Adult Outcomes Research Articles

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults >60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Efficacy of Fragility Fracture Integrated Rehabilitation Management in Older Adults With Hip Fractures: A Randomized Controlled Trial With 1-Year Follow-Up

ObjectivesComprehensive multidisciplinary rehabilitation has been proven to benefit patients recovering from hip fracture surgery, enhancing postoperative outcomes. However, challenges persist in delivering such rehabilitation due to health care system limitations and inadequate policies. This study aimed to evaluate the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to a conventional rehabilitation after hip fracture surgery. DesignA parallel-group, single-blind, multicenter randomized clinical trial. Setting and ParticipantsThree in-hospital rehabilitation settings; 203 hip fracture surgery patients aged 65 years and older were randomized and followed up for 1 year. MethodsThe main outcome assessed ambulatory function, using the Koval and Functional Ambulation Category (FAC) scales. Functional outcomes were evaluated upon rehabilitation admission, discharge, and during follow-up at 3, 6, and 12 months post-surgery. The prevalence of independent ambulation and recovery to prefracture ambulatory status at each follow-up time point were analyzed. ResultsThe FIRM group demonstrated superior improvements in Koval and FAC scores, along with most secondary outcomes during the 1-year follow-up. Significant changes from baseline to 12 months were observed in Koval scores (mean difference, −4.13 [95% CI, −4.56 to −3.70] vs −3.22 [95% CI, −3.86 to −2.61], P = .016) and FAC scores (mean difference, 3.37 [95% CI, 3.01 to 3.72] vs 2.56 [95% CI, 2.10 to 3.02], P = .006). At the 12-month follow-up point, this group also showed higher rates of independent ambulation (53 [76.8%] vs 28 [56.0%], P = .016) and recovery to prefracture ambulatory status (56 [81.2%] vs 31 [62.0%], P = .020) than the conventional group. Conclusions and ImplicationsThe FIRM demonstrated superior effectiveness compared with conventional rehabilitation in improving ambulation and other functional outcomes in older adults with hip fracture. This finding provides valuable insights for managing comprehensive multidisciplinary postoperative care for hip fractures in South Korea and beyond.

Relationship between Psychological Resilience and Health Outcomes in Older Adults with Advanced CKD

Relationship between Psychological Resilience and Health Outcomes in Older Adults with Advanced CKD

Associations Between Physical Activity, Systemic Inflammation, and Hospital Admissions in Adults With Heart Failure

Purpose: Among individuals with diagnosed heart failure (HF), the impact of physical activity on systemic inflammation and risk of hospital admissions remains unclear. Therefore, the purpose of this study was to examine the associations between physical activity and (1) systemic inflammation measured through C-reactive protein (CRP) levels and (2) frequency of hospital admissions in those with HF. Methods: We used data from the National Health and Nutrition Evaluation Survey in this observational cross-sectional study to include 377 community-dwelling adults with HF. Demographic, clinical, and functional variables were extracted from the data and included in the regression models as covariates during analysis. Associations between activity and hospital admissions were examined using Poisson regression. Multivariable logistic regression analysis was used for association between CRP and physical activity. Results: We found a direct linear relationship between CRP levels and hospital admissions, with higher levels of CRP significantly associated with greater number of hospital admissions in HF (incidence rate ratio [IRR] = 1.18, P < .001). Similarly, participating in vigorous activity was significantly associated with decreased expected rate of hospital admissions (IRR = 0.38, P = .013 (C.I. = 0.18–0.80) and with a significant decrease in the CRP levels (B = −0.44, P = .018 (C.I. = −0.80 to −0.83). Conclusion: To the best of our knowledge, this is the first study using population-level data to examine the association between physical activity level, systemic inflammation, and hospitalizations in individuals with HF. The findings of this study demonstrate that irrespective of sex, engagement in physical activity at higher intensity levels is strongly associated with favorable health outcomes in older adults with HF.

Effects of a specialized oral nutritional supplement with dietary counseling on nutritional outcomes in community-dwelling older adults at risk of malnutrition: A randomized controlled trial

Effects of a specialized oral nutritional supplement with dietary counseling on nutritional outcomes in community-dwelling older adults at risk of malnutrition: A randomized controlled trial

Manual wheelchair training approaches and intended training outcomes for adults who are new to wheelchair use: A scoping review.

Wheelchair training is pivotal for safety, independence, and occupational engagement in the community, yet adults coming into wheelchair use often receive insufficient or untailored training. This research aimed to understand the range and type of manual wheelchair training approaches that exist for adults commencing wheelchair use. A systematic scoping review involved searching eight electronic databases and grey literature up to September 2023. Papers relating to manual wheelchair training for adults and their caregivers were included for data extraction. Eighty-seven articles were included in this review. The International Classification of Functioning (ICF) was used to organise and analyse data related to intended training outcomes. Consumer consultation was not included in this review; however, the outcomes suggest that involving consumers in future wheelchair training research is critical to assure community participation outcomes. Data were extracted from 87 papers. Manual wheelchair training was delivered across diverse contexts encompassing varied support structures, trainer backgrounds, and technology and was commonly directed towards wheelchair users with spinal cord injury. Intended training outcomes most frequently mapped to the activity and participation component of the ICF (n= 39), followed by personal factors (n= 27), body structures and functions (n= 18), and environmental factors (n= 3), with limited focus on longer term occupational engagement outcomes. Most existing manual wheelchair training focussed on the acquisition of individual wheelchair skill and may not facilitate generalised and long-term occupational participation outcomes. Further exploration into the contexts that support occupational engagement, particularly for older adults with progressive conditions, is required to support service provision. We looked at what manual wheelchair training approaches exist for adults who need to use a manual wheelchair and what training helps people to do/achieve. We did a scoping review that looked at literature about manual wheelchair training programs for adult wheelchair users. We found 87 research papers and training programs that we included in our review. We recorded and analysed information from all the papers about the wheelchair training programs and outcomes for people who do these programs. We found that manual wheelchair training can be done in structured or ad hoc ways, can have different amounts of training, can be provided face-to-face or online, and can be given by different allied health professionals and other wheelchair users. Most training programs had short-term outcomes like learning manual wheelchair skills, being able to use the wheelchair properly, and feeling confident about using a wheelchair. Some had longer term outcomes about being able to use the manual wheelchair in everyday activities. Most people who did the training programs that we looked at in this review were manual wheelchair users with spinal cord injury. Because not many wheelchair programs have been tried with people who do not have a spinal cord injury, it is hard for occupational therapists to make recommendations about training for other people who use a manual wheelchair. Manual wheelchair training that is done in the community and made to meet the needs of individuals may help people with using their wheelchair for their everyday activities and participate in their community.

Is cardiovascular risk profiling from UK Biobank retinal images using explicit deep learning estimates of traditional risk factors equivalent to actual risk measurements? A prospective cohort study design

ObjectiveDespite extensive exploration of potential biomarkers of cardiovascular diseases (CVDs) derived from retinal images, it remains unclear how retinal images contribute to CVD risk profiling and how the results can...

The impact of adverse childhood experiences on adult physical, mental health, and abuse behaviors: A sex-stratified nationwide latent class analysis in Japan

Adverse childhood experiences (ACEs) have been reported to detrimentally impact physical and mental health. While experiencing multiple ACEs is common, previous research primarily assessed ACEs by their total count, neglecting the impacts of different experience types. Furthermore, sex-based differences in ACEs and their influences remain unclear. This study employed Latent Class Analysis (LCA) to uncover patterns of ACEs with consideration for sex differences, aiming to elucidate their effects on adult physical and mental health. A geographically nationally representative dataset from the “Japan COVID-19 and Society Internet Study (JACSIS)” conducted in 2022 was used. 13,715 men and 14,327 women retrospectively reported their experiences across fifteen ACEs. The analysis revealed four distinct ACE patterns for both sexes: a Multiple Adversities class with a wide range of severe ACEs, a Psychological Abuse class experiencing emotional abuse at home and bullying at school, a Poverty class facing economic hardships, and a Low Adversities class with the fewest ACEs. Multinomial logistic regression analysis indicated that more severe patterns of exposure correlated with heightened adverse adult outcomes. However, the extent of these impacts varied by sex and ACE pattern. For instance, men in Multiple Adversities and Psychological Abuse classes exhibited higher tendencies towards conducting physical and psychological abuse behaviors. While ACEs in men were linked to both underweight (in cases of psychological abuse) and obesity (across all classes), women with ACEs generally leaned towards higher body weight. These findings highlight the importance of developing support strategies sensitive to sex differences and the specific content of ACEs.

ADULT EDUCATION PROGRAM IMPLEMENTATION FACTORS AND ADULT LITERACY LEARNING OUTCOMES IN RWANDAA CASE OF GICUMBI DISTRICT

The research assessed adult education program implementation factorsand adult literacy learning outcomes in GicumbiDistrict, Rwanda. Specifically, the research identified teaching methods that affect adult literacy learning outcomes in GicumbiDistrict, Rwanda, established the extent of adult literacy learning outcomes in GicumbiDistrict, Rwanda and assessed the relationship between adult education program implementation factors and adult literacy learning outcomes in GicumbiDistrict, Rwanda. The population in this study consisted of 4625 respondents, while their sample size was 368. Sample size determination was done by using Yamane formula.Descriptive survey design was adopted by the researcher as the study wanted to obtain insight for basic information provision in the study area. This study used questionnaire, interview, and observation to gather data. The questionnaire was administered to instructors and learners while the interview was given to District Director of Education, District Education Officer and Sector Education Officers. It usedpurposive, simple random sampling and stratified methods. The data of the study were analyzed in tables and charts by relying on descriptive statistics. The researcher used statistical tools like means, percentages, standarddeviations, correlation coefficients and coefficients as regression models.IBM SPSS Version 21 was used to organize and summarize data with accuracy and finding evidences assurance. Both quantitative and qualitative methodologies were used, including content analysis. Regarding the first objective, results indicate that 74.9% strongly agreed that their instructor puts them in a small group to complete tasks, 64.2% strongly agreed that they take an active role in their learning by setting their own goals, 75.6% strongly agreed that their instructor uses games to increase their motivation, and 88.1% strongly agreed that they act out specific roles to learn different concepts.The implication of this is that the instructors use learner-centered teaching methods in order to improve adult literacy learning outcomes. For the second objective, 86.6% strongly agreed that improved learners living standards indicate adult literacy learning outcomes 74.9% strongly agreed that an increased number of small businesses indicates adult literacy learning outcomes 75.6% strongly agreed that increased digital communication indicates adult literacy learning outcomes and 63.2% strongly agreed that improved health practices indicate adult literacy learning outcomes. Results on the effects of teaching methods on adult literacy learning outcomes in public adult literacy centres in Gicumbi District. The study revealed a strong positive relationship between group learning, self-directed learning, and role-playing, as well as between game-based learning and improved learners living standards, small business growth, and digital communication. The positive correlation was less than 0.05, indicating that adjustments in group learning and self-directed learning positively impacted these factors. The study also found a significant positive correlation between game-based learning and improved learners living standards, small business growth, and high attractiveness rate. This implied that there is a positive correlation among adult education factors and adult literacy learning outcomes. The Pearsons p value was than 0.05. The researcher recommended that the Ministry of Education should provide robust government, support, clear guidelines, and infrastructure for adult education programs. Rwanda Basic Education Board should involve NGOs and local communities and authorities in monitoring and evaluating the functioning of adult education at grass root level. Gicumbi District should use quality materials, well-trained teachers for improved effectiveness.

Exploring the Experiences and Outcomes of Adults with Developmental Disabilities in Global Citizenship Education Programs

Exploring the Experiences and Outcomes of Adults with Developmental Disabilities in Global Citizenship Education Programs

Exploring the Impact of Social Engagement on the Mental Health of Elderly Individuals in India

This study explores how social interaction plays a critical role in determining the mental health outcomes of older adults in India. Given the rapidly ageing population and changing societal dynamics, it is critical to understand how social relationships affect older persons’ well-being. This study intends to explain the complex relationship between older Indians’ mental health and social involvement through an exploratory approach. Data was gathered from a varied sample of senior citizens in various parts of Delhi the National Capital of India using a mixed-methods technique. The frequency and caliber of social encounters, feelings of loneliness, and mental health markers including anxiety and sadness were all assessed using quantitative questionnaires. By offering actual data on the importance of social engagement for senior people’s mental health outcomes in the Indian setting, this study adds to the expanding body of research on geriatrics. The results highlight the need for focused interventions and policies that support social inclusion, intergenerational relationships, and the particular difficulties faced by ageing populations in quickly evolving cultures such as India. Also, we have documented that by and large female elderly enjoy a healthy mental life as compared to males.

Integrated Care in Action: A Case Study of Collaborative Multidisciplinary Approach for Older Adults in Ireland

Abstract Background In Ireland, the healthcare landscape is evolving with frameworks which emphasize community-based care, such as Enhanced Community Care and the National Integrated Care Programme for Older Persons. Our Integrated Care Team for Older Persons (ICPOP) service exemplifies this shift by providing intensive, immediate multidisciplinary care to frail adults, aiming to maintain their independence in their homes and communities. Methods In the case study we describe service users journey with ICPOP. The case study illustrates the transition from fragmented care to a collaborative, patient-centred approach. ICPOP employs a structured process involving comprehensive assessment, goal setting, weekly multidisciplinary team meetings, stakeholder liaison, and detailed discharge reports. This approach focuses on early supported discharge and close coordination with local MDT teams, fostering effective communication and shared decision-making. Results This case study demonstrates the effectiveness of ICPOP's multidisciplinary model. Key factors contributing to this success include physical co-location, shared goals and vision, mutual trust, and established relationships among professionals. Furthermore, the integration of Allied Health Professionals (AHPs) within community teams enriches the care continuum and enhances outcomes for older adults. Conclusion To further enhance integrated care delivery, digital solutions are crucial. Implementing shared electronic health records and facilitating access to medical findings can streamline communication and improve care coordination. Additionally, prioritizing written discharge summaries for clients can ensure continuity of care and empower patients and their families in the post-discharge phase. This patient journey underscores the importance of collaborative, patient-centred care models in achieving the objectives of Sláintecare leading to better outcomes for older adults in Ireland.

Long-Term Outcomes of Older Adults in Ireland after Geriatric Rehabilitation for COVID-19: A Prospective Cohort Study

Abstract Background COVID-19 is a contagious disease caused by the Sars-CoV-2 virus. Disease presentation and severity has evolved since its emergence in 2019. In May 2023, the World Health Organization declared the end of the COVID-19 pandemic but described it as an established and ongoing health issue. Studies to date have focused on disease presentation, prevalence and evolution and the immediate rehabilitation outcomes for older adults. There is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation. The primary aim of this study was to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation. Methods This is a subgroup analysis of Irish data gathered as part of a pan-European prospective cohort study. Patients were recruited from two acute hospitals in the Republic of Ireland: Beaumont Hospital and University Hospital Limerick. Patients with a confirmed case of COVID-19 infection and accepted for geriatric rehabilitation in the hospital setting were eligible for recruitment. Functional ability, patient reported symptoms and quality of life were measured using the Barthel Index, the COVID-19 Yorkshire Rehabilitation Screen and the EQ-5D-5L respectively. Results Thirty patients were included in the subgroup analysis. The rate of mortality was 23.3% at six months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at six months after discharge from rehabilitation. Conclusion Multidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.

The Goldilocks Effect Of Hydration For Patients In A Sub-Acute Rehabilitation Setting: Too Warm, Too Cold Or Simply Not Nice

Abstract Background Older adults are considered at risk of becoming dehydrated. Risk of dehydration is increased during a hospital stay. Offering a range of preferred drinks frequently during the day can improve total fluid intake and minimise the risk of low intake dehydration. A survey of patient access to and consumption of water on an inpatient ward for older adult rehabilitation was undertaken. Methods A point prevalence survey was conducted on each patient on an inpatient ward for the following six situations: Results All inpatients (n=26, 15 female and 11 male) completed the survey for each of the six situations. 85% of patients surveyed had access to water (n=22). 85% of patients (n=22) surveyed were able to reach the water and 85% (n=22) could pour the water independently. 15% of patients surveyed (n=4) required assistance to drink (modified consistency (n=2) or physical assistance (n=2). Only 35% of patients (n=9) reported drinking the available water. Of the 17 patients who reported not drinking the water accessible to them, 59% (n=10) reported the water was too warm and 29% of patients (n=5) reported the water didn’t taste nice. Conclusion Low intake dehydration is associated with adverse outcomes in older adults. The root causes of low fluid intake need to be established in order to minimise the risk of dehydration during a period of hospitalisation. Further research is required to establish the root causes of low intake dehydration and development of quality improvement initiatives to minimise low intake dehydration in a hospital setting.

Artificial Intelligence-Powered Technologies For Independent Living Among Older Adults: A Review

Abstract Background The ageing populations in Ireland and around the world has led to an increased focus on technologies that support independent living for older adults. Artificial intelligence (AI) has emerged as a promising solution, with various AI-powered technologies being proposed to assist their daily lives. This review aims to synthesize the findings of studies exploring AI-powered technologies for independent living among older adults. Methods A systematic literature search was conducted using relevant databases, including PubMed, IEEE Xplore, and Google Scholar. The search terms included “artificial intelligence” and “independent living”. Studies published between 2009 and 2023 that investigated AI-powered technologies for independent living among older adults were included in the analysis. Results The included studies investigated various AI-powered technologies including tablets, wearable devices like smartwatches, web portals for carers, Internet of Things (IoT) solutions, user-centered design considerations, the integration of AI with sociology and healthcare, smart home technology, and ambient information systems. The pooled results indicated that AI-powered technologies can improve independent living outcomes for older adults. Benefits included real-time monitoring and health deterioration recognition, fall detection, personalised care, cognitive assistance and reduced isolation. User-centered design approaches and the integration of AI with sociology and healthcare were also found to be essential factors in the successful implementation of these technologies. Conclusion This analysis provides evidence supporting the effectiveness of AI-powered technologies in promoting independent living among older adults. IoT solutions and smart home technology appear to be particularly promising. However, the successful implementation of these technologies requires a multidisciplinary approach, incorporating user-centered design and the integration of AI with sociology and healthcare. Further research is needed to explore the long-term impact of AI-powered technologies on the well-being and autonomy of older adults.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

Psychological Health Outcomes of Older Adult Volunteers: Findings from The Irish Longitudinal Study on Ageing

Abstract Background Volunteering has been shown to alleviate the feeling of loneliness and have indirect positive effects on the subjective quality of life of older adults. Volunteering post-retirement has been shown to have a positive effect on loneliness, quality of life, and depression. This research aimed to examine the relationship between volunteering and depression, loneliness, and quality of life among a nationally representative sample of older adults in the Republic of Ireland. These measures were also examined in the context of volunteering and retirement. Methods Through secondary analysis of five waves of data from the Irish Longitudinal Study on Ageing (TILDA), this research explored the relationships between volunteering, retirement, loneliness, depression and quality of life. To achieve this, both cross-sectional analyses using regression models and longitudinal analysis using mixed-effects modelling were utilised. Results Volunteering had a significant negative association with loneliness [Incident Rate Ratio (IRR)=0.87, 95% CI=0.80,0.95, p<0.01] and depression [IRR=0.88, 95% CI=0.81, 0.96, p<0.01], and a positive association with quality of life [Beta (B)=0.69, 95% CI=0.39, 1.00, p<0.05] at baseline. These associations were not significant over time. Volunteering in retirement was associated with increased quality of life [B=0.7, 95% CI=0.2, 1.1, p<0.05], while associations between depression and loneliness and retirement were not significant. Those who volunteered in retirement experienced less depression over time [IRR=0.90, 95% CI=0.83, 0.99]. Conclusion The findings of this study demonstrate the positive effects of volunteering on the psychological outcomes of older adults. This study also found evidence of the long-term effects of volunteering in retirement on depression, suggesting that continued participation in volunteer activities positively impacts depression. This research demonstrates the importance of increasing opportunities and promoting volunteer participation to contribute to the positive ageing of older adults.

Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department

Abstract Background This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED). Methods A retrospective chart review was conducted on all patients (>65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults >75) for those with a PHF was also analysed. Results A total of 53 older adults (>65) were identified within the study period with a PHF while 43 patients (<65) were identified. In the >65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the >65 group required admission to hospital (N=24) (P<0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (>75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (>75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package. Conclusion PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.

Irish Hip Fracture Database Frailty Index Predicts Delirium Incidence and Length of Stay in Older Adults Admitted with Hip Fractures

Abstract Background The Irish Hip Fracture Database (IHFD) Frailty Index was developed with the National Office for Clinical Audit has been shown to predict adverse outcomes in older adults with fractures in retrospective review of national data. Here we examined the tool prospectively in clinical practice and its ability to predict delirium and length of stay. Methods We prospectively collected data on all hip fracture patients admitted to an acute orthopaedic floor from October 2022 to May 2024. Patients aged < 60 years or those with atypical femoral or peri-prosthetic fractures were excluded. The 21-item frailty index was applied to all eligible patients. Delirium diagnosis was based on a composite of clinical diagnosis and a 4AT score ≥ 4. Regression analysis was used to examine the relationship between delirium and length of stay with Frailty Index, age and sex. Results A total of 260 patients were included in the study, of whom 72% were female. The mean age was 80 ± 10 years, and 7.7% were nursing home residents. Additionally, 24.2% of patients were discharged directly home, while 40.3% were discharged to rehabilitation. Delirium developed in 24.6% of patients, and 24.9% of patients had a LOS exceeding 30 days. Higher frailty index scores were significantly associated with both LOS (p = 0.001) and delirium (p = 0.013) in both unadjusted and adjusted analyses. There was no significant association between age or sex and LOS or delirium in adjusted analysis. Conclusion The IHFD Frailty Index facilitates a pro-active risk stratification that is based on comorbidities and functional status. IHFD Frailty index independently predicted delirium and length of stay while age did not. Further studies integrating this tool into everyday practice in the care of older patients with hip fractures is warranted.

An Early Supported Discharge Model of Care for Older Adults Admitted to Hospital: A Descriptive Cohort Study

Abstract Background Early supported discharge (ESD) facilitates an early discharge from hospital with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Evidence suggests it can have a positive impact on older adults discharging from the acute setting to home. This study aims to characterise an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 days and 180 days. Methods Consecutive older adults referred for ESD from four hospitals in the Mid-West of Ireland were recruited over a six-month period. Baseline assessments were carried out on initial review and patients were followed up at 30 days and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilisation. Results 130 older adults (mean age 76.623 years, SD 9.812 years) were recruited over six months, 44 due to surgical and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days. The incidence of functional decline was 16.406% at 30 days and 27.5% at 180 days. There was a significant improvement in self-reported function from index visit 72.939 (19.502) mean (SD) to 30 days 84.046 (21.078) mean (SD) which was maintained at 180 days 80.534 (30.930) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.061, 95%CI 1.386 to 3.062) and 180 days (OR 1.7, 95%CI 1.292 to 2.236). Conclusion An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days. Future research should explore the impact of an ESD model of care on specific cohorts, using RCT methodology.