Assessment Of Older Adults Research Articles

Validation of a Motor-Cognitive Assessment for a Stepping Exergame in Older Adults: Use of Game-Specific, Internal Data Stream.

Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (rs) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (ηp2), and feasibility by mean completion time and completion rates. Results: Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of rs including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (ηp2 = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Conclusion: Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.

Preliminary study of the validity and reliability of the Chinese version of the Saint Louis University Mental Status Examination (SLUMS) in detecting cognitive impairment in patients with traumatic brain injury

The Saint Louis University Mental Status Examination (SLUMS) has been shown to be useful in the cognitive assessment in older adults and patients with dementia. The aim of this study was to preliminarily explore the effectiveness of the Chinese version of the SLUMS in the detection of cognitive impairment in patients with traumatic brain injury (TBI) and to provide an objective basis for its clinical application in China. In this cross-sectional study, 42 patients with TBI and 30 matched normal controls were administered. Participants were assessed by the Chinese version of the Mini-Mental State Assessment scale (MMSE), Montreal Cognitive Assessment scale (MoCA) and SLUMS. Results showed that the Chinese version of the SLUMS had satisfactory internal consistency (Cronbach's α coefficient: 0.723), excellent interrater reliability (ICC: 0.990–0.998) and intrarater reliability (ICC: 0.968), as well as good validity. In the TBI group, the total SLUMS score was moderately positively correlated with the MMSE score (r = 0.702, p = .000) and highly positively correlated with the MoCA score (r = 0.831, p = .000). Receiver Operating Characteristic (ROC) curve analyses showed that the area under the curve (AUC) of the SLUMS, MMSE and MoCA were 0.872, 0.756 and 0.916, respectively. The optimal cutoff score of 22.5 or fewer points are suggested for the SLUMS to discriminate cognitive impairment, with a sensitivity of 0.844 and a specificity of 0.825. The Chinese version of the SLUMS has excellent reliability and validity, and can be used as a screening tool for cognitive impairment of patients with TBI in China.

Validity and reliability of hindi translated version of Montreal cognitive assessment in older adults.

To evaluate the validity and reliability of Hindi version of Montreal cognitive assessment (H-MoCA) as a screening tool to detect mild cognitive impairment among older adults of India. The study was conducted in three phases, namely content validation of H-MoCA reliability estimation, internal consistency and test- retest reliability. Qualitative and quantitative validation through expert review resulted in modification of H-MoCA which was tested on purposive sample of 30 subjects, and analysis was done for internal consistency reliability, then the scale was re-administered to the same group to establish test-retest reliability. Internal consistency was reported in terms of Cronbach's alpha (α) and test-retest reliability in terms of intra class correlation coefficient (ICC). Qualitative review and Content validation ratio (Lawshe) validate the content of H-MoCA with CVR of 0.99. The scale has good internal consistency, Cronbach's alpha (α) = 0.64 and high test-retest reliability, intra class correlation coefficient (ICC) = 0.87. Thus the Hindi translated version of MoCA is a valid and reliable tool for detecting mild cognitive impairment.

Y-Balance Test: A Valid and Reliable Assessment in Older Adults.

Testing balance and fall risk with older adults of varying abilities is of increasing importance. The primary aim of this study was to evaluate the validity of the lower quarter Y-balance test (YBT-LQ) in older adults. A secondary aim was to provide estimates of reliability with this population. A total of 30 male (n = 15) and female (n = 15) subjects (66.8 ± 6.5 years) performed the YBT-LQ, 30-s chair stand test, 8-foot up and go test, timed up and go test, single-leg stance, and Activities-Specific Balance Confidence Scale questionnaire. The YBT-LQ was performed on two separate occasions by two investigators in random order. YBT-LQ was significantly correlated with age (p < .01), timed up and go test (p = .003), 8-foot up and go test (p < .001), 30-s chair stand test (p < .001), Activities-Specific Balance Confidence Scale (p = .002), and single-leg stance (p = .005) performance. The intraclass correlation coefficient(3,1) score for the reliability of the YBT-LQ was .95 (95% confidence interval [.89, .97]). The YBT-LQ appears to be a valid and reliable assessment to use with older adults.

Effect of Hearing Ability and Mild Behavioural Impairment on MoCA and Memory Index Scores.

BackgroundThe life-course model of modifiable risk factors for dementia now recognizes managing hearing loss and addressing social isolation.ObjectiveTo investigate the contribution and inter-relationship of hearing ability and behaviour change on cognitive ability.MethodsWe present the preliminary findings from a prospective longitudinal study of 35 non-demented participants ages 60–93, recruited from community rehabilitation and acute-care programs of Geriatric Medicine, who underwent baseline hearing, behavioural, and cognitive testing.ResultsAfter controlling for age and hearing impairment, the left ear Dichotic Digit Test (DDT) score accounted uniquely for 20% of the variance in MoCA Memory Index (p = .016 with β = .598). Mild Behavioural Impairment (MBI) was highly prevalent, with 80% of older adults reporting at least one MBI symptom. People with hearing impairment had greater global MBI burden than people with normal hearing, especially in the domains of apathy and impulse dyscontrol; however, greater severity of hearing impairment was not associated with a higher number of neuropsychiatric symptoms (NPS).ConclusionsLow left DDT contributed to lower memory index and greater MBI burden is associated with hearing impairment. Our findings demonstrate the value of early non-invasive hearing and behavioural assessments as part of dementia risk assessment in older adults.

Triple Test Plus Rapid Cognitive Screening Test: A Combination of Clinical Signs and A Tool for Cognitive Assessment in Older Adults

Less time-consuming, easy-to-apply and more reliable cognitive screening tests are essential for use in primary care. The aim of this study was to investigate the diagnostic value of the Turkish version of the Rapid Cognitive Screen (RCS-T) and Triple Test individually and the combination of RCS-T with each sign and Triple Test to screen elderly patients for cognitive impairment (CI). A total of 357 outpatients aged 60 or older, who underwent comprehensive geriatric assessment, were included in the study. Presence or absence of attended alone sign (AAS), head-turning sign, and applause sign was investigated. The mean age of the patients was 74.29 ± 7.46. Of those, 61 patients (28 men, 33 women) had Alzheimer’s disease (AD), 59 patients had mild cognitive impairment (MCI) (29 men, 30 women), and 237 (80 men, 157 women) were cognitively robust. The sensitivity of the combination of RCS-T and negative for AAS for CI, AD and MCI is 0.79, 0.86 and 0.61, respectively; the specificity was 0.92, 0.93 and 0.92, respectively; and the positive and negative predictive values revealed good diagnostic accuracy. The combination of RCS-T and negative for AAS is a simple, effective and rapid way to identify possible CI in older adults.

Financial difficulty and biopsychosocial predictors of loneliness: A cross-sectional study of community dwelling older adults

AimTo investigate the interplay of sociodemographic, health, functional and psychosocial factors in predicting loneliness in community dwelling older adults accessing home support services and long-term aged residential care. MethodsOlder New Zealanders (age 65+), who had their first interRAI Home Care assessment between July 2014 and June 2016, were included. The outcome variable was the binary interRAI item “Lonely”. The predictor variables included sociodemographics, hearing, vision, self-reported health, activities of daily living, social interaction and support, and depression. ResultsData from 51,239 assessments of older adults (mean age: 82.3 years; female: 61%; European: 87.3%) were analysed. Loneliness was reported in 21%. A stepwise logistic regression model explained 12.1% of the variance and was statistically significant (Chi2 = 3501.0.8, df = 22; p < 0.001). The factors with the largest odds ratios (OR > 1.5) were depression, living alone, being Asian, financial difficulty and not in a relationship. Functional impairment was negatively associated with loneliness. ConclusionsDetermining the predictors of older adults’ loneliness is complex, multi-factorial, with each factor having a small, additive effect on the development of loneliness. Depression, social factors and financial difficulty are the strongest predictors but much of the variance remains unexplained. These factors could be targeted as modifiable risk factors for addressing loneliness in older adults.

Psychometric properties of the expanded version of the inventory of depression and anxiety symptoms (IDAS-II) in a sample of older adults

Objective: Given the strong relationship often found between self-report measures of anxiety and depression, the Inventory of Depression and Anxiety Symptoms (IDAS) was created and then expanded (IDAS-II) to assess common and unique symptom dimensions of these emotional disorders. Limited research has focused on the use of the IDAS-II with older adults and the purpose of the current study was to provide data on the reliability and validity of the IDAS-II in this population.Method: A sample of 323 participants (age 55–80 years) were recruited online using Amazon’s Mechanical Turk (MTurk). They completed the IDAS-II and several other self-report questionnaires of internalizing symptoms, including widely used measures developed specifically for older adults. Internal consistency and validity of the IDAS-II were examined.Results: The IDAS-II demonstrated marginal to excellent internal consistency (α = .68–.91). An exploratory factor analysis indicated three factors: Distress, Positive Mood, and Obsessions. The IDAS-II explained a large amount of variance in the other measures of depression and anxiety (ranging from 52% to 76%) and the IDAS-II Dysphoria scale significantly related to all of the other measures of depression and anxiety (ranging from r = .69 to r = .81).Conclusion: These results support the use of the IDAS-II with older adults as it has good convergent validity with other commonly used measures of depression and anxiety, including those commonly used in the assessment of older adults. Further research can use the IDAS-II with both younger and older adults to examine age-related changes in depression and anxiety symptoms.

Reliability and Validity of Computerized Force Platform Measures of Balance Function in Healthy Older Adults

Postural control declines with aging and is an independent risk factor for falls in older adults. Objective examination of balance function is warranted to direct fall prevention strategies. Force platform (FP) systems provide quantitative measures of postural control and analysis of different aspects of balance. The purpose of this study was to examine the reliability and validity of FP measures in healthy older adults. This study enrolled 46 healthy elderly adults, mean age 67.67 (5.1) years, who had no history of falls. They were assessed on 3 standardized tests on the NeuroCom Equitest FP system: limits of stability (LOS), motor control test (MCT), and sensory organization test (SOT). The test battery was administered twice within a 10-day period for test-retest reliability; intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change based on a 95% confidence interval (MDC95) were calculated. FP measures were compared with criterion clinical balance (Mini-BESTest and Functional Gait Assessment) and gait (10-m walk and 6-minute walk) measures to examine concurrent validity using Pearson correlation coefficients. Multiple linear regression analysis examined whether age and activity level were associated with FP performance. The α level was set at P < .05. SOT composite equilibrium scores, MCT average latency, and LOS end point excursion measures all demonstrated excellent test-retest reliability (ICC = 0.90, 0.85, and 0.77, respectively), whereas moderate to good reliability was found for SOT vestibular ratio score (ICC = 0.71). There was large variability in performance in this healthy elderly cohort, resulting in relatively large MDC95 for these measures, especially for the LOS test. Fair correlations were found between LOS end point excursion and clinical balance and gait measures (r = 0.31-0.49), and between MCT average latency and gait measures only (r =-0.32). No correlations were found between SOT measures and clinical balance and gait measures. Age was only marginally significantly (P = .055) associated with LOS end point excursion but was not associated with SOT or MCT measures, and activity level was not associated with any of the FP measures. FP measures provided reliable information on balance function in healthy older adults; however, small learning effects were evident, particularly for the SOT. The SEM and MDC95 for the LOS and SOT measures were relatively large for this healthy elderly cohort. A relationship between FP measures, which assess underlying balance mechanisms, and clinical balance and gait measures was not strongly supported in this study. Further research is needed to justify the value of adding FP measures to a test battery for balance assessment in older adults without a history of falls.

Ultrasound Muscle Assessment and Nutritional Status in Institutionalized Older Adults: A Pilot Study.

Muscle thickness, measured by ultrasonography, has been investigated for nutritional assessment in older adults, however the associations between muscle ultrasound parameters in the lower limb and nutritional status have not been studied. The aim of this study was to investigate the relationship between muscle thickness echo intensity (EI), and nutritional status in home care residents. A cross sectional study was conducted involving 19 older adults from a home care in Malaga (Spain). We evaluated lower leg muscles by ultrasound, anthropometric data, physical function (measured by gait speed and the Short Physical Performance Battery), strength (handgrip and knee extensors strength) and nutritional status across the Mini-Nutritional Assessment Short-Form (MNA-SF). We found that muscle thickness assessed by ultrasonography independently predicts nutritional status by MNA-SF and after adjusting for handgrip strength or age and sex. As secondary findings, we found relations between strength, functional capacity and the MNA-SF test. These results suggest that lower leg muscle ultrasound parameters could be used as a low-cost objective method for muscle evaluation in nutritional assessment in older adults.

Frailty assessment in older adults undergoing interventions for peripheral arterial disease

ObjectiveFrailty is a multidimensional syndrome that influences postoperative morbidity and mortality after vascular procedures; however, its integration in clinical practice has been limited, given the lack of consensus on how to measure it. This study sought to compare the incremental predictive value of six different nonphysical performance frailty scales to predict poor outcomes after interventions for peripheral arterial disease (PAD). MethodsThis preplanned analysis of the FRailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort included two centers recruiting patients between July 1, 2015, and October 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The following scales were compared: Edmonton Frail Scale, Groningen Frailty Indicator (GFI), modified Essential Frailty Toolset (mEFT), modified Frailty Index, Multidimensional Prognostic Index, and the Risk Analysis Index-C. The primary end point was a composite of all-cause mortality and major disability at 12 months after the procedure. The secondary end point was length of stay. Logistic regression was used to determine the association of frailty with the primary end point after adjusting for confounders. To compare the incremental predictive value of each frailty scale, model performance statistics were calculated. ResultsThe cohort was composed of 148 patients with a mean age of 70 years. Depending on the scale used, the prevalence of frailty ranged from 16% to 70%. Frailty as measured by the GFI (adjusted odds ratio, 1.76; 95% confidence interval, 1.14-2.72) and mEFT (adjusted odds ratio, 2.71; 95% confidence interval, 1.29-5.73) predicted mortality and worsening disability at 12 months after interventions for PAD. Furthermore, there was statistically significant C-statistic, Bayesian information criterion, and integrated discrimination improvement when the GFI and mEFT were added to the baseline model. Frailty was not associated with length of stay. ConclusionsFrailty is associated with mortality and worsening disability after interventions for PAD. The GFI and mEFT performed well and identified vulnerable older adults who are at risk of poor outcomes after interventions for PAD and recommended for use in this setting.

Cancer Pain Management Considerations in Older Adults.

To address the pharmacokinetics and pharmacodynamics of aging and its impact on the complexities of pain management in older adults with cancer. To describe assessment and nursing strategies for individualized care and side effect management DATA SOURCES: Peer-reviewed articles. Cancer pain is a complex problem in older adults because of the variations in aging and alterations in pharmacokinetics and pharmacodynamics. Pain management must be based on thorough assessment, incorporating the unique factors of each patient. Ongoing follow-up is critical to ensure adequate pain control with optimization of functional status. Awareness of physiological changes of aging is important in caring for older adults. Oncology nurses can play a key role in the assessment of older adults with cancer and education of patients and caregivers regarding pain medications, side-effects, and oral adherence.

Preliminary evaluation of a self-guided fall risk assessment tool for older adults

Falls are a major health problem for older adults with significant physical and psychological consequences. The first step of successful fall prevention is to identify those at risk of falling. Recent technology advancement offers the possibility of objective, lowcost and self-guided fall risk assessment. The present work evaluated the preliminary validity and usability of a Kinect camera-based selfinitiated fall risk assessment system in a hospital setting. A convenience sample of 29 female participants (77.5 ± 7.9 years old) enrolled in this study. This low-cost self-guided system included a Kinect depth-sensing camera, a PC-based computer, and custom-built software. An onscreen Fall Risk Assessment Avatar (FRAAn) utilizing visual and verbal instructions led participants through a fall risk assessment consisting of self-report measures and clinically validated balance and mobility tests. Participants also completed clinical fall risk evaluation (Timed-Up and Go, and Berg Balance Scale) led by a researcher. User experience was evaluated by the System Usability Scale (SUS). Results indicate that FRAAn-based outcome measures (postural sway metrics, and sit-to-stand speed) were highly correlated with clinical fall risk measures, and were able to differentiate individuals with increased fall risk. Additionally, 83% participants reported high usability (SUS > 80), indicating the system is well received among older users. Overall, our results indicate that the FRAAn system has promise for providing a self-guided fall risk assessment, and is well received by older users. This affordable, portable and self-guided system has potential to facilitate objective fall risk assessment in older adults in various settings.

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Background: The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. Objective: The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. Methods: A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. Results: The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83–0.91), 0.83 (95% CI 0.80–0.86), and 0.81 (95% CI 0.78–0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06–2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. Conclusion: Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician’s office as a screening tool for impaired physical performance.

Geriatric Assessment in Older Adults with Multiple Myeloma.

The incidence of myeloma in older adults is increasing, yet little is known about geriatric impairments in these patients. We aimed to examine the prevalence of geriatric impairments in older adults with myeloma and the association between geriatric assessment and autologous stem cell transplant eligibility. Prospective cohort study. Two academic medical centers. A total of 40 adults 65 years and older with newly diagnosed myeloma were enrolled. Participants completed a primarily self-administered geriatric assessment, including measures of functional status, comorbidities, polypharmacy, psychosocial status, social support, quality of life, cognition, and physical performance. Outcomes were autologous stem cell transplant eligibility and receipt. Forty patients enrolled; their mean age was 71 years. Geriatric impairments were common: 62% reported dependence in one or more instrumental activities of daily living (IADL), 76.9% had polypharmacy (four or more medications), and 47.5% had one or more comorbidities. Median time on the Timed Up and Go was 13.3 ± 4.9 seconds. Those considered candidates for autologous stem cell transplant (N = 26) were younger, with fewer comorbidities, better performance status, and faster performance on the Timed Up and Go test. Factors independently associated with receiving autologous stem cell transplant (N = 21) included age and IADL dependence. Impairments in geriatric domains are common in this population, even among those considered to have a good performance status. Geriatric assessment domains are associated with both transplant eligibility and receipt. J Am Geriatr Soc 67:987-991, 2019.

Improving fracture risk assessment in older adults

Improving fracture risk assessment in older adults

The Disease Burden Morbidity Assessment in older adults and its association with mortality and other health outcomes.

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan-Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan-Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.

Improving Functional Assessment in Older Adults Transitioning From Hospital to Home.

The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. This article focuses on case management of older adults transitioning from hospital to home. There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.

Avoidance of unnecessary hospital admissions through the implementation of a digital health programme

Introduction: 62% of hospital bed days are occupied by older adults 65 and older in the UK and it is estimated that there is a cost to the NHS of £820 million1. Elderly patients admitted to hospital have worse morbidity and mortality outcomes and often have a poorer experience2,3,. To reduce emergency admissions Tameside and Glossop Integrated Care NHS Foundation Trust developed a Digital Health Service, which supports frail people to stay within the community where their care can be managed, avoiding an Emergency room attendance and potential emergency admission. Practice change: To enhance the value of care provided to the local community a digital health service has been implemented in care homes. The service provides digital technology that enables care home staff to access a hospital specialist for advice and guidance on residents who have a deterioration in health before considering an Ambulance/ GP visit. Aim and theory of change: The aim is to use technology to enable care home staff to maintain older people with complex co-morbidities, within their home setting and avoiding unnecessary hospital admissions. Timeline: The programme was launched in March 2017 and will run for 3 years Highlights: In the period April and September 2017 94 Emergency and 258 GP attendances were avoided. Total hospital bed days saved 1268. Deflection rate of Emergency room attendance is currently 70% Comments on sustainability: The programme has now been expanded across the whole of the residential care home sector and will launched as a 24/7 service this year. Limitations: Awaiting more long term finding, ongoing evaluation is required to ensure that early results are sustainable overtime. Comments on transferability A joint End of Life bid is being developed. Conclusions: Elderly people suffer worsening health and poor experience when in hospital 3, 5. There is also a significant financial cost to systems treating frail elderly patients in hospitals 3. The Digital health programme enabled care staff to access acute hospital specialists for advice and guidance, which has led to a significant deflection in attendance. Discussions: The programme has proven successful at reducing admissions and in Emergency room attendance within the population group, data appears to show that the service has the potential to support people to remain within their place of residence rather than be treated in hospital. Lessons learned: General practitioners are key influencers within community setting and proved key to promoting and service

Frailty Assessment in Older Adults Undergoing Interventions for Peripheral Arterial Disease

Frailty Assessment in Older Adults Undergoing Interventions for Peripheral Arterial Disease