Scientific Research

INTRODUCTION: Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by frightening or traumatic events. Delirium is a state of acute confusion associated with acute illness, surgery, and hospitalisation. Delirium is known to be associated with a risk of PTSD in patients in the Intensive Care (ICU) setting. However, there is limited information on the prevalence of delirium in older adults outside of Intensive Care. Therefore we undertook a systematic review to ascertain the prevalence of PTSD in elderly patients after an episode of delirium on a general ward.

METHODS: The systematic review was conducted using MEDLINE (1946-10/01/2024), Embase (1974- 10/01/2024), and PsycINFO (1806- 10/01/2024) to identify studies. Studies were eligible if they included adults aged ≥ 65 years, admitted to an acute hospital, diagnosed with delirium using a validated screening tool, (e.g. 4AT, CAM-ICU) and subsequently screened for PTSD at any point following discharge with a validated screening tool (e.g. the PTSS-14). The exclusion criteria excluded ICU cohorts and terminal illness with < 3 months life expectancy. Two researchers (SM, NM) independently reviewed all studies with any disparities resolved though a 3rd researcher (AM)

RESULTS: After removal of duplicates, the search identified 1042 titles from which only 3 eligible studies were identified. All 3 studies were in older patients after surgical procedures (n=132 participants in total). Two of the studies reported no association between delirium and the subsequent risk of PTSD. However, the largest study (n=77) reported a significant independent association between delirium and the 3-month risk of PTSD.

CONCLUSION: The current body of research on the prevalence of PTSD following episodes of in-patient delirium in older adults is limited. The findings of this review highlight the need for further research. A prospective cohort study on Geriatric Medicine wards is being planned.

Introduction

Hyponatremia is the most common electrolyte imbalance caused by serum sodium level of less than 135mmol/L, prevailing 15 and 30% among hospitalised patients [Zhang X, Li XY. Eur Geriatr Med. 2020;11(4):685-692]

Methods

PRISMA guidelines were followed for this study. Pubmed was searched with the search term : (hyponatremia) AND (treatment OR control OR management[MeSH]) AND (elderly[MeSH]) with filters, timeline: 2000 to 21/07/2023, free full text articles and human species.Data extraction was done using  Covidence app and depicted in PRISMA Flow diagram. Quality assessment was done by Cochrane Risk of Bias version 1.Odd’s ratio with 95% conifidence interval was calculated for dichotomous outcomes. Mantel-Haenszel statistical  method  along with random effects model was used. Cochrane Q test was employed and I² index was computed. Forest and Funnel plots were plotted. The analysis was done by Cochrane Review Manager.

Results

Out of 3222 results , 9 studies were included with total 980 patients. 8 were of vaptans and 1 of empagliflozin. Of the vaptans, tolvaptan was studied in 5 studies, satavaptan, lixivaptan and conivaptan in other three. Three studies had low risk of bias and were included in meta-analysis.Mean age  and BMI were 70.55(SD=14.5)  years and 24.73(SD=3.95)  kg/m²  respectively.

Most frequently occuring etiology , comorbidity and symptom were congestive heart failure, hypertension and fatigue/malaise respectively.  Mean baseline serum sodium was 124.89 mmol/L mean rise was 9.142  mmol/L.

Meta-analysis showed that placebo was significantly associated with achieving normonatremia as compared to treatment group(OR=2.5, 95%CI:1.54,4.04, p=0.0002,I²⁼0%).

The most frequent reported side effects were nausea, dry mouth, pyrexia and thirst.Side effects both mild/moderate (OR=1.12, 95%CI:0.69,1.81, p=0.65, I² =0%) and serious  (OR= 1.51, 95%CI: 0.77,2.98, p=0.23,I² =0%) showed no difference between treatment and placebo groups.

Treatment was not associated with rapid risk of overcorrection (OR=1.65, 95% CI:0.57,4.81, p=0.36, I² =0%). None showed osmotic demyelination syndrome.

Discussion

The main conclusions drawn out were:
 (1) The most commonly available drugs beside fluid restriction, hypertonic saline were vaptans- vasopressin receptor 2 antagonists. 
 (2) The possible new drug of choice for treatment of Hyponatremia could be empagliflozin.

Meta-analysis carried out for three studies [28, 29, 34] showed no significant improvement in Hyponatremia by treatment with hyponatremia drugs i.e., satvaptan, lixivaptan and empagliflozin as compared to placebo.

Instead placebo reported a significant improvement Hyponatremia.These results were similar to a review by Jovanovich [37] et al which concluded that they have no role in treatment.

Currently only tolvaptan and conivaptan are approved by the FDA for treatment of hypervolemic and euvolemic hyponatremia The use of vasopressin receptor antagonists remains limited due to its controversial efficacy and potential risks for overcorrection [9].

Rapidly correcting hyponatremia (>12 mEq/L/24 hours) can cause osmotic demyelination, leading to dysarthria, mutism, dysphagia, lethargy, emotional abnormalities, spastic quadriparesis, seizures, coma, and death. 

We did not find any significant rapid overcorrection of Hyponatremia in treatment group as compared to placebo.  This was in contrast to Krisapan et al[38]which reported a greater risk of rapid overcorrection. This could be due to small sample size of the study and yet 3 studies in this review (Estilo et al, Humayun et al and Sag et al) recommended starting with a small dose and imply strict sodium monitoring and for those with a history of hyperlipidemia and who have recently taken thiazide diuretics.

No significant association of treatment group was found with mild/moderate/severe side effects.

Refardt et al showed that empagliflozin could be a promising new treatment due to its reported long term cardiovascular and nephroprotective effects, broader availability and good tolerability. With the daily treatment cost of empagliflozin being similar to urea(2USD vs 4USD), it was th cost of Tolvaptan and therefore it could prove a cost effective treatment option in future when fluid restriction and hypertonic saline fail [37,39].

Conclusion

We conclude that vaptans and Empagliflozin ,although safe, show limited efficacy in hyponatremia treatment.

Introduction. Social support for physical activity is important for engaging older adults in physically active lifestyles. Few studies examined the impact of individual exercise trainers (IETs) in the context of dementia prevention interventions with physical activity. We aimed to assess the contributions of IETs in the remote delivery of a home-based dementia prevention program combining physical exercise and cognitive training targeting older adults at risk for dementia.
Methods. Convergent mixed-method analysis was conducted using data from SYNERGIC@Home, a feasibility study of a 16-week intervention that included one-on-one supervised physical exercise (3 sessions/week) fully delivered through Zoom. Quantitative data consisted of descriptive statistics, measures of adherence, participants’ preference and satisfaction. Qualitative interviews centred on participants’ experience and motivation were conducted post-intervention.
Results. Of the 60 participants randomized to one of four intervention arms (mean age 68.9, 76.7% female), 52 completed the interventions with high overall adherence (87.5%). Pre-intervention, participants expressed a clear preference for cognitive interventions, but post-intervention preference shifted to exercise. IETs (n=21) were part-time research assistants, each assigned to one participant after completing CSEP Certified Personal Trainer® or Clinical Exercise Physiologist™ certification as part of their training. One full-time Lead IET coordinated and supervised the other trainers. IETs worked the closest with study participants, also working closely with study coordinator and with study physician for adverse event monitoring. Interviewed participants (n=15) often described the positive relationships that developed with their IET. Trainers were instrumental in participants’ motivation and enjoyment, personalizing the sessions and addressing technological issues. Satisfaction rates with IETs (n=54 exit survey respondents) were high.
Conclusions. Exercise trainers played crucial roles that extended beyond the supervision of exercise sessions and contributed to participant engagement in the interventions. Access to these allied health professionals should be featured more prominently in strategies/programs promoting active lifestyles among older adults.
 

Introduction

The British Geriatrics Society “Joining the Dots” blueprint recommends delivery of inter-professional education aligned with the Skills for Health Frailty Core Capabilities Framework as part of a system wide frailty strategy. Our ambition is to educate and train the entire health and care system in frailty awareness through the Guildford & Waverley Frailty Academy (GWFA).

Methods

The GWFA developed a Frailty Awareness course aligned to Tier 1 Core Capabilities and introduced this as part of a system wide programme of education and workforce development in frailty. The course was embedded in e-learning platforms across Acute, Community, Ambulance services and Local Authorities. A blend of virtual and face to face (FTF) workshops were used in undergraduate University programmes, the Voluntary sector and care sector.

Results

Between April 2023 and July 2024, 2,195 people completed Tier 1 training.

• Care sector, voluntary sector, Fire service, trading standards: 147 through 7 virtual workshops

• Undergraduate students at the University of Surrey: 234 (FTF)

• Acute, community, Local Authority, Ambulance service: 1,814 people through e-learning

Feedback showed the following:

• 83% said they had good/significant improvement in knowledge after participating in virtual workshops.

• 79% of paramedic students rated their improvement in knowledge and skills as good/ significant as a result of attending their session.

• 90% of nursing students rated their improvement in knowledge and skills as good/ significant as a result of attending their session.

Qualitative responses showed participants felt more aware of frailty and had a better understanding of how to adapt their practice when encountering older people with frailty.

Conclusions

Tier 1 training is an effective method of raising awareness of frailty across a health and care system when applied as part of a broader system strategy using a variety of mediums for delivery.

1. INTRODUCTION: Older adults, particularly those with multi-morbidity, frailty or cognitive impairment, are under-represented in clinical research studies. To facilitate inclusive research for this population requires empowerment of all members of the multi-disciplinary team to promote and advocate for this underserved population. However, understanding of the personal and organisational barriers to staff engagement with research within Elderly Care remains limited.

2. METHOD: Using an amended version of the research capacity and culture tool an anonymous online survey open all staff members of an Elderly Care Department (n=351) in a District General Hospital was undertaken. The survey results were used to inform the departmental 5-year research strategy and launch a multifaceted educational and engagement programme.

3. RESULTS: 107 responses to the survey were received with a wide multi-disciplinary contribution. Despite 89% of respondents stating research was not part of their job, 96% were willing to be more involved in research. Motivators to staff engagement in research included: dedicated time for research (74%), research skills training (73%), mentors (67%), research relevant to elderly care (62%), hearing from researchers within the department (54%) and local promotion of research studies (49%). Barriers to research included: lack of time (78%), unsure of opportunities (65%) and lack of skills (47%). As a result of the survey numerous departmental interventions have been staged: a multi-disciplinary research half day, research opportunity display boards, monthly departmental presentations, promotion of the associate Principal Investigator scheme, Q&A webinars and a section in quarterly newsletter.

4. CONCLUSION(S): Multi-disciplinary staff working within Elderly Care can be motivated to advocate and engage with research opportunities for older adults. Supporting their engagement through the provision of dedicated time, research skills training and promotion of opportunities is key.

Introduction

As a response to the increased demand for nursing home services for older adults, there are new initiatives include building larger nursing homes to accommodate greater numbers of residents. This initiative can be detrimental to those older residents who required to be relocated from their current nursing home to a new one. However, there is limited understanding about how older residents adapt to this relocation, particularly on how they tackle the various issues after relocation. Thereby hindering healthcare personnel to identify appropriate strategies to support older residents during the process of relocation. The aim of this poster is to present the experiences of older residents in the immediate period after relocating to a new nursing home.

Method

A descriptive qualitative approach was adopted. Purposive sampling was used to recruit twenty-four older residents, who were relocated from existing nursing home to a new nursing home, upon ethical approval was sought. Semi-structured interviews were conducted based on the “process of adjustment” framework after consent was obtained. Each interview lasted for around thirty minutes and audio-recorded. Data were analysed using thematic analysis.

Results

Four themes were identified namely: adaptation to the new environment, interaction with other residents, interaction with healthcare personnel, and changes to their daily life. In particular, participants highlighted changes to their daily routines and interactions with others, but most of them expressed positivity about their relocation to the new nursing home.

Conclusion

The results illuminate the initial experiences of older residents required to relocate from their nursing ‘home’ to another with no choice. These findings will inform further interviews over time to help inform person-centred care for residents, the role of carers and service providers, and the care environment.

Background

The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community).

Methods

54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n=28), patients (n=7), carers (n=19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged >65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE).

Results

Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience.

Conclusions

The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.

Introduction: 

There is limited data on the prevalence of hypertriglyceridemia (HTG), a recognized risk factor for cardiovascular disease, in the northeastern region of Colombia. Therefore, we aimed to characterize the local prevalence of HTG and cardiovascular disease-related variables in the subsidized regime population of a city in northeastern Colombia during the period 2020-2022.

Materials and Methods: 

We conducted a retrospective review of medical records from all health centers in Bucaramanga, Santander, Colombia. The study included patients aged 60-95 years who were part of the subsidized regime and had records of cardiovascular risk variables, including the lipid profile. Mean ± standard deviation (SD) was used to describe quantitative variables. Microsoft Excel was employed for database creation, and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS, v.22.1; Chicago, IL).

Results: 

We included 105,461 patients, of whom 72,556 (69%) were female. The mean age was 66 years. The most common comorbidities were hypertension (82%), followed by non-insulin-requiring diabetes mellitus (28%), chronic kidney disease (24%), hypercholesterolemia (24%), insulin-requiring diabetes mellitus (8%), and COPD (8%). A total of 58,456 (55%) patients had hypertriglyceridemia, with mean triglyceride levels of 194.9 mg/dL. Mean cholesterol levels were 168.4 mg/dL, mean HDL levels were 42.7 mg/dL and mean LDL levels were 111.9 mg/dL.

Conclusions: 

More than half of the population enrolled in the subsidized healthcare regime in Bucaramanga, Santander, Colombia, was found to have hypertriglyceridemia during the period 2020-2022, along with other variables related to cardiovascular disease. This finding aligns with reports from other regions of the country.

Introduction:

Receiving a dementia diagnosis can be overwhelming for persons living with dementia (PLWD) and their carers. Accessing information and home supports can be challenging.  Having access to a Patient Navigation (PN) program is one way that may assist PLWD and their carers.

Methods:

This study used a mixed methods design and involved the implementation of a Patient Navigation (PN) program in 6 primary care settings in New Brunswick, Canada, between July 2022-July 2023. PLWD/carers living in their own homes were eligible to enroll.

Results:

There were 150 PLWD with a mean age of 76.77 (SD = 9.2) years and 51.8% were female. The majority (60.7%) were living in rural communities. Most (53.7%) had been diagnosed within the past 2 years with 50.7% having seen a specialist, most commonly a geriatrician.  Almost all (88.7%) had a primary care provider; however, only 25.2% were connected to the social care system, and 19.8% were connected to the home care system.  The most common reasons for enrolling were gaining access to social programs and home supports and seeking dementia specific information.  The average number of goals per PLWD/carer was 3.77 (SD=1.7). The average time in the program was 116.79 days (SD= 91.08) and 76.6% achieved their goals.  The majority (84.0%) were somewhat to very satisfied with the PN program. Carers stated that with increased knowledge, access, and support there was a decrease in social isolation as well as improved confidence, which allowed PLWD to remain in the community longer.

Conclusions:

Most PLWD/carers were connected to the health system, but the minority were connected to social and home care programs. Through connection to the PN program, carers increased their confidence; improved their knowledge; and increased their access to home supports and other care programs, allowing PLWD to remain in the community longer.