Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland.

Introduction: Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults.

Nursing home patients and Emergency Department attendance in a single urban Irish catchment area: an observational study surrounding the introduction of a community medicine for older person service.

Background: Nursing home (NH) patients are at a high risk of Emergency Department (ED) attendance, and adverse events in the ED. With an increasing NH population, monitoring trends in ED utilization is important to aid service planning, and attention to potentially preventable attendances should be paid, to identify areas that may benefit from specialist support.

Aims: This 12-year (2008-2019) study aimed to observe trends in ED utilization of NH patients in a single urban Irish catchment area, surrounding the introduction of a Community Medicine for the Older Person (CMOP) outreach program.

Preventing and managing constipation in older inpatients.

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.

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from The Irish Longitudinal Study on Ageing (TILDA).

Objectives: To characterize the relationships between orthostatic blood pressure (BP) and heart rate recovery and frailty in an older population.

Design: Cross-sectional study.

Setting: Two health centers in the Republic of Ireland.

Orthostatic hypotension, orthostatic intolerance and frailty: The Irish Longitudinal Study on Aging-TILDA.

Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models.

Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA).

Background: In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample.

Methods And Results: Participants were recruited from a nationally representative cohort study (≥50 years). Beat-to-beat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475).

Higher orthostatic heart rate predicts mortality: The Irish Longitudinal Study on Ageing (TILDA).

Background: Orthostatic hemodynamic signals may predict adverse outcomes in elders.

Aims: To study the association between orthostatic hemodynamics and incident mortality in The Irish Longitudinal Study on Ageing (TILDA).

Methods: Wave 1 subjects underwent an active stand with non-invasive beat-to-beat blood pressure monitoring.

Insights into the clinical management of the syndrome of supine hypertension--orthostatic hypotension (SH-OH): the Irish Longitudinal Study on Ageing (TILDA).

Background: Our previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension-orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts.

Falls classification using tri-axial accelerometers during the five-times-sit-to-stand test.

The five-times-sit-to-stand test (FTSS) is an established assessment of lower limb strength, balance dysfunction and falls risk. Clinically, the time taken to complete the task is recorded with longer times indicating increased falls risk. Quantifying the movement using tri-axial accelerometers may provide a more objective and potentially more accurate falls risk estimate.

Factors affecting continuous beat-to-beat orthostatic blood pressure response in community-dwelling older adults.

Objective: To examine the effect of age, time of day, the timing of medication and food ingestion on orthostatic blood pressure response (OBP) in community-dwelling adults.

Methods: A nationally representative sample of 109 community-dwelling adults aged at least 50 years attended for health assessment in a pilot study of The Irish Longitudinal Study on Ageing. OBP was measured using continuous beat-to-beat plethysmography (Finometer) during active stand, and OBP with excessive artefacts were excluded.

Orthostatic hypotension and subjective sleep quality in older people.

Poor sleep quality and orthostatic hypotension are common complaints in an older population, and both are related to factors such as polypharmacy and depression. However, it is not known whether there is a direct association between the two. Our objective is to investigate a potential association between orthostatic blood pressure response and subjective sleep quality in older people.

Depression: a modifiable factor in fearful older fallers transitioning to frailty?

Objective: Fear of falling is one of the most common fears among community-dwelling older people and is as serious a health problem as falls themselves. Understanding fear of falling in fallers transitioning to frailty may help us identify effective strategies to reduce it in this already vulnerable group of older people. Our aim was to evaluate the psychological factors associated with fear of falling in a group of fallers transitioning to frailty when compared with robust or non-frail fallers.

Diurnal variations in the outcomes of instrumented gait and quiet standing balance assessments and their association with falls history.

One in three adults aged over 65 falls every year, resulting in enormous costs to society. Incidents of falling vary with time of day, peaking in the early morning. The aim of this study was to determine if the ability of instrumented gait and balance assessments to discriminate between participants based on their falls history varies diurnally.

Frailty, depression, and anxiety in later life.

Background: Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life.

An instrumented sit-to-stand test used to examine differences between older fallers and non-fallers.

An instrumented version of the five-times-sit-to-stand test was performed in the homes of a group of older adults, categorised as fallers or non-fallers. Tri-axial accelerometers were secured to the sternum and anterior thigh of each participant during the assessment. Accelerometer data were then used to examine the timing of the movement, as well as the root mean squared amplitude, jerk and spectral edge frequency of the mediolateral (ML) acceleration during the total assessment, each sit-stand-sit component and each postural transition (sit-stand and stand-sit).

Falls and falls efficacy: the role of sustained attention in older adults.

Background: Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. The aim of this study was to investigate whether performance and variability in sustained attention is associated with falls and falls efficacy in older adults.

Methods: 458 community-dwelling adults aged ≥ 60 years underwent a comprehensive geriatric assessment.

Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.

Objectives: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH).

Design: Cross-sectional.

Setting: Geriatric research clinic.

Amnesia for loss of consciousness is common in vasovagal syncope.

Aims: The aim of this study was to determine the prevalence of amnesia for loss of consciousness (A-LOC) in those who have a history suggestive of vasovagal syncope (VVS) and who develop syncope on head-up tilt (HUT) table testing. Furthermore, we wished to determine if A-LOC is an age-dependent phenomenon in VVS and whether haemodynamic parameters on tilting can predict for A-LOC.

Methods And Results: Patients were recruited in a dedicated syncope unit and underwent neurocardiovascular evaluation as indicated under European Society of Cardiology guidelines to illicit a diagnosis of VVS.

The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension: an open randomised controlled trial.

Background: the evidence for 6-inch tilt sleeping-head-up (SHU), a common therapy for the treatment of orthostatic hypotension (OH) in older people, is unavailable.

Objective: to investigate the effects of 6-inch SHU for 6 weeks in community-living patients with chronic OH.

Design: open labelled randomised controlled trial.

Mayer wave activity in vasodepressor carotid sinus hypersensitivity.

Aims: Mayer waves are low frequency blood pressure waves, whose modulation involves central/peripheral baroreflex pathways. Although vasodepressor carotid sinus hypersensitivity (VDCSH) is a common hypotensive disorder in ageing, the mechanism of VDCSH is unknown. We hypothesize that VDCSH is due to impaired baroreflex function and that Mayer wave amplitude and oscillation frequency are therefore altered.

Using the Finometer to examine sex differences in hemodynamic responses to orthostasis in older people.

Objectives: In young and middle age, women have higher orthostatic intolerance (OI) than men, and hemodynamic differences have been found supporting this finding. In older people, these sex differences are less studied. Our aim was to contribute evidence.

Objective real-time assessment of walking and turning in elderly adults.

Recent research suggests that falls are the most common cause of injury and disability in older persons. Invasive systems or body worn sensors can be employed in controlled clinical and laboratory settings to determine clinical measures of gait and stability. This study by contrast aims to explore how video technology, can be employed to unobtrusively determine the same measures.

Intolerance to initial orthostasis relates to systolic BP changes in elders.

Objectives: To explore the association of early symptoms of orthostatic intolerance (OI) with systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure changes in a sample of community-dwelling older people undergoing an active stand test; and to establish whether SBP and DBP changes have different symptomatic correlates during early orthostasis.

Methods: A total of 224 community-dwelling older subjects (mean age 72.6 years, 68.