bluuebunny/crossref_metadata_2025 huggingface dataset:
110 Identification of Urinary Incontinence through Comprehensive Geriatric Assessment among an integrated care programme of older persons population
Authors: Morris E , Dolphin H , Morrison L , Keating J , Kennelly S P
Published: September 2023

Background

Urinary incontinence (UI) is an under-reported and treatable condition, associated with reduced quality of life. The Integrated Care programme of Older Persons (ICPOP) supports people with complex care needs in their home. There is no available research on the rate of UI among the ICPOP population. This study aimed to assess UI in this group.

Methods

A convenience sample of 100 patient records selected randomly from an ICPOP serving approximately 30,000 people from 2017 to present were retrospectively reviewed; including patients charts, Comprehensive Geriatric Assessments (CGAs) and outpatient letters. As part of the CGA each person was assessed for UI on domiciliary visit. Irish geriatric medicine trainees were surveyed to assess their self-reported confidence assessing and treating UI.

Results

Of the 100 patients CGAs reviewed, 62% were female. 11% had UI reported on their referral to ICPOP. 56% reported UI during their CGA. Only 18% of those with UI had UI generated on to their problem list. Of those patients with UI, polypharmacy (≥5 medications) was noted in 89%. 77% of those with UI were on a medication associated with worsening UI, while only 18% of those with UI were on a treating medication for UI. 25% had their UI assessed at clinic, including 7% who were referred onwards to urology for management of their UI. 80% of geriatric medicine trainees said that they did not feel confident managing UI and 100% said they would like to receive further teaching on UI.

Conclusion

CGA is an excellent method for identifying UI. This data suggests that UI is more prevalent among the ICPOP as compared with an inpatient population and the general population in the same age group. Further specialist teaching is needed to improve trainee confidence in this area.
116 Shared Decision Making (SDM): implementation and evaluation in our perioperative care of older people undergoing (POPS) service
Authors: Hobbs H , Forsyth L , Litto E , McCluskey-Mayes B , Godage P , Bell T , Meilak C
Published: September 2023

Background

Shared decision making (SDM) is a routine part of our POPS service, where older, complex patients are seen. Up to 16% of patients are estimated to regret having had surgery. We wanted to see what impact SDM had on our patient’s surgical choices and decision regret after surgery.

Methods

Retrospective audit of all POPS outpatient letters between October 2019–February 2023: Age, Rockwood frailty score, operation type and outcome of SDM was recorded. Decision regret survey sent out 6 months post-surgery between August 22–April 23.

Results

SDM outcome data: (1) Threshold Abdominal Aortic Aneurysms (AAA): 262 patients, mean age 79, median Rockwood score 3–15% chose not to proceed with surgery. 16% not fit for proposed surgery; (2) Sub-threshold AAA: 78 patients, mean age 78, median Rockwood score 4–12% chose to stop surveillance, 23% not fit for aortic intervention; (3) Peripheral arterial disease: 127 patients, mean age 76, median Rockwood score 4–6% chose not to proceed with surgery and 17% not fit for proposed surgery; (5) Orthopaedic: 111 patients, mean age 83, median Rockwood frailty score 4–13% chose not to proceed with surgery, 5% not fit for proposed surgery. Decision regret outcome data: 87 questionnaires sent with a 69% response rate. 30% of patients who responded had some sort of complication. 23% had 30-day post discharge unplanned readmission. 3/60 (5%) of responders regretted having surgery. 52% of non-responders had some sort of complication and 41% had an unplanned readmission. One patient died.

Conclusion

Multidisciplinary team working helps us to inform patients in preparation for SDM. Asymptomatic versus symptomatic disease may influence decision making when based conversations about quality of life. Exploring decision regret helps to inform us how well we are supporting our patients with their surgical decisions.
126 Rhythmic connections: a pilot interdisciplinary music therapy group programme for people with Parkinson’s in a day hospital
Authors: Cassidy S , Armstrong E , Fox E , Farrell E , Gusha N , Carey G
Published: September 2023

Background

Rhythmic Connections is a music therapy-based (MT) interdisciplinary programme including MT, physiotherapy, occupational therapy and speech and language therapy. The aim of the group is to use evidence-based MT techniques to support participants’ physical, psychosocial and communication goals. There is a growing body of research that supports MT as part of an IDT to support people with Parkinson’s (PwP). However, there is limited research on specific interdisciplinary collaboration in this area.

Methods

This was an 8-week programme with 8 participants. Outcome measures assessing mobility, communication, mood and quality of life were used. Musical preferences were elicited and used to target specific goals. A selection of music was recorded for use between sessions at home. A typical session comprised: Breath support; sustained phonation of varying pitch; balancing tasks using Patterned Sensory Enhancement; Sit to stand; Rhythmic Auditory Stimulation for gait training; Singing to target volume, articulation and intonation.

Results

The majority of participants maintained or improved across all physiotherapy outcome measures. In relation to both mood and quality of life, results varied among participants, with a majority improving or remaining the same. Volume of phonation was either retained or improved for all participants. Of three participants who had impaired intelligibility pre-intervention, two improved and one maintained.

Conclusion

Participants’ feedback suggested that an opportunity to discuss the challenges they experience as PwP could be explored. Future research could investigate the effects of increased intensity e.g. twice weekly. The provision of an exercise log to motivate and monitor intensity could be considered.
129 Can we improve the patient experience for frail, older persons admitted with delirium?
Authors: O'Looney L , Leonard R , Lennon M , Treacy-McCarthy K , Hannon S , Heery H , Hannon N
Published: September 2023

Background

Delirium is a common feature in admission of older adults to inpatient wards. The diagnosis of delirium is often over-looked by healthcare professionals. This leads to lack of early intervention; associated with negative outcomes including prolonged Length of Stay (LoS), avoidable complications, and use of psychotropic medications. We assessed whether a Quality Improvement Program (QIP) should be implemented for frail older patients focused on identification and intervention of delirium.

Methods

The pre-intervention retrospective audit included patients aged 75 or older, assessed by the Frailty at the Front Door team in a four-month period (2022). All patients had 4AT score of 4 or greater, indicating a delirium syndrome. Data was collected on discharge destination, Clinical Frailty Score (CFS), LoS, and number of bed-moves. A selection of patients had in-depth medical record reviews to identify whether delirium was documented, and what interventions occurred, including pharmacological.

Results

Data was collected on 40 patients, age range 77–97 years, median age 86 years. 57.5% were aged 85 or older (23/40). Median CFS was 5, Median 4AT score was 5. 30% had a 4AT score ≥ 7 (12/40). 57.6% (19/33) were discharged home to their usual residence, 30.3%(10) went to inpatient ‘respite’. 4 patients were not admitted. Longest LOS was 42 days, average LOS 8 days. One patient experienced 13 bed moves during their inpatient stay (average = 8). 19 patients had in-depth chart review: 2/19 had appropriate documentation of delirium in the ED, 6/19 as an inpatient. 1 patient had non-pharmacological interventions recommended. 2 patients were discharged on a new psychotropic medication.

Conclusion

In an older, frail population presenting to ED, delirium is under-recognised despite routine use of 4AT score. Non-pharmacological interventions are under-utilised. Patients experience prolonged inpatient stays and frequent bed moves, and are likely to be discharged to a different inpatient unit for ‘respite’. A QIP will be developed aiming to improve patient experiences.
141 Perspectives of key stakeholders on an adaptive physical activity mHealth intervention in the prevention of secondary stroke: a qualitative study
Authors: Cardy N , Hunter A , Carter D , O'Donoghue M , Carvalho M , Carr E , Walsh J , Bernhardt J , Fitxsimons C , Rishardson I , Salsberg J , Glynn L , Walsh C , O'Driscoll E , Boland P , Cunningham N , Forbes J , Galvin R , Hayes S
Published: September 2023

Background

Engaging in regular Physical Activity (PA) is associated with lower mortality post-stroke, and PA reduces the chance of recurrent stroke. Despite recent guidelines to optimise PA post-stroke, people with stroke are known to be less active than their age-matched counterparts. Given the heterogenous nature of stroke, PA interventions, which are adaptive to individual performance, are recommended. Empirical data is lacking on the design and delivery of adaptive PA interventions post-stroke. Suggested strategies recommend the use of mobile health (mHealth) interventions. The aim of this study is to explore the perspectives of key stakeholders on the design and development of an adaptive mHealth PA intervention post-stroke.

Methods

People with stroke, healthcare professionals and carers participated in semi-structured one-to-one or focus group interviews. A reflexive thematic analysis was undertaken on transcribed interviews and key themes and sub-themes were developed.

Results

Twenty-eight interviews were conducted across stakeholder groups including people with stroke (n = 12, mean age 55 years), healthcare professionals (n = 10) and carers (n = 6, mean age 67 years). Three main themes relevant to the design and development of the intervention were identified: (1) Key features of a mHealth PA intervention, (2) Pragmatic intervention delivery, (3) Challenges to development and use.

Conclusion

There was widespread agreement across stakeholder groups that an adaptive mHealth PA intervention post-stroke would be beneficial following discharge from acute care. Our data supports the development of individually adapted programs, to increase PA post-stroke. These findings present new perspectives across stakeholder groups on the design and delivery of an adaptive, mHealth PA post-stroke. Taken together with existing quantitative evidence, these findings will inform the development of a feasibility trial, examining patient and process outcomes, to increase PA levels post-stroke.
143 Nursing home care in Ireland and the built environment: key emerging issues and insights
Authors: O'Donoghue J , Xidous D , Grey T , O’Neill D
Published: September 2023

Background

Nursing homes for older people were badly affected by COVID-19 resulting in serious impacts on residents, staff, and family members. Like other airborne infectious diseases, COVID-19 has implications for spatial practices and the built environment. Although limited research has identified certain built environment issues which impact Infection Control (IC), these issues also have a negative impact on resident quality of life. Based on the paradigm shift created by COVID-19, we explored aspects of the built environment and emerging issues within nursing homes in Ireland with key representatives/experts from different aspects of nursing home provision, policy, and IC.

Methods

20 interviews were conducted with various experts, followed by a thematic analysis to analyse, and generate key themes arising from the interviews.

Results

Some of the key emerging issues from the interviews included designing for infection control and future pandemic resilience, climate change and its impacts on older people, innovative care models, and nursing home integration with the community.

Conclusion

This research demonstrates the growing awareness of the built environment as a critical partner in the nursing home health and social care model and illustrates the need for a holistic design approach across all key spatial scales to support the health/wellbeing of older people in nursing homes.
152 Case study: the use of Talking Mats to facilitate assisted decision making in hospital settings with older adults
Authors: McCusker C
Published: September 2023

Background

Talking Mats is a picture based standardised tool to support person-centred decision making for those with impaired communication (or cognition), which is a useful communication tool for Speech & Language Therapists (SLTs). The tool ensures our client’s voice is heard and that they are central to the decision making process. With the newly implemented Assisted Decision Making Capacity Act 2015 (ADMCA) in the forefront of our minds, we must consider our client’s will and preference thoroughly with facilitated discussions, to be fully compliant with this legislative framework, and always ensuring our client’s wishes/requests are central in the decision-making process. In this case example, Talking Mats were used with an 85 year old lady after her second stroke. After a primary stroke (2019), she presented with a mild receptive and moderate expressive dysphasia, impeded by Apraxia Of Speech. She previously communicated with a communication book, with written words. A second stroke (2023), resulted in a moderate–severe receptive and expressive dysphasia.

Methods

Discussions involved a ‘Talking Mat’ with pictures placed on it and the ‘Topic’ cue card. Along the top of the Talking Mat, a standard scale of ‘Yes’, ‘Maybe/unsure’ and ‘No’ icons. Picture cards have written words to assist comprehension. Talking Mats was used in therapy for communicating wishes and problem-solving around discharge planning. The scales used were ‘Managing’ to ‘Not Managing’ or ‘Coping with’/‘Not Coping with’.

Results

The qualitative data collated from the client and her family was very powerful, in helping the client make her wishes known for home, spontaneously she articulated “But not on my own!.

Conclusion

Talking Mats help people with communication difficulties have a greater understanding about the topic and ensures they are ‘directly involved in the process, is more in control, and can consider the options in his/her own time’.
155 Review of the physiotherapy needs of hip fracture patients post discharge from offsite rehabilitation
Authors: McDaid E , Fenton L , Gilheany Á
Published: September 2023

Background

Post-hip fracture in Ireland, 25% of patients transfer to offsite rehabilitation. However, little is known about their ongoing physiotherapy needs at the point of discharge from offsite rehabilitation.

Methods

A retrospective audit of hip fracture patients admitted during 2022 who discharged home was completed. Measures collected included pre fracture mobility using New Mobility Score (NMS), rate of recovery at discharge using remeasured NMS, rehabilitation Length of Stay (LoS) and onward physiotherapy referral. This data was analysed using Microsoft Excel and descriptive statistics.

Results

Of 120 hip fracture patients admitted in 2022 who discharged home, there was complete data available for 116. No patient recovered their pre fracture mobility at point of discharge. The mean percentage recovery to pre fracture NMS at discharge was 55% and 84% for those with higher (NMS 7–9) and low (NMS 1–6) pre fracture mobility respectively. Over half (64%, n = 74) were referred for further physiotherapy on discharge from rehabilitation. Most onward referrals were for the rehabilitation day hospital (47%, n = 35), followed by community physiotherapy (28%, n = 21) with the remainder being referred to OPD and private physiotherapy. Those with higher pre fracture mobility (NMS 7–9) were more likely to be referred for further physiotherapy with 69% of this group being referred onwards compared to 36% of lower pre fracture mobility group (NMS 1–6). There were geographical trends reflecting service access with increased community physiotherapy referrals made in areas outside the catchment of the rehabilitation day hospital. Patients referred to community physiotherapy had a shorter mean rehabilitation LoS (35 days) compared to those referred to the rehabilitation Day Hospital (52 days).

Conclusion

Within this sample of hip fracture patients who went to off-site rehabilitation, those with higher pre-fracture mobility had a reduced rate of recovery to their pre-fracture mobility and were more likely to be referred for physiotherapy post discharge from rehabilitation.
187 Prospective study of patients admitted to a model 2 hospital
Authors: Kelly L , Watts M
Published: September 2023

Background

Model 2 hospitals provide in-patient and out-patient care for differentiated, low-risk medical patients, who are not likely to require full resuscitation. Smaller hospitals are generally very well regarded by the local population and general practitioners.

Methods

This is a prospective descriptive study. Data were collected from all patients admitted via the Medical Assessment Unit (MAU) or stepped-down from a model 4 hospital for six consecutive weeks. Data points included: route of admission, age, Rockwood Clinical Frailty Scale (CFS) on presentation, length of stay (LOS), long term care/community resident, if delirium was present, known cognitive impairment, number of medications, hospital admissions in the past year and discharge destination.

Results

144 patients were recruited to the study—79 via the MAU, 64 stepped down from a model 4 hospital and 1 via outpatient clinic, 95 of whom had a hospital admission within the previous year. The average age of patients was 72 years with a mean CFS of 4. 38% of patients were felt to be delirious on presentation to hospital, with 14% having a formal diagnosis of cognitive impairment prior to admission. Over 80% of patients were prescribed 5 or more medications in the community. Average overall LOS at the module 2 hospital was 9 days; 8 days for patients admitted via the MAU and 12 days for those stepped down from a model 4 hospital. The mean LOS at module 4 hospital prior to transfer was 6 days. 92% were living in the community prior to admission, 82% of which returned home.

Conclusion

Model 2 hospitals are a vital resource, particularly catering for the geriatric population. Patients are often multimorbid and admissions are often complicated with polypharmacy, delirium and discharge planning. Further exploration is required to assess how best to appropriately staff and resource them.
197 Transitions of older adults with dementia to and from acute general hospital and nursing home settings
Authors: George R M , Carey E , O'Malley T
Published: September 2023

Background

The life span of human beings is unceasingly growing. Keeping in line with global trends of ageing populations with increasingly complex needs, it is expected that there will be an increase in the number of people moving into nursing homes in Ireland. Frailty and dementia are two risk factors associated with ageing. Considering the high percentage of older persons diagnosed with dementia and co-morbidities living in nursing homes or long-term care facilities, patients’ transfer, to and from the hospital is a main concern.

Methods

A qualitative descriptive study design was used to examine nurses’ experiences of transitioning older adults with dementia between nursing homes and acute care settings. Ethical approval was obtained. By means of purposive sampling, data collected via semi-structured interviews with 10 nurse participants, were transcribed and analysed using thematic analysis and NVIVO 12. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data using the six stages of Braun and Clarke.

Results

Conceptualised from data analysis four key themes include ‘Complexity of caring and minimising stress’, ‘Continuum of supports and services’, ‘Clinical journey with deteriorating health’, and ‘Futuristic Planning’. To establish the trustworthiness of the findings researcher was guided by Lincoln and Guba’s strategies and checked using the Joanna Briggs Institute critical appraisal tool.

Conclusion

The findings highlight the need to integrate primary, community, and acute care services in providing safe and effective treatment for older adults with dementia in nursing homes. In addition, it provides insight for policymakers and educators to consider introducing novel services and initiatives to reduce the number of nursing home resident transfers. Further research exploration of the feasibility of reducing hospital admissions of persons with dementia from Nursing Homes is required to substantiate the concept of hospital avoidance and integrated care for persons with dementia.
219 Delirium snapshot—inpatient rates and demographics of delirium in an Irish university teaching hospital
Authors: Doherty R , Murphy E , Sheehan O , O'Connor M
Published: September 2023

Background

Delirium has been repeatedly demonstrated to increase morbidity and mortality both in the inpatient setting and post-discharge. This study sets out to examine the rates and demographics of delirium in the inpatient setting and identify significant risk factors for its development.

Methods

Data was collected on inpatients on a single day (13/12/22) using an internet application developed by the Hospital’s Quality and Improvement Department. Biographical data, length of stay (LOS), source of admission, admission diagnosis, clinical diagnosis of delirium and/or dementia and preadmission and current continence data were gathered from medical or nursing notes. Data was analysed and statistical significance determined via Pearson’s Chi-Squared Test.

Results

Data was available for 309 inpatients. The point prevalence of delirium was 25.2% (78/309). About half of delirious patients were female (41/78) and (38/78) had a previous diagnosis of dementia (p = <0.01). Almost a quarter of the cohort had pre-existing cognitive impairment (73/309, 23.6%). Nursing home residents had the highest percentage of delirium 17/42 (40.5%) by admission source (p = 0.01). Delirium prevalence increased with age reaching 37.5% in those over 90 years, (p = 0.03). Delirium was more prevalent in those with a longer LOS (19.8% LOS <7 days compared to 44.6% LOS >7 days). Delirium rates were higher in those incontinent or catheterized both at baseline and during admission (p = <0.01), as well as in those requiring assistance with mobility (p = <0.01).

Conclusion

Approximately a quarter of all inpatients experienced delirium during their admission. However, these figures were significantly higher in at risk categories such as those aged ≥70, Nursing Home residents and those with cognitive impairment. Despite extensive awareness and education of the risks of delirium, its prevalence remains too high. Further interventions are urgently needed.
222 Incontinence acquired during hospitalisation: targets for improving standards of care
Authors: Murphy E , Geoghegan C , Toole G O , Leonard S , Crowley K , Hassan H , O’Connor M
Published: September 2023

Background

Urinary incontinence is common in older adults, frequently underreported and consequently under-treated. Up to 15% of patients with hospital-acquired incontinence will have persistent incontinence afterwards. We performed an audit in a Level 3 hospital examining documentation of continence, pad use and call bell use in order to identify areas where continence care can be improved.

Methods

Data were gathered on all inpatient at a single timepoint. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug charts.

Results

The dataset comprised 309 patients. 9% were continent pre-admission and now had incontinence or occasional accidents. 72% of these were admitted >15 days. 17% had a diagnosis of dementia and 48% delirium. 31% were on diuretics. 14% were independently mobile. 44% of patients were wearing pads, one in two of whom were continent or had only occasional accidents. 15% of patients had a continence status documented in the medical admission proforma, 29% had a continence care bundle and 36% a toileting plan recorded. Patients whose continence status was documented at admission were more likely to have a toileting plan and continence care bundle than those without a documented continence status. 20% of patients did not have a call-bell in reach. In the population that required assistance to mobilise, 23% did not have a call-bell, 52% of which were incontinent.

Conclusion

Long duration of admission, diuretics, delirium and dependent mobility were all risk factors for hospital-acquired incontinence. Pads were used indiscriminately, regardless of continence status. A significant proportion of patients had no access to a call-bell, placing those who could not mobilise independently at risk of incontinence. Our study identifies a number of areas for improvement to promote continence throughout a person’s inpatient stay.
227 An evaluation of pharmacist-delivered medication education in a frailty at the front door interdisciplinary team
Authors: Cahill M , Pillay I , Silvari V , Kennedy E
Published: September 2023

Background

Adverse Drg Events (ADEs) are a significant cause of Emergency Department (ED) visits, with a major impact on healthcare resource utilisation. An Inter-disciplinary Team (IDT) in-service day identified pharmacy-delivered education as a priority. Education suited to the diversity of the team is key. This study aimed to evaluate pharmacist-delivered medication education to a Frailty at the Front Door (FFD) interdisciplinary team and assess the degree of importance the FFD team place on medication education.

Methods

Pharmacist–delivered medication education was conveyed via i) daily board rounds, where issues arising in relation to medication are discussed and ii) the ‘medication minute’, where education topics pertinent to frail older people are presented in a micro learning style applicable for all members. An anonymised, mixed methods questionnaire (open/closed questions) was distributed to the members of the FFD, which consisted of: Consultant Geriatrician, Registrar, Physiotherapists, Occupational therapists, Dietician, Speech and Language Therapist and Clinical Nurse Manager. The questionnaire ranked the effectiveness of the pharmacist mediated medication education using a Likert scale ranging from not at all effective/relevant to extremely effective/relevant. Data were analysed using descriptive statistics.

Results

Eight (89%) FFD members completed the questionnaire. 37.5% (n = 3) respondents rated board round education as effective or extremely effective. 87% (n = 7) respondents rated the ‘medication minutes’ as extremely effective. 100% (n = 8) respondents said medication education led to improved patient outcomes. 100% (n = 8) of respondents said that understanding patient’s medication was either very or extremely relevant within their role on the interdisciplinary team.

Conclusion

There is no published evaluation of medication education for IDTs. This IDT agreed that medication education is both relevant and effective for all members, leading to improved patient outcomes. The most effective method was the ‘medication minute’. Work is needed to develop a National model of medication education for IDTs.
236 Assessing communication of duration of Dual Antiplatelet Therapy on discharge letters: an acute stroke unit audit
Authors: Hussien A , Durcan R , Abdalla Y
Published: September 2023

Background

Short term Dual Anti-Platelet Therapy (DAPT) is commonly used for secondary prevention of major acute ischemic stroke events. However, long-term DAPT is associated with increased risk of bleeding without reduction in cardiovascular events. Proton pump inhibitors (PPI) are often co-prescribed for prevention of gastroduodenal toxicity of DAPT, but long-term use has potential side effects. This audit aims to assess if clear instructions are provided regarding to duration of DAPT prescription in stroke medicine unit in tertiary referral hospital.

Methods

Retrospective analysis Electronic Medical Records (EMRs; discharge and clinical letters) who were admitted with TIA or AIS in 3-month period, excluding those who were transferred back to their referring hospital.

Results

100 patients’ EMRs were reviewed. 34 were discharged on DAPT. 21 patients were reviewed in stroke OPD while 6 were readmitted to hospital. DAPT duration was documented in Discharge Letters (DL) of 28 patients (82%). In 28 (82%) patients, recommended durations of DAPT were documented in DL, 5(18%) of those were still inappropriately on DAPT on returning to OPD/readmission. 1 out of the 6 patients with no clear documentation of DAPT duration on DL were still inappropriately on DAPT. 22 patients were co-prescribed PPI, 19 of those had no documented recommended plan for PPI post completion of DAPT, and 12 of those were still on PPI on returning to OPD/readmission. 3 patients had a documented plan for PPI post completion of DAPT, 2 were still on PPI on returning to OPD/readmission.

Conclusion

Results were presented in stroke unit teaching. Key recommendations included education of NCHDs regarding clear documentation and communication with patients, pharmacists and GPs. Improvement in EMRs to highlight DAPT plan. Regular audits in this area.
238 An age related acute medical unit: creating an age-attuned model of acute care
Authors: Kelly L , Byrne M , Harding N , Humphreys S , Murphy M , Hayden D
Published: September 2023

Background

Multi-morbidity increases with age and older adults are more likely to present to acute hospital services with complex health states/Geriatric syndromes. For people with underlying physical or cognitive illnesses, these issues can be compounded by the built environment of acute hospitals. Meeting the needs of a frail older population is a key challenge for acute hospital services. The main aims of this development quality improvement project were to create a dedicated Age-related acute medical unit using the concept of universal design, with dedicated, Gerontological staffing including a Registered Advanced Nurse Practitioner (RANP) in Gerontology.

Methods

A project team was convened with representation from Geriatric nursing, Geriatric Medicine, Health and Social Care Professionals (HSCP), Estates, Technical services and the executive management team. An appropriate area was identified on the acute floor which was co-located with a newly developed Acute Medical Unit. Using a universal design approach, a 4-cubicle Age Related Assessment Unit (ARAU) including a dedicated multidisciplinary assessment room was created. The role of the RANP in ARAU was developed to provide comprehensive geriatric assessment to older medical patients presenting to unscheduled care.

Results

Following the implementation of the ARAU there has been a 40% increase in the number of unscheduled older patients (>65’s) assessed in the Acute Medical Unit (Q1 2019 to Q1 2023).

Conclusion

Operating within a defined scope of practice, the RANP in ARAU/AMU provides advanced specialist geriatric nursing skills and knowledge allowing for the identification of medical, psychosocial and functional needs of older adults for older adults who present to unscheduled care with common geriatric syndromes.
241 ‘Please consider bone assessment’: improving the identification and management of Vertebral Fractures by a ‘Fracture Liaison Service’
Authors: McGurk C , Ali A , Carvalho J , Ong J , McPartland A , Rooney B , O'Sullivan F
Published: September 2023

Background

Osteoporotic fractures are a major public health problem due to an ageing population causing profound disability and reduced quality of life. Vertebral Fractures (VFs) are the second most common osteoporotic fracture with nearly 1 in 4 women having one in their lifetime. Furthermore, a VF is a significant warning sign for another fracture in the following year—known as ‘imminent fracture risk’. Despite this early opportunity for clinical intervention with bone protective medication, VFs are frequently under-diagnosed and under-treated. This observational study aimed to look at the point prevalence of VFs picked up on radiology reports and compare with those identified by the ‘Fracture Liaison Service’ (FLS).

Methods

The PACs office ran a search for all MRI spine, CT-TAP and a plain radiographic film reports from January 2021 until April 2023 with the terms ‘vertebrae’ and ‘compression’ in the text. Inclusion criteria was all patients >65 without major trauma with a radiologist defined osteoporotic VF. Using excel, we cross-referenced the proportion of these already know to the FLS.

Results

There were 338 osteoporotic VFs diagnosed on radiological imaging between 2021 & 2023. Of these, 101 had been identified by the FLS. The median age was 77 years old. There were 228 (67.2%) females and 111 (32.8%) males.

Conclusion

This study helped to highlight that over 67.2% of the osteoporotic VFs are not being identified by the FLS. Therefore, is it assumed that timely intervention and management of their imminent fracture risk may not have been undertaken. This data is being used to drive a quality improvement project with the radiology department where any VF in women >70 will be reported to include—‘please consider bone assessment’.
245 ‘Pad culture: the use of continence wear in older people in an Irish University Hospital’
Authors: McGurk C , Paponette B , Alnajjar A , Carvalho J , Ong J , Reynolds O , Williams S , Moran C , Riaz S , O'Sullivan F , Hickey P
Published: September 2023

Background

Incontinence in hospital patients can result in a longer length of stay, a greater risk of being discharged to a residential care setting, as well as increased healthcare and personal costs. Older adults may find it difficult to regain continence post discharge contributing to caregiver strain, social isolation and functional decline. There is evidence to suggest that there is an over-reliance on continence aids (wearable absorbent ‘pads’ & urinary catheters) for older adults in hospital. The aim of this study was to assess the prevalence of continence aids among older in-patients in an Irish University Hospital, as part of wider service improvement project.

Methods

Data was collected on consecutive in-patients 65 years or older on a single day. Medical, surgical, oncology, coronary care and medical assessment unit were included. Current incontinence aid usage and pre-admission continence aid usage was recorded, along with demographics and current mobility status.

Results

156 older adults were included. 53.5% were male and the median age was 81. A total of 57.4% (N = 89) of older patients were wearing disposable pads. Of these, 64.5% (N = 58) were not wearing continence pads pre-admission. A total of 23.2% (N = 36) had a urinary catheter inserted. Of these, 91% (N = 33) did not have a urinary catheter pre-admission. 38.3% (N = 61) of those wearing pads could mobilise either independently or with assistance of one. We also found a direct correlation between pad use and length of stay.

Conclusion

This study highlights the high prevalence of continence aid deployment in the care of older adults admitted to an acute hospital, with conversion to an aid occurring even in those who are able to mobilise independently or with supervision. Continence care and rehabilitation may benefit from inter-disciplinary assessment and management, similar to other complications of ageing and hospitalisation, such as delirium.
246 Feasibility of a delirium intervention pathway by a frailty at the front door team
Authors: Fitzgerald R , Mupada B M , Leonard A , Cronin L , Condon F , Coakley E , Martin L , Allen S , Pillay I
Published: September 2023

Background

Consistent success in reducing delirium incidence and related falls, cognitive and functional decline, length of stay, use of one-to-one supervision, institutionalisation, readmissions, and health-care costs (hospital and 1-year) has been demonstrated in delirium, with and without dementia. Intervention strategies reduce delirium and its adverse outcomes by 30–40%. Frailty at the Front Door (FFD) emergency department teams perform 4AT as a routine component of comprehensive geriatric assessment. The aim of this study was to benchmark delirium with and without dementia in patients assessed by a FFD team in an urban tertiary referral centre and assess feasibility of an FFD delivered inter-disciplinary delirium intervention pathway.

Methods

Age, gender, Clinical Frailty Score (CFS), 4AT, AD8 and dementia diagnosis recorded in 500 consecutive patients in a clinical excel database were analysed using descriptive statistics. An inter-disciplinary delirium pathway, consisting of blood tests, anti-cholinergic cessation, neuro-imaging, individualised patient, carer, staff education was embedded into practice and use of the pathway recorded over a subsequent 2 month period.

Results

Mean (SD) age was 83 (6.9) years. Female to male ratio was 1.5:1. Mean(SD) CFS was 5 (1.2), with CFS unrecorded in 10%. 91% (n = 456) had 4AT recorded. 50% (n = 230) had a 4AT of zero. 38% (n = 177) had a 4AT of 1–3. 25% (n = 114) had a 4AT of >/=4. Of those where dementia diagnosis was recorded, n = 74, 40% (n = 29) had a 4AT of >/= 4. Where AD8 was measured, 50%(n = 12) had a 4AT of >/=4. The delirium intervention pathway was applied to 16% (n = 70) of the total population over a 2 month study period.

Conclusion

4AT>/4 was retrospectively benchmarked at 25% in this population. Recording of dementia diagnosis and AD8 was low. Targeting existing resources to prevent delirium resulted in two-thirds of the expected population benefitting from standardised delirium prevention. Dedicated delirium resources in acute hospitals will further improve outcomes.
254 The use of delirium screening tools during acute inpatient hospital admissions: a local audit
Authors: Healy A , Whelan A , Lynch O
Published: September 2023

Background

According to the ‘Second Irish National Audit of Dementia Care in Acute Hospitals (INAD-2), it is estimated that 20% of all adults admitted to hospital have a diagnosis of delirium during admission. Local HSE guidelines advise that all older adults (>65 years) should have a formalised delirium screening tool completed within the first 24 hours of presenting to the Emergency Department (ED).

Methods

We reviewed the medical admission documentation and subsequent medical notes in the charts of current inpatients on three Geriatric Medicine wards in the hospital. Data was collected from 56 patients over the age of 65 over a two day period.

Results

Data was collected from 56 patients. 21.4% (n = 12) had a delirium screening tool documented. Of those, 100% used 4AT testing and 100% were completed by the OPAL team (Older Person Assessment and Liaison Team)/ED Frailty Intervention Team. 5.4% (n = 3) met diagnostic criteria for delirium. 21.4% (n = 12) had delirium documented as a diagnosis on their medical admission, of which only 3 had delirium screening completed. 26.7% (n = 15) had a documented pre-existing diagnoses of dementia. Of those, 2 had a formal delirium screen documented. 25% (n = 14) were diagnosed with delirium later in their admission. Of those, 3 had a delirium screening tool completed at any point. The vocabulary used to describe delirium was also examined. Most commonly the words confusion (10) and agitated (4) were used instead of delirium. 4 had delirium subcategorised as hypoactive.

Conclusion

Delirium continues to be prevalent among our older inpatients and has been shown to be directly related to increased mortality. It is vital that we make use of the tools that are available to us to identify those at risk and those already suffering from this condition. We should prioritise appropriate delirium screening with standardised assessment tools in order to correctly identify those at risk.
263 Improving nutritional Care for Older Adults with hip fractures: insights from a multidisciplinary quality improvement workshop
Authors: Davey N , Bates N , Diggin B , Brent L , Hickey P , Horan B , O'Regan N
Published: September 2023

Background

Enhancing nutrition is a crucial element of hip fracture care, as malnutrition poses increased mortality risk within the initial 120 days post-hip fracture. Aiming to address key considerations and potential challenges, the National Office of Clinical Audit Orthogeriatric Network conducted a quality improvement workshop focusing on nutrition.

Methods

A workshop exploring various elements of Orthogeriatric care was conducted in September 2022. Over 30 multidisciplinary stakeholders from various hospitals and clinical programs engaged in a survey and workshops exploring key components of Comprehensive Geriatric Assessment (CGA), including nutrition.

Results

Survey results indicated strong consensus on the inclusion of nutritional assessment and monitoring within the CGA for hip fracture patients. Focused small-group discussions highlighted the adverse effects of inadequate nutrition on wound healing, bone health, energy levels, the catabolic process, and frailty. The under-recognition of nutrition was highlighted. Identified barriers to optimal nutritional care included limited dietetic support, portion sizes, modified diets, repeated fasting, unclear guidance, literacy levels, and the availability of dementia-friendly equipment. Facilitators included access to dietetics support, involving family members and catering staff, enhanced oral hydration plans, protected meal times, proactive protein-based supplements, using ‘red trays’ for assistance, and ‘sip til send’ initiatives. This topic was further explored at the subsequent online network last March with a view to developing guidance on nutritional management of older hip fractures patients.

Conclusion

To optimise clinical outcomes, individualised nutritional interventions should be tailored to patients’ specific needs, considering local resources. The development of national consensus guidance aims to provide valuable information to enhance patient outcomes.
266 The current rehabilitation needs of an acute tertiary hospital—a point prevalence study
Authors: Gannon E , Healy L , O’Donovan C , Blackburne H
Published: September 2023

Background

Rehabilitation needs are rising worldwide. The World Health Organisation recognises that many countries are not equipped to meet existing rehabilitation needs and has issued a call to action; Rehabilitation 2030 encouraging countries to focus on rehabilitation as a health priority. We sought to identify the rehabilitation needs of patients admitted to a tertiary hospital, measure the complexity of rehabilitation needs, and identify appropriate setting to meet these needs.

Methods

All admitted patients were identified using the electronic patient admissions system on February 17th, 2023. Patients under the care of emergency medicine were excluded. Data was collected by teams of two healthcare professionals familiar with rehabilitation. Data collected: demographics; most appropriate location of care—Hospital, Community, Rehabilitation Unit; Clinical Frailty Score (CFS); Rehabilitation Complexity Score (RCS); estimated Length-of-Stay (LoS).

Results

640 patients identified. Median age was 71. 42% (269/640) >75 years, 47% (127/269) CFS 4–6, 16% (43/640) CFS 7–9. 12% (78/640) identified as having rehabilitation needs best met in a rehabilitation unit. Rehabilitation needs were identified across specialities, majority identified in Medicine 36% (28/78), and Stroke 28% (22/78). Average RCS 9.4, max RCS 18. Highest average RCS 12 identified in Neurosurgery patients. 3% (33/640) estimated LoS of >3 months, 30% (10/33) with primary rehabilitation needs. Average RCS 12.71 in patients with estimated LoS 3–4 months, 12 in LoS > 4 months.

Conclusion

Our study identifies significant and complex rehabilitation needs in the acute hospital setting. Rehabilitation needs were diverse across specialities, with certain areas showing increased complexity of needs and longer estimated lengths of stay. Increased numbers of specialist rehabilitation beds are needed to ensure patients rehabilitations needs are optimised.
290 Documenting medication-related needs of older persons assessed by frailty at the front door teams
Authors: Fitzgerald R , Cahill M , Cronin L , Leonard A , Coakley E , Allen S , Martin L , Condon F , Pillay I
Published: September 2023

Background

Older persons presenting with frailty syndromes, polypharmacy and significant comorbidities to Emergency Departments (ED) have a higher rate of adverse outcomes. The aim of this study was to describe medication related needs of persons over 65 years seen by a Frailty at the Front Door (FFD) team in ED.

Methods

CGAs were performed by an inter-disciplinary team (IDT) between January–December 2022, and included a pharmacy prioritisation toolkit, collecting data including excessive polypharmacy, use of high-risk medications, specific patient or carer medication concerns, fall or medication-related admission and kidney injury. Age, gender, CFS, pharmacy toolkit triggers and specialist Geriatrician review were entered onto Excel and analysed using descriptive statistics.

Results

529 CGAs were included. 60 were excluded due to incomplete data (n = 57) or aged under 65 years (n = 3). Mean (SD) age 82.9 (7.9) years. Female:Male ratio 1.5:1. Mean (SD) CFS = 5.2 (1.1). 25% (n = 131) had a fall or medication-related admission. 20% (n = 109) had an acute kidney injury (AKI) or chronic kidney disease (CKD). 26% (n = 141) had excessive polypharmacy. 53% (n = 284) were on one or more high risk medications. 9% (n = 50) had a specific medication concern. 46% (n = 246) triggered for pharmacy review. 72% (n = 178) required specialist geriatrician review.

Conclusion

Use of high risk medications, excessive polypharmacy and medication or fall related admission are the most common reasons for pharmacy review. Specialist geriatrician review is needed in the majority of cases to assess medication-associated risk and effectively deprescribe. There is a need to develop pathways of care that allow for pharmacy and Geriatrician review of approximately half of older persons seen by an FFD.