Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Impact of Frailty and Comorbidities on Lung Cancer Screening Invitation Response, Low-Dose CT Uptake, and Selection Strategies(University of Leeds, 2024) Almatrafi, Anas; Beeken, Rebecca; Callister, Matthew; Neal, Richard; Gabe, RhianLung cancer screening (LCS) using low-dose CT reduces lung cancer mortality among individuals at high risk of the disease. This high-risk population may have a higher incidence of frailty and multiple comorbidities, potentially due to the influence of age and smoking history, compared to those undergoing screening for other cancers. However, the incorporation of frailty and comorbidities into LCS has not been thoroughly studied. This thesis aimed to investigate the prevalence of frailty and comorbidities and their impact on LCS invitation response, low-dose CT uptake, and selection strategies within the Yorkshire Lung Screening Trial (YLST). Study One was a systematic review and meta-analysis that examined the prevalence of comorbidities in the lung cancer screening population. This study identified several prevalent comorbidities and highlighted the lack of frailty assessment among individuals undergoing LCS. Study Two was a retrospective case-control analysis that explored the prevalence of frailty and comorbidities, as well as the response to the YLST lung cancer risk assessment invitation and subsequent uptake of low-dose CT screening. The analysis revealed that frailty of any degree was present in 47.9% of eligible individuals offered low-dose CT appointments, including 16.2% with moderate to severe frailty. Interestingly, individuals without frailty or comorbidities were less likely to respond to the risk assessment invitation but showed higher participation in low-dose CT screening when deemed eligible. Study Three was a retrospective comparative analysis that evaluated frailty, comorbidities, and survival among populations eligible for LCS, identified by different selection strategies. The study found that the risk models currently used in the UK (PLCOm2012 and LLPv2) identified similar populations in terms of frailty and comorbidities, with both models showing higher prevalence than the USPSTF2021 criteria. However, three-year overall survival appeared to be similar across all strategies. In conclusion, future LCS efforts should focus on increasing participation rates amongst fit individuals with fewer comorbidities (who appear less likely to take part currently) and comparing long term outcomes across different levels of frailty and comorbidity.16 0Item Restricted The Effectiveness and Feasibility of Neuromuscular Electrical Stimulation after Fragility Fracture(University of Nottingham, 2024) Alqurashi, Helal; Robinson, Katie; Gladman, John; Gordon, Adam; Masud, Tahir; Piasecki, MathewFrailty, the vulnerable state seen in older people due to the cumulative effects of ageing and disease, is characterised by loss of muscle mass and muscle strength (sarcopenia). Older people living with frailty are prone to falls and fragility fractures, which necessitate hospital admission, resulting in further muscle loss and eventually leading to further disability. Rehabilitation exercise can reduce these consequences but is not always possible or adequate due to factors such as pain and fatigue. An alternative or additional technique is Neuromuscular Electrical Stimulation (NMES), which stimulates muscle contractions via an electrical stimulus applied to the skin overlying the muscles. The aim of this PhD thesis was to investigate the feasibility and efficacy of NMES on neuromuscular function in patients after fragility fracture. To explore the evidence regarding the effectiveness of NMES in hospitalised patients, I conducted a systematic review and meta analysis. This is reported in Chapter 2. Across the 42 identified papers, NMES was proven to be safe, albeit with a small incidence of minor discomfort. The meta-analysis revealed that NMES had a small effect on muscle strength (moderate certainty) (SMD = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life. However, the effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. These findings showed that NMES may be a promising intervention for rehabilitation after fragility fracture. I then contributed to and took over the management of a feasibility study of NMES in patients admitted to hospital due to fragility fractures. The main results of this are reported in Chapter 3. The aim of the study was to evaluate the feasibility and effectiveness of NMES in patients with fragility fractures. The objectives included assessing the willingness and ability of patients to receive NMES, examining compliance and acceptability of NMES treatment, and identifying recruitment parameters and suitable outcome measures for a randomised clinical trial with clinical outcomes. The study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants’ homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. NMES was applied to quadriceps and tibialis anterior muscles for 30 minutes, 3 days/week. Sessions were progressed to achieve 60 minutes, 5-7 day/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months. The findings showed that 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. 53% achieved the target of 24 NMES sessions. 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs. It became clear during the feasibility study that hospital-based NMES was unlikely to be feasible, but that NMES might be more feasible if home-based NMES. In view of the limited use of this technique in fragility fracture patients at home, I utilised an action research iv approach to optimise the use of NMES in this group and setting whilst the feasibility study continued. The findings of this and those of semi structured interviews of participants reported in Chapter 4. The observational process highlighted issues related to the stimulation of tibialis anterior muscle, which could be overcome. Themes identified through interview included acceptability, safety, practicality, user experience, training, and support, and how and when. This sub-study reinforced the findings of the quantitative aspect of the feasibility study, confirming the safety and acceptability of NMES. In summary, my literature review has indicated that NMES is a potentially useful treatment to prevent and reverse the muscular consequences of hospitalisation for fragility fracture. Furthermore, the feasibility study has shown that trials of NMES in fragility fractures are feasible, albeit in a minority of mildly frail fragility fracture patients with little premorbid disability. I have argued that such trials should use home-based, self-administered NMES, and should consider this intervention as an adjunct to, rather than a replacement of, a rehabilitation programme. Additionally, the findings derived from this thesis serve as valuable insights for designing future randomised controlled trials, which is a necessary step before NMES becomes a routine part of clinical care.17 0Item Restricted The Association between Frailty and Quality of Life in Older People(University of Leeds, 2024-07) Alattas, Ali; West, RobertThis thesis examines the association between frailty and quality of life (QoL) in older adults, emphasizing successful aging as a primary goal for individuals and healthcare systems. Frailty and QoL are crucial concepts in understanding aging, as they encompass major concerns and extend into broader domains of successful aging. Using data from the English Longitudinal Study of Ageing, this research comprises three interconnected studies. The first study analyses frailty progression over 18 years, categorized by the number of long-term conditions (LTCs). Findings indicated that frailty increased with the number of LTCs for both genders, with males showing accelerated frailty with one or more LTCs, while females exhibited this acceleration with two or more LTCs. In the second study, several structural factor models for the CASP-12, a measure of quality of life, were tested. The study also examined the consistency of the best model across various demographics and two time periods. The results showed that the CASP-12 with the second-order common factors is a better model, and it maintained strong invariance across genders, age, and education, as well as over two different time points when the sample was divided into three subsamples based on age group. However, this invariance was not observed for net wealth. The third study investigated the two-way relationship between frailty and QoL, revealing a strong inverse and almost linear relationship over time. Although the cross-lagged relationship between QoL and frailty was statistically significant, the impact was minimal. Differences were noted at the group level, considering gender, age, net wealth, and multimorbidity, but not at the within-person level. By considering these findings, healthcare providers and policymakers can develop more effective strategies to support the well-being of older adults.11 0Item Restricted The Prognostic Value of Frailty in Major Trauma in Older People(The University of Nottingham, 2024) Alqarni, Abdullah Ghaythan; Ollivere, Benjamin; Gladman, JohnBackground: The incidence of major trauma in older people is rising. Frailty significantly raises the probability of poor trauma outcomes in older people. The purpose of this thesis is to investigate the predictive value of frailty in major trauma as well as to determine the need for developing a frailty evaluation instrument specifically for older individuals who have had major trauma. Methods: An overview and review of relevant literature concerning frailty and major trauma in older people was conducted. A systematic review and meta-analysis were undertaken to investigate the frailty concept's influence on the outcomes of older trauma patients. A trauma frailty index was created as a tool for diagnosing frailty in older people who had experienced trauma using routinely collected data. The index was verified against adverse outcomes using two samples in and out of sample data sets to prove its relevance and validity in a larger population of trauma patients. Two further validations were conducted to determine the index's ideal threshold for the development of adverse outcomes. Results: Frailty status in older persons with major trauma was linked to higher in-patient mortality, duration of hospital stay, discharge location, and comorbidities. Frailty was consistently a better predictor of death and unfavourable discharge location than age or injury severity. Frailty detection methods do not seem to be suitable for use with traumatically injured older people. The Nottingham Trauma Frailty Index (NTFI) has identified five variables that strongly predict frailty (regression coefficient B = 6.383 (95% confidence interval 5.03 to 7.74), p < 0.001): age, Abbreviated Mental Test score, admission haemoglobin concentration (g/l), pre-admission mobility (requiring assistance or not), and mechanism of injury (falls from standing height). During validation, there was a strong agreement between the NTFI and the CFS (mean difference 0.02), with no obvious systematic bias. In two validations against clinical outcomes, growing NTFI was related to adverse outcomes that included in-hospital complications, adverse discharge destinations, the increase in dependency level, and length of stay. NTFI ≥ 4.345 was a significant predictive threshold for adverse outcomes including discharge to rehabilitation unit, discharge to nursing care home, discharge to residential care home, mortality, increase in dependency level, and in-hospital complications. Conclusion: The frailty state of older trauma patients is a better predictor of poor outcomes than their age or injury severity score. The NTFI has shown a noteworthy performance in predicting clinical outcomes in both in-sample and out-of-sample data sets. The NTFI is a practical tool that clinicians and researchers may use to direct patient care and analyse quality improvement and research initiatives. It utilises readily and regularly recorded physiological and functional characteristics.47 0Item Restricted Rapid review of longitudinal studies on the association between oral health and frailty(King’s College London , 2024-08) Alhumaidi, Meshari; sabbah, waelAbstract Background Frailty and sarcopenia are prevalent conditions in the elderly, contributing to increased healthcare costs and higher mortality rates. Poor oral health, characterized by issues such as tooth loss and periodontal disease, has been associated with the onset and progression of these conditions. Despite this, there is a lack of comprehensive longitudinal studies examining the relationship between oral health and frailty in older populations. Objective This rapid review aims to consolidate and analyse the existing body of research from longitudinal studies on the association between various oral health conditions and frailty among older adults. The goal is to identify key oral health issues that significantly impact frailty and to provide insights for healthcare providers and policymakers. Methods The review systematically gathered and synthesized data from relevant studies using a standardized methodological approach. It focused on studies involving older adults aged 65 and above, examining conditions such as tooth loss, periodontal diseases, and overall oral hygiene status. The analysis included comparisons between individuals with poor oral health and those with healthier oral conditions, assessing the impact on frailty indicators. From an initial search yielding 1404 records (702 from PubMed, 93 from Ovid, and 609 from Cochrane Library), 609 records remained after removing duplicates. After screening titles and abstracts, 16 articles were assessed for eligibility. Ultimately, 11 studies met the inclusion criteria and were included in the final review. Results The findings highlight significant associations between poor oral health and increased frailty in the elderly. Conditions like tooth loss and periodontal disease were found to be major risk factors for frailty, affecting physical functions such as strength, mobility, and overall vitality. The review also identified gaps in the literature, particularly the need for more longitudinal studies to establish causal relationships. A total of 11 longitudinal studies met the inclusion criteria and were included in this systematic review. These studies provide valuable insights into the association between various oral health conditions and frailty among older adults, highlighting the importance of maintaining good oral health to mitigate the progression of frailty. However, the predominance of cross-sectional designs in some studies limits the ability to establish causal relationships and introduces potential biases, including measurement bias from self-reported data and residual confounding. Conclusion The review underscores the importance of integrating oral health assessments into routine geriatric care. Early interventions targeting oral health could potentially delay the onset of frailty, improving quality of life and reducing healthcare costs. These findings provide a foundation for developing comprehensive geriatric care models that prioritize oral health and for future research to address the identified gaps in the literature.23 0