Scientific Research

Introduction

Poor appetite affects 15-20% of community dwelling older adults. Studies link poor appetite with frailty and sarcopenia; however, lack of longitudinal evidence exists to inform potential causality. We aimed to determine if poor appetite predicts frailty or sarcopenia-related factors in community dwelling older adults.

Methods

Secondary data analysis on adults aged >60 years recruited from, syncope, fragility fracture and comprehensive geriatric assessment clinics with 2.5 year follow up. Appetite was assessed by Simplified Nutritional Appetite Questionnaire (SNAQ); a score of <14/20 defining poor appetite. Hand grip strength (HGS) was measured using a dynamometer, low HGS was defined by European criteria (<27kg for males and <16kg for females). Frailty was measured using self-report of Fried phenotype.

Results

86 participants, mean age of 78 years, 62% female. Sixty-two (72%) were followed up, of those 9 had died.

Baseline mean SNAQ score was 15.2 (SD 8.1); 14 (16.3%) scored <14. Mean SNAQ score for the 53 participants at 2.5 year follow up was 14.9, 12 (22%) scored <14. Baseline and follow up SNAQ scores correlated moderately (Pearson’s r=0.5; P=<.001).

Fifteen (28%) individuals had low HGS at follow up, 12 had frailty (22%). Baseline SNAQ score <14 was associated with increased odds of frailty (OR 18.00; 95% CI 2.92-111.00) and low HGS (OR 7.76; 95% CI 1.62-37.30) after 2.5 years. The association of baseline SNAQ <14 with presence of frailty was robust to adjustment for age and comorbidities (OR 13.50; 95% CI 1.14-160.03), while association with low HGS was attenuated (OR 2.29; 95% CI 0.27-19.39).

Conclusion

Poor appetite is predictive of presence of frailty and low HGS after 2 years in community dwelling older adults. This suggests poor appetite as causative in the development of poor health outcomes in older people and so a key intervention target to optimise healthy ageing.

Objectives: Older adults hospitalized with a hip fracture are at risk for adverse health outcomes depending on their level of frailty. This study examined how frailty levels prior to admission impacted length of stay (LOS), requirement for alternative level of care (ALC), returning home post-discharge, and mortality.

Methods: A random sample was generated from all hip fracture patients aged 65 and older admitted to a Level One Trauma Centre in New Brunswick, Canada from 2015-2019. This sample had their frailty level determined retrospectively using the Pictorial Fit-Frail Scale and the patients’ hospital electronic health record.

Results: Our study included 189 patients (mean age: 83.2 ± 8.2, 73.0% female), representing 91 not frail to mildly frail (48.2%; NF-MF), 32 moderately frail (16.9%; ModF), and 66 severely frail (34.9%; SF) patients. The ModF patients had a longer LOS (median: 20.0 days, IQR=22.5) compared to NF-MF patients (median: 11.0 days, IQR=10.0, p=0.039, Kruskal-Wallis test) and SF patients (median: 8 days, IQR=5.5, p<0.0001, Kruskal-Wallis test). More ModF patients (56.3%) required an ALC stay in acute care compared to NF-MF (30.8%) and SF (28.8%) patients (p=0.016, Chi-square test). More SF patients (28.8%) died in hospital or within six months post-discharge compared to NF-MF (8.8%) patients (p=0.005, Chi-square test). Logistic regression revealed that both NF-MF (OR=8.11, 95% CI: [3.12-21.06], p<0.001) and ModF (OR=5.18, 95% CI: [0.85-0.95], p=0.007) patients had greater odds of returning home compared to SF patients when accounting for sex, age, and time to surgery.

Conclusions: A patient’s level of frailty prior to hospital admission impacts various health outcomes following a hip fracture and may provide helpful information for guiding treatment as well as discussions about health care.  

An 85-year-old male presented with a hip fracture following an accidental fall. His medical history included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus.

He underwent intramedullary nail insertion, supplemented with a plate and screws, for a subtrochanteric fracture. Post-operatively, he received four units of red blood cells for low haemoglobin. He was unable to mobilise due to persistent swelling and pain, and recurrent drops in haemoglobin levels despite multiple transfusions, with no evidence of visible bleeding from the wound or other sites.  However, pelvic x-rays showed stable fixation of the hip.

The patient subsequently developed extensive deep vein thrombosis in the contralateral leg and was started on a therapeutic dose of low molecular weight heparin. Further acute drops in his haemoglobin prompted an ultrasound of his hip, which identified an intramuscular hematoma. A CT angiogram confirmed active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The imaging also revealed a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. The patient underwent coil embolisation under radiological guidance, successfully achieving complete haemostasis.

Following the procedure, pain and swelling improved, haemoglobin levels remained stable, and he tolerated full anticoagulation without further drops in haemoglobin. Additionally, his mobility improved, and he transferred to a rehabilitation unit before being discharged home.

CONCLUSION

Pseudoaneurysms following hip fracture surgery are rare. Persistent drops in haemoglobin, along with pain, swelling, and stable fixation of an intramedullary nail, should raise suspicion for a haematoma, warranting further investigation with a CT angiogram.

Introduction

People from ethnic minorities are 1.5 times less likely to use digital technology. Within Brighton and Hove, 2021 Census reports that 26.1% described themselves as non-White-British categorised as other White (11.5%), Mixed Race (4.8%), Asian (3.7%), Black (2.0%), Chinese (1.1%), Arab (1.1%), and Other (2.0%). The aim of the project was to understand the lived experience of older ethnic minority adults in Brighton and Hove with digital technology, and how this experience affects their potential engagement with research.

Methods

Older people from ethnic minorities were identified through Brighton and Hove Health Watch, Bridging Change, Sussex Interpreting Services, and Black and Minority Ethnic Partnership. Using a mixed-methods approach, focus group and one-to-one meetings were held with 22 people, exploring their digital literacy, using a Likert scale, and preferences for research engagement using digital means. Meetings were transcribed and thematic analysis was undertaken.

Results

The group average age was 71.6 years. Six identified as male, 16 as female, and confidence with digital technology averaged 3/5 (5 representing high confidence). Variation of digital skills was observed, with older age and language barriers limiting digital access. Digital technology was used for social, transactional and health purposes (booking GP appointments, receiving test results, and GP consultations). Trust and confidence in the research team enhanced the group’s likelihood to engage digitally. Explaining the research in their own language would be an incentive. Younger family members can help explain digital elements. Offering choice of digital alongside traditional methods was important. There was a preference for initial research conversations to be in person. Willingness to engage is higher when the research topic is common in their community or they are personally affected.

Conclusions

Older people from ethnic minorities in Brighton and Hove are willing to engage in research using digital means if tailored to their social circumstances.

Introduction: Wearable technology that continuously monitors physiological metrics has become increasingly popular and allows remote patient monitoring in virtual ward settings. Wearable technology has been shown to be effective in disease monitoring among younger adults. However, its use among older adults, including those with cognitive impairment, is yet to be explored. Aim: We aim to explore the acceptability of remote monitoring using wearable technology among older adults with delirium. Methods: Participants were recruited from an in-patient rehabilitation unit. Inclusion criteria included documented delirium and age over 65 years. Participants were enrolled until delirium resolved or until discharge. Wearable technology was worn continuously, except when being charged or the patient was washing. Device data was recorded every minute. Premorbid Barthel index and Hierarchical Assessment of Balance and Mobility (HABAM) was collected for each participant. Participants were assessed daily for delirium and mobility using the Memorial Delirium Assessment Scale and HABAM respectively. At point of discharge from the study, participants completed a questionnaire to gather feedback on their experience. Results: 20 participants were included, with a mean age of 83.0 years and an average premorbid Barthel’s index of 72. 6. Mean data capture from the wearable technology was 44.1% (12.8-65.8). None of the participants could independently manage the device. Three participants stated that the device interfered with their normal activities with five reporting the device uncomfortable to wear. However, nine participants stated they would wear the device again if asked to by a healthcare professional. Conclusions: Our findings demonstrate that wearable devices are tolerated by delirious older adults with delirium. We found that this group cannot manage these devices independently and need support from either a carer or healthcare professional. These results provides useful information to help pilot these devices among older adults with delirium in virtual ward settings.

Introduction

As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs.  Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning.

There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice.

Methods

Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings.

Results

From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly - mean age 78.5years. Only 4/38 studies integrated patient and public involvement.

Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven.

Conclusions

The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.

TITLE:

Process Evaluation of the BASIL+ trial: a Behavioural Activation approach to addressing low mood and depression among older people with long-term conditions

AUTHORS:

Kate Bosanquet ¹, Elizabeth Newbronner ¹, Peter Coventry ^1,3, Leanne Shearsmith ⁵, Elizabeth Littlewood ^1,4, Della Bailey ¹, Andrew Henry ⁶, Lauren Burke ⁷, Eloise Ryde ^1,9, Dean McMillan ^1,2, David Ekers ^1,4, Simon Gilbody ^1,2, Carolyn A. Chew-Graham ⁸

¹ Department of Health Sciences, University of York, UK

² Hull York Medical School, University of York, Heslington, York, UK

³ York Environmental Sustainability Institute, University of York, York, UK

⁴ Tees Esk and Wear Valley NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK 

⁵ Leeds Institute of Health Sciences, University of Leeds, Leeds UK

⁶ Homerton Healthcare NHS Foundation Trust, Hackney, London, UK

⁷ Manchester Institute of Education, University of Manchester, Manchester, UK

⁸ School of Medicine, Keele University, Staffordshire, UK

⁹ Improvement Academy, Yorkshire & Humber ARC, Bradford Institute for Health Research, Bradford, UK

Abstract

Older adults are at risk of low mood and depression, which can be exacerbated by long-term physical health conditions, leading to poorer health outcomes and increased mortality. The restrictions on social mixing during the COVID-19 pandemic heightened these risks. BASIL+ (Behavioural Activation in Social IsoLation) was a pragmatic randomised controlled trial conducted with patients recruited from general practices in England and Wales. It was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. A behavioural activation intervention, within a collaborative care framework, was delivered by telephone. Participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. A qualitative process evaluation (conducted within the BASIL+ trial), used one-to-one semi-structured interviews to explore the experiences of trial participants, caregivers and BASIL Support Worker experiences. Three main themes emerged from the data analysis: 1) Engagement Dynamic: from Altruism to Self-Realisation; 2) Changing Behaviour and Improving Mood; and 3) Synergistic Nature of the Intervention Components. Findings suggest that the intervention effectively fostered self-awareness among older adults, giving them the confidence and skills to address low mood. Participant engagement with intervention materials varied, highlighting the importance of flexibility in delivery. BASIL+ Support Workers acted as key facilitators, guiding participants through the intervention process, fostering understanding, and providing crucial support. The collaborative care element ensured participants received comprehensive and holistic support, promoting improved mental and physical well-being. These findings underscore the adaptability and flexibility of the BASIL+ intervention, demonstrating its potential to address mental and physical health problems among individuals with varying needs and different starting points. The BASIL+ trial is registered with the ISRCTN registry (ISRCTN63034289).

Introduction

The British Geriatric Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, “Transforming care for older people”. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n=37, 97%), working primarily in secondary (n=21, 55%) and primary care (n=12, 32%). Most respondents were female (n=31, 82%) and 61% (n=23) identified as white British. Over 80% (n=31) were at a senior level (band 8a or above), with 68% (n=26) having over 10 years’ experience. Many identified as specialists in care of older people (n=29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n=34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.

Background
Cognitive impairment (CCL) and dementia are conditions typically occurring throughout the aging process, becoming major concerns in elderly healthcare. Advanced age, genetic factors, lifestyle habits, and comorbidities are risk factors that may increase the risk for both conditions. Thus, the aim of this study is to assess sociodemographic characteristics and comorbidities associated with CCL and dementia in older adults.
Methods
Cross-sectional analysis of the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). To assess the definition of CCL and dementia, the z-score of global cognitive function was calculated, evaluated through measurements of temporal orientation, verbal fluency, episodic, retrospective, and semantic memory domains. In addition, the IQCODE instrument and Activities of Daily Living were used to evaluate dementia. The Chi-Square test was used for the association of variables. The study was approved by the ethics committee.
Results
A total of 2951 participants were included, of whom 158 (5.4%) had CCL and 204 (6.9%) had dementia. Prevalence analyses of CCL revealed higher rates among individuals aged 65 to 74 years (6.18%), females (6.71%), divorced individuals (10.65%), rural residents (8.39%), hypertensive individuals (5.95%), non-diabetics (5.70%), and noncardiac individuals (5.60%). Meanwhile, for dementia, prevalence was higher in individuals aged 75 or older (26.76%), females (8.50%), widowers (18.06%), rural residents (9.75%), hypertensive individuals (8.57%), diabetics (9.01%), and cardiac individuals (13.51%).
Discussion
It was observed that long-lived elderly individuals have higher rates of dementia compared to CCL, as dementia symptoms increase with advancing age. Females and rural residents are in more  vulnerable positions in society, explaining the high prevalence of both diseases. Comorbidities are significant risk factors for dementia development, with cardiovascular diseases, in particular, playing a prominent role in vascular dementia. This broad view highlights the importance of specific management and prevention approaches to preserve cognitive functions during the aging process.

Introduction:

With population aging comes challenges like dementia, prompting the urgent identification of risk factors and its associations with other psychiatric disorders. This review aims to explore the connection between depression and the onset of mild cognitive impairment (MCI) or dementia through recent literature analysis.

Methods:

Systematic review and meta-analysis, following PRISMA recommendations, with studies from 2013 onwards. The search strategy “Depression” AND “Dementia” AND “Aged” was employed in the Cochrane, Embase, LILACS, PubMed, Scopus, and Scielo databases. Cohort studies in Portuguese, English, or Spanish were included, while reviews or clinical trials were excluded.The meta-analysis was conducted using RevMan software, employing unadjusted OR effect measures for exposure in the Forest Plot graph. Study heterogeneity was calculated using the I² statistic, with a cutoff point of >75% indicating high heterogeneity.

Results:

The search strategy identified 3,394 articles, screened by title and abstract. Of these, 187 were fully read, and 26 were included in the review. The most used tool for assessing depressive symptoms was the Geriatric Depression Scale (38.4%), while the Mini-Mental State Examination was the most frequently used tool for assessing symptoms of MCI and dementia (26.9%). The quantitative analysis included 14 studies evaluating dementia and 8 studies evaluating MCI. The likelihood of older adults with depression developing dementia was 1.75 times higher than in the non-depressed population (OR = 1.75; 95% CI 1.46 - 2.11). Additionally, a twofold increase in the likelihood of developing MCI was found in depressed older adults (OR = 2.03; 95% CI 1.44 - 2.88). All analyses revealed high heterogeneity.

Conclusion:

Depression was found to be associated with higher likelihood of developing MCI or dementia in older adults. Understanding this complex relationship with new studies and reviews is crucial for developing targeted interventions and improving the prognosis for individuals affected by both conditions.