Stuart Graeme Parker

• MD FRCP
• Professor Emeritus at Newcastle University

Background The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for fu...

Background: The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for...

Background Delirium is a serious acute neuropsychiatric condition associated with altered attention and arousal. Objective To evaluate simple bedside tests for attention and arousal to detect delirium in those with and without Parkinson’s disease (PD) and dementia. Methods Participants from two prospective delirium studies were pooled comprising...

Background Acute hospitalisation and delirium have individually been shown to adversely affect trajectories of cognitive decline but have not previously been considered together. This work aimed to explore the impact on cognition of hospital admission with and without delirium, compared to a control group with no hospital admissions. Methods The D...

Background Delirium is common, distressing and associated with poor outcomes. Despite this, delirium remains poorly recognised, resulting in worse outcomes. There is an urgent need for methods to objectively assess for delirium. Physical function has been proposed as a potential surrogate marker, but few studies have monitored physical function in...

Objectives Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. Design A rapid review of primary studi...

Background Delirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over...

Background: Frailty is a significant determinant of health care utilisation and associated costs, both of which also increase with proximity to death. What is not known is how the relationships between frailty, proximity to death, hospital use and costs develop in a population aged 85 years and over. Methods: This study used data from a prospect...

Introduction: the aim of this study was to design an approach to improving care for frail older patients in hospital services where comprehensive geriatric assessment (CGA) was not part of the clinical tradition. Methods: the intervention was based on the principles of CGA, using quality improvement methodology to embed care processes. Qualitati...

Introduction The ageing of the population represents a significant challenge for aged care in Australia and in many other countries internationally. In an environment of increasing resource constraints, new methods, techniques and evaluative frameworks are needed to support resource allocation decisions that maximise the quality of life and well-be...

Background: Acquiring medical competencies alone does not necessarily lead to the delivery of quality clinical care. Many UK training programs are soon to be based on the curricula of entrustable professional capabilities (EPCs). These are tasks carried out in practice requiring proficiency in several competencies for quality practice. Assessments...

Background The aim of this study was to provide high-quality evidence on delivering hospital-wide Comprehensive Geriatric Assessment (CGA). Objective(s) (1) To define CGA, its processes, outcomes and costs in the published literature, (2) to identify the processes, outcomes and costs of CGA in existing hospital settings in the UK, (3) to identify...

Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation - including associated ethica...

Introduction: multiple conditions in later life (multi-morbidity) is a major challenge for health and care systems worldwide, is of particular relevance for older people, but has not (until recently) received high priority as a topic for research. We have identified the top 10 research priorities from the perspective of older people, their carers,...

This study explored the acceptability and usability of the iStep prototype a novel social innovation to encourage intergenerational physical activity (PA) to help reduce obesity levels in older age. Obesity is a major public health issue and physical inactivity is one of the many factors that influence this, especially in childhood and later life....

Background Older people are increasing users of health care globally. We aimed to establish whether older people with characteristics of frailty and who are at risk of adverse health-care outcomes could be identified using routinely collected data. Methods A three-step approach was used to develop and validate a Hospital Frailty Risk Score from In...

Objective To describe, using data from the Newcastle 85+ cohort study, the use of primary care and other healthcare services by 85-year-olds as they age. Design Longitudinal population-based cohort study. Setting Newcastle on Tyne and North Tyneside, UK. Participants Community dwelling and institutionalised men and women recruited through genera...

Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency. Purpose: This article explores the effects of the physical environment in thre...

Background: comprehensive geriatric assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. Objectives: our objectives were to describe the key elements, principal measures of outcome an...

The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbi...

Recent years have seen increased use of acute hospitals by older people. The effectiveness of CGA for inpatients is well established, but delivery of hospital wide CGA is not extensively described. The UK National Institute for Health Research recently called for more research on the delivery of hospital wide CGA. We performed an umbrella review of...

CGA is widely recommended for older hospital inpatients. The UK National Institute for Health Research (NIHR) recently called for more research on the delivery of hospital wide CGA. We carried out a survey of acute hospitals in the UK with the assistance of the British Geriatrics Society, The Royal College of Physicians of London and the NIHR Agein...

Older people with frailty and urgent care needs are major uses of health and social care services. Comprehensive geriatric assessment (CGA) is an evidence-based approach to improving their outcomes, as well as improving service outcomes. Geriatricians form a small proportion of the overall workforce and cannot address the population need alone, so...

In this article we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home, and institutionalisation. Traditionally It is delivered by special...

Background Delirium is common, affecting at least 20% of older hospital inpatients. It is widely accepted that delirium is associated with dementia but the degree of causation within this relationship is unclear. Previous studies have been limited by incomplete ascertainment of baseline cognition or a lack of prospective delirium assessments. There...

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services...

Introduction Genome-Wide Association Studies have identified associations between lung function measures and Chronic Obstructive Pulmonary Disease (COPD) and chromosome region 6p21 containing the gene for the Advanced Glycation End Product Receptor (AGER, encoding RAGE). We aimed to (i) characterise RAGE expression in the lung, (ii) identify AGER t...

Linear Regression analysis of lung function measures and rs2070600 genotyping. rs2070600T was associated with increased FEV1 and FEV1/FVC ratio. Minor allele frequency of tested population = 10%. Coded allele = T. (PDF)

Linear regression analysis of serum sRAGE level and lung function measures FEV1, FVC and FEV1/FVC. Serum sRAGE levels was not associated with FEV1, FVC or FEV1/FVC when subjects were stratified by genotype. F = statistical significance of the regression equation as a whole. (PDF)

Serum soluble RAGE levels in 102 individual stratified by rs2070600 genotype. Serum sRAGE levels were lower in individuals with a C:T genotype for rs2070600. (PDF)

Several regions of the genome have shown to be associated with COPD in genome-wide association studies of common variants. To determine rare and potentially functional single nucleotide polymorphisms (SNPs) associated with the risk of COPD and severity of airflow limitation. 3226 current or former smokers of European ancestry with lung function...

Objectives: To examine the extent and complexity of the morbidity burden in 85-year-olds; identify patterns within multimorbidity; and explore associations with medication and healthcare use. Participants. 710 men and women; mean (SD) age 85.5 (0.4) years. Methods: Data on 20 chronic conditions (diseases and geriatric conditions) ascertained fro...

Supplementary Material contains an appendix to the paper that gives further details of the sample selection and additional results tables (Supplementary Tables 1, 2, and 3).

Background and design: This research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characte ristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ, et al. The Relationship Between Workforce Flexibility and the Costs and Outcomes of...

Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibil...

The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for thei...

The soluble cleaved urokinase plasminogen activator receptor (scuPAR) is a circulating protein detected in multiple diseases, including various cancers, cardiovascular disease, and kidney disease, where elevated levels of scuPAR have been associated with worsening prognosis and increased disease aggressiveness. We aimed to identify novel genetic an...

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services...

To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Quali...

To assess patient preferences for different models of care defined by location of care, frequency of care and principal carer within community-based health-care services for older people. Discrete choice experiment administered within a face-to-face interview. An intermediate care service in a large city within the United Kingdom. The projected sam...

To determine the effect of a dietary intervention and micronutrient supplementation on self-reported infections in older adults. A randomized, placebo-controlled intervention trial. Community living older people in South Yorkshire, United Kingdom. Two-hundred seventeen older adults aged 65 to 85. Participants were randomized to a dietary interventi...

Research Aim: The aim of this study is to develop, implement and evaluate the cost and clinical impact of an Interprofessional Management Tool designed to optimise interprofessional working in community based older peoples' services. Type and location: The setting for this research is older peoples' community based intermediate care and rehabilitat...

Background: Household devices may have a positive impact on daily lives by reducing the burden of several tasks and enriching social interaction. There are varieties of assistive devices such as alarms, sensors, detectors, and life style monitoring devices, which can help in compensating for the activity limitations caused by impairments. This stu...

Technological interventions could help older people live independently. In this study with 160 people aged 55 and over who were living in extra care housing in England we aimed to explore awareness of, access to, attitudes towards availability, and use of home-based technological (HBT) devices, and factors that influence the use of devices. A quant...

We have previously shown evidence that polymorphisms within genes controlling leukotriene B4 (LTB4) production (ALOX5AP and LTA4H) are associated with asthma susceptibility in children. Evidence also suggests a potential role of LTB4 in COPD disease mechanisms including recruitment of neutrophils to the lung. The aim of the current study was to see...

British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical healt...

There is widespread evidence both of the exclusion of older people from clinical research, and of under-recruitment to clinical trials. This review and opinion piece provides practical advice to assist researchers both to adopt realistic, achievable recruitment rates and to increase the number of older people taking part in research. It analyses 14...

many frail older people who attend acute hospital settings and who are discharged home within short periods (up to 72 h) have poor outcomes. This review assessed the role of comprehensive geriatric assessment (CGA) for such people. standard bibliographic databases were searched for high-quality randomised controlled trials (RCTs) of CGA in this set...

to test the hypothesis that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR). pragmatic randomised controlled trial. four geriatric day hospitals and four home rehabilitation teams in England. eighty-nine patients referred for multidisciplinary rehabilitati...

Good care for frail older people should be part of mainstream clinical practice

The success of a human intervention trial depends upon the ability to recruit eligible volunteers. Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies. In order to predict recruitment rates accurately, researchers need information on the relative success of various recruitment strategies. Few published tria...

Factors associated with inflammation in older adults - Volume 69 Issue OCE3 - S. E. Forster, D. J. Flower, G. Foulds, L. Jones, H. J. Powers, J. M. Saxton, S. Parker, A. G. Pockley, E. A. Williams

COPD Severity Analyses (GOLD classification). This file contains phenotypic characteristics of GOLD stratified COPD subjects and association analyses for PLAUR SNPs with disease severity.

Baseline Lung Function Analyses. This file contains details of linear regression analyses for baseline lung function (FEV1, FEV1/FVC) for PLAUR SNPs.

PLAUR 5'region sequencing and bioinformatics analyses. This file contains details of additional sequencing of the PLAUR promoter region including the identification of novel SNPs and a bioinformatics analysis to identify putative transcription factor changes resulting from SNPs.

Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases involving an interaction between genetic and environmental factors. Interleukin-13 (IL13) has been suggested to have a role in both asthma and COPD. We investigated whether single nucleotide polymorphisms (SNPs) in the IL13 pathway may contribute to the suscept...

We have previously identified Urokinase Plasminogen Activator Receptor (PLAUR) as an asthma susceptibility gene. In the current study we tested the hypothesis that PLAUR single nucleotide polymorphisms (SNPs) determine baseline lung function and contribute to the development of Chronic Obstructive Pulmonary Disease (COPD) in smokers. 25 PLAUR SNPs...

The purpose of this paper was to develop a pro forma which classifies the components of service delivery and organization which may impact on the outcomes of elderly peoples’ community and intermediate care services. The resulting analytic template provides a basis for comparison between services and may help guide service commissioning and develop...

To test the hypotheses that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR) and that HBR is less costly. Two-arm randomised controlled trial. Four trusts in England providing both HBR and DHR. Clinical staff reviewed consecutive referrals to identify subje...

To assess the impacts of different forms of case management for people aged over 65 years at risk of unplanned hospital admission, in particular the impacts upon patients, carers and health service organization in English primary care; and, in these respects, compare the Evercare model with alternatives. Multiple qualitative case studies comparing...

To generate a picture of the range, configuration and staffing of community and intermediate care services in the United Kingdom (UK) and to ascertain whether any relationships exist between service configuration and staffing models. A service audit tool was sent to members of the Community Therapist's Network (CTN) and to chief executives of prima...

The health workforce has undergone unprecedented change over the past decade. Several countries have introduced substantial workforce changes to address staffing shortages in medicine, nursing and the allied health professions, and in some cases, to improve the productivity and efficiency of health services. This raft of changes, with various label...

The objectives of this study were to explore the costs and outcomes associated with different types of intermediate care (IC) services, and also to examine the characteristics of patients receiving such services. Five UK case studies of 'whole systems' of IC were used, with data collected on a sample of consecutive IC episodes between January 2003...

The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial. We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians. This study compared the...

We aimed to examine the role of tumour necrosis factor gene complex polymorphisms in subjects with chronic obstructive pulmonary disease (COPD). We hypothesized that individuals possessing polymorphic variants associated with higher tumour necrosis factor (TNF) secretion would be more susceptible to and/or have more severe disease. Patients with CO...

To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people. Practice level before and after analysis of hospital admissions data with control group. Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission....

to examine the influence of specific clinical impairments and disabilities on the completion of the SF-36 health status measure among older people. Prospective observational study. An SF-36 was administered to 245 subjects aged 65 years and older. Subjects were chosen by sampling from a variety of inpatient, outpatient and community sources to ensu...

Aims: The Dutch Hypothesis suggests that asthma and chronic obstructive pulmonary disease may share some pathogenic mechanisms. There is considerable evidence that polymorphisms of the β2 adrenoceptor have disease-modifying roles in juvenile onset asthma, determining severity and response to β agonists, but not determining disease susceptibility. T...