bluuebunny/crossref_metadata_2025_split huggingface dataset:
1270 DEVELOPMENT OF A COMPETENCY FRAMEWORK FOR EARLY CAREER NURSES UNDERTAKING POST-REGISTRATION EDUCATION IN CARE FOR OLDER PEOPLE
Authors: Hayes N , Naughton C 
Published: January 2023

Abstract

Introduction
Despite recognition of the status of gerontological nursing as a speciality, there is no specific UK competency framework for early career nurses working with older people. As part of a feasibility intervention to improve recruitment and retention of nurses within the speciality (ECHO Early Careers in Healthcare of Older People and PEACH Programme for early careers for care home nurses), we developed a bespoke competency framework appropriate for nurse working within all sectors.

Method
The national and international literature on published competency frameworks was reviewed to identify core domains of knowledge and skill. We integrated these within a CGA model to develop a draft competency framework which we then tested for face and content validity. It was reviewed by expert practitioners and managers from NHS and care home providers, and a national reference group (British Geriatrics Society Nurse Special interest group). It was then implemented by students under taking the ECHO and PEACH programmes. A mixed-methods approach was used involving online surveys, one-to-one interviews and focus group interviews with students, mentors, ward managers and care home managers. Ethical approval was obtained from the university ethics committee.

Results
From an initial draft of 80 competency statements 69 were adopted across 10 domains. Thirty students across the ECHO and PEACH programmes used the framework and participated in evaluation. Our analysis found that students benefited from recognising unique gerontological knowledge, expanded insights into practice and affirmation through mentor feedback. Some students faced logistical challenges including access to mentors. The framework was found to be appropriate and acceptable across both hospital, community and care home settings.

Conclusion/s
The competency framework was valid in clinical gerontological settings across hospital, community and care homes, and supported knowledge and skills development and evidencing for early career nurses.
1332 PREVALENCE AND OUTCOMES OF FRAILTY IN OLDER PEOPLE WITH UNPLANNED HOSPITAL ADMISSIONS: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Boucher E , Gan J , Shepperd S , Pendlebury S T 
Published: January 2023

Abstract

Background
Guidelines recommend screening for frailty in all hospitalised older adults to inform care, based mainly on studies in outpatient and speciality-specific settings. However, most hospital bed-days in older people are for acute, non-elective admissions to general medicine, for which the prevalence and prognostic value of frailty might differ. Therefore, we undertook a systematic review of frailty prevalence and outcomes in older people with unplanned hospital admissions.

Methods
We searched MEDLINE, EMBASE and CINAHL up to 30/04/2021 for observational studies using validated frailty measures in unplanned adult hospital-wide or general medicine admissions. We related frailty prevalence to measurement tool, setting and risk of bias (RoB). Relative risks (RR) for mortality, length of stay (LOS), discharge destination and readmission were pooled using random-effects models where appropriate, and area-under-the-ROC-curves calculated. Heterogeneity was explored with meta-regression. Dose-response effects were assessed with the Cochran-Armitage test.

Results
Among 38 cohorts (median/SD age=80/5 years; n=37,733,147 admissions), the median prevalence of moderate-severe frailty was 40.5% (IQR=33.2-53.2; low-moderate RoB=23/38), with considerable heterogeneity (PQ&lt;0.001) apparently unrelated to measure, setting or RoB. Nevertheless, frailty still predicted mortality (RR range=1.08-16.06), long LOS (range=1.35-3.04) and discharge destination (range=1.97-3.45) in all studies with more severe frailty associated with worse outcomes, although associations with 30-day readmission were conflicting (range=0.52-1.64). Studies reporting lower frailty prevalence showed stronger associations between frailty and mortality (beta=-0.009, P=0.03, R=49.6%), with the most consistent (PQ=0.11) associations found in studies using prospective measures (pooled RR=2.57, 95%CI=2.30-2.88) and little attenuation after adjustment for age, sex and comorbidity. Ordinal cut-points appeared to provide superior discrimination to dichotomous thresholds.

Conclusions
Frailty is common in older patients with acute, non-elective hospital admissions and remains an independent predictor of mortality, LOS and discharge home in the acute setting, justifying more widespread implementation of screening using prospective tools and consideration of the degree of frailty in guidance.
1361 THE EFFECTIVENESS OF PREVENTIVE HOME VISIT ON RESILIENCY,HEALTH STATUS AND QUALITY OF LIFE OF OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: Ramli Dayang Balkis , Shahar Suzana , Mat Sumaiyah , Ibrahim Norhayati , Ali Nazlena Mohamad , Tohit Noorlaili Mohd 
Published: January 2023

Abstract

Introduction
Resilient ageing is conceptualised as strive towards achieving satisfactory quality of life (QoL) at old age by embracing adaptive and coping mechanisms against adversities regardless of health conditions. Preventive Home Visit (PHV) including various types of home-care interventions were introduced to delay health deterioration and improved QoL. However, research related to resilience as indicator for QoL is scarce. Therefore, this systematic review aims to evaluate the effectiveness of PHV in improving resilience among community dwelling older adults and the association with health and other QoL related outcomes.

Method
Database search was conducted by using five databases (PubMed, PsycINFO, CINAHL, Web of Science and Scopus) up to 31 March 2022 involving community dwelling older adults who received PHV. Three authors reviewed the articles for inclusion and performed methodological quality assessment.

Results
Out of 1,580 records, 13 articles involving 7,254 participants met the inclusion criteria with age range between 79 to 85 years old. Quality assessment by using Joanna Briggs Institute (JBI) Critical Appraisal Tools indicated that all Randomised Controlled Trials (RCTs) and non-RCTs articles were having low risks of bias, suggesting high-quality studies were selected for this review. One remaining study was a cross-sectional study. More than two third of the studies focused on health or combination of health and QoL and only three studies yield positive impact of PHV. The rest were either yielded mixed results or no impact of PHV intervention. There was only one study measuring resilience with results showed no significant impact of PHV or home care intervention on resiliency of the older adults.

Conclusion
Research on the effectiveness of PHV has been introduced since for decades ago, however study focusing on resilience related outcomes is still lacking. Based on current evidence, it is essential to further evaluate the impact of multi-domain health and psychological intervention in PHV design considering the ability of older adults to face adversity in late life.
1294 ASSESSMENT AND MANAGEMENT OF FRAILTY: A SURVEY OF HEALTHCARE PROFESSIONALS
Authors: Venkatesh A , Noble A , Burgess A , Acquaye E , Maddock B , Davies E A 
Published: January 2023

Abstract

Introduction
By 2030, it is estimated that 25% of Europeans will be aged over 65. [Dugarova; UN Development Programme; 2017] Frailty in this group is a key contributor to poorer outcomes. [Eamer; BMC Anesthesiology; 2017; 17:99] The term is common in healthcare but research into the issues faced by staff around assessment and management of frailty has been limited. We undertook a survey to identify challenges faced in providing care to those living with frailty and considered potential interventions.

Method
The survey was across three hospitals in our health board (which serves a population of around 390,000 with a range of services). [SBUHB;2022] It was developed iteratively through consultation in a multidisciplinary group and adapted questions from other similar validated surveys. [Eamer; BMC Anesthesiology; 2017; 17:99][Taylor; Future Healthcare Journal; 2017; 4(3):207-212].

Results
218 responses were received covering a variety of medical and surgical specialties. Participants showed a strong (80%) self-reported understanding of frailty as a clinical concept, but only 46% felt confident in their ability to assess patients for frailty. 74% stated they would benefit from more education on frailty. Other barriers included systemic challenges such as staffing and social care, but also a lack of understanding of frailty by patients and relatives which impacted shared decision-making.

Conclusions
The survey showed a significant demand for more education, especially awareness of pathways and assessment methods. It also highlighted the issue of patients’ (and relatives’) lack of understanding of frailty. In response, we are planning a targeted multi-disciplinary educational programme on frailty across the health board, as well as introducing patient information leaflets.
1367 RECOGNITION AND MANAGEMENT OF ACUTE FUNCTIONAL DECLINE: A QUALITATIVE INTERVIEW STUDY WITH UK CARE HOME STAFF
Authors: Moore A , Glogowska M , Lasserson D , Hayward G 
Published: January 2023

Abstract

Introduction
Older people living in care homes sometimes experience episodes of acute functional decline. These represent a diagnostic challenge to healthcare professionals and can result in antibiotic prescriptions or hospital admissions, though this may not always the most appropriate management strategy. We aimed to understand how episodes of acute functional decline are recognised, managed and escalated by care home staff in the UK.

Method
This was a qualitative interview study with UK care home staff, including managers, nurses and carers. Participants were recruited through advertisements circulated via email, social media and word of mouth. Semi-structured interviews were conducted over the phone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software.

Results
25 care home staff were interviewed. Participants described feeling confident in recognising when residents were less well than usual, especially if they knew them well. However, they sometimes felt it was difficult to differentiate between an ‘off day’ and something more significant. Most participants talked about clear early communication amongst the team to flag a resident of concern. Initial management steps in the care home included checking clinical observations and doing a urine dipstick. Many participants talked about considering the underlying cause for deterioration. Some participants felt comfortable monitoring residents for a few days themselves or trying a simple intervention. Others preferred escalating directly to outside clinical support. Triggers for escalation included perceived severity of illness, gut feeling or failure to respond to initial supportive management.

Conclusions
These results highlight the skill base of care home staff. However, it has also helped to identify areas for additional support and training including the use and interpretation of the urine dipstick. The findings of this study are being used to inform the design of a feasibility prospective cohort study of UK care home residents.
1368 BEREAVEMENT IN THE TIME OF COVID-19: LEARNING FROM EXPERIENCES OF THE BEREAVED
Authors: Lightbody S , Catt L , Ahmad A , Glover D , Whitney J , Hasan S 
Published: January 2023

Abstract

Introduction
The COVID-19 pandemic has resulted in many people experiencing bereavement in challenging circumstances. In April 2020 at a large London Trust, a “Bereavement Welfare Hub” (BWH) was established to offer support and advice by telephone to relatives and carers of all adults who died as inpatients. Data from these calls has been used to examine and learn from experiences of the bereaved at this time.

Methods
Data from BWH call records regarding 809 adults who died at the Trust in March - May 2020 were collated and analysed quantitatively. A random selection of 149 call records were examined using thematic analysis.

Results
809 adults died at the Trust between March and May 2020. The mean age at death was 76 (SD=14) and 86% of deaths occurred on medical wards (outside intensive care). Bereavement calls were completed in 663 (82%) of cases. From analysis of call records, several themes that influenced the bereavement experience were identified. These included support from family and community, communication and contact with the dying person, support from bereavement services and ability to carry out usual rituals associated with dying.

Conclusions
Age is a significant risk factor for death from COVID-19 and the majority of deaths have occurred on medical wards. Improving hospital care of dying patients during the pandemic or at any time is relevant to geriatricians and other healthcare professionals working with older people. Our analysis identifies several factors which positively or negatively influenced the experiences of people bereaved during the first wave of COVID-19. From these findings, recommendations have been made which have the potential to improve the bereavement experience, particularly during the pandemic era.
1221 A CROSS-SECTIONAL STUDY EXPLORING THE TREATMENT BURDEN IN PEOPLE WITH PARKINSON’S AND THEIR CAREGIVERS
Authors: Tan Q Y , Roberts H C , Fraser S D S , Ibrahim K 
Published: January 2023

Abstract

Introduction
Treatment burden is the workload of healthcare and its impact on patient well-being and functioning. High treatment burden in other long-term conditions is associated with poor health outcomes. This study aimed to determine the extent and levels of treatment burden among people with Parkinson’s (PwP) and their caregivers, and explore modifiable factors.

Methods
A cross-sectional survey using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden was conducted among adults (age &gt;18 years) diagnosed with Parkinson’s or self-identified caregivers of someone with Parkinson’s. Factors associated with medium/high treatment burden levels on the MTBQ were analysed using logistic regression.

Results
190 valid responses were received: 160 PwP (mean age = 68years, 52% female), 30 caregivers (mean age = 69years, 73% female) with or caring for PwP with all stages of Parkinson’s severity (Hoehn and Yahr staging). Nearly half of PwP had frailty or multimorbidity. High treatment burden was reported by 21% of PwP and 50% of caregivers. Lifestyle changes was the most difficult aspect of treatment burden for both PwP and caregivers. Arranging appointments, seeing many healthcare professionals and taking multiple medications frequently contributed to the treatment burden reported by PwP and caregivers. Medium/high treatment burden was associated with PwP who were frail, had a higher number of non-motor symptoms, and took medications more than three times a day. Worsening Parkinson’s severity and limited health literacy had increased odds of medium/high treatment burden levels in PwP. Female caregivers, those caring for someone with Parkinson’s who experienced memory issues, and caregivers with poorer mental health well-being scores were associated with medium/high treatment burden.

Conclusions
PwP and caregivers experienced substantial treatment burden. Providing them support with enacting recommended lifestyle changes, streamlining healthcare appointments, addressing polypharmacy and frequency of medications, and improving health literacy may help reduce the treatment burden in Parkinson’s.
1283 MEDICATION-RELATED HARM (MRH) IN OLDER PEOPLE AFTER LEAVING HOSPITAL - AN UNDER-REPORTED EGYPTIAN CHALLENGE
Authors: Jamil M , Sweed H , Abou-Hashem R , Hamed H , Ali K 
Published: January 2023

Abstract

Introduction
Ageing is associated with multimorbidity, polypharmacy and medication-related harm (MRH). A 2013 systematic review reported only one study of medication errors (MEs) in older Egyptian patients. Our study investigated MRH (adverse drug reactions (ADR), drug errors, and non-adherence) in older Egyptian adults after hospital-discharge.

Methods
Between 2018 and 2020, we recruited 400 Egyptian patients, aged ≥60 years on discharge from Geriatrics and Internal Medicine wards from 3 hospitals, and followed them up for 8 weeks. Study procedures adopted a modified PRIME trial methodology (1).

Results
The average age of study participants was 71 (range 60 to 93, SD +/- 6.29) years with 53% females. In the cohort of 325 patients completing follow up, MRH occurred in 99 patients (incidence of 30.5%), with 5 patients (5.1%) experiencing a fatal MRH. Almost two thirds (65.7%) of MRH events were secondary to ADRs, 2 % related to non-adherence, 18.2 % due to both ADR and non-adherence, and 14% related to MEs. Multivariate logistic regression analysis showed that non-adherence (p-value 0.000, OR- 95% CI: 36.029), inappropriate prescription using Beer’s criteria (p 0.000, OR- 95% CI: 6.589), length of stay &gt;7days (p 0.001, OR- 95% CI: 6.176), presence of Ischaemic Heart Disease (IHD) (p 0.000,OR- 95% CI: 5.695), Platelets count ≤ 245X 109/L (p 0.021, OR- 95% CI: 2.640), and dementia medications (p 0.017, OR- 95% CI: 4.616) were all significantly associated with MRH.

Conclusions
Medication-related harm in older Egyptian adults is common after hospital discharge. An integrated care pathway is required targeting high-risk older patients.

Reference
1. Stevenson J, Parekh N, Ali K et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatrics 2016; 16: 22. https://doi.org/10.1186/s12877-016-0191-8.
1266 ASSOCIATION OF MULTIMORBIDITY PATTERNS AND INCIDENT DEPRESSION AMONG OLDER ADULTS IN TAIWAN: ROLE OF SOCIAL PARTICIPATION
Authors: Chu W-M , Ho H-E , Yeh C-J , Wei J C-C , Lee M-C 
Published: January 2023

Abstract

Background
Multimorbidity has negative impacts on the health outcomes of older adults. Previous research has discovered different patterns of multimorbidity. However, evidence is scarce for associations between multimorbidity patterns and depression, especially the role of social participation in it. This study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan and the effect of social participation in different multimorbidity patterns.

Methods
This population-based cohort study used data from the Taiwan Longitudinal Study on Aging. It included 1,975 older adults (age &gt;50 years) who were followed from 1996 to 2011. The participants’ multimorbidity patterns in1996 were determined by latent class analysis; their incident depression was ascertained in 2011 by using the 10-item CES-D. Multivariate logistic regression was used to analyse the relationship between multimorbidity patterns and depression.

Results
In 1996, the participants’ average age was 62.1 years. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis–cataract group (n = 105), (3) Multimorbidity group (n = 128), and (4) Relatively healthy group (n = 1649). After multivariate analysis, participants in the Multimorbidity group had a greater risk of incident depression (Odds ratio: 1.62; 95% Confidence interval: 1.02–2.58), compared with the Relatively healthy group. Subgroup analysis showed that participants without social participation in the Arthritis-Cataract and Multimorbidity groups had greater risks of developing depression.

Conclusion
This 16-year, population-based cohort study showed that distinct multimorbidity patterns among older adults in Taiwan were associated with incident depression during later life, while social participation played a role as protective factor.
1322 DEVELOPMENT OF A CORE OUTCOME SET FOR NUTRITIONAL INTERVENTION STUDIES IN OLDER ADULTS WITH MALNUTRITION AND THOSE AT RISK
Authors: Avgerinou C , Mendonça N , Cavdar S , Cederholm T , Cruz-Jentoft A J , Kiesswetter E , Siebentritt H M , Sieber C , Torbahn G , Volkert D , Visser M 
Published: January 2023

Abstract

Background
Malnutrition (i.e., protein-energy malnutrition) in older adults is associated with significant complications and increased mortality, highlighting the need for effective treatments. Many randomised controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and there is a need for meta-analyses. However, evidence synthesis is hampered by the wide variety of outcomes and assessment methods in RCTs. This project, led by EuGMS Special Interest Group Nutrition, aims to develop a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.

Methods
The project consists of five phases: 1) a scoping review (completed) to identify frequently used outcomes in published RCTs and select additional patient-reported outcome measures (PROMs). Patient and Public Involvement (PPI) representatives have been involved to provide feedback on the proposed list of outcomes resulting from the review and PROMs; 2) a modified Delphi Survey whereby experienced researchers and health care professionals working in the field of malnutrition in older adults will be invited to rate the importance of the proposed outcomes; 3) a consensus meeting to discuss and agree what critical outcomes need to be included in the COS; 4) a systematic review to determine how each COS outcome should be measured and a second consensus meeting; 5) a dissemination and implementation phase.

Conclusions
The result of this project will be a COS that should be included in any RCT testing the effectiveness of interventions to tackle malnutrition in older people as a minimum. This COS will facilitate comparison of RCT results, will promote efficient use of research resources and might reduce bias in measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.