bluuebunny/crossref_metadata_2025 huggingface dataset:
228 The impact of lack of fulfilled home support service allocation on informal caregivers
Authors: Shiel E , Whelan A , Mannion K , Donuhue M , Cleary A , Cosgrove J , Gavin C , Sestak K , McDonnell C , Geoghegan James , Hanrahan C , O'Malley K , Okan M , Murphy R , Costello M , Canavan M
Published: September 2023

Background

With an ageing population, there is a growing demand for home support services to enable older people live independently. Despite investment, there remains an acute labour shortage in this sector. Here we report the profile of patients impacted by the consequences of disparity in allocated support and care hours fulfilled.

Methods

Retrospective analysis of 155 patients presenting to community based clinics across a period of 2.5 years in whom data on home help hours were available was conducted. Participants included were new patients referred for comprehensive geriatric assessment.

Results

Participants had a mean age of 82 years (Standard Deviation: 7). 63% (n = 97) participants were female. 23.9% (n = 37) of participants had a mismatch in home support hours filled compared to hours allocation. Those with a mismatch in home support hours were more likely to be female, with higher CFS. While 85% were independently mobile, 85% were frail, 80% were dependent for IADLs, and median MOCA was 18. Patients who had an informal caregiver were more likely to have a mismatch in hours (Odds Ratio [OR]: 5.97; 95% Confidence Interval [CI]: 1.67–38.11). A mismatch in home support hours was associated with a significant increase risk of caregiver burnout/strain (OR: 3.58; 95% CI: 1.68–7.85). Patients assessed in 2023 had a higher proportion of mismatched hours (30% Vs 23.9%), and were noted to be predominantly rural dwelling (85% Vs 69%) and living alone (55% Vs 46%).

Conclusion

We identified that there was a sizable mismatch in support hours allocated and hours received among a predominantly rural dwelling, frail cohort with cognitive decline and this was significantly associated with caregiver strain. Further dedicated research is required to explore barriers to successful home support integration including needs and expectations of the older person, their informal carers and the people delivering home care services such as role development, training and incentives.
230 Inter-rater reliability assessment of OPTI-3S (criteria for optimising medicines by stopping, stepping down, or switching to safer alternatives)
Authors: Ali A A H , McMahon N , Ryder S
Published: September 2023

Background

The OPTI-3S criteria comprise newly developed consensus-based statements identifying potentially inappropriate medications for hospitalised frail older adults. This study assessed the inter-rater reliability of the OPTI-3S core list.

Methods

Data were collated from ten patient cases in the publicly archived ‘The Irish Longitudinal Study on Ageing’ (TILDA) dataset (Wave 3). Five healthcare professionals assessed medication appropriateness across the cases according to the OPTI-3S statements, indicating the applicable statement(s). Their assessments were compared against a ‘Gold Standard (GS) assessment’ consisting of a combined assessment of a research team member and a clinically experienced academic researcher, who independently assessed the medications’ appropriateness. Concordance between the GS rating and other raters was assessed by kappa statistics. Major discrepancies were identified when a rater applied a statement >2 times more or less frequently than GS [1].

Results

The ten patients’ median age was 74 (Interquartile Range: 70–80) years, and 40% were female. The median (IQR) number of medications was 10 (9–12). Cohen’s kappa coefficient ranged from 0.65 to 0.86, indicating substantial to perfect interrater reliability when agreement was measured between the GS rating and any other rater. The overall mean (95% CI) Fleiss kappa coefficient between all raters was 0.67 (0.65,0.69), indicating substantial interrater reliability. The mean Fleiss kappa coefficient (95% CI) between the GS rating and geriatricians was 0.63 (0.60, 0.67). A good Fleiss kappa coefficient of 0.81 (0.75, 0.86) was found between the GS rating and pharmacists. Major discrepancies in applying seven statements were noted between the GS rating and three raters. Three of these statements were misinterpreted, indicating revised wording is needed.

Conclusion

The OPTI-3S core list shows substantial inter-rater reliability between experts with no previous experience using it. However, further testing with a larger number of clinical cases and raters is required.
234 Staffs’ understanding of human rights based care in Long-Term Care facilities in Ireland- a qualitative study
Authors: Savolainen K , Phelan A
Published: September 2023

Background

In 2019, Health and Information Quality Authority (HIQA) in Ireland produced a human rights-based care guidance document for long-term care (LTC) facilities. Despite the guidance launch in 2019, little is known of the staff’s understanding of human rights-based care in Ireland. Also, internationally various bodies have acknowledged a deficit in knowledge of human rights in healthcare. The aim was to establish the staff’s understanding and knowledge of the human rights-based care framework in LTC facilities in Ireland.

Methods

Semi-structured interviews with 15 staff members in three LTC facilities were conducted between January and April 2022 as part of a more extensive study into the human rights of older people in LTC facilities in Ireland. Trinity College Dublin granted ethical approval. Staff were asked if they had heard of a human rights-based care framework. Transcribed interviews were analysed to establish knowledge of human rights-based care.

Results

Interviews with seven staff nurses and six healthcare assistants were conducted. Their professional experience varied, but the average length of employment in the LTC sector was 7.76 years. Only one staff member, a staff nurse with over 20 years of experience, had heard of the human rights-based care framework. There was no significance in understanding between staff nurses and healthcare assistants. Very little was known when asked for more detailed knowledge of human rights and how to apply it to care delivery for older people.

Conclusion

Although the guidance document being in place since 2019 and regulating bodies raising awareness of human rights-based care in LTC facilities, staff’s awareness about human rights-based care was limited. Similar to previous international studies, this study highlights the enormous gap in knowledge of human rights-based care for older people in LTC facilities and robust systematic awareness programmes are needed.
235 A clinical audit of detection and management of sarcopenia in a mixed stroke ward in an academic teaching hospital
Authors: O'Connor A , Harte G , Ryan D , Collins R
Published: September 2023

Background

Sarcopenia is the loss of skeletal muscle mass and function and correlates with physical disability, poor quality of life, and mortality. Screening guidelines have been set as per the International and European Clinical Practice Guidelines, and treatment recommends progressive resistive training and a protein-rich diet.

Methods

A retrospective chart review was conducted on a mixed stroke/geriatric ward, using a custom-designed audit tool.

Results

22 patients were included. 82% of patients were over the age of 65. No patients had sarcopenia documented on admission as a diagnosis, or were screened for it on admission. The majority of patients were under the care of a geriatric team (68%, n = 15), and were more likely to have their muscle strength assessed during their stay, than by other inpatient teams (53% vs 38%). 71% of inpatients under another team were over 65 (n = 5). Stroke patients were more likely to have muscle strength assessment vs non-stroke admissions (61.58%, n = 8 vs 33%, n = 3). 10 patients had difficulty following commands, and a third of these had muscle strength assessments undertaken. 96% of inpatients displayed evidence of, or possibility of sarcopenia. The most common muscle strength assessment tool used was isometric lower limb testing (n = 6), followed by oxford scale (n = 3), and grip-strength (n = 1). No patient had analysis of muscle quality. 87% (n = 13) of patients under geriatric care were assessed by clinical nutrition, whereas only 60%(n = 3) of the patients over 65, under the care of another team had such assessment.

Conclusion

Sarcopenia is not well screened for on our mixed geriatric/stroke ward. An all age cohort and multiple primary physicians may be factors. We plan to examine effects of an education tool on risk recognition, assessment (SARC-F) on screening and detection. Improvement in awareness may lead to more appropriate multidisciplinary referrals for intervention and analysis of muscle quality, which should help improve patient outcomes.
242 Optimising bone health assessment and management in Parkinson’s Disease: a closed loop quality improvement project
Authors: Gallagher C , Killeen E , McDonough A , Cronin A , Latoza P , Baldestamon G , Kimmage E , Quinn S , Leitch E
Published: September 2023

Background

People with Parkinson’s Disease (PD) are at increased risk of osteoporosis, falls, and fractures. An audit of our age related day hospital’s weekly PD Interdisciplinary Clinic (PDIC) assessment identified suboptimal management of bone health. We subsequently introduced a ‘bone health’ section to the proforma to identify areas of suboptimal bone health management warranting further investigation and/or intervention.

Methods

Cycle 1: Retrospective review of PDIC proformas and charts revealed multiple risk factors for falls and fractures and suboptimal management of bone health. A ‘bone health’ section was introduced to the proforma. Questions related to osteoporosis diagnosis, previous fractures, DXA scans, calcium/cholecalciferol supplementation, and anti-resorptive treatment. Cycle 2: Prospective data collection over four weeks using the PDIC proforma and ‘bone health’ section.

Results

Cycle 1: (N = 33), Cycle 2: (N = 12). Both cycles had similar patient demographics. Over 50% had orthostatic hypotension and/or identified falls risk medications. Over 70% had gait impairment, and over 66% had a history of falls. Cycle 1: 36% had known osteoporosis. Of these, 33% were not receiving osteoporosis treatment. 27% had a previous fragility fracture, 33% of these were not on osteoporosis treatment. 27% had a DXA scan. Cycle 2: 8.3% had known osteoporosis and 8.3% osteopenia. 42% were unsure of osteoporosis diagnosis. 33% had previous fracture, 75% of which were fragility fractures. 33% had a DXA. Areas of suboptimal bone health management warranting intervention were identified in 50% on the ‘bone health’ section. 25% were commenced on calcium/cholecalciferol supplementation. 8.3% were recommenced on denosumab. 8.3% were counselled on correct use of Denosumab. 8.3% had repeat DXA booked.

Conclusion

This closed loop QI project identified suboptimal bone health assessment in PD patients at risk of falls. The ‘Bone Health’ section had a positive impact, implementing low impact interventions to reduce fracture risk and associated morbidity/mortality.
250 Streamlining rehabilitation for hip fracture patients: a pilot quality improvement project
Authors: Sadiq M A , Laffan S , Power M , Corcoran S , Murphy T , O'Regan N
Published: September 2023

Background

University Hospital Waterford (UHW) is a busy trauma unit, serving five counties in Ireland’s South East. UHW treats approximately 400 hip fracture patients annually, 27% of whom are referred for off-site rehabilitation either locally or regionally. The national average Length-of-Stay (LoS) for hip fracture patients is 12 days, whereas in UHW the average LoS is 17 days, higher in those awaiting off-site rehabilitation (19 days). Earlier access to rehabilitation results in reduced LoS, better patient outcomes, and enhanced patient flow through the hospital system.

Methods

We created a pilot six-bedded rehabilitation unit in Kilcreene Regional Orthopaedic Hospital (KROH, an orthopaedic hospital affiliated with UHW) for hip fracture patients. Hip fracture patients for rehabilitation in KROH are identified by the Orthogeriatric team. Weekly multidisciplinary team meetings and wards rounds are conducted by the UHW based Orthogeriatric Consultant and Advanced Nurse Practitioner (ANP). We measured duration of time waiting for rehabilitation in hip fracture patients since this unit’s commencement and compared to data from a previous audit conducted in 2020 in hip fracture patients awaiting rehabilitation.

Results

Since April 19th 2023, seventeen hip fracture patients have been transferred to KROH for rehabilitation, fifteen of whom were transferred on the same day or the day after they were identified as medically fit and rehabilitation ready. To date, the longest wait time for transfer was three days in two patients. Data from 2020 indicated that the median wait for off-site rehabilitation in centres across the south-east was six days.

Conclusion

Early results indicate that this pilot six-bedded rehabilitation unit reduces the wait time for rehabilitation in selected hip fracture patients, enhances continuity of care, and improves patient flow through the hospital system. Our future aims include expansion of the unit and collaborating with regional integrated care services to ensure continuity of care post-discharge.
258 Using participatory co-design to develop recommendations on human rights for people living with dementia in Irish nursing homes
Authors: Donnelly S , Golden F , Keating M , Mackell S , O'Shea J , Paley G , Parfitt R , Quaid K , Quinlan K , Brennan H R
Published: September 2023

Background

Ireland had one of the highest concentrations of Covid-19 deaths in nursing homes globally, with 66% of all deaths in the first waves of the pandemic taking place there. Against this backdrop, the Alzheimer Society of Ireland’s Irish Dementia Working Group (IDWG) became increasingly concerned about the human rights of People Living with Dementia (PLwD) in nursing homes. The IDWG wanted to be a voice for the voiceless and advocate for PLwD in nursing homes. They commissioned the development of a briefing paper that would outline the key issues relating to upholding the human rights and safeguarding of PLwD in nursing homes including concrete recommendations for policy and practice.

Methods

A scoping review of the existing literature on this topic was carried out. Three co-design online sessions were convened with members of IDWG, and one co-design session was convened with members of the Alzheimer Society of Ireland Dementia Carers Campaign Network to develop and co-design general content and recommendations.

Results

30 recommendations relating to the human rights of PLwD in nursing homes were developed (Donnelly et al. 2022). These include having equal and rights-based access to multidisciplinary team support and health and social care services, including access and provision of equipment and mobility aids. It was also recommended that PLwD are cared for in a nursing home with staffing levels that align with the dependency levels of residents as outlined in each Common Summary Assessment Form (CSAR) or Care Plan. There should also be consistency in the carers who are providing day-to-day care to PLwD.

Conclusion

Engagement with key stakeholders such as the Department of Health, HIQA and political representatives is currently being progressed to ensure meaningful implementation of the recommendations developed.
270 FastTraX fracture service: reducing wait time for nursing home residents in the Emergency Department
Authors: Noonan C , Coveney S , Coughlan T , Kennelly S
Published: September 2023

Background

Nursing Home Residents (NHR) are among the frailest of older people requiring a gerontologically attuned approach to care. The introduction of a rapid response service, utilising mobile x-ray, for those patients with possible fracture was the result of a QI project to improve care for NHR. The impact of this service is compared to prior usual care. FastTraX ensures NHR receive optimal orthogeriatric care without Emergency Department (ED) presentation.

Methods

These initial case studies outline the rapid response pathway of a NHR post upper limb fracture compared to patient journey prior to this innovation.

Results

An 86 year old man referred to FastTraX following a fall. A mobile x-ray was done at the nursing home (NH), confirming a clavicle fracture. The images and report were presented by the RANP, with relevant medical and functional history, to the orthogeriatric and orthopaedic team. Consensus decision for was conservative management. A falls and medications review was completed liaising with primary care physicians. A virtual follow up 3 days post fall, ensuring effective pain management, facilitate physiotherapy review, to elicit any adverse events, to organise fracture clinic follow up.

A 78 year old female was transferred from NH to the emergency department post fall. She was triaged and waited to be seen by an ED physician who organised x-ray which confirmed a clavicle fracture. She was then seen by the orthopaedic team, conservative management was decided upon, she was discharged back to the nursing home with analgesia and a follow up fracture clinic appointment in a number of weeks. 12 hours spent in the ED.

Conclusion

This RANP-led integrated response to the conservative management of fractures in NHR has been recently introduced and data collection is ongoing. It has supported NH staff to allow residents avoid transfer to the ED, where appropriate, avoiding the potential risks, and adverse events associated with same.
272 Advanced nurse practitioner -supported nursing home liaison service
Authors: Noonan C , Dowling M , Soh J , Fallon A , Kennelly S
Published: September 2023

Background

Nursing Home Residents (NHR) are the frailest group of older people in society and require a gerontologically attuned approach to address multiple challenges presented to the practitioner. In 2018 we commenced an advanced nurse practitioner (ANP) specialist liaison service with bespoke comprehensive geriatric assessment (CGA) to support NHR admitted to a tertiary referral university teaching hospital. Given the impact of COVID-19 on NHR in particular, in 2020 this service was expanded to include a consultant physician and specialist registrar in geriatric medicine, when full care of NHRs came under geriatric medicine services. This includes a two-week post-discharge virtual clinic with the Nursing Home director of nursing and/or GP.

Methods

Information on all NHRs attending a tertiary referral university teaching hospital was collected from 2018–2023. Data on demographics, presenting complaints, CGA, and outcomes of Length of Stay (LoS), emergency department (ED) recidivism, and mortality were collected. Impact on clinical outcomes of liaison versus full geriatric medicine care are presented in this abstract.

Results

In 2018 there were 353 NHRs admitted from ED who represented 4,170 total hospital bed days. In 2019 there were 329 NHRs admitted with 3,991 total bed days. In 2021, 251 NHRs were admitted representing 2,582 total bed days. As result of the enhanced care model, where full inpatient governance came under the geriatric medicine services, we observed: (1) Readmission rate 37% (2018) vs 12.7% (2021), (2) Reduction in LoS from 2018–2021 from 11.8 to 10.0 days, (3) Halved the overall bed-usage days from 2018–2021.

Conclusion

The high complexity of this cohort of patients requires a timely, comprehensive gerontological approach in order to provide holistic care. Better care with CGA embedded also translates to better use of acute hospital resource.
276 Development of inter-professional simulation-based education in geriatric medicine
Authors: Irvine J , Nelson E
Published: September 2023

Background

Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication required within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence.

Methods

We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty.

Results

Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being ‘not at all confident’ and ten ‘extremely confident’). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment.

Conclusion

Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.
277 Audit of intentional rounds to measure compliance and explore patient feedback in a rehabilitation hospital for older adults
Authors: McDonnell C
Published: September 2023

Background

Intentional Rounding (IR) is a purposeful and proactive intervention with a strong focus on safety and consistency in delivering essential care to all patients. IR can help reduce falls, pressure ulcer incidence, improve communication and provide reassurance to patients. IR was introduced for Health-Care Assistant (HCA) Staff in our rehabilitation hospital for older adults. In collaboration with the HCA staff, the nurse practice development unit developed an IR check-list for each patient. Following introduction of IR, we carried out an audit to measure compliance with the practice and to gain feedback from patients in terms of how they experience IR.

Methods

An audit tool was developed to measure all elements of the IR practice and check-list. On each ward, 5 randomly selected IR check-lists were audited for compliance with the audit tool. Qualitative data was also collected through engagement with patients during the audit process. HCA staff were involved with the audit process.

Results

The audit revealed some good results in IR practice, notably 2 wards achieved the KPI (90%) and this was positive. Reasons for wards not achieving their KPI in this audit were mainly due to incomplete IR check-lists on night-duty shifts. Qualitative data collected through comments from patients during the audit was very positive. Comments such as ‘Staff are super’, ‘Staff are in every few minutes’, ‘Assistance offered all the time’ were typical of the feedback received. Further support and education are necessary to improve compliance with IR practice on the night-duty shift. It is important to include the HCA staff in auditing the practice and to take ownership of it.

Conclusion

Intentional Rounds provide a pro-active and consistent system for ensuring each patient is checked on regularly to ensure essential care is delivered. Audit is necessary to monitor the practice to ensure compliance and improvement.
279 The experience of designing an integrated service: a pragmatic approach to healthcare delivery
Authors: Flattery V , Lee S Quilter , Donoghue S , Coen M , Hanley O , Flynn C , Martin H , O'Connell C , Ansbro C
Published: September 2023

Background

Staff from nursing, occupational therapy, physiotherapy and social work from CHO2 and the Saolta Hospital Group were brought together. This group had the unique position of having a mandate and funding available to design an integrated service with an egress focus. The SlainteCare vision of ‘right care, right place, right time’ was central to the process. There are significant demands on hospital beds with a growing and ageing population around Galway. A gap exists in the provision of integrated multi-disciplinary interventions following hospital discharge.

Methods

The HSE Change Guide (2018) was used alongside Action Learning Set methodology. These tools allowed for creativity and open discourse. A SWOT analysis identified current practice, opportunities and threats with the culture of the organisations analysed and a context for change vision formed. Stakeholder identification, Influence Mapping Grid and an engagement plan was formulated. A Process Map using service user cases were discussed in relation to services they could receive and what was missing. This renewed clarity and gap analysis showed why change was required. An Options Appraisal to consider possible solutions with ease of implementation being a key consideration.

Results

The solution identified was a HSCP Liaison Team to complement the Liaison PHN service which would identify early discharges from the acute hospital. They would communicate with the Primary Care teams to progress discharge. Point prevalence data gathered during the define and design stages showed an average of 20 service users who would benefit from the proposed service. One network area was decided as the pilot site.

Conclusion

Given time and opportunity to design a service, this team have brought forward a solution that does not replicate services but complements and empowers existing structures and staff. Most importantly this proposed HSCP Liaison team will allow service users to spend more nights in their own beds whilst receiving the necessary HSCP services.
284 Electronic prescribing in a Rehabilitation Hospital for Older Persons: our experience to date
Authors: Prendergast F , Cogan L
Published: September 2023

Background

Electronic Prescribing (E Prescribing) isn’t routinely utilised in Irish Hospitals. We introduced a paperless E Prescribing system in our Rehabilitation Hospital for Older Persons in June 2022. One year after its introduction, we discuss our experience to date.

Methods

The digital transformation of the Irish Healthcare system is underway. E Prescribing represents one small element of this transformation away from paper based drug Kardexes to a fully electronic system. We have utilised an E Prescribing system for approximately one year. We outline the various features and benefits of E Prescribing and how we utilise them in our clinical practice in our Rehabilitation Hospital for Older Persons.

Results

The pros of E-Prescribing far outweigh the cons in our experience to date. The benefits include, for example, the ability to prescribe remotely, eliminating the risk of handwriting errors, medication usage reviews and prescription templates. The downsides include the potential for errors in the initial period of prescribing by Doctors and Nurses without prior experience in E Prescribing.

Conclusion

E-Prescribing is not without challenges, especially in the initial phase of implementation. However, our experience since its introduction in our Rehabilitation Hospital for Older Persons has been very positive. This has the potential to serve as an example of how the technology can be employed in other similar Hospitals and represents just one aspect of the digital transformation currently underway in Irish Healthcare.
288 Carers in transition: a support group for dementia carers whose spouse is transitioning to Long Term Care
Authors: Rychtarik A , Allen J , Hartnett P
Published: September 2023

Background

In Ireland, an estimated 32% of people with dementia (PwD) are about to move to Long-Term Care (LTC). For spousal dementia carers, the transition to LTC is their greatest period of grief. Spousal dementia carers deal with changes in their relationship, identity, and role, when their spouse prepares to enter LTC. The Carers’ Transition Group (CTG) supports spousal carers in processing grief, educates about dementia and what to expect as their caring role evolves, signposts to resources, and supports improvement of overall well-being. The group is comprised of spousal carers of PwD who are currently patients of a Mental Health Service for Older Persons, transitioning to LTC.

Methods

Feedback on the Group was obtained via participant questionnaires and an assessment tool based on the Carer Support Needs Assessment Tool (CSNAT) administered pre-and-post, to ensure both the sessions and associated tools accurately reflected members identified needs.

Results

Group member feedback was very positive in regard to session content, group size and structure, and facilitator communication. Several participants expressed that simply hearing that others had experiences similar to their own as comforting.

Conclusion

The CTG highlights the need for research and development of psychosocial and psychoeducational interventions that provide support throughout the caring journey. Findings indicate an overall positive experience, with respondents expressing that sharing emotions and experiences, and feeling understood as the most beneficial element.
292 Frailty at the front door team compliance with the 4Ms of the international healthcare improvement age-friendly healthcare system
Authors: Fitzgerald R , Coakley E , Condon F , Allen S , Martin L , Leonard A , Cronin L , Pillay I
Published: September 2023

Background

Age-friendly health systems entail assessing the 4Ms (1) what Matters to you (2) Mood and Mental state (3) Medication review and (4) Mobility and functional assessment. This study aimed to measure Frailty at the Front Door team compliance with the 4Ms.

Methods

An abbreviated ‘4MsComprehensive Geriatric Assessment (CGA) was designed. Members of an interdisciplinary team, including geriatric medicine doctors, physiotherapists, occupational therapists, speech and language therapist and dietitian completed CGAs for older patients. Data from scanned CGAs (compliance rate approximately 30%) between January–December 2022 was entered onto Excel by trained administrators. Compliance with the 4Msassessment was retrospectively assessed. Data was analysed using descriptive statistics.

Results

588 CGAs were scanned. 96 excluded due to incomplete data (n = 93), or age under 65 years (n = 3). 493 CGAs included. Mean (SD) age was 83 (7.8) years. Female:Male ratio was 1.4:1. Mean (SD) CFS was 5 (1.2). 83% (n = 412) answered ‘what matters to you’. No answer recorded in 16% (n = 81). Common themes were; home (20%), family/friends/pets (18%), functional independence (7%), health (6%), and miscellaneous (40%). 100% had a 4AT documented, mean (SD) 4AT of 2 (2.9). The presence/absence of dementia was recorded in 73% (n = 364). 80% (n = 395) recorded presence/absence of depression. 11% (n = 57) had current or previous depression. 87% (n = 450) had a medication screen +/− review performed. 27% (n = 126) of presentations were related directly to either medications or falls. 96% (n = 473) had a mobility/functional assessment recorded..

Conclusion

There was 83% or greater compliance across all areas of the 4Ms Cognition, mobility and functional status demonstrated the highest compliance rates. Data capture was incomplete due to the inefficiency of scanning CGAs onto a database. Incorporating age-friendly systems into FFD practice is feasible. Future steps will be to accredit the Emergency Department as an age-friendly healthcare system.
293 Advance Care Planning in older persons mental health, insights from interdisciplinary healthcare professionals
Authors: Allen J , Donnelly S , Morton S , Murphy S
Published: September 2023

Background

Later life can be time where older persons face increasing health challenges and major decisions relating to future care. ‘Advance Care Planning’ (ACP) refers to a process of discussion and reflection about a person’s values, goals, and preferences for future care in case they lose the capacity to make decisions and communicate these in the future. The aim of this three-stage action research study is to collaboratively explore the perceptions and understanding of interdisciplinary team members and attendees of Mental Health Services for Older Persons (MHSOP) and their family carers in relation to ACP and to identify ways of improving decision-making practice considering the newly commenced Assisted Decision-Making (Capacity) Act (2015).

Methods

This presentation focuses on findings from stage one, which involved a survey administered via survey monkey, 3 focus groups and a feedback session with 22 interdisciplinary team members of a MHSOP from the fields of nursing, occupational therapy, psychology, psychiatry, and social work.

Results

Whilst there is already a culture of facilitating ACP with service users and their family carers within the MHSOP, however this is not routine practice. While clinicians largely recognised the value of ACP, 95% reported a lack of education, 52% a lack of knowledge of ACP tools, and limited experience in engaging with service users (53%) and family carers (47%). Identified barriers to engagement included lack of allocated time, clinician’s confidence, capacity issues and ‘a dedicated pathway across services with joined up conversation’.

Conclusion

Interdisciplinary professionals overwhelmingly recognised the importance of ACP with service users and family carers, and the positive impact ACP can have on end-of-life care. All indicated an eagerness for additional ACP guidelines and skills training for MHSOP staff.
298 An atypical presentation of Creutzfeldt-Jakob Disease as a stroke mimic—experience from an Irish tertiary centre
Authors: Altaie H , Nasehi A , O'Malley T , Vasandani N
Published: September 2023

Background

Sporadic Creutzfeldt-Jakob Disease (sCJD) is a rare neurodegenerative prion disease that presents with symptoms of rapid neuropsychiatric decline including dementia, behavioural abnormalities and loss of higher cortical function. Patients commonly present with rapidly-progressive neuromotor symptoms such as ataxia and myoclonus. Very few cases of CJD have been reported in which the patient initially presents with stroke symptoms such as hemiparesis as their primary presenting symptom. We present a case of a 56 year old male who initially presented to the stroke unit with waxing and waning left sided weakness and a non-corresponding ipsilateral left-sided acute parietal infarct on diffusion-weighted MRI. Over four weeks, his condition progressively worsened with declining cognitive function, motor dysfunction, sphincter dysfunction and eventual death.

Methods

Methods used to confirm the suspected diagnosis included: (1) Periodic sharp wave complexes are the most classical EEG finding for CJD and are seen in two third of the patients diagnosed with sporadic CJD, (2) The presence of the 14–3-3 protein in CSF has been found to be a sensitive and specific marker for sporadic CJD, (3) Neuroimaging plays a vital role in the diagnosis of CJD including serial MRIs and EEG sufficient to exclude other differential diagnoses.

Results

MRI brain revealed an acute cortical infarct within left parietal lobe measuring 3 mm.A n EEG demonstrated periodic sharp wave complexes occurring maximally in the left centro-temporal region. EEG finding was suggestive of a diagnosis of a prion disease. CJD Surveillance Unit confirmed the cerebrospinal fluid analysis was positive for RT-QuIC indicating sporadic CJD.

Conclusion

In cases of patients presenting with clinical signs and symptoms of a stroke with subsequent ipsilateral neurological findings on MRI, CJD should be included as a differential diagnosis. Additionally, a lumbar puncture, not routinely recommended in stroke patients, should be performed early to aid in early detection of CJD in order to confirm diagnosis and optimise the ceiling of care.
301 Role of comprehensive geriatric assessment in determining appropriateness of admission to long term care
Authors: Merron G , O’Neill D
Published: September 2023

Background

The benefit of comprehensive geriatric assessment (CGA) in supporting discharge to home from hospital for older people has been identified. When discharge to long term care (LTC) is considered by generalist teams, through determination of potential for further remediation and support, as well as vigilance for elder abuse and inappropriate third-party pressure, CGA supports continued living at home. Although European guidelines recommend, and Irish policy mandates, CGA prior to consideration of entry to LTC, it is not clear to what extent this is routinely undertaken. We aimed to determine the value of CGA in supported continued living at home when entry to LTC is proposed by referring clinical teams.

Methods

Review of electronic system of geriatric medicine consultations for assessment for LTC in a Level 4 teaching hospital. Information on discharge destination was retrieved from discharge summaries and electronic patient management systems.

Results

Of 740 consultations over 14 months between 2020 and 2021, 99 were for assessment for LTC. At review at 8 months, of 49 (49%) discharges to LTC, 42 (42%) were discharged as new residents, 4 (4%) were existing residents and 3 (3%) were discharged for end of life care. Of those for whom CGA recommended alternatives, 22 (22%) went directly home, 7 (7%) were discharged to offsite rehabilitation, 10 (10%) remained inpatients, and 8 (8%) died during admission.

Conclusion

This review highlights the importance and value of the role of CGA in planning discharge destination, a key if under-emphasised role for Irish geriatricians. Only 42% of the consults were discharged to LTC as a new permanent residence. This supports previous recommendations to routinely incorporate CGA when entry to LTC is considered, ensuring the most appropriate discharge destination for patients with significant multi-morbidity and complex care needs.
303 The influence of social constructivism on children and young adults perspectives of parental young-onset dementia
Authors: Blake C , Hopper L
Published: September 2023

Background

Western countries have a significant cohort of children (≤ 18) and young adults who live with a parent with a life limiting condition. Children and young adults perspectives of certain parental illnesses have been well documented. However, the perspectives of children and younger adults of parental young onset dementia tend to be absent from the academic literature. Older adult children have reported on the impact parental young onset dementia, however, there is a necessity for research with younger adult children and children under the age of eighteen in relation to their perspectives of the condition. Utilising cultural transmission theory, the current research explored if the social and cultural perspective influences the narratives of children and younger adults of parental young onset dementia.

Methods

One-to-one semi-structured interviews were held with children and younger adults (n = 17) who currently live with (or have lived with) a parent with a formal diagnosis of young onset dementia (with various subtypes). The participants ranged in age from 14 to 33 years old (mean = 21·18 years old). Participant narratives were analysed using inductive qualitative thematic analysis.

Results

Five main themes (with related subthemes) emerged from the narratives: (1) Making sense, (2) Lack of representation, (3) Threat to the family system, (4) Life has completely changed, (5) Systemic psychosocial support and education.

Conclusion

It is clear from the current data that the social and cultural perspective can significantly influence the narratives of children and younger adults of parental young onset dementia. Children are faced with more responsibility, shifting roles, changing relationships, and may be forced to postpone educational or employment plans. Furthermore, the social perception of dementia as can act as a barrier to children and young adults accessing and using health and social care providers.
305 Assessing patient attire in a medical gerontology ward: impact of an ‘End PJ Paralysis’ audit
Authors: Merron G , Davey N , George A , McDonough A , Fallon A
Published: September 2023

Background

Richard Asher’s influential essay, ‘The Dangers of Going to Bed’, highlighted the risks of bed rest for inpatients, including deconditioning and pressure areas. This audit evaluates whether patients are sitting out of bed and wearing personal clothes during mealtimes.

Methods

Using the ‘End PJ Paralysis’ campaign as the audit standard, a single-day audit recorded patients’ positioning and attire at breakfast and lunch. All inpatients on our medical gerontology ward were included. Interventions involved staff education on pyjama (PJ) paralysis implications, promoting the day room’s use at lunchtime, facilitating communication with patients/relatives regarding personal clothes/footwear, and organising a clothing donation drive. A re-audit occurred after one month.

Results

The initial audit included 39 patients (mean age: 81.8 years). At breakfast, 38.5% sat out, with 25.6% in their own clothes, 69.2% in pyjamas, and 5.1% in hospital gowns. The lunchtime audit included 38 patients: 84.2% sat out, with 78.9% in their own clothes, 25% in pyjamas, and 2.6% in a hospital gown. In the re-audit with 44 patients, 56.8% sat out at breakfast, with 18.2% in their own clothes and 81.8% in pyjamas. For lunch, 81.8% sat out, with 75% in their own clothes and 25% in pyjamas. No patients wore hospital gowns in the reaudit.

Conclusion

The re-audit demonstrated an improvement with 18.3% more patients sitting out at breakfast. In both audits, most patients opted for pyjamas at breakfast (69.2% in the initial audit and 81.8% in the re-audit) and their own clothes at lunch (78.9% in the initial audit and 75% in the re-audit). Hospital gowns were eliminated in the re-audit. Overall, this suggests that the ‘End PJ Paralysis’ campaign has positively influenced patients sitting out and the use of hospital gowns. Future plans involve education sessions for the broader multidisciplinary team, displaying posters, developing patient information leaflets, and conducting a re-audit to assess sustained impact.
312 Paying attention to daily delirium screening in an acute hospital setting, an audit of implementation on orthopaedic wards
Authors: Doyle P , Laffan S , Khokhar A S , Doyle M , Sheehan M , Gardiner P , McManus C , Donnell Niamh O , Hearne S , O'Regan Niamh
Published: September 2023

Background

Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. In this audit, we aimed to assess efficacy of implementation of a Delirium Care Bundle (DCB), incorporating delirium screening, risk factor assessment, and management, on two Orthopaedic wards.

Methods

Following a detailed feasibility assessment by a multidisciplinary group, the RADAR (Recognising Acute Delirium As part of your Routine) was chosen for daily delirium screening locally. This was incorporated into a DCB and an online training module was developed. Online training of staff was supplemented by in-person training on the wards. Three months post-implementation on two Orthopaedic wards, we audited DCB use. Additionally, we reviewed if patients were screened for delirium on admission (4AT) in the Emergency Department (ED), also recommended in national algorithms.

Results

Of 57 inpatients on the wards, eight were excluded (seven were too young to meet screening criteria; one was in theatre), leaving 49 patients eligible for audit. Seven (16.6%) patients had been screened in the ED at presentation. Thirty-five patients (71.4%) patient had the DCB commenced. Despite awareness, although the RADAR should be administered twice daily, we estimate that it was completed to 46% of target utilisations. Eleven (22.4%) patients had a positive RADAR at some point, four of whom had a negative 4AT screen in the emergency department. In those with a positive RADAR, documentation of consequent actions and preventative strategies was suboptimal.

Conclusion

The DCB was commenced appropriately in most patients. This audit identified that the RADAR use can be improved and that action steps following a positive screen were not being taken. Next steps include identifying barriers and facilitators to the use of the DCB and enhancing staff training in its use.
313 Audit of adherence to the National Standards of acute stroke metrics in a tertiary hospital in Dublin, Ireland
Authors: Alshehhi S , Durcan R , Lynch J , Liddy A-M , Boyle Karl , Williams D , Bejleri J
Published: September 2023

Background

Acute stroke is a medical emergency defined as a sudden neurological event of vascular origin caused by decreased cerebral perfusion, preventing oxygen and nutrient supply to parts of the brain, leading to neuronal cell death. The annual cost for the management of stroke patients in Ireland is approximately €489–€805 million. Treatment of ischaemic stroke is very time-dependent and the two main therapies currently available, are intravenous thrombolysis with tissue plasminogen activator (tPA), and endovascular thrombectomy. The aim of this study is to assess the adherence to key performance parameters, but not limited to, such as the onset of symptoms to hospital arrival, time of hospital arrival to imaging, time of hospital arrival to tPA, and time of symptoms onset to recanalization in a tertiary stroke unit as compared to the 2021 Irish National Audit of Stroke report.

Methods

We carried out a retrospective chart review of 100 stroke patients admitted from 1st January 2022 until 31 December 2022 who were identified using The Hospital In-Patient Enquiry (HIPE). We accessed various hospital sources including PIPE, thrombectomy software, McKesson Radiology and medical charts to retrieve data of interest. This audit was registered with the Hospital Audit Office (CA 2023/112).

Results

We report here a thrombolysis rate of 18% with 75% receiving tPa within 1 hour of hospital arrival compared to 10% and 56% reported by INAS, respectively. The median door-to-image and door-to-needle for Beaumont Hospital were 24 mins and 42 mins compared to 63 mins and 43 mins reported by INAS, respectively.

Conclusion

Beaumont Hospital is compliant and performs higher compared to the national average. Inclusion of more study participants is needed to confirm the findings of this report.