Christopher Nnaemeka Osuafor

University of Cambridge

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Frances McCarthy

University of Saint Mary

Toddy Daly

Mater Misericordiae University Hospital

Victoria L. Keevil

University of Cambridge

Lorraine Kyne

Mater Misericordiae University Hospital

Alistair Mackett

Cambridge University Hospitals NHS Foundation Trust

Robert J. B. Goudie

MRC Biostatistics Unit

J. Duggan

Mater Misericordiae University Hospital

Catriona Davidson

Cambridge University Hospitals NHS Foundation Trust

Marie Goujon

University of Birmingham

Chie Wei Fan

St Mary's Hospital

Cooperative Institutions

Mater Misericordiae University Hospital

Cambridge University Hospitals NHS Foundation Trust

University of Cambridge

Addenbrooke's Hospital

Beaumont Hospital

University College Dublin

University of Edinburgh

St George’s University Hospitals NHS Foundation Trust

Mater Misericordiae Hospital

St. James's Hospital

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The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age

Geriatrics (2022)

Ben Carter Victoria L. Keevil Atul Anand Christopher Nnaemeka Osuafor Robert J. B. Goudie

Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27 February and 30 June 2020. Multivariable mixed-effects logistic modelling was undertaken, with 28-day mortality as the primary outcome. Nested models were compared between a base model, age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres. The median age was 80 (range:65−101), 453 (45%) were female, and 377 (37.8%) died within 28 days. The sample was replicated in a validation cohort of two additional centres (n = 672) with similar characteristics. In the primary cohort, both mFI and CFS were associated with mortality in the base models. There was improved precision when fitting CFS to the base model +mFI (LRT = 25.87, p < 0.001); however, there was no improvement when fitting mFI to the base model +CFS (LRT = 1.99, p = 0.16). AUROC suggested increased discrimination when fitting CFS compared to age (p = 0.02) and age +mFI (p = 0.03). In contrast, the mFI offered no improved discrimination in any comparison (p > 0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision-making and prognosis.

10.3390/geriatrics7050087

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Citations (3)

28 OLDER ADULTS' ROOM PREFERENCE IN AN ACUTE HOSPITAL SETTING: SINGLE VERSUS SHARED ACCOMMODATION

Age and Ageing (2016)

Christopher Nnaemeka Osuafor Hugh R. Butt Tunde Abdulsalam Toddy Daly J. Duggan

Objective: The objective of the survey was to determine whether older adults would prefer to be in a single room or a room shared with other patients following admission to an acute hospital.Methods: In 2015, we surveyed inpatients on their room preference.Using a physician administered questionnaire, information was obtained from patients who agreed to participate.Patients were asked their preferred choice of room and their preferred meal location

10.1093/ageing/afw024.28

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Frailty Assessment in Clinical Practice: Opportunity in the Midst of a Pandemic

Geriatrics (2020)

Victoria L. Keevil Christopher Nnaemeka Osuafor Alistair Mackett Richard Biram

Emerging evidence from studies of older adults hospitalised with COVID-19 suggests that there is a high prevalence of frailty in this patient group. We reflect on the measurement of frailty in older patients hospitalized as an emergency and the translation of frailty from a research to a clinical concept. We consider whether, despite the contemporary challenges in the care of older adults as a result of COVID-19, there are opportunities for care quality improvement during a pandemic.

Pandemic

2019-20 coronavirus outbreak

Clinical Practice

10.3390/geriatrics5040092

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Citations (3)

Vitamin D Assessment in Older Adults

Springer eBooks (2017)

Christopher Nnaemeka Osuafor Marguerite MacMahon Cora McGreevy Chie Wei Fan

10.1007/978-3-319-40007-5_59-1

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Citations (1)

Visualisation of lenticulostriate arteries using contrast-enhanced time-of-flight magnetic resonance angiography at 7 Tesla

Scientific Reports (2022)

Christopher Nnaemeka Osuafor Catarina Rua Andrew D. MacKinnon Marco Egle Philip Benjamin

Abstract 7 Tesla-field-strength (7 T) Magnetic Resonance Imaging allows the small perforating arteries in the brain to be visualised, and this modality may allow visualisation of the arterial pathology in cerebral small vessel disease. Most studies have used standard Time-of-Flight (ToF) Magnetic Resonance Angiography (MRA). Whether the use of contrast enhancement improves perforating artery visualisation at 7 T remains unclear. In a prospective study, we compared standard ToF MRA with contrast-enhanced (CE) ToF MRA at 7 T for the visualisation of the lenticulostriate arteries (LSAs). Ten patients with symptomatic lacunar stroke were recruited (mean age, SD, 64 ± 9.9 years). Visualisation was assessed using a visual rating scale administered by two independent expert readers and length of the LSAs visible. Visualisation of the LSAs was improved with CE ToF MRA. The mean Visibility and Sharpness Score was higher for CE ToF MRA over standard ToF MRA (2.55 ± 0.64 vs. 1.75 ± 0.68; P = 0.0008). The mean length of LSA visualised was significantly longer with CE ToF MRA compared to standard ToF MRA (24.4 ± 4.5 vs. 21.9 ± 4.0 mm; P = 0.01). CE ToF MRA offers improved visualisation of the LSAs over standard ToF MRA. The addition of contrast may improve the ability to visualise cerebral small vessel disease arterial pathology.

Magnetic resonance angiography

Stroke

10.1038/s41598-022-24832-z

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Citations (9)

Preventing and managing constipation in older inpatients

International Journal of Health Care Quality Assurance (2018)

Christopher Nnaemeka Osuafor Sree Lakshmi Enduluri Emma Travers Anne Bennett Elena Deveney

Purpose Constipation in hospitalised older adults leads to adverse events and prolonged stay. The purpose of this paper, therefore, is to effectively prevent and manage constipation in older adults undergoing inpatient rehabilitation using a multidisciplinary war on constipation (WOC) algorithm. Design/methodology/approach A quality improvement project in older adults undergoing rehabilitation for prevention and constipation management was conducted. Quality improvement "plan-do-study-act" cycles included an initial constipation audit in the wards and meetings with the multidisciplinary team (MDT) to develop an algorithm for the preventing, detecting and effectively treating constipation. Findings The project resulted in a 14 per cent reduction in constipation incidence after the newly developed WOC algorithm was introduced. The project also improved communication between patients and the MDT around patients' bowel habits. Practical implications The project shows that using quality improvement methods in rehabilitation settings, earlier detection, earlier intervention and overall reduction in constipation in older adults can be achieved. Originality/value The WOC algorithm has been developed and institutionalised in the current setting. This algorithm may also be applicable in other inpatient settings.

Bowel management

10.1108/ijhcqa-05-2017-0082

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Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

Research Square (Research Square) (2020)

Christopher Nnaemeka Osuafor Catriona Davidson Alistair Mackett Marie Goujon Lelane Van Der Poel

Abstract Background : A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19. Methods : This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status. Results : 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed. Conclusions : Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.

10.21203/rs.3.rs-61056/v1

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Citations (4)

Dysphagia screening in acute stroke care among non-consultant hospital doctors

Irish Journal of Medical Science (1971 -) (2017)

Christopher Nnaemeka Osuafor Jane Molloy Seán Murphy

Acute stroke

Stroke

Acute care

Acute hospital

10.1007/s11845-017-1584-1

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