Bethany Simmonds | University of Portsmouth (original) (raw)

Papers by Bethany Simmonds

Emergency medicine journal : EMJ, 2015

Falls occur increasingly frequently with age. 35% of people aged over 65 fall each year rising to... more Falls occur increasingly frequently with age. 35% of people aged over 65 fall each year rising to 50% at age 85. Many patients fall repeatedly. 56% of patients attending an emergency department were recurrent fallers, and 55% of patients presenting with an acute fracture had previously fallen. Fracturing bones is closely linked to falling and carries great costs both for the NHS and the individual. Paramedics do not routinely assess bone health (fracture risk) in people who fall. This is why a study called 'The OAK Project' is being carried out the South West of England to see if it is feasible for paramedics to collect FRAX (The Fracture Risk Assessment Tool) data and whether GPs will put patients with a high risk of fracture on osteoporosis treatment. A significant element of this feasibility study is a qualitative nested study exploring the acceptability of using FRAX amongst patients and paramedics. When shadowing paramedics (n=6), the level of professionalism and care p...

Background: The majority of fragility fractures occur in people who fall. However, only a minorit... more Background: The majority of fragility fractures occur in people who fall. However, only a minority of people who fall are assessed for fracture risk. We hypothesised that paramedics attending such patients could calculate 10-year fracture risk using FRAX and, by informing their GPs, increase assessment and treatment for osteoporosis for those at highest risk of fracture.
Methods: This feasibility study aimed to explore and refine issues regarding study design, recruitment, retention, sample size and acceptability to inform a future multicentre randomised control trial.

Volunteer paramedics were trained regarding osteoporosis, falls and FRAX. Patients ≥50years who fell were attended by paramedics. Once stabilised, they (or their carers if they lacked capacity) provided verbal consent to answer FRAX questions and subsequent contact by a researcher. Patients were formally recruited by the researcher and randomised to the intervention (FRAX calculation and advice sent to GPs) or usual care. The target recruitment was 50 participants per group.

Results: 23 paramedics verbally consented 175/1447(12.1%) patients who fell over a 12 month recruitment period. 53/175(30%) progressed to formal recruitment. The average age was 81years (57-98), 51% women. The median number falls per patient reported in previous year was 3.0. Prior fragility fracture was reported by 23/53 (43%). The median FRAX risk of hip fracture was 7.6% over 10years (>5% in 37/53 70%). 28/53 (53%) of patients were at intermediate/high risk (according to NOGG criteria). Only 9/28 had ever taken osteoporosis medication.

Qualitative work suggested that the intervention was acceptable to most patients, carers, GPs and paramedics.
However, recruitment was challenging, with paramedics and patients identifying the difficulties of consent in the context of a fall. GPs highlighted the complexities of fracture prevention advice in patients with comorbidities.

Conclusion: This feasibility study suggested that the intervention was acceptable, but highlighted some challenges in recruiting patients in this setting that can be addressed in future work. The calculated FRAX fracture risk was high in this patient group which supports the need for a targeted intervention.

This qualitative study explored the acceptability of high-impact physical activity for increasing... more This qualitative study explored the acceptability of high-impact physical activity for increasing bone strength in later life. Thematic analysis established the barriers and facilitators to this physical activity. They prioritised joint over skeletal health, of which they had little concept. Interventions need to clearly communicate the rationale and benefits.

Age and Ageing, 2014

Background: objective measures of physical activity and function with a diverse cohort of UK adul... more Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample. Methods: socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded. Analyses: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease. Results: for every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44-0.91, P = 0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04-2.68, P = 0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98-2.05, P = 0.045) were associated with diagnoses of more new diseases. Conclusion: physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development.

PLoS ONE, 2014

Objectives: To examine the associations between volume and intensity of older peoples' physical a... more Objectives: To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years.

Abstract Background: objective measures of physical activity and function with a diverse cohort o... more Abstract
Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s
were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period.

Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban
areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample.

Methods: socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline.
Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log
recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records
were accessed on average 50 months post baseline, when new diseases and deaths were recorded.

Analyses: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease.

Results: for every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44–0.91, P = 0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI
1.04–2.68, P = 0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98–2.05, P = 0.045) were associated with
diagnoses of more new diseases.

Conclusion: physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of
mortality and new disease development.

$Research paper thumbnail of Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall? Protocol for a randomised controlled feasibility study$

Abstract Introduction Currently identification, and therefore, management of patients at risk of ... more Abstract
Introduction Currently identification, and therefore, management of patients at risk of osteoporotic fracture in the UK is suboptimal. As the majority of patients who fracture have fallen, it follows that people who fall can usefully be targeted in any programme that aims to reduce osteoporotic fracture. Targeting vulnerable patients who are likely to benefit from intervention may help shift the management of fracture prevention into primary care, away from emergency departments. Paramedics who attend to patients who have fallen may be well placed to assess future fracture risk, using the Fracture Risk Assessment Tool (FRAX) and communicate that information directly to general practitioners (GPs).

Methods and analysis This feasibility study takes the form of a pragmatic, randomised controlled trial aimed at exploring and refining issues of study design, recruitment, retention, sample size and acceptability preceding a large-scale study with fracture as the end point. Patients (aged >50) who fall, call an ambulance, are attended by a study paramedic and give verbal consent will be asked FRAX and fall questions. Patients who subsequently formally consent to participation will be randomised to control (usual care) or intervention groups. Intervention will constitute transmission of calculated future fracture risk to the patients’ GP with suitable, evidence-based recommendations for investigation or treatment. 3 months after the index fall, data (proportion of patients in each group undergoing investigation or starting new treatment, quality of life and health economic) will be collected and analysed using descriptive statistics. A nested qualitative study will explore issues of acceptability and study design with patients, paramedics and GPs.

Ethics and dissemination This protocol was approved by NRES Committee South Central Oxford C in October 2012. Research Ethics Committee ref.12/SC/0604. The study findings will be disseminated through peer-reviewed journals, conference presentations and local public events. A publication plan and authorship criteria have been preagreed.

Trial registration number ISRCTN: 36245726.

Background: We evaluated end of life care services in two English counties including: coordinatio... more Background: We evaluated end of life care services in two English counties including: coordination centres, telephone advice line, 'Discharge in Reach' nurses, a specialist community personal care team and community nurse educators. Elsewhere, we published findings detailing high family carer satisfaction and fewer hospital admissions, Accident and Emergency attendances and hospital deaths for service users compared to controls. The aim of this paper is to discuss what contributed to those outcomes. Methods: Using realist evaluation, data collection included documentation (e.g. referral databases), 15 observations of services and interviews with 43 family carers and 105 professionals. Data were analysed using framework analysis, applying realist evaluation concepts. Findings were discussed at successive team meetings and further data was collected until team consensus was reached.

Gerontologists have promoted positive representations of ageing to challenge stereotypes of degen... more Gerontologists have promoted positive representations of ageing to challenge stereotypes of degeneration and decline, in order to change social practices and to encourage wellbeing . Subsequently, a range of 'active ageing' policy frameworks, in which physical activity has been a key component, have been promoted (see British Heart Foundation, 2007a;. However, instead of promoting wellbeing in older age, the positive / successful ageing discourse has created, by default, binary subject positions which most older people largely embody: the "good", fit, slim, third ager and the "bad", sedentary, overweight, fourth ager. This is partly due to the unproblematic assumption that people are able, have the resources, and want to be physically active in later life . This thesis explores the experiences of physical activity amongst older people in rural West Sussex, examining the factors that affect their ability to be physically active, their preferences for physical activities and the reasons for their choices. A narrative inquiry was the chosen research design, triangulating focus groups, narrative interviews, activity diaries and re-interviews, using visual elicitation. Findings indicate that a number of corporeal, socio-cultural and discursive factors affect older people's ability to be physically active in rural West Sussex. Furthermore, this thesis makes a number of social policy recommendations, including the importance of promoting socially-centred physical activity, and tailoring health and wellbeing social policy in later life to the local area. Finally, the theoretical framework contributes to Frank"s (1991) theory of the body, by introducing a spatial component to understand corporeal identity.