bluuebunny/crossref_metadata_2025 huggingface dataset:
32 HOLISTIC PERSON-CENTRED CARE FOR PEOPLE LIVING WITH DEMENTIA AND CO EXISTING MENTAL HEALTH ILLNESSES: A CASE FOR INTEGRATION
Authors: Murphy F , O'Reilly S , Clarke C , Kennelly S
Published: October 2022

Background

65,000 people live with dementia in Ireland, many have co-existing or emerging mental health illnesses and non-cognitive symptoms. During the COVID-19 pandemic there was a need to provide innovative solutions to service provision. As Medicine for the Elderly (MEDEL) and Psychiatry of Later Life (PLL) were established stand-alone services, there was no formalised working relationship, resulting in an overlap of cases and disparity in service provision.

Methods

A description of three cases to illustrate the joint working interface with MEDEL and PLL. These cases highlight their complex care needs and the speciality input required by both services within a shared catchment area. The age range was 78-88 years. All presented with at least two medical co-morbidities, including vascular risk factors and delirium. Each had at least one mental health illness including new onset psychotic and mood disorders. Sharing of resources including diagnostic services, nursing, medical, occupational therapy, physiotherapy and social work facilitated cost effective holistic care.

Results

Given the existing structures of MEDEL and PLL, it was possible to link with community partners attached to each service, allowing domiciliary visits for crisis intervention and best use of expertise from both disciplines. This resulted in the provision of timely patient centred care, reduced polypharmacy through a unified pharmacological approach, enhanced communication, shared learning and cost effectiveness. Care that is in the right place at the right time, in line with Sláinte Care, allowed timely access to diagnostics, improved care outcomes and a cohesive response.

Conclusion

This cohort present with complex care needs. An integrated approach enables patients to receive holistic care without duplication of resources or disparity of treatment and care options. Going forward this should involve a fully integrated memory service, with shared governance.
40 PREVALENCE OF DRUG-DRUG INTERACTIONS IN OLDER COMMUNITY-DWELLERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Hughes JE , Waldron C , Bennett KE , Cahir C
Published: October 2022

Background

Polypharmacy (regular use of ≥5 medicines) is common in the older population and is an independent risk factor for Drug-Drug Interactions (DDIs). We conducted a systematic review and meta-analysis to summarise the prevalence of DDIs in older (≥65years) community-dwellers.

Methods

An electronic database search was conducted in PubMed and EMBASE. Observational studies published in English between 01/01/2010-10/05/2021 reporting DDI prevalence in community-dwellers aged ≥65years were included. Nursing home and inpatient hospital studies were excluded. Articles were independently double screened for eligibility. Data were independently extracted, 20% extracted in duplicate. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tool. Prevalence estimates and 95% confidence intervals (CI) are presented. All analyses were performed using the metafor package(v3.0.2) in R(v4.1.2). (PROSPERO:CRD42020216686).

Results

5144 unique articles were identified. 33 studies involving 17,011,291 community-dwellers aged ≥65years (age range 65-103) met inclusion criteria. 22 studies measured DDIs broadly classified as (potentially) clinically important. DDI identification methods varied across studies: 5 used Micromedex®; 3 used the 2015 AGS Beers criteria®; 3 used Lexi-Interact®; 2 used drugs.com; 6 used multiple methods; and 14 used a unique method. 31 studies reported DDI prevalence at the study participant level; estimates ranged from 0.8% to 90.6%. 26 studies were qualitatively synthesised and 7 studies were eligible for meta-analyses. In a meta-analysis of 3 studies (n=1122) using Micromedex®, DDI prevalence in older (≥65years) community-dwellers was estimated to be 57.8% (95%CI: 52.2-63.2%; I2 69.6%, p<0.01). In a meta-analysis of 2 studies (n=809,113) using Lexi-Interact®, the estimated prevalence was 30.3% (95%CI: 30.2-30.4%; I2 6.8%). In a meta-analysis of 2 studies (n=947) using the 2015 AGS Beers criteria®, the estimated prevalence was 16.6% (95%CI: 5.6-40.2%; I2 97.5%, p<0.01).

Conclusion

DDIs are prevalent among older community-dwellers; however, the methodology used to estimate these events varies considerably. A standardised method is needed to allow meaningful measurement of DDI prevalence in this population.
41 PROFILING PHYSICAL ACTIVITY AND SARCOPENIA AMONG OLDER ADULTS ATTENDING A PHYSIOTHERAPY SERVICE DURING THE COVID-19 PANDEMIC: A MIXED METHODS STUDY
Authors: Tague AM , Keating L
Published: October 2022

Background

Reduced physical activity (PA) and increased levels of sarcopenia are possible consequences of the COVID-19 pandemic among older adults. During the pandemic, 26% of people over 70 were inactive. This mixed-methods study aimed to profile PA and sarcopenia levels among older adults attending a primary care physiotherapy service during the pandemic and to explore their experiences of PA.

Methods

Adults over 70 years of age attending a primary care physiotherapy service were invited to participate between September 2021 - January 2022. PA and levels of sarcopenia were captured using the International Physical Activity Questionnaire Short Form and the SARC-F. One-to-one semi-structured telephone interviews were conducted with a sample of the group and analysed using thematic analysis. The Irish College of General Practitioners granted ethical approval.

Results

59 participants (35 females) participated in the cross-sectional study (median age: 79.3; IQR: 12 years). Ninety-one percent of participants (n=54) followed cocooning restrictions. Fifty-six percent (n=33) of participants had low PA levels (95% CI: 43-69%), and 56% (n=33) scored 4 or more on the SARC-F (95% CI: 43-69%), which is predictive of sarcopenia. Ten participants (7 females) completed an interview (median age: 75.4; IQR: 5years). Four themes emerged; 1) a sudden in change in PA levels, 2) the impact of cocooning measures on PA levels, 3) barriers to PA and 4) enablers of PA during the COVID-19 pandemic.

Conclusion

Low PA levels and high levels of sarcopenia were identified among older adults attending a primary care physiotherapy service. Participants were uncertain if they would return to their pre-pandemic PA levels due to slowness of movement and fear of COVID-19. There is a need to address these low PA levels as society enters a new post-pandemic phase.
45 INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE IN FRAIL OLDER PERSONS’ CARE
Authors: McCarthy N , Daly J , Wall O , Wills T , Buckley C ,   HSE/UCC, IPE Development Group Cork, Ireland
Published: October 2022

Background

Frail older adults present with complex care needs. Inter-Professional Education (IPE) is a means of creating a practice-ready workforce to improve patient safety and healthcare outcomes. A Steering Group was established comprised of acute and community clinicians, members of the Health Service Executive, service user, students and members of all Schools in the College of Medicine and Health in an Irish University (Medicine, Nursing and Midwifery, Pharmacy, Public Health, Clinical Therapies and Dentistry) to evaluate the effectiveness of IPE. A workshop dedicated to the management of frail older adults occurred for multidisciplinary healthcare students as part of a suite of three IPE workshops.

Methods

The validated ‘Interprofessional Collaborative Competencies Attainment Survey’ (ICCAS) evaluated student views of IPE pre- & post-workshop. This workshop involved a case-based study and facilitated discussion with involvement of frail older adult service users. One service user was in a rehabilitation unit post hospital admission, the other was living well at home. Their participation occurred using an online platform, supported by a consultant geriatrician in the rehabilitation unit and a relative for the home-based service user.

Results

Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibilities, collaborative patient-centred approach, conflict management and team functioning) were compared. Scores in all categories achieved statistically significant increases after completion of the IPE workshop. The greatest positive change was observed in collaborative patient-centred approach with pre-workshop scores increasing from a mean of 2.61 to 4.25 (p<0.05).

Conclusion

This initiative explored the inclusion of a frail older adult workshop in the higher education setting. Older adults had an opportunity to share their lived experiences. Evaluation of this IPE initiative will inform future IPE activities to be incorporated into undergraduate education programmes. Similar IPE models can be replicated nationally to enable and enhance team-based working and integrated care.
47 FRAILTY: A QUALITATIVE STUDY EXPLORING THE PERCEPTIONS OF CCCUPATIONAL THERAPISTS IN IRELAND
Authors: Griffin N , O'Sullivan L , Usher R
Published: October 2022

Background

Ireland’s ageing population has resulted in an increasing number of frail older adults presenting to health and social care settings nationwide. Despite growing attention towards older adults’ and health professionals’ perspectives of frailty, the evidence base pertaining to occupational therapists is limited. This study aims to explore occupational therapists’ perceptions of frailty within an Irish context and to investigate whether their perceptions subsequently impact their approach to the assessment and management of frailty.

Methods

A qualitative descriptive design was undertaken to explore the perceptions of frailty of occupational therapists working with older adults. Qualitative data was collected from nineteen (n=19) occupational therapists working across Ireland in various clinical settings participating in four online focus groups. Data were analysed using thematic analysis.

Results

Perceptions of occupational therapists were constructed into three main themes; 1) Conceptualising frailty; 2) Management of frailty; 3) Advancing frailty practice. Occupational therapists in Ireland shared similar perceptions of frailty as a multidimensional concept. Findings suggest that although occupational therapists are well-equipped in the provision of care for frail older adults, participants believed that the profession’s scope is not optimised in the assessment and management of frailty.

Conclusion

This study is the first of its kind to be conducted in Ireland, therefore contributing to the growing frailty research field. Development of community services, the enhancement of undergraduate frailty education, and a movement towards a shared understanding of frailty between clinicians and patients are recommended to progress occupational therapy in the context of frailty management.
53 A REVIEW OF THE RAPID ACCESS FRAILTY TEAM (RAFT) IN THE EMERGENCY DEPARTMENT OF A MODEL THREE HOSPITAL
Authors: O'Neill A , Brady A , Donnelly T , McGlynn J , Moore A , Hopper C
Published: October 2022

Background

The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) has evolved since 2016. The team comprises of 1 senior occupational therapist and 1 senior physiotherapist. The focus of the team is recognition and management of frailty in ED. Patients discharged by RAFT in ED are often followed up in our Rapid Access Frailty Hub. This audit examined the incidence and outcomes of frail older persons presenting to our ED and the impact of intervention from the Rapid Access Frailty team.

Methods

A Variable Indicative of Placement Risk (VIP) positive patient triggers an assessment by RAFTT in ED post triage. Analysis of intervention and discharge destination were used to assess the effectiveness and role of the team.

Results

We compared data over two distinct 6 month periods, between September – February 2019-2020 and 2021-2022.  2723 patients >75 presented to ED in 2019 - 2020. Of these, 1620 were VIP positive patients. 628/1620 patients were seen by RAFFT. 443/628 (70.5%) assessed by RAFT were discharged. In comparison to 2021-2022, we saw an increase with 2818 patients >75, 1657 of which were triaged as frail. 559 patients were assessed by RAFTT and 286/559 (51%) were discharged. We observed 20% reduction in our discharge rate. Most patients received on average five interventions each. 60% of patients received a mobility assessment, 45% received falls prevention intervention and 37% were provided with equipment to facilitate discharge.

Conclusion

Over a two year period we observed an increase in frail patients presenting to our ED. Comprehensive assessment by RAFT in ED is promoting discharge. The follow up through the frailty hub has enhanced our ability to follow up in a timely manner. We hypothesize that the reduction in discharge rates in 2021- 2022 may be due to deconditioning experienced by older adults post pandemic and the increased demand for medical intervention and admission.
54 EMERGENCY PERIOPERATIVE FOR THE OLDER PERSON SERVICE (POPS) IN AN IRISH TERTIARY HOSPITAL: RESULTS OF 16-WEEK COMPREHENSIVE GERIATRIC ASSESSMENT INTERVENTION
Authors: Plant R , Stanely E , Dukelow T , Aherne E
Published: October 2022

Background

Evidence suggests older persons undergoing surgery benefit from Comprehensive Geriatric Assessment (CGA). The Republic of Ireland (ROI) is yet to implement formalised perioperative care services outside of Orthogeriatrics. We present data from an Emergency Perioperative for Older Person Service (POPS) utilising CGA as an intervention in an Irish Tertiary Hospital.

Methods

A geriatric medicine registrar performed CGA on patients over 75 admitted for unscheduled General or Vascular Surgery. Senior decision-makers could refer patients under 75 whom they considered frail. Data collected: demographics; clinical frailty score (CFS); identified delirium; length of stay (LOS); mortality during admission; 90-day mortality; 30-day readmission; new Acute Kidney Injury (AKI) during admission. We compared this data to the corresponding cohort of patients admitted in 2019 (Pre-COVID19 pandemic).

Results

104 patients underwent CGA over 16 weeks. 50.5% (48/104) were female. Average age was 82. 34.6% (36/104) CFS ≥5. 24.2% (23/104) had delirium on admission. 31.7% (33/104) had identifiable delirium throughout their admission. Pre-COVID19 data (n=92) vs POPS data (n=104): Average LOS: 14.6 days vs 13.3 days; AKI new/worse during admission 29% (28/92) vs 15% (16/104); Mortality during admission 8.6% (8/96) vs 7.7% (8/103); 30 day readmission 19.3% (17/88) vs 17.7% (17/96). 90 day mortality 14.1% (13/92) vs 16% (13/80 to date).

Conclusion

Our data is, to our knowledge, the first in the ROI to capture CGA intervention in an Emergency Surgical Ward. Early data demonstrate positive trends. We believe the implementation of perioperative CGA would benefit older patients undergoing emergency surgery in Ireland.
56 SARCOPENIA SCREENING FOR INDEPENDENTLY MOBILE STROKE PATIENTS IN AN ACUTE HOSPITAL SETTING
Authors: Murphy D , Crowley A , Fitzpatrick M
Published: October 2022

Background

Sarcopenia appears to be under-assessed and under-treated in the stroke population. It has been suggested by EWGSOP2 criteria, that if there is a clinical suspicion of sarcopenia, an intervention for this is appropriate. In order to establish the need for this in the independent stroke population an audit of the clinical prevalence of sarcopenia in independently mobile stroke patients was completed.

Methods

An excel spreadsheet was compiled of a convenient sample of stroke patients who were independently mobile post stroke. Their grip strength and five times sit to stand was audited along with the patient’s age and sex. This information was then used to assess for sarcopenia risk as per the EWGSOP2 guidelines.

Results

Fifteen patients were assessed, all of whom were independently mobile with or without an aid post admission for a primary diagnosis of acute stroke. Their age ranged from 64 to 86. Of these patients 93% were deemed likely to have sarcopenia based on their clinical assessment. This was based on grip strength measurements and time taken to complete five sit to stands. These clinical signs indicate low muscle strength and likely sarcopenia.

Conclusion

Currently no intervention is provided for these patients in relation to sarcopenia from the physiotherapy department. This audit indicates that this is currently an unmet need and these patients may benefit from an intervention to address this significant issue.
59 IMPROVING DELIRIUM AWARENESS AMONGST JUNIOR DOCTORS IN A REGIONAL HOSPITAL
Authors: Condon C , Connaughton R , Keady N , Martin M
Published: October 2022

Background

Delirium is a common medical emergency which is well known to be associated with adverse outcomes but often remains under recognised and inappropriately managed in the acute care setting. This audit aimed to assess Non-Consultant Hospital Doctors (NCHDs) approach to diagnosing, managing and prescribing in patients with delirium.

Methods

Data was collected via an anonymous questionnaire and distributed to NCHDs in April 2021 and repeated again in March 2022 following several education sessions on delirium and the inclusion of the 4AT screening tool in the medical admission pro-forma. A point prevalence survey on 20 randomised patient charts was completed in April 2022 to establish if a 4AT score was documented by NCHDs in the medical admission pro-forma.

Results

Two audits were completed over a one-year period between April 2021 and March 2022 including NCHDs, n=25 and n=26 respectively. The results showed that 56% vs 70% considered delirium as a medical emergency, 40% vs 77% stated that they used the 4AT tool when assessing cognition in patients aged over 65 years of age and 72% vs 76% stated that they did not use any guideline when prescribing a medication for a patient with delirium. However, on review of 20 medical charts, 0% of patients had a documented 4AT score completed on admission in April 2022.

Conclusion

Although there was a positive improvement in NCHD’s knowledge of delirium diagnosis and management on paper, it was evident that this did not transpire into clinical practice. We will address this by delivering further education sessions on delirium, with a plan to re-audit. We have also made the National Delirium Algorithms visible in the emergency department and on the wards to act as visual prompts for our NCHDs.
61 STROKE MIMIC CASE REPORT: A YOUNG PATIENT WITH COVID-19 REFERRED TO NEUROVASCULAR CLINIC SUBSEQUENTLY DIAGNOSED WITH SYSTEMIC ARTERIAL EMBOLI
Authors: Menagh C , Bowman M
Published: October 2022

Background

An independent 44 year-old is reviewed at Neurovascular Clinic with a suspected high-risk Transient-Ischaemic-Attack (TIA). He had a recent diagnosis of COVID-19. Investigations revealed multiple systemic arterial emboli responsible for his symptoms, rather than a cerebrovascular cause.

Methods

The patient attended our Neurovascular Clinic following a virtual Stroke Consultant telephone assessment 3 days previously, when he had been referred from his GP with a brief episode of left arm weakness. This was felt to be a high-risk TIA event. He had tested COVID-19 positive with mild flu-like symptoms 4 days prior to this event. He described sudden onset weakness involving the left forearm and wrist which became ‘floppy’. Symptoms had fully resolved within one hour. His only reported vascular risk factor was controlled essential hypertension. He was a life-long non-smoker with no family history of stroke. On examination his left arm felt significantly colder than the right. His radial pulses bilaterally were palpable with good volume. Blood pressure was satisfactory in both arms. No other focal neurology was found.

Results

Computed-Tomography (CT) angiogram of the left arm revealed an occlusion of the ulnar artery in the antecubital fossa, dilated aortic root, splenic infarcts and probable pulmonary emboli. CT pulmonary angiogram revealed large bilateral volume pulmonary emboli within both main pulmonary arteries extending into all lobar branches of both pulmonary arteries. A Patent Foramen Ovale was not seen on bubble-contrast transthoracic echocardiogram. Diffusion-weighted Magnetic-Resonance-Imaging (MRI) Brain was normal. Anticoagulation with Apixaban for 6 months was commenced for provoked emboli following consultation with our trust haematologist.

Conclusion

This case of a so-called “stroke mimic” highlights a pitfall of virtual assessment for neurovascular patients and the need for assessing in person those who we should have a higher suspicion for alternative pathology, especially in those who were recently COVID-19 positive given documented pro-thrombotic tendencies.
68 DEVELOPMENT OF AN IRISH HIP FRACTURE DATABASE FRAILTY INDEX: ASSOCIATIONS WITH LENGTH OF STAY, DELIRIUM, MORTALITY AND NURSING HOME ADMISSION
Authors: Walsh M , Brent L , Ahern E , Coughlan T , Ferris H , Romero-Ortuno R
Published: October 2022

Background

In older people, hip fracture can lead to adverse outcomes. Frailty, capturing biological age and vulnerability to stressors, can indicate those at higher risk. This study aimed to derive a frailty index (FI) in the Irish Hip Fracture Database (IHFD), to explore associations with prolonged length of hospital stay (LOS ≥ 30 days), delirium, inpatient mortality and new nursing home (NH) admission and to assess whether the FI added value to those predictions above and beyond age, sex, and pre-operative American Society of Anaesthesiology (ASA) score.

Methods

A 21-item FI was constructed with 16 dichotomous comorbidities, three 4-level ordinal pre-morbid functional variables (difficulty with indoor mobility, outdoor mobility, and shopping), and nursing home provenance (yes/no). The FI was computed as the proportion of items present, and divided into tertiles (low, medium, high risk). Independent associations between FI and outcomes were explored with logistic regression, from which we extracted adjusted Odds Ratios (aOR) and areas under the curve (AUC).

Results

From 2017-2020, the IHFD included 14,615 hip fracture admissions, mean (SD) age 80.4 (8.8), 68.9% women. Complete FI data was available for 12,502 (85.5%). By FI tertile (low to high risk), prolonged LOS proportions were 5.9%, 16.1% and 23.1%; delirium 5.5%, 13.5% and 17.6%; inpatient mortality 0.6%, 3.3% and 10.1%; and new nursing home admission 2.2%, 5.9% and 11.3%. All associations were statistically significant (p<0.001) independently of age and sex. AUC analyses suggested that the FI score, added to age, sex, and ASA score, added value to the prediction of delirium and new NH admission (p<0.05), and especially to prolonged LOS and inpatient mortality (p<0.001).

Conclusion

A 21-item FI in the IHFD was a significant predictor of outcomes and added value to traditional risk markers. The utility of a routinely derived FI to more efficiently direct limited orthogeriatric resources requires further investigation.
70 THE RESPONSIVE NATURE OF AN INTEGRATED CARE COMMUNITY REHABILITATION TEAM THROUGHOUT THE COVID PANDEMIC
Authors: Synnott P , Alookaran S , O'Malley G , Hickey P , O'Sullivan F , Drumm B
Published: October 2022

Background

The Integrated Care Team (founded 2018) provides community rehabilitation in the home. The Covid 19 pandemic, a new Reablement Service (June 2020) and Community Falls Service (September 2020) led to changes in the service, providing access to comprehensive geriatric assessment in the community when hospital outpatient services were limited. The effect of these changes on patient cohorts are explored.

Methods

Anonymised patient data from the team database was extracted for each episode of care under the service from July 2019 to February (Pre-covid), March 2020 to December 2020 (initial lockdown period), and January 2021 to December 2021 and analysed for length of stay (LOS), discharge destination, and reason for referral. A further analysis of discharge summaries for patients with the longest LOS in each period was conducted to assess for factors influencing LOS with the team.

Results

500 episodes of care were captured during the study period, 137 pre-covid, 179 March to December 2020 and 184 in 2021.From Pre-covid to 2021, the average LOS increased from 45.9 days to 57 days. The annual number of new referrals seen by the team was similar across this period (194 in 2019, 204 in 2020 and 190 in 2021). 40 patients with the longest LOS were analysed. No long-stay patients benefited from respite or day-centre care during the studied period (compared to 46% of all patients in 2018). 70% lived alone, 65% had cognitive decline or dementia and only 41% required mobility aids while indoor. Clinical frailty scores were unavailable.

Conclusion

A changing patient cohort may account for the increased length of stay, with less frail patients benefiting from reablement and falls services on hospital discharge, while high levels of cognitive impairment and low mobility aid usage may indicate limited rehabilitation potential. Ongoing access to social prescribing outlets such as respite and daycare are essential to sustain patients in their own homes.
75 EVALUATING DEMENTIA PALLIATIVE CARE SERVICES ACROSS IRELAND AND THE UK USING THE RE-AIM FRAMEWORK
Authors: Rukundo A , Fox S , Timmons S , O'Connor N , Guerin S , Kernohan G , Drennan J , Murohy A
Published: October 2022

Background

Dementia is a life-limiting illness, requiring a Palliative Care (PC) approach from diagnosis. In Ireland, People with Dementia (PwD) and their families rarely receive PC in a timely manner. This study aimed to evaluate five exemplar community-based dementia PC services across Ireland and the UK (as identified by key stakeholders), to inform a new service delivery model.

Methods

Data from semi-structured interviews and focus groups with 29 service providers, and service activity data (n=5), was evaluated using the RE-AIM framework.

Results

‘Reach’ - Caseloads varied significantly between 3-154 active cases. Most services accepted self-referrals; all wanted earlier referrals. Factors influencing reach included co-location, dyadic participation, service flexibility, and others’ awareness of PC appropriateness and the service’s existence.

‘Effectiveness’ - All service users received holistic assessments, person-centred care, advanced care planning, continuity of care, improved service access and ‘care-for-the-carer’. Some services offered complimentary therapies, 24/7 phone support, and bereavement support; these were perceived to improve quality-of-life, comfort, and independence.

‘Adoption’ - Staff were highly invested; some provided their personal numbers to families. Outside staff were more willing to engage (refer/support) if shared governance, training was provided, or already familiar with dementia or the tools. Incentive programmes increased adoption rates.

‘Implementation ’ - All services evolved on an ad-hoc basis, with funding provided by local organisations, and a single ‘driving force’, typically a consultant/nurse. Services heavily relied on volunteers. Perceived “essential” elements included a dyadic approach, MDT involvement, open communication, forming relationships, reflective practices, dedicated staff with problem solving skills, and staff support/training.

‘Maintenance’ - All services continued after initial project funding; three increased their activities/reach over time.

Conclusion

Important features and facilitators of community-based dementia palliative care services have been identified. These results are informing the development of the novel Dementia Palliative Care model for use in Ireland (https://pallcare4dementia.com/).
94 WORKING TOWARDS AN AGE-FRIENDLY HEALTH SYSTEM IN AN IRISH MODEL FOUR TERTIARY REFERRAL HOSPITAL
Authors: Cloney TM , Gannon E , Nor NM , Daly B , Ahern E , Pillary I
Published: October 2022

Background

Traditional consult services represent an area where the evidence-based 4Ms framework might be applied. A 4M framework Comprehensive Geriatric Assessment (CGA) consult form may help standardise the assessment of older persons outside of geriatric medicine. We aimed to incorporate a concise CGA tool based on the 4Ms within a geriatric medicine consult form.

Methods

Data from 100 geriatric medicine consult forms was entered onto an excel database. Each component was analysed, using descriptive statistics, for accuracy in completion, ability to contribute to referrers knowledge and a modified Delphi consensus model was used to inform the creation of a 4M framework-based concise CGA within the consult referral form. Time to completion was monitored.

Results

The median age of referred patients was 79 with a male:female ratio of 1:1. The average number of co-morbidities was 6, with 75% of patients having a significant vascular history, 30% a history of falls, and 16% diagnosed with delirium. 72% were on 5 or more medications. 53% had a complete Barthel index, with a median score of 12/20. What matters to the patient, clinical frailty score, mood and mental health were not well captured by the existing consult. These were incorporated, following consensus, into a ‘little g’, which takes between 4 and 15 minutes depending on user experience and patient complexity.

Conclusion

An evidence-based consult form, based on 4Ms, has been developed. Next steps are to introduce it to the next cohort of interns and assess efficiency and outcomes.
101 UTILITY OF BONE TURNOVER MARKERS IN GUIDING ZOLEDRONIC ACID THERAPY AFTER STOPPING DENOSUMAB
Authors: McLoughlin S , O'Reilly E , Fitzpatrick D , Bradley E , Maher N , O'Carroll C , Steen G , Fallon N , Lannon R , McCarroll K
Published: October 2022

Background

Denosumab is commonly used to treat osteoporosis, but drug holidays are not an option, with a risk of rebound bone loss and vertebral fractures on stopping. However, data on therapy safety and efficacy is lacking beyond 10-years and switching treatment to bisphosphonates may be appropriate for some patients. Recent guidelines suggest treatment with Zoledronic Acid if stopping Denosumab, with consideration for a second dose based on subsequent Bone Turnover Markers (BTM). We aimed to assess BTM of older patients transitioned to Zoledronic acid after stopping Denosumab.

Methods

Patients who received Zoledronic acid 6 months after their last and final Denosumab injection were identified at our bone health clinic. We compared BTM on Denosumab therapy versus at 3 months post Zoledronic acid administration. BTM measured was cross linked C-Telopeptide of type I collagen (CTX ) (ng/ml).

Results

48 patients were included (mean age 70.6 years and 90% female, mean Denosumab treatment 4.6 years). Mean CTX at baseline was 0.09 and 0.29 at 3-months post Zoledronic acid (mean difference 0.20, P <0.001). 40% of patients (19) had a CTX >0.30 (above the therapeutic range) at 3 months and in those, mean CTX was 0.45. Duration of prior Denosumab therapy, baseline CTX or age did not predict either change in CTX or CTX rises above 0.30.

Conclusion

All patients had a significant elevation in BTM at 3-months after transitioning to Zoledronic acid. However, a high proportion (40%) had a rise in CTX above the therapeutic range. Recent guidelines suggest treatment of such patients with a second infusion of Zoledronic acid to suppress bone resorption and bone loss. This highlights the value of using BTM in guiding therapy post Denosumab cessation. We did not find any predictors of greater rebound bone turnover but sample size was small and likely to be underpowered.
106 MORTALITY FOLLOWING HIP FRACTURE AMONG NURSING HOME RESIDENTS
Authors: Crowley P , Cloney T , Ahern E
Published: October 2022

Background

Little is known about mortality following hip fracture among Nursing Home (NH) residents. Prognostic data is important to guide management, including osteoporosis treatment.

Methods

We conducted a retrospective cohort study of all patients admitted to an Irish tertiary hospital from NHs with hip fracture during the years 2017-2020 inclusive. Mortality was assessed at 90, 180 and 365 days (one-year) following admission.

Results

One patient was lost to follow up, leaving 233 in the analysis group. 147 were female. Mean age was 85. All-cause mortality was 18.03% at 90 days, 27.04% at 180 days and 37.34% at one year. One-Year Mortality (OYM) was 34.01% among females and 43.02% among males. Among those aged 90 or over, OYM was 45.59% (31/68), being 65.22% (15/23) among males and 35.56% (16/45) among females. In those aged 75 or over, OYM was 39.9% (81/203), being 48.57% (34/70) among males and 35.34% (47/133) among females. In those aged under 75, OYM was 20% (6/30). OYM was 42.31% (11/26) among those who could mobilise independently before fracture, 37.23% (51/137) among those requiring an aid, 33.9% (20/59) among those requiring assistance, and 45.45% (5/11) among those unable to mobilise. 62 Rockwood Clinical Frailty Scales (CFS) were recorded (median score 7, range 5-9). OYM was 0% (0/4) for CFS 5, 50% (8/16) for CFS 6, 31.43% (11/35) for CFS 7, 80% (4/5) for CFS 8 and 100% (0/2) for CFS 9.

Conclusion

Mortality among NH residents following hip fracture was highest in older males. While mobility before fracture was a poor predictor of mortality, CFS showed promise among a smaller sample size.
107 LESSONS LEARNED FOLLOWING COVID-19: PLANNING FOR FUTURE INFECTIOUS OUTBREAKS IN A RESIDENTIAL CARE SETTING
Authors: Doyle M , Louw J , Corry M
Published: October 2022

Background

During the COVID-19 pandemic, maintaining resident and staff safety was a key priority. This study explored the experiences of the nursing team in a residential care facility for older adults and we report on the lessons learned for future infection control outbreaks.

Methods

Following ethical approval, all members of the nursing team were invited to take part in a one-to-one virtual interview using Microsoft teams. Eleven interviews were conducted. The data were imported into NVIVO data management software and analysed using thematic analysis.

Results

The findings highlight the importance of preparedness in terms of ‘keeping the house in order’ by having policy, guidelines and staff training up-to-date, so that they are easily amended to meet unexpected challenges. Having advanced care planning as part of routine care will ensure that the wishes of the residents are always respected. Keeping the channels of communication open by embracing technology and being technology ready emerged as key to relationship centred care. This was important for maintaining relationships between staff, residents, and family/caregivers, and was essential for resident and family well-being, particularly for residents with cognitive impairment.

Conclusion

Scientific predictions indicate that the next pandemic may come sooner and be deadlier than COVID-19. Health care managers and staff need to be ready to ensure that quality care is maintained. In residential settings, disruption to routine care can be minimised by embedding aspects of care embraced during COVID-19, into routine practice. Advanced care planning, embracing technology, and ensuring staff training, policy and procedures are up-to-date will make sure they can be easily amended to address infection specific requirements and this, will enable health care workers respond to outbreaks efficiently.
112 A STUDY OF REFERRALS TO THE EMERGENCY DEPARTMENT FROM NURSING HOMES PRIOR TO AND IN THE CONTEXT OF COVID-19
Authors: Conlon C , Feeney L , Drumm B , O'Sullivan F
Published: October 2022

Background

As of July 2020 there were 32,000 residential places in Ireland. In the context of Covid-19,there was a rise in attendance at Emergency Departments( ED) of those aged above seventy. The objectives were to collect data on the profile of Nursing Home (NH) residents referred to ED, establish if meeting target Patient Experience Times (PET) in ED with NH residents and to compare attendances of NH residents prior to and in the context of Covid-19.

Methods

The study was performed in two phases, the first a retrospective study in June 2017 and the second an observational study in December 2021. A proforma was drawn up to collect data of interest inclusive of reason for referral, mode of referral and clinical frailty scale. The data was analyzed using SPSS.

Results

The initial study included ninety charts, the second phase included twenty-six charts. In the recent study the majority were male 62% (16/26), aged 81-90 years 38% (10/26) and severely frail (Clinical Frailty Scale=7 50% 12/26). The percentage of weekend referrals remained similar with 26% and 27% of referrals on Saturday and Sunday in the initial and subsequent study respectively. Regarding medical review prior to transfer, 58% (15/26) had medical review (previously 62 %), 42% (11/26) had not (previously 38%). Of those who had a medical review 46% (7/15) were via telephone by out of hours service compared to 25%(14/56) in the initial study. PETs were greater than six hours in 73% (19/26) of cases, previously 68%.

Conclusion

Overall this timely study illustrates a majority of NH residents are brought to the ED without being seen face-to-face by a General Practitioner and an increase in virtual assessments since the advent of Covid-19. It highlights how a regional hospital and the NHs it serves could benefit from a community geriatric team and will help inform service provision.
113 AUDIT: DELIRIUM RECOGNITION ON AN ACUTE MEDICAL WARD
Authors: Gibbons C , Harte O , O'Donnell G , Kelleher R , Mulpeter K
Published: October 2022

Background

One-third of older general medical patients have delirium; it is present in half of these patients on admission and develops during hospitalisation in the other half. Despite its high prevalence, delirium is frequently not recognised, evaluated or managed appropriately resulting in poor outcomes. Our aim was to assess whether or not delirium was being recognised and documented on the General Medical Wards (GMW).

Methods

We completed a prospective chart review using an audit tool on all patients aged ≥65 years on a GMW and a Specialist Geriatric Ward (SGW) over a 24-hour period. We screened all identified patients using the 4AT Test. The standard measured against was the HSE Guideline – Delirium on General Hospital Wards: Identifying Patients at Risk, Delirium Screening and Next Steps.

Results

We included 27 patients in the study (n=27) – median age was 80 years (range 65-90); 17 were male (62.96%); 10 were on a SGW (37.04%). There was a 4AT documented on 9 (n=10) of the patients on the SGW (90%) in comparison to 0 (n=17) on the GMW (0%).

We identified n=7 patients with a 4AT ≥4 consistent with acute delirium – 4 were on the SGW (57.14%). All 4 of these patients (n=4) were documented as delirious on the SGW (100%). Of the 3 patients identified on the GMW (n=3), 1 was documented as delirious (33.33%).

All patients with delirium (n=7) had non-pharmacological measures implemented (100%), most commonly catheter avoidance (100%), analgesia (100%) and regular mobilization (85.71%). Pharmacological management was administered in 2 cases (28.57%).

Conclusion

Our audit demonstrates that despite a high prevalence of delirium amongst older adults on GMWs, it remains under-recognized missing a pertinent opportunity to investigate and initiate management. This may result in adverse outcomes. The first step in improving care in older adults suffering from delirium is detection. Detection begins with screening.
114 THE EFFECTIVENESS OF A 26-WEEK CLASS AND HOME-BASED OTAGO EXERCISE PROGRAMME ON BALANCE CONFIDENCE AND PHYSICAL PERFORMANCE IN OLDER ADULTS
Authors: Curley M , Brady S , Tyndall F , McVeigh J , McCullagh R
Published: October 2022

Background

Falls have a substantial burden on the Irish economy and on the individual. The Otago Exercise Programme (OEP) is a cost-effective falls prevention programme that can prevent 35% of falls. This study aims to evaluate the effectiveness of a 26-week modified OEP using a combined delivery approach of physiotherapists and Exercise Therapists (ET) on balance confidence and physical performance in older adults in rural Ireland.

Methods

Study-design: A prospective pre-post single arm intervention study. Older adults (≥60 years) were recruited from HSE waiting lists for the OEP which consisted of a group-class (1x/week) and a home OEP (3x/week). Participants were assessed at baseline, 6, 16 and 26 weeks. Outcome measures (OMs) were compared pre and post intervention using Paired T-Tests and Wilcoxon Signed Ranks tests. A repeated-measures ANOVA compared OMs across the time points.

Results

Improvements were detected in the CONFbal scale (diff = 2.12, 95% CI=1.353-2.803, p<0.01), 30-second sit-to-stand (diff = 3.49, CI= 2.361-4.201, p<0.01), timed-up and go (diff = 2.38, CI=8.08-12.0, p<0.01), functional reach (diff = 9.158, CI=6.758-11.294, p<0.01), 180° turn (diff = 1.04, CI=3-5, p<0.01), and the four-test balance scale (diff = 0.61, CI=1.0-3.0, p<0.01). Significant changes are noted for each measure (p<0.05) with small-moderate positive effects (ηp2=0.32-0.512). The most significant changes in the 180° turn are seen between week-0 (4.92 ±1.784) and week-6 (4.44 ±1.258) followed by a plateau in results.

Conclusion

Confidence and physical performance improved significantly pre and post intervention, suggesting the physiotherapist and ET combined delivery of the programme is effective. Static and dynamic balance improvements may plateau after 6-weeks of the OEP suggesting the participants may not have been adequately challenged. Lower limb strength and mobility continued to improve throughout suggesting the modified OEP is an effective intervention for older adults in Ireland.
115 BARRIERS AND FACILITATORS TO DOCTORS DEPRESCRIBING FALL-RISK INCREASING DRUGS IN OLDER ADULTS
Authors: Kalim R , Ryder S , Cunningham C , McMahon N
Published: October 2022

Background

Some medicines are associated with falls in older adults and have been classified as Fall-Risk Increasing Drugs (FRIDs). Deprescribing FRIDs is one of several possible preventive measures to reduce falls risk [1]. The aim of this qualitative study was to explore the barriers and facilitators to doctors deprescribing FRIDs in hospitals.

Methods

Doctors, who were experienced in caring for older patients, were interviewed individually, directed by an interview guide, at a large teaching hospital. Thematic analysis of transcribed audio recordings was undertaken in NVivo 12.

Results

A total of eighteen doctors participated in the study. Barriers and facilitators were classified into three categories: factors related to the care setting, to doctors and to patients. Incomplete patient medical records, limited time during inpatient stay, poor communication between care providers, and difficulties following up patients after discharge were major barriers to deprescribing in hospital. Doctors’ barriers included concerns about consequences and reluctance changing medications initiated by other prescribers. Acute illness or resistance to change were patient-related barriers to deprescribing. Facilitators included doctors’ awareness of the importance of deprescribing FRIDs, the ability to monitor patients during their inpatient stay, the use of electronic medical records, and support from other healthcare professionals e.g. clinical pharmacists.

Conclusion

Deprescribing FRIDs in older adults is challenging. Interventions based on identified facilitators, such as improved communication between prescribers, enhanced documentation using electronic medical records, and the support of team members with expertise in medication review, might enhance the feasibility of deprescribing.

Reference

1. Seppala LJ et al. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging. 2019; 36(4): 299–307.
117 THE ASSOCIATION BETWEEN SELF-REPORTED SENSORY FUNCTION (VISION AND HEARING) AND COGNITIVE FUNCTION FROM THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: O'Leary E
Published: October 2022

Background

With an aging population worldwide and in Ireland, comes more age-related health problems, including problems with hearing and vision. Ageing is also associated with a gradual decline in some cognitive functions. Sensory impairments (both hearing and vision) have been shown to have an association with cognitive impairment, with a greater cognitive decline seen in those with a combined hearing and vision loss. There is a well-established association between sensory and cognitive impairment, however, no study to date has looked at similar data collected in Ireland. The objective of this study is to analyse data from an Irish sample.

Methods

This study used data collected from Wave 4 of the Irish Longitudinal Study on Ageing (TILDA). Participants with missing data or information were excluded, leaving a complete dataset of 4,612, for analysis. Multiple linear regression analyses were carried out to compare Mini-Mental State Examination (MMSE) scores to self-reported sensory impairment (hearing impairment alone, vision impairment alone and Dual Sensory Impairment (DSI)) while adjusting for several covariates (age, gender, level of education, alcohol consumption, smoking history, depressive symptoms, mobility, loneliness, and physical activity).

Results

Self-reported fair/poor hearing and self-reported fair/poor vision had statistically significant lower MMSE scores than participants with self-reported excellent/very good/good hearing and self-reported excellent/very good/good vision respectively (hearing estimated standard error: –0.055, p value: 3.67e-11; vision estimated standard error: –0.080, p value: 5.14e-15). Self-reported DSI was associated with lower MMSE scores compared to participants without DSI (DSI estimated standard error: –0.13, p value: 5.55e-13).

Conclusion

This cross-sectional study and secondary data analysis demonstrated that in older Irish adults there is an association between hearing impairment, vision impairment and dual sensory impairment and lower cognitive function. These findings contribute to the growing body of research done internationally using other large scale health surveys.