Older people and technology: Time to smarten up our act.

The NHS faces challenges today that it was not designed to tackle at its conception in 1948. The UK demographic has changed considerably with higher life expectancy and 'an ageing population'. Keeping this demographic healthy through prevention and management of age-related degeneration is crucial to their independence and improving resource utilisation. The Department of Health and Social Care's agenda for digital transformation of the NHS is facilitating a move towards preventative healthcare and greater community care, which will likely be supported by virtual healthcare delivery models. Despite views on digital illiteracy in the older population, this demographic may stand to benefit the most. Research has shown that the older demographic adopts technology in line with the technology acceptance model if their needs are carefully considered. Executed successfully, the deployment of virtual healthcare could save transformational costs to the NHS and support better quality of life for the senior members of society. This is particularly relevant in the current COVID-19 pandemic with patients facing challenges in accessing outpatient appointments. With many hospitals kickstarting virtual outpatient clinics to ensure continuity of care during a time of social isolation; we await to see the ingenuities that arise from the current pandemic.

Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study.

BACKGROUND: An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS: Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS: Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS: Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Functional recovery in older women undergoing surgery for gynaecological malignancies: A systematic review and narrative synthesis.

OBJECTIVES: Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics. MATERIALS AND METHODS: Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974 to 2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: Results analysed and presented using narrative synthesis. RESULTS: Fifteen studies identified (8 Endometrial, 2 Ovarian, 2 Vulval, 3 mixed cancer types). 1/15 used a standalone functional assessment tool, 14/15 used Health-Related Quality of Life tools (EORTC QLQ C30 (8), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n = 13) than incomplete recovery (n = 2). Four studies reported a negative association between older age and functional trajectory. Recovery was more likely and occurred faster in minimally-invasive surgery. Few studies reported baseline characteristics including cognition, frailty or comorbidities and none examined associations with functional recovery. CONCLUSION: There is inadequate data on functional recovery of older women following gynaeoncology surgery. Future studies are needed to identify factors associated with poorer/better outcomes. This may enable identification of opportunities for risk reduction, improve equity of access and better shared-decision making.

Cannabinoids in the Older Person: A Literature Review.

INTRODUCTION: Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Whilst the efficacy of cannabinoids in the treatment of some childhood epilepsy syndromes is increasingly recognized, medical cannabinoids may also have potential clinical roles in the treatment of older adults. Prescribing restrictions for medical cannabinoids in certain jurisdictions (including the UK) has recently been relaxed. However, few geriatricians have the detailed knowledge or awareness of the potential risks or rewards of utilizing cannabinoids in the older person; even fewer geriatricians have direct experience of using these drugs in their own clinical practice. Older persons are more likely to suffer from medical illness representing potential indications for medical cannabinoids (e.g., pain); equally they may be more vulnerable to any adverse effects. AIM: This narrative literature review aims to provide a brief introduction for the geriatrician to the potential indications, evidence-base, contra-indications and side effects of medical cannabinoids in older people. METHODS: A search was conducted of CENTRAL, Medline, Embase, CINAHL and psycINFO, Cochrane and Web of Science databases. Reference lists were hand searched. Abstracts and titles were screened, followed by a full text reading of relevant articles. RESULTS: 35 studies were identified as relevant for this narrative review. CONCLUSIONS: Cannabinoids demonstrate some efficacy in the treatment of pain and chemotherapy-related nausea; limited data suggest potential benefits in the treatment of spasticity and anxiety. Risks of cannabinoids in older patients appear to be moderate, and their frequency comparable to other analgesic drug classes. However, the quality of research is weak, and few older patients have been enrolled in cannabinoid studies. Dedicated research is needed to determine the efficiency and safety of cannabinoids in older patients.

Proactive care of older people undergoing surgery.

The number of older patients undergoing surgery is increasing due to changing demographics, surgical and anaesthetic advances and shifts in patient expectations of healthcare. The benefits of surgery in older people are well documented and include symptom control and increased life expectancy. However, older surgical patients present not only with the index pathology requiring surgery but with concurrent age related physiological decline, multimorbidity and geriatric syndromes. These additional issues increase the risk of adverse postoperative outcome, in particular of postoperative medical and functional complications. In recent years, there has been recognition of the need for collaborative surgical and geriatric medicine working to address the health care needs of the increasingly complex older surgical population. Guidelines have been published to support clinicians looking after older surgical patients, however, there has been little published on the establishment of such services. In this paper, we describe the evolution of the proactive care of older patients undergoing surgery (POPS) service and how through the use of comprehensive geriatric assessment methodology and intervention throughout the surgical pathway, outcomes for complex older surgical patients can be improved.