195 THE IMPACT OF COVID-19 RESTRICTIONS ON PATIENTS ATTENDING A FALLS ASSESSMENT SERVICE

Background

Covid-19 impacted older peoples’ confidence and mobility. Restrictions from March 2020 on our cohort of patients (> 65 years) reduced movement and social interactions leading to deconditioning and brain health implications. In our falls assessment service the clinical nurse specialist conducts a multifactorial assessment. We aimed to see if a difference existed in assessments of similar cohorts of patients’ pre and post restrictions.

Methods

A retrospective review of assessment measures for patients attending the falls service between October – December 2019 and 2021. Measures compared included gender, age, Fear-of-Falling (FOF), Timed Up and Go (TUG), Fracture Risk Assessment tool (FRAX), Vitamin D levels, grip strength and Body Mass Index (BMI).

Results

Twenty-two patient charts were reviewed from 2019 and 2021. Both years had similar female and male patient data reviewed (14/22 female 2019, 15/22 female 2021). FOF was noted in 38% (8/21) of patients in 2019, versus 45% (10/22) in 2021. In 2021 the average age of our patient cohort had decreased by three years. The TUG average time increased by 2 seconds in 2021 (median time decreased by 2.5 seconds). The major osteoporotic average percentage decreased in 2021 by 1.1%, (median drop 9%), the hip fracture percentage decreased by 2.5% in 2021 (median drop 10.5%). The average vitamin D level decreased by 1mmol in 2021 (median decreased 54mmol), while BMI average increased by 2kg/m² (median increased by 6kg/m²). The average grip strength results in 2021 dropped by 11.5kg (median decreased by 10.5kg).

Conclusion

Potential trends are observed in this data. We intend to examine a larger timeline/number of patients to be able to validate these findings, particularly FOF.

271 DEVELOPMENT OF AN INNOVATIVE INTER-DISCIPLINARY PARKINSON’S CLINIC IN AN AMBULATORY CARE SETTING

Background

Ambulatory services provide specialist outpatient care, reducing costs associated with inpatient admissions and enabling the person to remain at home for longer (Report of the National Acute Medicine Programme, 2010). An Older Person’s Ambulatory Care Hub was established in a large teaching hospital. Prior service evaluation demonstrated that approximately one third of patients attending had a diagnosis of Parkinson’s Disease (PD). People with PD should have a collaborative approach between patient, family and healthcare providers to optimally manage their condition (NICE, 2017), therefore, the need was identified to evolve the traditional medical model to an interdisciplinary approach. The aim of this project was to complete a service evaluation and breakdown of Interdisciplinary Team (IDT) referrals.

Methods

An IDT working group including Clinical Nutrition (CN), Medical, Nursing, Occupational Therapy (OT), Physiotherapy (PT), and Speech and Language Therapy (SLT) was established. A comprehensive assessment form was developed and outcome measures were chosen. A short pilot was conducted and necessary amendments were made. A weekly clinic was established which included an IDT assessment, followed by a huddle with the medical team where referrals were generated. Data pertaining to the number of attendees and referrals generated were collected over a 3-month period.

Results

Over the data collection period, 31 patients attended the clinic. Referrals were as follows; Medical: 19, PT: 13, SLT: 10, OT: 7, CN: 6, Medical Social Work: 2. Patients requiring urgent medical review were seen immediately after the IDT huddle.

Conclusion

This project demonstrates a service evaluation of a novel IDT PD Clinic. This clinic highlights the need for an IDT approach to management of people with PD. Future service developments include obtaining patient feedback, pre-clinic calls to patients by a Healthcare Assistant to explain the purpose of the clinic, and adapting the clinic as appropriate.

953 PREVIOUS SARS-COV2 INFECTION, AGE AND FRAILTY PREDICT 6-MONTH BNT162B2 VACCINE-INDUCED ANTIBODY TITRE IN NURSING HOME RESIDENTS

Introduction

Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group.

Method

Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity.

Results

Of 86 participants (81.1 ± 10.8 years; 65% female), just-under half (45.4%; 39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00; 95% CI [Confidence Interval]: 2.32, 3.70; p < 0.001) and 6-months (β: 3.59; 95% CI: 2.89, 4.28; p < 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: −0.08, −0.02; p < 0.001) and frailty (β: -0.22; 95% CI: −0.33, −0.11; p < 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity.

Conclusion and Implications

In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.