bluuebunny/crossref_metadata_2025_split huggingface dataset:
1587 ASSOCIATION BETWEEN HANDGRIP STRENGTH-BASED MOTORIC COGNITIVE RISK SYNDROME AND THE RISK OF COGNITIVE IMPAIRMENT
Authors: Chen Z , Ho M , Chau P H 
Published: July 2023

Abstract

Background
Motoric cognitive risk syndrome (MCR), characterised by slow gait speed (GS) and subjective cognitive complaints, is a simple way to screen older adults at high risk of dementia. In primary care service, however, assessing GS may still be a challenge due to the short consultation time and space constraints common in general practice. Therefore, there is a need to explore alternative MCR subtypes with motor domains that can be measured conveniently. This study aimed to explore a new subtype of MCR, using low handgrip strength (HGS) as the motoric phenotype, and examined its association with the incidence of cognitive impairments among the Chinese community-dwelling older adults.

Methods
We used four-wave data (2011-2018) of participants (≥60 years) in the China Health and Retirement Longitudinal Study. We investigated two MCR subtypes. First, MCRg was defined in the literature as the coexistence of slow GS and cognitive complaints without dementia or morbidity disability. Then, we defined a new subtype, MCRh, by replacing slow GS with low HGS. Cox proportional hazards models were used to examine the association between baseline MCR subtypes (MCRg and MCRh) and incident cognitive impairment, controlling for sociodemographic characteristics, lifestyle behaviors and health conditions.

Results
Of 3325 participants (Mean age: 66.7±5.7, males: 54.9%), 5.2% had MCRg and 5.4% MCRh. Based on Cox models, both MCR subtypes were associated with the increased risk of cognitive impairment, with adjusted hazard ratios (95% CI) of 1.821 (1.402 to 2.368) for MCRg and 2.008 (1.567 to 2.574) for MCRh.

Conclusion
Low HGS, which can be quickly measured and requires no additional space, may be considered as a promising motoric phenotype of MCR subtypes. This study preliminarily supports the potential utilization of the HGS-based MCR subtype for early risk identification of cognitive impairment in primary care settings.
1474 DIABETES MANAGEMENT IN OLDER ADULTS WHO FALL: A RETROSPECTIVE COHORT STUDY
Authors: Burgess A J , Williams D M , Collins K , Roberts R , Burberry D J , Stephens J W , Davies E A 
Published: July 2023

Abstract

Introduction
Type 2 diabetes mellitus (T2D) is associated with poor health outcomes and tight glycaemic targets are questionable in those aged over 70 years. We examined whether people with T2D admitted to emergency department (ED) with a fall, were more likely to have greater frailty, co-morbidity burden, or risk factors for falls and whether use of insulin or gliclazide was associated with poor clinical outcomes.

Methods
The Older Persons Assessment Service (OPAS) is a local emergency department service which accepts patients on frailty criteria. The OPAS databank was retrospectively analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS).

Results
1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (±15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0±2.2 vs 5.9±2.1, p&lt;0.001). Of those people with T2D, 175 (59.5%) and 240 (81.6%) had a HbA1c ≤53 mmol/mol [7.0%] and ≤64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the emergency department. People with T2D treated with insulin and/or gliclazide had a greater mortality (36.6% vs 23.6%, p&lt;0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p&lt;0.001), and greater HbA1c (65.5±17.2 mmol/mol [8.2] vs 48.9±12.1 mmol/mol [6.6%]) compared to those who used other agents. People with T2D were not more likely to live in deprived areas.

Conclusion
Falls are a significant burden, and hypoglycaemia-inducing medication may contribute to the greater mortality observed in people with T2D. Clinician awareness can support de-prescribing for patients with frailty and HbA1c &lt;64mmol/mol. There should be increased awareness of the impact of hypoglycaemia, especially in those using insulin or gliclizade.
1559 USING QUALITY IMPROVEMENT METHODS TO DESIGN A WEEKLY WARD-BASED TEACHING PROGRAMME
Authors: Gill G , Wilkinson I , Collins S , Eleftheriades C 
Published: July 2023

Abstract

Introduction
A weekly ward-based teaching programme was designed and implemented using quality improvement methodology. 10 topics were identified to be covered during each 4-month rotation. 1) Topic of the week introduced via a presentation in the weekly teaching session; 2) Daily topic discussions at ward level.

Method
7 wards. PDSA 1 (weeks 1 and 2): Weekly poster with the topic and a daily fact / question PDSA 2 (week 3 onwards): a) Software introduced to enable interaction in the teaching session b) Departmental WhatsApp used to send out daily questions. PDSA 3: a) New topics selected b) More staff groups added to WhatsApp group c) Questions weekly for each ward to ‘answer’ in the WhatsApp group

Results
Cycle 1 – little daily ward level discussion. Generating discussion in weekly teaching difficult. Cycle 2 - more engagement with both discussions. Variation in (MDT)staff group awareness. Daily teaching not habitual everywhere. Nursing staff more engaged with prompt cards than via Whatsapp. It was clear that each ward should be supported to have a different approach to delivering the teaching. Not all staff could access to weekly teaching sessions. Cycle 3 – more ward level ownership and interaction in the virtual space. The wards that have gained the most benefit from the teaching have made the questions a fixed part within their morning routine and include the entire MDT in five-minute discussion around the questions.

Conclusion
Staff working in these wards were generally positive about the weekly topic style. Having clinical leaders who are invested in teaching can support daily - cooperation and “buy-in” from those in senior roles is crucial for the development of this learning culture. This work has demonstrated some of the challenges of teaching a diverse multidisciplinary team to make information and learning accessible and useful for all.
1589 CHARACTERISTICS, TREATMENT AND HEALTHCARE UTILISATION OF PATIENTS WITH XEROSTOMIA IN PRIMARY CARE SETTINGS IN THE UNITED KINGDOM
Authors: Hosnijeh F Saberi , Heaton D , Gomez J 
Published: July 2023

Abstract

Introduction
Xerostomia, also known as dry mouth, is prevalent in older populations and associated with key determinants such as continual use of medication, radiation, and chronic diseases. Xerostomia significantly increases the risk of experiencing demineralisation, dental caries, tooth sensitivity, candidiasis, and other oral conditions that may negatively affect quality of life. An effective strategy to manage the risk of dental caries for patients with xerostomia is the prescription of high-fluoride products with proven efficacy. The aim of this study was to provide evidence on the burden of xerostomia, patient characteristics, treatments, and healthcare resource use in this patient population in the United Kingdom.

Method
A retrospective observational study was conducted including all patients aged ≥16 years with a first diagnosis of xerostomia between 01/04/2015-31/03/2020 in the Optimum Patient Care Research Database, a primary care database. Patients with &lt;12 months’ baseline and follow-up data were excluded.

Results
11,731 patients with a mean age of 67.93 years (SD 15.64) newly diagnosed with xerostomia were included. 72.27% of patients were &gt;60 years and 65.3% were females. Patients aged ≥65 years received a median of 5 (Q1-Q3: 4-6) drug classes in the baseline period. Analgesic agents (80.6%), cardiovascular drugs (70.3%), antidepressants and antipsychotic agents (57.3%), and antihypertensive agents (47.6%) were common prescriptions reported before the diagnosis of xerostomia. Patients had 24.2 primary care visits with the associated costs of £727.66 per patient-year during follow-up. Only 2.2% of patients received high-fluoride toothpaste, whereas 99.6% of patients were prescribed artificial saliva and 16.3% received saliva stimulants.

Conclusions
The majority of patients aged ≥65 years had chronic diseases for which they received ≥4 medications in the baseline period. Although xerostomia is predominantly managed in primary care, few patients are prescribed high-fluoride toothpaste, which is a cost-effective and simple way to reduce the inevitable risk of dental caries.
1436 CLINICAL OUTCOMES OF OLDER HOSPITALISED ADULTS LIVING WITH FRAILTY IN NORTHERN TANZANIA: A PROSPECTIVE MULTICENTRE STUDY
Authors: Davidson S L , Rayers G , Motraghi-Nobes S M , Bickerstaff E , Emmence L , Kilasara J , Lyimo G , Urasa S , Mitchell E , Dotchin C L , Walker R W 
Published: July 2023

Abstract

Introduction
As global populations age, healthcare systems are facing challenges posed by multimorbidity, disability and geriatric syndromes. In high-income countries, frailty is a strong predictor of poor hospital outcomes. Comprehensive Geriatric Assessment is effective but resource-intensive and unavailable in sub-Saharan Africa where specialist geriatric training and allied health infrastructure are limited.

Aim
To establish clinical outcomes of older adults with frailty admitted to hospital in northern Tanzania.

Methods
All adults aged ≥60 years admitted to medical wards at four hospitals were invited to participate. Participants were screened for frailty using the Clinical Frailty Scale (CFS). The primary outcome was inpatient death, with secondary outcomes including length of stay, 30-day readmission and delirium (confirmed using the Confusion Assessment Method [CAM]). Outcomes for frail (≥5 on CFS) and non-frail participants (1-4 on CFS) were compared.

Results
Over 6 months, 308/540 patients admitted participated. Reasons for non-participation included death (n=34) and discharge (n=159) before researcher attendance. Mean age of participants was 74.9 years and 154 (50.1%) were female. Of these, 205 (67%) participants had a CFS ≥5. 21 (14.9%) frail participants died, compared with 5 (6.4%) in the non-frail group (Chi-squared, p=.095). Length of stay and re-admission rates were higher in frail participants, but differences were not statistically significant. Delirium was diagnosed in 35 (17%) frail participants, compared with 4 (4%) in the non-frail group (Fisher’s Exact test, p=&lt;.001).

Conclusion
Frailty in older adults admitted to hospitals in northern Tanzania is common and associated with significantly higher rates of delirium. Mortality, readmissions, and length of stay were higher in the frail group, but differences did not reach statistical significance. Type II Error (exacerbated by selection bias from non-inclusion of individuals who were discharged, or died, early in their admission) may explain this. Participants will now be followed-up for 12-months to assess outcomes longitudinally.
1667 VARIATION IN ACUTE GERIATRIC MEDICINE ACTIVITY AND OUTCOMES IN SCOTLAND BEFORE, DURING AND AFTER THE COVID PANDEMIC LOCKDOWNS
Authors: Soiza R L , Premathilaka C , Mitchell L , Myint P K ,   the SCoOP collaborative
Published: July 2023

Abstract

Introduction
The Scottish Care of Older People (SCoOP) collaborative reports outcomes of acute geriatric medicine admissions across Scottish hospitals. The covid pandemic caused major and variable restructuring of acute services across the country. Their impact on activity and outcomes is unknown.

Methods
We collated all SMR01/SMR01E hospital episodes from Public Health Scotland from 1st April 2017 to 31st March 2022 where over 50% of the total episode was spent under acute geriatric medicine (code AB) and the diagnosis was not stroke. Activity and outcomes in 19 major hospitals were compared across financial years 2017-19 (before-), 2020/21 (during-) and 2021/22 (after lockdowns).

Results
Admissions fell by 15% to 36954 in 2020/21 from an average 42566 before recovering to 41971 in 2021/22. Some hospitals were busier than ever in 2020/21 while others saw large reductions in activity. Age, sex and social deprivation profiles differed between hospitals (p&lt;0.001) but remained similar within each hospital at all timepoints. Mortality at 30 days post-admission was 8.5% higher in 2020/21 (17.9% v 16.5% in other years, p&lt;0.001), with 2-fold differences across hospitals. Mean median length of stay (LOS) across hospitals was 11.7 days, compared to 13.6 days in 2017-20, p&lt;0.001. There were up to 17-fold differences in median LOS between hospitals (2-34 days), p&lt;0.001. The impact of the pandemic on LOS within each hospital was variable. Readmission rates at 7 days post-discharge were broadly similar across all years but two-fold differences between hospitals were seen each year (2020/21 4.8%-9.8%, mean 6.8%, p&lt;0.001).

Conclusion
The impact of the pandemic on the activity and outcomes of individual hospitals was widely disparate, probably reflecting variation in how each hospital service responded to the pandemic. Overall activity and LOS were lower and mortality was higher in 2020/21.
1573 SUMMARISING REHABILITATION FOR COVID-19 PATIENTS: A LITERATURE REVIEW AND SYNTHESIS OF COCHRANE REH-COVER
Authors: Georgiev K , McPeake J , Fleuriot J , Shenkin S D , Anand A 
Published: July 2023

Abstract

Introduction
The role of rehabilitation medicine in treating post-acute COVID-19 survivors is currently ill-defined. Recently developed evidence-based initiatives, such as Cochrane REH-COVER, aim to describe the management of COVID-19 patients, but the variance and overlap in intervention types result in clinical uncertainty.

Methods
We collected evidence regarding performed COVID-19 rehabilitation interventions from studies collected by the Cochrane REH-COVER Rapid living Systematic Reviews between March 2020 and February 2022. We extracted a set of studies highlighting details of COVID-19 rehabilitation programmes in adult hospitalised patients. Our exclusion criteria consisted of removing case reports, opinion pieces, guidelines and review articles. We collected information on the delivered service, intervention type and length of rehabilitation where available.

Results
Out of 580 REH-COVER studies, 69 met the inclusion criteria. In-hospital interventions were present in 45 (65%) of cases, 14 (20%) were performed in community or home settings, and 10 (14%) were not explicitly defined. 44% of studies were conducted within the initial wave of COVID-19, in the first half of 2020. Among the intervention categories, 38 (55%) studies consisted of physical therapy, 41 (59%) respiratory training, 7 (10%) neurological treatment, 4 (6%) nutritional therapy and 4 (6%) speech and language therapies. Based on review, we inferred that only 34 (49%) of these studies described a multidisciplinary intervention. Among these treatments, the mean length of rehabilitation was 21 days (95% CI: 13-30), compared to 17 days (95% CI: 8-26) for those with a single intervention. However, these data were not reported in 32 (46%) studies.

Conclusions
There is currently a wide variation in descriptions of rehabilitation interventions for COVID-19 patients. The limited number of papers clearly describing the content and length of rehabilitation programmes reduce the ability to share best practices. Harmonising descriptions of rehabilitation could improve the quality and standardisation of research in this area.
1576 PATIENTS’ AND CARERS’ EXPERIENCES AND PERSPECTIVES OF THE MANAGEMENT OF ANXIETY AND DEPRESSION IN PEOPLE WITH DEMENTIA
Authors: Sinnamon C J , Hughes C M , Barry H E 
Published: July 2023

Abstract

Introduction
Many people with dementia (PwD) are affected by anxiety and depression, leading to significant changes in patient behaviour, carer burden and negative patient outcomes. Anxiolytics and antidepressants are commonly prescribed for PwD and may contribute to potentially inappropriate prescribing. This study aims to explore patients’ and carers’ experiences and perspectives of the management of depression and anxiety in PwD.

Methods
An online discussion forum, Talking Point, hosted by the Alzheimer’s Society, was searched for relevant archived threads and posts. These were identified using 64 search terms such as “depression” and “SSRI”. Data were extracted into Microsoft Word and inductive thematic analysis is ongoing to code the data and identify pertinent key themes.

Results
In total, 3539 posts were identified from 931 registered forum users. Initial findings have highlighted that anxiety and depression were commonly experienced by PwD and many described the difficulties in differentiating depression from dementia during the early stages of dementia. “Initially my wife was treated for depression and anxiety but that soon changed to MCI [mild cognitive impairment], then dementia…” [TP019]. Forum users described the use of anxiolytic and antidepressant medications as a process of trial and error: “The GP gave her sertraline but that didn’t work so now on mirtazapine. Only been 10 days and really makes her sleep just with half a tablet but now crying again” [TP022]. Frank accounts of the symptoms that PwD experienced were shared, highlighting the impact depression and anxiety has on both patients and their carers.

Conclusion
This online discussion forum is a source of rich and valuable data, which may not be accessible through traditional qualitative methods. This study will provide authentic insights on patients’ and carers’ lived experiences of managing anxiety and depression in PwD and will inform further qualitative work with key stakeholders.
1598 A TYPOLOGY OF COMMUNITY-BASED COMPLEX INTERVENTIONS TO SUSTAIN INDEPENDENCE IN OLDER PEOPLE
Authors: Crocker T , Jordão M , Lam N , Ellwood A , Mirza L , Patel I , Patetsini E , Ramiz R , Forster A , Clegg A , Gladman J ,   HTA complex interventions review team
Published: July 2023

Abstract

Introduction
Provision of community-based health services to support independence of older people, and further research in this area, would be improved by a typology of these complex interventions - thereby enabling evidence synthesis and the identification of effective intervention components. We aimed to produce such a typology in preparation for a systematic review and network meta-analysis.

Methods
The typology was developed based upon the descriptions of these interventions in published reports. This involved four stages: (1) systematic identification of relevant RCTs and related publications; (2) the extraction of descriptions of the interventions (including control/comparison) using the Template for Intervention Description and Replication (TIDieR); (3) a qualitative synthesis generating categories of key intervention features and (4) grouping the interventions based on the categories.

Results
Our search identified 496 reports of 129 studies, involving 266 intervention arms. 19 intervention components were identified: Formal homecare; Physical exercise; Health education; ADL training; Providing aids and adaptations; Nutritional support; Psychological therapy; Technology for communication and engagement; Cognitive training; Engagement in meaningful activities; Care voucher provision; Alternative medicine; Social skills training; Welfare rights advice; Medication review; Monitoring; Routine risk screening; Multifactorial-action from care planning; and Routine review following multifactorial-action from care planning. Multifactorial-action from care planning refers to a process of individualised, multidomain assessment and management resulting in a tailored selection of action components, as in comprehensive geriatric assessment. 63 different intervention types (combinations of these components) were identified.

Conclusions
The typology provides an empirical basis for service planning and evidence synthesis. Target populations are not explicitly integrated and should be considered separately. The components, being broad actions, are likely to endure; further components may be identified. However, the huge potential number of intervention types constitutes a challenge to typical approaches to effectiveness research. We recommend better reporting about organisational aspects of interventions and usual care.
1616 HOW CAN WE ENHANCE COMPREHENSIVE GERIATRIC ASSESSMENT FOR OLDER PEOPLE LIVING WITH FRAILTY IN PRIMARY CARE AND COMMUNITY SETTING
Authors: Mahmoud A , Frost J , Morley N , Whitney J , Goodwin V 
Published: July 2023

Abstract

Background
With advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (e.g. hospitalisation). Internationally, models of Comprehensive Geriatric Assessment (CGA) delivery in primary care/community settings vary, and effectiveness is uncertain. CGA is a complex intervention and improving the effectiveness and efficiency of it first requires exploration of how individual components may work and how the intervention can be strengthened.

Aims
To explore how to enhance current CGA, the conditions needed to implement enhanced CGA and the outcomes that older people, families, health and care professionals identify as important.

Methods
A qualitative study using semi-structured interviews with older people and healthcare practitioners working in non-hospital settings with older people in the UK. Data were analysed using an abductive analysis approach. Findings were shared with our stakeholder group involving older people, family members, health and social work professionals.

Results
Twenty-seven people participated including 14 older people and 13 healthcare professionals. We identified limitations in current CGA: the lack of information sharing between different healthcare professionals who are delivering the CGA; communication between older people and their healthcare professionals; and follow-up after conducting the CGA. There was variation in participant perceptions on the provision of digital and remote assessment. However, we found that introducing remote assessment and a designated comprehensive care coordinator might be a viable solution to address the gaps in the current delivery of CGA.

Conclusions
The study identified potential challenges in the implementation of enhanced CGA. However, the participants suggested possible solutions that can be used to overcome these challenges, which aligned with feedback from relevant stakeholders. The next stage of this research will involve using these findings, alongside existing evidence and key stakeholder engagement, to develop and refine a model of enhanced CGA that can then be assessed for feasibility and acceptability.