Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people.

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Effect of horticultural therapy on static, dynamic balance and gait speed among institutionalized older adults with cognitive impairment.

OBJECTIVES: Although horticultural therapy has been used successfully to reduce neuropsychiatric symptoms in elderly people with cognitive impairment, we do not yet know how it affects balance. The aim of our study was to determine the acceptability and effect of a 12-week horticultural therapy on balance and walking speed among institutionalized older adults with cognitive impairment. METHODS: This mixed-methods controlled trial included 23 participants. Subjects in the experimental group (n=13) participated in a 60 min horticultural therapy programme twice a week for 12 weeks in addition to the institution's usual social activities. Subjects in the control group (n=10) participated in the institution's usual social activities. Static and dynamic balance were measured with the Performance Oriented Mobility Assessment scale. In addition, gait speed was measured. Qualitative data were collected through a semi-structured interview with participants of the experimental group. RESULTS: At the end of the intervention period, the experimental maintained their baseline performance on the static balance, while the control group showed a decline. The gait speed of the experimental improved, while that of the control group did not change. In dynamic balance, no changes were demonstrated. The results of our qualitative data analysis indicate that horticultural therapy increases the possibility of social interactions, encourages older people to engage in conversation. CONCLUSIONS: As a conclusion, horticultural therapy should be more widely included in programmes for older people with cognitive impairment.

'It's a job to be done'. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty.

INTRODUCTION: Many older people live with both multiple long-term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under-explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home. METHODS: Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi-structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. FINDINGS: Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me-there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work. CONCLUSION: Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self-manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines. PATIENT AND PUBLIC INVOLVEMENT: An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.

Structural housing elements associated with injuries in older adults in the USA.

OBJECTIVE: To quantify the unintentional injuries associated with housing elements among older adults treated in US hospital emergency departments (EDs). To identify modifiable home hazards. METHODS: The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed to identify all codes associated with housing elements that were permanently attached to a home. We queried the 2020 NEISS data for older adults (aged 65 and older) to determine the number of injuries associated with each element. The 10 elements involved in the most hospitalisations and the most ED visits were each tabulated by the number of records in the NEISS sample and national estimate, yielding two separate lists of 10 housing elements. A review of case narratives was conducted on a random selection constituting 10% of all records or a minimum of 100 records to determine common precipitating factors and prevention recommendations. RESULTS: From the two lists, we identified 11 housing elements most commonly associated with housing-related injuries, resulting in ED visits or hospitalisations. The housing element most associated with housing-related injuries was floor, leading to 929 937 ED visits. Subsequent case narrative review yielded prevention recommendations, including modifications that support balance and fall recovery, reduce the need to reach and improve visibility. CONCLUSIONS: Housing element-related injuries affect hundreds of thousands of older adults. Case narratives reveal falls, tripping/slipping and sliding injuries that can potentially be prevented with home modification. NEISS is a valuable tool to identify injury risks in the home.

How to undertake a holistic nutritional assessment with older people.

RATIONALE AND KEY POINTS: Nutrition is a fundamental aspect of nursing care, however older people cared for in hospital, in a care home or in their own home do not always receive adequate support with their nutritional needs, which can leave them at risk of malnutrition. Using a holistic, biopsychosocial framework to support a comprehensive nutritional assessment that includes malnutrition screening can support the nurse to identify the older person's nutritional status and nutrition needs. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Malnutrition in older people can lead to a decline in functional ability, reduced muscle strength, fatigue, impaired immunity, suboptimal wound healing, increased risk of infection and increased risk of falls. • Screening for, and assessing the risk of, malnutrition is an important part of nursing assessments in any healthcare setting. • A holistic nutritional assessment should incorporate physiological, psychological, emotional, spiritual, social and cultural elements. REFLECTIVE ACTIVITY: ' How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a holistic nutritional assessment with an older person. • How you could use this information to educate nursing students or your colleagues on the appropriate techniques and evidence base for undertaking a holistic nutritional assessment with an older person.

Potentially inappropriate prescribing (PIP) in older people and its association with socioeconomic deprivation-a systematic review and narrative synthesis.

BACKGROUND: Potentially inappropriate prescribing (PIP) refers to the prescription of medications that carry a higher risk of adverse outcomes, such as drug interactions, falls, and cognitive impairment. PIP is of particular concern in older adults, and is associated with increased morbidity, mortality, and healthcare costs. Socioeconomic deprivation has been identified as a potential risk factor for PIP. However, the extent of this relationship remains unclear. This review aimed to synthesize the current literature on the association between PIP and socioeconomic status (SES) in older adults. METHODS: A literature search was conducted using the databases Medline, Embase and CINAHL. A search strategy was developed to capture papers examining three key concepts: PIP, socioeconomic deprivation and older/elderly populations. Peer-reviewed quantitative research published between 1/1/2000 and 31/12/2022 was eligible for inclusion. RESULTS: Twenty articles from 3,966 hits met the inclusion criteria. The sample size of included studies ranged from 668 to 16.5million individuals, with the majority from Europe (n = 8) and North America (n = 8). Most defined older patients as being 65 or over (n = 12) and used income (n = 7) or subsidy eligibility (n = 5) to assess SES. In all, twelve studies reported a statistically significant association between socioeconomic deprivation and an increased likelihood of experiencing PIP. Several of these reported some association after adjusting for number of drugs taken, or the presence of polypharmacy. The underlying reasons for the association are unclear, although one study found that the association between deprivation and higher PIP prevalence could not be explained by poorer access to healthcare facilities or practitioners. CONCLUSION: The findings suggest some association between an older person's SES and their likelihood of being exposed to PIP. SES appears to be one of several factors that act independently and in concert to influence an older person's likelihood of experiencing PIP. This review highlights that prioritising older people living in socioeconomically-deprived circumstances may be an efficient strategy when carrying out medication reviews.

Proportion and factors influencing healthcare-seeking behavior among older people in Motta town, East Gojjam: a community-based cross-sectional study, Ethiopia, 2023.

BACKGROUND: In resource-limited countries, older people who are at risk and face numerous health problems, often receive insufficient attention regarding their healthcare-seeking behavior. Assessing the proportion of healthcare-seeking behavior and associated factors among older people in Motta town, was the aim of the study. METHOD: A community-based cross-sectional study was carried out from April 22 to May 22, 2023. The study subjects were chosen using a systematic random sampling technique. To identify candidate variables for multivariable analysis, a bivariable logistic regression analysis was performed. Variables having a P-value of < 0.05 were considered statistically significant. RESULTS: From the total, 161 (39.3%) of respondents had good healthcare-seeking behavior with 95% CI [35%, 44%]. Secondary school [AOR = 2.69, 95% CI = 1.27, 5.68], Education college and above [AOR = 4.6, 95% CI = 2.27, 9.33], Family support during their illness [AOR = 1.39, 95% CI = 1.05, 3.09], Members of CBHI [AOR = 2.02, 95% CI = 1.21, 3.36], and presence of chronic illness [AOR = 2.55, 95%, CI = 1.64, 3.97] were significantly associated with good healthcare-seeking behavior. CONCLUSION AND RECOMMENDATION: This study found that good healthcare-seeking behavior among older people is significantly associated with higher education, strong family support, Community-Based Health Insurance (CBHI) membership, and chronic illnesses. Improving health literacy through education, strengthening family support systems, expanding CBHI participation for better healthcare access, and developing targeted chronic disease management programs to enhance this behavior is recommended. These strategies can collectively improve healthcare utilization and outcomes for older people.

Development of a prediction model for frailty among older Chinese individuals with type 2 diabetes residing in the community.

METHODS: The study employed a retrospective survey of 458 older individuals with T2D residing in a Chinese community, conducted between June 2020 and May 2021, to develop a predictive model for frailty. Among the participants, 83 individuals (18.1%) were diagnosed with frailty using modified frailty phenotypic criteria. The predictors of frailty in this community-dwelling older population with T2D were determined using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression. These predictors were utilized to construct a nomogram. The discrimination, calibration, and medical usefulness of the prediction model were assessed through the C-index, calibration plot, and decision curve analysis (DCA), respectively. Additionally, internal validation of the prediction model was conducted using bootstrapping validation. RESULTS: The developed nomogram for frailty prediction predominantly incorporated age, smoking status, regular exercise, depression, albumin (ALB) levels, sleep condition, HbA1c, and polypharmacy as significant predictors. Our prediction model demonstrated excellent discrimination and calibration, as evidenced by a C-index of 0.768 (95% CI, 0.714-0.822) and strong calibration. Internal validation yielded a C-index of 0.732, further confirming the reliability of the model. DCA indicated the utility of the nomogram in identifying frailty among the studied population. CONCLUSION: The development of a predictive model enables a valuable estimation of frailty among community-dwelling older individuals with type 2 diabetes. This evidence-based tool provides crucial guidance to community healthcare professionals in implementing timely preventive measures to mitigate the occurrence of frailty in high-risk patients. By identifying established predictors of frailty, interventions and resources can be appropriately targeted, promoting better overall health outcomes and improved quality of life in this vulnerable population.

Determining the Key Education Priorities Related to Heart Failure Care in Nursing Homes: A Modified Delphi Approach.

There is currently a limited understanding of what nurses in nursing homes view as the key education priorities to support their ability to provide the appropriate care for residents with heart failure (HF). A modified Delphi technique was utilized to gain a consensus on the key education priorities for nurses working in nursing homes in Northern Ireland. An initial list of items (n = 58), across 19 domains, was generated using the findings of a scoping review and stakeholder interviews, and a review of available clinical guidelines. Two rounds of surveys were undertaken. Items were presented using a 5-point Likert scale, with an additional exercise in the second round to rank the domains in order of importance. Fifty-four participants completed the first-round survey and 34 (63%) returned to complete the second. The findings highlight the importance of providing nurses in nursing home settings with general HF education and the delivery of person-centered care. Participants perceived education around technology for the management of HF and quality improvement or research methodologies associated with HF in nursing homes as lower priorities. This study illuminates key priorities from nursing home nurses regarding HF education that are applicable to this care setting.

AEGIS-AcutE Geriatric Intervention Study: pilot study of frontline acute geriatric assessment to improve quality of care in emergency department.

INTRODUCTION: Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. METHODS: This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75 years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. RESULTS: TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P = .001). Thirty-day revisit rates were 10% and 16%, respectively (P < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. CONCLUSIONS: TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs.

Implementation of a digital exercise programme in health services to prevent falls in older people.

BACKGROUND: StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK. METHODS: Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome. RESULTS: The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 ± 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred ≥5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 ± 39% of the prescribed dose (i.e. 39 ± 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources. CONCLUSIONS: StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

Revisiting unstable disability and the fluctuations of frailty: a measurement burst approach.

BACKGROUND: It has been hypothesised that frailty is the root cause of clinically observed but rarely systematically measured unstable disability among older adults. In this study, we measure the extent of short-term disability fluctuations and estimate their association with frailty using intensive longitudinal data. METHODS: Repeated measurements of disability were collected under a measurement burst design in the FRequent health Assessment In Later life (FRAIL70+) study. A total of 426 community-dwelling older adults (70+) in Austria were interviewed about difficulties with basic, instrumental and mobility-related activities of daily living biweekly up to a total of 14 times in two measurement bursts (2891 and 2192 observations). Baseline frailty was assessed with both physical frailty (FP) and the frailty index (FI). Disability fluctuations were measured with the intra-individual interquartile range (iIQR) and estimated with a two-step generalised mixed regression procedure. RESULTS: Fewer participants were frail at baseline according to FP (11%) than FI (32%). Frail study participants reported not only more severe disability but also had more short-term disability fluctuations (iIQR = 1.0-1.5) compared with their robust counterparts (iIQR = 0). Regression models indicated that baseline frailty was associated with 2-3 times larger short-term disability fluctuations, which were also more prevalent among women, and increased with age and disability severity. CONCLUSION: Compared with those who were robust, frail older adults were characterised by not only more severe but also more unstable disability. Short-term disability fluctuations are closely tied to disability severity. Future studies should assess both stressors that may cause disability fluctuations among frail older adults as well as their potential consequences to inform frailty-centred care.

Are quality of care instruments inclusive of older people living with dementia? A scoping review in long-term care settings.

More than half of older people in long-term care facilities have dementia. Little is currently known about the methods and instruments which can be used to capture the perspectives of older people, including those with dementia, regarding the quality of care provided in such facilities. The main aims of this scoping review were two-fold. Firstly, to identify quality of care instruments that have been applied in long-term care settings. Secondly, to evaluate how these instruments have been developed and validated, particularly in terms of their applicability among older people with dementia. Seven databases (Medline, Web of Science, Scopus, ProQuest, Ageline, CINHAL and google scholar) were searched for relevant literature without any date limit. We used quality criteria adapted from COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines to assess the psychometric properties of the instruments. The search identified 16 quality of care instruments which had been used in long-term care settings. Of which, two (12.5%) were specifically designed for older people with dementia, and three instruments (18.7%) were modified for use with older people with mild to moderate dementia. A variety of methods were used to develop the identified instruments including literature reviews, qualitative interviews, expert panel reviews, pre-testing and piloting with older people. None of the identified instruments had been subjected to comprehensive psychometric assessment. Most instruments for assessing quality of care in long term care settings lack alternative communication techniques tailored to people with dementia. This review highlights the need for more rigorous psychometric testing of existing instruments for assessing quality of care in long-term care settings. Several existing measures show promise and may be taken forward for further testing and development for widespread application with older people, including those living with dementia, in long term care settings.

Osteoarthritis, osteoarthritis treatment and risk of incident dementia: a prospective cohort study based on UK Biobank.

BACKGROUND: We aimed to investigate the association between OA and treatment with dementia risk and structural brain abnormalities. METHODS: We recruited a total of 466,460 individuals from the UK Biobank to investigate the impact of OA on the incidence of dementia. Among the total population, there were 63,081 participants diagnosed with OA. We subsequently categorised the OA patients into medication and surgery groups based on treatment routes. Cox regression models explored the associations between OA/OA treatment and dementia risk, with the results represented as hazard ratios (HRs) and 95% confidence intervals (95% CI). Linear regression models assessed the associations of OA/OA therapy with alterations in cortical structure. RESULTS: During an average of 11.90 (± 1.01) years of follow-up, 5,627 individuals were diagnosed with all-cause dementia (ACD), including 2,438 AD (Alzheimer's disease), and 1,312 VaD (vascular dementia) cases. Results revealed that OA was associated with the elevated risk of ACD (HR: 1.116; 95% CI: 1.039-1.199) and AD (HR: 1.127; 95% CI: 1.013-1.254). OA therapy lowered the risk of dementia in both medication group (HR: 0.746; 95% CI: 0.652-0.854) and surgery group (HR: 0.841; 95% CI: 0.736-0.960). OA was negatively associated with cortical area, especially precentral, postcentral and temporal regions. CONCLUSIONS: Osteoarthritis increased the likelihood of developing dementia, and had an association with regional brain atrophy. OA treatment lowered the dementia risk. OA is a promising modifiable risk factor for dementia.

Correlates of Frailty in Hospitalized Older Adults with Hypertension and Its Influence on Clinical Prognosis.

Objective: This study aims to explore the correlates of frailty in hospitalized elderly hypertensive patients and its impact on clinical prognosis, and to construct a predictive model for the occurrence of frailty in this population. Methods: A cross-sectional and prospective observational cohort study was conducted, involving 312 elderly hypertensive patients diagnosed at the institution from January to June 2022. Frailty was diagnosed using the Fried Frailty Phenotype (FP), while the Charlson Comorbidities Index (CCI) assessed the presence of chronic conditions. Data analysis was performed using SPSS 22.0. Binary logistic regression analysis was conducted with frailty as the dependent variable to identify risk factors. Patients were followed for one year to monitor readmission rates and all-cause mortality. Results: Multivariate logistic regression identified CCI grade (P=0.030), gender (OR=21.618, 95% CI: 4.062-115.061, P < 0.001), age (OR=1.147, 95% CI: 1.086-1.211, P < 0.001), bedridden state (OR=11.620, 95% CI: 3.282-41.140, P < 0.001), arrhythmia (OR=14.414, 95% CI: 4.558-45.585, P < 0.001), heart failure (OR=5.439, 95% CI: 1.029-28.740, P < 0.05), along with several biochemical markers, as independent predictors of frailty. A predictive model was developed, demonstrating a robust discriminative ability with an area under the receiver operating characteristic curve (AUC) of 0.915. Statistically significant differences in readmission rates and all-cause mortality were observed among the frail, pre-frail, and non-frail groups (P<0.001), with the frail group exhibiting the highest incidence of these adverse outcomes. Notably, frailty emerged as a significant predictor of readmission (P<0.05) but not of all-cause mortality in this cohort. Conclusion: This study establishes a robust frailty prediction model for elderly hypertensive patients, highlighting the influence of CCI grade, gender, age, and other clinical and biochemical factors on frailty. The model offers a valuable tool for healthcare providers to identify at-risk elderly individuals, facilitating targeted intervention strategies for cardiovascular disease management.

Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study.

BACKGROUND: The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population. METHODS: An international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics. RESULTS: The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) -11 (2.4) vs. -14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97-5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) -13 (2.0) vs. -12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups. CONCLUSIONS: Clinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.

Incidence of post-operative delirium increases as severity of frailty increases.

OBJECTIVE: The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium. METHODS: We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A's Test and Confusion Assessment Method-Intensive Care Unit. RESULTS: In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail). CONCLUSIONS: Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery.

Navigating artificial intelligence in care homes: Competing stakeholder views of trust and logics of care.

The COVID-19 pandemic shed light on systemic issues plaguing care (nursing) homes, from staff shortages to substandard healthcare. Artificial Intelligence (AI) technologies, including robots and chatbots, have been proposed as solutions to such issues. Yet, socio-ethical concerns about the implications of AI for health and care practices have also been growing among researchers and practitioners. At a time of AI promise and concern, it is critical to understand how those who develop and implement these technologies perceive their use and impact in care homes. Combining a sociological approach to trust with Annemarie Mol's logic of care and Jeanette Pol's concept of fitting, we draw on 18 semi-structured interviews with care staff, advocates, and AI developers to explore notions of human-AI care. Our findings show positive perceptions and experiences of AI in care homes, but also ambivalence. While integrative care incorporating humans and technology was salient across interviewees, we also identified experiential, contextual, and knowledge divides between AI developers and care staff. For example, developers lacked experiential knowledge of care homes' daily functioning and constraints, influencing how they designed AI. Care staff demonstrated limited experiential knowledge of AI or more critical views about contexts of use, affecting their trust in these technologies. Different understandings of 'good care' were evident, too: 'warm' care was sometimes linked to human care and 'cold' care to technology. In conclusion, understandings and experiences of AI are marked by different logics of sociotechnical care and related levels of trust in these sensitive settings.

The role of the World Guidelines for Falls Prevention and Management's risk stratification algorithm in predicting falls: a retrospective analysis of the Osteoarthritis Initiative.

INTRODUCTION: Recurrent falls are observed frequently among older people, and they are responsible for significant morbidity and mortality. The aim of the present study was to verify sensitivity, specificity and accuracy of World Guidelines for Falls Prevention and Management (WGFPM) falls risk stratification algorithm using data from the Osteoarthritis Initiative (OAI). METHODS: Participants aged between 40 and 80 years were stratified as 'low risk', 'intermediate risk' or 'high risk' as per WGFPM stratification. Data from the OAI cohort study were used, a multi-centre, longitudinal, observational study focusing primarily on knee osteoarthritis. The assessment of the outcome was carried out at baseline and during the follow-up visit at 24 months. Data about sensitivity, specificity and accuracy were reported. RESULTS: Totally, 4796 participants were initially included. Participants were aged a mean of 61.4 years (SD = 9.1) and were predominantly women (58.0%). The population was divided into three groups: low risk (n = 3266; 82%), intermediate risk (n = 25; 0.6%) and high risk (n = 690; 17.3%). WGFPM algorithm applied to OAI, excluding the intermediate-risk group, produced a sensitivity score of 33.7% and specificity of 89.9% for predicting one or more falls, with an accuracy of 72.4%. CONCLUSION: In our study, WGFPM risk assessment algorithm successfully distinguished older people at greater risk of falling using the opportunistic case finding method with a good specificity, but limited sensitivity, of WGFPM falls risk stratification algorithm.