Scientific Research

Introduction:

The appearance of dysphagia after intubation in COVID 19 patients is very frequent, however there are few studies carried out in this regard.

Methods:

Retrospective study of 306 adults infected by SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the risk factors involved in the appearance of dysphagia after intubation.

Results:

There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the time of mechanical ventilation greater than 14 days was a factor with a high association, as well as the appearance of pneumonia associated with mechanical ventilation. The occurrence of dysphagia in those over 70 years of age doubles that of those under 60 years of age. The present study showed an adequate correlation between the appearance of dysphagia in relation to age, the time of ventilation and the appearance of pneumonia associated with mechanical ventilation.

Conclusions:

The appearance of dysphagia after intubation in patients with COVID 19 is a frequent complication, studies with larger groups of patients are required to be able to validate the results found here and thus be able to have tools that allow us to stratify in a better way. to COVID 19 patients.

Introduction:

Mortality after a hip fracture increases compared to the general population. The main objective of this study is to examine the incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures.

Methods:

This is a retrospective cohort study from a South American hospital. Patients older than 65 years with osteoporotic hip fracture between 2015 and 2018 were identified. Demographic data and comorbidities were obtained. The incidence rate, standardized mortality rate, trend (Poisson regression), and risk (hazard ratio) were calculated.

Results:

A total of 304 patients admitted for osteoporotic hip fracture were found, 240 (79%) were women with a mean age of 81.3 years (SD 8.45) and 64 (22.1%) were men with a mean age of 85. .42 years (SD 10.08). The cumulative incidence of mortality was 72.5%. The annual mortality rate was 75.6/1000 patients/year (54.8 in men and 20.8 in women). The 1-year mortality rate increased significantly by 2% per year (HR 1.05, 95% CI 1.002–1.08). Median overall survival was 854 days (95%CI 802-906). The mortality probability density was 18% for women and 27% for men (first 90 days).

Conclusions:

A more significant increase in mortality was observed in men than in women. Institutionalization combined with comorbidities are associated with higher mortality.

Introduction

Hearing loss affects 12 million people in the UK, it can have a severe negative impact on individuals, especially their communication, cognition and quality of life. Commonly reported effects of hearing loss are social isolation and mental health problems (e.g. anxiety and depression). There are a number of interventions for hearing loss, including hearing aids and cochlear implants. However, many individuals delay seeking treatment. This may be due to limited ­awareness of hearing loss and its consequences amongst the public. In addition, there is a large stigma surrounding hearing loss and having hearing aids.

This study will investigate the representations of hearing loss in the UK news media, particularly its impact on mental health, and identify ways to improve these representations.

Methods
Using Nexis (a database of news), we will examine newspaper articles featuring hearing loss during 2022. Multimodal critical discourse analysis will be used, which regards communicative choices (here, images and text) as both reflecting and shaping society, including by contributing to or challenging stigma. Patient and public involvement representatives will be consulted throughout regarding research objectives methods and the data interpretation.

Results

Results suggest that hearing loss is often described using celebrity accounts, often these individuals were younger adults. Many articles included inspirational stories of those with hearing loss, however the PPI group recommended that newspaper stories should provide a diverse representation of hearing loss. Inaccurate and outdated language was used to describe hearing devices. Mental health problems commonly discussed were depression, social isolation and dementia.

Discussion

The research will inform best practice recommendations for representing hearing loss in the public domain, which could be applied by healthcare organisations, research centres, charities and media outlets to help destigmatise hearing loss.

Introduction

The SARC-F questionnaire can be rapidly implemented by clinicians to identify patients with probable sarcopenia. A score ≥4 is predictive of sarcopenia and poor outcome. We sought to identify the prevalence and demographic correlates of probable sarcopenia (SARC-F score ≥4) in community-dwelling older adults.

Methods

480 participants (219 men, 261 women) identified from Primary Care completed a questionnaire ascertaining demographic, lifestyle factors, comorbidities, nutrition risk score (DETERMINE) and SARC-F score. Participant characteristics in relation to probable sarcopenia were examined using sex-stratified logistic regression. Age was included as a covariate.

Results

The median (lower quartile, upper quartile) age was 79.8 (76.9, 83.5) years. 12.8% of men and 23% of women had probable sarcopenia. Self-reported walking speed strongly associated with probable sarcopenia (men: odds ratio (OR) 10.39 (95% CI: 4.55, 23.72), p<0.001; women: 11.42 (5.98, 21.80), p<0.001 per lower band). Older age was associated with probable sarcopenia in both sexes (p=0.01) as was higher DETERMINE score (men: 1.30 (1.12, 1.51), p=0.001; women: 1.32 (1.17, 1.50), p<0.001 per unit increase). Among men, being married or in a civil partnership or cohabiting was protective against probable sarcopenia (0.39 (0.17, 0.89), p=0.03) as was reporting drinking any alcohol (0.34 (0.13, 0.92), p=0.03) while in women generally similar relationships were seen though these were weaker. Higher BMI (1.14 (1.07, 1.22), p<0.001 per unit increase) and presence of comorbidities (1.61 (1.34, 1.94), p<0.001 per extra medical condition) were also associated with probable sarcopenia in women. All associations were robust after adjustment for age.

Conclusions

Probable sarcopenia (SARC-F score ≥4) was common in older adults living in their own homes. As expected, self-reported walking speed was highly predictive of probable sarcopenia. In addition to advancing age and malnutrition, socio-demographic factors were also important. Identifying these factors in clinical practice should trigger sarcopenia screening in older adults.

Introduction

With recent advances in surgical techniques and immunosuppressive therapy, solid organ transplantation (SOT) is increasingly accessible to older and more complex patients. Multiple previous studies have shown quality of life improvements in SOT patients post-transplant across age group and despite significant pre-transplant frailty. As such, we are investigating if SOT is associated with a reduction in frailty status post-tranplant.

Methods

Studies across five databases between 2000 and 2023 were included if an objective frailty status measurement was used, SOT was performed during the study, and no rehabilitation took place pre- or post-transplant. Included studies were graded for risk of bias using the Newcastle Ottawa Scale. Data extracted from the studies was pooled in a random-effects meta-analysis using the Mantel-Haenszel method.

Results

Across the 12 studies included in the review (6 kidney transplant, 2 liver transplant, 3 lung transplant and 1 heart transplant), there was a total of 3065 transplant recipients (62% male 38% female) with a mean age of 51.35 years old. There is an worsening of frailty status in transplant patient immediately post-transplant. Thereafter, there is a reduction in frailty status 3 months post-transplant sustained 6 – 12 months post-transplant. However, frailty status plateaus after this period up to 36 months, based on the 3 studies that did track frailty status beyond 12 months. Five studies were included in the meta-analysis which demonstrated an odds ratio = 0.27 (95% CI, 0.12, 0.59, P = .001, I^2= 82%), When the single paper deemed to be of poor quality was removed the remaining four studies demonstrated a reduced odds ratio of being frail at 6-12 months posttransplant (OR 0.45 (95% CI, 0.32, 0.65, P = .001, I^2= 13%).

Conclusions

Transplant is associated with a reversal in frailty status 6 to 12 months post-transplant, although heterogeneity was demonstrated across studies.

Reported delirium prevalence in inpatients with Parkinson’s disease (PD) varies widely across the literature and is often underreported. Delirium is associated with an increased risk of institutionalisation, dementia, and mortality, but to date there are no comprehensive prospective studies in PD. We aimed to determine delirium prevalence in PD compared to older adults and its associated risk with adverse outcomes. Participants from the ‘Defining Delirium and its Impact in Parkinson’s Disease’ (DELIRIUM-PD) and the ‘Delirium and Cognitive Impact in Dementia’ (DECIDE) studies were included. People with PD (DELIRIUM-PD) or older adults from the Cognitive Function and Ageing Study II – Newcastle cohort (DECIDE) admitted to hospitals in Newcastle were approached to take part. Delirium was assessed prospectively using the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition criteria. Outcomes were determined by medical note reviews and home visits 12 months post discharge. Cox regression or binary logistic regression were used to evaluate the effect of delirium on institutionalisation, dementia, and mortality, independent of covariates. Delirium developed in 66.9% (n=81/121) of PD participants compared to 38.7% (n=77/199) of controls (p<.001). Delirium was associated with a significant increased risk of developing dementia in one year in PD (OR=6.1 (1.3-29.5), p=.024) and in controls (OR=13.4 (2.5-72.6), p=.003). However, in only PD participants, delirium was associated with a significantly higher risk of institutionalisation (OR=10.7 (2.1-54.6), .004) and mortality (HR=3.3 [95% CI 1.3-8.6], p=.014). This is the first comprehensive prospective study of delirium in PD, showing that over two-thirds develop delirium during hospitalisation compared to a third of older adults. Delirium in PD is associated with a significant risk of dementia, institutionalisation, and death in one year.

Introduction: Evidence of the optimal blood pressure target for older people with disability in long-term care is limited. We aim to estimate the associations of blood pressure with all-cause and cause-specific mortality in older people with different profiles of disability.

Methods: This prospective cohort study was based on the government-led long-term care program in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.

Results: The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135-150 mmHg. In severe disability group, SBP <150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150-170 mmHg. The associations were robust in subgroup analyses in terms of age, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk.

Conclusion: The optimal blood pressure range was higher in older long-term care people with severe disability than those with mild-moderate disability. This study provides new evidence for optimal individualized management of blood pressure in disabled older people in long-term care settings.

Background: Clinical pharmacists are increasingly working as part of primary care teams in UK. Many people living with dementia live at home with the support of primary care. Given the complexity of their health problems and their use of several medications, clinical pharmacists may potentially play a crucial role in their support Aims: To explore clinical pharmacists’ experiences of working in primary care with people living with dementia and identify any specific training needs to provide effective support for this patient group.

Methods: An online survey sent via email in 2023 through professional organisations, social media, and utilising research team contacts. The survey covered topics including clinical pharmacists’ background, experience of working with people with dementia, and training needs.

Results: 57 clinical pharmacists responded to the survey; the meantime working as a clinical pharmacist was 9.6 years (standard deviation 8.6) and within a primary care setting was 6.1 years (standard deviation 6.1). Just over three-quarters of respondents (n=31, 77%) work with people living with dementia. While almost two thirds (n=35, 61%) had undertaken training for dementia care, such training often lasted a few hours (less than a day) (n=17, 49%). Most respondents (n=39, 89%) wanted further information or training; including non-pharmacological interventions to improve quality of life in dementia and how to support carers and relatives. Practice challenges reported included a lack of face-to-face consultations and getting assurance that the patient could safely take medications.

Conclusions: These findings indicate an interest in dementia care, a willingness to undertake further training but practice uncertainties that suggest a system approach might be beneficial.

Introduction: Turning is essential to mobility, constituting 35-45% of all daily steps. Falls during turning are more severe with 7.9x greater risk of hip fracture. Reduced quality of turning has been observed in people with Parkinson’s disease (PwP). Findings suggest head and trunk control during turning are different in PwP compared to controls, however it is unclear how this relates to clinical measures. Methods: 36 PwP completed an intermittent walking task with 180 degree turns (ICICLE-Gait). An inertial measurement unit attached to the head evaluated head rotations (>30 degrees). Turning features were extracted using a validated algorithm. Spatiotemporal (duration, velocity) and signal-based features reflecting movement intensity (root mean square [RMS] in the mediolateral [ML], anterior-posterior [AP] and vertical [VT] planes from the gyroscope) were extracted. Relationships between turning and clinical measures (Activities of Balance confidence (ABC), Mini Mental State Exam (MMSE), Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) II and III, Levodopa Equivalent Daily Dose (LEDD)) were evaluated using Spearman’s rho. Results: There were 2/6 spatiotemporal and 13/25 signal features with weak-to-moderate correlations with clinical measures. Lower cognition and reduced balance confidence were associated with slower head rotations (rho=0.416-465, p<.05) and lower head movement intensity (lower rms: rho=0.340, p<0.05). higher disease severity (higher mds updrs-ii, iii scores) was associated with slower rotations (rho="-0.322:-0.436," p<0.05) increased ledd greater conclusion: rotation velocity are important features of turning that correlate clinical outcomes relevant in parkinson’s. places a demand on sensory, cognitive motor systems which affected pwp. further analysis will explore whether correlations exist for other segments during (i.e. torso), (such as axial rigidity), gait. 

Introduction: Functional decline and restricted mobility are common issues among nursing home residents with dementia, resulting in frequent use of physiotherapy services. While these residents can typically articulate their therapy needs and preferences, these have not been investigated properly regarding physiotherapy and exercise, which may compromise therapy adherence. This study aims to explore the needs and preferences of nursing home residents with mild to moderate dementia in relation to physiotherapy and exercise interventions.

Methods: Semi-structured individual interviews were conducted with 15 nursing home residents diagnosed with mild to moderate dementia, who could understand and speak Dutch and were capable of providing informed consent. Thematic analysis was used to analyze interview data.

Results: A total of 82 unique codes were identified from the interviews, leading to four major themes: preferences regarding physiotherapy sessions; defining physiotherapy and exercise; exercise without physiotherapist supervision; communication. Generally, residents preferred physiotherapy that included exercise and advice aimed at maintaining independent physical functioning. Participants perceived physiotherapy as more intense compared to gymnastics classes, and it was not seen as applicable to all individuals. If safety and quality were ensured, exercises could be performed without physiotherapist supervision. While residents wanted their family caregivers to stay informed about their therapy, they mostly preferred to exercise with someone else.

Conclusions: Residents in our study expressed preferences regarding physiotherapy sessions, communication, and family caregiver involvement, which when implemented may enhance therapy adherence and effectiveness. Furthermore, a shift toward a more supervisory role for the physiotherapist, rather than the conventional "hands-on" approach, emerged as a possibility.