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This article discusses a case study of a 46-year-old woman who presented with corneal nerve thickening (CNT), a characteristic feature of multiple endocrine neoplasia (MEN) type 2B. However, genetic testing revealed that she had a new lineage of MEN2A, which is typically associated with medullary thyroid carcinoma (MTC), phaeochromocytoma, and primary hyperparathyroidism. The article highlights that while CNT is commonly associated with MEN2B, it can also be present in MEN2A, emphasizing the importance of considering both syndromes when CNT is detected. The study also discusses the intrafamilial variation in the presence and degree of CNT in families with MEN2A. [Extracted from the article]

Introduction multiple conditions in later life (multi-morbidity) is a major challenge for health and care systems worldwide, is of particular relevance for older people, but has not (until recently) received high priority as a topic for research. We have identified the top 10 research priorities from the perspective of older people, their carers, and health and social care professionals using the methods of a James Lind Alliance Priority Setting Partnership. Methods in total, 354 participants (162 older people and carers, 192 health professionals) completed a survey and 15 older people and carers were interviewed to produce 96 'unanswered questions'. These were further refined by survey and interviews to a shortlist of 21 topics, and a mix of people aged 80+ living with three or more conditions, carers and health and social care providers to prioritised the top 10. Results the key priorities were about the prevention of social isolation, the promotion of independence and physical and emotional well-being. In addition to these broad topics, the process also identified detailed priorities including the role of exercise therapy, the importance of falls (particularly fear of falling), the recognition and management of frailty and Comprehensive Geriatric Assessment. Conclusion these topics provide a unique perspective on research priorities on multiple conditions in later life and complement existing UK and International recommendations about the optimisation of health and social care systems to deliver essential holistic models of care and the prevention and treatment of multiple co-existing conditions. [ABSTRACT FROM AUTHOR]

Background: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. Objectives: our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. Methods: we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and metaanalyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. Results: we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. Conclusions: we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome. [ABSTRACT FROM AUTHOR]

In this article, we discuss the emergence of new models for delivery of Comprehensive Geriatric Assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and preoperative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients. [ABSTRACT FROM AUTHOR]

Several molecular subtypes of sporadic Creutzfeldt–Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications have demonstrated a potentially important role for magnetic resonance imaging in the pre-mortem diagnosis of sporadic Creutzfeldt–Jakob disease. Magnetic resonance imaging signal alterations correlate with distinct sporadic Creutzfeldt–Jakob disease molecular subtypes and thus might contribute to the earlier identification of the whole spectrum of sporadic Creutzfeldt–Jakob disease cases. This multi-centre international study aimed to provide a rationale for the amendment of the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease. Patients with sporadic Creutzfeldt–Jakob disease and fluid attenuated inversion recovery or diffusion-weight imaging were recruited from 12 countries. Patients referred as ‘suspected sporadic Creutzfeldt–Jakob disease’ but with an alternative diagnosis after thorough follow up, were analysed as controls. All magnetic resonance imaging scans were assessed for signal changes according to a standard protocol encompassing seven cortical regions, basal ganglia, thalamus and cerebellum. Magnetic resonance imaging scans were evaluated in 436 sporadic Creutzfeldt–Jakob disease patients and 141 controls. The pattern of high signal intensity with the best sensitivity and specificity in the differential diagnosis of sporadic Creutzfeldt–Jakob disease was identified. The optimum diagnostic accuracy in the differential diagnosis of rapid progressive dementia was obtained when either at least two cortical regions (temporal, parietal or occipital) or both caudate nucleus and putamen displayed a high signal in fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging. Based on our analyses, magnetic resonance imaging was positive in 83% of cases. In all definite cases, the amended criteria would cover the vast majority of suspected cases, being positive in 98%. Cerebral cortical signal increase and high signal in caudate nucleus and putamen on fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging are useful in the diagnosis of sporadic Creutzfeldt–Jakob disease. We propose an amendment to the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease to include findings from magnetic resonance imaging scans. [ABSTRACT FROM PUBLISHER]

Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome. [ABSTRACT FROM AUTHOR]

Outlines a consensus view from consultant geriatricians about appropriate performance measures for geriatric medical services. Assessment of the quality of health care; Development of measurement techniques for assessing quality; Geriatricians' priorities for performance measures; Rank order of performance measures by geriatricians versus patients.

The article focuses on the efficiency of a postal survey in generating data relevant to Trent Regional Health Authority, Sheffield, Great Britain. The authority needed the data for baseline measures as indicators for health promotion, as specified in its strategy for health promotion. Across the Region it was possible to examine patterns of response by age, gender and by social class. The content of health promotion postal lifestyle surveys has usually covered factors known to be closely related to major causes of morbidity and mortality, e.g. smoking status and physical activity.

Introduction: Osteoporosis and sarcopenia often co-exist (osteo-sarcopenia) and both are associated with increased risk of falls and fractures. Early identification and treatment of sarcopenia among older people with fragility arm fractures could prevent further fractures. This study evaluated the feasibility of assessing sarcopenia in a fracture clinic. Methods: People aged 65+ years with arm fracture attending fracture clinics in one acute trust were recruited. Sarcopenia was assessed using gait speed, grip strength with unfractured arm (hand dynamometer using appropriate cut off adjusted for age and gender), skeletal muscle mass index SMI (Bioimpedance BIA), SARC-F questionnaire, the European Working Group on Sarcopenia inOlder People (EWGSOP) I and II criteria.The sensitivity and specificity of each measure was calculated against the EWGSOP II criteria as the standard reference. Results: 100 patients (Mean age 75 years±7.2; 80 female) were recruited. Sarcopenia was identified among 4% (EWGSOP I), 5% (SMI), 13% (EWGSOP II), 16% (gait speed test), 18% (SARC-F) and 39% (grip strength) and was more prevalent among men. SARCF had the best sensitivity and specificity (100% and 96% respectively) when compared to the EWGSOP II criteria. Sensitivity and specificity for the remaining measures were respectively (100%, 71%) for grip strength, (75%, 94%) for gait speed, (25%, 97%) with SMI and (25%, 99%) for EWGSOP I. Time needed to complete the assessments was 1– 2 minutes for gait speed, grip strength and SARC-F; five minutes for BIA test, and nine minutes when EWGSOP I and II criteria were applied. Data were complete for grip strength and SARC-F. Missing data was reported among 2% for gait speed, 8% for BIA test, 8% for EWGSOP II and 10% for EWGSOP I. Conclusion: It was feasible to assess sarcopenia in fracture clinics and SARC-F was a quick, simple and sensitive tool suitable for routine use. [ABSTRACT FROM AUTHOR]

Introduction: Treatment burden is the “workload of healthcare and its impact on patient functioning and well-being”. High treatment burden may lead to non-adherence to treatment regimens, poor health outcomes, poor quality of life and wasted healthcare resources. Treatment burden among people with Parkinson’s (PwP) and their caregivers has not been previously explored. Methods: Using five electronic databases (MEDLINE, Embase, CINAHL, Scopus and PsychInfo), we conducted a systematic review of studies published since 2006 when the first National Institute for Clinical Excellence (NICE) ClinicalGuideline for Parkinson’sDisease was published. This allows an understanding of the impact of current healthcare systems on treatment burden.We included qualitative and mixed-method studies with a qualitative component that reported data from PwP and/or caregivers.Quantitative studies, qualitative data from clinical trials not related to usual care and grey literature were excluded. Two reviewers independently screened articles and extracted data. Data analysis was conducted using framework analysis. Results: 1757 articles were screened, and 39 included in this review. Understanding treatment burden among PwP and their caregivers was not the primary aim in any of the included studies. They described the experiences of those living at home and during hospital or care home admissions. Issues with medications (adherence to advice, effectiveness, sideeffects and timing), obtaining appropriate levels of information and healthcare provision (lack of integrated care, care coordination and person-centred approach) were among factors that exacerbate treatment burden experienced by PwP and caregivers. Both reported the impact of Parkinson’s on their daily lives, physical and mental exhaustion of self-care and limitations on their role and social activities. Conclusion: This review describes considerable treatment burden experienced by PwP and their caregivers and its major influences including aspects of current healthcare provision. Future research should focus on patient-centred care with service redesign to improve this treatment burden. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is associated with an increased risk of falling and fracture, but not routinely assessed in fracture clinic. Early identification and management of frailty among older people with arm fragility fracture could help avoid further falls and fractures, especially of the hip. We evaluated the feasibility of assessing frailty in a busy fracture clinic. Methods: People aged 65+ years with an arm fracture in one acute trust were recruited. Frailty was assessed in fracture clinics using six tools: Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS), and Study of Osteoporotic Fracture (SOF).The sensitivity and specificity of each tool was compared against FFP as a reference. Participants identified as frail by 2+ tools were referred for Comprehensive Geriatric Assessment (CGA). Results: 100 patients (mean age 75 years±7.2; 20 men) were recruited. Frailty prevalence was 9% (FRAIL scale), 13% (SOF), 14% (CFS>6), 15% (FFP; e-FI>0.25), and 25% (PRISMA-7). Men were more likely to be frail than women. Data were complete for all assessments and completion time ranged from oneminute (PRISMA-7; CFS) to sixminutes for the FFP which required most equipment. Comparing with FFP, the most accurate instrument for stratifying frail from non-frail was the PRISMA-7 (sensitivity=93%, specificity=87%) while the remaining tools had good specificity (range 93%–100%) but average sensitivity (range 40%–60%). Twenty patients were eligible for CGA. Five had recently had CGA and 11/15 referred were assessed. CGA led to 3–6 interventions per participant including medication changes, life-style advice, investigations, and onward referrals. Conclusion: It was feasible to assess frailty in fracture clinic and to identify patients who benefitted from CGA. Frailty prevalence was 9%—25% depending on the tool used and was higher among men. PRISMA-7 could be a practical tool for routine use in fracture clinics. [ABSTRACT FROM AUTHOR]

Introduction: Appetite loss in older people is common and associated with malnutrition, sarcopenia and frailty. Management of appetite loss may prevent these health burdens but currently no effective clinical interventions exist. This is partly due to lack of knowledge about influences on appetite perceived by older individuals.These views may provide novel avenues for intervention on appetite loss. Aim: To understand older individual’s perceptions of influences on appetite loss. Method: Semi-structured qualitative interviews with men and women aged ≥65 years, living in their own home, were audio-recorded and transcribed. Reflexive thematic analysis, with inductive coding, generated themes with data examples. Results: 13 individuals (8/13 female, 4/13 living alone) were recruited. Accounts of influences on appetite were grouped into three themes: physical, psychological and external factors. The physical theme related to a physical state of ageing, using energy and being active, and physical symptoms, illness and treatment. The psychological theme explained the influence of mood or wellbeing, the appeal of food, and reward in the activity of cooking. External factors related to influences of other people, coping with life experiences and transitions, and perceptions of health. Influences were perceived to impact on appetite loss in distinct ways, via a physical feeling of fullness (physical theme), or creating a negative experience with food and eating (psychological and external themes). Individuals tended to have either a physical or psychological focus. Importantly, illness and its treatment impacted on both appetite loss narratives. Conclusions: A number of influences on appetite are described by older individuals, relating to their physical and psychological self, and social and environmental factors. These seem to impact on appetite loss in distinct ways, by precipitating either a physical feeling of fullness, or a negative experience with food and eating. Identifying factors affecting an individual’s appetite could facilitate person-centred approaches to management. [ABSTRACT FROM AUTHOR]

Introduction: People with Parkinson’s (PwP) and their caregivers often report poor diagnosis experiences and a lack of information, support and control over Parkinson’s. First Steps is a two-day course delivered by volunteers with Parkinson’s, which aims to help those newly diagnosed and their caregivers face the future positively and take control of Parkinson’s. This study aimed to capture the views and experiences of participants and volunteer hosts of First Steps, and evaluate if it meets those aims. Methods: Using purposive sampling, twelve participants comprising four PwP, five caregivers and three volunteer hosts were recruited. Face-to-face, semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed thematically. Results: Course participants found First Steps informative, supportive, and helpful in feeling more positive about Parkinson’s. Participants were reassured by the hosts having Parkinson’s, despite prior concerns regarding seeing people who might have more advanced Parkinson’s. Some found First Steps more relatable than other support services and reported that the course complemented clinician-led courses as the content was aimed at caregivers as well as PwP, with variation in information delivery techniques. Among the PwP and caregivers, two thirds reported a lack of control over Parkinson’s and some felt First Steps had improved their control. Hosts felt they had control over Parkinson’s and perceived their role to be both challenging and rewarding. Conclusions: First Steps was perceived as a helpful course, offering information and support for those newly diagnosed and their caregivers in a positive and non-clinical environment. Volunteer hosts felt more control over Parkinson’s than other participants, but there was evidence that the course helped some experience more control. Suggested course improvements included: additions to the presentation content with more emphasis on taking control, and offering group follow up sessions. This will inform current expansion across the UK. [ABSTRACT FROM AUTHOR]

Introduction: Appetite loss in older people -anorexia of ageing (AA) - is common. Recognised consequences include under nutrition, sarcopenia, frailty, and increased mortality after discharge from hospital. Identification and management of AA may prevent onset of these health burdens. Whilst appetite can be assessed, this is often not routine. Methods: Cross-sectional data from three studies (carried out 2010-2017), with comparable data collection methods and drawn from the same population, were combined. Participants were over 70 years, admitted to acute wards within a large UK hospital. Appetite was assessed using the simple 4 item Simplified Nutritional Appetite Questionnaire (SNAQ); a score of ≤14/20 defines poor appetite. Correlates of SNAQ scores were evaluated. Results: The dataset included 474 participants (64% female) with mean age 84 (6.5), median Barthel 78 (IQR 53-91), mini-mental state exam (MMSE) 27 (IQR 23-29) and comorbidity index 5 (IQR 4-7). The median GDS for the population was 4 (IQR 4-6). The mean SNAQ score was 13.9 (SD 2.6), and 265 (56%) participants scored ≤14 indicating poor appetite. There was no significant difference between mean SNAQ scores of men and women (P=.26), or those living alone and with others (P=.62). Age, MMSE, comorbidity index, and total number of medications were not related to SNAQ score in continuous analyses but geriatric depression score (GDS-15) was (adjusted coefficient -.248; P<.001); such that lower mood was associated with poorer appetite. Conclusions: These findings highlight the importance of assessing appetite in hospitalised older people, as poor appetite is very common. Appetite can be assessed in hospital using the simple 4 item SNAQ tool. Subclinical low mood, measured by GDS-15, had the strongest association with SNAQ score whilst in hospital. Therefore, for those with poor appetite in hospital, clinicians should have a low threshold to evaluate and treat low mood. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning canmitigate this. The aim was to understand the experience of a planned relocation between two care homes. Methods: In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning canmitigate this. The aim was to understand the experience of a planned relocation between two care homes. Results: Seven themes were identified and organised under three stages: pre-move (communication and involvement; preparation for the move; and attitudes towards the move), day-of- the-move (organisation of the move), and post-move (environmental change and impact; staff organisation and management; and settling in). Family and staff members reported that the pre-move information provided was inconsistent and staff did not feel involved in the planning and design process. Pre-move visits and staff and family support were beneficial for residents’ preparation for the move. All participants expressed sadness about the closure, and reported apprehension about moving. The moving day felt disorganised and stressful to staff who had to spread between the two homes. Post-move, the new care home was perceived by many participants as a ‘hotel’ rather than a home. Its larger size and confusing layout impacted negatively on residents and staff. New staff and changes in management structure were perceived by the different stakeholders to cause increased staff workload. Residents adjusted variably to the new home, with family support and staff continuity of care proving to be facilitators. Conclusions: Despite extensive planning, relocation and adjustment was challenging. Recommendations for future relocations include: increasing involvement of staff in the planning and design of the home; ensuring consistent communication and organising staff rotas to maintain continuity of care. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

Examines performance measures for geriatric medical services. Improving the patient's quality of life; Improving the patient's physical function; Measurement of levels of activity.

Introduction: People with Parkinson's (PwP) frequently fall when walking, often tripping or failing to change direction successfully. Stepping backward, necessitating both ground clearance and travel without visual guidance, commonly causes falling among PwP. The single step backward has been little investigated, in comparison with backward walking, though the former is ‘everyday’ and the latter unusual. Unlike certain fall-related actions (such as turning), there is little evidence from which to develop rehabilitation strategies for safer backward stepping. We conducted a feasibility study to develop methods for analysing the backward step and to suggest avenues for rehabilitation.Methods: In a gait laboratory, 4 PwP (median age 75 years) and 4 healthy controls stepped back under two instructions: ‘Step back when you are ready’ and ‘Take a big step back’. Wall-mounted scanners tracked button-sized markers on their shoes, measuring step height and length, and base width (heel separation) before and after stepping. We present data as a percentage of participant height.Results: Backward steps were a median 5% of participant's height vertically and 20% in length, narrowing the base 3% in PwP. Values were 7%, 27% and <1%, respectively, in controls. ‘Big’ backward steps were a median 8% high and 29% long, narrowing the base 3% in PwP, compared with 11%, 39% and 2%, respectively, in controls. The protocol was successful; under close supervision, no-one fell and representative movements were recorded.Conclusion: Among PwP, a history of instability moving backwards warrants investigation and intervention to reduce the risk of falling. Further research is required but clinicians might observe patients stepping backward to identify low, short steps (increasing tripping risk), base narrowing (decreasing stability) and an inability to ‘up-scale’ attempting ‘big’ steps. Following advice/ education in the short term, these features are potentially amenable to intervention through movement-retraining in the longer term. [ABSTRACT FROM AUTHOR]

Introduction: Cachexia is an inflammatory syndrome associated with severe weight loss. It increases with age and the prevalence in the general population is around 1% but it has been little studied in older adults despite the well documented associations of weight loss and inflammation with poor outcomes. This study hypothesised that cachexia is common in hospitalised older women and associated with worse outcomes.Methods: Data was collected on female patients upon admission to an acute medicine for older people ward. Cachexia was characterised according to the consensus definition: more than 5% weight loss in the preceding 12 months plus three of: fatigue, anorexia, low grip strength, low fat free mass and biochemical evidence of inflammation. Pre-cachexia was defined by having all of: less than 5% weight loss in preceding 6 months, chronic disease, anorexia and inflammation. Participants were followed up in the community at 6 months where cachexia was re-characterised and at 2 years where mortality data was collected.Results: 148 older women were recruited to the study. Average age at baseline was 86 years and the prevalence of pre-cachexia and cachexia was 5% and 27% respectively and 8% and 34% at follow up. Cachexia at baseline was associated with an increased likelihood of hospital acquired complication (odds ratio 3.2, p = 0.07) and also increased mortality at two years (hazard ratio 2.6, p = 0.002); these data remained significant after adjustment for age, smoking, alcohol and functional status and co-morbidity.Discussion: Cachexia is highly prevalent in older women admitted to hospital. It is associated with worse clinical outcomes in an already frail population both during receipt of hospital care and after discharge home. There needs to be greater recognition of cachexia in this vulnerable group. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is a state of increased vulnerability; its prevalence amongst people over 85 years may be as high as 26% but individuals classified as frail differ considerably in terms of their function and clinical outcomes. An important healthcare challenge is to better discriminate between frail people who are expected to do less well to facilitate targeted intervention and prognostication. This study aimed to investigate the utility of physical performance testing in frail older people and ascertain relationships with all-cause mortality.Methods: 103 older women were followed up at home after original recruitment to the study during an acute hospital admission six months previously. Demographic information was collected and Fried frailty status was defined as three of: weight loss, weakness, exhaustion, slowness, low activity (2 = pre-frail). Physical performance was assessed using timed-up-and-go (TUG), gait speed, one-legged stand and chair rises. Mortality data was ascertained over the subsequent 18 months.Results: Average age was 87 years; 70% were frail and 17% were pre-frail. 19% of participants attempted all four physical performance tests; 25% were unable to attempt any. Only TUG predicted mortality over 18 months (hazard ratio per second faster, 0.99; age-adjusted p-value, 0.06); there were no associations with other functional assessments or frailty status. A physical performance score was generated according to the number of assessments attempted (0–4); this was the biggest predictor of long-term mortality (hazard ratio per point gained, 0.25; age-adjusted p-value, 0.008).Conclusions: Frailty was highly prevalent in community dwelling older women six months after discharge from hospital and was not a predictor of mortality in the next 18 months. Physical performance assessments were difficult for the study participants to complete. The simple physical performance score assessed ability and willingness to complete physical performance tests and was a powerful predictor of mortality. [ABSTRACT FROM AUTHOR]

Introduction: Age-related airway compliance changes contribute to the declining ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) with ageing. This leads to increased airflow obstruction during forced expiration. Consequently, many older people meet the spirometric criteria for obstructive airways disease despite no other evidence. Older people may be unable to generate and sustain sufficient expiratory pressure to reach and hold maximum flow as lung volume falls. This study used grip strength (GS) to reflect expiratory muscle strength (EMS) in investigating the relationship between EMS and lung function (LF).Methods: Patients on acute Medicine for Older People wards were recruited who met the inclusion criteria: age above 70 years; never smoked; no history, symptoms or signs of respiratory disease; Mini Mental State Examination (MMSE) ≥24; willing and able to consent to participate; able to perform hand grip and forced spirometry. Outcome measure was LF (FEV1, FVC, FEV1/FVC, peak expiratory flow rate (PEFR) and slow vital capacity (SVC)), covariates were GS, age, weight, height. Unadjusted and adjusted (for age, height, weight) linear regressions were used for analysis.Results: 50 patients (male = 20, female = 30) were recruited. Significant relationships were found in men between GS and FEV1 (unadjusted β = 0.032, 95%CI = (0.001,0.063), p = 0.047) although not significant after adjustment; in women between GS and PEFR (unadjusted β = 6.881, 95%CI = 1.537,12.226, p = 0.013); (adjusted β = 6.938, 95%CI = 1.268,12.607, p = 0.018), and in women between GS and SVC (unadjusted β = 0.052, 95%CI = 0.006,0.099, p = 0.028); (adjusted β = 0.050, 95%CI = 0.0005,0.100, p = 0.048). No other significant relationship was found.Conclusions: The relationship of GS with PEFR and SVC in women might reflect stronger patients generating higher intra-thoracic pressure at the start of spirometry and pushing harder against thoracic cage recoil at end-expiration. No significant relationship was found with FEV1/FVC and GS in this small study. Further research is needed to evaluate the relationship between LF and GS. [ABSTRACT FROM AUTHOR]

Scope: Sedentary behaviour and bed rest in hospital are associated with multiple complications and worse health outcomes in older people. There is evidence that early mobilisation of those patients improves not only health outcomes but also general wellbeing and satisfaction with healthcare. This aspect of care is frequently compromised due to the time pressures experienced by clinical staff. We undertook a systematic literature review of studies that included volunteers helping mobilise older inpatients.Search methods: We searched Cochrane, Medline, Embase, CINNAHL, Amed and Google databases using MeSH headings and keywords within six key themes: inpatients, older, exercise, delirium, falls and volunteers. The abstracts were screened first independently then jointly by two reviewers. Full texts of relevant articles were retrieved. Reference lists were reviewed. Hospital based studies, projects or programmes in which volunteers (+/- staff members) were used to assist mobilisation in medical inpatients aged over 65 were included. Multi – intervention trials were included if mobilisation was part of the protocol. We excluded studies limited to a single disease such as stroke or Parkinson's disease.Results: 1677 papers were identified and the titles and abstracts were screened. Only four studies fulfilled the search criteria and were included in the final review. Multiple scientific abstracts related to one controlled study which included volunteer assisted mobilisation as part of the delirium prevention multi-intervention (HELP).Three observational studies were identified only on Google but were poorly evaluated or still on-going. The data available indicated a positive effect of volunteers on patient and staff satisfaction with care.Conclusions: There is a lack of randomised controlled trials of volunteer assisted mobilisation of older inpatients. When adopted as part of delirium prevention programme volunteers contributed to improved outcomes. There is insufficient evidence to provide guidance on the use of volunteers specifically to deliver mobility assistance to older inpatients. [ABSTRACT FROM AUTHOR]

Introduction: Sarcopenia, defined by the European Working Group on Sarcopenia in Older People (EWGSOP) is the loss of muscle mass and function with age. Sarcopenia has a multifactorial aetiology, which includes reduced number and/or function of satellite cells (SC). These cells are central to the growth and repair of skeletal muscle. Previously, SC have been identified by electron microscopy and immunofluorescence techniques. Few studies have demonstrated the ability to identify SC by immunohistochemical techniques in fixed human tissue. The objective of this study was to develop a methodology and determine the feasibility of identifying and quantifying SC.Methods: 99 men born between 1931 and 1939 (mean age 72) consented for detailed characterisation of muscle mass and strength as well as a muscle biopsy of the vastus lateralis. Tissue was processed for immunohistochemical studies. Sections of muscle were stained with paired box protein transcription factor 7 (PAX-7) antibody. Photomicroscopy and image analysis were used to calculate muscle tissue area, satellite cell number and fibre number per section after which values for SC per mm2 muscle (SC density), SC per fibre and fibres per mm2 muscle were derived.Results: Due to incomplete tissue fixation, muscle sections were available for 75 participants. The median SC count was 2, interquartile range (IQR 1.5-3.2). The median satellite cell density was 4 cells per mm2 muscle (IQR 2.1- 6.0). There were 0.04 SC per fibre (IQR 0.02-0.07). fibre. The median fibre count was 198 (IQR 120-321), median fibre density was 99 fibres/mm2 (IQR 65.2-119.3).Conclusion: Identifying and quantifying SC by immunohistochemistry in human tissue is feasible. The next steps are to apply the EWGSOP algorithm to the HSS sample to determine the relationship between SC and sarcopenia. The methodological findings of this study can now be applied to future studies that also include women. [ABSTRACT FROM AUTHOR]

The article presents a study which described nonagenarians admitted to an acute medical admissions unit. The researchers performed a prospective study of consecutive admissions of patients more than 90 years to the medical admissions unit in February, May, and August 2005 and gathered information such as pre-admission socio-demographics and length of hospital stay. Results showed that 47 participants left the hospital with their pre-admission level of care support, 33 with additional support and 17 to rehabilitation.

The article presents a study associating handedness, side of onset or worst affected side, and the use of cueing methods in patients with Parkinson's disease (PD). Around 338 patients answered a questionnaire which asked about handedness, side of onset of syndromes, worst affected side, and the duration of diagnosis. Results found no correlation between side of onset/worst affected side and handedness and they are not associated with cueing methods in patients experiencing freezing episodes.

The article presents a research describing the factors that influence patient's ability to provide consent or to obtain assent from carer or family. Results cited reasons for lack of consent or assent, including confusion, moribund, stroke disease, early discharge, and refusal. The authors concluded that such inability of patients to consent or to gain assent makes full data collection difficult and limits the generalisability of study outcomes.

Discusses research being done on patient recovery after stroke. Reference to study by J. Kwan et al, presented at the British Geriatrics Society Communications to the Autumn Meeting in Harrogate, England from October 6 to 8, 2004; Accuracy of predicting functional outcome after stroke; Importance of healthcare professionals' prediction of recovery; Methodology and result of the study.

Investigates the wishes of elderly patients regarding cardiopulmonary resuscitation (CPR) and possible influences on these views. Patients with prior knowledge of CPR; Patients who had been involved in a CPR decision for a relative; Patients desiring CPR: Patients who did not want CPR: Undecided lot; Basis of choices; Patients wishing to be asked their wishes.