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Ageing & Dementia

A systematic review of the evidence for deprescribing interventions among older people living with frailty

A systematic review of the evidence for deprescribing interventions among older people living with frailty

Kinda Ibrahim, Natalie J. Cox, Jennifer M. Stevenson, Stephen Lim, Simon D. S. Fraser & Helen C. Roberts (April 2021)

Background

Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.

External web link - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8

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Assessment and treatment of the anorexia of aging: a systematic review

Cox N, Ibrahim K, Aihie Sayer A, Robinson S, & Roberts H. (January 2019)

Background

Appetite loss in older people, the 'Anorexia of Aging' (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment.

External web link - https://pubmed.ncbi.nlm.nih.gov/30641897/

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The challenge of managing undernutrition in older people with frailty. 

Roberts H, Lim S, Cox N & Ibrahim K. (April 2019). 

Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation
External web link - https://www.mdpi.com/2072-6643/11/4/808

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Comprehensive geriatric assessment in primary care: a systematic review.

Garrad J, Cox N, Dodds R, Roberts H, Sayer AA. (April 2019)

Background
Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team.

External web link - https://link.springer.com/article/10.1007%2Fs40520-019-01183-w

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Physical activity among hospitalised older people: the feasibility and acceptability of a volunteer-led mobility intervention in the SoMoVe study. 

Lim S, Ibrahim K, Dodds R, Purkis A, Baxter M, Rogers A, Aihie Sayer A, Roberts H. (September 2019)

Objectives: to determine the feasibility and acceptability of a volunteer-led mobility intervention to improve activity levels of older inpatients.

Design: pre-post mixed methods study.

Setting: acute medical wards for older people.

External web link - https://doi.org/10.1093/ageing/afz114

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Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies.

Bridges J, Collins P, Flatley M, Hope J, Young A, (February 2020)

Background
There is no recent synthesis of primary research studies into older people's experiences of hospital care.

External web link - http://https://doi.org/10.1016/j.ijnurstu.2019.103469

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Covid-19: supporting nurses’ psychological and mental health.

Maben J, Bridges J (April 2020)

Background
As the coronavirus disease 2019 (COVID‐19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time.

External web link - https://doi.org/10.1111/jocn.15307

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Volunteer-led physical activity interventions to improve health outcomes for community-dwelling older people: A systematic review.

Lim SER, Cox NJ, Tan QY, Ibrahim K, Roberts HC. (April 2020)

Background
Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. There is strong evidence to support the benefits of physical activity interventions on the health outcomes of older adults. Nonetheless, innovative approaches are needed to ensure that these interventions are practical and sustainable.

External web link - https://link.springer.com/article/10.1007/s40520-020-01556-6

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Self-management in older people living with cancer and multi-morbidity: A theory-led systematic review and synthesis of qualitative studies.

Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J (June 2020)

Objective
Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multimorbidity on self‐management. This qualitative systematic review and synthesis aimed to identify what influences self‐management from the perspective of older adults living with cancer and multimorbidity.

External web link - https://doi.org/10.1002/pon.5453

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Hybrid simulation modelling for dementia care services planning

Evenden D, Brailsford S, Walsh B, Kipps C, Roderick P. (June 2020)

Abstract
Dementia is an increasing problem in today’s ageing society, and meeting future demand for care is a major concern for policy-makers and planners. This paper presents a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to calculate the numbers of patients at different stages of disease severity over time, and their associated care costs.

External web link - https://doi.org/10.1080/01605682.2020.1772020

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Poor appetite is associated with six month mortality in hospitalised older men and women.

Cox N J, Lim SE, Howson FFA, Moyses HE, Ibrahim K, Sayer AA, Roberts HC, Robinson SM (July 2020). 

Abstract

Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women.

External web link - https://link.springer.com/article/10.1007/s12603-020-1442-0

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Progression modelling of cognitive decline and associated FDG-PET imaging features in Alzheimer’s disease.

Prosser AMJ, Evenden D, Holmes R, Kipps CM. (July 2020)

Background
Prognosis for Alzheimer’s disease is difficult, with rates of disease progression varying widely. Despite the extensive use of clinical dementia severity assessment scales to determine dementia diagnosis and to monitor progression, there is no consensus on which imaging factors may accurately predict future decline trajectories on these measures. Determination of baseline imaging patterns that are related to slower, or faster, decline rates could be used to identify those at highest risk of worse outcomes and inform care planning.

External web link - https://doi.org/10.1002/alz.045900

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New horizons in appetite and the anorexia of ageing.

Cox NJ, Morrison L, Ibrahim K, Robinson SM, Sayer AA, & Roberts HC. (July 2020)

Abstract
Appetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person’s society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty.

External web link - https://academic.oup.com/ageing/article/49/4/526/5733078?login=true

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Quality of Life Assessments in Individuals with Young-Onset Dementia and Their Caregivers.
Dixit D, Spreadbury J, Orlando R, Hayward E, Kipps C. (July 2020)
Background
Quality of life (QoL) has seldom been investigated or explicitly measured in young-onset dementia (YoD). The aims of this study were (1) to investigate and compare QoL self- and proxy reports in a sample of YoD patients and caregivers using different conceptual assessments of QoL and (2) to examine the relationship between caregiver QoL and both burden and mental health.
External web link - https://journals.sagepub.com/doi/10.1177/0891988720933348

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The impact of regional 99mTc-HMPAO singlephoton-emission computed tomography (SPECT) imaging on clinician diagnostic confidence in a mixed cognitive impairment sample.

Prosser A, Tossici-Bolt L, Kipps C. (September 2020)

AIM
To assess the clinical impact of regional cerebral blood flow (rCBF) single-photon-emission computed tomography (SPECT) imaging on diagnosis and clinician diagnostic confidence in a cohort of individuals with cognitive impairment.

External web link - https://doi.org/10.1016/j.crad.2020.04.016

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Future Impact of dementia within an ageing population; simulation modelling of prevalence, outcomes and costs of dementia within the Wessex region.

Evenden D, Brailsford S, Walsh B, Roderick P. (September 2020)

Objectives
The aim of the study was to model dementia prevalence and outcomes within an ageing population using a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to better inform dementia care service planning, taking into account severity progression variability.

External web link - https://doi.org/10.1016/j.puhe.2020.07.018

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Can probiotics, prebiotics and synbiotics improve functional outcomes for older people: a systematic review. 

Coutts L, Ibrahim K, Tan QY, Lim SER, Cox NJ and Roberts HC (September 2020)

Abstract
Research evaluating the effect of probiotics, prebiotics and synbiotics (PPS) on laboratory markers of health (such as immunomodulatory and microbiota changes) is growing but it is unclear whether these markers translate to improved functional outcomes in the older population. This systematic review evaluates the effect of PPS on functional outcomes in older people.

External web link - https://doi.org/10.1007/s41999-020-00396-x

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Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity.

Corbett T, Cummings A, Lee K, Calman L, Fenerty V, Farrington N, Lewis L, Young A, Boddington H, Wiseman T, Richardson A, Foster C, Bridges J. (October 2020)

Background
Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions.

External web link - https://doi.org/10.1371/journal.pone.0240516

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Association between Quality of Interactions Schedule ratings and care experiences of people with a dementia in general hospital settings: a validation study.

Lee K, Frankland J, Griffiths P, Hewer,  Richards L, Young A, Bridges J. (November 2020)

Introduction
Establishing methods to evaluate interactions between hospital staff and patients with a dementia is vital to inform care delivery. This study aimed to assess the validity of Quality of Interactions Schedule (QuIS) ratings in relation to the care experiences of people with a dementia in a general hospital setting.

External web link - https://doi.org/10.1002/gps.5464

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Clinical Nurse Specialist Role in Young Onset Dementia Care.

Spreadbury J, Kipps C. (December 2020)

Abstract
Post-diagnostic care in young-onset dementia (YoD) varies, from something that is occasionally structured, to improvised, to frequently non-existent depending on geographic region. In a few regions in England, a nurse designated to helping families may exist. This study aimed to describe this seldom-observed nursing role and its content. It used an investigative qualitative case study design based on the analysis of two YoD clinical nurse specialists (CNSs) describing the work they did in providing post-diagnostic care to YoD service users.

External web link - https://doi.org/10.12968/bjcn.2020.25.12.604

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Recommendations for the management of COVID-19 pandemic in long-term care facilities.

Gosch M, Heppner H, Lim S. et al. (January 2021)

Abstract
Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

External web link - https://doi.org/10.1007/s00391-021-01847-1

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Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials

Pazan F, Ibrahim K & et al. (January 2021). 

Background
Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.

External web link - https://eprints.soton.ac.uk/445965/

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The composition of the gut microbiome differs among community dwelling older people with good and poor appetite.

Cox N, Bowyer R, Lochlainn M, Wells P, Roberts H, Steves C. (February 2021)

Background
Anorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia.

External web link - https://doi.org/10.1002/jcsm.12683

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Implementing grip strength assessment in hip fracture patients: a feasibility project.

Doherty W J, Stubbs T A, Chaplin A, Langford S, Sinclair N, Ibrahim K, Reed M R, Sayer A A, Witham M D, Sorial A K. (February 2021)

Objectives
Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. 

External web link - https://eprints.soton.ac.uk/446434/