Scientific Research

Background: Falls in people with dementia often result in physical and psychological impacts, reducing independence and increasing healthcare costs. Falls place a significant economic burden on the healthcare system. Although individuals with dementia face a heightened risk of falling, there is limited evidence supporting effective home-based interventions for this population. Methods: A mixed-methods process evaluation was embedded within a pilot cluster randomised controlled trial, guided by a realist framework. The evaluation was conducted across six UK sites (three intervention, three control). It included fidelity checks of routine data collection, observation of intervention sessions, multidisciplinary team (MDT) meetings, and therapist supervision. Semi-structured interviews were conducted with people with dementia, caregivers, and therapists. Results: High fidelity was achieved in home assessments and intervention delivery, with participants completing an average of 15 out of 22 planned sessions. Regular home visits enhanced engagement and motivation, while MDT support boosted therapist confidence in managing complex cases. Most participants met their functional goals and reported improved confidence. However, challenges included geographical and capacity variability in service delivery and inconsistent referral pathways. Therapists’ attitudes toward advanced dementia influenced intervention delivery. The dyadic approach supported activity engagement but occasionally increased caregiver responsibilities. Conclusions: The Maintain intervention was feasible and acceptable, with preliminary evidence of improved daily living activities and quality of life. A future trial should focus on standardising MDT support, addressing falls-related anxiety, and developing sustainable post-intervention strategies. Protocol adaptations, such as video consultations, demonstrated potential to mitigate workforce challenges.

INTRODUCTION:

We now face an increasing challenge of managing type 1 diabetes (T1DM) in older people. 3% of patients with T1DM are over 80 years old - a number that is set to rise over the coming decades. Diabetes is a risk factor for frailty, and advanced age comes with a higher incidence and severity of comorbidities affecting patients’ ability to manage their treatments, such as arthritis or dementia. A recent systematic search in England highlighted the scarcity of data surrounding this, finding no articles specifically researching frailty in older adults with T1DM.

CASE STUDY:

●90-year-old lady with T1DM

●Living alone with mild frailty

●Mild cognitive impairment

Despite living alone and being independent with many of her activities of daily living, her mild cognitive impairment made her unable to manage her insulin safely. Consequently, she had recurrent hospital admissions due to labile blood sugars. Local services (even in central Manchester) offer a maximum of two visits each day, which is not a safe insulin regime for most patients living with T1DM. As family were not available to support, she had prolonged inpatient hospital stays and ultimately had to explore 24-hour nursing care, despite being otherwise independent.

The case provides a poignant illustration of an issue which is only going to become more frequent as the early users of insulin now reach older age.

Introduction

The British Geriatrics Society (BGS) Flexible Workforce Statement supports national policy such as the NHS People Plan in promoting less than full time (LTFT) working.1,2 As LTFT trainee representatives on the BGS Trainees' Council we were interested to know how consultant work patterns are advertised. We analysed job adverts for Consultants in Geriatric Medicine over a two-year period to identify how many were LTFT posts.

Method

A freedom of information (FOI) request was submitted to online recruitment website ‘NHS Jobs’. The request identified jobs in ‘Elderly Care Medicine’ OR those containing ‘Geriatric’ in their title between 01/04/2019 and 31/03/2021. The FOI data were filtered to include only Consultant posts, grouped by training deanery and analysed using Excel. Regional numbers of LTFT trainees were identified by emailing Training Programme Directors and a FOI request to deaneries for non-responders. The number of LTFT consultants was identified using the online Royal College of Physicians census.3

Results

The FOI request returned 7589 jobs; of these 1083 were consultant posts. These ranged from 42 in Thames Valley to 171 in East of England. Twenty-one jobs (1.9%) were advertised as LTFT, the highest proportion was 11% in Yorkshire and Humber. Twenty-eight (2.6%) were negotiable, the highest proportion was 23% in the South West. Twenty nine percent of LTFT jobs were advertised as permanent posts. Currently, 37% of trainees, and 25% of consultants, work LTFT.

Conclusion

Number of LTFT job adverts was low compared to the number of LTFT consultants and trainees, although there is regional variation. A limitation was that details of adverts were not seen, which made it unclear whether each job was a fresh advert or readvertising an unfilled post. The latter is likely given there are 1747 consultants working in the UK.3 Further avenues of work include identifying LTFT opportunities for SAS grade doctors and allied health professionals.

References

1. https://www.england.nhs.uk/ournhspeople/online-version/lfaop/

2. https://www.bgs.org.uk/resources/flexible-working-in-geriatric-medicine

3. https://www.rcplondon.ac.uk/projects/outputs/working-differently-shadow…

Introduction:

Post-diagnostic support is key to ensuring the well-being of people with dementia and unpaid carers. The COVID-19 pandemic has caused a shift from in-person to remote service delivery, often with the use of information communication technologies (ICT) formats. This systematic review examined how ICT has been used to access remote post-diagnostic support services that address the needs people with dementia, or those of dyad, and explored care recipients’ views on accessing dementia-related support remotely.

Method:

Concepts relating to dementia and ICT were searched across six databases (PsychInfo, PubMed, Cochrane Library, CINAHL, Social Care Online, and Web of Science) in March 2021 and updated in March 2022. Studies published from 1990 and written in English, German or French were considered for inclusion. Methodological quality was appraised using the Hawker quality assessment tool and reporting structured according to PRISMA guidelines.

Results:

The search yielded 8,485 citations. Following the removal of duplicates and two screening processes, 18 studies were included. Studies described a range of post-diagnostic support, including exercise classes and therapeutic sessions, which were largely delivered remotely on a one-to-one basis. Videoconferencing software was the most employed ICT format, and people with dementia were directly engaging with ICT to access post-diagnostic support in 13 studies. Whilst studies demonstrated the feasibility of accessing post-diagnostic service remotely, overall, care recipients’ views were mixed.

Conclusions:

Following the increased reliance on ICT during the pandemic, it is likely that service delivery will continue with a hybrid approach. Accessing post-diagnostic support remotely is likely to benefit some care recipients. However, to prevent widening inequalities in access, service provision is required to accommodate to people with dementia and unpaid carers who are digitally excluded. Future research should capture the support provided by unpaid carers facilitating the engagement of the person with dementia when accessing remote post-diagnostic support.

Introduction: Dementia-friendly hospitals (DFH) are mentioned as one of several key initiatives in national dementia strategies. In our previous integrative review, we identified 17 descriptions of DFHs and analysed six characteristics of DFH: continuity, person-centredness, consideration of phenomena within dementia, environment, valuing relatives and knowledge and expertise within the hospital (Manietta et al., BMC Geriatrics, 2022, 22, 468, 1-16). We also learned that the term DFH is based more on healthcare practice than research. To address this research gap, one step of our DEMfriendlyHospital study is to examine the perspectives of professional dementia experts working in hospitals in Germany.

Method: We used a qualitative design and conducted 14 semi-structured interviews with professional dementia experts from various healthcare professions (12 nurses, two physicians, and one physiotherapist). Data were collected between November 2021 and March 2022. Using an inductive content analysis, we furthermore analysed the interviews in a participatory way involving a group of research associates and professional dementia experts.

Results: From the professional dementia experts’ perspectives, a dementia-friendly hospital needs to focus on the people with dementia, their relatives and also on the staff who care for them. A DFH is characterised by specific hospital processes, structures and environment which consider the needs of people with dementia, dementia-specific knowledge and the skills of hospital staff, their awareness and attitude towards people with dementia. A DFH needs the social inclusion of patients with dementia and their perception as a person as well as the involvement of relatives, who are an important support for the patients and their care.

Conclusion: There are links between our results from interviews with professional dementia experts and our integrative review. At the same time, the perspectives of patients with dementia and their relatives are underrepresented. To fill this gap, our next step is to interview people with dementia who are hospitalised and their relatives, aiming to enhance the description of a DFH and its characteristics.

Background: Multimorbidity patterns is associated with future mortality among older adutls. However, the addictive effect of disability for distinct multimorbidity patters is unclear. Our aim was to identify the multimorbidity patterns of Taiwanese people aged over 50 years and to explore their association between multimorbidity patterns with/without disability and future mortality.

Methods: This longitudinal cohort study used data from the Taiwan Longitudinal Study on Aging. The data were obtained from wave 3, and the multimorbidity patterns in 1996, 1999, 2003, 2007, and 2011 were analyzed separately by latent class analysis (LCA). The association between each disease group with/without disability and mortality was examined using logistic regression.

Results: 5124 older adults with average age of 66.7 years old were included. Four disease patterns were identified in 1996, namely, the cardiometabolic (21.6%), arthritis-cataract (11.6%), relatively healthy (61.2%), and multimorbidity (5.6%) groups. After adjusting all the confounders, the cardiometabolic group with disability showed the highest risk for mortality (odds ratio: 2.83, 95% CI: 1.70-4.70), followed by Multimorbidity group with disability (odds ratio: 2.33, 95% CI: 1.17-4.64) and relatively health group with disability (odds ratio: 1.79, 95% CI: 1.22-2.62) and cardiometabolic group without disability (odds ratio: 1.21, 95% CI: 1.01-1.45).

Conclusion: This longitudinal study reveals disability plays an important role on mortality among older adults with distinct multimorbidity patterns. Older adults with a cardiometabolic multimorbidity pattern with disability had a dismal outcome. Thus, healthcare professionals should put more emphasis on the prevention and identification of cardiometabolic multimorbidity, with routine checkup of their functional limitation.

Introduction: Sialorrhoea is a common non motor complication experienced by people with Parkinson’s disease (PD).  Despite its prevalence there is conflicting evidence on how to effectively treat it. Our aim was to establish the efficacy and safety outcomes of pharmacological interventions used to treat sialorrhoea in people with idiopathic PD.

Methods: We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42016042470). We searched 7 electronic databases from inception until July 2022. Quantitative synthesis was performed where data allowed using random effects models.

Results: From 1374 records we included 13 studies (n=405 participants). Studies were conducted in Europe, North America and China. There was marked heterogeneity in the interventions used, follow up times and outcome measures investigated. The main source of risk of bias identified was reporting bias. 5 studies were included in the quantitative synthesis. Summary estimates showed administration of botulinum toxin significantly reduced saliva production, improved patient reported functional outcomes and was associated with an increase in adverse events.

Conclusion: Sialorrhoea in PD is an important condition, but current data does not allow for strong recommendations on optimal pharmacological treatments. There is significant heterogeneity in outcomes measures used to evaluate the burden of sialorrhoea with lack of consensus on what constitutes clinically meaningful change. More research is required to better understand the underlying mechanism and potential treatments of sialorrhoea in idiopathic PD

INTRODUCTION 
Video-recordings of patients may offer advantages over text-based documentation to supplement assessment and decision-making – particularly for older patients with complex needs. Our systematic review aimed to evaluate the application, acceptability, and impact of video-based records; here we highlight current evidence on using video-recordings to support direct care delivery for older patients.

METHODS 
Five electronic databases (Medline/Embase/PsycInfo/Cochrane/HMIC) were searched from 2012-2022. Studies involving videorecording patients aged ≥ 18 years for diagnosis, care, or treatment were identified. Study quality was assessed using published appraisal tools. Acceptability was evaluated through i) recruitment/retention rates, and ii) synthesis of patients’ and professionals’ perspectives and experiences. Sekhon’s Theoretical Framework of Acceptability (TFA), consisting of seven constructs (affective attitude/burden/ethicality/ intervention coherence/opportunity costs/self-efficacy), underpinned the synthesis. 

RESULTS 
Of 14,221 citations, 27 studies (mainly low-quality) met inclusion criteria. 10/27 studies recruited older patients including those with Parkinson’s Disease (PD), dementia, stroke, end-of-life care, average age was 69. Video-recording was used in diagnosis, management/monitoring, and rehabilitation of older patients. Mean recruitment rate was 58.8% (34.2%-73.7%): mean retention rate was 81.3% (73.4%-100%). Reasons for non-participation/withdrawal related to the video-recording intervention itself (privacy concerns/poor video quality) and other factors (patients lost to follow-up). Framework synthesis generated 17 sub-themes linked to the seven TFA constructs. Attitudes to video-based records were largely positive. Video-recordings were perceived to be helpful in facilitating diagnosis/treatment/care for patients with movement disorders (PD; high-risk fallers), including in dementia populations. Digital literacy, illness severity and cognitive impairment influenced patients’ capacity to consent to video-recording.  Healthcare professionals were concerned about technical challenges but burden was minimised through using portable devices (e.g.iPad) for video capture. 

CONCLUSION 
Video-based records may be acceptable to older patients and professionals, providing valid consent is obtained and the potential benefits are recognised. Further research is needed to evaluate the acceptability, feasibility, and effectiveness of this approach.

Introduction

Small vessel disease (SVD) lesions may cause symptoms apart from stroke. We aimed to determine whether white matter hyperintensity (WMH) progression and incident infarcts associate with gait, mood, and cognitive symptoms.

Method

We recruited patients with non-disabling stroke (modified Rankin Scale <3), performed diagnostic MRI, and questioned participants/informants about gait, mood, cognitive, Center Epidemiologic Studies-Depression Scale (CES-D), Neuropsychiatric Inventory-Questionnaire (NPI-Q) symptoms and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE).

The baseline visit occurred < 3months post-stroke. We repeated MRI and symptoms assessments every 3-6 months for 12 months, assessing WMH change and incident infarcts (i.e. new since previous scan) on DWI or FLAIR. We analysed WMH using cubed root normalised for intracranial volume. We used linear mixed-effects models, adjusting for age, gait speed, modified Rankin Scale, and time for gait symptoms; age, anxiety, MoCA, stroke subtype, and time for cognitive/neuropsychiatric symptoms. 

Results

We recruited 230 participants (mean age=65.8 [SD=11.2] years; 34% female; 56.5% lacunar); median baseline WMH volumes = 8.26mL (IQR 3.65-19.0); one-year = 8.24mL (IQR = 4.15-20.1). Incident infarcts (n=110, 82/110 (74.5%) small subcortical subtype) occurred in 53/230 (23%) of patients.

WMH progression over one year was associated with falls (OR=4.13 [95% CI=1.6-10.1]); self-reported brain fog (OR=3.13 [95% CI=1.11-8.82]); and increasing NPI-Q scores (est=2.12 [95% CI=0.46-3.77] p=0.012). Baseline and one-year WMH volumes were cross-sectionally associated with apathy (baseline OR=8.78 [95% CI=2.56-31.88]; one-year OR=4.83 [95% CI=1.43-17.26]).

Higher CES-D depression scores were associated with incident infarcts (mean 15.2 [12.9] with vs 11.9 [SD10.6] without; est=2.26 (95% CI=0.12-4.4), p=0.038). WMH progression and infarcts were not associated with fatigue, anxiety, subjective memory complaints, confusion, dizziness, or IQCODE scores.

Conclusions

SVD progression following minor stroke co-associates with specific gait/cognitive/mood symptoms. WMH progression and incident infarcts may cause non-focal, non-stroke symptoms which characterise a potential ‘SVD syndrome’.

Introduction

Sarcopenia is common in patients with hip fracture, but few studies have examined whether assessment of sarcopenia improves prediction of adverse post-operative outcomes. We examined whether sarcopenia, diagnosed using handgrip strength (HGS), could predict outcomes after hip fracture.

Methods

Routinely collected data from the National Hip Fracture Database were combined with locally collected HGS data from a high-volume orthopaedic trauma unit. Patients aged ≥65years with surgically managed, non-pathological hip fracture with grip strength measured on admission were included. The European Working Group on Sarcopenia in Older People (EWGSOP2) thresholds were used to identify patients with or without sarcopenia; those unable to complete grip strength testing were also included in analyses. Outcomes examined were 30-day and 120-day mortality, residential status and mobility, prolonged length of stay (>15 days) and post-operative delirium. Binary logistic regression models were used to examine prognostic value of HGS, and discriminant ability for the Nottingham Hip Fracture Score (NHFS) alone and on adding sarcopenia status were compared using c-statistics.

Results

We analysed data from 282 individuals; mean age 83.2 (SD 9.2) years; 200 (70.9%) were female. 99 (35.1%) patients had sarcopenia and 109 (38.7%) were unable to complete testing. Sarcopenia predicted higher 120-day mortality (OR 13.0, 95%CI 1.7-101.1, p=0.014), but not 30-day mortality (OR 1.5, 95%CI 0.1-16.9, p=0.74). Patients unable to complete HGS testing had higher 30-day mortality (OR 13.5, 95%CI 1.8-103.8, p=0.012) and 120-day mortality (OR 34.5, 95%CI 4.6-258.7, p<0.001). Sarcopenia status did not significantly improve discrimination for mobility but improved prediction of 120-day residential status (c-statistic 0.89 [95%CI 0.85-0.94] for NHFS+sarcopenia vs 0.82 [95%CI 0.76-0.87] for NHFS alone) and post-operative delirium (c-statistic 0.91 [95%CI 0.87-0.94] vs 0.78 [95%CI 0.73-0.84]).

Conclusion

Sarcopenia assessment via HGS testing may provide additional prognostic information to existing risk scores in older patients with hip fracture.