Interventions that have potential to help older adults living with social frailty: a systematic scoping review.

BACKGROUND: The impact of social frailty on older adults is profound including mortality risk, functional decline, falls, and disability. However, effective strategies that respond to the needs of socially frail older adults are lacking and few studies have unpacked how social determinants operate or how interventions can be adapted during periods requiring social distancing and isolation such as the COVID-19 pandemic. To address these gaps, we conducted a scoping review using JBI methodology to identify interventions that have the best potential to help socially frail older adults (age ≥65 years). METHODS: We searched MEDLINE, CINAHL (EPSCO), EMBASE and COVID-19 databases and the grey literature. Eligibility criteria were developed using the PICOS framework. Our results were summarized descriptively according to study, patient, intervention and outcome characteristics. Data synthesis involved charting and categorizing identified interventions using a social frailty framework.  RESULTS: Of 263 included studies, we identified 495 interventions involving ~124,498 older adults who were mostly female. The largest proportion of older adults (40.5%) had a mean age range of 70-79 years. The 495 interventions were spread across four social frailty domains: social resource (40%), self-management (32%), social behavioural activity (28%), and general resource (0.4%). Of these, 189 interventions were effective for improving loneliness, social and health and wellbeing outcomes across psychological self-management, self-management education, leisure activity, physical activity, Information Communication Technology and socially assistive robot interventions. Sixty-three interventions were identified as feasible to be adapted during infectious disease outbreaks (e.g., COVID-19, flu) to help socially frail older adults. CONCLUSIONS: Our scoping review identified promising interventions with the best potential to help older adults living with social frailty.

Hypertensive management in the elderly patient at risk for falls.

PURPOSE: Seventy percent of people over 65 years of age have hypertension, and one third of elders fall each year. These conditions frequently coexist, and each carries a risk for substantial functional decline or mortality. This article reviews the risks of and interventions to reduce falls in the elderly patient with hypertension. DATA SOURCES: A systematic review of the published and unpublished literature and consensus panel recommendations through January 2008 are discussed. CONCLUSIONS: Hypertension management in the frail elder at risk for fall must include a thoughtful assessment of the relative risks and benefits of treatments that are most likely to preserve function, independence, and quality of life. Stringent adherence to guidelines may not be appropriate for all patients. The periodic use of a standardized fall risk screening tool can assist the nurse practitioner (NP) to identify patients at risk for falls and adjust medication management accordingly. IMPLICATIONS FOR PRACTICE: This article will assist the NP to weigh management options in the context of the complex elderly patient.

Selecting an accurate point-of-care testing system: clinical and technical issues and implications in neonatal blood glucose monitoring.

ISSUES AND PURPOSE: Rapid identification and treatment of glucose abnormalities is crucial in the prevention of potentially devastating neurological injury in neonates. Choice of a point-of-care glucose testing system must consider accuracy, clinical advantages, and data management capabilities. CONCLUSIONS: The benefits and limitations of point-of-care testing must be weighed against the time delay of central laboratory testing. PRACTICE IMPLICATIONS: Considerations in selecting a point-of-care blood glucose monitoring system include accuracy, precision, versatility, and the potential for cross infection and blood loss. When a system is selected, studies must be done to identify potential sources of error and confirm the utility and accuracy of the system in the identified population.