Scientific Research

Introduction

People from ethnic minorities are 1.5 times less likely to use digital technology. Within Brighton and Hove, 2021 Census reports that 26.1% described themselves as non-White-British categorised as other White (11.5%), Mixed Race (4.8%), Asian (3.7%), Black (2.0%), Chinese (1.1%), Arab (1.1%), and Other (2.0%). The aim of the project was to understand the lived experience of older ethnic minority adults in Brighton and Hove with digital technology, and how this experience affects their potential engagement with research.

Methods

Older people from ethnic minorities were identified through Brighton and Hove Health Watch, Bridging Change, Sussex Interpreting Services, and Black and Minority Ethnic Partnership. Using a mixed-methods approach, focus group and one-to-one meetings were held with 22 people, exploring their digital literacy, using a Likert scale, and preferences for research engagement using digital means. Meetings were transcribed and thematic analysis was undertaken.

Results

The group average age was 71.6 years. Six identified as male, 16 as female, and confidence with digital technology averaged 3/5 (5 representing high confidence). Variation of digital skills was observed, with older age and language barriers limiting digital access. Digital technology was used for social, transactional and health purposes (booking GP appointments, receiving test results, and GP consultations). Trust and confidence in the research team enhanced the group’s likelihood to engage digitally. Explaining the research in their own language would be an incentive. Younger family members can help explain digital elements. Offering choice of digital alongside traditional methods was important. There was a preference for initial research conversations to be in person. Willingness to engage is higher when the research topic is common in their community or they are personally affected.

Conclusions

Older people from ethnic minorities in Brighton and Hove are willing to engage in research using digital means if tailored to their social circumstances.

Introduction: Wearable technology that continuously monitors physiological metrics has become increasingly popular and allows remote patient monitoring in virtual ward settings. Wearable technology has been shown to be effective in disease monitoring among younger adults. However, its use among older adults, including those with cognitive impairment, is yet to be explored. Aim: We aim to explore the acceptability of remote monitoring using wearable technology among older adults with delirium. Methods: Participants were recruited from an in-patient rehabilitation unit. Inclusion criteria included documented delirium and age over 65 years. Participants were enrolled until delirium resolved or until discharge. Wearable technology was worn continuously, except when being charged or the patient was washing. Device data was recorded every minute. Premorbid Barthel index and Hierarchical Assessment of Balance and Mobility (HABAM) was collected for each participant. Participants were assessed daily for delirium and mobility using the Memorial Delirium Assessment Scale and HABAM respectively. At point of discharge from the study, participants completed a questionnaire to gather feedback on their experience. Results: 20 participants were included, with a mean age of 83.0 years and an average premorbid Barthel’s index of 72. 6. Mean data capture from the wearable technology was 44.1% (12.8-65.8). None of the participants could independently manage the device. Three participants stated that the device interfered with their normal activities with five reporting the device uncomfortable to wear. However, nine participants stated they would wear the device again if asked to by a healthcare professional. Conclusions: Our findings demonstrate that wearable devices are tolerated by delirious older adults with delirium. We found that this group cannot manage these devices independently and need support from either a carer or healthcare professional. These results provides useful information to help pilot these devices among older adults with delirium in virtual ward settings.

Introduction

As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs.  Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning.

There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice.

Methods

Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings.

Results

From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly - mean age 78.5years. Only 4/38 studies integrated patient and public involvement.

Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven.

Conclusions

The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.

TITLE:

Process Evaluation of the BASIL+ trial: a Behavioural Activation approach to addressing low mood and depression among older people with long-term conditions

AUTHORS:

Kate Bosanquet ¹, Elizabeth Newbronner ¹, Peter Coventry ^1,3, Leanne Shearsmith ⁵, Elizabeth Littlewood ^1,4, Della Bailey ¹, Andrew Henry ⁶, Lauren Burke ⁷, Eloise Ryde ^1,9, Dean McMillan ^1,2, David Ekers ^1,4, Simon Gilbody ^1,2, Carolyn A. Chew-Graham ⁸

¹ Department of Health Sciences, University of York, UK

² Hull York Medical School, University of York, Heslington, York, UK

³ York Environmental Sustainability Institute, University of York, York, UK

⁴ Tees Esk and Wear Valley NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK 

⁵ Leeds Institute of Health Sciences, University of Leeds, Leeds UK

⁶ Homerton Healthcare NHS Foundation Trust, Hackney, London, UK

⁷ Manchester Institute of Education, University of Manchester, Manchester, UK

⁸ School of Medicine, Keele University, Staffordshire, UK

⁹ Improvement Academy, Yorkshire & Humber ARC, Bradford Institute for Health Research, Bradford, UK

Abstract

Older adults are at risk of low mood and depression, which can be exacerbated by long-term physical health conditions, leading to poorer health outcomes and increased mortality. The restrictions on social mixing during the COVID-19 pandemic heightened these risks. BASIL+ (Behavioural Activation in Social IsoLation) was a pragmatic randomised controlled trial conducted with patients recruited from general practices in England and Wales. It was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. A behavioural activation intervention, within a collaborative care framework, was delivered by telephone. Participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. A qualitative process evaluation (conducted within the BASIL+ trial), used one-to-one semi-structured interviews to explore the experiences of trial participants, caregivers and BASIL Support Worker experiences. Three main themes emerged from the data analysis: 1) Engagement Dynamic: from Altruism to Self-Realisation; 2) Changing Behaviour and Improving Mood; and 3) Synergistic Nature of the Intervention Components. Findings suggest that the intervention effectively fostered self-awareness among older adults, giving them the confidence and skills to address low mood. Participant engagement with intervention materials varied, highlighting the importance of flexibility in delivery. BASIL+ Support Workers acted as key facilitators, guiding participants through the intervention process, fostering understanding, and providing crucial support. The collaborative care element ensured participants received comprehensive and holistic support, promoting improved mental and physical well-being. These findings underscore the adaptability and flexibility of the BASIL+ intervention, demonstrating its potential to address mental and physical health problems among individuals with varying needs and different starting points. The BASIL+ trial is registered with the ISRCTN registry (ISRCTN63034289).

Introduction

The British Geriatric Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, “Transforming care for older people”. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n=37, 97%), working primarily in secondary (n=21, 55%) and primary care (n=12, 32%). Most respondents were female (n=31, 82%) and 61% (n=23) identified as white British. Over 80% (n=31) were at a senior level (band 8a or above), with 68% (n=26) having over 10 years’ experience. Many identified as specialists in care of older people (n=29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n=34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.

Background
Cognitive impairment (CCL) and dementia are conditions typically occurring throughout the aging process, becoming major concerns in elderly healthcare. Advanced age, genetic factors, lifestyle habits, and comorbidities are risk factors that may increase the risk for both conditions. Thus, the aim of this study is to assess sociodemographic characteristics and comorbidities associated with CCL and dementia in older adults.
Methods
Cross-sectional analysis of the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). To assess the definition of CCL and dementia, the z-score of global cognitive function was calculated, evaluated through measurements of temporal orientation, verbal fluency, episodic, retrospective, and semantic memory domains. In addition, the IQCODE instrument and Activities of Daily Living were used to evaluate dementia. The Chi-Square test was used for the association of variables. The study was approved by the ethics committee.
Results
A total of 2951 participants were included, of whom 158 (5.4%) had CCL and 204 (6.9%) had dementia. Prevalence analyses of CCL revealed higher rates among individuals aged 65 to 74 years (6.18%), females (6.71%), divorced individuals (10.65%), rural residents (8.39%), hypertensive individuals (5.95%), non-diabetics (5.70%), and noncardiac individuals (5.60%). Meanwhile, for dementia, prevalence was higher in individuals aged 75 or older (26.76%), females (8.50%), widowers (18.06%), rural residents (9.75%), hypertensive individuals (8.57%), diabetics (9.01%), and cardiac individuals (13.51%).
Discussion
It was observed that long-lived elderly individuals have higher rates of dementia compared to CCL, as dementia symptoms increase with advancing age. Females and rural residents are in more  vulnerable positions in society, explaining the high prevalence of both diseases. Comorbidities are significant risk factors for dementia development, with cardiovascular diseases, in particular, playing a prominent role in vascular dementia. This broad view highlights the importance of specific management and prevention approaches to preserve cognitive functions during the aging process.

Introduction:

With population aging comes challenges like dementia, prompting the urgent identification of risk factors and its associations with other psychiatric disorders. This review aims to explore the connection between depression and the onset of mild cognitive impairment (MCI) or dementia through recent literature analysis.

Methods:

Systematic review and meta-analysis, following PRISMA recommendations, with studies from 2013 onwards. The search strategy “Depression” AND “Dementia” AND “Aged” was employed in the Cochrane, Embase, LILACS, PubMed, Scopus, and Scielo databases. Cohort studies in Portuguese, English, or Spanish were included, while reviews or clinical trials were excluded.The meta-analysis was conducted using RevMan software, employing unadjusted OR effect measures for exposure in the Forest Plot graph. Study heterogeneity was calculated using the I² statistic, with a cutoff point of >75% indicating high heterogeneity.

Results:

The search strategy identified 3,394 articles, screened by title and abstract. Of these, 187 were fully read, and 26 were included in the review. The most used tool for assessing depressive symptoms was the Geriatric Depression Scale (38.4%), while the Mini-Mental State Examination was the most frequently used tool for assessing symptoms of MCI and dementia (26.9%). The quantitative analysis included 14 studies evaluating dementia and 8 studies evaluating MCI. The likelihood of older adults with depression developing dementia was 1.75 times higher than in the non-depressed population (OR = 1.75; 95% CI 1.46 - 2.11). Additionally, a twofold increase in the likelihood of developing MCI was found in depressed older adults (OR = 2.03; 95% CI 1.44 - 2.88). All analyses revealed high heterogeneity.

Conclusion:

Depression was found to be associated with higher likelihood of developing MCI or dementia in older adults. Understanding this complex relationship with new studies and reviews is crucial for developing targeted interventions and improving the prognosis for individuals affected by both conditions.

Introduction: Clinical decision making for older adults with multimorbidity can be complex and demanding. When facing complex decision-making, patients may experience decisional conflicts, leading to low treatment adherence, adverse health outcomes, and increased utilization of health services, etc. To address these issues, patient decision aids (DAs) have been developed and utilized in the decision-making process to facilitate informed decisions. The aim of this study is to identify DAs developed for patients with multimorbidity and assess their quality.

Method: We searched full-text papers on nine databases. Any article utilizing a DA for patients with multimorbidity was eligible and DAs for making medical decisions at any point were eligible. We used the International Patient Decision Aid Standards (IPDAS) checklist to assess the quality of DAs.

Results： In total, ten articles including six DAs were included. Two DAs targeted for the older patients with multimorbidity. Most DAs didn’t focus on specific treatment choices but rather aimed at improving the overall quality of life for patients with multimorbidity. The targets of these DAs are including setting goals about health care, preparing for conversation with doctors and taking ownership for the decisions. IPDAS checklist revealed that only one DA met all qualifying criteria and provided comprehensive choice. Three DAs were deemed to have poor quality due to their failure to provide the pros and cons of decisions. The quality of the remaining DAs was difficult to judge due to incomplete versions.

Conclusions: DAs for patients with multimorbidity were few and had poor quality. Designing DAs for this patient population presents challenges given the complex nature of multimorbidity and its lack of specific treatment options. Future development should focus on adhering to the IPDAS checklist, provide more information and possibility, and aim at improving the quality of life for patients with multimorbidity.

Introduction: Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF.

Methods: 20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long and short cases, including both clinical and non-clinical scenarios with a HF focus. Pre- and post-session questionnaires were used to rate confidence levels in a series of specific HF. A 10-point Likert scale was used.

Results: The majority of participants had a firm understanding of the importance of human factors in healthcare, especially the importance of teamwork, compassion, communication and situational awareness. 70% of participants felt that human factors training may not be adequately considered in current training pathways due to limited formal exposure, limited time, and its importance being underestimated. There was an increase in confidence in: managing disagreements (31%), negative emotions (38%), prioritisation (28%), delegation (23%), teamwork (34%) and leadership skills (30%), dealing with uncertainty (29%), challenging hierarchy (27%), anticipation (31%). 100% felt simulation training helped to develop their attainment of human factor skills.

Conclusion: This form of simulation training was successful in improving confidence and understanding of human factors in healthcare and showcased the value of using high-fidelity training to realistically recreate the clinical environment. Going forward, this type of teaching could be integrated within the specialty training curriculum to formally improve skills in human factors and therefore improve patient outcomes and relationships between team members, thus contributing to a more positive working environment.

Introduction

Iron deficiency anaemia (IDA) is common in older people, but traditional ferritin cutoffs may not be applicable in older people and iron studies are increasingly being used to diagnose iron deficiency anaemia. We wish to update guidance for diagnosing IDA, but first wished to survey current knowledge.

Methods

Clinical staff working with older people were asked to filled in a survey. They answered questions relating to confidence in interpreting ferritin and iron studies. Their knowledge of interpreting iron studies was assessed with two multiple choice questions illustrating common scenarios.

Results

When asked on a scale of 1-5 how confident the 135 participants were at interpreting ferritin, the mean was 3.7. For iron studies, it was 3.2. Amongst consultants, the mean confidence in interpreting ferritin was 4.18, in doctors of other grades (excluding GPs) this was 3.5, and for other medical professionals (PAs, ACPs and pharmacists) 2.8. Regarding iron studies, the mean confidence in consultants was 3.7, 2.9 in doctors of other grades (excluding GPs), and 2.7 in other medical professions. 88% of consultants, 73% doctors of other grades (excluding GPs), and 65% of other healthcare professionals correctly answered the case on a patient with anaemia of chronic disease. 94% consultants, 88% doctors of other grades (excluding GPs), and 70% of other healthcare professionals correctly answered the case on a patient with IDA. 

Conclusions

The data suggests that clinicians of all grades felt less confident in interpreting iron studies than ferritin. A significant proportion of medical professionals did not correctly interpret iron studies. We have consulted with our colleagues in haematology and gastroenterology and drafted a revised guideline to help interpretation, and suggest that IDA guidance should have advice on iron study interpretation. We will also examine IV iron prescription use and provide clear guidance on indications, tracking related costs.