Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.075
O Edwards, J Ball, Y Sensier, R Panerai, L Beishon
Introduction Transcranial Doppler ultrasonography (TCD) and Near-Infrared spectroscopy (NIRS) are indirect measures of neurovascular coupling (NVC). NVC is the relationship between cerebral blood flow and neuronal activity to meet the metabolic demands of the brain. No studies have integrated TCD-NIRS to investigate the feasibility of measuring NVC in those with dementia, delirium, and depression. Methods 32 participants (median [IQR] age 73.0 [70.0,78.5], 50% female, healthy (HC, n = 10), depression (n = 11), dementia (n = 6), delirium (n = 5)), underwent continuous cerebral blood velocity measurements in the middle (dominant MCAv) and posterior (non-dominant PCAv) cerebral arteries using TCD at rest and in response to four tasks. Heart rate (3-lead ECG), end-tidal CO (nasal capnography), blood pressure (Finometer), and prefrontal oxygenated (HbO2) and deoxygenated (HbR) haemoglobin (NIRS) were also measured. NVC was determined as absolute change in MCAv (cm/s) or concentration change for an attention task (serial subtraction), passive motor (arm movement) and passive sensory task (cotton wool), or PCAv for a visuospatial task (dot counting). We determined differences in NVC by a mixed two-way repeated measures analysis of variance, with post-hoc testing via Tukey. Results Resting CBv (cm/s) was significantly different between groups in MCAv (HC: 53.9 (SD = 8.09), depression: 41.9 (9.31), dementia: 42.5 (13.7), delirium: 32.6 (7.48), p = 0.002) and PCAv (p = 0.045), after correction for age and BP (p = 0.011). TCD: initial NVC responses increased for all three groups (delirium excluded) for all tasks (20–30s), (p = 0.026), but with no main effect of diagnosis. NIRS: There was a significant difference between tasks for the HbO2 and HbR responses (p = 0.046, p = 0.033). Diagnosis had a significant effect on the HbR response only (p = 0.034). Conclusion An integrated TCD-NIRS protocol was feasible in these patient groups to measure NVC, but less-so in delirium. Further work is needed to investigate NVC using integrated TCD-NIRS in larger sample sizes.
{"title":"2632 Determining the feasibility of a TCD-NIRS protocol to measure cerebral haemodynamics in dementia, delirium, and depression","authors":"O Edwards, J Ball, Y Sensier, R Panerai, L Beishon","doi":"10.1093/ageing/afae277.075","DOIUrl":"https://doi.org/10.1093/ageing/afae277.075","url":null,"abstract":"Introduction Transcranial Doppler ultrasonography (TCD) and Near-Infrared spectroscopy (NIRS) are indirect measures of neurovascular coupling (NVC). NVC is the relationship between cerebral blood flow and neuronal activity to meet the metabolic demands of the brain. No studies have integrated TCD-NIRS to investigate the feasibility of measuring NVC in those with dementia, delirium, and depression. Methods 32 participants (median [IQR] age 73.0 [70.0,78.5], 50% female, healthy (HC, n = 10), depression (n = 11), dementia (n = 6), delirium (n = 5)), underwent continuous cerebral blood velocity measurements in the middle (dominant MCAv) and posterior (non-dominant PCAv) cerebral arteries using TCD at rest and in response to four tasks. Heart rate (3-lead ECG), end-tidal CO (nasal capnography), blood pressure (Finometer), and prefrontal oxygenated (HbO2) and deoxygenated (HbR) haemoglobin (NIRS) were also measured. NVC was determined as absolute change in MCAv (cm/s) or concentration change for an attention task (serial subtraction), passive motor (arm movement) and passive sensory task (cotton wool), or PCAv for a visuospatial task (dot counting). We determined differences in NVC by a mixed two-way repeated measures analysis of variance, with post-hoc testing via Tukey. Results Resting CBv (cm/s) was significantly different between groups in MCAv (HC: 53.9 (SD = 8.09), depression: 41.9 (9.31), dementia: 42.5 (13.7), delirium: 32.6 (7.48), p = 0.002) and PCAv (p = 0.045), after correction for age and BP (p = 0.011). TCD: initial NVC responses increased for all three groups (delirium excluded) for all tasks (20–30s), (p = 0.026), but with no main effect of diagnosis. NIRS: There was a significant difference between tasks for the HbO2 and HbR responses (p = 0.046, p = 0.033). Diagnosis had a significant effect on the HbR response only (p = 0.034). Conclusion An integrated TCD-NIRS protocol was feasible in these patient groups to measure NVC, but less-so in delirium. Further work is needed to investigate NVC using integrated TCD-NIRS in larger sample sizes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"91 2 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.041
F Ali, E Obasi, R Burger, S Rodwell-Shah
Introduction Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old1. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality2. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes 3. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs1, according to criteria outlined by the Royal Osteoporosis Society4. Crucially, only 2% of reports in patients with moderate–severe VFFs recommended referral to Fracture Liaison Services (FLS), compared to the national target of 100%. Here, we evaluate local VFF recognition and reporting performance, relative to the Royal College of Radiologists (RCR) targets5. Methods Single-centre retrospective analysis of all CT thorax, abdomen and pelvis scans in >50-year-olds. Two cycles were completed, with implementation of educational posters and a quick-code reporting alert between cycles. The proportion of reports meeting best practice criteria were measured. The criteria included: assessment of bony integrity (target 100%), correct identification of moderate–severe VFFs (target 90%), use of correct terminology in reports (target 100%), referral of moderate–severe VFFs to the FLS (target 100%). Results Bony integrity was assessed in 100% in both cycles. Identification of moderate–severe VFFs improved from 37% to 64% between cycles. Correct terminology was used in 63% and 56% of reports in the first and second cycles respectively. 0% of patients were recommended for FLS referral in both cycles. Conclusion This audit demonstrates local shortcomings in VFF recognition and reporting. While there was an improvement in identification of VFFs between cycles, RCR targets were still not met post-intervention. This reflects a nation-wide issue in the under-diagnosis. References available on request.
{"title":"2812 Local radiological reporting of vertebral fragility fractures: a missed opportunity for early osteoporosis intervention?","authors":"F Ali, E Obasi, R Burger, S Rodwell-Shah","doi":"10.1093/ageing/afae277.041","DOIUrl":"https://doi.org/10.1093/ageing/afae277.041","url":null,"abstract":"Introduction Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old1. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality2. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes 3. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs1, according to criteria outlined by the Royal Osteoporosis Society4. Crucially, only 2% of reports in patients with moderate–severe VFFs recommended referral to Fracture Liaison Services (FLS), compared to the national target of 100%. Here, we evaluate local VFF recognition and reporting performance, relative to the Royal College of Radiologists (RCR) targets5. Methods Single-centre retrospective analysis of all CT thorax, abdomen and pelvis scans in >50-year-olds. Two cycles were completed, with implementation of educational posters and a quick-code reporting alert between cycles. The proportion of reports meeting best practice criteria were measured. The criteria included: assessment of bony integrity (target 100%), correct identification of moderate–severe VFFs (target 90%), use of correct terminology in reports (target 100%), referral of moderate–severe VFFs to the FLS (target 100%). Results Bony integrity was assessed in 100% in both cycles. Identification of moderate–severe VFFs improved from 37% to 64% between cycles. Correct terminology was used in 63% and 56% of reports in the first and second cycles respectively. 0% of patients were recommended for FLS referral in both cycles. Conclusion This audit demonstrates local shortcomings in VFF recognition and reporting. While there was an improvement in identification of VFFs between cycles, RCR targets were still not met post-intervention. This reflects a nation-wide issue in the under-diagnosis. References available on request.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"11 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.108
A Price, L Pearce, J Griffiths, J Smith, L Tomkow, P Martin
Introduction Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (> 90 days) following emergency laparotomy. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken, including records entered between 01/12/18 and 30/11/20. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected within NELA. Data are linked via NHS Digital with Office for National Statistics mortality data. A multivariate analysis was undertaken using a Cox proportional hazards model with hospital-level random effects. Potential confounders were identified via a directed acyclic graph and included in the model as covariates. Results 23,290 patients remained alive at 90 days post-surgery and were therefore included in the analysis. After adjusting for other covariates, increasing frailty was associated with an increased risk of longer-term mortality. Compared with CFS 1–3, adjusted HR were 1.86 (95% CI 1.68–2.05) for CFS 4, 2.23 (95% CI 2.03–2.45) for CFS 5, 3.26 (95% CI 2.99–3.57) for CFS 6, 4.53 (95% CI 3.97 (95% CI 5.17) for CFS 7, 5.80 (95% CI 4.44–7.57) for CFS 8 and 5.36 (95% CI 4.06–7.08) for CFS 9. Conclusion Older people living with frailty remain at increased risk of death beyond 90 days following emergency laparotomy. This information should be incorporated into shared decision-making, enabling patients to make informed choices about their care. Future work must explore how outcomes for this group might be improved through targeted post-operative support.
{"title":"2663 Estimating the effect of frailty on long term survival following emergency laparotomy","authors":"A Price, L Pearce, J Griffiths, J Smith, L Tomkow, P Martin","doi":"10.1093/ageing/afae277.108","DOIUrl":"https://doi.org/10.1093/ageing/afae277.108","url":null,"abstract":"Introduction Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (> 90 days) following emergency laparotomy. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken, including records entered between 01/12/18 and 30/11/20. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected within NELA. Data are linked via NHS Digital with Office for National Statistics mortality data. A multivariate analysis was undertaken using a Cox proportional hazards model with hospital-level random effects. Potential confounders were identified via a directed acyclic graph and included in the model as covariates. Results 23,290 patients remained alive at 90 days post-surgery and were therefore included in the analysis. After adjusting for other covariates, increasing frailty was associated with an increased risk of longer-term mortality. Compared with CFS 1–3, adjusted HR were 1.86 (95% CI 1.68–2.05) for CFS 4, 2.23 (95% CI 2.03–2.45) for CFS 5, 3.26 (95% CI 2.99–3.57) for CFS 6, 4.53 (95% CI 3.97 (95% CI 5.17) for CFS 7, 5.80 (95% CI 4.44–7.57) for CFS 8 and 5.36 (95% CI 4.06–7.08) for CFS 9. Conclusion Older people living with frailty remain at increased risk of death beyond 90 days following emergency laparotomy. This information should be incorporated into shared decision-making, enabling patients to make informed choices about their care. Future work must explore how outcomes for this group might be improved through targeted post-operative support.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"41 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.113
A Diaz, O Kozlowska, S Pendlebury
Introduction The incidence of dementia among patients in perioperative settings is on the rise, presenting significant challenges for healthcare professionals in delivering adequate and appropriate care to this patient population. In order to gain a deeper understanding of the perioperative care needs of patients with dementia, thirty healthcare professionals were interviewed. The focus was on their experiences and perspectives regarding the fulfilment of these needs. Key factors influencing perioperative care were identified and categorised into three main themes: patient-related factors, healthcare professional-related factors, and healthcare environment-related factors. Methods Thirty interviews were conducted with a diverse group of healthcare professionals, including anaesthetists, surgeons, nurses, and other perioperative staff. Thematic analysis was employed to process and interpret the data, identifying recurring themes and sub-themes that reflect the complexities of perioperative care for patients with dementia. Results The analysis revealed three primary themes: 1) Factors related to the patient with dementia: Cognitive impairment and comorbidities uniquely challenge perioperative care. The unfamiliar hospital environment often exacerbates cognitive symptoms, and adherence to postoperative protocols can be problematic. Family involvement is crucial in supporting these patients. 2) Healthcare Professional Factors: Perceptions of dementia, communication issues, pain assessment, and the need for personalised care were highlighted. Training and education deficits among healthcare professionals were evident, impacting the quality of care. 3) Institutional Factors: Organisational policies and resource allocation significantly affect the provision of dementia care. Support for healthcare professionals through ongoing education and the development of dementia-specific guidelines were identified as essential needs. Conclusion Effective perioperative care for patients with dementia requires addressing multifaceted challenges. Improving communication, enhancing education and training for healthcare professionals, involving family members, and ensuring institutional support are critical steps. A comprehensive, empathetic approach can lead to better outcomes and experiences for patients with dementia in the perioperative setting.
{"title":"2768 Needs of people with dementia in the perioperative environment from the perspective of healthcare professionals","authors":"A Diaz, O Kozlowska, S Pendlebury","doi":"10.1093/ageing/afae277.113","DOIUrl":"https://doi.org/10.1093/ageing/afae277.113","url":null,"abstract":"Introduction The incidence of dementia among patients in perioperative settings is on the rise, presenting significant challenges for healthcare professionals in delivering adequate and appropriate care to this patient population. In order to gain a deeper understanding of the perioperative care needs of patients with dementia, thirty healthcare professionals were interviewed. The focus was on their experiences and perspectives regarding the fulfilment of these needs. Key factors influencing perioperative care were identified and categorised into three main themes: patient-related factors, healthcare professional-related factors, and healthcare environment-related factors. Methods Thirty interviews were conducted with a diverse group of healthcare professionals, including anaesthetists, surgeons, nurses, and other perioperative staff. Thematic analysis was employed to process and interpret the data, identifying recurring themes and sub-themes that reflect the complexities of perioperative care for patients with dementia. Results The analysis revealed three primary themes: 1) Factors related to the patient with dementia: Cognitive impairment and comorbidities uniquely challenge perioperative care. The unfamiliar hospital environment often exacerbates cognitive symptoms, and adherence to postoperative protocols can be problematic. Family involvement is crucial in supporting these patients. 2) Healthcare Professional Factors: Perceptions of dementia, communication issues, pain assessment, and the need for personalised care were highlighted. Training and education deficits among healthcare professionals were evident, impacting the quality of care. 3) Institutional Factors: Organisational policies and resource allocation significantly affect the provision of dementia care. Support for healthcare professionals through ongoing education and the development of dementia-specific guidelines were identified as essential needs. Conclusion Effective perioperative care for patients with dementia requires addressing multifaceted challenges. Improving communication, enhancing education and training for healthcare professionals, involving family members, and ensuring institutional support are critical steps. A comprehensive, empathetic approach can lead to better outcomes and experiences for patients with dementia in the perioperative setting.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"83 5 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.111
SJ Meredith, L Holt, MPW Grocott, S Jack, J Murphy, J Varkonyi-Sepp, A Bates, SER Lim
Introduction Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay. Methods Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability. Secondary outcomes included physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy, and PA. Outcomes were measured and compared at baseline, post-intervention, and follow-up (3-months). Interviews were transcribed verbatim and analysed using thematic analysis. Results Five volunteers (mean age 16, 3 female) completed training, and 3 (60%) were retained at the end of the study. Twenty-seven older adults (mean age 80 years, 15 female) signed up to the intervention (10 online; 13 telephone). Seventeen completed the intervention. Participants attended 75% (IQR 38–92) online sessions, and 80% (IQR 68.5–94.5) telephone support. Self-reported total PA (p = 0.006), quality of life (p = 0.04), and appetite (p = 0.03) improved significantly post-intervention, with a non-significant decrease at follow-up. The intervention was safe and acceptable to volunteers, and older adults with frailty. Key barriers were lack of social support, and exercise discomfort. The online group was a positive vicarious experience, and telephone calls provided reassurance and monitoring to socially isolated older adults. Conclusion Volunteers can safely deliver a remote multimodal intervention for frail older adults discharged from hospital with training and support from a health practitioner.
{"title":"2882 Frail2Fit study: a feasibility and acceptability study of an intervention delivered by volunteers to improve frailty","authors":"SJ Meredith, L Holt, MPW Grocott, S Jack, J Murphy, J Varkonyi-Sepp, A Bates, SER Lim","doi":"10.1093/ageing/afae277.111","DOIUrl":"https://doi.org/10.1093/ageing/afae277.111","url":null,"abstract":"Introduction Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay. Methods Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability. Secondary outcomes included physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy, and PA. Outcomes were measured and compared at baseline, post-intervention, and follow-up (3-months). Interviews were transcribed verbatim and analysed using thematic analysis. Results Five volunteers (mean age 16, 3 female) completed training, and 3 (60%) were retained at the end of the study. Twenty-seven older adults (mean age 80 years, 15 female) signed up to the intervention (10 online; 13 telephone). Seventeen completed the intervention. Participants attended 75% (IQR 38–92) online sessions, and 80% (IQR 68.5–94.5) telephone support. Self-reported total PA (p = 0.006), quality of life (p = 0.04), and appetite (p = 0.03) improved significantly post-intervention, with a non-significant decrease at follow-up. The intervention was safe and acceptable to volunteers, and older adults with frailty. Key barriers were lack of social support, and exercise discomfort. The online group was a positive vicarious experience, and telephone calls provided reassurance and monitoring to socially isolated older adults. Conclusion Volunteers can safely deliver a remote multimodal intervention for frail older adults discharged from hospital with training and support from a health practitioner.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"80 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.087
EK Matharu, J Jegard, S Hague, B Roj, M Kaneshamoorthy
Introduction Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF. Methods 20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long and short cases, including both clinical and non-clinical scenarios with a HF focus. Pre- and post-session questionnaires were used to rate confidence levels in a series of specific HF. A 10-point Likert scale was used. Results The majority of participants had a firm understanding of the importance of human factors in healthcare, especially the importance of teamwork, compassion, communication and situational awareness. 70% of participants felt that human factors training may not be adequately considered in current training pathways due to limited formal exposure, limited time, and its importance being underestimated. There was an increase in confidence in: managing disagreements (31%), negative emotions (38%), prioritisation (28%), delegation (23%), teamwork (34%) and leadership skills (30%), dealing with uncertainty (29%), challenging hierarchy (27%), anticipation (31%). 100% felt simulation training helped to develop their attainment of human factor skills. Conclusion This form of simulation training was successful in improving confidence and understanding of human factors in healthcare and showcased the value of using high-fidelity training to realistically recreate the clinical environment. Going forward, this type of teaching could be integrated within the specialty training curriculum to formally improve skills in human factors and therefore improve patient outcomes and relationships between team members, thus contributing to a more positive working environment.
{"title":"2846 How can simulation training be used to teach skills in human factors (HF)?","authors":"EK Matharu, J Jegard, S Hague, B Roj, M Kaneshamoorthy","doi":"10.1093/ageing/afae277.087","DOIUrl":"https://doi.org/10.1093/ageing/afae277.087","url":null,"abstract":"Introduction Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF. Methods 20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long and short cases, including both clinical and non-clinical scenarios with a HF focus. Pre- and post-session questionnaires were used to rate confidence levels in a series of specific HF. A 10-point Likert scale was used. Results The majority of participants had a firm understanding of the importance of human factors in healthcare, especially the importance of teamwork, compassion, communication and situational awareness. 70% of participants felt that human factors training may not be adequately considered in current training pathways due to limited formal exposure, limited time, and its importance being underestimated. There was an increase in confidence in: managing disagreements (31%), negative emotions (38%), prioritisation (28%), delegation (23%), teamwork (34%) and leadership skills (30%), dealing with uncertainty (29%), challenging hierarchy (27%), anticipation (31%). 100% felt simulation training helped to develop their attainment of human factor skills. Conclusion This form of simulation training was successful in improving confidence and understanding of human factors in healthcare and showcased the value of using high-fidelity training to realistically recreate the clinical environment. Going forward, this type of teaching could be integrated within the specialty training curriculum to formally improve skills in human factors and therefore improve patient outcomes and relationships between team members, thus contributing to a more positive working environment.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"55 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.056
L Coleman, E Mensah, K Ali
Introduction As the prevalence of dementia continues to increase across the UK, understanding the lived experience of patients and carers affected by dementia becomes paramount. There is an established dementia pathway in Sussex for people living with dementia (PLWD) and their carers. To improve care and inform future commissioning priorities, the Brighton and Hove Health Watch (BHHW- a community interest company) surveyed the opinions of a group of PLWD and their carers around initial diagnosis and subsequent support. Methods PLWD and their carers receiving social support and willing to provide feedback were included in this survey. Using a topic guide, BHHW volunteers conducted a telephone interview with this group exploring their experience with their general practitioner (GP), and the memory assessment service (MAS) in relation to diagnosis, and post-diagnosis support. Transcribed interviews were analysed using qualitative thematic analysis (inductively and deductively) using Braun and Clarke’s method. Results Forty-five participants were interviewed, 37 carers and 6 PLWD (average age 78.2 range 64–95 years) between December 2022 and May 2023. Thirty-nine participants (86%) were of white-British ethnicity. Participants reported a range of different experiences with no consistent pattern by age, gender or location. Participants were generally satisfied with the initial GP care they received. The waiting time to access MAS was six weeks on average, an acceptable timeframe for the group. Some participants reported waiting as long as two years since the initial GP consultation before a dementia diagnosis was eventually made. Participants were generally satisfied by the thorough MAS review. Most participants felt that the information material they immediately received after dementia diagnosis was complex and overwhelming. Social support offered post-diagnosis was commendable. Conclusion The lived experience of PLWD and their carers in Sussex was generally positive. However, a tailored approach to post-diagnosis information provision is required.
{"title":"2843 Evaluating dementia pathway services: a Sussex-wide patients and carers’ perspective","authors":"L Coleman, E Mensah, K Ali","doi":"10.1093/ageing/afae277.056","DOIUrl":"https://doi.org/10.1093/ageing/afae277.056","url":null,"abstract":"Introduction As the prevalence of dementia continues to increase across the UK, understanding the lived experience of patients and carers affected by dementia becomes paramount. There is an established dementia pathway in Sussex for people living with dementia (PLWD) and their carers. To improve care and inform future commissioning priorities, the Brighton and Hove Health Watch (BHHW- a community interest company) surveyed the opinions of a group of PLWD and their carers around initial diagnosis and subsequent support. Methods PLWD and their carers receiving social support and willing to provide feedback were included in this survey. Using a topic guide, BHHW volunteers conducted a telephone interview with this group exploring their experience with their general practitioner (GP), and the memory assessment service (MAS) in relation to diagnosis, and post-diagnosis support. Transcribed interviews were analysed using qualitative thematic analysis (inductively and deductively) using Braun and Clarke’s method. Results Forty-five participants were interviewed, 37 carers and 6 PLWD (average age 78.2 range 64–95 years) between December 2022 and May 2023. Thirty-nine participants (86%) were of white-British ethnicity. Participants reported a range of different experiences with no consistent pattern by age, gender or location. Participants were generally satisfied with the initial GP care they received. The waiting time to access MAS was six weeks on average, an acceptable timeframe for the group. Some participants reported waiting as long as two years since the initial GP consultation before a dementia diagnosis was eventually made. Participants were generally satisfied by the thorough MAS review. Most participants felt that the information material they immediately received after dementia diagnosis was complex and overwhelming. Social support offered post-diagnosis was commendable. Conclusion The lived experience of PLWD and their carers in Sussex was generally positive. However, a tailored approach to post-diagnosis information provision is required.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"33 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.095
BI Nicholl, E Bischoff, JK Burton, J Canning, K Wood, R Collard, P Hanlon
Introduction People living with multiple long-term conditions (MLTC) are more likely to experience hospital admission, which is often associated with unintended consequences. Preventing or providing alternatives to admission by predicting adverse admission-related outcomes is important. This study aims to provide an overview of the association between MLTCs and adverse outcomes following hospital admission through a systematic review of systematic reviews. Method We searched Medline, Embase, CINAHL, Web of Science and PsycINFO for systematic reviews assessing risk factors/predictors of functional decline (FD), nursing home admission (NHA), or changes in quality of life among adults (≥18 years) experiencing unscheduled acute hospital admission. Eligible reviews had to assess MLTC (LTC counts, indices, or individual LTCs), either alone or with other predictors. Titles/abstracts and full texts were screened in duplicate and candidate predictors were extracted. Results 14 systematic reviews assessed predictors of FD (n = 8) or NHA (n = 6). Reviews focused on studies of general inpatients/mixed presentations (n = 8: 6 FD, 2 NHA); hip fracture (n = 2: 1 FD, 1 NHA); stroke (n = 2: 1 FD, 1 NHA) and cognitive impairment (n = 1, NHA) or delirium (n = 1, NHA). Assessment of MLTC was heterogenous: comorbidity indices (n = 4), counts of LTC (n = 2), specific LTC (n = 8), and ‘comorbidity’ without further qualification (n = 3). Higher comorbidity indices, higher counts, and a range of specific comorbidities (most notably dementia) were associated with FD and NHA. Reviews assessing MLTC alongside other predictors highlighted a broad range of sociodemographic, functional, social, and admission-related factors that were associated with FD and NHA. In general, reviews did not assess the relative importance of MLTC alongside other predictors. Conclusion While MLTC may predict unwanted outcomes following admission their qualification is often inconsistent and their relative importance as predictors, alongside broader factors such as social complexity, is rarely assessed in existing systematic reviews.
{"title":"2875 The association between multiple long-term conditions, person- and disease-related factors and adverse inpatient outcomes","authors":"BI Nicholl, E Bischoff, JK Burton, J Canning, K Wood, R Collard, P Hanlon","doi":"10.1093/ageing/afae277.095","DOIUrl":"https://doi.org/10.1093/ageing/afae277.095","url":null,"abstract":"Introduction People living with multiple long-term conditions (MLTC) are more likely to experience hospital admission, which is often associated with unintended consequences. Preventing or providing alternatives to admission by predicting adverse admission-related outcomes is important. This study aims to provide an overview of the association between MLTCs and adverse outcomes following hospital admission through a systematic review of systematic reviews. Method We searched Medline, Embase, CINAHL, Web of Science and PsycINFO for systematic reviews assessing risk factors/predictors of functional decline (FD), nursing home admission (NHA), or changes in quality of life among adults (≥18 years) experiencing unscheduled acute hospital admission. Eligible reviews had to assess MLTC (LTC counts, indices, or individual LTCs), either alone or with other predictors. Titles/abstracts and full texts were screened in duplicate and candidate predictors were extracted. Results 14 systematic reviews assessed predictors of FD (n = 8) or NHA (n = 6). Reviews focused on studies of general inpatients/mixed presentations (n = 8: 6 FD, 2 NHA); hip fracture (n = 2: 1 FD, 1 NHA); stroke (n = 2: 1 FD, 1 NHA) and cognitive impairment (n = 1, NHA) or delirium (n = 1, NHA). Assessment of MLTC was heterogenous: comorbidity indices (n = 4), counts of LTC (n = 2), specific LTC (n = 8), and ‘comorbidity’ without further qualification (n = 3). Higher comorbidity indices, higher counts, and a range of specific comorbidities (most notably dementia) were associated with FD and NHA. Reviews assessing MLTC alongside other predictors highlighted a broad range of sociodemographic, functional, social, and admission-related factors that were associated with FD and NHA. In general, reviews did not assess the relative importance of MLTC alongside other predictors. Conclusion While MLTC may predict unwanted outcomes following admission their qualification is often inconsistent and their relative importance as predictors, alongside broader factors such as social complexity, is rarely assessed in existing systematic reviews.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"57 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.077
H Wightman, E Butterly, L Wei, R McChrystal, N Sattar, A Adler, D Phillipo, S Dias, N Welton, A Clegg, M Witham, K Rockwood, D McAllister, P Hanlon
Background The representation of frailty in type 2 diabetes trials is unclear. This study used individual patient data (IPD) from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events. Method We analysed IPD from 34 trials of SGLT2 inhibitors, GLP1 receptor agonists and DDP4 inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes. Findings Trial participants numbered 25,208. Mean age 53·8 to 74·2 years. Using FI > 0·24 to indicate frailty, median prevalence was 1·9% (IQR 0·8% to 6·1%). Prevalence was higher in trials of older people and people with renal impairment. For SGLT2i and GLP1ra, there was a small attenuation in efficacy on HbA1c with increasing frailty (0·07%-point and 0·14%-point smaller reduction, respectively, per 0·1-point increase in FI). Findings for MACE had high uncertainty (few events). A 0·1-point increase in the FI was associated with more adverse events (incidence rate ratio, IRR 1·43, 95% confidence interval 1·34 to 1·53), treatment-related adverse events (1·35, 1·22 to 1·50), serious adverse events (2·04, 1·80 to 2·30), hypoglycaemia (1·18, 1·04 to 1·34), MACE (hazard ratio 3·02, 2·49 to 3·68) and withdrawal (odds ratio 1·45, 1·30 to 1·62). Interpretation Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE. Frailty was rare in most trials. While these findings support calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials as the absolute balance of risks and benefits remains uncertain.
{"title":"2834 Frailty in randomised controlled trials of glucose-lowering therapies for type 2 diabetes","authors":"H Wightman, E Butterly, L Wei, R McChrystal, N Sattar, A Adler, D Phillipo, S Dias, N Welton, A Clegg, M Witham, K Rockwood, D McAllister, P Hanlon","doi":"10.1093/ageing/afae277.077","DOIUrl":"https://doi.org/10.1093/ageing/afae277.077","url":null,"abstract":"Background The representation of frailty in type 2 diabetes trials is unclear. This study used individual patient data (IPD) from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events. Method We analysed IPD from 34 trials of SGLT2 inhibitors, GLP1 receptor agonists and DDP4 inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes. Findings Trial participants numbered 25,208. Mean age 53·8 to 74·2 years. Using FI > 0·24 to indicate frailty, median prevalence was 1·9% (IQR 0·8% to 6·1%). Prevalence was higher in trials of older people and people with renal impairment. For SGLT2i and GLP1ra, there was a small attenuation in efficacy on HbA1c with increasing frailty (0·07%-point and 0·14%-point smaller reduction, respectively, per 0·1-point increase in FI). Findings for MACE had high uncertainty (few events). A 0·1-point increase in the FI was associated with more adverse events (incidence rate ratio, IRR 1·43, 95% confidence interval 1·34 to 1·53), treatment-related adverse events (1·35, 1·22 to 1·50), serious adverse events (2·04, 1·80 to 2·30), hypoglycaemia (1·18, 1·04 to 1·34), MACE (hazard ratio 3·02, 2·49 to 3·68) and withdrawal (odds ratio 1·45, 1·30 to 1·62). Interpretation Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE. Frailty was rare in most trials. While these findings support calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials as the absolute balance of risks and benefits remains uncertain.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"60 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.022
S Ninan, V Printz, T Denman
Introduction We wished to improve the knowledge of care home staff in Leeds in identifying frailty and managing frailty related problems. Method We developed a frailty education course (www.leedsfrailtyeducation.co.uk) which was then refined and modified to target care home staff. We engaged key stakeholders at the council and the ICB to help develop and promote the course. The course was delivered across 4 venues in Leeds by geriatricians, a pharmacist and a community nurse. Results We had 128 attendees across the four days. From the feedback taken immediately after the study day (n = 69): From the follow-up feedback (n = 19): Attendees also valued the multi-sector, multi-professional expert presenters alongside the opportunity to meet and interact in-person. Conclusion(s) A dedicated study day for care home staff was well received by attendees and feedback received demonstrated self-reported lasting change to practice. Key enablers to the success of the course were: the reputation of the course locally which had been piloted and delivered in different formats previously, tailoring the material to the audience, and delivering the course in several different locations. More regular frailty teaching days can be implemented to capture more care home staff and ultimately improve care for residents.
{"title":"2853 A frailty education programme for care home staff","authors":"S Ninan, V Printz, T Denman","doi":"10.1093/ageing/afae277.022","DOIUrl":"https://doi.org/10.1093/ageing/afae277.022","url":null,"abstract":"Introduction We wished to improve the knowledge of care home staff in Leeds in identifying frailty and managing frailty related problems. Method We developed a frailty education course (www.leedsfrailtyeducation.co.uk) which was then refined and modified to target care home staff. We engaged key stakeholders at the council and the ICB to help develop and promote the course. The course was delivered across 4 venues in Leeds by geriatricians, a pharmacist and a community nurse. Results We had 128 attendees across the four days. From the feedback taken immediately after the study day (n = 69): From the follow-up feedback (n = 19): Attendees also valued the multi-sector, multi-professional expert presenters alongside the opportunity to meet and interact in-person. Conclusion(s) A dedicated study day for care home staff was well received by attendees and feedback received demonstrated self-reported lasting change to practice. Key enablers to the success of the course were: the reputation of the course locally which had been piloted and delivered in different formats previously, tailoring the material to the audience, and delivering the course in several different locations. More regular frailty teaching days can be implemented to capture more care home staff and ultimately improve care for residents.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"24 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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