Improving Healthcare for Older People: Selected Papers from the United Kingdom and Ireland

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 16513

Special Issue Editors


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Guest Editor
1. Medicine for Older People, University Hospital Southampton NHS FT, Southampton, UK
2. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHSFT and the University of Southampton, Southampton, UK
3. Faculty of Medicine, Southampton SO16 6YD, UK
Interests: geriatric medicine; falls; syncope; frailty; sarcopenia

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Guest Editor
1. Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
2. Department of Medicine, University of Cambridge, Level 5, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
Interests: frailty; physical capability; ageing; epidemiology; public health; health data science

Special Issue Information

Dear Colleagues,

We are acting as the guest editors for this Special Issue of Geriatrics MDPI, focusing on the physical and mental health and well-being of older adults living in the United Kingdom (UK) and Ireland. It is our pleasure to invite you to submit an article within the scope of this Special Issue.

Many countries around the world are experiencing the phenomenon of an ageing population, but within each country, this will present a different set of advantages and challenges. Modern health services in developed countries such as the United Kingdom and Ireland offer high-quality healthcare to their populations which is often free or at a reduced cost at the point of service. However, these healthcare systems were designed in the middle and latter half of the 20th century to meet the needs of patients usually presenting with single system problems. Today, in contrast, older adults are the most frequent users of health services, particularly emergency care services, and often present with health problems in the context of multimorbidity, frailty and polypharmacy. Thus, if modern health services are to remain at the cutting edge of healthcare delivery, they need to evolve to meet the needs and complexity of older patients. In addition, whilst modern societies offer a high-tech, high quality of life for their populations, this is often unequal. Older adults comprise one population group at greater risk of loneliness, social isolation and economic deprivation compared to the general population.

We aim to compile a selection of studies and reports that will be of value to health and social care practitioners, health service commissioners, politicians, other decision makers and the general public. We hope these manuscripts will describe, quantify and help explain the health and well-being of older adults living in the United Kingdom and Ireland so that health and social care services can evolve to meet their needs using an evidence-based approach. We particularly welcome articles presenting data from high-quality research studies exploring polypharmacy, multimorbidity, frailty, loneliness, social isolation and deprivation. We also welcome health service research and will consider high-quality service evaluations, audits and pertinent (systematic) reviews of the literature.

Dr. Harnish P. Patel
Dr. Victoria L. Keevil
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ageing
  • frailty
  • health status
  • healthcare services
  • patient-centred care
  • integrated care
  • multimorbidity

Published Papers (5 papers)

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Research

12 pages, 413 KiB  
Article
The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age
by Ben Carter, Victoria L. Keevil, Atul Anand, Christopher N. Osuafor, Robert J. B. Goudie, Jacobus Preller, Matthew Lowry, Sarah Clunie, Susan D. Shenkin, Kathryn McCarthy, Jonathan Hewitt and Terence J. Quinn
Geriatrics 2022, 7(5), 87; https://doi.org/10.3390/geriatrics7050087 - 24 Aug 2022
Cited by 2 | Viewed by 2243
Abstract
Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We [...] Read more.
Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27 February and 30 June 2020. Multivariable mixed-effects logistic modelling was undertaken, with 28-day mortality as the primary outcome. Nested models were compared between a base model, age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres. The median age was 80 (range:65–101), 453 (45%) were female, and 377 (37.8%) died within 28 days. The sample was replicated in a validation cohort of two additional centres (n = 672) with similar characteristics. In the primary cohort, both mFI and CFS were associated with mortality in the base models. There was improved precision when fitting CFS to the base model +mFI (LRT = 25.87, p < 0.001); however, there was no improvement when fitting mFI to the base model +CFS (LRT = 1.99, p = 0.16). AUROC suggested increased discrimination when fitting CFS compared to age (p = 0.02) and age +mFI (p = 0.03). In contrast, the mFI offered no improved discrimination in any comparison (p > 0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision-making and prognosis. Full article
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32 pages, 4304 KiB  
Article
Longitudinal Study on Sustained Attention to Response Task (SART): Clustering Approach for Mobility and Cognitive Decline
by Rossella Rizzo, Silvin P. Knight, James R. C. Davis, Louise Newman, Eoin Duggan, Rose Anne Kenny and Roman Romero-Ortuno
Geriatrics 2022, 7(3), 51; https://doi.org/10.3390/geriatrics7030051 - 22 Apr 2022
Cited by 3 | Viewed by 4736
Abstract
The Sustained Attention to Response Task (SART) is a computer-based go/no-go task to measure neurocognitive function in older adults. However, simplified average features of this complex dataset lead to loss of primary information and fail to express associations between test performance and clinically [...] Read more.
The Sustained Attention to Response Task (SART) is a computer-based go/no-go task to measure neurocognitive function in older adults. However, simplified average features of this complex dataset lead to loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we combine a novel method to visualise individual trial (raw) information obtained from the SART test in a large population-based study of ageing in Ireland and an automatic clustering technique. We employed a thresholding method, based on the individual trial number of mistakes, to identify poorer SART performances and a fuzzy clusters algorithm to partition the dataset into 3 subgroups, based on the evolution of SART performance after 4 years. Raw SART data were available for 3468 participants aged 50 years and over at baseline. The previously reported SART visualisation-derived feature ‘bad performance’, indicating the number of SART trials with at least 4 mistakes, and its evolution over time, combined with the fuzzy c-mean (FCM) algorithm, individuated 3 clusters corresponding to 3 degrees of physiological dysregulation. The biggest cluster (94% of the cohort) was constituted by healthy participants, a smaller cluster (5% of the cohort) by participants who showed improvement in cognitive and psychological status, and the smallest cluster (1% of the cohort) by participants whose mobility and cognitive functions dramatically declined after 4 years. We were able to identify in a cohort of relatively high-functioning community-dwelling adults a very small group of participants who showed clinically significant decline. The selected smallest subset manifested not only mobility deterioration, but also cognitive decline, the latter being usually hard to detect in population-based studies. The employed techniques could identify at-risk participants with more specificity than current methods, and help clinicians better identify and manage the small proportion of community-dwelling older adults who are at significant risk of functional decline and loss of independence. Full article
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10 pages, 1090 KiB  
Article
Factors Influencing Length of Stay and Discharge Destination of Patients with Hip Fracture Rehabilitating in a Private Care Setting
by Zoe Thornburgh and Dinesh Samuel
Geriatrics 2022, 7(2), 44; https://doi.org/10.3390/geriatrics7020044 - 31 Mar 2022
Cited by 6 | Viewed by 2435
Abstract
Background: Rehabilitation after a hip fracture has long-term importance, prompting some patients to utilise private services. Insufficient data regarding private rehabilitation in the UK can cause ambiguity and potential problems for all involved. Aim: The present study, involving patients with hip fractures rehabilitating [...] Read more.
Background: Rehabilitation after a hip fracture has long-term importance, prompting some patients to utilise private services. Insufficient data regarding private rehabilitation in the UK can cause ambiguity and potential problems for all involved. Aim: The present study, involving patients with hip fractures rehabilitating in a private UK care setting, examined relationships between length of stay (LoS), discharge destination (DD) and 12 predictor variables. Methods: The variables included the retrospective measurement of the Functional Independence Measure. The variables were informed by a literature review and patient and public involvement. Retrospective data from the records of patients with hip fractures were utilised. Data were analysed using Spearman’s rho, Mann–Whitney U, Kruskal–Wallis H and chi-squared tests as appropriate. Odds ratios, distribution quartiles and survivor analysis were also utilised. Results: The median length of stay (LoS) was 20.5 days: 82% returned home, 6.5% died and 11.5% remained as long-term residents. Significant relationships existed between LoS and age (p = 0.004), comorbidities (p = 0.001) and FIMadmission (p = 0.001). DD was associated with age (p = 0.007), delirium (p = 0.018), comorbidities (p = 0.001) and both FIMpre-fracture and FIMadmission (p = 0.000). Conclusions: Factors associated with length of stay were identified, but further research incorporating multiple sites is required for greater predictor precision. Discharge destination was evident by 90 days, facilitating long-term planning. Full article
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9 pages, 484 KiB  
Article
Biomarker Signatures of Two Phenotypical Prefrailty Types in the Irish Longitudinal Study on Ageing
by Palina Piankova, Roman Romero-Ortuno and Aisling M. O’Halloran
Geriatrics 2022, 7(2), 25; https://doi.org/10.3390/geriatrics7020025 - 27 Feb 2022
Cited by 1 | Viewed by 2900
Abstract
We investigated the biomarker signatures of two previously reported phenotypical prefrailty (PF) types in the first wave of The Irish Longitudinal Study on Ageing (TILDA): PF1 (unexplained weight loss and/or exhaustion) and PF2 (one or two among slowness, weakness, and low physical activity). [...] Read more.
We investigated the biomarker signatures of two previously reported phenotypical prefrailty (PF) types in the first wave of The Irish Longitudinal Study on Ageing (TILDA): PF1 (unexplained weight loss and/or exhaustion) and PF2 (one or two among slowness, weakness, and low physical activity). Binary logistic regression models evaluated the independent associations between available plasma biomarkers and each PF type (compared to robust and compared to each other), while adjusting for age, sex, and education. A total of 5307 participants were included (median age 61 years, 53% women) of which 1473 (28%) were prefrail (469 PF1; 1004 PF2), 171 were frail, and 3663 were robust. The PF2 median age was eight years older than the PF1 median age. Higher levels of lutein and zeaxanthin were independently associated with the lower likelihood of PF1 (OR: 0.77, p < 0.001 and OR: 0.81, p < 0.001, respectively). Higher cystatin C was associated with PF1 (OR: 1.23, p = 0.001). CRP (OR: 1.19, p < 0.001), cystatin C (OR: 1.36, p < 0.001), and HbA1c (OR: 1.18, p < 0.001) were independently associated with PF2, while a higher total (OR: 0.89, p = 0.004) and HDL (OR: 0.87, p < 0.001) cholesterol seemed to be PF2-protective. While PF1 seemed to be inversely associated with serum carotenoid concentrations and hence has an oxidative signature, PF2 seemed to have pro-inflammatory, hyperglycemic, and hypolipidemic signatures. Both PF types were associated with higher cystatin C (lower kidney function), but no biomarkers significantly distinguished PF1 vs. PF2. Further research should elucidate whether therapies for different PF types may require targeting of different biological pathways. Full article
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13 pages, 799 KiB  
Article
The Acute Effects of Breakfast Drinks with Varying Protein and Energy Contents on Appetite and Free-Living Energy Intake in UK Older Adults
by Daniel R. Crabtree, Adrian Holliday, William Buosi, Claire L. Fyfe, Graham W. Horgan, Alexandra M. Johnstone and on behalf of the Full4Health-study Group
Geriatrics 2022, 7(1), 16; https://doi.org/10.3390/geriatrics7010016 - 30 Jan 2022
Cited by 1 | Viewed by 3013
Abstract
Proposed strategies for preventing protein deficiencies in older patients include increasing protein intake at breakfast. However, protein is highly satiating and the effects of very high protein intakes at breakfast on subsequent appetite and free-living energy intake (EI) in older adults are unclear. [...] Read more.
Proposed strategies for preventing protein deficiencies in older patients include increasing protein intake at breakfast. However, protein is highly satiating and the effects of very high protein intakes at breakfast on subsequent appetite and free-living energy intake (EI) in older adults are unclear. This study compared the acute effects of two breakfast drinks varying in protein and energy contents on appetite and free-living EI in healthy older adults using a randomized 2 × 2 crossover design. Participants (n = 48 (20 men, 28 women); mean ± SD age: 69 ± 3 years; BMI: 22.2 ± 2.0 kg·m−2; fat-free mass: 45.5 ± 8.0 kg) consumed two drinks for breakfast (high-protein (30.4 ± 5.3 g), low-energy (211.2 ± 37.1 kcal) content (HPLE) and very high-protein (61.8 ± 9.9 g), fed to energy requirements (428.0 ± 68.9 kcal) (VHPER)) one week apart. Appetite perceptions were assessed for 3 h post-drink and free-living EI was measured for the remainder of the day. Appetite was lower in VHPER than HPLE from 30 min onwards (p < 0.01). Free-living energy and protein intake did not differ between conditions (p = 0.814). However, 24 h EI (breakfast drink intake + free-living intake) was greater in VHPER than HPLE (1937 ± 568 kcal vs. 1705 ± 490 kcal; p = 0.001), as was 24 h protein intake (123.0 ± 26.0 g vs. 88.6 ± 20.9 g; p < 0.001). Consuming a very high-protein breakfast drink acutely suppressed appetite more than a low-energy, high-protein drink in older adults, though free-living EI was unaffected. The long-term effects of adopting such a breakfast strategy in older adults at high risk of energy and protein malnutrition warrants exploration. Full article
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