Screening instruments to predict adverse outcomes for undifferentiated older adults attending the Emergency Department: Results of SOAED prospective cohort study.

BACKGROUND: frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention. We assessed the validity of the Identification of Seniors at Risk (ISAR), Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy seven item questionnaire (PRISMA-7) and InterRAI-ED at predicting adverse outcomes at 30 days and 6 months amongst older adults presenting to the Emergency Department (ED). METHODS: a prospective cohort study of adults ≥65 years who presented to the ED was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were assessed. Blinded follow-up telephone interviews were completed at 30 days and 6 months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity, specificity, negative predictive value and positive predictive value of the screening tools were calculated using 2 × 2 tables. RESULTS: a total of 419 patients were recruited; 47% female with a mean age of 76.9 (Standard deviation = 7.2). The prevalence of frailty varied across the tools (CFS 57% versus InterRAI-ED 70%). At 30 days, the mortality rate was 5.1%, ED re-attendance 18.1%, hospital readmission 14%, functional decline 47.6% and nursing home admission 7.1%. All tools had a high sensitivity and positive predictive value for predicting adverse outcomes. CONCLUSION: older adults who screened positive for frailty were at significantly increased risk of experiencing an adverse outcome at 30 days with the ISAR being the most sensitive tool. We would recommend the implementation of the ISAR in the ED setting to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention.

The effect of dance on physical health and cognition in community dwelling older adults: A systematic review and meta-analysis.

BACKGROUND: Dancing is an attractive form of exercise among older adults and may positively influence physical and psychosocial health. The aim of this systematic review was to synthesize the evidence examining the dance prescription and effectiveness of dance in community dwelling older adults. METHODS: Eight databases were searched to identify randomized controlled trials that evaluated the effectiveness of dance programs on community-dwelling older adults from 2007 to December 2020. Data regarding participants, dance programs and outcomes of interest were extracted and narratively synthesized. A meta-analysis was performed on the outcome data where possible. RESULTS: Twenty-two studies met the inclusion criteria, of those 15 were deemed to be fair quality and 7 high quality using the PEDro scale. Nineteen studies included in the meta-analysis found that dancing can improve mobility and endurance compared to no intervention and afforded equivalent outcomes compared to other exercise programs. CONCLUSION: The findings suggest that dance is an effective, safe and viable activity for community-dwelling older adults..

Can we predict the neutral breast position using the gravity-loaded breast position, age, anthropometrics and breast composition data?

BACKGROUND: This study aimed to identify the predictor variables which account for neutral breast position variance using a full independent variable dataset (the gravity-loaded breast position, age and anthropometrics, and magnetic resonance imaging breast composition data), and a simplified independent variable dataset (magnetic resonance imaging breast composition data excluded). METHODS: Breast position (three-dimensional neutral and static gravity-loaded), age, anthropometrics and magnetic resonance imaging breast composition data were collected for 80 females (bra size 32A to 38D). Correlations between the neutral breast position and the gravity-loaded breast position, age, anthropometrics, and magnetic resonance imaging breast composition data were assessed. Multiple linear and multivariate multiple regression models were utilised to predict neutral breast positions, with mean absolute differences and root mean square error comparing observed and predicted neutral breast positions. FINDINGS: Breast volume was the only breast composition variable to contribute as a predictor of the neutral breast position. While ≥69% of the variance in the anteroposterior and mediolateral neutral breast positions were accounted for utilising the gravity-loaded breast position, multivariate multiple regression modelling resulted in mean absolute differences >5 mm. INTERPRETATION: Due to the marginal contribution of breast composition data, a full independent variable dataset may be unnecessary for this application. Additionally, the gravity-loaded breast position, age, anthropometrics, and breast composition data do not successfully predict the neutral breast position. Incorporation of the neutral breast position into breast support garments may enhance bra development. However, further identification of variables which predict the neutral breast position is required.

Complementary and alternative medicine use among older adults with musculoskeletal pain: findings from the European Social Survey (2014) special module on the social determinants of health.

BACKGROUND: This study describes the use of complementary and alternative medicine (CAM) among older adults who report being hampered in daily activities due to musculoskeletal pain. The characteristics of older adults with debilitating musculoskeletal pain who report CAM use is also examined. METHODS: Cross-sectional European Social Survey Round 7 data from 21 countries were examined for participants aged 55 years and older, who reported musculoskeletal pain that hampered daily activities in the past 12 months. RESULTS: Of the 4950 older adult participants reporting musculoskeletal pain that hampered daily activities, the majority (63.5%) were from the West of Europe, reported secondary education or less (78.2%), and reported at least one other health-related problem (74.6%). In total, 1657 (33.5%) reported using at least one CAM treatment in the previous year. Manual body-based therapies (MBBTs) were most used, including massage therapy (17.9%) and osteopathy (7.0%). Alternative medicinal systems (AMSs) were also popular with 6.5% using homoeopathy and 5.3% reporting herbal treatments. A general trend of higher CAM use in younger participants was noted. CAM use was associated with physiotherapy use, female gender, higher levels of education, being in employment and living in West Europe. Those reporting multiple health problems were more likely to use all CAM treatments, except MBBT. CONCLUSION: A third of older Europeans with musculoskeletal pain report CAM use in the previous 12 months. Certain subgroups with higher rates of CAM use could be identified. Clinicians should comprehensively and routinely assess CAM use among older adults with musculoskeletal pain.

Association between work status and depression in informal caregivers: a collaborative modelling approach.

BACKGROUND: Care is regularly provided on an informal basis by family and friends and it is well established that caregivers experience high rates of depression. The majority of research on caregivers tends to focus on older, full-time caregivers, with less attention paid to working caregivers (in paid employment). The aim of this study is to explore the impact of work status on depression in caregivers. METHODS: A sample of individuals from the 2014 European Social Survey dataset, aged 18 and older, who reported being a caregiver, were investigated (n = 11 177). Differences in sociodemographic, mental and physical health and social network variables, between working and non-working caregivers, were investigated. Hierarchical logistic regression models were used to investigate associations between the caregivers' work status and depression. This study was developed in partnership with a panel of caregivers who contributed to the conceptualization and interpretation of the statistical analysis. RESULTS: Findings showed that 51% of caregivers reported being in paid employment. Non-working caregivers were more likely to be female, older, widowed, have lower education levels and provide intensive caring hours. They were also more likely to report depressive symptoms than working caregivers after controlling for sociodemographic, social networks and intensity of caring (adjusted odds ratio = 1.77, 95% confidence interval = 1.54-2.03). The panel considered policies to support continued work important as a means of maintaining positive mental health for caregivers. CONCLUSIONS: Supportive policies, such as flexible working and care leave, are recommended to allow caregivers to continue in paid work and better manage their health, caring and working responsibilities.

The impact of frailty Screening of Older adults with muLtidisciplinary assessment of those At Risk during emergency hospital attendance on the quality, safety and cost-effectiveness of care (SOLAR): a randomised controlled trial.

BACKGROUND: Older people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource-intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit. METHODS: This will be a parallel 1:1 allocation randomised control trial. All patients who are ≥ 75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥ 2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be the length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer-reviewed journals and national and international conferences. TRIAL REGISTRATION: ClinicalTrials.gov NCT04629690 . Registered on November 16, 2020.

Lower levels of physical activity are associated with pain progression in older adults, a longitudinal study.

BACKGROUND: While pain is common in older adults, the association with physical activity remains unclear. Currently, the role physical activity plays in impacting pain developing over time is not well defined. METHODS: Latent transition analysis (LTA) is a model-based approach to identifying underlying subgroups in a population, longitudinally, based on measured characteristics. In this study, LTA was used to explore the associations between physical activity levels and pain classes of adults aged over 50 years, from the Irish Longitudinal Study on Ageing (n = 8,175) across three waves of data collection (4 years). RESULTS: Using three previously established pain classes (No Pain; Low-Moderate Impact Pain; High Impact Pain), 66% of older adults were classified as having 'No Pain' across the three waves. At Wave 1, individuals reporting low (OR = 4.00, 95% CI [3.21, 5.17]) or moderate (OR = 1.59, 95% CI [1.27, 1.99]) levels of physical activity are more likely to be in the High Impact Pain class, than the No Pain class. Longitudinally, individuals in the No Pain class with low or moderate physical activity were more likely to transition to the High Impact Pain class compared to those with higher physical activity scores (from Wave 1 to Wave 2, OR = 1.90, 95% CI [1.15, 3.37]; and from Wave 2 to Wave 3, OR = 2.27, 95% CI [1.40, 4.74]). CONCLUSION: Older adults who do not meet minimum physical activity guidelines for moderate intensity exercise are at increased risk of higher impact pain when followed over 4 years. SIGNIFICANCE: Older adults who do not meet minimum physical activity guidelines are at increased risk of transitioning to higher impact pain classes when followed over 4 years.

Long-term antidepressant use in a cohort of older people.

OBJECTIVES: Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use. METHODS: Adults aged 50 and over, from The Irish Longitudinal Study on Ageing (TILDA), who participated at any one of the four TILDA waves (n = 8175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population. RESULTS: We found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of antidepressant use. Notably, 6% of older adults were categorised in a 'long-term antidepressant use' class, with consistent use across all four waves, and 6% were categorised in an 'Intermittent/Developing Use' class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services. CONCLUSIONS: These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary improve management of this condition.

Medication and healthcare utilization variation among older adults with pain.

BACKGROUND: While pain is very common in older adults, the associated impact on daily life, including usage of medication and healthcare, varies considerably and often pain remains inadequately treated. It is not clear what is associated with this variation. METHODS: Latent class analysis (LCA) is a model-based approach to identifying underlying subgroups in a population. In this study LCA was used to examine biopsychosocial risk classes of adults aged 50 years and older, who were often troubled by pain, from The Irish Longitudinal Study on Ageing (TILDA), (n = 2,896), and the associations with future medication and healthcare use. RESULTS: Four biopsychosocial risk classes (Low Biopsychosocial Risk, Physical Health Risk, Mental Health Risk, High Biopsychosocial Risk) were identified, with the 'High Biopsychosocial Risk' class accounting for 24% of older adults with pain. This class were much more likely to use medication and healthcare services when followed up across three waves of the TILDA study. In contrast, the Physical Health Risk and the Mental Health Risk classes reported lower usage of medication and healthcare at waves 2 and 3. Amongst the higher risk classes of older adults who are troubled by pain, there is considerable consumption of medication and healthcare services evident. CONCLUSION: Given our ageing population and significant number of adults in this high risk class, there is a need to optimize current pain management approaches among older adults. Intensive non-pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring. SIGNIFICANCE: While pain is very common in older adults, the usage of medication and healthcare varies considerably and often pain remains inadequately treated. Given our ageing population and the significant number of older adults reporting high biopsychosocial risk (24%), there is a need to optimize current pain management approaches. Intensive non-pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring.

The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial.

BACKGROUND: Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. METHODS: Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. RESULTS: Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and 'risk of malnutrition' was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. CONCLUSION: Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. TRIAL REGISTRATION: Protocol registered in ClinicalTrials.gov, ID: NCT03739515 , first posted November 13, 2018.

Exploring the beliefs and experiences of older Irish adults and family carers during the novel coronavirus (COVID-19) pandemic: A qualitative study protocol.

Background: In December 2019 a novel human coronavirus (COVID-19) was identified in Wuhan, China (Wu et al, 2020). The virus subsequently spread to most countries worldwide and the World Health Organisation characterised the outbreak a pandemic on March 11 th 2020 (WHO, 2020a). Older age is associated with an increased risk of mortality in patients with COVID-19 (Chen et al., 2020). In March 2020, the Irish Government introduced 'cocooning' as a measure for those over 70 years of age to minimise interactions with others by not leaving their homes (Dept. of Health, 2020). The COVID-19 pandemic presents unique threats to the health and well-being of older adults. This study aims to explore the longitudinal experiences and beliefs of older adults during the COVID-19 pandemic. Findings will be important for tailoring supports, interventions and public health information for this population. Methods: A longitudinal exploratory qualitative study will be conducted using repeated semi-structured telephone interviews with a convenient sample of older adults recruited from participants of an older adult and family carer stakeholder panel for health services research established by the Ageing Research Centre (ARC) at the University of Limerick and through known older adult contacts of ARC academic members. Interviews will be audio recorded, transcribed and analysed using a reflexive approach to thematic analysis. Participants will have the opportunity to review and discuss preliminary analysis of the interview data and to co-write / design dissemination materials. Ethics and Dissemination: Ethical approval has been granted by the Faculty of Education and Health Sciences University of Limerick, Research Ethics Committee (2020_03_51_EHS (ER)). Findings will be disseminated through open access journal publications and distribution of lay summaries, a press release and an infographic to organisations of and for older people in Ireland, broadcast and print media.

A protocol for the establishment and evaluation of an older adult stakeholder panel for health services research.

Background: There has been a policy shift towards public and patient involvement (PPI) in population health and health services research in Ireland and internationally. Despite growing empirical evidence that PPI can have positive impacts on the quality and appropriateness of health research and innovation, little is known about the involvement and impact of older adults as research partners. The aim of this study is to 1) describe the process of establishing a PPI panel of older adults, family carers and ageing research academics and 2) to evaluate the impact of this research partnership on all members of the PPI panel. Methods: A partnership-focused framework will guide the recruitment and establishment of a PPI panel of older adults, family carers and academic researchers. Between eight and ten older adults and four and six family carers with experience of using health services will be recruited through advertisement in community locations and through gatekeepers in a range of non-governmental, voluntary, and community organisations of older adults in the Mid-West region of Ireland. Academic researchers will be recruited through an established Ageing Research Centre at the University of Limerick. Data collected will include an activity log and records of all meetings, recorded panel discussions and recorded individual interviews with all members of the research team at key time points (12 and 24 months after establishment of the panel). Data will be transcribed, managed in NVivo and analysed using an inductive approach to thematic analysis. Dissemination of research findings will be facilitated by the research partnership team of academics and older adults. Discussion: This study will identify learning about the process of establishing a PPI panel guided by a partnership-focused framework and will qualitatively evaluate the impact of participation in a PPI panel for all members of the research team.

Examining what factors mediate treatment effect in chronic low back pain: A mediation analysis of a Cognitive Functional Therapy clinical trial.

BACKGROUND: Cognitive Functional Therapy (CFT) is a physiotherapist-led individualized intervention for people with people with non-specific chronic low back pain (CLBP), involving biopsychosocial pain education, graded movement exposure and lifestyle coaching. METHODS: A multicentre randomized controlled trial (RCT), including 206 participants with CLBP in Ireland, supported CFT's effectiveness for reducing disability, but not pain, compared to a group exercise and education intervention. In this study, causal mediation analysis was used to determine whether the effect of CFT on disability and the lack of effect on pain (relative to a group exercise and education intervention) is mediated by certain psychological and lifestyle factors. Hypothesized mediators measured were pain self-efficacy, stress, fear of physical activity, coping, depression, anxiety and sleep, at 6 months. The outcomes measured were functional disability and pain intensity at 12 months. RESULTS: This causal mediation study shows that the majority of benefit of CFT (relative to a group exercise and education intervention) for disability is due to increasing pain self-efficacy. CONCLUSION: Conclusion: CFT did not improve the majority of the hypothesized mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these mediators were not associated with either disability or pain. Unfortunately, the proportion of missing data in this study is substantial and these findings can only be considered hypothesis-generating. Therefore, future research should examine replicating the results of this study to verify the role of self-efficacy and other proposed mediators (e.g. stress, coping, sleep, fear) on clinical outcomes. SIGNIFICANCE: An exploration of seven potential mediators was undertaken to determine the effect of Cognitive Functional Therapy (CFT) on disability and pain intensity in individuals with chronic low back pain compared to a group exercise and education intervention. CFT improved pain self-efficacy, which was associated with disability and pain outcomes. CFT did not improve the other six potential mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these were not associated with disability or pain. The proportion of missing data in this study is substantial and these findings should be considered hypothesis-generating only.

The effect of 'paying for performance' on the management of type 2 diabetes mellitus: a cross-sectional observational study.

BACKGROUND: The 'cycle of care' (COC) pay for performance (PFP) programme, introduced in 2015, has resourced Irish GPs to provide structured care to PCRS eligible patients with type 2 diabetes mellitus (T2DM). AIM: To investigate the effect of COC on management processes. DESIGN &SETTING: Cross-sectional observational study undertaken with two points of comparison (2014 and 2017) in participating practices (Republic of Ireland general practices), with comparator data from the United Kingdom National Diabetes Audit (UKNDA) 2015-2016. METHOD: Invitations to participate were sent to practices using a discussion forum for Health One clinical software. Participating practices provided data on the processes of care in the management of patients with T2DM. Data on PCRS eligible patients was extracted from the electronic medical record system of participating practices using secure customised software. Descriptive analysis, using IBM SPSS Statistics for Windows (version 25), was performed. RESULTS: Of 250 practices invited, 41 practices participated (16.4%), yielding data from 3146 patients. There were substantial improvements in the rates of recording of glycosylated haemoglobin ([HbA1c] 53.1%-98.3%), total cholesterol ([TC] 59.2%-98.8%), urinary albumin:creatinine ratio ([ACR] 9.9%-42.3%), blood pressure ([BP] 61.4%-98.2%), and body-mass index ([BMI] 39.8%-97.4%) from 2014 to 2017. For the first time, rates of retinopathy screening (76.3%), foot review (64.9%), and influenza immunisation (69.9%) were recorded. Comparison of 2017 data with UKNDA 2015-2016 was broadly similar. CONCLUSION: The COC demonstrated much improved rates of recording of clinical and biochemical parameters, and improved achievement of targets in TC and BP, but not HbA1c. Results demonstrate substantial improvements in the processes and quality of care in the management of patients with T2DM.

The diagnostic and predictive accuracy of the PRISMA-7 screening tool for frailty in older adults: A systematic review protocol.

Background: Older adults are at risk of adverse outcomes due to frailty. A number of frailty screening instruments have been developed to identify older adults at increased risk of frailty. This systematic review and meta-analysis will look to examine the diagnostic accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7). Methods and analysis: A systematic literature search will be conducted from 2008-February 2020 in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation studies of the PRISMA-7 tool.  A pre-specified PRISMA-7 score of ≥3 (maximum score 7 points) will be used to identify frailty in older adults. Prospective or retrospective cohort studies, cross-sectional studies and the control arm of randomised controlled trials will be included that attempt to validate the diagnostic accuracy of the PRISMA-7 screening tool in older adults across all healthcare settings when compared to a reference standard. The predictive accuracy of the PRISMA-7 tool will also be explored. Study quality will be assessed by the QUADAS-2 tool. A bivariate random effects model will be used to generate pooled estimates of sensitivity and specificity. Statistical heterogeneity will be explored using validated methods. Ethics and dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the popular press. Protocol registration: Awaiting registration with the International Prospective Register for Systematic Reviews (PROSPERO).

High rate of tibial debonding and failure in a popular knee replacement: A cause for concern.

BACKGROUND: Total knee arthroplasty (TKA) is a common orthopedic procedure with 975,739 performed in the UK between 2003 and 2016. The two most common prosthetics used are P.F.C. Sigma and NexGen. The aim of this study is to compare the experience of a single fellowship-trained arthroplasty surgeon at a single dedicated orthopedic hospital using both of these prosthetics over a 17-year period. METHODS: This study was carried out as a retrospective review. Information was gathered from a database of primary TKAs and revision TKAs, as well as medical records, correspondence and operative notes. RESULTS: A total of 1,511 TKAs were performed between 1999 and 2015 - with a further follow-up period of 2 years. There were 1,161 consecutive P.F.C. primary TKAs done from 1999 to April 2013, after which, 350 consecutive NexGen primary TKAs were performed. Between 2015 and 2017, 26 NexGen revisions were required. 23 (6.6%) of the NexGen knees were carried out for aseptic loosening. The average time for revision from the NexGen index surgery was 30.4 months. The failures all presented similarly - with the tibial component having collapsed into varus and radiographic lucency noted under the implant. CONCLUSION: In spite of changes in orthopedic practice and advances in implant technology over the time period of this study, we would not expect this level of implant failure from a surgeon who had no previous significant issues with aseptic loosening using a different prosthetic. Usage of the NexGen knee has been discontinued at this center.

The change of pain classes over time: a latent transition analysis.

BACKGROUND: Pain is common in older adults, and associated with increased morbidity and reduced quality of life. Recent research has highlighted different classes of older adults with pain, each with differing impacts on their life. It has not yet been investigated if, and how, such classes change over time and what influences individuals to prospectively transition to a profile of either improved or worsened pain impact. METHODS: Latent transition analysis (LTA) is a longitudinal model-based approach to identifying underlying subgroups in a population. LTA was used to model the change in pain of people aged 50 and above, from The Irish Longitudinal Study on Ageing, across three waves (n = 5,925). The LTA model was extended to include biopsychosocial covariates to predict transition probabilities between classes over time. RESULTS: Three latent classes were identified based on three pain indicators (pain presence; pain affects daily life; pain requires medication) and were characterized as "No Pain", "Low-Moderate Impact Pain" and "High Impact Pain". Results indicate that the pain class of many changes over time. However, poor physical or mental health increased the risk of transitioning to a more severe pain class, from Wave 1 to Wave 2 and Wave 2 to Wave 3. CONCLUSIONS: These findings show the change in pain of older adults over time, with both marked improvement and deterioration being observed. Critically, the predictors of individuals transitioning between classes reflect the breadth of biopsychosocial factors involved in pain. SIGNIFICANT STATEMENT: This article identified differing classes of pain in older adults, using latent transition analysis. The analysis demonstrated how the pain classes of older adults are broadly consistent over time, however both improvement and deterioration in pain impact were observed. Transitions between classes were associated with several biopsychosocial factors. These results have important implications for the health and quality of life of older adults. Consideration of health, lifestyle and socio-demographic factors may enhance assessment and management of pain in older adults.

Patient-rated physician empathy and patient satisfaction during pain clinic consultations.

BACKGROUND: Little is known about the influence of patient-perceived healthcare provider empathy on patient satisfaction in the setting of a hospital pain clinic consultation. The objective of this research was to examine the relationship between patient-rated physician empathy and patient satisfaction after a single new pain clinic consultation. METHODS: After institutional ethics committee approval, a sample of 140 adult patients completed a two-page questionnaire, directly after a pain clinic consultation. This included a brief sociodemographic questionnaire, the Consultation and Relational Empathy (CARE) measure and an overall satisfaction rating. RESULTS: The sample, N = 140 patients, was balanced for gender and 80% of participants ranged in age from 30 to 70. Of these patients, 80.7% had been living with chronic pain between 1 and 5 years. The data were deemed to be non-parametric and a Spearman's ranked order correlation analysis yielded a strong positive correlation between patient-rated physician empathy and patient consultation satisfaction. CONCLUSION: Patient-rated physician empathy was strongly correlated with patient satisfaction in a pain clinic consultation. Patient satisfaction plays a significant role in adherence to treatment and contributes to a positive working patient-physician therapeutic relationship. This research supports the growing body of research citing the importance of investing in, promoting and developing educational programs for physicians and medical trainees to enhance empathic communication skills within the clinical setting.

Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations.

OBJECTIVES: The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. DESIGN: Cross-sectional design. SETTING: One urban primary care OOH facility located in the midwest of Ireland. PARTICIPANTS: 457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients' data being included in this study. There were 59.5% female participants and 40.5% male participants. RESULTS: 435 patients with acute URTI symptoms participated in the survey, representing 25.4% of those attending the single branch where the survey was conducted (n=1715). Of the study participants, 43% were aged under 6 years and 60% were women. The most common presenting symptoms were cough (72%), throat ache (46%) and common cold (26%). The most common expectations were for further examination (53%), reassurance (51%), information (49%) and medication for cough (47%), with 34% expecting an antibiotic. CONCLUSIONS: Only one in three patients attending this primary care OOH facility with acute URTI symptoms had an expectation of antibiotics, with most seeking further assessment, information and reassurance. Recognition of such expectations may be important considerations for clinicians when deciding on management options for patients with acute URTI.