bluuebunny/crossref_metadata_2025_split huggingface dataset:
1615 RECOMMENDATIONS FOR THE ASSESSMENT AND MANAGEMENT OF CO-EXISTING DEMENTIA AND HEARING LOSS WITHIN UK AUDIOLOGY SERVICES
Authors: Langdon A , Heffernan E , Somerset S , Calvert S , Broome E , Dening T , Henshaw H 
Published: July 2023

Abstract

Introduction
Dementia and hearing loss (HL) are becoming increasingly prevalent in society and commonly co-exist. People living with concurrent conditions have complex needs and face additional barriers to diagnosis and management. There is a paucity of research regarding the current and optimal management of HL in people living with dementia. This research aimed to: (1) examine the current clinical provision for people living with HL and dementia within UK audiology services, and (2) explore recommendations for the management of co-existing HL and dementia from professionals and people living with these conditions.

Methods
This was an online, qualitative study with three stages: (1) open-ended survey of 37 audiologists, (2) semi-structured interviews with 13 audiologists, and (3) semi-structured workshops with seven people with lived experience of HL and/or dementia.

Results
Audiologists used various adapted and additional hearing assessments for people with dementia. Audiological interventions for people with dementia included adapted hearing aids, alternative interventions/devices, and involvement of other services/professions. Approaches to ongoing audiological care for people with dementia included providing frequent follow-ups and face-to-face, rather than remote, follow-ups. Overarching approaches to audiological care for this population involved patient-centredness, specialist training, increased carer involvement, and adjusted appointment duration. However, there are no standard procedures/guidelines relating to dementia in UK audiology services. Recommendations included enhanced training in dementia and HL across health and social care, improved multidisciplinary collaboration, appropriate carer involvement, and greater personalised care.

Conclusions
Currently, there is no standard practice for assessing and managing HL in people with dementia in UK audiology services. Although this study identified several beneficial strategies and approaches, there remain significant areas for improvement. The study results could be used in the future to produce national guidelines and training programmes for the assessment and management of HL in people with dementia, which would reduce disparities in care.
1435 THE BURDEN OF MULTIMORBIDITY AMONGST OLDER HOSPITALISED ADULTS IN NORTHERN TANZANIA: A MULTI-CENTRE STUDY
Authors: Davidson S L , Bickerstaff E , Emmence L , Motraghi-Nobes S M , Rayers G , Lyimo G , Kilasara J , Mitchell E , Urasa S , Walker R W , Dotchin C L 
Published: July 2023

Abstract

Background
Populations in sub-Saharan Africa are ageing rapidly and Tanzania is one country experiencing this acute demographic shift. Multimorbidity (the presence of two or more chronic conditions [1]) is common in the community and associated with greater risk of hospitalisation. To-date, the prevalence amongst older hospital inpatients is unknown.

Objective
To establish the prevalence of multimorbidity amongst older hospitalised adults in northern Tanzania.

Methods
For 6-months, adults aged ≥60 admitted to medical wards in four hospitals were invited to participate. A standardised questionnaire, structured around the Comprehensive Geriatric Assessment, was completed. This included items regarding health insurance and exemption from health user fees (granted based on age and low socioeconomic means). Multimorbidity was self-reported using a list of 16 conditions from the Study of Global Ageing and Adult Health Questionnaire, with additional screening for hypertension.

Results
Between March and August 2021, 540 adults aged ≥60 years were admitted and 308 (57%) underwent assessment. Reasons for non-participation included discharge (n=159) and death (n=34) prior to researcher attendance. Of 277 participants, 145 (52%) had self-reported multimorbidity. Data were unavailable for 31 participants who were unsure of their past medical history. Hypertension was reported by 146 (52%) and an additional 35 (11%) had mean readings ≥140/90 when screened. Mann-Whitney U revealed a significantly greater burden of multimorbidity in those with health insurance (p&lt;0.001) or exemption from user fees (p=.34), compared with participants without.

Conclusion
Multimorbidity is common amongst hospitalised older adults in Tanzania. Higher rates amongst those with insurance or exemption are likely because of greater access to healthcare services and therefore diagnosis. Simple screening for hypertension identified further individuals with multimorbidity, demonstrating that it may remain underestimated. Widening access to healthcare is a government priority, but the impact of multimorbidity also poses a challenge to hospitals and policymakers.

Reference
1. Johnston MC et al. European Journal of Public Health 2018; 29: 182–9.
1454 THE CLINICAL UTILITY OF MUSCLE MASS ASSESSMENT IN PATIENTS WITH HIP FRACTURE: A SYSTEMATIC REVIEW
Authors: Prowse J , Jaiswal S , Sorial A K , Witham M D 
Published: July 2023

Abstract

Introduction
In the current European guidelines, sarcopenia is diagnosed on the basis of low muscle strength, with low muscle mass used to confirm diagnosis. The added value of measuring muscle mass is unclear. We performed a systematic review to assess whether muscle mass was independently associated with adverse outcomes in patients with hip fracture.

Method
The systematic review protocol was registered on the PROSPERO database (CRD42021274981). Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Clinicaltrials.gov) were searched for observational studies of patients with hip fracture aged ≥60 who had muscle mass or strength assessment perioperatively. Two reviewers independently screened titles/abstracts for inclusion. The association of muscle mass or strength with postoperative outcomes (mortality, Barthel Index, mobility, physical performance measures, length of stay, complications) was recorded. Risk-of-bias was assessed using the AXIS or ROBINS-I tool as appropriate. Due to the degree of study heterogeneity, data were analysed by narrative synthesis.

Results
The search strategy identified 3,007 records. Ten studies were included (n=2281 participants), containing 27 associations between muscle mass assessment and hip fracture postoperative outcomes. Four studies had intermediate risk of bias; 6 studies had high risk of bias. Lower muscle mass was associated with higher mortality and worse physical performance measures in univariate analyses but there was no significant association between muscle mass and mobility, length of stay and postoperative complication scores in any included study. Six studies assessed both muscle mass and strength. Muscle mass was not a significant independent predictor of any adverse outcome in any included study after adjustment for muscle strength and other predictor variables.

Conclusion
Data on the clinical utility of muscle mass measurement in patients with hip fracture are limited in volume and quality, but available studies suggest muscle mass does not offer additional prognostic benefit to muscle strength measures.
1547 PREFABRICATED ORTHOTICS WITH AND WITHOUT A METATARSAL PAD TO DECREASE PAIN AND FEAR OF FALLING IN OLDER ADULTS
Authors: LaCourse J , Sims J , Bharadwaj M , Ampat G 
Published: July 2023

Abstract

Background
Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability.

Objective
Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad. At baseline and 6-week follow-up, musculoskeletal pain was reported via Numerical Rating Scales (NRS), foot pain and functionality via the Foot Health Status Questionnaire (FHSQ), and fear of falling via the Short Falls Efficacy Scale International.

Results
Both groups reported significant improvements in pain in the back, hips, knees, ankles, and feet using the NRS (P &lt; 0.001). Using the FHSQ, foot pain significantly improved in both the intervention (x-= 18.47 ±20.58, P &lt; 0.001) and control group (x-= 17.21 ±18.74, P &lt; 0.001). Function also improved significantly in both groups (x-= 18.35 ±20.67, P &lt; 0.001 and x- = 15.07 ±20.15, P &lt; 0.001, respectively), as did fear of falling (x-= 1.55 ±3.79, P &lt; 0.001 and x-= 1.23 ±3.53, P &lt; 0.001, respectively). No statistically significant difference was observed between groups for any outcome (P &gt; 0.05).

Conclusion
Aetrex orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.
1508 OLDER PATIENTS’ ADHERENCE TO APPROPRIATE POLYPHARMACY: CHALLENGES, STRATEGIES AND OUTCOMES OF IMPORTANCE TO STAKEHOLDERS
Authors: Al Shaker H , Barry H , Hughes C 
Published: July 2023

Abstract

Introduction
Older patients often struggle to manage and take polypharmacy. Intervention studies have measured a variety of outcomes to improve adherence to polypharmacy. However, the scarcity of well-designed trials and inconsistencies in outcomes reported and measured have resulted in low-quality evidence. It is now recommended that researchers consider using a Core Outcome Set (COS); the minimum number of outcomes that should be measured and reported in all studies in a specific area. This study explored stakeholders’ perspectives regarding the challenges older patients face when taking polypharmacy, potential strategies to address such challenges, and outcomes of importance with a view to developing a COS for studies focusing on adherence to appropriate polypharmacy.

Method
Semi-structured virtual and telephone interviews were convened with relevant stakeholders, recruited through several approaches. Interview topic guides sought information on challenges and strategies associated with adherence to polypharmacy. A list of potential outcomes (n=7) associated with adherence research (derived from a previous Cochrane review and two other relevant studies) was presented to participants for comment. Content analysis of audio-recorded and transcribed interviews identified key themes on challenges, strategies and outcomes.

Results
Participants (15 academics, eight healthcare professionals, and six public participants) identified 11 challenges (encompassing medication, healthcare system, patient and socioeconomic issues) and 16 educational and behavioural strategies relevant to polypharmacy. They agreed that the seven outcomes presented to them were important and suggested six additional outcomes, generating a final list of 13 outcomes for potential use in trials focusing on adherence to appropriate polypharmacy.

Conclusion(s)
A range of challenges associated with polypharmacy was reported by participants, and a suite of strategies was suggested to address these challenges. The list of 13 outcomes will be used to inform the development of a COS for trials targeting interventions aiming to improve adherence to appropriate polypharmacy in older patients.
1540 YOGA FOR OLDER ADULTS WITH MULTIMORBIDITY: RANDOMISED CONTROLLED TRIAL WITH EMBEDDED ECONOMIC AND PROCESS EVALUATIONS
Authors: Tew G A , Wiley L , Ward L , Hugill-Jones J , Maturana C , Fairhurst C , Bell K , Bissell L , Booth A , Howsam J , Mount V , Rapley T , Ronaldson S , Rose F , Torgerson D J , Yates D , Hewitt C 
Published: July 2023

Abstract

Introduction
Older adults with multimorbidity can experience poor health-related quality of life (HRQOL). Yoga has the potential to improve HRQOL. The British Wheel of Yoga’s Gentle Years Yoga© (GYY) programme was developed for older adults with chronic conditions. We investigated the effectiveness and cost-effectiveness of the GYY programme in older adults with multimorbidity.

Method
This was a multi-site, individually randomised, open, superiority trial with embedded economic and process evaluations. Community-dwelling adults aged ≥65 years with ≥2 chronic conditions were recruited from general practices. All participants continued with usual care. Intervention participants were offered a 12-week GYY programme, which changed from face-to-face to online delivery during COVID-19. Most outcomes were participant reported. The primary outcome and endpoint was health-related utility measured using the EQ-5D-5L over 12 months. Secondary outcomes were HRQOL, depression, anxiety, loneliness, falls, adverse events and healthcare resource use.

Results
The mean age of the 454 participants was 73.5 years, 60.6% were female, and the median number of conditions was three. The primary analysis (n=422) showed no statistically or clinically significant difference in the EQ-5D-5L utility score over 12 months (adjusted mean difference of 0.020 favouring intervention; 95% CI -0.006 to 0.045, p=0.14). No statistically significant differences were observed in key secondary outcomes. No serious, related adverse events were reported. The intervention cost £80.85 more per participant (95% CI £76.73 to £84.97) than usual care, generated an additional 0.0178 quality-adjusted life years (QALYs) per participant (95% CI 0.0175 to 0.0180), and had a 79% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained.

Conclusion
The GYY programme showed no statistically significant benefits in terms of HRQOL, mental health, loneliness or falls. However, the intervention was safe, acceptable to most participants, and highly valued by some. The economic evaluation suggests that the intervention could be cost-effective.
1543 PROMOTING ACTIVITY, INDEPENDENCE AND STABILITY IN EARLY DEMENTIA AND MCI: THE PRAISED RANDOMISED CONTROLLED TRIAL
Authors: Harwood R H , Brand A , Goldberg S E , Masud T , Van Der Wardt V , Gladman J , Logan P , Hoare Z , Booth V , Howe L , Cowley A , Bajwa R , Burgon C , Di Lorito C , Godfrey M , Dunlop M , Welsh T 
Published: July 2023

Abstract

Introduction
People living with dementia and MCI progressively lose abilities, through increasing cognitive impairment, co-morbidities, inactivity, acute illnesses and injuries. Rehabilitation therapy may reduce disability and falls and increase resilience.

Methods
We co-produced a therapy intervention, comprising strength, balance and dual-task exercises, functional activity training and promoting community access, providing up to 50 therapy sessions, delivered over 12 months and underpinned by a behaviour change strategy. We evaluated the intervention in a 5-site multi-centred Randomised Controlled Trial, against a brief assessment control. Participants had a diagnosis of dementia or MCI, Montreal Cognitive Assessment (MoCA) between 13 and 25. Primary outcome was the Disability Assessment in Dementia (DAD), an ADL score, after 12 months, alongside a battery of other health status measures. The COVID-19 pandemic necessitated modifications.

Results
We recruited 365 participants, 42% female. Median age was 81 years (range 65-95), MoCA 20 (13-26), DAD 82 (5-100). Baseline balance between groups was good. Participants were predominantly white and socioeconomically advantaged. Intervention group participants received a median of 31 (IQR 22-40) session and undertook and additional mean 121 minutes of exercise per week. Assessed fidelity was good. 290 (79%) were followed up. There were no significant differences in DAD score (adjusted mean difference -1.3/100, 95% CI -5.2 to +2.6; effect size (d) -0.06; -0.26 to 0.15; p=0.5), physical activity, balance, quality of life, cognition or a range of other measures. Upper 95% confidence intervals excluded even small benefits. Rate of falling reduced by 22% (Rate Ratio=0.78; 0.46 to 1.3; p=0.3), but this was not statistically significant.

Conclusions
The intensive PrAISED intervention did not improve measured outcomes. It may be impossible to reduce the rate of functional decline in dementia. Alternatively, the pandemic may have distorted outcomes or participants may have been too advantaged to benefit. There may have been unmeasured psycho-social benefits.
1650 HOW DO PATIENTS AGED 65+, PHARMACISTS AND PHYSICIANS ENVISAGE THE IMPLEMENTATION OF PHARMACOGENOMIC-GUIDED CARE IN HOSPITAL?
Authors: David V , Tomlinson J , Cheong V-Lin , Sagoo G S , Smith H , Rattray M , Bryant E , Fylan B 
Published: July 2023

Abstract

Introduction
Pharmacogenomics is using a patient’s genetic information to predict their likely response to a medicine. There is evidence that patients who receive pharmacogenomic-guided care benefit from a reduction in clinically significant adverse drug reactions. Therefore, pharmacogenomic testing can be used as a medicines optimisation tool to prevent adverse drug reactions in older people and reduce associated hospital admissions. This qualitative study aimed to identify the facilitators and barriers to implementing pharmacogenomic-guided prescribing in acute care for older patients by examining the views of patients, pharmacists and physicians.

Method
Following consent, patients (aged 65+), pharmacists and physicians across two hospital sites, participated in a semi-structured interview. The interviews were transcribed and analysed using the Framework approach to identify themes describing barriers or facilitators to implementing pharmacogenomic-guided care. Patient interviews were analysed separately from the healthcare professional interviews and supporting quotes were selected to illustrate each theme.

Results
Nine patients, six pharmacists and five physicians participated in the study. Framework analysis of the patient interview transcripts identified three themes: (1) Information delivery (2) Standard of care (3) Participation in pharmacogenomic-guided care. Framework analysis of the professional interviews produced the themes: (1) Level of interest (2) Workforce pressures (3) Support required for the workforce. Professionals do not have enough knowledge of pharmacogenomic-guided care to confidently apply it to their clinical practice. Patients want to be involved in pharmacogenomic-guided prescribing decisions so pharmacogenomics does not feel imposed on them.

Conclusion(s)
Older patients view pharmacogenomic-guided care as therapeutically beneficial and would like to be involved in pharmacogenomic-guided prescribing decisions, with information about pharmacogenomic-guided care tailored to their information-seeking preferences. Professionals envisage pharmacogenomic-guided care as potentially useful in improving their prescribing and medicines reviews but are concerned that operational pressures could make its implementation impractical.
1591 BARRIERS AND FACILITATORS FOR THE PROVISION OF CONTINENCE CARE FOR CARE HOME RESIDENTS: A QUALITATIVE EVIDENCE SYNTHESIS
Authors: Wheeldon J , de Viggiani N , Cotterill N 
Published: July 2023

Abstract

Introduction
Incontinence affects a significant proportion of older adults who reside in care homes. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor for residents, further compromising the health and wellbeing of this vulnerable population.

Method
A systematic qualitative evidence synthesis and thematic analysis established the current evidence-base of barriers and facilitators for the provision of continence care in care homes.

Results
The evidence synthesis revealed complex barriers and facilitators at three influencing levels: macro (structural, societal and external influences), meso (organisational and institutional influences) and micro (day-to-day actions of individuals impacting care provision). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centred organisational cultures, ageist institutional perspectives regarding old age and incontinence, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included both staff and residents’ poor knowledge of continence care and negative attitudes towards incontinence symptoms, management and treatment.

Conclusions
These findings help to outline the complexities of continence care provision in older adult care homes. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision, services and individuals are impacted. Older adult social care policy-makers, researchers and service-providers must recognise this complexity in any intervention that aims to improve continence care in care homes.
1645 A SMALL VESSEL DISEASE SYNDROME? SYMPTOMS ASSOCIATED WITH CEREBRAL SVD PROGRESSION AND INCIDENT INFARCTS AFTER MINOR STROKE
Authors: Clancy U , Arteaga C , Garcia D J , Hewins W , Penman R , Valdés-Hernández M C , Wiseman S , Stringer M , Thrippleton M J , Kampaite A , Hamilton O K L , Chappell F M , Rudilosso S , Jochems A C C , Liu D , Zhang J , Brown R , Bastin M E , Muñoz Maniega S , Hamilton I , Job D , Doubal F N , Wardlaw J M 
Published: July 2023

Abstract

Introduction
Small vessel disease (SVD) lesions may cause symptoms apart from stroke. We aimed to determine whether white matter hyperintensity (WMH) progression and incident infarcts associate with gait, mood, and cognitive symptoms.

Method
We recruited patients with non-disabling stroke (modified Rankin Scale &lt;3), performed diagnostic MRI, and questioned participants/informants about gait, mood, cognitive, Center Epidemiologic Studies-Depression Scale (CES-D), Neuropsychiatric Inventory-Questionnaire (NPI-Q) symptoms and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). The baseline visit occurred &lt; 3months post-stroke. We repeated MRI and symptoms assessments every 3-6 months for 12 months, assessing WMH change and incident infarcts (i.e. new since previous scan) on DWI or FLAIR. We analysed WMH using cubed root normalised for intracranial volume. We used linear mixed-effects models, adjusting for age, gait speed, modified Rankin Scale, and time for gait symptoms; age, anxiety, MoCA, stroke subtype, and time for cognitive/neuropsychiatric symptoms.

Results
We recruited 230 participants (mean age=65.8 [SD=11.2] years; 34% female; 56.5% lacunar); median baseline WMH volumes = 8.26mL (IQR 3.65-19.0); one-year = 8.24mL (IQR = 4.15-20.1). Incident infarcts (n=110, 82/110 (74.5%) small subcortical subtype) occurred in 53/230 (23%) of patients. WMH progression over one year was associated with falls (OR=4.13 [95% CI=1.6-10.1]); self-reported brain fog (OR=3.13 [95% CI=1.11-8.82]); and increasing NPI-Q scores (est=2.12 [95% CI=0.46-3.77] p=0.012). Baseline and one-year WMH volumes were cross-sectionally associated with apathy (baseline OR=8.78 [95% CI=2.56-31.88]; one-year OR=4.83 [95% CI=1.43-17.26]). Higher CES-D depression scores were associated with incident infarcts (mean 15.2 [12.9] with vs 11.9 [SD10.6] without; est=2.26 (95% CI=0.12-4.4), p=0.038). WMH progression and infarcts were not associated with fatigue, anxiety, subjective memory complaints, confusion, dizziness, or IQCODE scores.

Conclusions
SVD progression following minor stroke co-associates with specific gait/cognitive/mood symptoms. WMH progression and incident infarcts may cause non-focal, non-stroke symptoms which characterise a potential ‘SVD syndrome’.