bluuebunny/crossref_metadata_2025_split huggingface dataset:
989 IS DIET QUALITY AS IMPORTANT AS DIET QUANTITY IN THE OLDER ADULT? MICRONUTRIENT DEFICIENCY, FRAILTY AND SARCOPENIA
Authors: Jennings C , Slee A , Weekes C E 
Published: June 2022

Abstract

Introduction
Dietary research in older adults has focused on energy content, macronutrient composition and diet quantity. Dietary antioxidants can theoretically ameliorate oxidative stress, which is widely implicated in age-related degeneration. Additional vital micronutrients are magnesium, being a co-factor for antioxidant enzyme function, and potassium, given its role in nerve and muscle function, and fluid balance. This study sought to investigate diet quality, specifically micronutrient content, and independent nutritional risk factors for frailty and sarcopenia.

Method
Secondary analysis of NUTRICOM 2015–2018 study participants (NIHR 19045)—exploring the impact of malnutrition on community-dwelling older adults—was conducted. Dietary intake was assessed using multiple-pass 24-hour dietary recall, nutrition risk status (NRS) using Guy’s and St Thomas’ NRS Tool, frailty using the 7-point Clinical Frailty Scale (CFS) and sarcopenia using EWGSOP2 handgrip strength cut-offs. Mann–Whitney U-Test assessed differences in dietary intake between malnutrition risk groups. Multivariable regression models, adjusting for age, gender, deprivation and comorbidities, established nutritional correlates of frailty and sarcopenia.

Results
142 participants; mean age 77.4(SD 8.4) years, 83(59%) female, mean BMI 26.05(SD 5.35). 79%–91% of older adults showed dietary deficiency in zinc, selenium, copper, magnesium and potassium. CFS increase was independently associated with NRS, and deficiency of potassium, copper and cumulative micronutrients, by 1.52, 1.19, 0.82 and 0.28 respectively (p &lt; 0.05). Individuals with dietary zinc deficiency were 3.25 times more likely to have sarcopenia than individuals with sufficient zinc intake (95%CI: 1.04–10.16, p = 0.042).

Conclusion
Routine nutrition risk screening (accounting for macronutrient intake) finds only about 5% of older adults to be at-risk of malnutrition, whilst assessment of dietary intake in this study suggests dietary micronutrient deficiency is very common and is associated with increased frailty. 24-hour recall only provides a snapshot of dietary intake; further studies should be conducted using method that measure habitual dietary intake e.g. 7-day dietary diary.
1070 IMPACT OF ECONOMIC FACTORS, SOCIAL HEALTH AND RECENT STRESSORS ON PHYSICAL HEALTH-RELATED QUALITY OF LIFE TRAJECTORIES
Authors: Phyo A Z Z , Gonzalez-Chica D , Stocks N , Woods R , Fisher J , Tran T , Owen A , Ward S , Britt C , Ryan J ,   on behalf of the ASPREE Investigator Group (www.aspree.org), Freak-Poli R 
Published: June 2022

Abstract

Introduction
Poorer physical health-related quality of life (HRQoL) has been shown to predict a higher risk of adverse health outcomes including cognitive decline, cardiovascular disease, and mortality among community-dwelling older individuals. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health, or recent stressors impact physical HRQoL trajectories.

Method
A cohort of 12,506 community-dwelling Australians aged ≥70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Physical HRQoL was assessed by using a validated instrument (SF-12; version-2) at baseline and over up to six annual follow-ups. Economic factors, social health, and recent stressors (i.e. stressful life events in the last 12 months) were assessed through a questionnaire at baseline. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors.

Results
Four physical HRQoL trajectories were identified—stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having economic burden, no voluntary work, loneliness, or recent stressors (i.e. spousal illness, friend/family illness, financial problem, pet died) were associated with a 10%–152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group.

Conclusion
Specific stressors including financial hardship had a greater impact on adverse physical HRQoL trajectories in older people than other factors. This study highlights that grassroots approaches are needed to emphasize economic autonomy and social support networks in order to support the wellbeing of older people. Volunteering may prevent physical HRQoL decline and requires further investigation.
762 FOR OLDER PATIENTS WITH FRAILTY, SIX WEEKS OF ENFORCED IMMOBILITY HAS NO DETRIMENTAL IMPACT ON MUSCLE STRENGTH OR THICKNESS
Authors: Lunt E , Gordon A L , Greenhaff P , Gladman J R 
Published: June 2022

Abstract

Introduction
Immobility can lead to rapid reductions in muscle size, strength and function. Understanding these changes could inform interventions to prevent or slow decline. This longitudinal study aimed to assess the extent of muscle changes in older patients admitted with fragility fractures where clinical management was immobilisation (non-weight bearing) of the affected limb for at least 6 weeks.

Method
Handgrip strength (HGS); knee extensor strength(KES); Vastus Lateralis thickness and cross-sectional area at ultrasound (VLMT, VLCSA); and skeletal mass index (SMI; bioimpedance analysis) were measured in the non-injured limb of 50 patients (88% female) aged ≥70. Pre-existing physical frailty meant patients were limited to transfers only while non-weight bearing. Measurements were performed at hospital admission, 1, 3 and 6 weeks. One-way repeated measures ANOVA was used to assess changes in measurements over time. Additionally, baseline measurements in female patients (n = 36) were compared to 11 healthy, non-frail, non-hospitalised females with comparable BMI, aged ≥70, using independent t-tests. Data are mean + SD.

Results
Patient Clinical Frailty Score (median, IQR) was 5 (4–6). At hospital admission, female patients were older (84 ± 7 years vs. 77 ± 6 years, p &lt; 0.05), weaker (HGS of 9.2 ± 4.7 kg vs. 19.9 ± 5.8 kg, p &lt; 0.001; KES 4.5 ± 1.5 kg vs. 7.8 ± 1.3 kg, p &lt; 0.001) and had lower VLMT (1.38 ± 0.47 cm vs. 1.75 ± 0.30 cm, p = 0.02) than non-frail female controls. Six weeks immobility had no temporal effect on any variable: HGS (F(2,51) = 1.04,p = 0.38,n = 27), KES (F(3,45) = 3.22,p = 0.81,n = 16), VLMT (F(3,54) = 2.52,p = 0.07,n = 19), VLCSA (F(3,42) = 0.74,p = 0.53,n = 15) and SMI (F(2,59) = 0.09,p = 0.94,n = 26).

Conclusion
Older patients admitted with fragility fractures were weaker and had lower VLMT compared to healthy, non-frail older people. This, together with the lack of decline in muscle strength and thickness with 6 weeks immobility strongly suggests muscle resilience was attenuated pre-admission, such that immobility had no further detrimental effect. These results differ from muscle changes seen in younger and non-frail cohorts, and warrants assessment of clinical interventions aimed at increasing muscle mass and function specifically in older people with frailty.
950 USE OF A ‘COVID BUNDLE’ TO IMPROVE PATIENT CARE DURING WAVE 2 IN A BUSY DGH
Authors: Quirie C , Olley R 
Published: June 2022

Abstract
The early stage of wave 2 in SJH was a very busy and rapidly evolving situation for the medical team. Dexamethasone and remdesivir had recently been introduced into clinical practice following RECOVERY trial results. High clinical demand, and a rapid turn-over of junior medical staff in the COVID wards meant unfamiliarity with the treatment. My COVID Bundle was designed as a support tool for medical staff in safely managing patients who tested positive for COVID-19 to: 1. Improve easy to see documentation of target oxygen saturations in patients with COVID-19 disease 2. Improve the monitoring of blood sugars when patients were started on dexamethasone for COVID-19 disease Thirty covid positive patients were included in the initial baseline data collection from the medical wards. Of these, only four (13.3%) had clear documentation of target oxygen saturations. Fifteen were commenced on dexamethasone, of which seven (46.7%) had appropriate monitoring of their blood sugars.
A series of interventions were then implemented. Initially I created a ‘COVID Bundle’ for patient’s bedside notes which prompted staff on 1) target oxygen saturations, 2) escalation status, 3) resuscitation status, 4) checking BMswhen on dexamethasone. I then updated and combined my COVID Bundle with a COVID treatment poster, which was placed in all ‘red’ patient notes.
I had several rounds of data collection during the series of interventions. The clear documentation of target oxygen saturations increased from 13.3% to 100%, while appropriate monitoring of BMsincreased from 46.7% to 93.3%. The management of COVID-19 is an ever evolving area, which can be difficult for both medical and nursing staff to keep up with in an ever busy working environment. This small scale QIP shows that the ‘COVID Bundle’ is a useful aid for staff in the safe management of patients with COVID-19.
954 FRAILTY PREVALENCE, TRAJECTORIES AND CLINICAL IMPLICATIONS IN PEOPLE WITH COPD: A SYSTEMATIC REVIEW
Authors: Hanlon P , Guo X , McGhee E , Lewsey J , McAllister D , Mair F 
Published: June 2022

Abstract

Background
Frailty is common in people with COPD. This systematic review assesses prevalence and trajectory of frailty and associations with adverse health outcomes in people with COPD.

Method
Three databases searched (Medline, Embase and Web of Science) from 2001 to September 2021, supplemented by forward citation searching and hand-searching reference lists. Eligibility criteria were observational studies of frailty (using any measure) in adults (&gt;18 years) with COPD, any setting (community, outpatient, inpatient, rehabilitation, residential care) assessing frailty prevalence, trajectories, or association with health-related outcomes. Study quality was assessed using Newcastle-Ottawa scale. Screening, quality assessment and data extraction performed independently by two reviewers. We synthesized results using narrative synthesis and, where heterogeneity allowed, random-effects meta-analyses.

Results
We identified 53 eligible studies using 11 frailty measures. Most common were frailty phenotype (32/53), frailty index (5/53) and Kihon checklist (4/53). Prevalence varied between frailty definitions, setting, and age of study population. Using the frailty phenotype, median prevalence was 12.5% in community studies. Prevalence was higher using other measures, and in inpatients, pulmonary rehabilitation and residential care settings. Frailty in COPD is dynamic, with airflow limitation, dyspnoea, and exacerbation frequency associated with worsening. Improvements in frailty status were observed following pulmonary rehabilitation. Frailty was associated with mortality (5/7 studies), COPD exacerbation (7/11), and hospital admission (3/4). Using frailty phenotype, pooled hazard ratio for mortality was 1.80 (95% CI 1.24–2.63) and pooled incident rate ratios were 1.42 (0.94–2.17) for COPD exacerbation and 1.46 (1.10–1.92) for hospitalization. Frailty was cross-sectionally associated with airflow limitation (11/14), dyspnoea (15/16), COPD severity scores (10/12), poorer QOL (3/4) and disability (1/1).

Conclusion
Frailty is a common and dynamic state in COPD, associated with adverse outcomes. However, frailty also appears responsive to intervention. A nuanced understanding of frailty identification, prognosis, and reversibility is required to allow appropriate individualization of COPD care.
966 IMPROVING COMMUNICATION WITH RELATIVES IN THE COVID ERA - DEVELOPMENT OF A NEW SERVICE STANDARD
Authors: Hough S , Alićehajić-Bečić Ð , Pederson A , Jordan T , Sharif F , Lakhi R , Maynard-Connor E , Knagg T 
Published: June 2022

Abstract

Background
Quality improvement project undertaken by the Ageing and Complex Medicine team to improve the quality and quantity of communication with patients’ relatives.

Introduction
Visitation restrictions at RAEI since the onset of the COVID pandemic have created barriers to effective communication between patients’ relatives and the medical team. Patients’ relatives were frequently receiving poorly structured information, incorrect information, or even no information. This problem was hospital wide and likely to have affected other trusts. It particularly affected elderly care wards, where the cohort of patients were often less able provide their relatives with updates themselves. We therefore agreed a service standard whereby the medical team would provide a medical update via phone to the patients’ next of kin within 24 hours of admission followed by twice weekly updates by any member of the wider MDT. Our aim was to improve the quality and quantity of communication with the patients’ relatives.

Method
So far 6 data capture cycles have seen us implement change in various ways such as utilisation of a white board to highlight when updates are due, a staff feedback survey to highlight barriers to providing the service and a relative feedback survey to evaluate their experience.

Results
Compared to baseline data we have seen an improvement in the quantity of relative updates with most cycles.

Conclusion
We have improved the quantity of relative updates and embedded it as established culture on Astley ward. Barriers to success include staffing levels, time burden, and low confidence levels amongst junior doctors. Cycle 7 will see implementation of a teaching session for new junior doctor cohorts to improve their confidence. I would like to share our learning and success with the wider hospital and see implementation of the service standard across all wards within the trust.
985 A QUALITY IMPROVEMENT PROJECT ON CALL BELL IN REACH IN AN ACUTE OLDER PERSON MEDICINE WARD (AGE &gt; 85 YEARS)
Authors: Noor M , Islam M F , Spice C 
Published: June 2022

Abstract

Introduction
Call bell within reach of patients is an important part of quality care and standard in the National Inpatient Falls Audit. Initial data collection showed 56% of patients had call bell in reach indicating potential for improvement Understanding the problem: Discussion with stakeholders included: Healthcare support worker, nurses & doctors of all grades, physio, and occupational therapist.

Aim
We aimed to improve call bell reach-ability from 56% to 95% or more for patients on the ward.

Method
Data were collected from 2 bays (Total 10 beds) on the ward three times a week for 2 weeks after implementation of each change assuming it should roughly reflect the whole ward. Balancing measure Inpatient falls on the ward (weekly data for the ward). Changes 1st Change: Stickers in medical notes as a reminder 2nd Change: Teaching session to staff nurses 3rd Change: A short video posted in a closed social group of ward 4th Change: Make a component in the safety huddle & reminder in daily nursing handover.

Results
After the 4th PDSA cycle, the call bell in reach was 93.88% which was sustained improvement. Inpatient fall did not show any specific correlation with call bell reach-ability and specific fall data for those 10 beds was not available separately Learning: • Teaching is effective but it may not be able to involve all the staff especially when staffing is not consistent. Despite attending the teaching, implementation of gained knowledge from the teaching session may not sustain. • Social media can be used to improve patient care provided that it’s closed media & no patient confidentiality is hampered but again may not be a solution. • Reminding the staff of the importance was our most effective change, possibly because of its proximity to patient care immediately being delivered afterward.
1012 ASSESSING THE CLINICAL EFFECTIVENESS OF EMERGENCY HEALTH CARE PLANS (EHCPS); A RETROSPECTIVE REVIEW
Authors: Thatcher C , Zin E T 
Published: June 2022

Abstract

Introduction
Almost 30% of hospital patients are in their last year of life; mortality is five times higher one year post-hospital admission for patients aged 85+ (Clark D, Armstrong M. Palliative Medicine, 2014, 28, 474–479). Studies have shown 40–50% of those who die in hospital could have died in the community (End of Life Care, National Audit Office, 2008). As a geriatric department, we wanted to adopt existing good practice to ensure we were recognising individuals in their last 12 months of life and enabling them to die where they chose.

Method
Using the Gold Standards Framework (Clifford C, Thomas K, Armstrong-Wilson J. End of Life, 2016, 6) in 2019 DrZin introduced a standardised document for EHCPs. We reviewed 123 EHCPs implemented March 2019—August 2021, focusing on the number of attendances to A&E in the year prior to implementation, the number of avoidable admissions to hospital following completion of an EHCP, and place of death.

Results
Of 123 patients, the mean number of A&E attendances in the year before EHCP implementation was 2.52 per patient; post implementation it was 0.18. There were 22 A&E attendances after implementation (17.8%); all resulted in an admission. Of those, 12 (54.5%) were deemed avoidable. There were 100 deaths (81.3%) within 12 months of implementation; 5% died in hospital.

Conclusion
95% of patients with an EHCP died in their preferred setting. Having an EHCP reduced patients’ attendance to A&E. However, work is required to reduce avoidable attendances, through education for GPs and community carers. Although every EHCP was sent to the patient’s GP and residence, several attendances contained no reference to the patient having an EHCP. Therefore, the next step of our project will be creating an alert for patients with an EHCP on their electronic record and re-reviewing hospital admissions rates.
1040 VALIDATION OF THE CHINESE VERSION OF THE ASSISTANCE PREFERENCE CHECKLIST
Authors: Lee L Y K , Yeung C K , Choi C W , Leung M N , Lui Y , Tam W Y , Tang K Y , Wong C , Wong Y , Yau C Y , Yeung T L , Lee J K L , Chui D L K 
Published: June 2022

Abstract

Introduction
Domestic robots have great potential to be developed as a useful and supportive device for elders in domestic setting. To achieve the intended purpose, the designs of domestic robots should make reference to elders’ preferences. The Assistance Preference Checklist is developed to assess elders’ preferences on receiving assistance from domestic robots. It comprises of 48 home-based task under six categories including personal care, leisure activities, health assistance, chores, information management, and manipulating objects. Altogether, these tasks are considered important for the elders to fulfil their general health needs and maintain their homes. The Assistance Preference Checklist is valid and reliable. To adapt it in the Chinese population, the Assistance Preference Checklist has been translated from English to Chinese according to the standard translation model. This study aims to validate the Chinese version of the Assistance Preference Checklist (the checklist).

Method
This was a validation study. Semantic and content equivalence of the checklist was evaluated by an expert panel (five academic specialized on instrument validation or translation and 15 nurses specialized on geriatrics). Content validity of the checklist was assessed by another expert panel (one academic specialized on instrument validation and two nurses specialized on geriatrics). Internal consistency of the checklist was determined by Cronbach's method on a convenience sample of 50 Chinese-speaking elders in Hong Kong.

Results
The checklist demonstrated good semantic and content equivalence with the original English version. The experts agreed that it was appropriately translated. The checklist demonstrated good content validity by having a content validity index of 1.00. Additionally, the checklist reported satisfactory internal consistency by having a Cronbach's alpha of 0.95.

Conclusion
The Chinese version of the Assistance Preference Checklist is a useful instrument for assessing elders’ preferences on receiving assistance from domestic robots. Findings provide evidence on its validity and reliability.
1046 STANDARDIZING THE APPROACH TO POSTURAL HYPOTENSION: A QUALITY IMPROVEMENT PROJECT
Authors: Glover T , Wise K , Malani S 
Published: June 2022

Abstract

Background & Aims
Falls in the older population cause significant morbidity and mortality, and can be a catalyst for deconditioning and a decrease in functional baseline. In the long-term, this results in higher levels of care needs and health issues. As orthostatic hypotension is a common cause for falls in the elderly, our QIP aims to develop a standardized approach to postural hypotension assessment.

Methodology
We undertook two rounds of retrospective data collection on the ward focusing on LSBP as part of the assessment that should be completed on every patient who presents with a fall. In between we undertook an intense period of small group education sessions. We involved a nurse and an HCA in delivering this teaching to ensure sustained change. We also created cards demonstrating the correct technique of doing a LSBP and attached these to all BP machines. Finally, we introduced a midday board round which allowed for more effective communication between the MDT.

Results
In cycle 1, 26% of patients presenting with a fall had a LSBP done prior to discharge whilst in cycle 2, 56% of patients did. We significantly improved the technique and documentation on our electronic system from 0% in the first cycle to 95% in the second. However, this increase in LSBP comes from increased nursing staff completion and documentation as opposed to more doctors requesting a LSBP as part of the falls assessment, with only 63% of patients having documented requests in both cycles.

Conclusion
Our results were encouraging but also highlighted further areas for development in this area. Moving forward, we have extended the project to increase doctors’ awareness of the falls assessment. We have presented at the departmental meeting and included multifactorial falls assessment teaching in the induction handbook to allow for sustained change.