Cognitive frailty (CF) has been considered as a subtype of frailty characterized by concurrent physical frailty and potentially cognitive impairment (Kelaiditi et al., 2013). Early detection of CF is an important issue in order to implement prevention and intervention to improve quality of life in aging. The aim of this study was to explore the prevalence of cognitive frailty in a sample of Portuguese old people, living in the community, and determine its relationship with sex, age, education and comorbidity.

Two hundred forty nine community-dwelling participants aged over 60 years and without dementia and other neurological and psychiatric diseases were assessed to obtain sociodemographic, functional, health, physical, cognitive and socio-affective measures. Participants were classified with/without mild cognitive impairment using the Montreal cognitive test (MoCa Test), and as physically robust, pre-frail and frail using the criteria of Fried et al. (2001). A cognitive frailty classification variable was created with six groups that were compared on sociodemographic variables and on comorbidity measured with the Charlson Index Scale (ChIS).

A 20.1% of participants were classified as physically robust and cognitively normal (Group 1), a 28.5% as physically pre-frail and cognitively normal (Group 2), a 11.2% as physically frail and cognitively normal (Group 3), a 6.8% as physically robust with cognitive impairment (Group 4), a 14.9% as physically pre-frail with cognitive impairment (Group 5), and a 18.5% as physically frail with cognitive impairment (Group 6). No significant group differences were registered in the distribution by sex. Significant differences were observed between Group 6 and Group 1 and Group 2 in age [F(5, 243)=6.20, p<.01] and in education [F(5, 243)= 6.54, p<.01], being the first older and with lower education level than the two last ones. Regarding comorbidity, Group 6 had significant higher scores in the ChIS [F(5,243)=9.91, p<.01] than all the other groups

The study reveals that a 33.4% of the older adults and with less education level living in community suffer the two more advanced stages of cognitive frailty. Prevention and interventions measures are need to improve their quality of life.

To assess the ‘Okay to Stay’ plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions.

The incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions.

Data from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.

Visits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.

The Comprehensive Geriatric Assessment (CGA) is used in geriatric medicine as a means to manage the health care needs of older adults and to grade frailty. We modified the CGA so that it could be completed independently by care partners (usually family) and be used to grade frailty. Our objective was to examine the feasibility of a care partner completing the CGA at the time of the first prehospital encounter.

A prospective, observational study was conducted with a convenience sample of patients ≥ 70 years accompanied by a knowledgeable care partner. Feasibility was measured by the time required and percent completeness of items on the form based on completion by the care partner and by paramedic perception of utility.

Subjects (N 5 104) were enrolled with three postenrolment exclusions due to ineligibility. Most participants were older women living in their own home. The mean time to complete the questionnaire was 18.7 minutes (SD 11.3; median 15 minutes; interquartile range 12-20 minutes). Only 64% of the care partners recorded the time it took. Nineteen percent of paramedics completed a follow-up survey, and all felt screening for frailty was worthwhile and most (> 70%) thought that the CP-CGA may be a useful approach. The study was limited by recruitment bias of potentially eligible patients, a high level of missingness in the outcome measures of interest, and low paramedic participation rates.

We observed a high rate of item completeness of questionnaires with a mean time to complete of 18.7 minutes in a convenience sample of older patients. A small sample of paramedics universally endorsed the utility of screening for frailty in the prehospital setting, and many thought the CP-CGA was a helpful tool.

This is an exploratory study of nursing home preparedness in South Carolina intended to: (1) examine nursing home administrators' perceptions of disaster preparedness in their facility in the absence of an immediate emergency or disaster, and changes in their views about preparedness following a large disaster; (2) study whether administrators' knowledge of shortcomings in preparedness leads them to change their views about planning; and (3) suggest ways to enhance preparedness.

A descriptive survey based on interviews with public officials responsible for nursing home safety was developed and mailed to all 192 licensed nursing homes in South Carolina in July 2005, and an extensive literature review was performed. As responses to the baseline survey were received, Hurricane Katrina devastated the Gulf Coast.Two weeks after Katrina, a brief, post-Katrina survey was mailed, asking administrators if Katrina had influenced their preparedness plans. Quantitative responses were analyzed using descriptive statistics. Three researchers coded the qualitative data and conducted a thematic analysis.

One hundred twelve baseline surveys and 50 post-Katrina surveys were completed (response rates 58.3% and 26%, respectively). A large number of respondents reported a high level of satisfaction with the overall ability of their facilities to protect residents during an emergency or disaster. However, many were less satisfied with their preparedness in specific, important areas, including: (1) providing shelter to evacuees from other nursing homes; (2) transportation; and (3) staffing. In the post-Katrina survey, 54% of respondents were re-evaluating their disaster plans; only 36% felt well-prepared. Those re-evaluating their plans specifically mentioned evacuation, transportation, supplies, staffing, and communication.

Transportation, communication, supplies, staffing, and the ability to provide shelter to evacuees are important domains to consider when evaluating nursing home preparedness. Administrators believe their nursing homes need to improve in all of these areas. Recommendations include developing improved transportation arrangements, redundant communication systems, and stronger linkages with local emergency preparedness systems.