Background: The role of rehabilitation medicine in treating post-acute COVID-19 survivors is currently ill-defined. Recently developed evidence-based initiatives, such as Cochrane REH-COVER, aim to describe the management of COVID-19 patients, but the variance and overlap in intervention types result in clinical uncertainty. Objective: To provide a summary of delivered rehabilitation services for COVID-19 patients during the pandemic. Methods: We collected evidence from the full set of REH-COVER Rapid living Systematic Reviews between March 2020 and February 2022 using the supplementary tables
Introduction: Frailty is a state of increased vulnerability to physiological stressors, which is associated with increased risk of adverse outcomes such as falls and delirium in older adults. For this patient group, healthcare decisions (as in whether to undergo elective surgery or continue a burdensome outpatient treatment) often have far-reaching consequences. Despite broad consensus that healthcare decision making should be a collaborative process, studies have shown frail older adults struggle to make healthcare choices and often do not feel fully involved in the decision-making process
Background: Populations in sub-Saharan Africa are ageing rapidly and Tanzania is one country experiencing this acute demographic shift. Multimorbidity (the presence of two or more chronic conditions (1)) is common in the community and associated with greater risk of hospitalisation. To-date, the prevalence amongst older hospital inpatients is unknown. Objective: To establish the prevalence of multimorbidity amongst older hospitalised adults in northern Tanzania. Methods: For 6-months, adults aged ≥60 admitted to medical wards in four hospitals were invited to participate. A standardised
Background: As global populations age, healthcare systems are facing challenges posed by multimorbidity, disability and geriatric syndromes. In high-income countries, frailty is a strong predictor of poor hospital outcomes. Comprehensive Geriatric Assessment is effective but resource-intensive and unavailable in sub-Saharan Africa where specialist geriatric training and allied health infrastructure are limited. Objective: To establish clinical outcomes of older adults with frailty admitted to hospital in northern Tanzania.= Methods: All adults aged ≥60 years admitted to medical wards at four
Background and Aims Many medical specialty trainees report a lack of confidence in hyperacute stroke management, contributing to inefficient patient care. We identified a lack of knowledge of our pathways, as well as difficulty managing human factors, particularly communication and teamwork. We hypothesised that the implementation of a simulation-based education programme could address these issues amongst medical specialty trainees and lead to improvements in our door-to-needle (DNT) times. Methods We organised a scenario-based simulation education session for our trainees led by a multi
Aims: i) Develop and test a theory-based diagnostic instrument to assess barriers and facilitators accurately and prospectively; and ii) survey barriers and facilitators to the delivery of skin hygiene care in care homes. Background: There is an ageing population and an increasing number of people residing in care homes. As skin ages it become vulnerable to dryness, itching, cracks, and tears. These are experienced by many older people and cause discomfort, compromised quality of life, skin breakdown, increased dependency, longer hospital stays, and greater financial and human costs. These
Introduction: Sleep is an essential requirement for good health. The hospital environment is often not compatible with adequate, restorative sleep. Disruption is multifactorial and affecting parameters can be environmental, physical, or psychological. Aims: To observe the difference in sleep quality in patients on medical wards compared with their baseline and highlight areas where sleep quality can be improved. Methods: This observational study analysed patients on four medical wards at Chelsea and Westminster Hospital. Inclusion criteria: Patients with good cognition who had been in hospital
Introduction: Cognitive impairment and dementia are prevalent in Parkinson’s disease (PD) and significantly impact patients’ quality of life. Accurate prognostic indicators of cognitive decline in this population are needed. Electroencephalography (EEG), a non-invasive measure of brain activity, is one such measure. The current study aimed to systematically review which EEG indices are associated with mild cognitive impairment (PD-MCI) and dementia in PD (PDD). Method: A systematic literature search was conducted in Embase, MEDLINE, PsycINFO and Web of Science in November 2022 to identify
Background: Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias, and it is associated not only with cognitive symptoms, but motor, neuropsychiatric, sleep and autonomic symptoms. There is increasing emphasis on the involvement of patients and their representatives in dementia research, but little is known about the extent and nature of surveys and qualitative research methods capturing the views of those affected by DLB. The objective of the scoping review is to determine the extent and nature of published literature that uses surveys and qualitative methods to
Introduction: At present no single symptom appears to be favoured in choosing primary outcomes for dementia with Lewy bodies (DLB) trials, nor are the perspectives of people affected by DLB reflected in their design. The aim of this study is to elicit the preferences of DLB patients and their care partners with respect to the DLB symptoms that they would most like to see improved upon by a potential therapy. We will do so using two complimentary health economic approaches in a single online survey: a best-worst scaling (BWS) exercise and a discrete choice experiment (DCE). Methods: Using
Introduction Across inpatient HSC settings ward based medicines management pharmacy technicians support ward based multi-disciplinary teams. The aim of this study was to explore the potential role and impact of a medicines management pharmacy technician and ‘stock solution’ in a Care Home facility. Method A 30 bedded private Care Home was identified for the pilot. A medicines management pharmacy technician liaised with senior nursing staff to review and understand the monthly medication ordering process. The technician audited the Care Home’s medication destruction records for 4 months and
Introduction Age is a risk factor for digital exclusion, but many older people have excellent access to digital services. Frailty may offer a clearer mechanism of exclusion. The aim of this study was to assess the association between living with frailty and digital exclusion from video consultation. Methods We undertook a multicentre cross-sectional study across primary care, interface, and secondary care services in South-West England. Patients were enrolled between 21st February and 12th April 2022. The primary outcome was complete digital exclusion from video consultation (defined as the no
Background NICE and SIGN guidelines recommend screening of inpatients at risk of delirium using the 4AT ( www.the4at.com) and communication of delirium to patients’ General Practitioners (GP). The aim of this audit was to establish whether delirium is currently being screened and documented, as recommended, in our Orthopaedic Trauma unit. Methods Data was collected by two junior doctors across four days (14/11/2022, 29/11/2022, 08/12/2022, 05/02/2023). Trauma and orthopaedic inpatients over the age of 65, who were more than four days post-surgery were included. Each patients’ medical notes
Introduction: Discharging patients from hospital is a complex process which requires multiple professions and processes. Late afternoon discharges can lead to admission bottlenecks and contribute to emergency department overcrowding. Focusing on discharging patients earlier in the day, can contribute to greater flow through the hospital and greater patient satisfaction. Leeds Teaching Hospital Trust (LTHT) aims to achieve 70% of discharges before 3pm. The Specialist and Integrated Medicine (SIM) department care for frail elderly patients who are at increased risk of harm following prolonged
Introduction Older adults with multimorbidity can experience poor health-related quality of life (HRQOL). Yoga has the potential to improve HRQOL. The British Wheel of Yoga’s Gentle Years Yoga© (GYY) programme was developed for older adults with chronic conditions. We investigated the effectiveness and cost-effectiveness of the GYY programme in older adults with multimorbidity. Method This was a multi-site, individually randomised, open, superiority trial with embedded economic and process evaluations. Community-dwelling adults aged ≥65 years with ≥2 chronic conditions were recruited from
Introduction Older patients admitted to the emergency department (ED) do not have a pharmacist-led medication review within the comprehensive geriatric assessment (CGA), yet the presenting complaint can be attributed to overprescribing and problematic polypharmacy. Taking ten or more medications increases the risk of hospital admission by 300% due to adverse drug reactions (ADRs)1, therefore a medication review can reduce this outcome by optimising current therapy2. Responsibility of safely transferring this medication information between care settings is a healthcare professional's duty, as
Delirium is common especially in the older adult (≥65 years) and is characterised by disturbed consciousness, cognitive function or perception. It develops acutely, often has a fluctuant course and is associated with several adverse outcomes including increased length of hospital stay, increased mortality and increased incidence of developing dementia. Delirium is under-recognised, however assessment tools such as 4AT and abbreviated mental test score (AMTS) have been developed to help clinicians assess for the presence of delirium. The “TIME” bundle developed by Healthcare Improvement
Introduction SDH is a community hospital within Cardiff and Vale University Health Board. There are 60 -70 beds, over three geriatric wards. The primary focus is for patients requiring rehabilitation and complex discharge planning. All admissions are transfers from the acute setting. There is a high level of frailty. There are ward doctors and a consultant geriatrician within working hours (Monday-Friday), OOH cover is provided by primary care. The concern of ‘blanket’ DNACPR orders, during the COVID-19 pandemic has featured in national news reports. In part, this led to our question and audit
Introduction Person-centred care is recognised as best practice for the care of people with delirium or dementia. In Cardiff and Vale University Health Board (CAVUHB), “Read About Me” (RAM) documents are used to support person-centred care in these patient groups. However, there are significant barriers to their routine use in clinical practice (Clark, E, Wood, F, Wood, S. Health Expect. 2022; 25: 1215- 1231). We conducted a two-cycle audit investigating the use of these documents on geriatric wards in two acute hospital sites, and trialled two interventions to increase their usage. Methods
Introduction Frailty is defined as “a condition characterised by loss of biological reserves, failure of physiological mechanisms and consequent increased risk of experiencing a range of adverse outcomes, including hospitalisation, longer length of inpatient stay, and delirium” [1-4]. We aim to investigate the association between baseline frailty and functional recovery amongst hospitalized older adults and its association with inpatient delirium. Method Retrospective analysis of patients admitted to a Geriatrics ward from August to November 2022. Interactions between clinical outcomes with