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Healy D, Murray C, McAdams C, Power R, Hollier PL, Lambe J, Tortorelli L, Lopez-Rodriguez AB, Cunningham C. Susceptibility to acute cognitive dysfunction in aged mice is underpinned by reduced white matter integrity and microgliosis. Commun Biol 2024; 7:105. [PMID: 38228820 PMCID: PMC10791665 DOI: 10.1038/s42003-023-05662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/02/2023] [Indexed: 01/18/2024] Open
Abstract
Age is a significant but heterogeneous risk factor for acute neuropsychiatric disturbances such as delirium. Neuroinflammation increases with aging but the determinants of underlying risk for acute dysfunction upon systemic inflammation are not clear. We hypothesised that, with advancing age, mice would become progressively more vulnerable to acute cognitive dysfunction and that neuroinflammation and neuronal integrity might predict heterogeneity in such vulnerability. Here we show region-dependent differential expression of microglial transcripts, but a ubiquitously observed primed signature: chronic Clec7a expression and exaggerated Il1b responses to systemic bacterial LPS. Cognitive frailty (vulnerability to acute disruption under acute stressors LPS and double stranded RNA; poly I:C) was increased in aged animals but showed heterogeneity and was significantly correlated with reduced myelin density, synaptic loss and severity of white matter microgliosis. The data indicate that white matter disruption and neuroinflammation may be key substrates of the progressive but heterogeneous risk for delirium in aged individuals.
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Affiliation(s)
- Dáire Healy
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Carol Murray
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Ciara McAdams
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Ruth Power
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Pierre-Louis Hollier
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Jessica Lambe
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Lucas Tortorelli
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Ana Belen Lopez-Rodriguez
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland
| | - Colm Cunningham
- School of Biochemistry & Immunology, Trinity Biomedical Sciences Institute & Trinity College Institute of Neuroscience, Trinity College Dublin, 152-160, Pearse St. Dublin 2, Dublin, Republic of Ireland.
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Fehlmann CA, Stuby L, Graf C, Genoud M, Rigney R, Goldstein J, Eagles D, Suppan L. Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study. BMC Emerg Med 2023; 23:121. [PMID: 37833643 PMCID: PMC10576312 DOI: 10.1186/s12873-023-00875-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). METHODS This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. RESULTS A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81-0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9-66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0-96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. CONCLUSION The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. REGISTRATION This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ).
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Affiliation(s)
- Christophe A Fehlmann
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada.
| | - Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, Geneva, CH-1201, Switzerland
| | - Christophe Graf
- Department of rehabilitation and geriatrics, Geneva University Hospitals, Geneva, CH-1211, Switzerland
| | - Matthieu Genoud
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | | | - Judah Goldstein
- Dalhousie Department of Emergency Medicine, Division of EMS, Halifax, NS, Canada
| | - Debra Eagles
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
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Fehlmann CA, Nickel CH, Cino E, Al-Najjar Z, Langlois N, Eagles D. Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review. Intern Emerg Med 2022; 17:2407-2418. [PMID: 35864373 PMCID: PMC9302874 DOI: 10.1007/s11739-022-03042-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research. METHODS We performed a systemic literature search to identify original research that used the CFS in emergency medicine. Several databases were searched from January 2005 to July 2021. Two independent reviewers completed screening, full text review and data abstraction, with a focus on study characteristics, CFS assessment (evaluators, timing and purpose), study outcomes and statistical methods. RESULTS A total of 4818 unique citations were identified; 34 studies were included in the final analysis. Among them, 76% were published after 2018, mainly in Europe or North America (79%). Only two assessed CFS in the pre-hospital setting. The nine-point scale was used in 74% of the studies, and patient consent was required in 69% of them. The main reason to use CFS was as a main exposure (44%), a potential predictor (15%) or an outcome (15%). The most frequently studied outcomes were mortality and hospital admission. CONCLUSION The use of CFS in emergency medicine research is drastically increasing. However, the reporting is not optimal and should be more standardized. Studies evaluating the impact of frailty assessment in the ED are needed. REGISTRATION https://doi.org/10.17605/OSF.IO/W2F8N.
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Affiliation(s)
- Christophe Alain Fehlmann
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Christian Hans Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Emily Cino
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | | | - Nigèle Langlois
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Debra Eagles
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
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Ansorge C, Miocic JM, Schauer F. Skin diseases in hospitalized geriatrics: a 9-year analysis from a University Dermatology Center in Germany. Arch Dermatol Res 2022; 314:427-437. [PMID: 34076756 PMCID: PMC9163006 DOI: 10.1007/s00403-021-02244-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
The demographic trend of an ageing society is mirrored in the rising number of hospitalized geriatric patients in Germany. However, there is still a wide gap of knowledge regarding the dermatological diseases, comorbidities and performed procedures within this growingly important group of patients. The study was conducted as a retrospective monocentric data analysis of all patients 65 years or older from the Department of Dermatology, Medical Center-University of Freiburg, Germany. In total, 10,009 individual hospitalisations were included from 2009 to 2017, and there was a notable increase of geriatric patients in the study period. This study illustrates the following: leading major diagnoses included malignant neoplasm of the head and neck, ulcerated and non-ulcerated inflammatory spectrum of chronic venous insufficiency, whereas angina pectoris, type 2 diabetes and cardiac diseases were noted most frequently as secondary diagnoses. Patients with venous diseases had considerably more often cardiopulmonary minor diagnoses, whereas endocrine diagnoses peaked in the cohort of patients with psoriasis and psychiatric and muscululoskeletal disorders in patients with bullous dieseases. Moh's surgery, dressings and multimodal dermatological treatments were the most often encoded procedures.
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Affiliation(s)
- Claudia Ansorge
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany
| | - Johannes M Miocic
- Institute of Earth and Environmental Sciences, University of Freiburg, Freiburg, Germany
- Geo-Energy, Energy and Sustainability Research Institute Groningen, University of Groningen, Nijenborgh 6, 9747 AG, Groningen, The Netherlands
| | - Franziska Schauer
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany.
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Trenholm JR, Warner DG, Eagles DD. Occupational Therapy in the Emergency Department: Patient Frailty and Unscheduled Return Visits. The Canadian Journal of Occupational Therapy 2021; 88:395-406. [PMID: 34693736 DOI: 10.1177/00084174211051165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Occupational therapy facilitates care for complex frail emergency department (ED) patients who may have unscheduled return visits (URVs). Purpose. To determine the prevalence of frailty amongst ED patients referred to occupational therapy and if frailty affected the rates and reasons for URVs. Methods. A mixed-methods health records review was conducted of older adults referred to an ED-based occupational therapy program. Findings. Most patients were frail (60.6%). 31.0% of patients discharged home had a URV within 30 days, with no difference in URV rates between frail and non-frail populations. Providing occupational therapy education reduced the frequency of URVs. Frail patients had complex reasons for their URVs, including functional, social/environmental, safety concerns, and/or "failure to thrive". Occupational therapy ED patients were typically vulnerable to moderately frail, dependent in some activities of daily living, and complex. Implications. ED-based occupational therapists must be aware of their patient's frailty and risk of URVs.
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Malocclusion of Molar Teeth Is Associated with Activities of Daily Living Loss and Delirium in Elderly Critically Ill Older Patients. J Clin Med 2021; 10:jcm10102157. [PMID: 34067550 PMCID: PMC8156973 DOI: 10.3390/jcm10102157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 01/27/2023] Open
Abstract
A single-center retrospective cohort study examined the association between molar malocclusion status at ICU admission and loss of activities of daily living (ADL) at hospital discharge among acutely ill patients. Patients were assigned to the bilateral occlusion group or malocclusion group (N = 227 and 93, respectively). The following data were collected from electronic medical records: age, sex, Clinical Frailty Scale (CFS) on admission, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, confirmed diagnosis (neurological disorders or others), CFS at hospital discharge, and occlusion condition. Patients who were frail at admission (CFS > 5) were excluded from analysis, and ADL loss was defined as CFS > 5 at hospital discharge. Multivariate analysis showed malocclusion was independently associated with ADL loss [OR, 2.03; 95% CI, 1.13-3.64; p = 0.02]. For those aged 65 and older, malocclusion was significantly associated with both ADL loss [OR, 3.25; 95% CI, 1.44-7.32; p < 0.01] and the incidence of delirium [OR, 2.61; 95% CI, 1.14-5.95; p = 0.02]. Malocclusion on ICU admission was associated with ADL loss in critically ill patients, and was associated with ADL loss and the incidence of delirium in the elderly. Poor oral health was a poor prognostic factor among critically ill patients.
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Pilotto A, Azzini M, Cella A, Cenderello G, Castagna A, Pilotto A, Custureri R, Dini S, Farinella ST, Ruotolo G, Padovani A, Custodero C, Veronese N. The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study. Arch Gerontol Geriatr 2021; 95:104415. [PMID: 33882420 PMCID: PMC8020604 DOI: 10.1016/j.archger.2021.104415] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Abstract
Background The topic of prognosis in COVID-19 research may be important in adopting appropriate clinical decisions. Multidimensional prognostic index (MPI) is a frailty assessment tool widely used for stratifying prognosis in older people, but data regarding inpatients, affected by COVID-19, are not available. Objectives To evaluate whether MPI can predict in-hospital mortality and the admission to intensive care unit (ICU) in older inpatients hospitalized for COVID-19 infection. Methods In this longitudinal, Italian, multi-center study, older patients with COVID-19 were included. MPI was calculated using eight different domains typical of comprehensive geriatric assessment and categorized in three groups (MPI 1 ≤ 0.33, MPI 2 0.34–0.66, MPI 3 > 0.66). A multivariable Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). Results 227 older patients hospitalized for SARS-CoV-2 infection were enrolled (mean age: 80.5 years, 59% females). Inpatients in the MPI 3 were subjected less frequently than those in the MPI 1 to non-invasive ventilation (NIV). In the multivariable analysis, people in MPI 3 experienced a higher risk of in hospital mortality (HR = 6.30, 95%CI: 1.44–27.61), compared to MPI 1. The accuracy of MPI in predicting in hospital mortality was good (Area Under the Curve (AUC) = 0.76, 95%CI: 0.68–0.83). People in MPI 3 experienced a significant longer length of stay (LOS) in hospital compared to other participants. No association between MPI and ICU admission was found. Conclusions Frailty- as assessed by high MPI score - was associated with a significant higher risk of in-hospital mortality, longer LOS, and lower use NIV, whilst the association with ICU admission was not significant. These findings suggest that prognostic stratification by using the MPI could be useful in clinical decision making in older inpatients affected by COVID-19.
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Affiliation(s)
- Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy,; Department of Interdisciplinary Medicine, University of Bari, Italy,.
| | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis " Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | | | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Romina Custureri
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | - Simone Dini
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | | | | | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Nicola Veronese
- Department of Primary Care, District 3, ULSS 3, Venice, Italy,; Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
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O'Shaughnessy Í, Romero-Ortuno R, Edge L, Dillon A, Flynn S, Briggs R, Shields D, McMahon G, Hennessy A, Kennedy U, Staunton P, McNamara R, Timmons S, Horgan F, Cunningham C. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med 2021; 85:50-55. [PMID: 33243612 DOI: 10.1016/j.ejim.2020.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017. AIM To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. DESIGN Retrospective observational study. METHODS We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital. RESULTS In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models. CONCLUSIONS Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.
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Affiliation(s)
- Íde O'Shaughnessy
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Roman Romero-Ortuno
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland.
| | - Lucinda Edge
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aoife Dillon
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Sinéad Flynn
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | | | | | | | - Una Kennedy
- Emergency Department, St James's Hospital, Dublin, Ireland
| | - Paul Staunton
- Emergency Department, St James's Hospital, Dublin, Ireland
| | - Rosa McNamara
- Emergency Department, St James's Hospital, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conal Cunningham
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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