Age and Ageing

PurposeThe United Kingdom (UK) care home population has experienced high mortality during the COVID-19 pandemic. Atypical presentations of COVID-19 are being reported in older adults and may pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterise the presenting symptoms and associated mortality of COVID-19 in older adults, with a focus on care home residents and older adults living in the community. MethodsThis was a retrospecti...

ObjectivesDetermine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study DesignLongitudinal observational cohort study using individual-level linked data. SettingCare home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. MethodsWe estimated odds ratios (ORs [95% confidence...

BackgroundFrailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, co-morbid adults. Awareness of atypical presentations is critical to facilitate early identification. ObjectiveTo assess how frailty affects presenting COVID-19 symptoms in older adults. DesignObservational cohort study of hospitalised older patients and self-report data for community-based older adults. SettingAdmissions to St Th...

BackgroundSeveral definitions exist for multimorbidity, frailty or polypharmacy, but no formal definition exists for "complex health needs". We aimed to identify and characterise older people with complex health needs based on healthcare resource use (unplanned hospitalisations or polypharmacy) or frailty. MethodsIn this cohort study, data was extracted from UK primary care records (CPRD GOLD), with linked Hospital Episode Statistics inpatient data. People aged >65 on 1st January 2010, register...

PurposeTo ascertain delirium prevalence and outcomes in COVID-19. MethodsWe conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. ResultsIn 71 patients, 31 (42%) had delirium, of which only 19 had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by t...

BackgroundCare home residents have complex care and support needs, as demonstrated by their vulnerability during the COVID-19 pandemic. There is a perception that the needs of residents have increased, but evidence is limited. We investigated changes in health and functioning of care home residents over two decades in England and Wales. MethodsWe conducted a repeated cross-sectional analysis over a 24-year period (1992-2016), using data from three longitudinal studies, the Cognitive Function an...

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-anal...

BackgroundOlder adults with coronavirus disease 2019 (COVID-19) face an increased risk of adverse health outcomes including mortality. Ethical guidelines consider allocation of limited resources based on likelihood of survival, frilty, co-morbidities and age. However, the association of frailty with clinical outcomes in older COVID-19 patients remains unclear. ObjectivesTo determine the association between frailty and short-term mortality in older adults hospitalized for COVID-19. DesignRetros...

ObjectivesDelirium in hospitalised older adults is associated with negative health outcomes. Admission to an alternative care setting may lower the incidence of delirium. The Acute Geriatric Community Hospital (AGCH) was recently opened in the Netherlands and uses a multi-component non-pharmacological intervention strategy to prevent delirium. The objective of this study was to describe the incidence of delirium at the AGCH and compare this incidence to existing rates from literature. If a possi...

PurposeOur aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. MethodsHospitalised patients aged [≥]70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. ResultsIn 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioecon...

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 E...

ObjectivesThe aim of this study is to determine if a geriatric co-management model, referred to as "The Geriatric Emergency Medicine (GEM)-team is associated with less admissions to hospital in older patients compared to the usual care without increasing the risk of mortality or 30-day ED readmissions. DesignThis observational, controlled study used 18-month data prospectively collected from hospital records. Inverse probability weighted, logistic and linear regression models were used for eval...

BackgroundFrailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its predictive ability for adverse outcomes in geriatric patients. MethodsEHRs were extracted for 18,225 geriatric patients with unplanned admissions between 1/3/2020 and 17/6/2021 from...

BackgroundCOVID-19 pandemic has had a major impact on society, including on residents of nursing homes (NH), who have a higher risk of complications and mortality due their physical and intellectual disabilities. AimTo identify which risk factors associated with developing COVID-19 infection with symptoms in institutionalized older people. MethodsA 1-year longitudinal multicenter study was conducted in 5 NH during the period December 2019 to March 2021. The inclusion criteria used were residen...

ObjectivesWandering is a common behaviour among people with dementia living in care homes, driven by various factors such as enjoyment, a sense of purpose, lifelong habits, and social interaction. These elements can bring both physical and mental benefits, highlighting the need for strategies that enable safe wandering while respecting individual autonomy. This realist synthesis aimed to explore these strategies and the conditions under which they lead to successful outcomes. MethodsThis realis...

ObjectiveHospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients. DesignIn this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control ...

PurposeTo describe the clinical features of COVID-19 in older adults, and relate these to outcomes. MethodsCohort study of 217 individuals ([≥]70 years) hospitalised with COVID-19, followed up for allcause mortality. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil: lymphocyte ratio were used as measures of immune activity. ResultsCardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hosp...

BackgroundThe COVID-19 pandemic has had a disproportionate impact upon older people. Frailty is being used to further refine the risk of poor outcomes in hospitalised older people. But studies to date on COVID related outcomes using frailty scales have reported inconsistent findings. We plan a retrospective cohort study using national data sources across England. The objectives are: O_LITo determine if there is there an association between COVID-19 infection (virus identified), frailty risk (me...

BackgroundFrailty assessment in the Emergency Department (ED) is essential for identifying older adults at risk of adverse outcomes. The 20-item Clinical-Functional Vulnerability Index (IVCF-20) is a rapid, multidimensional screening tool widely used in Brazilian primary care, but its predictive validity in the ED has not been established. We aimed to evaluate the ability of the IVCF-20 to predict 180-day mortality and other adverse outcomes in older adults admitted to a public ED. MethodsObser...

BackgroundVirtual wards (VWs) deliver multidisciplinary care at home to people with frailty at high risk of a crisis or in-crisis, aiming to mitigate the risk of hospital admission. Different VWs models exist and evidence of effectiveness is inconsistent. AimWe conducted a rapid realist review to identify different types of VWs, and to develop explanations for how and why VWs could deliver effective frailty management. MethodsWe searched published and grey literature to identify evidence on VW...