bluuebunny/crossref_metadata_2025 huggingface dataset:
283 AN EXPLORATION OF THE IRISH NATIONAL FRAILTY EDUCATION PROGRAMME ON PRACTICE: A FRAILTY FACILITATOR'S PERSPECTIVE
Authors: Munro F , Murphy C
Published: October 2022

Background

Frailty is associated with a range of adverse outcomes in older adults requiring prevention, early detection and management. Interprofessional collaboration in education and practice can facilitate integrated care for older people in the management of frailty. In Ireland, an interprofessional National Frailty Education Programme (NFEP) is delivered in partnership between the National Clinical Programme for Older People (NCPOP) and The Irish Longitudinal Study on Ageing (TILDA). On completion of the NFEP, Frailty Facilitators return to their regional/local frailty networks to deliver the programme to healthcare professionals across disciplines and settings. The aim of this study is to explore the impact of the National Frailty Education Programme on practice.

Methods

A qualitative exploratory approach was adopted to elicit the perspectives of Frailty Facilitators on the impact of the NFEP on practice. Purposive sampling was employed across frailty networks nationwide. Focus groups were conducted, and data were analysed using thematic analysis.

Results

Twenty-four participants from five frailty networks took part in five focus groups across Ulster, Leinster and Connaught. Frailty Facilitators collaborated to deliver education on frailty in their local networks following the NFEP. Management support particularly that provided by the Centres for Midwifery and Nurse Education was deemed a significant enabler of frailty education. Strong interprofessional alliances were developed that enhanced communication between primary and secondary care settings in the care of older people. The medical profession were noted to have low participation in the frailty networks. The results revealed widespread use of frailty instruments for assessment and a shared understanding and language on frailty.

Conclusion

The NFEP had a clear impact on Frailty Facilitator’s practice. Conceptualisation and reflection on frailty related practice was in evidence across the frailty networks thus enabling multidisciplinary teams to manage the care of an older person with frailty in an integrated way.
284 DO MEDICATIONS GET OPTIMISED DURING AN ACUTE ADMISSION TO HOSPITAL?
Authors: MokGatla O , Haupfear I , Cafferty J , Campbell E , Lavan AH
Published: October 2022

Background

Potentially Inappropriate Prescriptions (PIPs) and Potential Prescribing Omissions (PPOs) are common in hospitalised older adults and associated with poor outcomes. The aim of this study was to assess whether PIPs and PPOs are reduced during an acute hospital admission.

Methods

All inpatients on 5 gerontological wards (1 acute, 1 subacute, 2 rehabilitation, 1 long-stay) on October 31st 2021 were eligible for inclusion. Medical records were retrospectively reviewed. Medication appropriateness was assessed by two assessors at admission and discharge using STOPP/START version 2. Records were consecutively reviewed according to discharge date. Ethical approval was received from the local research and innovation office (ref6275)

Results

Of 144 eligible patients, 41 were included; mean age 82.1 (SD6.8) years; 48.8% female, 95.1% under the care of geriatricians. The median length of stay was 24 (IQR10-67.5) days. Mean number of conditions was 5.6 (SD2.9) with dementia present in 22.5%. The mean number of medications increased during admission from 7.2 (SD3.2) to 9 (SD3.1); p=0.006

The number of patients prescribed at least 1 STOPP-PIP reduced by 20.6%; 82.9% (admission) vs 65.9% (discharge), p<0.001. The most common PIPs at were (i) drugs without a clear indication, 34.1% (admission) vs 14.6% (discharge), (ii) high dose proton pump inhibitors, 34.1% (admission) vs 34.1% (discharge) and (iii) Z-drugs in fallers; 17.1% (admission) vs 12.2% (discharge). Of 41 patients, 35 could have START criteria applied. START PPOs were reduced by 53%; 47.2% (admission) vs 22.2% (discharge), p=0.001. The largest improvement was seen in bone absorptive therapy (11.4% (admission) vs 2.9% (discharge) and vitamin d in those experiencing falls/osteopenia; 5.57% (admission) vs 2.9% (discharge). Of the 134 STOPP/START criteria listed, 36 (19.4%) were identified in this cohort.

Conclusion

Although the average number of medications increased, PIPs reduced significantly. Only 19.4% of STOPP/START criteria were identified, suggesting that focusing on a number of key PIPs going forward could improve prescribing practices.
299 OLDER PERSONS’ EXPERIENCES AND PERSPECTIVES OF COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Leahy A , O’Shaughnessy I , Barry L , Gabr A , Shanahan E , O'Connor M , Galvin R , Robinson K
Published: October 2022

Background

There is an abundance of evidence to demonstrate the positive impacts of Comprehensive Geriatric Assessment (CGA) on clinical and process outcomes for older adults across settings of care. However, it is unclear how older adults themselves view CGA and their experiences of the care process. The aim of this qualitative evidence synthesis is to explore the experiences and perspectives of older adults of CGA.

Methods

A comprehensive literature search was completed across MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text. Qualitative or mixed methods studies that included qualitative data on the perspectives and experiences of older adults of CGA were included. The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Findings were synthesised using thematic analysis

Results

Nine studies were included in the synthesis, including studies where CGA was completed in hospital, outpatient assessment unit and home settings. Divergent experiences of CGA were reported. Older adults reported experiences of being respected and listened to during CGA and attention paid to all their issues and priorities. Good communication by healthcare providers was central to these positive experiences (theme 1). In contrast, experiences of being unclear about the aim of CGA or perceived benefits of CGA, feeling that the outcome of CGA did not align with their priorities (theme 2) and not feeling involved in decision making during CGA (theme 3) were also commonly reported.

Conclusion

Findings indicate that CGA is a process by which older adults can felt respected and paid attention to. However, scope exists to further improve older adults’ experiences of CGA. Enhanced healthcare provider communication and facilitation of older adult involvement in decision-making are priority areas for improvement. Further research should focus on exploring other stakeholder groups experiences of CGA including caregivers and healthcare professionals.
302 MONITORING FALLS RISK IN THE COMMUNITY USING AN IMPLANTABLE CARDIAC MONITOR WITH EMBEDDED ACCELEROMETER
Authors: Bourke R , Perez S , Mogollo AZ , Finucane C , Leenders M , Roberts F , Morren G , Maree A , De Melis M , Kenny RA , Foran T
Published: October 2022

Background

Falls are the most common cause of injury amongst older adults. Falls can lead to hospitalisation, functional decline and are associated with increased morbidity and mortality. The holy grail for clinicians would be to predict increased likelihood of falls occurring and intervene before the event. Understanding underlying dynamic biophysiological changes may therefore inform novel predictor models and falls prevention. This study examines activity and cardiac data acquired from an implanted Medtronic Reveal LINQ™ Insertable Cardiac Monitor (ICM) with an embedded tri-axial accelerometer.

Methods

Thirty participants with at least one unexplained fall in the previous two years were prospectively recruited. All met criteria for ICM insertion following comprehensive assessment. Participants were followed for one year and attended every three-months for cardiac and gait assessment. Information pertaining to activity levels, posture changes and cardiac parameters were collected daily from the device. Summary metrics and trends were collected for inclusion in a continual assessment of falls risk.

Results

Mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. There was seasonal variation in activity levels. Twelve participants had falls and cardiovascular, gait and activity variables were examined at the time of a fall to determine any trends in biophysiological changes.

Conclusion

Causes of falls are usually multifactorial. A holistic approach is necessary to manage and minimise risk factors. The use of an ICM with an embedded tri-axial accelerometer allows clinicians to formulate an algorithm to determine if a person is at an increased risk of falling based on biophysiological changes. This may create an opportunity for falls to be predicted and prevented.
304 IMPLEMENTING A FRAILTY SPECIFIC PHARMACY PRIORITISATION TOOLKIT IN AN OLDER PERSONS’ REHABILITATION UNIT
Authors: O'Reilly A , McKenna-Barry M , Kennedy N , Ryan S , O'Reilly A , Donnellan C , Pillay I
Published: October 2022

Background

Standardised identification of patients for medication review using nurse-delivered, frailty-specific pharmacy prioritisation toolkits should maximise effective use of limited pharmacy resources. A frailty-specific pharmacy prioritisation toolkit was introduced in a 21 bed older persons’ rehabilitation unit to standardise pharmacy referrals and categorise the interventions made.

Methods

The frailty-specific pharmacy prioritisation toolkit was applied to consecutive patients by upskilled rehabilitation nurses to identify patients for weekly senior pharmacist review over a 5-month period from 18th Jan 2022 to 24th May 2022. Regular use of high-risk medication, greater than 10 medications, patients with specific pharmaceutical concerns such as a desire to reduce their medication burden, acute or chronic kidney injury and admission potentially related to medications or admission with non-mechanical falls are included in this toolkit. Pharmacist interventions included recommendations on medications to be weaned or stopped, dose-adjusted, started or restarted and identification of prescribing errors. Age, gender and interventions were recorded onto Excel and data was analysed using descriptive statistics.

Results

The total number of patients screened was 82. Eighty five percent (n=70) fulfilled criteria for a medication review. Mean age (SD) was 77(10.9) years. Female:male ratio was 1.5:1. Review was completed in 50% (n=35) of these cases. In total there were 228 interventions, with a mean (SD) of 6.5 (2.4) per patient. Eighty-four recommendations were made to wean or stop medication and thirty to dose adjust, of which 60% (n=18) were proton pump inhibitor dose reduction. Thirty-eight were to start or restart a medication, 34% (n=13) of which were for bone protection. Eleven prescribing errors were identified.

Conclusion

The pharmacy prioritisation toolkit applied by existing rehabilitation nurses successfully identified patients for medication review. The review rate reflects a need for a twice-weekly senior pharmacy resource.
309 A FRAILTY CENSUS OF INPATIENTS AGED 65 AND OVER ADMITTED TO A MODEL 4 HOSPITAL
Authors: Carroll I , O'Connor M , Cunningham N , Ryan S , Corey G , McNamara D , Galvin R , Sheikhi A , Shannahan E , Mastalska A , Dillon J , Barry L
Published: October 2022

Background

Frailty is a risk factor for in-hospital mortality, long hospital stay and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty.

Methods

All patients aged ≥65 years and admitted to a medical or surgical inpatient setting, were screened over a 12-hour period (08:00-20:00) using validated frailty and co-morbidity scales. Age and Gender Demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CHI) and admitting specialty (Medical/Surgical) were collected. The data was fully anonymised and ethical approval was granted. Descriptive statistics were used to profile the cohort and Chi-squared tests applied for comparisons.

Results

Within a sample of 413 patients, 291(70%) were ≥65yrs. Of this cohort, 202(70%) were ≥75yrs. 207(71%) utilised in-patient medical services and 121(41%) surgical services while 37(12%) used both. The mean CFS was 6 indicating moderate frailty levels and the mean CCI score was 4 denoting moderate co-morbidity. Overall: 195(67%) had moderate-severe frailty (CSF ≥6) while 218 (75%) had moderate-severe co-morbidity (CCI Mod 3-4, Severe ≥5). Associations with age >75 and frailty (p=0.001) and medical service usage and frailty (p=0.004) were established. No significant differences were observed across genders for CFS (p=0.110) and CCI (p=0.465).

Conclusion

There is a high prevalence of frailty and co-morbidity within the admitted patient cohort ≥65yrs. Overcrowding across the hospital system and higher levels of frailty and comorbidity will contribute to increased lengths of stay and the need for specialist intervention, particularly for those ≥75yrs who represented 70% of patients screened. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services and staff training in frailty care across the hospital and community setting.
313 STREAMLINING A ZOLEDRONIC ACID SERVICE TO A LEVEL TWO HOSPITAL
Authors: Higgins M , McGuirk C , Devitt L , Ludgate S , Doyle R , O'Donoghue C , O'Dwyer C , O'Hanlon S
Published: October 2022

Background

Approximately, 350-400 patients are admitted to a level 4 hospital for hip-fractures yearly (2019). According to the Irish Hip Fracture Database (2020) the average age for a hip-fracture is 81 years old. Patients post-hip fractures are commenced on Zoledronic acid; a bisphosphonate which is given intravenously 10 days post-surgery and then annually in year two and three. Zoledronic acid is a first line choice of bisphosphonate for the ≥65 population with a fragility fracture.

Methods

274 patients were transferred from the level 4 Hospital waiting list to a level 2 hospital waiting list to streamline the service. Meetings occurred to establish a pathway for the transition of services. A rapid improvement of the level 2 Day Hospital (DH) was commenced. Essential resources, training and information leaflets were developed in order to begin the service. A policy review, procedure guidelines and referral pathway were implemented. An excel database of patient information was transferred between organisations. The 274 patients were triaged by the DH. Pre-assessment phone calls were conducted determining if patients were still eligible for Zoledronic acid.

Results

Of the 274 referrals; 24 had died; 30 refused; 37 were on other bone treatments and another 7 patients haven’t made creatinine clearance, leaving 176. All 176 patients were allocated an appointment for 2022. Of the 176 patients; currently 57 patients have received their Zoledronic acid infusion in the DH. 69 of these referrals had an indicative date for their next Zoledronic acid infusion for dates after April 2022. There are 50 patients yet to receive their treatment which is overdue.

Conclusion

With the prospect of service demands increasing due to Irelands aging population inevitably placing extra pressures on infusion suites in a level 4 hospital. The level 2 hospital has effectively managed to focus on tackling the backlog, streamlining referrals to the bone health service and thus reducing the risk of subsequent hip fractures.
326 USE OF A PHARMACY PRIORITISATION TOOLKIT IN FRAIL OLDER ADULTS PRESENTING TO THE EMERGENCY DEPARTMENT
Authors: Kennedy E , Mulvihill M , Cronin L , Scannell M , Coakley E , Lyons M , Barrett L , Cloney T , Pillay I
Published: October 2022

Background

A Pharmacy Prioritisation Toolkit (PPT) was adapted for use by a front door frailty multidisciplinary team to direct pharmacist review.

Methods

Over a 4-week period pharmacist referrals based on a toolkit used by the team were reviewed. Data was recorded in Excel including age, reason for referral and outcome of Medicines Optimisation Review (MOR). Pharmacy-identified patients were also analysed.

Results

Forty-Five patients were referred by the team using the PPT and 25 were pharmacist-identified for review. Reason for referral were use of high-risk medication (20/45), suspected medication related admission (9/45), chronic kidney disease or acute kidney injury (7/45), specific pharmaceutical concerns (5/45) >10 regular medications (4/45). Of those reviewed, 29 MORs were made. Of patients who were pharmacist identified, 10 MORs were made (53% of patients). The toolkit was retrospectively applied to these patients and would have selected all but 3.

Conclusion

The PPT was successfully used by the team to generate 45 referrals for pharmacist review over a 4-week period. As a result of analysis of these recommendations, antimicrobial prophylaxis for urinary tract infections will be added to the high-risk medicines list on the PPT. Development of the toolkit is ongoing using a plan, do, study, act model with input from all members of the team to further improve both its efficacy and utility.
331 THE USE OF BODY MASS INDEX IN PREDICTING ORTHOSTATIC HYPOTENSION IN OLDER ADULTS
Authors: Chen H , Morrison L , Sheehy T , Costelloe A , Griffin M , Quinn C , O'Connor M , Peters C , Lyons D
Published: October 2022

Background

The presence of Orthostatic Hypotension (OH) is known to be associated with an increased mortality risk. Previous Irish research has shown that elevated Body Mass Index (BMI) may be protective against OH, with overweight and obese patients having significantly smaller Systolic Blood Pressure (SBP) drops during Head-Up-Tilt (HUT) Testing.

Methods

Demographics, including age, height and weight, were obtained retrospectively from all head up tilt testing performed in a tertiary Irish hospital between 2000 and 2021. All incomplete records were excluded. A total of 4,717 patients were analysed. Linear regression models were used to examine the relationship between BMI and change in tilt SBP.

Results

2,089 males and 2,628 females over the age of 60 years old were examined. The mean age is 77 years ± 7.8 (S.D.), with majority (51.5%) of the cohort overweight or obese. 69.7% of individuals demonstrated OH. The mean change in tilt SBP was –7mmHg in the underweight and healthy weight group, and –10mmHg in the overweight or obese group. The linear regression model established that BMI significantly predicted a change in tilt SBP (beta=0.394, 95% CI: 0.235 to 0.554, p<0.001), but remains a poor predictive variable (R2=0.004) for this cohort. This correlation was similar for both genders (male: r=0.08, female: r=0.07).

Conclusion

Our findings confirmed a correlation between BMI and its predictive impact on OH in older adults. Future studies should explore targeted populations with multivariate analysis, taking into consideration age and gender, to reduce the heterogeneity of data.
332 THE PATIENT EXPERIENCE OF THE OLDER PERSONS REHAB AT HOME (OPRAH) SERVICE
Authors: Murphy R , Doyle E , O'Connor A , Coen M , Connolly A , Breen C , Carty J , Waters R , Canavan M , Robinson S
Published: October 2022

Background

The Older Persons Rehab at Home (OPRAH) team is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. This provides rehabilitation in the patients’ own home and accelerates discharge from the acute care sector. In this study patient and carer experiences of the service were explored.

Methods

Patients were sent a postal questionnaire after discharge from the service to collect information on the patient experience of the OPRAH service. The following measures were collected: satisfaction with the service, experience of interacting with therapy staff, involvement in shared goal setting and achievement of rehabilitation goals. Data from participants who responded to feedback questionnaires from the first 12 months of the service were analysed using descriptive statistics.

Results

Ninety-five participants were sent feedback questionnaires with 31 responses received (33%). 96% of participants reported that they were satisfied with the service, with the same proportion expressing that they both felt they were treated with respect and dignity and that they had confidence and trust in the staff. All respondents felt that they could understand the answers to any questions they had while receiving rehabilitation and 92% of participants understood their rehabilitation goals, with 88% of participants feeling they achieved their rehabilitation goals. 88% of participants felt they were adequately involved in their care planning with 83% of participants feeling their family members had ample opportunity to ask questions during their rehabilitation experience. Results did not different by age group of patient or by time with the service.

Conclusion

In this structured evaluation of the OPRAH team participants highly rated the service. Our results highlight that this integrated approach to care allowed patients to be involved in shared goal setting with the majority of patients satisfied that they achieved their goals.
333 FRAILTY KNOWLEDGE, USE OF FRAILTY SCREENING TOOLS AND EDUCATIONAL CHALLENGES IN EMERGENCY DEPARTMENTS: A MIXED-METHODS MULTI-SITE ED STAFF SURVEY
Authors: Moloney E , O'Caoimh R , O'Donovan MR , Timmons S , McGrath K
Published: October 2022

Background

Limited information is available on the extent of Emergency Department (ED) staff knowledge of frailty and frailty screening tools. Educational challenges unique to the ED environment are also little researched. This multi-site staff survey explores frailty knowledge and use of frailty screening tools in Irish emergency departments, as well as detailing educational challenges faced in the ED environment

Methods

A mixed-methods multi-site survey of twenty-five Irish adult emergency departments, aimed at all grades of ED staff. An anonymous online survey consisting of twenty-five statements across five categories was distributed via staff email at these sites. Five free-text sections were included after each category. Quantitative data were managed and analysed using IBM SPSS Statistics software. Qualitative results were analysed using reflexive thematic analysis

Results

181 ED staff (nursing, medical and allied health) across all grades responded to the survey. ED nursing staff made up the largest staff category (n=80, 44%). Less than half of respondents had received training on frailty identification (n=88, 48%,p=0.028), yet the majority felt confident of identifying frailty (n=99, 54%, p=0.007). ED staff aged under 35 years felt nursing staff were the most appropriate group to screen for frailty in ED (N=88, 87%, P=0.017). Most respondents felt overwhelmed by time pressures in ED, which left little opportunity for dedicated teaching (n=77, 45%). A thematic map was created to explore obstacles to frailty screening in ED.

Conclusion

The opinion of ED staff surveyed was that frailty screening is feasible to undertake in ED but quick, user-friendly frailty screening instruments are lacking. Most ED staff surveyed relied on clinical judgement rather than frailty teaching experience to diagnose frailty syndromes. The provision of inclusive education in ED is challenging. Learning strategies in ED should reflect the demands of the acute care environment and incorporate a flexible, hybrid multi-disciplinary teaching model
336 ASYMPTOMATIC ORTHOSTATIC HYPOTENSION AND RISK OF FALLS IN COMMUNITY-DWELLING OLDER PEOPLE
Authors: Claffey P , Pérez-Denia L , Lavan A , Kenny RA , Finucane C , Briggs R
Published: October 2022

Background

Many older people with Orthostatic Hypotension (OH) may not report typical symptoms of dizziness, light-headedness, or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established.

Methods

Continuous orthostatic BP was measured during active stand using a Finometer at Wave 1 of TILDA in participants aged≥70 years. OH, with and without dizziness, was defined as a sustained drop in systolic BP≥20 and/or diastolic BP≥10 mm Hg at 30, 60 and 90 seconds post-standing. The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5).

Results

Almost 11% (n=934; mean age: 75 years; 51% female) had OH, two-thirds of whom were asymptomatic. Dizziness was not associated with systolic BP drop at 30 (β=1.54; –1.27, 4.36; p=0.256), 60 (β=2.6; –0.19, 5.47; p =0.476) or 90 (β=2.02; –0.91, 4.95; p=0.176) seconds after standing in adjusted models. Asymptomatic OH was independently associated with unexplained falls (Odds Ratio: 2.01; 1.11, 3.65; p=0.022) but not explained falls (OR 0.93; 0.53, 1.62; p=0.797) during follow-up.

Conclusion

Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.
337 AN INVESTIGATION OF UNDER-TREATMENT OF KNOWN OSTEOPOROSIS IN PATIENTS WITH SUBSEQUENT HIP FRACTURE
Authors: Kitt K , Hanrahan C
Published: October 2022

Background

Hip fractures have long been associated with significant morbidity and mortality and threat to independent living. A major, treatable risk factor for the development of a hip fracture is osteoporosis. The objective of this study was to investigate what proportion of patients with a prior osteoporosis diagnosis admitted to acute hospitals with a new hip fracture are receiving suboptimal osteoporosis treatment. We further aimed to investigate if any demographic variables or features from clinical history and exam were associated with undertreatment.

Methods

Using the Irish Hip Fracture Database (IHFD), we prospectively examined patients over the age of 60 who were admitted to an acute trauma centre with a diagnosis of hip fracture, between January 2019 and December 2021. Patients were excluded if they had a pubic rami fracture or other non-hip fracture, or if they were under the age of 60. History of osteoporosis was either diagnosed by DEXA imaging or by previous fragility fracture. We also collected data on demographic and clinical variables that may be associated with being more likely to be treated with osteoporosis medications, such as age, sex, New Mobility Score, Abbreviated Mental Test Score and the American Society of Anesthesiologists grade.

Results

Initial data collection showed 246 patients who met our inclusion criteria, with only 97 patients (39.4%) on appropriate treatment for osteoporosis. We then applied a binary logistic regression model to our predictor variables in estimating the likelihood of a patient to be prescribed “appropriate” osteoporosis medication as previously described, however none of the selected variables were shown to have any significant value in predicting the likelihood of being undertreated with appropriate medication for osteoporosis.

Conclusion

This study demonstrated that 60% of patients admitted with hip fracture who had a known diagnosis of osteoporosis were undertreated for same. Treatment inertia in prescribing medications for osteoporosis must be tackled to try and remedy this.
339 SURGICAL INPATIENT DELIRIUM: AN AUDIT OF THE DOCUMENTATION OF THE 4AT SCORE
Authors: Smyth H , Mohammed T , Healy N , Vallely S , Byrne C , Kyne L , Scanaill PÓ
Published: October 2022

Background

Postoperative delirium and perioperative neurocognitive disorder are the commonest postoperative complications in patients over 65 years old. This has implications for brain health with an increased risk of length of stay, a higher incidence of morbidity and mortality. Internationally, perioperative teams often fail to routinely screen for delirium. Our aim was to audit the documentation of the 4AT score for surgical inpatients over 65 years old and gain insight into the incidence on surgical wards.

Methods

Using the guideline for Perioperative Care for People Living with Frailty undergoing Elective and Emergency Surgery from the CPOC and BGS as a standard, an audit of surgical inpatients over 65 was carried out on 3 surgical wards over 5 days. Data was collected including 4AT documentation on admission, day 1 and day 3 post operatively, type of surgery & anaesthesia and risk factors for delirium (dementia, polypharmacy, opioids & benzodiazepine use, PD, surgery>2h, stroke, alcohol, >2 medical conditions, multiple ward moves).

Results

36 surgical patients over 65 years of age were included in the audit. The average age was 78 years old (range 65-91). 50% were admitted under the orthopaedic team, 31% under general surgical teams, 11% urology and 8% under other surgical specialties. 33% of patients had a 4AT documented at any stage during their admission and 25% of patients had a baseline 4AT documented preoperatively. The incidence of delirium was 18.7%. Surgical risk factors for delirium were found in 69% of older inpatients.

Conclusion

Delirium screening was underused in our cohort of older surgical patients despite a proportion of patients developing delirium postoperatively. Under recognition of delirium perioperatively is associated with poor outcomes and higher morbidity and mortality. Further interdisciplinary educational sessions are required to increase awareness and screening of delirium in surgical patients >65 years old with the aim to re-audit in 6 months.
343 RIGHT CARE, RIGHT PLACE, RIGHT TIME? WHAT PROPORTION OF ACUTELY-UNWELL OLDER PATIENTS UNDERGO EVIDENCE-BASED COMPREHENSIVE GERIATRIC ASSESSMENT?
Authors: Lalor P , Briggs R
Published: October 2022

Background

There is robust evidence that Comprehensive Geriatric Assessment (CGA) improves outcomes for acutely unwell older people. Relatively little research has examined how this translates to real life clinical settings, however. The aim of this study therefore was to ascertain how many older people admitted to hospital underwent CGA and how this impacted on readmission rates.

Methods

The study site is a large teaching hospital with 150 specialist geriatric medicine beds and ‘specialty-take’ of frail, older people by the geriatric medicine service. Data pertaining to contact with a geriatric medicine service were collected for 400 consecutive ED presentations of patients aged ≥70 years from 1/1/21, as well as Clinical Frailty Scale (CFS) and readmission within 30 days.

Results

Over one-third (139/400, mean CFS 3.7) of patients were discharged home directly from the ED, with the remainder (261/400, mean CFS 4.5) admitted to hospital. Almost-half overall (122/261, mean CFS 4.7) and 58% of those ≥80 years, were admitted under the care of a geriatrician, with 73% (89/122) cared for on a specialist geriatric medicine ward. Of those not admitted under a geriatrician, 10% (13/139) subsequently underwent CGA on a consultation basis. In total, 48% (126/261, mean CFS 3.7) of patients ≥70 years, including one-third of those ≥80 years with a CFS≥5 (36/99), completed their admission without undergoing CGA. Of those ≥80 years with a CFS≥5 who did not receive CGA, readmission within 30 days was 24% compared to 13% for those who underwent CGA.

Conclusion

Patients who underwent CGA were older, with higher levels of frailty. However, one-third of those aged ≥80 years with CFS ≥5 did not undergo CGA and early readmission was higher in this cohort. CGA in the acute setting is a finite resource and it is imperative it is delivered to those who require it most.
346 A RETROSPECTIVE REVIEW OF THE PREVALENCE, MANAGEMENT AND SPECIALIST REVIEW OF TIA DIAGNOSIS
Authors: Geraghty T , Fernandez C
Published: October 2022

Background

Transient Ischaemic Attach (TIA) and suspected TIA are common presentations to emergency departments and stroke services, often heralding a subsequent stroke in up to 25% of patients. The first week after TIA symptom onset carries a significant risk of impending stroke, reported risk at 2 days of between 2.0 and 4.1%, and at 7 days of between 3.9 and 6.5%. As such, a TIA presentation may offer an opportunity to reduce the significant risk of chronic morbidity and mortality.

Methods

We conducted a retrospective review of all patient records with a diagnosis of TIA on their clinical discharge summary using the HIPE system from June 2020 to June 2021.

Results

Two-hundred and Sixty-nine patients were recruited into the study. 77 patients without discharge letters or incomplete medical information were excluded. The remaining 192 were analysed. Mean age was 75 (+/-10), 45.8% (n=88) patients were male and average length of stay 3.9 days. 52.6% (n=101) were followed up in designated TIA or Neurology OPD, 42.2% (n=81) were confirmed TIA. 10.4%(n=20) were diagnosed with another pathology. 47.4% (n=91) did not have any OPD follow up care. 100% of OPD confirmed TIA cases (n=81) were on anti-platelet or anticoagulation therapy. 4 out of 9 confirmed TIA cases with high HbA1c levels had no prior history of diabetes. 4.2% (n=8) were actively smoking and not on nicotine replacement therapy. 27.2% (n=22) had a history of previous TIA.

Conclusion

Accurate TIA recognition and management remains crucial to stroke prevention. Outpatient follow up in TIA and Neurology clinics can improve TIA diagnosis and guide appropriate management. Despite guidelines recommending an early referral to a stroke team, almost half (47%) of those patients diagnosed with TIA during admission did not have OPD follow up. TIA mimics represent a considerable pitfall in TIA diagnosis for NCHDs.
350 INTEGRATION OF VISION AND HEARING IS ASSOCIATED WITH GAIT VELOCITY IN A LARGE SAMPLE OF MIDDLE-AGED AND OLDER ADULTS
Authors: Setti A , Hernandez B , Hirst R , Donoghue O , Kenny RA , Newell FN
Published: October 2022

Background

Multisensory integration is the ability to appropriately merge information from several senses for the purpose of perceiving and acting in the environment. Its importance for higher level cognition and function has emerged in recent years. Walking requires to combine information from multiple senses to coordinate effective movements. In this study, we tested the association between a well characterised multisensory task, the Sound-Induced Flash Illusion (SIFI), and gait velocity in 3,255 participants from The Irish Longitudinal Study on Ageing. The SIFI is the illusory perception of two flashes when one flash is presented with two beeps. We hypothesised that high SIFI susceptibility would be associated with slower gait velocity

Methods

Gait was measured under three conditions; usual pace, cognitive dual tasking, and maximal walking speed. A separate logistic mixed effects regression was run for: (1) gait at usual pace, (2) change in gait speed for the cognitive dual-task relative to usual pace, and (3) change in maximal walking speed relative to usual pace. The model controlled for covariates including age, sex, education, vision and hearing abilities, Body Mass Index, and cognitive function.

Results

Slower gait was associated with more illusions, indicating that those who integrated incongruent sensory inputs over longer intervals, also walked slower. Relative change for cognitive dual tasking and maximal walking speed were also significantly associated with SIFI at longer SOAs.

Conclusion

These findings extend growing evidence showing that mobility is associated with multisensory processing in ageing; in particular, the mechanisms appear related to the temporal dynamics of sensory integration.
352 THE IMPACT OF ETHNICITY ON ACUTE STROKE ADMISSIONS IN AN IRISH HOSPITAL
Authors: Roche A , Duane C , Murchan A , Donaghy L , Guilfoyle P , Dolan E , Sheehan O
Published: October 2022

Background

Recent studies have demonstrated the variability of aetiology, clinical presentation and overall mortality between different ethnic groups presenting with acute stroke. The non-native Irish population accounts for almost 13% of the total population and is predicted to grow over the next decade. Recording and analysis of acute stroke patients based on their ethnicity and population demographics is an important step in planning for the future of stroke care in Ireland. In this study, we aimed to evaluate key differences between the Irish and non-Irish population presenting with acute stroke to an Irish hospital.

Methods

We reviewed our hospital stroke registry over a 12-month period (January-December 2021). Key parameters including country of birth, ethnicity, other patient demographics, clinical presentation, aetiology and subtype of stroke, stroke management and clinical outcomes.

Results

Of the 245 acute strokes admitted to our hospital in 2021, non-ethically Irish patients made up 12.2% (n = 30). The average age of non-ethnically Irish stroke presentations was younger than Irish stroke presentations (59 versus 71 years). Haemorrhagic strokes were more common in the non-Irish population (13.3% in non-Irish cohort vs 9.8% in Irish cohort). Median time of symptom onset to presentation to hospital was 3 hours and 58 minutes in the Irish patients and 6 hours and 10 minutes in the non-Irish patients. The overall length of stay in hospital post stroke was similar between the two population groups at an average of 19 days duration.

Conclusion

This study identifies disparities in acute stroke presentation between the Irish and non-Irish population presenting to an Irish hospital. This study demonstrated the importance of further research on a national scale to record the variability of strokes in different ethnic groups in order to adequately plan primary and secondary stroke care and provide targeted public health campaigns to remain inclusive to Ireland’s growing and increasingly diverse population.
354 PROMOTING THE BENEFITS OF COGNITIVE STIMULATION AMONGST OLDER PATIENTS: A BRIEF SURVEY AND QUALITY IMPROVEMENT PROJECT
Authors: Higgins M , Brewer L
Published: October 2022

Background

Cognitive Stimulation (CS) enhances cognitive function in patients with Cognitive Impairment (CI), including those with mild/moderate dementia. It has positive effects on various cognitive and non-cognitive symptoms. Engaging in CS can reduce the risk developing dementia and allows proactive improvement in wellbeing. Physical exercise and promotion of independence are also beneficial. Patients and staff are often poorly informed regarding such benefits.

Methods

We developed a 9-question survey, administered to a sample of representative doctors involved in the care of patients with CI to gauge their understanding of CS and its benefits. We envisaged this data may support the development of a patient-friendly information leaflet to educate about CS.

Results

Of 45 respondents, 68.89% could readily provide three examples of CS. 55.56% reported that CS “definitely” benefits patients with CI, 44.44% reported it “probably” does. All reported it was the joint responsibility of the doctor, memory nurse and occupational therapist to provide advice on CS. 44.44% regularly or sometimes discuss CS with patients/families, compared with 55.55% who rarely or never do. 55.56% were “not confident” giving advice on CS, only 8.89% were “quite confident”. 80% reported that exercise reduces the risk of CI. 37.78% could give an appropriate example of a compensatory strategy. All reported an information leaflet available for patients and their families, would be beneficial. We designed a patient information leaflet explaining cognitive domains, examples of impairments and measures patients can embrace to promote and maintain cognitive function. We highlighted physical and cognitive activities, social engagement and compensatory techniques to promote independence. We provided everyday examples of each including local clubs/classes to ensure accessibility and relatability.

Conclusion

Gaps in knowledge and confidence were identified amongst doctors rotating through the Geriatric Medicine Service. Recognising this, we designed an information leaflet ensuring we can readily impart accurate education and lifestyle advice to patients.
355 PREDICTORS OF HOME SUPPORT SERVICES AND THE CONSEQUENCES OF MISMATCH BETWEEN ALLOCATED AND RECEIVED SERVICES IN COGNITIVELY-IMPAIRED OLDER ADULTS
Authors: Whelan A , Murphy R , Shiel E , Griffith V , Mannion K , Neachtain M Ní , Mannion E , Conry M , Geoghegan J , Waters R , O'Donnell M , Robinson S , Canavan M
Published: October 2022

Background

Home support services aim to support older people to remain at home. Despite substantial investment in home support hours (€600 million), this has not translated into increased carers on the ground for older people. We aimed to report patterns of home support service utilisation in older patients with memory problems, and identify any mis-matches between allocated and received hours, and the impact on patients and caregivers.

Methods

Retrospective analysis of consecutive patients referred to community geriatric clinic from January 2021 to May 2022. 95/104 patients who were identified were suitable for inclusion.

Results

Participants had a median age of 82 (IQR 78-86) of whom 57% were female (n=54). 80% (n=76) were frail (CFS ≥4), with 82% dependent for IADLs (Lawton-Brody IADL Scale ≤6). Median MOCA score was 18, with 44% having moderate to severe cognitive impairment (MOCA ≤17). 40% of patients lived with alone (n=38). 52% (n=49) received formal home supports while 80% (n=76) had an informal carer. 37% (n=18) had a mismatch between hours allocated and hours received. There was a significant difference between median hours of care allocated (7) and median hours of care received (5), p <0.001. Increasing age and frailty, worsening cognitive and functional impairment and living status (living alone) predicted allocation of home supports. Patients who lived with family members were 3 times more likely not to receive allocated hours (OR 3.84 (95% CI 1.2–13.7))

Conclusion

In this vulnerable population with cognitive and functional decline, just over half received formal home support hours. A large proportion experienced significant mismatch between allocated and received hours. Family and informal caregivers often have to fill gaps, adding to existing carer strain. Future models of home support should prioritise early intervention for people with IADL loss to remain independent at home and broaden of the scope of practice of carers to facilitate this.
356 OLDER PERSONS LIVING ALONE IN INTEGRATED CARE: DEPRESSION, LOW EDUCATION AND FUEL POVERTY
Authors: Dolphin H , Dyer A , Domsa M , McNally D , Doyle M , Keating J , Noonan C , McGuinn C , Ahern L , Murphy A , Malone N , Kennelly SP
Published: October 2022

Background

An important consequence of population ageing has been the increasing number of older adults who live alone. According to TILDA data, older adults with the lowest levels of education tend to experience most social isolation and there is a strong association between living alone and loneliness. We sought to compare the cohort of patients open to the Integrated Care for Older Persons (ICPOP) team in a University Teaching Hospital serving a community area of approx. 300,000 population, to this national dataset.

Methods

A convenience sample of 174 patients who underwent comprehensive geriatric assessment via domiciliary visit between July 2021-May 2022 by was analysed. Data was anonymised and analysis was performed using SPSS v.27.

Results

The average age was 81.5 (±8.1) with 63% women in the sample. Eighty-five older adults i.e. 49% of the sample either lived alone or spent more than 21 hours alone per 24-hour period. Compared to those who live with someone, those who lived alone had higher rates of likely depression as determined by Geriatric Depression Score (6.6 vs 4.8 p=0.007). They were also likely to have less educational attainment, as determined by years spent in full time education (11.81 vs 10.42 42 p= 0.0016) and those living alone had overall less central heating in their homes than those not living alone (64/85 vs 81/89 p=0.0109). There were no significant differences in the rates of polypharmacy, falls, dementia and home ownership between groups. There were higher levels of frailty in the group living with someone than those living alone as determined by Clinical Frailty Scale (6.14 vs 5.23 p<0.001).

Conclusion

A high proportion of patients seen by our ICPOP team live alone and have complex care needs that require an innovative, multidisciplinary approach. Financial vulnerability in this group is likely to compound isolation and loneliness.
360 PROFILING FRAILTY IN A POPULATION OF OLDER FARMERS IN THE WEST OF IRELAND
Authors: Merrick C , French H
Published: October 2022

Background

Identification of different groups at risk of frailty is a key research focus. Farmers frequently have higher prevalence of some health problems; however, they undertake high levels of physical activity which may provide protection against the development of frailty in this cohort. To date, no published research has examined prevalence of frailty levels in older farmers in Ireland. This research aimed to profile frailty levels of older farmers in the west of Ireland, and, establish if there is an association between frailty levels in this group and different farming specific demographics/socioeconomic factors such as; type of farming undertaken, amount of time spent farming outdoors and amount of land owned by farmers

Methods

This cross-sectional study recruited older farmers via livestock marts in the west of Ireland. A questionnaire regarding participants characteristics and farming demographics was provided to participants. This questionnaire also included the Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7) questionnaire and the short 5-question assessment of Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight (FRAIL) questionnaire to assess frailty. Data were analysed using STATA statistical software.

Results

In total, 58 older farmers participated in the study. Results showed found that two participants (3.5%) were ‘frail’, with 27 participants (47%) classified as ‘prefrail’. An association existed between the type of farming undertaken and frailty levels based on the FRAIL scale (p=0.009). No association was found between frailty levels and the amount of land owned by farmers (p=0.34) or the amount of time spent farming outdoors (p=0.18).

Conclusion

A minority of participants in this study were classified as frail. The type of farming undertaken by farmers may have an association with frailty levels. Results should be interpreted with caution secondary to the small sample size and the small geographical scope of recruitment.