bluuebunny/crossref_metadata_2025 huggingface dataset:
152 EXPLORATORY ANALYSIS OF TROPONIN AS BIOMARKER OF ACUTE ISCHAEMIC STROKE SUBTYPES IN A GROUP OF PATIENTS RECRUITED TO THE MIND STUDY
Authors: Bejleri J , Cvetkova J , Williams D , Pfeiffer S
Published: October 2022

Background

Stroke is a major common cause of acquired disability and death worldwide. Atrial dysfunction or cardiomyopathy, defined by the presence of specific serum biomarkers, ECG findings, or echocardiographic findings, increases the risk of atrial fibrillation, which has been implicated as a key risk factor for ischaemic stroke. There is now growing body of evidence which suggests that early positive troponin after ischaemic stroke may be independently associated with a cardiac embolic source. miRNA as Novel Diagnostic biomarker (MiND) is a current Irish-led research study whose aim is to discover a unique highly diagnostic and prognostic biomarker expressed in acute ischaemic stroke.

Methods

Data were retrospectively extracted from patients recruited to the MiND study with confirmed diagnosis of acute ischaemic stroke within 12 hours of symptoms onset having also undergone high-sensitivity troponin testing from July 2019 to November 2021. Stroke subtypes were classified as per ESUS criteria. Statistical analysis was carried out using STATA/SE, version 16.0.

Results

We identified 52 patients who had troponin performed within 12 hours of symptoms onset. Twenty-two patients were identified as having cardioembolic stroke (CE), 17 as non-cardioembolic stroke (NCE) and 13 as Embolic stroke of unknown source (ESUS). The mean age for each group was 77.5 (±9.8), 65.5 (±12.8) and 66.3 (±11.7) years, respectively. The rate of troponin positivity for each group was 55% (12/22), 29% (5/17) and 15% (2/13), respectively. The unadjusted logistic analysis revealed a positive association between CE stroke subtype and elevated troponin (OR 3.94, 95% 1.20-12.98, p = 0.024) and an inverse association between ESUS stroke subtype and elevated troponin (OR 0.24, 95% CI 0.05-1.21, p = 0.083).

Conclusion

Our analysis reveals that early positive troponin after ischaemic stroke is a strong predictor of CE stroke subtype but not of ESUS stroke subtype.
153 AN EVALUATION OF OLDER PERSONS WITH VESTIBULAR DYSFUNCTION AS IDENTIFIED DURING COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Sayers K , Treacy G , King L , Ryan S , Donnellan C
Published: October 2022

Background

Vestibular dysfunction accounts for 25% of dizziness complaints. In 30-50% of these cases, dizziness is attributed to Benign Paroxysmal Positional Vertigo (BPPV). Thirty percent of people will experience vestibular dysfunction in their lifetime, with likelihood increasing with age. Individuals with vestibular dysfunction are eight times more likely to experience a fall. Vestibular assessment and rehabilitation services can be difficult to access.

Methods

A Plan, Do, Study, Act (PDSA) cycle was undertaken. All referrals to the Older Persons’ Services Clinics from November 2021 to May 2022 were triaged by an Integrated Care Team for the Older Person and scheduled for Comprehensive Geriatric Assessment (CGA). In the course of CGA, patients who reported symptoms suggestive of vestibular dysfunction received assessment by a Physiotherapist with vestibular expertise. Results were entered on an Excel spreadsheet and analysed using descriptive statistics.

Results

Six patients (4 female, 2 male) received vestibular assessment and treatment. Mean age was 75 years (SD: 11) with median Clinical Frailty Score of 4 (vulnerable). Reported symptoms were dizziness (n=3) and spinning (n=3). Sixteen percent (n=1) reported a fall and 66% (n=4) reported fear of falling. All patients had symptom duration of >2 years. Following vestibular assessment, the following diagnoses were made; right posterior canal BPPV, (n=2), vestibular migraine (n=2), right horizontal canal canalithiasis BPPV, with secondary diagnosis of persistent postural-perceptual dizziness (n=1) and left peripheral vestibular hypofunction due to vestibular neuronitis (n=1). The mean number of Physiotherapy visits per person was 4. Three patients reported full resolution of symptoms. The remaining 3 reported an improvement in symptoms and confidence to self-manage.

Conclusion

This small cohort of older persons with chronic vestibular dysfunction benefited from vestibular diagnosis and intervention. The next step of the process is to include specific vestibular screening questions into CGA. This will enable Integrated Care Team members to screen more specifically for vestibular dysfunction.
158 AN AUDIT ON DISCHARGE SUMMARIES IN A MEDICAL GERONTOLOGICAL WARD
Authors: Makhura RW , Nzeji C , Rahaman F , Fallon A
Published: October 2022

Background

Discharge summaries are an integral part of communication within healthcare to ensure safe care across settings. Alterations are documented and relayed between relevant healthcare professionals. This audit evaluates quality of discharge summaries from a medical gerontology ward against the National Standard for Patient Discharge Summary Information (HIQA)

Methods

A retrospective audit was carried out with data collected from a ward discharge registry over 3-months (February-April 2022) and associated discharge summaries.

Results

A total of 31 discharges (including death) were identified during the set period, 97% (n=30) of which had completed discharge summaries. Upon assessment against the standard, 100% (n=30) included details vital to patient identification including name, date of birth, gender and address. In addition,100% (n=30) included information on date of admission-discharge, clinical course, relevant investigations, treatments, procedures, discharge medications and details of the doctor completing the discharge summary. The audit identified that 20% (n=6) of summaries stated referral source, which is mandatory according to the standard. 13% (n=4) included dietary interventions and 0% included immunization information (whether as an inpatient or prior). Regarding information on further management, 77% (n=23) had guidance on follow-up hospital care, 27% (n=8) had information about social care actions, 20% had advice, recommendations and future plans documented and in 10% information was documented to be given to patient and carer.

Conclusion

Compliance with mandatory information including patient details, admission/discharge date, diagnoses, hospital course, and author fully met the standard. However, there was poor compliance with information relevant to continuation of patient care in the community. This is particularly relevant for older patients with multiple co-morbidities and complex care needs. Doctors working on this ward are receiving education regarding the importance of documentation of functional status, social care needs and diet at discharge. In future, mandatory documentation as part of electronic discharge summaries may improve compliance and continuity of care across settings.
160 A CLOSED-LOOP AUDIT EXAMINING THE USE OF PROPHYLACTIC ANTI-COAGULATION IN OLDER ADULTS ADMITTED TO A SPECIALIST GERIATRIC SERVICE
Authors: Brar SK , Sheehan O , Martin R , Rasheed M
Published: October 2022

Background

Guidelines recommend prescription of Prophylactic Anticoagulation (PA) to all hospitalized older adults unless a contraindication exits. In many cases this does not happen at the time of admission increasing the risk of thromboembolic events. We aimed to assess the use of PA across the medicine for the geriatric service of a level 3 hospital (average daily census of service 120) then use quality improvement to achieve our goal of 95% prescription of prophylactic anticoagulation when appropriate.

Methods

Medication kardexes and clinical notes were reviewed to collect variables including age, length of stay, creatinine clearance, weight, mobility status, use and dose of antithrombotic medications and documentation of reason if not prescribed. Following initial data collection, cause and effect analysis was performed to identify reasons for under-prescription and small tests of change were conducted across 4 PDSA cycles before data collection was repeated.

Results

Initial data collection revealed that only 80% of older adults admitted to the service were receiving prophylactic anticoagulation. Cause and effect analysis identified many reasons for failure to prescribe PA including inadequate history taking, lack of clinician education and training, poor documentation, lack of handover between clinicians, failure to complete medication reconciliation on admission and lack of pharmacy support on some wards. Each of these contributory factors were addressed in turn. After a month of QI activities prescription of PA improved to 83% and by 3 months 98.1% (104/106) of patients were receiving PA with only 2 patients for whom PA was not prescribed without clear documentation of the reason.

Conclusion

Sustained quality improvement resulted in a culture change across our service improving rates of appropriate prescription of PA and raising the quality of care delivered to older adults. This model of quality improvement is now being replicated across our department to address other gaps in service delivery.
162 A REVIEW OF THE GENERAL PRACTITIONER REFERRALS TO A RAPID ACCESS FRAILTY ASSESSMENT UNIT IN A MODEL-3 HOSPITAL
Authors: Kitic DB , Ibrahim M , McGlynn J , O'Keane C , Donnelly T , Kemple O
Published: October 2022

Background

The Rapid Access Frailty assessment unit (RAFAU) was set up in February 2021 and is run by a Raft (Rapid access frailty team). This is a dedicated multidisciplinary team in a model three hospital to review frail older patients to improve outcomes and admission avoidance. They review patients in the Emergency department as well as the assessment unit and on the ward for inpatient frailty reviews. The team is expanding as new roles are incorporated into the team and our service has evolved into a five day a week rapid access service.

Methods

We examined the number of GP referrals to our RAFU since May 2021 to March 2022 and the outcome of the review. Data was collected on all patients attending the RAFAU over an 11-month period. We selected all GP referrals which produced a cohort of 259 referrals to the unit.

Results

A total of 259 referrals were reviewed in RAFAU clinics. Mean age was 70-75 years old 60% were female, 40 % male. Reason for referral included: 38 % medical reasons, 32% cognitive issues, 18 % mobility ,7 % falls. Overall, 41% of referred patients had Clinical frailty scale score of 1-3, 16 % had a clinical frailty scale of 4, 8% clinical frailty scale of 5, 9% clinical frailty scale of 6, 5% clinical frailty scale of 7.The outcome of this cohort were as follows: 86 % needed further follow up, 9% were discharged and 1% admitted.

Conclusion

The RAFAU gives an alternative referral destination to GP’s for rapid review of frail older patients and thus potentially avoiding ED referral and admission. The vast majority of these referrals were for review of medical issues and cognitive assessment. The majority of patients required ongoing specialist frailty services and we hope to expand our service in the future.
167 ASSISTED DECISION-MAKING (CAPACITY) ACT 2015: KNOWLEDGE AND ATTITUDES AMONG HOSPITAL DOCTORS
Authors: Ragab I , O'Brien M , Martin A
Published: October 2022

Background

Assessing capacity is part of our daily practice, and an important pillar of patient centred care. Assisted Decision-Making (Capacity) Act 2015, which is due to commence in June 2022, is an act to provide reform of the law to assist patients who require help in making decisions in a manner that will ensure their autonomy, dignity, and best interests. This study aimed to investigate the knowledge, attitudes, and confidence of hospital doctors regarding this act.

Methods

This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and attitudes about capacity assessment. The second section contained practical scenarios to test knowledge around the new framework for decision support under the Act.

Results

Of the 670 consultants and non-consultant hospital doctors (NCHD) surveyed, an 11% response rate was achieved (75 respondents), 44% were consultants 56% were NCHD. 43% reported to lack confidence in assessing capacity. 92% felt that they needed more training regarding the act. Also, 80% agreed the act will have an impact on our practice. 80% thought capacity was carried out by a certain specialty (mostly Psychiatry and Geriatrics). In the decision support scenarios 18-27% of responders felt they did not know what the appropriate level of decision support was. In each scenario, with the exception of one, the most frequent response was the correct one but responses were widely distributed on most questions.

Conclusion

Despite the lack of a representative sample, doctors’ knowledge about capacity seems to have improved compared to previously carried out studies. However, our study appears to indicate a significant knowledge gap and further training is needed regarding the Assisted Decision-Making (Capacity) Act 2015 proposed to commence next month. Mandatory training on the act should be considered by HSE and the professional training bodies.
168 AN EXPLORATION OF ATRIAL FIBRILLATION AND ANTICOAGULATION IN STROKE PATIENTS WHO UNDERGO THROMBECTOMY IN A TERTIARY THROMBECTOMY CENTRE
Authors: Murphy J , Kelly R , Cathasaigh CN , Murphy D , Cloney T , Hayes K , Arrigan G , O'Sullivan A , Barry P , James K , Healy L
Published: October 2022

Background

Atrial Fibrillation is a significant cause of ischaemic stroke. Prevalence of atrial fibrillation in patients requiring thrombectomy is approximately 33%. Embolic thrombi which develop due to Atrial fibrillation may become targets for clot removal by thrombectomy in appropriate patients. Anticoagulation is one of the mainstays of treatment for atrial fibrillation.

Methods

A list of patients who had thrombectomy performed for ischaemic stroke in 2021 was compiled. Charts were reviewed to establish the prevalence of atrial fibrillation and the rates of appropriate dosing of anticoagulant. Of those who were not anticoagulated, we aimed to establish if there was a clear reason for this. This was performed in a tertiary referral centre with 24/7 access to thrombectomy.

Results

97 patients had thrombectomy performed for ischaemic stroke in 2021. 34/97(35%) had atrial fibrillation (21/97 pre-existing , 13/97 newly diagnosed on admission). 15/21 were anticoagulated and 6/21 were not anticoagulated at the time of their stroke. 5/6 had a clear reason documented for stopping anticoagulation. One patient had stopped anticoagulation due to cost. Of those with atrial fibrillation who were anticoagulated at the time of their stroke, 11 were anticoagulated with a Direct-Acting AntiCoagulant (DOAC) and four were anticoagulated with Warfarin. Of the Warfarin group, just one patients’ INR was therapeutic at the time of their stroke. Of the DOAC group, all were on the appropriate dose.

Conclusion

Stroke patients requiring thrombectomy are a group who may suffer the largest strokes. Incidence of atrial fibrillation was similar to previous studies. It was encouraging that there was a documented reason for all patients who were not anticoagulated, and that the DOAC dose was appropriate. Issues with therapeutic levels of Warfarin are further highlighted here. This study concludes that we may not be as bad at anticoagulation as we may think.
179 WHAT IS THE RISK OF FALLS DUE TO PSYCHOTROPIC MEDICATIONS IN A LARGE POPULATION-REPRESENTATIVE COHORT OF COMMUNITY-DWELLING OLDER PEOPLE?
Authors: Gallagher E , Mehmood M , Lavan A , Kenny RA , Briggs R
Published: October 2022

Background

Psychotropic medications including antidepressants, anticholinergics, benzodiazepines, ‘Z’ drugs and antipsychotics, are frequently identified as Falls Risk Increasing Drugs (FRIDS), yet there is a relative lack of robust data detailing the prospective risk of falls associated with these drug classes.

Methods

Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) were included and followed from Waves 1 to 5 (Mean 7.6 years follow-up). Incidence of falls was ascertained by self-report and unexplained falls were defined as falls not caused by a slip or trip with no apparent cause. Medication lists were examined for medications of interest. Logistic Regression models, reporting odds ratio with 95% confidence intervals, were used to assess the association between medication classes and incident fall types and were adjusted for relevant covariates.

Results

2,090 participants were included (mean age at baseline 72 years, 53% female). During follow-up, over half of participants (52%, n=1,089) had a fall, with one quarter (25%, n=526) reporting an unexplained fall and almost one fifth (19%, n=394) reporting a fall causing injury. Anti-depressants were associated with an increased risk of falling (OR=3.01, 1.98-4.58, p<0.001), injurious falls (OR=1.96, 1.37-2.81, p<0.001) and unexplained falls (OR=2.71, 1.88-3.91, p<0.001) in fully adjusted models. Anti-cholinergic medications were associated with an increased risk of falling (OR=1.79, 1.11-2.88, p=0.017) and of unexplained falls (OR=1.89, 1.19-3.01, p=0.007). ‘Z’ drugs were associated with an increased risk of falling (OR=2.96, 1.64-5.32, p<0.001) and of injurious falls (OR=2.05, 1.26-3.34, p=0.004). Benzodiazepines and Anti-psychotics were not associated with incident falls in fully adjusted models.

Conclusion

Anti-depressants, anti-cholinergic medications and ‘Z’ drugs are independently associated with an increased falls risk. Given the profound impact falls can have on functional trajectory and quality of life, regular review of ongoing need for these medications should be central to the comprehensive geriatric assessment.
183 DEVELOPING AND FACILITATING ONLINE INTERGENERATIONAL CAFÉS
Authors: Tuohy D , Cassidy I , Carey E , Graham M , McCarthy J , Murphy J , Morrissey K , Shanahan J , Tuohy T
Published: October 2022

Background

Many older people throughout their lives will require nursing care, consequentially most nurses will care for older people during their career. It is important that older people and student nurses are provided with shared learning opportunities so that professional caring partnerships can be nurtured and realised for mutual benefit. Intergenerational projects offer opportunities for intergenerational learning. However, few projects explore student nurse-older person dyads and how these can be integrated within undergraduate pre-registration programmes. This paper describes the development and facilitation of online older person-student nurse intergenerational cafés.

Methods

The project was managed by a design team comprising senior administration, lecturers in BSc Nursing programmes and a lecturer in Design for Health and Wellbeing. The ‘world café’ concept along with values of enablement and participation underpinned the design. The initiative was planned to align with a year three community care module. Regular online team meetings were held to agree the aims and outcomes for student nurse-older person cohorts, decide recruitment strategies, agree the process and format of facilitation. Older people were recruited through retirement, church, volunteer, social and sporting organisations, media and also using snowballing methods.

Results

Both student nurse and older person cohorts were offered support on how to access and participate in the café. Participants attended one of three online cafés hosted through Microsoft Teams. Each café followed the same format: 1) Group meeting convened with all participants; 2) Breakout small group ‘table’ discussions with student nurse-older people participants and design team facilitation; 3) The café was reconvened to whole group meeting where feedback was collated to elicit shared learning.

Conclusion

The initiative proved successful and there is merit in embedding intergenerational cafés into professionally accredited health care programmes. Through sharing life experiences and perspectives, intergenerational barriers can be reduced and new insights developed on person-centred gerontological care.
184 THE EFFECTS OF MEDICINE OPTIMISATION BY A CONSULTANT PHARMACIST IN A 'HOSPITAL AT HOME' SETTING
Authors: Ryan K , Darcy C , Miller-Anderson R
Published: October 2022

Background

Hospital at Home is a rapidly growing initiative whereby patients are offered hospital equivalent interventions at their home. Given that patient numbers under the care of this team are often smaller than those on inpatient hospital wards, there is often more time to develop a personalised approach to medicine optimisation.

Methods

All 42 patients under the care of the local 'Hospital at Home' team had their medication reviewed by the team's Consultant Pharmacist for Older People. Using the STOP START tool with information from patients and carers each patient's medication was optimised.

Results

This data was analysed by a research pharmacist and anticholinergic burden, Eadon score, pill burden, adverse drug events and average direct drug cost savings were identified. All residents had their medication optimised. 5.25 clinical interventions per resident 81% were Eadon Grade 4. Medication appropriateness improved with downwards trend, pre and post intervention. The mean anticholinergic burden reduced to less than 3. (pre 3.63 vs post 2.63). An overall reduction in pill burden; for every 1 drug started 3 drugs were stopped (mean number of drugs 16 vs 13, pre and post intervention respectively). 50% of residents had an adverse drug event (causing harm) identified. Average direct drug costs savings of £385.28 per patient per annum.

Conclusion

This research shows the importance of the role of the 'Consultant Pharmacist for OIder People' in medicine optimisation in the 'Hospital at Home' team. It also highlights the benefit of the 'Hospital at Home' service to facilitate the often time-consuming task of effective medicine optimisation.
185 CURRENT CHALLENGES IN MANAGING MULTIMORBID OLDER PATIENTS WITH ATRIAL FIBRILLATION – A PAN-EUROPEAN PERSPECTIVE
Authors: Lee G , Baker E , Desteghe L , Heidbuchel H , Merino J , Collins R
Published: October 2022

Background

Atrial Fibrillation (AF) is the most common cardiac arrhythmia and associated with a substantial burden to patients and health systems globally and its prevalence is increasing as the population ages.

Methods

An online survey was distributed as part of a Horizon 2020 project (EHRA-PATHS) with the aim of evaluating how AF multimorbidity is currently addressed by clinicians, to characterize the treatment structure and to assess current interdisciplinary management of multimorbid AF. The survey included 21 questions and free-text option for comments on detection, assessment and management of AF-related comorbidities.

Results

A total of 451 responses were received with 339 responses eligible for inclusion with the highest response rate from United Kingdom, Spain and Ireland (n=149, 44%). From all responses, 221 were male (66%), 300 (91.5%) were physicians and 196 (57.8%) were working in academic university teaching hospitals. Half of the respondents managed between 20 to 50 patients per month with multimorbid AF. The survey revealed varying rates of specialist services and referral to these services such as diabetes and heart failure across Europe. Academic university teaching hospitals offered greater numbers of specialist services compared to non-teaching hospitals (e.g. anticoagulation clinic 92 (47%) vs 50 (35%), p<0.03). 67% (n=227) of respondents reported that approximately 40% of patients with multimorbid AF need onwards referral to other specialist clinicians. Barriers to referring to specialist services for AF comorbidities were identified and included lack of integrated care model (n=174, 51%), organisational or institutional issues (n=145, 43%) and issues with patient adherence (n=126, 37%). Respondents identified areas where patient outcomes could be improved: better access to patient lifestyle modifications; improved organisation flexibility to enable innovation; greater access to evidence-based guidelines; and better interdisciplinary collaboration.

Conclusion

The survey demonstrated the need for systematic, integrated management of AF-related comorbidities in older people and the results will inform the next stage of the EHRA-PATHS project.
188 A REVIEW OF THE REABLEMENT PROGRAM WHICH INCLUDES THERAPY ASSISTANTS WITHIN THE AMBULATORY HUB
Authors: Conaty J , Smith B , Sweeney M
Published: October 2022

Background

The Ambulatory Hub for the older person commenced in May 2021 in line with the Enhanced Community Care Implementation Guidance documents. From a client and carer perspective, the hub provides a single point of access and a co-ordinated approach to the client's care needs with a focus on frailty. The Reablement service is provided alongside the Hub team providing a specialist Occupational Therapy and Physiotherapy geriatric assessment. Depending on the outcome of the assessment and needs identified, the client can avail of the Reablement program. Each patient will have an individualised therapy program which is carried out by the therapy assistants in the client’s home. The Reablement program aims to provide care in line with the “Right Care, Right Place, Right Team, Right Time” ethos.

Methods

The charts of 20 clients who completed the Reablement program were reviewed. The data collected included the number of visits by the Occupational Therapist, Physiotherapist and therapy assistants. Feedback from the client and their family was sought and documented.

Results

The results showed that clients received on average 4 Occupational Therapy and 4 Physiotherapy sessions each. The therapy assistants provided on average 15 visits per client to support the implementation of specialist programs developed by the therapy team. The feedback from clients and family was very positive and the following feedback was received “A program like this is a great initiative”, “ It Improved my confidence”, “I’m able to cook my meals for myself again”

Conclusion

The Reablement program with the support of therapy assistants has led to a patient centred service and co-ordinated approach to the care of the client with increased client compliance. A similar service was not available in the community previously. The Reablement program has reduced the need for inpatient reablement beds which was previously the pathway of care for these clients in the community.
190 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): FACTORS ASSOCIATED WITH THE BURDEN EXPERIENCED BY CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , Power D , O'Shea D , Doyle R , Blake C
Published: October 2022

Background

To date, little research has been carried out exploring the burden experienced by informal caregivers of People with Dementia (PwD). We explored factors that influence the burden experienced by caregivers of PwD over 12 months.

Methods

Fifty-two PwD and their informal caregivers were recruited by convenience sampling to the “CHESS” Study. Data were collected at five time points over 12 months between April 2017 and November 2019. Mixed model analyses were used to investigate associations of caregiver burden (measured by the Zarit-Burden Interview; ZBI) with factors in four domains: 1) Psychological Well-Being (PWB; measures of anxiety, depression, and caregiver distress); 2) Social Capital and Resources (SCR; incorporating access to community-based health services, transportation needs, education level, occupation and living situation of the PwD, and employment status of the caregiver); 3) Physical Fitness and Health (PFH; including the Quantitative Timed Up and Go (QTUG), baseline grip strength, indices of frailty, sensory acuity); and Managing Everyday life with Dementia (MED; incorporating measures of cognition, behavioural disturbances, functional ability, and indices of dependence of PwD.

Results

Across all domains, caregiver burden significantly increased over time (p<0.001) and less burden was experienced by caregivers of older PwD (p<0.05). In PWB, higher caregiver depression levels predicted higher levels of caregiver burden (p=0.033). In the SCR domain, caregivers of PwD who were independent in their transport needs experienced lower levels of burden (p=0.002). No other factors within the PFH or MED domains reached significance in predicting caregiver burden.

Conclusion

This longitudinal analysis elucidates potential predictors of caregiver burden and highlights the need for future research to be carried out in this area. In particular, psychological well-being in caregivers was shown to significantly impact on the experience of burden. Interventions to alleviate caregiver burden should be tailored to include support for psychological well-being.
201 AVAILABILITY AND APPROPRIATENESS OF STROKE SURVIVORS’ FOOTWEAR ON AN ACUTE STROKE UNIT
Authors: Condon M , Hayes H , Wedel U
Published: October 2022

Background

Stroke Survivors (SSs) often present with an increased fall risk due to physical, sensory, cognitive and visual impairments. Footwear has the potential to positively impact the gait and balance of SSs, while poorly fitting or unsupportive footwear is associated with falls. Research to date has focused on older adult populations. Little is known about the type of footwear SSs wear on an Acute Stroke Unit (ASU). The aim of this study was to identify the type and suitability of footwear available to SSs on an ASU.

Methods

Consecutive inpatients (>18) on a 31-bed ASU were assessed on one day in May 2022. Footwear available to SSs was assessed for suitability using the Footwear Assessment Tool, a six-item tool with established inter- and intra-rater reliability. Descriptive statistics were employed to examine results.

Results

In all, 38 pairs of footwear were available to 31 patients with a median age of 72 and 61% (19/31) were male. Two or more types of footwear were available to 29% (9/31) of patients, 61% (19/31) had one type of footwear available, while 10% (3/31) had no footwear. The most common type of footwear were slippers with backs (36%; 14/38) followed by athletic shoes (21%; 8/31) and backless slippers were the last common type (3%; 1/38). Based on the Footwear Assessment Tool, less than half (47%; 18/38) of the footwear available were appropriate.

Conclusion

This study highlights the large number of SSs in an ASU who have inappropriate footwear to support their rehabilitation and safety. Ensuring SSs have suitable footwear is a simple way of promoting safety and improving mobility. Healthcare professions have a responsibility to consider footwear characteristics in the management of SSs. Evidence-based advice to patients and families on safe and appropriate footwear could improve rehabilitation outcomes while minimising falls risk.
205 DESIGN OF AN AMBULATORY CARE HUB IN AN OLDER PERSONS SETTING
Authors: Cronin A , Kennelly S
Published: October 2022

Background

The service was established to deliver rehabilitation based in a day care setting. The Multi-Disciplinary Team (MDT) allocated to cover the unit often had other clinical responsibilities. Therapy was delivered in silo with differing plans/goals for individual patients. There was often reduced with insufficient/no cover to the department. The department was closed during the pandemic. Upon reopening a decision was made to restructure service delivery. A pathway of change was decided on to move from a day care setting to an ambulatory hub model of care.

Methods

A Delphi method was undertaken and a review of processes conducted by the Clinical Nurse Manager 2 (CNM2). Consequently, all new referrals were screened and virtual telephone clinics held. Nursing Comprehensive Geriatric Assessments (CGA) were conducted on patients referred by their GP or who had not attended the Age-Related Healthcare Department within 6 months. This ensured clarity around patient needs. Individualised care plans were initiated before the patient’s medical appointment took place. Any urgent reviews were flagged to specific therapists by the CNM2.

Results

The service was restructured and is now interdisciplinary in approach. The Service moved from a day care setting reviewing approx. 60 patients weekly to an ambulatory care hub model with over 450 targeted interdisciplinary reviews weekly. A spreadsheet was developed and collated weekly by the CNM2 informing therapists of referrals received hence streamlining care- planning. This enabled MDT collaboration and merging of appointments to prevent multiple attendances. This development has been welcomed by patients and families.

Conclusion

The Ambulatory Care Hub operates at a maximum capacity with patient’s receiving targeted comprehensive interdisciplinary therapy input. There is a greater sense of teamwork within the department and patients benefit from this collaboration. This redesign has shown that a well-structured MDT provides essential support in many areas of disease management.
207 CLINICAL FRAILTY SCORE (CFS) IN THE ORTHOGERIATRIC POPULATION: DESCRIPTIVE ANALYSIS AND CHARACTERISTICS.
Authors: Cloney T , Crowley P , Rafferty M , Gannon E , Ahern E
Published: October 2022

Background

In a hospital in the South of Ireland, all older adults admitted with hip and other fragility fractures are co-managed by the Orthopaedic & Orthogeriatric services. Identifying a patient's Clinical Frailty Scale (CFS) has become a standard part of our comprehensive geriatric assessment for this cohort. We reviewed characteristics of those with documented CFS.

Methods

We retrospectively reviewed 5 years of the hospital's hip fracture database. The data was downloaded into an Excel spreadsheet where it was formatted and cleaned to binary data to enable accurate assessment. We sub-grouped the cohort based on admission, dating from July 2019 - the onset of co-management care and routine identification and documentation of CFS - to date (September 2021).

Results

1132 adults were admitted with hip fractures between July 1st 2019 and September 30th 2021. 65.8% of admissions were female. 944 (83.4%) had documented CFS. The median CFS is 5. 515 (54.5%) had a score 5 or greater. Of the 944 patients, 83.9% of were admitted from home, 13.7% from nursing home (NH) and 2.4% from an alternative healthcare facility. Frailer patients are more likely to be admitted from NH. 92.3% of patients with documented CFS had a 4-AT administered. 99.7% of patients with documented CFS had a New Mobility Score (NMS) documented. The median NMS was 5. Patients with lower NMS had a higher CFS. 83.4% of people were mobilised day 1 post-operatively, with rates decreasing in frailer patients. The majority of people admitted from home were discharged to rehab (64.5%) and home (22.2%). 2.4% of those admitted from home were discharged to NH, with 95% (18/19) having a CFS 5 of greater. 5.3% of patients died (50/944), with 92% of deaths having a CFS 5 or greater.

Conclusion

CFS may offer us information into care planning for the orthogeriatric population. More work needs to be done evaluate its usefulness.
210 AUDIT OF AN AUDIT: UNDERSTANDING THE INTERPRETATION AND REPORTING OF KEY PERFORMANCE VARIABLES OF THE IRISH NATIONAL AUDIT OF STROKE
Authors: McCartan D , McCormack J , Hickey A , Williams DJ , Harbison J
Published: October 2022

Background

The Irish National Audit of Stroke (INAS) coordinates the collection and analysis of key performance variables which can be interpreted as proxies of care quality in stroke. Time metrics such as “Time-to-CT” and “Time-to-Thrombolysis” reflect the organisation of in-hospital stroke care pathways, with shorter times reflecting better care coordination and quality. While the INAS data dictionary defines each variable, differing interpretations of a definition can impact on the exact data point collected. We wished to understand the interpretation and reporting of key performance variables at all clinical sites reporting to INAS.

Methods

An online survey in three parts was designed and distributed to 34 INAS audit co-ordinators along with the INAS dictionary definition of each data variable. Audit co-ordinators were asked to select the exact data point they collect for that variable from a dropdown list, with space also allotted for free-text entry of any challenges they may encounter for that variable.

Results

Responses were received from 11/34 audit co-ordinators, representing 10/24 hospitals. Variability was seen in the specific times selected for data points including hospital arrival time, team time, and brain imaging time. This variability was seen across sites and regions. Data points with less scope for interpretation such as thrombolysis or thrombolysis time showed less variability.

Conclusion

By understanding the scope of responses given to any data point definition and the challenges that may exist for audit co-ordinators, it is hoped to achieve a consensus approach to defining variables for a robust core data set. Future data definitions may be refined to assist in the collection of exact data points that are accurate, consistent and reproducible across hospital sites. In so doing, all key elements of a patient’s pathway can be captured accurately and compared with best practice guidelines with a view to optimising future care provision and service organisation.
211 ASSOCIATION OF PLASMA ANTIOXIDANTS AND COGNITIVE OUTCOMES IN NORTHERN IRISH MEN FROM PROSPECTIVE EPIDEMIOLOGICAL STUDY OF MYOCARDIAL INFARCTION (PRIME) STUDY
Authors: Marley A , Potter C , Passmore P , Linden G , McEvoy C , Patterson C , McGuinness B
Published: October 2022

Background

Oxidative stress and chronic inflammation have been demonstrated to contribute to cognitive decline in older age and the development of neurodegenerative disorders. Antioxidants have been revealed to help mitigate the effects of the damage caused by oxidative stress and inflammation, but their relationship with cognitive decline is not yet fully understood. The aim of this study was to investigate the association between various plasma antioxidant levels and cognitive status in participants from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study.

Methods

10,600 men were recruited to the PRIME study between 1991-1993 and have been followed up across eleven time points. Baseline health and lifestyle characteristics were assessed, and plasma antioxidants were obtained and quantified. Baseline cognitive status was screened in 2000 using Mini-Mental State Examination (MMSE). Follow up assessment of cognitive status was performed in 2015 with MMSE and Addenbrooke’s Cognitive Examination-Revised (ACE-R) examinations.

Results

2,009 men underwent cognitive assessment in 2000 and 873 men in 2015. At both 2000 and 2015 with the use of the MMSE and ACE-R examinations to assess cognitive status, serum concentration of all the antioxidants except for gamma-tocopherol and lycopene were higher in the men with better cognitive performance at a significant level of p<0.05. Better cognitive performance was associated with more time spent in education and higher level of education achieved at a statistically significant level (p<0.01). Furthermore, those with cognitive impairment were more likely to be older. After adjustments for lifestyle variables with a linear regression model, the only significant variable associated with cognition was time spent in education (B = 0.521, p= 0.02).

Conclusion

The findings suggest that the concentration of plasma antioxidants is associated with cognitive status. Smoking and education, as well as other lifestyle factors were, demonstrated to have an impact on cognitive status.
222 TOWARDS A DELIRIUM FRIENDLY EMERGENCY DEPARTMENT
Authors: Kajawo S , Linn M , Maher M , Rath S , Fitzmaurice K , Brolly A , Buckley M
Published: October 2022

Background

Delirium affects approx. 10-30 % of patients over the age of 65. Up to 70% of cases are missed in the Emergency Department (ED). Delirium results in increased morbidity, mortality, increased length of stay and decreased functional status with increased discharges to residential care centres. Delirium in the ED is an independent predictor of death within 6 months.

Methods

We completed an audit which showed 40% of those > 65 years of age in the ED were delirious and 60% of those had dementia. None of these had been identified as delirious prior to review. We have approx. 5,000 patients >75 years of age attending our ED annually (1/7th of presentations). This audit was used as a catalyst for our quality improvement project. We established a steering group with a small quality improvement sub-committee. We combed the literature, identified areas for improvement and costed our project. We also looked at reliance on 1:1 carers for those with delirium and potential benefits to patient, staff and management.

Results

We used the SPARK ignite programme as a means to gain momentum and also educate ourselves on business management and change management. We competed in the finals with our “delirium package” – focussing on orientation, stimulation, safety and education. These 4 pillars of delirium care have been shown to prevent delirium, reduce hospital stay for those with delirium and also augment their delirium cycle. Competing and winning a prize highlighted the importance of delirium care and brought our project to a bigger stage.

Conclusion

Due to our multi-disciplinary team composed of non-consultant hospital doctors, advanced nurse practitioners and occupational therapists, we have been able to introduce the national dementia programme for early identification of delirium in the emergency department. We now have a space for managing those with delirium and have received funding to put our package in place. This can be replicated in hospitals around the country highlighting the non-pharmacological treatments for delirium.
226 DUAL ANTI-PLATELET THERAPY: AUDIT OF COMMUNICATION OF DIAGNOSIS AND DURATION ACROSS PRIMARY AND SECONDARY CARE
Authors: McCaughey D , OHagan L
Published: October 2022

Background

Dual Anti-Platelet Therapy (DAPT) is indicated in vascular disease & duration of treatment depends on factors such as indication, age, bleeding risk, disease severity & co-morbidities. Inappropriately prolonged DAPT may increase the risk of major bleeding without a reduction in all-cause mortality and decisions for the duration of DAPT are best made by specialists in secondary care which should be communicated definitively to partners in primary care.

Methods

A retrospective search of patients prescribed Aspirin and a PY2 inhibitor from 01/01/2020 to 30/04/2022 was conducted. Patients were excluded if DAPT was not prescribed concurrently or if the patient deceased before the duration of DAPT had passed. Each record was evaluated to determine if: (1) Secondary care correspondence stated indication & duration of treatment; (2) Patients had stop dates for DAPT on their prescription; (3) Patients had been on DAPT for correct duration and (4) Any errors/improvements were identified.

Results

Number of patients met criteria = 81, Average Age = 69.7yrs, Male = 58%, Female = 42%. 12% of letters from Secondary Care did not specify a duration. 43% did not have a stop date on their prescriptions. 19% prescribed DAPT for the incorrect duration. 15% classified as having a serious medication error (DAPT >3yrs, No obvious indication for DAPT, DAPT & Antithrombotic therapy without review). 14.8% not prescribed a PPI & 4.9% admitted to hospital with a GI bleed. 24.7% Patients prescribed Esomeprazole/Omeprazole & Clopidogrel

Conclusion

DAPT is an important pharmacotherapy intervention in the treatment of vascular disease, but it's duration should be regularly assessed by specialists and clearly communicated to prescribers in Primary care to optimise treatment and reduce bleeding risk. Clinical system warnings have now been utilised to alert prescribers to well defined time limits of DAPT and patients on less appropriate PPI's have been switched. Secondary care colleagues have been reminded of the importance of clear and concise communication of clinical interventions and plans.
229 NEW STROKE EARLY SUPPORTED DISCHARGE SERVICE PROVIDES ALTERNATIVE REHAB PATHWAY AND IMPROVES PATIENT AND ORGANISATIONAL OUTCOMES
Authors: O'Connor S , Conlon L , Carney M , Joseph H , Nolan-Shaw D , Hickey P
Published: October 2022

Background

Early Supported Discharge (ESD) for stroke is an international model of best care for stroke patients. ESD improves patient outcomes while facilitating a faster hospital discharge through providing stroke specific rehabilitation at home. ESD can be expected to improve disability outcomes and quality of life and reduce length of hospital stay. A pilot ESD service was introduced to this model 3 hospital in 2021 which encompasses a large geographical rural area that historically had an absence of Stroke rehabilitation services.

Methods

A retrospective review of routine data extracted from 57 patients accepted to the ESD service in 2021 was completed. This initial examination explored the effectiveness of ESD with the population in this rural area. Service Objectives as follows: (1) Improve patient’s functioning as measured by Functional Independence Measure (FIM) and Functional Assessment Measures (FAM); (2) Demonstrate a reduction in disability outcomes as evidenced on the Modified Rankin Scale (MRS); (3) Increase number of early supported discharges directly home for patients; and (4) Reduce length of hospital stay for patients post-stroke.

Results

Implementation of an ESD service over a 12-month period achieved the following: (1) 8.1% improvement in total FIM/FAM scores indicating positive functional outcomes and enhanced independence when discharged home with ESD; (2) A decrease in the average MRS score indicating improved disability outcomes; (3) 25% of all stroke patients in 2021 were discharged with ESD rehabilitation; (4) An increase of 12% in total number of discharges home post stroke from 2020 to 2021; (5) 244 bed saving days.

Conclusion

The introduction of an ESD service resulted in patient and organisational benefits. Participation in ESD rehabilitation had a positive impact on reduction of disability scores captured using MRS and improvements in functional outcome measure scores captured using the FIM/FAM.