Age and ageing最新文献

{"title":"Correction to: Frailty in colorectal cancer-are we speaking the same language?","authors":"","doi":"10.1093/ageing/afaf038","DOIUrl":"https://doi.org/10.1093/ageing/afaf038","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389649","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}

{"title":"A qualitative study regarding older people's goals of care in relation to frailty status: finding meaning in 'smaller things' in life.","authors":"Veerle M G T H van der Klei, Frederiek van den Bos, Simon P Mooijaart, Anneke G Julien, Mabel J E Maissan, Bas F M van Raaij, Jan Festen, Jacobijn Gussekloo, Yvonne M Drewes","doi":"10.1093/ageing/afaf022","DOIUrl":"10.1093/ageing/afaf022","url":null,"abstract":"<p><strong>Background: </strong>Increasingly frailty assessment is part of the shared decision-making process of older patients. However, little is known of the role of frailty in goals of care among the diverse group of older persons.</p><p><strong>Objective: </strong>To explore the role of frailty in older people's perspectives on goals of care in case of acute and/or severe disease.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with people aged ≥70 years in the Netherlands (n = 26), which were purposively sampled based on a self-reported Clinical Frailty Scale. The interviews were analysed using thematic content analysis to compare frailty subgroups.</p><p><strong>Results: </strong>Three themes regarding goals of care emerged: (1) preserving well-being in one's lifeworld through life goals; (2) goals related to care, as access to appropriate care, good contact with care professionals and a dignified end-of-life; (3) differences in attainment and adaptation of goals of care according to frailty status. The first two themes appeared to be independent of frailty status. However, differences were seen in theme 3, as fit older people primarily strengthened their capacity to attain goals of care, while frail older people primarily adapted the meaning ascribed to goals of care and had higher acceptance of the life cycle.</p><p><strong>Conclusion: </strong>Goals of care that older people want to attain are driven by life goals, independent of frailty. Therefore, older people with varying frailty status could be treated similarly in goal-setting and life goals. However, different support may be needed for the attainment and adaptation of their goals of care.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition supplementation combined with exercise versus exercise alone in treating knee osteoarthritis: a double-blinded, randomised, placebo-controlled trial.","authors":"Wei Liu, Yingxiang Yu, Zhida Zhang, Zhongxia Li, Yanpu Wu, Lan Xie, Ziyi Xu, Cuiqing Chang","doi":"10.1093/ageing/afaf010","DOIUrl":"https://doi.org/10.1093/ageing/afaf010","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of formula nutrition supplementation (mainly containing glucosamine sulphate, chondroitin sulphate and rhizoma drynariae) plus supervised exercise versus exercise alone for the treatment of knee osteoarthritis (OA).</p><p><strong>Methods: </strong>This was a double-blinded, single-centre, randomised, placebo-controlled trial. The study recruited 65 participants (40-75 years) with knee OA. Participants were randomly allocated to nutrition supplementation plus exercise (N + E) group or placebo plus exercise (P + E) group. The intervention lasted for 6 months. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes included physical function and performance scores, lower extremity strength and serum biomarkers.</p><p><strong>Results: </strong>Among the 65 randomised patients, 56 (86%) completed the trial. At 3 months, more participants in the N + E group than in the P + E group achieved minimum clinically important difference (MCID) in WOMAC total score (19/30 [63.3%] vs 8/26 [30.8%]; P < .01). At 6 months, more participants in the N + E group than in the P + E group achieved MCID in WOMAC stiffness score (19/30 [63.3%] vs 10/26 [38.5%]; P < .05). Meanwhile, at 6 months the decreased percentages of WOMAC stiffness score in the N + E group was greater than in the P + E group (P < .05). The flexor peak torque at 120°/s and 180°/s in the N + E group were significantly higher than those in the P + E group at 3 months (P < .05). Moreover, compared with baseline, improvements in the WOMAC overall and pain score, visual analogue scale pain and 30-second chair stand test were observed in both groups at 6 months. However, these indicators in the N + E group were improved as early as 3 months (P < .05).</p><p><strong>Conclusions: </strong>The improvement effects of nutrition supplementation plus exercise were superior to those of exercise alone, and the improvement occurred earlier. Nutrition supplementation plus exercise would be a more efficient strategy for knee OA.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 2","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466742","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}

{"title":"2870 Improving multidisciplinary team meetings on an elderly medicine Ward at Leeds teaching hospitals trust","authors":"E Brew, A Cracknell, A Flinders, S Ninan","doi":"10.1093/ageing/afae277.024","DOIUrl":"https://doi.org/10.1093/ageing/afae277.024","url":null,"abstract":"Introduction Within our ward multidisciplinary team (MDT) meetings we noted that there was often a lack of attendance from key disciplines, inconsistent content, and an overly medical emphasis. We wished to create an MDT that was structured, with consistent input from nursing and therapy teams, covering components of comprehensive geriatric assessment (CGA). Methods On one pilot ward, we agreed a new structure to MDT meetings. Clinical leadership was required to facilitate staff sharing their observations, with clinicians speaking less. We used an A0 poster as a clear visual prompt for maintaining structure. A survey on teamworking and safety was performed on the pilot ward by the Improvement Academy. We had several iterations, but a standardised structure with key ingredients for MDTs was rolled out across five other Elderly Medicine wards. A further survey was performed examining opinions on quality of MDT working. Results After our interventions, CFS, 4AT and mobility went from being discussed 0% of the time in July 2021 to 100% of the time on the pilot ward between January and July 2024. Mobility went from being discussed from 0% in July 2021 to 71% in May 2024 across all wards. 90.5% of the pilot team thought that decision making utilised input from relevant team members. In a further survey in May 2024, 82.6% agreed that the relevant team members opinions were listened to. Conclusion A structured MDT process was successful in incorporating key elements of CGA whilst improving MDT teamworking. Starting with a single ward allowed others to gain confidence in the success of the process and enable natural spread. Key stakeholders including organisational leads were consulted and involved in improvement work, such that this is now a standard way of working. The lessons learned are being used to contribute to a digital dashboard tracking MDT progress.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"20 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071747","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}

{"title":"2873 Post traumatic stress disorder in older adults after delirium: a systematic review","authors":"S Narayanasamy, N Muchenje, A McColl","doi":"10.1093/ageing/afae277.126","DOIUrl":"https://doi.org/10.1093/ageing/afae277.126","url":null,"abstract":"Introduction Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by frightening or traumatic events. Delirium is a state of acute confusion associated with acute illness, surgery, and hospitalisation. Delirium is known to be associated with a risk of PTSD in patients in the Intensive Care (ICU) setting. However, there is limited information on the prevalence of delirium in older adults outside of Intensive Care. We therefore undertook a systematic review to ascertain the prevalence of PTSD in elderly patients after an episode of delirium on a general ward. Methods The systematic review was conducted using MEDLINE (1946–10/01/2024), Embase (1974–10/01/2024), and PsycINFO (1806–10/01/2024) to identify studies. Studies were eligible if they included adults aged ≥65 years, admitted to an acute hospital, diagnosed with delirium using a validated screening tool, (e.g. 4AT, CAM-ICU) and subsequently screened for PTSD at any point following discharge with a validated screening tool (e.g. the PTSS-14). The exclusion criteria excluded ICU cohorts and terminal illness with &amp;lt;3 months life expectancy. Two researchers (SM, NM) independently reviewed all studies with any disparities resolved through a 3rd researcher (AM). Results After removal of duplicates, the search identified 1042 titles from which only 3 eligible studies were identified. All 3 studies were in older patients after surgical procedures (n = 132 participants in total). Two of the studies reported no association between delirium and the subsequent risk of PTSD. However, the largest study (n = 77) reported a significant independent association between delirium and the 3-month risk of PTSD. Conclusion The current body of research on the prevalence of PTSD following episodes of in-patient delirium in older adults is limited. The findings of this review highlight the need for further research. A prospective cohort study on Geriatric Medicine wards is being planned.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071842","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}

{"title":"2765 Reducing avoidable discharge delays on an elderly admissions Ward","authors":"A Newton-Clarke, M Atkinson, K Shelton, S McDaniel","doi":"10.1093/ageing/afae277.032","DOIUrl":"https://doi.org/10.1093/ageing/afae277.032","url":null,"abstract":"Introduction Our aim is to improve clinical efficiency by reducing avoidable discharge delays, increased number of discharges and availability of specialist Frailty beds. We intend to undertake 8 PDSA cycles with a new idea. Background 23 bedded Acute Frailty Short Stay Unit (AFU). Patient group defined as those admitted to the unit from April ‘24 to current. Our initial spot-audit analysed 18 patients; the mean total avoidable delay was 31.52 hours (range 4.73–123.3 hours). Initial analysis demonstrated that delays became longer throughout the course of the day. Methods We evaluated staff opinions on the discharge process with a survey. Outcome measure identified as number of weekly discharges and appropriate patient flow to the AFU. Balancing measure identified as number of readmissions within 48 hours. PDSA cycle 1 allocated a doctor to write discharge letters during MDT. PDSA cycle 2 allocated a suitcase symbol to a potential discharge in the next 24 hours. We then adapted the suitcase with colours to differentiate between ready and awaiting investigations/aim home in 24 hours. The next involved allocating a discharge doctor to review patients with an amber suitcase from the previous day first. Results Initial staff feedback has been positive. Data demonstrated an increase from the baseline (from below 20 to an average of 25 discharges a week). This then dipped throughout May, during which time there was an unusual level of escalation, staff absences and annual leave. The data has begun to recover to a high of 27 discharges in the week of the start of June. Conclusions Utilising the MDT has been vital in the sustainability of the project. On-going staff surveys and regular meetings will help to ensure sustainability. Ongoing focus and further cycles are on encouraging junior members of the team to be involved with the intervention.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071740","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}

{"title":"2851 Reducing the number of unplanned admissions to hospital through a multidisciplinary single point of access pre-hospital","authors":"S Sage, A Baxter, S O’Riordan, J Seeley, J McGarvey","doi":"10.1093/ageing/afae277.021","DOIUrl":"https://doi.org/10.1093/ageing/afae277.021","url":null,"abstract":"Background East Kent has 38,101 people over 80 years, 39, 021 living with moderate or severe frailty and 304 care homes. This population have high levels of unplanned admissions which can put them at risk of long hospital stays, reduced mobility and increased delirium. East Kent Ambulance services (SECAMB), Acute hospitals (EKHUFT) and Community Services (KCHFT) have piloted a single-point of access consisting of an ED consultant, community frailty clinician, Urgent care senior nurse, advanced paramedic practitioners. They sit together at the ambulance bases, 10 am-6 pm Monday to Fridays. This team reviews all patients awaiting ambulances to assess whether there are alternative services to ED which would meet the individuals’ needs. Method The MDT assesses all patients listed as awaiting an emergency ambulance. Clinical records can be accessed from all services including GP records. If patients would benefit from treatment by alternative services, rather than conveyance, the paramedics are asked to call the MDT. This allows clinical assessment, history and investigation results to be taken into account in planning care. Patients and Carers are involved in deciding how they would like to receive medical care via a video or phone link with clinicians. Results Conveyance to hospital pre pilot 62% post pilot less than 50%. Ashford catchment: admissions save weekly 27.3, bed days saved weekly 179.2. Thanet Catchment: admissions saved weekly 19.1, bed days save weekly 106.9. Conclusion Many people can be treated effectively without conveyance to hospital through pre-hospital triage, consultation and planning by senior clinicians in a multi-disciplinary team.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"77 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071741","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}

{"title":"2638 First study of cardiovascular risk estimation using Globorisk in a Latin American geriatric cohort with COPD","authors":"J Hernández, V Ochoa, J Theran, L Badillo, H Torres, L Dulcey, J Gómez, M Trillos, D Vera, V Gómez, A Peña, C Amaya, M Rodriguez, G Ramos, N Gandur, V Gómez, A Olarte, V Trillos, M Picón","doi":"10.1093/ageing/afae277.073","DOIUrl":"https://doi.org/10.1093/ageing/afae277.073","url":null,"abstract":"Introduction It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. Methods A pilot study was conducted from January 2020–December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution and qualitative variables as percentages. Student’s t-test was performed to evaluate differences between two variables. All statistical analyses were performed with (SPSS for Windows, v.22.1; Chicago, IL). Results The present study showed that metabolic syndrome variables in these patients were elevated. Male sex was 77% and female 23%, smoking 61%. The GLOBORISK equation found mostly patients with low to moderate cardiovascular risk. It was found that there was a higher cardiovascular risk in those patients with FEV1 less than 30%, showing a statistical correlation of this alteration for the GLOBORISK scale. Conclusions This is the first pilot study that estimates cardiovascular risk using GLOBORISK in the COPD population. We consider integrating national and international networks to compare the results found here.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071743","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}

{"title":"2852 A proactive multidisciplinary approach to reviewing health and care needs of nursing home residents in a primary care network","authors":"F Jumabhoy, S Ninan, D Narayana","doi":"10.1093/ageing/afae277.035","DOIUrl":"https://doi.org/10.1093/ageing/afae277.035","url":null,"abstract":"Introduction We proactively reviewed nursing home residents using a multidisciplinary team (MDT) approach within a Primary Care Network (PCN). We aimed to enhance care coordination, reduce inappropriate medication use and ensure all residents had current advanced care plans in place. Method An MDT comprising a geriatrician, prescribing pharmacist, general practitioner, and nurse reviewed residents proactively. This involved reviewing the residents’ current health and care needs, falls risk, medication regimens and advance care plans. We then performed medication reviews, reviewed advanced care plans, and identified the need for further interventions. When we repeated the process, we used a proforma that could be pre-populated prior to the meeting by the pharmacist and geriatrician to improve efficiency of the discussion. Results The initiative was piloted in two residential nursing homes with a total of 65 residents reviewed, of which 86% (n = 56) received interventions. There was a 47% (n = 29) increase in completed advanced care plans. 62% (n = 40) of residents had medicines optimised, with polypharmacy being reduced in 46% (n = 30) by an average of 2 medications per resident. 8% (n = 5) were referred to additional services and 8% (n = 5) required further investigations. Conclusion(s) This proactive MDT model effectively addressed the needs of residents whilst demonstrating immediate positive outcomes. Key facilitators to good practice were teamwork, clarifying the objectives of the MDT, prior reviews of patient records, and ensuring staff who knew the residents well were present. We will use this approach with other nursing homes within the PCN and share our results with colleagues. This has the potential to reduce costs of medications and hospital admissions, as well as improve quality.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071748","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}

{"title":"2441 Reducing anticholinergic burden in older adults from an acute geriatric Ward—a quality improvement activity using education","authors":"KY Loh, APY Ho, KS Lim, SD Varman","doi":"10.1093/ageing/afae277.067","DOIUrl":"https://doi.org/10.1093/ageing/afae277.067","url":null,"abstract":"Introduction In older adults, anticholinergic burden (ACB) is associated with serious adverse effects including delirium, falls, functional decline, cognitive decline and death. We carried out a quality improvement project in an inpatient acute geriatric ward, aiming to reduce the percentage of older adults with high ACB scores on discharge by 15% from a baseline of 48% over a period of 3 months. Method A pre-interventional analysis of all patients discharged from a single acute geriatric ward in Changi General Hospital was performed. A pre-intervention survey was conducted to assess awareness among physicians of ACB and tools used. Fish-bone diagram, pareto chart and driver diagram were used to identify root causes, highlight the barriers and to prioritise interventions. Interventions in the form of educational posters on ACB, non-pharmacological management of delirium and behavioural symptoms of dementia were made available at the ward. ACB scores were generated for all patients on discharge, using an online ACB calculator [1], which combined the use of 2 validated scales: anticholinergic cognitive burden scale [2] and the German anticholinergic burden scale [3]. Results 396 patients were included in the analysis. Median percentage of patients with high ACB scores (≥3) on discharge was reduced from 48.4% pre-intervention to 16.1% post-intervention. Out of 14 physicians surveyed pre-intervention, 21.4% was unaware of the term ‘ACB’ and availability of ACB scoring systems. Conclusion An education approach is effective in raising awareness and reducing use of anticholinergic medications in an acute geriatric ward. This highlights the importance of incorporating ACB awareness and the tools into geriatric department teaching programmes. References 1. ACB Calculator. (n.d.). https://www.acbcalc.com/. 2. Boustani M., et al.Ageing Health. 2008. 4(3). 311–320. 3. Kiesel EK. et al.BMC Geriatr. 2018;18:239.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"86 1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071810","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}