bluuebunny/crossref_metadata_2025 huggingface dataset:
70 Caregiving, all-cause mortality and cause specific mortality: findings from the NIH-AARP diet and health study
Authors: Costello M , Judge C , Reddin C , McCarthy C , Murphy R , McDermott C , Smyth A , O'Donnell M , Canavan M
Published: September 2023

Background

There have been conflicting findings in studies exploring the relationship between caregiving and mortality, which may relate to differences in type and intensity of caregiving.

Methods

In the prospective National Institutes of Health American Association of Retired Persons (NIH-AARP) Diet and Health Study (n = 148,792, mean age 70.8 years), we evaluated the association of caregiving with all-cause mortality and cause-specific mortality, and explore whether the association differed by type of caregiving (adult or children) and by duration (hours per week). Hazard ratios (HR) and 95% confidence intervals (CI) for mortality associated with caregiving of adults and of children were estimated with the use of Cox proportional-hazards regression models, with non-caregivers as the reference category.

Results

During a mean follow-up of 12.9 years, 59,046 deaths were recorded. Overall caregiving for adults (HR 0.90; 95%CI 0.88–0.93) and children (HR 0.71; 95%CI 0.70–0.73) were associated with a lower risk of all cause-mortality, which was consistent for cardiovascular and non-cardiovascular deaths. However, among adult caregivers, there was evidence of a dose–response with attenuation risk reduction among those caregiving for 7 hours per week or more (HR 0.95; 0.89–1.01) compared to those with short duration adult caregiving (HR 0.88; 0.85–0.91), on multivariable analyses. The association of caregiving of children was consistent across duration categories.

Conclusion

Among older adults, caregiving was associated with an overall reduced risk of mortality. However, we found differences in magnitude of association by caregiver type and duration and observed no reduction in mortality among those providing adult caregiving for 7 hours or more per week.
134 Evaluation of the Community Rehabilitation Inpatient Specialist Program (CRISP)—an advanced nurse practitioner (RANP)-led program for frail older adults
Authors: Doyle M , Mathew J , Morris E , Ryan D , McDonagh R
Published: September 2023

Background

Frail older adults disproportionately access acute healthcare services. Novel integrated care programs are needed to redesign care delivery focusing on community-based health promotion, as opposed to crisis response. CRISP is a bespoke, RANP-led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment. Referrals are received from Geriatric ED services, geriatric/neurology/rehabilitation medicine outpatient clinics, ICPOP and local GPs. Admission to a Model 2 Age- Related rehabilitation centre occurs within 4–8 weeks of referral.

Methods

This Prospective cohort study examines the short to medium-term effects of the CRISP program. Functional, mobility and Quality-of-Life (QoL) measures were collected on admission and discharge. Fall rates, QoL and carer stress are measured four months after completion of the program. Data were analysed using Microsoft Excel. Functional outcome and QoL measurements were compared using paired t-test.

Results

73 patients (78%) completed the program and attended for follow up (2021–2022), average age: 80.9 yrs, SD-6.6 yrs, frailty index 5.6 (mild to moderate frailty). There have been statistically significant gains made in performance in activities of daily living (Barthel Index; 76.7A vs 83.9 DC) (p < 0.001), balance (Berg Balance Scale:29.6A vs 36.3 DC) (p < 0.001 and QOL (EQ5D:45.2 A vs 69.8 DC) (p < 0.001). CRISP delivers long-term positive benefits including reduction in falls rates: 2.9(4 months pre-admission) vs 0.5 (4 months following completion of the program) (p < 0.001) and improvement in self-reported QoL, EQ5D:45.2 A vs 62.6 at 4 months following completion of the program. Carers who reported stress 62% (n-45), 91% reported a reduction in stress levels 4 months following the program.

Conclusion

CRISP provides early intervention at the lowest level of care complexity resulting in reduced fall rates and consequent crisis presentations to acute care. CRISP improves mobility and function promoting independence and improving QoL for community dwelling older adults.
146 Reducing distressed behaviour in cognitively vulnerable patients during hospitalisation: the role of a Health and Wellbeing Health Care Assistant (HWB-HCA)
Authors: Naughton C , Allen Y , Myers H , Wills T , Fehin P , Jacob S , Hennessy C , Twomey N , O'Sullivan B , Curtin D
Published: September 2023

Background

Over 40% of older people admitted to acute care experience physical and/or cognitive hospital-associated decline (HAD). People with cognitive vulnerabilities (dementia, delirium) are at particular risk of HAD due to longer hospital stays, use of psychotic medication, boredom, and separation from family. We aimed to implement and evaluate a new ‘Health and Wellbeing Health Care Assistant (HWB-HCA) role as part of a multidisciplinary older adult ward team to provide positive stimulation for cognitively vulnerable patients.

Methods

The HWB-HCA role was funded by the South/South-West Hospital Group. It combines elements of the standard HCA role (personal care, nutrition, mobilisation etc.) with protected time (four hours per day) for cognitive distraction activities tailored to the individual patient. Interactions start with the HWB-HCA, family and patient completing the Sunflower tool to identify personal interests, dislikes, and triggers for distressed behaviour. Individual activities at the bedside are planned and driven by the patient’s interest. The multiple methods evaluation includes audit of psychotic prescribing, observation, patient and family feedback, and staff interviews.

Results

To date, the HWB-HCA has delivered 130 structured sessions (72 hours) to 14 patients (median hospital stay 22 days). Activities include chatting, reading, prayers, painting, creative writing, exercise, hand massage. Patients’ reactions are overwhelmingly positive (smiling, laughing, engaged, more relaxed). The role is positively viewed by families, one testimony- ‘she is amazing, so patient, I don’t know how she does it’. Monthly point prevalence audit of PRN psychotic indicates a reduction (mean 5.5% vs 9% in the previous six-month). Lack of social space and staff shortages remain the biggest challenge to operationalising the role.

Conclusion

The HWB-HCA has been a positive innovation enabling a wider range of non-pharmacological activities to reduce incidents of distressed behaviour managed by psychotic prescribing.
153 Challenges and facilitators experienced by professionals recording long-term outcomes after hip fracture: a Consolidated Framework for Implementation Research qualitative study
Authors: Walsh M , Cunningham C , Brent L , Savin B , Blake C
Published: September 2023

Background

Older people with hip fracture can experience slow recovery. Hospitals in Ireland record inconsistent information about survival, recovery, and treatment adherence up to one year after fracture. The Irish Hip Fracture Database aims to implement outcome fields to standardise this information. This study aimed to explore local facilitators and challenges experienced by hospital-based health professionals in Ireland to long-term hip fracture outcome recording.

Methods

Health care professionals who had experience of collecting long-term outcomes after hip fracture in Irish acute and rehabilitation hospitals were identified through a systematic literature review and advertisement. They were sampled purposively by profession and geographical location. Semi-structured interviews and focus groups were conducted online, audio-recorded, and transcribed. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Research Ethics Committee approval was received.

Results

There were 21 participants: eight geriatricians, six physiotherapists, three nurses, three orthopaedic surgeons and an anaesthetist. Challenges and facilitators across five CFIR domains were identified. 1) Characteristics of Individuals: Patient-focused, persistent, and flexible professionals have driven long-term outcome recording locally. 2) Innovation characteristics: Patient contact mode and complexity of information recorded affected activity difficulty. 3) Process: Protected space, time, administrative support, role clarity and staff consistency aided sustainability. 4) Inner setting: Support of local governance groups, senior clinicians and management facilitated activity. 5) Outer setting: Professional collaborations between hospitals and international exemplars inspired activity, while perceived policy focus on acute data hindered prioritisation of long-term outcome recording.

Conclusion

While site-specific circumstances are evident, common challenges and facilitators have been identified to recording of long-term outcomes after hip fracture by hospital-based health professionals across Ireland. Education and implementation strategies are currently being developed based on these findings, with input from patients and international experts. Further research will evaluate implementation outcomes including feasibility of specific data fields.
166 Effect of religious attendance on loneliness, quality of life, stress and anxiety among older adults during COVID-19 in Ireland
Authors: O'Maoileidigh B , Kenny R A , Ward M , Scarlett S
Published: September 2023

Background

Religious attendance has been shown to have a positive effect on psychological health among the older population of Ireland. Due to COVID-19 lockdown restrictions and precautionary health advice, many older adults struggled to attend service in person. However, 87% of faith organisations provided a form of remote service.

Methods

Data were from Wave 6 (2021) of The Irish Longitudinal Study on Ageing (TILDA). The analysis sample was made up of 3,961 community-dwelling adults living in Ireland aged 60 years and older. To assess religious attendance, participants were asked about how often they attended in person and how often they attended remotely using radio, television, or internet streaming. Relationships between religious attendance, Quality of Life (QoL), Loneliness, Stress, and Anxiety were modelled using linear regressions.

Results

The sample was 44.1% male and 55.9%female, with a mean age of 72.0 years. In person religious attendance was found to be positively associated with higher QoL [Beta = 0.07, 95% Confidence Intervals (CI) = 059.45, 564.16, p < 0.001] and negatively associated with Loneliness [Incidence Rate Ratio = 0.98, 95% CI = 0.97, 0.99, p < 0.001]. Remote religious attendance was positively related to higher anxiety [IRR = 1.03, 95% CI = 1.02, 1.04, p < 0.001].

Conclusion

These results suggest that in person religious attendance had some positive effect on QoL and Loneliness among older adults during the COVID-19 pandemic. Digital religious attendance was not shown to have the same positive effect on psychological health as in person attendance, and, in fact was associated with higher anxiety. This could be due to the lack of social benefit that would typically be found from in person attendance. Future research should be done to assess how the relationship that older people have with digital religious services.
172 Using the early identification and management of delirium to optimise memory pathway referrals and resources
Authors: Prendergast A , Doyle M , Doherty-Walsh A , Byrne E , Simpson S , Murphy G , Nugent M , Bambrick P
Published: September 2023

Background

Priority actions within the National Dementia Strategy are to ensure early diagnosis of dementia and to develop appropriate referral pathways and interventions to support patients. One element is the consideration of referral to memory services for patients who develop delirium within the acute hospital setting, which may suggest possible underlying cognitive impairment. We examined the effect of early identification and diagnosis of delirium via an inpatient frailty service on this process.

Methods

Over a 9-month period (September 2022–May 2023), patients >75 years admitted to the acute medical floor were screened with the Rockwood Clinical Frailty Scale (CFS) by a multi-disciplinary in-patient frailty team. Those with a CFS score of 5–6 (mild to moderate frailty) were prioritised for Comprehensive Geriatric Assessment (CGA), which included the 4AT delirium screening tool. Patients presenting with a 4AT of 1–3 indicating cognitive vulnerability and those with a 4AT of >4 suggesting a probable delirium with possible dementia were identified for assessment.

Results

3,200 patients >75 years were admitted to the medical floor during the 9 months. Over 2,100 patients were screened for mild to moderate frailty and 495 CGA’s were completed. 105 patients presented with a 4AT of >4 with 44% not having a formal diagnosis of cognitive impairment. 74% of this cohort were referred onward to memory streams. 143 patients presented with a 4AT of 1–3. 66% did not have a formal diagnosis of cognitive impairment, of which 61% were referred onward to memory services.

Conclusion

The development of delirium in the acute hospital setting is an important opportunity to assess for the presence of an underlying neurodegenerative process. Early identification and management pathways for delirium can allow timely initiation of referral to specialist memory streams to aid prompt diagnosis of dementia, facilitating optimisation of care, supports, and advanced planning.
218 An analysis of the impact of psychotropic medications on gait in the Irish longitudinal study on ageing (TILDA)
Authors: O’Donnell D , Moriarty F , Lavan A , Kenny R A , Briggs R
Published: September 2023

Background

Prescriptions of psychotropic medications for older adults have become increasingly prevalent, despite older adults being most susceptible to their side effects. There is currently a paucity of information regarding how psychotropics effect gait parameters.

Methods

Participants were included if they: were aged ≥60 years at Wave 1, had a medication list examined for medications of interest and underwent the TILDA health assessment with measures of gait and mobility (Timed-Up-and-Go [TUG], gait speed, double support time, stride length, stride width). Antidepressants were identified with an ATC code of N06A. Benzodiazepines were coded N05BA, N05CD and N03AE. ‘Z’ drugs were coded as N05CF and antipsychotics N05A. Linear regression models assessed the relationship between psychotropics and individual gait parameters. Logistic regression assessed the relationship between psychotropic use at Wave 1 and gait parameters at Wave 3.The likelihood of transitioning from a normal to an abnormal TUG and to the lowest quartile of each gait parameter was examined. Models were adjusted for age, sex, educational attainment, alcohol intake, chronic disease burden, heart disease, depressive symptoms, poor sleep and cognitive impairment.

Results

Of 2,620 participants, 12% were prescribed a psychotropic medication (0.12 [95% Confidence Interval [CI] 0.11–0.13]), with 4% prescribed 2 or more psychotropics (0.04 [95% CI 0.03–0.05]). Participants prescribed one (mean TUG 9.9 seconds [95% CI 9.5–10.3]; n = 201) or more psychotropics (10.2 seconds [95% CI 9.7–10.6]; n = 105) had a significantly longer TUG than those not prescribed psychotropics (9.0 seconds [95% CI 8.9–9.1]; n = 2,314). Step length was shorter in participants prescribed one (64.6 cm (95% CI 63.4–65.9)) or more (63.4 cm (95% CI 61.6–65.1)) psychotropics, compared to participants not prescribed psychotropics (69.1 cm (95% CI 68.7–69.5)).

Conclusion

Psychotropic medications adversely affect mobility by slowing gait speed, reducing stride length and increasing double support time. Patients should be counselled regarding these potential effects.
243 A missed opportunity for intervention: vertebral fracture reporting
Authors: McGurk C , Alnajjar A , Carvalho J , Ong J , Paponette B , Hickey P , O'Sullivan F
Published: September 2023

Background

Vertebral Fractures (VFs) are the most common fragility fracture—with an incidence of 1 in 5 women over 70. A Vertebral Fragility Fracture (VFF) is a powerful predictor of another VF and of future hip fractures. Yet nearly 70% of VFs do not come to medical attention. Opportunities to identify a VFF and institute secondary prevention arises when a patient is referred for imaging for any clinical reason. However, VFFs are commonly unrecognised radiologically or reported ambiguously. The aim of this audit was to retrospectively evaluate VFF reporting terminology and recommendations as per published guidelines.

Methods

All radiographic reports from 2021–2023 in an Irish hospital were screened for osteoporotic and VFF key-terms in patients >65 years via the PACs platform. Data was analysed for 1) comments on vertebral integrity; 2) usage of the term ‘vertebral fracture’; 3) inclusion of actionable recommendations.

Results

A resultant total of 250 reports were reviewed, 223/250 from plain films. Fracture was reported 50.8% (n = 127) of the time. Ambiguous terminology like ‘compression’; ‘sagging’; ‘height loss’ ‘collapse’; ‘wedging’ was used in 49.2% (n = 123). Even where vertebral height loss was reported as 20% or greater, the term ‘fracture’ was not used in 59% (29/49). No report made recommendations for further investigation.

Conclusion

This audit highlights that even when osteoporotic challenges to vertebral integrity are recognised, they are not reported in a standardised way that reflects the ‘red flag’ significance of a VFF. The heterogeneous and ambiguous reporting fails to alert other clinicians to their significance—resulting in a missed opportunity to intervene. A reporting template and addition of actionable recommendations is for review at the internal monthly radiology quality forum.
275 Changing patient preferences: from the greatest generation to millennials
Authors: Chapman L , Daly S , Doyle R
Published: September 2023

Background

A study in an urban teaching tertiary hospital in 1999 surveyed patient preferences regarding the use of first names in doctor-patient interactions, doctors’ age and gender as well as room preference. We sought to replicate this survey to assess changing preferences.

Methods

A 10-item survey was administered to hospitalised inpatients in April 2023. Comparison between preferences in 1999 and 2023 and between those aged under and over 65 years were performed using Chi-Square.

Results

Of the 167 inpatients surveyed, 52% (n = 87) were male. Median age was 66 years. In 1999, 206 patients were surveyed. Median age was 60 years. In 2023, the overwhelming majority (98%) preferred to be addressed by their first name compared with 74% (n = 151) of the 1999 cohort (p < 0.0001). Almost two-thirds (62%) preferred their doctor to introduce themselves by their first name compared to 14% (n = 29) of the 1999 cohort (p < 0.0001). Among those over 65 years, a significant decline in preference of doctors using their full title was observed (90% in 1999 versus 38% presently; p < 0.0001). Previously, 93% indicated no preference regarding physician’s gender versus 80% currently (p = 0.0006). Among those over 65 years, preference for male doctors fell significantly from 22% in 1999 to 1% in 2023 (p = 0.0003). A single room was preferred by 39% (n = 64) now compared with 27% (n = 56) in 1999 (p = 0.03). However, half (52%) of those over 65 years and 38% (n = 30) of those under 65 years still prefer multi-bed wards (p = 0.08). A reduction in those favouring mixed-sex wards was observed from 15% in 1999 to 4% presently (p = 0.01). Less patients under 65 years favour a mixed-sex ward now (3%) compared to 1999 (20%; p = 0.0003) Almost all (98%) patients agreed with medical students (68% in 1999; p < 0.0001).

Conclusion

Agreement with first name use in the doctor-patient relationship as well as medical student education is increasing. Single rooms are increasingly preferred although multi-bed wards are still favoured.
338 Profile of older adults post hip fracture: a pre and post-Covid comparison
Authors: Costello R , Larkin J , O'Connor M
Published: September 2023

Background

The Irish Government implemented public health measures during the COVID-19 pandemic, including self-isolation among older citizens. Within our rehabilitation centre, the multidisciplinary team remarked on what they perceived to be negative health repercussions from ‘cocooning’, particularly those admitted following hip fracture. We sought to compare patient cohorts in 2019 and 2022.

Methods

Data was examined from the Irish Hip Fracture Database online portal specific to our Model 3 hospital for 2019 and 2022. Subset analysis was performed on hip fracture patients admitted to an off-site rehabilitation centre using that hospital’s electronic patient database.

Results

245 hip fractures were recorded in 2019 and 380 in 2022. In 2019 37% were aged between 80–89, 12% were over 90. In 2022 45% were aged between 80–89, 14% were over 90. ASA grade pre-operatively; in 2019, 33% were classed as normal or with mild systemic disease, 61% were in the severe systemic disease category. The same categories in 2022 were 41% and 55% respectively. Discharge destination for patients in 2019 and 2022 respectively were as follows: discharged directly home 27% vs 25%, discharged to offsite rehabilitation 32% vs. 38%, new Long-Term Care (LTC) admission 2% vs 3%. Our rehabilitation unit received 26 patients in 2019 and 39 in 2022. The average timed up and go (TUG) on admission in 2019 vs 2022 was 38.7 and 53.7 seconds respectively.

Conclusion

There was a 55% increase in the number of patients presenting with hip fracture post Covid. Despite similar age and co-morbidity profiles patients average TUG was 39% slower post Covid. Less patients were discharged directly home in 2022, more patients required a period of rehabilitation and the number of new admissions to LTC increased. This small study supports our hypothesis surrounding the detrimental effects of cocooning on older patients.
350 Evaluation of analgesia prescribing in hospitalised adults ≥ 65
Authors: Ryan M , Russell T , Khan P , Briggs R , Cunningham C , Relihan E , Lavan A
Published: September 2023

Background

Pain is common in hospitalised patients aged ≥65. It is recommended to follow the World Health Organisation pain ladder but special consideration should be given to the adverse effects of opiates and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

Methods

A retrospective review of geriatric medicine inpatients aged ≥65 years was conducted. Data was collected from August 2023 over a 24-hour period using electronic patient records.

Results

One hundred and nineteen patient records were reviewed. The average age was 84 years (SD = 3.53 years); 56% female. One hundred and eleven patients (93%) were prescribed analgesia. Seventy patients (56%) had pain documented as a clinical issue with musculoskeletal (MSK) pain, the most common type at 64%(n = 45)), 10% (n = 7) undocumented pain source, 8.5%(n = 6) visceral pain, 8.5% (n = 6) vascular pain, 3% (n = 2) neuropathic pain, 3% (n = 2) cancer related pain, and 3% (n = 2) dental pain. Fifty-five patients (49.5%) were prescribed regular paracetamol, and fifty-one (46%) as required (PRN) paracetamol. Twenty-two (20%) were on a regular opiate and forty-two (38%) on a PRN opiate. Oramorph was the most common opiate prescribed (n = 26). Nineteen patients (17%) were on a regular NSAID; with twenty-one (19%) on a PRN NSAID. Topical diclofenac was the most common agent (28 patients). Sixteen (14%) patients were on a neuropathic agent, of which pregabalin was the most common (9 patients). 53% (N = 63) of patients were newly prescribed paracetamol, 26% (N = 31) opiates, 18% (N = 21) NSAIDs and 8% (N = 9) neuropathic agents. Twelve patients without an active pain issue were charted regular paracetamol. Thirty-four patients prescribed opiates had renal impairment.

Conclusion

There was a high rate of analgesia prescribing among older hospitalised patients (93%). Paracetamol was followed by opiates, NSAIDS and neuropathic agents in frequency. Issues identified include paracetamol over prescribing, NSAID underuse and use of opiates in renal impairment. These findings suggest that clinicians would benefit from a local guideline for the management of pain in the older population.
4 How do befriending services impact health? A mixed-methods analysis of potential mechanistic pathways
Authors: Power J M , O'Reilly A , Hannigan C
Published: September 2023

Background

Befriending services do not appear to impact loneliness, but they may have an effect on health. To understand their effect further, we conducted a mixed methods study of the ALONE Befriending and Practical Support Service, using a single case experimental design and supplementary dyadic constructivist grounded theory interviews.

Methods

To understand the potential mechanistic pathways between befriending services and health outcomes, we integrated qualitative and quantitative findings using a pluralistic triangulation approach. Qualitative and quantitative findings were sequentially paired and described as either in agreement, in partial agreement, dissonant, or silent.

Results

Qualitative and quantitative findings were in full agreement that befriending had a direct impact on the health of older adults. There was dissonance on the impact of befriending on loneliness; while quantitative findings showed no direct effect of befriending on loneliness, the qualitative findings suggested that befriending reduced loneliness. The quantitative findings supplemented the qualitative by demonstrating that the befriending service is likely to buffer the negative effect of loneliness on health. The qualitative study revealed four other mechanisms through which befriending may impact health (by providing emotional support, lifting mood, opportunities for engagement in health behaviours, and cognitive stimulation) which were not explored in the quantitative study.

Conclusion

Findings suggest that further research is still required to unpick the nature of the link between befriending and loneliness. It is possible that gratitude for the service mediates this link, which warrants further exploration. Overall we can recommend that befriending services are useful for older adults for protecting health.
7 Designing and testing an integrated community care model with a remote home monitoring-alert device: a pilot study in Japan
Authors: Obayashi K , Kodate N , Kondo H , Okamoto Y , Kurishima S , Ishii Y , Nonoda T , Yasukawa T , Masuyama S
Published: September 2023

Background

An integrated model of health and social care in the community has been considered to be the gold standard, although many obstacles and challenges still exist. Living at one’s private home for as long as one wishes requires highly personalised arrangements, and therefore is costly, but assistive technologies can potentially facilitate this. In order to test the concept, a remote monitoring and care delivery system was developed. The usability and efficacy of the model were examined.

Methods

Sensor devices (biometric, temperature sensor and infrared camera sensor) were set up in the homes of five older people (aged 70 years and over), and the information was sent online to each older person, plus his/her family and caregivers. Using these devices, fifteen care professionals delivered home care and remotely supported the home life of the older adults between December 2022 and January 2023. A pre-post study design was adopted, collecting the System Usability Score (SUS), the International Classification of Functioning, Disability and Health (ICF) and the InterRAI assessments. The participating older adults and family members all consented to the research, which involved being observed or watched (all images are silhouettes only) when the system was in operation.

Results

Remote monitoring with alerts and two-way communication functions was highly valued by caregivers, as it provided an alternative model of care delivery, particularly for those living alone. While the device usability was not highly rated (D), several improvements in ICF and InterRAI scores were recorded (e.g. interpersonal communication, self-care, depressive tendencies).

Conclusion

While more research is necessary to increase the sample size and the duration of the data collection period, there is great potential for this model, embedding the use of assistive technologies into home care delivery. The study was funded in part by the Japan Agency for Medical Research and Development (22he2002023j0002).
14 How can remote rural island place influence the ageing of mid-life women?
Authors: Herbert A
Published: September 2023

Background

This contribution to social gerontology and nissology addresses a knowledge gap in contemporary gendered ageing within remote, rural island place. Reflecting participant narrative, this study explores personal and place identity, place attachment, and perspectives on gendered island ageing at mid-life and in older age.

Methods: Drwing on empirical data gathered through in-depth interviews with 12 mid-life (48–69 years old) women living in remote islands of Scotland, the relationship between ageing and remote rural island living is examined. This qualitative work adopts a life-course framework in order to acknowledge lived experience and cultural context from childhood to adulthood. Data were analysed and informed by constructivist grounded theory, a methodology well placed for exploratory research about which little is known.

Results

Data found no island mono-culturalism. Remote rural island ageing appears distinct from mainland rural ageing. Findings indicate diverse relationships between ageing and place among mid-life women living in the islands of this study. The connection between ageing and island place is influenced by a range of socio-economic factors, the primary one of which is the natural environment. Other influencing factors include social relationships, employment, health, and demographic status. Perspectives on ageing vary between those native and non-native to the islands; those who live with partners or alone; those who have children and those child-free; and between those who enjoy socio-economic stability and those who do not.

Conclusion

Despite remote location, and limitations of employment, education, health and transport, participant data reveals an overall positive relationship between remote rural island living and ageing among this study’s indigenous and in-migrant women. The physical, mental and spiritual benefits derived from the natural landscape of island home place proved primarily to be the greatest positive influence reported towards perceived better ageing.
18 Early supported discharge for older adults admitted to hospital with medical complaints: a qualitative study exploring the views of stakeholders
Authors: Williams S , O'Riordan C , Steed F , Leahy A , Shanahan E , Peters C , O’Connor M , Galvin R , Morrissey A-M
Published: September 2023

Background

Early Supported Discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD reduces length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints.

Methods

We conducted a qualitative interview and focus group study at University Hospital Limerick (UHL) from November 2021 to January 2022. Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used for focus groups. Braun and Clarke’s approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021).

Results

Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: (1) Pre-ESD experiences of providing and receiving older adult inpatient care, (2) Navigating discharge procedures from acute hospital services and (3) A vision for more integrated model of care and a medical ESD team.

Conclusion

This qualitative study was the first to explore the views and perceptions of older adults and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. The current experiences and barriers to efficient and safe discharge home from hospital were highlighted by stakeholders. The potential role for ESD in this population group was discussed, as well as the key factors to be considered in running an ESD service for medical older adults.
28 Training future leaders in geriatrics—an executive leadership academy
Authors: O’Donovan C , Gannon E , James K
Published: September 2023

Background

Medical training has continued to move towards a competency-based framework of education. Leadership, management, and non-clinical skills are core competencies included in the Geriatrics HST training programme however formal training opportunities in this area are often limited. We designed a novel geriatric medicine registrar executive leadership academy with the following aims: (1) Enhance registrar leadership and management skills; (2) Explore non-clinical career interests e.g. research, education and (3) Develop non-clinical skills essential for consultant posts e.g. conflict resolution, service development.

Methods

We organised a consultant led executive leadership academy held once per month November–May. Consultant of the month provided a brief overview of their career and taught on a leadership and management topic. We created an educational needs assessment survey prior to commencement to rank leadership/management topics and assess the baseline level of knowledge and exposure thus far to training/experience in leadership and management. Pre and post-test surveys were conducted to assess for improvements in self-efficacy and knowledge in areas of leadership and management skills following this educational intervention.

Results

12 registrars took part in the program with a range of registrar experience from one to six years. 10/12 completed a pre-program survey with three of these stating they felt ‘very confident’ in their leadership/management skills. Ranking of a list of topics allowed the program to be tailored to the registrars preferences. At the end of the program there was an increase in the registrars’ ability to identify personal areas in need of improvement.

Conclusion

The program was very successful with increased knowledge in non-clinical areas of medicine, increased confidence among trainees in applying for consultant posts and an enhanced relationship with consultants within the department.
33 Audit: delirium recognition on an acute medical ward
Authors: Gibbons C , Casey M , Shanley O , Connolly-Bree M , Lipsett O , Rothwell C , Casey N , Ocsio A , O'Malley G
Published: September 2023

Background

Delirium is a serious medical condition that is common in older adults in hospital settings. Clinical guidelines recommend that this cohort should be routinely screened for delirium. Our aim was to assess whether or not delirium was being recognised and documented on General Medical Wards (GMW) and to trial a multifaceted intervention to improve delirium detection and treatment.

Methods

We completed weekly prospective chart reviews on all patients aged ≥65 years on a GMW over a month-long period. We screened all identified patients using the 4AT. We then completed a multidisciplinary quality improvement initiative encompassing a comprehensive awareness and education program on delirium. We introduced standardised delirium screening using recognised tools and a new management tool for delirium for placement in medical notes. A re-audit was carried out.

Results

We included 37 patients (n = 37) in the pre-intervention study—mean age 81 years; 23 women (62%). 1 (2.7%) patient had a 4AT documented in their chart. We identified n = 5 patients with a 4AT ≥4 consistent with acute delirium. Of these 5, 2 (40%) had been flagged by the CNM and 1 (20%) by the medical team as delirious. We included 39 patients (n = 39) in our post-intervention study with similar demographics. 64% (25) of these patients had a 4AT or SQUID documented during the study period. We identified n = 3 patients with a 4AT ≥4–2 (67%) were flagged by the CNM and 3 (100%) by the medical team. Two thirds (66.67%) were documented as delirious in the medical notes.

Conclusion

Our audit demonstrates that a comprehensive education and awareness program can improve the detection of delirium in older adults on a GMW. This initiative was designed as a quality improvement project to support the development of a standardised program to be rolled out across all relevant units in a level 3 hospital.
35 Age, procrastination, depressive symptomatology, and loneliness: a structural equation modelling approach
Authors: Monaghan C , Power J M
Published: September 2023

Background

Procrastination, the voluntary delay of an intended course of action despite potentially negative consequences, is experienced by individuals of all ages, and yet little research to date has focused on procrastination behaviours among older adults. We wanted to explore the potential association between age and procrastination, and potential causal mechanisms therein.

Methods

We applied structural equation modelling to data from two waves of the United States Health and Retirement Study (collected during 2016–2020). The sample consisted of adults predominantly over the age of 50 (n = 1,320; mean = 64, range = 28–92) who completed measures of depressive symptomatology, loneliness, and procrastination across the two waves. The direct association between age and procrastination was investigated with both depressive symptomatology and loneliness being assessed as potential mediators.

Results

Model fit was acceptable (e.g. Comparative Fit Index = 0.931). The model results showed that age did not have a significant effect (beta = 0.010; p = 0.782) on procrastination. However, an indirect effect was present (beta = −.040; p < 0.001). While age was not directly associated with procrastination, age was associated with increased likelihood of depressive symptomatology, which was in turn associated with increased likelihood of procrastination. No mediating effect of loneliness was observed (beta = −.010; p = 0.371).

Conclusion

We report an indirect effect of age on procrastination via depression, absent of a direct effect (which is not uncommon). Our findings suggest the presence of an inhibiting mediator, one not included in our model. For instance, while age may increase the likelihood of depression, yielding a positive effect on procrastination, age may also be associated with increased time management skills, or wisdom, which would potentially be associated with lower procrastination likelihood. Results are discussed in relation to potential implications for procrastination behaviours beyond retirement, and for potential sequelae such as financial decision-making or health behaviour.
41 Prevalence of delirium among older patients attending a Frailty service in an Emergency Department
Authors: Sheil O , Okon M , Roche E , Duffy P , Small C , Shortt C
Published: September 2023

Background

Delirium is a common clinical syndrome in older patients attending the emergency department and its incidence increases with patient age, disease severity and baseline cognitive impairment. However delirium is frequently unrecognised in emergency departments. The 4AT is a simple and short delirium detection tool designed for easy and effective clinical use. Early proactive recognition of delirium in the ED may improve outcomes such as length of stay and discharge to patients own home.

Methods

We undertook a retrospective study of 92 patients who attended the Frailty service in the ED between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and screened for frailty using the CFS with additional data collected to define age, sex, presenting complaint, length of stay and readmission rates.

Results

The 4AT was completed for 92/94 patients. 21/94 scored positive for delirium indicating a delirium prevalence rate of 22% among our Frailty service cohort. The average age of the patients was 84 years and 57% were female. Clinical Frailty Scale ranged from CFS 4–7 reflective of service parameters. The primary presenting reasons were fall (38% of patients) and infection (LRTI or UTI) for (38% of patients). The average length of stay was 8 days and the readmission rate was 12%. Baseline cognitive impairment was present in 71% of cases. 53% of patients were discharged to their own homes.

Conclusion

Delirium prevalence in the ED among frail older persons is 22%. The 4AT is a useful tool to quickly detect delirium in the ED. Delirium prevalence is greater in patients with baseline cognitive impairment.
42 Resolution of delirium upon discharge & mortality rates among frail older persons attending an Emergency Department frailty service
Authors: Okon M , Sheil O , Roche E , Patricia D , Shortt C , Small C
Published: September 2023

Background

Delirium is an acute confusional state, frequently associated with older hospitalised patients and has been found to be related to several adverse outcomes including longer length of stay and mortality. Better baseline cognition has been linked with a lower risk of delirium however those with high baseline cognition may experience greater cognitive decline post delirium.

Methods

We undertook a retrospective study of 92 patients who attended the Frailty service in the Emergency Department between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and collected additional data collected to define baseline cognitive status, delirium resolution, and length of stay and discharge disposition.

Results

Delirium prevalence in this cohort was estimated at 22%. Overall delirium had resolved for our patients at discharge in 56% of cases. In the cognitively intact at baseline group (29%) delirium had resolved at discharge in 33% of cases only. For patients with baseline cognitive impairment (71%) delirium had resolved in 50% of cases. The mortality rate for patients with delirium was 14% with average CFS of 6. All patients who died had cognitive impairment at baseline. The mortality rate for patients without delirium was 1.4%. Length of stay ranged from 0 to 80 days. Length of stay for patients with delirium & baseline cognitively intact was 39 days. Length of stay for patients with delirium and baseline cognitively impaired was 8 days.

Conclusion

Two thirds of patients who were cognitively intact at baseline experienced longer length of stays & non resolution of delirium at discharge. There may be a need for dedicated follow up of these patients post-acute discharge. There was a higher mortality rate for patients with delirium and baseline cognitive impairment. Future studies may address illness acuity, delirium severity and duration & emergency department length of stay as influencers on mortality rate.
63 Introduction of an older persons comfort cart to an emergency department
Authors: Sheil O , Patricia D , Eavanna R
Published: September 2023

Background

Increasing numbers of older persons are presenting to our emergency department with complex needs. There has been a 13.8% increase in ED attendances by patients aged 75 years and over since 2019. Patients aged 75 plus spent on average 13.75 hours in the ED. Poor vision and hearing, functional decline, cognitive impairment and impaired communication can be exacerbated by the busy ED environment. The Frailty service identified a gap in our ability to provide comfort & communication items to our older patients in the ED.

Methods

We administered pre-intervention surveys to both older adult patients and ED staff to identify the level of interest in access to non-pharmacological comfort-enhancing resources & what items they wanted included in the cart. The cart included items to aid safety, comfort, mobility, memory, hearing, vision and activity. We measured the effectiveness of the comfort cart through a patient and staff survey.

Results

95% of surveyed patients strongly agreed that the comfort cart items improved their comfort, aided sleep, helped them to communicate and aided their overall ED experience. 100% of surveyed staff strongly agreed that comfort cart items improved patient comfort, increased staff satisfaction in providing care and improved efficiencies in accessing comfort items such as eye masks, earplugs, grippy socks etc.

Conclusion

The introduction of an older person’s comfort cart improved satisfaction of older patients in the ED and increased staff’s perception of patient comfort, as well as enhanced communication through availability of hearing devices & glasses. Helping our older patients feel comfortable and valued is what we set out to do with this quality improvement project and we hope it will continue to have a positive effect on our older patient’s experience in the ED. Other areas of the hospital are now rolling out similar carts for their patient cohort.
64 Driving positive ageing at home: older adults’ engagement with ALONE support services
Authors: O'Reilly A , Petrie N G , Bennett C , Geoghegan C , Gallagher J , Power J M
Published: September 2023

Background

It is estimated that by 2050 approximately 1.6 million Irish people will be aged 65 or over. This dramatic shift in population highlights the importance of supporting positive ageing, and the need to develop medical and non-medical infrastructure and services that can meet the needs of this growing age group. ALONE is a national organisation that aims to transform ageing in Ireland, by supporting older adults to age within their own homes and communities positively and securely. This research aims to provide a descriptive portrayal of the response of older adults to ALONE’s services. Specifically, this study examined the demographic and clinical characteristics of older adults who seek support from ALONE and described the implications of these findings for policy and service delivery.

Methods

Data from older people who engage with ALONE services are captured through an online system designed to record salient clinical and service delivery information. Data analysed for this study included demographic characteristics, presenting needs, and nature, duration, and frequency of service engagement.

Results

Most older people engaging with ALONE were female, aged 76–85 years and were referred to ALONE from the HSE, hospitals and primary care centres. Older people living in non-owner occupied homes, and reporting a recent fall and mobility issues were overrepresented in the data whilst social isolation, physical health issues and housing needs were commonly reported. Visitation support and befriending represented the highest area of need among older people, who generated an average of 3.4 interventions.

Conclusion

The findings from this research provide insights into older people’s needs and contribute to our understanding of emerging features of innovative health service delivery for older people. These findings will support policymakers and service providers in creating and implementing integrated psychosocial and medical community services for older people.