bluuebunny/crossref_metadata_2025_split huggingface dataset:
2251 Geriatric medicine competencies required by all hospital doctors caring for older adults: a scoping review
Authors: Buckley E , Bennett D , Barrett A , O'Tuathaigh C , Cooke J 
Published: August 2024

Abstract

Introduction
An ageing population globally has created an escalating demand for age-attuned healthcare services. Most older adults will continue to receive their medical care from doctors without specialised geriatric medicine training. It is important therefore that all doctors possess fundamental gerontological competencies. Which specific competencies and how they might best be integrated into medical education remain unclear. Our aim was to summarise the literature on the geriatric medical competencies required by all doctors caring for older adults.

Methods
We undertook a scoping review following Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). We systematically searched the electronic databases PubMed, Cochrane, Cinahl, PsycInfo, ERIC and Embase for eligible records from January 2012 to December 2022. Studies related to physician or doctor or resident and competencies or curriculum or education and geriatric medicine or gerontology were included. We also searched the websites of included countries’ medical specialty professional bodies for relevant competency frameworks.

Results
Eighty-seven sources were included in the review. The most common competencies identified were medication management, recognition and management of cognitive impairment and management of chronic disease and co-morbidities. Considerable heterogeneity existed among the remaining competencies identified including interprofessional communication skills, advanced care planning and discharge planning. Competencies addressing subspecialty areas including stroke, orthogeriatrics, movement disorders were less prominent.

Conclusion
Multiple attempts to create and implement competency frameworks on local, national, and international levels in addition to educational interventions to address competency gaps locally reflect the wide-ranging challenges faced by healthcare systems in caring for an ageing population. Significant variation in competencies exists among the sources included in this scoping review. An overarching competency framework is now necessary to define the required competencies for all hospital doctors caring for older adults.
2344 The British geriatrics Society’s training programme director survey 2023: a summary of our findings
Authors: True S , Koh A , Arora A 
Published: August 2024

Abstract

Introduction
As we strive to generate more geriatricians we must understand the journey of the training programme. Whilst information is available from the RCP census and BGS workforce survey this study will compliment that data and obtain a broader picture. A similar survey was last undertaken by the BGS in 2019 and since that time much has changed, from a pandemic to the first published NHS Long term workforce plan.

Method
TPDs were contacted directly by the BGS VP for workforce at the geriatric medicine specialty advisory committee and invited to complete an electronic survey. The survey had been designed by the BGS workforce committee in line with the BGS strategic plan to strengthen the workforce for older people. The survey was open for 6 weeks.

Results
Surveys were returned from 14 out of 19 deaneries, some were incomplete. National training numbers have increased since the 2019 survey, in total and with less vacancies. Six trainees had left the training programme in 2023 before obtaining CCT for various reasons. The percentage of trainees working less than full time has doubled from 21.9% in 2019 to 44.8%, the majority for parenting responsibilities. Most deaneries reported at least one trainee spending time out of programme, the majority pursuing additional experience directly related to the curriculum such as stroke. Qualitative data suggested solutions to increasing national training numbers and encouraging doctors to consider the specialty early in their career.

Conclusions
This study was limited by incomplete data, a mixture of non and partial responses. What this study adds is an insight into the paths to becoming a geriatrician and solutions TPDs have found to supporting individual needs. These solutions can now be shared to help our members tend to the workforce crisis by successfully recruiting, training and retaining the geriatricians of the future.
2238 How can effective teaching about dementia be integrated into the undergraduate medical curriculum? A realist review
Authors: Tullo E , Wakeling L , Pearse R , Khoo TK , Teordorczuk A 
Published: August 2024

Abstract

Introduction
The prevalence of dementia is increasing and yet healthcare professionals (HCP) do not always have sufficient education and training to deliver optimal care for patients with dementia (PWD). There is an evidence base as to how to deliver effective undergraduate education about dementia but this is infrequently integrated into the medical curriculum.

Methods
We undertook a realist synthesis to review the barriers to integrating effective interventions on dementia into the medical curriculum. A realist synthesis differs from a traditional systematic review in terms of explaining how interventions might succeed (or not) in a particular context, involving iterative cycles of literature review and synthesis to develop and refine a ‘programme theory’ (PT).

Results
We analysed and synthesised twenty relevant studies of undergraduate educational interventions on dementia to identify common themes. We constructed an ‘initial programme theory’ (IPT) to illustrate the contexts where teaching on dementia occurs and outline four main categories of barriers to curriculum integration: culture, concern for patient welfare, student attitudes, and logistics.

Conclusion
We have identified key barriers to implementation of undergraduate education about dementia, and potential mechanisms to overcome them. The next stage of our realist synthesis is to gather stakeholder feedback on the validity of the IPT before returning to the next cycle of literature review to refine and finalise our PT. This model will serve as a guide for those aiming to successfully integrate effective education about dementia into the medical curriculum.
2214 Using poisons Centre data to identify potential safety risks associated with the use of monitored dosage systems.
Authors: Price H , Edwards E , Thomas C , Gray L 
Published: August 2024

Abstract

Introduction
Monitored dosage systems (MDS) encompass a wide range of devices to help management of medication. This research uses poison centre data to explore risks associated with their use.

Method
A search of accidental overdose enquiries to the UK National Poisons Information Service (NPIS) between 1/01/2017–31/12/22, classified as ‘therapeutic error/medical error’ involving patients aged 65 or over was performed. Enquiries involving an MDS were identified. Data were analysed using descriptive statistics and chi-square test.

Results
There were 394 enquiries concerning 393 patients and mean patient age was 81 years. There were significantly more females (n = 266) than males (n = 127), p = &lt;0.0001. Exposures occurred at home (n = 372), in care homes (n = 18), in prisons (n = 2) and in hospital (n = 1). Cognitive impairment was reported in 32.5% patients (n = 127). The 10 most common medications involved were bisoprolol (n = 74), lansoprazole (n = 59), atorvastatin (n = 58), aspirin (n = 47), omeprazole (n = 43), amlodipine (n = 44), paracetamol (n = 42), clopidogrel (n = 42), ramipril (n = 42) and metformin (n = 35). Most patients were asymptomatic (n = 312). Common symptoms recorded were somnolence (n = 16), dizziness (n = 13), confusion (n = 11), fatigue (n = 7) and hypotension (n = 5). Common reasons for incidents were a mistake by patient or family member (n = 189), medications taken unwitnessed (n = 88), MDS incongruent with current prescription (n = 22), patient took another person’s medications (n = 19), patient took medication in MDS in addition to that in normal packaging (n = 15) and extra doses administered by different people (n = 15). Almost 51% of patients were recommended to attend Emergency Department (ED) by the NPIS (n = 200) and 18% were advised to contact their GP (n = 71).

Conclusion
MDS are perceived to improve adherence, these results reveal their potential harm. For example, most of patients in these enquiries were advised to seek medical help. MDS harm is likely underreported as this was a retrospective study and some information was not routinely collected. Further work including a prospective study is needed alongside support of safer medicine use through improved communication, education, and alternative tailored support.
2277 Predictive factors of delirium in neck of femur fracture and post-operative outcomes at Morriston hospital
Authors: Cochrane J , Ng KL , Russ J , Roberts M 
Published: August 2024

Abstract

Introduction
Neck of femur fractures (NOF) remain a significant cause of mortality in the elderly, especially in those who develop delirium post operatively. The aim of our study is to identify risk factors that may contribute to developing a delirium.

Method
A prospective cohort study of 717 patients presenting to Morriston Hospital who underwent operative management for a NOF fracture.

Results
A total of 103 patients developed a post-operative delirium, an incidence of 14.4%. Clinical Frailty Score (CFS) and Abbreviated Mental Test Score (AMTS) proved to be significantly associated with developing delirium (p &lt; 0.0001). Delirium was highly prevalent in patients with moderate frailty (CFS6≥) and an abnormal AMT score (&lt;8), present in 70% and 73% respectively with individual odds ratios of 4.1 and 5.2. Delirious patients suffered higher inpatient mortality (16% v 5%, p 0.0004), an increased length of stay (32 vs 23 days, p &lt; 0.0001) and were more likely to be directly institutionalised (10% vs 3% p 0.002) without rehabilitation. Admission inflammatory markers and prolonged waiting times for theatre were highly prevalent in both groups and not pursued.

Conclusions
Patients presenting with moderate frailty and abnormal AMTS were at greatest risk of developing a delirium which was associated with poorer outcomes. We propose identifying high-risk patients from the point of admission to ensure early targeting of potential reversible factors. A delirium toolkit could aid in identifying these patients and there may also be an argument for the prioritisation of high-risk individuals in theatre list given their increased mortality.
2328 Knowledge of dying in place and preferences for place of death among older adults in Hong Kong
Authors: Lee LYK , Kwan QCM , Cheung MCY , Cheung RTM , Lee MAWS , Po EYP 
Published: August 2024

Abstract

Introduction
The preference for place of death and the concept of dying in place have been subjects of debate in numerous jurisdictions. Despite the growing prevalence of ageing populations and the increasing demand for dying in place, there is a limited body of literature exploring older adults’ knowledge of dying in place and their preferences for the place of death. In Hong Kong, there are ongoing legislative efforts to revise the policy on dying in place. This study aims to investigate the knowledge of dying in place and the preferences for the place of death among older adults in Hong Kong.

Methods
This cross-sectional study recruited 503 older adults. A questionnaire was disseminated through online social media platforms and face-to-face interview. ANOVA was conducted to compare the differences in knowledge scores among participants with varying preferences for the place of death.

Results
Participants demonstrated a sub-optimal knowledge level (mean = 3.55; range 0–8). Notably, 54.7% of participants were unaware of the existing law that regulates dying in place in Hong Kong, and 43.5% did not know about the availability of community resources to support patients who choose to die at home. A greater number of participants (55.5%) preferred to die at home. Other preferences included hospital (18.9%), hospice (17.1%), and care home (8.5%). Participants who preferred to die at home exhibited a higher knowledge score (mean 3.84) compared to those who preferred to die in hospital (mean = 2.79) (F = 5.323, p = 0.001).

Conclusions
The findings of this study provide insights that can inform the revision of current policies, the enhancement of community resources supporting dying in place, and the strengthening of life and death education targeted at older adults.
Acknowledgement: The work described in this paper was fully supported by a fund from Hong Kong Metropolitan University (RD/2022/2.17).
2213 The prevalence of medication-related harm in people with dementia – a systematic review
Authors: Carabine F , Hughes CM , Barry HE 
Published: August 2024

Abstract

Introduction
Medication-related harm (MRH) is defined as any negative outcome, harm or injury caused by taking a medication (Falconer et al. Eur J Clin Pharmacol, 2018;75(2):137–145). People living with dementia (PLWD) take more medications than those without dementia, increasing their risk of MRH (Mueller et al. Exp Gerontol 2018;106:240–245). There is urgent need to explore the scale of MRH affecting PLWD. This systematic review aimed to determine the prevalence of MRH in PLWD and evaluate various outcomes to assess its impact.

Methods
Twelve databases were systematically searched for articles published in English from date of inception to April 2023. Papers of any study design reporting on the prevalence and/or outcomes of MRH in PLWD were eligible for inclusion. Quality was assessed using the Cochrane Risk Of Bias tool for randomised trials (ROB-2) or the Risk Of Bias In Non-randomised Studies of Exposures (ROBINS-E). Due to lack of consensus on the definition of MRH and the heterogeneity of included studies, a narrative synthesis will be undertaken.

Results
In total, 5951 articles were identified, and 4946 remained following removal of duplicates. After title/abstract screening, 419 full-text articles were assessed for eligibility. Ninety-eight studies were included in the review. Quality assessment is ongoing. Overall, 29 studies investigated adverse drug events, affecting 5–83% of participants, and 22 studies assessed mortality associated with drug use, with most reporting an increase in mortality. Antipsychotics were the most commonly implicated medication class, studied in 24 papers.

Conclusion
This systematic review is the first to report on the prevalence of MRH in PLWD. However, it will not be possible to conduct a meta-analysis to fully analyse the scale of this issue. This review will identify gaps in the current evidence base and inform future research aiming to explore factors contributing to, and ways to reduce, PLWD experiencing MRH.
2153 Yesavage geriatric depression scale (GDS) and mini mental test as characterisation tools in a south American cohort with type 2
Authors: Medina M , Dulcey L , Amaya M , Gomez J , Vargas J , Lizcano A , Hernández C , Ciliberti M , Blanco J , Estévez M , Castillo S , Gutiérrez E , Angulo R , Martínez J , Acevedo D , Arias A , Ramos G 
Published: August 2024

Abstract

Introduction
T2DM is a chronic disease that affects millions of people worldwide. In older adults, T2DM may be associated with an increased risk of two serious conditions: cognitive impairment and depression.

Objective
The aim of this research was to assess the mental health of older adults with type 2 diabetes mellitus (T2DM) in Mérida, Venezuela. Methodology A cross-sectional study was conducted with 100 older adults with T2DM and 100 older adults without T2DM. Two assessment instruments were used: the Mini Mental State Examination (MMSE) to assess cognitive function and the Geriatric Depression Scale (GDS) to assess depression.

Results
The results showed that older adults with T2DM had a higher risk of cognitive impairment and depression than older adults without T2DM. In particular, 25% of older adults with T2DM were cognitively impaired, compared to 5% of older adults without T2DM. In addition, 20% of older adults with T2DM had depression, compared to 10% of older adults without T2DM.

Conclusions
The results of this study suggest that older adults with T2DM are at increased risk of cognitive impairment and depression. It is important for health professionals to be aware of these risks and provide interventions to prevent or treat them.
2318 The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review
Authors: Richardson SJ , Cropp AD , Ellis SW , Gibbon J , Sayer AA , Witham MD 
Published: August 2024

Abstract

Introduction
Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium.

Methods
Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines.

Results
After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. 151 met inclusion criteria and were included in the final review. Much of the literature focusing on hospitalised participants (n = 140) explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 107/151) and Confusion Assessment Method (n = 88/151), respectively.

Conclusion
Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.
2346 Modified hospital frailty risk score (mHFRS) as a tool to identify frail hospitalised older adults
Authors: Rosario BH , Sim LE , Lim A , Selvaratnam T , Chang TY , Conroy S 
Published: August 2024

Abstract

Introduction
Frailty is common in hospitalised older adults. This study compared efficacy of a modified Hospital Frailty Risk Score (mHFRS) to standard HFRS and Clinical Frailty Scale (CFS) to determine whether mHFRS can be used to identify frail hospitalised patients.

Methods
Anonymised retrospective review of Electronic Health Records was undertaken in patients = &gt; 65 years old attending the Emergency Department (ED) and admitted to hospital 1st July 2022 to 31st March 2023. mHFRS utilises 2 prior emergency admissions within 2 years to generate a frailty risk score, whereas HFRS requires an index admission plus 2 prior emergency admissions. Hospitalisation outcomes and predictive models were evaluated with correlation and measures of agreement between CFS and HFRS, CFS and mHFRS using Spearman’s rank correlation and Cohen’s kappa.

Results
Of 3042 patients, CFS categorised 1635 patients as non-frail (CFS 1–4) and 1407 as frail (CFS 5–9). Using mHFRS, only 1623 patients could be categorised and of these, 608 were deemed low, 657 intermediate and 358 high risk of frailty. Frail patients were older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p = &lt;.001), had significantly longer LOS (52.5% % vs 31.5%, p = &lt;0.001), higher 30-day unplanned hospital readmissions (18.5% vs 9.9%, p = &lt;0.001), and higher in-patient (6.1% vs 2.0%, p &lt; 0.001), 30-day (9.1% vs 2.3%, p &lt; 0.001), and 90-day (15.8% vs 5.1%, p &lt; 0.001) mortality. mHFRS achieved comparable association with hospitalisation outcomes compared to CFS & HFRS. Cohens’s kappa, showed fair agreement across HFRS and mHFRS, κ of 0.235 0.243 respectively. mHFRS was less sensitive at identifying frail patients but had better specificity to identify non frail patients.

Conclusion
mHFRS is a comparable frailty screening tool that doesn’t require clinical assessment but is standardised and easy to use in those who can be scored.
Osteoarthritis, osteoarthritis treatment and risk of incident dementia: a prospective cohort study based on UK Biobank
Authors: Guo Rong , Ou Ya-Nan , Ma Li-Yun , Tang Lian , Yang Liu , Feng Jian-Feng , Cheng Wei , Tan Lan , Yu Jin-Tai 
Published: August 2024

Abstract

Background
We aimed to investigate the association between OA and treatment with dementia risk and structural brain abnormalities.

Methods
We recruited a total of 466,460 individuals from the UK Biobank to investigate the impact of OA on the incidence of dementia. Among the total population, there were 63,081 participants diagnosed with OA. We subsequently categorised the OA patients into medication and surgery groups based on treatment routes. Cox regression models explored the associations between OA/OA treatment and dementia risk, with the results represented as hazard ratios (HRs) and 95% confidence intervals (95% CI). Linear regression models assessed the associations of OA/OA therapy with alterations in cortical structure.

Results
During an average of 11.90 (± 1.01) years of follow-up, 5,627 individuals were diagnosed with all-cause dementia (ACD), including 2,438 AD (Alzheimer’s disease), and 1,312 VaD (vascular dementia) cases. Results revealed that OA was associated with the elevated risk of ACD (HR: 1.116; 95% CI: 1.039–1.199) and AD (HR: 1.127; 95% CI: 1.013–1.254). OA therapy lowered the risk of dementia in both medication group (HR: 0.746; 95% CI: 0.652–0.854) and surgery group (HR: 0.841; 95% CI: 0.736–0.960). OA was negatively associated with cortical area, especially precentral, postcentral and temporal regions.

Conclusions
Osteoarthritis increased the likelihood of developing dementia, and had an association with regional brain atrophy. OA treatment lowered the dementia risk. OA is a promising modifiable risk factor for dementia.
Introduction to network meta-analysis: understanding what it is, how it is done, and how it can be used for decision-making
Authors: Brignardello-Petersen Romina , Guyatt Gordon H 
Published: August 2024

Abstract
Network meta-analysis (NMA), a statistical technique that allows systematic reviewers to simultaneously compare more than 2 alternatives, makes use of indirect evidence from studies comparing interventions of interest to a common comparator. The capacity for multiple simultaneous comparisons makes NMA appealing for evidence-based decision-makers. This article, aimed at users of systematic reviews (SRs) with NMAs and at those who are considering conducting SRs with NMAs, provides an introductory level overview of this topic. We describe the main considerations that those conducting systematic reviews with NMA should bear in mind, including decisions regarding grouping interventions into analysis nodes, and testing the assumptions that assure the validity of NMA. We explain and illustrate how both systematic reviewers and users should draw conclusions from NMA that are appropriate and useful for decision-making. Finally, we provide a list of tools that facilitate the conduct and interpretation of NMAs.