bluuebunny/crossref_metadata_2025_split huggingface dataset:
1986 Hypoglycaemia in older people with diabetes and symptoms suggestive of hypoglycaemia - continuous glucose monitoring (CGM) study
Authors: Navaneetharaja N , Mattishent K , Loke Y 
Published: January 2024

Abstract

Introduction
Older people with diabetes are often admitted with falls, dizziness or confusion that may stem from undiagnosed episodes of hypoglycaemia. We examined the use of a 10-day period of round the clock glucose monitoring (CGM), to detect hypoglycaemia in older people with diabetes with symptoms potentially related to hypoglycaemia.

Methods
Population: Age 75 years and older, on sulfonylureas and/or insulin, presenting to hospital with a fall and/or symptoms suggestive of unrecognised hypoglycaemia.

Design
Single-centre, observational study (no change to standard diabetes care). Intervention: 10 days of CGM with Dexcom G6 sensor and Android app on smartphone to continuously transmit data.

Primary outcomes
Proportion of participants with captured hypoglycaemia; within that group, time spent in the hypoglycaemic range (Battelino T, Danne T, Biester T, et al. Diabetes Care. 2019;42(8):1593-603.).

Secondary outcomes
Overall time in range; emergency department re-attendances and/or hospital re-admissions for falls, fractures, heart attacks, ischaemic strokes and death within 30 days. REC IRAS project ID: 301286.

Results
26 eligible participants of which 13 consented to participate. At the time of writing, nine participants (mean age 81 years) completed the study. There were no reports of pain or skin reactions from the participants. Hypoglycaemic events were captured in 3 of 9 participants, with two participants suffering &gt;1 hour below 3.9mmol/L. Only 3 participants achieved &gt;50% time in range target (3.9-10.0mmol/L).

Discussion
We have detected significant hypoglycaemic episodes in our participants. CGM should be used more widely in older patients with diabetes who present with falls, dizziness or confusion. Limitations include issues around data capture due to participants struggling to navigate the mobile phone app. Despite this, all participants felt that CGM was better than finger-prick glucose testing. Future work is needed to explore how CGM can be deployed after acute admissions in this patient group.
2051 How representative are UK-based trials investigating lifestyle interventions for diabetes mellitus: a systematic review
Authors: Miles G , Smith R A 
Published: January 2024

Abstract

Background
Type 2 Diabetes mellitus (T2DM) is the most common long-term metabolic condition in older people. In the UK, half of all diabetic patients are over 65 and prevalence reaches 10% in over 75s. Lifestyle interventions reduce diabetic complications and can achieve remission, however, there are concerns over the generalisability of these findings to the diabetic population, particularly elderly, complex patients, and those from ethnic minorities. This systematic review quantifies the disparity between diabetes clinical trial cohorts and the UK diabetic population.

Method
This is a systematic review of UK-based randomised control trials (RCTs) of non-pharmaceutical interventions in adults with T2DM. Data was collected on characteristics of participants included in these studies, including age, sex, ethnicity, socioeconomic status and education of participants.

Results
Our search strategy identified 5437 results, of which 161 met the criteria for full-text screening. After full-text screening and de-duplication, 80 RCTs were included in our analysis. Of 80 studies, 60% (48/80) reported a mean participant age under 60. Only 40 (50%) reported participant age range; of these the maximum participant age was under 65 in 20% and under 75 in 60%. Where the mean age of participants was over 60, 56% (18/32) restricted participation by comorbidities. Almost all of these precluded anyone with pre-existing CVD (17/18), one third precluded any comorbidities, and 5/18 precluded hypertensive patients. Only 26% of studies reported the ethnicity of participants. These cohorts were not representative of the UK diabetic population, with underrepresentation of Asian ethnic groups in 90% of trials.

Conclusions
Representation of elderly patients with comorbidities and those belonging to ethnic minority groups is severely limited in UK based T2DM RCTs of lifestyle interventions. Failure to include a representative population in clinical trial cohorts risks guidance that is not generalisable to the UK diabetic population, potentially exacerbating existing health inequities.
1850 Dogs and Bones
Authors: Williams L , Nyunt N , Davies R , Adhiyaman V 
Published: January 2024

Abstract

Introduction
The health benefits of owning dogs include improved physical activity, mental well-being, companionship, and so forth. However, musculoskeletal injuries caused by dog-related activities might negate the aforementioned benefits. The aim of this study was to estimate the number of femoral fractures directly linked to dog-related activities in people above the age of 60.

Methods
In this observational study, we included all patients above the age of 60 with femoral fractures caused by dog-related activities, over a one-year period (June 2022 to May 2023). We chose to include people above the age of 60 because they are more likely to have a fragility fracture and are entered in the National Hip Fracture Database.

Results
387 patients (above the age of 60) were admitted with femoral fractures during the study period. Of these, 16 were directly related to dog-related activities. The common mechanisms of injuries include being tripped, pulled down and jumped over by a dog, and tangled and tripped by the dog leash.

Conclusion
4% of femoral fractures (1 in 25) in people above the age of 60 were caused by dog-related activities. This is probably an underestimate, because some owners may not have volunteered this information out of love for their dogs and inadequate history regarding the circumstances that led to the fall. Despite the injuries, all patients still loved their dogs and wanted to go home as soon as possible to be with them. There were more fractures in spring and summer (11) compared to autumn and winter (5) which reflects increased activity with better weather. Having a dog is a risk factor for falls and fractures. We recommend that dog owners carefully consider their choice of dogs and if there are issues with handling them, both dogs and their owners should receive appropriate training.
1866 The impact of patient and public involvement on partnership in the DREAM project
Authors: Morley N , Sanders T , Goodwin V A ,   on behalf of the DREAM team
Published: January 2024

Abstract

Introduction
Patient and Public involvement is a cornerstone of the DREAM (Digital and Remote Enhancements for the Assessment and Management of older people) project. An advisory group of 10 diverse older people and carers was established to shape the research through regular discussions and explore inclusive involvement approaches for future work.

Methods
We conducted a reflective process evaluation to highlight the impact of the involvement process on the project and our public partners themselves. We collated impact logs, reflections and feedback from our public partners and an artist recorded the impacts using illustration.

Results
The advisory group:
• helped to lay the foundations of the project and steered its development with their views, knowledge and experiences
• shaped how evidence is captured and analysed so that it is usable, acceptable and makes sense to older people and carers
• provided insights to consider for implementation and shaped our dissemination strategy Our public partners and researchers also expressed relational impacts such as shared ownership. Public partners joined this project to improve health care for other people. They felt safe to share their experiences and be listened to. It gave them confidence in their health management, and they have built friendships. People also found comfort in the diversity of individuals and sharing common concerns.

Conclusion(s)
Public partners have been instrumental in the development of the DREAM project and supported the programme by being a critical friend beyond the remit of the research. Continued communication and feedback resulted in public partners feeling heard and their suggestions acted upon. Researchers and public partners felt gratitude, ownership and joy working on this project, and finding shared values. Our involvement approaches have shaped reciprocal relationships and had impact on our research culture, forming a foundation to the values of the people it is serving.
2009 Integrated physical-mental health care models for older people under specialist mental health services: a systematic review
Authors: Hickey B , Desai B , Chithiramohan T , Robinson T , Mukaetova-Ladinska E , Evley R , Dening T , Rajamani A , Subramaniam H , Tako A , Tarrant C , Beishon L 
Published: January 2024

Abstract

Background
Older people have complex health needs, with the inter-play between physical and mental health being a prominent issue. The ageing population has resulted in a large proportion of older people living with co-occurring physical and mental health disorders, which can prove challenging to manage simultaneously, particularly for serious mental illness. The aim of this systematic review was to explore models of integrated physical-mental health care available for older people, and whether these result in improved health outcomes. Sources of heterogeneity in the current evidence base alongside limitations were also explored.

Methods
Medline, Embase, CINAHL, PsycINFO and Scopus were searched with a predefined search strategy, generating 5257 articles. Studies were suitable for inclusion where an integrated physical-mental health care service model was utilised in a population of older people (aged &gt;60 years) with a mental health diagnosis and at least one concomitant physical health condition requiring physical health care input. All studies were quality assessed for risk of bias and results were synthesised narratively.

Results
Ten studies met the inclusion criteria. All studies incorporated service models involving integrated and/or multidisciplinary care. These included joint medical-mental health wards as well as the implementation of multidisciplinary teams in hospital and care facilities. Overall, this enhanced the quality of care for elderly patients with benefits including but not limited to, enhanced patient experience, the expansion of multidisciplinary team practice, improved management of illness, and timely intervention.

Conclusions
Multidisciplinary and integrated care resulted in improvement of a range of health outcomes for older people with combined physical and mental health needs. Larger and more robust studies are needed to explore the development of these service models further, with cost-effectiveness analyses.
1970 How can health care professionals understand and incorporate spirituality into Comprehensive Geriatric Assessment?
Authors: Turner L 
Published: January 2024

Abstract

Introduction
Little is known about how Health Care Professionals (HCPs) conducting Comprehensive Geriatric Assessment (CGA) assess spiritual needs. The aim of this study was to better understand how UK HCPs understand and incorporate assessment of spirituality into CGA for community dwelling frail older people.

Methods
Semi-structured interviews were undertaken with HCPs who regularly undertake CGA in the community as well as Anna Chaplains (ACs) whose remit is to provide chaplaincy to community dwelling older people. An inductive approach was taken using a topic guide to structure the interviews. Thematic analysis was undertaken using NVIVO. Ethics approval was granted through St Augustine’s College of Theology.

Results
Three HCPs and two ACs were interviewed. Three themes emerged. Firstly, that spiritual assessment needs time, trust and skill and cannot be established using checklists. Assessment hinges on building a rapport between the patient and HCP. HCPs and ACs suggested potential questions that could support assessment of spiritual needs. Secondly, supporting spirituality is focused on sustaining identity, fostering hope and encouraging spiritual growth. Finally, health care professionals lacked confidence and understanding in how to recognise and meet spiritual needs. Several suggestions were made as to how to address this.

Conclusions
All participants agreed that incorporating assessment of spirituality into CGA was important but that doing so effectively requires understanding and skill. The questions suggested by participants mapped well onto existing models of spirituality in ageing and frailty. Study findings could be used to develop training for HCPs undertaking CGA.
1943 Thyroid dysfunction and its relationship with cardiometabolic risk in a South American cohort, cross-sectional study
Authors: Medina M , Amaya M , Dulcey L , Gomez J , Vargas J , Lizcano A , Teran J , Hernandez C , Ciliberti M , Blanco C 
Published: January 2024

Abstract

Introduction
A growing body of evidence suggests that metabolic syndrome is associated with endocrine disorders, including thyroid dysfunction. Thyroid dysfunction in patients with metabolic syndrome may further increase the risk of cardiovascular disease, thus increasing mortality. This study was conducted to assess thyroid function in patients with metabolic syndrome and to assess its relationship to components of metabolic syndrome.

Methods
A cross-sectional study was carried out among 170 geriatric patients. Anthropometric measurements (height, weight, waist circumference) and blood pressure were taken. Fasting blood samples were analysed for glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, and thyroid hormones (triiodothyronine, thyroxine, and thyroid-stimulating hormone).

Results
Thyroid dysfunction was observed in 31.9% (n = 54) of the patients with metabolic syndrome. Subclinical hypothyroidism (26.6%) was the main thyroid dysfunction, followed by overt hypothyroidism (3.5%) and subclinical hyperthyroidism (1.7%). Thyroid dysfunction was much more common in women (39.7%, n = 29) than in men (26%, n = 25), but not statistically significant (p = 0.068). The relative risk of having thyroid dysfunction in women was 1.525 (CI: 0.983-2.368) compared to men. Significant differences (p = 0.001) were observed in waist circumference between patients with and without thyroid dysfunction and HDL cholesterol that had a significant negative correlation with thyroid-stimulating hormone.

Conclusion
Thyroid dysfunction, particularly subclinical hypothyroidism, is common among patients with metabolic syndrome and is associated with some components of metabolic syndrome (waist circumference and HDL cholesterol). Keywords: metabolic syndrome, hypothyroidism, cardiovascular diseases.
1718 Co-Producing an Intervention to Reduce Sedentary Behaviour in Community-Dwelling Older Adults Through Behaviour Change Theory
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A 
Published: January 2024

Abstract

Background
Older adults are the fastest-growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research, and tailored strategies to reduce sedentary time may be warranted for this subset of older adults. The development of an intervention to reduce sedentary behaviour in adults aged ≥75 years using co-production and behaviour change theory is reported.

Methods
Four co-production workshops with community-dwelling older adults aged ≥75 years were held between October-December 2022. The intervention development process was informed by the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). Audio recordings and workshop notes were iteratively analysed, with findings used to inform subsequent workshops.

Results
The co-production group consisted of six community-dwelling older adults aged ≥75 years and two researchers. The developed intervention consists of four components (activity monitoring, educational material, group sessions and researcher follow-up), maps to 24 behaviour change techniques and targets barriers to reducing sedentary time. Participants were receptive of the co-production process.

Conclusions
Integrating co-production with the BCW can provide several benefits, with the BCW providing structure to the intervention development process, and co-production increasing the likelihood of the developed intervention being viewed as feasible by older adults. Furthermore, coding intervention components to the BCW may further our understanding of what approaches are successful or unsuccessful at influencing behavioural change. Transparent reporting of the intervention development process may benefit researchers developing interventions with older adults. Future research will pilot the co-produced intervention.
1717 Interventions to Reduce Sedentary Behaviour in Community-Dwelling Older Adults: A Mixed Method Review
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A 
Published: January 2024

Abstract

Introduction
Sedentary behaviour has been associated with several deleterious health outcomes and older adults are the fastest-growing and most sedentary group in society. This review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults.

Methods
This mixed-method systematic review (PROSPERO registration number: CRD42021264954) considered quantitative articles (randomised-controlled trials (RCTs) and cluster RCTs), qualitative articles (semi-structured interviews and focus groups) and mixed-method studies that explored interventions to reduce sedentary behaviour in community-dwelling older adults. Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus and PEDRO were searched from inception to March 2023. Articles were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed, qualitative evidence was thematically synthesised and both were combined in a mixed-method synthesis.

Results
Forty-one studies (15 RCTs, 21 qualitative and 5 mixed-method studies) were included. Interventions were somewhat effective at reducing sedentary time (-29.10 mins/day, 95% CI -51.74, -6.46). Three analytical themes were identified (what sitting means to older adults, expectations of ageing and social influence in older adults). The mixed-method synthesis identified that existing interventions have been limited by a recruited sample that is not representative of the wider population of older adults, and outcome measurement and intervention content that is not consistent with older adults’ priorities.

Conclusions
Future research should focus on inclusive recruitment strategies to recruit under-represented populations (such as adults aged 75 years and above), incorporate outcome measures that are valued by older adults, and incorporate older adults’ preferences in intervention content.
1877 Recruitment to a phase 3, RCT in Parkinson’s: strategies and association between participant characteristics and PI specialty
Authors: Henderson E J , Young G , Pendry-Brazier D , Smith M , Lloyd K , Metcalfe C , Hollingworth W , Ben-Shlomo Y 
Published: January 2024

Abstract

Introduction
Falls are a common complication of Parkinson’s disease, driven in part by an underlying cholinergic deficit that contributes to gait and cognitive impairment. Phase 2 studies have established that amelioration of this deficit using cholinesterase inhibitors may reduce falls.

Methods
CHIEF-PD (CHolinesterase Inhibitor to prEvent Falls in Parkinson's Disease) is a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease that recruited from NHS sites. Relationships between the Principal Investigators’ specialty and the participants baseline characteristics were evaluated using linear, logistic and ordinal logistic regression. Cognitive impairment was defined as MoCA ≤26, while falls in the prior 12 months were separated into ordinal quartiles (1-2, 3-5, 6-12, 13+).

Results
Recruitment to CHIEF-PD commenced in January 2020 and completed in April 2023. Recruitment increased up until the start of the pandemic and thereafter there were 2 peaks. Potential participants were identified through clinic lists, databases, via national and local media and charities. 600 participants were enrolled across 38 sites. Sites enrolled between 1 and 74 participants, each. The median recruitment rate was 19 participants per month (IQR 6-27). 14 (37%) sites had Principal Investigators that were neurologists and 24 (63%) sites had PIs that were geriatricians. Most participants (76%) were over the age of 65 years. Compared with neurologists, geriatricians recruited older patients (difference in means 2.08 (95% CI 0.68, 3.48); p=0.004), with similar levels of cognitive impairment (OR 1.20 (95% CI 0.85, 1.69); p=0.293) and a lower fall rate (OR 0.46 (95% CI 0.34, 0.62); p&lt;0.001) at baseline.

Conclusion
Recruitment of older participants to a Clinical Trial of an Investigational Medicinal Product (CTIMP) trial throughout the Covid-19 pandemic across 38 UK centres was feasible using multiple strategies. Characteristics of participants varied according to the sub-speciality of the Principal Investigator at the site.
1852 The effectiveness of structured physical activity on agitation for people living with dementia: a rapid review
Authors: McCartney A , Crosswell J , Hoe J , Rafnsson S B 
Published: January 2024

Abstract

Background
Managing agitation and other behavioural and psychological symptoms of dementia (BPSD) is a significant challenge and impacts on quality of life for people living with dementia. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects.

Objectives
This review evaluates the effectiveness of structured physical activity on agitation in people living with dementia

Methods
A rapid review of the literature was carried out following PRISMA guidelines. Four electronic databases were searched (Cochrane CENTRAL, MEDLINE, CINAHL and Embase) looking for interventional studies that used a structured physical activity programme in people with a diagnosis of dementia, studied the effects of this activity on BPSD and compared this with a control group that did not follow an exercise programme.

Results
From 112 identified articles, 13 were included in this review, involving a total of 1546 participants. The results were analysed and synthesised according to the type of exercise intervention (aerobic, multicomponent or strength training) and by the frequency and intensity of the intervention. Quality assessment using CAPS guidelines indicated four studies as higher quality with seven being of moderate quality. The results showed that aerobic exercise in particular appears to be effective in reducing agitation and those studies with higher adherence to exercise tended to demonstrate more positive effects on agitation and BPSD.

Conclusions
There is evidence that physical activity can be effective in the reduction of agitation in older adults with a dementia diagnosis. Further research is needed to clarify the type of intervention that is most beneficial and strategies to make physical activity more acceptable and available to older people with dementia need to be es established.