While some training studies have identified that
walking increases strength and reduces functional
limitations in older adults, others have identified that
aerobic physical activity is ineffective in preventing
loss of muscle strength associated with ageing
(Harridge et al., 1997: Aging, 9, 80 – 87). As muscle
weakness in the legs has been found to be predictive
of falls, this would appear to be problematic for
aerobic-based physical activity recommendations for
the prevention of falls.
The purpose of this study was to identify whether
‘‘fallers’’ and ‘‘non-fallers’’ demonstrated significantly
different levels of attainment of the current
physical activity recommendations over the life
course. Self-report lifetime physical activity was
obtained through estimation of how many days per
week an individual accumulated 30 min or more of
at least moderate-intensity physical activity during
each decade of their adult life. A fall was identified as
a loss of balance resulting in the body, or part of the
body, coming to rest on the ground. Ethical approval
was granted through institutional procedures undertaken
at departmental level.
The participants were 74 males (mean age 71.7
years, s¼7.4) and 228 females (mean age 71.0 years,
s¼7.5; range 54 – 94) with 72% indicating that they
had experienced a fall. Differences between the sexes
were apparent for the number of days active in their
thirties (females: mean 6.41 days, s¼1.98; males:
mean 5.73 days, s¼2.01 days; t308¼2.56,
P50.05). Independent samples t-tests showed that
while ‘fallers’ (mean 4.75 days, s¼2.15) were
currently less active than ‘‘non-fallers’’ (mean 5.43
days, s¼2.03; t305¼2.52, P50.05), there was no
significant difference in the number of days on which
they had performed 30 min or more of moderateintensity
physical activity in any of the decades throughout the life-span. When participants were
then classified as either active or inactive in relation
to achieving 5630 min per week, chi-square tests
revealed no differences in proportional attainment of
the recommended amounts of physical activity in
fallers and non-fallers in any decade.
Although demonstrating a progressive decline in
physical activity through the decades, the sample was
more active than the current population in each
decade, with the majority attaining recommended
amounts of physical activity into their seventies.
Attainment of current physical activity guidelines
throughout the life-span would not appear to reduce
the likelihood of falling and would suggest that
strength-based physical activity recommendations
may be needed in addition to the current general
health guidelines if the number of falls in older adults
is to be significantly reduced.
Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services. Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population. Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans. Results: End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support. Conclusion: There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.
37.5% of deaths in our area occur in hospital. There are known high unmet needs of adult patients dying in hospital, this unmet need can be reduced by using an individualised care plan and specialist palliative care review.
Intervention
In 2022 UHSussex developed an electronic comfort observation chart and individualised care plan, with a centralised dashboard allowing Specialist Palliative Care Teams (SPCT) to view trends, target interventions, and a rolling prospective audit based on the SEECare criteria.
Results
Since introduction one year ago, over 3000 patients have had their care supported with electronic comfort observations (e-comfort obs). Over 72% of all deaths in the Trust in the last 3 months have been on e-comfort obs, with 2/3 of all deaths in the first 12 months on e-comfort obs. The average length of time on e-comfort obs is 4 days resulting in 70 000 sets of e-comfort obs recorded since launch. Seven percent of e-comfort obs record moderate or severe symptoms. Our integrated rolling SEECare audit has prospectively audited care of 126 patients in the first 4 months and will ensure an annual prospective quality assurance audit of over 400 patients. We have identified benefits to people who are dying, those important to them, ward staff, SPCT and on a systems level.
Conclusion
E-comfort obs can be successfully embedded in a large acute Trust. This development should improve quality of end of life care in our hospitals both for individuals and for future patients, through on-going targeted education and intervention. Further work is needed to develop the system further including integrating data from electronic prescribing. Given the richness of data, the tool could be used to successfully support research and compare interventions in end of life care.
The purpose of this study was to compare 136 frontier and 148 urban patients with chronic heart failure who were aged 60 years and older. Medical records from 2000 to 2002 were reviewed from a regional tertiary hospital in Montana. While the two groups did not differ with respect to New York Heart Association functional class and number of comorbid conditions, the frontier sample was more likely to be male, married, and younger. Frontier patients were more depressed and scored significantly lower on quality‐of‐life measures. Among those who had died, frontier patients survived an average of 7.7 months, in contrast to urban patients who survived an average of 13.4 months following index hospitalization. Frontier patients have few available health care services and providers may not treat patients as expertly or aggressively as urban providers. Frontier patients tend to be isolated due to illness, lack of transportation, travel distances, and weather‐related barriers. Many may be falling through the cracks.
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