Search

Objectives: Frailty is common in hospitalised older people. Clinical practice guidelines for the management of frailty provide recommendations for identification and management; however, adoption into practice in hospitals is limited. This study identified and quantified the evidence‐practice gap between frailty guidelines and clinical practice in two hospitals using an audit tool. Methods: A cross‐sectional audit of medical records of frail older patients admitted to two hospitals was conducted. Data were collected using an audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management. Data were analysed using descriptive statistics and inter‐rater reliability of the tool was assessed. Results: Auditing of n = 70 electronic medical records showed that assessment of frailty in the acute setting did not regularly occur (17%). Few participants received guideline‐recommended interventions. Physiotherapy treatment was limited, with 23% of participants receiving progressive resistance strength training. Gaps exist in provision of nutritional supplementation (26%) with limited recordings of weight during the admission for 10% of participants. Pharmacy review of medications was consistently documented on admission (84%) and discharge (93%). Vitamin D was prescribed for 57% of participants. Inter‐rater reliability showed a high level of agreement using the audit tool. Conclusions: An audit tool was feasible to assess frailty evidence‐practice gaps in the hospital setting. Further understanding of the contextual barriers is needed to inform implementation strategies (dedicated staffing, education and training and ongoing audit of practice cycles) for the uptake of frailty guidelines in hospital settings. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences and perceptions of staff regarding the use of individualised music for people with dementia living in residential aged care. Methods: A qualitative descriptive methodology was used. Methods included a focus group and face‐to‐face interviews, open‐ended responses to a pre‐post survey and relevant clinical notes about older participants' responses. Qualitative content analysis was used to analyse data. Results: There were four themes: (1) transcendental reminiscing, the calm, the joy and the elation; (2) optimism, excitement and the snowball effect; (3) pitching in for older person, it is not rocket science and the hurdles; and (4) music beyond the intervention. Conclusions: Overall, the individualised music was a generally positive experience. While some older participants reported discomfort with the use of headphones, staff concerns related to care and accessibility of music equipment. [ABSTRACT FROM AUTHOR]

Objectives: To determine in a sample of older community‐dwelling adults: (1) the proportion who have engaged in medical and financial planning; (2) the factors associated with advance care directive (ACD) completion and substitute decision maker (SDM) appointment; and (3) for those without an ACD, what might prompt completion. Methods: A cross‐sectional survey was undertaken with individuals receiving community aged care services in metropolitan and regional communities. Data collection was conducted by case managers during a home visit. Results: Overall, 158 individuals (M = 78 years, SD = 8.7) participated (53.5% consent rate). Financial planning participation (will = 85%; enduring power of attorney = 66%) was higher than medical planning participation (SDM: 54%; ACD: 30%). No health status factors were significantly associated with ACD completion or SDM appointment. Diagnosis of a life‐limiting illness was most likely to prompt ACD completion (77.6%). Conclusions: One third of older people residing in the community have completed an ACD. Strategies to improve uptake in this vulnerable population require further exploration. [ABSTRACT FROM AUTHOR]

Objective: To summarise frailty measures and outcomes reported in trials involving frail older inpatients. Methods: Databases were searched for randomised controlled trials enrolling frail older inpatients. Results: Twenty‐four articles describing twelve trials were included. Seven trials applied six tools to measure frailty, whilst five trials employed ad hoc measures. Eighty outcomes were examined with survival and functional status reported most commonly. Nine studies trialled multidisciplinary, geriatrician‐led interventions. Statistically significant between‐group differences were detected for at least one outcome in ten trials. All studies represented high risk of bias within at least one domain. Conclusions: Heterogeneity of interventions, measurement of frailty and outcomes reported limit generalisability of findings. Many articles purport to study frail patients, yet do not enrol patients using any frailty measurement tool. Utilising validated instruments to measure frailty and a standard set of health outcomes relevant to older people would assist consistent reporting and evaluation of future studies. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the long‐term symptom relapse rates among older adults previously treated with cognitive behaviour therapy (CBT) for anxiety and/or depression during COVID‐19. Methods: Participants were 37 older adults (M = 75 years, SD = 5; 65% female) previously treated with CBT for anxiety and/or unipolar depression who were re‐assessed an average of 5.6 years later, during the first Australian COVID‐19 lockdown. Results: On average, there was no significant group‐level change in anxiety, depression or quality of life. When assessing change in symptoms based on clinical cut‐off points on self‐report measures, results suggest only 17%‐22% showed a relapse of symptoms by the COVID‐19 pandemic. Conclusions: Findings suggest that CBT may be protective in coping with life stressors many years after treatment ends. However, results warrant replication to attribute continued symptom improvement to CBT given the lack of control group. [ABSTRACT FROM AUTHOR]

Objectives: This research aimed to explain how the Safe Recovery Programme (SRP) may best work to reduce falls in older adults undergoing rehabilitation in four wards in an older person's health and rehabilitation service. Methods: Qualitative realist methods were used, including surveys completed by patients and staff, and qualitative interviews or focus groups exploring views of patients, ward staff and SRP educators. Results: Emphasising different types of information for patients with different pre‐existing understandings may facilitate their responses to SRP messaging. Consistency and coherence of SRP messaging within ward routines varied in response to staff SRP training and ongoing feedback mechanisms from SRP educators. Conclusions: Tailored individualised approaches for patients with specific characteristics may lead to patients being less likely to engage in risky behaviours. Staff training and processes for facilitating ongoing feedback between patients, SRP and ward staff are required to ensure consistency and coherence of SRP messaging. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of sarcopenia, its associated factors and its impact on readmission in older hospitalised patients with cardiovascular diseases (CVD) in Vietnam. Methods: Patients aged ≥60 with CVD were recruited from 12/2018 to 6/2019 at a tertiary hospital in Vietnam. Sarcopenia was defined by the criteria proposed by the Asian Working Group for Sarcopenia (AWGS). Results: There were 251 participants, with a mean age of 73.7 ± 8.8, 39.4% were female, and 34.3% had sarcopenia. On multivariable logistic regression, heart failure, chronic kidney disease and being currently unmarried were significantly associated with sarcopenia. The incidence of 5‐month readmission was 35.7% (50.0% in sarcopenic participants and 27.9% in non‐sarcopenic participants, P =.001). Sarcopenia independently increased the risk of readmission (adjusted OR 2.19, 95% CI 1.08‐4.42). Conclusion: Sarcopenia was present in one‐third of older hospitalised patients with CVD and increased their risk of readmission. This finding suggests the need to raise awareness of sarcopenia among clinicians and older patients in Vietnam. [ABSTRACT FROM AUTHOR]

Objective: To examine the feasibility of developing an in‐reach parenteral iron infusion service to residents of residential aged care facilities (RACFs). Methods: An audit comparing the use of iron infusions in RACFs prior to and following the introduction of an in‐reach iron infusion service. Results: Of the 738 inpatient iron infusions administered to inpatients ≥65 years in the 12 months prior to the in‐reach service, 52 (7%) lived in an RACF, with no significant adverse events reported. After implementation of an in‐reach service, a total of 37 RACF residents received parenteral iron in the first 12 months of the service, with no significant adverse events reported. Conclusion: It is possible to safely provide parenteral iron through an in‐reach service to residents in RACF. Further research is required to identify the person‐level benefits achieved by this service. [ABSTRACT FROM AUTHOR]

Objectives: Malnutrition after hip fracture is recognised as the co‐morbidity most likely to impact hospital length of stay and cost. Despite this, the role of enteral tube feeding in hip fracture patients remains unclear. Methods: A modified Delphi process was used to establish consensus for an enteral tube feeding decision support tool. Three rounds of the Delphi survey were administered to a purposeful sample of twenty multidisciplinary clinicians from the Australian and New Zealand Hip Fracture Registry. Results: Consensus markedly improved across the three rounds (33, 44 and 87%, respectively). More than 80% of participants positively supported implementing the tool in clinical practice. Conclusions: This study describes experienced, multidisciplinary clinician consensus and support for an ‘Enteral tube feeding decision support tool’ to be applied in acute hip fracture settings. Further studies are being undertaken to identify the impact of the checklist tool on informed consent decision processes in this population. [ABSTRACT FROM AUTHOR]

Objective: To systematically assess the effects of exercise interventions on body composition and functional outcomes in older adults with sarcopenia. Methods: PubMed/Medline, Embase and Cochrane Library were searched from 2006 to 2017 for exercise randomised controlled trials and controlled clinical trials in adults 60 years and older with sarcopenia. Preferred Reporting Items for Systematic Review and Meta‐Analysis protocol (PRISMA‐P) and Physiotherapy Evidence Database (PEDro) scale assessed internal validity. Meta‐analysis and sensitivity analysis were performed. Results: Searches retrieved 1512 titles. Thirty‐two full texts were evaluated, and six trials were included. Methodological quality was 5.5 (0–10). Meta‐analysis revealed that knee‐extension strength (P ≤ 0.01), timed up and go (P < 0.0001), appendicular muscle mass (P = 0.04) and leg muscle mass (P = 0.04) significantly improved in response to exercise interventions. Conclusions: Exercise interventions significantly improved strength, balance and muscle mass. However, the number of trials was small and the training effect was inconsistent due to heterogeneity in exercise mode, duration and intensity. Lack of detailed description makes it impossible to reflect on the progressive resistance training approaches used. More research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: Due to the impact of climate change, mobile applications (apps) providing information about the external environment have the potential to improve the health of older people. The purpose of this research was to undertake a scoping review of the evidence on the usability, feasibility and effectiveness of mobile apps to encourage access to activities outside the home in older people. Methods: A search of databases was undertaken with relevant keywords. Selected manuscripts were judged for relevance to the inclusion criteria and assessed for quality. Results: Very few published studies examined mobile apps specifically designed to prevent, or to treat, chronic disease in ageing populations, and fewer had rigorous designs. No study addressed accessing the external environment in the context of climate change. Conclusion: This study demonstrates that there is a gap in the evidence about the mobile apps designed for healthy ageing and, more specifically, to improve access to the external environment. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of frailty and associated factors in the North West Adelaide Health Study (2004-2006) using the Frailty Phenotype (FP) and Frailty Index (FI). Methods: Frailty was measured in 909 communitydwelling participants aged ≥65 years using the FP and FI. Results: The FP classified 18% of participants as frail and the FI 48%. The measures were strongly correlated (r = 0.76, P < 0.001) and had a kappa agreement of 0.38 for frailty classification, with 37% of participants classified as non-frail by the FP being classified as frail by the FI. Being older, a current smoker, and having multimorbidity and polypharmacy were associated with higher frailty levels by both tools. Female, low income, obesity and living alone were associated with the FI. Conclusion: Frailty prevalence was higher when assessed using the FI. Socioeconomic factors and other health determinants contribute to higher frailty levels. [ABSTRACT FROM AUTHOR]

Objective: To examine frailty prevalence in Australian older adults. Methods: Frailty was measured using a modified Fried Frailty Phenotype (FFP) in a combined cohort of 8804 Australian adults aged ≥65 years (female 86%, median age 80 (79-82) years) from the Dynamic Analyses to Optimise Ageing Project and the North West Adelaide Health Study. Results: Using the FFP, 21% of participants were frail while a further 48% were prefrail. Chi-squared testing of frailty among four age groups (65-69, 70-74, 75-79 and 80-84 years) for sex, and marital status revealed that frailty was significantly higher for women (approximately double that of men), increased significantly with advancing age for both sexes, and was significantly higher for women who were widowed, divorced or never married. Conclusion: If frailty could be prevented or reversed, it would have an impact on a larger number of older people. [ABSTRACT FROM AUTHOR]

Objectives: The measurement of frailty using a Frailty Index (FI) has been criticised as too time-consuming for use in hospital settings. We aimed to assess the feasibility and characteristics of an FI derived from routinely collected data. Methods: A total of 258 participants aged 65 and older were included in a single-centre prospective cohort study conducted in inpatient geriatric rehabilitation wards. The functional independence measure (FIMTM), medication count and comorbidities were coded as deficits. Results: An FI could be derived in all participants. It was normally distributed with a mean (SD) of 0.42 (0.13) and reached a submaximal limit of 0.69. Adjusting for age and sex, the odds ratio of a poor outcome (death/discharge to higher care) was 1.38 (confidence interval 1.11-1.70) per unit (0.1) increase in FI. Conclusion: Derivation of an FI from routinely collected data is feasible in geriatric rehabilitation settings and is predictive of poor outcomes. [ABSTRACT FROM AUTHOR]