bluuebunny/crossref_metadata_2025_split huggingface dataset:
2258 The need for delirium education and psychosocial care after discharge: a realist analysis of interviews with key stakeholders
Authors: Raghuraman S , Richards E , Mahmoud A , Morgan-Trimmer S , Clare L , Anderson R , Goodwin V , Allan L 
Published: August 2024

Abstract

Introduction
There is limited understanding of long-term delirium care after discharge from hospital for older people. A realist approach was used to investigate the contextual factors and mechanisms of care that influence recovery from delirium. Realist evaluation is fundamentally theory-driven. A preliminary programme theory was used as the foundation for theory testing and refinement to develop the RecoverED intervention.

Method
Realist interviewing techniques were used to obtain real-world and lived experiences of delirium recovery and service use in the community for theory-building and testing. Semi-structured interviews were conducted with a purposive sample of people with delirium (N = 7), informal carers (N = 14), and healthcare professionals (N = 24). Data from the interviews were analysed using a deductive codebook of Context-Mechanism-Outcome (CMO) configurations. Open coding was also performed to identify inductive themes, which were then aggregated to elicit explanatory statements.

Results
There was support for a multicomponent delirium intervention including cognitive and physical rehabilitation, and psychosocial support. The analysis revealed the need for an additional component which focused on improving awareness and understanding about delirium among those with lived experience. In the context of insufficient knowledge about delirium, people experienced increased fear and anxiety among other negative outcomes. Offering a focused educational component as part of the intervention is expected to contribute to recovery outcomes. This was associated with CMOs identifying the need for positive relationships with staff, improving communication with staff and sense-making through staff emotional support.

Conclusion(s)
The preliminary programme theory was refined based on the realist analysis data. Additional components were included, one of which was targeted education for people with delirium and carers. Following a consultation with an expert panel, the intervention is being tested in a feasibility trial and process evaluation, which will analyse data from multiple sources using realist methods to further refine the intervention.
2304 Models of care and the role of clinical pharmacists in UK primary care for older people: findings from a scoping review
Authors: Burnand A , Woodward A , Kolodin V , Manthorpe J , Jani Y , Orlu M , Bhanu C , Samsi K , Vickerstaff V , Wilcock J , Rait G , Davies N 
Published: August 2024

Abstract

Introduction
Pharmacists have traditionally worked in primary care, in the community, and with GPs. However, the role of the clinical pharmacist in primary care is evolving and there are plans to employ more clinical pharmacists in the NHS. With an ageing UK population, there is an increase in the number of people living with multiple long-term conditions, accompanied by polypharmacy, posing numerous challenges to healthcare systems. This review investigates the evidence about the varied roles and services delivered by clinical pharmacists in primary care, capturing the perspectives of health and care professionals, older adults, and their carers.

Method
Our scoping review followed the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. A broad search was conducted in 2023 in CINAHL, Cochrane, Medline, SCOPUS, and Web of Science. We included articles that explored the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences.

Results
A total of 23 articles was included. These shed light on the multifaceted responsibilities of clinical pharmacists for older people. Stakeholder perspectives, including healthcare professionals and care home staff, emphasise the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps among the primary care team and those living with dementia, concerns about competence, and the need for clear role definitions of clinical pharmacists emerge as challenges.

Conclusions and implications
The review enhances our understanding of the clinical pharmacist service in the UK and identifies gaps in research evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. The findings can be used for policymaking, workforce planning, and healthcare provision to improve the services for older people in the UK.
2197 Effectiveness of horticultural therapy on the psychosocial and physical function of older adults with normal cognitive function.
Authors: Johandi F , Giang TA , Cheng LJ , Hay MSG , Yap P 
Published: August 2024

Abstract

Introduction
Horticultural therapy (HT) is not uncommonly used as non-pharmacological therapy for patients with dementia. However, less is known about its effects on older adults with normal cognition. This systematic review and meta-analysis syntheses available evidence to evaluate the effects of HT on psychosocial and physical function in cognitively intact older adults.

Method
A systematic search in 9 electronic databases for experimental and quasi-experimental studies was performed between January 1, 2001, and July 19, 2021. Studies involving participants above 60 years old with normal cognition, analysing psychosocial and physical effects of HT, were included. Cochrane Risk of Bias 2 (RoB2) tool and Risk of Bias in Non-randomised Studies- of Interventions (ROBINS-I) were used to assess risk of bias. Meta-analysis was conducted using Stata software. Cochran’s Q test and I2 were used to explore statistical heterogeneity. Narrative synthesis was conducted for trials unsuitable for quantitative pooling.

Results
Nineteen articles (2191 participants) were included. Meta-analyses found that HT showed moderate-large effects on psychosocial outcomes, with improved self- efficacy (Hedges’ g = 0.49, 95%Confidence Interval: 0.07,0.91, 3 trials, I2:0.00%) and self-esteem (g = 1.01, 95%CI:0.33,1.68, 2 trials, I2:0.00%), and decreased depressive symptoms (g = −3.33, 95%CI:-6.29,-0.37, 4 trials, I2:98.51%). Narrative synthesis suggested benefits in Health-related Quality of Life. Regarding physical effects, HT improved exercise duration and intensity (g = 1.37, 95%CI:0.92,1.82, 2 trials, I2:0.00%). Effects on anxiety, social engagement and fitness did not achieve statistically significance.

Conclusion
The findings support the potential role of HT in promoting psychosocial and physical function among older adults with intact cognition. Given high statistical heterogeneity, more work is needed to explore the effect of possible moderators on treatment effects.
2200 Association between gait speed deterioration and EEG abnormalities
Authors: García-Agustin D , Rodríguez-Rodríguez V 
Published: August 2024

Abstract

Introduction
Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition.

Methods
A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function.

Results
Results show that 70% of the sample had a gait speed deterioration (i.e. lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed&lt;0.8 m/s and an abnormal EEG frequency composition.

Conclusions
Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.
2319 Deficits comprising multi-dimensional frailty indices based on routine data: sub-analysis of a scoping review
Authors: Dlima S , Hall A , Aminu A , Todd C , Vardy E 
Published: August 2024

Abstract

Introduction
The frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of deficits, or ‘things that individuals have wrong with them’, to the total number of variables in the index. Routine health and administrative databases are valuable sources of deficits to automatically calculate FIs. There is large heterogeneity in the deficits used in FIs. This sub-analysis of a scoping review on routine data-based FIs aimed to describe and map the deficits used in multi-dimensional FIs.

Methods
Seven databases were searched to find literature published between 2013 and 2023. The main inclusion criterion was multi-dimensional FIs constructed from routinely collected data. Multi-dimensional FIs should have deficits in at least two of the following categories: ‘symptoms/signs’, ‘laboratory values’, ‘disease classification’, ‘disabilities’, and ‘other’.

Results
Of the 7526 publications screened, 57 distinct FIs were identified from 56 included studies. Most FIs were developed in the USA (n = 15) and in hospital settings (n = 19). The most dominant data source of deficits to calculate the FIs was hospital records (n = 21). Twenty-five FIs were developed for specific conditions and populations, for example, cancer, HIV, dementia, organ transplant recipients, and veterans. The median number of deficits used in the FIs was 36 (range = 5–72). Almost all the FIs (n = 56) had at least one deficit in the ‘symptoms/signs’ category, followed by ‘disease classification’ (n = 55) and ‘disabilities’ (n = 50). Approximately two-thirds of all the deficits were ‘symptoms/signs’ and ‘disease classifications’.

Conclusion
These findings highlight the reactive approach to frailty assessment, as most of these FIs were calculated from hospital data and used symptoms/signs and diseases as deficits. Given the heterogenous manifestations and long-term impacts of frailty, using a more proactive approach that leverages non-clinical routine data is warranted to prevent frailty development and progression.
2358 Evaluation of a novel screening protocol for respiratory viral infections in long-term care homes
Authors: Devereaux E , King C , Meeker S , Rockwood K 
Published: August 2024

Abstract

Introduction
Respiratory viral illnesses (RVI) pose a serious threat to LTC residents. Those with frailty often experience non-specific presentations causing delayed diagnosis and treatment of infection. To facilitate early RVI detection, a screening protocol was developed to evaluate changes in cognitive and functional status of LTC residents using the Single Question in Delirium (SQiD) with new Single Question in Functioning (SQiF) and Single Question in Reduced Mobility (SQiRM). This study aims to address: (i) If novel (SQiD/SQiF/SQiRM) screening was superior to public health in detecting COVID-19 in LTC, and; (ii) Did combining the novel and public health screening improve detection of COVID-19.

Methods
The novel screening protocol was integrated into daily screening for RVI at three LTC homes in Nova Scotia, Canada. Daily assessments were recorded in consenting residents. If any of the novel protocol was positive, the 4As Test (4AT) and Hierarchal Assessment of Balance and Mobility (HABAM) were evaluated and a positive 4AT and/or HABAM triggered an RVI swab for COVID-19. Area under the curve (AUC,) sensitivity and specificity analysis using PCR tests as the reference criterion was utilised. Between October 2021 to February 2024, 378 LTC residents consented to participate, resulting in 142 positive COVID-19 PCR tests.

Preliminary results
show public health screening had a sensitivity of 68.3%, specificity of 52.1% and AUC of 0.60. Novel protocol exhibited sensitivity of 12.0%, specificity of 85.2% and AUC of 0.49. Combining public health and novel screening yielded a sensitivity of 80.3%, specificity of 32.3% with a AUC of 0.59.

Conclusions
Preliminary results suggest that incorporating public health and novel protocol screening for daily RVI assessments in LTC is advantageous. Predictive accuracy is slightly less with combined screening, but sensitivity of the combined screening protocols remains high.

Other information
Ethical approval obtained from Nova Scotia Health Research Ethics Board # 1026558.
2296 Co-developing a qualitative study exploring the determinants of safe anti-coagulation in frail older adults.
Authors: Ali K , Mensah E , Kirkham F , Rajkumar C 
Published: August 2024

Abstract

Introduction
Despite the knowledge that oral anti-coagulation (OAC) is effective in secondary prevention of stroke, prescribing rates are low in frail older patients with atrial fibrillation (AF), dementia, and high fall risks. A joint decision-making approach between clinicians, patients and carers is needed to negotiate the risk–benefit balance. The aim of this participatory study was to engage with a group of older adults, their carers and healthcare professionals to identify key themes that will inform a planned qualitative study exploring frail older patients’ acceptance of and adherence to OAC.

Methods
We identified a group of twenty-eight adults (aged &gt;65 years) and carers from community partners: ‘Ageing Well’ platform, Health Watch team, and the University of the Third Age (U3A) in Brighton and Hove, East Sussex, UK. Using two case vignettes of hypothetical OAC decisions, we hosted two virtual focus group meetings with the above cohort, followed by a virtual meeting with four geriatricians, two pharmacists, a GP and a patient champion. Inductive thematic analysis was performed on the group discussions by two researchers independently.

Results
Five key themes were identified as crucial to include in the future qualitative study discussions: (i) age should not be a barrier to anti-coagulation (ii) individualised, holistic assessment by a specialist is mandatory (iii) annual review of anti-coagulation should be performed, revisiting patients and carers’ understanding of the risks and benefits (iv) patient and carer education should be tailored to their medical and social background, and (v) quality of life should be a key factor in OAC decisions.

Conclusion
Engaging with a group of older adults in a co-development exercise helped identify key themes for a future study of anti-coagulation in frail older adults with AF.
Implementation of a digital exercise programme in health services to prevent falls in older people
Authors: Taylor Morag E , Ambrens Meghan , Hawley-Hague Helen , Todd Christopher , Close Jacqueline C T , Lord Stephen R , Clemson Lindy , Lung Thomas , Berlowitz David , Blennerhassett Jannette , Dayhew Julia , Gluchowski Ashley , Hodge Wendy , Johnson Pamela , Lasrado Reena , Merlene Marita , Miles Lillian , O’Rourke Sandra , Said Catherine M , White Leanne , Wilson Nicola , Zask Avigdor , Delbaere Kim 
Published: August 2024

Abstract

Background
StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK.

Methods
Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome.

Results
The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants’ mean age was 73 ± 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred ≥5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 ± 39% of the prescribed dose (i.e. 39 ± 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources.

Conclusions
StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available.

Trial registration
Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.
The role of the World Guidelines for Falls Prevention and Management’s risk stratification algorithm in predicting falls: a retrospective analysis of the Osteoarthritis Initiative
Authors: Ragusa Francesco Saverio , Di Bella Giovanna , Dominguez Ligia J , Veronese Nicola , Smith Lee , Barbagallo Mario 
Published: August 2024

Abstract

Introduction
Recurrent falls are observed frequently among older people, and they are responsible for significant morbidity and mortality. The aim of the present study was to verify sensitivity, specificity and accuracy of World Guidelines for Falls Prevention and Management (WGFPM) falls risk stratification algorithm using data from the Osteoarthritis Initiative (OAI).

Methods
Participants aged between 40 and 80 years were stratified as ‘low risk’, ‘intermediate risk’ or ‘high risk’ as per WGFPM stratification. Data from the OAI cohort study were used, a multi-centre, longitudinal, observational study focusing primarily on knee osteoarthritis. The assessment of the outcome was carried out at baseline and during the follow-up visit at 24 months. Data about sensitivity, specificity and accuracy were reported.

Results
Totally, 4796 participants were initially included. Participants were aged a mean of 61.4 years (SD = 9.1) and were predominantly women (58.0%). The population was divided into three groups: low risk (n = 3266; 82%), intermediate risk (n = 25; 0.6%) and high risk (n = 690; 17.3%). WGFPM algorithm applied to OAI, excluding the intermediate-risk group, produced a sensitivity score of 33.7% and specificity of 89.9% for predicting one or more falls, with an accuracy of 72.4%.

Conclusion
In our study, WGFPM risk assessment algorithm successfully distinguished older people at greater risk of falling using the opportunistic case finding method with a good specificity, but limited sensitivity, of WGFPM falls risk stratification algorithm.
Policies and indicators to operationalize structural racism for quantitative health research
Authors: Ali Talha , Allgood Kristi L , Needham Belinda , Ro Annie , Hirschtick Jana L , Fleischer Nancy L 
Published: August 2024

Abstract
The field of structural racism is developing rapidly, with researchers moving from commentaries and review papers toward empirical research that aims to quantify the impact of exposure to structural racism on racial and ethnic inequities in health. Despite the increasing recognition of the impact of structural racism on health outcomes, its measurement in the empirical literature has focused on a limited set of area-based measures. We propose 2 ways to expand the measurement of structural racism in public health research: first, by situating indicators of structural racism within the broader context of discriminatory policies that gave rise to racial and ethnic inequities; and second, by broadening the range of area-level indicators of structural racism beyond what has been used in the extant literature. We provide practical tools, including an extensive list of discriminatory federal policies, a list of common and novel indicators of structural racism across multiple domains, and an applied example showing how to connect policies and indicators of structural racism. These tools will aid researchers in developing a robust empirical evidence base to examine the role of structural racism in long-standing health inequities and advance quantitative research on the impact of structural racism on health inequities.
Racial disparities in maternal exposure to ambient air pollution during pregnancy and prevalence of congenital heart defects
Authors: Arogbokun Knutson Olufunmilayo C , Luben Thomas J , Stingone Jeanette A , Engel Lawrence S , Martin Chantel L , Olshan Andrew F 
Published: August 2024

Abstract
Air pollution may be a potential cause of congenital heart defects (CHDs), but racial disparities in this association are unexplored. We conducted a statewide population-based cohort study using North Carolina birth data from 2003 to 2015 (n = 1 225 285) to investigate the relationship between air pollution and CHDs (specifically pulmonary valve atresia/stenosis, tetralogy of Fallot [TOF], and atrioventricular septal defect [AVSD]). Maternal exposure to particulate matter ≤ 2.5 μm in diameter (PM2.5) and ozone during weeks 3 to 9 of pregnancy were estimated using the Environmental Protection Agency’s Downscaler Model. Single- and co-pollutant log-binomial models were created for the entire population and stratified by race to investigate disparities. Positive associations between PM2.5 and CHDs were observed. An increasing concentration-response association was found for PM2.5 and TOF in adjusted, co-pollutant models (quartile 4 prevalence ratio: 1.46; 95% CI, 1.06-2.03). Differences in the effect of PM2.5 on CHD prevalence were seen in some models stratified by race, although clear exposure-prevalence gradients were not evident. Positive associations were also seen in adjusted, co-pollutant models of ozone and AVSD. Study results suggest that prenatal PM2.5 and ozone exposure may increase the prevalence of certain CHDs. A consistent pattern of differences in association by race/ethnicity was not apparent.
This article is part of a Special Collection on Environmental Epidemiology.