bluuebunny/crossref_metadata_2025 huggingface dataset:
126 CENTRAL ADIPOSITY IS ASSOCIATED WITH INCREASED PREVALENCE OF VERTEBRAL FRACTURES
Authors: Feely O , Laird E , Hoey L , Hughes C , McNulty H , Ward M , Strain JJ , Tracey F , Molloy A , Cunningham C , Fallon N , Lannon R , McCarroll K
Published: October 2022

Background

Increased body weight and obesity are associated with greater bone mineral density (BMD) though effects on fracture risk appear to be site specific. In particular, the relationship between Body Mass Index (BMI), abdominal weight and Vertebral Fractures (VF) is complex. Some studies have found greater incidence of VF's with obesity though results are inconsistent. Recent evidence supports a stronger association between measures of abdominal fat and VF's. We aimed to examine the association between central adiposity and VF's in older Irish adults.

Methods

Participants were from a large cross-sectional study of older Irish adults (aged >60) attending GP or hospital outpatient services. VF diagnosis was based on self-report (ie. clinical vertebral fracture) so we excluded those with a Mini Mental State Examination (MMSE) < 25. BMD was measured with DXA and patients taking antiresorptive or anabolic therapies were excluded. The relationship of waist hip ratio (a surrogate marker of central adiposity) with VF's was explored in regression models.

Results

2055 identified, mean age 69.8 ± 6.3 years (range 60-99), 58.6% female. Vertebral fracture prevalence was 6.3% (n=130). Waist hip ratio was positively associated with presence of a vertebral fracture after adjusting for age, sex, BMI, timed up and go, smoking, serum vitamin D, lumbar spine BMD and steroid use > 3 months (beta: 0.04, P<0.001).

Conclusion

We identified that central adiposity (as measured by waist/hip ratio) was associated with VF presence independent of several factors including BMI and spine BMD. This suggests that body fat distribution and/or altered bone quality may play a role. Visceral body fat (which is correlated with waist hip ratio) is associated with increased production of adipocytokines, altered vertebral geometry and micro-architecture, increased vertebral bone marrow fat and greater loading forces on the spine, all of which may mediate increased VF risk.
127 THE RELATIONSHIP BETWEEN RELIGIOUS INVOLVEMENT AND PSYCHOLOGICAL HEALTH DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: O'Maoileidigh B , Kenny RA , Ward M , Scarlett S
Published: October 2022

Background

Religious involvement has been shown to be protective against negative mental health outcomes and encourage positive coping behaviour among older adults. During the COVID-19 pandemic and lockdown in Ireland, public health restrictions created a barrier to in person religious participation. It is important to examine the effect this may have had on psychological health in older adults.

Methods

Data were from The Irish Longitudinal Study on Ageing (TILDA). Data from Wave 4 (2016), Wave 5 (2018) and the COVID-19 SCQ (2020) were used for analysis. The final sample was made up of 3,044 community-dwelling adults living in Ireland aged 60 and older. Relationships between religious participation, psychological health and loneliness were modelled using cross-sectional and longitudinal regression analyses.

Results

Religious attendance was positively associated with Purpose in Life [Beta(B)=0.01, 95% CI=-0.00, 0.02, p<0.05], Life Satisfaction [B=0.01, 95% CI= 0.00, 0.02, p<0.001] and Anxiety [Incident Rate Ratio= 1.04, 95% CI=1.01-1.08, p<0.01], during COVID-19. Self-Rated Mental Health significantly decreased between Wave 5 and COVID-19 relative to Religious Attendance reported at Wave 4 [OR= 0.87, 95% CI= 0.75, 0.99, p<0.05]. Loneliness also increased between Wave 5 and COVID-19 relative to Prayer Frequency reported at Wave 4 [OR=0.06, 95% CI= 0.02, 0.10, p<0.01].

Conclusion

These results suggest a complex relationship between psychological health and religious participation and the barriers to it during COVID in the older population. While it there was a protective effect carried into the lockdown, there was also a negative effect regarding some domains of religious participation. Future research should focus on measuring the relationship at later stages of the pandemic and the use of alternative forms of religious practice, such as streaming religious services.
130 CHARACTERISTICS AND OUTCOMES OF OLDER NURSING HOME RESIDENTS ATTENDING AN EMERGENCY DEPARTMENT
Authors: Fallon A , Noonan C , Kennelly S
Published: October 2022

Background

Older nursing home (NH) residents are among the most vulnerable members of society, often with multiple comorbidities and complex care needs. The Emergency Department (ED) is a common point of access to the acute hospital for NH residents. This study aims to review characteristics and outcomes of older NH residents presenting to ED over one year.

Methods

A prospective cohort study was carried out. NH residents aged 50 years and older attending ED of a university teaching hospital over one year (01/10/2019-30/09/2020) were included. Data on demographics, comorbidities, functional status, frailty and details of ED attendance were collected.

Results

There were a total of 515 ED attendances by 341 NH residents over one year. Mean age was 76.3 years (50-103 years; SD ± 10.9). 50.9% (n=262) were female. Mean Charlson Comorbidity Index (CCI) was 5 (0-12; SD ± 2.1). 46.6% (n=240) had a dementia diagnosis. A mean of 12.6 medications (0-31; SD ± 5.3) were prescribed in the NH. Mean Clinical Frailty Score (CFS) was 6.5 (3-9; SD ± 0.9). Mean Barthel Index (BI) was 8.9 (0-20; SD ± 6.0). 38.3% (n=197) of presentations occurred “in-hours”. Mean Manchester Triage Score (MTS) was 2.54 (1-5; SD ± 0.7) with 92.0% (n=474) scoring 1-3. Delirium was documented in 31.8% (n=164). Mean ED Length of Stay (LOS) was 13.7hours (0-80hours; SD ± 11.0). 14.6% (n=75) were discharged without follow-up. 61.2% (n=315) were admitted to hospital. Mean hospital (LOS) was 9.7days (0-191 days) and 8.7% (n=47) of those admitted died in hospital. 12 months after ED presentation, 40.4% (n=138) of the cohort had died.

Conclusion

NH residents are a frail group, with high levels of multimorbidity, polypharmacy and significant care needs. This complexity is reflected in the numbers requiring urgent review on attendance, rates of delirium, ED LOS and hospital admission rates. Dedicated NH liaison teams may enhance care and improve outcomes for this cohort.
139 A PHARMACIST-LED INTERVENTION TO IMPROVE QUALITY OF CARE AND REDUCE RISK OF RECURRENCE IN HOSPITALISED STROKE PATIENTS
Authors: Coughlan-Siam E , Diskin M , Hannon N
Published: October 2022

Background

Stroke is the leading cause of acquired disability, and the 3rd leading cause of death, in Ireland. This Quality Improvement Project focused on improving the pathway of care provided to stroke inpatients in an acute general hospital admitting up to 60 stroke patients per annum. The care pathway of stroke patients should include specialist input from the wider Multi-Disciplinary Team (MDT), including pharmacists.

Methods

An audit collected data in 2 phases: (A) a retrospective data review looking for broader themes, and (B) a prospective data collection focused on primary drivers of quality care, including patient feedback questionnaires and follow-up phone calls to patients post-discharge. A Pharmacist Screening Tool was applied to individual patient data, and medication changes documented. Key drivers of improvement were identified

Results

Phase A of the audit included 20 patients with confirmed stroke, average age 66 years, all with ischaemic stroke. Phase B included 20 patients, average age 69 years, all with ischaemic stroke. Four primary drivers of quality were identified: (1) Lack of, or delayed, referral to the stroke specialist team; (2) Transcription/prescription errors; (3) Low rate of patient counselling on medications pre-discharge; (4) High rates of interventions and medication changes, with other complexities in medication regimens. Future audit cycles will implement (a) increased education of healthcare professionals about best-practice in stroke and (b) dedicated specialist pharmacist input for stroke inpatients.

Conclusion

Patient feedback highlighted that written information given on discharge was unclear; and errors in medication prescriptions or lack of specialist input were common. A focused, patient-centric approach can improve patient satisfaction, and overall outcomes post-stroke. Pharmacist-led interventions are a key part of the stroke bundle of care.
143 ASSOCIATIONS BETWEEN NTPROBNP AND COGNITION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: O'Halloran A , Fitzpatrick A , Feeney J , De Looze C , Kenny RA
Published: October 2022

Background

Cardiovascular insults increase the risk for future neurological diseases in late life. NT-proB-type Natriuretic Peptide (NTproBNP) is a hormone released in response to pressure changes inside the heart, often related to heart failure and other cardiac problems. We investigated whether levels of this biomarker are related to cognition in older adults from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older living in Ireland.

Methods

NTproBNP levels were measured in 4,963 participants, mean age 62.6 years and 53.4% women, from blood drawn during wave 1 of the study (2009-2011). Cognitive outcomes collected at wave 1 included: memory function (the sum of scores of immediate word recall, delayed recall and prospective memory), a measure of global cognitive function (the Montreal Cognitive Assessment - MoCA), and a measure of semantic fluency (the Animal Naming task). Both NTproBNP and the MoCA scores were log-transformed to correct for skewedness.

Results

Cross-sectional analyses using multivariable linear regression found that NTproBNP was significantly and negatively associated with memory (std coeff. –0.049, std error 0.057, p=.001) and the MoCA (std coeff –0.034, std error .002, p=0.027) after adjusting for age, gender, education, and depressive symptoms. After further adjustment for cardiovascular risk factors (hypertension, high cholesterol, current smoking and problem drinking) and prevalent cardiovascular diseases (heart failure, myocardial infarction, angina pectoris, stroke, and transient ischemic attack), the associations remained for both cognitive measures (memory: std coeff –0.047, std error 0.061, p=.003; MoCA: std coeff. –0.036, std error .002, p=.029). No significant associations were found for the Animal Naming task (full model std coeff. –0.016, std error 0.087, p=0.37).

Conclusion

These results suggest that NTproBNP may be a useful early indicator for declines in some domains of cognitive function in older adults, with and without current cardiovascular diseases. Additional research is needed to evaluate the predictive value of this biomarker.
144 A PILOT STUDY TO BENCHMARK FRAILTY NEEDS IN AN ACUTE OLDER SURGICAL INPATIENTS
Authors: Khan I , Nor MNBMD , Pillay I
Published: October 2022

Background

Evidence to support screening for frailty among acute surgical inpatients is limited. Our aim was to identify surgical inpatients on a general/vascular surgery ward with unmet, frailty-associated needs.

Methods

From 01/03/2022 to 12/04/2022, all inpatients under a vascular/general surgery service in a model 4 hospital were screened for frailty using a modified THINKfrail tool. An abbreviated CGA (‘little g’), to identify what matters to the patient, mobility and functional impairment, mood and mental state and medication review was performed and actions taken on the results.

Results

138 patients were admitted under the surgical teams during the study period. 30% (n=42) were over 70 years. 8% (n=11) screened positive for frailty, all of whom underwent a ‘little g’. The mean (SD) age was 77 (4) years. 45% (n=5) were male. Identified needs were included abnormal 4AT in 50% (n=5), 3 of whom had no prior diagnosis of dementia. 45% had altered ADLs resulting in a reduced ability to dress or mobilise. 80% (N=9) required optimisation of mobility and/or physical function. 45% (n=5) had medication changes made.

Conclusion

A simple modified THINKfrail tool can be implemented by surgical nurses to screen for patients who may need geriatric input. Most have physio and OT needs and 45-50% have undetected cognitive or medication related issues, detected by employing a ‘little g’. Employing a ward-based frailty screen, followed by little g assessment is effective. This approach should be prospectively validated.
148 ORTHOSTATIC HEMODYNAMICS AND ACCELERATED BRAIN AGING
Authors: Shirsath MA , O'Connor J , Boyle R , Newman L , Whelan R , Knight S , Meaney J , Kenny RA
Published: October 2022

Background

Impaired recovery of blood pressure (BP) in response to standing up is a prevalent condition in older individuals. We evaluated the relationship between the recovery of hemodynamic responses to standing and brain health in adults over 50.

Methods

Participants from The Irish Longitudinal Study on Aging (TILDA) (n=418) performed an active stand challenge while BP and heart rate (HR) were continuously monitored. The recovery of these parameters was determined as the difference in measurements taken at 10 s and 20 s after standing, in relation to the baseline value. The difference between biological and chronological brain age was determined using BrainPAD, a novel validated measure of accelerated brain ageing. The data was fitted using linear regression models, using age, sex, weight, height, cardiac disease prevalence, antihypertensive and antidepressant use, smoking status, standing speed and pulse wave velocity as covariates.

Results

Adjusting for age and sex only, each additional year of BrainPAD was associated with a –0.35 mmHg (95% CI: –0.54 – –0.16, P<.001) change in orthostatic systolic BP recovery. In a fully adjusted model, the regression coefficient was estimated at –0.29 mmHg (95% CI: –0.48 – –0.10, P<.01). Similarly, a year increase in BrainPAD was associated with –0.21 mmHg (95% CI: –0.32– –0.10, P<0.001) and –0.14 mmHg (95% CI: –0.25– –0.04, P<.01) change in orthostatic diastolic BP recovery, for minimally and fully adjusted models respectively. HR recovery was not significantly associated with BrainPAD.

Conclusion

These results demonstrate that impaired systolic and diastolic BP recovery after standing is associated with accelerated brain aging in older individuals. This suggests that the BP response to standing, measured using beat-to-beat monitoring, has potential to be used as a marker of accelerated brain aging, relying on a simple procedure and devices that are easily accessible for clinical use.
150 ESTABLISHING A PFO PATHWAY FOR ACUTE STROKE PATIENTS WITH A POSITIVE BUBBLE STUDY
Authors: Donaghy L , Saiva L , Guilfoyle P , Sheehan O , Dolan E
Published: October 2022

Background

A bubble study is performed routinely on patients under the age of 65 years of age with a confirmed diagnosis of either acute ischaemic stroke or TIA in order to assist with the presence of a Patent Foramen Ovale(PFO)/Atrial Septal Defect(ASD) as an aetiology for the stroke event. Historically, a referral letter would be written to a hospital who specialises in cardiac structural surgeries, requesting a review of a patient with a positive bubble study and acute stroke. Closure would typically exceed 9 months.

Methods

The Stroke RANP led out on the project as she performs all bubble studies in stroke survivors. A designated Cardiologist, who also works in a hospital where PFO closures takes place, is notified by the RANP or team about a positive bubble study and the images are reviewed. It is then decided if the patients requires a TOE or not. A 2-page PFO referral form was created which contains all relevant information.

Results

Stroke RANP performed 92 bubble studies between January 2021 and May 2022. There were 18 positive studies (20% positivity rate): 7 positive studies from January to August 2021 (pre-pathway) and 11 positive studies from September 2021 to May 2022 (post-pathway). 72% (5/7) of patients had a TOE performed following a positive bubble study result pre-pathway, whereas only 1 TOE was performed out of 11 cases (9%) post-pathway. The time from positive bubble study to closure time reduced from 9months on average to 3 months.

Conclusion

There was a 63% reduction in the number of TOEs being performed for patients with a positive bubble study with the introduction of this PFO pathway. Additionally, there was a 6-month reduction time from the positive bubble study result to closure. This pathway has improved patient outcomes for this young group of stroke survivors and assists with the reduction of further stroke events in the future.
156 A SIGN IN TIME…; WHAT IMPACT DOES THE INTRODUCTION OF SIGNAGE HAVE FOR DEMENTIA PATIENTS? – A STAFF PERSPECTIVE
Authors: Doyle C , Davis A , McNally S
Published: October 2022

Background

Dementia is often seen as a presenting or existing medical condition for older adults attending hospital services. There are over 64,000 people in Ireland living with dementia. A hospital-wide environmental audit of an acute Irish hospital was completed using the Irish National Audit of Dementia tool. A priority action from this audit was the introduction of new dementia-friendly signage in key patient areas across the hospital, including nurses’ stations, toilets and bedrooms.

Methods

Random selection was used to distribute staff questionnaires, gathering their perceptions on the effectiveness of this signage. These questionnaires were multiple-choice based.

Results

Forty-six questionnaires were completed across 11 wards and from at least 4 different disciplines. Over 70% of staff members noticed the signage prior to survey completion. Twenty-eight percent of staff members felt that patients required less prompting to topographically orientate themselves. Over 75% of staff felt signage helped improve overall orientation by either a small, moderate or significant amount. Over 40% of staff feel their ward is dementia-friendly.

Conclusion

The implementation of dementia-friendly signage has had a positive impact on in-patients with dementia, by improving orientation and by promoting independence levels with this group. Dementia-friendliness of the hospital has improved but further exploration in this area is required.
159 DOES SHARED DECISION MAKING (SDM) ADDRESS POTENTIALLY INAPPROPRIATE PRESCRIBING (PIP)?
Authors: Kinahan C ,   iSIMPATHY Project Team
Published: October 2022

Background

Potentially Inappropriate Prescribing (PIP) as identified by STOPP/START criteria is associated with poor patient outcomes. The objective of this study was to investigate the extent of reduction in PIP achieved by Shared Decision Making (SDM) employed by pharmacists delivering, comprehensive, person-centred medication reviews as part of the EU INTERREG-VA funded iSIMPATHY project. The relationship between reductions in PIP and improvements in the iSIMPATHY Patient Reported Outcome Measures (PROMs) was explored.

Methods

This study was conducted across 3 General Practice (GP) practice sites. List of eligible patients aged ≥65 years and on ≥10 regular medications were generated from practice software. Patients were contacted by phone and offered iSIMPATHY reviews and consented to data collection. The first 100 iSIMPATHY reviews actioned by the GPs and for which post review PROM data was collected were included. Data was independently reviewed and analysed by the Medication Safety, Quality Improvement Division of the Health Service Executive.

Results

At least one STOPP/START criteria was identified in 93% of study participants and an average of 4 per patient, were found. 76% of these were resolved within the study timeframe. 88% of patients reported an improvement in at least one PROM domain. 76% reported an improvement in their Understanding, 54% in their experience of Adverse Drug Reactions (ADRs), 21% in their Activities of Daily Living (ADLs) and 8% in adherence. 68% of STOPP/START criteria were resolved for the 53% patients reporting improvements in 0-1 PROM domains, whereas 85% were resolved for the 47% reporting improvements in 2-4 domains.

Conclusion

Delivery of the iSIMPATHY medication review service in the Irish GP practice setting significantly improves both medicines appropriateness and Patient Reported Outcome Measures (PROMs). There appears to be a positive relationship between the extent in reduction in PIP achieved by SDM and reported improvements in PROMs. The relationship between PROM outcomes and individual PIP criteria warrants further investigation.
161 CLEAR DISCHARGE PRESCRIBING IN STROKE PATIENTS: A RETROSPECTIVE AUDIT OF DUAL ANTIPLATELET DURATION AT FIRST FOLLOW-UP APPOINTMENT
Authors: Higgins M , Healy A , Eakins S , Brennan A , Cregg K
Published: October 2022

Background

The risk of further ischaemic events post stroke and TIA is high in the following weeks. Short term treatment with Dual Anti-Platelet Therapy (DAPT) in appropriate patients has been shown to decrease the incidence of recurrent ischaemic events. However continuing DAPT longer than six weeks increases the risk of haemorrhagic complications.

Methods

Retrospective analysis of patients admitted to the Acute Stroke Unit over 4 months in a tertiary referral centre, reviewing discharge summaries and follow-up Outpatient Department (OPD) clinic letters on the online hospital computer system.

Results

We analysed data from 205 patients. 57 patients were discharged on DAPT. Of those, 18(31.6%) did not have a recommended duration of DAPT documented in their discharge summary. 40 patients returned to OPD for review, 16 patients had no documented follow-up, 11 were repatriated to a referring hospital for follow-up locally. The average time of OPD review was 4 months post discharge. Of those 40 patients who attended OPD follow up appointment, 33(82.5%) had documented evidence of a medication review in clinic. 9 of those patients (27.3%) were still inappropriately on DAPT, 5 of whom (55.6%) had no DAPT duration instructions documented in the discharge summary.

Conclusion

Treatment with DAPT puts patients at risk of haemorrhagic complications with longer term use. Clear documentation of treatment duration and communication with the patient and the patient’s GP is vital to ensure medication errors and unnecessary complications for the patient are avoided. Intervention: Following these results, we organised an education session for the Stroke Department staff and re-designed the stroke discharge summary template to highlight instructions on DAPT duration. We also emphasised the importance of communication with the patient’s GP and medication counselling with patients.
163 AN AUDIT OF STAFF NAME BADGE VISIBILITY ON A STROKE UNIT IN A LARGE TEACHING HOSPITAL IN IRELAND
Authors: Ryan K , Healy L , Crowley P , Aherne D , O'Donnell M , Murphy J
Published: October 2022

Background

The National Patient Experience Survey highlighted the importance of name badge wearing in hospitals, with patients noting that badges made it easier to remember staff and refer to them by name. Based on her experience of identification, the #hellomynameis campaign was initiated in 2013 by Dr. Kate Granger to reinforce the importance of name badge wearing. In an era where mask wearing further inhibits communication and identification, clear identification has never been as important. This audit aims to assess the adherence to name badge wearing on a stroke unit.

Methods

An observational audit was carried out in March 2022 over one morning. Staff were not notified in advance of the audit. Inclusion criteria: Name badge placed on uniform in a visible place with/without photo. Exclusion criteria: Lanyards with swipe card identification due to small font and difficulty in viewing name and photo. The standard for this audit was for 100% compliance with name badge wearing as name badges are a crucial element of communication in best patient care.

Results

24 people across 11 different professions were identified on the ward. Seven staff members (29.16%) were wearing name badges of which 5 included photos therefore the standard set for this audit was not met.

Conclusion

There was an overall poor compliance with name badge wearing on the stroke ward. Compliance varied amongst the different professions with Speech and Language therapists, Occupational Therapists and nursing staff having a higher compliance with wearing name badges compared to other professions. Most staff members had identification in the form of swipe cards on lanyards, but did not wear clearly legible name badges. Education around the importance of name badges and distribution of name badges to all staff members is planned prior to a re-audit phase.
164 OLDER PATIENTS AT THE PREOPERATIVE ASSESSMENT CLINIC: CHANGING THE FOCUS FROM FIT FOR SURGERY TO OPTIMISATION FOR SURGERY
Authors: McGarvey C , Larkin J , Costello R , Connor MO
Published: October 2022

Background

The Pre-operative Assessment Clinic (PAC) is run by the Anaesthetic Department and assesses older patients undergoing elective orthopaedic surgery. The aim of this study was to examine how PAC currently assesses older patients and how effective it is in assessing for likelihood of postoperative complications and requirement for rehabilitation.

Methods

A single-centre, retrospective study that received approval from the local ethics committee. Data were collected on all patients post elective orthopaedic surgery admitted to the on-site specialist rehabilitation unit for older persons, between 1st May 2020 and 31st December 2021. Data were collected from hospital Information Technology platform, Bluespiers.

Results

Seventy-six patients (58 female; median age: 80 years) were included. Median time from PAC to surgery was 95 days. Functional assessment was completed in 63.16% of cases, formal cognitive assessment was done in 13% of cases. Number of falls in the preceding year was recorded in 31% of patients. Baseline mobility was recorded in 93% of cases. Whilst smoking and alcohol history was recorded in 96% of cases, number of units was not calculated. 45% (n=34) of patients were correctly identified as likely to require post-operative inpatient rehabilitation. PAC did not record sarcopaenia, polypharmacy or delirium risk factors. From our dataset, at least 13% had sarcopaenia, 80% had polypharmacy and 23% required opiate medications. Post-operatively, 16% of patients developed a delirium and 12% had an acute kidney injury.

Conclusion

In its current format, PAC fails to optimally risk stratify frail, older patients. Attention concentrates on fitness for surgery rather than optimisation of patients. Failure to record frailty, sarcopenia, cognitive impairment and risk factors for delirium is leading to missed opportunities in terms of delirium prevention, and peri-operative optimisation of older patients as well as discharge planning before surgery. Collaboration with specialist geriatric services at PAC should improve patient outcomes.
165 PHARMACIST-LED MEDICINES RECONCILIATION: AN OBSERVATIONAL STUDY TO EVALUATE INFORMATION SOURCES AS A QUALITY INDICATOR OF THE SERVICE
Authors: Hadzic D , Ryan T , Murphy D
Published: October 2022

Background

Medicines Reconciliation (MR) involves obtaining a Best-Possible Medication History (BPMH) and is essential for reducing medication errors and adverse events. Recommendations on how best to undertake MR range from utilising the patient alone to using ≥2 sources (in addition to the patient). Few studies evaluate the use of >1 source as a measure of MR quality.

Methods

This observational study was undertaken in a major teaching hospital that provides a dedicated pharmacist-led MR service. Eligible patients (aged ≥65 years, admitted through the Emergency Department) were randomly recruited. MRs were compiled using 2 sources and compared to individual 1-source MRs (both in addition to patient/carer interview). Additional Medication Discrepancies (AMDs), or differences between 1-source and 2-source MR, were assessed and potential predictors analysed.

Results

A total of 114 patients were included. Community pharmacy was the most frequently used and most accurate source (full agreement in 97.4% of BPMHs). Two-thirds of MRs would not differ if either of the two sources were used in isolation, alongside patient/carer interview. The remaining MRs identified a total of 85 AMDs (1–6 per MR). The majority were drug omissions (49.4%). Most were deemed “low” potential clinical significance (59%). Higher patient/carer reliability was associated with lower incidence (p=0.001) and fewer AMDs (p=0.001).

Conclusion

Contrary to some international guidelines, using >1 source (in addition to patient/carer interview) does not add value to the BPMH in the majority of cases.
166 INAPPROPRIATE PRESCRIBING IN COMMUNITY-DWELLING OLDER ADULTS: A CROSS SECTIONAL REVIEW USING THE STOPP/START CRITERIA
Authors: McDermott CM , Shanahan E
Published: October 2022

Background

Older adults are a heterogenous cohort of patients, often with multiple comorbidities and prescribed numerous drugs. Polypharmacy, defined as use of five or more medications, and inappropriate prescribing are risk factors for adverse outcomes. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are criteria that facilitate medication review in older people to aid better prescribing and health outcomes. This review aims to identify inappropriate prescribing in the community-dwelling older adult attending Integrated Care Programme for Older Persons (ICPOP).

Methods

We performed a cross-sectional review of patients attending the ICPOP Hub between January 2022 and May 2022. Patients’ prescriptions were obtained from pharmacies and/or General Practitioners (GP) and cross checked against the medications brought to their appointment. Patients’ past medical history was obtained from the patient, GP and hospital letters. Their prescriptions were analysed using the STOPP/START criteria.

Results

This study included 68 patients. The mean age was 83.5 years. Polypharmacy was present in 94%, with an average of 9.5 drugs prescribed. Common medications identified via STOPP criteria were hypnotic z-drugs in patients with falls (13.2%); loop diuretics for pedal oedema without heart failure (11.8%) and benzodiazepines for >4 weeks in patients with falls (10.3%). Common medications identified to commence via START criteria were vitamin D supplement in those with falls (32.4%); bone anti-resorptive therapy in those with osteoporosis (13.2%); laxatives in patients taking opiates (11.8%) and acetylcholinesterase inhibitors in those with memory impairment (8.8%). 48 participants had medications commenced with 46 having medications stopped. Only 9 patients required no change to their medication prescription. Following STOPP/START, there was an overall reduction in prescribed medications by 0.12 (p=0.494).

Conclusion

Applying STOPP/START criteria lead to a reduction in inappropriate medications prescribed in our multi-morbid older people cohort while identifying appropriate treatments to improve health outcomes.
169 THE SPECTRUM, ASSESSMENT AND DIAGNOSIS OF NEUROVASCULAR OPHTHALMIC PRESENTATIONS REFERRED TO AN ACUTE MEDICAL UNIT
Authors: Mensch R , Dahab T , Barry P , Murphy J
Published: October 2022

Background

Ocular emergencies may require urgent intervention to prevent vision loss. Physicians must be confident in recognizing their presentations. However, literature published in this area is lacking.

Methods

This study assesses the consistency of the assessment of patients with neurovascular ophthalmic conditions in the Acute Medical Unit (AMU) at an Irish tertiary healthcare centre . Conditions of interest include retinal artery and vein occlusions, ischaemic optic neuropathies, and cranial nerve palsies (III, IV, and VI). Research questions to be addressed: 1. The percentage of patients referred from Eye Casualty Services (ECS) to the AMU with neurovascular ophthalmic presentations 2. The investigations performed to diagnose neurovascular ophthalmic conditions 3. How the diagnostic approach used in the AMU compares to that recommended by the literature 4. The accuracy of ECS referral diagnoses. This is an audit of 164 patients attending the AMU during a one-year period who were diagnosed with ophthalmological conditions.

Results

Of patients studied, 58 (35%) were diagnosed with conditions of interest. The most common neurovascular ophthalmic diagnosis was cranial nerve palsy (21, 36%). Among neurovascular patients, routine laboratory investigations were performed in over 90% of cases. Routine imaging was performed in over 80% of cases. Referral diagnoses from the ECS accompanied 13 (22%) of neurovascular patients, all of which were accurate.

Conclusion

Neurovascular ophthalmic conditions represent a significant proportion of ECS referrals to the AMU, and most aren’t diagnosed until after leaving the ECS. Laboratory and imaging investigations may be inappropriately utilized in some cases. More research is needed in this area.
170 DELIRIUM SCREENING CONCURRENT AUDIT UTILISING THE 4AT ASSESSMENT TOOL IN THE EMERGENCY DEPARTMENT
Authors: Mupada BM
Published: October 2022

Background

Delirium is an acute onset of clinical serious conditions associated with poor outcomes, seen in older patients in Emergency Department (ED). Despite its seriousness, delirium can be missed by 57-83% and 25% with unrecognised delirium discharged from ED. The audit aim is to improve delirium screening for older people in ED using the 4AT assessment tool.

Methods

Criteria included patients over 75 and under 75 with complaints of new confusion, history of dementia and cognitive impairment presented to ED over 20 day period in January 2022. Exclusion criteria included patients with alcohol and drug withdrawal, trauma and critically ill. Data collection through concurrent chart review using self-designed tool performed by two auditors. 30 patient charts gathered through consecutive sampling accessed in IMS Maxims (electronic patient record system) for 3 random days approved by Assistant Director of Nursing and data collected with respect and in accordance with General Data Protection Regulation. Algorithm of Early Identification and Management of Delirium in ED/AMAU (HSE 2021) and ED Delirium Screening Bundle (University Limerick Hospital Group 2021) were standards used.

Results

70% were screened using the 4AT tool and 4 cases identified with delirium. 9 patients were not screened implying 30% variance against the national standard. 100% expected level of compliance but 50% failed compliance standard. Results discussed at staff meeting, daily huddles and poster presentation in ED information board.

Conclusion

The audit shows satisfactory results on the awareness and importance of delirium screening and moderately poor compliance on documentation. Strategies to improve practice and maintain sustainability include staff re-education, increase awareness in triage by adding blue-colored sticker “Screen me with 4AT” and rewarding staff with Delirium Champion of the Day to promote use.
174 DEVELOPING THE ROLE OF THE OLDER PERSONS ADVANCED NURSE PRACTITIONER
Authors: Farrelly A
Published: October 2022

Background

Advanced Nurse Practitioners (ANP) for Older Persons have advanced clinical skills and work with the Multidisciplinary Team, patients and carers. They practice with a high degree of autonomy under the clinical governance of a Geriatrician. These new roles have been developed in line with the emergence of clinical care pathways and an ageing population. Many are in the area of frailty assessment in the Emergency Department setting. This audit examined the development of the role of Older Persons ANP in a level three hospital.

Methods

Inclusion and exclusion criteria for ANP caseload were developed. ANP referral pathways were established. Referrals and interventions were captured by Audit. Data collection was both quantitative and qualitative

Results

Referrals to the ANP are generated in ED using a Variable Indicator of Placement (VIP) score and via consults from medical teams. 245 inpatients aged over 75 years were seen in 2021. Half referrals were generated by VIP and the other half by consult. Clinical Frailty Scale (CFS) of patients ranged from 4 to 9 but were predominantly 6,7 and 8. The ANP undertook a comprehensive geriatric assessment for these patients. Interventions included medication adjustment, social assessment and specialist advice to the MDT. The ANP “pulls the story together” (Cowley, 2016) providing a holistic link between all parties. Ongoing support is provided in an outpatient setting.

Conclusion

The ANP is well placed to lead holistic care for older people in conjunction with the MDT. In this level three hospital, the ANP role has made a significant impact on the wards as part of the wider specialist geriatric team. This is novel in that many hospitals to date have placed the role in the ED. Variables such as impact on patient outcome, length of stay, readmission rates and service quality are worthy of exploration as the service progresses.
178 THE ROLE OF THE RAPID ACCESS FRAILTY ASSESSMENT UNIT (RAFAU) IN PATIENTS REFERRED WITH COGNITIVE IMPAIRMENT
Authors: Lynch O
Published: October 2022

Background

The ageing population in Ireland is rising, as is the need to access specialized services. As a result, the RAFAU commenced in February 2021 at a level 3 hospital, to provide clinics for rapid comprehensive assessment of frail patientsd In this audit we set out to examine the role of the RAFAU in older persons referred with cognitive impairment.

Methods

Data collection was quantitative. We examined patients referred with cognitive impairment. The data collected included: Clinical Frailty Scale, medication use, the medical and multidisciplinary interventions and follow up arrangements.

Results

From February 2021 to May 2022, 584 new patients attended the clinic. Of these, 154 older people were referred for cognitive issues. The majority had a Clinical Frailty Scale of between 2 and 5. 154 patients saw a Doctor and 13 were seen by the candidate Advanced Nurse Practitioner (cANP). 39 people were assessed by the Occupational Therapist. 46 were assessed by the Physiotherapist. Polypharmacy was prevalent, with 88 people taking between 5 and 15 medications. 99 of the 154 people seen had changes to their medications. This included memory medications and adjustment to medications for Behavioural and Psychological Symptoms of Dementia (BPSD). Diagnostic tests included CT Brain, cardiac investigations and bloods. Follow-up included: return clinics to the Geriatrician and ANP and referral to primary care and voluntary services. A small number of patients were admitted to hospital.

Conclusion

Over 26% of the RAFAU referrals were for cognitive issues. The Clinical Frailty Scale suggests that this population is physically robust. RAFAU offers a multidisciplinary assessment in a one stop shop setting. This audit highlights the prevalence of cognitive issues in a frail older population and the interventions undertaken by the multidisciplinary team to address identified needs. Future research on the patient's perception and experience of the RAFAU service in their ongoing care needs would be beneficial.
191 THE DEVELOPMENT OF A COGNITIVE COMMUNICATION PROGRAMME FOR OLDER PERSONS IN THE EARLY STAGES OF REDUCED COGNITIVE FUNCTION
Authors: McCusker C , Cawley T , Cannon E , Cullen C
Published: October 2022

Background

Research indicates that cognitive and language stimulation activities can promote the maintenance of skill set. The Speech and Language and Occupational Therapy Service on an Integrated Care Team for the Older Person’s and Reablement team developed and implemented a six-week cognitive communication stimulation programme aimed at targeting cognitive and communication functions in older people in the early stages of cognitive decline. The programme outline targeted the following four domains: Memory, Attention, Language and Problem Solving. These areas have been identified as imperative skills for successful engagement and communication in everyday tasks. It was developed during the pandemic with an awareness of the social isolation and reduced opportunity for engaging with cognitive and language activities for older persons locally.

Methods

The programme was targeted within the person’s home in order to optimise the best outcomes for generalisation of skills. The implementation of the programme was supported by therapists and therapy assistants. The impact of the project was measured by a 10-point scale targeting the Older Person’s perceived skills in each cognitive domain pre and post programme implementation. The Mini-Cog was also completed pre and post-programme implementation.

Results

Preliminary results from 20 participants demonstrated positive outcomes for older persons who engaged in the programme. Older persons' reported feeling more confident in managing the skills required to maintain cognitive functions.

Conclusion

Cognitive and language stimulation activities can support the maintenance of cognitive skills when targeted in the early stages of cognitive decline. There is a greater likelihood of skill maintenance when targeted within the person’s home context.
192 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): 12-MONTH TRAJECTORY OF QUALITY OF LIFE IN PEOPLE WITH DEMENTIA
Authors: Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , Power D , O'Shea D , Doyle R , Blake C
Published: October 2022

Background

Research is needed to examine how Quality of Life (QoL) changes as dementia progresses. We explored QoL trajectories over a 12-month period and examined factors that influence QoL in People with Dementia (PwD).

Methods

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

Results

Across all domains, caregivers’ ratings of QoL for PwD decreased over time (p=0.012). In PWB, greater levels of depression (p=0.007) and anxiety in the PwD (p<0.001) predicted lower self-rated QoL, and higher caregiver anxiety levels predicted lower caregiver-rated QoL (p=0.012). In PFH, having a caregiver administer medication (p=0.03) was associated with higher self-rated QoL. Interestingly, caregiver-rated QoL was higher for PwD who took longer to return to sitting during the QTUG (p=0.043). In MED, being independently mobile (p=0.012) predicted higher self-rated QoL. No other factors within the SCR domain reached significance in predicting QoL.

Conclusion

This longitudinal analysis elucidates potential predictors of QoL in PwD. Psychological well-being in PwD and their caregivers was shown to significantly impact on QoL, and so, these factors should be routinely included in future research studies and clinical assessments.
194 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): SMART HEALTH TECHNOLOGY ACCEPTABILITY BY INFORMAL CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Blake C , Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , O'Shea D , Doyle R , Power D
Published: October 2022

Background

The prevalence of dementia is increasing worldwide, and innovative strategies are required to meet increasing demands on health services. The Connected HEalth Sustaining home Stay in Dementia (CHESS) Study aimed to provide support to People with Dementia (PwD) and their caregivers in their homes. We aimed to quantitatively assess the acceptance of smart connected health technology by caregivers of PwD through use of standardised questionnaires.

Methods

Fifty-two PwD and their informal caregivers were recruited by convenience sampling to the intervention arm of the CHESS Study. An additional 25 dyads acted as control participants. Questionnaire data were collected following completion of the CHESS study from 27 informal caregivers from the CHESS Technology group and 16 informal caregivers from the Control group. Measures of health technology acceptability included the System Usability Scale (SUS), the eHealth Literacy Scale (eHEALS), the Technology Readiness Index 2.0 (TRI), and the Unified Theory of Acceptance and Use of Technology Scale (UTAUT). Univariate analyses of variance were used to explore differences between groups.

Results

Internal consistency (Cronbach’s alpha) was high for all measures (range 0.68 – 0.96). The SUS score for the technology group was high (M=70.07, SD=17.69), indicating that the CHESS technology had a high level of usability. All participants had a high level of eHealth literacy (M=33.61, SD=10.51). Both groups performed similarly on the TRI and UTAUT, however the control group indicated greater discomfort with health technology and felt less secure in providing their personal information electronically to healthcare professionals than the technology group.

Conclusion

Caregivers across the technology and control groups had high levels of eHealth literacy and found health technology to be generally acceptable. The CHESS technology in particular was rated as highly usable on the SUS by those who used it. These findings offer support for a Connected Health model of care.
196 AN AUDIT OF PROTON-PUMP INHIBITOR PRESCRIBING IN PATIENTS ATTENDING A RAPID ACCESS FRAILTY ASSESSMENT UNIT
Authors: McDonnell E , Corcoran L , Donnelly T
Published: October 2022

Background

Proton-Pump Inhibitor (PPI) usage has revolutionised gastroenterology practice with clinical indications for conditions such as Gastro-Oesophageal Reflux Disease (GORD), gastric and duodenal ulceration and Barrett's Oesophagus. However, these drugs are inappropriately prescribed, particularly among patients with an already heavy polypharmacy burden. PPI usage has been linked with electrolyte disturbances, most commonly hypomagnesaemia, resulting in higher rates of osteoporosis. It has also been shown to have adverse effects on renal function, an increased correlation with clostridium difficile and most recently, a deleterious impact on cognitive function. The purpose of this audit was to assess the appropriateness and clinical indication of PPI prescribing among patients attending Rapid Access Frailty Assessment Unit (RAFAU) in 2022.

Methods

A database of patients attending RAFAU in an Irish regional hospital was accessed. Records from years 2021-2022 were searched and documents citing patients’ medical history and clinical indication for prescribed medications included hospital discharge letters, outpatient clinic letters and GP referral letters. NICE guidelines from the UK NHS were used as comparison for prescribing guidelines.

Results

120 patients’ records were assessed. 63 (52.5%) patients were found to be prescribed a PPI among this cohort. Of those taking PPIs, only 15 (23.8%) patients were prescribed a PPI with a documented clinical indication in accordance with NICE Guidelines. Although several patients were taking gastro-erosive drugs including antiplatelets, anticoagulants and steroids, only one patient record mentioned PPIs being prescribed for iatrogenic gastritis. No records mentioned deprescribing or cessation of PPIs.

Conclusion

Most patients prescribed PPIs were without documented appropriate clinical indication and without clear duration of use. This is of particular importance among a frailty population where de-prescribing medications associated with significant co-morbidities should be prioritised.