Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.039
A Heskett, J Mummaneni, W Hicks
Introduction Home Treatment Service (HTS, a Frailty Hospital at Home model that provides Comprehensive Geriatric Assessment, diagnostics and treatments to avoid hospital admission for people with frailty) within Kent Community Health NHS Foundation Trust has increased links with the Acute and Ambulance Trusts. The MDT interacts with visiting paramedics within a clinical navigation hub (CHUB). Method 61 HTS referrals from the CHUB were compared with 61 direct clinician referrals from December 2023 to February 2024. The NEWs score, length of stay (LOS) and Advance Care Planning (ACP) documents were analysed. Results The average LOS under HTS via the CHUB was 2.61 days and 3.65 days for direct referrals. 27% of NEWS scores from the CHUB were high compared with 14% from direct referrals. 48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage. Conclusion(s) Referrals directed to HTS proactively from the CHUB have a higher percentage of NEWS scores that would require hourly observations and/or escalation to medical assessment. The CHUB explores community options while weighing benefits and risks of transfer to hospital in real time. The LOS between the two referral sources is not hugely different and suggests that we are identifying patients requiring similar management regardless of source of referral. The CHUB gives options to patients who have fewer advance decisions recorded to support the direction of their care at the point of an emergency response. The CHUB allows HTS to access a different group of patients who may not have had routes to HTS enabled previously.
{"title":"2780 Avoiding acute admissions by working in a multi-disciplinary team alongside paramedics in the West Kent clinical navigation hub","authors":"A Heskett, J Mummaneni, W Hicks","doi":"10.1093/ageing/afae277.039","DOIUrl":"https://doi.org/10.1093/ageing/afae277.039","url":null,"abstract":"Introduction Home Treatment Service (HTS, a Frailty Hospital at Home model that provides Comprehensive Geriatric Assessment, diagnostics and treatments to avoid hospital admission for people with frailty) within Kent Community Health NHS Foundation Trust has increased links with the Acute and Ambulance Trusts. The MDT interacts with visiting paramedics within a clinical navigation hub (CHUB). Method 61 HTS referrals from the CHUB were compared with 61 direct clinician referrals from December 2023 to February 2024. The NEWs score, length of stay (LOS) and Advance Care Planning (ACP) documents were analysed. Results The average LOS under HTS via the CHUB was 2.61 days and 3.65 days for direct referrals. 27% of NEWS scores from the CHUB were high compared with 14% from direct referrals. 48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage. Conclusion(s) Referrals directed to HTS proactively from the CHUB have a higher percentage of NEWS scores that would require hourly observations and/or escalation to medical assessment. The CHUB explores community options while weighing benefits and risks of transfer to hospital in real time. The LOS between the two referral sources is not hugely different and suggests that we are identifying patients requiring similar management regardless of source of referral. The CHUB gives options to patients who have fewer advance decisions recorded to support the direction of their care at the point of an emergency response. The CHUB allows HTS to access a different group of patients who may not have had routes to HTS enabled previously.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071742","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/afae277.104
K Faig, A Steeves, M Gallibois, CA McGibbon, G Handrigan, CC Tranchant, A Bohnsack, P Jarrett
Objectives The objective of this study was to examine participant’s experience with remote delivery during SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681), a home-based, double-blind, randomised controlled trial targeting older adults at risk for dementia. Metrics included study adherence, adverse events (AEs), participant’s attitudes towards technology, and protocol deviations (PDs) due to technological difficulties. Methods Participants underwent 16 weeks of physical and cognitive interventions (three sessions/week) remotely administered in their homes via Zoom for HealthcareTM. Participants used a laptop, webcam, and required email and internet access. Throughout the trial, adherence, AEs, and PDs were recorded. Post- intervention, survey questions about satisfaction with technology were administered and semi-structured interviews were conducted which underwent thematic analysis. Results Sixty participants, mean age 68.9 and 76.7% female, were randomised to one of four intervention arms, with 52 completing the 16-week intervention. Adherence rate was 87.5% with no significant difference between treatment arms (p = 0.656). There were 88 AEs reported in 42 participants. The majority (71.6%) of AEs were unrelated to the intervention, and 69.3% were classified as mild. There was one serious AE, unrelated to the intervention. Most (74.9%) participants reported overall satisfaction with technology, with Zoom being both enjoyable (81.0%) and easy to use (96%). Most enjoyed using the computer (87%), and the majority (87.0%) encountered few difficulties with connectivity. Of the 2496 intervention sessions, 14 (0.56%) were missed due to technical difficulties. Technical difficulties requiring modification to the intervention, such as an unstable internet connection, were reported on 79 occasions (3.0%). Themes from the interviews were: participants built rapport with the research assistants; felt better participating; had fun; and technology helped overcome barriers to participation. Conclusions Using technology to deliver dementia prevention interventions remotely was well received by participants Participation occurred safely from the comfort of their own home with few technical difficulties.
{"title":"2776 Leveraging Technology for Delivery of dementia prevention interventions remotely: through the Participant’s Lens","authors":"K Faig, A Steeves, M Gallibois, CA McGibbon, G Handrigan, CC Tranchant, A Bohnsack, P Jarrett","doi":"10.1093/ageing/afae277.104","DOIUrl":"https://doi.org/10.1093/ageing/afae277.104","url":null,"abstract":"Objectives The objective of this study was to examine participant’s experience with remote delivery during SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681), a home-based, double-blind, randomised controlled trial targeting older adults at risk for dementia. Metrics included study adherence, adverse events (AEs), participant’s attitudes towards technology, and protocol deviations (PDs) due to technological difficulties. Methods Participants underwent 16 weeks of physical and cognitive interventions (three sessions/week) remotely administered in their homes via Zoom for HealthcareTM. Participants used a laptop, webcam, and required email and internet access. Throughout the trial, adherence, AEs, and PDs were recorded. Post- intervention, survey questions about satisfaction with technology were administered and semi-structured interviews were conducted which underwent thematic analysis. Results Sixty participants, mean age 68.9 and 76.7% female, were randomised to one of four intervention arms, with 52 completing the 16-week intervention. Adherence rate was 87.5% with no significant difference between treatment arms (p = 0.656). There were 88 AEs reported in 42 participants. The majority (71.6%) of AEs were unrelated to the intervention, and 69.3% were classified as mild. There was one serious AE, unrelated to the intervention. Most (74.9%) participants reported overall satisfaction with technology, with Zoom being both enjoyable (81.0%) and easy to use (96%). Most enjoyed using the computer (87%), and the majority (87.0%) encountered few difficulties with connectivity. Of the 2496 intervention sessions, 14 (0.56%) were missed due to technical difficulties. Technical difficulties requiring modification to the intervention, such as an unstable internet connection, were reported on 79 occasions (3.0%). Themes from the interviews were: participants built rapport with the research assistants; felt better participating; had fun; and technology helped overcome barriers to participation. Conclusions Using technology to deliver dementia prevention interventions remotely was well received by participants Participation occurred safely from the comfort of their own home with few technical difficulties.","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":"143071812","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/afae277.123
H Davies, K Watchman, L Hoyle
Introduction Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the residents’ experience, largely representing them as passive recipients in the activity. Objective The aim of this study was to explore the experience of residents of care homes for older people who need help from care staff to take their medication. Its purpose was to answer a single research question, ‘What is the experience of residents of care homes when oral medication is administered?’ Methods Observation of an episode of medication administration and semi-structured interviewing were conducted with eight residents between the ages of 84 and 95 from care homes in Scotland. Data was analysed in accordance with a Gadamerian philosophy of hermeneutics, with a commitment to understanding and representing the participants’ experience. Results Four themes emerged from the data, ‘Being in control/relinquishing control’, ‘Being comfortable in routine’, ‘Trusting’, and ‘Swallowing’. Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff and with the medication can be an indicator of vulnerability. The risks to autonomy in relation to taking medication, and an imbalance of power for care home residents who are given medication to take emerged as an overarching concept. Conclusion Recommendations focus on the potential for empowering practices in relation to taking medication, both for those who provide care, and for those who prescribe medication.
{"title":"2624 Exploring the experience of older people in care homes with the Administration of Oral Medication","authors":"H Davies, K Watchman, L Hoyle","doi":"10.1093/ageing/afae277.123","DOIUrl":"https://doi.org/10.1093/ageing/afae277.123","url":null,"abstract":"Introduction Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the residents’ experience, largely representing them as passive recipients in the activity. Objective The aim of this study was to explore the experience of residents of care homes for older people who need help from care staff to take their medication. Its purpose was to answer a single research question, ‘What is the experience of residents of care homes when oral medication is administered?’ Methods Observation of an episode of medication administration and semi-structured interviewing were conducted with eight residents between the ages of 84 and 95 from care homes in Scotland. Data was analysed in accordance with a Gadamerian philosophy of hermeneutics, with a commitment to understanding and representing the participants’ experience. Results Four themes emerged from the data, ‘Being in control/relinquishing control’, ‘Being comfortable in routine’, ‘Trusting’, and ‘Swallowing’. Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff and with the medication can be an indicator of vulnerability. The risks to autonomy in relation to taking medication, and an imbalance of power for care home residents who are given medication to take emerged as an overarching concept. Conclusion Recommendations focus on the potential for empowering practices in relation to taking medication, both for those who provide care, and for those who prescribe medication.","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":"143071814","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/afae277.052
E Swain, K Ramsay
Introduction The geriatric population has a high incidence of dementia, delirium and frailty meaning often these patients cannot give comprehensive histories themselves. We are left with missing pieces of the puzzle; we might not know their ‘normal’ and frequently ask: ‘Are they always like this?’ A collateral history becomes a valuable tool, contributing to a Comprehensive Geriatric Assessment and assisting the whole MDT to make informed decisions for patient-centred care. The primary aim of this project was to improve the quality of collateral histories taken for patients admitted to the geriatric wards, with content measured against 8 domains. A secondary aim was to encourage timely collateral histories within 48 hours of admission to the ward. Method Using PDSA methodology, collateral histories were analysed before and after implementation of a poster and teaching session. Results At baseline each domain was covered a mean of 40.5% of the time (range 9%—81%). Following intervention this increased by 22% to 62.5% (range 18%—89%), demonstrating a significant improvement (paired t-test, P < 0.05). It was already common practice to take collateral histories within 48 hours of admission to the ward (91%) which was sustained post-intervention (88%). Conclusion Use of a poster as a prompt, and delivering teaching, led to more thorough collateral histories. This suggests two barriers are knowing what to ask and perceived importance, elements which could be integrated into early postgraduate education. The impact on patient care has the potential to be significant and multidimensional but further work would be needed to understand this.
{"title":"2771 Improving collateral history taking in the geriatric population","authors":"E Swain, K Ramsay","doi":"10.1093/ageing/afae277.052","DOIUrl":"https://doi.org/10.1093/ageing/afae277.052","url":null,"abstract":"Introduction The geriatric population has a high incidence of dementia, delirium and frailty meaning often these patients cannot give comprehensive histories themselves. We are left with missing pieces of the puzzle; we might not know their ‘normal’ and frequently ask: ‘Are they always like this?’ A collateral history becomes a valuable tool, contributing to a Comprehensive Geriatric Assessment and assisting the whole MDT to make informed decisions for patient-centred care. The primary aim of this project was to improve the quality of collateral histories taken for patients admitted to the geriatric wards, with content measured against 8 domains. A secondary aim was to encourage timely collateral histories within 48 hours of admission to the ward. Method Using PDSA methodology, collateral histories were analysed before and after implementation of a poster and teaching session. Results At baseline each domain was covered a mean of 40.5% of the time (range 9%—81%). Following intervention this increased by 22% to 62.5% (range 18%—89%), demonstrating a significant improvement (paired t-test, P &lt; 0.05). It was already common practice to take collateral histories within 48 hours of admission to the ward (91%) which was sustained post-intervention (88%). Conclusion Use of a poster as a prompt, and delivering teaching, led to more thorough collateral histories. This suggests two barriers are knowing what to ask and perceived importance, elements which could be integrated into early postgraduate education. The impact on patient care has the potential to be significant and multidimensional but further work would be needed to understand this.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"63 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071844","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/afae277.023
S Balakrishnan, O Vick, J Mitchell, H McCluskey
Introduction Hip fractures, predominantly affecting older adults, represent a significant health concern due to high morbidity, mortality, and healthcare resource utilisation. This ongoing Quality Improvement Project within Forth Valley Royal Hospital aims to enhance adherence to recommendations from the 2023 and 2024 Scottish Hip Fracture Audit. It specifically focusses on the timely administration of Vitamin D and IV Zoledronic Acid to frail patients with hip fractures. Method A retrospective and prospective cohort study design was employed, analysing the records of 165 inpatients under orthogeriatric care from November 2023 to May 2024. Initial data analysis indicated low rates of IV zoledronic acid and vitamin D administration, primarily due to clinician unfamiliarity and process inefficiencies. Subsequent interventions included staff education sessions, process standardisation, and the introduction of tracking tools such as Bone Health stickers and whiteboards. Formal referral pathways and decision-making protocols were implemented to ensure comprehensive and timely patient care. Results The interventions led to substantial improvements in adherence rates. Between November 2023 and March 2024 vitamin D administration rates increased from 14.71% to 100%, and IV Zoledronic Acid administration rose from 12.12% to 95.45%. These improvements were achieved through systematic tracking, enhanced clinician education, and standardised care processes. Despite these gains, challenges remain in achieving 100% adherence to IV Zoledronic Acid administration and addressing initial data capture inaccuracies due to inconsistent use of referral systems. Conclusion(s) The project demonstrates that targeted interventions and standardised care pathways substantially improve adherence to national guidelines for hip fracture patients. Sustained efforts in education, process refinement, and collaboration with the Hip Fracture Audit Team are essential to maintain these improvements. Future proposals include integrating Vitamin D and Adcal-D3 doses into an electronic prescribing protocol and conducting detailed statistical analyses to identify further areas for improvement.
{"title":"2868 Improving bone health: a quality improvement journey implementing Scottish hip fracture audit recommendations","authors":"S Balakrishnan, O Vick, J Mitchell, H McCluskey","doi":"10.1093/ageing/afae277.023","DOIUrl":"https://doi.org/10.1093/ageing/afae277.023","url":null,"abstract":"Introduction Hip fractures, predominantly affecting older adults, represent a significant health concern due to high morbidity, mortality, and healthcare resource utilisation. This ongoing Quality Improvement Project within Forth Valley Royal Hospital aims to enhance adherence to recommendations from the 2023 and 2024 Scottish Hip Fracture Audit. It specifically focusses on the timely administration of Vitamin D and IV Zoledronic Acid to frail patients with hip fractures. Method A retrospective and prospective cohort study design was employed, analysing the records of 165 inpatients under orthogeriatric care from November 2023 to May 2024. Initial data analysis indicated low rates of IV zoledronic acid and vitamin D administration, primarily due to clinician unfamiliarity and process inefficiencies. Subsequent interventions included staff education sessions, process standardisation, and the introduction of tracking tools such as Bone Health stickers and whiteboards. Formal referral pathways and decision-making protocols were implemented to ensure comprehensive and timely patient care. Results The interventions led to substantial improvements in adherence rates. Between November 2023 and March 2024 vitamin D administration rates increased from 14.71% to 100%, and IV Zoledronic Acid administration rose from 12.12% to 95.45%. These improvements were achieved through systematic tracking, enhanced clinician education, and standardised care processes. Despite these gains, challenges remain in achieving 100% adherence to IV Zoledronic Acid administration and addressing initial data capture inaccuracies due to inconsistent use of referral systems. Conclusion(s) The project demonstrates that targeted interventions and standardised care pathways substantially improve adherence to national guidelines for hip fracture patients. Sustained efforts in education, process refinement, and collaboration with the Hip Fracture Audit Team are essential to maintain these improvements. Future proposals include integrating Vitamin D and Adcal-D3 doses into an electronic prescribing protocol and conducting detailed statistical analyses to identify further areas for improvement.","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":"143071877","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/afae277.043
A Lynch, D Ensar, C Clancy, D Ryan
Introduction Telemedicine uses communications technology for remote healthcare. Unreadiness includes difficulties with hearing, speaking, cognitive issues, vision problems, lack of internet-enabled devices, or no recent use of digital communication. Telehealth can enhance access and convenience, especially for rural patients, but faces challenges such as technology issues and impacts on patient-provider relationships, examination quality, care quality, and patient satisfaction. The COVID-19 pandemic has accelerated telemedicine adoption to protect medical personnel and patients, with significant promotion of video visits for home-based care. Objective This study aims to evaluate telemedicine unreadiness in an older, frail population at a geriatric clinic. Patients were contacted from February 1st to March 14th, 2021, during Ireland’s COVID-19 ‘third wave,’ with up to three contact attempts made. Method Statistical analysis was conducted using STATA 14. 84 patients attended the Geriatric clinic, with 33 excluded for various reasons, leaving 51 participants (67%) who completed the survey. The mean age was 81.7 years, with 49% female. Most referrals were for cognitive issues (59%), followed by BPSD (13%), weight loss (9%), and falls (7%). The median Clinical Frailty Score was 4, indicating moderate to severe frailty. Regarding mobility, 77% were independent, 21% used an aid, and 2% were immobile. Cognitive assessments revealed 25% had normal cognition, 18% had mild impairment, and 57% had dementia. Results Only 10% of patients were ideal for teleconsultations, while 90% faced significant barriers, such as environmental impairments (26), sensory impairments (2), and both (18). Additionally, 25% lacked computer, and only 10% used the internet regularly. Despite 59% having family assistance, overall, 82% had some form of environmental impairment. Sensory impairments were common, with 29% using hearing aids but 37% still experiencing issues. Visual impairments were better managed, with 76% wearing glasses. Conclusion Telemedicine adoption has accelerated due to COVID-19, but significant barriers for geriatric patients highlight the need for better support.
{"title":"2893 Telemedicine Unreadiness in an older frail population attending the geriatric day hospital","authors":"A Lynch, D Ensar, C Clancy, D Ryan","doi":"10.1093/ageing/afae277.043","DOIUrl":"https://doi.org/10.1093/ageing/afae277.043","url":null,"abstract":"Introduction Telemedicine uses communications technology for remote healthcare. Unreadiness includes difficulties with hearing, speaking, cognitive issues, vision problems, lack of internet-enabled devices, or no recent use of digital communication. Telehealth can enhance access and convenience, especially for rural patients, but faces challenges such as technology issues and impacts on patient-provider relationships, examination quality, care quality, and patient satisfaction. The COVID-19 pandemic has accelerated telemedicine adoption to protect medical personnel and patients, with significant promotion of video visits for home-based care. Objective This study aims to evaluate telemedicine unreadiness in an older, frail population at a geriatric clinic. Patients were contacted from February 1st to March 14th, 2021, during Ireland’s COVID-19 ‘third wave,’ with up to three contact attempts made. Method Statistical analysis was conducted using STATA 14. 84 patients attended the Geriatric clinic, with 33 excluded for various reasons, leaving 51 participants (67%) who completed the survey. The mean age was 81.7 years, with 49% female. Most referrals were for cognitive issues (59%), followed by BPSD (13%), weight loss (9%), and falls (7%). The median Clinical Frailty Score was 4, indicating moderate to severe frailty. Regarding mobility, 77% were independent, 21% used an aid, and 2% were immobile. Cognitive assessments revealed 25% had normal cognition, 18% had mild impairment, and 57% had dementia. Results Only 10% of patients were ideal for teleconsultations, while 90% faced significant barriers, such as environmental impairments (26), sensory impairments (2), and both (18). Additionally, 25% lacked computer, and only 10% used the internet regularly. Despite 59% having family assistance, overall, 82% had some form of environmental impairment. Sensory impairments were common, with 29% using hearing aids but 37% still experiencing issues. Visual impairments were better managed, with 76% wearing glasses. Conclusion Telemedicine adoption has accelerated due to COVID-19, but significant barriers for geriatric patients highlight the need for better support.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"121 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071880","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/afae277.089
SRR Batista, VS Wottrich, EM Pereira, RR Silva
Introduction The coexistence of two or more morbidities, including at least one mental morbidity, is defined as mental-physical multimorbidity (MP-MM). It is linked to significant poor outcomes, such as a high burden of healthcare utilisation, particularly in the elderly. Method To evaluate the complex connections between the 16 physical and mental morbidities among Brazilian older people from the Brazilian Longitudinal Study of Ageing, we performed a network analysis (NA), a sophisticated multivariate statistical technique to estimate all relationships between morbidities represented by an undirected grafus. The objective was to estimate patterns in a complex set of multiple aleatory variables and display them in a network map within nodes and edges representing the variables and the interrelationships among them. In this study, we applied the NA to model interrelationships among chronic physical morbidities and depression. We utilised data from 6.104 participants of the second wave (2019–2020) of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). The data were adjusted according to the Ising model with the IsingFit function by R Software. Centrality and stability measures were assessed by the bootstrap method through the bootnet library. Findings In this network, depression, low back pain, and hypertension were the morbidities that had the most effects on the network’s overall structure, according to an examination of the centrality metrics of the nodes (strength, proximity, and betweenness). Depression was the morbidity with the higher betweenness. Conclusion The model’s interpretation indicates that depression is the illness that has the highest influence on the model and would likely be the most beneficial area for intervention.
{"title":"2858 A network analysis of morbidities associated with mental-physical multimorbidity among Brazilian elderly people (ELSI-Brazil)","authors":"SRR Batista, VS Wottrich, EM Pereira, RR Silva","doi":"10.1093/ageing/afae277.089","DOIUrl":"https://doi.org/10.1093/ageing/afae277.089","url":null,"abstract":"Introduction The coexistence of two or more morbidities, including at least one mental morbidity, is defined as mental-physical multimorbidity (MP-MM). It is linked to significant poor outcomes, such as a high burden of healthcare utilisation, particularly in the elderly. Method To evaluate the complex connections between the 16 physical and mental morbidities among Brazilian older people from the Brazilian Longitudinal Study of Ageing, we performed a network analysis (NA), a sophisticated multivariate statistical technique to estimate all relationships between morbidities represented by an undirected grafus. The objective was to estimate patterns in a complex set of multiple aleatory variables and display them in a network map within nodes and edges representing the variables and the interrelationships among them. In this study, we applied the NA to model interrelationships among chronic physical morbidities and depression. We utilised data from 6.104 participants of the second wave (2019–2020) of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). The data were adjusted according to the Ising model with the IsingFit function by R Software. Centrality and stability measures were assessed by the bootstrap method through the bootnet library. Findings In this network, depression, low back pain, and hypertension were the morbidities that had the most effects on the network’s overall structure, according to an examination of the centrality metrics of the nodes (strength, proximity, and betweenness). Depression was the morbidity with the higher betweenness. Conclusion The model’s interpretation indicates that depression is the illness that has the highest influence on the model and would likely be the most beneficial area for intervention.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"37 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071883","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/afae277.118
SP Bowers, P Black, L McCheyne, D Wilson, RS Penfold, L Stapleton, P Channer, SEE Mills, L Williams, F Quirk, J Bowden
Introduction As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs. Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning. There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice. Methods Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings. Results From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly—mean age 78.5 years. Only 4/38 studies integrated patient and public involvement. Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven. Conclusions The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.
{"title":"2786 Defining advanced multimorbidity: a scoping review of research, policy and practice","authors":"SP Bowers, P Black, L McCheyne, D Wilson, RS Penfold, L Stapleton, P Channer, SEE Mills, L Williams, F Quirk, J Bowden","doi":"10.1093/ageing/afae277.118","DOIUrl":"https://doi.org/10.1093/ageing/afae277.118","url":null,"abstract":"Introduction As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs. Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning. There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice. Methods Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings. Results From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly—mean age 78.5 years. Only 4/38 studies integrated patient and public involvement. Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven. Conclusions The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071811","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/afae277.129
B Hickey, B Desai, F Davies, D Chari, R Evley, C Clegg, A Donovan, AP Rajkumar, T Dening, H Subramaniam, E Mukaetova-Ladinska, T Robinson, C Tarrant, L Beishon
Background The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community). Methods 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n = 28), patients (n = 7), carers (n = 19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged >65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE). Results Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience. Conclusions The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.
{"title":"2796 Improving physical health care in older people in mental health settings: the ImPreSs-care qualitative study","authors":"B Hickey, B Desai, F Davies, D Chari, R Evley, C Clegg, A Donovan, AP Rajkumar, T Dening, H Subramaniam, E Mukaetova-Ladinska, T Robinson, C Tarrant, L Beishon","doi":"10.1093/ageing/afae277.129","DOIUrl":"https://doi.org/10.1093/ageing/afae277.129","url":null,"abstract":"Background The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community). Methods 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n = 28), patients (n = 7), carers (n = 19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged &gt;65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE). Results Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience. Conclusions The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"30 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071837","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}
Susanna Gentili, Amaia Calderón-Larrañaga, Debora Rizzuto, Adam Lee Gordon, Janne Agerholm, Carin Lennartsson, Åsa Hedberg Rundgren, Laura Fratiglioni, Davide Liborio Vetrano
Objective We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings. Methods Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions. Results Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06–1.08) and being a woman compared with being a man (HR range 1.35–4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14–1.23) and slow gait speed (HR range 1.11–1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99–2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57–3.07). Conclusions Accounting for older adults’ whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults’ needs.
{"title":"Predictors of 15-year transitions across living and care settings in a population of Swedish older adults","authors":"Susanna Gentili, Amaia Calderón-Larrañaga, Debora Rizzuto, Adam Lee Gordon, Janne Agerholm, Carin Lennartsson, Åsa Hedberg Rundgren, Laura Fratiglioni, Davide Liborio Vetrano","doi":"10.1093/ageing/afaf006","DOIUrl":"https://doi.org/10.1093/ageing/afaf006","url":null,"abstract":"Objective We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings. Methods Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions. Results Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced &gt;10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06–1.08) and being a woman compared with being a man (HR range 1.35–4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14–1.23) and slow gait speed (HR range 1.11–1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99–2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57–3.07). Conclusions Accounting for older adults’ whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults’ needs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"119 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044342","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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