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  • 1.

    【2hr】1INTRODUCING GAIT SPEED TO ASSESS FRAILTY OUTCOMES IN DAY HOSPITAL PATIENTS

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    机译 1步态加快，可评估日间住院患者的脆弱性结果
    摘要：
  • 2.

    【2hr】Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries

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    机译 多发病率，医疗保健利用率和健康状况之间的关联：来自16个欧洲国家的证据
    摘要：Background: with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe.Methods: we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011–12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity.Results: overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27–0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42–1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03–2.24), being depressed (AOR 1.48, 95% CI = 1.42–1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02–2.22).Conclusion: multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.
  • 3.

    【2hr】Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study

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    机译 髋骨骨折患者的老年医学和骨折联络服务模式的临床效果：基于人群的纵向研究
    摘要：Objectives: to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).Setting: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.Population: patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.Methods: each hospital was analysed separately and acted as its own control in a before–after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.Results: of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI: 0.65–0.82) and HR = 0.81 (CI: 0.75–0.87), respectively. Following an FLS, these associations were as follows: HR = 0.80 (95% CI: 0.71–0.91) and HR = 0.84 (0.77–0.93). There was no significant impact on time to second hip fracture.Conclusions: the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.
  • 4.

    【2hr】Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of externally derived risk scores

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    机译 连续入选非急性药物的妄风险分层：外部风险评分的验证
    摘要：Background: reliable delirium risk stratification will aid recognition, anticipation and prevention and will facilitate targeting of resources in clinical practice as well as identification of at-risk patients for research. Delirium risk scores have been derived for acute medicine, but none has been prospectively validated in external cohorts. We therefore aimed to determine the reliability of externally derived risk scores in a consecutive cohort of older acute medicine patients.Methods: consecutive patients aged ≥65 over two 8-week periods (2010, 2012) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The reliability of existing delirium risk scores derived in acute medicine cohorts and simplified for use in routine clinical practice (USA, n = 2; Spain, n = 1; Indonesia, n = 1) was determined by the area under the receiver operating characteristic curve (AUC). Delirium was defined as prevalent (on admission), incident (occurring during admission) and any (prevalent + incident) delirium.Results: among 308 consecutive patients aged ≥65 (mean age/SD = 81/8 years, 164 (54%) female), existing delirium risk scores had AUCs for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior.Conclusions: externally derived delirium risk scores performed well in our independent acute medicine population with reliability unaffected by simplification and might therefore facilitate targeting of multicomponent interventions in routine clinical practice.
  • 5.

    【2hr】Race and fall risk: data from the National Health and Aging Trends Study (NHATS)

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    机译 种族和跌倒风险：来自美国国家健康与老龄化趋势研究（NHATS）的数据
    摘要：Objectives: the objective of this study was to explore whether race-based difference in fall risk may be mediated by environmental and physical performance risk factors.Methods: using data from a nationally representative longitudinal survey of 7,609 community-dwelling participants in the National Health and Aging Trends Study (NHATS), we evaluated whether racial differences in fall risk may be explained by physical performance level (measured by the Short Physical Performance Battery), mobility disability, physical activity level and likelihood of living alone. Multivariate Poisson regression and mediation models were used in analyses.Results: in whites and blacks, the annual incidence of ‘any fall’ was 33.8 and 27.1%, respectively, and the annual incidence of ‘recurrent falls’ was 15.5 and 12.3%, respectively. Compared with whites, blacks had relative risks of 0.7 (95% confidence interval 0.6–0.8) and 0.6 (0.5–0.8) for sustaining any fall and recurrent falls, respectively, in adjusted analyses. Blacks had poorer performance on the SPPB (P < 0.001), higher levels of mobility disability (P < 0.001), similar levels of physical activity (P = 0.19) and were equally likely to live alone relative to whites (P = 0.77). Mediation analysis revealed that these risk factors collectively acted as suppressors and none of these factors accounted for the racial differences in fall risk observed.Conclusions: relative to whites, blacks were at 30 and 40% decreased risk of sustaining any fall and recurrent falls, respectively. This difference in risk remains unexplained.
  • 6.

    【2hr】The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study

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    机译 多维预后指数预测老年患者的住院时间：一项多中心前瞻性研究
    摘要：Background: prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation.Objective: to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients.Design: prospective multicentre cohort study.Setting: twenty Geriatrics Units.Participants: patients aged 65 and older consecutively admitted to Geriatrics Units.Measurement: at admission, the CGA-based MPI was calculated by using a validated algorithm that included information on basal and instrumental activities of daily living, cognitive status, nutritional status, the risk of pressures sores, co-morbidity, number of drugs and co-habitation status. According to validated cut-offs, subjects were divided into three groups of risk, i.e. MPI-1 low risk (value ≤0.33), MPI-2 moderate risk (value 0.34–0.66) and MPI-3 severe risk of mortality (value ≥0.67).Results: two thousand and thirty-three patients were included; 1,159 were women (57.0%). Age- and sex-adjusted mean LOS in patients divided according to the MPI grade was MPI-1 = 10.1 (95% CI 8.6–11.8), MPI-2 = 12.47 (95% CI 10.7–14.68) and MPI-3 = 13.41 (95% CI 11.5–15.7) days (P for trend <0.001). The overall accuracy of the MPI to predict LOS was good (C-statistic 0.74, 95% CI 0.72–0.76). Moreover, a statistically significant trend of LOS means was found even in patients stratified according to their International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) main diagnosis.Conclusions: the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.
  • 7.

    【2hr】The facilitators of communication with people with dementia in a care setting: an interview study with healthcare workers

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    机译 在护理机构中与痴呆症患者沟通的促进者：与医护人员的访谈研究
    摘要：Objectives: to describe the views of healthcare workers on the facilitators of communication with people with dementia in a care setting.Design: thematic analysis of semi-structured interviews.Setting: all participants were interviewed in their place of work.Participants: sixteen healthcare workers whose daily work involves interacting with people with dementia.Results: four overarching categories of themes were identified from the interviews that impact on communication: the attributes of a care worker, communication strategies used, organisational factors and the physical characteristics of the care environment.Conclusion: many strategies used by healthcare workers to facilitate communication have not yet been studied in the research literature. Participants' views on training should be incorporated into future dementia training programmes.
  • 8.

    【2hr】Observational cohort study: deprivation and access to anti-dementia drugs in the UK

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    机译 观察性队列研究：英国的剥夺和获得抗痴呆药的机会
    摘要：Background: UK National Dementia Strategies prioritise fair access to dementia treatments for the whole population. We investigated for the first time inequalities in NHS national dementia prescribing and how they have varied between UK countries and over time.Method: we investigated the association between Townsend deprivation score and anti-dementia drug prescribing in 77,045 dementia patients from UK primary care records from 2002 to 2013.Results: we included 77,045 patients with recorded dementia diagnosis or anti-dementia drug prescription. Least deprived patients were 25% more likely to be initiated on anti-dementia drugs than the most deprived (adjusted incidence rate ratio 1.25, 95% confidence interval 1.19–1.31). This was driven by data from English practices where prescribing rates were consistently lower in more deprived patients compared with Scotland, Northern Ireland and Wales, where prescribing was not related to deprivation quintile. Compared with English practices, anti-dementia medication was prescribed more often in Northern Irish (1.81, 1.41–2.34) and less in Welsh practices (0.68, 0.55–0.82), with a trend towards more prescribing in Scottish practices (1.14, 0.98–1.32). Drug initiation rates were also higher in younger people and men.Conclusion: four years after the English National Dementia Strategy, there is no evidence that the Strategy's key objective of reducing treatment inequalities is being achieved. Higher overall anti-dementia drug prescribing in Scottish and Northern Irish practices, and differing clinical guidelines in Scotland from other UK countries might explain greater equality in prescribing in these countries. Strategies to offer treatment to more deprived people with dementia in England are needed.
  • 9.

    【2hr】Social engagement and depressive symptoms: do baseline depression status and type of social activities make a difference?

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    机译 社交参与和抑郁症状：基线抑郁状态和社交活动类型是否有所不同？
    摘要：Objectivesour purpose is to examine whether the association between social engagement and depressive symptoms differs by initial level of depressive symptoms and by the types of social engagement in which older adults engage.
  • 10.

    【2hr】A longitudinal comparative study of falls in persons with knee arthroplasty and persons with or at high risk for knee osteoarthritis

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    机译 膝关节置换术患者和膝骨关节炎高危人群跌倒的纵向比较研究
    摘要：Objectiveswe determined the yearly prevalence of single and multiple falls in persons with or at risk of knee osteoarthritis (OA) and persons undergoing knee arthroplasty over an 8-year period. We also compared annual fall rates among persons with and without knee arthroplasty to determine if fall rates are associated with knee arthroplasty.
  • 11.

    【2hr】Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing

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    机译 老年男性和女性跌倒的患病率和危险因素：衰老的英语纵向研究
    摘要：Backgroundfalls are a major cause of disability and death in older people. Women are more likely to fall than men, but little is known about whether risk factors for falls differ between the sexes. We used data from the English Longitudinal Study of Ageing to investigate the prevalence of falls by sex and to examine cross-sectionally sex-specific associations between a range of potential risk factors and likelihood of falling.
  • 12.

    【2hr】Calibrating EASY-Care independence scale to improve accuracy

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    机译 校准EASY-Care独立量表以提高准确性
    摘要：Backgroundthere is currently limited support for the reliability and validity of the EASY-Care independence scale, with little work carried out in low- or middle-income countries. Therefore, we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community.
  • 13.

    【2hr】Sarcopenia, frailty and mortality: the evidence is growing

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    机译 肌肉减少症，虚弱和死亡率：证据在增加
    摘要：
  • 14.

    【2hr】The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people

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    机译 PiTSTOP研究：老年人养老院预防ir妄的可行性整群随机试验
    摘要：Background and objectives: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called ‘Stop Delirium!’ In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes.Design: a cluster randomized feasibility study with an embedded process evaluation.Setting and participants: residents of 14 care homes for older people in one metropolitan district in the UK.Intervention: Stop Delirium!: a 16-month-enhanced educational package to support care home staff to address key delirium risk factors. Control homes received usual care.Measurements: we collected data to determine the following: recruitment and attrition; delirium rates and variability between homes; feasibility of measuring delirium, resource use, quality of life, hospital admissions and falls; and intervention implementation and adherence.Results: two-thirds (215) of eligible care home residents were recruited. One-month delirium prevalence was 4.0% in intervention and 7.1% in control homes. Proposed outcome measurements were feasible, although our approach appeared to underestimate delirium. Health economic evaluation was feasible using routinely collected data.Conclusion: a definitive trial of delirium prevention in long-term care is needed but will require some further design modifications and pilot work.
  • 15.

    【2hr】Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

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    机译 英国老年社区居民的听力障碍，事故残疾和全因死亡率
    摘要：Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality.Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study.Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register.Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates.Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.
  • 16.

    【2hr】Sex differences in the risk of receiving potentially inappropriate prescriptions among older adults

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    机译 老年人中接受不适当处方的风险中的性别差异
    摘要：Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences.Design: a retrospective cohort study.Setting: community setting of British Columbia, Canada.Participants: residents of British Columbia aged 65 and older (n = 660,679).Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors.Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12–1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs.Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients.
  • 17.

    【2hr】New Horizons: Dietary protein, ageing and the Okinawan ratio

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    机译 新视野：膳食蛋白质，衰老和冲绳比例
    摘要：Nutrition has profound effects on ageing and lifespan. Caloric restriction is the major nutritional intervention that historically has been shown to influence lifespan and/or healthspan in many animal models. Studies have suggested that a reduction in protein intake can also increase lifespan, albeit not as dramatically as caloric restriction. More recent research based on nutritional geometry has attempted to define the effects of nutrition on ageing over a broad landscape of dietary macronutrients and energy content. Such studies in insects and mice indicate that animals with ad libitum access to low-protein, high-carbohydrate diets have longest lifespans. Remarkably, the optimum content and ratio of dietary protein to carbohydrates for ageing in experimental animals are almost identical to those in the traditional diets of the long-lived people on the island of Okinawa.
  • 18.

    【2hr】Increasing delirium skills at the front door: results from a repeated survey on delirium knowledge and attitudes

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    机译 前门del妄技巧的提高：对del妄知识和态度的反复调查结果
    摘要：Background: delirium is under-recognised in comparison to other common and serious acute disorders. A 2006 survey of UK junior doctors (not undertaking specialist training) identified poor knowledge of the diagnostic criteria and treatment of delirium. We hypothesised that increased prominence accorded to delirium in the form of national initiatives and guidelines may have had an impact on understanding among junior doctors.Objective: we repeated a multi-centre survey of knowledge of and attitudes to delirium in junior doctors (not undertaking specialist training) assessing unselected acute medical presentations (the ‘medical take’).Design: questionnaire-based survey in 48 acute hospitals in UK and Ireland.Methods: we used questionnaires designed to test understanding of delirium, including prevalence, knowledge of the DSM-IV diagnostic criteria, use of specific screening tools, association with adverse outcomes and pharmacological management.Results: one thousand two hundred and fifteen trainee physicians participated. Compared with the 2006 cohort, improvements were seen in 9 of 17 knowledge-based questions and overall score improved in the 2013 cohort. Nonetheless, significant deficits in knowledge, particularly for the diagnostic criteria for delirium, remained.Conclusions: despite improvements in some aspects of delirium knowledge, the diagnostic criteria for delirium remain poorly understood. Challenges remain in ensuring adequate training for junior doctors in delirium.
  • 19.

    【2hr】Late-life deficits in cognitive, physical and emotional functions, childhood intelligence and occupational profile: a life-course examination of the Aberdeen 1936 Birth Cohort (ABC1936)

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    机译 认知，身体和情感功能，儿童智力和职业特征的晚年缺陷：1936年阿伯丁出生队列（ABC1936）的生命历程检查
    摘要：Objectives: the ‘triad of impairment’ phenomenon describes the co-occurrence of age-related cognitive, emotional and physical functioning deficits. We investigated how occupational profile and childhood intelligence contribute to the triad of impairment in late life.Methods: we analysed data of a subsample of the Aberdeen Birth Cohort of 1936 (n = 346). Data were collected on participants' childhood intelligence, late-life cognitive ability, physical functioning, depressive symptoms and main lifetime occupation. We summarised the various occupational and impairment measures into two latent variables, ‘occupational profile’ and the ‘triad of impairment’. We used a series of data reduction approaches and structural equation models (SEMs) of increasing complexity to test both the validity of the models and to understand causal relationships between the life-course risks for the triad of impairment.Results: occupational profile had a significant effect on the triad of impairment independent of childhood intelligence. Childhood intelligence was the predominant influence on the triad of impairment and exerted its effect directly and indirectly via its influence on occupation. The direct effect of childhood intelligence exceeded the independent influence of the occupational profile on impairment by a factor of 1.7–1.8 and was greater by a factor of ∼4 from the indirect pathway (via occupation).Conclusions: childhood intelligence was the predominant influence on the triad of impairment in late life, independently of the occupational profile. Efforts to reduce impairment in older adults should be informed by a life-course approach with special attention to the early-life environment.
  • 20.

    【2hr】66HIGHER LEVELS OF APOMORPHINE AND ROTIGOTINE PRESCRIBING SPEND REDUCE THE TOTAL HEALTHCARE COSTS FOR PARKINSON'S PATIENTS

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    机译 66种高水平的阿扑吗啡和罗替戈汀处方支出减少了帕金森氏病患者的总医疗费用
    摘要：
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