine, presenting real limitations in validity where studies seek to analyse routinely collected data to reach representative inferences. Screening practices and retrievability of data warrant further study and improvement.
2217 Experiences of older residents in anticipation of transitioning to a new nursing home
Authors: Yau SY , Lee YK , Pang CK , Fitzpatrick JM , Harris R , Wan MW , Chan SH 
Published: August 2024

Abstract

Introduction
Transition is potentially a stressful incident to individuals as it requires major life adjustment. Older residents living in a nursing home consider it as their last place of life. When the older residents need to be relocated to a new nursing home, they inevitably face a significant transition due to their high dependency on the physical, psychological, and social needs. There is limited empirical evidence revealing the experiences of older residents who anticipate a transition from the existing nursing home to a new nursing home, thereby hampering our understanding of their needs and limiting the health care professionals, families, and friends to provide appropriate support in such major life event. The aim of this study is to explore the experiences of older residents in anticipation of transitioning to a new nursing home.

Method
A descriptive qualitative approach was adopted. Thirty older residents who were going to be relocated from the existing nursing home to a new nursing home were recruited through purposive sampling. Semi-structured interviews, each lasted for around 30-minute, were conducted and audio-taped. Data were analysed through thematic analysis.

Results
Experiences of older residents were summarised in four themes, namely preparing for the transition, having expectations on the new living environment, worrying about changes in daily living, and valuing the support from others. In general, the older residents viewed the transition positively and perceived well-prepared for the transition. Such positive experience was mainly due to the support provided by nursing home staff and families before the transition took place.

Conclusion
The findings significantly expanded our understanding on the experiences of older residents in anticipation of transitioning to a new nursing home, which is largely absent from empirical evidence.

Acknowledgement
The work described in this paper was fully supported by Hong Kong Metropolitan University Research Grant (No. RD/2023/1.18).
2287 Residents with dementia had an increase in BMI after the introduction of an extra meal in nursing homes in Norway
Authors: Søreide H , Simonsen M , Sandvoll AM , Kleiven OT 
Published: August 2024

Abstract

Introduction
The past decade, many nursing homes in Norway have introduced an extra meal daily, with a hot lunch, and pushing dinner to later in the day. This initiative aims to reduce the long-time interval between breakfast and supper. This study examines how an extra meal affects the residents’ body mass index (BMI) at nursing homes in Norway. Research questions include how an extra meal affects BMI among residents in the dementia unit.

Method
We used a cross-sectional design to analyse data from residents over 65 years old in dementia care units. Both parametric and non-parametric statistical tests were used to evaluate changes in BMI.

Results
The results of the study show that the dementia unit experienced an increase in BMI following the introduction of an extra meal. At most, we saw a weight gain of up to 7 kg over two years among residents. Our study reveals that the introduction of an extra meal resulted in a slight increase in BMI among the residents with dementia, which does not correspond with previous studies indicating malnutrition among these residents. The dementia disease reduces functional abilities, and challenges related to mealtime behaviour, restlessness, and depression can lead to weight loss. The fact that our results show a slight increase in BMI at the dementia units may be related to these residents often being troubled with restlessness and not finding the peace to consume a full meal. By introducing an extra meal, the total food intake increases since residents still eat a little at each meal, and focusing more on accommodating each resident might have influenced the increase in BMI values.

Conclusion
The study indicates that the introduction of an extra meal has a positive effect on the BMI value of residents with dementia in nursing homes.
2350 A scoping review of guidelines and resources to promote evidence-based prescribing for older people with sensory impairment
Authors: Morrison BC , Asante E , Lennon MR , Watson MC 
Published: August 2024

Abstract

Introduction
By 2030, hearing impairment is expected to affect one in four people globally (WHO, 2022) and one in five in the UK (Hearing Link, 2023). Visual impairment is projected to impact 2.7 million people in the UK by 2030 (ONS, 2020), rising to 4 million by 2050. The prevalence of hearing and visual impairment (hereafter referred to as sensory impairment (SI)) increases with age and older people with SI often experience substantial challenges with medicine management compared with older people without SI (Alhusein, 2019). This review aimed to identify guidelines and resources for prescribing decisions for older people with sensory impairment (OPwSI).

Methods
Standard Joanna Briggs Institute [JBI] methodology (Page, 2021) for scoping reviews was used. Electronic databases were searched: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Qualitative and quantitative studies published between January 2012 and April 2023 were included. Grey literature sources, including Google and Google Scholar, were also searched. Eligible studies focused on prescribing behaviour for OPwSI (aged ≥65 years) in primary care settings. Duplicate independent screening and data extraction was undertaken and critical appraisal completed for all included studies.

Results
A total of 3590 records were identified through database searching and 10 full text articles were retrieved. Grey literature identified a further 61 records. Despite extensive searches, no studies or resources fulfilled the inclusion criteria. Several generic guidelines and resources were identified related to medicines and safe prescribing for older adults in general i.e. without specified SIs.

Conclusions
This review highlights a dearth of guidelines or other resources to support safe and effective prescribing for OPwSI. There is an urgent need to provide bespoke guidance and/or the modification of existing guidelines, to address the additional medicine-related needs of OPwSI.