Findings from a pragmatic cluster randomised controlled feasibility trial of a music and dance programme for community dwelling older adults.

INTRODUCTION: Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design. METHODS: Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks. RESULTS: The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme. DISCUSSION AND IMPLICATIONS: The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.

Preliminary findings from the early phases of the Music and Movement for Health study: the feasibility of an arts-based health programme for older adults.

Introduction (including aim): There is a lack of community-based programmes for older adults in Ireland. Such activities are vital to enable older people to (re)connect after COVID-19 measures, which had a detrimental effect on physical function, mental health and socialisation. The aims of the preliminary phases of the Music and Movement for Health study were to refine stakeholder informed eligibility criteria, recruitment pathways and obtain preliminary measures for feasibility of the study design and programme, which incorporates research evidence, practice expertise and participant involvement. METHODS: Two Transparent Expert Consultations (TECs) (EHSREC No: 2021_09_12_EHS), and Patient and Public Involvement (PPI) meetings were conducted to refine eligibility criteria and recruitment pathways. Participants from three geographical regions in the mid-west of Ireland will be recruited and randomised by cluster to participate in either a 12-week Music and Movement for Health programme or control. We will assess the feasibility and success of these recruitment strategies by reporting recruitment rates, retention rates and participation in the programme. RESULTS: Both the TECs and PPIs provided stakeholder-informed specification on inclusion/ exclusion criteria and recruitment pathways. This feedback was vital in strengthening our community-based approach as well as effecting change at the local level. The success of these strategies from phase 1 (March-June) are pending. DISCUSSION: Through engaging with relevant stakeholders, this research aims to strengthen community systems by embedding feasible, enjoyable, sustainable and cost-effective programmes for older adults to support community connection and enhance health and wellbeing. This will, in turn, reduce demands on the healthcare system.Note: We would like to thank and acknowledge those who participated in the PPIs for their time and invaluable feedback.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults.

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

Electronic medical orders for life-sustaining treatment in New York State: Length of stay, direct costs in an ICU setting.

OBJECTIVE: In the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, accounting for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals, costing more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a standardized documentation process used in New York State to convey patients' wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. No study to date has looked at the effect of eMOLST as an advance care planning tool on ICU and hospital costs using estimates of direct costs. The objective of our study was to investigate whether signing of eMOLST results in any reduction in length of stay and direct costs for a community-based hospital in New York State. METHOD: A retrospective chart review was conducted between July 2016 and July 2017. Primary outcome measures included length of hospital stay, ICU length of stay, total direct costs, and ICU costs. Inclusion criteria were patients ≥65 years of age and admitted into the ICU with a diagnosis of sepsis. An independent samples t test was used to test for significant differences between those who had or had not completed the eMOLST form. RESULT: There were no statistical differences for patients who completed or did not complete the eMOLST form on hospital's total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU. SIGNIFICANCE OF RESULTS: Completing an eMOLST form did not have any effect on reducing total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.

Older adults' perceptions of recovery from mental illness: Impact of psychiatric hospitalization prior to 1990.

OBJECTIVE: We tested the hypothesis that older adults are more likely than younger adults to consider their current mental health status when estimating their own recovery from psychiatric illness because many older people were first hospitalized for psychiatric illness prior to the emergence of the recovery movement in the 1990s, before recovery was redefined to include life improvements other than symptom alleviation. METHOD: Seventy-one members of a rehabilitation program (age 23 to 69; M = 49) were asked to rate satisfaction with their own recovery and with their current mental and physical health. The study hypothesis was tested in two hierarchical regression analyses that examined variation in the correlation between mental health and recovery self-ratings first by age and then by year of first hospitalization. RESULTS: The correspondence between mental health and recovery self-ratings was twice as strong for adults age 50 and older compared with those younger than age 50 and this same age difference in self-ratings was also evident for participants first hospitalized for a psychiatric illness earlier versus later than 1990. The correlation between physical health and recovery self-ratings did not vary by age or year of first hospitalization. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Recovery-oriented interventions will be most effective for older individuals when service providers take into account their personal histories and the propensity of many older adults to associate recovery with symptom improvement even while embracing other life improvements.

The ethics of delivery-room resuscitation.

Perinatal care continues to improve and the number of extremely preterm babies delivered increases. What is the outcome for those babies? Under what circumstances should we not initiate resuscitation or under what circumstances should we discontinue support? How accurate and predictive are the data we have and how can these be improved? Who should make the decisions and how should they be made? Should we follow different guidelines in different settings? The following narrative will examine some of these questions but cannot answer them all.

Non-initiation and discontinuation of resuscitation.

Whereas certain aspects of neonatal resuscitation may benefit from evidence evaluation using standard evaluation techniques, the ethical aspects of non-initiation and discontinuation of resuscitative efforts are more subjective and might certainly be influenced by the biases of the reviewers. The outcome data are relatively straightforward, although survival and morbidity data differ significantly by region and even among hospitals classified at similar levels in the same region. However, the interpretation of that data is necessarily somewhat subjective. Whereas certain aspects of neonatal resuscitation may benefit from evidence evaluation using standard evaluation techniques, the ethical aspects of non-initiation and discontinuation of resuscitative efforts are more subjective and might certainly be influenced by the biases of the reviewers. The outcome data are relatively straightforward, although survival and morbidity data differ significantly by region and even among hospitals classified at similar levels in the same region. However, the interpretation of that data is necessarily somewhat subjective. Does a survival rate of 1% of patients at a certain weight or gestational age warrant full resuscitative efforts? What about 20% or 49%? Similar questions could be posed regarding significant morbidity. However, as the science of neonatal resuscitation advances, it is important to review objective evidence-based outcome data in certain situations in which non-initiation or discontinuation of resuscitative efforts may be appropriate to determine if certain common themes can be elicited.