bluuebunny/crossref_metadata_2025_split huggingface dataset:
658 THE RISK OF ANTICOAGULATION IN ELDERLY FALLERS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sarathy P P , Cruces F 
Published: March 2022

Abstract

Introduction
Anticoagulation of elderly patients with Atrial Fibrillation (AF) and falls remains a domain of contention amongst clinicians. There is limited evidence to guide long-term anticoagulation decision in such patients. We performed a systematic-review and meta-analysis to guide anticoagulation decision.

Methods
We conducted a prospectively registered systematic-review and meta-analysis (PROSPERO: CRD42021228661). Studies investigating patients &gt;65 years of age anticoagulated for AF at risk of falls were included. Outcomes included were stroke/systemic embolism (SSE), CNS bleeds, major non-CNS bleeds, and mortality. CENTRAL, MEDLINE, PsycINFO, CINAHL, DARE, Web of science and Scopus were searched. Two authors performed paper inclusion/exclusion, data extraction, risk of bias and GRADE assessment. Data was pooled quantitatively using random-effects models and expressed as Odds Ratio (OR) and 95% Confidence Intervals (95%CI).

Results
Nine studies were included and five were combined quantitatively. Studies had low to moderate risk of bias. Anticoagulated fallers were at higher risk of SSE (OR = 1.73, 95%CI:1.21–2.47, p = 0.003), CNS bleeds (OR = 1.67, 95%CI:1.25–2.23, p &lt; 0.001), major bleeds (OR = 1.87, 95%CI:1.66–2.11, p &lt; 0.001) and mortality (OR = 1.96, 95%CI:1.71–2.25, p &lt; 0.001) compared to anticoagulated non-fallers. Anticoagulated fallers were at higher risk of major bleeds compared to fallers not on anticoagulation (OR = 1.69, 95%CI:1.03–2.77, p = 0.04). However, there was no statistically significant difference in SSE, CNS bleeds or mortality. In fallers, Direct Oral Anticoagulants (DOACs) have lower risk of CNS bleeds (OR = 0.19, 95%CI:0.09–0.041, p &lt; 0.001) and major bleeds (OR = 0.78, 95%CI:0.60–1.01, p = 0.06) compared to warfarin. There was no statistically significant difference in SSE or mortality between the anticoagulants.

Conclusion: (s)
Falling on anticoagulation is associated with increased risk of complications. However, only risk of major non-CNS bleeds increases when anticoagulating fallers. In fallers, DOACs appear safer than warfarin for bleeding complications. There remains paucity of evidence about anticoagulation in fallers (GRADE certainty = very low—moderate). Further evidence is needed to help clinicians and patients regarding anticoagulation.
676 OPTIMISING ENGAGEMENT OF OLDER ADULTS IN AN ONLINE PHYSICAL ACTIVITY PROGRAMME TO IMPROVE COGNITION: A QUALITATIVE STUDY
Authors: Ritchie S , Lawrence V , Jones J , Corbett A 
Published: March 2022

Abstract

Introduction
Maintaining physical activity is a modifiable risk factor for cognitive impairment. However, despite numerous public health interventions, older adults do not routinely meet activity guidelines. Online interventions offer an alternative means of engaging with this group. The role of an online intervention holds particular value in the context of a global pandemic where people have become accustomed to digital living. Furthermore, such an intervention negates barriers frequently faced by older adults in attending face to face interventions, whilst providing an economically viable option. This study explored the factors which maximise engagement in an online programme to promote physical activity.

Methods
A qualitative study was conducted with adults aged 50 and over. Individual were recruited through the online UK PROTECT study cohort. Four focus groups (n = 21) examined key contributors to engagement with a digital programme to promote physical activity. Iterative Categorization was utilised to identify categories and themes of the focus group data. Semi-structured interviews were subsequently conducted (n = 5) whereby participants were asked to comment on a concept-stage online intervention.

Results
Four major themes emerged from the focus group data: interaction at the fore, incentives as foundations, fitting around me and identity is critical. The semi-structured interviews identified further key areas of programme acceptability and specific needs for enhancing engagement.

Conclusions
Older adults are open to using digital physical activity programmes, with the recent COVID-19 pandemic driving an appetite for online delivery. Any intervention must be tailored to individual usability preferences and take account of the fitness, health and lifestyle needs specific to older adults. Furthermore, the conceptual-stage intervention used in this study was found to be acceptable, with key changes needed to maximise engagement.
684 LONG-TERM CONDITIONS, MULTIMORBIDITY, LIFESTYLE FACTORS AND GRIP STRENGTH CHANGE OVER 9 YEARS IN 44,315 UK BIOBANK PARTICIPANTS
Authors: Hurst C , Murray J C , Granic A , Hillman S J , Cooper R , Sayer A A , Robinson S M , Dodds R M 
Published: March 2022

Abstract

Introduction
Weak grip strength is associated with a range of adverse health outcomes, and an accelerated decline in grip strength confers an even greater risk. To date there has been limited research into the factors associated with change in grip strength in mid-life. Using data from UK Biobank our aim was to investigate the associations of long-term conditions (LTCs), multimorbidity and lifestyle factors with patterns of change in grip strength.

Methods
We used data from 44,315 UK Biobank participants with grip strength measured at baseline (2006–10) and a subsequent study visit around nine years later. At baseline, participants’ LTCs were self-reported and categorised against a hierarchy. Multimorbidity was characterised by the number of LTC categories present (0, 1, 2 and 3+). Lifestyle factors (body mass index (BMI), smoking, diet and physical activity) were also assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression models.

Results
Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% Confidence Interval [CI] 1.49–1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change: those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18;95% CI 1.08–1.28) compared to those with no LTCs. Low physical activity was associated with adverse patterns of grip strength, while raised BMI had divergent associations (both the decline and stable high patterns of grip strength change).

Conclusion
Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of loss of strength over time.
799 FRAILTY MATTERS PROJECT
Authors: Duffy F J R , Papadopolou C , Barrie J , Hendry A , Andrew M , Martin J 
Published: March 2022

Abstract

Introduction
Preventing and managing frailty is a new area for many community practitioners yet frailty specific education remains limited. We aimed to understand and strengthen the capability of District Nurses (DNs) in leading personalised care for older people with frailty.

Methods
We conducted a participatory action research (PAR) study with DNs in one Scottish NHS Board area. Phase 1 involved three focus groups (n = 17); one one-to-one interviews; and collection of baseline team dynamics questionnaires (n = 10). Evidence from phase 1 informed co-design of an educational framework, delivered in Phase 2 as a combined coaching and educational programme through small group learning, web based coaching and bite sized online education. Interactive sessions were supported by a person-centred coach and 2 older citizen ‘co-coaches’ to bring the experience of people affected by frailty. In Phase 3 we analysed participant feedback and assessed transferability to other disciplines and to health and care settings across the UK.

Results
At baseline, DNs did not perceive frailty as a long term condition. They identified a need for help to understand the concept of frailty and to build skills and confidence in delivering community interventions. Participants embraced the coaching and educational intervention and valued the opportunity for dialogue with peers and citizen co-coaches about what really matters to patients, families and professionals. Our survey of other disciplines and teams highlighted this educational programme is both relevant and transferable.

Conclusion
Through co-design we developed a contextually sensitive programme that makes sense of frailty in the reality of both community professionals and people living with frailty. Combining technical knowledge and relational skills-building with peer support and coaching helps prepare DNs to lead interprofessional teams caring for people living with frailty. The educational framework and combined coaching and educational package are highly applicable to interdisciplinary teams in other community settings.
660 PHYSIOTHERAPISTS PERCEPTIONS OF MECHANISMS FOR OBSERVED VARIATION IN PRACTICE DURING EARLY POSTOPERATIVE PHASE AFTER HIP FRACTURE
Authors: Volkmer B , Sadler E , Lambe K , Martin F C , Ayis S , Beaupre L , Cameron I D , Gregson C L , Johansen A , Kristensen M T , Magaziner J , Sackley C , Smith T O , Sobolev B 
Published: March 2022

Abstract

Objective
To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.

Methods
A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings.

Results
Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting ‘postoperative physiotherapy’ as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services.

Conclusion
Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
670 FACTORS ASSOCIATED WITH MORTALITY IN MULTI-ETHNIC HOSPITALISED COVID PATIENTS
Authors: Omotade I , Bennett M , Chitson S , Asiedu F , Harrington B , Patel M 
Published: March 2022

Abstract

Introduction
Whilst most patients during the COVID pandemic made an uneventful recovery, there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to evaluate independent risk factors for those who died of COVID compared to survivors and to identify any markers for improvement in future management.

Methods
Medical records of all COVID patients admitted to two multi-ethnic, inner city acute district general hospitals over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for those who died from COVID compared to survivors.

Results
Of 951 patients admitted with COVID, 284 died[30%]. Compared to survivors(n = 667), univariate analyses revealed COVID deaths were associated with increasing age[mean(CI): 79.3(77.9–80.7)vs64.7(63.4–66.0);P &lt; 0.001], Black African [16.2%vs11.7%;p &lt; 0.001] & South-Asian [12%vs9.1%;p &lt; 0.001] ethnicity, Hypertension [64.4%vs49.5%;p &lt; 0.001], Chronic Heart Disease(CHD)[40.1%vs20.7%;p &lt; 0.001], Chronic Respiratory Disease [17.6%vs12.0%;p = 0.02] Chronic Kidney Disease [18%vs11.1%;p = 0.004], Chronic Neurological Disease 43.3%vs23.7%;p &lt; 0.001]. Gender, Diabetes, asthma, obesity, Chronic Liver Disease and immunosuppression (disease or treatment related) were not associated with increasing mortality. Death rates between those in general wards vs intensive care were comparable[4.7%vs2.5%;p = 0.1]. Multivariable analyses showed age 60–70 [OR 2.3], age &gt; 70 [OR 6.5], Black Caribbean [OR 1.6], and CHD [1.5] were independent risk factors for COVID deaths.

Discussion
This large multi-ethnic study showed that age &gt; 60, Black Caribbean, and chronic heart disease were independent risk factors for COVID deaths. This study provides valuable information on independent prognostic implications for COVID, which can be used in future interventional studies aiming to improve COVID outcomes or in audits of clinical practice.
671 DEMOGRAPHIC VARIABILITY IN MORTALITY FROM COVID DURING THE TWO SURGES
Authors: Patel M , Umasankar U , Aitken E 
Published: March 2022

Abstract

Introduction
COVID-19 resulted in significant mortality over the last several months. This survey aims to evaluate demographic differences between those hospitalised patients who died of COVID during the first surge [until 31/08/2020] and those who died during the second [01/09/2020–15/03/2021].

Methods
Data was obtained for all patients admitted with COVID during the two pandemic surges at two multi-ethnic,inner-city district general hospitals. Univariate and multivariable analyses [stepwise backward logistic regression] were conducted to evaluate mortality as per patient demographics, length of stay, and whether patients had been managed in critical care.

Results
1013 [21.5%] of 4,707 patients died during this period. Mortality was significantly lower during the second wave,compared to first i.e. 18.5% [632/2784]vs29.5% [381/901];39% reduction [P &lt; 0.001]. This reduction was observed across all ages, gender, ethnic subgroups, and both sites. Advancing age was associated with significant mortality at all times with no differences between the two waves. 77% of all deaths occurred in patient&gt;70. There were fewer deaths among those&lt;50 during the second wave compared to first [7vs12]. Reduction in mortality during second wave was noted across all ethnic sub-groups. However,significantly greater reduction was observed in Black African [54.6%],South-Asian [47.3%],Black Caribbean [44.4%],and East-Asian [44.2%] groups, compared to white subgroup [34.2%]. Majority of patients who died were managed on general medical wards during both waves [n = 824,81.3%]. For patients who spent time in critical care, there were no significant differences in mortality [30.6vs33.7%,p = ns]. There were no differences in terms of length of hospital stay between the two waves. Multivariable analyses showed that Black African [OR 0.47,95%CI 0.27–0.82] was independently associated with lesser mortality during second wave.

Discussion
This large survey has described demographic differences in mortality between the two surges. Lower mortality rates during second wave may be due to better treatment modalities, greater awareness of infection prevention and control,and possibly vaccination. This survey indicates greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.
771 LET’S TALK ABOUT RESUS. DO WE DO IT? WHO DOES IT? WHAT ARE THE OUTCOMES?
Authors: Gilmore S , Murray S , Taylor S , Ninan S 
Published: March 2022

Abstract

Introduction
Discussing preferences around cardiopulmonary resuscitation (CPR) is recommended to patients who wish to discuss this, or where there is foreseeable risk of life-threatening clinical deterioration. Our team felt that we discussed this routinely for our inpatients but wished to investigate how we did this, when we did this, why decisions were made and who led these discussions.

Methods
We retrospectively reviewed the electronic patient notes of 118 patients recently discharged from elderly medicine between February and November 2020 and recorded demographic details, co-morbidities and outcomes of discussions regarding resuscitation.

Results
100/118 patients had a RESPECT form documenting preferences. Of these 100 patients, 97% had a DNACPR recommendation, 2 had a ‘for resuscitation’ recommendation and one was undecided. 69% of patients had their preferences recorded during the current admission. 43% of discussions were led by a tier 1/2 doctor. 21% of discussions were led by a tier 3 doctor. 23% of discussions were led by a consultant. It was unclear who had led the discussion 13% of the time. 29/97 patients had a DNACPR due to their wishes. 16/97 patients had a DNACPR based on clinical grounds that it would not succeed. 33/97 patients had a DNACPR on the grounds that burden outweighed risks and they had capacity In 19/97 patients the reason for DNACPR was not clearly documented. There were 6 discussions where there was distress or disagreement—all of the discussions resulted in DNACPR recommendation 1 patient had a DNACPR reversed during their admission and none were reversed afterwards.

Conclusion
Systematically discussing preferences around resuscitation is feasible and rarely results in distress. The majority of patients have a recommendation for DNACPR and discussions are led by ‘junior’ doctors.
778 THE IMPACT OF MUSCULOSKELETAL CONDITIONS AND FRAILTY ON THE ABILITY TO SELF-CARE OR BE IN RECEIPT OF CARE: A STUDY OF COMMUNITY-
Authors: Bevilacqua G , Laskou F , Jameson K , Fuggle N , Cooper C , Dennison E M , Patel H P 
Published: March 2022

Abstract

Introduction
Musculoskeletal conditions (MSC) and frailty lead to a significant burden of disease in later life. Living independently remains the aim of older adults but ability to self-care or access care at home may hamper this. Our aim was to consider whether MSC (osteoporosis, sarcopenia, osteoarthritis) and frailty were associated with ability to self-care or influence access to formal/informal care among community-dwelling older adults.

Methods
Participants were recruited from an established cohort study of community-dwelling adults in the UK. Osteoporosis was assessed using Dual-energy X-ray Absorptiometry. Sarcopenia was assessed using EWSGOP2 criteria. Osteoarthritis of the hand, hip or knee was defined by clinical examination. Frailty was assessed using Fried criteria. Ability to self-care and access to formal/informal care were self-reported.

Results
443 men and women (median age 75.5 [IQR 73.5–77.9] years) participated. Osteoporosis affected (n = 74) 21.4% of participants, (n = 115) 26.8% had osteoarthritis, (n = 30) 8.6% had sarcopenia, and (n = 33) 7.6% were identified as frail. Most participants (n = 402 [90.7%]) reported no problems with self-care. Identical proportions of participants received informal (n = 53 [12%]) and formal (n = 53 [12%]) care at home in the previous year. Reporting difficulties with self-care was associated with clinical osteoarthritis (OR 3.48, 95% CI 1.63–7.43, p = 0.001) and frailty (5.29, 2.12–13.2, p &lt; 0.001), but not with osteoporosis or sarcopenia. Receiving informal care at home in the past year was associated with osteoarthritis (2.56, 1.28–5.14, p = 0.008), the coexistence of two or more MSC (6.50, 1.66–25.39, p = 0.007), and frailty (6.25, 2.59–15.08, p &lt; 0.001), but not with osteoporosis or sarcopenia alone. None of the conditions were associated with receiving formal care.

Conclusion
MSC are associated with informal receipt of care. Presence of two or more MSC convey similar informal care requirements to those living with frailty. Early assessment and management of MSC and frailty in clinical practice may reduce need for care and preserve independence.
802 CONCURRENT PATHOLOGIES OBSERVED IN OLDER ADULTS WITH COVID-19 INFECTION
Authors: Murphy C , Hartop K , Aggrey K , Bilan J , Lumsden J , Colquhoun K , Quinn T 
Published: March 2022

Abstract

Introduction
This study aimed to look at the effect of frailty and multi morbidity on short-term outcomes in patients diagnosed with COVID-19 in a hospital setting, looking specifically at the variety of concurrent pathologies diagnosed during their admission and how these affected the course of their illness and mortality.

Methods
The study took place at Glasgow Royal Infirmary. We retrospectively collected data from 280 patients who were admitted to the medicine for the elderly department between the 1st October and 1st December 2020 and diagnosed with COVID-19.

Results
In this cohort, 65% of older adults in hospital with COVID-19 had their admissions complicated by concurrent pathologies; most commonly delirium, acute kidney injury and pulmonary embolism, also increasing mortality in this group. It was also found that 39% of patients in this group had co-pathologies that were not necessarily associated with COVID-19 disease, for example AKI, AF and stroke/TIA. 35% of older adults in this group had no concurrent medical diagnoses during their admission, however this did not correlate with reduced mortality in this group.

Conclusion
The data highlights the vulnerability of older adults with COVID-19 infection making them more susceptible to concurrent disease and contributing to further morbidity and mortality. We also found a large number of patients had co-pathologies not associated with COVID-19 disease, highlighting the importance of considering other diagnoses in frail elderly patients.