bluuebunny/crossref_metadata_2025_split huggingface dataset:
1964 Wearable devices to measure gait and balance remotely that could be used in Comprehensive Geriatric Assessment: A scoping review
Authors: Bollen J , Morley N , Jamaludin E Arjunaidi , Hall A , Bethel A , Mahmoud A , Crocker T , Lyndon H , Del Din S , Frost J , Goodwin V , Whitney J 
Published: January 2024

Abstract

Introduction
Comprehensive Geriatric Assessment (CGA) is widely used in the management and assessment of older people living with frailty, however optimal ways of delivering CGA are not well understood. Gait and balance impairments, common in those living with frailty, are assessed in CGA. Advancements in digital technology provide opportunities to improve patient outcomes by digital monitoring, rather than observation-based assessments - which may be less accurate. As part of the Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM) study, the aim of this review was to identify devices to assess gait and balance remotely, to enhance CGA.

Methods
Searches were conducted across six databases. Papers published since 2008 were included if: participants were over 65; evaluated gait or balance using wearable technology suitable for community use; presented data on validity, reliability, or acceptability of the device.

Results
Of 6,203 papers identified, 48 papers were included evaluating 49 devices. 35 evaluations assessed gait, 7 assessed balance, and 7 assessed gait and balance. The most common modality was a single sensor (n= 30) on a participants’ back (n=22). Seven studies assessed more than one aspect of validity, but the majority examined criterion validity (n=35) and reliability (n=12). Good-excellent agreement between the wearable and a comparable method of analysing gait/balance was found in 15 studies. Devices could distinguish between healthy populations and those with Parkinson’s disease (n=8), cognitive impairment (n=4), falls (n=4), mobility disability (n=3) and frailty (n=3).

Conclusion
Wearable technologies offer accurate and reliable assessment of gait and balance that could be used to enhance CGA. These tools could be applied remotely in domiciliary settings, freeing up healthcare professionals to focus on other components of CGA, such as ensuring the delivery of interventions to address identified gait and balance impairment.
1982 A new way of involving experts by experience in social care research
Authors: Faraday J , Brown B , Brown N , Rowland D , Shenton F , Hand A 
Published: January 2024

Abstract

Introduction
Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018).

Methods
A care home in northeast England is working with researchers to pioneer a new approach to involvement, with residents and staff at the centre. The care home has helped to shape a number of research projects, for example a feasibility study of mealtime care training. In this study, an advisory group was set up initially within the care home itself, comprising residents, staff and family carers. Subsequently the group was joined by people from other care homes in the area, with support from the local authority. In parallel to this, health and social care professionals have contributed to the advisory group through one-to-one meetings with the researcher.

Results
Advisory group meetings in the care home have provided an inclusive and equitable platform for residents and staff to share their views on the research topic and design. Other stakeholders have been able to input into the project, but separately and in a way that has left room for key voices to be properly heard. Contributors have felt valued and are keen to continue in the process.

Conclusion
This study offers an alternative and authentic model for the involvement of experts by experience in social care research, inverting the more typical approach so that residents and staff are at the centre not the periphery.
1972 A scoping review of remotely delivered cognitive assessment tools that could be used in comprehensive geriatric assessment
Authors: Whitney J , Jamaludin E A , Bollen J C , Hall A , Bethel A , Frost J , Mahmoud A , Morley N , Freby S , Goodwin V 
Published: January 2024

Abstract

Introduction
Community-based comprehensive geriatric assessment (CGA) reduces hospital admissions but the optimal way in which CGA can be delivered is not well understood. Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM) is a programme of research seeking to develop an enhanced community CGA intervention. We aimed to identify candidate cognitive assessment tools (CATs) that could be undertaken remotely and enhance CGA.

Methods
Searches were carried out on Medline, PsycINFO, CINAHL and Cochrane databases. Papers published since 2008 were included if they analysed the validity, reliability or acceptability of CATs that could be undertaken remotely in a domestic setting and were tested on older people.

Results
Of 4286 papers identified, 56 were included. Four types of CAT were identified: computer/tablet/smartphone applications (23tools/27papers), telephone (16tools/23papers), video (2tools/2papers) and specialist equipment (4tools/4 papers). 14 tools demonstrated excellent accuracy for identifying mild cognitive impairment or dementia (specified as AUC &gt;0.80 or sensitivity/specificity&gt;80%). 42 papers presented concurrent/convergent validity, 14 reliability and 16 acceptability data. Time taken to perform tests ranged between 2-30 mins. Of the 23 computer/tablet/smartphone applications, 7 tools are currently available to download.

Conclusions
Remote CATs could be used in CGA. Computer/tablet/smartphone applications and some specialist equipment could enhance assessment by quickly and accurately identifying cognitive impairment, in some cases with greater accuracy than traditional tests. Tools that use ‘games’ may be more appealing than conventional pen and paper tools. However, many of the computer/tablet/smartphone applications tested are not available for clinical use.
1911 Recommendations for a deprescribing approach that can be implemented in care homes: STOPPING study findings and lessons
Authors: Warmoth K , Rees J , Day J , Cockcroft E , Aylward A , Pollock L , Coxon G , Craig T , Walton B , Stein K 
Published: January 2024

Abstract

Introduction
Care home residents often have multiple long-term conditions and experience polypharmacy. Deprescribing is the reduction or stopping of prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe but it is unknown how to make it work well in practice, like care homes.

Method
Using the findings from the NIHR-funded STOPPING project, which aimed to support the development of better deprescribing practice approaches within care homes, considering different views and environments, recommendations for designing a deprescribing approach for care homes were developed. The STOPPING project included interviews with residents and their family members/friends, care home staff, and healthcare professionals about their experiences and beliefs about what influences deprescribing in 15 different care homes, and in-depth interviews with care home staff assessing current deprescribing tools/approaches about their acceptability, feasibility, and suitability for use in care homes.

Results
The developed approach included four implementation aspects: (1) plan and coordinate, (2) communicate and collaborate, (3) access and share information, and (4) monitor and evaluate. Proposed actions to encourage deprescribing in care homes were identified for each aspect (e.g., communication with residents and families about medication changes addressing concerns and offering clear instructions about observations).

Conclusion
Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique clinical and care skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Communication and collaboration between care homes and healthcare professionals (such as GPs, nurses, and pharmacists) are essential to ensure deprescribing is done well. Information sharing and integrated working may support better communication and collaboration. Further work is needed to develop tools and approaches, and this work must include input from care home staff and residents.
1985 Understanding the Perceptions of Caregivers of Older People in Residential Homes in Cairo
Authors: Rakhawy M , Shahin M , Sabry N , Tadros G , Nawwara R , Ali K 
Published: January 2024

Abstract

Introduction
Institutional care for older people is a relatively new social phenomenon in Egypt that is associated with societal stigma. Traditionally dependent older people are looked after by family members at home. There are currently 145 care homes in Egypt, mostly based in Cairo serving 2% of the older population. The aim of this study was to understand the perspectives of paid caregivers on the strengths, weaknesses, opportunities, and threats (SWOT) associated with their professional roles. This knowledge is crucial to deliver a culturally sensitive training program for caregivers, and enhance their job satisfaction, ultimately leading to person-centred high-quality care.

Method
Two focus group meetings, 90 minutes each, were conducted with 39 caregivers in a private care home in Cairo. Each group was further divided into four working sub-groups using a SWOT approach to guide the discussion. Generic themes were identified, analysed, and agreed on by the group participants.

Results
Thirty-nine caregivers (31 % males), age range 18-50 years, were interviewed including undergraduate and qualified nurses and social workers. Five themes were identified: administration, team values, training, place and equipment, and residents and families. SWOT findings related to each theme are summarised below:
Theme
Strength
Weakness
Opportunities
Threats
Administration
Support and flexibility
Poor incentives
Access to healthcare services
Lack of rest facilities
Team values
Peer support
Mixed qualities in different leaders
Outdoor recreational activities
Lone working
Training
Mentoring programme
Unfulfilled training needs
Regular updates on CGA
No medical cover
Place & Equipment
Resident accommodation
Not always fit for purpose
Health and safety compliance
Cost of accommodation
Residents and families
Sharing knowledge
Discriminatory attitudes toward staff
Documentation of resident’s priorities
Unfounded complaints

Conclusion
Reflecting on the views of paid caregivers provided valuable insight that could enhance the quality of institutional care for older people in Cairo.
1963 `Three sides to every story'- Living the patient, carer and staff experience of COVID
Authors: Ramsey S , Hurst H , Briggs M , Wentworth L 
Published: January 2024

Abstract

Introduction
When COVID-19 first entered our world in March 2020 and the country went into lock down, the NHS braced itself for one of its biggest challenges of this century. Older, frail patients were in the highest risk group, with those in care homes not only at higher risk of death, but higher risk of contracting COVID-19, often suffering more psychological disturbances (Hewitt et al., 2020; Numbers & Brodaty, 2021). This study was conceived by two nurse researchers working throughout the pandemic on a COVID ward for predominantly older people, aiming to capture the experiences of patients, families/carers and staff members.

Methods
Phenomenology was the most appropriate methodology to provide an in-depth lived experience perspective. Full ethical approval was obtained and participants were sampled purposively. In-depth unstructured interviews were conducted and transcribed in full before being analysed hermeneutically using the four steps outlined by Fleming et al. (2003).

Results
30 participants were recruited (10 patients, 10 relatives, including several bereaved and 10 staff members). Whilst experience varied between and within groups, core themes emerged:
1. Communication difficulties were poignantly expressed, with staff acting as intermediaries between patients and their family members who were kept apart through visiting restrictions, whilst managing clinical care and their own emotional responses.
2. Challenges of care were experienced by all groups, with anxiety around contagion conflicting with feelings of guilt and long-term psychological impact described by staff. 3. Collective experiences of grief and loss were described as participants grappled with coming to terms with encountering death and dying on an unprecedented scale and under such extraordinary conditions.

Conclusion
This study adds to the growing evidence base around experience of the COVID pandemic, adding insight into the triangulated experience of those affected and highlighting the profound effect on patients, relatives and staff.
2014 The experience of frailty in the Tanzanian hospital system: A qualitative exploration service user and provider perspectives
Authors: Davidson S L , Hardy J , Randall T , Murray A , Lyimo G , Msangi W , Kilasara J , Mariki L , Urasa S , Breckons M , Dotchin C L , Walker R W 
Published: January 2024

Abstract

Background
Frailty is becoming increasingly prevalent in Low- and Middle-Income Countries (LMICs). However, little is known about the lived experience of older people with frailty in their interactions with the healthcare systems in LMICs. This study aimed to explore the experiences, attitudes and needs of hospitalised older people with frailty in a low-income setting, from the perspective of service users and providers.

Methods
A purposive sample of older people with frailty recently admitted to hospital, their carers and healthcare providers, were recruited from four hospitals in the Kilimanjaro Region of Tanzania. One-to-one and dyad interviews were conducted in Swahili, based around a structured topic guide. Recordings were transcribed and translated into English in an iterative process aimed at preserving the original meaning through “transliteration”. Transcripts were analysed using a reflexive thematic paradigm.

Results
Interviews with 43 service users and 15 service providers highlighted the cultural norm of respect and value placed on older people; as such it is considered the role of everyone in society to provide care. However, many working age adults struggle with the competing responsibilities of supporting their parents and their children. Maintaining strong relationships with family and financial preparation were therefore considered critical to healthy ageing. The complex health problems and significant care needs of older people with frailty pose a considerable challenge during hospital admission. On the ward, family often take responsibility for personal care and feeding to reduce the work of healthcare providers. Economic worries and resource scarcity impact every part of the patient journey from struggles in accessing hospital services, to quality of care during admission and after discharge.

Conclusion
Frailty is understood as a communitywide issue in Tanzania, and family are expected to take a much larger role in care during acute hospital admission, partly mitigating the impact of resource scarcity.
1897 Older stroke survivors and rehabilitation therapists’ views on home-based resistance exercise for upper limbs
Authors: Ali K , Shafizadeh M , Nasr N , Balchin T , Hart J , Kelley J 
Published: January 2024

Abstract

Introduction
Upper limb recovery after stroke depends on participating in personalised task-specific exercise programmes. However, older adults with stroke find it challenging to maintain an optimal level of engagement with such exercise programmes due to personal and environmental factors. The aim of this study was to explore the views of stroke survivors and rehabilitation therapists on home-based resistance exercises for upper limbs.

Method
A qualitative study of semi-structured virtual and in-person interviews was conducted between January and March 2023 in England. Participants were 11 older adults &gt;65 years (6 females (55%), with chronic stroke (&gt;1 year after a stroke) and moderate to severe disabilities. Twenty rehabilitation therapists were also interviewed (3 physiotherapists, and 17 Action for Rehabilitation from Neurological Injury (ARNI) instructors). The group was asked about perceived personal and environmental barriers and facilitators as well as expectations of resistance exercises in relation to upper limb neurorehabilitation programmes. Interview sessions were audio recorded for transcription and thematic data analysis. The study was approved by Sheffield Hallam University ethics committee (reference number: AA43961583).

Results
Both groups mentioned that the main barrier to performing upper-limb exercises is weakness in the paretic arm affecting grip strength with consequent adverse impact on adherence to a home-based programme and poor patient motivation. Patients also reported safety concerns such as dropping equipment and being dependent on a carer to undertake regular exercises. Stroke survivors preferred a program that activates the paretic arm and is relevant to their daily functional activities. They preferred simple exercise instructions and demonstrations through visual aids and video materials. Patients also valued regular feedback on adjusting their exercise dose, monitoring progress over time, and ongoing encouragement.

Conclusions
Our study showed that designing home-based resistance exercises for upper limb in older stroke survivors should be individualised, functionally orientated, and motivational.
1898 Feasibility study of a hospital deprescribing intervention: CompreHensive geriAtRician-led MEdication Review (CHARMER)
Authors: Scott S , Martin-Kerry J , Pritchard M , Alldred D A , Clark A B , Hammond A , Murphy K , Colles A , Keevil V , Kellar I , Patel M , Sims E , Taylor J , Turner D , Witham M , Wright D , Bhattacharya D 
Published: January 2024

Abstract

Introduction
CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention to support geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. The intervention comprises: formulating a deprescribing action plan, workshops, benchmarking reports and weekly briefings between geriatricians and pharmacists. We assessed feasibility and acceptability of the CHARMER intervention and study processes.

Method
A two-arm purposive allocation feasibility study was undertaken in four hospitals (three intervention, one control) in England in 2022. Data were collected to check completeness and quality, and assess intervention fidelity. Rapid qualitative analysis of staff and patient interviews, intervention implementation observations (action plan launch, pharmacist workshop and geriatrician videos), and study meeting minutes was undertaken.

Results
Study data were feasible to collect, of sufficient completeness and quality. Geriatrician and pharmacist principal investigators managed intervention implementation. They were able to implement most intervention components with ease and fidelity. Principal investigators felt that dedicated support for intervention implementation would better equip them with the resource and expertise to fidelitously implement all intervention components. Detailed instructions for preparing the action plan and how it might be delivered were desired. Geriatricians and pharmacists who received the intervention found it acceptable. Pharmacists felt that the weekly briefings encouraged them to dedicate time to review medicines and raise with geriatricians, opportunities to deprescribe. Geriatricians indicated that participating in CHARMER allowed them to focus on deprescribing conversations with patients and they involved junior doctors more in the deprescribing process.

Conclusion(s)
The CHARMER intervention and trial processes were feasible and acceptable. Revisions to support intervention implementation include providing a template action plan for hospitals to adapt; funds for a project manager one day a week to work with CHARMER principal investigators for three-months to oversee implementation, and support from Eastern Academic Health Science Network in the definitive trial (winter 2023).
1937 The future of research: Participant perspectives on remote trial delivery
Authors: Milczanowska W , Bowyer R C E , García M P , Wadge S , Baleanu A F , Nessa A , Sheedy A , Akdag G , Hart D , Whelan K , Steves C J , Lochlainn M Ni 
Published: January 2024

Abstract

Introduction
The PROMOTe trial was conducted entirely remotely, which aimed to enable a wider recruitment of participants, minimised risk of Covid-19 exposure and adhere to former travel restrictions. Participant experiences with remote clinical trials are not well understood. This work aimed to characterise participant perspectives on the remote delivery of the PROMOTe trial.

Methods
The trial involved remote measurement of short physical performance battery and grip strength, and remote collection of stool, urine, saliva, and capillary blood. Equipment including a dynamometer was posted to participants. Participants returned biological samples by post. A mixed methods approach was used, whereby participants were invited to complete an online questionnaire consisting of Likert, multiple-choice and open-ended questions upon trial completion.

Results
Of 72 trial participants, mean age 73.1, 80.6% (n = 58) completed the questionnaire. 53.5% (n = 31) had no preference between remote or in-person participation. Of those who preferred to take part remotely, 57.1% (n = 4) stated this was because there was no need to travel. 57.1% (n = 12) of those who preferred to take part in-person stated this was because they preferred to talk to the staff and ask questions face-to-face. Participants found that taking 5 out of the 8 physical measures were of similar difficulty over video teleconferencing compared to in-person. 100.0% (n = 58) of participants found it “easy” or “average” to collect stool, urine, and saliva, while 63.2% (n = 36) of participants thought it was “easy” or “average” to collect capillary blood. All participants found packaging and returning all four sample types of “easy” or “average” difficulty.

Conclusion
These findings suggest that the majority of participants found remote trial delivery, including handling equipment and collecting biological samples, both acceptable and manageable. Remote trial delivery has potential for increasing access of older people to trial participation.