Introduction Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL). Method The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments. Results 28.7% of participants had a clinically significant score (ACB> 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms. Conclusion A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.

Introduction Major trauma including Traumatic Brain Injury (TBI) is an increasingly common cause of hospitalisation in older adults (OAs). We studied post-discharge recovery from TBI using a remote healthcare monitoring system that captures data on activity and sleep. We aim to assess the feasibility and acceptability of this technology to monitor recovery at home following a significant acute health event in OAs. Methods We installed Minder, a remote healthcare monitoring system, in recently discharged patients >60 years with moderate-severe TBI. We present descriptive analyses of post-discharge recovery for two males, corroborating data from Minder against verified activities and events. We recorded semi-structured interviews assessing acceptability. Both participants have similar household set-up, multimorbidity profiles and clinical frailty scores; however, one participant has prior cognitive impairment (PAT1), and one does not (PAT2). Results We present 10 weeks of sleep and activity data from Minder and feedback from interviews. Data observed from PAT1 revealed habitual patterns of activity and sleep. These remained stable, despite discrete clinical events. Conversely, PAT2's data revealed irregular sleep patterns that became increasingly fragmented. Activity was detected in multiple rooms throughout the house at night, consistent with carer reports of night-time wandering. Increased overnight activity coincided with multiple falls, prompting increased care provision. Initial feedback from interviews was the technology helped participants and those involved in their care feel supported. Conclusions As pressure on services mounts, novel approaches to post-discharge care are of increasing importance. Remote healthcare monitoring can provide high temporal resolution data offering ‘real world’ insights into the effects of significant health events in OAs. Our provisional results support our hypothesis that use of this technology is feasible and acceptable for frail, multimorbid participants and highlights the substantial potential of this technology to help clinicians improve community-based care and more effectively monitor interventions and chronic conditions.

IntroductionTraumatic Brain Injury (TBI) is common, and increasing in older adults, in whom functional outcomes can be particularly poor. We studied post-TBI recovery using Minder, a remote home monitor- ing system that records sleep and activity data.MethodsWe installed Minder in recently discharged patients >60years with moderate-severe TBI. We present comparative descriptive analyses of early post-discharge recovery for two male patients, cross referencing observed data against verified activities and events. Both have similar socioeconomic back- grounds, non-neurological comorbidity burden and household set-up. One had prior cognitive impair- ment (PAT1), whilst the other did not (PAT2).ResultsWe present 10 weeks of sleep and activity data. The data from PAT1 revealed extremely regular sleep-wake schedule, which remained stable. There was minimal time out of bed overnight, with corresponding bathroom activity, consistent with self-reported overnight toilet trips. Conversely, PAT2’s data revealed highly irregular and fragmented sleep patterns, despite PAT2 reporting good sleep. There were significant periods out of bed overnight with activity detected in rooms throughout the house, con- sistent with carer reports of night-time wandering. A period of increased overnight activity coincided with a sequence of falls, necessitating increases in care.DiscussionOur data suggests important interactions between cognitive comorbidity and injury on function after TBI. Our novel approach provides valuable ‘real world’ insights into TBI recovery, particularly in those with poor insight, and could also help guide clinical care.