bluuebunny/crossref_metadata_2025 huggingface dataset:
223 READMISSION POST STROKE: RATES AND REASONS FOR READMISSION IN THE 18 MONTHS FOLLOWING HOSPITAL DISCHARGE
Authors: Hobson H , Cogan N , Dunne S , Collins R , Ryan D
Published: October 2022

Background

The Irish healthcare system faces the same challenges presented to healthcare systems worldwide, ageing populations and the increasing disease burden from chronic conditions. There is a need to respond to and meet these challenges placed on an already pressurized healthcare systems originally set up to respond to acute, episodic care. It would be beneficial to review reasons for unplanned readmissions post stroke to examine whether these readmissions could be predicted, targeted and prevented and whether there are individuals who could be targeted for intervention post hospital discharge, to reduce readmission rates post stroke.

Methods

Using data from the Hospital In-Patient Enquiry (HIPE) patients were identified who had been discharged with a primary diagnosis of stroke. Data was then examined to identify whether these patients had acute hospital readmissions in the 18-month period following discharge for stroke. Using HIPE and patient discharge letters we identified the reasons for these readmissions and categorized them accordingly.

Results

A total of 224 live stroke discharges were identified from 2018. 77 patients were readmitted within 18 months of discharge. In total these 77 patients accounted for 139 admissions. Of the 77 patients that were readmitted average Length of Stay (LOS) was 19 days. Of the 77, 12 were due to recurrent stroke while 49 presented with a new complaint that fell into one of the following four categories, pneumonia, falls/fractures, dementia related, medical complications/medication related

Conclusion

There is a need to identify the unmet needs of stroke patients post hospital discharge so as to reduce the number of readmissions. This would involve screening to identify those suitable to attend a specialist multidisciplinary six-month review clinic where these patients could have onward referral to the appropriate in hospital and community services including intensive dysphagia clinics, therapy-lead spasticity clinic, upper limb rehabilitation programmes, and medical social work support for unmet needs with links to the community.
224 “OLDER PEOPLE WANT TO BE IN THEIR OWN HOMES”: THEMATIC ANALYSIS- PATIENT AND CARER FEEDBACK AFTER PATHFINDER EMERGENCY CALL RESPONSE
Authors: Bernard P , Corcoran G , O'Brien C , Ward P , Kenna L , Laura H , Mooney R , Howard W , Horgan F , Malone A , Masterson S
Published: October 2022

Background

Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is a growing evidence base for alternative care pathway models at the time of a low acuity emergency medical services (EMS) call. Previous research has found a high level of patient satisfaction with the Pathfinder model, in which an Advanced Paramedic and a Physiotherapist or Occupational Therapist respond to EMS calls [1]. However, the reasons underpinning this from a patient perspective have not previously been reported.

Methods

This is a qualitative study employing thematic analysis of open-ended responses recorded in 429 telephone interviews with service users (patients or their next-of-kin), who had been attended by the Pathfinder service following an EMS call.

Results

Five primary themes were identified: (1) the professionalism of the interdisciplinary clinical team; (2) “the right service, in the right place at the right time”; (3) the role of Pathfinder in “getting the ball rolling” through following up and co-ordinating referrals and services; (4) the lasting impact of the experience on the patient and their next-of-kin; (5) the value of skilled communication with the older person, as well as smooth and “tuned-in” communication across the team.

Conclusion

Older people voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be assessed and treated in their homes at the time of an EMS call rather than automatic conveyance to the ED. They recognised the value of a skilled interdisciplinary team, with a follow-up service, that effectively positions itself between the acute hospital and community services.

Reference

1. Bernard P, Corcoran G, Kenna L, et al. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50(5):1854–1858.
225 OLDER PERSONS REHAB AT HOME (OPRAH) INDICATES AN EFFECTIVE ALTERNATIVE PATHWAY TO INPATIENT REHABILITATION
Authors: Coen M , Murphy R , Connolly A , O'Connor A , Doyle E , Byrne S , Carty J , Breen C , Canavan M , Waters R , Robinson S
Published: October 2022

Background

Older adults have longer hospital stays, higher incidence of nosocomial complications and higher readmissions rates. Older persons rehabilitation at home (OPRaH) is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. OPRaH offers a comprehensive geriatric and interdisciplinary approach. The model enables a safe and accelerated discharge from acute care to home.

Methods

Patients are identified and screened by a team coordinator. On Discharge to OPRaH the following measures were collected; basic demographics, referral source, clinical frailty score and Functional Independence Measures (FIM). Outcomes evaluated are the FIM change, readmission rates, length of inpatient stay savings and time on the service. Data from the first year of operation was analysed using descriptive statistics.

Results

109 patients have undergone rehabilitation with the service with a median age of 82 years (63-103 range). Over two thirds (68%) were classified as frail, with 44% living alone. An injurious fall was the most common reason for index hospitalisation (50%). Referral source was inpatient acute medical team in 50% of cases, with 21% from acute geriatrics , 13 % ortho geriatrics, 13% surgical. Average functional independence measure scores improved from 89 to 102 (p = 0.007). There was no difference in the magnitude of improvement by frailty status (13 vs 14, p = 0.85). The average length of stay saving was 7 days per case, with a total of 757 days saved in one year. Readmission rate within 30 days was 9.3 %. Participants highly rated the service through structured evaluation.

Conclusion

This novel service provides a valuable intervention to a wide case-mix of older adults with evidence of improvements in formal markers of functional impairment after intervention. Referral was based on definable rehabilitation goals and not just on frailty status, age, or gender.
227 UNSCHEDULED ACUTE HOSPITAL ADMISSIONS FROM A COMMUNITY REHABILITATION TEAM – GERIATRIC GIANTS OR “ACOPIA”?
Authors: Synnott P , Alookaran S , O'Malley G , Hickey P , Drumm B , O'Sullivan F
Published: October 2022

Background

The Integrated Care Team (founded 2018) provides community rehabilitation in the home for frail older adults. Frail older adults are at increased risk of hospitalisation, and frailty is associated with increased length of stay and mortality. This retrospective cohort study aims to explore the acute hospital admissions of this frail cohort from July 2019 to December 2021.

Methods

Patients were identified from the integrated care team database who had a discharge destination of “Acute Hospital”. Hospital IT system data and discharge summaries were used to analyse inpatient Length of Stay (LOS), presenting complaints and discharge diagnosis. The study period was from July 2019 to December 2021.

Results

67 patients were admitted to hospital during the study period from the care of the integrated care team, accounting for 98 individual hospital admissions. This accounted for 19.8% of discharges from the team during the study period, with 77% of patients discharged to community support. 23.8% of patients (n=16) had multiple admissions, with the majority of these(n=14) admitted twice. The average age of patients was 82.6 years. 58% of admitted patients were female. The longest LOS was 99 days, and shortest less than one day. The average LOS was 12.9 days for the total population. Excluding two outlier stays of 99 and 82 days, the average LOS was 11.27 days.

32% of patients presented with functional decline, 28% with falls, 18% with shortness of breath and 19% with delirium. Infections were diagnosed in 28% of patients, neurological events in 12% and bleeding diagnoses in 11% of patients. 1 patient died during admission. Only 12.2% of stays (n=12) were less than 72 hours in duration.

Conclusion

This frail patient cohort presented with a range of frailty syndromes and complications of medical comorbidities. The low prevalence of short hospital stays may reflect the ongoing role of the community team supporting patients in the community.
231 NURSING HOME RESIDENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH FALLS
Authors: O'Connor A , Fallon A , Noonan C , McElwaine P , Kennelly S
Published: October 2022

Background

Nursing Home Residents (NHR) are the most-frail group of older persons, with many comorbidities that increase their risk of falling. Falls are a frequent reason for ED attendance by NHR’s as it is for all older persons, but little is reported on their characteristics and outcomes specifically.

Methods

A prospective cohort study of all NH presentations with falls to the ED of a university teaching hospital over a one-year period. Detailed operational and clinical phenotype characteristics, and outcomes were recorded in all instances.

Results

There were 519 ED presentations by 344 NHR over one year. Almost half of all presentations (48.2%, 250/519), were as result of a fall, by 172 residents. The majority were female (137/250, 55%), with an average age of 77.8 years (±10.8). Many, 84.3% (145/172), had a prior fall in the past six-months. Almost half had a diagnosis of dementia (124/250, 49.6%). A third mobilised with a Zimmer-frame (83/250), and 10.8% (27/250) wheelchair. 33.2% (83/250) had visual impairment. The mean Barthel Index was 9.55 (±5.12) indicating high-dependency. NHRs fallers frequently attended ED outside routine working hours, with 36.8% (92/250) and 27.6% (69/250) presenting after 5pm (Monday to Friday), or at the weekend respectively. 54.8% of patients were admitted (137/250), and only 25.6% of patients had review by a GP prior to ED-referral (64/250). The average Length Of Stay (aLOS) for admitted NHR fallers was 10.4 (±9.1) days. Injurious falls were noted in only 10.4% (26/250) presentations. aLOS for those admitted with documented injuries (14/26, 54%) was 5.0 days (±7.0, n=14).

Conclusion

NH residents have complex clinical needs and falls is a frequent reason for attending ED. Better access to “out of hours” clinical support within the NH, and better integrated falls prevention programmes/ care pathways between NHs and primary/secondary services are necessary to enhance care and optimise falls prevention.
237 POTENTIALLY INAPPROPRIATE PRESCRIBING IN HOSPITALISED FRAIL OLDER ADULTS: DEVELOPMENT OF THE OPTI-3S PRELIMINARY STATEMENTS
Authors: Ali AH , McMahon N , Ryder S
Published: October 2022

Background

Few assessment criteria exist for Potentially Inappropriate Medications (PIMs) in the hospital setting. This study aims to develop the preliminary statements of OPTI-3S, criteria for optimising medicines by stopping, stepping down or switching to safer alternatives. These are designed to be of value to clinical practitioners in the routine care of hospitalised, frail older adults.

Methods

A systematic literature review was conducted in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, CINAHL, EMBASE and Scopus (2010-2021). Search terms included the concepts of inappropriate prescribing, deprescribing and the target population (e.g. older, frail, hospitalized). This was supplemented with a PubMed focused search (2010-2021) using key words pertaining to the index diseases/conditions or inappropriate medications. The structured reviews included clinical based guidelines, PIMs lists, systematic/non-systematic reviews, or clinical/observational trials that assessed safe and/or effective use of medications in older adults. The preliminary statements were then drafted based on the available relevant evidence.

Results

Searches yielded ~1500 articles. These were included in structured reviews, yielding a total of 109 initial statements across seven physiological systems, and one patient-centred point of care (perioperative care). In addition to detailed PIMs statements (n=98), 11 statements address clinically important Potential Prescribing Omissions (PPOs) (e.g. anticoagulant underdosing) and altered blood pressure and glycaemic targets. Uniquely for criteria of this kind, 23 statements suggest PIMs be considered based on the different frailty levels, according to the Clinical Frailty Scale. 11/98 PIMs statements concern prescribing cascades and suggest tapering regimens for six inappropriate medication classes (e.g. antipsychotics, benzodiazepines). Several statements address medication appropriateness in other frailty related circumstances (e.g. non-compliance, overlapping co-morbidities, feeding tube incompatibility, pill burden/ polypharmacy).

Conclusion

Literature provides a large body of evidence to support prescribing optimization. This has been distilled into consensus-based statements, which should guide hospital-based health care professionals caring for frail older adults.
239 PATIENT PERCEPTIONS OF THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Davis AJ , Kenny L , Delaney A , Doyle C , Sweeney A , Nally SM , Namara RM
Published: October 2022

Background

The EDITH service provides an alternative to Emergency Department (ED) attendance for the older adult by providing emergency care in the person home. It is imperative to explore how this service is received by the key stakeholders in order to ensure it is meeting the needs of older adults and to improve and diversify same.

Methods

A patient feedback survey was circulated to patients and family members who received the EDITH service. A postal option and a QR code leading to an online option were utilised. 50 surveys were randomly selected for inclusion. Quantitative data was analysed via paper count method and thematic analysis was completed for the qualitative data.

Results

74% rated the service as “excellent”, 22% “very good” and 4% “good”. Alternative options to the service were identified as “going to ED” 22% , “going to GP” 22%, “waited until they would get better” 4%, “waited until they got worse” 2%, “would do nothing” 6%. 80% rated the combined expertise of a doctor and OT as “extremely important”, 94% rated the home visit aspect as “extremely important” and 90% rated ED avoidance as “extremely important”. Key themes that emerged regarding what the service does well included “personalised care”, “ED avoidance”, “compassion” and “timeliness of service”. Areas for improvement included “improving communication loop to both patients and/or community services! and “ability to directly access the service”. 95% of respondents advised they would or have already recommended the service to others. Of note, a key theme in the comments section was the need for a similar service in other hospitals.

Conclusion

The EDITH service appears to be meeting stake-holders expectations, areas for improvement have been identified and are currently being addressed. It is imperative to obtain the perception of the service user and to tailor interventions accordingly, this feedback is invaluable in order to meet future service needs.
240 STANDARDISING POST-FALL MEDICAL REVIEWS FOR HOSPITAL INPATIENTS
Authors: Daly S , Gibbons C , Callaly E , Gaynor E
Published: October 2022

Background

Falls are the most common adverse incident of inpatients in Irish hospitals. 6% of inpatient falls cause serious injury. Older inpatients have the highest risk of falling and the highest risk of injury. The post-fall medical review is critical to assess why a patient fell, did the fall cause injury and for the introduction of measures to prevent future falls. We assessed the quality of the post fall reviews in a large hospital. We then introduced a standardised post-fall medical review pro forma and reassessed the quality of the reviews.

Methods

We reviewed 18 charts of patients that fell in hospital and assessed the documentation of the post fall review in terms of the inclusion of key elements such as patient identifiers, history, examination, injury management and future falls prevention. We then introduced a post-fall standardised pro-forma on five wards in the hospital and following this assessed 19 charts of patients who had fallen looking at the same key elements of the post fall review. We compared the quality of the post-fall review before and after the introduction of the pro forma.

Results

The post-falls medical review pro forma improved the quality of the post fall medical review. Hip Trauma: 11.1% of doctors asked about hip strike prior to proforma versus 100% who asked with the proforma. Joint examination: 50% assessed this prior to the proforma versus 100% with the pro-forma. Other aspects of the review that improved included head-strike assessment (89% versus 100%), loss of consciousness history (61% versus 95%), medication reviewed (22% versus 68%) and vital signs assessed (67% versus 95%).

Conclusion

The introduction of a standardised post fall review pro forma improves the quality of this important medical review. It is a useful aid for doctors and provides a framework to follow when reviewing the patient.
249 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR GENERALIZED ANXIETY DISORDER AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Herring M , Rasmussen CL , Kenny RA , Laird E
Published: October 2022

Background

Among older adults, Generalized Anxiety Disorder (GAD), a debilitating condition characterized by persistent excessive worry, is associated with poorer quality of life and estimated cost to the individual of €1,864 annually. Meeting recommended Physical Activity (PA) levels has been associated with lower odds of GAD; however, the minimally-sufficient dose associated with benefits is currently unknown. Herein, we quantified the association between different PA doses and worry symptoms and GAD status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods

PA was measured at each wave using the short-form International Physical Activity Questionnaire. Five dose categories were examined (0, 1-<600, 600-<1,200, 1,200-<2,400, and ≥2,400 MET.min.week-1). At all waves, worry symptoms were assessed using the abbreviated Penn State Worry Questionnaire continuous score; a score of ≥23 classified GAD status. Additionally, for Waves 2-5, the CIDI GAD quantified diagnosis of GAD during the past 12 months. Poisson regression with Stata quantified associations between PA dose and GAD and worry symptoms, adjusted for age, health/lifestyle variables and antipsychotics/anxiolytic medication.

Results

Among 2,200 participants, compared to lowest PA dose, only the highest PA dose (i.e., ≥2,400 MET.min.week-1) was significantly associated with 35% lower odds of GAD (OR=0.65; 95%CI: 0.51, 0.82; p≤0.001). For continuous worry symptoms, meeting the recommendation of at least 600 MET.min.week-1 was significantly, inversely associated with worry symptoms (coefficient= –0.02; 95%CI: –0.033, –0.005; p≤0.009). Female sex, less education, taking anxiolytics, and current smoking were also associated with greater odds of GAD and greater worry severity.

Conclusion

High physical activity dose was associated with lower odds of GAD over 10 years among older adults. Present findings suggest that older adults, particularly females and smokers, may need to exceed recommended physical activity levels to protect against GAD.
253 DELIRIUM IDENTIFICATION AT INITIAL TRIAGE IN AN IRISH EMERGENCY DEPARTMENT SETTING
Authors: Jennings E , McLoughlin K , Maher G , O’Sullivan J , Gilligan P , Dockery F
Published: October 2022

Background

Over 10% of older adults are affected by delirium on presentation to Emergency Departments (ED), with many more developing it during a prolonged ED stay. Early detection is key to delirium management, but the diagnosis is often missed, with over 50% of delirium going undetected in the ED. In 2019 the HSE guideline on Early Identification and Management of Delirium in the ED recommended that all those over 65 years be screened on presentation to ED using the 4AT, a validated instrument in delirium screening. Through our ED’s delirium working group, we conducted a baseline audit on current rates of screening for delirium, ahead of a quality improvement project on management of patients with, or at risk of delirium in our ED.

Methods

A retrospective review was conducted of consecutive patients >65yrs who presented to ED in one month with the following terms mentioned in the presenting complaint at triage: confusion/delirium/memory/speech/language disturbance/agitation i.e. terms that could indicate possible delirium as considered by the triage practitioner. We also recorded whether a 4AT was recorded. An additional 50 charts from the consecutive series were randomly selected and examined for probable delirium on presentation which was not captured at triage.

Results

n=23/1,597 (<1%) had possible delirium recorded at triage as per our criteria. In-depth case note review supported the diagnosis of delirium in 20 of the 23 initially identified at triage. Only 5 of these had a documented 4AT score. Of the additional 50 charts screened, a further 6 had likely delirium of whom n=3 had a 4AT score completed. N=16 required hospital admission.

Conclusion

Delirium screening and detection rates at ED triage are less than expected, and below the 2019 national screening recommendations. Implementing same in any busy ED is challenging. We are developing a multifaceted educational program to address this and plan a repeat audit following implementation.
256 THE DEVELOPMENT OF A PATIENT AND CARER INFORMATION LEAFLET FOR PATIENTS FOLLOWING HIP FRACTURE
Authors: Rafferty M , Murphy D , Creech J , Dukelow T , Ahern E
Published: October 2022

Background

Consistent delivery of high-quality information to family and caregivers can significantly improve patient experience and care during and after hospital admission. This became especially important with limited visiting hours during the COVID pandemic and our unit noted the need for appropriate written information. We aimed to complete a search of available resources nationally and internationally and develop our own information pack for distribution to our patients.

Methods

Literature search was conducted for available patient and carer information resources nationally and internationally including grey literature search. Key areas and patient priorities were identified. We then began developing a patient information booklet for distribution in our unit.

Results

We identified several key areas to be included in our information pack including what to expect during the hospital admission. This included pre-operative care, operative management, post-operative care especially delirium, pain, nutrition and continence promotion. Information regarding post-discharge care including off-site rehabilitation, rehabilitation at home and future actions including bone health and falls prevention interventions with home modification advice was also included. We developed a patient and caregiver information leaflet for our unit using data from the Irish Hip Fracture Database and our local unit practices and pathways to ensure information was relevant to our patients.

Conclusion

We completed the design of a patient and caregiver information leaflet highlighting important aspects of care post hip fracture in our unit.
264 FREEDOM AND LONELINESS: SPOUSAL DEMENTIA CARE-GIVERS AND THE NURSING HOME TRANSITION
Authors: Power JM , Holton E , Warters A , Simons R , Pertl M , O'Sullivan R , O'Philbin L , Lawlor B
Published: October 2022

Background

Many persons with dementia transition to nursing home care, but little is known about the impact, positive and negative, that this may have on the social isolation and loneliness of their spouse.

Methods

Using our existing theoretical synthesis of loneliness to provide sensitising concepts, we conducted a deductive grounded theory study of loneliness during the nursing home transitions. We recruited 11 spousal participants to engage in semi-structured remote interviews during 2021.

Results

Participants provided their own definitions of loneliness, and spoke about their life history of loneliness, the loneliness associated with living with a spouse with dementia, and the loneliness, and alleviation of loneliness through re-engagement with social contacts, associated with their spouse moving to the nursing home. Participants agreed with the idea that loneliness has a physical feeling. More distal parts of the theoretical synthesis, such as the influence that culture and gender have on loneliness, were not corroborated by the findings.

Conclusion

We conclude that loneliness is a frequent experience among spousal caregivers whose spouse has moved to nursing home care, but that loneliness is also associated with living with a spouse with dementia. Loneliness in this population was aggravated by the COVID-19 pandemic and associated lockdowns. Further research steps will involve more targeted interviewing to focus on the link between transitions and loneliness in this and in other populations.
265 A PHYSIOTHERAPY-LED TRANSITION TO HOME INTERVENTION FOR OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE: A PILOT FEASIBILITY RANDOMISED-CONTROLLED TRIAL
Authors: Conneely M , Holmes A , O'Connor M , Leahy A , Gabr A , Saleh A , Okpaje B , Corey G , Barry L , Griffin A , O'Shaughnessy Í , Ryan L , Synott A , McCarthy A , Carroll I , Leahy S , Trepél D , Ryan D , Robinson K , Galvin R
Published: October 2022

Background

Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS).

Methods

Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation.

Results

29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups.

Conclusion

High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.
272 PHYSIOTHERAPISTS' EXPERIENCES OF WORKING IN RESIDENTIAL CARE IN THE REPUBLIC OF IRELAND DURING COVID-19
Authors: O'Callaghan S , Reilly A , O'Shea O
Published: October 2022

Background

COVID-19 was officially declared a pandemic in March 2020. Social distancing and visiting restrictions were introduced in Irish residential care units in March 2020. The impact of COVID-19 and associated restrictions on physiotherapists working in residential care in the Republic of Ireland (ROI) is unknown. This study aimed to explore the experience of physiotherapists working in residential care units in the ROI during the COVID-19 pandemic.

Methods

A qualitative phenomenological study design was used. Physiotherapists working in residential care units were invited to participate in one-to-one semi-structured interviews from December 2021 to March 2022. Participants were recruited via purposive and snowball sampling. Data were analysed using reflexive thematic analysis by two independent reviewers.

Results

Seven one-to-one semi-structured interviews were conducted among five female and two male physiotherapists. Four major themes emerged: (i) service adaptation (ii) communication (iii) physical and emotional impact of COVID-19 pandemic on staff and (iv) physical and emotional impact of COVID-19 pandemic on residents. A number of subthemes were identified under each theme. Participants experienced changes in service delivery including redeployment, reduced resident contact and social distancing. These changes resulted in innovation, mainly through telehealth. Participants felt communication from managers could be improved through clarity regarding protocol changes. The pandemic stimulated enhanced inter-professional communication among physiotherapists. Some participants contracted COVID-19 resulting in residual physical impairments. Participants were affected emotionally through the increased stress experienced due to COVID-19 restrictions. Residents experienced isolation due to visiting restrictions. Due to reduced physiotherapy input participants observed reduced physical functioning among residents.

Conclusion

COVID-19 and its associated restrictions had a profound impact on physiotherapists working in residential care units as well as on residents. The extent of this impact is only beginning to emerge. Planning for future pandemics should consider the long-term physical and emotional consequences of restrictions on both physiotherapists and residents.
279 INCLUSION OF OLDER PATIENTS IN CLINICAL TRIALS: A REVIEW OF A SINGLE, HIGH IMPACT, MEDICAL JOURNAL OVER A 2-YEAR PERIOD
Authors: Mc Carthy CE , Murphy R , McAteer C , Okon M , O'Donnell M
Published: October 2022

Background

Older patients have the highest rates of multimorbidity and prescription drug use. Despite this, previous research has found that these patients are not well represented in Randomised-Control Trials (RCTs), limiting external validity. In recent years many guidelines have been issued to help facilitate the inclusion of older patients in RCTs. We aimed to explore the inclusion of older patients in recent RCTs publications.

Methods

A single, high impact, medical journal was systematically reviewed, with all full text publications between March 2019 and March 2021 being screened. All adult, Phase III, RCTs were selected. The age descriptors of controls were extracted, in addition to information on eligibility criteria that could lead to exclusion based on age, comorbidity, or cognition.

Results

Of 123 RCT publications, the mean age was ≥65 in 42.1% and ≥75 in 8.3%, while the 75th centile age was ≥65 in 72% and ≥75 in 25%. An explicit capacity requirement was present in 41.5% and those with cognitive impairment were excluded in 15.4%. Eligibility determined at the discretion of the investigator and a life-expectancy exclusion criteria were present in 33.3% and 36.6%, respectively. A maximum age limit was present in 18.7%. No RCTs excluded on the basis of polypharmacy. The mean/75th centile age differed significantly by speciality (p<0.05), oldest in cardiovascular and medical RCTs. Having a maximum age limit was significantly associated with a lower mean/75th centile age (p<0.01), while having a life-expectancy exclusion criteria was associated with a higher mean/75th centile age (p<0.05). The age did not differ significantly between pre/post-COVID-19 RCTs, or for other eligibility criteria studied.

Conclusion

While those ≥65 were well represented, those ≥75 were not. Eligibility criteria that could potentially lead to exclusion based on age, comorbidity, or cognition were also common, although the majority did not significantly affect age.
287 SILVER TRAUMA REVIEW CLINIC – A NOVEL MODEL OF CARE FOR OLDER TRAUMA
Authors: Maoileannaigh L Ó , Mahony A , Riches R , Ramiah V , Byrne C
Published: October 2022

Background

Increasing numbers of older patients are presenting to Emergency Departments (ED) following trauma. These patients require multidisciplinary care that the traditional trauma model fails to provide. Therefore, a Silver Trauma Review Clinic (STRC) was developed in conjunction with the geriatric, ED and physiotherapy services. The goal of the clinic is to provide a comprehensive multidisciplinary management for older patients following non operative traumatic injuries.

Methods

A retrospective review of routinely gathered data was performed of the first 100 patients reviewed in the STRC between May 2021 and April 2022.

Results

Median patient age was 81 years old (IQR 73-86) and 69% were female. Median clinical frailty score was 3 (IQR 2-4). Median time from the patient’s initial ED presentation to clinic was 14 days (IQR 10-24) and median time from the initial review to discharge was 21 days (IQR 8-35). Mean number of assessments was 2. 70% of presentations were as a result of falls under 2 metres. Primary injuries were 17% vertebral fractures, 49% limb fracture, 17% thoracic trauma, 11% pelvic trauma with 15% of patients suffering from multiple injuries. 59% were already on bone protection and a further 29% were commenced on treatment. 21% had an abnormality on Mini-cog testing. 21% were newly diagnosed with orthostatic hypotension and 49% had difficulty with balance or walking. Only 5% required surgery.

Conclusion

The STRC is a novel approach of patient focused multidisciplinary trauma care for frail older patients following non operative trauma, ensuring timely care.
297 ADHERENCE TO DENOSUMAB PRESCRIPTION FOLLOWING DISCHARGE FROM A GERIATRIC REHABILITATION UNIT
Authors: Lynch A , Murray D , Whelan O , Mello S
Published: October 2022

Background

Post-acute geriatric rehabilitation units are an ideal setting to address bone health following acute admission with a fracture. Longer lengths of stay allow for vitamin D replacement and comprehensive multidisciplinary input. However, persistence with osteoporosis medications is suboptimal amongst older Irish adults, and breaks in therapy reduce the medications effectiveness. This study aims to determine adherence rates to Denosumab six-months after discharge from geriatric rehabilitation in patients with fragility fracture who either commenced or continued treatment whilst an inpatient.

Methods

Patients admitted with fragility fracture between January and October 2021 were identified through review of an online database. The type of osteoporosis medication, and dates of treatment were documented. Adherence to denosumab prescription six months post-discharge was checked using the Primary Care Reimbursement Service (PCRS) database.

Results

98 patients were admitted with fragility fractures, representing one third of total admissions. Patients were excluded for incomplete data (10), transfer back to acute facility (10) or death (4). Of the 74 included, the average age was 80 (range 65-94), and 53 (71%) female. One in five had a diagnosis of dementia. 52 Patients received first dose Denosumab as an inpatient, 4 were continuing on Denosumab, 11 were on bisphosphonates (4 changed from Denosumab on discharge) and 10 not on bone protection. The majority of patients (N=30, 57%) who had Denosumab administered in hospital did not have the second dose administered at six months.

Conclusion

In keeping with prior research, this study found that persistence with osteoporosis medications is low. Reasons are multifactorial and may include the infrequent timing of Denosumab and a lack of reminders to give the medication in primary care settings. New guidelines recommend enhanced screening for and treatment of osteoporosis in frail older adults including follow-up appointments to check adherence to treatment.
305 PHYSICAL ACTIVITY & DEPRESSION AMONG OLDER ADULTS WITH DIABETES: PRELIMINARY EVIDENCE FROM 10 YEARS OF THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: Rasmussen CL , Laird E , Kenny RA , Herring M
Published: October 2022

Background

Older adults living with diabetes are at increased risk of physical and mental health issues, including depression. Among older adults living with diabetes, the salutary benefits of Physical Activity (PA), including increased insulin sensitivity and improved glycaemic control, are well established; however, less is known about the relationship between PA and depression. Thus, we quantified associations between different PA doses and depressive symptoms and status among older adults living with diabetes across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods

Older adults (n=268) living with diabetes were identified through self-report and/or medication use. PA was measured with the short-form International Physical Activity Questionnaire. Five dose categories (0, 1-<600, 600-<1,200, 1,200-<2,400 and ≥2,400 MET.minutes per week) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form; a score of ≥16 classified depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression models quantified the associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables, and antidepressant medication.

Results

The minimal PA dose associated with lower depressive symptoms was 1-<600 MET.mins (coefficient = –0.20; 95%CI: –0.35, –0.05; p≤0.009). A dose of 600-<1200 MET.min was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Additionally, being male, having sufficient vitamin D intake and lower age were associated with lower odds of depressive symptoms.

Conclusion

Present findings suggest that even low PA doses protect against depressive symptoms among older adults living with diabetes. This further supports the importance of promoting PA for mental health among this high-risk population group.
312 DOES EXCLUDING PATIENTS WITH ORTHOSTATIC HYPOTENSION AFFECT SAFETY ESTIMATES IN HYPERTENSION TRIALS? A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS
Authors: Reddin C , Hanrahan C , Murphy R , Costello M , Waters R , O'Donnell M
Published: October 2022

Background

In order to apply the findings of antihypertensive randomised controlled trials to older adults, it is important to understand the populations included and consider the generalizability of the results to cohorts that may have been excluded. The purpose of this study was to determine whether participants with orthostatic hypotension were included in randomised controlled trial of antihypertensive therapy and whether adverse event rates of particular importance to this cohort; namely falls or syncope differed based on their exclusion.

Methods

We performed a systematic review and meta-analysis of randomised controlled trials comparing antihypertensives to placebo, combination of antihypertensive agents compared to fewer antihypertensive or higher compared to lower blood pressure targets that reports falls or syncope outcomes. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials which excluded patients with orthostatic hypotension and trials which did not exclude patients with orthostatic hypotension. Difference in treatment effect was assessed by testing P for interaction. The primary outcome measure was falls events.

Results

Forty-Seven trials were included, including 18 trials which excluded those with orthostatic hypotension and 29 trials which did not exclude those with orthostatic hypotension. Thirteen trials (n=94,222) reported falls. The baseline incidence of falls in the control group was 4.8% in trials which excluded orthostatic hypotension compared to 8.8% in trials which did not exclude participants with orthostatic hypotension. The association of antihypertensive treatment and falls was similar for trials which excluded those with orthostatic hypotension (OR 1.00; 95%CI, 0.89-1.13) and trials which did not exclude those with orthostatic hypotension (OR, 1.02; 95%CI, 0.88 –1.18).

Conclusion

The exclusion of patients with orthostatic hypotension may under-estimate the event rate of adverse events such as falls but does not appear to affect relative risk estimates associated with antihypertensives.
323 A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT FOR MANAGING NON-COGNITIVE SYMPTOMS OF DEMENTIA IN ACUTE CARE
Authors: Allen Y , Foubert M , Curtin D , Hennessy C , Twomey N , Galvin AM , Naughton C
Published: October 2022

Background

Over 80% of patients with dementia in acute care hospitals are prescribed an antipsychotic drug (INAD2) for management of Non-Cognitive Symptoms of Dementia (NCSD). Antipsychotics have a high side effect burden including increased mortality. Non-pharmacological interventions are first line management but many acute care wards are poorly equipped to deliver such interventions. The project aims to improve management of patients’ NCSD and reduce pro re nata (PRN)/stat and intra-muscular (IM) antipsychotic prescribing in an acute care older adult ward.

Methods

Using Plan-Do-Study-Act cycles (PDSA) a multicomponent intervention was iteratively designed and the implementation strategy is being tested. The components includes: an antipsychotic decision algorithm, Clinical Nurse Specialist (CNS) led patient review, patient behaviour charts, staff education and one-to-one coaching by CNS, patient ‘Get-to-Know-Me’ document and distraction resources. The evaluation involves a monthly point-prevalence audit of patient drug charts.

Results

Over a seven-month period, baseline data indicated wide variability in patterns of antipsychotic prescribing. A median of 14 patients per month (min 7, max 18) were prescribed an antipsychotic drug, a median of five patients (min 3, max 12) were prescribed PRN antipsychotics and a median of two patients (min1,max3) received one or more IM injection for NCSD. There was often little information on the reason for administering PRN antipsychotic medication. There was some evidence of reduced PRN and IM medication for new patient admissions (0-4 doses), but individual patients with prolonged hospital stays had high levels of antipsychotic use.

Conclusion

Reducing reliance on antipsychotic drugs requires multicomponent intervention and MDT collaboration. This intervention focussed primarily on coaching of healthcare professionals and improving the quality and consistency of prescribing. However, much more is required on environment design and access to cognitively stimulating activities to achieve a sustained improvement in patient outcomes, especially patients who experience a prolonged hospital stay.
327 REVIEW OF ONCOLOGY PATIENTS ADMITTED FROM 2019-2021: DEFINING THE NEED FOR AN ONCO-GERIATRIC SERVICE
Authors: Cummiskey AG , Briggs R , Lavan A
Published: October 2022

Background

With an aging population, there is an increased need to consider older patients for cancer treatment. Involvement of a Comprehensive Geriatric Assessment (CGA) in an oncology workup can help guide cancer treatment and non-pharmacological treatment in older patients. We undertook a retrospective study looking at older patients admitted during their cancer treatment to establish the need for an onco-geriatric service in our hospital.

Methods

All patients over 85 admitted under oncology from 2019-2021 had a retrospective chart review. Patient demographics, indication for admission and discharge destination were collected. Clinical markers, such as total medications, comorbidities and social history were used to generate an overall understanding of the patient’s Clinical Frailty Score (CFS). We then retrospectively implemented a geriatric assessment to see how patients would benefit from a CGA if an onco-geriatric service was implemented in our hospital.

Results

A total of 22 patients over 85 accounted for 33 admissions, with 54.5% female (n=12). The median CFS was 4 (3-5). At time of admission, 90.1% were on concomitant cancer treatment; 41.7 concurrent chemo, 13.6% concurrent RT. The mean patient had conditions 5.61 (SD3.2 and took an average of 9.2 (SD3.7) regular medications. Most admissions (n=18) required at least one consult from another service (54.5%), with palliative care and cardiology having the highest burden of consults at 11 (33%) and 8 (26.7%) respectively. Only 1 patient had a geriatric consult, while another was seen by our Falls and Syncope Unit after a fall leading to admission. Patients following each attendance were discharge home in 75.7% cases (n=25). Hospice (12.1%), convalescence (3%) and nursing home (3%).

Conclusion

We identified multiple areas in which a CGA can improve management of older patients undergoing cancer treatment, including medication rationalisation. We feel that a onco-geriatric service development in our hospital will lead to better patient care for our older population.
Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty?
Authors: Fontes de Moraes Betina Zimmermann , Ferreira Lydia Masako , Martins Maria Roberta Cardoso , Rostom Lucas , Castro Hugo Alexandre Sócrates de , Nahas Fabio Xerfan
Published: October 2022

Background

The main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery.

Objectives

The authors sought to evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty.

Methods

Thirty-two women aged 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. Statistical tests included t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of .05 (P ≤ .05).

Results

The no-garment group showed a trend toward lower mean waist circumference at 29 days following abdominoplasty and significantly lower waist circumference after postoperative day 35 compared with the garment group (P < .001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (P = .05).

Conclusions

Patients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.