ACRC Lay Summaries

Globally, people living with one or more health conditions at one time, known to healthcare professionals as ‘multimorbidity’, is increasingly common. However, research on the tracking of multimorbidity and how it is defined is mixed which makes it difficult to make accurate estimates of how common it is. The number and type of illnesses are considered but there is little guidance to support researchers on which are relevant to a ‘multimorbidity’ label. This study used English primary care data (which refers to the first contact point of healthcare) from a single point in time (November 30th, 2015). This was done to explore relationships between the number and groups of single and multiple illnesses on the wider prevalence of multimorbidity.

Data was analysed from people who were alive and with at least 2 years of GP registration across 149 general practices in England. Researchers filtered those who had 2 or more conditions from a list of 80 as identified from electronic GP health records. The study calculated the number of people with multiple conditions by comparing the data to 9 lists of published conditions in the Health Data Research UK Phenotype Library.

Results showed 40.5% of 1,168,520 people captured in the data had two or more conditions based on the full 80 conditions. These individuals were more likely to be older (60+), female (54.3%), and living in more deprived areas (44%). Six conditions were present in more than 5% of the whole population. Frequency of people with 2 or more conditions varied from 11.1% - 36.4% depending on the condition lists used.

Overall, there was significant range of frequency in the number of people and type of condition that led to large differences in prevalence for people with additional health problems. This study argues for a more “standardized” approach in defining “multimorbidity” or those who live with multiple health conditions. This would offer a more representative and accurate comparison of future data. Full Text Link: https://doi.org/10.1371/journal.pmed.1004208

An individual can be described as frail if they are in a state of declining health. Frailty is considered to be a major public health issue in the UK. A primary care study which refers to day-to-day healthcare was done to evaluate the impact of a Living Well Assessment (LWA). This was through analysis of GP-led interviews to patients who then received a questionnaire. After the face to face or remote assessment, GPs were interviewed and attended focus groups. Researchers analysed these transcriptions who wanted to determine whether patients preferred the LWA to be conducted as a face to face or through remote consultation. 75% of the 220 patients of whom completed the survey, 86% felt they had a positive experience of the LWA. Patients preferred face-to-face assessments followed by remote telephone calls. However, technical issues or health-related issues such as, deafness or poor vision can lead to limited effectiveness. GPs noted success of home-based assessments, but concern was raised on how this may increase workloads of current GPs. Future studies should be done to explore the effectiveness and best practice of community and GP-led primary care assessments. This may offer a more standardized template which can allow for more effective healthcare services. Full Text Link: https://doi.org/10.3399/BJGPO.2022.0184

Pathways into care are complex and poorly understood, and this lack of understanding can impact the success of care delivery. To better understand what exactly about service planning and support, this study compares the similarities and differences of individuals who move into a care home from hospital or directly from the community. Using the Scottish Care Home Census, data from adults moving into care homes in Scotland from April 2013 – March 2016 was analysed. It was found individuals who follow these pathways were clinically distinct each other based upon dependency for those requiring nursing care after the move, frailty and recent health events such as, stroke, fracture or mental illness. This research showed that linking social care data and health measures is possible, but health records need to be further developed to make this happen. This can highlight any distinct needs to improve pathways into care and support those who transition. Full Text Link: https://doi.org/10.1093/ageing/afac304 

Age related problems, such as frailty and multimorbidity are on the rise which has led to research exploring more technological methods of care. These digital methods may improve the experiences and support of care home users. Using care home resident data from three Scottish-based studies, barriers to adopting digital services  in care homes were found. These obstacles included unreliable internet connectivity, difficulties with accessing resident data, lack of long-term planning, low levels of resident trust in large scale data storage and towards technology that may reduce the impact of changes able to be made to care homes. The effective usage of data and digital services in care homes can be improved if these barriers are addressed.

Full Text Link: https://doi.org/10.3390/ijerph19127407

COVID-19 has had a significant effect on UK care home residents. A government review was undertaken in 2020 by the Public Accounts Committee (PAC) investigating discharged patients from hospital and the number of COVID-19 outbreaks in care homes. Findings revealed any person with COVID-19 could spread the infection into the care home with high-risk points of contact relating to the hospital and care home. COVID-19 outbreaks in care homes were caused, partly caused or intensified by discharged patients from hospital entering the care home and those who were not tested earlier in the pandemic. However, this study established it is very unlikely these findings were the primary cause of all care home outbreaks at the start of COVID-19. 

Full Text Link: https://www.gov.uk/government/publications/the-association-between-the-discharge-of-patients-from-hospitals-and-covid-in-care-homes/consensus-statement-on-the-association-between-the-discharge-of-patients-from-hospitals-and-covid-in-care-homes

Globally, the need for increased medical resources has led to the reliance of implant medical devices such as, a pacemaker to provide routine services. A review was conducted to explore the history, types, safety, buying options, device components and improvements to implantable wireless medical devices (IWMD). It was found these services can provide benefits such as monitoring patient health and offering remote medicine delivery. These devices may reduce the need for repeated doctor visits and can limit physical contact with others. This may allow patients to have a more comfortable recovery in familiar places such as at home. This type of telemedicine (which refers to remote diagnosis or treatments) has allowed for popular and low-cost implant medical devices to be used for routine medical services. 

Full Text Link: https://doi.org/10.3390/s22103635

It is crucial that key workers remain healthy to be able to carry out their duties. Recently, COVID-19 has especially impacted healthcare workers leading to social distancing measures. Yet, locations are not always able to meet these measures, increasing the risk of illness. This study proposes the use of a monitoring device fitted in a person’s ear to measure their core body temperature to reduce the spread of infection in places where social distancing guidelines cannot be met. Similar to that of a hearing aid, radio frequency is used to take these temperature readings. Sensors within the device are activated when a user is within range of a radio frequency reader. An auditory notification of their temperature is heard. The device is battery free made of a miniature temperature sensor and custom earplug. This could be a general solution to limiting workplace sickness by monitoring body temperature in work environments. Although, a question is whether key workers are prepared to wear these devices and the ethical issues involved?

Full Text Link: https://www.scopus.com/record/display.uri?eid=2-s2.0-85120858830&origin=inward&txGid=2279b875d8ad0bb1c71254ef91665fa1

People aged 85+ are rapidly increasing in the population; yet little research has been done on changes to their home or place of residence over time. A 10-year research study based in Newcastle has shown 648 (76.3%) of 849 total participants aged 85+ have lived and remained in non-supported or standard housing with few moving in to care homes. The need for further support to help these individuals to remain living in their own homes as many of these individuals experience frailty and dependency. Research is required to address the support of informal and formal types of care for those aged 85+. 

Full Text Link: https://doi.org/10.1093/ageing/afac056

People in later life often have more than one health condition which leads to higher healthcare costs for the NHS. Globally, this results in governments wanting to improve the healthcare experience and reduce costs without losing quality of care for those living with multiple long term conditions. This study included 37 interviews with primary and social care staff to discover drivers and challenges of integrated care, whereby different healthcare specialities come together to treat a patient.  Effective drivers of integrated care included group leaders, multiple services in the same location and expanding roles to enable communication. The primary barrier was a lack of communication between departments leading to the need for a broader approach to increase the potential for greater policy impact. However, this is neither a quick nor easy solution. In particular, the difference in access to health care in wealthier and poorer areas in the UK is a significant issue, leading to those in poorer areas not receiving adequate care or developing multiple health conditions at an earlier age. This study argues for more evaluative research which focuses on an overall assessment of integrated care and a plan to collect data the same way each time to be able to be an effective comparative tool. This will allow for greater learning and comparison across countries to improve the needs of older adults.

Full Text Link: https://doi.org/10.3399/bjgp21X717101

Most people with COVID-19 are able to manage without medical help. However, there is a risk that the condition can quickly worsen if the lungs are unable to deliver enough oxygen to the body. If this can be detected early enough, the damage may be limited or even eliminated, but this is difficult if the person is managing the illness at home. A solution could be to use available technology to monitor the person’s symptoms and have the information recorded remotely. This study designed a system to record symptoms that may indicate deterioration such as changes to a person’s pulse and body temperature. Alerts were sent to the person’s phone if these measures exceeded the normal range.

A red alert was sent to the person’s phone informing them to phone for an ambulance and an amber alert was sent to request NHS advice. This system could be used via SMS, touch-tone phone or app and advance guidance was provided. Patients who were at risk of their condition worsening used a device called a pulse oximeter to test the level of oxygen in their blood, and results can be fed into the new monitoring system. An evaluation of the study revealed that patients found self-monitoring to be reassuring while clinicians accepted the value of new system. However, some patients ignored warnings that their condition was deteriorating because they did not actually feel any more unwell. This highlights the need to impress on patients at the outset the importance of early detection of COVID-19 effects, even before they are aware of it themselves.

Full Text Link: https://pubmed.ncbi.nlm.nih.gov/34449404/

Alzheimer’s disease is an increasingly common and progressive illness which impacts the lives and livelihoods of those who are directly and indirectly affected. Current methods to diagnose and monitor the progress of the disease require facilities that not all hospitals possess and thus, can be difficult for many patients to access. There is a need to develop alternative tests to identify the various stages of the disease and predict progress so appropriate treatments may be determined. In this study, information on brain activity was collected from monitors placed on the heads of patients living with Alzheimer’s disease and analysed using a number of different computer processes. The processes were then scored on their ability to identify different stages of the disease. One such process was identified as the most accurate and furthers the ability of medical professionals to use machine learning as a means of non-invasive treatment for Alzheimer’s disease.

Full Text Link: https://www.scopus.com/record/display.uri?eid=2-s2.0-85120858830&origin=inward&txGid=2279b875d8ad0bb1c71254ef91665fa1

A key public health priority is to protect vulnerable residents in care homes. This study aimed to identify patterns, and the main risk factors, in COVID-19 outbreaks across Scottish care homes. Data was collected between March and May 2020 with a follow up in June 2020. Using advanced data analysis, it was found that 41% of the 334 care homes experienced a COVID-19 outbreak which could be classified as typical, severe, contained, or late-onset, based on the number of cases and the duration of infection. The risk of an outbreak increased with the size of the care home and the number of cases in the surrounding community. The effectiveness of response to future COVID-19 infections in care homes would benefit from more national data collection and a better understanding of the lived experience of care home residents.

Full Text Link: https://doi.org/10.1093/ageing/afab099

Social exclusion refers to a process of isolation or disadvantage based upon discrimination. In later life, this leads to poor health and a lower quality of life. Yet, the relationship between the neighbourhood in which older people live, their personal attributes and the extent of their social exclusion is not fully understood. This study used seven different sources of information collected from the same population over the course of 13 years.to look at the links between neighbourhood and social exclusion. Numerous characteristics were included such as, service or amenity access, civic, leisure or cultural participation, and friends and family relationships. Findings showed that living in a deprived area increased the risk of social exclusion, especially in urban settings. A sense of neighbourhood belonging, primarily based on the length of residence and personal attachment, lowered feelings of exclusion although local residents moving out of the area had little impact on exclusion levels felt by those who were left behind. These new insights can support future predictive research on individual and neighbourhood characteristics on social exclusion in later life.

Full Text Link: https://doi.org/10.1016/j.socscimed.2019.112722

There is a lack of routine data collection on care home residents in the UK. National data is required to improve service development, research, and support policy for care homes. This study identified seven main priorities to address the data gap. These include detailed information on the individual characteristics of residents, bringing together information currently held by different stakeholders such as, the public, policymakers, or researchers and identification of new data sources. These areas would also benefit from protecting residents’ collected data, and investment in combining diverse expertise from different stakeholders to analyse data. These steps would help to meet the ultimate goal of creating a national data set on care home residents in the UK which would be a step towards  investing in supportive care, policy and research in UK care homes.

Full Text Link: https://doi.org/10.23889/ijpds.v5i4.1391

Globally, it is known that COVID-19 has impacted care home residents. Yet, there is a lack of research on the nature of these outbreaks. This study collected data on COVID-19 testing, case numbers and deaths within care homes in the NHS Lothian region of Scotland. The data was analysed based on the type of care home, locality, number of beds, timing of outbreaks, confirmed cases, and deaths. Within the six-month period of March – August 2020, the effect of COVID-19 was significant yet concentrated in care homes with known outbreaks. UK care home residents are vulnerable to Covid-19, leading to the need for rapid action to lessen any future spread of the virus.

Full Text Link: https://doi.org/10.1016/S2666-7568(20)30012-X

This study explores the relationship between NHS hospital discharges and COVID-19 outbreaks in Scottish care homes during the first wave of infection in 2020. It was found that older adult hospital discharges into care homes during this period was not statistically linked to any increased risk of an outbreak of COVID-19. Whilst cases of COVID-19 were identified in some patients discharged into care homes, the pattern of outbreaks was not consistent with the cause of these being directly related to hospital discharge.

Full Text Link: https://publichealthscotland.scot/publications/discharges-from-nhsscotland-hospitals-to-care-homes/discharges-from-nhsscotland-hospitals-to-care-homes-between-1-march-and-31-may-2020-revised/