Abstract
Background
There are concerns that the COVID-19 pandemic could lead to a rise in mental health problems including anxiety amongst older people, especially those shielding alone during the ...pandemic.
The aim of this study therefore is to examine the prevalence of anxiety symptoms during the COVID-19 pandemic amongst older people and clarify factors associated with higher burden of symptoms.
Methods
We analysed data from the COVID-19 study of The Irish Longitudinal Study on Ageing, conducted on over 3,100 community dwelling people aged ≥60 years from July–November 2020.
Anxiety symptoms were measured with the Generalised Anxiety Disorder-7 Questionnaire with a score ≥ 10 indicating moderate–severe anxiety.
Linear regression models were used to assess the association of variables of interest with anxiety symptoms.
Results
Almost 9% of participants (n = 3,128; mean age 71 years) had moderate–severe symptoms of anxiety.
Factors independently associated with a higher burden of anxiety symptoms included female sex (β = 0.60 (0.33–0.87)); living alone (β = 0.72 (0.41–1.02)); ≥2 chronic diseases (β = 0.85 (0.41–1.30); heart disease (β = 0.95 (0.45–1.46)) and reporting frequent loneliness (β = 6.59 (6.03–7.16)). Age ≥ 80 years (β = −0.77 (−1.16—0.37)) and tertiary level education (β = −0.48 (−0.86—-0.10)) were associated with lower anxiety symptom burden.
Conclusion
Almost 1 in 10 of this population-representative sample of older people had moderate to severe anxiety symptoms during the COVID-19 pandemic.
Strategies to address loneliness, which was particularly strongly associated with anxiety symptoms during the pandemic, should be a priority.
Abstract
Background
Older adults are at high risk from coronavirus 2019 (COVID-19). Even with the introduction of a widespread vaccination programme, adherence to public health guidelines continue to ...be of vital importance to reducing the spread of COVID-19. This study examines the factors associated with adherence to two public health guidelines, social distancing and mask wearing, among older adults (50 years and over) in Ireland.
Methods
Data from the Irish Longitudinal Study on Ageing (TILDA) COVID-19 study and previous waves of TILDA was used. The COVID-19 study data was collected between July 2020 and November 2020. Logistic regression analysis was conducted separately to examine the relationship between the independent variables and social distancing and mask wearing respectively. Along with socio-demographic variables, the Health Belief Model (HBM) was used to identify variables for inclusion in the analysis.
Results
In total, 2,816 participants were included in this study. Females were more likely than males to adhere to social distancing and mask wearing guidelines. Those most concerned about COVID-19 were more likely to adhere to both behaviours. Education levels were associated with adherence to both behaviours but the direction of the relationship differed. Those who trusted the Health Service Executive as a news source were more likely to socially distance, while those with less understanding of government guidance and those who trusted in government news sources were less likely to socially distance. Participants who were working were less likely to socially distance than those who weren’t. While, participants who were over 70 and those who returned the survey after the introduction of mandatory mask wearing were more likely to wear a mask. Participants who lived outside of Dublin were less likely to wear a mask.
Conclusion
Factors associated with adherence to public health guidelines vary according to the guideline. Differences between groups need to be considered when implementing policy around public health guidelines.
Abstract
Background
Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation ...development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture.
Methods
Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants.
Results
The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions.
Conclusion
This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
Abstract
Background
The Sars-CoV-2 global pandemic placed an unprecedented demand on acute health services and led to significant morbidity and mortality in older populations. Nearly half of ...attendances to this ED are over the age of 65 years and there are over 80 nursing homes in the catchment area. A pilot study in January 2021 showed that nursing home attendances increased significantly during the third wave of COVID-19 with many of these attendances potentially avoidable and suitable for optimised care in the nursing home.
The primary objective of this quality improvement project was to enhance the older person’s care and experience when presenting to ED or being reviewed in the community with symptoms and signs of COVID-19. Secondary aims were reduced nursing home attendances to ED and subsequent admissions from these attendances.
Methods
A guideline was constructed based on the RCEM standard for Quality Care for Older People and using the HSE guidelines for managing COVID-19 in nursing home patients. The guideline was introduced to staff and implemented in ED and via the EDITH service.
Results
Two PDSA cycles were undertaken post guideline implementation. There were substantial improvements in the frequency of discussion and documentation of advanced directives with increased numbers of patients being discharged directly back to the nursing home or treated in the nursing home using the guideline. There was a decrease in the number of nursing home attendances throughout the project.
Conclusion
This successful QIP shows the importance of manging older patients appropriately, while considering their wishes. Post-COVID work should centre on managing all older patients with optimised treatment and considering how they will benefit most from their attendance to ED.
Abstract
Background
The geriatric day hospital (GDH) provides outpatient medical, nursing and rehabilitation care to older adults. Historically the main focus has been on rehabilitation. This ...project’s objective was to evaluate how the GDH adapted during the COVID-pandemic to provide acute medical care to older adults.
Methods
This is a pre and post COVID-19 comparative study. Referral source, multidisciplinary-team input and admission rates were evaluated for all new patient referrals from April 1st to May 31st 2019 (pre-pandemic) and compared to April 1st to May 31st 2020 (during-pandemic). This service evaluation project was approved by the local Research and Innovation Office.
Results
There was a 37.7% reduction in the number of new patient referrals for 2020 compared to 2019, p < 0.00; Geriatric medicine referrals reduced by 46.5%, emergency department referrals reduced by 61.5%; community referrals increased 15-foldAL1. There were no differences in patients referred in terms of gender (p = 0.069), mean age (80.9(SD7.6) vs 79.1(SD6.6), p = 0.092), median conditions (5(IQR3.75–7) vs 6(IQ4–8), p = 0.329) and median medications (8(IQR5–11) vs 8 (IQR5.25–9), p = 0.600). Those referred pre-pandemic were frailer according to the clinical frailty score; median 5(IQR5–6) vs 5(IQR4–6), p = 0.013. In 2020, there was a significant reduction in referrals for physiotherapy (72.9% vs 37.3%, p < 0.001), occupational therapy (58.5% vs 37.8%, p = 0.005) and social work (47.5% vs 26.7%, p = 0.004). Clinical nutrition and speech and language remained the same, 16.1% vs 12%, p = 0.430 and 9.3% vs 12%, p = 0.552, respectively. In 2020, patients referred had significantly fewer attendances; median 4(IQR2–7) vs 3(IQR1–5), p = 0.002. There was no difference in admission rates between 2019 and 2020 (3.3% vs 7.9%, p = 0.149).
Conclusion
During the COVID-Pandemic, the GDH evolved to provide more acute ambulatory medical care to avoid admissions. The GDH continues to adapt as the pandemic evolves and older adults needs change. Further comparative analysis will be required.
Abstract
Background
The clinical frailty score (CFS) is a 9 point validated outcome measure used to measure function, mobility, cognition and co-morbidities in patients aged 65 or older. The ...physiotherapy department was restructured due to COVID-19 pandemic. This resulted in the formation of a mixed specialty team which consisted of Frailty Intervention Team (FIT), Medical Respiratory, Acute Medicine Service, Orthopaedics, General Rehabilitation and Care of the Older Person (COTOP). This service review aimed to identify frailty using the CFS across services and to compare CFS versus age, length of stay, falls history and discharge outcomes.
Methods
The CFS data was collected over two weeks. Inclusion criteria included patients who scored ≥4 on the CFS. Exclusion criteria included patients aged under 65. Variables such as age, history of falls, LOS and discharge destinations were compared across all services using Microsoft Excel.
Results
166 patients were included, the average CFS was 5.24 and the average age was 77.2 years. COTOP had the oldest (Av. age 85.4), frailest (Av. CFS 6.1) and longest avLOS (25.3 days) across all services. Frailty was prevalent across all services, with 81% of patients on the medical respiratory service classed as frail. Patients who scored a CFS of ≥4 had higher falls risk and greater LOS. Of the medical respiratory cohort only 12% were discharged to rehabilitation with 77% discharged home. Orthopaedics had the highest percentage of patients discharged to rehabilitation (44%), followed by the general rehabilitation (34%). Only 14% of the COTOP patients were transferred to rehabilitation.
Conclusion
A high incidence of frailty and falls history was identified across all services. Patients who scored lower on the CFS resulted in reduced LOS and were more likely to be discharged directly home. Proactive screening and detection of frailty allows for targeted interventions that may improve outcomes and inform early discharge planning.
Abstract
Background
The aging population of Ireland continues to increase rapidly. As the age continues to increase, so too does the need for long-term care (LTC). In 2006 LTC utilisation was ...estimated between 4.4%–4.8% of the over 65s population. It was proposed that this would increase to between 4.8%–5.3% by 2021 (Wren et al., 2012). This study intended to explore if this projection was evident in discharges from an acute Care of the Older Person’s setting between 2016 and 2021.
Methods
A random selection approach was used to retrospectively review 45 patients seen by occupational therapy in an Irish acute Care of the Older Person’s service in 2016. Discharge destinations were recorded. These were then compared to the discharge destinations of 45 randomly selected patients open to occupational therapy in the same service during the first half of 2021.
Results
The review of 2016 found that 15.56% (n = 7) of those seen by occupational therapy discharged to a LTC facility, and 4.45% (n = 2) discharged home with a back-up LTC plan. Additionally, 33.33% (n = 15) transferred to a rehabilitation facility and 42.22% (n = 19) went home with community supports, 4.44% (n = 2) passed away.
Contrastingly, in 2021, 28.89% (n = 13) patients discharge to LTC with an additional 6.66% (n = 3) going home with 24/7 private care in place, and 4.45% (n = 2) went home with a LTC back-up plan. Just 22.22% (n = 10) went for rehabilitation and 26.67% (n = 12) went home with community supports. In 2021, 11.11% (n = 5) of those randomly selected passed away during their admission.
Conclusion
A significant increase of the number of inpatients discharging to LTC between 2016 and 2021 was found. These findings are greater than that previously proposed and may suggest that COVID-19 has caused a further increase in individuals requiring LTC. However, this sample size was small and other factors such as age, physical ability and cognition were not explored. Further studies are recommended.
Abstract
Background
Quarantine, lockdowns and mandatory isolation have slowed the transmission of Covid-19. However, these public health measures have amplified frailty in our vulnerable older person ...population by increasing social disconnection, reducing exercise and access to early interventions. In response to this increasingly dependent older population we introduced a ‘frailty hub’ in our hospital. This hub allowed early access to a geriatric review as well as a broader multidisciplinary team intervention.
Methods
We performed a cross sectional review of our new hub which was introduced in our tertiary centre to priortise care of the older person.We analysed attendees from February to June 2021 (20 weeks of data).
Results
There were 121 new patient reviews and 127 follow up consultations.Commonly requested reason for referral was medical assessment (30%), cognitive assessments (30%) and falls(28%). Referral sources were analysed and included consultant referrals (11% n = 13), GP referrals (55% n = 67), multidisciplinary team referrals (6% n = 7) and emergency department referrals (26% n = 32). The average age of those review was 79 years (range 59 years to 99 years). Of all patients 65% were reviewed by physiotherapist, 45% were seen by an occupational therapist, 10% were seen by a speech and language therapist or dietician. 85% had a medication changes. 95% had a follow up review with either a geriatrician or advanced nurse practitioner.
Conclusion
Innovation is required to appropriately target our most vulnerable frail adults.The pandemic has had a detrimental effect on some older adult’s function.Our hub is targeting this group and optimising their care.These are our preliminary findings, we plan on doing further analysis.
Abstract
Background
With the development of network technology, telemedicine model plays an increasingly important role as a supplement to the traditional medicine, especially during the period of ...Novel coronavirus pneumonia (NCP, 2019-nCoV) to reduce inter-hospital cross-infection. Remote consultation enables the consultations between a doctor and a patient to be held from distance, facilitating patients’ medical treatment and improving their adherence. However, some patients are reluctant to use it for psychological reasons such as distrust. This study aims to evaluate the effecacy of remote consultation from a psychological point of view, and then analyze patients’ satisfaction on remote consultation.
Subjects and Methods
A retrospective study was implemented, which relied on the remote consultation system of the First Affiliated Hospital of Anhui Medical University. Three county district hospitals (i.e., Jinzhai County People’s Hospital, Huoshan County Hospital, and jinzhai County Hospital of Chinese Medicine) and their subordinate township hospitals in Lu’an areas were chosen as the investigated hospitals for Questionnaire Survey. Jinzhai County Hospital was selected as the sample hospital for studying the clinical efficacy. Data were collected through questionnaire surveys. Statistical descriptions and comparisons were conducted to explore participants’ satisfaction on remote consultation, and to evaluate the different effect of remote consultation on clinical benefits, economic as well as social benefits between participants with and without a remote consultation.
Results
1. The comparison study showed that patients who used remote consultation had shorter hospitalization days, higher diagnosis coincidence rate, and higher treatment effectiveness rate than those who did not (t = –4.80, P<0.05; t=2.84, P<0.05; χ2= 180.20, P<0.05; χ2= 144.21, P<0.05). 2. Statistical data study revealed some economical costs were spared by using remote consultation, including 4,799,000 RMB in patient costs, 179,100 and RMB in transportation costs, 1,484,300 RMB in accommodation costs, and 12,873,100 RMB in social compensation funds. 3. The overall internal correspondence of the questionnaire was 0.761 (each dimension alpha was from 0.745 to 0.955). The patients’ overall satisfaction was 0.81, and the overall satisfaction score of the service attitude, consultation process, and service environment were 0.78, 0.65, and 0.85, respectively. 60.8% of patients were willing to use remote consultation again, and 60.8% of patients were willing to introduce friends.
Conclusions
Telemedicine yield beneficial effects in terms of clinical and financial contribution. First, patients can get better diagnosis and treatment, including shorter hospitalization days, higher diagnostic accuracy and better treatment effectiveness. Second, patients’ medical costs were reduced and social compensation funds were saved, producing a positive influence on health, society and economies of scale with large-scale use. Third, patients felt satisfied and were more compliant with telemedicine.
Acknowledgements
Supported by a project grant from the Major special project of science and Technology Department of Anhui Province (Grant No.16030901061).
Abstract
Background
With the rapid development of the sports industry and the increasingly mature market environment, many sports organizations in Europe and the United States have gradually realized ...the importance of social responsibility. They often use holidays to carry out social responsibility activities and improve the brand image by performing social responsibility. China's sports industry has developed rapidly in recent years, but professional sports still need to learn from European and American countries in fulfilling their social responsibilities. At present, the contradiction between the growing spiritual and cultural needs of the people and the insufficient and unbalanced supply is becoming increasingly prominent. Professional sports is an important industry to meet people's spiritual and cultural needs. Professional sports clubs are responsible for training excellent athletes for the country, seeking economic benefits for the club, providing public services for cities and communities, disseminating urban sports culture, promoting sports development, protecting the environment, engaging in philanthropy and other important responsibilities. They are the core of professional sports. Whether professional sports clubs can actively fulfill their corporate social responsibility will have an important impact on the development of professional sports. Therefore, it is of great significance to understand the current situation of social responsibility of professional sports clubs and the influencing factors of consumers' emotion, and to explore the ways for professional sports clubs to fulfill their social responsibility.
Research Objects and Methods
Taking CBA club as the research object, this study investigates the implementation status and influencing factors of CBA club's social responsibility from the perspective of the psychological perception of sports experts and spectators by using the combination of quantitative questionnaire survey and qualitative content analysis. In order to improve the impact of sports club rules on consumers' emotion, this study first revised the emotion questionnaire compiled by Dong Yan and Yu Guoliang (2007) according to the basic characteristics of the environment, and then measured the subjects' emotion with the revised scale. Among them, positive emotion (30 items in total) includes two dimensions: positive high arousal emotion and positive low arousal emotion, and negative emotion (42 items in total) includes two dimensions: negative high arousal emotion and negative low arousal emotion. The questionnaire adopts Likert's 5-level continuous evaluation, “1” means “completely unqualified” and “5” means “fully qualified”. Statistics show that the internal consistency reliability of the two subscales of positive emotion and negative emotion is 0.5% 75 ~ 0. Four factor validity: 245 21,x2 / df = 1. 96, CFI = 0. 94, TLI = 0. 91, RMSEA = 0. 050, SRMR = 0. 067.
Results
The survey results show that sports experts and ordinary audiences are not satisfied with the current implementation of corporate social responsibility in CBA clubs. It is generally believed that the lack of corporate social responsibility in CBA clubs is serious. Sports experts believe that the most important factors affecting the performance of social responsibility by CBA clubs are unclear property rights, vague relationship between responsibilities and rights in the business process, lack of perfect social responsibility supervision and evaluation mechanism, while ordinary audiences believe that there is a lack of perfect corporate social responsibility supervision and evaluation mechanism, backward system and imperfect relevant laws and regulations. The results showed that the effect of interpersonal emotion regulation on implicit positive emotion decreased with the increase of regulation difficulty level; And expression inhibition is the mediating variable of regulatory effect, which has some mediating effect. With the enhancement of expression inhibition, the mediating effect has an increasing trend. Because interpersonal interaction can more activate psychological processing processes such as empathy, viewpoint selection and attention conversion, it will help interpersonal emotion regulation to positively predict implicit positive emotions at the level of automatic processing. The result of the negative regulation effect of regulation difficulty is consistent with the theoretical viewpoint proposed by the dual resource model of interpersonal emotional interaction. The dual resource model holds that the emotional regulation of interpersonal interaction is based on the resources of two nervous systems. Self regulated public resources can realize top-down cognitive control, and the work of this system needs to be realized at the level of consciousness.
Conclusion
This paper puts forward the ways to promote the implementation of social responsibility of professional sports clubs: clarify the legal subject status of professional sports clubs, legalize the social responsibility connotation of professional sports clubs, comprehensively build the social responsibility awareness of professional sports clubs and stakeholders, strengthen the social responsibility consciousness of professional sports clubs, and establish a scientific social responsibility evaluation system of professional sports clubs, Improve the social responsibility supervision system of professional sports clubs.
Acknowledgments
National Social Science Foundation of China 20BTY051: Research on competitive balance driving high-quality development of Professional sports in China.
