Department Of Geriatric Medicine Research Articles

Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care.

Approximately 1 in 5 adults are diagnosed with depression in their lifetime. However, less than half receive help from a health professional, with the treatment gap being worse for individuals with socioeconomic disadvantage. Computer-assisted cognitive behavioral therapy (CCBT) is an effective and convenient strategy to treat depression; however, its cost-effectiveness in a sociodemographically diverse population remains unknown. To evaluate the cost-effectiveness of clinician-supported CCBT compared with treatment as usual (TAU) in a primary care population with a substantial number of patients with low income, limited computer or internet access, and lack of college education. This economic evaluation was a randomized clinical trial-based cost-effectiveness analysis. The trial was conducted at the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville. Enrollment occurred from June 24, 2016, to May 13, 2019. Participants had mild to moderate depression and were followed up for 6 months after treatment completion. The last follow-up assessment was conducted on January 30, 2020. Statistical analysis was performed from August 2023 to August 2024. CCBT intervention was provided for 12 weeks and included 9 modules ranging from behavioral activation and cognitive restructuring to relapse prevention strategies, supported by telephonic sessions with a clinician, in addition to TAU, which included standard clinical management in primary care. The primary health outcome was quality-adjusted life years (QALYs), estimated using the Short-Form 12 questionnaire (SF-12). The secondary outcome was treatment response, defined as at least 50% improvement in the Patient Health Questionnaire. The intervention cost included sessions with mental health clinicians and the cost of the CCBT software, plus the cost of loaner computer and internet data plan for low-resource households. An incremental cost-effectiveness ratio (ICER) was computed, while adjusting for baseline scores, age, and sex. The cost-effectiveness acceptability curve presented the probability of CCBT being cost-effective for a range of willingness-to-pay values. Among the 175 primary care patients included in this study, 148 (84.5%) were female; 48 (27.4%) were African American, 2 (1.2%) were American Indian or Alaska Native, 4 (2.5%) were Hispanic, 106 (60.5%) were White, and 15 (8.6%) were multiracial; and the mean (SD) age was 47.03 (13.15) years. CCBT was associated with better quality of life and higher chance of treatment response at the posttreatment and 6-month time points, compared with the TAU group. The ICER for CCBT was $37 295 (95% CI, $22 724-$66 546) per QALY, with a probability of 89.4% of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. The ICER per case of treatment response was $3623 (95% CI, $2617-$5377). In this trial-based economic evaluation, CCBT was found to be cost-effective, compared with TAU, in primary care patients with depression. As this study included individuals with low income and with limited internet access who are underrepresented in cost-effectiveness studies, it has important policy implications for addressing unmet needs in sociodemographically diverse populations.

The potential of body mass index-adjusted calf circumference as a proxy for low muscle mass in the global leadership initiative on malnutrition criteria

Background & AimsReduced muscle mass is one of the diagnostic components for Global Leadership Initiative on Malnutrition (GLIM), with various assessment methods proposed. Calf circumference (CC), a representative anthropometric marker of skeletal muscle mass, is now recommended to adjustment based on body mass index (BMI). This study aimed to evaluate the validity and efficacy of BMI-adjusted CC in very older adults, compared with other methods of assessing muscle mass. MethodsThis prospective cohort study included 284 patients aged 65 years and older who were admitted to the Department of Geriatric Medicine at the National Center for Geriatrics and Gerontology Hospital. Health indicators, including nutritional status, were assessed upon admission. Three months after discharge, a telephone survey was conducted to assess patients’ living conditions and survival status. Skeletal muscle mass was estimated using a dual-energy X-ray absorptiometry (DXA); moreover, anthropometric measurements (unadjusted and BMI-adjusted CC) were used as markers of muscle mass. Logistic regression analysis was performed to examine the association between mortality and GLIM-based malnutrition, using each muscle mass assessment method. ResultsThe mean age of the patients was 86.2 ± 6.2 years, and 60.9% were women. The prevalence of GLIM-based malnutrition ranged from 55.3% to 58.8% across the three methods used to assess reduced muscle mass. Three months after discharge, 244 patients were followed up, of whom 29 (11.9%) died. Multivariate logistic regression analysis, adjusted for age, sex, and comorbidities, showed that all methods significantly predicted 3-month mortality, with odds ratios of 5.67, 5.44, and 4.90 for unadjusted CC, BMI-adjusted CC, and appendicular skeletal muscle mass index using DXA, respectively. The prevalence and survival-predictive ability were similar across all methods. ConclusionGLIM-based malnutrition, diagnosed using different methods for assessing muscle mass, similarly predicted 3-month mortality in patients admitted to an acute geriatric ward. These results suggest that BMI-adjusted CC are sufficient alternatives when technical measurements such as DXA are not feasible.

ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital

Abstract Aims The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail. Methods we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA. Results A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65. Conclusions we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.

Short-term heart rate variability: A potential approach to frailty assessment in older adults.

This study aimed to evaluate cardiac autonomic modulation using short-term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre-frail (n = 70), and non-frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5-min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre-frail and non-frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre-frail and non-frail subjects (P < 0.05). Measures of sympatho-vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre-frail and non-frail individuals, although maintaining a balanced sympatho-vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty.

Decision-Making in Healthcare Resources Optimal Management: the Case of Inpatient Bed Occupancy and Associated Costs

The aim of this paper is to explore how efficient is the \textit{Fish School Search} (FSS) algorithm in building a \textit{Decision Support System (DSS)} for healthcare facility managers in order to optimize both the number of beds in their facilities and their budget. We have used a finite capacity queueing model with phase-type service distribution combined with a compartmental model and associated cost model. The \textit{Fish School Search} algorithm was used to optimize the queueing model. To illustrate the proposed approach, we used the available data reported by a department of geriatric medicine of a hospital. Our findings showed that by encoding the whole information provided by the queueing system and the cost model in a fish, the Fish School Search is a potentially beneficial tool for optimizing healthcare resources and the facility's budget. The model can be extended to different medical facilities with respect to the objective parameters.

Hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand.

To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision. An electronic survey was sent to HODs of public geriatric medicine departments. Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps. Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services.

Geriatrics and artificial intelligence in Spain (Ger-IA project): talking to ChatGPT, a nationwide survey.

The purposes of the study was to describe the degree of agreement between geriatricians with the answers given by an AI tool (ChatGPT) in response to questions related to different areas in geriatrics, to study the differences between specialists and residents in geriatrics in terms of the degree of agreement with ChatGPT, and to analyse the mean scores obtained by areas of knowledge/domains. An observational study was conducted involving 126 doctors from 41 geriatric medicine departments in Spain. Ten questions about geriatric medicine were posed to ChatGPT, and doctors evaluated the AI's answers using a Likert scale. Sociodemographic variables were included. Questions were categorized into five knowledge domains, and means and standard deviations were calculated for each. 130 doctors answered the questionnaire. 126 doctors (69.8% women, mean age 41.4 [9.8]) were included in the final analysis. The mean score obtained by ChatGPT was 3.1/5 [0.67]. Specialists rated ChatGPT lower than residents (3.0/5 vs. 3.3/5 points, respectively, P < 0.05). By domains, ChatGPT ​​scored better (M: 3.96; SD: 0.71) in general/theoretical questions rather than in complex decisions/end-of-life situations (M: 2.50; SD: 0.76) and answers related to diagnosis/performing of complementary tests obtained the lowest ones (M: 2.48; SD: 0.77). Scores presented big variability depending on the area of knowledge. Questions related to theoretical aspects of challenges/future in geriatrics obtained better scores. When it comes to complex decision-making, appropriateness of the therapeutic efforts or decisions about diagnostic tests, professionals indicated a poorer performance. AI is likely to be incorporated into some areas of medicine, but it would still present important limitations, mainly in complex medical decision-making.

Correlation between longitudinal changes of clinical symptoms and striatal DAT uptake in DLB

AbstractBackgroundIt is widely known that there is low striatal 123I‐FP‐CIT dopamine transporter single photon emission tomography (DaT‐SPECT) uptake in patients with dementia with Lewy bodies (DLB). There are no study about the association between longitudinal changes of clinical sign and DaT‐uptake in Parkinson syndrome, especially in DLB. The aim of this study is to investigate the association between the longitudinal changes of DaT uptake and severity of parkinsonism and cognitive funtion in DLB.MethodA total of 35 outpatients with probable DLB who underwent DaT‐SPECT twice (initial and follow up period) from the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study from April 2014 until September 2020. We examined the correlation between annual changes of DaT uptake and symptoms (cognitive function decline, parkinsonism) in the patients with DLB.ResultThere was significant correlation between annual changes of severity of parkinsonism and DAT uptake in left posterior putamen (r = ‐0.39, p = 0.03), MMSE scores and DaT uptake in the entire regions except right posterior putamen (P&lt; 0.05) in patients with DLB.ConclusionThese results may suggest clarifying the mechanism of dysfunction of nigrostriatal projection pathway in DLB.

Development of Behavioural and Psychological Symptoms of Dementia(BPSD) App for use in a hospital setting

AbstractIntroductionPrevious quantitative audits at Wyong Hospital, a 300 bed regional and teaching hospital in the Central Coast Local Health District (CCLHD) showed that the majority of Clinical Aggression Response Team (CART) calls occurred in the geriatric population.Results suggested that often BPSD guidelines which were on the CCLHD intranet were not adhered to. It was suggested that medical officers need ready access to local guidelines and more education. Interviews with staff who were participating in CART calls found that medical staff were not confident in when to and what to prescribe and what was the most appropriate management.These audits, which involved interviewing participants of CART calls, plus evidence about implementing practice change, suggests that mobile phone apps are used more frequently and are more effective than intranet documents.ObjectiveDevelop a BPSD app with the potential to make evidence based recommendations and local guidelines accessible to the user at the bedside using a mobile device particularly during CART calls and enables the user to manage BPSD with ease.Methods1. Content of the app is based on BPSD guidelines published on the CCLHD intranet geriatric medicine webpages.2. A prototype of the app was developed on Marvel designs and provided to the IT and e‐health New South Wales department who provided suggestions, guidance on the app development and integration of the app onto the hospital IT system. Training sessions were provided via drop in sessions and online videos using Microsoft teams. Targeted education sessions on app usage was provided to medical personnel. Costs for the development of the app was funded by the Department of Geriatric medicine, Wyong and Gosford Hospital.3. Ethics approval was obtained from the Central Coast Local Health District Human Research Ethics Committee.ResultsThere has been more than 100 downloads of the app with levels of usage ranging from 1 to 38 on a daily basis.ConclusionThe development of the app allows ease of access to concise evidenced based information and supports clinicians in their role in managing BPSD.

Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults.

Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.

Association between longitudinal changes in striatal dopamine transporter uptake and clinical features of dementia with Lewy bodies.

It is widely known that there is low striatal 123 I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3- fluoropropyl) nortropane (123 I-FP-CIT) dopamine transporter single photon emission tomography (DaT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). No studies to date have analyzed the association between longitudinal changes of clinical features and DaT uptake in patients with Parkinson syndrome, particularly those with DLB. The aim of this study was to investigate the association between the longitudinal changes in DaT uptake and the severity of parkinsonism and cognitive function in DLB patients. A total of 35 outpatients with probable DLB who underwent DaT-SPECT twice (at the initial examination and the follow-up period) in the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study between April 2014 and September 2020. The correlation between annual changes in DaT uptake and clinical features (cognitive function decline and parkinsonism) of the patients was analyzed. A significant correlation was detected between annual changes in parkinsonism symptom severity and DaT uptake in the left posterior putamen (r = -0.39, P = 0.03), and between Mini-Mental State Examination scores and DaT uptake in all regions except the right posterior putamen (P < 0.05) in patients with DLB. Our results suggested that the pathway from the ventrolateral tier of the substantia nigra to the putamen might be more crucial for motor function than other pathways, not only in Parkinson's disease but also in DLB.

88 An audit of the quality of documentation during the end of life phase of older adults in acute hospital settings

Abstract Background End of Life Care (EoLC) is commonly provided to Older Adults presenting to acute stroke or medical services. Death is considered a ‘poor medical outcome’ but a ‘good death’ is of medical, cultural and spiritual significance for patients and families. Our audit aimed to examine how well medical staff document quality indicators of the EoLC phase of hospital care in a cohort of older adults who died on the geriatric and stroke medicine services. Methods Inclusion criteria were patients who died under the care of the Stroke or Acute internal Geriatric Medicine department between May to October 2022 aged &amp;gt;75. We collected data using the BMJ Support Palliative Care Journal ‘Guidance for completing End of Life Structured Judgement Review’. Data points included recognition of dying, communication with patients and their families, palliative interventions and pastoral care. Results 28 patients were identified with a diagnosis of stroke. 17 patients were identified from AIGM. Data described as Stroke vs AIGM. Recognition of dying was documented in 92.9% (26/28) vs 94.1% (16/17). DNAR was documented in 100% (26/26) vs. 100% (16/16). An escalation/de-escalation plan was documented in 84.6% (24/28) vs. 75% (13/17). Risk of dying was communicated to: the patient 3.6% (1/28) vs. 0% (0/12); family 75% (21/28) vs. 59% (10/17). Anticipatory medicine were: prescribed; 94.1% (26/28) vs. 92.9% (16/17); administered: 85.7% (24/28) vs. 82.4% (14/17); evaluated for effect; 78.6% (22/28) vs 70.6% (12/17). Documentation of spirituality: 17.9% (5/28) vs. 5.9% (1/17). Documentation of available chaplaincy service 17.9% (5/28) vs 5.9% (1/17). Patient’s wishes around dying documented: 7.1% (1/28) vs 0% (0/17). Palliative Care services were consulted in 14.3% (4/28) vs 29.4% (5/17). Conclusion Further improvement, via education and awareness, is needed around the documentation of EOLC by medical staff, particularly in regard to communication to families and referral to pastoral care services.

Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study

ObjectivesTo evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier.DesignStaggered difference-in-difference...

Specialized Care Resources for Diagnosis and Management of Patients Who Have Suffered Falls: Results of a National Survey in Geriatric Units.

Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations. A descriptive study was conducted by the Falls Study Group of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas. Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources. This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.

Is paracetamol prescribed appropriately in elderly patients admitted for a fall? – A Geriatrician’s perspective

Background Paracetamol is a commonly used analgesic among older adults. There have been reports of adverse events with chronic paracetamol use even at therapeutic doses. The objective of this clinical audit is twofold – 1. To evaluate the prevalence of inappropriate paracetamol prescription in the elderly admitted for falls; 2. To introduce strategies to reduce the rate of inappropriate paracetamol prescription in this population. Methods A clinical audit was performed on 100 patients aged 75 years and older who were admitted to the Geriatric Medicine department of a tertiary hospital between July 2019 and October 2019 with a primary diagnosis of a fall. Data collected included demographic data, relevant medical history of cirrhosis, cognitive impairment, alcohol use and weight &lt;50 kg, prescription pattern of paracetamol on day 1 or two of admission and on discharge as well as clinical data on the documented indications for paracetamol use. Results Paracetamol was prescribed in 84 patients. Out of these 84 patients, 56 were prescribed round-the-clock paracetamol with a median duration of 9 (IQR = 10) days. In this group, paracetamol use was inappropriate in 32 (57%) of them and 32 (57%) patients were discharged with round-the-clock paracetamol for a median duration of 17.5 (IQR = 46) days. Conclusion This clinical audit revealed a high prevalence of round-the-clock and inappropriate paracetamol prescription in elderly patients admitted for a fall. Moving forward, we hope that the implementation of a paracetamol prescribing algorithm may reduce the rates of inappropriate paracetamol prescribing in this population.

Stereotypes and benevolent ageism: Lessons from Tatie Danielle.

Journal of the American Geriatrics SocietyEarly View ARS LONGA: HUMANITIES AND AGING Stereotypes and benevolent ageism: Lessons from Tatie Danielle Neasa Fitzpatrick MB, BCh, BAO, MSc, MRCPI, Corresponding Author Neasa Fitzpatrick MB, BCh, BAO, MSc, MRCPI [email protected] orcid.org/0000-0003-3797-5699 Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland Correspondence Neasa Fitzpatrick, Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland. Email: [email protected]Search for more papers by this authorDesmond O'Neill MD, FRCPI, Desmond O'Neill MD, FRCPI orcid.org/0000-0002-5542-9897 Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, IrelandSearch for more papers by this author Neasa Fitzpatrick MB, BCh, BAO, MSc, MRCPI, Corresponding Author Neasa Fitzpatrick MB, BCh, BAO, MSc, MRCPI [email protected] orcid.org/0000-0003-3797-5699 Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland Correspondence Neasa Fitzpatrick, Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland. Email: [email protected]Search for more papers by this authorDesmond O'Neill MD, FRCPI, Desmond O'Neill MD, FRCPI orcid.org/0000-0002-5542-9897 Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, IrelandSearch for more papers by this author First published: 28 February 2023 https://doi.org/10.1111/jgs.18294Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

1292 MEDICALLY SAFE FOR DISCHARGE (MSFD): REDUCING DOCTOR INPUT IN MSFD PATIENTS ACROSS GERIATRIC MEDICINE WARDS AT A DGH IN SOMERSET

Abstract Introduction Large numbers of geriatric inpatients within acute settings are deemed medically safe for discharge (MSFD) but stranded within the hospital due to a lack of community services and social care packages, leading to increasing length of patient stay and reduced hospital flow. These patients do not require inpatient care and would otherwise be discharged to their home or residential care. This project aimed to identify these patients and rationalise their medical input to mirror a community setting (without routine daily medical reviews). Methods MSFD patient were identified by the multi-disciplinary team (MDT). Patients identified received standard nursing and therapy input, alongside daily MDT discussion at a board round to progress discharge planning. If the MDT expressed concern about a MSFD patient, they would receive a medical review. A sticker placed in the notes identified patients deemed MSFD. Results A 3-week trial on a 19-bedded geriatric ward showed 46% of bed days were occupied by MSFD patients. On average, 8 MSFD patients did not require daily review. 0.6 unplanned reviews/day were needed due to MDT concern, saving an average of 7.4 patient reviews/day, equating to 3.3 hours/day doctor time saved. Conclusions Doctor time saved allowed redistribution of staff to busier wards with more unwell patients, with no detriment to patient care noted. The trust formalised a SOP and the MSFD pathway was introduced across the geriatric medicine department. A MSFD ward has now been opened, to cohort patients awaiting discharge to community pathways. This ward should require minimal doctor input to allow continued redistribution of medical staff across the hospital, as well as facilitating patient flow by admitting patients who reside on the acute frailty unit who require increased community care.

Evaluation of a Machine Learning-Based Dysphagia Prediction Tool in Clinical Routine: A Prospective Observational Cohort Study

Based on a large number of pre-existing documented electronic health records (EHR), we developed a machine learning (ML) algorithm for detection of dysphagia and aspiration pneumonia. The aim of our study was to prospectively apply this algorithm in two large patient cohorts. The tool was integrated in the hospital information system of a secondary care hospital in Austria. Based on existing data such as diagnoses, laboratory, and medication, dysphagia risk was predicted automatically, and patients were stratified into three risk groups. Patients’ risk groups and risk factors were visualized in a web application. Prospective predictions of 1270 admissions to geriatric or internal medicine departments were compared with the occurrence of dysphagia or aspiration pneumonia of routinely documented events. The discriminative performance for internal medicine patients (n = 885) was excellent with an AUROC of 0.841, a sensitivity of 74.2%, and a specificity of 84.1%. For the smaller geriatric cohort (n = 221), the AUROC was 0.758, sensitivity 44.4%, and specificity 93.0%. For both cohorts, calibration plots showed a slight overestimation of the risk. This is the first study to evaluate the performance of a ML-based prediction tool for dysphagia in a prospective clinical setting. Future studies should validate the predictions on data of systematic dysphagia screening by specialists and evaluate user satisfaction and acceptance. The ML-based dysphagia prediction tool achieved an excellent performance in the internal medicine cohort. More data are needed to determine the performance in geriatric patients.

Stress and needs of caregivers of individuals with dementia during the COVID-19 pandemic.

Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore Correspondence: Dr. Chin Yee Cheong, Consultant, Department of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore. E-mail: [email protected] Received March 23, 2021 Accepted July 25, 2021

Metabolic adverse drug reactions in geriatric patients in Odisha

Background: Geriatric patients are at a greater risk of developing adverse drug reaction (ADR) because of changed metabolic activity and renal status associated with aging. As most of the elderly patients suffer from multiple chronic diseases (Diabetes, Hypertension, Arthritis, constipation, peptic ulcer disease, etc.), they are under polypharmacy and the risk of ADRs is exacerbated by multiple medications. Metabolic ADRs include weight gain, hypoglycemia, hyponatremia, hypokalemia, and the endocrinal abnormality are the frequent cause of hospital admission in geriatric patients. Most metabolic ADRs due to drugs are treatable. There are few such studies conducted in India regarding metabolic ADR in geriatric patients. Hence, this study aims to evaluate the metabolic ADRs encountered in geriatric patients with the following objectives in Odisha. Aim and Objectives: The prevalence and spectrum of metabolic ADRs in geriatric population were studied. The causality assessment, severity assessment, and preventability were done using standard scales. Materials and Method: This was a prospective and observational study conducted from September 2016 to September 2018 in Department of Pharmacology in collaboration with Department of Geriatric Medicine and Department of Medicine of SCB Medical College and Hospital. All geriatric patients (≥60 years) with ADR, reporting to the above departments, were included in the study. The detailed information of type of ADRs and its characteristics was filled up in Suspected ADR Reporting Form designed by Indian pharmacopeia commission version 1.3. The incidence and spectrum of metabolic ADRs were observed. Their causality, severity, and preventability were evaluated by the WHO-UMC System, Hartwig’s Severity Scale, and Schumock Thornton Preventability Scale, respectively. Result: A total of 236 ADRs were reported in 2 years, out of which 28.8% were metabolic ADRs. Metabolic ADRs were more reported in young old patients and often encountered ADR was hypoglycemia 73.5% due to use of oral anti diabetics. About 29% of the metabolic ADRs had a causal relation of probable association. About 94.2% were moderate in severity and 89.7% metabolic ADRs could be probably preventable. Conclusion: There was a probable causal association of metabolic ADR with the drug used and they were moderate verity. The metabolic ADRs found in our study can be preventable with appropriate means.