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Age and Ageing
Journal Prestige (SJR): 1.989
Citation Impact (citeScore): 4
Number of Followers: 107  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
Published by Oxford University Press Homepage  [415 journals]
  • Editor’s view

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      Authors: Harwood R.
      Pages: 1431 - 1432
      PubDate: Sat, 11 Sep 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab171
      Issue No: Vol. 50, No. 5 (2021)
       
  • COVID-19 testing during care home outbreaks: the more the better'

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      Authors: Barker R; Astle A, Spilsbury K, et al.
      Pages: 1433 - 1435
      Abstract: care homeCOVID-19mass testinglong-term care facilityolder people
      PubDate: Wed, 12 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab100
      Issue No: Vol. 50, No. 5 (2021)
       
  • Delirium in COVID-19: common, distressing and linked with poor
           outcomes. . . can we do better'

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      Authors: Peterson A; Marengoni A, Shenkin S, et al.
      Pages: 1436 - 1438
      Abstract: deliriumcovid-19mortalityolder people
      PubDate: Fri, 25 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab153
      Issue No: Vol. 50, No. 5 (2021)
       
  • Low hospital mobility—resurgence of an old epidemic within a new
           pandemic and future solutions

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      Authors: Pereira D; Welch S, Montgomery C, et al.
      Pages: 1439 - 1441
      Abstract: Low mobility during hospitalisation poses risks of functional decline and other poor outcomes for older adults. Given the pervasiveness of this problem, low mobility during hospitalisation was first described as ‘dangerous’ in 1947 and later described as an epidemic. Hospitals have made considerable progress over the last half-century and the last two decades in particular, however, the COVID-19 pandemic presents serious new challenges that threaten to undermine recent efforts and progress towards a culture of mobility. In this special article, we address the question of how to confront an epidemic of immobility within a pandemic. We identify four specific problems for creating and advancing a culture of mobility posed by COVID-19: social distancing and policies restricting patient movement, personnel constraints, personal protective equipment shortages and increased patient hesitancy to ambulate. We also propose four specific solutions to address these problems. These approaches will help support a culture of healthy mobility during and after hospitalisation and help patients to keep moving during the pandemic and beyond.
      PubDate: Wed, 02 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab132
      Issue No: Vol. 50, No. 5 (2021)
       
  • COVID-19 point-of-care testing in care homes: what are the lessons for
           policy and practice'

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      Authors: Buckle P; Micocci M, Tulloch J, et al.
      Pages: 1442 - 1444
      Abstract: COVID-19 has devastated care homes. Point-of-care tests (POCTs), mainly using lateral flow devices (LFDs), have been deployed hurriedly without much consideration of their usability or impact on care workflow. Even after the pandemic, POCTs, particularly multiplex tests, may be an important control against spread of SARS-CoV-2 and other respiratory infections in care homes by enabling identification of cases. They should not, however, replace other infection control measures such as barrier methods and quarantine. Adherence to LFDs as implemented among care home staff is suboptimal. Other tests—such as point-of-care polymerase chain reaction and automated antigen tests—would also need to be accommodated into care home workflows to improve adherence. The up-front costs of POCTs are straightforward but additional costs, including staffing preparation and reporting processes and the impacts of false positive and negative tests on absence rates and infection days, are more complex and as yet unquantified. A detailed appraisal is needed as the future of testing in care homes is considered.
      PubDate: Wed, 12 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab101
      Issue No: Vol. 50, No. 5 (2021)
       
  • Prevalence, incidence and mortality of delirium in patients with COVID-19:
           a systematic review and meta-analysis

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      Authors: Shao S; Lai C, Chen Y, et al.
      Pages: 1445 - 1453
      Abstract: BackgroundAttention should be paid to delirium in coronavirus disease 2019 (COVID-19) patients, especially older people, since advanced age poses increased risk of both delirium and COVID-19-related death.ObjectiveThis study aims to summarise the evidence on prevalence, incidence and mortality of delirium in COVID-19 patients.MethodsWe conducted a comprehensive literature search on Pubmed and Embase from inception to 1 December 2020. Three independent reviewers evaluated study eligibility and data extraction, and assessed study quality. Outcomes were analysed as proportions with 95% confidence interval (CI). We also compared mortality differences in COVID-19 patients using odds ratio.ResultsIn total, we identified 48 studies with 11,553 COVID-19 patients from 13 countries. Pooled prevalence, incidence and mortality rates for delirium in COVID-19 patients were 24.3% (95% CI: 19.4–29.6%), 32.4% (95% CI: 20.8–45.2%) and 44.5% (95% CI: 36.1–53.0%), respectively. For patients aged over 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 28.2% (95% CI: 23.5–33.1%), 25.2% (95% CI: 16.0–35.6%) and 48.4% (95% CI: 40.6–56.1%), respectively. For patients under 65 years, prevalence, incidence and mortality rates for delirium in COVID-19 patients were 15.7% (95% CI: 9.2–23.6%), 71.4% (95% CI: 58.5–82.7%) and 21.2% (95% CI: 15.4–27.6%), respectively. Overall, COVID-19 patients with delirium suffered higher risk of mortality, compared with those without delirium (OR: 3.2, 95% CI: 2.1–4.8).ConclusionDelirium developed in almost 1 out of 3 COVID-19 patients, and was associated with 3-fold overall mortality. Our findings suggest that first-line healthcare providers should systematically assess delirium and monitor related symptoms among COVID-19 patients.
      PubDate: Wed, 12 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab103
      Issue No: Vol. 50, No. 5 (2021)
       
  • Are presymptomatic SARS-CoV-2 infections in nursing home residents
           unrecognised symptomatic infections' Sequence and metadata from weekly
           testing in an extensive nursing home outbreak

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      Authors: van den Besselaar J; Sikkema R, Koene F, et al.
      Pages: 1454 - 1463
      Abstract: BackgroundSars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus.AimsTo assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH.MethodsObservational study in a 185-bed NH with two consecutive testing strategies: testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment.Results185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624).ConclusionsSymptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.
      PubDate: Fri, 07 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab081
      Issue No: Vol. 50, No. 5 (2021)
       
  • Is point-of-care testing feasible and safe in care homes in England'
           An exploratory usability and accuracy evaluation of a point-of-care
           polymerase chain reaction test for SARS-CoV-2

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      Authors: Micocci M; , Gordon A, et al.
      Pages: 1464 - 1472
      Abstract: IntroductionReliable rapid testing for COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. This study aimed to examine the usability and test performance of a point of care polymerase chain reaction (PCR) test for detection of SARS-CoV-2 (POCKITTM Central) in care homes.MethodsPOCKITTM Central was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and used errors were assessed.ResultsNo significant usability-related hazards emerged, and the sources of error identified were found to be amendable with minor changes in training or test workflow. POCKITTM Central has acceptable sensitivity and specificity based on RT-PCR as the reference standard, especially for symptomatic cases.Asymptomatic specimens showed 83.3% (95% confidence interval (CI): 35.9–99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2–99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932– 0.999). Symptomatic specimens showed 100% (95% CI: 2.5–100%) positive agreement and 100% negative agreement (95% CI: 85.8–100%), with overall PABAK of 1.Recommendations are provided to mitigate the frequency of occurrence of the residual use errors observed. Integration pathways were discussed to identify opportunities and limitations of adopting POCKIT™ Central for screening and diagnostic testing purposes.ConclusionsPoint-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.
      PubDate: Wed, 21 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab072
      Issue No: Vol. 50, No. 5 (2021)
       
  • Magnitude, change over time, demographic characteristics and geographic
           distribution of excess deaths among nursing home residents during the
           first wave of COVID-19 in France: a nationwide cohort study

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      Authors: Canouï-Poitrine F; , Rachas A, et al.
      Pages: 1473 - 1481
      Abstract: BackgroundThe objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement.MethodsWe studied a cohort of 494,753 adults in 6,515 NHs in France exposed to COVID-19 pandemic (from 1 March to 31 May 2020) and compared with the 2014–2019 cohorts using data from the French National Health Data System. The main outcome was death. Excess deaths and standardized mortality ratios (SMRs) were estimated.ResultThere were 13,505 excess deaths. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than females (SMR: 1.51 and 1.38) and decreased with increasing age (SMRs in females: 1.61 in the 60–74 age group, 1.58 for 75–84, 1.41 for 85–94 and 1.31 for 95 or over; males: SMRs: 1.59 for 60–74, 1.69 for 75–84, 1.47 for 85–94 and 1.41 for 95 or over). No mortality displacement effect was observed up until 30 August 2020. By extrapolating to all NH residents nationally (N = 570,003), we estimated that they accounted for 51% of the general population excess deaths (N = 15,114 out of 29,563).ConclusionNH residents accounted for half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger than older residents.
      PubDate: Wed, 12 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab098
      Issue No: Vol. 50, No. 5 (2021)
       
  • Care-home outbreaks of COVID-19 in Scotland March to May 2020: National
           linked data cohort analysis

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      Authors: Burton J; McMinn M, Vaughan J, et al.
      Pages: 1482 - 1492
      Abstract: Backgroundunderstanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents.Objectiveto describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 and 31/03/2020, with follow-up to 30/06/2020.Design and settingNational linked data cohort analysis of Scottish care-homes for older people.Methodsdata linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression.Results334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1–63 cases; median = 6) and duration (1–94 days, median = 31.5 days). Four distinct patterns of outbreak were identified: ‘typical’ (38% of outbreaks, mean 11.2 cases and 48 days duration), severe (11%, mean 29.7 cases and 60 days), contained (37%, mean 3.5 cases and 13 days) and late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs <20, adjusted OR = 55.4, 95% CI 15.0–251.7) and rising community prevalence (OR = 1.2 [1.0–1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size.Conclusionsreducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future.
      PubDate: Sat, 08 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab099
      Issue No: Vol. 50, No. 5 (2021)
       
  • New horizons in understanding the experience of Chinese people living with
           dementia: a positive psychology approach

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      Authors: Lau W; Stoner C, Wong G, et al.
      Pages: 1493 - 1498
      Abstract: As the global average age increases, the incidence of dementia is also rising. Given improvements in diagnosis and life expectancies, people now live longer with dementia. Thus, the wellbeing and quality of life among people living with dementia are increasingly important areas for research.Research with Western populations has recently begun to apply positive psychology concepts to understand wellbeing in people with dementia. Positive psychology focuses on positive emotions and traits that allow individuals to flourish and thrive—it highlights the possibility of positive subjective experiences in the face of loss and functional decline, and contrasts the traditional deficit-focused perception of dementia.Despite being a major driver in the global growth of dementia prevalence, there is a dearth of research using such positive concepts to understand people with dementia in non-Western communities. This review contains discussion of research on positive constructs in Chinese older adults, and parallels between traditional Chinese cultural values and positive psychology. On this basis, we propose the applicability of a positive psychology framework to Chinese people with dementia, and that ‘harmony’ is an important culturally specific concept to consider in this area of research.A positive psychology approach acknowledges that strengths and positive experiences can endure after dementia diagnosis. This not only adds to the under-researched area of lived experience of dementia in Chinese people, but highlights areas that could be the focus of interventions or measured as outcomes. By improving understanding, this approach also has potential to reduce carer burden and stigma around dementia.
      PubDate: Wed, 09 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab097
      Issue No: Vol. 50, No. 5 (2021)
       
  • New horizons in falls prevention and management for older adults: a global
           initiative

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      Authors: Montero-Odasso M; van der Velde N, Alexander N, et al.
      Pages: 1499 - 1507
      Abstract: Backgroundfalls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries.Methodsa steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together.Conclusionin this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented.
      PubDate: Wed, 26 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab076
      Issue No: Vol. 50, No. 5 (2021)
       
  • HEARTS, minds and souls—it is time for geriatricians to bring more
           to continence management

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      Authors: Schlögl M; Gordon A.
      Pages: 1508 - 1511
      Abstract: Urinary incontinence (UI), the involuntary loss of urine, is a common health condition that may decrease the quality of life and which increases in incidence and prevalence with age. Recent epidemiologic data suggest an overall prevalence of 38% in women older than 60 years, increasing to 77% in older women living in nursing homes. Despite this high prevalence, incontinence remains underdiagnosed and undertreated in this age group. In a representative population of 7,000 participants drawn from the Irish Longitudinal Study of Ageing, 750 had UI of whom 285 (38%) had not sought the help of a health care professional. The reasons that older people do not seek help for incontinence are complex and multiplex. Stigma surrounding diagnosis, a sense of futility coupled to a notion that incontinence is a part of normal ageing and the fact that incontinence simply gets ‘lost’ in the midst of multimorbidity and frailty have all been shown to play a role. Active case finding has therefore been highlighted as a cornerstone of effective care in serial international guidelines.
      PubDate: Wed, 09 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab088
      Issue No: Vol. 50, No. 5 (2021)
       
  • Talking to multi-morbid patients about critical illness: an evolving
           conversation

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      Authors: Puthucheary Z; Osman M, Harvey D, et al.
      Pages: 1512 - 1515
      Abstract: Conversations around critical illness outcomes and benefits from intensive care unit (ICU) treatment have begun to shift away from binary discussions on living versus dying. Increasingly, the reality of survival with functional impairment versus survival with a late death is being recognised as relevant to patients.Most ICU admissions are associated with new functional and cognitive disabilities that are significant and long lasting. When discussing outcomes, clinicians rightly focus on patients’ wishes and the quality of life (QoL) that they would find acceptable. However, patients’ views may encompass differing views on acceptable QoL post-critical illness, not necessarily reflected in standard conversations.Maintaining independence is a greater priority to patients than simple survival. QoL post-critical illness determines judgments on the benefits of ICU support but translating this into clinical practice risks potential conflation of health outcomes and QoL.This article discusses the concept of response shift and the implication for trade-offs between number/length of invasive treatments and change in physical function or death. Conversations need to delineate how health outcomes (e.g. tracheostomy, muscle wasting, etc.) may affect individual outcomes most relevant to the patient and hence impact overall QoL.The research strategy taken to explore decision-making for critically ill patients might benefit from gathering qualitative data, as a complement to quantitative data. Patients, families and doctors are motivated by far wider considerations, and a consultation process should relate to more than the simple likelihood of mortality in a shared decision-making context.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab107
      Issue No: Vol. 50, No. 5 (2021)
       
  • Appropriate deprescribing in older people: a challenging
           necessityCommentary to accompany themed collection on deprescribing

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      Authors: van der Velde N; Minhas J.
      Pages: 1516 - 1519
      Abstract: Older people are often taking several medications for a number of different medical conditions. Although physicians prescribe medications to treat diseases and symptoms, there may be also harmful side effects, especially so in older people taking several medications. Unfortunately, regular review of the benefits or risks of prescribed medications is as of yet not part of standard care. Also, data on how and in whom to stop medications in older people are scarce. The reason this is an important area of work is that medication related issues in older people are a common cause of harm, including both expected and unexpected effects of medications. Research to date tells us that to ensure successful implementation of structured and appropriate deprescribing, careful planning within hospital systems is needed. This includes involving different members of the team to ensure the patients truly benefit. The themed collection published on the Age and Ageing journal website offers key articles providing tools to assist decision-making, implementation strategies and multidisciplinary interventions—all with the aim of improving patient outcome and sustainability of deprescribing approaches.
      PubDate: Wed, 14 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab142
      Issue No: Vol. 50, No. 5 (2021)
       
  • Prevalence of initial orthostatic hypotension in older adults: a
           systematic review and meta-analysis

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      Authors: Tran J; Hillebrand S, Meskers C, et al.
      Pages: 1520 - 1528
      Abstract: BackgroundInitial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults.ObjectiveTo provide a prevalence estimate of initial OH in adults aged 65 years or older.MethodsLiterature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms ‘initial orthostatic hypotension’, ‘postural hypotension’ and ‘older adults’. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis.ResultsOf 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n = 4,157), geriatric outpatient (n = 1,136), institutionalised (n = 55) and mixed (n = 117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1–36.9%, I2 = 94.6%); 27.8% in the general population (95% CI: 17.9–40.5%, I2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2–48.1%, I2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4–33.1%, I2 = 0%) and 21.4% in the mixed population (95% CI: 7.0–49.6, I2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5–18.9%, I2 = 81.1%); 1.0% in the general population (95% CI: 0.0–23.9%, I2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8–27.0%, I2 = 86.7%).ConclusionThe prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.
      PubDate: Wed, 14 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab090
      Issue No: Vol. 50, No. 5 (2021)
       
  • Pre-operative prognostic factors for walking capacity after surgery for
           lumbar spinal stenosis: a systematic review

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      Authors: McIlroy S; Walsh E, Sothinathan C, et al.
      Pages: 1529 - 1545
      Abstract: BackgroundLumbar spinal stenosis (LSS) reduces walking and quality of life. It is the main indication for spinal surgery in older people yet 40% report walking disability post-operatively. Identifying the prognostic factors of post-operative walking capacity could aid clinical decision-making, guide rehabilitation and optimise health outcomes.ObjectiveTo synthesise the evidence for pre-operative mutable and immutable prognostic factors for post-operative walking in adults with LSS.DesignSystematic review with narrative synthesis.MethodsElectronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, OpenGrey) were searched for observational studies, evaluating factors associated with walking after surgery in adults receiving surgery for LSS from database inception to January 2020. Two reviewers independently evaluated studies for eligibility, extracted data and assessed risk of bias (Quality in Prognosis Studies). The Grading of Recommendations Assessment, Development and Evaluation method was used to determine level of evidence for each factor.Results5526 studies were screened for eligibility. Thirty-four studies (20 cohorts, 9,973 participants, 26 high, 2 moderate, 6 low risk of bias) were included. Forty variables (12 mutable) were identified. There was moderate quality of evidence that pre-operative walking capacity was positively associated with post-operative walking capacity. The presence of spondylolisthesis and the severity of stenosis were not associated with post-operative walking capacity. All other factors investigated had low/very low level of evidence.ConclusionGreater pre-operative walking is associated with greater post-operative walking capacity but not spondylolisthesis or severity of stenosis. Few studies have investigated mutable prognostic factors that could be potentially targeted to optimise surgical outcomes.
      PubDate: Sat, 24 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab150
      Issue No: Vol. 50, No. 5 (2021)
       
  • Duration of antibiotic treatment using procalcitonin-guided treatment
           algorithms in older patients: a patient-level meta-analysis from
           randomized controlled trials

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      Authors: Heilmann E; Gregoriano C, Annane D, et al.
      Pages: 1546 - 1556
      Abstract: BackgroundOlder patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients.Objective and designWe performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome.Subjects and methodsWe had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay.ResultsCompared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05).ConclusionsThis large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.
      PubDate: Mon, 17 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab078
      Issue No: Vol. 50, No. 5 (2021)
       
  • Efficacy of exercise-based interventions in preventing falls among
           community-dwelling older persons with cognitive impairment: is there
           enough evidence' An updated systematic review and meta-analysis

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      Authors: Li F; Harmer P, Eckstrom E, et al.
      Pages: 1557 - 1568
      Abstract: ObjectiveExercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment.MethodsPubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment).ResultsWe identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low.ConclusionsThe positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice.PROSPERO Registration number: CRD42020202094.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab110
      Issue No: Vol. 50, No. 5 (2021)
       
  • Frailty—a risk factor of global and domain-specific cognitive decline
           among a nationally representative sample of community-dwelling older adult
           U.S. Medicare beneficiaries

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      Authors: Chu N; Xue Q, McAdams-DeMarco M, et al.
      Pages: 1569 - 1577
      Abstract: Objectivesfrail older adults may be more vulnerable to stressors, resulting in steeper declines in cognitive function. Whether the frailty–cognition link differs by cognitive domain remains unclear; however, it could lend insight into underlying mechanisms.Methodswe tested whether domain-specific cognitive trajectories (clock-drawing test, (CDT), immediate and delayed recall, orientation to date, time, president and vice-president naming) measured annually (2011–2016) differ by baseline frailty (physical frailty phenotype) in the National Health and Aging Trends Study (n = 7,439), a nationally representative sample of older adult U.S. Medicare beneficiaries, using mixed effects models to describe repeated measures of each cognitive outcome. To determine if the association between frailty and subsequent cognitive change differed by education, we tested for interaction using the Wald test.Resultswe observed steeper declines for frail compared to non-frail participants in each domain-specific outcome, except for immediate recall. Largest differences in slope were observed for CDT (difference = −0.12 (standard deviations) SD/year, 95%CI: −0.15, −0.08). By 2016, mean CDT scores for frail participants were 1.8 SD below the mean (95%CI: −1.99, −1.67); for non-frail participants, scores were 0.8 SD below the mean (95%CI: −0.89, −0.69). Associations differed by education for global cognitive function (Pinteraction < 0.001) and for each domain-specific outcome: CDT (Pinteraction < 0.001), orientation (Pinteraction < 0.001), immediate (Pinteraction < 0.001) and delayed (Pinteraction < 0.001) word recalls.Conclusionfrailty is associated with lower levels and steeper declines in cognitive function, with strongest associations for executive function. These findings suggest that aetiologies are multifactorial, though primarily vascular related; further research into its association with dementia sub-types and related pathologies is critical.
      PubDate: Mon, 07 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab102
      Issue No: Vol. 50, No. 5 (2021)
       
  • Differential risk of falls associated with pain medication among
           community-dwelling older adults by cognitive status

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      Authors: Yoshikawa A; Smith M, Ory M.
      Pages: 1578 - 1585
      Abstract: BackgroundPersons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status.MethodsWe analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics.ResultsAbout 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively.ConclusionDifferential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.
      PubDate: Fri, 26 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab051
      Issue No: Vol. 50, No. 5 (2021)
       
  • Association between everyday walking activity, objective and perceived
           risk of falling in older adults

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      Authors: Jansen C; Klenk J, Nerz C, et al.
      Pages: 1586 - 1592
      Abstract: Backgroundolder persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into ‘vigorous’ (low ORF/PRF), ‘anxious’ (low ORF/high PRF), ‘stoic’ (high ORF/low PRF) and ‘aware’ (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet.Objectivewe examined everyday walking activity in those four groups and its association with ORF and PRF.Designcross-sectional.Settingcommunity.SubjectsN = 294 participants aged 70 years and older.MethodsORF was determined based on multiple independent risk factors; PRF was determined based on the Short Falls Efficacy Scale-International. Subjects were allocated to the four groups accordingly. Linear regression was used to quantify the associations of these groups with the mean number of accelerometer-assessed steps per day over 1 week as the dependent variable. ‘Vigorous’ was used as the reference group.Resultsaverage number of steps per day in the four groups were 6,339 (‘vigorous’), 5,781 (‘anxious’), 4,555 (‘stoic’) and 4,528 (‘aware’). Compared with the ‘vigorous’, ‘stoic’ (−1,482; confidence interval (CI): −2,473; −491) and ‘aware’ (−1,481; CI: −2,504; −458) participants took significantly less steps, but not the ‘anxious’ (−580 steps; CI: −1,440; 280).Conclusionwe have integrated a digital mobility outcome into a fall risk categorisation based on ORF and PRF. Steps per day in this sample of community-dwelling older persons were in accordance with their ORF rather than their PRF. Whether this grouping approach can be used for the specification of participants’ needs when taking part in programmes to prevent falls and simultaneously promote physical activity remains to be answered in intervention studies.
      PubDate: Fri, 12 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab037
      Issue No: Vol. 50, No. 5 (2021)
       
  • The relationship between frailty and delirium: insights from the 2017
           Delirium Day study

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      Authors: Mazzola P; , Tassistro E, et al.
      Pages: 1593 - 1599
      Abstract: Backgroundalthough frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality.Objectiveto examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients’ 30-day survival.Designobservational study nested in the Delirium Day project, with 30-day follow-up.Settingacute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy.Subjectsa total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards.Methodsa 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days.Resultsoverall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting.Conclusionsin hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality.
      PubDate: Wed, 31 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab042
      Issue No: Vol. 50, No. 5 (2021)
       
  • Hospital admission as a deprescribing triage point for patients discharged
           to Residential Aged Care Facilities

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      Authors: Roberts G; Pegoli M, Grzeskowiak L, et al.
      Pages: 1600 - 1606
      Abstract: BackgroundDeprescribing may benefit older frail patients experiencing polypharmacy. We investigated the scope for deprescribing in acutely hospitalised patients and the long-term implications of continuation of medications that could potentially be deprescribed.MethodsAcutely hospitalised patients (n = 170) discharged to Residential Aged Care Facilities, ≥75 years and receiving ≥5 regular medications were assessed during admission to determine eligibility for deprescribing of key drug classes, along with the actual incidence of deprescribing. The impact of continuation of nominated drug classes (anticoagulants, antidiabetics, antiplatelets, antipsychotics, benzodiazepines, proton pump inhibitors (PPIs), statins) on a combined endpoint (death/readmission) was determined.ResultsHyperpolypharmacy (>10 regular medications) was common (49.4%) at admission. Varying rates of deprescribing occurred during hospitalisation for the nominated drug classes (8–53%), with considerable potential for further deprescribing (34–90%). PPI use was prevalent (56%) and 89.5% of these had no clear indication. Of the drug classes studied, only continued PPI use at discharge was associated with increased mortality/readmission at 1 year (hazard ratio 1.54, 95% confidence interval (1.06–2.26), P = 0.025), driven largely by readmission.ConclusionThere is considerable scope for acute hospitalisation to act as a triage point for deprescribing in older patients. PPIs in particular appeared overprescribed in this susceptible patient group, and this was associated with earlier readmission. Polypharmacy in older hospitalised patients should be targeted for possible deprescribing during hospitalisation, especially PPIs.
      PubDate: Tue, 25 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab082
      Issue No: Vol. 50, No. 5 (2021)
       
  • Recent trends of invasive mechanical ventilation in older adults: a
           nationwide population-based study

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      Authors: Bouza C; Martínez-Alés G, López-Cuadrado T.
      Pages: 1607 - 1615
      Abstract: BackgroundCritical care demand for older people is increasing. However, there is scarce population-based information about the use of life-support measures such as invasive mechanical ventilation (IMV) in this population segment.ObjectiveTo examine the characteristics and recent trends of IMV for older adults.MethodsRetrospective cohort study on IMV in adults ≥65 years using the 2004–15 Spanish national hospital discharge database. Primary outcomes were incidence, inhospital mortality and resource utilization. Trends were assessed for average annual percentage change in rates using joinpoint regression models.Results233,038 cases were identified representing 1.27% of all-cause hospitalizations and a crude incidence of 248 cases/100,000 older adult population. Mean age was 75 years, 62% were men and 70% had comorbidities. Inhospital mortality was 48%. Across all ages, about 80% of survivors were discharged home. Incidence rates of IMV remained roughly unchanged over time with an average annual change of −0.2% (95% confidence interval (CI): −0.9, 0.6). Inhospital mortality decreased an annual average of −0.7% (95% CI: −0.5, −1.0), a trend detected across age groups and most clinical strata. Further, there was a 3.4% (95% CI: 3.0, 3.8) annual increase in the proportion of adults aged ≥80 years, an age group that showed higher mortality risk, lower frequency of prolonged IMV, shorter hospital stays and lower costs.ConclusionsOverall rates of IMV remained roughly stable among older adults, while inhospital mortality showed a decreasing trend. There was a notable increase in adults aged ≥80 years, a group with high mortality and lower associated hospital resource use.
      PubDate: Fri, 12 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab023
      Issue No: Vol. 50, No. 5 (2021)
       
  • Dynapenia, abdominal obesity or both: which accelerates the gait speed
           decline most'

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      Authors: de Oliveira Máximo R; de Oliveira D, Ramírez P, et al.
      Pages: 1616 - 1625
      Abstract: Objectiveto investigate whether the combination of dynapenia and abdominal obesity is worse than these two conditions separately regarding gait speed decline over time.Methodsa longitudinal study was conducted involving 2,294 individuals aged 60 years or older free of mobility limitation at baseline (gait speed >0.8 m/s) who participated in the English Longitudinal Study of Ageing. Dynapenia was determined as a grip strength <26 kg for men and <16 kg for women. Abdominal obesity was determined as a waist circumference >102 cm for men and >88 cm for women. The participants were divided into four groups: non-dynapenic/non-abdominal obese (ND/NAO); only abdominal obese (AO); only dynapenic (D) and dynapenic/abdominal obese (D/AO). Generalised linear mixed models were used to analyse gait speed decline (m/s) as a function of dynapenia and abdominal obesity status over an 8-year follow-up period.Resultsover time, only the D/AO individuals had a greater gait speed decline (−0.013 m/s per year, 95% CI: −0.024 to −0.002; P < 0.05) compared to ND/NAO individuals. Neither dynapenia nor abdominal obesity only was associated with gait speed decline.Conclusiondynapenic abdominal obesity is associated with accelerated gait speed decline and is, therefore, an important modifiable condition that should be addressed in clinical practice through aerobic and strength training for the prevention of physical disability in older adults.
      PubDate: Thu, 03 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab093
      Issue No: Vol. 50, No. 5 (2021)
       
  • Neutrophil-to-lymphocyte ratio predicts delirium after stroke

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      Authors: Guldolf K; Vandervorst F, Gens R, et al.
      Pages: 1626 - 1632
      Abstract: BackgroundDelirium is an underdiagnosed and possibly preventable complication in acute stroke and is linked to poor outcome. Neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, is also associated with poor outcome after acute ischemic stroke.AimTo determine whether NLR is a predictor of post-stroke delirium (PSD).MethodsWe reviewed the UZ Brussel stroke database and included 514 patients with acute ischemic stroke within 24 hours from stroke onset between February 2009 and December 2014. The presence of delirium was evaluated by two raters based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, using a retrospective chart review method. When no consensus was reached, a third evaluator was consulted. Patients were divided into two groups: those who developed delirium within the first week after stroke onset (n = 201; 39%) and those who did not (n = 313; 61%). Receiver operating characteristics (ROC) and multiple logistic regression analysis (MLRA) were used to identify predictors of PSD.ResultsMLRA showed that NLR (odds ratio (OR) 1.14; 95% confidence interval (CI) 1.04–1.26), age (OR 1.05; 95% CI 1.03–1.07), National Institutes of Health Stroke Scale (NIHSS; OR 1.14; 95% CI 1.10–1.18), premorbid modified Rankin Scale (mRS) (OR 1.35; 95% CI 1.05–1.74) and premorbid cognitive dysfunction (OR 3.16; 95% CI 1.26–7.92) predicted PSD. ROC curve of a prediction model including NLR, age, NIHSS and premorbid cognitive dysfunction showed an area under the curve of 0.84 (95% CI = 0.81–0.88).ConclusionsBesides age, stroke severity, premorbid mRS and cognitive impairment, NLR is a predictor of PSD, even independent of the development of pneumonia or urinary tract infection.
      PubDate: Mon, 05 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab133
      Issue No: Vol. 50, No. 5 (2021)
       
  • The rate by which mortality increase with age is the same for those who
           experienced chronic disease as for the general population

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      Authors: Ebeling M; Rau R, Malmström H, et al.
      Pages: 1633 - 1640
      Abstract: BackgroundMortality doubles approximately every 6–7 years during adulthood. This exponential increase in death risk with chronological age is the population-level manifestation of ageing, and often referred to as the rate-of-ageing.ObjectiveWe explore whether the onset of severe chronic disease alters the rate-of-ageing.MethodsUsing Swedish register data covering the entire population of the birth cohorts 1927–30, we analyse whether being diagnosed with myocardial infarction, diabetes or cancer results in a deviation of the rate-of-ageing from those of the total population. We also quantify the long-term mortality effects of these diseases, using ages with equivalent mortality levels for those with disease and the total population.ResultsNone of the diseases revealed a sustained effect on the rate-of-ageing. After an initial switch upwards in the level of mortality, the rate-of-ageing returned to the same pace as for the total population. The time it takes for the rate to return depends on the disease. The long-term effects of diabetes and myocardial infarction amount to mortality levels that are equivalent to those aged 5–7 years older in the total population. For cancer, the level of mortality returns to that of the total population.ConclusionOur results suggest an underlying process of ageing that causes mortality to increase at a set pace, with every year older we become. This process is not affected by disease history. The persistence of the rate-of-ageing motivates a critical discussion of what role disease prevention can play in altering the progression of ageing.
      PubDate: Wed, 26 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab085
      Issue No: Vol. 50, No. 5 (2021)
       
  • Predicting readmission and death after hospital discharge: a comparison of
           conventional frailty measurement with an electronic health record-based
           score

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      Authors: Tew Y; Chan J, Keeling P, et al.
      Pages: 1641 - 1648
      Abstract: Backgroundfrailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.Objectiveto compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death.Designobservational cohort study.Settinghospital ward.Subjectsconsented cardiology inpatients ≥70 years old within 24 hours of discharge.Methodspatients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home (‘home time’) at 12 months.Resultsin total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18–1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01–1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02–1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months.Conclusionsfrailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.
      PubDate: Thu, 25 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab043
      Issue No: Vol. 50, No. 5 (2021)
       
  • Factors associated with initiation of bone-health medication among older
           adults in primary care in Ireland

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      Authors: Walsh M; Nerdrum M, Fahey T, et al.
      Pages: 1649 - 1656
      Abstract: BackgroundAdults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common.ObjectiveThis study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care.DesignThis was a retrospective cohort study.SettingThe study used data from forty-four general practices in Ireland from 2011–2017.SubjectsThe study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months.MethodsOverall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution.ResultsOf 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association.ConclusionsBone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.
      PubDate: Mon, 08 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab033
      Issue No: Vol. 50, No. 5 (2021)
       
  • Association of life satisfaction with disability-free survival: role of
           chronic diseases and healthy lifestyle

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      Authors: Wu W; Shang Y, Calderón-Larrañaga A, et al.
      Pages: 1657 - 1665
      Abstract: Backgroundthis article investigates the association between life satisfaction and disability-free survival, and explores the roles of chronic diseases and healthy lifestyle in this association.Methoda cohort of 2,116 functionally independent adults aged ≥60 was followed up to 12 years. At baseline, life satisfaction was assessed with the Life Satisfaction Index A (LSI-A). Disability-free survival was defined as the survival till the first occurrence of either death, dementia or physical disability. Information on lifestyle factors was collected via questionnaire. Chronic diseases were ascertained through clinical examinations at baseline and each follow-up. Data were analysed using Cox proportional hazard regression models and Laplace regression.Resultsover follow-up, 1,121 participants died, developed dementia, or became disabled. High LSI-A versus Low LSI-A had a lower risk of death, dementia and physical disability (hazard ratio [HR] 0.79, 95% confidence intervals [CI] 0.67–0.94), and had a longer disability-free period by 1.73 (95% CI 0.18–3.32) years. In mediation analysis, accumulation of chronic diseases mediated 17.8% of the association between LSI-A and disability-free survival. In joint effect analysis, participants with high LSI-A and a favourable lifestyle profile had a HR of 0.53 (95% CI 0.41–0.69) for the composite endpoint, and lived 3.2 (95% CI 1.35–5.11) disability-free years longer than those with low life satisfaction and an unfavourable lifestyle profile.Discussionhigh life satisfaction is independently associated with longer disability-free survival. This association is partially mediated by a lower burden of chronic diseases and is reinforced by healthy lifestyle.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab086
      Issue No: Vol. 50, No. 5 (2021)
       
  • Individual changes in anthropometric measures after age 60 years: a
           15-year longitudinal population-based study

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      Authors: Guo J; Shang Y, Fratiglioni L, et al.
      Pages: 1666 - 1674
      Abstract: Backgroundweight loss is commonly observed with ageing. We explored the trajectory of body mass index (BMI) and two proxies of muscle mass—calf circumference (CC) and mid-arm circumference (MAC)—and identified their determinants.Methodswithin the SNAC-K cohort, 2,155 dementia-free participants aged ≥60 years were followed over 15 years. BMI, CC and MAC were measured at baseline and follow-ups. Baseline sociodemographic and lifestyle factors were collected through interviews. Diabetes and vascular disorders were diagnosed by physicians through clinical examination and medical records. Data were analysed using linear mixed-effect models stratified by age (younger-old [<78 years] vs. older-old [≥78 years]).Resultsover the 15-year follow-up, BMI remained stable among participants aged 60 years at baseline (βslope = 0.009 [95% confidence interval −0.006 to 0.024], P = 0.234) and declined significantly among those aged ≥66 years, while CC and MAC declined significantly across all age groups. The decline over 15 years in BMI, CC and MAC separately was 0.435 kg/m2, 1.110 cm and 1.455 cm in the younger-old and was 3.480 kg/m2, 3.405 cm and 3.390 cm in the older-old. In younger-old adults, higher education was associated with slower declines in all three measures, while vascular disorders and diabetes were associated with faster declines. In older-old adults, vigorous physical activity slowed declines in BMI and CC, while vascular disorders accelerated declines in BMI and MAC.ConclusionsCC and MAC declined earlier and more steeply than BMI. Cardiometabolic disorders accelerated such declines, while higher education and physical activity could counteract those declines.
      PubDate: Fri, 26 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab045
      Issue No: Vol. 50, No. 5 (2021)
       
  • Hospitalisation without delirium is not associated with cognitive decline
           in a population-based sample of older people—results from a nested,
           longitudinal cohort study

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      Authors: Richardson S; Lawson R, Davis D, et al.
      Pages: 1675 - 1681
      Abstract: BackgroundAcute hospitalisation and delirium have individually been shown to adversely affect trajectories of cognitive decline but have not previously been considered together. This work aimed to explore the impact on cognition of hospital admission with and without delirium, compared to a control group with no hospital admissions.MethodsThe Delirium and Cognitive Impact in Dementia (DECIDE) study was nested within the Cognitive Function and Ageing Study II (CFAS II)–Newcastle cohort. CFAS II participants completed two baseline interviews, including the Mini-Mental State Examination (MMSE). During 2016, surviving participants from CFAS II–Newcastle were recruited to DECIDE on admission to hospital. Participants were reviewed daily to determine delirium status.During 2017, all DECIDE participants and age, sex and years of education matched controls without hospital admissions during 2016 were invited to repeat the CFAS II interview. Delirium was excluded in the control group using the Informant Assessment of Geriatric Delirium Scale (i-AGeD). Linear mixed effects modelling determined predictors of cognitive decline.ResultsDuring 2016, 82 of 205 (40%) DECIDE participants had at least one episode of delirium. At 1 year, 135 of 205 hospitalised participants completed an interview along with 100 controls. No controls experienced delirium (i-AGeD>4). Delirium was associated with a faster rate of cognitive decline compared to those without delirium (β = −2.2, P < 0.001), but number of hospital admissions was not (P = 0.447).ConclusionsThese results suggest that delirium during hospitalisation rather than hospitalisation per se is a risk factor for future cognitive decline, emphasising the need for dementia prevention studies that focus on delirium intervention.
      PubDate: Mon, 03 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab068
      Issue No: Vol. 50, No. 5 (2021)
       
  • Longitudinal trajectories of physical functioning among Chinese older
           adults: the role of depressive symptoms, cognitive functioning and
           subjective memory

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      Authors: Yang R; Xu D, Wang H, et al.
      Pages: 1682 - 1691
      Abstract: Background and ObjectiveMaintaining physical functioning (i.e. mobility, activities of daily living [ADLs], instrumental activities of daily living [IADLs]) in older adults is essential for independent living. However, little is known about how longitudinal trajectories of physical functioning differ by varying levels of depressive symptoms, subjective memory impairment and cognitive functioning. We aimed to examine whether, and to what degree, the rate of change in physical functioning over time was associated with depressive symptoms, subjective memory and cognitive functioning.DesignA correlational longitudinal design.MethodsThe sample included 5,519 older adults (mean age = 68.13 years) from the China Health and Retirement Longitudinal Study (three waves: 2011–15) who self-reported their depressive symptoms, subjective memory impairment and physical functioning. Cognitive functioning was assessed through interview-based tests.ResultsThere were significant increases in mobility impairment (β = 0.27, P < 0.001), ADLs impairment (β = 0.05, P < 0.001) and IADLs impairment (β = 0.03, P = 0.006) over time. Compared with the mean score at baseline in 2011, the mobility, ADLs and IADLs impairment increased by 13.32, 10.57 and 4.34% for every 2 years, respectively. Those with high depressive symptoms had accelerated rates of mobility (β = 0.212, P < 0.001), ADLs (β = 0.104, P < 0.001) and IADLs impairment (β = 0.076, P = 0.002). Those with poorer cognitive functioning had more rapid rates of mobility impairment. In contrast, those with differing levels of subjective memory impairment did not experience different physical functioning trajectories.ConclusionsHigh depressive symptoms and poor cognitive functioning may be precursors to rapid declines in physical functioning. Proactive screening for these precursors may attenuate physical decline among Chinese older adults.
      PubDate: Sat, 03 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab135
      Issue No: Vol. 50, No. 5 (2021)
       
  • Cause-specific mortality prediction in older residents of São Paulo,
           Brazil: a machine learning approach

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      Authors: do Nascimento C; dos Santos H, de Moraes Batista A, et al.
      Pages: 1692 - 1698
      Abstract: BackgroundPopulational ageing has been increasing in a remarkable rate in developing countries. In this scenario, preventive strategies could help to decrease the burden of higher demands for healthcare services. Machine learning algorithms have been increasingly applied for identifying priority candidates for preventive actions, presenting a better predictive performance than traditional parsimonious models.MethodsData were collected from the Health, Well Being and Aging (SABE) Study, a representative sample of older residents of São Paulo, Brazil. Machine learning algorithms were applied to predict death by diseases of respiratory system (DRS), diseases of circulatory system (DCS), neoplasms and other specific causes within 5 years, using socioeconomic, demographic and health features. The algorithms were trained in a random sample of 70% of subjects, and then tested in the other 30% unseen data.ResultsThe outcome with highest predictive performance was death by DRS (AUC−ROC = 0.89), followed by the other specific causes (AUC−ROC = 0.87), DCS (AUC−ROC = 0.67) and neoplasms (AUC−ROC = 0.52). Among only the 25% of individuals with the highest predicted risk of mortality from DRS were included 100% of the actual cases. The machine learning algorithms with the highest predictive performance were light gradient boosted machine and extreme gradient boosting.ConclusionThe algorithms had a high predictive performance for DRS, but lower for DCS and neoplasms. Mortality prediction with machine learning can improve clinical decisions especially regarding targeted preventive measures for older individuals.
      PubDate: Mon, 03 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab067
      Issue No: Vol. 50, No. 5 (2021)
       
  • The effect of opioids on the cognitive function of older adults: results
           from the Personality and Total Health through life study

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      Authors: Neelamegam M; Zgibor J, Chen H, et al.
      Pages: 1699 - 1708
      Abstract: Backgroundchronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population.Objectivewe examined the association between opioid use, and changes in cognitive function of older adults.Designprospective study.Settingcommunity dwelling older adults.Subjectsstudy population consisted of 2,222 individuals aged 65–69 years at baseline from the Personality and Total Health Through Life Study in Australia.Methodsmedication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models.Resultscumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = −0.34, Model 2: β = −0.35 and Model 3: β = −0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use.Conclusionprolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
      PubDate: Mon, 22 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab048
      Issue No: Vol. 50, No. 5 (2021)
       
  • Neuropsychiatric symptoms in early stage of Alzheimer’s and
           non-Alzheimer’s dementia, and the risk of progression to severe dementia
           

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      Authors: Liew T.
      Pages: 1709 - 1718
      Abstract: BackgroundNeuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs.MethodThis cohort study included 7,594 participants who were ≥65 years and had early dementia (global Clinical Dementia Rating [CDR] = 1). Participants completed Neuropsychiatric-Inventory–Questionnaire at baseline and were followed-up almost annually for progression to severe dementia (global CDR = 3) (median follow-up = 3.5 years; interquartile range = 2.1–5.9 years). Cox regression was used to examine progression risk, stratified by AD and non-AD.ResultsThe presence of NPSs was associated with risk of progression to severe dementia, but primarily in AD (HR 1.4, 95% confidence interval [CI]: 1.1–1.6) and not in non-AD (HR 0.9, 95% CI: 0.5–1.5). When comparing across various NPSs, seven NPSs in AD were associated with disease progression, and they were depression, anxiety, apathy, delusions, hallucinations, irritability and motor disturbance (HR 1.2–1.6). In contrast, only hallucinations and delusions were associated with disease progression in non-AD (HR 1.7–1.9).ConclusionsNPSs in early dementia—especially among individuals with AD—can be useful prognostic markers of disease progression. They may inform discussion on advanced care planning and prompt clinical review to incorporate evidence-based interventions that may address disease progression.
      PubDate: Thu, 25 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab044
      Issue No: Vol. 50, No. 5 (2021)
       
  • Frailty is associated with long-term outcome in patients with sepsis who
           are over 80 years old: results from an observational study in 241
           European ICUs

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      Authors: Haas L; Boumendil A, Flaatten H, et al.
      Pages: 1719 - 1727
      Abstract: BackgroundSepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.ObjectiveTo investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.DesignProspective cohort study.Setting241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.SubjectsAcutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.MethodsSepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.ResultsOut of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14–1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18–1.51, P < 0.0001).ConclusionsThere is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
      PubDate: Sat, 20 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab036
      Issue No: Vol. 50, No. 5 (2021)
       
  • Measuring the impact of a Chronic Obstructive Pulmonary Disease Community
           Respiratory Programme on emergency admissions to hospital: a controlled
           interrupted time series analysis

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      Authors: Levin K; Milligan M, Bayes H, et al.
      Pages: 1728 - 1735
      Abstract: BackgroundA community respiratory service was implemented in the North West of Glasgow (NW) in January 2013, as part of the Reshaping Care for Older People programme (RCOP). This study aimed to measure the impact of the service on older people’s emergency admissions (EAs) to hospital.MethodsEAs to hospital with a primary diagnosis of COPD (COPD EAs) per 1,000 population aged 65 years+ in NW were compared before and after onset of the service with a 6-month phase-in period, using segmented linear regression. South and North East Glasgow (S + NE) was the control—an area with no such service in place. The model adjusted for the rate of all-cause EAs to control for the impact of other localised RCOPP initiatives. Autoregressive terms and a Fourier term to adjust for seasonality were included in the model.ResultsPrior to implementation of the respiratory service, increases in COPD EAs over time were evident in NW. Adjusting for changes in COPD EAs in NE + S, an additional reduction of −0.04 (−0.03, −0.05) per 1,000 population per month was observed in NW following the phase-in, so that by March 2015, the predicted reduction due to the respiratory service was −0.85 COPD EAs per 1,000 population, a relative reduction of 34.3%. No significant changes in admissions with COPD as a secondary diagnosis (COPD5 EAs) were observed, suggesting that the intervention had no impact on these.ConclusionsThe community respiratory service was associated with a significant reduction in the rate of COPD EAs among older people and no change in COPD5 EAs.
      PubDate: Wed, 09 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab104
      Issue No: Vol. 50, No. 5 (2021)
       
  • Enrolment of older adults with cancer in early phase clinical trials—an
           observational study on the experience in the north west of England

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      Authors: Gomes F; Descamps T, Lowe J, et al.
      Pages: 1736 - 1743
      Abstract: Introductionolder patients represent the majority of cancer patients but are under-represented in trials, particularly early phase clinical trials (EPCTs).Material and Methodsobservational retrospective study of patients referred for EPCTs (January–December 2018) at a specialist cancer centre in the UK. The primary aim was to analyse the successful enrolment into EPCTs according to age (<65/65+). The secondary aims were to identify enrolment obstacles and the outcomes of enrolled patients. Patient data were analysed at: referral; in-clinic assessment and after successful enrolment. Among patients assessed in clinic, a sample was defined by randomly matching the older cohort with the younger cohort (1:1) by tumour type.Results555 patients were referred for EPCTs with a median age of 60 years, of whom 471 were assessed in new patient clinics (38% were 65+). From those assessed, a randomly tumour-matched sample of 318 patients (159 per age cohort) was selected. Older patients had a significantly higher comorbidity score measured by ACE-27 (P < 0.0001), lived closer to the hospital (P = 0.045) and were referred at a later point in their cancer management (P = 0.002). There was no difference in suitability for EPCTs according to age with overall 84% deemed suitable. For patients successfully enrolled into EPCTs, there was no difference between age cohorts (20.1 vs. 22.6% for younger and older, respectively; P = 0.675) and no significant differences in their safety and efficacy outcomes.Discussionolder age did not affect the enrolment into EPCTs. However, the selected minority referred for EPCTs suggests a pre-selection upstream by primary oncologists.
      PubDate: Wed, 09 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab091
      Issue No: Vol. 50, No. 5 (2021)
       
  • Mortality in hip fracture patients after implementation of a nurse
           practitioner-led orthogeriatric care program: results of a 1-year
           follow-up

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      Authors: van Leendert J; Linkens A, Poeze M, et al.
      Pages: 1744 - 1750
      Abstract: Background: Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported.Methods: An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random.Results: In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P < 0.001). The adjusted hazard ratio (aHR) for 3-month (aHR 0.50 [95%CI: 0.26–0.97]) and 1-year mortality (aHR 0.50 [95%CI: 0.29–0.85]) remained lower in NPOCP compared to UC. Median LOS was 9 days [IQR 5–13] in patients receiving UC and 7 days [IQR 5–13] in patients receiving NPOCP (P = 0.08). Thirty-eight (27.5%) patients receiving UC and fifty-seven (40.4%) patients receiving NPOCP were discharged home (P = 0.023).Conclusion: Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population.
      PubDate: Fri, 12 Mar 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab031
      Issue No: Vol. 50, No. 5 (2021)
       
  • Acceptance and commitment therapy for late-life treatment-resistant
           generalised anxiety disorder: a feasibility study

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      Authors: Gould R; , Wetherell J, et al.
      Pages: 1751 - 1761
      Abstract: BackgroundGeneralised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people.ObjectivesTo examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD.ParticipantsPeople aged ≥65 years with TR-GAD (defined as not responding to GAD treatment, tolerate it or refused treatment) recruited from primary and secondary care services and the community.InterventionParticipants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care.MeasurementsCo-primary outcomes were feasibility (defined as recruitment of ≥32 participants and retention of ≥60% at follow-up) and acceptability (defined as participants attending ≥10 sessions and scoring ≥21/30 on the satisfaction with therapy subscale). Secondary outcomes included measures of anxiety, worry, depression and psychological flexibility (assessed at 0 and 20 weeks).ResultsThirty-seven participants were recruited, 30 (81%) were retained and 26 (70%) attended ≥10 sessions. A total of 18/30 (60%) participants scored ≥21/30 on the satisfaction with therapy subscale. There was preliminary evidence suggesting that ACT may improve anxiety, depression and psychological flexibility.ConclusionsThere was evidence of good feasibility and acceptability, although satisfaction with therapy scores suggested that further refinement of the intervention may be necessary. Results indicate that a larger-scale randomised controlled trial of ACT for TR-GAD is feasible and warranted.
      PubDate: Tue, 13 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab059
      Issue No: Vol. 50, No. 5 (2021)
       
  • Developing a UK sarcopenia registry: recruitment and baseline
           characteristics of the SarcNet pilot

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      Authors: Witham M; Heslop P, Dodds R, et al.
      Pages: 1762 - 1769
      Abstract: Backgroundsarcopenia registries are a potential method to meet the challenge of recruitment to sarcopenia trials. We tested the feasibility of setting up a UK sarcopenia registry, the feasibility of recruitment methods and sought to characterise the pilot registry population.Methodssix diverse UK sites took part, with potential participants aged 65 and over approached via mailshots from local primary care practices. Telephone pre-screening using the SARC-F score was followed by in-person screening and baseline visit. Co-morbidities, medications, grip strength, Short Physical Performance Battery, bioimpedance analysis, Geriatric Depression Score, Montreal Cognitive Assessment, Sarcopenia Quality of Life score were performed and permission sought for future recontact. Descriptive statistics for recruitment rates and baseline measures were generated; an embedded randomised trial examined the effect of a University logo on the primary care mailshot on recruitment rates.Resultssixteen practices contributed a total of 3,508 letters. In total, 428 replies were received (12% response rate); 380 underwent telephone pre-screening of whom 215 (57%) were eligible to attend a screening visit; 150 participants were recruited (40% of those pre-screened) with 147 contributing baseline data. No significant difference was seen in response rates between mailshots with and without the logo (between-group difference 1.1% [95% confidence interval −1.0% to 3.4%], P = 0.31). The mean age of enrollees was 78 years; 72 (49%) were women. In total, 138/147 (94%) had probable sarcopenia on European Working Group on Sarcopenia 2019 criteria and 145/147 (98%) agreed to be recontacted about future studies.Conclusionrecruitment to a multisite UK sarcopenia registry is feasible, with high levels of consent for recontact.
      PubDate: Wed, 26 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab084
      Issue No: Vol. 50, No. 5 (2021)
       
  • Preoperative comprehensive geriatric assessment and optimisation prior to
           elective arterial vascular surgery: a health economic analysis

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      Authors: Partridge J; Healey A, Modarai B, et al.
      Pages: 1770 - 1777
      Abstract: Backgroundincreasing numbers of older people are undergoing vascular surgery. Preoperative comprehensive geriatric assessment and optimisation (CGA) reduces postoperative complications and length of hospital stay. Establishing CGA-based perioperative services requires health economic evaluation prior to implementation. Through a modelling-based economic evaluation, using data from a single site clinical trial, this study evaluates whether CGA is a cost-effective alternative to standard preoperative assessment for older patients undergoing elective arterial surgery.Methodsan economic evaluation, using decision-analytic modelling, comparing preoperative CGA and optimisation with standard preoperative care, was undertaken in older patients undergoing elective arterial surgery. The incremental net health benefit of CGA, expressed in terms of quality-adjusted life-years (QALYs), was used to evaluate cost-effectiveness.ResultsCGA is a cost-effective substitute for standard preoperative care in elective arterial surgery across a range of cost-effectiveness threshold values. An incremental net benefit of 0.58 QALYs at a cost-effectiveness threshold of £30k, 0.60 QALYs at a threshold of £20k and 0.63 QALYs at a threshold of £13k was observed. Mean total pre- and postoperative health care utilisation costs were estimated to be £1,165 lower for CGA patients largely accounted for by reduced postoperative bed day utilisation.Conclusionthis study demonstrates a likely health economic benefit in addition to the previously described clinical benefit of employing CGA methodology in the preoperative setting in older patients undergoing arterial surgery. Further evaluation should examine whether CGA-based perioperative services can be effectively implemented and achieve the same clinical and health economic outcomes at scale.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab094
      Issue No: Vol. 50, No. 5 (2021)
       
  • Hospital frailty risk score and adverse health outcomes: evidence from
           longitudinal record linkage cardiac data

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      Authors: Nghiem S; Afoakwah C, Scuffham P, et al.
      Pages: 1778 - 1784
      Abstract: BackgroundDespite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD).MethodsWe conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups.ResultsThe proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30 days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7–55.3%) and stayed in the hospital longer (by 49%).ConclusionUsing the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.
      PubDate: Sat, 15 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab073
      Issue No: Vol. 50, No. 5 (2021)
       
  • Frailty is an outcome predictor in patients with acute ischemic stroke
           receiving endovascular treatment

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      Authors: Pinho J; Küppers C, Nikoubashman O, et al.
      Pages: 1785 - 1791
      Abstract: IntroductionFrailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST).MethodsWe performed a retrospective study of patients with AIS of the anterior circulation submitted to EST between 2012 and 2017, based on a prospectively collected local registry of consecutive patients. The Hospital Frailty Risk Score (HFRS) at discharge was calculated for each patient. We compared groups of patients with and without favourable 3-month outcome after index AIS (modified Rankin Scale 0–2 and 3–6, respectively). A multivariable logistic regression model was used to identify variables independently associated with favourable 3-month outcome. Diagnostic test statistics were used to compare HFRS with other prognostic scores for AIS.ResultsWe included 489 patients with median age 75.6 years (interquartile range [IQR] = 65.3–82.3) and median NIHSS 15 (IQR = 11–19). About 29.7% presented a high frailty risk (HFRS >15 points). Patients with favourable 3-month outcome presented lower HFRS and lower prevalence of high frailty risk. High frailty risk was independently associated with decreased likelihood of favourable 3-month outcome (adjusted odds ratio = 0.48, 95% confidence interval = 0.26–0.89). Diagnostic performances of HFRS and other prognostic scores (THRIVE and PRE scores, SPAN-100 index) for outcome at 3-months were similar.DiscussionFrailty is an independent predictor of outcome in AIS patients submitted to EST.
      PubDate: Thu, 03 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab092
      Issue No: Vol. 50, No. 5 (2021)
       
  • Examining the role of specialist palliative care in geriatric care to
           inform collaborations: a survey on the knowledge, practice and attitudes
           of geriatricians in providing palliative care

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      Authors: Runacres F; Poon P, King S, et al.
      Pages: 1792 - 1801
      Abstract: BackgroundThe global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant.AimTo examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care.DesignA prospective cross-sectional study surveying Australasian geriatricians was conducted.Setting/ParticipantsThis was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine.ResultsA total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test.ConclusionsGeriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery.
      PubDate: Fri, 09 Apr 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab058
      Issue No: Vol. 50, No. 5 (2021)
       
  • The meaning of confidence from the perspective of older people living with
           frailty: a conceptual void within intermediate care services

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      Authors: Underwood F; Latour J, Kent B.
      Pages: 1802 - 1810
      Abstract: BackgroundConfidence is a cornerstone concept within health and social care’s intermediate care policy in the UK for a population of older people living with frailty. However, these intermediate care services delivering the policy, tasked to promote and build confidence, do so within an evidence vacuum.ObjectivesTo explore the meaning of confidence as seen through the lens of older people living with frailty and to re-evaluate current literature-based conceptual understanding.DesignA phenomenological study was undertaken to bring real world lived-experience meaning to the concept of confidence.MethodsSeventeen individual face-to-face interviews with older people living with frailty were undertaken and the data analysed using van Manen's approach to phenomenology.ResultsFour themes are identified, informing a new conceptual model of confidence. This concept consists of four unique but interdependent dimensions. The four dimensions are: social connections, fear, independence and control. Each is ever-present in the confidence experience of the older person living with frailty. For each dimension, identifiable confidence eroding and enabling factors were recognised and are presented to promote aging well and personal resilience opportunities, giving chance to reduce the impact of vulnerability and frailty.ConclusionsThis new and unique understanding of confidence provides a much needed evidence-base for services commissioned to promote and build confidence. It provides greater understanding and clarity to deliver these ambitions to an older population, progressing along the heath-frailty continuum. Empirical referents are required to quantify the concept’s impact in future interventional studies.
      PubDate: Sat, 03 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab109
      Issue No: Vol. 50, No. 5 (2021)
       
  • Perspectives on ageing: a qualitative study of the expectations,
           priorities, needs and values of older people from two Canadian provinces

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      Authors: Savage R; Hardacre K, Bashi A, et al.
      Pages: 1811 - 1819
      Abstract: BackgroundUnderstanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples’ expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations’ age.ObjectiveTo develop an understanding of self-perceptions of ageing and societal ageing among Canadian retirees of the education sector to define a meaningful health research agenda.MethodsWe conducted four qualitative focus groups among 27 members of a Canadian retired educators’ organisation. Data were analysed using an inductive thematic approach.ResultsWe identified four overarching themes: (1) vulnerability to health challenges despite a healthier generation, (2) maintaining health and social connection for optimal ageing, (3) strengthening person-centred healthcare for ageing societies and (4) mobilising a critical mass to enact change. Participants’ preconceptions of ageing differed from their personal experiences. They prioritised maintaining health and social connections and felt that current healthcare practices disempowered them to manage and optimise their health. Although the sheer size of their demographic instilled optimism of their potential to garner positive change, participants felt they lacked mechanisms to contribute to developing solutions to address this transition.ConclusionOur findings suggest a need for health research that improves perceptions of ageing and supports health system transformations to deliver person-centred care. Opportunities exist to harness their activism to engage older people as partners in shaping solution-oriented research that can support planning for an ageing society.
      PubDate: Sat, 03 Jul 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab136
      Issue No: Vol. 50, No. 5 (2021)
       
  • How do people living with dementia perceive eating and drinking
           difficulties' A qualitative study

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      Authors: Anantapong K; Barrado-Martín Y, Nair P, et al.
      Pages: 1820 - 1828
      Abstract: BackgroundEating and drinking problems are common among people living with later-stage dementia, yet few studies have explored their perspectives.ObjectiveThis study aimed to explore how people living with mild dementia understand possible future eating and drinking problems and their perspectives on assistance.DesignQualitative study using semi-structured interviews.SettingCommunity.MethodsWe conducted semi-structured interviews with 19 people living with mild dementia. Interviews were transcribed verbatim and analysed thematically.ResultsFive themes were identified: (i) awareness of eating and drinking problems; (ii) food and drink representing an individual’s identity and agency; (iii) delegating later decisions about eating and drinking to family carers; (iv) acceptability of eating and drinking options; and (v) eating and drinking towards the end of life. For people living with mild dementia, possible later eating and drinking problems could feel irrelevant and action may be postponed until they occur. Fears of being a burden to family and of being treated like a child may explain reluctance to discuss such future problems. People living with mild dementia might wish to preserve their agency and maintain good quality of life, rather than be kept alive at later stages by artificial nutrition and hydration.ConclusionFor people with mild dementia, eating and drinking problems may seem unrelated to them and so get left undiscussed. Negative connotations regarding eating and drinking problems may hinder the discussion. The optimal time to discuss possible future problems with eating and drinking with people with mild dementia may need an individual approach.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab108
      Issue No: Vol. 50, No. 5 (2021)
       
  • Changes in social, psychological and physical well-being in the last
           5 years of life of older people with cancer: a longitudinal study

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      Authors: Pivodic L; De Burghgraeve T, Twisk J, et al.
      Pages: 1829 - 1833
      Abstract: Backgroundolder people with cancer are at risk of complex and fluctuating health problems, but little is known about the extent to which their well-being changes in the last years of life.Objectiveto examine changes in physical, psychological and social well-being in the last 5 years of life of older people with cancer.Designprospective cohort study.SettingBelgium, the Netherlands.Participantspeople with a new primary diagnosis of breast, prostate, lung or gastrointestinal cancer, aged ≥70 years, life expectancy >6 months, were recruited from nine hospitals. We analysed data of deceased patients.Methodsdata were collected from participants around diagnosis, and after 6 months, 1, 3 and 5 years through structured questionnaires administered through interviews or as self-report. Outcomes were physical, emotional, social, role functioning (EORTC QLQ-C30), depressive symptoms (GDS-15), emotional and social loneliness (Loneliness Scale). We conducted linear mixed model analyses.Resultsanalysing 225 assessments from 107 deceased participants (assessments took place between 1,813 and 5 days before death), mean age at baseline 77 years (standard deviation: 5.2), we found statistically significant deterioration in physical functioning (b = 0,016 [95%confidence interval 0.009–0.023]), depressive symptoms (b = −0,001 [−0.002 to 0.000]) and role functioning (b = 0.014 [0.004–0.024]). Changes over time in emotional and social functioning and in social and emotional loneliness were smaller and statistically non-significant.Conclusionscare towards the end of life for older people with cancer needs to put their social and psychological well-being at the centre, alongside physical needs. Future research should focus on understanding inter-individual variation in trajectories.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab125
      Issue No: Vol. 50, No. 5 (2021)
       
  • Feasibility of patient-reported outcome research in acute geriatric
           medicine: an approach to the ‘post-hospital syndrome’

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      Authors: Franke A.
      Pages: 1834 - 1839
      Abstract: BackgroundA patient’s self-reported health-related quality of life (HRQoL) can be quantified by a patient-reported outcome measure (PROM). A patient’s HRQoL can provide another avenue to understand the ‘post-hospital syndrome’, a period after hospital discharge that a patient remains vulnerable to subsequent re-admission. The purpose of the study was to establish the feasibility of collecting HRQoL of older inpatients treated for acute illnesses on medical ward. Feasibility of the PROM would be qualitatively judged upon completion time, response rate and sensitivity to change in HRQoL over time.MethodsA prospective observational cohort of consecutively admitted patients to a step-down medical ward over 1 year. The COOP/WONCA chart was the PROM. Patients were interviewed by the author face-to-face within 48 hours of admission and then 2 weeks after discharge by telephone.ResultsFrom the 300 patients admitted, 182 were excluded. Of the remaining 118, median age was 78 years (interquartile range, IQR, 64–86 years), and 71 (60.2%) were female. Proxies were used for 26 (22%) patients. Ninety-two (78%) completed follow-up. The participants were contacted at a median of 14 days (IQR, 13–16) after discharge. Exploratory analyses found that the COOP/WONCA had test–retest responsiveness, that is detected change in HRQoL over time.ConclusionThe completion time of 3 minutes, high response rate (78%) and test–retest responsiveness are evidence that collecting PROs from acutely unwell elderly patients using the COOP/WONCA is feasible. PRO research could become fundamental to the understanding of the ‘post-hospital syndrome’.
      PubDate: Mon, 17 May 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab074
      Issue No: Vol. 50, No. 5 (2021)
       
  • Safety of oesophagogastroduodenoscopy in a nonagenarian population

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      Authors: Ellis R; Livovsky D, Shapiro D, et al.
      Pages: 1840 - 1844
      Abstract: Backgroundinvasive gastrointestinal (GI) procedures are increasingly performed on much older patients but data regarding oesophagogastroduodenoscopy (OGD) in this population are limited. We compared the indications, safety and benefits of OGD for nonagenarians compared to octogenarians.Methodsan observational retrospective review of patients who underwent OGD between 2013 and 2018 at a gastroenterology institute in one large hospital. Patients aged 90 and above ‘nonagenarians’ were compared to those aged 80–89 ‘octogenarians’.Results472 patients (231 nonagenarians and 241 octogenarians), median age of 91 for nonagenarians (201 aged 90–94, 30 aged 95 and older) and 82 (174 aged 80–84, 67 aged 85–89) for octogenarians. GI bleeding was a more common and dyspepsia, a less common, indication for nonagenarians compared to octogenarians (55 and 7%, versus 43 and 18%). Significant findings and need for endoscopic treatments were both more commonly found in nonagenarians compared to octogenarians (25 and 24% versus 15 and 8%, respectively). General anaesthesia was more commonly given to nonagenarians (35 versus 10%). Immediate complications and 30-day mortality rate were similar between the groups: (2.6% of nonagenarians versus 1.6% of octogenarians). Of 30 patients aged 95 and older, 13% had late adverse events, compared to 1% of the overall cohort.ConclusionsOGD appears safe in nonagenarians. Pathological findings and endoscopic interventions are more common. Decisions regarding OGD should not be based on age alone.
      PubDate: Fri, 11 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab129
      Issue No: Vol. 50, No. 5 (2021)
       
  • Burden of cardiovascular diseases in older adults using aged care services

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      Authors: Hsu B; Korda R, Naganathan V, et al.
      Pages: 1845 - 1849
      Abstract: ObjectiveTo quantify the burden of cardiovascular diseases (CVD) in older adults using community and residential care services.MethodsThe study population comprised people aged 45+ from the 45 and Up Study (2006–09, n = 266,942) in Australia linked with records for hospital stays, aged care service and deaths for the period 2006–14. Follow-up time for each person was allocated to three categories of service use: no aged care, community care and residential care, with censoring at date of death. We calculated the prevalence at baseline and entry to aged care, and incidence rates for major CVD and six cardiovascular diagnoses, seven cardiovascular interventions (collectively CV interventions), cardiovascular-related intensive care unit stays and cardiovascular death.ResultsThe prevalence of major CVD at entry into community care and residential care was 41% and 58% respectively. Incidence per 1,000 person-years of all major CVD hospitalisations and CV interventions, respectively, was 182.8 (95% CI: 180.0-185.8) and 37.0 (95% CI: 35.6–38.4) for people using community care, and 280.7 (95% CI: 272.2–289.4) and 11.7 (95% CI: 9.8–13.9) for people using residential care. Similar trends were observed for each of the CVD diagnoses and interventions. Crude incidence rates for cardiovascular deaths per 1,000 person-years were 1.4 (95% CI: 1.3–1.5) in no aged care, 13.3 (95% CI: 12.6–14.1) in community care, and 149.7 (95% CI: 144.4–155.2) in residential care.ConclusionOur findings demonstrate the significant burden of CVD in people using both community-based and residential aged care services and highlights the importance of optimising cardiovascular care for older adults.
      PubDate: Fri, 18 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab083
      Issue No: Vol. 50, No. 5 (2021)
       
  • Learning from a successful process evaluation in care homes

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      Authors: Allen F; Darby J, Cook M, et al.
      Pages: 1850 - 1853
      Abstract: Introductionprocess evaluations (PE) are increasingly used in parallel with randomised controlled trials (RCT) to inform the implementation of complex health interventions. This paper explores the learning accrued from conducting a PE within the Falls in Care Homes Study (FinCH), a large UK RCT.Methodsin the FinCH study, six purposively sampled care homes provided data for the PE, which followed a realist approach. In this study researchers kept written diaries of their experiences in completing the interviews, focus groups and observations. We have reflected on these and present the main themes for discussion.Findingscare home staff were enthusiastic to participate in the PE but researchers found it difficult to collect data due to staff not having time to take part, environmental factors such as no space for focus groups and low levels of research understanding. Researchers found that the expectations of the PE protocol were often unrealistic due to these limitations. Flexible and pragmatic approaches such as interviews in place of focus groups enabled data collection but required a reduced sample size and length of data collection to be accepted by researchers.Conclusionto enable care home staff to participate in successful PEs, researchers should build flexibility into research schedules, spend time building trust, collaborate with all levels of care home staff prior to data collection, increase research capacity in care home staff and co-design research projects.
      PubDate: Thu, 24 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab139
      Issue No: Vol. 50, No. 5 (2021)
       
  • Is Pathfinder a safe alternative to the emergency department for older
           patients' An observational analysis

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      Authors: Bernard P; Corcoran G, Kenna L, et al.
      Pages: 1854 - 1858
      Abstract: Backgroundmany patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. Alternative care pathway models can reduce ED crowding and improve outcomes. Internationally, there is no consensus on which model is recommended.Aimthe aim of this study is to investigate the impact of the Pathfinder model on ED conveyance rates and patient safety.Methodsthe Pathfinder service is a collaboration between the National Ambulance Service and Beaumont Hospital Occupational Therapy and Physiotherapy Departments. It is supported by the Government of Ireland’s Sláintecare Integration fund. This is a retrospective cohort study of the Pathfinder service over a 5-month period.Resultsone-hundred and seventy-eight patients were responded to by the Pathfinder ‘Rapid Response Team’. Average age was 79.6 years (standard deviation 7.6), median clinical frailty score was 6 (interquartile range: 5–6). Sixty-four percent remained at home following initial review. None re-presented to the ED within 24 hours, and 10% re-presented within 7 days. The majority (67%) of patients required follow-up by the Pathfinder ‘Follow-Up Team’ and/or another community-based service. Feedback demonstrates 99% patient satisfaction with the service.Conclusionthe Pathfinder service is a safe alternative to ED conveyance for older people following an EMS call. It is the first model of this kind to be evaluated in Ireland. The overwhelmingly positive feedback confirms that older people want this service. This model could expand, with local adaptation, nationally and internationally.
      PubDate: Wed, 09 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab095
      Issue No: Vol. 50, No. 5 (2021)
       
  • Diagnostic complexity in the older patient: an unusual presentation of
           advanced biliary disease

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      Authors: Hosty J; Narramore R, Boothroyd M, et al.
      Pages: 1859 - 1860
      Abstract: Biliary disease is common in the older population, and gallbladder dysfunction and increased bile lithogenicity predispose to calculi formation. This case demonstrates an unusual presentation of gallbladder empyema. A 90-year-old male with metastatic prostate cancer presented with hypoactive delirium. With no localising features, normal liver function tests but persistently raised inflammatory markers, he was initially managed as a urinary tract infection. Chest wall discomfort and swelling over the right costal margin later developed. Abdominal imaging demonstrated a massive gallbladder empyema invaginating through the lower right rib cage, causing the superficial swelling. Pre-morbid status prevented cholecystectomy and he was managed conservatively with percutaneous cholecystostomy and antibiotics. He was discharged to 24-h care 2 weeks after diagnosis with a long-term drain.
      PubDate: Fri, 18 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab123
      Issue No: Vol. 50, No. 5 (2021)
       
  • Tetanus presenting as painful muscle spasms, dysphagia and delirium in an
           older adult

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      Authors: Merrick M; Scarrott I.
      Pages: 1861 - 1862
      Abstract: While tetanus is now a rare disease in the UK, it remains an important differential diagnosis for trismus and muscle spasms. Even more so in older adults, as this population is less likely to have received full vaccination. Hence, the highest incidence of tetanus in England is seen in older adults. Written informed consent for publication of their clinical details was obtained from the patient proxy.
      PubDate: Sat, 12 Jun 2021 00:00:00 GMT
      DOI: 10.1093/ageing/afab124
      Issue No: Vol. 50, No. 5 (2021)
       
 
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