Scientific Research

Introduction

In the UK, concerns regarding the safe use of bedrails, especially in nursing homes and a person’s own home, prompted a National Patient Safety Alert in August 2023. A scoping review was conducted to identify and map the literature relating to bedrail use in hospital and community settings and identify future areas of research. 

Methods

The scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted using MEDLINE, EMBASE, EMCARE, COCHRANE, BASE, CINAHL, and Google Scholar. Two reviewers independently contributed to screening. Data extraction included reason and prevalence of use, causes of harm and alternatives to bedrails. Findings were reported narratively. 

Results 

A total of 33 papers were included. Bedrails were widely used across hospital settings and nursing homes. No studies examined bed rail use in a person’s own home. Bed rails were primarily prescribed as a falls prevention device, despite the absence of empirical evidence supporting their effectiveness. In the UK, bedrail use appeared to be influenced by local culture and practice rather than policy. Self-reported use of bedrails as patient restraints in the UK, perhaps indicates inadequate legal literacy among equipment prescribers. Bedrails were found to be safe when used appropriately. There is concern that bedrail use is increasing with increasing patient dependency and advances in bed technology but authors express apprehension that it may be ethically impossible to design a randomised controlled trial to address patient safety concerns. 

Conclusion

Empirical data supporting bedrails as a falls prevention device are lacking. Additionally, there is a dearth of evidence reporting the opinions of users or inquiries regarding bedrails in a person’s own home. Therefore, clinicians are advised to consider bedrail prescriptions with a sense of responsibility and inquisitive inquiry to support both ethical and lawful use. 

Older Patients’ and Caregivers’ Perceptions of and Attitudes to Deprescribing in Saudi Arabia: A Cross-Sectional Study

T M Alenzy1,2; C Parsons1; H E Barry1; S A Alkahtani3

1.School of Pharmacy, Queen’s University Belfast, Belfast, UK; 2. Department of Clinical Pharmacy, College of Pharmacy, Princess Nourah bint Adulrahman University, Riyadh, Saudi Arabia; 3. Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Saudi Arabia

Introduction: Development of effective deprescribing interventions requires thorough understanding of attitudes of relevant stakeholders involved in the medication decision-making process. This study aimed to examine older patients’ and caregivers’ perspectives on deprescribing in Saudi Arabian hospitals and explored factors influencing their attitudes.

Method: A survey study was conducted using the Revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire (Arabic version), which was administered to older patients and caregivers recruited from two hospitals in southern Saudi Arabia through convenience sampling. Participants provided written informed consent and ethical approval was obtained. Descriptive analyses (frequencies and proportions) summarised beliefs about medication inappropriateness, burden, discontinuation concerns, involvement and two global questions. Bivariate analyses examined links between participant characteristics and questionnaire responses.

Results: Questionnaires were completed by 253 participants (126 older patients and 127 caregivers; response rate 87.00%). Most patients were aged 65-69 years (53.17%), married (78.60%), and taking 5-8 medications (65.07%). Almost two-thirds (65.87%) were satisfied with medications, and 88.10% were willing to have them deprescribed. Patients taking 5-8 medications showed significantly greater willingness for deprescribing compared to those taking ≥9 medications (p<0.001). Married patients were more involved in medication decision-making than non-married patients (p<0.05). Most caregivers were aged 25–34 years (38.58%) and married (75.59%). Their care recipients were primarily ≥80 years, with 67.71% taking 5-8 medications. Most caregivers (60.00%) were satisfied with care recipients' medications, and 82.68% were willing to have these deprescribed. Caregivers of care recipients taking ≥9 medications reported greater burden associated with managing medications (p<0.001).

Conclusion: Characteristics such as the number of prescribed medications influenced patients’ and caregivers’ perceptions of medication burden and willingness to have medications deprescribed, while marital status influenced involvement in medication decision-making among patients. These insights may be used to help guide hospital deprescribing interventions. 

Introduction: Age friendly communities aim to create inclusive social and physical environments that facilitate older people to age actively, enjoy good health and continue participating fully in society. The built environment can profoundly influence older adults’ health and wellbeing. This study aimed to explore mid-to-older adults’ perceptions of the age-friendliness of their communities and how they defined localness. 

Methods: Semi-structured interviews were conducted remotely and in-person between September 2023 and March 2024 with community-dwelling mid-to-older aged adults (n=22; 65.0 ± 5.5 years) from two communities with high levels of deprivation in Scotland, Renfrewshire and South Lanarkshire. Taking a systems-based approach, identified barriers and supports to the age-friendliness of communities were charted against the World Health Organization Age-Friendly Cities and the Place Standard frameworks, and perceptions of localness were explored. 

Results: Physical influences on age-friendliness included the accessibility of transport modalities, the maintenance of public spaces and paths, the suitability of homes, and seasonal influences and environmental hazards. Social influences included access to places that facilitate social interactions such as churches or community centres, community cohesion, and employment and volunteering-related factors. Service influences included digital inclusion, ageist sentiments, and healthcare accessibility. Localness was defined by i) accessible and preferred modes of transport, with local areas shrinking as mobility declines; ii) the distance people needed to travel to access essential services like supermarkets and pharmacies; and iii) where they knew people, socialised with others, or visited family. 

Conclusions: The gradual deterioration of communities has contributed to a decline in the age-friendliness of mid-to-older aged adults’ local areas. The impact of declining mobility, individual- and area-level deprivation, and closure of essential facilities and social spaces on place attachment must be considered by policy makers to support older adults to age well in place.

Introduction 

Despite the growing evidence from North America and Europe suggesting a decreasing trend in the incidence of dementia globally, the number of people affected by dementia is estimated to have increased by 117% (The Lancet Public Health, e105 - e125, 2019). This can be attributed to an ageing population, increased longevity, increased duration of the disease, and improved diagnosis. The aim of our study was to identify the mortality trend in AD over the last 10 years. 

Methods 

Data was collected from the Office of the National Statistics (England and Wales). The number of deaths from 2013 to 2023 was extracted using the code G.30 which included all types of AD. Results The number of deaths due to AD was 9787 in 2013, and it gradually increased year by year; to 11,298, 14323, 15,795, 17,984, 19,864, 20,400, 23,657, 21,495, 23,474 and 24,522 by 2023. 

Discussion 

The number of deaths due to AD has more than doubled over the last decade. The increase was gradual and affected both males and females. The dip seen in 2021 was also seen in other neurodegenerative conditions like Parkinson’s disease; this was probably due to Covid-19, when people were advised to shield and Covid-19 was given precedence as the cause on the death certificates. The increasing number of deaths due to AD is likely primarily due to people with AD living longer, leading to an increased prevalence and duration of the condition. It is important to recognize the increasing burden and we should convince decision makers to invest in resources to improve the care
 

Introduction Health affects older people’s quality of life (QoL). Those experiencing health decline often require multiple medications (polypharmacy). This narrative review aims to explore the effect polypharmacy has on QoL and health-related QoL (HRQoL). We also wished to determine the QoL/HRQoL measurement tools employed and polypharmacy definitions used in included studies. 

Method Searches were carried out primarily in MEDLINE and EMBASE. Publication databases for The Irish Longitudinal Study on Ageing (TILDA) and the English Longitudinal Study of Ageing (ELSA) were also searched. Search terms such as “polypharmacy”, “older person”, “health-related quality of life” and “quality of life” were used. Primary or secondary research articles investigating the association between polypharmacy and QoL/HRQoL, including qualitative studies, QoL/HRQOL tool development studies, and randomised controlled trials investigating the number of medications and QoL/HRQoL as outcomes were included. Screening and data extraction were undertaken by one reviewer and a narrative synthesis conducted. 

Results In total, 55 articles were included. The key finding of this review was the heterogeneity of the effect of polypharmacy on QoL/HRQoL, ranging from no association to a significant negative clinical association. Considerable variation was seen in the number of QoL/HRQoL measurement tools and polypharmacy definitions used. Qualitative studies highlighted factors which were perceived to impact QoL/HRQoL, including the relationship between patients and healthcare providers, clear benefit of medication and commitment to everyday medication management. These findings highlight the difficulty in interpreting the true impact of polypharmacy on QoL/HRQoL. 

Conclusion(s) In qualitative research, patients highlight the negative impact of polypharmacy on QoL; however, this isn’t always reflected in quantitative research. The range of differing associations could be due to the responsiveness of the tools used, populations studied, or the nature of the relationship between polypharmacy and QoL, which is likely intertwined bidirectionally with many contributing and confounding factors.

Introduction

People living with dementia (PLWD) take five more medications on average than those without dementia. This can increase the risk of medication-related harm, defined as any negative outcome, harm or injury caused by taking a medication. The aim of this systematic review was to identify studies that reported the prevalence of medication-related harm in PLWD and to assess its impact by evaluating various outcomes.

Methods

Twelve databases were searched from date of inception to April 2023. Papers published in English, reporting on the prevalence and/or adverse outcomes of medication-related harm in PLWD using any study design were eligible for inclusion. Methodological quality was assessed using the Cochrane Risk Of Bias 2 tool for randomised controlled trials (RCTs) or the Risk Of Bias In Non-randomised Studies of Exposures for non-randomised studies. A meta-analysis was conducted to determine combined hazard ratios (HRs) and 95% confidence intervals (CIs) on studies with similar harm-related outcomes using Review Manager software.

Results

Ninety-seven studies were included in the review; 93 were non-randomised studies and four were RCTs. Quality assessments found all four RCTs and the majority of non-randomised studies (n=58) to be at a low risk of bias. Adverse health outcomes, including hospitalisations and mortality, were most frequently reported (n=45 studies), with psychoactive medications (such as antipsychotic medications) being the most implicated class of medicines (n=54 studies). Analysis showed that the use of antipsychotics was associated with a significantly increased mortality risk in six studies (n=25,715 participants; HR=1.42; 95% CI 1.10-1.84; p=0.008).

Conclusion

This systematic review is the first to report the impact of medication-related harm among PLWD, with evidence to suggest that antipsychotic medication use is associated with mortality. However, the included studies had high heterogeneity, which made it difficult to draw comparisons between studies.

Introduction:

World Guidelines for Falls Prevention & Management for Older Adults[1] recommends medication review as part of multifactorial risk assessment for those at high risk of falling. Use of Falls Risk Increasing Drugs (FRIDs) [2], polypharmacy and anticholinergic burden are known to increase risk of falls in older people [3]. This prospective observational study was conducted to assess if polypharmacy, prescription of FRIDs and anticholinergic burden [4] improve after hospitalisation with a fall.

Method:

Data gathered from electronic medication records once necessary ethical approvals in place, for patients aged ≥ 65 years, taking ≥4 medicines, at hospital admission with a fall, at discharge, and 3 months after discharge included number of medications prescribed, number of Falls Risk Increasing Drugs (FRIDs) prescribed [2] and anticholinergic burden (ACB) score [4]. 

Results:

Patients were included from March 2023 until May 2024 (n=113). Mean age was 81±8.58 years and 80% of patients were female (n=90). The mean number of medicines per patient was 8.05±0.37(SE) at hospital admission, increasing by 32% to average 10.66±0.39(SE), three months after discharge (p<0.001). The mean number of FRIDs per patient increased by 7.8% from 2.44±.16(SE) at hospital admission to 2.63±.17(SE) three months after discharge (p=0.057).

Most common FRIDs were bisoprolol, furosemide, codeine, amlodipine and amitriptyline. Codeine was the most common FRID started after discharge (n=13; 12% of patients).

ACB score increased by 18% to 2.40± 0.21(SE) at 3 months following discharge compared to 2.04±0.21(SE) at admission (p=0.003). Furosemide, codeine, amitriptyline, sertraline and diazepam were the top medicines with anticholinergic burden.

Conclusion:

Three months after discharge from hospital following a fall, older people experience increased polypharmacy and anticholinergic burden and are prescribed more Falls Risk Increasing Drugs, compared to at the time of hospital admission.

1. Montero-Odasso, M., van der Velde, N., Martin, F.C. et al. (2022) The Task Force on Global Guidelines for Falls in Older Adults, World Guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 51, 9.
2. Saeed, D., Carter, G., Miller, R. et al. (2024) Development and Delphi consensus validation of the Medication-Related Fall (MRF) screening and scoring tool, International Journal of Clinical Pharmacy, 46, pp. 977–986 https://doi.org/10.1007/s11096-024-01734-w
3. National Institute Health and Clinical Excellence (NICE). 2013 Falls in Older People: Assessing risk and prevention Guidance. www.nice.org.uk
4. Anticholinergic Burden Calculator web app (ACBcalc®) created by Dr Rebecca King and Steve Rabino 

Title: Unseen Spine: A Case of Infective Discitis masked by diverticulitis in older patient

Introduction:

Spinal infections include vertebral osteomyelitis, septic discitis, facet joint septic arthritis, and spinal epidural abscesses. The common presentation usually involves back pain, fever, and elevated inflammatory markers, with signs of neurological deficits implying presence of spinal epidural abscess. Spinal infections are infrequent (0.2–3.7 per 100,000 hospital admissions for spondylodiscitis), with relatively higher incidence in elderly patients.

Case presentation:

We present a case of an 80-year-old female patient with a complex past medical history, including chronic back pain, osteoarthritis, bladder cancer, breast cancer, and lymphedema. She presented to the emergency department with a 3-day-history of lower back pain radiating to the abdomen. There was no history of trauma. Examination revealed no signs of intra-abdominal infection. There was a significant elevation of white blood cell count and C-reactive protein (CRP). The initial CT scan identified acute, uncomplicated sigmoid colonic diverticulitis, which was treated under the surgical team conservatively with antibiotics, following which the patient was discharged. Thirteen days later, the patient represented again with the same symptoms with additional pain radiation to the right leg affecting mobility. There was lumbar spinal process tenderness on examination with persistently high inflammatory markers in blood. Blood cultures resulted positive for Streptococcus agalactiae. An MRI spine revealed infective discitis with a right paravertebral abscess, causing thecal sac compression evident on CT scan also with bilateral psoas abscess. Following starting an appropriate antibiotic course guided by the cultures, and CT-guided drainage of the abscess, the patient improved symptomatically and clinically.

Conclusion:

Spinal infections are uncommon, yet significant aetiology of back pain. They should be considered a differential diagnosis in anyone with new or increasing back pain. The investigation and treatment approach must be guided by history taking and clinical examination.

About 73% of people living with osteoarthritis are older than 55 years. Osteoarthritis can greatly reduce the quality of life. While surgical interventions (including joint replacement) present one approach to advanced and disabling osteoarthritis, non-surgical interventions help people living with the condition to manage pain and maintain optimal levels of functioning. Pharmacological options should be used in combination with non-pharmacological measures at the lowest effective dose for the shortest period of time possible. Lidocaine 5% plasters are used off license in clinical practice to treat chronic pain, and pain from osteoarthritis. The lidocaine contained in the medicated plaster diffuses continuously into the skin, providing a local analgesic effect. The low systemic exposure to lidocaine following use of the lidocaine patch 5% is particularly beneficial for patients with polypharmacy, or for patients who have low tolerance for systemic analgesics. 

The aim of this review was to examine the current evidence for using transdermal lidocaine patch in managing pain from osteoarthritis. A comprehensive literature search was performed using electronic databases to identify studies that assessed the effectiveness of transdermal lidocaine in osteoarthritis. Reference lists of included studies were also reviewed. 

6 studies were included in the review, with a total of 359 patients. 3 studies used the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and showed significant improvement from baseline with use of 5% lidocaine patch in WOMAC pain scores(p<0.01), and 1 study showed significant improvement all 4 Neuropathic Pain Scale composite measures(p<0.001). 3 studies were included in a meta-analysis. This showed a significant improvement across pain, stiffness and physical function on WOMAC Osteoarthritis Index. 

Although these studies included small numbers, they have shown a positive effect. Older patients are more likely to have co-morbidities, frailty and polypharmacy which would prevent surgical/systemic pharmacological interventions. Further trials in this area would be beneficial.

Background: The incidence of falls is a major public health issue with one- third of older people falling annually. Consequently, there are many interventions available to prevent falls such as education and exercise training. However, their effectiveness at reducing fall prevalence is minimal due to low adherence, especially amongst ethnic minority groups. There is currently a paucity of research in this area particularly among older adults from ethnic minority groups.

Aims: This systematic review aims to identify the main facilitators and barriers to the uptake of fall prevention programs in older adults from ethnic minority groups.

Methods: The review was registered onto PROSPERO (CRD42024586433) before conducting a literature search on Medline, Embase and CINAHL databases using the PICO framework to extract relevant English language studies. Inclusion criteria included studies focusing on older adults aged 65 years and above and from ethnic minority groups. After removal of duplicates and full text screening, articles underwent quality assessment using the JBI tool. Data extraction took place, and key themes were categorised using the COM-B model.

Results:  12 studies were included in the final review: 9 qualitative and 3 mixed method studies. The review included 1176 participants including Hispanics, South Asians, Chinese and African American ethnic groups. Main themes included language barriers, cultural beliefs and inadequate support from healthcare professionals. Quantitative findings showed a statistically significant correlation between adherence and the following factors: living alone, low mood, level of education and culture.

Conclusion: This review has identified key barriers and facilitators to engage older adults from ethnic minority groups. Future interventions should consider these facilitators and barriers to enhance inclusivity and engagement.