Hospitalization In Older Adults Research Articles

1898 Feasibility study of a hospital deprescribing intervention: CompreHensive geriAtRician-led MEdication Review (CHARMER)

Abstract Introduction CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention to support geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. The intervention comprises: formulating a deprescribing action plan, workshops, benchmarking reports and weekly briefings between geriatricians and pharmacists. We assessed feasibility and acceptability of the CHARMER intervention and study processes. Method A two-arm purposive allocation feasibility study was undertaken in four hospitals (three intervention, one control) in England in 2022. Data were collected to check completeness and quality, and assess intervention fidelity. Rapid qualitative analysis of staff and patient interviews, intervention implementation observations (action plan launch, pharmacist workshop and geriatrician videos), and study meeting minutes was undertaken. Results Study data were feasible to collect, of sufficient completeness and quality. Geriatrician and pharmacist principal investigators managed intervention implementation. They were able to implement most intervention components with ease and fidelity. Principal investigators felt that dedicated support for intervention implementation would better equip them with the resource and expertise to fidelitously implement all intervention components. Detailed instructions for preparing the action plan and how it might be delivered were desired. Geriatricians and pharmacists who received the intervention found it acceptable. Pharmacists felt that the weekly briefings encouraged them to dedicate time to review medicines and raise with geriatricians, opportunities to deprescribe. Geriatricians indicated that participating in CHARMER allowed them to focus on deprescribing conversations with patients and they involved junior doctors more in the deprescribing process. Conclusion(s) The CHARMER intervention and trial processes were feasible and acceptable. Revisions to support intervention implementation include providing a template action plan for hospitals to adapt; funds for a project manager one day a week to work with CHARMER principal investigators for three-months to oversee implementation, and support from Eastern Academic Health Science Network in the definitive trial (winter 2023).

Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial

BackgroundSTRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, STRIDE was associated with reduced odds of hospital discharge to skilled nursing facility. STRIDE has the potential to become a system-wide approach to address hospital-associated disability in Veteran’s Affairs; however, critical questions remain about how best to scale and sustain the program. The overall study goal is to compare the impact of two strategies on STRIDE program penetration (primary), fidelity, and adoption implementation outcomes.MethodsReplicating Effective Programs will be used as a framework underlying all implementation support activities. In a parallel, cluster randomized trial, we will use stratified blocked randomization to assign hospitals (n = 32) to either foundational support, comprised of standard, low-touch activities, or enhanced support, which includes the addition of tailored, high-touch activities if hospitals do not meet STRIDE program benchmarks at 6 and 8 months following start date. All hospitals begin with foundational support for 6 months until randomization occurs. The primary outcome is implementation penetration defined as the proportion of eligible hospitalizations with ≥ 1 STRIDE walks at 10 months. Secondary outcomes are fidelity and adoption with all implementation outcomes additionally examined at 13 and 16 months. Fidelity will be assessed for STRIDE hospitalizations as the percentage of eligible hospital days with “full dose” of the program, defined as two or more documented walks or one walk for more than 5 min. Program adoption is a binary outcome defined as ≥ 5 patients with a STRIDE walk or not. Analyses will also include patient-level effectiveness outcomes (e.g., discharge to nursing home, length of stay) and staffing and labor costs. We will employ a convergent mixed-methods approach to explore and understand pre-implementation contextual factors related to differences in hospital-level adoption.DiscussionOur study results will dually inform best practices for promoting successful implementation of an evidence-based hospital-based walking program. This information may support other programs by advancing our understanding of how to apply and scale-up national implementation strategies.Trial registrationThis study was registered on June 1, 2021, at ClinicalTrials.gov (identifier NCT04868656).

Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer's Disease and Mild Cognitive Impairment.

Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia. Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights. The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ2 test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ2 = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person). The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.

Serum Albumin as Prognostic Marker for Older Adults in Hospital and Community Settings.

Serum albumin, known for its multifaceted role in health, is hypothesized to serve as a prognostic marker for older adults, both in hospital and community settings. Nine studies were included in the review, revealing consistent associations between low serum albumin levels and increased mortality risk in hospitalized older individuals. In community settings, low serum albumin levels were linked to higher mortality rates compared to those with normal levels. The synthesis of evidence underscores the potential of serum albumin as a prognostic marker for older adults, offering valuable insights for risk stratification and targeted interventions. While robust evidence supports its utility in hospital settings, further research is warranted in community settings to address current limitations and enhance the applicability of serum albumin as a prognostic tool. This review merges existing knowledge of the prognostic significance of serum albumin in older adults across hospital and community settings. The findings emphasize the importance of serum albumin as a potential prognostic marker, urging continued research efforts to refine its application in diverse healthcare contexts and improve outcomes for the aging population.

Impact of Frailty on Gait Speed Improvements in Home Health after Hospital Discharge: Secondary Analysis of Two Randomized Controlled Trials.

More than half of older adults are frail or prefrail in the United States, and hospital-associated deconditioning likely increases this risk. However, the impact of frailty on potential functional improvements after hospital discharge is poorly understood. We sought to identify the influence of baseline frailty on gait speed change in older adults receiving home health physical therapy (PT) after hospital discharge. The severity of frailty was assessed using Cardiovascular Health Study frailty criteria (weakness, slowness, weight loss, physical inactivity, and exhaustion). Gait speed was measured at baseline and 60-days post-hospital discharge. Upon admission to home health rehabilitation services, half of older adults (total N=250) were considered frail, with slowness (90%) and weakness (75%) being the most common characteristics. Older adults, whether pre-frail or frail, demonstrated similar and clinically meaningful improvements in gait speed after receiving home health rehabilitation for 60 days following hospital discharge. These results suggest that clinicians caring for older adults in the hospital can counsel both pre-frail and frail patients that, with home health rehabilitation, clinically significant improvements in function can be expected over the 2 months following discharge. Furthermore, we observed encouraging gait speed improvement with physical therapy following hospitalization in older adults. Results can inform anticipatory guidance on hospital discharge.

Serum and mucosal antibody-mediated protection and identification of asymptomatic respiratory syncytial virus infection in community-dwelling older adults in Europe.

Respiratory syncytial virus (RSV) causes acute respiratory tract infection (ARTI) and reinfects adults throughout life, posing a risk for hospitalization in older adults (>60 years) with frailty and comorbidities. To investigate serum and mucosal antibodies for protection against RSV infections, baseline serum samples were compared for RSV-pre- and -post-fusion (F) binding, and RSV-A2 neutralizing IgG antibodies between symptomatic RSV-ARTI (N = 30), non-RSV (RSV negative) ARTI (N = 386), and no ARTI (N = 338). Mucosal RSV-pre-F IgA and IgG levels, as well as serum RSV-G IgG antibodies, were analyzed to determine their association with protection from symptomatic RSV-ARTI in a subset study. Using a receiver operating characteristic (ROC) analysis, we established thresholds of 1.4- to 1.6-fold change (FC) for RSV-pre-F and -post-F, and RSV-A2 neutralizing IgG antibodies, respectively, enabling the identification of asymptomatic RSV cases with high sensitivity and specificity (>80% and >90%, respectively). As a result, serum RSV-pre-F, RSV-G IgG, and mucosal pre-F binding IgA antibodies showed correlations with protection against symptomatic RSV infection. RSV-pre-F IgG antibodies were correlated with protection from RSV infections irrespective of the symptoms. This study provides insights into antibody-mediated protection for symptomatic RSV infection in a community-dwelling older-adult population and establishes a threshold to identify asymptomatic RSV infection using a data-driven approach.

Complications and outcomes of hospitalizations for patients with and without Parkinson disease.

To examine complications and outcomes of hospitalizations for common indications for hospitalization among patients with Parkinson disease (PD). We identified and selected the ten most common indications for hospitalization among individuals ≥65 years of age using principal diagnoses from the California State Inpatient Database, 2018-2020. Patients with comorbid PD were identified using secondary diagnosis codes and matched one-to-one to patients without PD based on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching). We identified potentially preventable complications based on the absence of present on admission indicators among secondary diagnoses. In the matched cohort, we compared inpatient complications, early Do-Not-Resuscitate (DNR) orders (placed within 24 h of admission), use of life-sustaining therapies, new nursing facility requirement on discharge, and death or hospice discharge for patients with and without PD. We identified 35,457 patients with PD among the ten leading indications for hospitalization in older adults who were matched one-to-one to patients without PD (n = 70,914 in total). Comorbid PD was associated with an increased odds of developing aspiration pneumonia (OR 1.17 95% CI 1.02-1.35) and delirium (OR 1.11 95% CI 1.02-1.22) during admission. Patients with PD had greater odds of early DNR orders [placed within 24 h of admission] (OR 1.34 95% CI 1.29-1.39). While there was no difference in the odds of mechanical ventilation (OR 1.04 95% CI 0.98-1.11), patients with PD demonstrated greater odds of tracheostomy (OR 1.41 95% CI 1.12-1.77) and gastrostomy placement (OR 2.00 95% CI 1.82-2.20). PD was associated with greater odds of new nursing facility requirement upon discharge (OR 1.58 95% CI 1.53-1.64). Patients with PD were more likely to die as a result of their hospitalization (OR 1.11 95% CI 1.06-1.16). Patients with PD are at greater risk of developing aspiration pneumonia and delirium as a complication of their hospitalization. While patients with PD more often have early DNR orders, they have greater utilization of life-sustaining therapies and experience worse outcomes of their hospitalization including new nursing facility requirement upon discharge and greater mortality.

Validity, Reliability, and Feasibility of Smartphone Application Intended for Home Measurement of Gait Speed and Other Gait Dynamics in Older Adults with Blood Cancers

Introduction: Gait speed is a cardinal measure of mobility and frailty recommended to be assessed in all older adults with cancer (Dale, JCO, 2023). Four-meter gait speed (4MGS) is strongly predictive of mortality and hospitalization in older adults with hematologic malignancies (Liu, Blood, 2019). Remote monitoring technology can expand measurement of gait speed beyond the clinic (Clancy, JCO CCI, 2023), and smartphone applications (App) have been developed and validated to measure meaningful gait metrics via embedded internal motion sensors (Manor, JMIR Mhealth Uhealth, 2018). However, the validity and reliability of a smartphone App for remotely measuring gait speed in older adults is not known, nor is the feasibility of using an App to measure longitudinal gait speed in older adults with blood cancers. Methods: We conducted two studies to (1) determine the validity and reliability of a smartphone App in measuring 4MGS in community-dwelling older adults, and (2) determine the feasibility of measuring 4MGS weekly for six weeks in older adults with multiple myeloma (MM) and myelodysplastic syndromes (MDS). For the validity and reliability study, we enrolled adults aged ≥ 65 years living in an independent living housing facility. Each participant self-administered two supervised and three unsupervised gait assessments at home via the smartphone carried in their pocket, with the App providing multimedia instructions on how to complete the test. For each gait assessment, the participants walked back and forth along a 4-meter strip of ribbon for 45 seconds. For the first two supervised sessions, while the participants were self-administering the gait assessment, the study team concurrently captured their walking performance with a video camera (as a gold standard). For the following three unsupervised sessions, the participants administered the gait assessment App alone. We obtained the time for the first instance of walking along the 4-meter ribbon before turning and compared the gait speed (i.e. dividing 4 meters by the time) between the smartphone and the video capture. For the feasibility study, we enrolled patients age ≥73 years with either MDS or MM cared for at Dana-Farber Cancer Institute. Patients self-administered the gait assessment described above alone at home once a day for six weeks after a dedicated teaching session with study staff. We reported completion rates and participants' feedback regarding acceptability. Results: 14 older adults (77.2±6.3, 13 females) completed the validity and reliability study. The smartphone 4MGS demonstrated strong criterion validity yielding a high correlation with the camera 4MGS ( Figure 1) along with high reliability as demonstrated by high internal consistency and low measurement error ( Figure 2). The smartphone 4MGS also showed good test-retest reliability over three unsupervised sessions (intra-class correlation coefficient 0.78). In the feasibility study, 12 patients (79.3±3.14, 4 females, 50% MDS, 42% MM, and 8% both) were enrolled out of 19 contacted for recruitment (63%). To date, nine have completed the study: 9/9 completed at least one 4MGS test, 8/9 (89%) completed at least three weeks, and 3/9 (33%) completed all six weeks. When asked, “How important is measuring your function and mobility to you?” on a scale of 1 (low) to 5 (high), 7/9 participants answered 4 or 5. When asked to rate their experience completing the walking tests on a scale of 1 (very poor) to 5 (very good), 6/9 participants answered 4 or 5. When asked the degree to which one agrees with the statement, “I feel that the walking tests are too burdensome,” on scale of 1 (strongly disagree) to 5 (strongly agree), 9/9 patients answered 1 or 2. Conclusions: The App was both valid and reliable in measuring 4MGS in older adults' homes. User acceptance was also high, and the app was rated as minimally burdensome by patients with blood cancers with the majority completing at least three weekly home 4MGS tests. Our findings support using existing smartphone technology to assess a key measure of mobility and frailty in the homes of older adults with blood cancers, allowing for more frequent longitudinal assessment of how blood cancers and their treatments impact older adult mobility and frailty.

2650. Characteristics of In-Hospital Care and Immediate Post-Discharge Care Status among Older Adults Hospitalized with Respiratory Syncytial Virus Infection, Seasonal Influenza, Acute Myocardial Infarction, and Stroke in the US

Abstract Background Despite increased recognition of the morbidity, mortality, and economic burden of respiratory syncytial virus (RSV) in adults, few studies have documented the status of post-discharge care after RSV hospitalization. This study assessed in-hospital and immediate post-discharge care status in older adults hospitalized with RSV in the US and compared it with other serious medical conditions (influenza, acute myocardial infarction (AMI), and stroke) that have long-standing disease prevention efforts. Methods This retrospective cohort study used data from Premier Healthcare Database between January 1, 2015, to December 31, 2019. Adults aged ≥ 65 years hospitalized due to primary diagnosis of RSV, influenza, AMI, or stroke were included. Discharge statuses were used to categorize the levels of immediate post-discharge care as shown in Figure 1. Descriptive statistics and Sankey diagrams were used to summarize the four cohorts. Results Overall, 2,559 RSV, 174,826 influenza, 208,448 AMI, and 274,102 stroke hospitalizations were identified with similar mean patient ages of 79.8, 76.8, 76.3, and 78.0 years, respectively. Almost all patients ( &amp;gt; 90%) had underlying comorbidities. The mean inpatient length of stay (LOS) was similar in the four cohorts (4.0, 4.4, 3.7, and 4.1 days, respectively), but the prevalence of mechanical ventilator use varied, i.e., 0.4%, 13.7%, 5.9%, and 1.4%, respectively. Intensive Care Unit (ICU) admissions during RSV hospitalizations were infrequent (3.0%) as compared to influenza (16.8%), AMI (24.5%), and stroke (20.5%). The mean ICU LOS for these four cohorts were 2.3, 2.8, 1.7, and 1.7 days in the same order. Immediately following discharge, moderate care was required for 23.9%, 22.9%, 14.1%, and 17.5% of RSV, influenza, AMI, and stroke hospitalizations, respectively. Elevated care was considerably more frequent for stroke hospitalizations (48.1%) than RSV (18.8%), influenza (21.4%), and AMI (19.3%) hospitalizations (Figure 2). Conclusion Older adults discharged from RSV hospitalizations require considerable care with needs comparable to influenza and AMI discharges. Given the substantial care requirements of RSV hospitalizations in older adults, focus on disease prevention efforts for RSV are needed. Disclosures Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer: Stocks/Bonds Kari Yacisin, M.D., Pfizer: Employee|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds Poorva Sardana, MSc, Pfizer Inc: Contracted Research Neha Agrawal, MA, Pfizer Inc: Contracted Research Anchita Goswami, MSc, Pfizer Inc: Contracted Research Manvi Sharma, RPh, MBA, PhD, Pfizer Inc: Contracted Research

Influenza Vaccine Effectiveness Pre-pandemic Among Adults Hospitalized With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease and Older Adults.

Data are limited on influenza vaccine effectiveness (VE) in the prevention of influenza-related hospitalizations in older adults and those with underlying high-risk comorbidities. We conducted a prospective, test-negative, case-control study at 2 US hospitals from October 2018-March 2020 among adults aged ≥50 years hospitalized with acute respiratory illnesses (ARIs) and adults ≥18 years admitted with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations. Adults were eligible if they resided in 1 of 8 counties in metropolitan Atlanta, Georgia. Nasopharyngeal and oropharyngeal swabs were tested using BioFire FilmArray (bioMérieux, Inc.) respiratory panel, and standard-of-care molecular results were included when available. Influenza vaccination history was determined from the Georgia vaccine registry and medical records. We used multivariable logistic regression to control for potential confounders and to determine 95% confidence intervals (CIs). Among 3090 eligible adults, 1562 (50.6%) were enrolled. Of the 1515 with influenza vaccination history available, 701 (46.2%) had received vaccination during that season. Influenza was identified in 37 (5.3%) vaccinated versus 78 (9.6%) unvaccinated participants. After adjustment for age, race/ethnicity, immunosuppression, month, and season, pooled VE for any influenza-related hospitalization in the eligible study population was 63.1% (95% CI, 43.8-75.8%). Adjusted VE against influenza-related hospitalization for ARI in adults ≥50 years was 55.9% (29.9-72.3%) and adjusted VE against influenza-related CHF/COPD exacerbation in adults ≥18 years was 80.3% (36.3-93.9%). Influenza vaccination was effective in preventing influenza-related hospitalizations in adults aged ≥50 years and those with CHF/COPD exacerbations during the 2018-2020 seasons.

Delirium Due to Potentially Avoidable Hospitalizations Among Older Adults.

Delirium is a common complication during acute care hospitalizations in older adults. A substantial percentage of admissions are for ambulatory care-sensitive conditions (ACSCs) or potentially avoidable hospitalizations-conditions that might be treated early in the outpatient setting to prevent hospitalization and hospital complications. This retrospective cross-sectional study examined rates of delirium among older adults hospitalized for ACSCs. Participants were 39 933 older adults ≥65 years of age admitted from January 1, 2015 to December 31, 2019 to general inpatient units and ICUs of a large Southeastern academic medical center. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale or positive on the Confusion Assessment Method for the Intensive Care Unit during admission, and ACSCs were identified from the primary admission diagnosis using standardized definitions. Generalized linear mixed models were used to examine the association between ACSCs and delirium, compared with admissions for non-ACSC diagnoses, adjusting for covariates and repeated observations for individuals with multiple admissions. Delirium occurred in 15.6% of admissions for older adults. Rates were lower for ACSC admissions versus admissions for other conditions (13.9% vs 15.8%, p < .001). Older age and higher comorbidity were significant predictors of the development of delirium. Rates of delirium among older adults hospitalized for ACSCs were lower than rates for non-ACSC hospitalization but still substantial. Optimizing the treatment of ACSCs in the outpatient setting is an important goal not only for reducing hospitalizations but also for reducing risks for hospital-associated complications such as delirium.

Seeing the forest (plot) for the trees-the importance of evidence synthesis in older adult care.

Systematically reviewing all the available evidence and then creating summary analyses of the pooled data is the foundation of evidence-based practice. Indeed, this evidence synthesis approach informs much of the care of older adults in hospital and community. It is perhaps no surprise that the journal Age and Ageing is a frequent platform for publishing research papers based on systematic review and synthesis. This research has evolved substantially from the early days of evidence-based medicine and the Cochrane Collaboration. The traditional approach would be a quantitative summary, calculated using pair-wise meta-analysis of randomised controlled trials of drug versus placebo, or a synthesis of observational studies to create summaries of prevalence, associations and outcomes. Methods have evolved and newer techniques such as scoping reviews, test accuracy meta-analysis and qualitative synthesis are all now available. The sophistication of these methods is driven in part by the increasingly complex decisions that need be made in contemporary older adult care. Age and Ageing continues to champion established and novel evidence synthesis approaches, and in the accompanying Collection exemplars of these differing methods are presented and described. Whilst there is marked heterogeneity in the techniques used, the consistent and defining feature of all these papers is the desire to comprehensively, and critically summarise the evidence in order to answer the most pertinent questions regarding older adult care.

Revising and evaluating falls prevention education for older adults in hospital

Objective: Partnering with patients and staff to develop and evaluate falls prevention education could better enable patient learning and engagement. This study aimed to create a revised version of the Safe Recovery falls prevention education programme in partnership with older patients and hospital staff, to improve patient engagement in undertaking falls preventive strategies in hospital. Design: Two-phase sequential mixed methods participatory design. Setting: Hospital rehabilitation wards in Western Australia. Method: Phase 1: older patients ( n = 10) and staff ( n = 10) were surveyed before and after original programme delivery to ascertain their reaction and learning. Consumer-focused discussions were undertaken with staff and patients online to inform programme revision. A patient video and workbook were co-produced, and staff were trained to deliver the revised programme. Phase 2: older patients ( n = 10) and staff ( n = 10) were surveyed before and after receiving the revised programme to gain reactions and learning. Deductive content analysis and Wilcoxon signed-rank tests were used to analyse the qualitative and quantitative data. Results: Patients and staff perceived the original programme to be outdated and expressed low levels of satisfaction with the original resources. In contrast, both patients and staff were highly satisfied with the revised programme. Both original and revised Safe Recovery programme patient groups demonstrated significant improvements in knowledge and awareness to reduce their risk of falling after receiving the education ( p = .008, p = .005, respectively). However, patients receiving the revised programme were significantly more likely to intend to take action ( p = .024) and have a clear action plan ( p = .010). Staff perceived that the revised resources showed significant improvements in aesthetic appeal ( p = .007) and ability to engage patients in learning ( p = .007). Conclusion: Patients and staff contributed to successfully revising the Safe Recovery programme with positive reactions to the co-produced resources. Participating in falls education significantly improved older patients’ knowledge and attitudes regarding falls prevention.

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.

Impact of 14 Days of Bed Rest in Older Adults and an Exercise Countermeasure on Body Composition, Muscle Strength, and Cardiovascular Function: Canadian Space Agency Standard Measures

Introduction: Head-down bed rest (HDBR) has long been used as an analog to microgravity, and it also enables studying the changes occurring with aging. Exercise is the most effective countermeasure for the deleterious effects of inactivity. The aim of this study was to investigate the efficacy of an exercise countermeasure in healthy older participants on attenuating musculoskeletal deconditioning, cardiovascular fitness level, and muscle strength during 14 days of HDBR as part of the standard measures of the Canadian Space Agency. Methods: Twenty-three participants (12 males and 11 females), aged 55–65 years, were admitted for a 26-day inpatient stay at the McGill University Health Centre. After 5 days of baseline assessment tests, they underwent 14 days of continuous HDBR followed by 7 days of recovery with repeated tests. Participants were randomized to passive physiotherapy or an exercise countermeasure during the HDBR period consisting of 3 sessions per day of either high-intensity interval training (HIIT) or low-intensity cycling or strength exercises for the lower and upper body. Peak aerobic power (V̇O2peak) was determined using indirect calorimetry. Body composition was assessed by dual-energy X-ray absorptiometry, and several muscle group strengths were evaluated using an adjustable chair dynamometer. A vertical jump was used to assess whole-body power output, and a tilt test was used to measure cardiovascular and orthostatic challenges. Additionally, changes in various blood parameters were measured as well as the effects of exercise countermeasure on these measurements. Results: There were no differences at baseline in main characteristics between the control and exercise groups. The exercise group maintained V̇O2peak levels similar to baseline, whereas it decreased in the control group following 14 days of HDBR. Body weight significantly decreased in both groups. Total and leg lean masses decreased in both groups. However, total body fat mass decreased only in the exercise group. Isometric and isokinetic knee extension muscle strength were significantly reduced in both groups. Peak velocity, flight height, and flight time were significantly reduced in both groups with HDBR. Conclusion: In this first Canadian HDBR study in older adults, an exercise countermeasure helped maintain aerobic fitness and lean body mass without affecting the reduction of knee extension strength. However, it was ineffective in protecting against orthostatic intolerance. These results support HIIT as a promising approach to preserve astronaut health and functioning during space missions, and to prevent deconditioning as a result of hospitalization in older adults.

182 Pharmacists’ opinions on deprescribing Fall Risk Increasing Drugs in older people

Abstract Background Falls are prevalent in older adults and can be associated with medication use. Pharmacists play a role in deprescribing Fall Risk Increasing Drugs (FRIDs) and fall prevention. The aim of this study was to explore the factors that prevent or influence the process of deprescribing of FRIDs in older adults, from a pharmacist’s point of view. Methods Individual online semi-structured interviews, involving clinical pharmacists (CPs) who work with older adults in hospitals, were conducted. The interviews were steered by an interview guide based on the Theoretical Domains Framework (TDF) and interviews continued until saturation. The transcripts were coded using NVivo 12. Challenges and enablers were matched with possible behavioural change techniques, to identify potential future intervention strategies. Results Twelve senior CPs participated in the study (11 female and 1 male; years of practice range 5–30 years). Common challenges included: deprescribing FRIDs not being prioritised by medical teams; medication review is time-consuming; written recommendations to doctors not always read/actioned; fear of withdrawal symptoms; and follow up on patients after discharge is difficult. Deprescribing enablers included: building good team relationships, the belief that medication review is a shared responsibility, verbal being the most effective method of communication, medication review being a core part of pharmacists’ workload, and having the opportunity to review medication and monitor during the inpatient stay. Conclusion Work environment challenges and concerns about safety after discharge were considered significant barriers to deprescribing FRIDs in hospitals. Involving pharmacists in multidisciplinary teams in hospitals may facilitate deprescribing.

245 ‘Pad culture: the use of continence wear in older people in an Irish University Hospital’

Abstract Background Incontinence in hospital patients can result in a longer length of stay, a greater risk of being discharged to a residential care setting, as well as increased healthcare and personal costs. Older adults may find it difficult to regain continence post discharge contributing to caregiver strain, social isolation and functional decline. There is evidence to suggest that there is an over-reliance on continence aids (wearable absorbent ‘pads’ &amp; urinary catheters) for older adults in hospital. The aim of this study was to assess the prevalence of continence aids among older in-patients in an Irish University Hospital, as part of wider service improvement project. Methods Data was collected on consecutive in-patients 65 years or older on a single day. Medical, surgical, oncology, coronary care and medical assessment unit were included. Current incontinence aid usage and pre-admission continence aid usage was recorded, along with demographics and current mobility status. Results 156 older adults were included. 53.5% were male and the median age was 81. A total of 57.4% (N = 89) of older patients were wearing disposable pads. Of these, 64.5% (N = 58) were not wearing continence pads pre-admission. A total of 23.2% (N = 36) had a urinary catheter inserted. Of these, 91% (N = 33) did not have a urinary catheter pre-admission. 38.3% (N = 61) of those wearing pads could mobilise either independently or with assistance of one. We also found a direct correlation between pad use and length of stay. Conclusion This study highlights the high prevalence of continence aid deployment in the care of older adults admitted to an acute hospital, with conversion to an aid occurring even in those who are able to mobilise independently or with supervision. Continence care and rehabilitation may benefit from inter-disciplinary assessment and management, similar to other complications of ageing and hospitalisation, such as delirium.

154 Tobacco smoking: impact on medication use, healthcare utilisation and hospitalisation in older adults; TILDA waves 3–4

Abstract Background Smoking is a significant cause of preventable mortality, morbidity and healthcare costs. Tobacco Free Ireland aims to reduce smoking prevalence to &amp;lt;5% by 2025. The recently published Department of Health and HSE National Clinical Guidelines for Tobacco Control emphasise the need for healthcare professionals to address smoking cessation during hospital admissions. The aim of this study was to investigate the relationship between smoking and hospitalisation, health service utilisation and prescribed medication use. Methods TILDA (The Irish Longitudinal Study on Ageing) wave 3 and wave 4 datasets were used, with 5,564 participants in both wave 3 and 4. Following univariate analysis, logistic regression analysis was performed to determine the health service usage outcomes associated with smoking. Results On univariate analysis, primary/no education (p &amp;lt; 0.001) and lower age group (&amp;lt;53 years) were significantly associated with increased smoking. After adjustment for demographic variables, smokers had a reduced likelihood of attending ≥1GP appointments over the past 12 months than non/ex-smokers (adjusted Odds Ratio [OR]: 0.65, 95% Confidence Interval [CI]: 0.42–0.72). Hospitalisations during the same period were found to have no significant association with smoking (p = 0.490). Smoking was also shown to cause a reduced likelihood of having ≥1 regular medications (adjusted OR: 0.69, 95% CI: 0.57–0.85). Conclusion Considering the impact of smoking on health, the results appear initially counterintuitive. There are a couple of explanations. Older smokers with more severe smoking-related morbidity may not participate in the TILDA Study. In addition, the results suggest that smokers tend to avoid visiting the GP which may indicate either that smokers are unconcerned about their health or do not wish to discuss smoking. Deferral of care to a later stage may impact prognosis and costs. Further research is required to investigate the dose-effect relationship of smoking with health service utilisation in the Irish setting.

Vaccine Effectiveness of non-adjuvanted and adjuvanted trivalent inactivated influenza vaccines in the prevention of influenza-related hospitalization in older adults: A pooled analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN)

BackgroundInfluenza vaccines prevent influenza-related morbidity and mortality; however, suboptimal vaccine effectiveness (VE) of non-adjuvanted trivalent inactivated influenza vaccine (naTIV) or quadrivalent formulations in older adults prompted the use of enhanced products such as adjuvanted TIV (aTIV). Here, the VE of aTIV is compared to naTIV for preventing influenza-associated hospitalization among older adults. MethodsA test-negative design study was used with pooled data from the 2012 to 2015 influenza seasons. An inverse probability of treatment (IPT)-weighted logistic regression estimated the Odds Ratio (OR) for laboratory-confirmed influenza-associated hospitalization. VE was calculated as (1-OR)*100% with accompanying 95% confidence intervals (CI). ResultsOf 7,101 adults aged ≥ 65, 3,364 received naTIV and 526 received aTIV. The overall VE against influenza hospitalization was 45.9% (95% CI: 40.2%–51.1%) for naTIV and 53.5% (42.8%–62.3%) for aTIV. No statistically significant differences in VE were found between aTIV and naTIV by age group or influenza season, though a trend favoring aTIV over naTIV was noted. Frailty may have impacted VE in aTIV recipients compared to those receiving naTIV, according to an exploratory analysis; VE adjusted by frailty was 59.1% (49.6%–66.8%) for aTIV and 44.8% (39.1%–50.0%) for naTIV. The overall relative VE of aTIV to naTIV against laboratory-confirmed influenza hospital admission was 25% (OR 0.75; 0.61–0.92), demonstrating statistically significant benefit favoring aTIV. ConclusionsAdjusting for frailty, aTIV showed statistically significantly better protection than naTIV against influenza-associated hospitalizations in older adults. In future studies, it is important to consider frailty as a significant confounder of VE.

Nurses Improving Care for Health Systems Elders (NICHE): An evidence-based professional practice model for an aging nation

Nurses Improving Care for Healthsystems Elders (NICHE), one of the original geriatric care models, enhances the overall quality and safety of nursing care provided to older adults in hospital and post-acute care settings. NICHE is a relatively low-cost, high-impact investment in the nursing workforce to improve performance on the nurse-sensitive quality indicators including falls, pressure injuries, medication safety, urinary incontinence, restraint reduction, delirium identification and management, reducing preventable readmissions, among others. NICHE also serves as a foundation to enhance nursing care to achieve national accreditation standards for a number of geriatric and nursing quality programs.