Volume 7, Issue 1, March 2022

Objectives

Randomised control trials (trials) involving people with dementia lack detailed analysis of recruitment and retention strategies. To address this, we examined the effectiveness of strategies in “The TACIT Trial: TAi ChI for people with demenTia”.

Methods

We recruited dyads (people with dementia and carers) from 3 South of England sites utilising different strategies. Recruitment strategy effectiveness was measured by percent yield (number randomised of total referrals) and cost per randomised participant. Our retention strategy (maintaining contact with participants during weekly telephone calls) was measured by percent yield (number retained by six-month follow-up).

Results

Of 359 dyads, 24% were randomised into the study (n=85). The most resource-intensive strategy (research nurses spending 30 minutes explaining the study) had the highest referral to randomisation rate. An incremental cost-effectiveness ratio suggested an alternative approach (nurses and doctors spending 5 minutes explaining the study) was most cost-effective. Retention rates were 86% (n=36/42; intervention group) and 81% (35/43 control group); main reasons for attrition were worsening health and lack of study interest.

Conclusions

The results demonstrate person-centred strategies enabling staff to spend time with participants were effective in supporting recruitment and retention. Those designing future trials must consider such strategies and the associated costs.

Objectives

Achieving the hip fracture best practice tariff is associated with decreased mortality rates. The aim of this study is to evaluate the impact of Covid-19 pandemic on achieving Best Practice Tariff.

Methods

We retrospectively reviewed all adult hip fractures admitted to our unit between March and June 2020. Patient’s characteristics, place of residence, delirium assessment, and mobility status were recorded. All the Best practice Tariff criteria have been analysed. Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction.

Results

178 patients with a mean age of 82.8 years presented with hip fractures during the study period. 18 patients (10.1%) tested positive for COVID-19. 44.4% failed to achieve the BPT from the COVID-19 positive group and 22.5% from the negative group.

Conclusion

Based on this study, hip fractures associated with Covid-19 infection are more likely to fail the BPT and have higher 30-day mortality rates compare to the COVID-19 negative patients.

Physical inactivity and sedentary time are associated with all-cause mortality, chronic non-communicable diseases and falls in the elderly. Objective of this review is to assess and summarize recommendations from clinical guidelines for physical activity (PA) of older adults in general and related to falls. A scoping review of the existing clinical guidelines was conducted. The included studies should have been developed under the auspices of a health organization and their methodology should be described in detail. Nine clinical guidelines providing specific recommendations for the elderly were identified. There was a strong agreement across the guidelines regarding goals, activities parameters, adverse effects of PA, in addition to reference for preventing falls. Keeping even the minimum of physical activity, introducing balance exercises and strengthening exercises for preventing falls, avoiding unexpected accelerations in the intensity of the activities, applying the necessary precautions and consulting a health professional are the main pillars of recommendations. Despite any deficiencies in definitions, monitoring and optimal dosage consistency of recommendations, is an ideal incentive for countries and organizations to adopt and enhance physical activity as an antidote to the degeneration of human’s health and quality of life.

Population aging is evident globally. The traditional model of care based on disease management is not sufficient to develop a generation of functional older adult population. The construct of Physical Resilience (PR) holds great potential to make the agenda of healthy aging a reality if we were to properly understand it and develop intervention strategies to maintain PR through life. There are several difficulties and challenges with this novel construct that need to be resolved through research, so as to foster its vast possibilities to maintain functional ability in old age.

Vitamin B12, widely known as cobalamin, is a water-soluble vitamin crucial for human metabolism. It is synthesized only by prokaryotic organisms and since humans do not have the ability to synthesize it, they rely on its exogenous dietary intake. After its consumption, vitamin B12 undergoes a complicated procedure of absorption and assimilation and it is essential for cellular function, especially for nervous system, red blood cell production and DNA synthesis. Deficiency of vitamin B12 is considered as an important public health issue worldwide, while it is common in the elderly. Deficiency of this vitamin, as well as high levels, indicate a risk factor for morbidity with various clinical manifestations. Frailty is an age-related syndrome, which affects the elderly and is characterized by decreased function in many physiological systems, accompanied by vulnerability to stressors. A narrative non-systematic mini review of the literature was conducted and highlighted that vitamin B12 levels may have an impact on frailty and vice versa. As shown in several studies, vitamin B12 levels may be related to sarcopenia, cognitive and musculoskeletal disorders, neurological or psychiatric symptoms, which are closely linked to frailty. Furthermore, it is suggested that the extensions of frailty may affect the bioavailability of vitamin B12.

Objective

Psoas muscle metrics from diagnostic computerized tomography (CT) scans are emerging as clinically relevant biomarkers. Most muscle metrics from the US population are from older cohorts with co-morbidities. Published reports from a young or healthy population in the United States on psoas muscle metrics optimized for age, body mass index (BMI), and sex are lacking. This study determines the psoas muscle index (PMI) and psoas muscle density (PMD) for a normal young Midwestern US population.

Methods

Retrospective cross-sectional analysis of pre-existent abdominal non-contrast CT scans from a young (19-40 years old), Midwestern, predominately Caucasian population was conducted within Aquarius iNtuition software automatically after manual identification of the psoas muscle. Electronic medical records provided access to subject data and archived CT scans were reviewed.

Results

From 193 (45 male, 148 female) CT scans, for males, PMI was 5.9 cm²/m² (SD=1.7) and PMD 48.4 HU (SD=5.5); for females PMI was 5.4 cm²/m² (SD=1.4) and PMD 48.18 HU (SD=5.5). BMI was significantly correlated with PMI and PMD for both men (p<0.001, p<0.001 respectively) and women (p<0.001, p<0.001 respectively).

Conclusion

Psoas muscle metrics are newly generated for PMI and PMD in a healthy population, allowing for future comparison studies determining muscle status.

Activity restrictions during the COVID-19 pandemic left many older adults without access to community-based falls prevention programs. Despite a lack of evidence to support the digital delivery of exercise and rehabilitation, these services were quickly implemented during the pandemic in an effort to prevent the transmission of COVID-19, yet support a continuity of care. Our report describes the novel practice and digital delivery of a condensed Otago Exercise Program, a well-documented falls prevention program, to an 83-year-old female with high falls risk. After four weeks of the Otago Exercise Program via digital delivery, the patient in our case had notable improvement in her scores on the Timed Up and Go, Five Times Sit to Stand, 30-Second Chair Stand Test and One Leg Stance tests. Our findings necessitate the additional exploration of the digital delivery of exercise for future community-based falls prevention programs and provide an alternate method of delivery for falls prevention for practitioners to consider.