bluuebunny/crossref_metadata_2025 huggingface dataset:
84 IMPACT OF RELOCATION AND MIGRATION ON THE SOCIAL RELATIONS OF OLDER MEN AND WOMEN OVER THEIR LIFE COURSE
Authors: Sheridan C
Published: February 2023

Background

While there is a recognition in the established literature of the need to investigate life-course factors in the construction of exclusion from social relations and gender pathways, how those pathways intersect with the relocation and migration histories of older people has not been sufficiently explored. Thus, illuminating this intersection is important in understanding major turning points in people’s social connections, and this has particular significance in Ireland given that most older people are likely to have experienced some form of migration.

Methods

Thirty in-depth semi-structured qualitative telephone interviews with older men and women in Ireland, as part of a wider GENPATH study into exclusion from social relations.

Results

There is preliminary evidence to suggest that relocation and migration has a differential impact on the social relations of men and women over their life course. The findings reflect the common phenomenon in Ireland where it was usual for women to move into new communities upon marriage. Also, women’s experience of within-country relocation was often linked to their husband’s working-life trajectories, whereas employment was the motivation behind this form of relocation for the male participants. For those who had experienced emigration, returning to Ireland was driven by a desire to return to their place of origin or to retire in Ireland to be nearer to family in later life.

Conclusion

Findings point to the intersection between relocation and migration life histories and gendered pathways to exclusion from social relations. The impact on social connectivity is experienced differently at different points across the lives of these older men and women. Consideration needs to be given to gender normative roles and structural influences to gain a greater understanding of how these intersect with migration.
106 EDITH (EMERGENCY DEPARTMENT IN THE HOME): AN 18 MONTH AUDIT OF A NOVEL SERVICE
Authors: Davis A J , Delaney A , Doyle C , Sweeney A , Kenny L , Nally S M , Namara R M
Published: February 2023

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. The traditional model, which involved the transport of an older adult to an emergency department has been replaced with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods

Data from electronic patient records and OT logbooks were audited from the period 22/02/20 to 09/08/21. Data was gathered regarding attendances, outcomes and conveyance rates.

Results

Since its’ inception the EDITH service has treated 3,137 patients. Following treatment, 2,909 patients remained at home while 228 patients were transferred to hospital. This gives a conveyance rate of 7.2%. Three hundred and thirty six patients were referred to primary care or day hospital services. The average age of patients is 82 years and the average Manchester Triage category is priority 4. The EDITH service has saved the hospital 7.9 years of bed days (2,909 bed days) as these patients have not presented to the emergency department.

Conclusion

There is a growing body of evidence highlighting the detrimental impact a hospitalisation can have on an older adult (Mudge et al., 2019). There is a clear need for health care services to diversify in order to meet the needs of this ageing population. The EDITH service is leading this change in Irish healthcare by providing specialised emergency care and OT intervention for the older adult in their own homes.

Reference

1. Mudge et al. (2019). Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. Journal of the American Geriatrics Society. 67(2).
107 EMERGENCY DEPARTMENT IN THE HOME, WHO IS THE EDITH PATIENT?
Authors: Davis A J , Doyle C , Delaney A , Sweeney A , Nally S M , Namara R M
Published: February 2023

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. This vulnerable patient population receive emergency medical and occupational therapy treatment and intervention in their home environment. The typical patient profile is assumed to be ‘frail older adults’, but this needs to be more specifically defined within the clinical practice in EDITH.

Methods

A total of 230 electronic patient records were selected at random. Data was audited and analysed with regard to clinical descriptors for this patient population.

Results

Of the 230 patients treated, 26 were referred to hospital or rehabilitation facilities. This is a conveyance rate of 11% which is above the average rate of 7.2% for this service.

The Rockwood Clinical Frailty Scale (CFS): 22% had a CFS of 5 (mildly frail), 37% had a CFS of 6 (moderately frail), 22% had a CFS of 7 (severely frail), 3% had a CFS of 8 (very severely frail).

Living Status: 26% living alone, 48% living with family, 4% sheltered living accommodation and 22% in nursing homes.

Formal Supports: 37% have no formal supports, 18% have <10 hours per week, 19% have between 11–21 hours, 4% have 24-hour care and 22% reside in nursing homes.

Presenting complaint: 41% medically unwell, 23% fall, 14% functional decline, 9% pain, 5% infection, 5% orthopaedic and 2% confusion.

Ages range from 61 years to 100 years with an average age of 82 years.

Conclusion

It is imperative to identify the type of patient that uses this service, in order to plan for future service needs and ensure their current clinical care needs are being met. Of note, a significant proportion of patients are living alone, have high CFS scores and have no formal supports in situ.
108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM
Authors: Duff E , Moran J , Doyle M , O'Gorman M , Ryan M D , Finucane P , Cooke J , Pope G , Mulcahy R , O’Regan N
Published: February 2023

Background

Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition.

Methods

We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought.

Results

This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety.

Conclusion

This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.
110 TO IDENTIFY WHETHER THE CURRENT SEATING AVAILABLE IN AN IRISH EMERGENCY DEPARTMENT MEETS THE NEEDS OF THE OLDER POPULATION
Authors: Maher G
Published: February 2023

Background

A recent campaign in the NHS highlighted that sitting in a chair can help to prevent deconditioning such as the loss of muscle strength, as well as helping to maintain a patient’s dignity (NHS improvement).

The aim of this audit was to review whether the current seating available in our Emergency Department (ED) meets the needs of the older population who attend.

Methods

A prospective audit was completed over 6 days. It captured the number of patients who were seated in chairs in the morning and early afternoon, and if not, why.

Results

Total number of patients reviewed: 62.

Total number of patients on a trolley: 50/62.

Average CFS: 6.

Average age: 83.

Sex: 25 male, 37 female.

• 54% not appropriate due to ongoing medical issues.

Of the remaining 46%;

• 17% lacked appropriate seating.

• 47.8% who were appropriate to sit out did not for a number of reasons i.e. presentation surges in ED, demand outstripped capacity in terms of 1:1 care.

• The remainder either declined to sit out, required specialise seating or no clear reason reported.

• Only 10% of those who were in bed had no medic.

Conclusion

54% of patients who remained on a trolley were medically unwell and not fit to sit out. However 47.8% of those medically fit to sit were not sitting out as per reasons discussed above. More education is needed for all staff about the importance of sitting patients out. Future plans should include staff education sessions and the development of a standard operating procedure to assist with identifying patients on arrival to the ED who could safely sit out. This could help in preventing patients’ cascade to dependency at the front door.
112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP)
Authors: Shiel E , Costello M , McCarthy C , Murphy R , McDermott C , Geoghegan J , Mannion E , Conry M , Flanagan L , Moroney E , Bhaoill C U , Walsh C , Coffey K , Waters R , Robinson S , O'Donnell M , Canavan M
Published: February 2023

Background

Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.

Methods

A referral template was designed. Criteria for referral included; age > 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.

Results

From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.

Conclusion

Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
114 FALLS AND SYNCOPE GUIDELINES APPLIED TO EMERGENCY DEPARTMENT ATTENDEES—HOW DO WE PERFORM?
Authors: Merron G , Lyons C , Dockery F
Published: February 2023

Background

Falls and syncope are one of the most common presentations to emergency departments amongst older people. European Society of Cardiology (ESC) guidelines describe investigation of suspected syncope to assist care.

Methods

Following a previous audit we delivered an education program to Emergency Department (ED) staff, on assessment of fallers and syncope. This was a repeat cycle audit on consecutive patients aged who presented with a fall/faint/collapse/blackout/syncope, to assess impact of education sessions. We also conducted a survey of n = 23 ED staff members, on role of orthostatic blood pressures and ECGs in falls assessments.

Results

Of 80 consecutive attendees with a fall, n = 41 (51%) had possible syncope as documented in the history. ECG was done within the ED in 88% vs. 51% on baseline audit however only 14% (11/80) had lying and standing blood pressure checked vs. 15% on baseline audit. This is despite our survey showing that 17/23 (74%) of ED staff felt that orthostatic BP checks were essential in all fallers, and 44% stating they measure it themselves. Brain imaging was conducted in 44% vs. 40% in baseline audit, rationale for which was unclear in some. 31% (n = 25) were admitted compared to 42% previously. Of the n = 23 admitted, 24% (n = 6) had telemetry or Holter monitor, 20% had an echocardiogram.

Conclusion

Despite an education program on assessment of older fallers, embedding it to alter practice is challenging. While the education program resulted in some improvements, it supports a dedicated team for assessing fallers in the ED. Given the low rate of further investigations into causes for those admitted, a rapid access out patient pathway is warranted. Brain imaging is carried out relatively frequently though we cannot conclude on appropriateness in this limited audit.
123 ACUTE-PHASE BED-REST DURATION WAS ASSOCIATED WITH LOWER GRIP STRENGTH IN A POST-COVID-19 COHORT
Authors: Monaghan A , Jennings G , Xue F , Knight S , Rizzo R , Davis J , Duggan E , Kenny R A , Romero-Ortuño R
Published: February 2023

Background

Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort.

Methods

Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model.

Results

Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39–522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta = −0.158, 95% Confidence Interval − 0.242 to −0.074, p = 0.001).

Conclusion

In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.
131 A REVIEW OF FRAILTY AND PATIENT DISCHARGE OUTCOMES IN A NEWLY FORMED PHYSIOTHERAPY TEAM IN A LEVEL 4 TEACHING HOSPITAL
Authors: Magner S , Collins L , Quaid S , Burke P , Lynch A , Horan E
Published: February 2023

Background

The clinical frailty score (CFS) is a 9 point validated outcome measure used to measure function, mobility, cognition and co-morbidities in patients aged 65 or older. The physiotherapy department was restructured due to COVID-19 pandemic. This resulted in the formation of a mixed specialty team which consisted of Frailty Intervention Team (FIT), Medical Respiratory, Acute Medicine Service, Orthopaedics, General Rehabilitation and Care of the Older Person (COTOP). This service review aimed to identify frailty using the CFS across services and to compare CFS versus age, length of stay, falls history and discharge outcomes.

Methods

The CFS data was collected over two weeks. Inclusion criteria included patients who scored ≥4 on the CFS. Exclusion criteria included patients aged under 65. Variables such as age, history of falls, LOS and discharge destinations were compared across all services using Microsoft Excel.

Results

166 patients were included, the average CFS was 5.24 and the average age was 77.2 years. COTOP had the oldest (Av. age 85.4), frailest (Av. CFS 6.1) and longest avLOS (25.3 days) across all services. Frailty was prevalent across all services, with 81% of patients on the medical respiratory service classed as frail. Patients who scored a CFS of ≥4 had higher falls risk and greater LOS. Of the medical respiratory cohort only 12% were discharged to rehabilitation with 77% discharged home. Orthopaedics had the highest percentage of patients discharged to rehabilitation (44%), followed by the general rehabilitation (34%). Only 14% of the COTOP patients were transferred to rehabilitation.

Conclusion

A high incidence of frailty and falls history was identified across all services. Patients who scored lower on the CFS resulted in reduced LOS and were more likely to be discharged directly home. Proactive screening and detection of frailty allows for targeted interventions that may improve outcomes and inform early discharge planning.
135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS
Authors: O'Flaherty N , Moloney K , Ahmad R , Laird E , Hughes C , McNulty H , Ward M , Strain J J , Molloy A M , Cunningham C , McCarroll K
Published: February 2023

Background

Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.

Methods

We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged >60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level < 30 nmol/l.

Results

2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P < 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P < 0.001).

Conclusion

Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.
139 OLDER PERSONS REHABILITATION: A SIX MONTH PATIENT PROFILE
Authors: Black C , Joyce O , Armitage D , McDermott J , Flynn B , McDonald M , O'Hara C , Costello M
Published: February 2023

Background

For quality improvement to be assessed in a healthcare setting, understanding the specific patient profile is vital. Only then can system performance and service development be reviewed accurately. The purpose of this review was to analyse the patient profile of a 20 bed older persons rehabilitation unit.

Methods

Data was collected weekly for patients admitted and discharged to a sub-acute rehabilitation unit over a six month period (January to June 2021) by a multi-disciplinary team (MDT). Information collected included; age, clinical frailty scale (CFS, revised 2008, Rockwood et al., 2005), MDT involvement, care needs on discharge, onward community referrals and length of stay.

Results

62 patients were included (25 males and 37 females) with an average age of 81 (range 61–99). The CFS was measured for 58 patients and ranged from 1 to 7. On examination, 9% of patients had a CFS of 1–2, 38% a CFS of 3–4, 46% a CFS of 5–6 and 7% a CFS of 7.

Of the 62 patients included, all received physiotherapy and occupational therapy, 28 speech and language therapy, 25 dietetics and 48 medical social work.

The average length of stay was 42 days (range 10–162).

On discharge 42% of patients went home with existing supports, 50% went home with increased supports and 8% went to a residential care facility. Referrals to community services were sent for 65% of patients.

Conclusion

53% of patients admitted to an older person rehabilitation unit had a CFS of 5 or more, indicating they were at least mildly frail. The average length of stay was six weeks and all patients required a minimum of two MDT members during their stay. This highlights the presence of frailty and the importance of effective MDT working in the sub-acute rehabilitation setting.
141 USING A TEMPLATE TO IMPROVE COMMUNICATION ON DISCHARGE LETTERS REGARDING BONE PROTECTION THERAPY AFTER HIP FRACTURE
Authors: Doyle K , McManus C , O'Brien M , Brewer L
Published: February 2023

Background

Hip fractures are a significant cause of morbidity and mortality amongst older adults. The Irish Hip Fracture Database Standard 5 requires that all patients with hip fracture have a bone health assessment completed; most are commenced on bone protection therapy (BPT) to reduce future fractures. Communication to general practitioners (GPs) regarding long-term BPT is often incomplete and challenging to improve. We aimed to upgrade this communication process at discharge.

Methods

Initial audit was conducted assessing documentation of BPT after hip fracture in discharge letters to GPs. Subsequently we created a detailed BPT template for discharge letters containing clear information for GPs regarding medication initiation and advice for ongoing management. The template was introduced and doctors were educated on its use. We then re-audited discharge letters following this intervention. Patients included were over 60 years old with hip fracture. Patients deemed clinically unsuitable for BPT were excluded.

Results

Ninety discharge letters were reviewed, 45 at initial audit and another 45 after introducing the BPT template. Mean age was 80 years old, 66 (73%) were female. In the first audit cycle, 28/45 discharge letters (62%) briefly specified BPT. On repeating the audit cycle (following introduction of the discharge letter template) all 45/45 discharge letters (100%) clearly specified BPT. Most letters (41/45; 91%) included the detailed BPT template. Following this intervention all doctors reported increased awareness and understanding of BPT, and satisfaction with template use in discharge letters.

Conclusion

Effective implementation of a discharge letter template significantly improved communication to GPs regarding BPT following hip fracture.
146 INTRODUCTION OF A STANDARDISED SCREENING TOOL FOR REFERRAL TO OCCUPATIONAL THERAPY AND PHYSIOTHERAPY ON SPECIALIST GERIATRIC WARDS
Authors: Peppard S , Howard M
Published: February 2023

Background

The Occupational Therapists (OTs) and Physiotherapists (PTs) on the Specialist Geriatric Wards provide assessment, rehabilitation, and discharge planning for frail older adults. All patients are screened on admission by OT or PT to determine the need for therapy input. This rapid response eliminates delay in accessing therapy input and allows for proactive commencement of intervention and discharge planning without the delay of awaiting a referral.

It was identified that the existing process for screening patients lacked structure and clarity, leading to inefficient use of time and resources with the risk of duplication.

The aim of this local Quality Improvement (QI) initiative was to standardise the process for screening using a triage sticker containing set criteria for referral to OT/PT.

Methods

Following team consultation and review of frailty screening tools, a triage sticker was adapted and modified from the ‘Think Frailty’ tool1. QI methodology and PDSA cycles identified 6 blanket triggers for OT/PT assessment on the ward.

F—Functional impairment.

R—Resident in a care home.

A—Acute/chronic confusion.

I—Immobility/Instability.

L—Living at home with support.

S—Specialist seating or skin integrity issues.

Retrospective review of traditional triage vs the new sicker was performed to evaluate accuracy.

Results

Retrospective analysis found 83% accuracy between the new triage sticker and the traditional triage method. Of the patients who did not meet the criteria for referral, to date none have been subsequently referred during their admission, demonstrating its comprehensiveness as a tool.

Conclusion

Pro-active and early intervention from OT and PT is beneficial for ensuring optimum patient care and efficient discharge planning for frail older adults admitted to hospital. This local QI project demonstrated that standardising the screening process for referral to OT/PT could improve clarity and enable more efficient use of time and resources.
153 DIFFERENCES IN POTENTIALLY INAPPROPRIATE PRESCRIBING (PIP) AT DISCHARGE ACCORDING TO FRAILTY STATUS
Authors: Auliffe C M , Hayden D , Kenny J , Byrne S
Published: February 2023

Background

Frailty is a key concept in healthcare service planning development for our ageing population. Guidelines recommend that older patients requiring acute hospital care should be routinely assessed for frailty (NCPOP). Potentially Inappropriate Prescribing (PIP) encompasses both over- and under-prescribing and is associated with adverse health outcomes for older persons. The objective of this study was to investigate differences in PIP at discharge of older patients according to frailty status (robust, pre-frail and frail).

Methods: In this retrospective single-centre cohort study, a random sample of older patients (≥75 years) assessed for frailty on admission, was selected. The discharge prescriptions of 150 patients were reviewed using STOPP and START criteria to identify Potentially Inappropriate Medications (PIMs and Potential Prescribing Omissions (PPOs). Drg Burden Index (DBI) scores, a measure of anticholinergic and sedative burden, were calculated for each patient. Data was analysed using descriptive statistics.

Results

There was a significant difference in the mean number of medications between the groups (F = 12.335,p < 0.001), with frailer patients prescribed more medications. Significantly more hyperpolypharmacy (≥10 regular medications) was identified in the frail group (χ2 = 17.378,p < 0.001).

A high prevalence of both PIMs(72%) and PPOs (63.3%) was found, as was a significant difference in the proportion of patients with PPOs according to frailty status (χ2 = 6.507,p = 0.039). The median number of PPOs increased significantly from the robust to pre-frail and frail groups (χ2 = 8.194,p = 0.017).

DBI scores increased significantly from the robust to pre-frail and frail groups (χ2 = 7.389, p = 0.025) and there was a significant difference in the proportion of patients with high DBI exposure (scores≥1) across the groups (χ2 = 6.497,p = 0.039).

Conclusion

Frail patients were on more medications, had more instances of PPOs and a higher anticholinergic and sedative burden than their non-frail counterparts. The results of this study support the use of frailty assessments in identifying patients for targeted medication reviews aimed at reducing PIP.
154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING
Authors: Killeen E , Higgins M , Keogh C , Russell S , Curran C
Published: February 2023

Background

Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.

Methods

10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.

Results

91% response rate.

184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).

47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.

61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.

49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.

Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.

170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.

Conclusion

Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.
156 POTENTIAL ELIGIBILITY FOR ADUCANUMAB THERAPY IN A REGIONAL SPECIALIST MEMORY SERVICE UTILISING AD PHENOTYPE, CSF BIOMARKERS AND APPROPRIATE USE CRITERIA
Authors: Dolphin H , O'Dowd S , Kennelly S P
Published: February 2023

Background

Aducanumab, the first monoclonal antibody directed against amyloid beta peptide has recently been licensed for use by the FDA for treatment of patients with mild cognitive impairment (MCI) due to Alzheimer’s Disease (ad) or mild ad dementia. Appropriate use criteria (AUC) for Aducanumab have recently been released. In light of these AUC, the aim of this study was to review patients in our specialist memory service with positive CSF biomarkers for ad [low amyloid- beta-42 (AB-42), high phosphorylated tau (p-tau)] to assess their hypothetical eligibility for Aducanumab therapy.

Methods

Retrospective database analysis was undertaken of patients with positive (high p-tau, low AB-42) ad-biomarker CSF analysis. Demographic, neuropsychological performance, neuro-radiological, laboratory, and clinical phenotype diagnosis data were reviewed at time of CSF analysis to determine hypothetical eligibility for Aducanumab. Data was extracted and analysed using SPSS v.25.

Results

Forty-nine patients had positive ad-CSF biomarkers, 41/49 (84%) of whom presented with common ad phenotypes. 28/49 (57%) were male. Mean patient age was 71.2 (±5.9) RBANS delayed memory index score mean was 80.2 (±14.5) and mean EXIT-25 scores were 13.2 (±6.7). 63.2% (31/49) patients met eligibility criteria for Aducanumab therapy by AUC guidelines. 12.2% (6/49) wouldn’t have qualified due to abnormal laboratory findings and 14.2% (7/49) due to MMSE <21 or MoCA <17. Two patients would not have qualified due to underlying medical conditions and two were prescribed therapeutic anticoagulation. However by FDA guidelines, a further 30.6% (15/49) of patients may have been unsuitable due to global Clinical Dementia Rating Scale ≥0.5.

Conclusion

AUC for Aducanumab address some of the controversial aspects in its licencing. This report highlights the presence of patients eligible for Aducanumab therapy should a European licence be granted, and the need to develop a system readiness and capacity to deliver this and other emerging disease-modifying ad therapies.
161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC
Authors: Lynch A , Quinn L , Briggs R , Tan T , Thorpe O , Romero-Ortuno R , Byrne T , Cunningham C , Lavin A
Published: February 2023

Background

The geriatric day hospital (GDH) provides outpatient medical, nursing and rehabilitation care to older adults. Historically the main focus has been on rehabilitation. This project’s objective was to evaluate how the GDH adapted during the COVID-pandemic to provide acute medical care to older adults.

Methods

This is a pre and post COVID-19 comparative study. Referral source, multidisciplinary-team input and admission rates were evaluated for all new patient referrals from April 1st to May 31st 2019 (pre-pandemic) and compared to April 1st to May 31st 2020 (during-pandemic). This service evaluation project was approved by the local Research and Innovation Office.

Results

There was a 37.7% reduction in the number of new patient referrals for 2020 compared to 2019, p < 0.00; Geriatric medicine referrals reduced by 46.5%, emergency department referrals reduced by 61.5%; community referrals increased 15-fold[AL1]. There were no differences in patients referred in terms of gender (p = 0.069), mean age (80.9(SD7.6) vs 79.1(SD6.6), p = 0.092), median conditions (5(IQR3.75–7) vs 6(IQ4–8), p = 0.329) and median medications (8(IQR5–11) vs 8 (IQR5.25–9), p = 0.600). Those referred pre-pandemic were frailer according to the clinical frailty score; median 5(IQR5–6) vs 5(IQR4–6), p = 0.013. In 2020, there was a significant reduction in referrals for physiotherapy (72.9% vs 37.3%, p < 0.001), occupational therapy (58.5% vs 37.8%, p = 0.005) and social work (47.5% vs 26.7%, p = 0.004). Clinical nutrition and speech and language remained the same, 16.1% vs 12%, p = 0.430 and 9.3% vs 12%, p = 0.552, respectively. In 2020, patients referred had significantly fewer attendances; median 4(IQR2–7) vs 3(IQR1–5), p = 0.002. There was no difference in admission rates between 2019 and 2020 (3.3% vs 7.9%, p = 0.149).

Conclusion

During the COVID-Pandemic, the GDH evolved to provide more acute ambulatory medical care to avoid admissions. The GDH continues to adapt as the pandemic evolves and older adults needs change. Further comparative analysis will be required.
165 WHAT FACTORS ARE ASSOCIATED WITH ADVANCED CARE PLANNING IN COMMUNITY-DWELLING OLDER PEOPLE?
Authors: Breslin L , Connolly E , Lavan A , Kenny R A , Briggs R
Published: February 2023

Background

Advance Care Planning (ACP) involves expressing wishes regarding your future medical care and/or preferences about your end-of-life in the event of serious illness.

The aim of this study was to clarify the proportion of community-dwelling older people who engage in ACP and what factors are independently associated with ACP.

Methods

Participants aged ≥60 years (n = 4,831, mean age 71 years) at Wave 4 of the Irish Longitudinal Study on Ageing were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? If yes, they were asked if this had been documented informally (family/carers or medical professionals) or formally (by written advanced care plan).

Logistic regression models assessed the association of covariates of interest with ACP.

Results

One quarter of the study sample (1,153/4,831) had an ACP. Only 10% (119/1,153) had ACP documented in writing, while only 2% (27/1,153) had discussed ACP with a healthcare professional.

Age ≥ 80 years (OR 1.63 (1.31–2.02)), female sex (OR 1.58 (1.37–1.83)), higher educational attainment (OR 1.42 (1.18–1.71), poorer self-rated health (OR 1.58 (1.04–2.39) and lower levels of religiosity (OR 1.50 (1.03–2.19) were independently associated with ACP.

Conclusion

While ACP may have benefits in extending autonomy and facilitating decision-making, only 1 in 4 of this population-representative sample of older people had engaged in ACP, with only 1 in 50 having their ACP documented in writing.

Further work is therefore required to educate the public and healthcare professionals regarding the benefits of ACP.
166 HEALTH TRAJECTORIES OF FRAIL, OLDER PEOPLE WHILE COCOONING DURING THE COVID-19 PANDEMIC
Authors: Bailey L , Ward M , DiCosimo A , Lavan A , Briggs R
Published: February 2023

Background

Cocooning, i.e. staying at home and reducing interaction with others, was a key part of the strategy to protect older people during the COVID-19 pandemic.

Unfortunately, there are concerns this has had a negative impact on the physical and mental wellbeing of those who have been isolated.

Methods

We completed a survey of 150 patients (55% female, mean age 79.8 years, average Clinical Frailty Scale 4.8) attending ambulatory medical services in a large university hospital.

Questions were focused on: access to healthcare services, mental health, physical health, and attitudes to COVID-19 restrictions.

Results

Almost 40% reported that their mental health was ‘worse’ or ‘much worse’ while cocooning, while over 40% reported a decline in their physical health.

Over 57% had a scheduled healthcare-related visit cancelled while cocooning, most frequently hospital outpatient appointments.

Worryingly, almost 1/6 reported not seeking medical attention for an illness that they would usually. Of these, half did not as they were worried about catching COVID and 46% did not as this service was not currently available to them.

Conclusion

The COVID-19 pandemic and lack of access to essential services, both medical and social, has had a devastating impact on older people.

This is evident in both the acute presentations to hospital and the longer-term impact it has had on health and function.

It is important that in the future clear policies are in place to enable older people to access care when they need it.
168 ANXIETY SYMPTOMS AMONG OLDER PEOPLE DURING THE COVID-19 PANDEMIC: PREVALENCE AND ASSOCIATED FACTORS
Authors: Robinson A , Ward M , Kenny R A , Briggs R
Published: February 2023

Background

There are concerns that the COVID-19 pandemic could lead to a rise in mental health problems including anxiety amongst older people, especially those shielding alone during the pandemic.

The aim of this study therefore is to examine the prevalence of anxiety symptoms during the COVID-19 pandemic amongst older people and clarify factors associated with higher burden of symptoms.

Methods

We analysed data from the COVID-19 study of The Irish Longitudinal Study on Ageing, conducted on over 3,100 community dwelling people aged ≥60 years from July–November 2020.

Anxiety symptoms were measured with the Generalised Anxiety Disorder-7 Questionnaire with a score ≥ 10 indicating moderate–severe anxiety.

Linear regression models were used to assess the association of variables of interest with anxiety symptoms.

Results

Almost 9% of participants (n = 3,128; mean age 71 years) had moderate–severe symptoms of anxiety.

Factors independently associated with a higher burden of anxiety symptoms included female sex (β = 0.60 (0.33–0.87)); living alone (β = 0.72 (0.41–1.02)); ≥2 chronic diseases (β = 0.85 (0.41–1.30); heart disease (β = 0.95 (0.45–1.46)) and reporting frequent loneliness (β = 6.59 (6.03–7.16)). Age ≥ 80 years (β = −0.77 (−1.16—0.37)) and tertiary level education (β = −0.48 (−0.86—-0.10)) were associated with lower anxiety symptom burden.

Conclusion

Almost 1 in 10 of this population-representative sample of older people had moderate to severe anxiety symptoms during the COVID-19 pandemic.

Strategies to address loneliness, which was particularly strongly associated with anxiety symptoms during the pandemic, should be a priority.
169 RECOGNITION OF POLYPHARMACY IN OLDER ADULTS: AN AUDIT OF POLYPHARMACY DOCUMENTATION AT TIME OF ADMISSION IN AN ACUTE HOSPITAL
Authors: Tangney N , McMahon I , McCarthy K
Published: February 2023

Background

The World Health Organisation has highlighted the international importance of recognising polypharmacy by including it as part of Medication Without Harm, the third Global Patient Safety Challenge. Older adults are at the greatest risk of polypharmacy and the adverse outcomes or events that can occur secondary to polypharmacy. For example, an increased risk of drug interactions, incorrect administration of medications, unacceptable pill burden, increased medication side effects potentially leading to a prescribing cascade and a decrease in medication adherence. This audit aimed to identify if polypharmacy is being recognised as a diagnosis for older adults on admission to an acute hospital.

Methods

An audit was performed of medical wards, over a single day, in an acute hospital to identify those patients, who were seventy years of age or more, with polypharmacy and whether polypharmacy was included as a diagnosis in their admission note. Polypharmacy was defined as five or greater medications listed on admission.

Results

Thirty two patients were identified that fit the inclusion criteria. None of these patients had polypharmacy included in the admission diagnoses list.

Conclusion

The above results highlight a lack of recognition of polypharmacy as a significant issue for many older patients that are admitted acutely. Of note the most common admission diagnoses recorded were hyponatraemia, acute kidney injury, and confusion which are frequent adverse effects of commonly prescribed medications in older adults. Several screening tools have been developed for identifying inappropriate prescribing and for applying a systematic approach to potential deprescribing.As such, the application of a screening tool in the emergency department may aid the process of timely appropriate deprescribing.
177 REDUCTION OF RESTRICTIVE PRACTICES IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; THE IMPACT ON HUMAN RIGHTS AND RESIDENT SAFETY
Authors: Hogan F H , Ahern A , Faherty L , Lordan R , O'Toole M
Published: February 2023

Background

We are a 140 bed long term care residential care facility for older people. We strive to achieve a ‘Restraint Free Environment’ in accordance with Article 40.4 of the Irish Constitution and Articles 14 (liberty and security) and 15 (freedom from torture or cruel, inhuman or degrading treatment) of the UN Convention on Rights of Persons with Disabilities(1). Health Act 2007, Regulations 2013 defines restrictive practice as ‘the intentional restriction of a person’s voluntary movement or behaviour’. Use of restrictive practices is warranted when there is a real and substantial risk to a person and this risk cannot be addressed by non-restrictive means’ (HIQA, 2019) (2).

Methods

An extensive review of non pharmacological restrictive practices in the Organisation was undertaken. This included One to One supervision, use of bedrails, Exit Alarm mats and Electronic Monitoring bracelets. Bedrails were replaced for some residents with Safety Wedges and Ultra Low beds.

Results

Review of restraint interventions showed no clear link to prevention of falls or injuries as a result of restraint. Contrary there was evidence of breach of dignity and privacy for the residents. Based on the review, bedrail use was reduced radically between 2016 and 2021 by 79% (42–9). Falls rate remained consistent approximately 3.6–3.2 per 1,000 Occupied Bed Days.

Exit Alarm mats, Electronic Monitoring bracelets and One to One supervision was discontinued. These were replaced with direct observation and two hourly anticipation of needs. Cost saving on One to One estimated to have been €25,000 in 2016 alone. Clear care planning of the resident’s needs are core.

Conclusion

We have demonstrated that we could successfully reduce restrictive practices, thus respecting Human Rights, with no compromise to resident safety.

References

1. United Nations Convention on Rights for Persons with Disabilities (2007)

2. H.I.Q.A 2019 Guidance on promoting a Care Environment that is Free of Restrictive Practice.
181 FIGHTING BACK AGAINST FRAILTY—THE INTRODUCTION OF A DEDICATED FRAILTY HUB
Authors: Dennehy K , Farrelly A , Gallagher E , Kennedy F , McGlynn J , Donnelly T
Published: February 2023

Background

Quarantine, lockdowns and mandatory isolation have slowed the transmission of Covid-19. However, these public health measures have amplified frailty in our vulnerable older person population by increasing social disconnection, reducing exercise and access to early interventions. In response to this increasingly dependent older population we introduced a ‘frailty hub’ in our hospital. This hub allowed early access to a geriatric review as well as a broader multidisciplinary team intervention.

Methods

We performed a cross sectional review of our new hub which was introduced in our tertiary centre to priortise care of the older person.We analysed attendees from February to June 2021 (20 weeks of data).

Results

There were 121 new patient reviews and 127 follow up consultations.Commonly requested reason for referral was medical assessment (30%), cognitive assessments (30%) and falls(28%). Referral sources were analysed and included consultant referrals (11% n = 13), GP referrals (55% n = 67), multidisciplinary team referrals (6% n = 7) and emergency department referrals (26% n = 32). The average age of those review was 79 years (range 59 years to 99 years). Of all patients 65% were reviewed by physiotherapist, 45% were seen by an occupational therapist, 10% were seen by a speech and language therapist or dietician. 85% had a medication changes. 95% had a follow up review with either a geriatrician or advanced nurse practitioner.

Conclusion

Innovation is required to appropriately target our most vulnerable frail adults.The pandemic has had a detrimental effect on some older adult’s function.Our hub is targeting this group and optimising their care.These are our preliminary findings, we plan on doing further analysis.