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Evaluation of Nursing Home Referrals: A retrospective study of Nursing home admissions to acute hospital 疗养院转诊的评估:疗养院急症入院的回顾性研究
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.172
Muhammad Abrar ul haq, Ayesha Hina, Areeba Khan, Izhar Rashid, Yasir Ali, Aziz Ahmad, Marie Hayden
Background Older nursing home residents (NHRs) typically present with multiple comorbidities and high frailty, necessitating careful management to avoid potentially avoidable hospital transfers . International reports indicate that between 6.8 % and 45.7 % of NHRs are transferred to acute hospitals over variable follow-up periods . Such transfers carry increased risks of in-hospital complications, including pressure ulcers, nosocomial infections, delirium, functional decline, and substantial healthcare costs. Moreover, nearly 40 % of care home residents who die in hospital do so within 24 hours of admission, suggesting that many transfers may be inappropriate. Methods To characterize referral processes and outcomes, we performed a retrospective chart analysis audit of 38 consecutive NHR admissions to our model 3 hospital over a 30 day period. Results The cohort’s mean age was 83 years. Sepsis accounted for 50% of admissions, with falls, delirium, acute kidney injury, and lower respiratory tract infections also common. 35% of referrals occurred at weekends, and 50% of weekday referrals were out-of-hours. Only 10 % underwent in-person general practitioner review and 20 % had telephone assessment before transfer. Transfer documentation was complete in 12 % of cases, incomplete in 65 %, and absent in 23 %, while 90 % had full medication lists. Advance directives precluding hospital admission existed for 13 % of admissions. In-hospital mortality within 24 hours occurred in 5 % of admissions, 15 % were discharged on oral therapy within 24 hours, and 27 % were readmitted within 30 days. Conclusion These findings highlight significant deficiencies in pre-transfer clinical review and communication, particularly during out-of-hours periods, underscoring the need to strengthen community-based care pathways, standardize documentation, and ensure timely GP involvement to reduce avoidable hospitalizations in this vulnerable population.
背景:老年养老院居民(nhr)通常存在多种合并症和高度虚弱,需要仔细管理,以避免可能可以避免的医院转院。国际报告表明,在不同的随访期间,6.8%至45.7%的国家卫生保健员被转移到急性医院。这种转移增加了院内并发症的风险,包括压疮、医院感染、谵妄、功能衰退和大量的医疗费用。此外,近40%在医院死亡的养老院居民在入院24小时内死亡,这表明许多转移可能是不合适的。方法:为了描述转诊过程和结果,我们对模型3医院在30天内连续收治的38例NHR患者进行了回顾性图表分析审计。结果本组患者平均年龄83岁。败血症占入院人数的50%,跌倒、谵妄、急性肾损伤和下呼吸道感染也很常见。35%的转介发生在周末,50%的工作日转介发生在非工作时间。只有10%的患者在转院前接受了全科医生的亲自检查,20%的患者接受了电话评估。12%的病例转院文件完整,65%的病例不完整,23%的病例没有转院文件,而90%的病例有完整的药物清单。有13%的住院患者存在预先指示排除住院。入院患者中有5%在24小时内住院死亡,15%在24小时内口服治疗出院,27%在30天内再次入院。这些发现突出了转院前临床审查和沟通的重大缺陷,特别是在非工作时间,强调需要加强社区护理途径,标准化文件,并确保全科医生及时参与,以减少这一弱势群体的可避免住院。
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引用次数: 0
Simulation-based Education To Implement National Clinical Guideline No.21 Guidelines In An Acute Hospital Setting 在急性病医院实施国家临床指南第21号指南的模拟教育
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.034
Emily Buckley, Patrick Doyle, Aoife McFeely, Dilara Ensar, Annie Shabu, Cathy Mullen, Aoife Fallon
Background Non-cognitive symptoms of dementia encompass behavioural, affective and psychotic symptoms that can occur in patients living with dementia. National Clinical Guideline No.21 recommends that a comprehensive assessment should be conducted prior to considering psychotropic medicine to treat non-cognitive symptoms in a person with dementia and that non-pharmacological interventions should be trialled before considering anti-psychotic medication (1). However, 41% of patients with dementia are prescribed new psychotropic and/or existing psychotropic medication is increased during an inpatient admission (2). The aim of this study was to implement National Clinical Guideline No.21 in an acute hospital setting using simulation-based education (SBE). Methods An interdisciplinary simulation scenario focusing on non-pharmacological management of non-cognitive symptoms in patients with dementia was developed. We employed a multi-component intervention approach combing a didactic lecture followed by a simulation scenario and debrief. Healthcare professionals from multiple specialties were invited to participate in simulation scenario which was delivered multiple times over one month. The scenario was facilitated utilising minimal resources and two embedded simulation participants from the Age-Related Healthcare department. The intervention was evaluated using a self-developed questionnaire. Responses were measured on a five-point Likert scale. Results The intervention was conducted three times. Twenty participants completed the questionnaire, including HCPs from occupational therapy (n=3), nursing (n=2), and medicine (n=15). Most (n=13) were previously unaware of National Clinical Guideline No. 21. Following participation, all participants were confident in recognising contributing factors to non-cognitive symptoms of dementia. Fifteen participants agreed they could now manage non-cognitive symptoms. Seventeen participants were confident in their knowledge of when pharmacological measures should be considered. Conclusion This study demonstrates that SBE may be a feasible intervention to implement the management of non-cognitive symptoms of dementia in an acute hospital setting. Next steps should focus on the impact of SBE on clinical practice, including psychotropic medication prescribing and patient outcomes.
背景:痴呆的非认知症状包括痴呆患者可能出现的行为、情感和精神症状。国家临床指南第21号建议,在考虑使用精神药物治疗痴呆患者的非认知症状之前,应进行全面评估,并且在考虑使用抗精神病药物之前,应进行非药物干预试验(1)。然而,41%的痴呆患者在住院期间开了新的精神药物和/或增加了现有的精神药物(2)。本研究的目的是在急性医院环境中使用基于模拟的教育(SBE)实施国家临床指南第21号。方法建立一个跨学科的模拟场景,重点研究痴呆患者非认知症状的非药物管理。我们采用了一种多成分的干预方法,结合教学讲座,然后是模拟场景和汇报。来自多个专业的医疗保健专业人员被邀请参与模拟场景,该场景在一个月内多次交付。该方案利用了最少的资源和来自年龄相关医疗保健部门的两名嵌入式模拟参与者。采用自行编制的问卷对干预措施进行评估。调查采用李克特五分制。结果干预共进行3次。20名参与者完成了问卷调查,包括来自职业治疗(n=3)、护理(n=2)和医学(n=15)的HCPs。大多数(n=13)以前不知道国家临床指南第21号。参与后,所有参与者都有信心认识到导致痴呆非认知症状的因素。15名参与者同意他们现在可以控制非认知症状。17名参与者对自己的知识有信心,他们知道什么时候应该考虑药物措施。结论本研究表明,SBE可能是一种可行的干预措施,以实施管理痴呆的非认知症状在急性医院设置。下一步应关注SBE对临床实践的影响,包括精神药物处方和患者预后。
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引用次数: 0
Experiences Of People With Parkinson’s Disease Of Video-Based Motor Symptom Assessment 基于视频的帕金森病患者运动症状评估经验
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.058
Lauren O Mahony, Lorna Kenny, Marco Sica, Colum Crowe, Savatore Tedesco, John Barton, Brendan O'Flynn, Suzanne Timmons
Background Parkinson’s Disease (PD) symptoms vary widely, making objective assessment challenging. PragmaClin Research Inc. developed the Parkinson's Remote Interactive Monitoring system (PRIMS), which collects the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor examination data via an instruction screen and Microsoft Kinect Depth cameras, and assigns severity ratings using machine-learning algorithms. We captured the experiences of people with PD (PwPD) trialing the system. Methods PwPD were recruited via local PD, neurology and geriatric clinics and PD social/support groups. Participants completed the PRIMS trial (performing actions in front of the camera system), a post-assessment survey (including the System Usability Scale (SUS)), and an optional audio-recorded interview. Survey data were analysed descriptively, with interview findings providing additional context. Results Twenty-seven participants completed the PRIMS trial and survey; 13 completed an optional interview. Most participants were aged 65-69 (44.4%) or 75-79 (33.3%), and male (66.7%), across Hoehn & Yahr stages 1-4. Almost all (95.6%) users reported being ‘extremely’ or ‘somewhat’ satisfied with the assessment, considering PRIMS potentially valuable for symptom monitoring over time, where video-based assessments could complement in-person consultations and communication with healthcare providers. SUS scores (80–85+) reflected excellent usability, with strong agreement on ease-of-use and low perceived-complexity. However, 52.1% 'somewhat' or 'strongly' disagreed that PRIMS could replace face-to-face consultations, noting usability may depend on technological ability, and some questioned whether clinicians would "trust it". Suggestions for improvement included clarified movement demonstrations and addressing participants’ varied perspectives on viewing themselves on camera. Participants considered PRIMS could be available in GP surgeries or health centers, but that home-based (laptop/phone) assessment would be most accessible. Conclusion PwPD suggest that remote video-based symptom assessment such as PRIMS would be acceptable and usable, aiding communication with healthcare teams on symptom variability, but this must consider technological abilities and setting convenience.
帕金森氏病(PD)的症状差异很大,使得客观评估具有挑战性。PragmaClin研究公司开发了帕金森远程互动监测系统(PRIMS),该系统通过指示屏幕和微软Kinect深度摄像头收集运动障碍协会的统一帕金森病评定量表(MDS-UPDRS)运动检查数据,并使用机器学习算法分配严重程度等级。我们收集了PD患者试用该系统的经验。方法通过当地PD、神经病学和老年诊所以及PD社会/支持团体招募PwPD。参与者完成了PRIMS试验(在相机系统前表演动作)、评估后调查(包括系统可用性量表(SUS))和可选的录音访谈。调查数据进行了描述性分析,访谈结果提供了额外的背景。结果27例受试者完成了PRIMS试验和调查;13 .完成了一次选择性面试。大多数参与者年龄在65-69岁(44.4%)或75-79岁(33.3%),男性(66.7%),在Hoehn & Yahr阶段1-4。几乎所有(95.6%)的用户报告对评估“非常”或“有些”满意,考虑到PRIMS对长期症状监测的潜在价值,其中基于视频的评估可以补充面对面的咨询和与医疗保健提供者的沟通。SUS得分(80-85 +)反映了出色的可用性,在易用性和低感知复杂性方面有很强的一致性。然而,52.1%的人“有点”或“强烈”不同意PRIMS可以取代面对面的咨询,指出可用性可能取决于技术能力,一些人质疑临床医生是否会“信任它”。改进建议包括明确的动作演示和解决参与者在镜头前看待自己的不同观点。参与者认为PRIMS可以在全科医生诊所或健康中心使用,但家庭(笔记本电脑/电话)评估将是最容易获得的。结论PwPD提示,基于视频的症状评估(如PRIMS)是可接受和可用的,有助于与医疗团队就症状变变性进行沟通,但这必须考虑技术能力和设置的便利性。
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引用次数: 0
Comparison Of Demographics And Outcome Measures Of Patients > 65yrs Admitted To A Rehabilitation Unit With And Without Parkinson’s Disease 65岁至65岁帕金森病患者与非帕金森病患者在康复中心的人口学特征和预后指标比较
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.127
Kei Yen Chan, Bláithin Ní Bhuachalla
Background Parkinson’s disease (PD) is Ireland’s second most common neurodegenerative disorder. Multidisciplinary rehabilitation improves motor and cognitive outcomes. Access remains limited and fragmented. The aim of this analysis was to compare the functional outcomes of patients with and without a PD diagnosis admitted to our rehabilitation unit. Methods Using medical records, data was retrospectively collated on all patients admitted to a 10 bed rehabilitation unit from January 2024-March 2025. Data collated included demographics, source of referral for rehabilitation, length of stay (LOS), clinical frailty scale (CFS) on discharge and discharge destination. The following outcome measures on admission and discharge were collated: Barthel score, Berg Balance, Timed Up and Go (TUG), de Morton Mobility Index (DEMMI) and Lindop Parkinson’s Assessment Scale (LPAS). Excluded from analysis were those who did not have discharge outcome measures, due to being transferred back to acute hospital/unplanned discharge/death (n=22). Data was analysed using Microsoft Excel. Results 160 patients were admitted to the unit over the 15 month period. Of those 10% had PD (n=16), 38% (n=6) were newly diagnosed, 63% (n=10) male and in 38% (n=6) presenting complaint was a fall. Source of referral: General Medicine 81% (n=13), Orthopaedics 13% (n=2), General Surgery 6% (n=1). In the PD cohort (n=16), from admission to discharge the following were the changes in outcome measures: Barthel (48/100 to 67/100), Berg (29/56 to 42/56), TUG (50.6s to 32.1s), DEMMI (41/100 to 54/100) and Lindop (14/30 to 21/30). In the non-PD cohort (n=122), Barthel (50/100 to 70/100), Berg (29/56 to 43/56), TUG (40.4s to 27.9s), DEMMI (43/100 to 54/100). On discharge, PD versus Non-PD cohort: CFS 6 versus 5.5, LOS 36 versus 34 days, discharge home 95% versus 90%. Conclusion PD patients showed functional improvement during rehabilitation, although starting from a lower baseline and with slightly longer stays than the general cohort.
帕金森氏病(PD)是爱尔兰第二常见的神经退行性疾病。多学科康复改善运动和认知预后。访问仍然是有限和分散的。本分析的目的是比较我们康复部门收治的有和没有PD诊断的患者的功能结果。方法回顾性整理2024年1月至2025年3月收治的10张床位康复病房的所有患者的病历资料。整理的数据包括人口统计、康复转诊来源、住院时间(LOS)、出院时的临床虚弱量表(CFS)和出院目的地。整理入院和出院时的预后指标:Barthel评分、Berg Balance、Timed Up and Go (TUG)、de Morton活动指数(DEMMI)和Lindop帕金森评估量表(LPAS)。分析排除了那些由于转回急性住院/计划外出院/死亡而没有出院结果测量的患者(n=22)。数据采用Microsoft Excel进行分析。结果在15个月内共收治160例患者。在这10%的PD患者(n=16)中,38% (n=6)是新诊断的,63% (n=10)是男性,38% (n=6)的主诉是跌倒。转诊来源:普通内科81% (n=13),骨科13% (n=2),普通外科6% (n=1)。在PD队列(n=16)中,从入院到出院的结局指标变化如下:Barthel(48/100至67/100)、Berg(29/56至42/56)、TUG (50.6s至321 s)、DEMMI(41/100至54/100)和Lindop(14/30至21/30)。在非pd组(n=122)中,Barthel(50/100至70/100),Berg(29/56至43/56),TUG(40.4至27.9),DEMMI(43/100至54/100)。出院时,PD组与非PD组:CFS 6 vs 5.5, LOS 36 vs 34天,出院95% vs 90%。结论PD患者在康复过程中表现出功能的改善,尽管从较低的基线开始,停留时间略长于一般队列。
{"title":"Comparison Of Demographics And Outcome Measures Of Patients > 65yrs Admitted To A Rehabilitation Unit With And Without Parkinson’s Disease","authors":"Kei Yen Chan, Bláithin Ní Bhuachalla","doi":"10.1093/ageing/afaf318.127","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.127","url":null,"abstract":"Background Parkinson’s disease (PD) is Ireland’s second most common neurodegenerative disorder. Multidisciplinary rehabilitation improves motor and cognitive outcomes. Access remains limited and fragmented. The aim of this analysis was to compare the functional outcomes of patients with and without a PD diagnosis admitted to our rehabilitation unit. Methods Using medical records, data was retrospectively collated on all patients admitted to a 10 bed rehabilitation unit from January 2024-March 2025. Data collated included demographics, source of referral for rehabilitation, length of stay (LOS), clinical frailty scale (CFS) on discharge and discharge destination. The following outcome measures on admission and discharge were collated: Barthel score, Berg Balance, Timed Up and Go (TUG), de Morton Mobility Index (DEMMI) and Lindop Parkinson’s Assessment Scale (LPAS). Excluded from analysis were those who did not have discharge outcome measures, due to being transferred back to acute hospital/unplanned discharge/death (n=22). Data was analysed using Microsoft Excel. Results 160 patients were admitted to the unit over the 15 month period. Of those 10% had PD (n=16), 38% (n=6) were newly diagnosed, 63% (n=10) male and in 38% (n=6) presenting complaint was a fall. Source of referral: General Medicine 81% (n=13), Orthopaedics 13% (n=2), General Surgery 6% (n=1). In the PD cohort (n=16), from admission to discharge the following were the changes in outcome measures: Barthel (48/100 to 67/100), Berg (29/56 to 42/56), TUG (50.6s to 32.1s), DEMMI (41/100 to 54/100) and Lindop (14/30 to 21/30). In the non-PD cohort (n=122), Barthel (50/100 to 70/100), Berg (29/56 to 43/56), TUG (40.4s to 27.9s), DEMMI (43/100 to 54/100). On discharge, PD versus Non-PD cohort: CFS 6 versus 5.5, LOS 36 versus 34 days, discharge home 95% versus 90%. Conclusion PD patients showed functional improvement during rehabilitation, although starting from a lower baseline and with slightly longer stays than the general cohort.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"48 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680507","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}
引用次数: 0
A Pilot Older Persons Trauma Service at a University Teaching Hospital and Designated Trauma Unit 在一所大学教学医院和指定创伤科试点老年人创伤服务
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.163
Claire McAteer, Tadhg Cronin, Aoife Dunphy, Louise Hogan, Suzanne Laffan, Eleanor Maher, Kirsty Mason, Aleisha McDonald, Katie Ronan, Terence Murphy, Niamh O'Regan
Background Early Comprehensive Geriatric Assessment (CGA) and Multidisciplinary Team (MDT) intervention is one of 12 core principles of the Management of Major Trauma in Older Adults. At our Model 4 University Teaching Hospital, a designated Trauma Unit, all low-impact hip fracture patients aged 60 and above are seen by the Orthogeriatric Service, however due to staffing constraints, other older orthopaedic trauma patients are not routinely seen. In early 2025 we piloted an Older Persons Trauma Service, as part of an Aspire Fellowship programme, to provide Orthogeriatric care to older adults who had sustained a fracture, other than hip fracture, due to trauma. We emulated the care provided to hip fracture patients, i.e. CGA focusing on preventing future falls and fractures. Here we present some patient demographics of the pilot service. Methods Included patients were aged 75 and above, admitted under Orthopaedics on an Orthopaedic ward, with a fracture(s) (other than hip fracture) due to trauma. Patients were seen and followed by a Clinical Fellow and discussed at weekly MDT. CGA was conducted for all patients. Results Forty-one patients were reviewed during the c. 14-week pilot service. Average age was 82, Clinical Frailty Scale ranged from 1 to 7. Two thirds were female (n = 27) and 68% were from out of county (n= 28). The most common fractures were C-Spine fractures (24%), followed by ankle fractures (20%). Most injuries were from low falls. Feedback to date has been positive from patients, carers, and the MDT, and service evaluation is ongoing. Conclusion In this pilot service, 41 older trauma patients received CGA including falls and bone health assessment. Low falls were the leading cause of trauma, consistent with the results of the NOCA Major Trauma Audit 2021. Formal evaluation of the service is ongoing, however to date feedback has been encouraging.
背景早期综合老年评估(CGA)和多学科团队(MDT)干预是老年人重大创伤管理的12项核心原则之一。在我们的模范大学教学医院,一个指定的创伤科,所有60岁及以上的低冲击性髋部骨折患者都由骨科服务部门就诊,但由于人员配备限制,其他老年骨科创伤患者并不经常就诊。在2025年初,作为Aspire奖学金项目的一部分,我们试点了老年人创伤服务,为因创伤而遭受骨折(髋部骨折除外)的老年人提供正畸护理。我们模拟了髋部骨折患者的护理,即CGA侧重于预防未来跌倒和骨折。在这里,我们提出了试点服务的一些患者人口统计数据。方法纳入的患者年龄在75岁及以上,在骨科病房骨科住院,因外伤导致骨折(髋部骨折除外)。患者由临床研究员进行观察和随访,并在每周一次的MDT上进行讨论。所有患者均行CGA。结果41例患者在14周的试点服务期间被复查。平均年龄82岁,临床虚弱量表1 ~ 7分。三分之二为女性(n= 27), 68%为外地(n= 28)。最常见的骨折是颈椎骨折(24%),其次是踝关节骨折(20%)。大多数受伤是由低位坠落造成的。迄今为止,患者、护理人员和MDT的反馈都是积极的,服务评估正在进行中。结论41例老年外伤患者接受了包括跌倒和骨健康评估在内的CGA。低跌落是造成创伤的主要原因,这与NOCA 2021年重大创伤审计的结果一致。目前正在对这项服务进行正式评价,但迄今为止的反馈令人鼓舞。
{"title":"A Pilot Older Persons Trauma Service at a University Teaching Hospital and Designated Trauma Unit","authors":"Claire McAteer, Tadhg Cronin, Aoife Dunphy, Louise Hogan, Suzanne Laffan, Eleanor Maher, Kirsty Mason, Aleisha McDonald, Katie Ronan, Terence Murphy, Niamh O'Regan","doi":"10.1093/ageing/afaf318.163","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.163","url":null,"abstract":"Background Early Comprehensive Geriatric Assessment (CGA) and Multidisciplinary Team (MDT) intervention is one of 12 core principles of the Management of Major Trauma in Older Adults. At our Model 4 University Teaching Hospital, a designated Trauma Unit, all low-impact hip fracture patients aged 60 and above are seen by the Orthogeriatric Service, however due to staffing constraints, other older orthopaedic trauma patients are not routinely seen. In early 2025 we piloted an Older Persons Trauma Service, as part of an Aspire Fellowship programme, to provide Orthogeriatric care to older adults who had sustained a fracture, other than hip fracture, due to trauma. We emulated the care provided to hip fracture patients, i.e. CGA focusing on preventing future falls and fractures. Here we present some patient demographics of the pilot service. Methods Included patients were aged 75 and above, admitted under Orthopaedics on an Orthopaedic ward, with a fracture(s) (other than hip fracture) due to trauma. Patients were seen and followed by a Clinical Fellow and discussed at weekly MDT. CGA was conducted for all patients. Results Forty-one patients were reviewed during the c. 14-week pilot service. Average age was 82, Clinical Frailty Scale ranged from 1 to 7. Two thirds were female (n = 27) and 68% were from out of county (n= 28). The most common fractures were C-Spine fractures (24%), followed by ankle fractures (20%). Most injuries were from low falls. Feedback to date has been positive from patients, carers, and the MDT, and service evaluation is ongoing. Conclusion In this pilot service, 41 older trauma patients received CGA including falls and bone health assessment. Low falls were the leading cause of trauma, consistent with the results of the NOCA Major Trauma Audit 2021. Formal evaluation of the service is ongoing, however to date feedback has been encouraging.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"128 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673579","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}
引用次数: 0
Falls Profile of Older Adults Attending a Community Specialist Team for Comprehensive Geriatric Assessment 参加社区专家小组进行综合老年评估的老年人跌倒概况
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.053
Karen Sayers, Lorna King, Siobhan Ryan, Josephine Keating, Christina Donnellan
Background The aim of this study was to evaluate the falls risk stratification, assessment and management of older adults who receive Comprehensive Geriatric Assessment (CGA). Methods A retrospective evaluation was undertaken of all patients ≥65 years who attended a Community Specialist Team over a 7-month period. Falls risk stratification and Multifactorial Falls Risk Assessment (MFRA) were undertaken as part of CGA. Data was analysed using descriptive statistics and binary logistic regression. Results Ninety-six patients attended during the study period, 37 male, 59 female, mean age: 80 years (SD=7), median Clinical Frailty Scale score: 5 (mild frailty), Barthel score: 17/20 (low dependency). Forty-four percent (n=42) were referred for CGA because of falling. Opportunistic screening identified 97% (n=93) had falls risks, 86% (n=83) were high risk and 66% (n=63) reported falling in the past year. Balance and gait impairment was an independent predictor of falls (OR=3.167, CI=1.157-8.668, p<0.025). Other risk factors were musculoskeletal disorder (68% n=65), cognitive impairment (66% n=63), Falls-Risk-Increasing-Drgs (62% n=59), probable sarcopenia (40% n=38) and Orthostatic Hypotension (30% n=28). Median number of falls-specific interventions required was 4 (range 0-9). Most frequent interventions were Physiotherapy (51% n=49), medication changes (47% n=45), Dietetics (42% n=40), Occupational Therapy (38% n=36), Pharmacy (35% n=33), Memory Clinic (35% n=34) and Cardiology (13% n=12). Conclusion Older adults attending for CGA are at high risk for falls. MFRA is an essential component of CGA. This evaluation will guide multi-domain service delivery to address the key risk factors.
本研究的目的是评价接受综合老年评估(Comprehensive Geriatric assessment, CGA)的老年人跌倒风险分层、评估和管理。方法回顾性评估所有≥65岁的社区专家小组7个月期间的患者。跌倒风险分层和多因素跌倒风险评估(MFRA)作为CGA的一部分进行。数据分析采用描述性统计和二元逻辑回归。结果96例患者在研究期间就诊,其中男性37例,女性59例,平均年龄80岁(SD=7),临床虚弱量表中位评分:5分(轻度虚弱),Barthel评分:17/20(低依赖)。44% (n=42)的患者因跌倒而接受CGA治疗。机会性筛查发现97% (n=93)有跌倒风险,86% (n=83)有高风险,66% (n=63)报告在过去一年中跌倒。平衡和步态障碍是跌倒的独立预测因子(OR=3.167, CI=1.157-8.668, p<0.025)。其他危险因素是肌肉骨骼疾病(68% n=65)、认知障碍(66% n=63)、跌倒-风险增加-药物(62% n=59)、可能的肌肉减少症(40% n=38)和直立性低血压(30% n=28)。针对跌倒需要的干预措施中位数为4次(范围0-9)。最常见的干预措施是物理治疗(51% n=49)、药物改变(47% n=45)、饮食(42% n=40)、职业治疗(38% n=36)、药学(35% n=33)、记忆门诊(35% n=34)和心脏病学(13% n=12)。结论因CGA就诊的老年人有较高的跌倒风险。MFRA是CGA的重要组成部分。该评估将指导多领域服务交付,以解决关键风险因素。
{"title":"Falls Profile of Older Adults Attending a Community Specialist Team for Comprehensive Geriatric Assessment","authors":"Karen Sayers, Lorna King, Siobhan Ryan, Josephine Keating, Christina Donnellan","doi":"10.1093/ageing/afaf318.053","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.053","url":null,"abstract":"Background The aim of this study was to evaluate the falls risk stratification, assessment and management of older adults who receive Comprehensive Geriatric Assessment (CGA). Methods A retrospective evaluation was undertaken of all patients ≥65 years who attended a Community Specialist Team over a 7-month period. Falls risk stratification and Multifactorial Falls Risk Assessment (MFRA) were undertaken as part of CGA. Data was analysed using descriptive statistics and binary logistic regression. Results Ninety-six patients attended during the study period, 37 male, 59 female, mean age: 80 years (SD=7), median Clinical Frailty Scale score: 5 (mild frailty), Barthel score: 17/20 (low dependency). Forty-four percent (n=42) were referred for CGA because of falling. Opportunistic screening identified 97% (n=93) had falls risks, 86% (n=83) were high risk and 66% (n=63) reported falling in the past year. Balance and gait impairment was an independent predictor of falls (OR=3.167, CI=1.157-8.668, p&amp;lt;0.025). Other risk factors were musculoskeletal disorder (68% n=65), cognitive impairment (66% n=63), Falls-Risk-Increasing-Drgs (62% n=59), probable sarcopenia (40% n=38) and Orthostatic Hypotension (30% n=28). Median number of falls-specific interventions required was 4 (range 0-9). Most frequent interventions were Physiotherapy (51% n=49), medication changes (47% n=45), Dietetics (42% n=40), Occupational Therapy (38% n=36), Pharmacy (35% n=33), Memory Clinic (35% n=34) and Cardiology (13% n=12). Conclusion Older adults attending for CGA are at high risk for falls. MFRA is an essential component of CGA. This evaluation will guide multi-domain service delivery to address the key risk factors.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"156 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673580","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}
引用次数: 0
Understanding The Whole Story: Assessing Doctor-Patient Communication with Older People in Acute Care 了解整个故事:评估急症护理中老年人的医患沟通
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.092
Caoimhe Murphy, Kieran O’Connor
Background Communication is the cornerstone of our interaction with people. Effective doctor-patient communication is central to building a therapeutic doctor-patient relationship. Some older patients may have challenges with communication due to hearing loss, various co-morbidities, and possible cognitive impairments. However, there is limited Irish research into understanding specific communication challenges. Our objective was to explore doctors’ and older patients’ perceptions of hospital-based communication and to identify perceived aids and barriers to effective doctor-patient communication. Methods A cross-sectional study design was used. Two previously validated Doctor-Patient Communication Scales (one for patients and one for doctors) were utilised to assess our two groups, inpatients aged 65 years and older and doctors treating this population. The questionnaires included similar questions about doctor-patient communication, with some variations to suit the different populations. Quantitative data was generated by graded responses (Likert Scale 1-4). A qualitative component was additionally incorporated into both questionnaires to explore perceived communication barriers, time spent by doctors per patient, and prior training received in communication. A total of 100 in-patients and 38 doctors participated. Results Patients reported a mean communication score of 42.27/52 (SD=8.35); doctors averaged 39.21/44 (SD=3.11), suggesting generally positive perceptions. However, a significant negative correlation was found between patient scores and number of co-morbidities (r = -0.327, p &lt; 0.001), indicating poorer communication experiences among patients with more conditions. Notably, 43% of patients had difficulty understanding their doctor. Cited barriers included time constraints, hearing impairments, hospital noise, medical jargon, and doctors’ varying accents. Among doctors, 39.5% had not received post-graduate communication training. Positive influences on satisfaction included doctors’ friendly demeanours, involving patients in decisions, and use of clear, simple language. Conclusion Doctor-patient communication must be improved for older adults with complex needs. Addressing key barriers—such as limited consultation time and insufficient communication training—may enhance patient understanding and outcomes.
交流是我们与人互动的基石。有效的医患沟通是建立治疗性医患关系的核心。一些老年患者可能由于听力损失、各种合并症和可能的认知障碍而面临沟通方面的挑战。然而,爱尔兰在理解具体的沟通挑战方面的研究有限。我们的目的是探讨医生和老年患者对医院沟通的看法,并确定有效医患沟通的辅助因素和障碍。方法采用横断面研究设计。两个先前验证的医患沟通量表(一个用于患者,一个用于医生)用于评估我们的两组,65岁及以上的住院患者和治疗该人群的医生。调查问卷包括了类似的关于医患沟通的问题,并针对不同人群做了一些调整。定量数据采用分级反应(Likert Scale 1-4)生成。另外,在这两份问卷中都加入了定性成分,以探讨感知到的沟通障碍、医生在每个病人身上花费的时间以及之前接受的沟通培训。共有100名住院病人和38名医生参与。结果患者平均沟通评分为42.27/52 (SD=8.35);医生的平均得分为39.21/44 (SD=3.11),总体上持积极态度。然而,患者评分与共病数量呈显著负相关(r = -0.327, p < 0.001),表明患者的沟通体验越差,病情越多。值得注意的是,43%的患者难以理解他们的医生。被提到的障碍包括时间限制、听力障碍、医院噪音、医学术语和医生不同的口音。39.5%的医生未接受过研究生沟通培训。对满意度的积极影响包括医生友好的举止,让病人参与决策,以及使用清晰、简单的语言。结论对有复杂需求的老年人,需加强医患沟通。解决关键障碍,如有限的咨询时间和沟通培训不足,可能会提高患者的理解和结果。
{"title":"Understanding The Whole Story: Assessing Doctor-Patient Communication with Older People in Acute Care","authors":"Caoimhe Murphy, Kieran O’Connor","doi":"10.1093/ageing/afaf318.092","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.092","url":null,"abstract":"Background Communication is the cornerstone of our interaction with people. Effective doctor-patient communication is central to building a therapeutic doctor-patient relationship. Some older patients may have challenges with communication due to hearing loss, various co-morbidities, and possible cognitive impairments. However, there is limited Irish research into understanding specific communication challenges. Our objective was to explore doctors’ and older patients’ perceptions of hospital-based communication and to identify perceived aids and barriers to effective doctor-patient communication. Methods A cross-sectional study design was used. Two previously validated Doctor-Patient Communication Scales (one for patients and one for doctors) were utilised to assess our two groups, inpatients aged 65 years and older and doctors treating this population. The questionnaires included similar questions about doctor-patient communication, with some variations to suit the different populations. Quantitative data was generated by graded responses (Likert Scale 1-4). A qualitative component was additionally incorporated into both questionnaires to explore perceived communication barriers, time spent by doctors per patient, and prior training received in communication. A total of 100 in-patients and 38 doctors participated. Results Patients reported a mean communication score of 42.27/52 (SD=8.35); doctors averaged 39.21/44 (SD=3.11), suggesting generally positive perceptions. However, a significant negative correlation was found between patient scores and number of co-morbidities (r = -0.327, p &amp;lt; 0.001), indicating poorer communication experiences among patients with more conditions. Notably, 43% of patients had difficulty understanding their doctor. Cited barriers included time constraints, hearing impairments, hospital noise, medical jargon, and doctors’ varying accents. Among doctors, 39.5% had not received post-graduate communication training. Positive influences on satisfaction included doctors’ friendly demeanours, involving patients in decisions, and use of clear, simple language. Conclusion Doctor-patient communication must be improved for older adults with complex needs. Addressing key barriers—such as limited consultation time and insufficient communication training—may enhance patient understanding and outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673638","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}
引用次数: 0
Audit of Mood Assessment Post Stroke At a University Hospital 某大学医院卒中后情绪评估的审计
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.114
Zubair Mughal, Kuruvilla Sebastian, Ali Sibtain Azhar, Abdirahman Shiekh Mohamed, Ahmed Gabr, Yousuf Ibrahim, Tala Abdelatif, Adlin Wahab, Donatas Galickas, Ming Cheun Chong, Aneesa Mangalam, Jennita Ariaratnam, Nouman Niaz, Raihan Alheyali, Hye Won Yang, Natasha Slattery, Lisa Woodland, Ida Carroll, Claire Collins, Margaret O'Connor, Nora Cunningham, Virginie McCarty
Background Post-stroke mood disturbances are common, negatively impact recovery and quality of life and are amenable to treatment. The National Clinical Guidelines for Stroke 2023 recommended the routine assessment of mood as an essential component of comprehensive stroke management. A quality improvement (QI) project was initiated to standardise mood screening in 2022 at a university teaching hospital. Consensus was reached on a shared multidisciplinary team-based model for the implementation of the SODS (S: Sadness, O: Outlook, D: Decision-making, S: Sleep) mood screening tool, incorporating routine verification of mood screening completion at the weekly multidisciplinary team meeting. Patients screening positive were referred for psychological assessment. This audit aimed to evaluate the longer term impact on mood screening in the subsequent years 2023-2024. Methods This was a retrospective audit reviewing stroke admissions from 2022-2024 using data extracted from the HIPE database and Institutional Stroke Portal. All patients admitted with a confirmed diagnosis of stroke were included. Data collected included demographics, outcomes, and mood assessment completion. Descriptive analysis was conducted. Results A total of 1,624 stroke cases were reviewed: 512 in 2022, 561 in 2023, and 551 in 2024. Mood assessment completion rates were 71.7% (367/512) in 2022, 75.9% (426/561) in 2023, and 84.0% (463/551) in 2024. This is benchmarked to a mood screening rate of 34% nationally (2023). Conclusion This audit demonstrated a progressive improvement in mood assessment compliance following implementation of a QI project in 2022, highlighting the sustainability of such an initiative when supported by the multidisciplinary team and psychology resource. Other QI interventions could benefit from extending beyond educational initiatives to include elements such as process changes and protocols supported by multidisciplinary engagement and participation.
脑卒中后情绪障碍是常见的,对康复和生活质量有负面影响,并且是可以治疗的。《2023年国家卒中临床指南》建议将日常情绪评估作为卒中综合管理的重要组成部分。2022年,一所大学教学医院启动了一项质量改进(QI)项目,以规范情绪筛查。达成共识的是一个基于多学科团队的共享模型,用于实施SODS (S: Sadness, O: Outlook, D: decision - decision, S: Sleep)情绪筛查工具,并在每周多学科团队会议上对情绪筛查完成情况进行例行验证。筛查阳性的患者转介进行心理评估。该审计旨在评估对随后2023-2024年情绪筛查的长期影响。方法回顾性审核2022-2024年卒中入院情况,数据提取自HIPE数据库和机构卒中门户网站。所有确诊为中风的住院患者均被纳入研究。收集的数据包括人口统计、结果和情绪评估完成情况。进行描述性分析。结果共回顾脑卒中病例1624例,其中2022年512例,2023年561例,2024年551例。2022年心境评估完成率为71.7%(367/512),2023年为75.9%(426/561),2024年为84.0%(463/551)。以全国(2023年)34%的情绪筛查率为基准。该审计表明,在2022年实施QI项目后,情绪评估依从性逐步改善,突出了在多学科团队和心理学资源的支持下,该倡议的可持续性。其他QI干预措施可以从扩展到教育计划之外,包括由多学科参与和参与支持的过程变更和协议等元素中受益。
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引用次数: 0
Sensory Dysfunction As a Marker of Clinical Phenotype Across the Lewy Body Disease Spectrum 感觉功能障碍作为路易体病谱系临床表型的标志
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.105
Adele Ravelli, Ciara Gibbons, Patrick Chirilele, Adam Roche, Anusha Yasoda-Mohan, Joseph Kane, Romàn Romero-Ortuño, Iracema Leroi
Background Lewy Body Disease (LBD) presents with a complex phenotype encompassing neuropsychiatric, motor, and autonomic symptoms, with substantial clinical variability across individuals. Sensory impairments - particularly in vision, hearing, and olfaction - are emerging as early and non-invasive markers of neurodegeneration, yet their role in LBD remains underexplored. This study investigates the association between sensory dysfunction and core non-cognitive clinical features of LBD across its spectrum, from Parkinson’s Disease with Mild Cognitive Impairment (PD-MCI) to probable Dementia with Lewy Bodies (DLB), aiming to identify sensory profiles linked to more severe clinical phenotypes. Methods In this observational cross-sectional study, participants with PD-MCI and probable DLB underwent a comprehensive assessment across sensory, neuropsychiatric, motor, and autonomic domains. Sensory function was assessed using objective measures of olfaction, vision, and hearing. Associations between sensory impairments and core LBD symptoms were explored to identify potential phenotype patterns. Results To date, 46 participants have been recruited (37 LBD, 9 PD-MCI; mean age = 74.1, SD = 5.6; 30% female). The overall sample showed widespread sensory dysfunction: 100% exhibited moderate-to-severe olfactory loss, 98% auditory deficits, and 24.4% visual impairment. Neuropsychiatric symptoms were highly prevalent, particularly hallucinations (62.2%), apathy (73%) and REM sleep disturbances (64.9%). Clinically significant anxiety and depression were present in 33% and 18.7% of participants, respectively. Motor and autonomic abnormalities were also common. Conclusion These findings highlight the potential of sensory profiling as a feasible and informative approach to capture clinical heterogeneity in LBD. Assessing sensory function may aid early identification of more severe non-cognitive phenotypes and inform tailored clinical strategies across the disease spectrum.
背景:路易体病(LBD)具有复杂的表型,包括神经精神、运动和自主神经症状,个体之间具有显著的临床差异。感觉障碍——尤其是视觉、听觉和嗅觉——作为神经退行性疾病的早期和非侵入性标志出现,但它们在LBD中的作用仍未得到充分探讨。本研究调查了LBD的感觉功能障碍与核心非认知临床特征之间的关系,从帕金森病伴轻度认知障碍(PD-MCI)到可能的路易体痴呆(DLB),旨在确定与更严重的临床表型相关的感觉特征。方法在这项观察性横断面研究中,PD-MCI和可能的DLB患者接受了感觉、神经精神、运动和自主神经领域的综合评估。用嗅觉、视觉和听觉的客观测量来评估感觉功能。我们探讨了感觉障碍和核心LBD症状之间的联系,以确定潜在的表型模式。迄今为止,已招募了46名参与者(37名LBD, 9名PD-MCI,平均年龄= 74.1,SD = 5.6, 30%为女性)。整体样本显示广泛的感觉功能障碍:100%表现为中度至重度嗅觉丧失,98%表现为听觉障碍,24.4%表现为视觉障碍。神经精神症状非常普遍,特别是幻觉(62.2%),冷漠(73%)和快速眼动睡眠障碍(64.9%)。临床显著的焦虑和抑郁分别出现在33%和18.7%的参与者中。运动和自主神经异常也很常见。结论:这些发现强调了感觉谱分析作为一种可行且信息丰富的方法来捕捉LBD的临床异质性的潜力。评估感觉功能可能有助于早期识别更严重的非认知表型,并为整个疾病谱系量身定制临床策略提供信息。
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引用次数: 0
Evaluation Of A Once Weekly Exercise Class For Patients With Parkinson’s Disease In A Sub-Acute Rehabilitation Setting 帕金森病患者亚急性康复环境下每周一次运动课程的评价
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2025-12-05 DOI: 10.1093/ageing/afaf318.052
Sophie Keddie
Background Patients with Parkinson’s Disease (PD) admitted to a sub-acute rehabilitation setting presented with motor symptoms such as bradykinesia, tremor, balance and gait impairments and reduced awareness of the benefits of exercise and physiotherapy on their PD symptoms. An exercise class based on the Lee Silverman Voice Treatment (LSVT) BIG principles was implemented to evaluate the effectiveness of a single physiotherapy led exercise class for patients presenting with motor symptoms associated with PD. Methods A Parkinson's exercise group class based on LSVT principles of BIG movements was designed, consisting of a 30-minute physiotherapist led class including warm up, seated and standing based exercises and cool down. The five times sit to stand (5TSTS) outcome measure was evaluated pre and post each intervention to determine immediate functional impact on each participant. A retrospective review of data collected was conducted on all participants who attended each exercise class. Results A total of 20 participants (60% male, 40% female) took part in the exercise class across a 6-month period. The average age of the participants was 79.8 years (SD 7.65 years) and a median clinical frailty scale score of 5. The mean 5TSTS score pre-intervention was 24.42 seconds (SD 20.2 sec). The mean 5TSTS score post intervention was 20.81 seconds (SD 16.57sec) with a mean change between pre and post intervention 5TSTS of 3.61 seconds (SD 9.66 sec) Conclusion Patients admitted with PD presented with coexisting frailty. The data collected demonstrated an immediate improvement in function after a single group exercise intervention. Further evaluation is required to determine longer term effects of this exercise intervention on patients with PD and coexisting frailty.
帕金森氏病(PD)患者在亚急性康复环境中表现出运动症状,如运动迟缓、震颤、平衡和步态障碍,并且对运动和物理治疗对其PD症状的益处的认识降低。基于Lee Silverman声音治疗(LSVT) BIG原则的运动课程被实施,以评估单个物理治疗主导的运动课程对出现PD相关运动症状的患者的有效性。方法设计基于LSVT BIG运动原理的帕金森运动组课程,由物理治疗师主导的30分钟课程,包括热身、坐立基础运动和放松运动。在每次干预之前和之后评估五次坐立(5TSTS)结果测量,以确定对每位参与者的直接功能影响。对参加每个锻炼班的所有参与者收集的数据进行回顾性审查。结果共有20名参与者(60%男性,40%女性)参加了为期6个月的锻炼课程。参与者的平均年龄为79.8岁(SD为7.65岁),临床虚弱量表得分中位数为5分。干预前5TSTS平均评分为24.42秒(SD为20.2秒)。干预后5TSTS平均评分为20.81秒(SD为16.57秒),干预前后5TSTS平均变化为3.61秒(SD为9.66秒)。收集的数据表明,在单组运动干预后,功能立即得到改善。需要进一步的评估来确定这种运动干预对PD和共存虚弱患者的长期影响。
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Age and ageing
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