Scientific Research

Introduction

Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.

Introduction:

The presence of ischemic cerebrovascular accident in COVID 19 patients is a complication that has stood out due to its complications, the predisposing factors are the procoagulant state derived from the infection as well as cardiovascular arrhythmic causes. Patients: Describe the frequency of cerebral ischemia and cardiac rhythm disturbances in patients admitted to the emergency room from July 2020 to January 2021 and its impact on prognosis and mortality.

Methods:

Retrospective study of 306 adults infected by SARS COV2 by antigenic or molecular test. The presence of these events was examined in a follow-up and the associated complications were described.

Results:

There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the ROX values were higher in the survivors at 2 h 5.7 (4.6 - 6.8), in relation to the deceased 3 ,2 (2.9 - 4.2), The presence of ischemic cerebrovascular events occurred in 9 patients (2.9%), occurring in 8 of the male gender and 1 of the female gender, the average age of those who presented said complication was 72, 3 years with standard deviations of 62.9 and 81.7 respectively, 3 of them presented cardiorespiratory arrest. Arrhythmic causes were found in only 1 of the patients, the rest were cryptogenic events. None of the cerebral panangiography studies showed aneurysms or vascular malformations. The mortality of patients with cerebral ischemia was 33% (3/9). It was not possible to perform thrombolysis in any patient. Only 1 patient was a candidate for mechanical thrombectomy.

Conclusions:

The present study showed that the presence of cerebral ischemia is not so uncommon, approaching what has been published in other series and reported works. Studies with larger groups of patients are required to validate the results found here.

Introduction:

Since the first wave of COVID-19, caused by SARS-CoV-2 virus, we have sought to identify possible short- and long-term complications, the so-called "post-discharge syndrome", especially in patients at higher risk, after prolonged hospitalization and intensive care.

Objective:

The aim of the study was to study the outcomes, possible adverse consequences after severe COVID-19 illness and its predictors in the 90-day post-hospitalization stage in elderly patients with asthma.

Methodology and Results:

We conducted a longitudinal observational study including 131 patients older than 60 years hospitalized for COVID-19, with a history of bronchial asthma who met the GINA 2020 criteria. The main risk factors for death in the post-hospital stage included Charlson comorbidity index values of 4 points or more, CT lung damage ≥30%, absolute number of eosinophils less than or equal to 100 cells/μl and the presence of diabetes mellitus, with the presence of diabetes mellitus being the factor with the shortest mean survival time after discharge.

Discussion:

COVID-19 usually requires hospital treatment and mortality of hospitalized patients is high, the factors for death were old age (82.1 years), a higher frequency of concomitant diseases and the presence of addiction. An increased risk of death was found in patients with asthma and heart failure. A greater number of comorbidities also correlated with worse clinical outcomes.

Background:

Patients not yet receiving medication provide insight to drug-naïve early physiology of Parkinson's Disease (PD). Decisions to start medication and assessment of response to its initiation can be challenging for physicians and patients alike.

Aim:

To identify objective, sensor-derived features of upper limb bradykinesia, postural stability, and gait that can inform decision-making in a movement disorder clinic. Methods: We used a single finger sensor to identify upper limb features and an array of six body-worn sensors to measure postural stability and gait. Patients were tested over nine visits, at three-monthly intervals, as part of a standard neurological examination.

Results:

Three upper limb bradykinetic features (finger tapping speed, pronation supination speed, and pronation supination amplitude) and three gait features (gait speed, arm range of motion, duration of stance phase) were found to progress in unmedicated early-stage PD patients. In all features, progression was masked after the start of medication.

Conclusion:

Commencing antiparkinsonian medication is known to lead to masking of progression signals in clinical measures in de novo PD patients. In this study, we show how this effect can be measured using digital devices. The testing kit can be used in movement disorder clinics to inform decision-making and progression monitoring in early PD.

Toby Jack Ellmers (Imperial College London), Jodi Ventre (University of Manchester), Ellen Freiberger (Friedrich-Alexander-University Erlangen-Nürnberg), Klaus Hauer (AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg), David B Hogan (University of Calgary), Lisa McGarrigle (University of Manchester), Samuel Nyman (University of Winchester), Mae Ling Lim (Neuroscience Research Australia), Chris Todd (University of Manchester), Kim Delbaere (Neuroscience Research Australia), The World Falls Guidelines Working Group on Concerns About Falling

Background: Concerns (or, ‘fear’) about falling are common among older people. They have been reported to be associated with various negative outcomes, including activity restriction, depression, decreased quality-of-life and social isolation. Whilst prior conceptualisations have proposed an association between concerns about falling and future falls, the evidence base for such purported association is uncertain. We therefore conducted a systematic review to explore the association between concerns about falling and future prospective falls.

Methods: We searched 4 databases for articles that included concerns about falling as a baseline predictor for future falls over a 6-month period or longer. Following the removal of duplicates, we screened the abstract and titles of 10,554 articles; and the full text of 172 articles.

Results: We included and extracted data from 58 articles. A significant association between baseline concerns about falling and future falls was reported in 76% of the articles assessed (44/58); with higher concerns associated with a greater risk/odds of future falls. This significant association remained when controlling for confounding variables (n=16 articles).

Conclusion: These findings support previous conceptualisations and identify concerns about falling as an independent risk factor for future falls. As part of the World Falls Guidelines, we recommend that clinicians working with older people regularly screen for concerns about falling, using the short 7-item Falls Efficacy Scale-International (FES-I). Further analysis is currently ongoing to conduct meta-analyses based on specific outcomes (e.g., recurrent vs. single falls) and assessment tools (e.g., FES-I vs. single-item measures).

Introduction:

The sign of Frank or sign of the cleft lobe has been associated with the existence of a disorganization of the elastic fibers and a thickening of the arterioles that causes a vascular sclerosis and a chronic local ischemia of the lobe of the ear.

Objectives:

To determine the relationship of the split lobe sign with cardiovascular diseases in geriatrics patients of the Internal Medicine service of a Southamerican hospital 2017 to July-2018.

Methodology:

A descriptive and cross-sectional observational study of cases and controls to establish a relationship between the sign of the diseased lobe and cardiovascular disease.

Results:

We observed Smoking is a risk factor directly associated with the presence of the cleft lobe sign p (0.047), there being a greater tendency to appear when the intensity of smoking is higher. The presence of the lobe sign generates a relative risk of 2.062 times in terms of cardiovascular events compared to those who do not. Conclusions: We consider that the association found between the sign of the cleft lobe, smoking and cardiovascular diseases, give us an easily identifiable tool for a population at higher risk for the development of these pathologies.

Introduction:Aging has been defined as a progressive, generalized impairment of function resulting in a loss of adaptive responses.Balance impairment is a major contributor to falling in elderly as efficiency of postural control system decreases with aging.Several different exercise programs have been suggested to address balance and falls in elderly.Virtual reality gaming and dual task training on balance may be an effective tool for addressing these problems because it includes different elements of balance which may improve functional mobility and is at the same time enjoyable and engaging.

Method:A total of 30 participants with the mean age of 67.63 ±4.32 years were included in the study, they were randomly divided in two groups. Group 1(Virtual reality Gaming) and Group 2(Dual task training).Both the groups received conventional therapy along with the specific interventions mentioned.The total duration of the intervention was 2 weeks and 5 sessions were given per week, each lasting for about 40 minutes.Pre and post-assessment for balance was assessed by scales including One-legged standing(OLS) test and Performance Oriented Mobility Assessment(POMA).The within-group comparison was made using Wilcoxon Signed rank test and between-group using the Mann Whitney U test to see the effect of treatment intervention.

Results:Within-group comparison for OLS and POMA showed statistically significant differences for the Pre and Post-intervention values (p<0.05).Between-group comparison demonstrated that Dual task training was more effective in improving the OLS balance as compared to virtual reality gaming (p=0.038).For POMA both the interventions were equally effective (p=1.00)

Conclusion:The study concluded that both Virtual reality Gaming and Dual task training were equally effective in improving balance when measured on POMA scale but Dual task training proved to be more effective in improving the OLS balance of the elderly when compared with Virtual reality.Therefore, we conclude that both the interventions can be used in improving balance of the elderly.

Introduction:Aging has been defined as a progressive, generalized impairment of function resulting in a loss of adaptive responses.Balance impairment is a major contributor to falling in elderly as efficiency of postural control system decreases with aging.Several different exercise programs have been suggested to address balance and falls in elderly.Virtual reality gaming and dual task training on balance may be an effective tool for addressing these problems because it includes different elements of balance which may improve functional mobility and is at the same time enjoyable and engaging.

Method:A total of 30 participants with the mean age of 67.63 ±4.32 years were included in the study, they were randomly divided in two groups. Group 1(Virtual reality Gaming) and Group 2(Dual task training).Both the groups received conventional therapy along with the specific interventions mentioned.The total duration of the intervention was 2 weeks and 5 sessions were given per week, each lasting for about 40 minutes.Pre and post-assessment for balance was assessed by scales including One-legged standing(OLS) test and Performance Oriented Mobility Assessment(POMA).The within-group comparison was made using Wilcoxon Signed rank test and between-group using the Mann Whitney U test to see the effect of treatment intervention.

Results:Within-group comparison for OLS and POMA showed statistically significant differences for the Pre and Post-intervention values (p<0.05).Between-group comparison demonstrated that Dual task training was more effective in improving the OLS balance as compared to virtual reality gaming (p=0.038).For POMA both the interventions were equally effective (p=1.00)

Conclusion:The study concluded that both Virtual reality Gaming and Dual task training were equally effective in improving balance when measured on POMA scale but Dual task training proved to be more effective in improving the OLS balance of the elderly when compared with Virtual reality.Therefore, we conclude that both the interventions can be used in improving balance of the elderly.

Objective: To evaluate the environmental impact from home visits the ESD team carry out and the implementation of electric vehicles to reduce the carbon footprint.

Methods: Travel expense data of the ESD team across the last 2 weeks of April was collected and CO2 emissions from each team member was derived. A focus group was conducted to gather the team’s stance on electric vehicles for home visits.

Results: A significant amount of CO2 is produced daily, with the total across the two weeks being close to that of a small-to-medium enterprise. Introducing an electric vehicle would help reduce the CO2 emissions, with a 62% reduction seen in week 1 if the person with the greatest emissions were to have the vehicle.

Conclusion: Although there are disadvantages, implementing an electric car into a department where multiple home visits are carried out in a day would help significantly in reducing the carbon footprint and help NHS Wales reach their environmental targets.

Fractures occurring after “low energy trauma” are described as fragility fractures. They most commonly happen in the spine, hip and wrist due to osteoporosis and its associated risk factors, including gender, age, medications (e.g. steroids), etc (1). Menopause in women also has a drastic impact on the risk of osteoporosis. In 2019, 3,775,000 UK citizens had a diagnosis of osteoporosis - 820,000 men and 2,955,000 women. In the same year, there were 527,000 new fragility fractures in the UK (2). Nevertheless, osteoporosis and fragility fractures do not only pose a problem within the UK. It is estimated that the number of hip fractures worldwide will increase by 4,600,000 between 1990 and 2050 as a result of an ageing population (3). The percentage of the world's population over the age of 60 is projected to rise from 12% to 22% between 2015 and 2050 (6). This age shift in particular will bring on challenges as the risk of hip fractures doubles every 10 years after the age of 50 (3). Fragility fractures can have a drastic effect on patient well-being. Surgery for hip fractures for instance has a 4% mortality rate and approximately 20% of patients die within a year (3). Patient mobility, housing conditions and quality of life all deteriorate after hip fractures (4). The impact on health economics is also significant. Direct medical costs resulting from fragility fractures in the UK were approximated at £1.8 billion in 2000 and were projected to rise to £2.2 billion by 2025 (1). However, newer reports have shown that we underestimated this burden with the total annual cost of fragility fractures in the UK reaching £4.4 billion in 2022 (5).

Introduction:

Around 10% of calls received by English ambulance services are for older adults who have fallen¹; with an ageing population there are significant care provision needs. Decision-making on the treatment for people who fall, can impact their future physical and mental health. Previous research in decision-making of ambulance staff found perception of role, confidence, service demands and training to be key drivers². Previous work highlights drivers, but not experiences that explain why they occur.

Aim: to determine the experiences and confidence of frontline emergency clinicians in attending older adults who have fallen.

Method:

Online cross-sectional survey of frontline ambulance staff from one English ambulance service in May 2023. Including open questions that generated qualitative data for thematic analysis³. Ethical and regulatory approvals, and informed consent, were obtained.

Results:

81 participants completed the survey. Analysis identified three themes:

Care Pathways: Provision of hospital avoidance pathways varies throughout the region. Concerns arose from not knowing what different areas had and reduced accessibility out of hours.

“Only issue does arise when it’s between 1700 and 0900, as there’s very very limited alternative pathways” P6

Shared Decision-Making: Patients, family and clinicians were all valued as part of shared decision-making, with past feedback on decision-making informing future practice. 

Communication: Decision-making confidence was impacted by the participants experiences; positive experiences encouraged use of hospital avoidance pathways, whilst negative experiences impeded willingness to avoid hospital for fear of repercussion.

"Many services are helpful and willing to assist with education for hospital avoidance.” P18

Conclusion:

Prominent themes arose from the challenge of a regional and 24/7 ambulance service, not having consistent pathways available. This variation led to concerns when responding to patients outside of the clinician’s usual area and further challenges ambulance clinicians must balance in their practice.

References:

1. Snooks, Anthony, Chatters, et al. (2017) Health Technology Assessment, 21; 1-218.

2. Simpson, Thomas, Bendall, et al. (2017) BMC Health Services Research. 17; 299.

3. Braun and Clarke. (2006) Qualitative Research in Psychology, 3; 77-101.