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The generation of the active form of vitamin B-6, pyridoxal 5'-phosphate (PLP), in tissues is dependent upon riboflavin as flavin mononucleotide, but whether this interaction is important for maintaining vitamin B-6 status is unclear.To investigate vitamin B-6 and riboflavin status, their metabolic interaction, and relationship with methylenetetrahydrofolate reductase (MTHFR) genotype in adulthood.Data from 5612 adults aged 18-102 y were drawn from the Irish National Adult Nutrition Survey (NANS; population-based sample) and the Trinity-Ulster Department of Agriculture (TUDA) and Genovit cohorts (volunteer samples). Plasma PLP and erythrocyte glutathione reductase activation coefficient (EGRac), as a functional indicator of riboflavin, were determined.Older (≥65 y) compared with younger (65 y) adults had significantly lower PLP concentrations (P 0.001). A stepwise decrease in plasma PLP was observed across riboflavin categories, from optimal (EGRac ≤1.26), to suboptimal (EGRac: 1.27-1.39), to deficient (EGRac ≥1.40) status, an effect most pronounced in older adults (mean ± SEM: 76.4 ± 0.9 vs 65.0 ± 1.1 vs 55.4 ± 1.2 nmol/L; P 0.001). In individuals with the variant MTHFR 677TT genotype combined with riboflavin deficiency, compared with non-TT (CC/CT) genotype participants with sufficient riboflavin, we observed PLP concentrations of 52.1 ± 2.9 compared with 76.8 ±0.7 nmol/L (P 0.001). In participants with available dietary data (i.e., NANS cohort, n = 936), PLP was associated with vitamin B-6 intake (nonstandardized regression coefficient β: 2.49; 95% CI 1.75, 3.24; P 0.001), supplement use (β: 81.72; 95% CI: 66.01, 97.43; P 0.001), fortified food (β: 12.49; 95% CI: 2.08, 22.91; P = 0.019), and EGRac (β: -65.81; 95% CI: -99.08, -32.54; P 0.001), along with BMI (β: -1.81; 95% CI: -3.31, -0.30; P = 0.019).These results are consistent with the known metabolic dependency of PLP on flavin mononucleotide (FMN) and suggest that riboflavin may be the limiting nutrient for maintaining vitamin B-6 status, particularly in individuals with the MTHFR 677TT genotype. Randomized trials are necessary to investigate the PLP response to riboflavin intervention within the dietary range. The TUDA study and the NANS are registered at www.ClinicalTrials.gov as NCT02664584 (27 January 2016) and NCT03374748 (15 December 2017), respectively.Clinical Trial Registry details: Trinity-Ulster-Department of Agriculture (TUDA) study, ClinicalTrials.gov no. NCT02664584 (January 27th 2016); National Adult Nutrition Survey (NANS), ClinicalTrials.gov no. NCT03374748 (December 15th 2017).

The ability of an older adult to walk independently in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, outdoor mobility is often one of the first activities, where a decline is observed. The aim of this study was to examine the factors associated with community ambulation in community dwelling older adults attending a day hospital.This was a cross-sectional observational study design. Inclusion criteria were community dwelling older adults, over 65 years, attending a day hospital and able to ambulate at least 10 m with or without an assistive device. The primary outcome measure was a community ambulation questionnaire. A range of other outcome measures were completed assessing motor, cognitive, executive function and behavioural domains. Multivariate logistic regression was employed to identify independent predictors of community ambulation.161 participants completed this study. The median age was 83 years (IQR 9), 64% were female and 49.1% lived alone. 55.3% of participants were classified as independent community ambulators. Mean gait speed was 0.8 m/s, median TUG score was 16.6 s and median frailty was 4 (IRQ 2) using the Clinical Frail Scale. Self-efficacy (p 0.001) and gait speed (p = 0.030) were independently associated with community ambulation.The findings demonstrate the complexity and multifactorial nature of community ambulation in older adults. This suggests the need to adopt a broader approach to the management of older adults, to promote the achievement of independent community ambulation.

Background Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up. Methods OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures. Results Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59–7.24); P Discussion The ‘Bermuda Triangle’ of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.

Background Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking. Objectives To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults. Methods Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008–2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value

Objectives The aim of this study was to describe the associations between sarcopenia and variables derived from wrist accelerometry in community-dwelling older adults attending a day hospital service in Ireland. Methods An observational cross-sectional study was carried out using a consecutive series of older adults attending a day hospital service. Sarcopenia was diagnosed using the latest European Working Group of Sarcopenia in Older People guidelines. Accelerometers were worn by each participant for a 7-day period on their non-dominant wrist. Results Thirty-eight out of forty-one participants (93%) met the accelerometer wear time criterion and were included in statistical analyses. Included participants had a mean age of 81.1 years (standard deviation 6.2). Both sarcopenia (Grip) and sarcopenia (Lower limb) were associated with increased time spent in low physical activity and reduced average of Kcals per hour. Only sarcopenia (Lower limb) was associated with increased time in sedentary behaviour as well as reduced number of steps taken in a week. Conclusions Accelerometer data can be used in an older day hospital population to track physical activity levels and sedentary behaviours. The assessment tool used to assess muscle strength and the cut-off criteria for physical activity behaviour influences the association with sarcopenia.

BACKGROUND Long-term use of anticholinergics, benzodiazepines and related drugs (or "Z-drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain-specific neuropsychological performance in older adults without dementia, is unclear. METHODS 5135 older adults (74.0 ± 8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity-Ulster-Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). RESULTS A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n = 500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n = 363), whilst 7.5% (n = 387) used a "Z-drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: -0.09; 95% CI: -0.14, -0.03, p = 0.002 for MMSE; β: -0.04; 95% CI: -0.06, -0.02; p

Objectives Progressive resistance training can successfully target functional decline in healthy older community-dwelling adults. There are concerns about the safety and acceptance of its use in frail older populations. The aim of this study was to evaluate the feasibility of using progressive resistance training in an older, post-acute, inpatient setting. Methods A randomised controlled feasibility study was conducted. Appropriate older inpatients undergoing post-acute rehabilitation were recruited. Feasibility measures examined were safety, recruitment, outcome measurement, adherence and retention rates and satisfaction. A range of clinical measures were used to capture changes in body structure and function, activity and participation. Assessments were performed on admission to the study and six weeks later. Results A sample of 33 patients were included and randomised to the treatment group (n=16) or the control group (n=17). There were no serious adverse events, adherence rates were 63% and retention rates were 82%. While both groups improved between time 1 and 2, there were no significant differences in clinical measures between the groups. Conclusion Progressive resistance training is a safe and acceptable intervention for use with this population. Further work on the effectiveness of progressive resistance training in this setting is now required.

Whilst chronic kidney disease has been associated with cognitive impairment, the association between reduced estimated Glomerular Filtration Rate (eGFR) and domain-specific cognitive performance is less clear and may represent an important target for the promotion of optimal brain health in older adults.Participants aged60 years from the Trinity-Ulster-Department of Agriculture study underwent detailed cognitive assessment using the Mini-Mental State Examination (Mini-Mental State Examination (MMSE)), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Poisson and linear regression models assessed the relationship between eGFR strata and cognitive performance.In 4887 older adults (73.9 ± 8.3 years; 67.7% female), declining eGFR strata was associated with greater likelihood of error on the MMSE/FAB and poorer overall performance on the RBANS. Following robust covariate adjustment, findings were greatest for GFR45 ml/ml/1.73 mReduced kidney function was associated with poorer global and domain-specific neuropsychological performance. Associations were strongest with eGFR45 ml/min/1.73 m

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Introduction: The objective of this pilot study was to obtain preliminary data on the efficacy and feasibility of incorporating geriatric assessment (GA) into radiation oncology (RO) with regard to patient outcomes and treatment decisions. Materials and Methods: Feasibility was assessed via the percentage of patients able to complete certain aspects of the assessment on their own, or with the assistance of a carer before appointments, was recorded. Consultation times and referrals were also documented. All participants (n=30) underwent GA at baseline, before randomisation to the intervention/control arm and commencement of radiotherapy treatment planning procedures. The results of GA were relayed to the Radiation Oncologist (RO) for the intervention arm only. GA was repeated for each participant three months after the completion of radiotherapy. Results: There was some evidence of increasing dependence, at three month follow-up, in ADLs and IADLs, less mobility (TUG score), higher GDS scores and increased vulnerability. However, these were not statistically significant. All patients underwent their predefined radiotherapy treatment plan, without modification. A number of deficits on GA were identified that may be considered significant for older patients. Conclusion: The impact on decision making may reflect a lack of experience and familiarity with GA and how to interpret it, as well as an obvious gap in the literature as to how it affects radiotherapy patient outcomes.

We evaluated predictors of the Clinical Frailty Scale (CFS) scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). This was a retrospective observational study (service evaluation) utilising ED-based CGA data routinely collected by Home FIRsT between January and October 2020. A linear regression model was computed to establish independent predictors of CFS. This was complemented by a classification and regression tree (CRT) to evaluate the main predictors. There were 799 Home FIRsT episodes, of which 740 were unique patients. The CFS was scored on 658 (89%) (median 4, range 1-8; mean age 81 years, 61% women). Independent predictors of higher CFS were older age (p0.001), history of dementia (p0.001), mobility (p≤0.007), disability (p0.001), and higher acuity of illness (p=0.009). Disability and mobility were the main classifiers in the CRT. Results suggest appropriate CFS scoring informed by functional baseline.

Aims Given that diabetes is associated with cognitive impairment and dementia in later life, we aimed to investigate the relationship between glycated haemoglobin (HbA1c), diabetes and domain-specific neuropsychological performance in older adults. Methods Cross-sectional cohort study using data from the Trinity-Ulster-Department of Agriculture (TUDA) study. Participants underwent detailed cognitive and neuropsychological assessment using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Assessment for Neuropsychological Status (RBANS). Linear regression was used to assess associations between HbA1c, diabetes status and neuropsychological performance, with adjustment for important clinical covariates. Results Of 4,938 older adults (74.1 ± 8.3 years; 66.9% female), 16.3% (n = 803) had diabetes (HbA1c ≥ 6.5%; 48 mmol/mol), with prediabetes (HbA1c ≥ 5.7% to 6.4%; 39 to 47 mmol/mol) present in 28.3% (n = 1,395). Increasing HbA1c concentration was associated with poorer overall performance on the FAB [β: -0.01 (-0.02, -0.00); p = 0.04 per % increase] and RBANS [β = -0.66 (-1.19, -0.13); p = 0.02 per % increase]. Increasing HbA1c was also associated with poorer performance on immediate memory, visuo-spatial, language and attention RBANS domains. Diabetes was associated poorer performance on neuropsychological tests of immediate memory, language, visual-spatial and attention. Conclusions Both increasing HbA1c and the presence of diabetes were associated with poorer cognitive and domain-specific performance in older adults. HbA1c, and not just diabetes status per se, may represent an important target in the promotion of optimal brain health in older adults.

Given that diabetes is associated with cognitive impairment and dementia in later life, we aimed to investigate the relationship between glycated haemoglobin (HbACross-sectional cohort study using data from the Trinity-Ulster-Department of Agriculture (TUDA) study. Participants underwent detailed cognitive and neuropsychological assessment using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Assessment for Neuropsychological Status (RBANS). Linear regression was used to assess associations between HbAOf 4938 older adults (74.1 ± 8.3 years; 66.9% female), 16.3% (n = 803) had diabetes (HbABoth increasing HbA

Background An emergency department (ED) visit is often considered a sentinel event for an older person due to elevated risks of deleterious outcomes. This prospective cohort study explored factors associated with disposition post ED index visit and unscheduled 30 day revisit. Methods Consecutive ED attendees aged ≥70 years, and Manchester Triage System 3-5, in a 6-month period, were eligible for inclusion. Participants underwent an interdisciplinary assessment by a Home FIRsT (Frailty Intervention & Response Team) member. Logistic regression analyses were performed to identify factors predictive of admission post ED index visit and unscheduled revisit. Predictive validity of frailty instruments were performed using receiver operating characteristic (ROC) curves Results 1,156 ED attendances were included - 59% were female; median age was 80 years; 66% were discharged home post index visit; 17.8% had an unscheduled ED revisit within 30 days. Age and sex did not predict hospital admission. Hospital admission post ED visit was imperfectly predicted by mild-moderate frailty: Clinical Frailty Scale 5-6 (Odds Ratio (OR) 1.83 (95% CI 1.11 – 3.04), p=0.019); ‘Think Frailty’ 3 (OR 1.75 (95% CI 1.07 – 2.85), p=0.025) and 4 (OR 2.32 (95% CI 1.16 – 4.63), p=0.017). Paradoxically, higher frailty scores were not predictive. Cognitive impairment (4AT 1-3) similarly predicted admission (OR 1.62 (95% 1.16 – 2.27, p=0.005), while delirium (4AT ≥4) was the strongest predictor of admission (OR 5.87 (95% CI 3.17 – 10.88, p Conclusion Home FIRsT operationalised the assessment of frailty and delirium in the ED. Delirium is a strong predictor of admission post ED index visit, more than frailty status. Older persons have a high rate of 30-day unscheduled revisits; however, it is difficult to produce models from patient information available at index visit that can reliably predict unscheduled revisits.

Background Falls, syncope and presyncope comprise a large proportion of emergency department (ED) presentations among older people, however accurate data detailing this is limited. The aim of this study therefore was to ascertain the percentage of ED presentations in older people due to falls/syncope/presyncope, and examine admission rates, length of stay and likely underlying diagnosis. Methods Over 1,300 consecutive presentations of older people (aged ≥60 years) to the ED of a large urban university teaching hospital in March 2018 were examined (electronic and hard-copy notes) to ascertain the prevalence of falls/syncope/presyncope presentations. Data was collected for each presentation with fall/syncope/presyncope on demographics, and relevant clinical characteristics, including admission outcome and length of stay (LOS). Results Falls/syncope/presyncope comprised 19% (250/1,324) of presentations of older people to the ED, with a mean age of 75.3 +/-0.64 years. Almost 60% (158/250) presented during ‘normal’ working hours, i.e. Monday to Friday, 0800-1800. Almost half (121/250) had a Manchester Triage Score (MTS) of 3, indicating a need for urgent care, while one third (93/250) were categorized as requiring very urgent or immediate assessment (MTS 2 or 1 respectively). Over one third (97/250) presented with explained/accidental falls, while 26% (66/250) and 35% (87/250) presented with syncope and unexplained falls respectively. One in two (118/250) older people presenting with falls/syncope/presyncope were admitted to the acute hospital, and this rises to almost two thirds (82/135) of those aged ≥75 years. The median LOS was 15 (9.9 -22.0) days. Conclusion Older people frequently present to the ED with falls/syncope/presyncope. The majority present during working hours and admission rates and LOS are relatively high. Falls/syncope/presyncope therefore represent an appropriate target for structured, multidisciplinary assessment at the ‘front door’ to provide early specialist assessment and management, and reduce complications associated with unnecessary admission to hospital.

Background Patient handover has been described as “one of the most perilous procedures in medicine” (British Medical Association, 2004). The Irish Medical Council underlines the importance of high-quality, relevant clinical information communication at shift changes. Methods On Friday January 26th 2018, the weekend handover practice for medical inpatients requiring medical registrar review was formalised in a large Dublin teaching hospital. Firstly, pertinent clinical information and the purpose of review were captured in an electronic order placed on the electronic patient record (EPR). A verbal handover meeting each Friday supported further discussion and patient handover. Data from the 26th of January to the 7th of July 2018 was analysed from the EPR. The purpose of weekend review was grouped under four categories - full clinical review, laboratory results review, review to facilitate discharge and patients who did not demand formal review but were handed over for information only. Results Over the 23 week period, 652 electronic orders for weekend review were placed on medical inpatients. This equated to an average of 27 reviews per weekend. The average age of patients reviewed was 63 years (SD 18.8 years). Median length of stay (LOS) was 4 days with a higher median LOS (6.7 days) observed for those aged 65 years and over. Over half (54%) of all weekend reviews required full clinical review whilst 27% of reviews were for laboratory results follow up only. Comparison between medical inpatients aged less than 65 and greater than 65 years noted little differences between the two cohorts in terms of the purpose of weekend review. Daily review was required for 73% of patents handed over to the medical registrar. Conclusion Weekend review of medical inpatients by medical registrars constitutes a significant workload. A formalised weekend handover practice complimented by an electronic process facilitates safer patient handover by improving the quality, transparency and accessibility of clinical information.

Background Patients with falls/syncope/presyncope frequently present to the emergency department (ED) and many that could be managed safely in an ambulatory care setting are admitted for extensive diagnostic work-up. A pilot intervention commenced in March 2019, with direct access to specialist assessment in the ED for patients presenting with falls/syncope/presyncope, aiming to provide appropriate testing and early diagnosis to reduce unnecessary hospitalizations. This pilot study assessed the feasibility of embedding this service within the ED, as well as the effectiveness of the intervention in terms of admission avoidance. Methods The study was conducted between 25th March and 19th April 2019 in a large urban teaching hospital with a dedicated Falls & Syncope Unit and compared to similar data from March/April 2018. The core ED-FASU team comprised a consultant geriatrician, specialist registrar in geriatric medicine and clinical nurse specialist. Inclusion criteria were those of all ages, presenting with falls/syncope/presyncope/dizziness between 0800-1800 Monday-Friday. Patients were reviewed directly from triage or after referral from the ED team. Results In total, 203 patients were assessed during the pilot, an average of 10 assessments per day. The median age of those seen was 63 (58.0-67.0) years. Almost one third (57/203) were aged ≥75 years. After excluding those who were already admitted to the acute hospital and awaiting a bed when seen in the ED (n=29), 24% (41/174) of those seen were admitted to hospital. This compares to an admission rate of 33% (73/223) for the 2018 comparison group (p = 0.045). Conclusion This pilot study shows that it is feasible to embed specialist assessment for falls/syncope/presyncope in the ED. Initial pilot data suggests a significant reduction in admission rates for those seen by this service but needs to be confirmed over a more prolonged assessment period and alongside data on readmission and length of stay.

Background In a large teaching hospital, a specialist interdisciplinary team identify frailty and begin comprehensive geriatric assessment of older adults in the Emergency Department (ED). This study aimed to determine the clinical utility of a range of measures: grip strength, calf circumference, frailty and functional mobility to evaluate whether they help to estimate the care pathways for patients. Objectives included: (1) To ascertain the prevalence of frailty and (2) To profile this population’s demographics, falls history, calf circumference and grip strength. Methods This was a cross-sectional study. Inclusion criteria were persons ≥ 70 who presented to ED weekdays during research hours 9:00 – 16:00, with Manchester triage score ≥ 3. Information on gait aids, social supports and falls in the past 6 months was self-reported. Grip strength was assessed using hydraulic hand-held dynamometry. Sarcopenia was measured using calf circumference as a proxy. Frailty was determined using the Clinical Frailty Scale (CFS). Functional mobility was assessed by an interdisciplinary team member. Onward referrals and admission to hospital were recorded. Data was analysed using SPSS statistics software. Results One hundred and one participants were included, 39 male (38.6%) and 62 female (61.4%), mean age 79.3 years. Thirty-five percent (n=36) were considered Frail (a CFS score of ≥5), 35.6% (n=36) lived alone, 52.5% (n=53) used a gait aid. Outcomes included admission to hospital (27.7%, n=28) and discharge with onward referral (25.7%, n=26). The most common referral was community physiotherapy (11.9%, n=12). The population identified as frail were more likely to be female (p = 0.036), to use a gait aid (p = 0.001) and to have fallen within the past 6 months (p = 0.007). Conclusion The prevalence of frailty was determined in this population and was not significantly associated with hospital admission, grip strength or calf circumference. A focus on alternative pathways to hospital admission with appropriate access to community services is recommended for individuals with frailty.

Identifying physical frailty is useful in the context of falls and syncope assessment. The phenotype-based SHARE Frailty Instrument for Primary Care (SHARE-FI) does not measure gait speed. We evaluated the association between SHARE-FI and gait speed in a Falls' and Syncope Unit (FASU).We recruited a pilot sample of patients aged 50 and over attending FASU between November 2019 and March 2020. The association between gait speed and SHARE-FI was assessed with the Spearman's co-efficient (r104 participants were included (34 frail) median (IQR) age 74 (68-79) years. 68 were female. There was a significant negative correlation between frailty and gait speed (rSHARE-FI significantly captured gait speed in this clinical sample, adding to its validity.

The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996, 95% Confidence Interval (CI) 0.995–0.998, p &lt, 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p &lt, 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996, 95% CI 0.994–0.998, 0.001) and length of stay (LOS) (β = −0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.

Summary Background Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health. Aim To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years. Design Survey of 150 patients (55% female, mean age 80 years and mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital. Methods The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data were presented descriptively. Results Almost 40% (59/150) reported that their mental health was ‘worse’ or ‘much worse’ while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely ‘very often’. Half of participants (75/150) reported a decline in their quality of life. Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term ‘cocooning’. Conclusions Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness and continue physical activity and access timely medical care and rehabilitation services should be a priority.

To evaluate the association between SHARE-FI and gait speed in a Falls’ and Syncope Unit. There was a significant negative correlation between frailty and gait speed. After controlling for age, sex, body mass index, co-morbidities and polypharmacy, gait speed was an independent predictor of frailty. SHARE-FI significantly capture gait speed in patients attending a Falls’ and Syncope Unit. Identifying physical frailty is useful in the context of falls and syncope assessment. The phenotype-based SHARE Frailty Instrument for Primary Care (SHARE-FI) does not measure gait speed. We evaluated the association between SHARE-FI and gait speed in a Falls’ and Syncope Unit (FASU). We recruited a pilot sample of patients aged 50 and over attending FASU between November 2019 and March 2020. The association between gait speed and SHARE-FI was assessed with the Spearman’s co-efficient (rs). Logistic regression was conducted to investigate the association controlling for age, sex, body mass index, comorbidities and polypharmacy. 104 participants were included (34 frail) median (IQR) age 74 (68–79) years. 68 were female. There was a significant negative correlation between frailty and gait speed (rs − 0.54, P

Key summary points Aim The aim of this study was to describe the prevalence and associated factors of sarcopenia in community-dwelling older adults attending a day hospital service in Ireland, using the latest European Working Group of Sarcopenia in Older People (EWGSOP) guidelines. Findings The prevalence of sarcopenia in older adults attending a day hospital service in Ireland was 27–37% and varied depending on the strength test used. Sarcopenia was associated with older age, female gender, reduced BMI, reduced calf circumference, frailty, malnutrition, and reduced gait speed, irrespective of how muscle strength was assessed. Message Further consideration on the assessment of sarcopenia needs to be considered, regarding the use of muscle strength assessment, whether to assess upper limb, lower limb, or both., Purpose Sarcopenia is a muscle disease that is linked to the effects of ageing, chronic diseases, physical inactivity, and poor nutrition. In Ireland, there is a lack of readily available information on sarcopenia in older adults. The aim of this study was to describe the prevalence and associated factors of sarcopenia in community-dwelling older adults attending a day hospital service in Ireland, using the European Working Group of Sarcopenia in Older People (EWGSOP) guidelines. Methods An observational cross-sectional study was conducted, where a consecutive series of older adults attending a day hospital service were invited to participate. The measure of primary interest was the diagnosis of sarcopenia using the EWGSOP 2019 guidelines. We also collected other Comprehensive Geriatric Assessment measures including cognition, nutrition, frailty and physical activity. Results A total of 134 participants took part in the study. The mean age was 81.7 (SD ± 7.1). Sixty-one percent (N = 82) were female. The prevalence of sarcopenia ranged from 27 to 37% depending on the assessment tool used to assess muscle strength. Sarcopenia was associated with older age, frailty, reduced nutritional state, poor physical performance and reduced anthropometric measures, irrespective of how muscle strength was measured. Independently associated factors differed depending on muscle strength test, except for older age. Conclusion The prevalence of sarcopenia in the day hospital ranged from 27 to 37%. The assessment tool used to assess muscle strength influenced both the prevalence and associated factors of sarcopenia, suggesting scope for further research.

Background Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017. Aim To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. Design Retrospective observational study. Methods We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital. Results In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P Conclusions Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.

Background Machine learning techniques, specifically classification algorithms, may be effective to help understand key health, nutritional, and environmental factors associated with cognitive function in aging populations. Objective This study aims to use classification techniques to identify the key patient predictors that are considered most important in the classification of poorer cognitive performance, which is an early risk factor for dementia. Methods Data were used from the Trinity-Ulster and Department of Agriculture study, which included detailed information on sociodemographic, clinical, biochemical, nutritional, and lifestyle factors in 5186 older adults recruited from the Republic of Ireland and Northern Ireland, a proportion of whom (987/5186, 19.03%) were followed up 5-7 years later for reassessment. Cognitive function at both time points was assessed using a battery of tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with a score Results In the classification of a low RBANS score ( Conclusions The results suggest that it may be possible for a health care professional to make an initial evaluation, with a high level of confidence, of the potential for cognitive dysfunction using only a few short, noninvasive questions, thus providing a quick, efficient, and noninvasive way to help them decide whether or not a patient requires a full cognitive evaluation. This approach has the potential benefits of making time and cost savings for health service providers and avoiding stress created through unnecessary cognitive assessments in low-risk patients.

BACKGROUND Machine learning techniques, specifically classification algorithms, may be effective to help understand key health, nutritional, and environmental factors associated with cognitive function in aging populations. OBJECTIVE This study aims to use classification techniques to identify the key patient predictors that are considered most important in the classification of poorer cognitive performance, which is an early risk factor for dementia. METHODS Data were used from the Trinity-Ulster and Department of Agriculture study, which included detailed information on sociodemographic, clinical, biochemical, nutritional, and lifestyle factors in 5186 older adults recruited from the Republic of Ireland and Northern Ireland, a proportion of whom (987/5186, 19.03%) were followed up 5-7 years later for reassessment. Cognitive function at both time points was assessed using a battery of tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with a score RESULTS In the classification of a low RBANS score (F1 score range 0.73-0.93), all highlighting the individual’s score from the Timed Up and Go (TUG) test, the age at which the participant stopped education, and whether or not the participant’s family reported memory concerns to be of key importance. The classification models performed well in classifying a greater rate of decline in the RBANS score (F1 score range 0.66-0.85), also indicating the TUG score to be of key importance, followed by blood indicators: plasma homocysteine, vitamin B6 biomarker (plasma pyridoxal-5-phosphate), and glycated hemoglobin. CONCLUSIONS The results suggest that it may be possible for a health care professional to make an initial evaluation, with a high level of confidence, of the potential for cognitive dysfunction using only a few short, noninvasive questions, thus providing a quick, efficient, and noninvasive way to help them decide whether or not a patient requires a full cognitive evaluation. This approach has the potential benefits of making time and cost savings for health service providers and avoiding stress created through unnecessary cognitive assessments in low-risk patients.

Background Genome-wide and clinical studies have linked the 677C→T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR) with hypertension, whilst limited evidence shows that intervention with riboflavin (i.e. the MTHFR co-factor) can lower blood pressure (BP) in hypertensive patients with the variant MTHFR 677TT genotype. We investigated the impact of this common polymorphism on BP throughout adulthood and hypothesised that riboflavin status would modulate the genetic risk of hypertension. Methods Observational data on 6076 adults of 18–102 years were drawn from the Joint Irish Nutrigenomics Organisation project, comprising the Trinity-Ulster Department of Agriculture (TUDA; volunteer sample) and the National Adult Nutrition Survey (NANS; population-based sample) cohorts. Participants were recruited from the Republic of Ireland and Northern Ireland (UK) in 2008–2012 using standardised methods. Results The variant MTHFR 677TT genotype was identified in 12% of adults. From 18 to 70 years, this genotype was associated with an increased risk of hypertension (i.e. systolic BP ≥ 140 and/or a diastolic BP ≥ 90 mmHg): odds ratio (OR) 1.42, 95% confidence interval (CI) 1.07 to 1.90; P = 0.016, after adjustment for antihypertensive drug use and other significant factors, namely, age, male sex, BMI, alcohol and total cholesterol. Low or deficient biomarker status of riboflavin (observed in 30.2% and 30.0% of participants, respectively) exacerbated the genetic risk of hypertension, with a 3-fold increased risk for the TT genotype in combination with deficient riboflavin status (OR 3.00, 95% CI, 1.34–6.68; P = 0.007) relative to the CC genotype combined with normal riboflavin status. Up to 65 years, we observed poorer BP control rates on antihypertensive treatment in participants with the TT genotype (30%) compared to those without this variant, CT (37%) and CC (45%) genotypes (P Conclusions The MTHFR 677TT genotype is associated with higher BP independently of homocysteine and predisposes adults to an increased risk of hypertension and poorer BP control with antihypertensive treatment, whilst better riboflavin status is associated with a reduced genetic risk. Riboflavin intervention may thus offer a personalised approach to prevent the onset of hypertension in adults with the TT genotype; however, this requires confirmation in a randomised trial in non-hypertensive adults.

BackgroundFalls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes.MethodsA consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants’ self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann–Whitney U tests.ResultsThe mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear.ConclusionsWearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.

Background Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial and include extrinsic factors such as unsafe footwear. Inappropriate footwear may increase the risk of falls. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. Methods A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, use of glasses, social support, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Subjects’ self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Participation was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. Those with shoes fitting on at least one foot were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann–Whitney U tests. Results 72% of participants were wearing footwear that did not fit correctly on both feet according to our definition based on previous literature. Only 6% were wearing footwear that fitted correctly on both feet. 67% wore slippers at home. 90% had shoes with smooth, partly worn or fully worn sole treading. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. Conclusions Wearing incorrectly fitting shoes and shoes with unsafe features is common among older adults attending geriatric day services. The large number of participants who reported wearing slippers at home is also an important finding. Ill-fitting footwear and slippers are risk factors for falls thus warranting further investigation to help guide future falls prevention services at day hospitals.

Vitamin B12 deficiency is common among older adults, even with dietary intakes well in excess of current recommendations. Severe clinical B12 deficiency (i.e. pernicious anaemia) leads to irreversible neurological damage, but once diagnosed, can be treated effectively with B12 injections. A much more common cause of low vitamin B12 status in older adults is food-bound malabsorption owing to atrophic gastritis. This in turn leads to reduced gastric acid secretion, thus limiting B12 absorption from food (given the essential role of gastric acid in releasing B12 from food proteins). Proton pump inhibitor (PPI) drugs reduce gastric acid secretion, similar to atrophic gastritis, thus there is a concern that these medications may lead to vitamin B12 malabsorption. Therefore, the aim of this study was to investigate biomarker status of vitamin B12 in relation to atrophic gastritis and PPI usage. Data were accessed from The Trinity Ulster Department of Agriculture (TUDA) Ageing Cohort Study, a cross-sectional study of community-dwelling adults (n 5186, ≥ 60 years) recruited across Northern Ireland and the Republic of Ireland (2008–2012). TUDA participants were classified into 3 groups; ‘healthy’ controls, atrophic gastritis and PPI users. Vitamin B12 status was assessed using a total of four biomarkers: serum total B12; serum holotranscobalamin, holoTC; plasma methylmalonic acid, MMA; plasma homocysteine. Atrophic gastritis was identified using pepsinogen analysis (via ELISA), with a pepsinogen I : II ratio of < 3 considered indicative of atrophic gastritis. Based on results from all four biomarkers, participants with atrophic gastritis were found to have significantly lower B12 status compared to healthy controls: e.g. mean (95% CI) serum total vitamin B12, 188 (156, 218) pmol/L vs. 262 (252, 272) pmol/L P < 0.001; holoTC, 46.0 (38.1, 53.8) pmol/L vs. 60.3 (57.8, 62.8) pmol/L P < 0.001; plasma MMA, 0.65 (0.52, 0.78) μmol/L vs. 0.37 (0.32, 0.42) μmol/L P = 0.001. No differences in B12 biomarker concentrations were observed between PPI users and healthy controls. Regular consumption of fortified foods (i.e. ≥ 5 portions per week) compared to non-regular consumption (i.e. 0–4 portions per week) impacted positively on B12 biomarker status in all participants. This effect however appeared insufficient to restore normal vitamin B12 status in those with atrophic gastritis. These results show that older adults with atrophic gastritis have significantly lower vitamin B12 biomarker status, particularly in those who did not regularly consume fortified foods. Further investigations of the effect of atrophic gastritis and PPI usage on B12 status are warranted.

Previous reports investigating adiposity and cognitive function in the population allude to a negative association, although the relationship in older adults is unclear. The aim of this study was to investigate the association of adiposity (BMI and waist:hip ratio (WHR)) with cognitive function in community-dwelling older adults (≥60 years). Participants included 5186 adults from the Trinity Ulster Department of Agriculture ageing cohort study. Neuropsychological assessment measures included the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multi-variable linear regression models were used to assess the association between adiposity and cognitive function adjusting for insulin resistance, inflammation and cerebrovascular disease. The mean ages were 80·3 (sd6·7), 71·0 (sd7·3) and 70·2 (sd6·3) years on the cognitive, bone and hypertensive cohorts, respectively. In the cognitive cohort, BMI was positively associated with immediate and delay memory, visuospatial/constructional ability, language and MMSE, and negatively with FAB (log-transformed), whereas WHR was negatively associated with attention. In the bone cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with visuospatial/constructional ability, attention and MMSE. In the hypertensive cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with immediate and delayed memory, visuospatial/constructional ability, language and MMSE and positively with FAB (log-transformed). In the cognitive and bone cohorts, the association of WHR and attention disappeared by further controlling for C-reactive protein and HbA1C. In this study of older adults, central adiposity was a stronger predictor of poor cognitive performance than BMI. Older adults could benefit from targeted public health strategies aimed at reducing obesity and obeseogenic risk factors to avoid/prevent/slow cognitive dysfunction.

Objectives: To investigate the relationship between area‐level deprivation and risk of cognitive dysfunction. Design: Cross‐sectional analysis. Setting: The Trinity, Ulster, and Department of Agriculture (TUDA) study from 2008 to 2012. Participants: Community‐dwelling adults aged 74.0 ± 8.3 without dementia (N = 5,186; 67% female). Measurements: Adopting a cross‐jurisdictional approach, geo‐referenced address‐based information was used to map and link participants to official socioeconomic indicators of deprivation within the United Kingdom and the Republic of Ireland. Participants were assigned an individual deprivation score related to the smallest administrative area in which they lived. These scores were categorized into comparable quintiles, that were then used to integrate the datasets from both countries. Cognitive health was assessed using the Mini‐Mental State Examination (MMSE); cognitive dysfunction was defined as a MMSE score of 24 or less. Results: Approximately one‐quarter of the cohort resided within the most‐deprived districts in both countries. Greater area‐level deprivation was associated with significantly lower MMSE scores; fewer years of formal education; greater anxiety, depression, smoking and alcohol use, and obesity; and more adverse outcomes, including higher blood pressure and diabetes risk. After adjustment for relevant covariates, area deprivation was associated with significantly higher risk of cognitive dysfunction (odds ratio = 1.40, 95% confidence interval = 1.05–1.87, P = .02, for most vs least deprived). Conclusion: This analysis combining data from two health systems shows that area deprivation is an independent risk factor for cognitive dysfunction in older adults. Adults living in areas of greatest socioeconomic deprivation may benefit from targeted strategies aimed at improving modifiable risk factors for dementia. Further cross‐national analysis investigating the impact of area‐ level deprivation is needed to address socioeconomic disparities and shape future policy to improve health outcomes in older adults.

Vitamin B12 deficiency is common in older individuals. Circulating vitamin B12 concentration can be used to diagnose deficiency, but this test has substantial false positive and false negative rates. We conducted genome-wide association studies (GWAS) in which we resolved total serum vitamin B12 into the fractions bound to transcobalamin and haptocorrin: two carrier proteins with very different biological properties. We replicated reported associations between total circulating vitamin B12 concentrations and a common null variant in FUT2. This allele determines the secretor phenotype in which blood group antigens are found in non-blood body fluids. Vitamin B12 bound to haptocorrin (holoHC) remained highly associated with FUT2 rs601338 (p.Trp154Ter). Transcobalamin bound vitamin B12 (holoTC) was not influenced by this variant. HoloTC is the bioactive the form of the vitamin and is taken up by all tissues. In contrast, holoHC is only taken up by the liver. Using holoHC from individuals with known FUT2 genotypes, we demonstrated that FUT2 rs601338 genotype influences the glycosylation of haptocorrin. We then developed an experimental model demonstrating that holoHC is transported into cultured hepatic cells (HepG2) via the asialoglycoprotein receptor (ASGR). Our data challenge current published hypotheses on the influence of genetic variation on this clinically important measure and are consistent with a model in which FUT2 rs601338 influences holoHC by altering haptocorrin glycosylation, whereas B12 bound to non-glycosylated transcobalamin (i.e. holoTC) is not affected. Our findings explain some of the observed disparity between use of total B12 or holoTC as first-line clinical tests of vitamin B12 status.