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Background Syncope is aetiologically diverse and associated with adverse outcomes; in older people, there is clinical overlap with complex falls presentations (i.e. recurrent, unexplained and/or injurious). Aim To formulate an index to predict future risk of syncope and falls in the Irish longitudinal study on ageing (TILDA). Design/Methods Using the frailty index methodology, we selected, from TILDA Wave 1 (2010), 40 deficits that might increase risk of syncope and falls. This syncope-falls index (SYFI) was applied to TILDA Wave 1 participants aged 65 and over, who were divided into three risk groups (low, intermediate and high) based on SYFI tertiles. Multivariate logistic regression models were used to investigate, controlling for age and sex, how SYFI groups predicted incident syncope, complex falls and simple falls occurring up to Wave 4 of the study (2016). Results At Wave 1, there were 3499 participants (mean age 73, 53% women). By Wave 4, of the remaining 2907 participants, 185 (6.4%) had reported new syncope, 1077 (37.0%) complex falls and 218 (7.5%) simple falls. The risk of both syncope and complex falls increased along the SYFI groups (high risk group: odds ratio 1.88 [1.26–2.80], P  = 0.002 for syncope; 2.22 [1.82–2.72], P  < 0.001 for complex falls). No significant relationship was identified between SYFI and simple falls. Conclusion The 6-year incidences of falls and syncope were high in this cohort. SYFI could help identify older adults at risk of syncope and complex falls, and thus facilitate early referral to specialist clinics to improve outcomes. [ABSTRACT FROM AUTHOR]

Background Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health. Aim To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years. Design Survey of 150 patients (55% female, mean age 80 years and mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital. Methods The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data were presented descriptively. Results Almost 40% (59/150) reported that their mental health was 'worse' or 'much worse' while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely 'very often'. Half of participants (75/150) reported a decline in their quality of life. Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term 'cocooning'. Conclusions Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness and continue physical activity and access timely medical care and rehabilitation services should be a priority. [ABSTRACT FROM AUTHOR]

We explored the relationships between the use of Angiotensin II receptor blockers (ARBs), Angiotensin I-converting enzyme (ACE) genetic polymorphisms and memory performance in older adults, whilst controlling for confounders. Retrospective observational case-control study. 104 patients over 60 years of age (mean age 74) without known cognitive disorder were included, 52 cases (ARB users) and 52 controls (non-users). ACE insertion/deletion (ACE I/D) polymorphism was determined in all patients. The Wechsler Memory Scale (memory quotient) was used to evaluate cognition. We measured years of education, Charlson Comorbidity Index (CCI) and total number of medications taken. The mean (SD) age in cases and controls were: 75.3 (7.5) and 72.0 (7.0) respectively (p = 0.020). Cases had higher CCI (p = 0.006) and took more medications (p < 0.001). Cases had a higher memory quotient: 99.6 (5.9) and 95.3 (6.7) (p < 0.001). In the I/I group, cases had higher memory quotient [99.5 (5.5) vs. 95.0 (5.7), p = 0.005]. No significant difference in memory performance was found between cases and controls within genotype ACE I/D (p = 0.056) and D/D (p = 0.290). A multiple linear regression predicting memory score in n = 104 (predictors: ARB use, age, female sex, years of education, CCI, number of medications, ACE I/I status, interaction ARB user ACE I/I status) suggested that only ARB use (p = 0.001) and higher education (p < 0.001) were significant predictors of higher memory performance. Despite ARB users being older and more comorbid, their memory was better even when controlling for the ACE I/I risk genotype. Education may confer cognitive reserve. The protective role of ARBs merits further investigation. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: Drugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay. Methods: This is a multi‐centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy. Results and discussion: 21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naïve patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR = 1.82, 95% CI for OR: 1.36‐2.45, P < .001). What is new and conclusion: There was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase‐inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects. [ABSTRACT FROM AUTHOR]

Background Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. Methods This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. Results 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09-1.83; p = 0.008). Conclusion Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality. [ABSTRACT FROM AUTHOR]

Background: the clinical frailty scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people. In our hospital, the use of the CFS in emergency admissions of people aged 75 years was introduced under the Commissioning for Quality and Innovation payment framework. Aim: we retrospectively studied the association of the CFS with patient characteristics and outcomes. Design: retrospective observational study in a large tertiary university National Health Service hospital in UK. Methods: the CFS was correlated with transfer to specialist Geriatric ward, length of stay (LOS), in-patient mortality and 30- day readmission rate. Results: between 1st August 2013 and 31st July 2014, there were 11 271 emergency admission episodes of people aged 75 years (all specialties), corresponding to 7532 unique patients (first admissions); of those, 5764 had the CFS measured by the admitting team (81% of them within 72 hr of admission). After adjustment for age, gender, Charlson comorbidity index and history of dementia and/or current cognitive concern, the CFS was an independent predictor of in-patient mortality [odds ratio (OR)¼1.60, 95% confidence interval (CI): 1.48 to 1.74, P<0.001], transfer to Geriatric ward (OR¼1.33, 95% CI: 1.24 to 1.42, P<0.001) and LOS 10 days (OR¼1.19, 95% CI: 1.14 to 1.23, P<0.001). The CFS was not a multivariate predictor of 30-day readmission. Conclusions: the CFS may help predict in-patient mortality and target specialist geriatric resources within the hospital. Usual hospital metrics such as mortality and LOS should take into account measurable patient complexity. [ABSTRACT FROM AUTHOR]

Background: The analysis of routinely collected hospital data informs the design of specialist services for at-risk older people.Aim: Describe the outcomes of a cohort of older emergency department (ED) attendees and identify predictors of these outcomes.Design: retrospective cohort study.Methods: All patients aged 65 years or older attending an urban university hospital ED in January 2012 were included (N = 550). Outcomes were retrospectively followed for 12 months. Statistical analyses were based on multivariate binary logistic regression models and classification trees.Results: Of N = 550, 40.5% spent ≤6 h in the ED, but the proportion was 22.4% among those older than 81 years and not presenting with musculoskeletal problems/fractures. N = 349 (63.5%) were admitted from the ED. A significant multivariate predictor of in-hospital mortality was Charlson comorbidity index [CCI; odds ratio = 1.19, 95% confidence interval: 1.07, 1.34, P = 0.002]. Among patients who were discharged from ED without admission or after their first in-patient admission (N = 499), 232 (46.5%) re-attended ED within 1 year, with CCI being the best predictor of re-attendance (CCI ≤ 4: 25.8%, CCI > 5: 60.4%). Among N = 499, 34 (6.8%) had died after 1 year of initial ED presentation. The subgroup (N = 114) with the highest mortality (17.5%) was composed by those aged >77 years and brought in by ambulance on initial presentation.Conclusions: Advanced age and comorbidity are important drivers of outcomes among older ED attendees. There is a need to embed specialist geriatric services within frontline services to make them more gerontologically attuned. Our results predate the opening of an acute medical unit with specialist geriatric input. [ABSTRACT FROM AUTHOR]

Background: Material deprivation in cold weather may increase the risk of hypothermia and contribute to excess winter mortality. To date, there were no local data to support the potential contribution of material deprivation to the incidence of hypothermia in Irish older people. Aim: To contribute evidence from a hospital-based perspective. Methods: Patient series from St James's Hospital Dublin, Ireland. Of all patients aged ≥65 years experiencing their last medical admission between 1 January 2002 and 31 December 2010, we selected those who presented with a body temperature of <35 °C. Their clinical characteristics were compared with those of a random sample of 200 age and gender-matched non-hypothermic patients. Multivariate logistic regression was used to identify predictors of presentation with hypothermia. The following predictors were considered: age, gender, mean air temperature on the day of admission, year of admission, comorbidity, major diagnostic categories, and material deprivation as per the Irish National Deprivation Index (NDI). Results: Eighty patients presented with hypothermia over the period. They presented in colder days (mean 8.8 vs. 10.8 °C, P < 0.001) were less likely to present in summer ( P < 0.002), more likely to present in winter ( P = 0.010), and their mortality was high (50 vs. 17 %, P < 0.001). The interaction NDI* air temperature was a significant multivariate predictor of hypothermia (OR = 1.03, 95 % CI 1.01-1.06, P = 0.033). Conclusions: The NDI could be an adequate tool to target fuel poverty in older people. [ABSTRACT FROM AUTHOR]

Objectives: To examine psychosocial and functional correlates of nutrition in a nonrandom sample of Irish community dwelling older adults. Design: Cross sectional observational study. Setting: Technology Research for Independent Living (TRIL) Clinic, a comprehensive geriatric assessment facility in St James's Hospital, Dublin. Data were collected from participants by medical personnel (physical assessments) and psychologists (questionnaires), between August 2007 and May 2009. Participants: 556 participants (388 females; 168 males) ranging in age from 60 92 years (Mean 72.5 years, SD 7.1). All were community dwelling and provided informed consent. Measurements: The Nestlé Mini-Nutritional Assessment (MNA®), Time to get up and go (TUG) and the Lubben Social Network Scale-18 (LSNS-18) were used to assess nutrition, functional mobility and social support. Methods: Multivariate binary logistic regression was used to examine the association between social support or mobility and nutritional status, whilst controlling for possible confounders (age, gender, living alone and material deprivation). Results: The strongest predictors of abnormal nutritional status were mobility (p < 0.001) and social support (p = 0.005). Other significant predictors of nutritional risk were age (p = 0.032) and deprivation (p = 0.018). Conclusion: The results emphasise the importance of mobility and social supports in mediating nutritional outcomes in Irish community dwelling older adults. [ABSTRACT FROM AUTHOR]

Future ultracompact photonic integrated circuits (PICs) will rely on high-index-contrast dielectric materials, which permit a strong confinement of the optical field in the diffraction limit as well as low propagation losses. This is the case of PICs implemented on a silicon-on-insulator (SOI) platform. To achieve confinement beyond the diffraction limit, plasmonic waveguides (based on metal-dielectric interfaces) have been recently proposed. This new kind of waveguide provides a strong enhancement of the field in the metal-dielectric interface, which is of paramount importance for nonlinear functionalities or sensing. Plasmonic waveguides can also be built on SOI wafers. Thus, it can be reasonably thought that high index contrast as well as plasmonic waveguides can coexist in future ultradense PICs. In this paper, a theoretical and numerical study on the performance of several dielectric and plasmonic waveguides is presented. Thanks to their plasmon-coupled supported modes, ultracompact devices as hybrid ring resonators can be devised and integrated with silicon photonic circuits. [ABSTRACT FROM PUBLISHER]

Introduction: Hospital associated deconditioning is a well-established phenomenon. Whilst mechanisms are not well understood, one is thought to be skeletal muscle wasting and/or loss of muscle strength. The primary aim of this study was to investigate changes in knee-extension muscle strength in older patients during and after an acute-hospital admission. We also aimed to explore the potential contributions of frailty, acute-illness severity and sedentary activity, with changes in knee-extension strength. Methods: This was a prospective repeated-measures cohort study. Measurements of muscle strength and functional mobility were taken at recruitment, on day 7 of admission (or at discharge if earlier) and again 4-6 weeks post-hospitalisation. During the first 7 days of admission, daily measurements of muscle strength were taken. Results: We recruited 70 participants, of which 65 had at least one repeated measure in hospital. Median age was 84 years, and participants participated in the study for a median of 6 days whilst in hospital, on average participants were ‘active’ for less than 4% of the day. Knee-extension strength significantly reduced by approximately 11% during hospitalisation, but no significant changes occurred post-hospitalisation. A repeated measures mixed model included 292 observations from 62 participants and showed a significant decrease in the reduction in muscle strength as patients’ sedentary time decreased on days 2 to 7 of the study. Additionally, the model showed that a higher frailty score, higher baseline knee-extension strength, lower baseline c-reactive protein levels were associated with greater loss in knee-extension strength during hospitalisation. Association between change in functional mobility after hospitalisation and change in knee-extension strength during hospitalisation was non-significant. Conclusion: Our findings provide an important link in understanding themechanisms and relative contributions of risk factors to hospital associated deconditioning. Further research is needed to confirm these findings and examine the impact of reducing sedentary time on muscle strength during and post-hospitalisation. [ABSTRACT FROM AUTHOR]

Introduction: Recent literature suggests that impaired systolic blood pressure (SBP) recovery after standing predicts mortality1. Orthostatic heart rate (HR) signals have received less attention. We studied the association between beat-to-beat orthostatic hemodynamic variables in TILDA wave 1 (2010) and incident mortality in wave 2 (2012).Methods: Of the 8175 participants aged 50 and over in the first wave of TILDA, 5037 (62%) had a Health Centre (HC) assessment (active stand testing with Finometer® was only available in HC). Good quality active stand data was available in 4468 participants. Receiver operating characteristic curves explored univariate associations between orthostatic hemodynamic variables (baseline, nadir and recovery until 110 seconds post-stand) and mortality. Multivariate analyses were based on binary logistic regression.Results: 233 subjects (3%) had died at wave 2. Amongst those who had died, 53 (23%) had had aFinometer® active stand in Wave 1. Compared to the 4415 who had not died and had active stand data, the 53 who had died had no statistically significant differences in orthostatic SBP variables or DBP variables. However, those who had died had a higher baseline HR (mean of 69 vs. 65 bpm)and a higher mean orthostatic HR, especially between 30-60 seconds post-stand (mean of 79 vs. 73 bpm). Adjusted for age, sex, baseline HR, cardiovascular comorbidity and antihypertensives (including beta-blockers), the mean HR between 30-60 seconds post-stand was an independent predictor of mortality (OR = 1.05, 95% CI: 1.01–1.10, P = 0.012), together with age (OR = 1.05, 95% CI: 1.02-1.09, P = 0.001) and female sex (OR = 0.55, 95% CI: 0.31-0.97, P = 0.038).Conclusions: Although the small number of mortality events could have led to underpower for blood pressure variables, higher orthostatic HR was independently associated with mortality and could be a novel (and perhaps more sensitive) risk signal. [ABSTRACT FROM AUTHOR]

Introduction: Recent literature suggests that impaired systolic blood pressure (SBP) recovery after standing predicts mortality1. Orthostatic heart rate (HR) signals have received less attention. We studied the association between beat-to-beat orthostatic hemodynamic variables in TILDA wave 1 (2010) and incident mortality in wave 2 (2012).Methods: Of the 8175 participants aged 50 and over in the first wave of TILDA, 5037 (62%) had a Health Centre (HC) assessment (active stand testing with Finometer® was only available in HC). Good quality active stand data was available in 4468 participants. Receiver operating characteristic curves explored univariate associations between orthostatic hemodynamic variables (baseline, nadir and recovery until 110 seconds post-stand) and mortality. Multivariate analyses were based on binary logistic regression.Results: 233 subjects (3%) had died at wave 2. Amongst those who had died, 53 (23%) had had aFinometer® active stand in Wave 1. Compared to the 4415 who had not died and had active stand data, the 53 who had died had no statistically significant differences in orthostatic SBP variables or DBP variables. However, those who had died had a higher baseline HR (mean of 69 vs. 65 bpm)and a higher mean orthostatic HR, especially between 30-60 seconds post-stand (mean of 79 vs. 73 bpm). Adjusted for age, sex, baseline HR, cardiovascular comorbidity and antihypertensives (including beta-blockers), the mean HR between 30-60 seconds post-stand was an independent predictor of mortality (OR = 1.05, 95% CI: 1.01–1.10, P = 0.012), together with age (OR = 1.05, 95% CI: 1.02-1.09, P = 0.001) and female sex (OR = 0.55, 95% CI: 0.31-0.97, P = 0.038).Conclusions: Although the small number of mortality events could have led to underpower for blood pressure variables, higher orthostatic HR was independently associated with mortality and could be a novel (and perhaps more sensitive) risk signal. [ABSTRACT FROM PUBLISHER]

Background: The frailty syndrome will become (has become) an important focus for supporting and targeting resources to our ageing population. Frail individuals are at higher risk of adverse outcomes and need priority access to Comprehensive Geriatric Assessment (CGA). In the community, the prevalence of frailty is 4-7%. Our aim was to establish the prevalence and correlates of frailty in new referrals to our geriatric Day Hospital (DH).Method: Data was prospectively collected between August 2012–April 2013. Levels of frailty were measured with the SHARE Frailty Instrument for Primary Care (SHARE-FI, http://www.biomedcentral.com/1471-2318/10/57). Frailty correlates included demographics, physical performance scores, falls history, and need for higher level CGA services.Results: Of the 257 patients assessed (90 men, 167 women), 81 (31.5%) were frail, 66 (25.7%) pre-frail and 110 (42.8%) non-frail. Mean age was 84.3 years for the frail, 83.2 for the pre-frail and 82.2 for the non-frail (P = 0.021 frail vs. non-frail). Mean Berg Balance Score (BBS) was 43.1 for the frail, 47.1 for the pre-frail and 50.7 for the non-frail (P < 0.01 frail vs. others). Mean Timed Up and Go (TUG) test was 33.9 seconds for the frail, 19.5 for the pre-frail and 14.5 for the non-frail (P < 0.01 frail vs. others). Forty-one per cent of the frail reported two or more falls in the preceding year, compared to 38% of the pre-frail and 21% of the non-frail. Of the 27 patients who were referred to a higher level CGA service, 16(59.3%) were frail, 4(14.8%) pre-frail and 7(25.9%) non-frail.Conclusions: The prevalence of frailty in our DH (31.5%) was higher than in the community (4-7%). Frail patients had worse physical performance scores, more history of falls and were in greater need for higher level CGA services. The use of SHARE-FI in primary care may aid the efficient targeting of CGA resources to our ageing population. [ABSTRACT FROM AUTHOR]

Background: The frailty syndrome will become (has become) an important focus for supporting and targeting resources to our ageing population. Frail individuals are at higher risk of adverse outcomes and need priority access to Comprehensive Geriatric Assessment (CGA). In the community, the prevalence of frailty is 4-7%. Our aim was to establish the prevalence and correlates of frailty in new referrals to our geriatric Day Hospital (DH).Method: Data was prospectively collected between August 2012–April 2013. Levels of frailty were measured with the SHARE Frailty Instrument for Primary Care (SHARE-FI, http://www.biomedcentral.com/1471-2318/10/57). Frailty correlates included demographics, physical performance scores, falls history, and need for higher level CGA services.Results: Of the 257 patients assessed (90 men, 167 women), 81 (31.5%) were frail, 66 (25.7%) pre-frail and 110 (42.8%) non-frail. Mean age was 84.3 years for the frail, 83.2 for the pre-frail and 82.2 for the non-frail (P = 0.021 frail vs. non-frail). Mean Berg Balance Score (BBS) was 43.1 for the frail, 47.1 for the pre-frail and 50.7 for the non-frail (P < 0.01 frail vs. others). Mean Timed Up and Go (TUG) test was 33.9 seconds for the frail, 19.5 for the pre-frail and 14.5 for the non-frail (P < 0.01 frail vs. others). Forty-one per cent of the frail reported two or more falls in the preceding year, compared to 38% of the pre-frail and 21% of the non-frail. Of the 27 patients who were referred to a higher level CGA service, 16(59.3%) were frail, 4(14.8%) pre-frail and 7(25.9%) non-frail.Conclusions: The prevalence of frailty in our DH (31.5%) was higher than in the community (4-7%). Frail patients had worse physical performance scores, more history of falls and were in greater need for higher level CGA services. The use of SHARE-FI in primary care may aid the efficient targeting of CGA resources to our ageing population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about the results of the SAFE PACE-2.