Age and Ageing

In Adult Social Care, UK local authorities have statutory responsibilities for assessing needs and delivering services to ensure adults wellbeing. Administrative data collected during this process may help local authorities compliance with these duties. We developed and internally validated predictive models for older people (>- 60 years) receiving social care for whether they remained at home or were admitted to care homes, two years after index assessments, using administrative data from one English City authority. We enquired whether the right data, to predict older peoples vulnerability to adverse outcome (care home) or evidence their strengths (remaining at home), were present in local authority systems, and if accurate datasets for large numbers of older people could be constructed to allow robust modelling. Logistic regression models were created with binary outcome (remaining at home/entering care homes). Sample size calculations determined the maximum number of candidate predictors we could consider for model development. 20,128 older people in the data cohort indicated we could consider a maximum of 46 candidate predictor parameters. In our final analyses we considered 31 candidate predictor parameters, in the areas of: age, sex, ethnicity, deprivation, housing tenure, abilities in activities of daily living, access to carer, Primary Support Reason, diagnosis of dementia. We used all data for model development and internal validation using cross-validation. Models were robust as to assumptions, with no evidence of overfitting and good predictive accuracy. Circumstances predicting strongly that older people would not remain at home were that they were: from other (non-white) ethnic groups, privately rented tenants or other (unstable) tenancies, not able to eat or keep their home habitable, with their Primary Support Reason for personal care, mental health, or support with cognition. With public involvement partners, we created a prototype index for local authority use to inform professional decisions and/or local planning.

BackgroundThere is a paucity of evidence relating to the implementation of interventions for dementia care. The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a 12-month, home-based, individually tailored rehabilitation programme, delivered by therapists and rehabilitation support workers, with a focus on strength, balance, physical activity and activities of daily living which has been tested in a randomised controlled trial (RCT). The aim of this study was to identify what is required to implement PrAISED, or similar interventions, in a real-world setting in routine practice. MethodsA 6-month version of PrAISED was delivered as a pilot service in one National Health Service organisation in England. Adaptations were made to intervention processes to facilitate the delivery of PrAISED as a service instead of as part of a research study. The number and duration of visits for each patient were recorded by intervention delivery staff and were summarised using descriptive statistics. Semi-structured interviews were conducted with seven members of staff delivering the PrAISED pilot service (two managers, five delivery staff) and eight members of staff from other sites involved in the PrAISED RCT (four managers, four delivery staff). The Consolidated Framework for Implementation Research was used to inform interview guides and conduct a codebook thematic analysis. ResultsBetween April and November 2022, 11 patients were referred to, and participated in, the service. Patients received on average 20.9 visits (mean duration 82.1 mins). Five themes were identified from interviews relating to the pilot service: operational processes; workforce capacity; referral; intervention delivery and patient impact. A further six themes were identified regarding the wider implementation of dementia therapy programmes: the need for support post-dementia diagnosis; acceptability; effective delivery; reach/referral; intervention design and adaptability; and intervention materials and training. ConclusionsInterventions like PrAISED are needed to fill a gap in support immediately post-dementia diagnosis. Future implementation in practice will require attention to the identification of intervention funding; leadership and management; time to establish operational processes; therapists with appropriate skills and experience; providing training and resources to support intervention delivery; defining patient eligibility, refining referral processes; and maintaining fidelity of the intervention.

BackgroundCare home residents are at high risk of severe outcomes following respiratory infection due to age, co-morbidities, and close contact with staff and other residents. Frequent staff testing could potentially reduce respiratory infection cases in residents, but evidence is limited. This study uses historical COVID-19 data in England to assess the impact of varying staff testing rates under different transmission scenarios to inform response during future pandemics. MethodsWe developed a compartmental model of SARS-CoV-2 transmission in England, with three population strata: general population, care home staff, and residents. The model was calibrated using prevalence data from January 2021 to March 2022 and testing rates from the VIVALDI Study (ISRCTN14447421). We conducted a scenario analysis projecting resident cases and deaths over 12 months under varying staff testing frequencies (monthly, twice-monthly, weekly, twice-weekly, daily) assuming a new dominant strain. We also explored the impact of testing when combined with a hypothetical low-cost highly-effective public health and social measures. FindingsStaff testing alone has little impact on reducing cases and deaths in the resident population. Daily testing could avert only 3.8% (95%UI: 3.1-4.4%) cases and 3.5% (95%UI: 2.3-4.4%) deaths compared to a baseline testing of less than one test per month. When combined with public health and social measures, however, the effect is large. Daily staff testing, combined with public health and social measures, can reduce resident cases by 54% (95%UI: 50-58%) and deaths by 50% (95%UI: 26-59%). Additionally, if testing frequency is reduced but there is still a public health and social measure, the effect size decreases, however there are potential cost savings ({pound}0.7 to {pound}3.4 million). InterpretationIncreasing staff testing alone is insufficient to significantly reduce SARS-CoV-2 cases and deaths in care home residents. However, combining testing with some form of a public health and social measure aimed at reducing transmission among residents, is epidemiologically effective and cost-effective in most scenarios and possibly cost saving.

BackgroundUrinary tract infections (UTIs) are a leading cause of hospitalisation in people living with dementia (PLWD), making accurate detection and prompt treatment essential in this vulnerable population. MethodsThis retrospective longitudinal cohort study assessed the concordance between self-reported symptoms, urine colony counts >10{square} CFU/mL, dipstick results positive for leukocytes and/or nitrites, and urinary IL-8 levels in identifying UTIs among PLWD. The study included 78 community-dwelling individuals aged over 50 with a confirmed dementia diagnosis, recruited from cohorts established by the Surrey and Borders Partnership NHS Foundation Trust and the Hammersmith & Fulham Partnership Primary Care Network between late 2019 and 2023. ResultsUTI frequency among PLWD was highly variable, with some individuals experiencing recurrent infections whilst others had none throughout the study period. The microbial taxa identified were consistent with those seen in other populations. There was no clear concordance between self-reported symptoms and laboratory indicators of UTI. However, dipstick-positive results correlated with urine samples showing >10{square} CFU/mL of a single colony morphology growth and elevated IL-8 concentrations. ConclusionsUrinary dipstick tests for nitrites and leukocytes may serve as a practical screening tool for UTIs in PLWD, particularly in individuals unable to reliably report symptoms. However, future research is needed to evaluate the clinical impact of this diagnostic approach on outcomes such as hospitalisation rates, delirium incidence, and antibiotic resistance and stewardship in this vulnerable population.

IntroductionDementia is becoming increasingly prevalent in the UK. Older adults from black and south Asian communities have a higher risk for dementia due to an increased prevalence of dementia specific risk factors such as hypertension, diabetes, and heart disease. Deprivation has also been linked to an increased risk of dementia. Ethnic minority and lower socioeconomic groups are underrepresented in dementia research. The aim of this study was to explore factors influencing diversity in dementia and rehabilitation research within the context of the Promoting Activity, Independence, and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT). MethodsWe conducted an exploratory sequential mixed methods study to explore disparities in socioeconomic and ethnic diversity between the PrAISED RCT population and recruitment pathways used in one study site (Nottinghamshire) and compared these with regional and national data. We aimed to collate and summarise data available on ethnicity and deprivation for recruitment/referral pathways (Nottinghamshire site) and the PrAISED cohort (all sites). Additionally, we interviewed healthcare professionals (n=2), researchers (n=2) and members of black and south Asian communities (n=4) to explore barriers to participating in research for people with dementia. ResultsUnder 2% of the overall PrAISED RCT sample (across all sites) were from a non-white ethnic minority background and a third of participants lived in areas with the least deprivation. Referrals to memory assessment services in Nottinghamshire included people from diverse socioeconomic backgrounds, with 7.3% being from non-white ethnic minority communities. Through interviews, several barriers to healthcare, research and rehabilitation were identified. Healthcare barriers included lack of awareness of dementia, mistrust, stigma, fear, and lack of culturally appropriate services. Research barriers included recruitment routes, awareness of research, language, and recruiter beliefs. Barriers to rehabilitation research included a lack of use of culturally appropriate language, more culturally specific barriers, and lack of representation. ConclusionParticipants recruited to the PrAISED RCT were mainly white and socioeconomically privileged. Data recording and access around ethnicity is still inconsistent, making it difficult to ascertain at which point services and research become inaccessible for people from underserved communities. Future research needs to work with these communities to develop innovative solutions to overcome the barriers identified in this study and to put recommendations made into practice.

Structured AbstractO_ST_ABSINTRODUCTIONC_ST_ABSIf mild cognitive impairment (MCI) is diagnosed after dementia, it suggests either the dementia diagnosis was premature, or the MCI diagnosis is incorrect. We investigated the prevalence and predictors of such "diagnostic reversion"--MCI diagnosis following dementia diagnosis--in a large academic health system. METHODSAmong 5,965 patients aged 50+ with incident dementia in UCSF Health electronic health records, we identified "reverters" with a subsequent MCI diagnosis. We used Group LASSO-regularized logistic regression and random forest models to identify predictors. RESULTSReversion occurred in 13.7% of patients. Lower odds were observed among older adults (OR=0.95/year; 95% CI: 0.92-0.98), while higher odds were found among Spanish speakers (OR=2.26; 95% CI: 1.28-4.00), those with greater cardiovascular risk (OR=1.16; 95% CI: 1.01-1.33), and higher Charlson comorbidity burden (OR=1.09; 95% CI: 1.05-1.14). DISCUSSIONDiagnostic reversion is common and socially patterned, suggesting contributions from misdiagnosis, clinical uncertainty, or variability in clinical presentation and care setting.

BackgroundSleep disturbances are common in people living with dementia and negatively affect them and their family carers. Non-pharmacological interventions like DREAMS:START (Dementia Related Manual for Sleep: Strategies for Relatives) offer potential benefits but are not yet implemented widely in NHS practice. AimsTo explore the barriers and facilitators to implementing DREAMS:START in UK NHS dementia services, from the perspective of healthcare professionals and intervention facilitators, using qualitative interviews. MethodWe interviewed 19 NHS staff - (n=10) staff with no prior DREAMS:START experience and (n=9) DREAMS:START facilitators using semi-structured interviews and analysed data using reflexive thematic analysis, organized according to the Consolidated Framework for Implementation Research (CFIR). Ethical approval was granted by the London-Camden and Kings Cross Research Ethics Committee (Reference: 20/LO/0894). ResultsFive key themes emerged: 1) perceived need for interventions targeting sleep in dementia; 2) importance of evidence and cost-effectiveness; 3) influence of service manager attitudes and support; 4) inter-professional interconnectedness and training; and 5) staff capacity and attitudes toward change. Participants highlighted the need for flexible, personalised delivery, robust evidence, training, supervision, and local champions to facilitate adoption. ConclusionsImplementation of DREAMS:START in NHS services is feasible but organisational barriers need addressing to enhance staff capacity, and promote evidence-based, cost-effective practices. Findings from this study will inform strategies for scaling up the intervention to improve sleep outcomes for people with dementia and their carers.

BackgroundDelirium is strongly associated with subsequent dementia, but this is often assumed to reflect underlying associations of baseline health with dementia. We examined the associations of delirium on admission with incident dementia across the spectrum of multimorbidity. MethodsRetrospective population-based cohort study using linked primary care and hospital data for emergency admissions aged [≥]65 years in Lothian, Scotland, from 1 Apr 2017 to 1 Apr 2020. Delirium on admission was assessed at the bedside for all patients using the 4AT (www.the4AT.com). Associations of delirium, multimorbidity, and their interaction with incident dementia and mortality were examined using Fine-Gray competing-risks regression and Cox proportional hazards models. ResultsOf 23,558 people without pre-existing dementia (mean age 78.9 years, 54% female), 4135 (18%) had an admission with delirium. Delirium was associated with higher incident dementia risk. The relative risk was highest in those without multimorbidity (adjusted Hazard Ratio (aHR) 3.38, 95% CI 2.46-4.63) and decreased with an increasing number of long-term conditions. Delirium was also associated with increased mortality, regardless of multimorbidity. In those without multimorbidity, delirium was associated with higher early mortality ([≤]90 days: aHR 4.23, 95% CI 3.27 to 5.49) and late mortality (>90 days: aHR 1.64, 95% CI 1.33 to 2.03). ConclusionDelirium is strongly associated with incident dementia in older adults across the multimorbidity spectrum, with the highest relative risk in people without multimorbidity. Findings support routine delirium assessment on hospital admission for all older adults and highlight need to further investigate neurodegenerative mechanisms in delirium.

ImportanceHealthcare workers (HCWs), including those with mild symptoms, may be an important source of COVID-19 within elderly care. ObjectiveTo gain insight into the spread of SARS-CoV-2 among HCWs working in elderly care settings. DesignCross-sectional study among HCWs working in elderly care in the South-East of the Netherlands, testing for SARS-CoV-2, between March 31 and April 17, 2020. SettingHCWs working in geriatric rehabilitation, somatic and psychogeriatric wards or small-scale living groups and district nursing, with a total of 5245 HCWs within 4 organisations. Participants621 HCWs with mild respiratory symptoms. Main OutcomesNumber of HCWs testing positive for SARS-CoV-2 in pharyngeal swabs, using realtime reverse-transcriptase PCR targeting the SARS-CoV-2 E-gene, N-gene, and RdRP. HCWs filled out a survey to collect information on symptoms and possible sources of infection. Results133/615 (21.6%) HCWs tested positive for SARS-CoV-2, ranging from 15.6 to 44.4% per elderly care organisation, and from 0 to 64.3% per separate location of the organizations, respectively. 74.6% of tested HCWs were nursing staff, 1.7% elderly care physicians, 20.3% other HCWs with patient contact and 3.4% HCWs without patient contact. In the univariate analysis, fever, runny or stuffy nose, anosmia, general malaise, myalgia, headache and ocular pain were associated with SARS-CoV-2 positivity, while gastro-intestinal symptoms and respiratory symptoms, other than runny or stuffy nose were not. Risk factors for SARS-CoV-2 positivity were contact with patients or colleagues with suspected or proven COVID-19. Whole genome sequencing of 22 samples in 2 facilities strongly suggests spread within facilities. Conclusions and RelevanceWe found a high SARS-CoV-2 prevalence among HCWs in nursing homes and district nursing, supporting the hypothesis of undetected spread within elderly care facilities. Structural testing of elderly care HCWs, including track and trace of contacts, should be performed to control this spread, even when only mild symptoms are present.

The COVID-19 pandemic negatively affected known dementia risk factors and cognition in older adults. We invited adults with mild cognitive concerns without dementia, aged [≥]60 years participating in a randomised controlled trial of a psychosocial, secondary dementia prevention intervention, to complete a co-designed, semi-structured qualitative survey, regarding how the pandemic impacted their lifestyle and wellbeing in areas relevant to dementia risk: social connections, activities, diet, mental and physical health, community and family support. Data was collected between October 2020 and December 2022; we conducted manifest content analysis. 551/746 trial participants completed the survey. Most (n=530, 96%) described pandemic-related changes to lifestyle or wellbeing; two thirds (n=369/545, 67.7%) reported less activities. A quarter (n=145, 26.8%) identified no change in social connections, with others reporting less in-person meetings (n=139, 25.7%) or speaking to less people (n=99; 18.2%); a minority engaged in compensatory online activities (n=31, 5.7%) and online (n=63, 11.6%) or phone (n=90, 16.6%) social contact. Relatively few reported weight gain (n=22, 4.0%); two-thirds reported no change in their diet (n=360, 66.1%), with others eating more unhealthy food (n=31, 4.8%), more food (n=21, 3.9%) and/or snacks (n=11, 2.0%); others reporting more healthy eating (n=26, 4.8%) and/or more home cooking (n=57, 10.5%). Modes of support changed, with reliance on food parcels, online services and shopping by neighbours. Over half reported (almost exclusively negative) mental health pandemic-related changes (n=307, 56.9%), including depression, stress, fear and loneliness; many reported declines in physical health (n=153, 28.1%) and/or fitness (n=70, 12.8%). Stoical accounts of adaptation and resilience, enabled by technology and community support predominated, but were not possible for all. Reducing the digital divide, tackling loneliness and developing inclusive online/in-person support programmes that are more resilient in future lockdowns could protect cognitively frail people now and in any future pandemic, and contribute to national dementia prevention strategy. Trial registration: ISRCTN17325135; https://doi.org/10.1186/ISRCTN17325135 (27.11.19)

BackgroundDementia is associated with frailty leading to increased risks of falls and hospitalisations. Interventions are required to maintain functional ability, strength and balance. DesignMulti-centre parallel group randomised controlled trial, with embedded process evaluation. Procedures were adapted during the COVID-19 pandemic. ParticipantsPeople with mild dementia or mild cognitive impairment (MCI), living at home, and a family member or carer. ObjectivesTo determine the effectiveness of an exercise and functional activity therapy intervention compared to usual care. InterventionA specially-designed dementia-specific rehabilitation programme focussing on strength, balance, physical activity and performance of ADL, which was tailored, progressive, addressed risk and the psychological and learning needs of people with dementia, providing up to 50 therapy sessions over 12 months. The control group received usual care plus a falls risk assessment. Main outcome measureThe primary outcome was the informant-reported Disability Assessment for Dementia (DAD) 12 months after randomisation. Secondary outcomes were: self-reported ADL, cognition, physical activity, quality of life, frailty, balance, functional mobility, fear of falling, mood, carer strain and service use (at 12 months) and falls (between months 4 and 15). Results365 people were randomised, 183 to intervention and 182 to control. Median age of participants was 80 years (range 65-95), median Montreal Cognitive Assessment score 20/30 (range 13-26), 58% were men. Participants received a median of 31 (IQR = 22-40) therapy sessions out of a possible maximum of 50. Participants reported completing a mean 121 minutes/week of PrAISED activity outside of supervised sessions. Primary outcome data were available for 149 (intervention) and 141 (control) participants. There was no difference in DAD scores between groups: adjusted mean difference -1.3/100, 95% Confidence Interval (-5.2 to +2.6); Cohens d effect size -0.06 (-0.26 to +0.15); p=0.5. Upper 95% confidence intervals excluded small to moderate effects on any of the range of secondary outcome measures. Between months 4 and 15 there were 79 falls in the intervention group and 200 falls in the control group, adjusted incidence rate ratio 0.78 (0.5 to 1.3); p= 0.3. ConclusionThe intensive PrAISED programme of exercise and functional activity training did not improve ADLs, physical activity, quality of life, reduce falls or improve any other secondary health status outcomes even though uptake was good. Future research should consider alternative approaches to risk reduction and ability maintenance. Trial registrationISRCTN15320670. FundingNational Institute for Health and Care Research What is already knownO_LIDementia is associated with progressive loss of functional ability, including activities of daily living and mobility, and a high risk of falls C_LIO_LIExercise programmes and rehabilitation therapies may improve ability, or slow the rate of decline, but evidence from trials and systematic reviews is equivocal C_LI What this study tells usO_LIWe developed an intensive dementia-specific exercise and functional activity rehabilitation programme, lasting 12 months, taking account of motivation, learning needs and context, in particular the need to engage carers, and evaluated it in a randomised controlled trial C_LIO_LIThe programme was very well received by participants and therapists, but had no effect on activities of daily living, physical activity, quality of life, falls, cognition or any other health status outcome C_LIO_LIWe are unlikely to be able to change rate of loss of ability in dementia through exercise or functionally orientated rehabilitation therapy. C_LIO_LIWe need different ways of defining wellbeing after a dementia diagnosis. C_LI

BackgroundUnderstanding whether apathy in older adults is related to incident dementia and mortality could help identify at-risk individuals, and inform public health efforts. This study aimed to investigate associations between apathy and these outcomes over long-term follow-up, and their independence from the overlapping symptoms of depression and fatigue. MethodsIn an Australian population-based cohort of 1,030 community-dwelling older adults aged 70-90, without dementia at baseline, apathy was assessed using the self-report Geriatric Depression Scale-3A subscale. Incident dementia was established via consensus diagnosis over 12 year follow-up, and mortality by record linkage over 18 years. We calculated hazard ratios (HRs) using Cox proportional hazards analyses. We repeated analyses adjusting for depression, fatigue and covariates, accounting for competing risk of mortality, and excluding short-term cases. FindingsUnadjusted primary analyses showed the presence of self-reported apathy was associated with higher risk of dementia (HR 1.45, 95% confidence interval (CI) 1.05-2.00) and mortality (HR 1.76, 95% CI 1.43-2.16). Participants with apathy developed dementia a year earlier, and died three years earlier. These findings remained significant when adjusting for depression. The association with dementia was no longer significant when adjusting for fatigue or covariates, nor when taking mortality into account or excluding those cases where dementia developed in the shorter term. InterpretationThe presence of apathy may represent an important risk indicator for dementia and mortality in older adults without dementia, independent of depression. Its association with dementia may reflect reverse causality. Future studies are needed to better understand the causal relationships that may underpin this observed association in the short and long-term, and the utility of apathy for screening in public health settings. FundingDementia Australia Research Foundation, Centre for Healthy Brain Ageing.

BackgroundJapan is fast becoming an extremely aged society and older adults are known to be at risk of severe COVID-19. However, the impact of risk factors specific to this population for severe COVID-19 caused by the Omicron variant of concern (VOC) are not yet clear. MethodsWe performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive SARS-CoV-2 test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors--dementia, admission from a long-term care facility, and poor physical activity status--and used Fishers exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. ResultsOf the 4,868 cases analyzed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility, and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility, and poor physical activity status was -0.04 (95% confidence interval -0.07, -0.01), 0.09 (0.06, 0.12), and 0.17 (0.14, 0.19), respectively. ConclusionsOur results suggest that poor physical activity status and living in a long-term care facility have a substantial impact on the risk of severe COVID-19 caused by the Omicron VOC, while dementia might be associated with non-severe illness.

Nursing homes (NH) continue to struggle with COVID-19 morbidity and mortality with older adult residents at greater risk of infection due to proximity to other residents, advanced aging-related chronic illnesses, and contact with staff. While many states have prioritized COVID-19 vaccinations among older adults, vaccinations among NH staff vary. The purpose of this study was to quantify the relationship between nursing home staff vaccination uptake and COVID-19 infections among residents. A zero-inflated Poisson regression model was constructed to predict the weekly number of COVID-19 cases among Missouri nursing home residents using data from the Centers for Medicaid and Medicare Services. A total of 1,124 COVID-19 infections were reported among 504 NH residents between January 1, 2021 and August 22, 2021. After adjusting for number of total residents, resident vaccine rate, staff quality rating, and respective county COVID-19 rate, for every percent increase in nursing home staff vaccine rate the risk of COVID-19 infections significantly decreased by 13% (IRR 0.87, 95% CI 0.81, 0.93). This study identified that NH staff, likely due to greater mobility, are important to prioritize in vaccination efforts to protect themselves and residents of their facilities from COVID-19 infections. Further, the CMS staff ratings were significant predictors of infection as well, which highlight the structural challenges that exist within and outside the context of a highly infectious and deadly pandemic. These results also provide insights to optimizing vaccination roll-out to best protect our communities most vulnerable residents.

IntroductionThe public health measures imposed to contain Covid-19 during the first UK lockdown resulted in significant changes in the provision of community support and care for people with dementia. People with low prevalence and young-onset dementias often experience non-memory, behavioural or neuropsychiatric symptoms that require specialised support. ObjectiveWe explored the impact of the first Covid-19 lockdown on people living with low prevalence and young-onset dementia and their carers in the UK. MethodAn online survey, including eleven questions about the impact of the lockdown on both the person with dementia and their family caregivers was conducted. Participants were people living with dementia and caregivers who are members of the UK national-reach organisation Rare Dementia Support. Results184 carers and 24 people with dementia completed the survey. People with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%) and well-being (57%) according to their carers. Carers also reported a reduction in the support received for caring (55%). 93% of carers of people living in care homes reported a reduction in their ability to provide care. 26% of carers reported changes in the medication of the person with dementia during the lockdown. 74% of people with dementia reported decreased ability to connect with people socially. ConclusionsPeople with dementia experienced a worsening of dementia symptoms, removal of support and increased difficulty to connect with other people socially during the 1st wave of Covid-19. Carers encountered barriers to both receiving and providing support and a decline in their own mental health and well-being. Key pointsO_LI70 % of carers reported cognitive symptoms getting worse during the lockdown (e.g., the person with dementia being more disoriented and finding it more difficult to communicate). C_LIO_LI26 % of carers reported a change (initiation or increase) in medication in the person with dementia during the lockdown. C_LIO_LI79 % carers reported their own physical or mental health getting worse due to the lockdown. This increased to 93% when considering responses only from family carers of people living in care homes. C_LIO_LI93 % of family carers of people living in care homes found it harder to continue providing care and support for their relative due to Covid-19. C_LI

BackgroundMobility loss is common in hospitalized older adults, and resources to prevent mobility loss are finite. Our goal was to develop a rapid, universal screening tool that identifies individuals at risk of losing the ability to walk during hospitalization on the first hospital day. Second, we determined if the model could inform the use of mobility-preserving interventions. MethodsWe included patients admitted to a general medical service, aged [&ge;]65 years, who could walk on admission (Braden Scale Activity subset >=3). Patients were considered to have a new mobility impairment if the activity score was <3 on discharge. We used predictors available on the first hospital day to develop (2017-18) and validate (2019) a prediction model. We determined the association between predicted risk and therapy use in the validation cohort to highlight the models clinical utility. Results5542 patients were included (median age 76yrs, 48% women); 7.6% were discharged unable to walk. The model included six predictors: age, marital status, medication administrations, Glasgow Coma Scale verbal score, serum albumin, and urinary catheter presence. In the validation cohort, the model discriminated well (c-statistic 0.75) and was strongly associated with hospital-acquired mobility loss (lowest decile 1%, highest decile 24%). In the validation cohort, therapy consultation ordering increased linearly with predicted risk; however, observed mobility loss increased exponentially. ConclusionThe Day-1 Mobility Loss model predicts the risk of mobility loss in hospitalized older adults on the first hospital day. Further, it identifies at-risk older adults who may benefit from mobility interventions.

ObjectiveSystematically review and critically appraise evidence for the association between delirium and falls in community-dwelling adults aged 60 years and above MethodsWe searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews (EBMR) databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle Ottawa scale), provide a narrative synthesis and where appropriate conduct meta-analysis. ResultsWe included eight studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (RR 6.66;95% CI 2.16-20.53) but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled OR 2.01; 95%CI 1.52-2.66), one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns. ConclusionsWe found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship, establish how and why this operates bi-directionally and identify potential modifying factors involved. We recommend the use of standardised assessment measures for delirium and falls. Clinicians should be aware of the potential relationship between these common presentations. Key pointsO_LIThis is the first systematic review of the association between delirium and falls in the wider community population. C_LIO_LIThere is relatively limited but consistent evidence on the direction of effect for both delirium preceding falls and falls preceding delirium. C_LIO_LIMore high-quality longitudinal work is needed to explore the nature of this potentially complex and bidirectional relationship. C_LIO_LIHistory of falls and delirium should be considered when assessing patients with incidence/suspected incidence of falls or delirium. C_LI

Dementia is a progressive degenerative disease, typically affecting older adults for which there is currently no cure. Dementia is characterised by progressive impairment to several cognitive functions including memory and orientation, practical abilities and mood changes, all of which can impact personality and social relationships. The theory of social death has been explored for people living with dementia as the ability to maintain social interactions are threatened leading to a loss of social identity and exclusion and withdrawal from the wider community. A relationship-centred care approach has been recommended to improve care for older people in long-term care, aiming to create environments conducive to relationships, considering the needs of the person living with dementia and also the staff and family members involved in their care. The Senses Framework by Nolan was designed to promote relationships, acknowledging the experiences of all parties across six senses: security, continuity, belonging, purpose, fulfilment and significance. Utilising the Senses Framework has the potential to sustain meaningful relationships by fostering a sense of value and empowerment. This Rapid Evidence Summary aims to explore the evidence assessing the benefits of a relationship triad approach (Senses Framework and other relationship-centred care approaches) in long term care settings (including care homes) for people living with dementia. Nine primary studies and one systematic review were identified. The benefits of using a relationship-centred approach were mapped under each of the senses described within the Senses Framework, detailed separately for people living with dementia, relatives and care home staff. For people living with dementia, interventions using touch and music increased the sense of security and belonging reducing neuropsychiatric conditions such as agitation and aggression. Memory boxes were used to support a sense of significance and continuity and significant moments from the past brought pleasure and enabled meaningful conversations. For relatives and staff, improved communication and relationships increased confidence and trust and by working together they found that they could exert more influence and could develop into a powerful force for change.

This study challenges the assumption that undiagnosed cognitive impairment (CI) is driven primarily by patient-level barriers like poor awareness. In a population-weighted cohort of 1,856 older Singaporeans, CI prevalence was 24.7% (95%CI 18.8-31.8); yet the undiagnosed rate was high (81.4%, 95%CI 65.6-90.9), especially for mild CI (97.9%, 95%CI 94.1-99.3). This diagnostic gap persisted despite high symptom awareness (81.3%, 95%CI 63.6-91.5) and help-seeking intent (63.3%, 95%CI 47.5-76.7), with informants becoming key as CI worsened. Findings suggest successful public health campaigns have shifted the bottleneck from community awareness to healthcare system capacity, creating an opportunity for a policy shift to meet rising demand for diagnosis--by empowering primary care with efficient case-finding tools, formalizing integrated diagnostic pathways, and establishing channels for family informants involvement. From these findings, we conceptualized a paradox of success model, providing a framework for other health systems to adapt policy as public engagement grows.

Understanding the genetic and environmental risk factors for serious bacterial infections in ageing populations remains incomplete. Utilising the UK Biobank (UKB), a prospective cohort study of 500,000 adults aged 40-69 years at recruitment (2006-2010), could help address this. We assess the feasibility of linking an England-wide dataset of microbiological isolations to UKB participants, to enable characterisation of microbial infections within the UKB Cohort. Microbiological infections occurring in patients in England, as recorded in the Public Health England Second Generation Surveillance System (SGSS), were linked to UKB participants using pseudonymised identifiers. By January 2015, ascertainment of laboratory reports from UKB participants by SGSS was estimated at 98%. 4.5% of English UKB participants had a positive microbiological isolate in 2015. Half of UKB isolates came from 12 laboratories, and 70% from 21 laboratories. Incidence rate ratios for microbial isolation, which is indicative of serious infection, from the UKB cohort relative to the comparably aged general population ranged from 0.6 to 1, compatible with the previously described healthy participant bias in UKB. Data on microbial isolations can be linked to UKB participants from January 2015 onwards. This linked data would offer new opportunities for research into infectious disease in older individuals.