Publisher: Oxford University Press   (Total: 413 journals)

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Showing 1 - 200 of 413 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (Followers: 3, SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 61, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 8, SJR: 1.434, CiteScore: 1)
Aesthetic Surgery J. Open Forum     Open Access   (Followers: 1)
African Affairs     Hybrid Journal   (Followers: 74, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 95, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 21, SJR: 1.376, CiteScore: 3)
American Entomologist     Hybrid Journal   (Followers: 8)
American Historical Review     Hybrid Journal   (Followers: 216, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 54, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 232, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 228, SJR: 2.713, CiteScore: 3)
American J. of Health-System Pharmacy     Full-text available via subscription   (Followers: 64, SJR: 0.595, CiteScore: 1)
American J. of Hypertension     Hybrid Journal   (Followers: 29, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 19, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 11, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 31, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 19, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 25, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal   (Followers: 2)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 15, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 38, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 62, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 11, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 11, SJR: 0.728, CiteScore: 2)
Antibody Therapeutics     Open Access   (Followers: 1)
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 66, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 32, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 58, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 396, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Open Access   (Followers: 1)
Biology of Reproduction     Full-text available via subscription   (Followers: 11, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 3, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 234, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 69)
Brain     Hybrid Journal   (Followers: 78, SJR: 5.858, CiteScore: 7)
Brain Communications     Open Access   (Followers: 2)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 53, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 42, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 24, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 622, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 99, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 6, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 35)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 76, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 13, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 3, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 16, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 56, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 24, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 8, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 5, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 24, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 11, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 29, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 79, SJR: 5.051, CiteScore: 5)
Communication Theory     Hybrid Journal   (Followers: 29, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 29, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 28, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 3, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 12, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 8, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 5)
Current Legal Problems     Hybrid Journal   (Followers: 29)
Current Zoology     Full-text available via subscription   (Followers: 6, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 10, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 15, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 25, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 6, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 4)
Early Music     Hybrid Journal   (Followers: 17, SJR: 0.139, CiteScore: 0)
Econometrics J.     Hybrid Journal   (Followers: 34, SJR: 2.926, CiteScore: 1)
Economic J.     Hybrid Journal   (Followers: 124, SJR: 5.161, CiteScore: 3)
Economic Policy     Hybrid Journal   (Followers: 51, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 27, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 60, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 23, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 12, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 2)
Environmental History     Hybrid Journal   (Followers: 28, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 3, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 23, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 67, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 10, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access   (Followers: 1)
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 239, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 5, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 31, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 46, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Family Practice     Hybrid Journal   (Followers: 16, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 19, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 29, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 38, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 26, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 8, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 36, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 21, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 17, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 39, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 27, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 6, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 10, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 68, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 19, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 26, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 27, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 33, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 30, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 16, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 11, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 76, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 18, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 66, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 59, SJR: 1.591, CiteScore: 3)
ICSID Review : Foreign Investment Law J.     Hybrid Journal   (Followers: 11)
ILAR J.     Hybrid Journal   (Followers: 3, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 12, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 29, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 45, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Innovation in Aging     Open Access   (Followers: 1)
Insect Systematics and Diversity     Hybrid Journal  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 10, SJR: 1.319, CiteScore: 2)
Integrative Biology     Full-text available via subscription   (Followers: 5, SJR: 1.36, CiteScore: 3)
Integrative Organismal Biology     Open Access  
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 72, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 22)
Intl. Health     Hybrid Journal   (Followers: 7, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 4, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 40, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 57, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 291, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 21, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 9, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 11, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 38, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 14, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 41, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 25, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 55, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 24, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 2, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 18, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 55, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 15, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 16, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 5, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 46, SJR: 1.226, CiteScore: 2)

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Similar Journals
Journal Cover
Age and Ageing
Journal Prestige (SJR): 1.989
Citation Impact (citeScore): 4
Number of Followers: 95  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
Published by Oxford University Press Homepage  [413 journals]
  • Editor’s view
    • Authors: Harwood R.
      Pages: 495 - 496
      PubDate: Wed, 01 Jul 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa101
      Issue No: Vol. 49, No. 4 (2020)
       
  • Delirium: a missing piece in the COVID-19 pandemic puzzle
    • Authors: O’Hanlon S; Inouye S.
      Pages: 497 - 498
      Abstract: deliriumCOVID-19older people
      PubDate: Wed, 06 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa094
      Issue No: Vol. 49, No. 4 (2020)
       
  • Frailty in the face of COVID-19
    • Authors: Hubbard R; Maier A, Hilmer S, et al.
      Pages: 499 - 500
      Abstract: frailtyCOVID-19intensive careolder people
      PubDate: Wed, 06 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa095
      Issue No: Vol. 49, No. 4 (2020)
       
  • COVID-19 in older people: a rapid clinical review
    • Authors: Lithander F; Neumann S, Tenison E, et al.
      Pages: 501 - 515
      Abstract: AbstractIntroductionthe COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials.Methodswe searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively.Resultsscreening of over 1,100 peer-reviewed and pre-print papers yielded n = 22 on COVID-19 testing, n = 15 on treatment and n = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period.Conclusiongiven the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research.
      PubDate: Wed, 06 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa093
      Issue No: Vol. 49, No. 4 (2020)
       
  • COVID-19 outbreak: organisation of a geriatric assessment and coordination
           unit. A French example
    • Authors: Koeberle S; Tannou T, Bouiller K, et al.
      Pages: 516 - 522
      Abstract: AbstractOlder people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient’s level of care and the organisation of specific networks is essential.To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service.This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.
      PubDate: Wed, 06 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa092
      Issue No: Vol. 49, No. 4 (2020)
       
  • Atypical presentation of COVID-19 in a frail older person
    • Authors: Tay H; Harwood R.
      Pages: 523 - 524
      Abstract: AbstractCommon symptoms of pandemic coronavirus disease (COVID-19) include fever and cough. We describe a 94-year-old man with well-controlled schizoaffective disorder, who presented with non-specific and atypical symptoms: delirium, low-grade pyrexia and abdominal pain. He was given antibiotics for infection of unknown source, subsequently refined to treatment for community-acquired pneumonia. Despite active treatment, he deteriorated with oxygen desaturation and tachypnoea. A repeat chest X-ray showed widespread opacification. A postmortem throat swab identified COVID-19 infection. He was treated in three wards over 5 days with no infection control precautions. This has implications for the screening, assessment and isolation of frail older people to COVID-specific clinical facilities and highlights the potential for spread among healthcare professionals and other patients.
      PubDate: Tue, 21 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa068
      Issue No: Vol. 49, No. 4 (2020)
       
  • Can the COVID-19 crisis strengthen our treatment escalation planning and
           resuscitation decision making'
    • Authors: McIntosh L.
      Pages: 525 - 525
      Abstract: Sir,
      PubDate: Wed, 22 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa083
      Issue No: Vol. 49, No. 4 (2020)
       
  • New horizons in appetite and the anorexia of ageing
    • Authors: Cox N; Morrison L, Ibrahim K, et al.
      Pages: 526 - 534
      Abstract: AbstractAppetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person’s society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty. Early identification of poor appetite could allow timely intervention before weight loss occurs. There is no standardised tool for assessing appetite in clinical settings at present but the 4-item Simplified Nutritional Appetite Questionnaire (SNAQ) has the potential to be used in this way. This review, designed for clinicians, will discuss the regulation of appetite and the pathogenesis of the anorexia of ageing. It will describe the current evidence for interventions to manage the anorexia of ageing, which is limited, with little benefit reported from individual studies of education, physical activity and medication. There is some positive evidence for flavour enhancement, fortified food and oral nutritional supplements but mainly within single studies. Looking ahead, the aim is to develop multicomponent approaches to the treatment of the anorexia of ageing based on growing understanding of the role of physiological signalling, hedonism and external cues.
      PubDate: Mon, 10 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa014
      Issue No: Vol. 49, No. 4 (2020)
       
  • Does frailty predict post stroke mortality'
    • Authors: McEnhill P; Torsney K, Rajkumar C.
      Pages: 535 - 536
      Abstract: frailtyolder peoplestrokethrombolysismortality
      PubDate: Tue, 26 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa030
      Issue No: Vol. 49, No. 4 (2020)
       
  • Reducing medication errors and transitions of care
    • Authors: Cardwell K.
      Pages: 537 - 539
      Abstract: medication errorstransition of caremultimorbiditypolypharmacypotentially inappropriate prescribingolder people
      PubDate: Sat, 30 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa065
      Issue No: Vol. 49, No. 4 (2020)
       
  • Special needs of frail people undergoing emergency laparotomy surgery
    • Authors: McCarthy K; Hewitt J.
      Pages: 540 - 543
      Abstract: AbstractThere are now over 30 000 emergency laparotomies under taken in the UK every year, a figure that is increasing year on year. Over half of these people are aged over 70 years old. Frailty is commonly seen in this population and becomes increasingly common with age and is seen in over 50% of elderly emergency laparotomies in people aged over 85 years old. In older people who undergo surgery one third will have died within one year of surgery, a figure which is worse in frail individuals. For those that do survive, post-operative morbidity is worse and 30% of frail older people do not return to their own home. In the UK, the National Emergency Laparotomy Audit (NELA) is leading the way in providing the evidence base in this population group. Beyond collecting data on every Emergency Laparotomy undertaken in the UK, it is also key in driving improvement in care. Their most recent report highlights that only 23% of patients over 70 years received geriatric involvement following surgery. More encouragingly, the degree of multidisciplinary geriatric involvement seems to be increasing. In the research setting, well designed studies focusing on the older frail emergency laparotomy patient are underway. It is anticipated that these studies will better define outcomes following surgery, improving the communication and decision making between patients, relatives, carers and their surgical teams.
      PubDate: Mon, 22 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa058
      Issue No: Vol. 49, No. 4 (2020)
       
  • The politics of frailty
    • Authors: Vernon M.
      Pages: 544 - 548
      Abstract: AbstractThe world population is ageing because of falling fertility and improved life expectancy. Knowing this has not helped governments develop sustainable health and care policies because the underlying causes and impacts of population ageing remain poorly understood. Planning using only population age structure does not account for uneven geographical distribution of older people, their health characteristics, functional needs or lived experiences. English National Health Service (NHS) policy has previously focused on arbitrary age segmentation, failing to capture the origins of cumulative disease and functional burden and missing the opportunity to incorporate wider determinants of health into prevention of poor-quality ageing. This is despite growing international evidence that adults living in places with low per capita income and educational attainment experience a higher burden of age-related disease. Lack of a credible ageing narrative and good quality population health data have contributed to a focus on single disease prevention, rather than life course disease aggregation and its personal impacts. However, a fully explicated health and care narrative incorporating frailty does now give some cause for optimism. In 2017, England became the first country to characterise and systematically identify frailty as a long-term treatable health condition. This was coincident with a UK Government’s Industrial Strategy targeting societal ageing. In 2019, the English NHS published a funded long-term plan including a major programme focused on ageing well. Policy makers, health leaders and clinicians must not squander these opportunities but instead pursue frailty prevention and intervention to improve the quality of population ageing.
      PubDate: Sat, 07 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa023
      Issue No: Vol. 49, No. 4 (2020)
       
  • The association of delirium severity with patient and health system
           outcomes in hospitalised patients: a systematic review
    • Authors: Rosgen B; Krewulak K, Stelfox H, et al.
      Pages: 549 - 557
      Abstract: AbstractBackgrounddelirium is an acute state of confusion that affects >20% of hospitalised patients. Recent literature indicates that more severe delirium may lead to worse patient outcomes and health system outcomes, such as increased mortality, cognitive impairment and length of stay (LOS).Methodsusing systematic review methodology, we summarised associations between delirium severity and patient or health system outcomes in hospitalised adults. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases with no restrictions, from inception to 25 October 2018. We included original observational research conducted in hospitalised adults that reported on associations between delirium severity and patient or health system outcomes. Quality of included articles was assessed using the Newcastle–Ottawa Scale. The level of evidence was quantified based on the consistency of findings and quality of studies reporting on each outcome.Resultswe included 20 articles evaluating associations that reported: mortality (n = 11), cognitive ability (n = 3), functional ability (n = 3), patient distress (n = 1), quality of life (n = 1), hospital LOS (n = 4), intensive care unit (ICU) LOS (n = 2) and discharge home (n = 2). There was strong-level evidence that delirium severity was associated with increased ICU LOS and a lower proportion of patients discharged home. There was inconclusive evidence for associations between delirium severity and mortality, hospital LOS, functional ability, cognitive ability, patient distress and quality of life.Conclusiondelirium severity is associated with increased ICU LOS and a lower proportion of patients discharged home. Delirium severity may be a useful adjunct to existing delirium screening to determine the burden to health care system resources.
      PubDate: Tue, 28 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa053
      Issue No: Vol. 49, No. 4 (2020)
       
  • Successful care transitions for older people: a systematic review and
           meta-analysis of the effects of interventions that support medication
           continuity
    • Authors: Tomlinson J; Cheong V, Fylan B, et al.
      Pages: 558 - 569
      Abstract: AbstractBackgroundmedication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity.Methodsa database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible.Resultstwenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions.Conclusionour results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.
      PubDate: Thu, 20 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa002
      Issue No: Vol. 49, No. 4 (2020)
       
  • The prevalence and impact of potentially inappropriate prescribing among
           older persons in primary care settings: multilevel meta-analysis
    • Authors: Liew T; Lee C, Goh S, et al.
      Pages: 570 - 579
      Abstract: AbstractBackgroundPotentially inappropriate prescribing (PIP) may not have received as much attention in primary care settings (compared to tertiary hospital and nursing home settings), due to uncertainty about its prevalence in this healthcare setting. We conducted a systematic review with meta-analysis to summarise the prevalence of PIP specific to primary care settings and computed the population attributable risk (PAR) to estimate the impact of PIP in primary care.MethodWe searched PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO and previous review articles for studies related to ‘older persons’, ‘primary care’ and ‘inappropriate prescribing’. Two reviewers selected eligible articles, extracted data and evaluated risk of bias. Multilevel meta-analysis was conducted to pool the prevalence estimates across the included studies, while meta-regression was conducted to investigate the sources of heterogeneity.ResultsOf the 4,259 articles identified, we included 67 articles with 111 prevalence estimates and a total of 5,054,975 participants. Overall, PIP had a pooled prevalence of 33.3% (95% CI 29.7–37.0%). Based on population attributable risks, PIP explained 7.7–17.3% of adverse outcomes related to older persons in primary care. If current PIP prevalence is halved, 37–79 cases of adverse outcomes may potentially be prevented (per 1,000 adverse outcomes).ConclusionsThe findings demonstrate the relevance and potential impact of PIP specific to primary care settings. Given the increasingly central role that primary care plays in coordinating healthcare, the findings highlight the need to prioritise PIP intervention in primary care as a key strategy to reduce iatrogenic medication-related harm among older persons in current healthcare system.
      PubDate: Mon, 04 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa057
      Issue No: Vol. 49, No. 4 (2020)
       
  • Potentially inappropriate medication use in older adults with
           mild-moderate Alzheimer’s disease: prevalence and associations with
           adverse events
    • Authors: Murphy C; Dyer A, Lawlor B, et al.
      Pages: 580 - 587
      Abstract: AbstractAimPotentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer’s Disease (AD), who may represent a particularly vulnerable group.DesignAnalysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated.Setting and Participants448 older adults with mild-to-moderate AD from 23 centres in nine European countries.ResultsOf 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13–1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17–1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03–1.30, P = 0.016) and GP visits (IRR 1.22, 1.15–1.28, P < 0.001). PIM use was not associated with dementia progression.Conclusions and ImplicationsPIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.
      PubDate: Sat, 30 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa067
      Issue No: Vol. 49, No. 4 (2020)
       
  • Clinical frailty independently predicts early mortality after ischaemic
           stroke
    • Authors: Evans N; Wall J, To B, et al.
      Pages: 588 - 591
      Abstract: AbstractBackgroundClinical frailty is an important syndrome for clinical care and research, independently predicting mortality and rates of institutionalisation in a range of medical conditions. However, there has been little research into the role of frailty in stroke.ObjectiveThis study investigates the effect of frailty on 28-day mortality following ischaemic stroke and outcomes following stroke thrombolysis.MethodsFrailty was measured using the Clinical Frailty Scale (CFS) for all ischaemic stroke admissions aged ≥75 years. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). 28-day mortality and clinical outcomes were collected retrospectively. Analysis included both dichotomised measures of frailty (non-frail: CFS 1–4, frail: 5–8) and CFS as a continuous ordinal scale.ResultsIn 433 individuals with ischaemic stroke, 28-day mortality was higher in frail versus non-frail individuals (39 (16.7%) versus 10 (5%), P < 0.01). On multivariable analysis, a one-point increase in CFS was independently associated with 28-day mortality (OR 1.03 (1.01–1.05)). In 63 thrombolysed individuals, median NIHSS reduced significantly in non-frail individuals (12.5 (interquartile range (IQR) 9.25) to 5 (IQR 10.5), P < 0.01) but not in frail individuals (15 (IQR 11.5) to 16 (IQR 16.5), P = 0.23). On multivariable analysis, a one-point increase in CFS was independently associated with a one-point reduction in post-thrombolysis NIHSS improvement (coefficient 1.07, P = 0.03).ConclusionClinical frailty is independently associated with 28-day mortality after ischaemic stroke and appears independently associated with attenuated improvement in NIHSS following stroke thrombolysis. Further research is needed to elucidate the underlying mechanisms and how frailty may be utilised in clinical decision-making.
      PubDate: Fri, 17 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa004
      Issue No: Vol. 49, No. 4 (2020)
       
  • Knee pain and future decline in higher-level functional competence in
           community-dwelling older Japanese: the Kurabuchi cohort study
    • Authors: Sugai K; Michikawa T, Takebayashi T, et al.
      Pages: 592 - 598
      Abstract: AbstractBackgroundThe effect of knee osteoarthritis, which causes knee pain, on higher-level functional competence (HLFC) is not clear.ObjectiveTo clarify the effect of knee pain on HLFC in older people.DesignCommunity-based prospective cohort study.SettingKurabuchi town, Gumma prefecture, Japan.SubjectsCommunity-dwelling individuals aged 65 and older.MethodsA total of 808 residents participated to the baseline examinations. The frequency of knee pain, degree of pain and functional impairment resulting from the pain were asked at baseline (2005–2006) via a self-administered questionnaire in Japanese based on an English version of the Western Ontario and McMaster Universities Osteoarthritis Index. Information on HLFC at baseline and during home visits were collected annually until 2014 with the Tokyo Metropolitan Institute of Gerontology Index of Competence. The association between baseline knee pain and HLFC decline was assessed with a Cox proportional hazards model.ResultsTwo factors, persistent knee pain and severe functional impairment caused by the pain, were significantly associated with future declines in total HLFC, with adjusted hazard ratios (95% confidence intervals) of 1.51 (1.08–2.11) and 1.49 (1.10–2.00). In analysis by subcategory, persistent knee pain had a significant adverse effect on participants’ intellectual and social activities, and that severe physical functional impairment also had a significant impact on social activities.ConclusionsThe clear association of the frequency of knee pain and resultant functional impairment with future HLFC decline indicates that collecting information about these factors may be useful in identifying older people at high risk of future HLFC decline.
      PubDate: Tue, 03 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa024
      Issue No: Vol. 49, No. 4 (2020)
       
  • Loneliness as a mediator of the impact of social isolation on cognitive
           functioning of Chinese older adults
    • Authors: Yang R; Wang H, Edelman L, et al.
      Pages: 599 - 604
      Abstract: AbstractBackground and Objectiveolder adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context.Designsecondary analysis of the baseline wave (2011–12) of the harmonised China Health and Retirement Longitudinal Study.Setting and Subjectscommunity-dwelling older adults in China (N = 7,410 participants aged 60–101 years).Methodswe applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest.Resultsthe results demonstrated that social activity engagement, weekly adult children contact and caregiving for grandchildren were significantly related to social isolation (β = −0.26 to −0.28) (Living alone was fixed to 1 for model identification.) The indirect effect of social isolation on cognitive functioning through loneliness was significant (β = −0.15), indicating loneliness was an important mediator. However, the direct effect of social isolation on cognitive functioning also remained significant (β = −0.83), suggesting a partial mediation effect.Conclusionsour study highlights the mediation role of loneliness in the relationship between social isolation and cognitive functioning among Chinese older adults. The findings support the beneficial effects of maintaining social relations and coping with feelings of loneliness on older adults’ cognitive functioning.
      PubDate: Sat, 07 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa020
      Issue No: Vol. 49, No. 4 (2020)
       
  • Prevention of adverse drug reactions in hospitalized older patients with
           multi-morbidity and polypharmacy: the SENATOR* randomized controlled
           clinical trial
    • Authors: O'Mahony D; Gudmundsson A, Soiza R, et al.
      Pages: 605 - 614
      Abstract: AbstractBackgroundMulti-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention.MethodsWe undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life.ResultsFor the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77–1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%).ConclusionsIn this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.
      PubDate: Tue, 02 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa072
      Issue No: Vol. 49, No. 4 (2020)
       
  • Computer-generated STOPP/START recommendations for hospitalised older
           adults: evaluation of the relationship between clinical relevance and rate
           of implementation in the SENATOR trial
    • Authors: Dalton K; Curtin D, O’Mahony D, et al.
      Pages: 615 - 621
      Abstract: AbstractBackgroundfindings from a recent qualitative study indicate that the perceived clinical relevance of computer-generated STOPP/START recommendations was a key factor affecting their implementation by physician prescribers caring for hospitalised older adults in the SENATOR trial.Aimto systematically evaluate the clinical relevance of these recommendations and to establish if clinical relevance significantly affected the implementation rate.Methodsa pharmacist–physician pair retrospectively reviewed the case records for all SENATOR trial intervention patients at Cork University Hospital and assigned a degree of clinical relevance for each STOPP/START recommendation based on a previously validated six-point scale. The chi-square test was used to quantify the differences in prescriber implementation rates between recommendations of varying clinical relevance, with statistical significance set at P < 0.05.Resultsin 204 intervention patients, the SENATOR software produced 925 STOPP/START recommendations. Nearly three quarters of recommendations were judged to be clinically relevant (73.6%); however, nearly half of these were deemed of ‘possibly low relevance’ (320/681; 47%). Recommendations deemed of higher clinical relevance were significantly more likely to be implemented than those of lower clinical relevance (P < 0.05).Conclusionsa large proportion (61%) of the computer-generated STOPP/START recommendations provided were of potential ‘adverse significance’, of ‘no clinical relevance’ or of ‘possibly low relevance’. The adjudicated clinical relevance of computer-generated medication recommendations significantly affects their implementation. Meticulous software refinement is required for future interventions of this type to increase the proportion of recommendations that are of high clinical relevance. This should facilitate their implementation, resulting in prescribing optimisation and improved clinical outcomes for multimorbid older adults.
      PubDate: Tue, 02 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa062
      Issue No: Vol. 49, No. 4 (2020)
       
  • Positive and negative experiences and life satisfaction among spousal
           caregivers for frail older adults in urban China: a parallel process model
           
    • Authors: Jiang N; Lu N, Sun Q, et al.
      Pages: 622 - 627
      Abstract: AbstractObjectivesPrevious literature has suggested that negative and positive aspects of spousal caregiving co-exist. However, positive and negative experiences were often examined independently. This study aimed to empirically test a parallel process model of spousal caregiving.MethodsThis cross-sectional survey of family caregiving involved 269 frail older adults living in Shanghai, China, in 2016. Quota sampling was conducted to find community-dwelling frail older adults with a primary caregiver. Path analysis was used to identify the relationship between negative and positive caregiving experiences and life satisfaction.ResultsWe found two independent paths towards life satisfaction: (i) activities of daily living were negatively associated with burden, and burden was associated with lower life satisfaction; and (ii) spousal caregivers’ self-reported health and financial state were positively associated with positive appraisal, and positive appraisal was associated with higher life satisfaction. Caregiving time contributed to both aspects of caregiving experiences. The covariance between caregiving burden and positive appraisals was not statistically significant.ConclusionSpousal caregiving involves a parallel process. Negative and positive experiences are separate constructs and their associations with life satisfaction vary. We advocate for policy and interventions that promote positive views of caregiving that encourage caregivers to develop a high level of overall life satisfaction despite the hardships of their caregiving tasks.
      PubDate: Sat, 18 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa032
      Issue No: Vol. 49, No. 4 (2020)
       
  • Symptoms of mood disorders in family carers of older people with dementia
           who experience caregiver burden: a network approach
    • Authors: França A; Gordon A, Samra R, et al.
      Pages: 628 - 633
      Abstract: AbstractBackgroundinformal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden.Methodssixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale. The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions.Resultsthe resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression.Conclusionsthis network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions.
      PubDate: Mon, 24 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa008
      Issue No: Vol. 49, No. 4 (2020)
       
  • Temporal trends in handgrip strength for older Japanese adults between
           1998 and 2017
    • Authors: Tomkinson G; Kidokoro T, Dufner T, et al.
      Pages: 634 - 639
      Abstract: AbstractObjectiveto estimate temporal trends in handgrip strength (HGS) for older Japanese adults between 1998 and 2017.Design and methodsadults aged 60–79 years were included. Annual nationally representative HGS data (n = 176,449) for the 19-year study period were obtained from the Japanese Ministry of Education, Culture, Sports, Science and Technology. Temporal trends in mean HGS were estimated by sample-weighted regression models relating the year of testing to mean HGS. National trends in absolute, percent and standardised HGS were estimated by a post-stratified population-weighting procedure. Temporal trends in variability were estimated as the ratio of coefficients of variation (CVs).Resultscollectively, there was a small improvement in mean HGS of 1.4 kg (95% confidence interval [CI]: 1.3–1.5), 4.5% (95%CI: 4.3–4.7) or 0.27 standard deviations (95%CI: 0.26–0.28) between 1998 and 2017. The rate of improvement progressively increased over time, with more recent values (post-2008) 1.5-fold larger than earlier values. Gender- and age-related temporal differences were negligible. Variability in HGS declined substantially over time (ratio of CVs [95%CI]: 0.88 [0.86–0.90]), with declines 1.9-fold larger in women compared to men and 1.7-fold larger in 70- to 79-year-olds compared to 60- to 69-year-olds.Conclusionsthere has been a small, progressive improvement in mean HGS for older Japanese adults since 1998, which is suggestive of a corresponding improvement in strength capacity. The substantial decline in variability indicates that the improvement in mean HGS was not uniform across the population.
      PubDate: Sun, 09 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa021
      Issue No: Vol. 49, No. 4 (2020)
       
  • A multicentre, pragmatic, cluster randomised, controlled feasibility trial
           of the POD system of care
    • Authors: Young J; Green J, Farrin A, et al.
      Pages: 640 - 647
      Abstract: AbstractObjectiveto provide a preliminary estimate of the effectiveness of the prevention of delirium (POD) system of care in reducing incident delirium in acute hospital wards and gather data for a future definitive randomised controlled trial.Designcluster randomised and controlled feasibility trial.Settingsixteen acute care of older people and orthopaedic trauma wards in eight hospitals in England and Wales.Participantspatients 65 years and over admitted to participating wards during the trial period.Interventionsparticipating wards were randomly assigned to either the POD programme or usual care, determined by existing local policies and practices. The POD programme is a manualised multicomponent delirium prevention intervention that targets 10 risk factors for delirium. The intervention wards underwent a 6-month implementation period before trial recruitment commenced. Main outcome measure incidence of new-onset delirium measured using the Confusion Assessment Method (CAM) measured daily for up to 10 days post consent.Resultsout of 4449, 3274 patients admitted to the wards were eligible. In total, 714 patients consented (713 registered) to the trial, thirty-three participants (4.6%) withdrew. Adherence to the intervention was classified as at least medium for seven wards. Rates of new-onset delirium were lower than expected and did not differ between groups (24 (7.0%) of participants in the intervention group versus 33 (8.9%) in the control group; odds ratio (95% confidence interval) 0.68 (0.37–1.26); P = 0.2225).Conclusionsbased on these findings, a definitive trial is achievable and would need to recruit 5220 patients in 26 two-ward hospital clusters.Trial registration: ISRCTN01187372. Registered 13 March 2014.
      PubDate: Sat, 18 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa044
      Issue No: Vol. 49, No. 4 (2020)
       
  • Investigation of ward fidelity to a multicomponent delirium prevention
           intervention during a multicentre, pragmatic, cluster randomised,
           controlled feasibility trial
    • Authors: Smith J; Green J, Siddiqi N, et al.
      Pages: 648 - 655
      Abstract: AbstractBackgrounddelirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging.Objectiveto investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial.Settingfive care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales.Data collectionresearch nurse observations of ward practice; case note reviews and examination of documentation.Assessment10 health care professionals with experience in older people’s care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1).Resultsthe mean score (range) for each domain was: installation 4.5 (3.5–5); delivery 32.6 (range 27.3–38.3); coverage 7.9 (range 4.2–10.1); and duration 0.38 (0–1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51–79%) in five wards and low (≤50%) in one ward.Conclusionthe trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.
      PubDate: Sat, 18 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa042
      Issue No: Vol. 49, No. 4 (2020)
       
  • Older patients undergoing emergency laparotomy: observations from the
           National Emergency Laparotomy Audit (NELA) years 1–4
    • Authors: Aitken R; Partridge J, Oliver C, et al.
      Pages: 656 - 663
      Abstract: AbstractBackgroundolder patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014–2017) since NELA was established.Methodspatient-level data were populated from the NELA data set years 1–4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation.Resultsin total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P < 0.001) and 90-day mortality (20.4 versus 7.2%, P < 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P < 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P < 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1–4 (8.5 to 16.5%, P < 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio [OR] 0.38, confidence interval [CI] 0.35–0.42, P < 0.001; 90-day OR 0.6, CI 0.56–0.65, P < 0.001).Conclusionsolder NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input.
      PubDate: Tue, 02 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa075
      Issue No: Vol. 49, No. 4 (2020)
       
  • What is important to people with dementia living at home' A set of
           core outcome items for use in the evaluation of non-pharmacological
           community-based health and social care interventions
    • Authors: Reilly S; Harding A, Morbey H, et al.
      Pages: 664 - 671
      Abstract: AbstractObjectivesinconsistency in outcome measurement in dementia care trials impedes the comparisons of effectiveness between trials. The key aim of this study is to establish an agreed standardised core outcome set (COS) for use when evaluating non-pharmacological health and social care interventions for people with dementia living at home.Methodwe used a mixed-methods research design, including substantive qualitative research with five key stakeholders groups. We consulted with people living with dementia for many aspects of this research. We applied a modified two-round 54 item Delphi approach to attain consensus on core outcomes. The COS was finalised in a face-to-face consensus meeting in 2018.Resultsof the 288 who completed round 1 (21 people living with dementia, 58 care partners, 137 relevant health and social care professionals, 60 researchers, 12 policy makers), 246 completed round 2 (85% response rate). Twenty participants attended the consensus meeting. We reached consensus for the inclusion of 13 outcome items.Conclusionwe identified 13 outcome items which are considered core; many relate to social health. Providing there are adequate measures, measuring these core outcome items will enhance comparisons for effectiveness making trial evidence more useful. The items will provide commissioners and service planners with information on what types of interventions are most likely to be valued highly by people living with dementia.Trial registrationThe study is registered on the COMET initiative database.
      PubDate: Mon, 17 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa015
      Issue No: Vol. 49, No. 4 (2020)
       
  • Use of a digital delirium pathway and quality improvement to improve
           delirium detection in the emergency department and outcomes in an acute
           hospital
    • Authors: Vardy E; Collins N, Grover U, et al.
      Pages: 672 - 678
      Abstract: AbstractBackgrounddelirium is a common condition associated with hospital admission. Detection and diagnosis is important to identify the underlying precipitating cause and implement effective management and treatment. Quality improvement (QI) methodology has been applied in limited publications. There are even fewer publications of the role of development of the electronic health record (EHR) to enhance implementation.Methodswe used QI methodology to improve delirium detection in the emergency department (ED). Plan Do Study Act (PDSA) cycles could be broadly categorised into technology, training and education and leadership. As part of the technology PDSA an electronic delirium pathway was developed as part of an NHS England digital systems improvement initiative (NHS England Global Digital Exemplar). The electronic pathway incorporated the 4AT screening tool, the Confusion Assessment Method, the TIME delirium management bundle, investigation order sets and automated coding of delirium as a health issue.Resultsdevelopment of the EHR combined with education initiatives had benefit in terms of the number of people assessed for delirium on admission to the ED and the total number of people diagnosed with delirium across the organisation. The implementation of a delirium pathway as part of the EHR improved the use of 4AT in those 65 years and over from baseline of 3% completion in October 2017 to 43% in January 2018.Conclusionwe showed that enhancement of the digital record can improve delirium assessment and diagnosis. Furthermore, the implementation of a delirium pathway is enhanced by staff education.
      PubDate: Sat, 16 May 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa069
      Issue No: Vol. 49, No. 4 (2020)
       
  • Factors associated with non-prescription of oral anticoagulant treatment
           in non-valvular atrial fibrillation patients with dementia: a CPRD–HES
           study
    • Authors: Besford M; Graham S, Sammon C, et al.
      Pages: 679 - 682
      Abstract: AbstractDementia is a common comorbidity in patients with atrial fibrillation (AF) and treatment guidelines recommend oral anticoagulant (OAC) therapy for AF patients with dementia unless concordance cannot be ensured by the caregiver. Despite this, the literature reports a low prescribing of OAC treatment in these patients.This study investigated possible factors associated with non-prescribing of OAC treatment in dementia patients newly diagnosed with non-valvular atrial fibrillation (NVAF) at age ≥ 65 years between 2013 and 2017 using the Clinical Practice Research Datalink and Hospital Episodes Statistics databases.Of 1090 dementia patients newly diagnosed with NVAF, 693 (63.6%) patients did not have a prescription for an OAC in the year following their diagnosis. The likelihood of experiencing a thromboembolic event was high, with 97% of the population having a CHA2DS2-VASc score > 2; however, little difference in the presence of stroke risk factors was observed between the prescribed and non-prescribed groups. The presence of bleeding risk factors was high; only 28 (2.6%) of patients did not have a previous fall or a HAS-BLED bleeding risk factor. A history of falls [OR = 0.76, 95% confidence intervals (CIs) (0.58, 0.98)], previous major bleed [OR = 0.56, 95% CI (0.43, 0.73)] and care home residence [OR = 0.47, 95% CI (0.30, 0.74)] were associated with not having an OAC prescription.The results suggest that dementia patients with NVAF and certain risk bleeding risk factors are less likely to be prescribed an OAC. Further work is needed to establish possible relationships between bleeding risk factors and other potential drivers of OAC prescribing.
      PubDate: Thu, 02 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa045
      Issue No: Vol. 49, No. 4 (2020)
       
  • Gender-specific risk for late-life suicide in rural China: a case-control
           psychological autopsy study
    • Authors: Niu L; Ma Z, Jia C, et al.
      Pages: 683 - 687
      Abstract: AbstractBackgrounddespite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce. This study aims to clarify the gender-specific risk factors of late-life suicide in rural China.Methodsthe study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively.Resultsmen used alcohol before suicide more than women (12.6 versus 4.7%, P < 0.05). There was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness.Discussiondepression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community.
      PubDate: Sat, 18 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa036
      Issue No: Vol. 49, No. 4 (2020)
       
  • Older couples in acute geriatric care: boiling frogs
    • Authors: Hoeyweghen Raf V.
      Pages: 688 - 688
      Abstract: Sir,
      PubDate: Sat, 07 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ageing/afaa039
      Issue No: Vol. 49, No. 4 (2020)
       
 
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