Scientific Research

Introduction

There is an association between frailty and arterial stiffness. However, arterial stiffness does not uniformly correlate with the spectrum of frailty states. Both oxidative stress and inflammaging contribute to vascular aging. There are no human studies exploring links between arterial stiffness, oxidative stress, inflammaging and frailty. Our objective is to investigate arterial stiffness and inflammaging as predictors of frailty states.

Methods

An observational longitudinal cohort study will be used to examine the association between arterial stiffness, oxidative stress, and inflammation in 50 older adults (≥70 years) with clinical frailty scores (CFS) ≤6 over six months. All study measurements will be taken at baseline. Frailty assessment will include hand-grip strength, timed-up and go test, mini-mental state examination, geriatric depression scale and sarcopenia using body composition measurements with Tanita®. Arterial stiffness measurements will include carotid-femoral pulse wave velocity (cfPWV) and carotid-radial pulse wave velocity (crPWV) using Complior (Alam Medical, France). CAVI device will measure Cardio-ankle vascular index and ankle brachial index (ABI). Oxidative stress blood markers nitrotyrosine (NT) and 8-hydroxy-2’-deoxyguanosin (8-oxo-dG) and inflammation markers high-sensitive C-reactive protein (hs-CRP) and interlukin-6(IL-6) will be measured at baseline and 6-months along with lipid profile and glycated haemoglobin.

Data Analysis

Descriptive statistics for continuous data using means and standard deviations for normality distributed variables or medians and inter-quartile ranges for skewed variables will be used. Participants will be categorized into CFS 1-3, and CFS 4-6. Categorical data will use frequencies and comparison between groups. Change in frailty between the groups over 6 months will be compared using paired t-test. Simple linear regression will be done between frailty measures, arterial stiffness, inflammation, and oxidative stress biomarkers. Significance will be at p<.05.

Conclusion

This study data will inform a larger, multi-centre exploring further the interplay between frailty, biomarkers, and arterial stiffness parameters. is funded by BGS.

Introduction: Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation, preserve autonomy, improve satisfaction with care and consequently can be understood as a core aspect of person-centered care. However, it is currently unknown how people receiving ADS understand leisure and which leisure activities they prefer.

Method: To gain insight, a qualitative design was chosen. We conducted semi-structure interviews with 15 people receiving ADS in Germany. Participants were recruited from three different ADS in one state in Germany. Interviews were recorded, transcribed verbatim and analyzed using reflexive thematic analysis and categories of the SDT.

Results: The results show that over 90 % of participants were diagnosed with dementia and we identified two different themes. The first theme, the sweet bitter symphony, emphasizes the positive (sweet tones: autonomy, competence, and relatedness) and negative (bitter tones: incompetence, unrelatedness, and heteronomy) sensations and feelings that shape interviewees’ understanding of leisure. The second theme, young, wild & free!, describes the different preferred leisure activities. 

Conclusion: The results indicate the importance of preference-based service design in ADS to meet clients’ psychological needs and thus provide person-centered care to improve well-being and quality of life. These results can be used to develop an item-based assessment tool to assess the preferences of people with care needs regarding leisure activities in ADS.

Background: Multimorbidity has negative impacts on the health outcomes of older adults. Previous research has discovered different patterns of multimorbidity. However, evidence is scarce for associations between multimorbidity patterns and depression, especially the role of social participation in it. This study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan and the effect of social participation in different multimorbidity patterns.

Methods: This population-based cohort study used data from the Taiwan Longitudinal Study on Aging. It included 1,975 older adults (age >50 years) who were followed from 1996 to 2011. The participants’ multimorbidity patterns in1996 were determined by latent class analysis; their incident depression were ascertained in 2011 using the 10-item CES-D. Multivariate logistic regression was used to analyze the relationship between multimorbidity patterns and depression.

Results: In 1996, the participants’ average age was 62.1 years. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis–cataract group (n = 105), (3) Multimorbidity group (n = 128), and (4) Relatively healthy group (n = 1649). After multivariate analysis, participants in the Multimorbidity group had a greater risk of incident depression (Odds ratio: 1.62; 95% Confidence interval: 1.02–2.58), compared with the Relatively healthy group. Subgroup analysis showed that participants without social participation in the Arthritis-Cataract and Multimorbidity groups had greater risks of developing derpression.

Conclusion: This 16-year, population-based cohort study showed that distinct multimorbidity patterns among older adults in Taiwan were associated with incident depression during later life, while social participation played a role as protective factor.

Introduction

Xerostomia, also known as dry mouth, is prevalent in older populations and associated with key determinants such as continual use of medication, radiation, and chronic diseases. Xerostomia significantly increases the risk of experiencing demineralisation, dental caries, tooth sensitivity, candidiasis, and other oral conditions that may negatively affect quality of life. An effective strategy to manage the risk of dental caries for patients with xerostomia is the prescription of high-fluoride products with proven efficacy. The aim of this study was to provide evidence on the burden of xerostomia, patient characteristics, treatments, and healthcare resource use in this patient population in the United Kingdom.

Method

A retrospective observational study was conducted including all patients aged ≥16 years with a first diagnosis of xerostomia between 01/04/2015-31/03/2020 in the Optimum Patient Care Research Database, a primary care database. Patients with <12 months’ baseline and follow-up data were excluded.

Results

11,731 patients with a mean age of 67.93 years (SD 15.64) newly diagnosed with xerostomia were included. 72.27% of patients were >60 years and 65.3% were females. Patients aged ≥65 years received a median of 5 (Q1-Q3: 4-6) drug classes in the baseline period. Analgesic agents (80.6%), cardiovascular drugs (70.3%), antidepressants and antipsychotic agents (57.3%), and antihypertensive agents (47.6%) were common prescriptions reported before the diagnosis of xerostomia. Patients had 24.2 primary care visits with the associated costs of £727.66 per patient-year during follow-up. Only 2.2% of patients received high-fluoride toothpaste, whereas 99.6% of patients were prescribed artificial saliva and 16.3% received saliva stimulants.

Conclusions

The majority of patients aged ≥65 years had chronic diseases for which they received ≥4 medications in the baseline period. Although xerostomia is predominantly managed in primary care, few patients are prescribed high-fluoride toothpaste, which is a cost-effective and simple way to reduce the inevitable risk of dental caries.

Introduction

Patient and public involvement and engagement (PPIE) is essential to delivering patient centred, quality research. Older adults constitute an increasing proportion of the surgical population but are unintentionally excluded from traditional models of engagement.

We describe the process and outputs of conducting PPIE to support future research examining the scale up of CGA-based perioperative services such as POPS (Perioperative medicine for Older People undergoing Surgery).

Methods

Patients undergoing elective surgery at four NHS hospitals in England and Wales were asked to consider participation in PPIE. Twenty-two expressed interest; nine offered to participate, six declined due to their own or relative’s ill health, two withdrew, five did not respond.

Six were able to participate on proposed dates. Three had access to email and video calling to join a group Microsoft Teams call. Three took part in 30-minute individual telephone calls. A patient representative from Centre for Perioperative Care (CPOC) acted as peer facilitator for the interview structured around five pre-agreed questions.

Results

Six older patients contributed through PPIE to codesign research examining perioperative services for older people, with three volunteers for long-term involvement as part of a research steering group. The group offered insight into their experience of traditional and POPS-led perioperative pathways.

This group emphasised the need for coordinated care, delivered by clinicians with a holistic understanding of the whole perioperative pathway, the need to reduce duplication of information provision and diagnostic testing and a proactive approach to hospital discharge planning.

Participants agreed that POPS services should be established nationwide and that research should focus on implementation and scale-up. The need for PPIE in the dissemintation of future research findings was highlighted.

Conclusion

Involving older adults in PPIE is possible and necessary to deliver healthcare services, including novel perioperative care pathways, tailored to service users.

Introduction

Substantial variations remain in hip fracture care delivery across the UK despite established standards and guidelines. We aimed to predict adverse patient outcomes following hip fracture from modifiable hospital-level organisational factors and develop implementation tools to improve national service delivery.

Method

We used a national record-linkage cohort of 178,757 patients (≥60 years) with a hip fracture in England and Wales (2016–19). We linked patient-level hospital admissions, National Hip Fracture Database and mortality data with 231 metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with patient outcomes: length of hospital stay, emergency 30-day readmission, 120-day mobility recovery, days in hospital and health costs over 365-days, and mortality (30- and 365-day) in 172 hospitals across England and Wales.

Results

Over one-year patients with mean (SD) age 83 (8.6) years, spent 31.7 (32.1) days in hospital, costing £14,642 (£9,017), and 50,354 (28.2%) died. We identified 46 key organisational factors independently associated with one or more patient outcome, of which 14 were (a) associated with cost and/or bed-day savings over one year, (b) consistently associated with other positive patient outcomes, and (c) potentially modifiable. Factors included weekend physiotherapy provision (mean saving per patient/year: £676 [95%CI:£67-1285]), orthogeriatrician assessment (£529 [£148-910]), direct admission to a hip fracture ward (3.4 [-0.36-7.07]days), regular dissemination of audit data to staff (0.85 [0.30-1.39]days). These data have informed the development of a hospital-specific cost-benefit calculator, with a model business case for service improvement, specialty checklists, audit and ‘how to’ guides for complex care delivery.

Conclusion

All hospitals should try to provide the best available hip fracture care equally across England and Wales. We identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture. Our practical and freely-available toolkit should help reduce variation in service delivery.

Introduction
Stress and communication difficulties, both prone in people with dementia, are risk factors for challenging behaviour. Challenging behaviour negatively impacts the quality of life of people with dementia and their caregivers. Technology can help caregivers detect stress in people with dementia. However, implementation of these technologies is not always successful. The aim of this study is to explore the implementation opportunities for a garment-integrated sensor system that enables caregivers to identify early signs of stress in people with dementia.

Methods
A qualitative design with online focus groups (n=9) and interviews (n=21) with persons living with dementia (n=4), family (n=10) and professional caregivers (n=9) was used to collect stakeholders’ perceptions towards the sensor system and requirements for its implementation into long-term care. Participants took part in three focus groups or interviews, of which the last round focused on implementation. Qualitative data were analysed using inductive conventional content analysis.

Results
Participants were positive about the idea of a garment-integrated sensor system and could see several groups in both intramural and extramural healthcare settings benefit from the system. Besides early stress detection, participants also saw an added value of the system for the identification of triggers for challenging behaviour or for diagnostic purposes. According to participants, implementing the system in long-term care requires clear guidelines and agreements for its use, a trial period and educating caregivers. The sensor system needs to meet several requirements (e.g. customizability, ease of use) to increase user acceptance and thereby implementation success.

Conclusions
Participants perceive the idea of a garment-integrated sensor system for people with dementia in long-term care as positive. To increase implementation success, it is important to create an easy-to-use, tailor-made system, educate stakeholders, and establish clear guidelines for its use. The next step is to validate and implement the system in long-term care.

Introduction:

The appearance of dysphagia after intubation in COVID 19 patients is very frequent, however there are few studies carried out in this regard.

Methods:

Retrospective study of 306 adults infected by SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the risk factors involved in the appearance of dysphagia after intubation.

Results:

There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the time of mechanical ventilation greater than 14 days was a factor with a high association, as well as the appearance of pneumonia associated with mechanical ventilation. The occurrence of dysphagia in those over 70 years of age doubles that of those under 60 years of age. The present study showed an adequate correlation between the appearance of dysphagia in relation to age, the time of ventilation and the appearance of pneumonia associated with mechanical ventilation.

Conclusions:

The appearance of dysphagia after intubation in patients with COVID 19 is a frequent complication, studies with larger groups of patients are required to be able to validate the results found here and thus be able to have tools that allow us to stratify in a better way. to COVID 19 patients.

Introduction:

Mortality after a hip fracture increases compared to the general population. The main objective of this study is to examine the incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures.

Methods:

This is a retrospective cohort study from a South American hospital. Patients older than 65 years with osteoporotic hip fracture between 2015 and 2018 were identified. Demographic data and comorbidities were obtained. The incidence rate, standardized mortality rate, trend (Poisson regression), and risk (hazard ratio) were calculated.

Results:

A total of 304 patients admitted for osteoporotic hip fracture were found, 240 (79%) were women with a mean age of 81.3 years (SD 8.45) and 64 (22.1%) were men with a mean age of 85. .42 years (SD 10.08). The cumulative incidence of mortality was 72.5%. The annual mortality rate was 75.6/1000 patients/year (54.8 in men and 20.8 in women). The 1-year mortality rate increased significantly by 2% per year (HR 1.05, 95% CI 1.002–1.08). Median overall survival was 854 days (95%CI 802-906). The mortality probability density was 18% for women and 27% for men (first 90 days).

Conclusions:

A more significant increase in mortality was observed in men than in women. Institutionalization combined with comorbidities are associated with higher mortality.

Introduction

Hearing loss affects 12 million people in the UK, it can have a severe negative impact on individuals, especially their communication, cognition and quality of life. Commonly reported effects of hearing loss are social isolation and mental health problems (e.g. anxiety and depression). There are a number of interventions for hearing loss, including hearing aids and cochlear implants. However, many individuals delay seeking treatment. This may be due to limited ­awareness of hearing loss and its consequences amongst the public. In addition, there is a large stigma surrounding hearing loss and having hearing aids.

This study will investigate the representations of hearing loss in the UK news media, particularly its impact on mental health, and identify ways to improve these representations.

Methods
Using Nexis (a database of news), we will examine newspaper articles featuring hearing loss during 2022. Multimodal critical discourse analysis will be used, which regards communicative choices (here, images and text) as both reflecting and shaping society, including by contributing to or challenging stigma. Patient and public involvement representatives will be consulted throughout regarding research objectives methods and the data interpretation.

Results

Results suggest that hearing loss is often described using celebrity accounts, often these individuals were younger adults. Many articles included inspirational stories of those with hearing loss, however the PPI group recommended that newspaper stories should provide a diverse representation of hearing loss. Inaccurate and outdated language was used to describe hearing devices. Mental health problems commonly discussed were depression, social isolation and dementia.

Discussion

The research will inform best practice recommendations for representing hearing loss in the public domain, which could be applied by healthcare organisations, research centres, charities and media outlets to help destigmatise hearing loss.