Scientific Research

Introduction: Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018).

Methods: A care home in north east England is working with researchers to pioneer a new approach to involvement, with residents and staff at the centre. The care home has helped to shape a number of research projects, for example a feasibility study of mealtime care training. In this study, an advisory group was set up initially within the care home itself, comprising residents, staff and family carers. Subsequently the group was joined by people from other care homes in the area, with support from the local authority. In parallel to this, health and social care professionals have contributed to the advisory group through one-to-one meetings with the researcher.

Results: Advisory group meetings in the care home have provided an inclusive and equitable platform for residents and staff to share their views on the research topic and design. Other stakeholders have been able to input into the project, but separately and in a way that has left room for key voices to be properly heard. Contributors have felt valued and are keen to continue in the process.

Conclusions: This study offers an alternative and authentic model for the involvement of experts by experience in social care research, inverting the more typical approach so that residents and staff are at the centre not the periphery.

Introduction

Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA.

Methods

We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater.

Results

53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality.

Conclusion

This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.

Introduction: Care home residents often have multiple long-term conditions and experience polypharmacy. Deprescribing is the reduction or stopping of prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe but it is unknown how to make it work well in practice, like care homes.

Methods: Using the findings from the NIHR-funded STOPPING project, which aimed to support the development of better deprescribing practice approaches within care homes, considering different views and environments, recommendations for designing a deprescribing approach for care homes were developed. The STOPPING project included interviews with residents and their family members/friends, care home staff, and healthcare professionals about their experiences and beliefs about what influences deprescribing in 15 different care homes, and in-depth interviews with care home staff assessing current deprescribing tools/approaches about their acceptability, feasibility, and suitability for use in care homes.

Results: The developed approach included four implementation aspects: (1) plan and coordinate, (2) communicate and collaborate, (3) access and share information, and (4) monitor and evaluate. Proposed actions to encourage deprescribing in care homes were identified for each aspect (e.g., communication with residents and families about medication changes addressing concerns and offering clear instructions about observations).

Conclusion: Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique clinical and care skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Communication and collaboration between care homes and healthcare professionals (such as GPs, nurses, and pharmacists) are essential to ensure deprescribing is done well. Information sharing and integrated working may support better communication and collaboration. Further work is needed to develop tools and approaches, and this work must include input from care home staff and residents.

Introduction:

Frailty is a condition that makes it increasingly difficult for individuals to recover from adverse health events and gradually erodes independence. NHS interventions in England have focused on those with more severe frailty. We tested HomeHealth, a home-based, tailored, multi-domain (six-session) behaviour change intervention to promote independence in the over-65s living with mild frailty, in a RCT recruiting 388 people (intervention 195; control 193). HomeHealth was delivered by the voluntary sector in three diverse areas and addressed mobility, nutrition, socialising, and psychological goals, among other domains. We aimed to explore acceptability, participant engagement, and experiences of delivering and receiving the service.

Methods:

Following a mixed-methods approach, we extracted quantitative data on types of goals and progress towards goals from Health and Wellbeing plans and appointment checklists. Between July 2022 and May 2023, we interviewed 49 older participants, 7 HomeHealth workers and 8 stakeholders. Older people were purposively sampled for diversity in socio-demographic characteristics, cognitive and physical functioning, intervention adherence and allocated HomeHealth worker. Interviews explored their motivations to engage; experience of participation, delivery and study support followed by their suggestions for improvement. We analysed qualitative data thematically and quantitative data descriptively.

Results:

Most participants set mobility goals (49%), followed by a combination of goals (31%), and made moderate progress towards these. The intervention (completed by 93.3% participants) was positively received, boosted participants’ confidence, and provided emotional support. Participants reported that sometimes behaviour was maintained post-intervention, but further appointments would have been welcomed to fill the gap in other services. However, some people found it difficult to identify goals to work on, particularly when they already felt independent and well supported.

Conclusions:

Services to support older people with mild frailty are acceptable, have good engagement, and can lead to behaviour change, particularly among those who self-identify a need for change.

Introduction

The PROMOTe trial was conducted entirely remotely, which aimed to enable a wider recruitment of participants, minimise risk of Covid-19 exposure and adhere to former travel restrictions. Participant experiences with remote clinical trials are not well understood. This work aimed to characterise participant perspectives on the remote delivery of the PROMOTe trial.

Methods

The trial involved remote measurement of short physical performance battery and grip strength, and remote collection of stool, urine, saliva, and capillary blood. Equipment including a dynamometer was posted to participants. Participants returned biological samples by post. A mixed methods approach was used, whereby participants were invited to complete an online questionnaire consisting of Likert, multiple-choice and open-ended questions upon trial completion.

Results

Of 72 trial participants, mean age 73.1, 80.6% (n = 58) completed the questionnaire. 53.5% (n = 31) had no preference between remote or in-person participation. Of those who preferred to take part remotely, 57.1% (n = 4) stated this was because there was no need to travel. 57.1% (n = 12) of those who preferred to take part in-person stated this was because they preferred to talk to the staff and ask questions face-to-face. Participants found that taking 5 out of the 8 physical measures were of similar difficulty over video teleconferencing compared to in-person. 100% (n = 58) of participants found it “easy” or “average” to collect stool, urine, and saliva, while 63.2% (n = 36) of participants thought it was “easy” or “average” to collect capillary blood. All participants found packaging and returning all four sample types of “easy” or “average” difficulty.

Conclusion

These findings suggest that the majority of participants found remote trial delivery, including handling equipment and collecting biological samples, both acceptable and manageable. Remote trial delivery has potential for increasing access of older people to trial participation.

Introduction

When COVID-19 first entered our world in March 2020 and the country went into lock down the NHS braced itself for one of its biggest challenges of this century. Older, frail patients were in the highest risk group, with those in care homes not only at higher risk of death, but higher risk of contracting COVID-19, often suffering more psychological disturbances (Hewitt et al., 2020; Numbers & Brodaty, 2021). This study was conceived by two nurse researchers working throughout the pandemic on a COVID ward for predominantly older people, aiming to capture the experiences of patients, families/carers and staff members.

Methods 

Phenomenology was the most appropriate methodology to provide an in-depth lived experience perspective. Full ethical approval was obtained and participants were sampled purposively. In-depth unstructured interviews were conducted and transcribed in full before being analysed hermeneutically using the four steps outlined by Fleming et al. (2003).

Results 

30 participants were recruited (10 patients, 10 relatives, including several bereaved and 10 staff members). Whilst experience varied between and within groups, core themes emerged:

1. Communication difficulties were poignantly expressed, with staff acting as intermediaries between patients and their family members who were kept apart through visiting restrictions, whilst managing clinical care and their own emotional responses.

2. Challenges of care were experienced by all groups, with anxiety around contagion conflicting with feelings of guilt and long-term psychological impact described by staff.

3. Collective experiences of grief and loss were described as participants grappled with coming to terms with encountering death and dying on an unprecedented scale and under such extraordinary conditions.

Conclusion

This study adds to the growing evidence base around experience of the COVID pandemic, adding insight into the triangulated experience of those affected and highlighting the profound effect on patients, relatives and staff.

Introduction:

Infection caused by the SARS-CoV-2 has been found to have serious consequences for the cardiovascular system. Among these, the development of heart failure (HF) has been stipulated; however, its causality has not yet been established. Therefore, the purpose of this study is to evaluate the role of clinical and laboratory parameters in determining the risk of developing HF in patients infected with SARS-CoV-2.

Methodology:

151 electronic medical records were taken from hospitalized patients with confirmed SARS-CoV-2 infection and pneumonia, from 03/11/20 to 10/02/21. HF was diagnosed by signs and symptoms, elevated NTproBNP and echocardiogram. Nonparametric statistical tests were applied due to the lack of normality in the data distribution.

Results were considered statistically significant at p<.05. uncorrelated clinical and laboratory indicators were selected to predict hf validated with separate samples. confidence intervals (95% ci) calculated for all listed metrics. oversampling was used in the training set. resulting binary classification model showed validity evaluated metrics roc curves. results: study included 46 patients 105 without hf. median age 66.2 (50-92) years, a predominance of women 91 (60.3%). most both groups had concomitant diseases, however group more ≥4 diseases (63%). significant risk predictors ≥66 years (p < 0.001), procalcitonin level ≥0.09 ng />ml (p <.001), thrombocytopenia ≤220-10^9 />l (p = 0.01), neutrophil-to-lymphocyte ratio ≥4,11% (p =0,010), history of chronic kidney disease (p =0.018).

Conclusion:

A possible predictive model including age, procalcitonin, creatinine, bilirubin, C-reactive protein, lactate dehydrogenase, platelets, international normalized ratio, neutrophil-to-lymphocyte ratio, as well as QTc interval on electrocardiogram and history of chronic kidney disease has been found that could identify patients with COVID-19 at risk of developing heart failure, which will allow more effective and earlier care

Introduction

Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.

Introduction:

The presence of ischemic cerebrovascular accident in COVID 19 patients is a complication that has stood out due to its complications, the predisposing factors are the procoagulant state derived from the infection as well as cardiovascular arrhythmic causes. Patients: Describe the frequency of cerebral ischemia and cardiac rhythm disturbances in patients admitted to the emergency room from July 2020 to January 2021 and its impact on prognosis and mortality.

Methods:

Retrospective study of 306 adults infected by SARS COV2 by antigenic or molecular test. The presence of these events was examined in a follow-up and the associated complications were described.

Results:

There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the ROX values were higher in the survivors at 2 h 5.7 (4.6 - 6.8), in relation to the deceased 3 ,2 (2.9 - 4.2), The presence of ischemic cerebrovascular events occurred in 9 patients (2.9%), occurring in 8 of the male gender and 1 of the female gender, the average age of those who presented said complication was 72, 3 years with standard deviations of 62.9 and 81.7 respectively, 3 of them presented cardiorespiratory arrest. Arrhythmic causes were found in only 1 of the patients, the rest were cryptogenic events. None of the cerebral panangiography studies showed aneurysms or vascular malformations. The mortality of patients with cerebral ischemia was 33% (3/9). It was not possible to perform thrombolysis in any patient. Only 1 patient was a candidate for mechanical thrombectomy.

Conclusions:

The present study showed that the presence of cerebral ischemia is not so uncommon, approaching what has been published in other series and reported works. Studies with larger groups of patients are required to validate the results found here.

Introduction:

Since the first wave of COVID-19, caused by SARS-CoV-2 virus, we have sought to identify possible short- and long-term complications, the so-called "post-discharge syndrome", especially in patients at higher risk, after prolonged hospitalization and intensive care.

Objective:

The aim of the study was to study the outcomes, possible adverse consequences after severe COVID-19 illness and its predictors in the 90-day post-hospitalization stage in elderly patients with asthma.

Methodology and Results:

We conducted a longitudinal observational study including 131 patients older than 60 years hospitalized for COVID-19, with a history of bronchial asthma who met the GINA 2020 criteria. The main risk factors for death in the post-hospital stage included Charlson comorbidity index values of 4 points or more, CT lung damage ≥30%, absolute number of eosinophils less than or equal to 100 cells/μl and the presence of diabetes mellitus, with the presence of diabetes mellitus being the factor with the shortest mean survival time after discharge.

Discussion:

COVID-19 usually requires hospital treatment and mortality of hospitalized patients is high, the factors for death were old age (82.1 years), a higher frequency of concomitant diseases and the presence of addiction. An increased risk of death was found in patients with asthma and heart failure. A greater number of comorbidities also correlated with worse clinical outcomes.