bluuebunny/crossref_metadata_2025 huggingface dataset:
Frail Patients Referred to a Community Specialist Team- What Were Their Frailty Scores?
Authors: Ryan Sheila , Lynch Paula , McDonnell Fergal , Ryan Siobhan , Mathai Vimal , Hassett Patricia , Farrell Claire , Morriarty Eoin , Shanahan Elaine , Bourke Bill
Published: September 2024

Background

Frailty is synonymous with older patients, where multiple body systems slowly lose their reserves and lead patients to become more vulnerable. When developing the inclusion criteria for our integrated care programme for older persons (ICPOP), the limited resources and large geographical area played a role. In order to maximize the outcomes for patients we targeted those with a Rockwood Clinical Frailty Score (CFS) between 4 and 6. We perceived that these patients would benefit from multidisciplinary intervention.

Methods

All patients referred to ICPOP were reviewed from November 2022 to April 2024. Our electronic patient database records information on ICPOP patients. Using this database we searched for the word “frailty” in the reason for referral field. We also correlated this with any patients who had a CFS recorded. The level of frailty in older patients with the scores ranging from 1 (very fit) to 9 (terminally ill) was recorded.

Results

182 patients were found during the database search. 55 patients were referred for frailty alone, 64 patients were referred for frailty with balance/mobility issues, 47 patients were referred for frailty with falls, 16 patients were referred for frailty with memory issues. CFS were available for 132/182(73%) patients. 119/132(90 %) patients with a CFS score were classified as scoring between 4 and 6 on the Rockwood scale. 3/132(2%) scored 2, 6/132(5%) scored 3 and 4/132(3%) scored 7 on the CFS.

Conclusion

The national ICPOP framework prioritise improving care of frail older patients. A measure of a persons’ frailty level is subjective and dependent on clinical judgement along with a good understanding of the term “frailty”. Overall, our findings highlight that the referrers to our service have a good knowledge of frailty as a term. Our ICPOP hub is also effectively targeting the appropriate cohort of patients as per our inclusion criteria.
To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment
Authors: Ryan Sheila , Ryan Siobhan , Mathai Vimal , Lynch Paula , Alamin Mohammed , Shanahan Elaine , Bourke Bill
Published: September 2024

Background

Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN).

Methods

We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines.

Results

75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment.

Conclusion

Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.
Optimizing Opioid Prescriptions in Geriatric Populations at Nottingham University Hospitals Foundation Trust (NUH)
Authors: Ali Haider , Venkatesh Hari
Published: September 2024

Background

Severe pain is associated with adverse outcomes in the geriatric populations (Ref -Pain and Mortality in Older Adults: The Influence of Pain Phenotype - PubMed (nih.gov)).

Currently it is recommended in local and national guidelines (Ref -Guidance on the management of pain in older people | Age and Ageing | Oxford Academic (oup.com), Clinical Guidelines Policy (koha-ptfs.co.uk)) that the following be implemented to geriatric patients being prescribed strong opioid medication

Methods

A multi-disciplinary team involving doctors, pharmacists, nurses and the NUH quality improvement team was involved in all aspects of this project. Initial data collection was done between 1st August 2023 to 1st March 2024. We intend to carry out further data collection between April and August 2024 after our proposed interventions. Data collection was carried out using the EPMA prescribing platform.

Results

Data collected from 1st August 2023 to 1st March 2024 only 70% of patients in health care of the elderly (HCOE) wards had correctly prescribed oxycodone as their strong opioid analgesia. It was noted that 37% of HCOE patients have had morphine incorrectly prescribed at least once during their admission. Only 11% of strong opioid prescriptions on HCOE wards in NUH had a review scheduled. A. Whilst 73% of patients had laxatives co-prescribed only 25% had anti-emetics co-prescribed.

Conclusion

From our initial results there is an obvious need for improvement in terms of guideline adherence. We will aim to collect further data and we will put into place interventions in a ‘PDSA’ manner to improve this.
Preventing Emergency Department Visits: Success Of A Community Dementia Care Model
Authors: Bradley Eoin , Mills Donna , McEvoy Marie , Moodley Kevshni , Conneely Aoibheann , O'Toole Ronan , Nee Rory
Published: September 2024

Background

Advanced dementia care in the community is an extremely complex task. NICE guidelines 2021 suggested that a gap in care was evident bridging between clinic attendance and end of life care. Secondary to a required need- a new advanced dementia care model was created in 2021.This was co-developed by an ANP with a specialist interest in gerontology, an integrated care team for older persons (ICPOP) consultant and palliative care in the community. Joint governance remains to this day. My aim is to review unexpected emergency department (ED) attendances of patients accepted to this pathway.

Methods

Patient records were reviewed of all cases accepted for review and managed under this model of care, time frame Jan 2023- May-2024. All patients > 65. Outcomes of management interventions were assessed. Those found to have an ED attendance during their time engaging with this model of care had closer review of their notes to assess reason why.

Results

81 patients. Of which 75% were female. Average age – 89. Of these 48% died at home and are 37% still alive. Of the 81 patients only 5 (6%) had ED attendances. Of these 5 patients - 3 had unexpected traumatic falls- 2 resulting in hip fracture and 1 in humeral fracture. 2 were admitted with worsening delirium.

Conclusion

The advanced dementia care model has proved very successful in preventing ED attendances prior to direct end of life care engagement. Of those who were admitted – fractures appropriately warrant admission and the remaining 2 cases, had families who were resistant to accepting overall aims of treatment. This interdisciplinary model of care saves bed days. Expanding this care model further to ensure appropriate management of complex dementia cases is maintained in the community would further reduce hospital overcrowding and grant many patient and family wishes.
“Conversations with Friends”: A review of communication between two services
Authors: Davis Aisling , Staunton Ruth , O'Kane Aoibheann , Doyle Cliona , Smith Finola , Doran Arthur , Hilery Patrick , Namara Rosa Mc , Boyle Nicola
Published: September 2024

Background

EDITH (Emergency Department in the home) is a rapid response team consisting of a doctor/ANP and OT who assess patients in their home to avoid an ED attendance. The Integrated Care Team for Older People (ICPOP) is a community-based specialist multidisciplinary team that provides assessment and intervention for frail older adults in order to facilitate them to remain living at home. These two teams work collaboratively to keep older adults out of hospital and refer a high volume of patients between the two services. It is imperative to reflect on current communication practices in order to future proof these services and ensure optimum patient care.

Methods

An electronic survey was designed to evaluate the service and was circulated to members of both teams. Quantitative data was captured via likert scales and qualitative feedback was analysed via thematic analysis. There was a total of 13 respondents.

Results

One hundred percentage of participants rated confidentiality of communication “average” and “above average”. 92% rated accuracy and accessibility of communication as “average” and “above average” while 15% rated speed of communication as “below average”. Key themes such as “prompt communication”, “friendly working relationships” and “using therapy specific language” emerged as areas that are working well. Area for improvement include “close loop communication/referral process” and “lack of a shared electronic healthcare record”.

Conclusion

Overall, the feedback from both teams appears to be positive and it is beneficial to reflect on communication processes. It is important to build on good working relations between acute and community teams as it likely results in better patient outcomes. Key areas for improvement have been highlighted and an action plan to address same can be formulated.
Artificial Intelligence-Powered Technologies For Independent Living Among Older Adults: A Review
Authors: Gamble Eugene , Chami Peter , Nancoo Tamara
Published: September 2024

Background

The ageing populations in Ireland and around the world has led to an increased focus on technologies that support independent living for older adults. Artificial intelligence (AI) has emerged as a promising solution, with various AI-powered technologies being proposed to assist their daily lives. This review aims to synthesize the findings of studies exploring AI-powered technologies for independent living among older adults.

Methods

A systematic literature search was conducted using relevant databases, including PubMed, IEEE Xplore, and Google Scholar. The search terms included “artificial intelligence” and “independent living”. Studies published between 2009 and 2023 that investigated AI-powered technologies for independent living among older adults were included in the analysis.

Results

The included studies investigated various AI-powered technologies including tablets, wearable devices like smartwatches, web portals for carers, Internet of Things (IoT) solutions, user-centered design considerations, the integration of AI with sociology and healthcare, smart home technology, and ambient information systems. The pooled results indicated that AI-powered technologies can improve independent living outcomes for older adults. Benefits included real-time monitoring and health deterioration recognition, fall detection, personalised care, cognitive assistance and reduced isolation. User-centered design approaches and the integration of AI with sociology and healthcare were also found to be essential factors in the successful implementation of these technologies.

Conclusion

This analysis provides evidence supporting the effectiveness of AI-powered technologies in promoting independent living among older adults. IoT solutions and smart home technology appear to be particularly promising. However, the successful implementation of these technologies requires a multidisciplinary approach, incorporating user-centered design and the integration of AI with sociology and healthcare. Further research is needed to explore the long-term impact of AI-powered technologies on the well-being and autonomy of older adults.
Development and Implementation of a Venous Thromboembolism Prophylaxis Protocol in the Rehabilitation Setting – A Completed Audit Cycle
Authors: Synnott Pádraig , Hamaty Jeries , Perrira Nicole , Frindunbekov Yuri , Khalid Maryam , McCarthy Frances
Published: September 2024

Background

63% of all Venous Thromboembolic disease (VTE) is hospital-acquired, and 70% of hospital-acquired VTE is potentially preventable with appropriate prophylaxis. NICE recommends a VTE risk assessment for all patients admitted to acute hospitals within 24 hours. Validated risk assessment models for acute hospitals enhance provision of thromboprophylaxis, but no such protocols exist for the rehabilitation setting. The aims of this audit were to determine if VTE risk assessments are occurring on admission and during acute illness in rehabilitation wards, to assess the proportion of rehabilitation inpatients receiving VTE prophylaxis, and to develop and pilot a VTE Prophylaxis Protocol.

Methods

An initial audit was carried out on three rehabilitation wards in May/June 2023. A VTE Prophylaxis Protocol was developed based on the HSE VTE Prevention Program template, incorporated into the admission booklet on 3 pilot wards in February 2024, and practice re-audited in April 2024.

Results

Pre-intervention, 41 patient records were assessed. 0 patients (0%) had a documented VTE risk assessment on admission, 23(56%) had therapeutic anticoagulation continued, and 3(7%) commenced appropriate VTE prophylaxis on admission. 8 eligible at-risk patients did not receive prophylaxis. Post intervention, all patients (n=25) on the three pilot wards were re-audited. 10 patients (40%) had a documented VTE Risk assessment within 24 hours of admission, 9(36%) had therapeutic anticoagulation continued, and 5(20%) received appropriate VTE prophylaxis on admission (2 without a documented risk assessment). 3 at-risk patients did not receive prophylaxis (1 with a completed risk assessment), and 1 risk-assessed patient inappropriately received prophylaxis.

Conclusion

Implementation of a VTE Prophylaxis Protocol improved VTE risk assessment in rehabilitation. This small sample however did not demonstrate an association between prophylaxis prescription and use of the protocol. Further education and feedback is required to increase use of the protocol as part of this ongoing quality improvement project.
Parkinson’s Disease Medications Prescribing and Falls Assessment in Older Persons Movement Disorder Clinic
Authors: Ragab Inas , Magennis Brian
Published: September 2024

Background

Parkinson’s Disease is a progressive neurodegenerative movement disorder. It is the second most common neurodegenerative condition after Alzheimer’s. The movement disorder clinic for Older Persons is well established in the Mater Hospital for years. Patients are followed regularly, and multiple domains are assessed including UPDRS (Unified Parkinson’s Disease Rating Scale), medications, and falls.

Methods

A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment. A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment.

Results

Of the total number of 48 patients audited, 65% were females and 35% were males. The majority (83%) of patients were ≥75yrs of age, and 17% age 65-75yrs, with mean age of 83years old. 68.8% didn’t have the year of diagnosis documented. 88% were on levodopa/decarboxylase inhibitor, 29% on MAOB-I (6% only on it as first line), 17% on dopamine agonist, 2% on Amantadine. 83% of the patients had assessment of falls reflected on history taking and lying (sitting)/standing BP documentation. Of which 60% had no falls, and 21% had evidence of postural drop.

Conclusion

Most of the patients attending the clinic were 75 years of age or older. Levodopa combined with a decarboxylase inhibitor was the most commonly used medication in this cohort of patients. The majority of patients had falls assessments conducted and documented. However, for most patients, the year of diagnosis was not recorded.
An Audit Of Post Fall Medical Reviews In Older Hospital Inpatients
Authors: Carroll Thomas , Daly Simon , Briggs Robert
Published: September 2024

Background

After an older person falls in hospital, the post-fall medical review is critical to assess injury and to put a plan in place to prevent further falls. We performed an audit to assess the post fall medical review and management of patients ≥65 years in a large university teaching hospital compared to national standard “Service User Falls: A Practical Guide for Review” and NICE Guidelines.

Methods

In a consecutive cohort of patients with falls, the post-fall medical review note was examined for crucial details from the history (mechanism, head/hip strike, loss of consciousness, pain) and examination (confusion, vital signs, joint assessment). In addition, we audited if there was an indication for CT Brain and compared to NICE criteria.

Results

49 post fall medical review notes were audited (Mean age 79 years, range 66-96).

27% of patients who fell had a CT Brain. 6% (3/49) of patients who fell met NICE criteria for CT Brain, but it was not performed.

Conclusion

A significant proportion of post fall medical reviews omit important details that could help diagnostically and to inform a plan to prevent further falls. There is limited guidance for clinicians as to when to order a CT Brain for inpatient falls. We plan to introduce a post fall medical review pro forma/checklist and to standardise a CT Brain decision tool. We will then re-audit post introduction of these to assess for quality improvement.
Identifying the Burden of Inappropriate Prescribing Using Consensus in a Day Hospital Setting
Authors: Walsh Johnny , Gannon Elizabeth , Carroll Joanna , Brewer Linda
Published: September 2024

Background

Inappropriate prescribing (IP) is highly prevalent in older adults and is associated with increased risk of adverse drug reactions, increased morbidity, mortality and healthcare utilisation. Risk factors associated with IP include older age, polypharmacy and having multiple healthcare providers. The aim of our study was to identify the prevalence of polypharmacy and potential IP in the day hospital setting.

Methods

Patients attending our day hospital over two months were included. Consensus was reached between two Geriatric medicine SpRs and the day hospital pharmacist regarding various categories of potentially IP, and a proforma was agreed. We gathered demographic data, number of medications and subjective medication burden. We recorded data in Excel, and we quantified potentially inappropriate medicines and categorised all identified IP.

Results

179 participants were included, mean age 83 (range 68-98). 80% of patients were taking ≥5 medications, overall, 40% perceived they were taking too many. 79% of participants had at least one example of IP, 25% had ≥3. The commonest example of IP involved PPIs, involving 26% participants, followed by antihypertensives involving 21% of participants. Overall, 48% of potentially inappropriate medications were identified due to ‘inappropriate indication’, and 37% related to side-effects. People aged 65-69 and 90-94 were the most likely to report they were taking too many medicines, 75% and 46% respectively. This correlated with the same age brackets having the highest number of average IP, 2.75 and 2.2 respectively.

Conclusion

Despite the well-known associated risk of harm, our study confirms ongoing high prevalence of polypharmacy and IP amongst older adults. Prescriber vigilance is key in reducing harm. Regular presence of a pharmacist, liaising strongly with medical staff, is invaluable in the day hospital setting.
Ending Pyjama Paralysis; Physical Steps In The Right Direction For An Irish University Hospital
Authors: Nugent Michael , O'Neill Christine , Shae'n Lim Chad , Chen Shi , Haydar Ibrahim , O'Brien Úna , Bambrick Pádraig
Published: September 2024

Background

The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”.

Methods

A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3).

Results

A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days.

Conclusion

This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.
Detecting Delirium: The Missed Medical Emergency
Authors: Chakkittakandy Deepthi , Kelly Louise , Farrelly Angelina , Wall Catherine , Regi Cicily , Hayden Derek
Published: September 2024

Background

Delirium is among the most common of medical emergencies with approximately 1 in 5 patients aged 65 and above presenting with or developing delirium, during their acute hospital admission. Delirium is more common in certain patient groups including those with hip fractures, dementia, previous delirium, frailty and other comorbidities. It is associated with poorer outcomes and complications. Delirium also has the potential to cause significant patient and carer stress. Despite the significance of delirium, it is frequently underdiagnosed. It can be prevented and treated if it is identified early. As per the National Dementia Office all acute Hospitals have to complete the Delirium care algorithm for all patients aged 65 years and above, admitted to hospital or who have any known risk factors for delirium.

Methods

The Delirium Multidisciplinary Care Bundle was rolled out across the hospital with education provided both face to face and via eLearning. Using the Quality Care Metrics (QCM) delirium indicator and a locally developed audit tool, medical and nursing records where reviewed to identify the level of concordance with the Delirium Multidisciplinary Care Bundle.

Results

The gradual increase in the compliance in use of the care bundle reached up to hundred percent. The bundle use was audited utilising the Quality Care Metrics (QCM) with the delirium indicator showing an improvement of an average of 60-80% hospital-wide. The hospital-wide audit on the compliance of the delirium care bundle was conducted and identified that compliance on the bundle had improved to 60-100%.

Conclusion

Continuous evaluation, monitoring and improvement plans are in place. This will be further supported by providing multiple methods of education delivery throughout the organisation to meet the needs of all learners. Ultimately continuing to improve delirium detection and management for our patient group.
End Of Life Care in Nursing Home Residents Supported Through a Nursing Home Specialist Liaison Service
Authors: Saric Denis , Kennelly Siobhan
Published: September 2024

Background

Advance Care Planning (ACP) is a crucial aspect of ensuring that nursing home residents receive care aligned with their preferences and values, especially as they approach the end of life. Supportive end of life care planning involves discussion with the person and/or their support person, symptom management and multidisciplinary collaboration. Evidence shows that even where an ACP has been recorded there can be significant barriers to enabling end of life care in the nursing home. We examined the role of a nursing home specialist liaison team in supporting implementation of ACPs towards end of life.

Methods

Retrospective analysis of medical and nursing care records from deceased residents referred to the liaison service in 2023 across four nursing homes in the hospital catchment was examined. Data included recording and/or reviewing of ACP at time of liaison consultation, anticipatory medication prescribing, cause and location of death.

Results

41 resident reviews conducted by Registered Advanced Nurse Practitioner and/or Consultant Geriatrician. 16 (39%) of residents had an ACP in place at the time of initial review. 18 (26%) residents had anticipatory medications prescribed prior to liaison service consultation. Following consultation ACP documentation in residents increased to n=40 (97%). A further 11 (26%) residents were charted anticipatory medications at time of review as they were actively dying. Five (12%) residents required referral to specialist palliative care services for complex symptom management. All 41 residents passed away in the nursing home. Cardiac related issue was documented in 63% of reviews as cause of death.

Conclusion

Documentation of ACPs was low in this cohort of nursing home residents towards end of life. Input from the nursing home liaison service supported resident’s end of life care through consultation, support with ACP and anticipatory medication prescribing.
Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study
Authors: Wade Ruth , Nash Karen , Cooney Freda , Ciuba Damian , Cahill Theresa , Connolly Warren
Published: September 2024

Background

An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents.

Methods

An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel.

Results

The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days.

Conclusion

This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.
Nutritional Analysis Of The “Regular” Hospital Menu In A Model-2 Hospital
Authors: Forbes Rebekah , O'Shea Katherine , Dennehy Anne , Jennings Emma
Published: September 2024

Background

Hospital malnutrition is associated with adverse clinical outcomes, particularly for older adults with pre-existing frailty. In our Model-2 hospital, the majority of inpatients are older (≥65 years) and at higher risk of developing malnutrition. Protein recommendations for older adults with acute or chronic disease are 1.2-1.5 g/kg/day. The amount of protein consumed per meal is also important.

Methods

Nutritional analysis of individual components comprising the 7-day regular hospital menu cycle was completed using Nutritics software for all foods and beverages available to inpatients. The results were then compared to nutrition standards as set for the regular hospital menu in the national “Food, Nutrition and Hydration Policy for acute hospitals 2018”.

Results

The “regular” menu of the hospital provided: mean 2056 kcal/day versus national standards 2100-2400kcal/day, protein 84 g/day versus national standard 90g/day. These values equate to 100% consumption of all foods offered on the “regular” menu. Energy distribution across the menu shows breakfast providing 29%, lunch 31%, supper 19%, tea & snack rounds 21% of total energy. Protein distribution showed breakfast providing 29%, lunch 41%, supper 18% and tea & snack rounds 12% of total protein. Of 37 surveyed patients 53% reported consuming less than their usual intake at home with actual menu intakes ranging from 50-60% of total food offered.

Conclusion

Nutritional analysis of meals offered on the “regular” menu revealed 98% adherence to the recommended daily intake (RDI) for energy and 94% of the RDI for protein requirements as per national standards. These results are based on actual servings rather than actual consumption, implying potential discrepancies. Consequently, there is a clear need for recalibrating the menu to achieve more consistent caloric and protein intake across each dish. This study also highlighted the need to develop an “energy dense” menu for patients with poor nutritional intakes and frailty.
Going Against the Flow: Impacts of Effective Streaming on Older Adults on the Acute Floor
Authors: Kelly Louise , Davey Naomi , Widdowson Matt , Doran John Paul , Cullen John , Soh Josephine , Byrne Mary , Hayden Derek
Published: September 2024

Background

The development of a dedicated Age-related acute medical unit, with a Registered Advanced Nurse Practitioner (RANP) in Gerontology, targeting older adults with complex health states/Geriatric syndromes presenting to unscheduled care, commenced in Q4 of 2022.

Methods

An age attuned 4-cubical Age-Related Assessment Unit (ARAU) was created and co-located with the Acute Medical Unit (AMU). The RANP in Gerontology for ARAU operated under the guidance of the AMU consultants, providing comprehensive geriatric assessment to older medical patients presenting to unscheduled care.

Results

With the establishment of ARAU, the commencement of the RANP in Gerontology, and the additional focus on streaming and management of acute medical gerontological presentations through the ARAU, there has been a 63% increase in patients aged 75+ treated via the AMU in 2023 (378 patients aged 75+ -2022 vs 618 Patients aged 75+ - 2023). A key area of focus in this patient population group, Patient Experience Times (PET) in decision to admit vs discharge within a 6 hour time frame, showed marked improvement (25% increase 2022 vs 2023 in PET targets met), highlighting the impact of a dedicated age attuned assessment space and RANP in gerontology on the acute floor.

Conclusion

The RANP in ARAU provides advanced specialist geriatric nursing skills and knowledge to positively impact on 75+ flow and PETs while addressing the medical, psychosocial and functional needs of older adults who present to unscheduled care.
Existing and Emerging Measures of Muscle Strength and Mass in the Assessment of Sarcopenia
Authors: Duggan Eoin , Xue Feng , Knight Silvin P , Romero-Ortuno Roman
Published: September 2024

Background

Sarcopenia, an accelerated loss of muscle strength and mass is a major driver of adverse health outcomes in older people. The European Working Group on Sarcopenia recommends muscle strength assessment with handgrip strength (HGS) or five chair stands test (5CST) and muscle mass assessment with dual energy X-ray absorptiometry or bioelectrical impedance analysis (BIA). However, these methods can be contraindicated, unavailable or patients can be unable to perform them. We sought to compare the existing measures HGS, 5CST and BIA to emerging measures: quadriceps muscle strength (QMS) and muscle ultrasound.

Methods

Thirty-one participants from a local healthy ageing group (mean age 71±5 years, 80% female) were recruited to the FRAILMatics Physiological Cohort. Max HGS was assessed using the Jamar Plus+ dynamometer and 5CST timed from a standard height chair. Max QMS was measured with the Actiforce hand-held dynamometer. BIA was performed with the TANITA DC-430 MAP and the Sergi equation used to estimate appendicular skeletal muscle mass (ASMM). Rectus femoris muscle thickness (RFMT), vastus lateralis muscle thickness (VLMT) and anterior thigh muscle thickness (ATMT) measurements were taken using the linear array transducer on the GE Vscan Air point of care ultrasound system. Pearson correlation was used to examine the relationship between measures.

Results

Strong correlation was seen between max QMS and max HGS (r = 0.73, P <0.001); moderate correlation between RFMT, VLMT, ATMT and ASMM (r = 0.51, P <0.01; r = 0.56, P<0.01; r = 0.40, P <0.05). 5CST was not correlated with any of the measures (P >0.05).

Conclusion

In the assessment of sarcopenia, QMS and muscle ultrasound could be alternatives to HGS and BIA respectively, especially in cases where the latter are not available or contraindicated. 5CST appears less useful in the assessment of sarcopenia and may be more appropriate as a test of physical performance.
Enhancing Education and Training for Professionals and Formal Carers: Implementing Microlearning
Authors: Zrnic Darko
Published: September 2024

Background

Current technological, economic and social changes trigger the need for new concepts and strategies to support lifelong learning. Education, including work-based learning, is in need of transformation, requiring renewal and innovative ways of relating appropriately to the way we live, work and learn today (Downes, 2005; Kuhlmann & Sauter 2008; Chisholm 2005). Staff shortages and heavier workloads has reduced the availability of health care staff to attend in-depth training courses. This, coupled with the recent moves away from traditional face-to-face learning to e-learning, we had to re-consider teaching theories and teaching methods.

Methods

In this poster I will present how we utilised microlearning to improve staff knowledge about dementia and nutrition. Microlearning is a method of delivering small, bite-sized pieces of information that can be easily consumed and retained by learners. It offers customised learning experiences that cater to the unique needs and preferences of each learner and provides an engaging and interactive learning experience through the use of multimedia, quizzes, and games.

Results

Microlearning facilitates self-directed lifelong learning, as short activities can be easily integrated into everyday activities. Small learning steps with small pieces of information can be used for learning in between and on-demand. In this way microlearning enables individuals to stay up to date in today’s knowledge society and offers a viable supplement to more time-consuming and formalized modes of learning, such as classroom courses or web-based trainings. Additionally, this poster will describe how we have applied microlearning as an emerging pedagogy that enables learners and clinicians to engage in short, focused, asynchronous and just-in-time learning.

Conclusion

Microlearning as an educational strategy has demonstrated a positive effect on the knowledge and confidence of health professions learners in performing procedures, retaining knowledge, studying, and engaging in collaborative learning.
The Effect of Fludrocortisone on Ambulatory Blood Pressure Markers of Falls Risk Amongst Older People with Falls
Authors: Doyle Kate , Kenny Roseanne , Briggs Robert , Lavan Amanda
Published: September 2024

Background

Fludrocortisone is frequently used to raise blood pressure in older patients with falls due to hypotension, yet evidence to support its use is limited. The aim of this study was to assess changes in Ambulatory Blood Pressure Monitors (ABPM) markers of future falls risk seen after commencing/increasing Fludrocortisone in older people with falls due to orthostatic hypotension (OH) or vasovagal syncope.

Methods

A cohort of older patients (≥65 years) attending a tertiary-referral falls & syncope unit and prescribed Fludrocortisone were included. ABPM at index visit and follow-up (after commencing/increasing Fludrocortisone) were analysed, with specific focus on markers of future falls risk: overall Systolic Blood Pressure (sBP), minimum sBP, sBP variability & ‘dips’ in systolic sBP <100 mm Hg. These variables were compared pre and post Fludrocortisone using paired t-tests.

Results

Twenty-three patients (median age 74 years (SD 6.05), 3/4 with OH) were followed for median 4.5 (SD 6.53) months. Two-thirds were commenced on Fludrocortisone, with the dose increased in the rest. Patients commencing Fludrocortisone had a significant increase in overall sBP from 110.13mmHg (95% CI 104.26 – 116.00) to 127.93mmHg (95% CI 120.00 – 135.87) (p<0.001) at follow-up, and a significant increase in minimum sBP from 82.2mmHg (95% CI 76.25 – 88.15) to 99.87mmHg (95% CI 91.47 – 108.26) (p=0.001). There was also a significant reduction in the number of SBP ‘dips’ after commencing Fludrocortisone (9.6 pre to 2.67 post, (95% CI 0.08 – 5.25), p=0.004)), and after commencing/increasing Fludrocortisone dose (8.09 pre to 2.74 post (95% CI 0.62 – 4.85) (p=0.012)).

Conclusion

This study provides clinical data on the effectiveness of Fludrocortisone in older patients with falls due to hypotension, demonstrating significantly improved markers of future falls risk. Overall sBP increased significantly by 16% and minimum sBP increased by over 20% after starting Fludrocortisone. The number of SBP ‘dips’ also significantly reduced, by over 70% in those who commenced Fludrocortisone.
Antipsychotic Prescribing and Falls Risk in Nursing Home Residents with Dementia
Authors: D'Alton Maeve , Eustace Andrew
Published: September 2024

Background

Falls are a common syndrome in older adults leading to adverse outcomes including functional decline, activity restriction, injury and death. They can still occur in residential care. We examined prescribing of medications included in STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) (1) in nursing home residents with dementia.

Methods

A point prevalence audit was conducted in a dementia-specific nursing home. Data were collected from the electronic healthcare record on demographics, dementia severity, and number of falls in the preceding 12 months. The number and class of regular medications were recorded. Non-cognitive symptoms of dementia were quantified using the Cohen Mansfield Agitation Inventory (CMAI).

Results

Seventy-four residents were included with mean age 82 years, 59(70%) female. The average Mini Mental State Examination (MMSE) was 5/30 and 80% had severe dementia. The average CMAI score was 50. The mean number of falls was 3 (range 0-14). Regular prescribing of specific STOPPFall medications was as follows: antipsychotics 42/74 (57%), benzodiazepines 8/74 (11%), opioids 13/74 (18%), antidepressants 44/74 (59%), antiepileptics 11.74 (15%), diuretics 12/74 (16%). Prescription of a regular antipsychotic was associated with one or more falls (OR 3.19, p = 0.029). There was no significant difference in falls with the other medications studied. The number of falls increased with higher agitation scores.

Conclusion

Antipsychotics increased the risk of falls in a nursing home setting. Fallers had higher rates of agitation, perhaps explaining the increased usage of antipsychotics. Medications should be reviewed on a regular basis and deprescribing considered where appropriate.

Reference

1. Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, et al. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drgs. Age and Ageing. 2020;50(4):1189-99.
The Spectrum Of Symptoms In Older Patients With Severe Orthostatic Hypotension
Authors: Byrne Lisa , Poulose Bindu , Joseph Lincy , Hade Dymphna , Rice Ciara , Deirdre Kelly , Briggs Robert
Published: September 2024

Background

Orthostatic Hypotension (OH) is an important cause of falls in older people, with patients typically presenting with postural dizziness/light-headedness. However, while we recognise clinically that in older patients with OH, symptoms are often absent or atypical, little work to date has captured this spectrum of OH symptoms. The aim of this study therefore was to examine symptom profiles in a large cohort of older people with severe OH and ascertain the prevalence of ‘asymptomatic’ OH.

Methods

We included a consecutive cohort of older patients (aged ≥60 years) with severe OH attending a tertiary referral falls unit. OH, was identified during an active stand using a Finometer® measuring beat-to-beat phasic blood pressure. Patients were asked to report any symptoms during the test and each symptom was recorded. Severe OH was defined as failure of recovery of BP to within 20 mmHg systolic/10mmHg diastolic of baseline value within 3 minutes of standing.

Results

71% of patients (n=393) reported symptoms during the active stand, with two thirds of these reporting ≥2 symptoms. The most frequent reported symptoms were dizziness (52%) and poor balance (52%), followed by weakness (38%), visual disturbance (28%), light-headedness (21%), fatigue (6%), nausea (4%), feeling warm (4%) and palpitations (1%). Nurses reported pallor in 13% of patients, while 3% needed to lie down due to hypotension/presyncope. Average time to symptom reporting was 16 seconds (compared to 11 seconds in patients who did not have severe OH).

Conclusion

Almost one third with severe OH reported no symptoms during an active stand, while only half reported ‘typical’ OH symptoms of dizziness/light-headedness. Atypical symptoms such as fatigue, and generalised weakness are relatively common. Atypical symptomatology is therefore frequent in older patients with severe OH. These findings have important implications for the clinical assessment of older people with falls.
Identification and Management of Post-Stroke Spasticity
Authors: Harte Gillian , Lawson Susan , Walsh Rachel , Ryan Dan
Published: September 2024

Background

Spasticity is thought to affect up to 40% of people with severe weakness after stroke, with 15% of those experiencing severe and disabling spasticity. Untreated, it can lead to pain, increased dependence, contracture and other motor impairments (National clinical guideline for stroke for the UK and Ireland, 2023). Guidelines recommend that people with motor weakness should be assessed for spasticity, and spasticity guidelines recommend that all people with problematic spasticity should be managed within a specialist service, using physical and pharmacological management as appropriate (Royal College of Physicians, 2018). The objective of this study was to determine the prevalence of spasticity reported by patients attending a post stroke review clinic, and the subsequent management of these patients.

Methods

Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Data: All patients were asked if they experience stiffness, cramping or spasms. Responses and subsequent onward referrals were recorded. Where patients were referred onward for further assessment and management, the interventions employed were recorded. Analysis was performed using descriptive statistics.

Results

During the data collection period, 270 patients visited the clinic. Stiffness, cramps or spasms were reported by 32 (11.9%), with the majority of these (n=27, 84%) referred to a specialist physiotherapist with expertise in spasticity management for comprehensive assessment. Of the referred patients, 5 (18.5%) did not attend their appointments, 5 (18.5%) are still awaiting appointments, 6 (22.2%) were diagnosed with non-neural stiffness, and 9 (33.3%) received botulinum toxin injections at a specialist physiotherapist-led spasticity clinic.

Conclusion

Data from this exploratory study indicates the importance of assessing spasticity in patients post stroke and highlights the importance of access to a physiotherapist with specialist knowledge and skills in spasticity management.
A Review of the Concurrent Incidence and Evidence for Dysphagia and Constipation in Acute Stroke Patients
Authors: Almahal Hammam , McCarthy Kate , Robinson Shelia , Hartigan Irene
Published: September 2024

Background

Dysphagia post-acute stroke is a commonly reported complication. It can effect up to 80% of the post stroke population (Banda et al., 2022). Constipation is a well-recognised complication in all hospital admissions. The cause of which is thought of as multifactorial, change in diet and fluid intake, reduced mobility, change in routine etc. A scoping review has found that despite both conditions being prevalent in a stroke population, their concurrent incidence has not been studied or reported.

Methods

A scoping literature review was carried out to investigate the incidence of these conditions concurrently in stroke. Databases used were CINAHL, EMBASE and MEDLINE. Inclusion criteria for the review included 1) Stroke population over 18 years 2) published in English 3) any measure taken of constipation. Opinion pieces and non-peer reviewed papers were excluded. An audit of our current inpatient cohort on the stroke unit was also carried out to identify if these concurrent conditions are being documented and acted upon.

Results

The literature review resulted in an empty review. There was no clearly defined literature that reported on the concurrent incidence of dysphagia and constipation in an acute stroke population. The supportive audit on the ward included 29 patients on the inpatient acute stroke unit. 2 of 29 had documented constipation, while 21 of 29 (72%) patients were prescribed laxatives. 15 of 29 (51.7%) had been commenced on a modified diet by speech and language therapy secondary to dysphagia.

Conclusion

Dysphagia and constipation have been identified as common post stroke complications. 72% of the inpatient cohort have been commenced on laxatives, this indicates the recognition and pre-emptive management off this prevalent complication. Dysphagia was documented in over 50% of patients. Continued research needs to be carried out on the concurrent incidence and management of these post stroke complications.