Recent Submissions

  • World guidelines for falls prevention and management for older adults: A global initiative

    Masud, Tahir; Robinson, Katie; Ogliari, Giulia (2022)
    BACKGROUND: falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES: to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS: a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS: all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS: the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources. Copyright © The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
  • Recognising and responding to deterioration in care homes: A scoping review protocol

    Hodge, Sevim Y.; Ali, Mohammad R. (2021)
    Objective: To identify the available published primary research and any relevant policies, guidelines, or protocols regarding how care home staff recognize and respond to an acutely deteriorating resident. Introduction: Older people living in care homes have complex health care needs. Chronic illnesses, comorbidities, frailty, cognitive impairment, and physical dependency can contribute to unpredictable changes in their health status that can lead to residents becoming unwell and acutely deteriorating. Exploring how care home staff recognize and respond to acutely deteriorating health among residents is important to understand whether opportunities exist to minimize these unpredictable changes in health. Inclusion criteria: This scoping review will consider studies that feature the recognition and response to acute deterioration in care home residents. This review will consider qualitative and quantitative primary research. Non-indexed and gray literature such as policies, deterioration tools, and reports from health policy organizations will also be included. Methods: The searches will be conducted using bibliographic databases, university repositories, and non-indexed and gray literature, such as reports by health care and health policy organizations. The studies will be independently selected from the inclusion criteria by two researchers based on their title and abstract. In case of disagreement, a third researcher will be consulted. An adapted version of the JBI data extraction form will be used to extrapolate data from included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objectives of the scoping review.
  • Identifying and managing frailty in Brazil: A scoping review protocol

    Robinson, Katie (2020)
    ABSTRACT Objective: The objective of this review is to scope the evidence on how researchers, health, and social care professionals in Brazil currently identify and manage frailty in older adults. Introduction: The rapidly aging population and associated increased healthcare usage by older people with frailty are challenging the sustainability of healthcare for older people in Brazil. Understanding how frailty is identified, measured, categorized, and managed in Brazil is an important part of building a response to the challenge. Inclusion criteria: This scoping review will consider studies that included older Brazilian adults (>=60 years old) recruited from different settings (community, primary care, health care centers, hospital, and long-term care institutions). Studies will be included if they involved any kind of frailty assessment (tools, scales, and measures) and/or interventions. This review will consider all study designs, regardless of their rigor. National policies for older people will be also be considered for analysis. Methods: Indexed and gray literature in English or Portuguese from 2001 to the present will be considered. The searches will be conducted using bibliographic databases, university repositories, and the Brazilian Government official database. The studies will be independently screened according to the inclusion criteria by two reviewers based on their title, abstract, and full text. In case of disagreement, a third reviewer will be consulted. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objective of the present scoping review.
  • Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults: A systematic review

    Booth, Vicky; Kearney, Fiona (2016)
    EXECUTIVE SUMMARY Background Cognitive impairment is a risk factor for falls. Older adults with cognitive impairment (such as dementia) have an increased risk of falling compared with age-matched individuals without a cognitive impairment. To reduce falls in this population, interventions could theoretically target and train both physical and cognitive abilities. Combining and addressing cognitive components in falls rehabilitation is a novel and emerging area of healthcare. Objectives The objective of this review was to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. Inclusion criteria Search strategy A three-step search strategy was utilized in this review, including search of electronic databases: CENTRAL, JBISRIR, MEDLINE, EMBASE, AMED, CINAHL and PsychINFO. Initial keywords used were dementia, cognitive impairment, memory loss, exercise, rehabilitation and accidental falls. Grey literature (Google Scholar) and trials registers (Current Controlled Trials) searches were also completed. Methodological quality The methodological quality of included studies was assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) software. Data extraction Data was extracted from articles included in the review using the standardized data extraction tool from JBI-MAStARI. Data synthesis A quantitative meta-analysis was performed where possible. Otherwise, data synthesis was in the form of narrative review. Sub-group analysis according to level of cognitive impairment was completed where possible.
  • Predicting falls in older adults: An umbrella review of instruments assessing gait, balance, and functional mobility

    Robinson, Katie; Ogliari, Giulia; Masud, Tahir (2022)
    BACKGROUND: To review the validated instruments that assess gait, balance, and functional mobility to predict falls in older adults across different settings. METHODS: Umbrella review of narrative- and systematic reviews with or without meta-analyses of all study types. Reviews that focused on older adults in any settings and included validated instruments assessing gait, balance, and functional mobility were included. Medical and allied health professional databases (MEDLINE, PsychINFO, Embase, and Cochrane) were searched from inception to April 2022. Two reviewers undertook title, abstract, and full text screening independently. Review quality was assessed through the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS). Data extraction was completed in duplicate using a standardised spreadsheet and a narrative synthesis presented for each assessment tool. RESULTS: Among 2736 articles initially identified, 31 reviews were included; 11 were meta-analyses. Reviews were primarily of low quality, thus at high risk of potential bias. The most frequently reported assessments were: Timed Up and Go, Berg Balance Scale, gait speed, dual task assessments, single leg stance, functional Reach Test, tandem gait and stance and the chair stand test. Findings on the predictive ability of these tests were inconsistent across the reviews. CONCLUSIONS: In conclusion, we found that no single gait, balance or functional mobility assessment in isolation can be used to predict fall risk in older adults with high certainty. Moderate evidence suggests gait speed can be useful in predicting falls and might be included as part of a comprehensive evaluation for older adults. Copyright © 2022. The Author(s).
  • Technology based instruments for predicting falls in older people: An umbrella review

    Robinson, Katie; Ogliari, Giulia; Masud, Tahir (2021)
    Introduction: Technology based instruments (such as wearable sensors) could potentially be an alternative approach to functional measures in predicting falls in older adults. This umbrella review aims to describe the literature on the use of these technological assessments for predicting falls in older people. Method(s): We conducted an umbrella review. Medical and allied health databases were searched from their inception date to November 2020. Inclusion criteria were: all types of reviews; older adults aged >= 60 years in any setting; gait and balance assessment by accelerometers, sensors or platforms to predict falls; published in English. The screening of titles/abstracts (and then full texts) for inclusion, the data extraction using a standardised spreadsheet and the quality appraisal using the Risk of Bias in Systematic Review tool were performed in duplicate. Result(s): Eleven reviews (1 narrative review, 8 systematic review without meta-analysis and 2 systematic reviews with meta-analysis) met the inclusion criteria. Five reviews were considered to have a high risk of bias, 5 an unclear risk of bias and 1 a low risk of bias. Most reviews included independent community-dwelling older people. Kinematic measures were obtained using accelerometers, wearable sensors and platforms. Seven reviews reported some, but not all positive findings in the objective measurements in predicting falls. Three reviews reported inconsistencies in the applicability of the instrumented test for falls prediction. Key conclusions: Objective measures of technology-based instruments demonstrate early potential and warrant further high-quality prospective studies to determine their clinical ability to predict falls in older adults.
  • Pain and quality of life in older men and women: Crosssectional findings from the survey of health, ageing and retirement In Europe

    Ogliari, Giulia; Cowley, Alison; Robinson, Katie; Booth, Vicky; Gladman, John; Harwood, Rowan; Masud, Tahir (2022)
    Introduction: Pain is associated with poorer physical and mental health in older adults. We investigated the association between pain and quality of life in older adults. Method(s): Data from 34,090 community-dwelling adults >= 65 years, without cognitive impairment, who were direct respondents in Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. Participants were asked "Are you troubled with pain?", and "In the last month, have you felt that you would rather be dead?". The association between pain intensity and the response to the "rather be dead" question was analysed by binary logistic regression, adjusted for age, sex, country, self-rated health, co-morbidities, medications, physical inactivity, living alone, loneliness, and stratified by sex. Result(s): The mean age was 73.8 years (standard deviation 6.6, range 65-102); 18,775 (55.1%) participants were women. 2,475 (7.3%) reported they felt they would rather be dead: This proportion increased with the severity of pain: 758/17,524 (4.3%) with no pain, 201/3395 (5.9%) with mild pain, 779/9275 (8.4%) with moderate pain and 737/3896 (18.9%) with severe pain reported they felt they would rather be dead. In age and sex-adjusted analyses, mild, moderate and severe pain were all associated with an increased likelihood of feeling "I would rather be dead" compared to no pain. After full adjustment, severe pain was associated with an increased likelihood (odds ratio 1.56, 95% confidence interval 1.35-1.81) of feeling "I would rather be dead". Key conclusions: Pain is significantly associated with poorer quality of life in older adults.
  • Association of frailty with mortality in older inpatients with Covid-19: A cohort study.

    Aw, Darren; Woodrow, Lauren; Ogliari, Giulia; Harwood, Rowan (2020)
    BACKGROUND: COVID-19 has disproportionately affected older people. OBJECTIVE: The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. DESIGN: Cohort study. SETTING: Secondary care acute hospital. PARTICIPANTS: Participants included are 677 consecutive inpatients aged 65 years and over. METHODS: Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. RESULTS: Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1-3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34-3.38) and those with CFS 7-9 had a 1.79-fold (95% CI 1.12-2.88) increased mortality risk, compared to those with CFS 1-3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. CONCLUSIONS: Frailty is associated with all-cause mortality risk in older inpatients with COVID-19. Copyright © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
  • The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: An observational study.

    Ogliari, Giulia; Lunt, Eleanor; Marshall, Lindsey; Sahota, Opinder (2020)
    We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE: Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS: In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS: Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION: During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.
  • Seasonality of adult fragility fractures and association with weather: 12-year experience of a UK Fracture Liaison Service.

    Ogliari, Giulia; Marshall, Lindsey; Sahota, Opinder (2021)
    PURPOSE: To investigate the monthly and seasonal variation in adult osteoporotic fragility fractures and the association with weather. METHODS: 12-year observational study of a UK Fracture Liaison Service (outpatient secondary care setting). Database analyses of the records of adult outpatients aged 50 years and older with fragility fractures. Weather data were obtained from the UK's national Meteorological Office. In the seasonality analyses, we tested for the association between months and seasons (determinants), respectively, and outpatient attendances, by analysis of variance (ANOVA) and Tukey's test. In the meteorological analyses, the determinants were mean temperature, mean daily maximum and minimum temperature, number of days of rain, total rainfall and number of days of frost, per month, respectively. We explored the association of each meteorological variable with outpatient attendances, by regression models. RESULTS: The Fracture Liaison Service recorded 25,454 fragility fractures. We found significant monthly and seasonal variation in attendances for fractures of the: radius or ulna; humerus; ankle, foot, tibia or fibula (ANOVA, all p-values Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
  • Association between body mass index and falls in community-dwelling men and women: A prospective, multinational study in the Survey of Health, Ageing and Retirement in Europe (SHARE).

    Ogliari, Giulia; Masud, Tahir (2021)
    PURPOSE: To investigate the longitudinal associations between body mass index (BMI) categories and falls risk in men and women. METHODS: Prospective cohort study using data from 50,041 community-dwelling adults aged >= 50 years assessed in Wave 6 and 7 in the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE). Socio-demographic and clinical factors were assessed at baseline (Wave 6). Functional impairment was defined by any limitations in activities of daily living (ADL) or instrumental ADL (IADL). Participants were classified as underweight, normal weight, overweight or obese at baseline. At 2-year follow-up (Wave 7), falls in the previous six months were recorded. The longitudinal associations between BMI categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. Furthermore, analyses were stratified by sex, age and functional impairment. RESULTS: Mean age was 67.0 years (range 50-102); 28,132 participants were women; 4057 (8.1%) participants reported falls at follow-up. Participants had an increased falls risk [OR (95% CI)] if they were underweight [1.41 (1.06-1.88), p = 0.017] or obese [1.20 (1.09-1.32), p = 65 years. In participants with functional impairment, underweight was associated with higher falls risk [1.61 (1.09-2.40), p = 0.018], while obesity was not. CONCLUSION: A U-shaped relationship between BMI and falls risk was found in community-dwelling adults. Copyright © 2021. European Geriatric Medicine Society.
  • Subjective vision and hearing impairment and falls among community-dwelling adults: A prospective study in the Survey of Health, Ageing and Retirement in Europe (SHARE).

    Ogliari, Giulia; Masud, Tahir (2021)
    PURPOSE: To investigate the association between vision and hearing impairment and falls in community-dwelling adults aged >= 50 years. METHODS: This is a prospective study on 50,986 participants assessed in Waves 6 and 7 of the Survey of Health, Ageing and Retirement in Europe. At baseline, we recorded socio-demographic data, clinical factors and self-reported vision and hearing impairment. We classified participants as having good vision and hearing, impaired vision, impaired hearing or impaired vision and hearing. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The cross-sectional and longitudinal associations between vision and hearing impairment categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. RESULTS: Mean age was 67.1 years (range 50-102). At baseline, participants with impaired vision, impaired hearing, and impaired vision and hearing had an increased falls risk (OR (95% CI)) of 1.34 (1.22-1.49), 1.34 (1.20-1.50) and 1.67 (1.50-1.87), respectively, compared to those with good vision and hearing (all p Copyright © 2021. European Geriatric Medicine Society.
  • No association between frailty index and epigenetic clocks in Italian semi-supercentenarians.

    Ogliari, Giulia (2021)
    Centenarians experience successful ageing, although they still present high heterogeneity in their health status. The frailty index is a biomarker of biological age, able to capture such heterogeneity, even at extreme old age. At the same time, other biomarkers (e.g., epigenetic clocks) may be informative the biological age of the individual and potentially describe the ageing status in centenarians. In this article, we explore the relationship between epigenetic clocks and frailty index in a cohort of Italian centenarians. No association was reported, suggesting that these two approaches may describe different aspects of the same ageing process. Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.
  • A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: Curricula, topics and teaching methods.

    Masud, Tahir; Ogliari, Giulia; Lunt, Eleanor; Blundell, Adrian (2022)
    PURPOSE: The world's population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. METHODS: We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students' attitudes and (4) published in a scientific journal. No language restrictions were applied. RESULTS: We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students' skills and medical students' attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. CONCLUSION: We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients. Copyright © 2021. The Author(s).
  • Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE).

    Ogliari, Giulia; Masud, Tahir (2022)
    We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 +/- 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02-1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00685-3. Copyright © The Author(s), under exclusive licence to Springer Nature B.V. 2022.
  • Emergency department use and length of stay by younger and older adults: Nottingham cohort study in the emergency department (NOCED).

    Ogliari, Giulia; Coffey, Frank; Keillor, Lisa; Aw, Darren; Azad, Michael Yakoub; Allaboudy, Mohammad; Ali, Aamer; Jenkinson, Tom; Christopher, Mike; Szychowski-Nowak, Kosma; et al. (Springer, 2022)
    BACKGROUND: Younger and older adults attending the Emergency Department (ED) are a heterogeneous population. Longer length of ED stay is associated with adverse outcomes and may vary by age. AIMS: To evaluate the associations between age and (1) clinical characteristics and (2) length of ED stay among adults attending ED. METHODS: The NOttingham Cohort study in the Emergency Department (NOCED)-a retrospective cohort study-comprises new consecutive ED attendances by adults >= 18 years, at a secondary/tertiary care hospital, in 2019. Length of ED stay was dichotomised as = 4 h. The associations between age and length of ED stay were analysed by binary logistic regression and adjusted for socio-demographic and clinical factors including triage acuity. RESULTS: 146,636 attendances were analysed; 75,636 (51.6%) resulted in a length of ED stay >= 4 h. Attendances of adults aged 65 to 74 years, 75 to 84 years and >= 85 years, respectively, had an increased risk (odds ratio (95% confidence interval) of length of ED stay >= 4 h of 1.52 (1.45-1.58), 1.65 (1.58-1.72), and 1.84 (1.75-1.93), compared to those of adults 18 to 64 years (all p = 4 h, with the oldest old having the highest risk. ED target times should take into account age of attendees. Copyright © 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
  • Association of pain and risk of falls in community-dwelling adults: A prospective study in the survey of health, ageing and retirement in Europe (SHARE).

    Ogliari, Giulia; Cowley, Alison; Robinson, Katie; Booth, Vicky; Gladman, John; Harwood, Rowan; Masud, Tahir (Springer, 2022)
    PURPOSE: To investigate the longitudinal associations between pain and falls risks in adults. METHODS: Prospective cohort study on data from 40,636 community-dwelling adults >= 50 years assessed in Wave 5 and 6 in the Survey of Health, Ageing and Retirement in Europe (SHARE). Socio-demographic and clinical information was collected at baseline (Wave 5). At 2-year follow-up (Wave 6), falls in the previous 6 months were recorded. The longitudinal associations between pain intensity, number of pain sites and pain in specific anatomic sites, respectively, and falls risk were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. All analyses were adjusted for socio-demographic and clinical factors and stratified by sex. RESULTS: Mean age was 65.8 years (standard deviation 9.3; range 50-103); 22,486 (55.3%) participants were women. At follow-up, 2805 (6.9%) participants reported fall(s) in the previous 6 months. After adjustment, participants with moderate and severe pain at baseline had an increased falls risk at follow-up of 1.35 (1.21-1.51) and 1.52 (1.31-1.75), respectively, compared to those without pain (both p = 2 sites or all over (multisite pain) was associated with an increased falls risk of 1.29 (1.14-1.45) compared to pain in one site (p = 2 sites or all over (multisite pain) was associated with an increased falls risk of 1.29 (1.14-1.45) compared to pain in one site (p Copyright © 2022. The Author(s).
  • Chronic pain in people living with dementia: Challenges to recognising and managing pain, and personalising intervention by phenotype.

    Harwood, Rowan; Cowley, Alison; Masud, Tahir; Ogliari, Giulia; Gladman, John (Oxford University Press, 2023)
    Pain is common in people with dementia, and pain can exacerbate the behavioural and psychological symptoms of dementia. Effective pain management is challenging, not least in people with dementia. Impairments of cognition, communication and abstract thought can make communicating pain unreliable or impossible. It is unclear which biopsychosocial interventions for pain management are effective in people with dementia, and which interventions for behavioural and psychological symptoms of dementia are effective in people with pain. The result is that drugs, physical therapies and psychological therapies might be either underused or overused. People with dementia and pain could be helped by assessment processes that characterise an individual's pain experience and dementia behaviours in a mechanistic manner, phenotyping. Chronic pain management has moved from a 'one size fits all' approach, towards personalised medicine, where interventions recommended for an individual depend upon the key mechanisms underlying their pain, and the relative values they place on benefits and adverse effects. Mechanistic phenotyping through careful personalised evaluation would define the mechanisms driving pain and dementia behaviours in an individual, enabling the formulation of a personalised intervention strategy. Central pain processing mechanisms are particularly likely to be important in people with pain and dementia, and interventions to accommodate and address these may be particularly helpful, not only to relieve pain but also the symptoms of dementia. Copyright © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.