Scientific Research

Background : Three challenges for ageing populations are frailty (a state of reduced physiological reserve), social isolation (objective lack of social connections), and loneliness (subjective experience of feeling alone). These are associated with adverse outcomes. This study aims to examine how frailty in combination with loneliness or social isolation is associated with all-cause mortality and hospitalisation rate using data from UK Biobank, a large population-based research cohort. Methods: 502,456 UK Biobank participants were recruited 2006-2010. Baseline data assessed frailty (via two measures: Fried frailty phenotype, Rockwood frailty index), social isolation, and loneliness. Adjusted cox-proportional hazards models assessed association between frailty in combination with loneliness or social isolation and all-cause mortality. Negative binomial regression models assessed hospitalisation rate. Findings: Frailty, social isolation, and loneliness are common in UK Biobank (frail as per frailty phenotype 3.38%, frail as per frailty index 4.68%, social isolation 9.04%, loneliness 4.75%). Social isolation/loneliness were more common in frailty/pre-frailty. Frailty is associated with increased mortality regardless of social isolation/loneliness. Hazard ratios for frailty (frailty phenotype) were 3.38 (3.11-3.67) with social isolation and 2.89 (2.75-3.05) without social isolation, 2.94 (2.64-3.27) with loneliness and 2.9 (2.76-3.04) without loneliness. Social isolation was associated with increased mortality at all levels of frailty; loneliness only in robust/pre-frail. Frailty was also associated with hospitalisation regardless of social isolation/loneliness. Incidence rate ratios for frailty (frailty phenotype) were 3.93 (3.66-4.23) with social isolation and 3.75 (3.6-3.9) without social isolation, 4.42 (4.04-4.83) with loneliness and 3.69 (3.55-3.83) without loneliness. At all levels frailty, social isolation/loneliness are associated with increased hospitalisation Results were similar using the frailty index definition. Conclusion: Social isolation is relevant at all levels frailty. Risk of loneliness is more pronounced in those who are robust or pre-frail. Proactive identification of loneliness regardless of physical health status may provide opportunities for intervention.

Introduction

Vertebral fragility fractures (VFF) are the most common osteoporotic fracture. VFF can result in significant pain requiring hospitalisation. However, there is little data on patient numbers, hospital bed days and costs, contributed to by these patients.

Methodology

We report a retrospective analysis of patients aged 55 years and over admitted to hospitals across England from 2017-2019. ICD-10 classifications for VFF and OPCS codes were used to identify admissions and patients who had undergone vertebral augmentation (VA).

Results

There were a total of 99,240 patients (61% Female) admitted during this period, with 64,370 (65%) patients aged 75 and over. On average, there was a 14.3% increase in admissions annually. The increasing trend was more notable in those aged 75 years and over. Patients aged over 75 years accounted for 1.5 million bed days, costing £465million (median length of stay (MLOS) 14.4 days). In comparison, those aged 55-74 years, accounted for 659,000 bed days, costing £239 million (MLOS 10.7 days). The majority of patients (84%) were admitted under a non-surgical speciality and were primarily older (median age 76.8 vs 67.6 years, MLOS 8.2 vs 6.0 days). 1755 patients underwent VA (1.8% of the total cohort). 775 (44.2%) of these were aged 75 years and over. The MLOS and cost per patient admission was lower in the VA group compared to those managed non-surgically (MLOS 2.4 vs 10.8 days, p=<0.01, cost £4737 vs £7250)

Conclusion

Patients aged 75 years and over hospitalised with VFF represented a significant number, cost, use of bed days and associated longer MLOS. Those undergoing VA had a significantly shorter length of stay. Further studies are necessary to identify older patients with VFF who may benefit from early VA.

Introduction: Moving into a care home is a significant, life-changing experience which occurs to address care needs which cannot be supported elsewhere. UK health policy recommends against moving into a care home from the acute hospital. However, this occurs in practice. Better understanding pathways into care homes could improve support for individuals and families, service planning and policymaking. Our aim was to characterise individuals who move-in to a care home from hospital and those moving-in from the community, identifying factors associated with moving-in from hospital.

Method: A retrospective observational cohort study was conducted involving adults moving into care homes in Scotland between 1/3/13-31/3/16 using the Scottish Care Home Census (SCHC), a national individual-level social care dataset. SCHC data were linked to routine data sources including hospital admissions, community prescribing and mortality. The data were split into those moving-in from hospital and those moving-in from the community. Descriptive statistics characterising the two groups were generated and multivariate regression undertaken to identify factors associated with moving-in from hospital.

Results: A total of 23,892 individuals were included in the analysis, of whom 13,564 (56.8%) moved-in from hospital. A third came directly from an acute hospital, with 57.7% from rehabilitation or community hospitals and 7.1% from inpatient psychiatry. Being male, receiving nursing care, high frailty risk, increasing numbers of hospital admissions and diagnoses of any fracture or stroke in the six months before moving-into the care home were all significant predictors of moving-in from hospital.

Conclusions: The population moving-in to care homes from hospital are clinical distinct from those moving-in from the community. National cross-sectoral data linkage of health and social care data is feasible, but the available data are dominated by health characteristics. There is an urgent need to operationalise other meaningful variables which shape care pathways to enhance understanding and evidence.

Background: People living with dementia are more likely to move into care homes. The true prevalence of dementia among care home residents in Scotland is not known. People living with dementia often interact with multiple social and healthcare services, thus routine data may offer a way to enhance understanding.

Aim: To compare national health and social care data sources recording dementia status for Scottish care home residents.

Methods: A retrospective cohort study of adult (≥ 18 years) care home residents in Scotland during financial years 2012/13 and 2013/14. An indexing process linked data from the Scottish Care Home Census (SCHC) to Community Health Index numbers to allow linkage to healthcare datasets. Anonymised individual data was accessed in a secure environment, within the National Safe Haven. A linked dataset with acute/general and psychiatric hospitalisations (SMR01, SMR04), prescriptions (Prescribing Information System), Scottish Patients at Risk of Admission and Readmission (SPARRA) data, and National Records of Scotland (NRS) mortality records was analysed. Dementia recording was studied across these datasets.

Results: In 2012/13 and 2013/14, 31,589 and 31,504 care home residents were included for analysis. In 2012/13, 17,548 (55.5%) had dementia according to SCHC. PIS and SMR01 confirm 4,701 (26.8%) and 4,254 (24.3%) SCHC dementia records, respectively. SMR04 and SPARRA confirm 1,830 (10.4%) and 964 (5.5%). Among 2012/13 residents, 19,593 (62.0%) have at least one dementia record across datasets. Of these, 10,445 (53.3%) have one record – 83.9% SCHC records, 7.3% SMR01 records, and 5.0% PIS records. Of 15,781 residents who die within 5 years from 2012/13, 6,984 (44.3%) have death records confirming dementia. Results for 2013/14 are similar.

Conclusion: Routine data enhances dementia ascertainment amongst care home residents, with most confirmation from general hospitalisations and prescriptions. Primary care data and analysis of more financial years would enable further exploration of dementia recording patterns.

Introduction: Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga.

Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS.

Methods: We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to locate randomized controlled trials which compared BT with standard care post HFS. The Cochrane’ Library Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used as our template for the review.

Results: Overall, nine randomized controlled trials were selected, comprising a total of 712 patients, all aged 65 years of age and older. With regards to the type of BT rehabilitation: four trials used step-ups (n=500), three trials used balance task-specific exercise (n=170) and two studies used standing on one leg (n=42). The BT group demonstrated improvement in physical functioning post HFS compared to the control group (Standardized Mean Difference (SMD) = 0.410). Moreover, all functional parameters which include, lower limb strength, performance task and health related quality of life, were also improved in the BT group.

Conclusion: Evidently, the results demonstrate an improvement of physical functioning by BT post HFS. Furthermore, the positive effects on all functioning parameters were apparent. As a result, the implementation of BT in postoperative rehabilitation programs in elderly patients with hip fractures should be considered. References: Monticone M, Ambrosini E, Brunati R, et al. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil. 2018;32:340–351

Introduction

Diagnosis of Transient Ischaemic Attack [TIA] is important to minimise risk of future strokes. This retrospective descriptive study aimed to evaluate sociodemographic and risk factor differences between TIA and TIA ‘mimics’ in patients presenting to an inner-city neurovascular clinic.

Methods

Data was obtained over a 2-year period [2019-2020] for all new patients assessed in a consultant-provided daily week-day neurovascular service that serves a million multi-ethnic, population. Data collected included socio-demographic details, clinical risk factors, source of referral and final clinical diagnoses.

Results

Of 1764 patients, 39% [694] were diagnosed as TIA; 61% [1070] were TIA mimics with 40 distinct differential diagnoses. Compared to TIA mimics, TIA patients were older [mean (SD): 69.3(13.8) vs 59.7(16.1), p<0.001]; higher prevalence of TIA mimics in females vs males [66%vs54%; p<0.001]. There were proportionately more patients with TIA mimics from Black and minority ethnic groups (401/610:66%) compared whites (669/1154:58%) [p=0.034]. Compared to TIA mimics, TIA patients had higher prevalence of hypertension [56%vs40%, p<0.001], Diabetes [22%vs14%, p<0.001], Atrial Fibrillation [10%vs4%, p<0.001], Chronic Heart Disease [18%vs9%, p<0.001] and moderate to severe carotid stenosis [5%vs0.4%, p<0.001]. Prevalence of other risk factors in TIA patients included Patent Foramen Ovale [1.4%], Cardiolipin Antibodies [3.2%], and Thrombophilia [2.3%]. 14% of TIA patients had no identifiable risk factors.

Discussion

This large survey has described socio-demographic [age, gender and ethnicity] differences and prevalence of risk factors between TIA patients and TIA mimics. These differences may be useful in terms accurate diagnosis of TIA by experienced clinicians. This study provides valuable information for clinicians and researchers of stroke services in future.

Introduction

Geriatric and general medical wards have nationally been troubled with an ever increasing patient population requiring carer support at home and a widespread shortage of those able to deliver it. This pilot project aimed to assess patient understanding of the care they were awaiting, their understanding of the reason for ongoing hospitalisation and their satisfaction with the care on discharge. We aimed to improve patient understanding with the use of a patient information leaflet (PIL).

Method

Patients identified during multi-disciplinary team meetings at two district general and one community hospitals as being medically fit for discharge and awaiting care at home were questioned. Those lacking capacity for the discussion were excluded. Approximately half questioned were given a PIL detailing the scope of a domiciliary care package. Patients discharged home were followed up via telephone.

Results

Twenty nine patients were questioned. 21% of patients died before follow up and 14% were excluded due to direct care home admission. Only 59% were discharged home. Two thirds had received domiciliary care previously. Good awareness that wait for care was hindering discharge (76%) but poor understanding of scope of carers. 21% believed care call duration was limitless, 28% expected their home to be cleaned and 31% believed they chose the timing of care calls. All happy with care received at home. Poor recall of information on PIL.

Conclusion

Prolonged periods waiting for care is associated with high mortality and institutionalisation rates. Awareness of the discharge process and scope of care could be improved but PIL unlikely to be a sufficient method for such complex matters. For those discharged, patient satisfaction of the care received is high. Further research is required.

Introduction

Perioperative geriatrics is an emerging specialty with immense importance to all medical and surgical specialties. Only a small number of papers have been published on the topic. A bibliometric analysis is used to identify themes and trends in current research and practice. Objectives To identify and describe research topics relating to perioperative geriatrics.

Methods

Thompson Reuters Web of Science indexing database was searched for all manuscripts relating to perioperative geriatrics. Of these, the top 100 were subcategorised into manuscript type, age, theme, specialty, journal and citation rate.

Results

The highest cited article was by Bhandari et al with 294 citations. The highest citation rate was achieved by Partridge et al, 23.75 citations/year. Across the series, the mean number of citations was 50.41 (range 294-12). The highest number of manuscripts were published between 2010-19 (n=55), with 70% of manuscripts published in journals with impact factor < 5. The specialty with the highest number of publications was orthopaedics (n=36), followed by cardio-thoracics (n=15). Most articles focussed on surgical management of geriatrics patients, followed by anaesthetic management.

Conclusion

This is the first bibliometric analysis of the top 100 most cited papers in perioperative geriatrics. Only 395 papers were returned, indicating that this needs to be further researched as a topic. Key themes identified were surgical management and anaesthetic treatment. Key Words Bibliometric analysis, literature review, geriatrics, perioperative

Introduction

Parkinson’s Disease is the second most common neurogenerative disorder and has a pervasive effect on health-related quality of life. There is increasing evidence of the importance of the endocannabinoid system in pre-clinical models of disease. However, there is a paucity of clinical evidence on cannabis-based medicinal products (CBMPs) in Parkinson’s Disease. This study presents a preliminary analysis of those with Parkinson’s Disease enrolled in the UK Medical Cannabis Registry (UKMCR). Method Patients prescribed CBMPs for Parkinson’s Disease symptoms for longer than one month were identified from the UKMCR. The primary outcomes were changes from baseline in Parkinson's Disease Questionnaire-39 (PDQ-39), Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L scales at one month. p<0.050 was defined as statistically significant.

Results

Thirty-four patients were identified from the UKMCR that met the inclusion criteria. Twenty (58.82%) patients were male, and the mean age was 66.76 ± 11.60 years. The median Charlson co-morbidity index score was 5.00 (IQR: 3.00-6.00). There was a significant improvement at one month follow up in the EQ-5D-5L index value, as well as the pain and discomfort, and usual activities domains (p<0.050). There was no significant change at one month in the PDQ-39, GAD-7 or SQS measures (p>0.050). Twelve adverse events were reported by two (5.88%) participants. The majority of adverse events were mild (n=7; 20.59%) or moderate (n=3; 8.82%). There were no life-threatening adverse events.

Conclusions

This preliminary analysis demonstrates a possible association with improved general health-related quality of life secondary to improvements in the ability to perform usual activities, as well as pain in those with Parkinson’s Disease. Moreover, the results suggest that CBMPs are well-tolerated in the first month of treatment. However, this must be interpreted with caution considering the small sample size, length of follow-up and the limitations of observational study design.

Introduction

As we face a 7th wave of Covid in our geriatric wards, we as caregivers are exhausted and find it increasingly difficult to repeat these isolation measures again and again. We are aware of the importance of avoiding clusters but it is mostly the elderly who are positive for Sars-Cov-2 and hospitalised. Fortunately the virus no longer kills, but nevertheless has enormous deleterious consequences on the mental health of our elderly.

Methods

To expose the practical consequences of clinical cases experienced during these successive waves of Sars-Cov-2 and make a review of the literature concerning this theme.

Results

The patients with moderate to severe cognitive disorders almost all presented a confused state and lost autonomy during their period of isolation. After more than 2 years, it can be stated that these patients really suffered from this quarantine for sometimes 14 days or more. Behavioural disorders increased, patients who were paranoid increased their disorders The families also suffered as well as the geriatric carers who had all the difficulties to take care of these patients in a global way with all the paramedics and stimulations that we usually bring them.

Conclusions

The consequences of this forced isolation, whether in hospital in an acute unit, at home or in a nursing home, has had and will have serious consequences on the mental well-being of our seniors. If we "have to live with these successive mutations", should we not think about not isolating our elderly patients in such a deleterious way? Ethical considerations must be analysed as much as public Health. We must also be careful not to increase "ageism" in this period of pandemic.

^{References R.Manca et al,Front.Psychiatry,2020,D.Piette et al, Louvain Medical ,2021,B.Meisner et al,Canadian Journal on Aging,2020}