bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence of Potentially Inappropriate Medications (PIMs) Among Frail Older Participants of The Irish Longitudinal Study on Ageing (TILDA)
Authors: Ali Ahmed Hassan , McMahon Niamh , Moriarty Frank , Ryder Sheila
Published: September 2024

Background

This study aimed to assess PIMsprevalence among frail older participants of The Irish Longitudinal Study on Ageing (TILDA), using a newly developed OPTI-3S criteria (criteria for OPTImising medicines by Stopping, Stepping down, or Switching to safer alternatives).

Methods

All TILDA participants with polypharmacy (i.e. ≥5 medicines) and frailty based on Clinical Frailty Scale (CFS) ≥4 were included. PIMswere assessed based on the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail v2) [1], Poudel et al. algorithm [1], the Norwegian General Practice--Nursing Home criteria (NORGEP-NH) [1], and OPTI-3S. The prevalence of PIMsidentified by each tool was assessed across all frailty levels (CFS ≥4). Poisson regression assessed associations between PIM prevalence and covariates (e.g. medications).

Results

Most of the study cohort (86.5%, n=504) had at least one PIM identified by any of the four tools. OPTI-3S identified at least one PIM in 62.6% of participants, followed by Poudel’s algorithm (53.9%) and NORGEP-NH (40.5%). OPTI-3S could identify at least one PIM in 97.8% of participants with CFS ≥7, followed by STOPPFrail (88.9%). Overall, 34.8% of prescribed medications were considered to be PIMsThe OPTI-3S list detected more PIMsthan any other tool for all frailty levels (e.g. OPTI-3S, 78.4% vs STOPPFrail, 40.2% in CFS ≥7). Deprescribing all OPTI-3S-defined PIMswould reduce polypharmacy by 20.6% compared to NORGEP-NH (13.3%) and Poudel’s algorithm (12.0%). The most prevalent PIMswere aspirin, benzodiazepines and z-drugs, and antihypertensive medications. The number of medications, anticholinergic burden, and being on specific medications (e.g. aspirin, NSAIDs, benzodiazepines, antidepressants) were significantly associated with increased PIMs.

Conclusion

OPTI-3S is a useful PIM screening tool in community-dwelling frail older adults, pending further testing in the hospital setting.

Reference

1. Anlay, D.Z et al. Br J Clin Pharmacol. 2024;90(1):12-106.
Efficacy of a Nursing Home Liaison Service In Supporting Early Hospital Discharge For Long-Term Care Facility Residents
Authors: Power Leslee , O'Mahoney Niamh , Mello Sarah
Published: September 2024

Background

Long-term care facility residents (LTCR) are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. A new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) commenced recently with the aim of providing early supported discharge for LTCR admitted to hospital. This study aims to describe the efficacy of the NHL service in reducing length of stay (LOS) and readmission rates for LTCR in comparison to data from the year prior to NHL commencement.

Methods

Hospital In-Patient Enquiry (HIPE) data was retrospectively obtained for the pre-service group (PSG), consisting of all medically admitted LTCR in 2022. This included demographic data, International Classification of Diseases diagnosis, LOS, and discharge outcome. The same prospective data was obtained by chart review for the service group (SG), for LTCR following the initialization of NHL between September 2023 and March 2024. Unpaired t-test and Chi-squared test was used to determine significant difference between the two groups.

Results

There were 249 LTCR in the PSG and 171 in the SG. The average age (84 vs 81) and dementia diagnosis rate (60% vs 55%) were similar amongst the two groups. The most common reason for admission in both groups was infection (60% vs 40%). The median LOS was significantly lower for the SG as compared to the PSG (8 vs 6 days, p=0.02). The PSG also had higher seven-day (6.4% vs 4.1% p=0.3) and 30-day (14.5% vs 7.6% p=0.03) readmission rates.

Conclusion

The introduction of a dedicated NHL service for LTCR has resulted in a significant reduction in hospital LOS and readmission rates. By providing enhanced communication through telehealth review and assistance with advanced care planning, the NHL service effectively bridges the gap between acute and community care, resulting in improved patient flow and delivery of person-centred outcomes.
Creating a Guidance Template for NCHDs to Evaluate Cognition in Geriatric Medicine Clinics
Authors: Healy Anna , Brewer Linda , Curran Carmel
Published: September 2024

Background

Non-Consultant hospital doctors (NCHDs), when rotating through geriatric medicine, often take a comprehensive cognitive history for the first time. Graduate clinical exams often overlook this complex assessment, and knowledge of cognitive disorders amongst NCHDs is often limited. We aimed to create a template to guide NCHDs in taking this history, including investigations and management options.

Methods

We developed a 9-question survey, administered to a sample of representative NCHDs and specialist nurses who have rotated through our department, to gauge their confidence in assessing cognition. We examined their understanding of cognitive assessments and if a template would be useful. With consultants, we subsequently drafted an agreed guidance template for use at clinics.

Results

We included 35 respondents who rotated through geriatric medicine clinics this year; 8 registrars, 18 SHOs, 5 interns, 1 ANP. 10(31.25%) felt very confident completing a cognitive history, 17(53.13%) felt just somewhat confident and 5(15.65%) did not feel confident. Regarding investigating a new cognitive impairment (CI) n=10 (31.25%) felt very confident, 12(37.5%) felt somewhat confident and 10(31.25%) did not feel confident. Management of CI - 12(37.5%) felt very confident, 11(34.38%) felt somewhat confident and n=9 (28.13%) did not feel confident. MMSE, MOCA, clock drawing test, Addenbrooks and RUDAS were listed as cognitive assessments. Regarding investigations, CT/MRI Brain were mentioned in all but just n=12 mentioned a PET scan. Services listed included Occupational Therapy (20), Social Work (6), Dublin Alzheimer’s Society (6), psychology (6). Almost all 96.87% (31) felt a guide would be helpful and 100% of participants said that they would use it.

Conclusion

We identified gaps in confidence and knowledge amongst NCHDs regarding assessment of cognition. Consequently, we designed a guidance template to ensure rotating junior staff are more confident and informed during cognitive assessments at clinics in our department.
Challenges and Benefits of Developing Case Management in an ICPOP Hub
Authors: Lewis Natasha , McDonald Patricia , Lee Jennifer , McGrath Keith , McAuliffe Eileen
Published: September 2024

Background

Case management is a collaborative procedure involving assessment, planning, facilitation, care coordination, evaluation, and advocacy. Its aim is to address the comprehensive health needs of individuals and families by utilising communication and existing resources to achieve high-quality and cost-effective results. The Integrated Care Program for Older Persons (ICPOP) aims to improve life for older people by providing access to tailored interventions supporting them to live well in their own homes. (ICPOP, 2017). The goal of nurse-led case management interventions within the ICPOP Hub, is to provide continuous, patient-centred, comprehensive care for older adults with complex care needs.

Methods

The Nursing team, comprising Clinical Nurse Specialists, Candidate Advanced Nurse Practitioner, undertook case management of 40 patients with complex care needs, over a six-month period. Diagnoses included Delirium, Dementia, Parkinson’s disease, frailty syndromes. Particular attention was given to patients who, through case management, were able to be discharged earlier from the acute hospital, aligning with the goals of the Integrated Care Model. Quality Improvement methodologies were used aiming to improve service delivery, efficiency, patient outcomes.

Results

(Required)

Benefits

Challenges

Conclusion

Case management enables older adults to continue living independently at home but requires integration into a broader system prioritising seamless delivery utilising a collaborative, multidisciplinary approach to health and social care.
Exploring the Perceptions of Physiotherapists and Occupational Therapists, Working in the Acute Hospital Setting, of Communication of Older Adults' Rehabilitation
Authors: Smyth Claire
Published: September 2024

Background

As the ageing population continue to rise with this comes an increase in `geriatric syndromes' such as gait, balance or cognitive issues as well as the implications of frailty. Hospitalisation amongst older adults can often see risks such as deconditioning, delirium and losing independence. The role of rehabilitation for older adults becomes key to restoring one’s ability to live independently but can often be impacted by medical or cognitive status, communication and resources within the acute hospital setting. Issues such as uncertainty around goals or abilities as well as lack of resources can mean terms such as `rehabilitation potential' can impact on communication of rehabilitation. Physiotherapists and Occupational therapists frequently communicate with patients, their families and carers as well as the wider multidisciplinary team about older adults’ rehabilitation.

Methods

Focus groups were conducted among physiotherapists and occupational therapists, who worked in acute hospital settings in Ireland, to explore their perceptions of communication of older adults' rehabilitation.

Results

Nineteen therapists were recruited across five focus groups, which identified a number of themes around communication of older adults’ rehabilitation. Participants reported on communication strategies such as building rapport and using meaningful goals with older adults' rehabilitation. Participants discussed the rehabilitative journey through the acute setting and the impact of 'rehabilitation potential', resources as well as cognitive and medical status on communication of rehabilitation. Further training on communication were highlighted by participants as an area for future development.

Conclusion

Communication plays a key role in older adults' rehabilitation and can often be complicated by resources, time and pressures of the acute hospital setting. Multidisciplinary training could play a role in addressing how communication can enhance older adults' rehabilitation.
The Effect of Physiotherapy on Strength, Mobility and Balance in Older Adults Attending an Integrated Care Programme for Older Persons
Authors: Hassett Patricia , Ryan Eileen
Published: September 2024

Background

Physiotherapy has a significant impact on strength, mobility and balance in older adults but does the presence of frailty negate this? This study aimed to determine the benefit of a six-week physiotherapy intervention as part of an Integrated Care Programme for Older Persons (ICPOP) admission in frail older adults.

Methods

This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP between 2022 and 2024. All patients had a Clinical Frailty Score of 4-6. Each patient referred to physiotherapy had strength assessments including Five Times Sit to Stand (5TSTS) & Grip Strength Test, mobility assessment including Timed Up and Go (TUG) and balance assessment using the Mini BESTest. Patients with pre- and post-admission outcome measures were included in the study. Patients were offered individualised interventions of strength, mobility, and balance rehabilitation once per week for six weeks. Data was collected from a hospital clinical system using Microsoft Excel.

Results

82 patients were included in the data for 5TSTS with an average of 22.3 seconds pre physiotherapy intervention and 18.5 seconds post. 163 patients were included in the Grip Strength Test. Initial mean left/right grip strength was 17.0/18.9kg while final left/right grip strength was 18.2/20.2kg. 173 patients were included in TUG testing with an average of 23.1 seconds pre-physiotherapy and 16.9 seconds post. 41 patients were included in the balance data with mean score of 15.7 pre-physiotherapy intervention and 20.0 post.

Conclusion

Lower limb strength, mobility and balance had on average minimally clinical important differences (MCID) post physiotherapy intervention despite the presence of frailty. The MCID was not achieved for grip strength potentially reinforcing the appropriateness of grip strength as part of the frailty phenotype.
Audit Of Clinical Frailty Scale (CFS) Screening In Medical Assessment Unit (MAU) Admitted Patients In A Model-2 Hospital
Authors: Costello Ciara , Woulfe Cliona , Daly Siobhan , Jennings Emma
Published: September 2024

Background

This model-2 hospital serves a demographic where 1-in-3 MAU attendees are over 75-year-old. It has been shown that in those where frailty is identified and managed early, outcomes are better. This study audits the newly established frailty screening pathway to capture frailty data on patients from point of admission, commencing January 2024.

Methods

The Hospital Frailty Committee established a frailty screening pathway for all patients presenting to the MAU. Using the CFS and a bespoke sticker incorporated into the MAU booklets, patients ≥75 years old were routinely screened. In admitted patients, a CFS score of ≥ 6 triggers a referral to the Clinical Nurse Specialist (CNS) of the Older Adult. For discharged patients, a CFS score of ≥ 6 triggers referral to the public health nurse. We compared the completion of the bespoke sticker to number of onward received referrals to the CNS via electronic referral system. We measured i.) proportion of completed bespoke stickers; ii.) quality of sticker completion and iii.) proportion of appropriate triggered referrals (inpatients).

Results

We identified 34% (n=94) of 247 MAU attendees as meeting the criteria for frailty screening (age≥75) for which the MAU booklet was reviewed manually. A total of 81% (n=77) had a bespoke sticker in their documentation, 71% of which were completed (n=55). Of these 55, 72% (n=40) were admitted with a median CFS of 6 (Average 5.5). Of the 40, 57.5% (n=23) were referred and seen by the CNS, 35% (n=14) were not referred (appropriately), 2.5% (n=1) not referred who should have been and 5% (n=2) were referred but not seen.

Conclusion

Establishment of this pathway and subsequent audit highlights the high level of frailty in our patient cohort. In addition, 5% of admissions would have benefitted from CNS input, but didn’t get it, highlighting need to further expand and develop service.
Piloting a Joint Occupational Therapy and Physiotherapy Falls and Balance Group in an Acute Older Persons’ Ward
Authors: Ryan Ciara , O'Neill Alicia
Published: September 2024

Background

Approximately 1 in 5 older adults in Ireland experience recurrent falls. Consequences of falls include functional decline, fear of falling, reduced participation in activities, hospitalisation and mortality (TILDA, 2017). Increased prevalence of frailty and falls related admissions was identified on this acute older persons’ ward. Therapists found it increasingly difficult to provide comprehensive falls intervention given the ward’s quick turnover and increasing caseloads.

Methods

A joint occupational therapy and physiotherapy falls and balance group was piloted. Weekly once off group sessions were provided to patients over a two-month period. Inclusion criteria included patients who had/were at fear/risk of falling, and demonstrated the cognitive capacity to engage/attend to information in a group setting. Clinical indicators included Timed Up and Go (TUG), Clinical Frailty Scale (CFS), and the PRISMA 7. The group consisted of an educational and practical component including elements from the Otago Exercise Programme (OEP). Qualitative participant feedback was gathered post group attendance and qualitative descriptive analysis was used for evaluation.

Results

A total of 35 patients attended this group over the two-month pilot period. Participants’ mean age was 79 years, with 54.3% being female. 80% had a history of falling. 63% were living with mild to moderate frailty (CFS 4-6) with an average TUG time of 19.3 seconds. An open-ended questionnaire highlighted that 31 participants found the group beneficial with 68.6% valuing the peer support element. 94.2% found their knowledge on falls prevention increased, with 77.1% commenting on their increased awareness of the importance of regular physical activity in falls prevention.

Conclusion

This intervention successfully increased the quality of falls intervention provided on this acute older persons’ ward and effectively increased participants’ awareness/knowledge of falls intervention. It was feasible to deliver this group on an acute ward within existing therapy resources.
CARotenoid and Parkinson’s Disease Severity study (CARPS) – Preliminary results from a Pilot Study
Authors: O'Donoghue Alice , O'Gorman Millie , Nugent Michael , Power Tommy , Nolan John , Cooke John , Mulcahy Ríona
Published: September 2024

Background

Carotenoids are naturally occurring anti-oxidants that give fruit and vegetables their bright colour. Skin carotenoid score (SCS) gives total carotenoid-levels in the body and corresponds well to blood carotenoid-levels. Studies have shown blood carotenoid-levels are low in individuals with Alzheimer’s disease compared with controls. CARPS exams the relationship between carotenoids and Idiopathic Parkinson’s Disease (IPD) by measuring carotenoids in the skin and blood of individuals with IPD vs. controls.

Methods

Cross-sectional, case-control study with age-matched controls. Recruitment commenced January 2024. Case-subjects must have IPD and attend the hospital movement-disorder clinic. Control-subjects are spouse/care-partners of IPD-patients. Exclusion criteria: other forms of PD, Dementia, taking anti-oxidant supplements. Data collected: demographic information, medical history, BMI, frailty assessment. IPD severity assessed using UPDRS. Carotenoid-specific food frequency questionnaire (FFQ) to assess dietary intake. Data was inputted to excel and exported to SPSS.

Results

41 IPD-cases (23 Men, 16 Women) and 12 controls (8 Men, 4 Women) have been recruited to-date. 9/12 controls are spouses of an IPD-participant. Mean age of IPD-cases vs control: 76.1 vs. 74.5. Mean UPDRS score for IPD-cases: 28.02. The skin carotenoid score (SCS) was low in both groups, with a score >400 being within normal range. Mean SCS was lower in the IPD-cases compared to controls: 282.61 vs. 320.58. The IPD cohort are slightly frailer compared to the controls, with higher median-CFS: 3 vs. 1. Mean BMI was similar in both groups. Analysis of blood samples and FFQ is due to take place at a later date.

Conclusion

Early results suggest a trend towards lower SCS scores in the IPD cohort, with an interesting trend towards higher SCS scores in spouse-controls vs. their IPD partners, despite similar food intake. CARPS recruitment is ongoing with further analysis of blood-carotenoids and FFQ required to determine if the link between IPD severity and reduced carotenoid-levels is statistically significant.
Does an Inpatient Rehabilitation Admission Via the Community Prevent Hospital Readmissions in Older Adults? An Integrated Care Initiative
Authors: Campbell Claire , Martin Ruth
Published: September 2024

Background

Rehabilitation interventions are essential in supporting frail older adult’s recovery following periods of decompensation and preventing future hospitalizations. Previously patients (age > 65 years) could only access inpatient rehabilitation via an inpatient stay in an acute hospital. Within the ICT (Integrated Care Team) in Dublin North West (DNW) a community rehabilitation pathway to two inpatient rehabilitation units exists. We retrospectively evaluated patients that were admitted to rehabilitation units via this pathway and measured their 90-day readmission rate to their local acute hospital.

Methods

17 referrals were received from three pathways: Primary Care, the Holly Day clinic and the Frailty Intervention Team (FITT). Clinical frailty score’s (CFS), Falls risk (as per the world falls guidelines) and sarcopenia status as per the European Consensus on the definition of sarcopenia (EWGSOP) were recorded prior to admission. Readmissions within 90 days were collected from the hospital electronic database.

Results

CFS scores ranged from 5 to 7. All patients were identified as a high risk of falls and sarcopenic. The 90-day readmission rate was 11%. 5.5% of these were due to falls and the other 5.5% was due to the exacerbation of a pre-existing condition. All had CFS score of >6.

Conclusion

Readmission to acute care is not common in our patient cohort and shows the involvement of the ICT Geriatrician and Physiotherapist in identifying and referring frail older adults for inpatient rehab is successful. Ongoing development of interagency pathways and further referrals is needed to further progress this pathway and measure its efficacy in preventing readmission to an acute hospital. A 90 day and 180 day follow up and falls risk outcome measure pre and post admission would further demonstrate the success of this initiative and help measure the efficacy of this initiative in reducing the risk of preventable hospitalizations in older adults.
Enhancing Care For Nursing Home Residents Through A Specialised Geriatrician-led Acute Care Team
Authors: Noonan Claire , Davey Naomi , Farrelly Angelina , Soh Josephine
Published: September 2024

Background

Nursing home residents (NHRs) represent one of the most vulnerable groups of older adults, requiring complex and comprehensive care due to their multiple comorbidities and intricate healthcare needs. The establishment of a specialised Geriatrician-led Acute Care Team specifically for NHRs can provide better clinical outcomes over traditional care models. These services are designed to address the unique needs of this population, providing appropriate treatment in settings conducive to their well-being and aiming to mitigate adverse consequences associated with unnecessary hospitalizations.

Methods

In 2023, 343 NHRs were admitted to acute care via Emergency Department in a University Teaching Hospital. Of these, 227 (66%) were admitted under the care of this specialized geriatrician-led team, with an average length of stay of 7 days, totalling 376 bed days, and a readmission rate of 15%. In contrast, 112 NHRs admitted under other non-medical services (surgical specialities) had an average length of stay of 9 days, totalling 849 bed days, and a readmission rate of 11%.

Results

The primary advantage of this specialist team lies in the personalized attention and expertise provided by gerontologically attuned practitioners. These professionals have a profound understanding of age-related changes, complex health conditions, and psychosocial aspects affecting older adults. By tailoring care plans to individual needs and preferences, they optimize treatment outcomes and enhance quality of life for NHRs.

Conclusion

In conclusion, the establishment of a specialised acute care team specifically for NHRs represents a significant advancement in addressing the complex needs of this cohort. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centred care approaches, these services offer a holistic and tailored solution to improve outcomes and enhance the quality of life for this vulnerable population. Continued investment in developing and expanding such services is crucial for advancing care standards for older adults and promoting a more age-friendly healthcare system.
An Audit On Minimising Unnecessary Catheter Use In An Older Population Attending The Emergency Department
Authors: Gargan Daire , Jubril-Raji Omotayo , O'Rourke Kevin , McCabe Aileen
Published: September 2024

Background

Catheter-associated urinary tract infections (CAUTI) pose a great risk of morbidity and mortality to our older population. It is estimated that around 20% of patients admitted to hospital receive an indwelling catheter at some point. Each day that a catheter is in situ increases the risk of urinary tract infection by 5 %. Inappropriate placement of catheters in this population poses an unnecessary and significant risk. Many catheters are inserted in the Emergency Department in older patients, and we wanted to find out if these urinary catheters were inserted in accordance with best practice guidelines.

Methods

An audit was conducted to look at indwelling catheter use in a cohort of patients over 75 years of age who presented to the Emergency Department of a tertiary hospital over a two-week period in November 2023. Using the software Symphony patient records and Emergency Department physician notes were accessed to look at the following: age, whether catheter insertion was consistent with current best practice evidence, whether the indication for catheter insertion was documented and whether the catheter was removed while in the emergency department. Patients who had long term catheters were also included.

Results

We included 22 patients in this audit (n=22)- median age was 81 (range 75-90); 11 were male (50%) and 20 had urinary catheterisation consistent with best practice guidelines (91%). 8 patients had clear documentation of indication for the catheter (36%), while no patients had their catheter removed whilst in the emergency department (0%).

Conclusion

The vast majority of patients had an appropriate indication for urinary catheterisation however clear documentation of a physician order for the urinary catheter was lacking in over half of the cases. A guideline was created showing clear indications for urinary catheterisation in this population and an education session with medical and nursing staff is planned prior to re-auditing.
Introduction of Geriatric Medicine Multidisciplinary Service to Emergency Department
Authors: Merron Georgia , Brolly Amanda , Maher Mairin , O'Carroll Susan , Brick Jacqueline , Randles Mary
Published: September 2024

Background

Ireland has an ageing demographic with a significant community dwelling population living with frailty. Identification of frailty at the hospital front door via a Geriatric Emergency Multidisciplinary Service (GEMS) was expanded in October 2023 with the aim to trigger early comprehensive geriatric assessment (CGA) in the Emergency Department (ED)and to ensure that older people with frailty are diverted to the most appropriate services as quickly as possible and, where appropriate, discharged home on the same day.

Methods

Using Plan Do Study Act (PDSA) cycle framework a screening pathway for all over 75-year-olds who present to ED was established. The service provides screening for frailty and delirium (using 4AT) in the ED with high clinical frailty scores (CFS) or requiring specialist input were selected for CGA. Information was collected on all patients on admission and data was also collected on discharge destination and readmission rates.

Results

1308 patients were reviewed since introduction with average age 82.3 years (68-101). 63.6% (832) patients had CGA and 36.4% (476) were screened. Of those who did not have a CGA, 46.1% (185) were not frail with CFS 3 or less. Average CFS was 4.84 and average 4AT score was 2. 46.7% (611) of patients reviewed were discharged from ED with discharge rates increasing from 40.9% (93) in November 2023 to 49.5% (104) in April 2024 and 28-day readmission rates decreasing from 6.87% in April 2023 to 5.98% in March 2024.

Conclusion

This quality improvement project highlights the impact of GEMS in the ED in reducing admission rates and readmissions. Ongoing areas for improvement include expanding the service to review all patients identified with frailty where possible, and in the future establishing pathways for improved access to community services/supports to further reduce readmission rates and to capture the impact on length of stay.
Improving Delirium Care: A Retrospective Audit of Early Detection and Management Practices
Authors: Devlin Kate , McGreal-Bellone Aimee
Published: September 2024

Background

Delirium, an acute change in cognition, consciousness, attention, and perception, is prevalent among older adults in hospitals. Patients with delirium experience longer hospital stays, higher fall risks, increased mortality, and greater care needs upon discharge. However, delirium is under-recognized, with up to 50% of cases missed. With an aging population, the need for improved delirium recognition and management is critical.

Methods

We conducted a retrospective audit on the charts of 47 patients over the age of 65 on two General Medical Wards at an Irish Model 3 hospital. We assessed medical admission proformas and notes to evaluate delirium recognition and management within the first 24 hours. The audit measured compliance with the 4AT cognitive screening tool, documentation of delirium and risk factors, non-pharmacological management, and antipsychotic use against HSE National Guidelines. Data was analysed in Excel.

Results

47 patients with a median age of 80 years, 51% (n=24) male and 49% (n=23) female, were captured. Cognitive screening within 24 hours was performed in 34% (n=16) of patients, with 75% (n=12) showing abnormal results. Delirium was documented in 8.5% (n=4) of patients, and 50% (n=2) of these had a 4AT score recorded. 15% (n=7) were prescribed new antipsychotics within 24 hours, with 57% (n=4) lacking a formal delirium diagnosis.

Conclusion

This audit reveals deficiencies in initial cognitive screening and delirium recognition among high-risk patients. Only 8.5% of the cohort was identified with delirium compared to national statistics that suggest up to 31% of older patients are affected upon admission. Compliance with cognitive screening and diagnostic tool use was poor. Antipsychotic prescribing without a documented delirium diagnosis was prevalent, highlighting the need for improved diagnostic accuracy and non-pharmacological management. We plan to introduce a “Delirium Tool” for 4AT assessments and “PINCH-ME” risk-factors, alongside regular education sessions. A re-audit will measure improvements in care and outcomes.
Identification of the Needs of Patients ≥ 75 Years Admitted to an Acute Hospital
Authors: McCarthy Gemma , DeFoubert Marguerite , Dukelow Tim , Curtin Denis , Daly Bart
Published: September 2024

Background

More than 30% of older people are discharged with new or additional disability following an acute hospital admission.1, 2 Older adults who are frail experience even higher levels of hospital-associated disability.3 For patients who experience hospital-associated disability, fewer than half will recover to their pre-illness level of functioning after 1 year and rates of death and nursing home placement are high.4 The economic consequences of hospital-associated disability are longer hospital length-of stay, increased rates of re-admission after discharge, an increased requirement for home care packages and long-term residential care beds.

Methods

An observational study was undertaken to determine the profile and needs of adults ≥75 years admitted to an acute hospital. Medical records were reviewed by two advanced nurse practitioners on day 1 of admission. From January 8th -22nd 2024, 352 hospital admission episodes were reviewed.

Objectives

Results

Conclusion

In conclusion, the results highlighted a need for

1. An increase in beds available in a Specialist Geriatric ward

2. A greater awareness at ED level of admitting specialty

3. An increase in the number of beds to be made available such as rehabilitation beds to facilitate early discharge from the acute hospital.
Amplifying Influence: Unveiling the Dynamic Role of Speech and Language Therapists within ICPOP Specialist Community Teams across Ireland
Authors: O'Gara Justyne
Published: September 2024

Background

Integrated Care Programme for Older People (ICPOP) provide services for people with complex needs requiring specialist community multidisciplinary assessment and intervention. This national programme aims to shift care from hospitals, toward communities. As of October 2023, 23 of 30 planned ICPOP teams have been established (Butler, 2023). The Irish Association for Speech and Language Therapists, recommend speech and language therapists (SLT) be included on all frailty intervention teams across all service areas, ensuring equal access regardless of geographical area. Currently 10 ICPOP teams have an SLT in post. The contribution of SLT within these teams remains unstudied. Understanding the role of SLTs within ICPOP, exploring similarities and differences, is essential for informing professional clinical guidelines and practice.

Methods

This study utilised an anonymous, non-experimental, cross-sectional survey design. The survey design incorporated the Tailored Research Method to enhance response rates. Survey Monkey (http://www.surveymonkey. com) was used to create and disseminate the open survey. All SLTs working on ICPOP teams were invited to participate.

Results

Findings highlight the diverse roles and responsibilities of SLTs within ICPOP. While some commonalities were observed in services provided by SLTs, such as dysphagia assessment and communication support, variations existed based on team location, setting, and individual professional experience. The majority of SLTs participated in non SLT specific activities such as triaging, conducting assessments and administrative duties. Rural SLTs faced challenges related to resources and coordination of care. Urban SLTs had greater access to specialist instrumental assessments.

Conclusion

This study underscores the importance of recognising and addressing the varied roles of SLTs within ICPOP teams to guide professional guidelines and promote consistency. By understanding the unique challenges and opportunities faced by SLTs in different geographical and organisational contexts, policymakers and healthcare leaders can better support professionals to meet the diverse needs of older individuals across Ireland.
Sleep In Europe: Changes In Prevalence Of Sleep Disturbances In Middle-aged And Older Europeans
Authors: O'Donovan Mark , Crowley Patrick , Flanagan Evelyn , O'Caoimh Rónán
Published: September 2024

Background

We analysed the prevalence of sleep-related parameters in those aged ≥50 years in 28 countries participating in waves 8 (2019/2020) and 9 (2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Methods

Overall and per country prevalence rates of subjective trouble sleeping, daytime napping/resting and use of medication to aid sleep were analysed. Survey-weighted generalised linear models were used to assess changes between waves 8 and 9.

Results

A total of 34,322 people were included from wave 8 (55% female; mean age 68.27) and 50,670 from wave 9 (55% female; mean age 68.77). There was no statistically significant difference in the overall prevalence of subjective trouble sleeping (both 35%), use of medication to aid sleep (both 7%) or daytime napping/resting (both 47%) between waves 8 and 9. For trouble sleeping, prevalence ranged from 20% (Greece) to 52% (Estonia) in wave 8 and from 16% (Greece) to 50% (Portugal) in wave 9. Statistically significant reductions were observed in Estonia (52% vs. 49%, p = 0.006), Poland (49% vs. 37%, p <0.001) and Slovenia (38 vs. 33%, p = 0.001). A statistically significant increase was observed in Spain (27% vs. 37%, p = 0.004). Similarly for sleep-related medication use, statistically significant reductions were again observed in Estonia (11% vs. 9%, p = 0.028) and Poland (10% vs. 6%, p <0.001) but not Slovenia (both 4%, p = 0.858). The prevalence of daytime napping/resting remained very similar between waves 8 and 9, with the only marginally significant difference being in France (38% vs. 35%, p = 0.033).

Conclusion

This analysis shows the prevalence of subjective trouble sleeping, use of medication to aid sleep, and daytime napping/resting among middle-aged and older adults across Europe. Trouble sleeping remains a prevalent symptom amongst middle-aged and older adults but varies significantly across countries.
Breaking New Ground, Not Bones: A Machine Learning Odyssey in Osteoporosis Treatment Predictions
Authors: Asri Nur Atikah Mohd
Published: September 2024

Background

Delayed or omitted treatment for osteoporosis represents a recognised challenge within orthogeriatric healthcare. Machine-learning (ML) decision support systems offer a potential solution by enabling osteoporosis treatment recommendations without necessitating specialist intervention. This study seeks to evaluate the efficacy of ML in accurately recommending osteoporosis treatment.

Methods

Datasets from January to March 2023 in University Hospital Waterford were sourced from the IHFD (N=85). Osteoporosis treatment decisions were obtained from discharge letters. The dataset was entered into the WEKA 3.8.6 environment for ML processing. The Zero-Rule algorithm is selected as a baseline cross-validation technique to estimate ML performance.

Results

The Correctly Classified Instances (CCI) and Incorrectly Classified Instances (ICI) are 74.12% and 25.86%, respectively. Eight algorithms were selected, with 800 results produced and tested with a paired T-Tester. The significance level is set at 0.05, with the “Percent_correct” metric selected as the performance measure to compare the algorithms. The J48-Tree algorithm showed the best accuracy at 86% and is statistically better than the baseline algorithm; hence, it was selected as the trained model. Application of the trained model on the unseen dataset revealed CCI and ICI of 98.24% and 1.7%, respectively, indicating a high prediction accuracy rate.

Conclusion

In conclusion, this study has shown promising strides in using ML to assist osteoporosis treatment decisions. The resulting model showed notable predictive performance, indicating the viability of ML in decision-making. Future studies should focus on acquiring larger datasets for validation, algorithm refinement and exploring the integration of clinical expertise to bolster the model's applicability and reliability in real-world scenarios.
Alternative Scenarios for Projected Prevalence of Stroke and Post-Stroke Dementia to 2046 in Ireland: A Model-Based Analysis
Authors: Sexton Eithne , O'Flaherty Martin , Hickey Anne , Macey Chris , Williams David , Horgan Frances , Timmons Suzanne , Collins Rónán , Bennett Kathleen
Published: September 2024

Background

Understanding future population need is key for informing stroke service planning. This study aims to evaluate alternative scenarios for future trends in stroke age-specific incidence and case-fatality and estimate impact on projected stroke and post-stroke dementia prevalence in Ireland.

Methods

We used a probabilistic Markov model to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40-89 years to 2046. Using systematic review and observational evidence, we extrapolated trends in stroke age-specific incidence and case-fatality from 1990-2019 to 2016-2046. We defined optimistic, realistic and pessimistic scenarios, including scenarios where trends decelerated over time.

Results

The stable (pessimistic) scenario indicates a projected 95,278 stroke survivors in 2046 (95% uncertainty interval, UI = 91,404-99,487) (30.1 per 1000 pop), an increase of 53% from 2022 to 2046. The most optimistic scenario would involve a 3.2% increase from 2022 to 2046, to a projected 61,000 survivors. More realistic scenarios based on lower rates of incidence/case-fatality decline, or rates of decline slowing over time, imply an increase ranging between 22.9% and 37.2%. There will be a projected 19,430 with post-stroke dementia in 2046 (95% UI 17,182-21,904), an increase of 69.2% from 2022. In the most optimistic scenario, the increase would be 22.6%, with realistic scenarios implying an increase ranging between 38.9% and 53.2%.

Conclusion

Future stroke healthcare needs will vary substantially depending on epidemiological trends. A large increase in post-stroke dementia is projected across scenarios. Further work is needed to identify optimal policies to promote continuing decline in stroke incidence.
A SADMAN With No Plan; Medication Management and Adherence To SADMAN Guidelines In Ambulatory Geriatric Care
Authors: Singh Mikar , Young Conor , Ryan Colm , Morrison Laura , McElwaine Paul , O'Neill Desmond
Published: September 2024

Background

Medication side effects are common causes of ill health, with ‘SADMAN’ medications identified as frequent offenders- sulphonylureas, angiotensin-converting enzyme inhibitors (ACEi), diuretics, metformin, angiotensin-receptor blockers, nonsteroidal anti-inflammatories and sodium/glucose cotransporter-2 inhibitors. Recent consensus recommendation published in the American Journal of Kidney Diseases is that patients on these should omit them if unwell1. We examined SADMAN usage within our Day Hospital, knowledge of this guidance and patients’ confidence in managing their medications.

Methods

All patients presenting for review in one week in our Day Hospital were included. Data collected included age, gender and number of medications including SADMAN. Patients were asked had they been advised to stop SADMAN medications if unwell, whether medications were blister packed and if they would be confident identifying and stopping a particular medication.

Results

27 patients were included. 56% male, mean age 80 years old and mean number of medications 9 (range 0-22). 67% had medications blister-packed. 48% were prescribed one or more SADMAN medications and 15% more than one. Most commonly prescribed were ACEi (30%) and diuretics (19%). No patients had been advised to stop taking a SADMAN medication if they became unwell. Only 19% of patients (31% on SADMAN medications) were confident they could identify/stop a particular medication.

Conclusion

Despite clear guidelines to stop SADMAN medications if unwell, we found that no patients attending our Day Hospital were aware of this. Even if patients were appropriately educated, there was a lack of confidence in medication management. Polypharmacy and blister packing of medications pose significant barriers, leading us to question the feasibility of SADMAN guideline implementation in an Ambulatory Geriatric Care setting.

Reference

1. Watson KE et al. Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process. Am J Kidney Dis. 2023 May;81(5): 564-574.doi: 10.1053/j.ajkd.2022.10.012.
To Print or Not to Print - Sustainable Practice in Geriatric Integrated Care Clinics
Authors: Murphy Dearbhla Edwards , Cashen Aoife , Chan Kei Yen , Reddin Catriona , MacLoughlin Roisin , Ramjohn Joshua , Martin Niamh , Memon Muhammed Sajjan , Conlon Chloe , Okon Mary , Burke Shona , McDermott Clodagh , Stankard Aidan , Higgins Meave , Geoghegan James , McCleane Fiona , Neachtain Maire Ni , Mannion Karen , Shiel Edel , Small Cliona , Robinson Stephanie , Waters Ruairi , Costello Maria , Canavan Michelle
Published: September 2024

Background

The Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric medicine and is frequently carried out in integrated care clinics using a paper document (1). The expansion of integrated care services occurs alongside climate change, an increasingly challenging public health crisis at a local and national level (2). Paper waste is a contributor to deforestation and carbon emissions. We aimed to assess the environmental impact of paper use within our geriatric integrated care service.

Methods

12 months of Geriatric Integrated Care attendances were included between 1st January 2023 to 1st January 2024. We measured the number of CGAs performed and A4 pages used in documentation. Environmental impact was evaluated based on carbon emissions per A4 page (3).

Results

A CGA was completed on 780 patients in a 12-month period which included in-hospital, frailty at the front door and 2 community specialist teams' assessments. This resulted in 11,700 pages of A4 paper in documentation. Estimated carbon emissions are 70.2kg CO2 emissions for the 12-month period. Extrapolating this solely to the 32 ICPOP teams in geriatric medicine in Ireland it would result in the equivalent of 22 trees per year, emitting 1,123.2 Kg of CO2 emissions per year from these assessments alone or equivalent to driving 8028.6km (4).

Conclusion

The benefits for patients and staff of integrated digital healthcare records are well established. The environmental impact of how we provide healthcare is not. Paperless solutions are required for both patient safety, seamless record keeping and environmental sustainability in keeping with UN sustainable development goals.

References

1. Pilotto A, Polidori MC. The comprehensive geriatric assessment: Goal-oriented, patient-centered care. Practical Issues in Geriatrics. 2017 Aug 11;273–86. doi:10.1007/978-3-319-61997-2_26.

2. Climate Change [Internet]. [cited May 2024]. https://www.publichealth.ie/climate-change.

3. CO2 neutral printing [Internet]. 2024 [cited May 2024]. https://www.ezeep.com/co2-neutral-printing/.

4. CO2 Converter [Internet]. [cited May 2024]. https://www.openco2.net/en/co2-converter
Malnutrition Management in Older Adults Referred to Integrated Care Program for Older People (ICPOP) Service
Authors: Devitt Aoife , Sadeghi Fatemeh , Connolly Warren
Published: September 2024

Background

Older adults are at increased risk of malnutrition, and it is estimated that 70,000 Irish people over 65 years old are malnourished or at risk of malnutrition. The ICPOP service provides access to community-based treatment for eligible older people for a period of up to 6 weeks. The aim of this study is to review the nutrition care provided by our ICPOP service and identify current gaps.

Methods

Data was collected by retrospective chart review of 80 patients who received dietetic input from June to December 2023; from two ICPOP teams, with 0.5 WTE dietitians per team. Demographic data, supplement usage, intervention provided, and discharge destination were recorded. Malnutrition screening tool (MST) and Mini Nutritional Assessment – Short Form (MNA®-SF) were used to assess nutritional status.

Results

The charts of 80 patients referred to ICPOP dietitians were reviewed. Patients’ mean age was 83 years old (range: 65-97yrs). 55 (68%) patients were malnourished or at risk of malnutrition. 30 (37.5%) patients were taking oral nutrition supplements (ONS) to meet their dietary requirements. Personalised dietetic intervention was provided to all patients. 44 (55%) patients required more than one dietetic review and 87.5% of initial dietitian assessments were domiciliary visits. At the end of the 6 weeks of intervention, 25 (31%) patients required follow-up dietetic care, however, for 6 (24%), who required ongoing dietetic care, and no community dietetic service was available.

Conclusion

Malnutrition is common in older adults referred to the ICPOP service, and the continuation of care is crucial for treating malnutrition as a chronic condition. However, current limitations in available dietetic services may affect malnutrition management and should be considered in older person care pathways. Therefore, additional investments in community dietetic services in our area, are required to ensure the successful management of malnutrition.