Scientific Research

Introduction: Older people in care homes with atrial fibrillation (AF) have complex health needs and would benefit from taking part in research. This study assessed the feasibility of pharmacist implementation of the Atrial Fibrillation Better Care (ABC: Anticoagulation; Better symptoms; Cardiovascular comorbidity management) pathway, and collection of an AF-specific, resident-centred outcome.

Methods: Older residents (aged ≥65 years) with AF were recruited from care homes within Liverpool and Sefton and randomised to receive the pharmacist intervention, or continue their existing treatment. Resident quality of life was assessed using the Atrial Fibrillation Effect on Quality of Life Questionnaire (AFEQT).

Results: Twenty-two care homes were approached about the study, and seven signed up to take part between 28 September 2020 and 29 April 2021. Time taken to recruit care homes ranged from 0 to 122 days. There were 83 residents identified as potentially eligible to take part, but after screening only 28 residents (34%) were invited. Overall, 21 residents were recruited. Eleven residents received the pharmacist intervention and three had ABC recommendations made to their GPs. Two out of four recommendations were implemented. The pharmacist administered the AFEQT questionnaire to 17 residents with capacity and completion rates were 94% and 93% at baseline and six-months, respectively. Residents found the questionnaire difficult; most were unable to distinguish if symptoms were AF-related (n=3), or did not know they had AF (n=8), and questions related to physical activity were not applicable to any of the residents who were bed bound (n=5) or had severely limited mobility (n=12).

Conclusion: There were procedural (encountered before research starts), system (encountered during research) and resident-specific barriers that impacted this study. Barriers need addressing before wider implementation, and AF-specific quality of life measures need to be developed and validated for care home residents. A detailed commentary has been accepted for publication.

Introduction Oral frailty (OF), gradual loss of oral function combined associated with presbyphagia often in conjunction with cognitive and physical decline, has been recommended to be considered as a geriatric giant. DENTAL has been suggested as a possible screening tool for OF. We have looked at the prevalence of OF and its association with dysphagia, frailty and formal care, amongst people admitted acutely to the acute medical/frailty wards in our hospital. Methods OF, dysphagia and frailty were screened for as part of the routine clinical assessment of patients during the usual clinical ward round. Screening tools used were DENTAL for OF, Rockwood Score for frailty and 4QT for dysphagia. Age, sex comorbidities and the need for formal care was documented. Results 101 people were assessed over a 4 week period. Mean age was 84 years (65-99), 58 (57.4%) were female, 31(30.7%) were independent, 33 (32.6%) dementia, 57 (56.4%) frail, 54 (53.4%) had swallowing problems, and 34 (33.6%) OF. Of those with OF 97% had dysphagia, 88% were frail and 85% required formal care support (85%). OF was associated with dysphagia (p<.0001), frailty (p< 0.0001), formal care support (p<0.05) and dementia (p<0.05). there was an association between needing (p<0.01). conclusions of is associated with dysphagia, the need for care. may result in poor oral health contribute to dysphagia frailty, conversely due dependency nutrition dehydration. associations most likely be bidirectional. further work required elucidate this. clinical staff aware include screening their assessment older adult.

Introduction: It has been considered that widowed persons have a higher risk of death. This study intends to explore whether social participation can improve this trend.

Methods: A longitudinal study database was conducted to explore the trend of survival and its change with social participation in the widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007 and 2011 was linked with the National Death Registry from 1999 through 2012. Results: Totally, there were 1,417 widowed persons and 4,500 non-widowed persons included in this study excluding divorced and never-married people. The survival trend analysis was carried out, with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed are older than the non-widowed, are female-dominant, have a lower education level, being more economically stressed  and are  less likely to have regular exercise,  and thus show generally poorer health ,for example, being more vulnerable to have chronic diseases, disability with Activities of Daily Living(ADL), cognitive impairment with Short Portable Mental State Questionnaire (SPMSQ) and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed is significantly higher than that of the non-widowed, but the death trend for those with social participation is significantly lower than that of their counterparts in both the widowed and non-widowed. After matching with gender and age for widowed persons, the widowed with social participation have a significantly lower risk of death.

Conclusions: It is concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.
Keywords: Social participation, survival, mortality, widowed persons

Introduction

People who recover poorly after delirium are likely to require an increased level of care. It is presently unknown whether interventions to improve recovery after delirium are effective and cost-effective. This research aimed to develop a programme theory to inform the design of an intervention to improve recovery after delirium.

Method

A rapid realist review of literature was conducted to develop an initial programme theory. Following this, a qualitative investigation of the perceived rehabilitation needs of older people who have experienced delirium during a hospital stay was conducted via semi-structured interviews with 41 key stakeholders (older people (5), carers (12), and healthcare professionals (24)). Data were analysed using a realist approach to identify what works, for whom, and in what context. This was deductively informed by the initial programme theory while also employing an inductive analysis to identify novel insights. Through an iterative, retroductive process, context-mechanism-outcome configurations (CMOCs) were coded to reflect stakeholders’ views to refine the programme theory.

Results

The initial programme theory highlighted the importance of cognitive and physical rehabilitation and emotional support as key domains of recovery. New CMOCs included optimisation of good medical care to manage delirium and monitoring and management of underlying medical conditions to promote recovery. Others included developing educational resources and support networks for older people and their carers to aid sense-making, and encouraging social interaction to reduce isolation and empower independent functioning. These recovery elements should be addressed in a person-centred manner that is tailored to individual needs and preferences, engages carers, integrates intervention goals into daily functioning, and ensures continuity of care.

Conclusion

A refined programme theory was developed and is currently being used to design a manualised intervention to improve recovery after delirium. The acceptability of the intervention will be tested in a multi-centre, single-arm feasibility study.

Introduction

Demographic evaluation of urgent community response teams [UCR] is important to ensure equity of access and clinical outcomes for patients from all socio-demographic groups using such services. This retrospective descriptive study aimed to evaluate demographic and mortality differences between patients referred to UCR in terms of those managed in the community [Group1] versus those subsequently hospitalised [Group2].

Methods

Data was obtained over a 12-month period [2021-2022] for all new patients referred to a 7-day consultant-led UCR that serves a multi-ethnic, inner-city population. Data included demographic details, source of referral, urgency of referral and mortality within 60 days.

Results

Of 995 patients, 75.6%[n=752] were in Group 1; 24.4%[243] were in Group 2. The two groups were comparable in terms of age [mean(SD): 80.1(12.6) vs 80.0(11.4), p=ns] and gender [males:39.4% vs 42.4%,p=ns]. There were similar proportion of Black and minority ethnic patients within the two groups [21.0% (158) vs 24.7% (60), p=ns]. Source of referral were comparable between the two groups[p=ns]; overall, 67.7%[674] were from GP practices, 5.6%[56] Community Practitioners, 4.7%[47] NHS111, 2.7%[27] Ambulance, 32%[32] Palliative care, 5.9%[59] Emergency department, 10.1%[100] post-hospitalisation. Compared to Group 1 [46.9% (353)], significantly more patients in Group 2 were referred for urgent assessment within 2 hours [65.4% (159), p<.001]. more patients died in group2 within 60 days [22.2% (54) vs 11.3% (85), p<0.001].

Discussion

This large survey has described age, gender and ethnic similarities between the two groups, demonstrating equity of provision irrespective protected characteristics. as might be clinically expected, referred for hospitalisation were assessed urgently had higher mortality rates compared to those managed community. study provides valuable information clinicians researchers similar ucr services future.

Introduction

Treatment burden is the workload of healthcare and its impact on patient well-being and functioning. High treatment burden in other long-term conditions is associated with poor health outcomes. This study aimed to determine the extent and levels of treatment burden among people with Parkinson’s (PwP) and their caregivers, and explore modifiable factors.

Methods

A cross-sectional survey using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden was conducted among adults (age >18 years) diagnosed with Parkinson’s or self-identified caregivers of someone with Parkinson’s. Factors associated with medium/high treatment burden levels on the MTBQ were analysed using logistic regression.

Results

190 valid responses were received: 160 PwP (mean age = 68years, 52% female), 30 caregivers (mean age = 69years, 73% female) with or caring for PwP with all stages of Parkinson’s severity (Hoehn and Yahr staging). Nearly half of PwP had frailty or multimorbidity. High treatment burden was reported by 21% of PwP and 50% of caregivers. Lifestyle changes was the most difficult aspect of treatment burden for both PwP and caregivers. Arranging appointments, seeing many healthcare professionals and taking multiple medications frequently contributed to the treatment burden reported by PwP and caregivers. Medium/high treatment burden was associated with PwP who were frail, had a higher number of non-motor symptoms, and took medications more than three times a day. Worsening Parkinson’s severity and limited health literacy had increased odds of medium/high treatment burden levels in PwP. Female caregivers, those caring for someone with Parkinson’s who experienced memory issues, and caregivers with poorer mental health well-being scores were associated with medium/high treatment burden.

Conclusions

PwP and caregivers experienced substantial treatment burden. Providing them support with enacting recommended lifestyle changes, streamlining healthcare appointments, addressing polypharmacy and frequency of medications, and improving health literacy may help reduce the treatment burden in Parkinson’s.

Aim

Dysphagia affects up to 70% of nursing home residents and incorrect management can result in choking and aspiration pneumonia. (SLT). This study aimed to understand the mealtime experience of residents with dysphagia, how this compared with best practice for preventing aspiration pneumonia and what factors influenced their care.

Methods: 

Mealtime care of residents with dysphagia from 2 care homes was observed using structured tool to capture 12 elements of expected practice related to safe nutrition/hydration care and compare observed practice with recommendations in Speech and language therapists (SLT)/care plans. Interviews with care staff) sought to understand factors that contributed to the delivery of care.

Results

66 episodes of mealtime care for 11 residents were observed. SLT recommendations were mostly incorporated into the care plans and predominantly focused on food and fluid, other safe swallowing strategies such as positioning, prompting and ensuring mouth clear were mentioned in less than 40%. Observed adherence to many elements of best practice was less than 60%. Nutrition care was less safe when residents were being fed in the dining room when multiple care staff were present. Interviews with care home staff found training was focused on food and fluid modification not other safer swallowing strategies. Communication about care needs occurred verbally during daily handovers and time pressures during mealtimes influenced how staff assisted residents with dysphagia. 

Conclusions 

Safer swallowing care for residents with dysphagia is essential to prevent aspiration and reduce the risk of pneumonia. Staff have limited knowledge and training on how to manage safe swallowing. Workforce and system issues need to be addressed to create a safe swallowing culture and improve the experience of care home residents with dysphagia. 

Intracerebroventricular streptozotocin (ICV-STZ) injection is among the best animal models to simulate sporadic Alzheimer’s disease (sAD). Abnormality in brain insulin signaling, neurodegeneration, neuroinflammation, cholinergic damage, mitochondrial dysfunction, genetic abnormality, respiratory problem, oxidative stress, gliosis, sleep disturbances are associated with cognitive abnormalities seen in ICV-STZ injected rats. Available experimental evidence has used varying doses of STZ (<1 to 3mg/kg) and studied its effect for different study durations, ranging from 14-21 (short), 30-42 (mild), 90-105 (moderate) and 250-270 (long) days. These studies indicated that 3mg/kg of body-weight is the optimum dose for inducing sAD in the rodents. However, studies on the pathological process with related the morphological and functional abnormalities reported were illusive. Hence in the present study, we have investigated the morpho-functional changes after 3mg/kg ICV-STZ treatment with a follow-up of two months in 54 male Wistar rats (ethical no. 937/IAEC/PhD-2016). Results exhibited a spatial, episodic and avoidance memory decline and increase in anxiety (p<.05) in icv-stz group progressively with time from 15th day to 60th post-injection. morphometry showed hippocampal atrophy ca1, ca3 layer thinning (p="0.007)" ≤0.01) and loss of neurons (p<0.0001) associated third ventricular enlargement rats versus sham, along-with extracellular amyloid plaque ad congored staining. addition, spine golgi-cox impregnation mossy fiber a reduction density control sham (p<0.0001). finally, immunohistochemistry gsk3ß, pi3k mtcox-1 antigen coronal sections revealed an increase mean intensity gsk3ß decrease brain areas limbic system on day. these findings suggests, progressive dementia anxiety 3mg />kg STZ treated rats, which may be due to hippocampal atrophy, amyloidopathy, ventricular enlargement, synaptic dysfunction and deficits in energy homeostasis of brain.

Introduction:

Recent evidence suggests extensive grey matter abnormalities in Parkinson’s Disease Psychosis (PDP), as well as dysfunction of dopaminergic and serotonergic receptors. However, findings remain unclear. This meta-analysis aimed to identify neuroanatomical correlates of PDP and to examine the relationship between grey matter and key candidate receptors.

Method:

Peak coordinates were extracted from structural magnetic resonance imaging (MRI) studies (identified through systematic searches on PubMed, Web of Science, and Embase) for PDP patients and Parkinson's Disease patients without psychosis (PDnP) and were analysed using Seed-based d mapping with permutation of subject images (SDM-PSI). Gene expression data for dopaminergic (D1/D2) and serotonergic (5-HT2a/5-HT1a) receptors were extracted from the Allen Human Brain Atlas, probe-to-gene re-annotation data were downloaded from Arnatkevic̆iūtė et al. (Neuroimage, 2019;189:353-67) and parcellated on 78 regions of the Desikan-Killiany brain atlas. Effect-size estimates, extracted from the SDM-PSI analysis for these 78 regions as a measure of grey matter in PDP patients, were entered in multiple regression models.

Results:

10 studies were included in the meta-analysis (PDP, n= 211; mean age = 69.01 years, 52.1% males; PDnP, n = 298, mean age = 67.34 years, 41.9 % males). Reduction in grey matter was observed in parieto-temporo-occipital regions in PDP patients (uncorrected, p < 0.05). When controlling for PD medications, expressed in Levodopa equivalent daily dose (LEDD), results remained significant (uncorrected, p < 0.05). 5-HT2a and 5-HT1a gene receptor expressions were associated with estimates of grey matter volume (5-HT2a, b=-0.20, p=0.01, adjusted for LEDD, b=-0.18, p=0.03; 5-HT1a, b=0.11, p=0.02, adjusted for LEDD, b=0.12, p=0.01).

Conclusion:

We observed lower cortical volume in parieto-temporo-occipital areas, which are involved in information processing, integration, and attention in PDP compared to PDnP patients. We also reported an association between regional brain expression of serotonergic receptors and grey matter volume suggesting a role of serotonin in PDP.

Background
This study aimed to determine trajectories of depressive symptoms among older adults in England, overall and for those with hip fracture. The study aimed to explore the differential characteristics of each trajectory identified.
Methods
Analysis of adults aged 60 years or more (n=7,050), including a hip fracture subgroup (n = 384), from the English Longitudinal Study of Ageing. Latent class growth mixture modelling was completed. Depressive symptom prevalence was estimated at baseline. Chi-squared tests were  completed to compare baseline characteristics across trajectories.
Results
Three trajectories of depressive symptoms (no, mild, and moderate-severe) were identified overall and for those with hip fracture. The moderate-severe trajectory comprised 13.7% and 7% of participants for overall and hip fracture populations, respectively. The proportion of participants with depressive symptoms in the moderate-severe trajectory was 65.4% and 85.2% for overall and hip fracture populations, respectively. Depressive symptoms were stable over time, with a weak trend towards increasing severity for the moderate-severe symptom trajectory. Participants in the moderate-severe symptom trajectory were older, more likely to be female, live alone and had worse health measures than other trajectories (p < 0.001).
Conclusions
Older adults, and those with hip fracture, follow one of three trajectories of depressive symptoms which are broadly stable over time. Depressive symptoms’ prevalence was higher for those with hip fracture and, when present, the symptoms were more severe than the overall population. Results suggest a role of factors including age, gender, and marital status in depressive symptoms trajectories.