East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

A feasibility study to identify attitudes, determine outcome measures and develop an intervention to inform a definitive trial that will determine the effectiveness of adapted cardiac rehabilitation for sub-acute stroke and TIA patients.

Stroke leads to reduced cardiorespiratory fitness (CRf) and increased risk of future cardiovascular events. Cardiac rehabilitation (CR), has been shown to reduce the risk of future cardiovascular events in cardiac patients. The use of CR for the stroke population has only been explored in one study in England. This study provided CR for stroke patients for 30 weeks and focussed on people with very mild severity stroke.The overall aim of this thesis was to establish the feasibility of conducting a definitive study investigating the effect of six weeks of adapted CR on CRf, blood pressure, heart rate, activity levels, quality of life, fatigue, tone, falls, body mass index, anxiety and depression for people with mild to moderate stroke in the sub-acute stage of recovery. Feasibility was determined by: acceptability, ability to recruit, adherence to the programme, identifying outcome measures and adverse events. This mixed-methods thesis reports firstly on the attitudes and knowledge of healthy lifestyles in people post stroke and their thoughts on attending CR. Secondly, it identifies the attitudes of stroke and CR teams towards people with stroke attending CR and the adaptations that would be needed. These two phases informed the design of the final cohort study by identifying the CR adaptations needed and the recruitment strategies to be used.The third phase of this thesis reports on the results of a validity and reliability study which aimed to identify the most valid and reliable clinical test of CRf in people with mild-to-moderate severity stroke. The Incremental Shuttle walk test (ISWT) was shown to have modest validity (r=0.58, 95% confidence intervals (CI) 0.34-0.75, p=0.001) and strong reliability (ICC of 0.99, 95% CI 0.96-0.99) for measuring CRf in people post-stroke and this measure was used in the final phase of the thesis. Finally, this thesis reports on the results of a mixed-methods cohort study that integrated people with stroke into CR programmes in the sub-acute phase of recovery.It was found that adapted CR: was acceptable to people with NIHSS <3, the stroke and cardiac teams if suitable support and training provided, and the cardiac patients; had acceptable recruitment; had high adherence and only one adverse event; and identified outcome measures that could measure change. It concludes that a definitive study to explore CR for a very mild stroke population (NIHSS <3) is feasible with appropriate adaptations and support.</div

A response to call for “A New Paradigm” for Long Covid in Lancet Respiratory Medicine: Long COVID is not a functional disorder

A Response to Call for “A New Paradigm” for Long COVID in Lancet Respiratory Medicin

A qualitative study exploring patients', with mild to moderate stroke, and their carers' perceptions of healthy lifestyles

Background/Aims: To explore patients', with mild to moderate stroke, and their carers' experiences after a stroke and to explore their perceptions of healthy lifestyles. Methods: A qualitative study using semi-structured interviews was undertaken with 20 people (12 males and 8 females) with mild to moderate stroke or transient ischaemic attack (1 week to 6 months' post event) and seven of their carers. Each interview was transcribed and a thematic analysis approach guided the analytic process. Results: Patients with sub-acute, mild to moderate stroke were positive about healthy lifestyles and their ability to achieve them post stroke. Three core themes were identified: perceptions related to exercise; perceptions related to other lifestyle factors; and understanding of stroke and healthy lifestyles. Conclusions: In the sub-acute phase of stroke recovery, barriers to exercise such as lack of motivation do not appear to be an issue. People with stroke have a lack of understanding of healthy guidelines, risk factors and cause of their stroke. It is not clear if this is due to a lack of information provision or a lack of recall. They also do not appear to make the link between lifestyle choices and the cause of their stroke

Does cardiac rehabilitation for people with stroke in the sub-acute phase of recovery lead to physical behaviour change? Results from compositional analysis of accelerometry-derived data

ObjectivesDoes adapted cardiac rehabilitation (CR) improve the physical behaviours of people with mild-to-moderate stroke in the sub-acute recovery phase using a compositional data analysis (CoDA) approach?DesignBefore-after.SettingUniversity Hospitals of Leicester, Glenfield Hospital, UK.Participants24 individuals completed CR and provided valid physical activity (PA) data (mean (SD) 63.1 (14.6) years, 58% male (14/24)).Intervention6-week adapted CR program within 6-months of stroke.Main outcome measuresPhysical behaviours were assessed using waist-worn accelerometry. Step count, stationary time (ST), light PA (LPA), and moderate-to-vigorous PA (MVPA) were compared pre post CR using conventional analyses and CoDA. Analysed compositions were: Waking day (ST, LPA, MVPA); ST (1–9-minutes, 10–29-minutes, ≥30-minutes bouts); and MVPA (1–4-minutes, 5–9-minutes, ≥10-minutes bouts).ResultsFollowing CR, patients took significantly more steps (mean (SD) 3255 (2864) vs 3908 (3399) steps/day, P = 0.004) and engaged in more bouts of MVPA lasting ≥5 and ≥10-minutes (≥5-minutes: mean (SD) 0.7 (1.4) vs 1.2 (1.8) bouts/day, P = 0.008). Using CoDA, no changes in waking day or ST compositions occurred. For waking day, 42% (10/24) increased their LPA and MVPA at the expense of ST. For ST, 33% (8/24) increased their short bouts at the expense of medium and long bouts. For MVPA, 13% (3/24) increased their medium and long bouts at the expense of short bouts.ConclusionPeople with stroke in the sub-acute stage of recovery exhibited low levels of PA. CR appears to be an effective intervention to increase step count but did not alter the overall proportion of time individuals spent being sedentary, or engaging in LPA or in MVPA.RegistrationISRCTN65957980.</div