Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.
There is an urgent need to address the grand sustainability challenges of our time, and to explore new and more responsible ways of operating, researching, and innovating that enable society to respond to these challenges. The emergent Responsible Research and Innovation (RRI) policy agenda can act as a catalyst towards the development of new and more responsible research and innovation efforts. Inevitably, higher education needs to be closely attuned to this need and agenda, by preparing students to engage in RRI efforts. This paper makes a first step towards guiding the embedding of RRI within higher education. It does so by bringing together academic knowledge with phronesis or practical knowledge about what should be done in an ethical, political, and practical sense. It draws on a literature review and on the reflective practices of partners in the European Commission funded project EnRRICH (Enhancing Responsible Research and Innovation through Curricula in Higher Education), as well as on interviews and case studies gathered as part of the project. The paper suggests elements, especially design principles and a competence framework, for (re)designing curricula and pedagogies to equip higher education students to be and to become responsible actors, researchers, and innovators in a complex world, and to address grand sustainability challenges. In addition, this paper proposes that contemporary higher education teaching and learning policies and strategies, especially those promoting neoliberal agendas and marketized practices, need to adopt a more responsible and responsive ethos to foster the renewal of higher education in times of systemic dysfunction.High Educ
The growing diversity of the student population twinned with a shift towards more learner-centred education provides the impetus to develop innovative teaching approaches. Imagined as personalised learning (PL), this approach argues for greater flexibility for the learner and more opportunities to include students' voice in the design and enactment of learning. This paper distils the learning from the members of the INTERPEARL project consortium including
This commentary piece, using a narrative inquiry frame, explores the experiences of five individuals who came together to participate in a community-based participatory research (CBPR) module. Owing to the short time frame of this accredited module, when the module was live, a particular focus was directed towards dialogical techniques to build trust and respect within the group and subsequently generate potential research questions. The inaugural experience of collaborating on a CBPR module stimulated unique feelings, reflections and learnings for participants, many of which took time to surface. This article aims to make sense of those experiences to support those wishing to engage in CBPR initiatives.
Background The traditional model of acute episodic care for older people is reactive and outdated. The integrated care team (ICT) was introduced in April 2017. It comprises a physiotherapist, occupational therapist, clinical nurse specialist and case manager and provides intensive rehabilitation at home to frail older adults after an acute presentation to hospital, thus bridging acute hospital care and coordinated longitudinal care in the community. Methods We evaluated the integrated care team referral database as well as discharge letters from July to November 2018. Results Over 5 months, 45 out of approximately 90 referrals were deemed appropriate for the ICT. Almost half of referrals were unsuitable because of medical acuity or specific instructions such as being unable to weight-bear. Over half of referrals came from the emergency department with no referrals from general surgery, orthopaedics or cardiology. During the time of review, the service was operating at <85% capacity. There is no specific registrar assigned to review ICT referrals. The service is expanding with 123 referrals in six months, compared to 54 in the same period the previous year. Conclusion The integrated care team helps older adults to avoid hospital admission, return home sooner and regain independence and is a much-appreciated service in the area. We identified shortcomings in the referral process, formal medical oversight and awareness of the service in areas where it could provide the most value. The ICT can expand as a key asset for frail older adults if supported by the necessary resources, staffing, consultant geriatrician leadership, referral criteria and pathways and is promoted and publicized in the clinical settings where it has the greatest potential for benefit.
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