Population Of Older Patients Research Articles

"Hello… I'm Here!" A Co-Productive Qualitative Study Involving Older People With Vision Impairment and Their Experiences of Acute Hospital Care.

To understand the experience and care needs of older people living with vision impairment in the acute hospital setting. A qualitative study using co-productive user-based design. Seven older people living with vision impairment and six healthcare students collaborated in a series of six researcher facilitated co-productive workshops. Recorded data were analysed using thematic analysis. The needs of older people with vision impairment are often overlooked in the acute hospital setting. Four themes identified (1) Trauma and Loss; (2) Vulnerability and Feeling Invisible; (3) Being disabled, and (4) Feeling safe. Trauma associated with vision loss was acute, particularly if acquired during the hospital admission. The experience of vision impairment coupled with illness served to heighten feelings of vulnerability and needs were often overlooked creating a sense of invisibility. The hospital environment was experienced as disabling, and care needs were not always acknowledged. Supportive communications and access to own audio/supportive devices were vital in supporting a sense of safety. Our study is significant in highlighting the increasing global importance of vision aware care in the context of an ageing population. The study is also unique in illustrating the potential for inclusive and creative co-productive approaches which engage both older people with sight loss and healthcare students to promote vision aware practice. Supporting vision impaired older people through diagnosis, care and discharge is vital for promoting equitable positive health outcomes and quality of life. What problem did the study address? Despite a high prevalence of sight loss within the older patient population, it is unclear how the acute hospital setting supports people living with vision impairment. What were the main findings? The hospital environment and lack of vision aware care can impact negatively on the care experience resulting in poorer physical and psychosocial wellbeing. Where and whom will the research have an impact? This work will inform the development of vision aware care educational resources, policy, and practice. Vision aware care is vital for supporting quality of life and health outcomes for all older people. EQUATOR guidelines have been adhered to using the COREQ checklist. The charitable organisation Sheffield Royal Society of Blind (SRSB) was involved in the planning of the research to ensure that volunteer participants could take part and the conduct of the research was inclusive to their needs.

Atypical Teratoid Rhabdoid Tumor of the Brain in a Young Adult With Down Syndrome: Case Report and Literature Review.

Atypical teratoid/rhabdoid tumor (ATRT) is an aggressive, malignant embryonal tumor with dismal long-term survival despite aggressive multimodal therapy. While this tumor typically presents in infancy or early childhood, there are published case reports of adult-onset ATRT. Making prognostic conclusions or therapeutic decisions for this older patient population remains challenging due to the paucity of these reports. A 25-year-old female with Down syndrome presented with dysphagia and facial droop and was found to have an avidly enhancing, cerebellopontine angle mass. Histology demonstrated sheets of rhabdoid cells with loss of INI1 expression, pathognomonic for ATRT. Further sequencing detected a frameshift SMARCB1 mutation and methylation profiling matched with high confidence to the MYC subclass of ATRT. The patient was treated with subtotal surgical resection and focal proton beam irradiation, followed by chemotherapy on a modified regimen due to concern for heightened risk of treatment-related toxicity. On most recent follow-up 22 months from diagnosis, the patient remains without evidence of disease. This report represents the first known case of ATRT in a young adult patient with Down syndrome, offering unique mechanistic insight into the tumorigenesis of ATRT. Further studies are needed to define an appropriate risk-adapted and standardized therapeutic approach for this patient population.

Abstract 4124293: Exercise Capacity in Patients with Fontan Physiology

Introduction/Background: In the absence of a sub-pulmonary ventricle in the Fontan circulation, augmentation of pulmonary blood flow and filling of the systemic ventricle during exercise are limited. Cardiopulmonary exercise testing (CPET) is a reliable method for evaluation of aerobic capacity, gas exchange, and other physiologic parameters used for risk stratification in this population. Despite the ubiquitous use of CPET, reference ranges for patients with Fontan physiology are limited. The purpose of this study is to describe exercise characteristics and their relationship with different characteristics of Fontan physiology, imaging, and hemodynamics. Methods/Approach: In this retrospective cohort study, CPET results were reviewed for adult Fontan patients at the University of Washington between May 2021 and February 2024. Demographics, comorbidities, medications, type of Fontan conduit, imaging characteristics, hemodynamics, and exercise characteristics were included. Results were compared to a large previously published cohort of Fontan patients. Univariate linear regression was used to identify associations between demographics, cardiac anatomy, and exercise parameters. A p-value of less than 0.05 was considered statistically significant. Results/Data: Baseline demographics were notable for an older patient population (31±7 years) with lower indexed peak VO 2 (20.5±5.6 mL/kg/min) and greater V E /VCO 2 slope (37±7) compared to the historic cohort. Indexed peak VO2 was associated with age, BMI, type of Fontan conduit, FEV1, FVC, resting oxygen saturation, peak systolic blood pressure, and peak heart rate. Indexed peak VO 2 was notably not significantly associated with sex, systemic ventricular morphology, ventricular systolic function, Fontan pressure, or the presence of conventional heart failure medical therapy. Conclusions: In the growing population of older patients with Fontan physiology, development of age-specific population normative data may increase the clinical utility of CPET. Further investigation of the relationship between imaging characteristics, hemodynamics, and exercise parameters is needed in the Fontan population.

Frailty and Behavioral and Psychological Symptoms of Dementia: A Single Center Study.

Background: During the time-course of cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, negatively impacting the outcomes. Methods: The aim of this single center, longitudinal study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified into three clusters: "mood/apathy" (depression, apathy, sleep disturbances, appetite disturbances), "psychosis" (delusions, hallucinations, and anxiety), and "hyperactivity" (agitation, elation, motor aberrant behavior, irritability, disinhibition). Using the Clinical Frailty Scale (CFS), patients were categorized as "severely frail", "mild/moderately frail" and "robust" (CFS ≥ 7, 4-6, and ≤ 3, respectively). Results: In total, 209 patients (mean age 83.24 ± 4.98 years) with a clinical diagnosis of dementia were enrolled. BPSD were prevalent among the severely frail patients. A positive correlation at regression analysis was found between frailty and "hyperactivity" cluster at baseline and follow-up visits (p < 0.001, p = 0.022, p = 0.028, respectively), and was confirmed at the network analysis. Loss of independence in IADL was correlated to hyperactivity and psychosis symptoms (p < 0.001 and p = 0.013, respectively). Conclusions: Scarce literature is available regarding the correlation between frailty and BPSD, which in our study is significant, especially for symptoms in the hyperactivity cluster. Frailty assessment may help identify patients at the highest risk for developing BPDS who might benefit from targeted intervention in the earliest phases of the disease.

Outcome of Centenarians with Hip Fracture: An Analysis of the Registry for Geriatric Trauma (ATR-DGU).

Background/Objectives: Outcomes for hip fracture patients have improved over the years, yet the population of older patients (≥80 years) continues to grow. By 2100, the global centenarian population is projected to exceed 25 million, but data on hip fracture outcomes in this group are rare and often derived from small samples. This study aimed to analyze outcomes for centenarian hip fracture patients in specialized geriatric trauma centers and compare them with those of patients under 80. Methods: We conducted a retrospective analysis of the AltersTraumaRegister DGU® from 2016 to 2022, including all proximal femur fracture data. Patients were categorized into two groups: under 80 years and centenarians. The primary outcome was in-hospital mortality, with secondary outcomes including quality of life, walking ability on postoperative day seven, length of hospital stay, readmission rates, and changes in living situations. Results: Among 14,521 patients, 316 were over 99 years old. In-house mortality was significantly higher in centenarians (15.44% vs. 3.58%; p < 0.001), with more discharged to nursing homes. After matching by the Geriatrics at Risk (GeRi) score, mortality differences diminished. Conclusions: While age is a risk factor for mortality, centenarian hip fracture patients' outcomes do not significantly differ from those aged ≤80 when considering other risk factors.

Sexual Orientation and Gender Identity Collection of Older Adults in the UCHealth Electronic Health Record: Assessing the First Three Years of Implementation

ABSTRACT Objectives This study examines sexual orientation/gender identity (SOGI) data collection in older adults from the UCHealth systems electronic health record. Methods Data of older adults aged 55 and older were analyzed between January 2019 and December 2022. Prevalence of SOGI documentation based on four new SOGI-related questions were analyzed along with social history documentation. Results Data were missing in reports (93% for sexual orientation and 96% for gender identity). Of 459,544 older adults potentially identifiable as a sexual or gender minority (SGM), 8.24% could be identified through other social history, and 91.76% could not. Data often returned a response of “undisclosed” (1.04%) or “unspecified” (98.79%), leaving .005% to represent the identifiable population of SGM minority adults. Conclusions SOGI data often was not documented through questions recommended since January 2019. It is unlikely that .005% accurately represents the SGM older patient population as national estimates are between 7%-11%. Lower reported percentages of SGM older adults may lead to less recognition of patient needs, and thus less equitable and personalized care. Clinical Implications These findings exemplify the need for evaluation strategies to be designed to improve SOGI collection with the primary goal of promoting equity and inclusion for SGM older adults.

Trends in knee cartilage repair procedures in the United States, 2010 to 2020

IntroductionSurgical intervention of knee articular cartilage injuries may prevent degeneration in symptomatic patients. ObjectiveThis study aims to analyze trends, demographics, and yearly incidence of four different knee cartilage repair procedures in the U.S. from 2010 to 2020. MethodsThe PearlDiver database was queried for patients who underwent knee microfracture, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) procedures from 2010 to 2020. Student t and χ-square tests were used for statistical comparisons and analysis of data trends. Regression models and Compound Annual Growth Rates (CAGR) further assessed trends of each procedure. Results220,674 patients from 2010 to 2020 were included in this study. Microfracture incurred a 62.4% decrease in occurrence (P < 0.001). Incidence of OCA trended upwards (37.7%; P = 0.065) whilst OAT procedures significantly decline (53.9%; P < 0.001). ACI procedure numbers remained relatively stable (11.2% increase; P = 0.847). ConclusionsThe incidence of microfracture significantly decreased in the United States from 2010 to 2020. There was a positive trend in the incidence of OCA cases, whilst the number of OAT cases decreased significantly. The number of ACI cases performed per year did not change significantly over the study period with the exception of an increase from 2017-2019. Microfracture procedures were performed in an older patient population than the other cartilage procedures. Males were more likely to undergo the four cartilage preservation surgeries compared to females. Similar studies should be carried out in other large health databases to confirm the external validity of these trends across the United States.

Prevalence of Age-related Macular Degeneration among Elderly Bulgarian Population

Age-related macular degeneration (AMD) is the leading cause of blindness worldwide in an older patient population with the highest risk of disease development in individuals older than 65 years. This study aims to estimate the prevalence of AMD and its stages among the elderly population of Sofia city. An observational study among elderly Sofia citizens, held as prophylactic ophthalmological examinations was performed. The participants underwent full ophthalmic examination including autorefractometry, noncontact tonometry, best-corrected visual acuity measurement, biomicroscopy, and indirect ophthalmoscopy through a dilated pupil. Optical coherent tomography was performed in cases with difficulties to determine the stage of AMD or when the visual acuity did not correspond to the ophthalmoscopy findings. All participants were asked to fill in informed consent and a specifically structured questionnaire based on the modified Wolffson LVQOL questionnaire that was previously used in the study in Eastern Bulgaria (in 2014 by Nencheva). Overall 700 patients, with a median age of 74 years (69 to 96 years) met the inclusion criteria and were enrolled in the study. The prevalence of AMD, early, intermediate and late AMD was estimated as 26.1%, 14%, 6.6%, and 5.6%, respectively. Age was strongly associated with the prevalence of AMD and its stages. The ageing of the population in Bulgaria and worldwide and the large proportion of elderly persons, affected by AMD, emphasize the necessity of regular ophthalmological examinations of that part of the population. The timely diagnosis and treatment are very important for diminishing of blindness and visual impairment.

Tolerability and Outcomes for Treatment of Older Myxoid Liposarcoma Population.

Myxoid liposarcoma predominantly affects young and middle-aged individuals, and little is known regarding treatment tolerability and outcomes in older patients. This study aims to better understand this older patient population. This single institution retrospective study included patients aged 70 years and older with localized (non-metastatic) myxoid liposarcoma. Sixteen patients were included. The median age was 75 years, and 9 (56%) were female. Fourteen (88%) were extremity tumors and two (12%) were trunk. The median tumor size was 10.4 cm (range, 3.6 to 28 cm). Five (31%) tumors had a round cell component. All patients had surgery. Fourteen (88%) had perioperative radiation, and three (19%) had perioperative chemotherapy. One patient had postoperative infection, and one patient had neutropenic fever from preoperative chemotherapy. The median follow up from surgery was 6.3 years. Eight (50%) patients died from MLPS. The median relapse-free survival and overall survival were 34 months and 75 months, respectively. Most older patients with localized MLPS received perioperative radiation therapy with surgery, and few serious toxicities were reported. Even with treatment, half of the patients relapsed.

Efficacy of Sodium-Glucose 2 Transporter Inhibitors in Heart Failure With Preserved Ejection Fraction: A Narrative Review.

Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent condition. It occurs more commonly in older patient populations with multiple comorbidities, such as hypertension, diabetes, and obesity. However, managing HFpEF has been challenging due to its complex pathophysiology, and medications effective for heart failure with reduced ejection fraction (HFrEF) have not shown similar efficacy in HFpEF. Sodium-glucose 2 transporter (SGLT2) inhibitors were originally developed for the treatment of type 2 diabetes mellitus, yet several trials and papers have proved their significant role in HFpEF. Through a variety of mechanisms, including natriuresis, diuresis, and anti-inflammatory effects, to name a few, this class of drugs has shown promising results in HFpEF patients. The use of SGLT2 inhibitors in HFpEF has resulted in improvements in several aspects, including biomarkers, imaging, symptomatology, and mortality. Moreover, SGLT2 inhibitors have a favorable safety profile, which is especially significant given the high comorbidity burden in HFpEF patients. This feature is particularly notable given the type of patient being managed. Extensive research is still being undertaken for their use in HFpEF, given the positive results obtained thus far.

Using Systems Engineering and Implementation Science to Design an Implementation Package for Preoperative Comprehensive Geriatric Assessment Among Older Adults Having Major Abdominal Surgery: Protocol for a 3-Phase Study.

Older Americans, a growing segment of the population, have an increasing need for surgical services, and they experience a disproportionate burden of postoperative complications compared to their younger counterparts. A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, which has been identified as vulnerable. The pCGA optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social and environmental support. The pCGA has been shown to decrease postoperative morbidity, mortality, and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of the pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic medical centers. By applying implementation science and human factors engineering methods, this study will provide the necessary evidence to optimize the implementation of the pCGA in a variety of health care settings. The purpose of this paper is to describe the study protocol to design an adaptable, user-centered pCGA implementation package for use among older adults before major abdominal surgery. This protocol uses systems engineering methods to develop, tailor, and pilot-test a user-centered pCGA implementation package, which can be adapted to community-based hospitals in preparation for a multisite implementation trial. The protocol is based upon the National Institutes of Health Stage Model for Behavioral Intervention Development and aligns with the goal to develop behavioral interventions with an eye to real-world implementation. In phase 1, we will use observation and interviews to map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery. In phase 2, we will apply user-centered design methods, engaging health care providers, patients, and caregivers to co-design a pCGA implementation package. This package will be applicable to a diverse population of older patients undergoing major abdominal surgery at a large academic hospital and an affiliate community site. In phase 3, we will pilot-test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness trial. We anticipate that this study will take approximately 60 months (April 2023-March 2028). This study protocol will generate (1) a detailed process map of the pCGA; (2) an adaptable, user-centered pCGA implementation package ready for feasibility testing in a pilot trial; and (3) preliminary pilot data on the implementation and effectiveness of the package. We anticipate that these data will serve as the basis for future multisite hybrid implementation-effectiveness clinical trials of the pCGA in older adults undergoing major abdominal surgery. The expected results of this study will contribute to improving perioperative care processes for older adults before major abdominal surgery. DERR1-10.2196/59428.

“They forget that I’m a human being”—ward round communication with older patients living with frailty and informal caregivers: a qualitative study

Skilful communication prompts quality patient care. Informal caregivers occupy a crucial role when caring for hospitalised older patients living with frailty. However, skilful communication with both patients and informal caregivers during ward rounds has not been studied. Thus, we aimed to explore communication preferences of patients and informal caregivers during ward rounds. We conducted semi-structured interviews with hospitalized patients and informal caregivers until information redundancy occurred. We used inductive coding of the transcribed interviews followed by a reflexive thematic analysis. The study included 15 patients and 15 informal caregivers. Patients had a median age of 85years (range 75-100years) and seven patients were females. Informal caregivers' median age were 45years (range 38-80years) and 13 were females. Three themes were generated: (1) building relationships and conveying information, (2) alleviating informal caregiver strain and (3) sharing the decision-making process. Themes highlighted the importance of collaborative and empathetic approaches in healthcare interactions, emphasizing interpersonal communication skills, such as fostering professional relationships. The interviews unveiled informal caregiver burden stemming from disempowerment during hospital discharge process and managing mistrust within the healthcare system. The shared decision-making process should address patients' and informal caregivers' needs and circumstances. Communication preferences of a population of older patients living with frailty and informal caregivers during ward rounds encompass interpersonal communication, demonstrating ample time, and being seen as a human being. Informal caregivers value being included in the decision-making process. Skilful communication includes for doctors to recognize informal caregivers' narratives and burdens.

Implementing and monitoring high-quality community health worker care in adult primary care at New York City Health + Hospitals

BackgroundThis study describes how New York City (NYC) Health + Hospitals implemented a large-scale Community Health Worker (CHW) program in adult primary care clinics between January 2022 and December 2023 and established metrics to monitor program implementation. This study is timely as healthcare systems consider how to scale high-quality CHW programs.MethodsWe collected metrics in the following areas: (1) Workforce demographics, team structure, and training; (2) Enrolled patient demographics; (3) Patient-centered metrics, such as patient counts (e.g. patients outreached and enrolled) and engagement (e.g. median time in program, caseloads per CHW), and goals (e.g. median number of goals identified and completed). Metrics are based on standard data elements captured through CHW documentation in the electronic health record collected during program implementation. Data cleaning is completed using SQL queries and R scripts.ResultsIn June 2023, there were a total of 97 CHW and 22 CHW Supervisor staff lines in adult primary care across 17 healthcare sites. There were 4.6 CHWs to 1 CHW supervisor on average though this ranged by facility from 1:1 to 1:6. Compared to the population that receives primary care at NYC H + H, CHWs served more African American/Black patients (40% vs. 32%) and an older patient population (35% older than 65 vs. 21% older than 65). From January 2022 to December 2023, 13,812 patients were outreached by CHWs. Of these, 9,069 (66%) were referred by clinicians, 7,331 (53%) were enrolled, and 5,044 (37%) successfully graduated. The median number of goals identified by patients was four, and the median number of goals completed with a CHW per patient was three. The top three goals were primary care engagement (47%), specialty care engagement (46%), and food insecurity (45%).ConclusionEstablishing clear implementation and process metrics helps to ensure that CHWs embedded in health systems can meaningfully engage adult patients in health care, address patient-centered goals, and connect patients to community and government services.

Complete Versus Culprit-Only Revascularization in Older Patients With ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis.

Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

Treatment Trends and Epidemiologic Changes in Acetabular Fracture Management over the Course of 10 Years: An Analysis Based on 2853 Patients as Treated by the German Pelvic Multicenter Study Group.

Background/Objectives: Acetabular fractures, traditionally linked to high-impact trauma in younger adults, are increasingly observed in the elderly due to falls and poor bone quality. This demographic shift necessitates updated treatment approaches. This study analyzes demographic trends and treatment evolution over a decade using the German pelvic fracture registry. Methods: Data on acetabular fractures were analyzed from the German pelvic fracture registry of the German Trauma Society. Parameters included classification, demographics, treatment methods, and surgical details. Trends were assessed by grouping patients based on treatment intervals and age, comparing treatment methods, surgical approaches, and reduction quality across these groups, considering fracture types and treatment volume. Results: The study included 2853 unilateral acetabular fractures with a mean patient age of 61.5 years, showing an increasing age trend. A shift from simple to complex fractures involving the anterior acetabular column was observed. Operative treatment was performed in 62.5% of cases, more common in non-geriatric patients and those with posterior column involvement. The use of anterior intrapelvic approaches increased over time, replacing the Ilioinguinal extrapelvic approach. Anatomical reduction was achieved in 47.4% of cases, with 31.7% having imperfect reductions and 20.9% poor reductions. High-volume centers had significantly better reduction outcomes, particularly for simple fractures. Geriatric patients exhibited worse reduction quality compared to younger patients. In-hospital mortality was stable at 3.3%. Conclusions: The study highlights a demographic shift towards an older patient population, leading to more complex fracture patterns. Despite advancements in surgical techniques and new implant technologies, these demographic changes have resulted in lower reduction quality for complex fractures. Emphasis is placed on careful patient selection for reconstructive surgery or endoprosthetic replacement to ensure high-quality outcomes.

Membranoproliferative Glomerulonephritis over 20 Years at a Tertiary Referral Center in the UK

Introduction: Membranoproliferative glomerulonephritis (MPGN) is a pattern of injury seen on kidney biopsy, with various underlying etiologies. The component types, including complement-mediated MPGN, are relatively rare. This study presents longitudinal real-world data over 20 years in a tertiary renal center in the UK. Methods: All patients with an MPGN pattern on kidney biopsy between 2000 and 2020 were identified. After applying exclusion criteria, 38 patients remained. Data including patient demographics, details of the renal histology from the kidney biopsy, baseline laboratory results, treatments received, and clinical outcomes including renal replacement therapy and death were collected from the organization’s electronic patient record. Results: Twenty-eight of the cohort had immune complex-mediated MPGN, and 10 had complement-mediated MPGN (8 with C3 glomerulonephritis and 2 with dense deposit disease). Median follow-up was 72 months. Median age was 61 years. Overall, 60.5% were female, and 92.1% white. At presentation, median eGFR was 31.5 mL/min/1.73 m2 and uPCR 394 mg/mmol. Here, 78.9% received renin-angiotensin-aldosterone system inhibitors and 71.1% received any immunosuppression. In total, 47.4% progressed to ESKD and 50% died during follow-up. Conclusions: The study found an older patient population than typically reported. Poor outcomes were observed in the overall cohort with progression to ESKD and mortality both at almost 50%. This may be influenced by the older patient population. Individualized management of patients with an MPGN biopsy finding is paramount, with comprehensive evaluation for triggers and complement abnormalities. Going forward, registry enrolment and collaborative studies may enhance knowledge and outcomes.

Risk factors for older people re-presenting to the emergency department with falls: A case-control analysis.

Falls are a leading cause for ED presentations among older adults. Existing secondary falls prevention interventions have not been shown to decrease fall-related ED re-presentation, indicating a need to better understand contributing factors. Our aim was to evaluate risk factors for fall re-presentations among the older patient population presenting to the ED. This is a single-centre case-control study. Cases were patients aged ≥65 years with two falls-related ED presentations within 6 months. Age- and sex-matched controls had a corresponding index, but no subsequent ED fall presentation. Data collected included falls risk factors and clinical features of the index presentation. Univariate and multivariate analyses were conducted to assess the relationship between potential exposures and fall re-presentation. A total of 300 patients (mean age 83.8 years) were studied. On univariate analysis, factors significantly associated with ED fall re-presentation included increasing multimorbidity (P < 0.0001), increasing number of medications (P < 0.0001) and residing in residential aged care facility (RACF) (odds ratio [OR] 3.06, P < 0.001). No factors remained significant on multivariate analysis. Post-hoc analyses for the RACF subgroup showed that psychotropic medication use (OR 1.65, P = 0.04) and prior fall within 12 months (OR 2.68, P < 0.001) were significantly associated with re-presentation. Initial presentation with serious musculoskeletal injury was a significant protective factor (OR 0.21, P = 0.02). The present study failed to identify factors independently associated with ED fall re-presentation, suggesting that the factors are complex and inter-related. Two high-risk populations were identified - those from RACF and those initially presenting with falls not resulting in serious injury.

P-719 The fertility clinic landscape in England 2012-2017: a study of the impact of clinic size and environment on success rates

Abstract Study question How are fertility clinics in England distributed and has this changed over time? Does clinic size, geography and local deprivation level influence live birth rates? Summary answer A clinic’s size, urban/rural environment and local deprivation level shows no statistically significant impact on a clinic’s live birth rates. What is known already It has been established that children born through assisted reproduction are more likely to have parents from higher socioeconomic groups compared to those conceived through natural conception. However, studies examining the relationship between socioeconomic status and fertility treatment success rates have varied outcomes and occasionally conflicting results. There has so far been little research internationally as to whether geographical, environmental and socioeconomic markers influence fertility treatment outcomes on a national scale. Study design, size, duration Publicly available HFEA data from 2012 to 2017 for all registered clinics in England was accessed. The total number of IVF/ICSI cycles for all age groups and live birth rate per embryo transferred were recorded. 56 clinics (32,091 treatment cycles) were recorded in 2012, rising to 69 clinics (36,638 treatment cycles) in 2017. Clinic postcode was used to determine Rural-Urban Classification and postcode-level and local authority-level deprivation according to the Index of Multiple Deprivation (IMD). Participants/materials, setting, methods Statistical analysis was performed using R Statistical Software and Datawrapper was used to generate map infographics. Clinic size was categorised by the number of IVF/ICSI cycles conducted per year – small (0-499), medium (500-999) and large (&amp;gt;1000). Clinic environment was classified as urban or rural and IMD was used to categorise clinics into deprivation quintiles. Weighted live birth rates were analysed to determine any difference in clinic success based on its size and environment. Main results and the role of chance The majority of clinics conducted between 0-499 IVF/ICSI cycles per year. There was no statistically significant difference in the live birth rate per embryo transferred based on clinic size with an average success rate of 31.8% in small clinics, 33.9% in medium clinics and 32.2% in large clinics (p-value 0.885). A large proportion of clinics were located in London (28-29% of clinics and 34-40% treatment cycles) between 2012 and 2017 despite only ∼16% of the population of England living in London. There were significantly fewer clinics (p-value 0.047) and treatment cycles (p-value &amp;lt;0.001) conducted in rural, compared to urban locations. There was a small, but not statistically significant, increase in success rate in clinics located in the least, compared to most deprived quintile. The difference in average live births/embryo transferred between the most and least deprived quintile across all years studied was 3.8% (31.1% in most deprived vs 34.9% in least deprived, p-value 0.227). There was also no statistical difference between the live birth rates per embryo transferred across the local-authority deprivation quintiles, although there was a trend for slightly higher success rates in the least deprived quintile compared to most deprived quintile. (30.3% compared to 33.9% (p-value 0.211)). Limitations, reasons for caution Clinic postcode only was used, therefore deprivation may not be representative of the whole population it treats. All IVF/ICSI treatments for all age groups were included, but some clinics may treat an older population of patients. Many IVF laboratories have satellite clinics in surrounding areas, whose postcodes were not included. Wider implications of the findings It is reassuring that local environment and deprivation do not significantly impact on clinic success rates. More detailed analysis of individual patient data on a nationwide level is required to understand this further either through access to primary care records or collaboration between clinics. Trial registration number not applicable

Paper 37: Outcomes of Medial Patellofemoral Ligament Reconstruction Patients Over 30 Years of Age

Objectives: Medial patellofemoral ligament reconstruction (MPFLR) is a common procedure to treat recurrent patellofemoral instability, typically in a younger, active patient population. While many patients treated with MPFLR fall into this age group, patellar instability is encountered in older patients as well. Outcomes in older patient populations have been less frequently reported in the literature. We hypothesize that patients over 30 at the time of surgery will have poorer postoperative patient reported outcome measures (PROMs) following MPFLR than patients under age 30. Methods: Retrospective review was undertaken to identify patients who underwent isolated MPFLR between 2008 and 2020. Chart review was utilized to obtain patient demographic, anatomical, and surgical factors. Patients were contacted via mail and/or phone and patient-reported outcomes were recorded. PROMs included the knee injury and osteoarthritis injury outcome score (KOOS), Norwich patellar instability score, and Marx activity score. Differences between groups were evaluated by Mann-Whitney and Fisher-exact tests. KOOS and Norwich scores were also evaluated using a multivariable linear regression adjusting for the following variables selected a priori: sex, body mass index, Caton-Deschamps index, TT-TG distance, sulcus angle, and the presence or absence of ≥ Grade 2 cartilage damage. Results: A total of 228 patients underwent isolated MPFL reconstruction in the study period. 177 patients (78%) had data on repeat patellar dislocations at least 1 year postoperatively, with a median follow-up interval of 40.8 months (3.4 years) postoperative. Of these 177, 140 were under age 30 at time of surgery, 7 (5%) of whom had a repeat dislocation; of 37 patients at or over age 30 at time of surgery, 2 (6.6%) had a repeat dislocation. 147 patients further completed KOOS, Norwich, and Marx activity score surveys with a median follow-up of 45.3 months (3.8 years) post-operative. Patients ≥ 30 years old at surgery (n=31) had lower KOOS pain (82.1 vs 91.7; p=0.03), KOOS activities of daily living (94.1 vs 97.1; p=0.04), and Marx activity scores (1 vs 7; p&lt;0.001) compared to the patients under age 30 (n=116) (Table 1). After adjusting for covariates, multivariable regression models for KOOS and Norwich scores showed only KOOS pain subscores were lower for patients ≥ 30 years (β= -4.2; 95% CI -8.3, -0.2; p=0.04). Conclusions: Patients over age 30 at the time of MPFLR demonstrated similar recurrence risk but lower KOOS pain and Marx activity scores at 3.8 years postoperative than patients under age 30 at the time of MPFLR. [Figure: see text]

ATRT-08. ATYPICAL TERATOID RHABDOID TUMOR IN AN ADULT PATIENT WITH DOWN SYNDROME

Abstract BACKGROUND Atypical teratoid/rhabdoid tumor (ATRT) is a malignant, highly aggressive embryonal tumor of the central nervous system. Long-term survival remains dismal despite aggressive multimodal therapy, including a maximal safe surgical resection and intensive systemic chemotherapy +/- radiation therapy. While these tumors typically present in infancy or early childhood, there are scattered case reports of adult-onset ATRT. Making prognostic conclusions or therapeutic decisions for this older patient population remains challenging due to the paucity of these reports. CASE REPORT A 25-year-old female with Down syndrome presented with nausea, vomiting, dysphagia, and facial droop and was found to have an avidly enhancing, left cerebellopontine angle mass. There was initial clinical suspicion for leukemic chloroma given the patient’s Down syndrome status and known association with higher rates of hematologic malignancy concurrent with a dramatic scarcity of solid tumors in the Down syndrome population. However, histology demonstrated sheets of high-grade rhabdoid cells with loss of INI1 expression, pathognomonic for ATRT. Further sequencing defined a frameshift mutation in SMARCB1 (p.C298), and methylation profiling matched with high confidence to the MYC subclass of ATRT. The patient was treated with subtotal surgical resection and focal proton radiation, followed by chemotherapy on a modified regimen based on the Children’s Oncology Group protocol, ACNS0333. Systemic methotrexate and all consolidative high-dose chemotherapy with stem cell rescue were omitted due to concern for heightened risk of treatment-related toxicity. The patient remains alive and clinically asymptomatic 19 months from diagnosis. CONCLUSION This report represents the first known case of ATRT in an adult patient with Down syndrome, offering unique mechanistic insight into the tumorigenesis of ATRT. Adult ATRT is a rare entity without standardized treatment or established prognostic understanding. Further studies are needed to define an appropriate risk-adapted therapeutic approach for this patient population.