bluuebunny/crossref_metadata_2025 huggingface dataset:
189 IMPROVING DEMENTIA CARE THROUGH SELF-EXPERIENCE; CO-DESIGNING A SIMULATION-BASED DEMENTIA EDUCATION TOOLKIT
Authors: Collins R , Forristal K , Hopper L , Riello M , Conotter V , Meyer G , Vugt MD
Published: October 2022

Background

Although specialised dementia education programmes have begun to appear in recent years, they lack consistency. Knowledge gaps persist, which results in a professional workforce who can struggle to anticipate the care needs of people with dementia. Self-experience or simulation practices (e.g., roleplays, virtual reality, sensory tools) are established teaching methods that can provide learning opportunities to experience aspects of illness. These innovative learning approaches can positively impact empathy, understanding, and quality of care; however, they are rarely implemented in specialised care for people with dementia. The Improving demeNtia care Through Self-Experience (INTENSE) project has co-designed a dementia simulation toolkit to educate, equip, and train professionals to better support people with dementia.

Methods

As part of the Erasmus+ INTenSE project, a series of three participatory, online workshops were conducted with people with dementia, informal caregivers, and dementia-care professionals in Ireland, Italy, Germany, and the Netherlands. The first explored the co-design of training scenarios using simulation tools to demonstrate the lived experience of dementia. The second involved the co-design of an online training platform. The third examined the sustainable implementation of INTenSE into practice. All workshops were inductively coded and analysed thematically.

Results

Recommended training scenarios demonstrate daily activities and environments that impact people with dementia using a combination of existing and newly developed simulation tools. Four themes arose from workshop discussions: 1) representation of dementia, 2) daily challenges that impact people with dementia, 3) applying a person-centred approach, and 4) implementing self-experience training. Together these were used to develop facilitation guides to support the implementation of the INTenSE simulation toolkit into practice.

Conclusion

These findings demonstrate the potential of simulating self-experience across a range of everyday scenarios as a means to increase professionals' empathy and understanding of the lived experience of dementia. Recommendations have been developed that support the use of self-experience tools in practice.
193 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): HEALTH-RELATED QUALITY OF LIFE IN CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Blake C , Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , O'Shea D , Doyle R , Power D
Published: October 2022

Background

Caregivers of People with Dementia (PwD) can experience high levels of distress, which can negatively affect their physical and psychological well-being. We explored factors that influence Health-Related Quality of Life (HRQoL) of caregivers of PwD over 12 months.

Methods

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

Results

In the PWB domain, greater levels of caregiver depression (p<0.001) and a greater change over time in caregiver distress related to PwD behavioural disturbances (p=0.008) predicted lower caregiver HRQoL. In the PFH domain, HRQoL was lower for caregivers of PwD who were frail (p=0.04) and had severe comorbidities (p=0.037). None of the factors within the SCR or MED domains reached significance.

Conclusion

This longitudinal analysis elucidates potential predictors of HRQoL in caregivers of PwD. In particular, caregiver depression and distress related to behavioural disturbances in PwD were shown to significantly impact on HRQoL ratings. Caregiver interventions should be tailored to include support for psychological well-being.
218 DEVELOPING CONSENSUS-BASED INTEGRATED NUTRITION CARE PATHWAYS TO PREVENT, IDENTIFY AND MANAGE MALNUTRITION IN IRELAND
Authors: Griffin A , Hedderman A , Mortimer A , McGowan R , Kennelly S , Keller H
Published: October 2022

Background

The expected policy and standards of nutritional care in acute settings in Ireland has recently been developed (Department of Health, 2020). Based on these and international guidelines, integrated care pathways have been proposed by a panel of experts for (i) the transition of nutrition care of adult patients (>18 years) from hospital to community and, (ii) screening and identifying nutrition risk among community dwelling older adults (>65 years). The purpose of this study was to develop a consensus amongst diverse stakeholders for the proposed integrated nutrition care pathways.

Methods

A cross-sectional online survey collected data to identify pathway practices for retention. The survey was adapted to the Irish context based on previous research. Relevant stakeholders including healthcare professionals working in hospital, community and primary care, general practitioners, nurses, registered dietitians, healthcare workers from voluntary community services, and patients/patient advocates were recruited. Participants responded on the relevance and importance of discreet care practices in the proposed Nutrition Care Pathway and a consensus was set at ≥ 80%.

Results

Ninety-seven healthcare professionals and eight patient/patient advocates completed the survey. There was no response from healthcare workers from voluntary community services. Most of the discreet care practices gained consensus ratings ≥80% from healthcare professionals. Among the patient/patient advocates, only 3 pathway elements gained consensus ≥80%.

Conclusion

Healthcare professionals’ agreement with the relevance and importance of the proposed integrated nutrition care pathways offer guidance to prevent, identify, and manage malnutrition among older adults transitioning between care settings or living at home. The opinion of patients/patient advocates and healthcare workers of voluntary community services providers requires further engagement using alternative methodologies.
234 PATIENT COLLABORATION TO DRIVE REFORM: EMBEDDING BRIDGES SELF-MANAGEMENT APPROACH IN AN ACUTE STROKE SERVICE
Authors: Kelly N , McDonnell M , Murtagh N , O'Malley T
Published: October 2022

Background

Bridges Self-Management approach is an evidence-based set of self-management skills, practices and interventions which when implemented can deliver more collaborative and patient-centred care to people suffering stroke [1]. Our acute stroke service underwent training in this approach in 2020. In order to further embed this approach and adapt it to our local setting, patient experiences were captured to help inform ongoing service delivery and quality improvements.

Methods

Ethical approval was granted for this project. Following consent, 20 acute stroke inpatients (length of stay >/=3 days) participated in the study. Patient experiences of their time on the Stroke Unit were sought using a 10-item open-ended questionnaire, which was developed based on the guiding principles of Bridges i.e. what matters most to the person, reflecting on what was/wasn’t going well, what they believe would help them and others.

Results

Thematic analysis was used to analyse the responses, and a number of themes emerged. These include: Loss of autonomy and freedom; Environmental challenges (including boredom, sleep poverty, loss of social interaction, loss of dignity and privacy); Shock, and difficulty adjusting to diagnosis (the importance of being informed and being heard); Loneliness and the role of family and visitors in their recovery journey (coupled with a consistent desire to be in their own home).

Conclusion

Rich data emerged, providing us with a unique insight into the experience of patients. This will compel us to review our service and environment, to tailor changes that matter to patients, and deliver on the Bridges self-management principles of patient inclusion and empowerment.

Reference

1. Jones et al. Building bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke. Neurorehabilitation. 2016. 39(4), pp. 471–480.
238 THE IMPACT OF COVID-19 ON ACUTE STROKE TREATMENT
Authors: Connor AO , Hobson H , Ryan D , Collins R
Published: October 2022

Background

Acute stroke management is time critical. Treatment options are dictated by time of symptom onset. 2019 Irish National Audit of Stroke (INAS) showed less than 50% stroke cases arrived in hospital within three hours of symptoms and national average rate of thrombolysis was 11%. The median time Door-To-Needle time (DTN) was 56 minutes, and to thrombectomy 93 and 240 minutes ‘direct to mothership’ / ‘drip and ship’ transfer to thrombectomy centre respectively.

Methods

Retrospective review of all stroke FAST calls on our acute stroke database in TUH from July 2019 -2021. Data was analysed pre (up until March 2020) and during COVID-19 pandemic.

Results

FAST protocol imaging was obtained in 78% of cases (464/594). Documented time of symptom onset to CT was 1:50:00 pre-Covid-19 and 2:26:00 during Covid (p<0.001). ED registration to CT was 28mins pre-Covid-19 and 30mins during Covid (p<0.001). The median DTN time was 41mins pre-Covid-19 (n=21), and 54mins during Covid-19 (n=37).

Conclusion

In contrast to INAS COVID-19 report, median DTN times and thrombolysis rates dis-improved at TUH. Trends observed probably reflect multiple factors; patient hesitation to attend ED; patient isolation from family; busier ambulance service; Infection control protocols. We observed small but significant change in door-to-CT time but a more significant increase in DTN. This may reflect time taken donning Personal Protective Equipment (PPE) or general increased ED activity. Understanding the impact of COVID-19 on acute stroke treatment metrics in addition to differences at sites may identify targets for national quality improvement in service delivery.
242 FALLS-RISK INCREASING DRUGS AND FRAILTY IN OLDER ADULTS EXPERIENCING FALLS: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Randles M , Gannon E , Gallagher P , O'Mahony D
Published: October 2022

Background

Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of falls, a leading cause of injury and injury-related mortality. One of the more prominent extrinsic risk factors for falls in older adults is the use of Falls-Risk Increasing Drugs (FRIDS). This study aims to examine the relationship between measured frailty and FRIDS in older people who have experienced a fall in the previous 12 months.

Methods

A prospective observational study was undertaken. Inclusion criteria were age ≥ 65 years and a history of falling in the preceding 12 months. Exclusion criteria were age <65 years of age, inability to provide informed consent or participation declined. Medical chart and drugs Kardex review was carried out, followed by a short interview with the patient using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale (CFS) and the point-prevalence of FRIDS was established using the STOPPFall screening tool.

Results

Results are presented for the first 100 participants: The mean (±standard deviation [SD]) age of study participants was 82.1 (±6.2), 63% were female. The prevalence of frailty measured using the CFS was 60% (CFS ≥5). The median number of falls in the previous 12 months was 3 (IQR 3). 82% of people who had fallen in the previous 12 months had ≥1 STOPPFall FRID. The difference between number of FRIDs in Frail vs Non-Frail people was not statistically significant.

Conclusion

Prescription of FRIDS was detected in over 4 out 5 older fallers. Structured medication review using the STOPPFall screening tool for older adults at risk of falls is one useful and easy way of detecting FRIDS with a view to deprescription. Measured frailty does not appear to increase the prevalence of FRIDS in older fallers.
244 A PILOT STUDY: FRAILTY AND COGNITIVE IMPAIRMENT IN PATIENTS WITH KERATINOCYTE CANCER
Authors: Cino D , Hollywood A , Moloney A , Collins O , Moriarty B , Lally A
Published: October 2022

Background

Incidence of keratinocyte cancer is increasing, and age-related variations in management pose risk of over and under-treatment [1]. Comorbidities and frailty may predict quality of life, mortality and surgical outcomes [2]. This study investigated patient presentations in those with skin cancer aged ≤ 70-years versus >70-years.

Methods

Patients attending dermatology skin cancer clinics were recruited over 8 weeks, June-August 2021. Data including comorbidities, Mini Mental State Exam (MMSE) and Rockwood Clinical Frailty Scale were recorded. Chi-square test for binary characteristics were performed.

Results

107 patients were interviewed, the younger cohort (n=46) had a frailty scale of very fit (81.8%), well (11.4%), managing well (6.8%), whereas the older cohort (n=61) were very fit (14.8%), well (21.3%), managing well (34.4%), vulnerable (14.8%), mildly frail (4.9%), moderately frail (3.2%) and severely frail (6.6%). The older cohort with confirmed skin cancer were significantly more frail (vulnerable, mild, moderate and severely frail) than those in the same cohort without skin cancer (p = 0.01). The older cohort MMSE ranged from; no cognitive impairment (85.2%), mild (6.6%), moderate (4.9%), and severe (3.3%). The older cohort with confirmed skin cancer had significantly more cognitive impairment (moderate and severe) than those in the same cohort without skin cancer (p = 0.04).

Conclusion

Patients with higher frailty score and cognitive impairment were more likely to have skin cancer than their age matched counterparts without. This highlights the importance of the two parameters, and may support clinical guidelines to assist with selecting treatment for older patients with keratinocyte cancer.

References

1. Garcovich S et al. Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging and Disease. 2017; 8(5):643–61.

2. Valdatta L et al. FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non-melanoma skin cancer. Oncology Letters. 2019; 17(1):263–9.
248 BENEFITS OF POST-OPERATIVE SPECIALIST GERIATRIC CARE FOR OLDER PATIENTS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY
Authors: McGarvey C , Larkin J , Costello R , Connor MO
Published: October 2022

Background

The Covid-19 pandemic changed work practices across many different healthcare institutions. The difficulties with cross-site transfers created an opportunity in our institution to provide on-site post-operative rehabilitation for older patients undergoing elective orthopaedic surgery. The aim of this study is to assess the impact of post-operative specialist geriatric care on older patients.

Methods

This is a single-centre, retrospective study that received approval from the local hospital ethics committee. Data were collected on all patients admitted to the on-site specialist rehabilitation unit post-elective orthopaedic surgery between 1st May 2020 and 31st December 2021. Two patients in this group were excluded as they had not attended a pre-operative assessment clinic. Data were collected from hospital Information Technology platform, Bluespiers.

Results

76 patients, 18 males and 58 females, were included in this study. The median age was 80 years. In the specialist rehabilitation unit, evidence of cognitive impairment was established in 40.79% of cases, there were 3 cases of newly diagnosed dementia, a history of falls was identified in 32.89% of patients and 13.16% of patients were found to have sarcopaenia. The median length of stay in the rehabilitation unit was 25 days. 51.32% of patients were discharged home independently, 23.68% of patients went home with a new Home-Care Package (HCP), 15.79% of patients were discharged home with an existing HCP, 6.58% of patients were transferred for further treatment and 2.63% patients were discharged to residential care units.

Conclusion

This data demonstrates a clear role for specialist geriatric care in elective rehabilitation, with a significant proportion of patients being discharged home independently. The benefits of a comprehensive geriatric assessment in the peri-operative setting include increased identification of cognitive impairment allowing appropriate implementation of brain health as well as identification of a history of falls, enabling falls risk assessment and management including bone health assessment.
255 THE ROLE OF GERIATRIC MEDICINE IN CARE OF OLDER ADULTS WITH MAJOR TRAUMA
Authors: Rafferty M , Murphy D , Cloney T , Brent L , Dukelow T , Ahern E
Published: October 2022

Background

In recent Major Trauma Audit Reports the most common cause of major trauma is low falls, 46-49% of injured patients were aged over 65. These are an important group to identify and to prioritise for geriatrician led MDT care. There is currently no specialist geriatric medicine service in Ireland for older adults with major trauma. We aimed to evaluate patients with major trauma currently co-managed by orthopaedic surgery and geriatric medicine, the role of geriatric medicine and the potential role of a major trauma geriatric service.

Methods

We reviewed local data collected for the Irish Hip Fracture Database to examine the incidence of major trauma presenting in older adults and the role of geriatric medicine. We included patients who had injuries in addition to hip fracture including radius, ulna, clavicle, humerus, rib, vertebra, pelvis fracture subdural haemorrhage, diffuse brain injury and traumatic subarachnoid haemorrhage.

Results

In 2020, there were 437 older adults admitted with hip fractures and likely 2185 patients presenting with fragility fractures. We identified 32(7%) patients who sustained other major injuries in addition to hip fracture. Nationally, these patients have a higher in-hospital mortality (11% v 5%). All of these patients had comprehensive geriatric assessment (CGA) and geriatrician-led MDT care. These patients are at high risk for poorer outcomes; delirium, pressure ulcers, hospital acquired infection and disability, prolonged length of stay, delayed transfers of care, premature institutionalisation and death.

Conclusion

There is a role for expansion of proactive early identification and geriatric medicine input for all older adults with major trauma, in addition to those with hip fractures and other injuries. The increased mortality in these patients has not previously been published. International evidence supports early intervention from a specialist geriatric medicine service, with CGA to provide exceptional, continuous and co-ordinated care.
271 DEVELOPMENT OF AN INNOVATIVE INTER-DISCIPLINARY PARKINSON’S CLINIC IN AN AMBULATORY CARE SETTING
Authors: Kimmage E , Carney C , Conaty S , Cronin A , Digan E , Kennelly SP , McDonagh A , McWilliams O , Nolan E , O'Dwyer A , O'Rourke L , Pierpoint R , Quinn S , Sheridan L , Smith A , Tobin F
Published: October 2022

Background

Ambulatory services provide specialist outpatient care, reducing costs associated with inpatient admissions and enabling the person to remain at home for longer (Report of the National Acute Medicine Programme, 2010). An Older Person’s Ambulatory Care Hub was established in a large teaching hospital. Prior service evaluation demonstrated that approximately one third of patients attending had a diagnosis of Parkinson’s Disease (PD). People with PD should have a collaborative approach between patient, family and healthcare providers to optimally manage their condition (NICE, 2017), therefore, the need was identified to evolve the traditional medical model to an interdisciplinary approach. The aim of this project was to complete a service evaluation and breakdown of Interdisciplinary Team (IDT) referrals.

Methods

An IDT working group including Clinical Nutrition (CN), Medical, Nursing, Occupational Therapy (OT), Physiotherapy (PT), and Speech and Language Therapy (SLT) was established. A comprehensive assessment form was developed and outcome measures were chosen. A short pilot was conducted and necessary amendments were made. A weekly clinic was established which included an IDT assessment, followed by a huddle with the medical team where referrals were generated. Data pertaining to the number of attendees and referrals generated were collected over a 3-month period.

Results

Over the data collection period, 31 patients attended the clinic. Referrals were as follows; Medical: 19, PT: 13, SLT: 10, OT: 7, CN: 6, Medical Social Work: 2. Patients requiring urgent medical review were seen immediately after the IDT huddle.

Conclusion

This project demonstrates a service evaluation of a novel IDT PD Clinic. This clinic highlights the need for an IDT approach to management of people with PD. Future service developments include obtaining patient feedback, pre-clinic calls to patients by a Healthcare Assistant to explain the purpose of the clinic, and adapting the clinic as appropriate.
275 “MOVING ON UP”: FEASIBILITY OF A WARD-BASED THERAPY INITIATIVE TO IMPROVE PATIENT ACTIVITY LEVELS IN NEUROLOGICAL REHABILITATION
Authors: Doran N , Murphy R , Clarke E , Quigley S , Kiernan S , Malone A
Published: October 2022

Background

Patients admitted for neurological rehabilitation are not receiving sufficient dosage of activity to facilitate optimal recovery. Previous research has reported issues with feasibility and patient adherence to intensity programs.

Methods

Mixed methods were employed for this feasibility study. The “Moving On Up” program encompassed “Activitea” structured practice of sit to stands prompted by mealtimes, “Step It Up” a gradual walking program using pedometers and “Weekend Workout” increasing practice of exercise programs. These activities were in addition to daily therapy sessions over a four-week intervention period. Primary feasibility outcomes investigated recruitment, retention, adherence, adverse events, facilitators, barriers and acceptability of the program and preliminarily assessed changes in activity levels using the ActivPAL accelerometer. Functional tests assessed mobility, health-related quality of life and fear of falls. Descriptive statistics were used for analysing quantitative data. Braun and Clarke’s thematic analysis was adopted when reviewing qualitative data.

Results

Ten participants were recruited with zero dropouts. Median age was 72 years and five had a diagnosis of brain tumour excision. Eight participants demonstrated excellent adherence with completion of daily activity logs. There was one participant non-injurious fall, no other adverse events. Clinical outcomes demonstrated improvement in median daily step count, stepping and standing time. The median daily step count for the group increased from 1,375 steps (IQR 2,867, range 82-4,248) to 1,724 steps (IQR 2,914, range 80-8,207). All functional tests improved. Seven participants and three therapists completed semi-structured interviews. Five themes emerged; motivation to move more, empowerment, barriers to increasing activity, weekends long and boring and job satisfaction.

Conclusion

The “Moving On Up” program was feasible to implement without additional staffing and was accepted by key stakeholders. Future research is warranted into the program's effectiveness, incorporating a larger sample and randomised pilot trial. Inclusion of a follow-up of participants after discharge would be desirable to investigate long-term effects on activity.
277 The ‘Bermuda Triangle’ of Orthostatic Hypotension, Cognitive Impairment and Reduced Mobility: Associations with Falls and Fractures in Community-dwelling Older People
Authors: Donnell DO , Romero-Ortuno R , Kennelly S , Kenny RA , Lavan A , Neill DO , McElwaine P , Briggs R
Published: October 2022

Background

Orthostatic Hypotension (OH), cognitive impairment and mobility impairment frequently co-occur in older adults who fall. The aim of this study was to examine the clustering of these three geriatric syndromes and ascertain their longitudinal associations with falls and fractures in a large cohort of community-dwelling older people (≥65 years).

Methods

This study utilized data from Waves 1-5 of TILDA. OH was defined as a drop of ≥20 mmHg in systolic blood pressure when measured after standing from a seated position and/or reporting unsteadiness when getting up from a chair. Cognitive impairment was defined as MMSE ≤24 and/or self-reporting memory as fair or poor. Mobility impairment was defined as 'Timed Up and Go' ≥12 seconds. Logistic regression models, including 3-way interactions, were used to assess the longitudinal associations of the three geriatric syndromes with future falls (explained and unexplained) and fractures.

Results

Of those with at least one geriatric syndrome (993/2108, 47%), over two-thirds (644/993) had any one of the three, one-quarter had any two (261/993) and almost 10% (88/993) had all three syndromes. One-fifth of the study sample had an unexplained fall during follow-up (mean 6.6 years), while one-tenth had a fracture. In fully adjusted models, the cluster of OH, cognitive impairment and mobility impairment was associated with a greater than 4-fold likelihood of unexplained fall (Odds Ratio 4.36 (2.61–7.28); p<0.001) and double the likelihood of incident fracture (Odds Ratio 2.51 (1.27–4.96); p=0.008) during follow-up, when compared to other clusters. There was no association with explained falls.

Conclusion

The ‘Bermuda Triangle’ of co-existing OH, cognitive impairment and mobility impairment, was independently associated with increased risk of future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
280 PERCEIVED NEED FOR A CLINICAL ETHICS SUPPORT SERVICE AT AN IRISH UNIVERSITY HOSPITAL
Authors: O'Donovan M , Crowley P , Flanagan E , McManus C , Moloney E , Favier C , McKiernan M , Cornally N , Campbell L , O’Connor K , O’Caoimh R
Published: October 2022

Background

Ethics are the set of moral principles that guide a person’s behaviour. Ethical issues are a key component of healthcare and frequently arise in the management of hospitalized older patients. To improve decision-making and reduce burden on individual hospital staff, Clinical Ethics Support Services (CESS) have been widely-integrated into care pathways internationally. However, the need for CESS has received little attention in Irish hospitals.

Methods

A cross-sectional analysis of the ethical situation and CESS readiness at a tertiary hospital in Ireland was collected from July-October 2021 and in February 2022 via hard copies and online collection (SurveyMonkey). Both clinical (medicine, nursing other patient care role) and non-clinical (administrative, clerical, ICT, HR, general support staff and management) staff participated. Descriptive statistics were assessed taking the valid percentages, mean 5-item Likert scores and Friedman Test mean rank for ten ranked statements.

Results

In total, 199 people (13% response rate) completed the survey. Staff were largely (76%) clinical and the majority were qualified >10 years (57%). In all, 78% reported that ethical issues arise in the role (83% clinical staff, 59% non-clinical staff). Most (63%) were unsure who to contact about ethical concerns, instead seeking informal advice from colleagues (>90%). The majority of participants were interested in additional ethical training, especially on decision-making capacity (mean interest 4.18 out of 5), strategies for working with challenging patient/family situations (4.07 out of 5) and end-of-life care (4.06 out of 5). Out of ten options assessed, participants preferenced the development of a formal clinical ethics committee over education and training or the provision of educational materials.

Conclusion

Ethical issues commonly arise when caring for older hospitalized patients. This study found a perceived need and widespread interest in additional education as well as formal approaches to develop a hospital-based CESS, centred around a formal committee structure.
285 DEVELOPING A FRAILTY CARE PATHWAY IN A REHABILITATION HOSPITAL: A PILOT STUDY
Authors: Murphy J , Webster C
Published: October 2022

Background

Frailty is a common condition in older adults. The Clinical Frailty Scale (CFS) is a widely used frailty screening-tool within the Irish healthcare system due to its time-efficiency and transferability between settings. The Edmonton Frailty Scale (EFS) is heralded as an effective tool capturing multi-dimensional aspects of frailty. Due to the lack of blanket referral system for some Multi-Disciplinary Team (MDT) members in our Irish rehabilitation hospital, early identification of frailty is key to ensure timely input from all disciplines. To optimise MDT intervention, the EFS was piloted alongside the CFS comparing user-experience and sensitivity.

Methods

Education sessions were held by frailty-group members to familiarise staff with frailty concepts and frailty-tool administration. The EFS and CFS were administered with all patients over 65 years within 72 hours of admission onto two wards of our hospital over a three-month period. Frailty scale completion was co-ordinated by the physiotherapists and occupational therapists who operate a blanket referral system. Detection of frailty triggered an urgent referral to dietician, medical social work and speech and language therapy colleagues who don’t operate a blanket referral system. The target time for MDT input was two days for the severely frail cohort and one week for mild or moderately frail patients.

Results

The EFS was administered for 83 patients (mean age: 84 years). Of those, 6% were severely frail, 23% were moderately frail and 28% were mildly frail. The CFS was found to detect a higher frailty level in 47% of patients screened when compared to the EFS and took an average of ten minutes less to administer.

Conclusion

The CFS will continue to be administered with patients due to its higher sensitivity to frailty and time efficiency for completion. Referrals will continue to be generated to all MDT members to expedite input with frail patients.
290 THE VARIABLE INDICATIVE OF PLACEMENT IN ACUTE HOSPITAL OUTPATIENT CLINICS IDENTIFIES OLDER ADULTS WHO BENEFIT FROM SPECIALIST GERIATRIC ASSESSMENT
Authors: Maher J , McKenna-Barry M , Donnellan C , Pillay I
Published: October 2022

Background

Opportunistic screening of older adults results in early detection of frailty. The Variable Indicative of Placement (VIP) is validated to identify those being admitted to hospital who may benefit from specialist geriatric assessment. VIP screening was gradually introduced throughout hospital-based outpatient clinics in April 2021. The aim of this study was to quantify patient benefit following VIP screening.

Methods

A positive VIP triggered referral for Comprehensive Geriatric Assessment (CGA). Exclusion criteria included prior CGA within a year, nursing home resident or patient declined assessment. Data was prospectively entered onto Excel by a trained administrator. Demographics, Clinical Frailty Score (CFS), modified Barthel Index (mBI) and patient interventions post CGA, between July 2021 and April 2022, were analysed using descriptive statistics.

Results

Of 168 referrals received, 52 were excluded, 53 completed and 63 await review. Thirty-five of those excluded had a prior CGA. Mean (SD) age of patients receiving CGA was 79 (7.6) years. Male:female ratio was 1:1.4. Median (SD) CFS was 6 (0.8) and median (SD) mBI was 16(3.9). There was a mean (SD) of 2.8 (1.6) targeted interventions per patient. Eighty three percent (n=43) required medication changes, 47% (n=25) bone health management, 28% (n=15) dietician, 26% (n=14) occupational therapy, 17% (n=9) public health nursing, 17% (n=9) speech and language therapy, 17% (n=9) memory assessment and 15% (n=8) physiotherapy.

Conclusion

Outpatient clinic VIP screening resulted in identification of frail older adults who benefited from CGA. The VIP should be validated in various outpatient settings.
314 COMMUNITY-BASED INTEGRATED CARE TEAMS EFFECTIVENESS IN PREVENTING CRISIS EMERGENCY DEPARTMENT ATTENDANCES
Authors: Bradley E , Mills D , Byrne A , Ramalingam K , Spencer M , Wheelan M , Nee R
Published: October 2022

Background

Community based integrated care Multi-Disciplinary Teams (MDT) are a mainstay for future management of older adults. They have evolved to meet the needs of many different sub-types of clinical cases in the community. Complex Cases, are patients over 65 who reside within the catchment area, suffer from at least 2 frailty traits, and would be at increased risk of crisis emergency department (ED) attendance. Can the crisis ED attendances be prevented by integrated care team intervention?

Methods

The study population comprised adults identified as complex cases as per integrated care team standard operating procedure. Collated data was reviewed, and electronic medical records assessed as to whether any complex cases had been admitted within 30 days, 60 days, and 1 year of community team review. The study time frame was March 2021- to March 2022. As many patients have more than one unique identifying number, all patients were double-checked with an assessment based on their name and date of birth.

Results

112 complex cases were identified within one year, and 96 individual patients were represented. Average age 83 years old. 65% female and 35% male. 11% were admitted to hospital within 30 days, a further 6% were admitted within 60 days and by one year 30% of reviewed complex cases had been admitted to hospital.

Conclusion

In one year 70% of complex cases have been successfully maintained in the community. This has been achieved based on a multidisciplinary-based, patient-centred care approach. Given that 53% of hospital inpatient bed days are occupied by those over 65. This review concurs with previous research suggesting that an increase in community based integrated care teams is justified and should the aim for a fully staffed team per 150,000 patients over 65 come to fruition more than two-thirds of even the most complicated geriatric cases could be managed in the community.
315 “I JUST GOT ON WITH IT”: EXPLORING THE PATIENT EXPERIENCE OF STROKE REHABILITATION DURING THE COVID-19 PANDEMIC
Authors: Madden R , Galvin R , Horgan F
Published: October 2022

Background

There are emerging studies examining the pandemic experiences for older adults and healthcare staff, however the impact of COVID-19 on stroke rehabilitation has yet to be examined. Family involvement and social support is central to adjustment during stroke rehabilitation and this was impacted by the pandemic and its restrictions. The aim of this study was to explore first-person lived experiences of stroke rehabilitation in an Irish rehabilitation hospital setting during the COVID-19 pandemic and understand how COVID-19 restrictions impacted on patients’ experiences of stroke rehabilitation.

Methods

A qualitative descriptive design was implemented with a purposive sample of stroke survivors, who had undergone stroke rehabilitation between January – December 2021 at an Irish post-acute rehabilitation hospital. Semi-structured interviews were used as the primary data collection method and were audio-recorded and transcribed verbatim. Data were analysed using Braun & Clarke’s (2018) six-step approach and external data validator was used for inter-coder reliability.

Results

Eight stroke survivors were interviewed (male n=5, female n=3). Four main themes were identified: (i) Resilience and coping, (ii) Feeling supported along the journey, (iii) The pinch of COVID-19, (iv) Adjustment and moving on. The stroke survivors’ resilience was an important recurring theme throughout the analysis. A sense of feeling supported by hospital staff and peers was also prominent. The impact of COVID-19 restrictions was felt by all participants, however, resilience, support from hospital staff and peers were the strongest recurring themes.

Conclusion

COVID-19 restrictions had an impact on the stroke rehabilitation experience, however, stroke survivors felt well-supported and showed resilience in spite of this. To the best of the researchers’ knowledge, this is the first study which examines first-person accounts of stroke survivors during the COVID-19 pandemic, thus offering a unique perspective on the experiences of this cohort, who were hospitalised during this time.
341 ROLE AND TOLERANCE OF LUMBAR PUNCTURE TESTS FOR CSF BIOMARKERS OF ALZHEIMER'S DEMENTIA IN A SPECIALIZED MEMORY CLINIC
Authors: Clancy C , Dolphin H , McHale C , Dookhy J , Fallon A , Kennelly S
Published: October 2022

Background

People living with mild cognitive symptoms often require clarity on the underlying aetiology of their symptoms, and with the advent of disease modifying therapies for Alzheimer’s Disease (AD), establishing diagnostic accuracy for amyloid and tau pathology in AD will become more clinically relevant. CSF biomarker analysis via Lumbar Puncture (LP) is the most accurate and cost-effective means of establishing AD pathology. This study aimed to assess memory clinic patients’ tolerance of LP as a diagnostic tool in the work-up of memory symptoms.

Methods

A consecutive sample of patients offered CSF analysis as part of their diagnostic plan in a tertiary memory service of a University Teaching Hospital were included. After clinician discussion, an LP for AD biomarker detection is offered to all patients with amnestic/non-amnestic mild cognitive impairment, or those with atypical motor-cognitive symptoms in this service.

Results

119 patients offered an LP from 2019-2020 were contacted, fifty-four (45%) of whom participated in this study. The average age was 70.1 (±7.5) years, 50% female. Forty-two (42/54, 78%) had an LP performed. More women declined an LP than men (8/12, 66%). Almost all of those who had an LP, (38/42, 90.4%) thought it yielded useful information and would recommend it for others. Side effects included mild back pain relieved with simple analgesia (11/42, 26%) and headache (3/42, 7%). There were no incidences of neurological sequelae or requirements for dural patch. Of the 12/54 (22%) who declined CSF analysis; reasons for same were pre-existing back pain (3/12, 25%), needle-phobia (3/12, 25%), and only 2/12, (16%) declined because they did not wish to know the results of the investigation.

Conclusion

This study highlights high levels of acceptance of CSF analysis when offered as part of routine care, with infrequent side effects. Most patients found the clinical information yielded was useful.
Mortality and Life Expectancy Lost in Canada Attributable to Dietary Patterns: Evidence From Canadian National Nutrition Survey Linked to Routinely Collected Health Administrative Databases
Authors: Jessri Mahsa , Hennessey Deirdre , Bader Eddeen Ana , Bennett Carol , Sanmartin Claudia , Manuel Douglas
Published: October 2022

Using 5 diet quality indexes, we estimated the mortality and life expectancy lost, at the national level, attributable to poor dietary patterns, which had previously been largely unknown. We used the Canadian Community Health Survey 2004, linked to vital statistics (n = 16,212 adults; representing n = 22,898,880). After a median follow-up of 7.5 years, 1,722 deaths were recorded. Population attributable fractions were calculated to estimate the mortality burden of poor dietary patterns (Dietary Guidelines for Americans Adherence Index 2015, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative Healthy Eating Index, and Mediterranean Style Dietary Pattern Score). Better diet quality was associated with a 32%–51% and 21%–43% reduction in all-cause mortality among adults aged 45–80 years and ≥20 years, respectively. Projected life expectancy at 45 years was longer for Canadians adhering to a healthy dietary pattern (average of 5.2–8.0 years (men) and 1.6–4.1 (women)). At the population level, 26.5%–38.9% (men) and 8.9%–22.9% (women) of deaths were attributable to poor dietary patterns. Survival benefit was greater for individuals with higher scores on all diet indexes, even with relatively small intake differences. The large attributable burden was likely from assessing overall dietary patterns instead of a limited range of foods and nutrients.
The guitar in imperial Rio de Janeiro:  a fashion among the elite
Authors: Taborda Marcia E
Published: October 2022

Introduced in Brazil at the beginning of the 19th century and widely accepted by the economic and social elite of the time, the guitar was played in aristocratic venues such as the Quinta da Boa Vista palace, where the Empress Leopoldina would practice music daily. Beginning in the 1840s in the hands of foreign artists, who fostered the development of Rio de Janeiro’s 19th-century musical life, a busy agenda of musical performances allows us to become acquainted with the guitar’s repertory, which was composed of original works and, especially, transcriptions of opera arias. This information is in stark contrast with the highly negative image of the instrument in Brazilian society during the advent of the Republic, due to the guitar’s unshakeable association with the cultural practices of the urban poor.
Prevention of alcohol, drugs and tobacco during the COVID-19-pandemic – consequences and inequalities in Swedish municipalities
Authors: Owen U , Lindström E
Published: October 2022

Background and objectives

The COVID-19 pandemic and measures to prevent the spread of the virus challenged public health practice at the local and regional level in Sweden. The objective of this study was to follow-up how local preventive ADT prevention (alcohol, drugs, and tobacco) in Sweden was affected during 2020-2021.

Methods

All Swedish municipalities (N = 290) were included in surveys on how the pandemic affected local ADT prevention. Response rates ranged between 82 and 91 percent. Quantitative data were analysed with reference to socioeconomic and demographic conditions. Qualitative data were analysed thematically.

Results

A majority of the municipalities reported a decrease in ADT prevention, especially aimed at groups such as parents, children, and young people. There was no correlation between the decrease in municipal ADT prevention and socio-demographic conditions. A majority of the municipalities reported that activities were adapted, often with a digital approach. Adaptation of ADT prevention was less common in smaller municipalities and municipalities where residents had lower levels of education and lower incomes. An increase in activities, as a consequence of measures to prevent the spread of the virus, was more common in larger municipalities and municipalities with a greater proportion of residents with higher educational backgrounds and higher incomes.

Conclusions

ADT prevention carried out by municipalities in Sweden was initially deeply affected by the COVID-19 pandemic and by measures to prevent the spread of the virus. However, activities were adapted over time, mainly with a digital approach. The ability to adapt differed depending on the sociodemographic conditions of the municipalities. Follow-up studies on ADT prevention and the consequences of the digital approach during 2021 will be presented at the conference.
Incremental net benefit of wearable devices for home monitoring of chronically ill patients
Authors: Altamura G , Nurchis MC , Santoli G , Riccardi MT , Sapienza M , Sessa G , Damiani G
Published: October 2022

Background

Hospital overcrowding is a growing problem worldwide. Studies demonstrated that up to 40% to 67% of hospitalizations of residents in nursing homes may be avoidable, causing health and economic damages. Furthermore, research shows that for non-critical patients there are arguably no differences between home and hospital recovery in terms of health outcomes, with a preference for home settings in most patients. During COVID-19 pandemic, telemedicine and homecare increased its range of possible intervention, allowing efficient and cost-effective processes of care. Transdermal sensors are indeed a cheap and easy to use alternative to conventional instruments, allowing a continuously operative and ready-to-use tool to care providers. This systematic review aims to map the application fields of these technologies, demonstrating their accuracy and assessing their cost-effectiveness in chronically ill home-assisted patients.

Methods

Articles were retrieved from Scopus, Web of Science, and PubMed. The dominance ranking matrix (DRM) tool was applied to allow a qualitative synthesis of the studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. A comparison between wearables and conventional tools accuracy was simultaneously carried out through a literature review.

Results

The database search identified 1156 publications of which six articles were considered eligible for the meta-analysis. According to DRM, 80% of evaluated studies showed the cost-effectiveness of wearable devices. The pooled INB of wearables over conventional measurement was estimated at US$1280 (95% CI US$952 - US$2849). In 85% of evaluated wearables the accuracy resulted comparable to conventional measurement tools.

Conclusions

Wearables performances resulted as accurate as conventional methods and their application cost-effective. A continuous measurement of parameters may relate to a better process of care for chronically ill outpatients.

Key messages

• Wearables are a cheap and accurate alternative to conventional life parameters measurement tools.

• Technology evolution might soon reduce the pressure on hospitals, changing the care process of chronically ill outpatients allowing continuous evaluation of their health status.
Promoting and growing your podcasts and ensuring sustainability and consistency in your approach
Authors: Rachadell J
Published: October 2022

The main challenges after getting started with a podcast will be growth and sustainability. This presentation will focus on promotion tactics for digital health podcasts, including the pros and cons of different hosting platforms and the use of social and academic networks for promotion. The importance of sustainability and consistency for growth will also be discussed, including some practical tips on productivity and team management for content producers.