bluuebunny/crossref_metadata_2025 huggingface dataset:
274 Regular dog walking is associated with reduced likelihood of unexplained falls, fear of falling and mobility problems in later life
Authors: Gallagher E , Briggs R , Kenny R A
Published: September 2023

Background

It has been suggested that regular dog walking may confer important health benefits in later life, including reducing the risk of falls, but little work has been done to date examining this. The aim of this study therefore was to assess whether community-dwelling older people who regularly walk their dog had reduced likelihood of falls, fear of falling and mobility problems.

Methods

At TILDA Wave 5, self-report was elicited from participants aged ≥60 years (n = 4,161; Mean age 71 years; 54% female) for dog ownership and frequency of dog walking. Regular dog walking was ≥4 days/week. Incidence of unexplained falls (not caused by a slip/trip) in the last 2 years was also by self-report. Fear of falling was defined as answering ‘yes’ to: ‘Are you afraid of falling?’ Mobility was measured with the Timed-Up-and-Go (TUG). Abnormal TUG was ≥14 seconds. Logistic Regression models reporting odds ratios assessed the association between regular dog walking and outcomes of interest, adjusting for age, sex, marital status, educational attainment, alcohol excess.

Results

15% of participants (629/4,151) were regular dog walkers. Dog walkers had a significantly faster TUG than non-dog walkers (10.3 [95% Confidence Interval [CI] 10.1–10.5]) vs 11.7 (95% CI 11.1–12.2) seconds). Regular dog walkers had a lower likelihood of unexplained falls (OR 0.59 (95% CI 0.37–0.95; p = 0.028), fear of falling (OR 0.78 [95% CI 0.63–0.96]; p = 0.022) and mobility problems (0.62 [95% CI 0.43–0.89]; p = 0.009) in fully adjusted models.

Conclusion

Cross-sectionally, regular dog walkers were less likely to report unexplained falls and fear of falling and had better mobility (by TUG) than non-dog walkers, after robustly controlling for covariates. While longitudinal data confirming the direction of the association is required, older people should be encouraged to continue regular dog walking where feasible.
43 Nursing Home Residents presenting to the Emergency Department; what can multidisciplinary, integrated frailty teams offer?
Authors: Cronin L , Leonard A , Pillay I
Published: September 2023

Background

Comprehensive Geriatric Assessment (CGA) in the Emergency Department (ED) may provide opportunities to improve care of Nursing Home Residents (NHR). The aim was to develop an abbreviated CGA (aCGA) for NHRs presenting to the ED and identify their multidisciplinary care needs.

Methods

The existing Frailty at the Front Door (FFD) CGA was simplified. Over a three-month period, consecutive patients over the age of 75 years in an age friendly hospital accredited emergency department, were selected by address from iPMS and underwent an aCGA. Age, gender, Clinical Frailty Score (CFS), 4AT, excessive polypharmacy, high risk medications usage, 4QT swallow screen, MST nutrition screen, need for physiotherapy and/or occupational therapy input, use of intravenous (IV) antibiotic therapy and the number of those experiencing their last 1,000 days was entered prospectively onto an Excel database. Data was analysed using descriptive statistics.

Results

104 NHR presented to the ED, 59 of which (57%) underwent an ‘a-CGA’. Co-ordinated care was then delivered through the FFD. The mean (SD) age was 85 years (+/−6.5). Male to female ratio was 2:1. The mean CFS was 6.6(+/−0.5) 0.39% (n = 23) were at risk of delirium (4AT ≥ 2), 80% (n = 47) had excessive poly-pharmacy or were prescribed high risk medications, 63% (n = 37) presented with dysphagia, 50% (n = 30) were at risk for malnutrition (MST ≥ 2), 39% (n = 23) required trans-disciplinary assessment of function/mobility, 52% (n = 31) required IV antibiotics and 20% (n = 12) were experiencing their last 1,000 days.

Conclusion

The aCGA effectively identified frailty syndromes, triggering early input from the ED based interdisciplinary team. A significant number of NHRs were in their last 1,000 days. Administering IV antibiotics in nursing homes with on-site access to the wider multi-disciplinary team would address the needs of many NHRs who currently have no option other than admission to hospital. For those in their last 1,000 days particularly, this would represent a more person-centred approach.
55 Dysphagia identification practices in residential long-term care settings in the Republic of Ireland: a cross-sectional electronic survey
Authors: Artiles C E , Mooney M , Regan J , Donnellan C
Published: September 2023

Background

Dysphagia is common in older adults with neurological and/or neurodegenerative conditions requiring early identification to avoid serious complications, including malnutrition, dehydration and aspiration pneumonia. The aim of this study was to describe dysphagia identification practices in Residential Long-Term Care Settings (RLTCS) in the Republic of Ireland.

Methods

A cross sectional electronic survey was designed using Qualtrics XM Platform that included 40 questions divided in 5 sections. The survey was circulated via email to RLTCS to be completed by either a clinical nurse or nurse manager in each facility. Descriptive data analysis was conducted on survey responses using RStudio.

Results

There were 45 surveys completed out of N = 429 electronically circulated (10% response rate). All RLTCS that completed the survey reported to routinely implement dysphagia identification practices. Observation of signs and symptoms of dysphagia at mealtimes (100%), review of clinical records to identify dysphagia risk factors and comorbidities (93%) and resident self-report of swallowing difficulties (91%) were the most common dysphagia identification practices. Poor oral motor function (89%) and history of aspiration pneumonia (87%) were reported as the main dysphagia risk factors. A swallow screening test was less commonly used to identify dysphagia (42%). Coughing or choking on food or fluids, inability to swallow medication, oral or pharyngeal residue, delayed or absent initiation of swallow, leaking of food or fluids and difficulty with coordination of breathing and swallowing were identified by all respondents as key criteria for risk of dysphagia. Almost all participants reported that residents at risk of dysphagia were routinely referred to speech and language therapy services for further assessment.

Conclusion

A range of practices were identified in RLTCS that participated in the survey. Further research approaches are required to provide a more in-depth perspective of dysphagia identification practices and protocols used in RLTCS for timely and accurate identification of dysphagia to avoid associated complications.
60 Surgical inpatient delirium: a re-audit of the documentation of the 4AT score
Authors: Koay W J , Wilkinson G , Cohalan D , Burke P , Vallely S , Byrne C , O'Scanaill P
Published: September 2023

Background

Postoperative delirium and perioperative neurocognitive disorder are the commonest postoperative complications in patients over 65. This has implications for brain health, hospital length of stay and incidences of morbidity and mortality. Our aim was to perform a re-audit of the documentation of 4AT scores for surgical inpatients >65 following educational sessions across key ward-based staff (medical, nursing, and allied-health).

Methods

Using the guidelines for Perioperative Care for People Living with Frailty undergoing Elective and Emergency Surgery from the Centre of Perioperative Care (CPOC) and the British-Geriatric-Society (BGS) as a standard, a re-audit of surgical inpatients >65 was performed on four surgical wards over two weeks. Data was collected on 4AT documentation on admission, day one and day three post-operatively, type-of-surgery, anaesthesia and risk factors for delirium (dementia, polypharmacy, opioid & benzodiazepine use, alcohol excess, ≥2 medical co-morbidities, number of ward moves and surgery >2 hours).

Results

Of the 55 surgical patients, the average age was 76 (65–93). 32.7% of patients presented for hip fracture surgery (n = 18), 40% abdominal/pelvic surgery (n = 22), 15% other surgeries (n = 15). 35% of patients (n = 19) had baseline 4AT documented preoperatively compared to 25%(n = 9) in the initial audit. 4AT score documentation during admission was 47.3%(n = 26) compared to 33%(n = 11). ≥2 surgical risk factors for delirium were found in all patients. The incidence of delirium was 14.5% with eight patients having a 4AT score > 4. Patients who developed delirium had 3–8 risk factors. Four of eight patients with delirium had pre-existing cognitive impairment and/or dementia.

Conclusion

There was an increase in frequency of 4AT assessments as a delirium screening tool in our cohort following successful collaboration between medical, surgical, anaesthesia, nursing and allied-health staff. Regular educational sessions to maintain awareness and screening of delirium peri-operatively in surgical patients >65 will be a focus for continued quality improvement.
61 Dietetics addition to a frailty intervention team—an analysis
Authors: McGuinness A , Julian S
Published: September 2023

Background

A Frailty Intervention Team (FIT) for those >75 years was established at Wexford General Hospital (WGH) Emergency Department in 2018 comprising Nursing, Physiotherapy and Occupational Therapy.

In January 2022 support from Dietetics and Speech & Language Therapy were added. We aimed to analyse the first 50 dietetic contacts as part of this service improvement, as limited data is available about nutritional needs of the older population presenting to the ED.

Methods

This study was a retrospective service analysis which received audit committee approval. Comprehensive Geriatric Assessment (CGA) was performed. The Mini Nutritional Assessment-Short Form (MNA-SF) was used as a screening tool. Referral occurred if MNA-SF ≤11/oral nutrition supplements (ONS)/wound healing concerns.

Results

Participants were aged 72–99 years (30% > 90 years). Clinical Frailty Scale was 4–7. 13 (26%) were advised in ED. 19 (38%) necessitated hospital admission: assessment/care plan implemented in ED. 8 (16%) discharged before seen: 7 received telephone consultation <1 week, 1 non-responder.

10 (20%) queries: consultation not necessary (known to dietitian, or concerns but stable/improving). On Assessment (n = 50), 41% were malnourished/risk of malnutrition, BMI where available 16-30 kg/m2, 5% pressure sore. 27% ONS already prescribed. Intervention (n = 39) included dietary advice adaptations indicated included energy dense (87%)/meal provision (57%)/constipation (30%)/renal (30%)/dysphagia (15%)/eat well (10%). 72% had ONS review/commencement. Admission care plans included recording of intake/management refeeding syndrome risk (10%)/prescription of appropriate diet or ONS. Outcomes included (n = 39): 19 (49%) inpatient follow-up, 13 (33%) referred to GP care, 4 discharged and 3 discharged to usual dietitian.

Conclusion

This analysis confirms the extent of malnutrition/malnutrition risk in this cohort (41%), comparable to the UHL OPTI-MEND study (36.6%). Dietetic needs in this population are diverse. Those categorised as queries where dietetic consult not indicated highlights new service education needs. This development facilitates prompt access to dietetic assessment/advice, ensures early implementation of appropriate nutrition care plan for the high numbers necessitating admission, and enables admission avoidance.
62 Falls prevention is everyone’s business
Authors: Mangan B , McDonnell C , Nunan M , Daly C , Gannon E
Published: September 2023

Background

Falls among inpatients are the most commonly reported incident within the HSE and HSE funded services (NIMS). For older persons with multiple comorbidities and frailty, even a ‘minor’ injury following a fall can have a significant effect in terms of impaired or delayed rehabilitation, loss of confidence, longer stay in hospital and ultimately, a poorer quality of life. In our Hospital as part of our fall prevention strategy, an education programme for all Staff was launched to raise awareness of falls prevention and management of patients post falls.

Methods

In 2021 Ward A, a post -acute care rehabilitation ward had a high incidence of falls N = 56. In collaboration with Ward A’s Clinical Nurse Managers, Falls Prevention Committee, Quality Improvement and Practice Development Department a plan of action was developed to reduce the number of patients’ falls. Formal Monthly Education Awareness training for all Staff and informal Ward based training were implemented which included: Overview of falls risk factors, Information on the impact of patient falls, A review of the Hospital’s falls prevention programme and policy, Roll out of a new Multifactorial Falls Risk Assessment form which addresses risk factors and interventions to reduce falls, Reviewing the link between falls and frailty, Promoting safe mobility and activity for patients, Falls Safety Cross—to raise awareness within the team and others regarding the falls/near misses being tracked monthly and Post-fall management of patients.

Results

In 2021 Ward A recorded N = 56 patient falls. Following the above interventions, the number of patient falls reduced to N = 37, 34% by Quarter 42,022. Staff evaluation highlighted that staff knowledge and awareness of falls prevention and post fall management had increased.

Conclusion

Falls awareness training had a positive impact on reducing falls in a Rehabilitation ward.
88 An audit of the quality of documentation during the end of life phase of older adults in acute hospital settings
Authors: Plant R , O'Flynn F , Rubel M
Published: September 2023

Background

End of Life Care (EoLC) is commonly provided to Older Adults presenting to acute stroke or medical services. Death is considered a ‘poor medical outcome’ but a ‘good death’ is of medical, cultural and spiritual significance for patients and families. Our audit aimed to examine how well medical staff document quality indicators of the EoLC phase of hospital care in a cohort of older adults who died on the geriatric and stroke medicine services.

Methods

Inclusion criteria were patients who died under the care of the Stroke or Acute internal Geriatric Medicine department between May to October 2022 aged >75. We collected data using the BMJ Support Palliative Care Journal ‘Guidance for completing End of Life Structured Judgement Review’. Data points included recognition of dying, communication with patients and their families, palliative interventions and pastoral care.

Results

28 patients were identified with a diagnosis of stroke. 17 patients were identified from AIGM. Data described as Stroke vs AIGM. Recognition of dying was documented in 92.9% (26/28) vs 94.1% (16/17). DNAR was documented in 100% (26/26) vs. 100% (16/16). An escalation/de-escalation plan was documented in 84.6% (24/28) vs. 75% (13/17). Risk of dying was communicated to: the patient 3.6% (1/28) vs. 0% (0/12); family 75% (21/28) vs. 59% (10/17). Anticipatory medicine were: prescribed; 94.1% (26/28) vs. 92.9% (16/17); administered: 85.7% (24/28) vs. 82.4% (14/17); evaluated for effect; 78.6% (22/28) vs 70.6% (12/17). Documentation of spirituality: 17.9% (5/28) vs. 5.9% (1/17). Documentation of available chaplaincy service 17.9% (5/28) vs 5.9% (1/17). Patient’s wishes around dying documented: 7.1% (1/28) vs 0% (0/17). Palliative Care services were consulted in 14.3% (4/28) vs 29.4% (5/17).

Conclusion

Further improvement, via education and awareness, is needed around the documentation of EOLC by medical staff, particularly in regard to communication to families and referral to pastoral care services.
91 Audit of percentage of stroke patients having swallow screen performed within 4 hrs of diagnosis on the stroke ward in OLOL Hospital Drogheda
Authors: Clancy C
Published: September 2023

Background

The swallow screen has become an imperative method of identifying those post-stroke patients in the hyperacute setting who are high risk for developing a swallowing abnormality which confers a higher risk of aspiration pneumonia and the associated morbidity and mortality effects of same. The HSE’s National Guideline for Swallow Screening 2017 states that swallow screen should occur within 4 hrs of diagnosis and so we compared our attainment levels in OLOL Hospital Drogheda stroke ward to the national standard.

Methods

We looked at 1 calendar month (January 2023) and collected data from HIPE records based on the number of patients discharged from the stroke ward within that month who had confirmed stroke diagnoses by the time of discharge. Within this number, we looked at not only those who had a documented stroke screen within that period within the medical notes but also those who attained national standard of assessment within 4 hrs.

Results

We found that there were 29 stroke confirmed patients discharged from the stroke ward within the month of January. Of these 29 patients, 24 had a documented swallow assessment done during the admission, with only 3 patient having that screen done within 4 hrs of diagnosis.

Conclusion

This study highlights the poor compliance in this level 3 stoke ward with national swallow screen guidelines in the hyperacute setting. The much improved overall screening numbers show that the majority of swallow screen assessments are taking place within hours, most likely by allied health professionals, senior nursing staff/ward managers or stroke specific medical staff. Therein lies a great opportunity to educate on-call NCHDs and Resus nursing/stroke ward staff nurses about the importance of early swallow screening with allocated teaching sessions and reminder charts, which will be the focus of my quality improvement project around same.
101 An audit of falls risk assessment in older adults in an Irish general practice
Authors: Fitzgerald A , Daly B , Dukelow T , Foley T
Published: September 2023

Background

Falls in older adults are common; 30% of over 65 s fall at least once a year, increasing to 50% in the over 80s. Falls are associated with significant morbidity and mortality. By 2020 the national economic burden of falls related injury is expected to exceed €2 billion. International guidance recommends annual screening for falls risk in older adults. The Chronic Disease Management programme (CDM) was introduced into Irish General Practice in 2020, but does not include falls risk assessment. The aim of our audit was to evaluate whether GPs are following international guidelines by routinely assessing falls risk in older adults.

Methods

A full audit cycle was completed in a large Irish general practice with a mixed population. Cycle 1: October 2022. Cycle 2: April 2023. Audit Standard: Opportunistic case finding as per the September 2022 World Guidelines for Falls Prevention and Management in Older Adults: A Global Initiative. Criteria: All patients 65 years of age and older should be asked 3 Key Questions (3KQ): (1) Any falls in the last year? (2) Any unsteadiness when standing or walking? (3) Any fear of falling? All patients meeting referral criteria should be referred. Falls prevention advice should be given routinely. Inclusion criteria: Patients aged 65 years and over attending for routine CDM GP review. Intervention: Practice education session, falls algorithm in every room, consensus meeting.

Results

Cycle 1, 34 patients: (a) 3KQ 0% (b) appropriate referrals 75% (c) falls risk advice 9%; Cycle 2, 32 patients: (a) 3KQ 50% (b) appropriate referrals 89% (c) falls risk advice 22%.

Conclusion

This audit shows that a targeted falls risk assessment, completed as part of the CDM reviews, leads to a significant improvement in adherence to international falls guidelines. We suggest that this is a feasible intervention, and recommend the incorporation of a falls risk assessment in the chronic disease management template.
156 Capturing older adults’ rehabilitation needs and complexity in a rehabilitation hospital
Authors: Fenton L , McDaid E
Published: September 2023

Background

The Rehabilitation Complexity Scale Extended (RCSE) can measure both the rehabilitation needs and complexity of a patient group as well as the services and resources required to meet their needs. The tool is now used in Ireland to identify rehabilitation needs for both trauma and neurological rehabilitation. This pilot explored its application in an older adult’s rehabilitation unit to measure both rehabilitation complexity and outcome.

Methods

The RCSE was completed on admission and discharge for all older adults admitted to the unit during the pilot (March–May 2023). An analysis of the RCSE scores was completed using Microsoft Excel. Paired T Test was used to measure change in RCSE from admission to discharge.

Results

Forty-four patients were admitted during the RCSE pilot. The mean admission RCSE score was 10.5, median 10. The highest scoring domain was therapy need (mean 2.6, median 3) indicating 4–5 HSCP disciplines were required to meet their rehabilitation needs. The mean therapy intensity score was 2 indicating that daily individual therapy sessions was required to meet their rehabilitation needs. The mean nursing need score was 2 indicating most patients required nursing staff who were training or experienced in rehabilitation. Discharge RCSE was completed on 20 patients (mean score 1.7) and there was a significant decrease in mean discharge RCSE score (p < 0.0001) compared to admission. On discharge most patients had minimal rehabilitation needs, the mean therapy need score was 0.7 (median 1) reflecting those referred onward for low-intensity or maintenance rehabilitation input.

Conclusion

The RCSE was feasible to use as an outcome measure in an older adult’s rehabilitation unit. The primary domain of complexity in this sample was the number of disciplines needed and the high intensity of intervention required. This highlights the need for appropriately resourced and skilled rehabilitation services for older people in Ireland.
162 Establishing a geriatric friendly Emergency Department in Ireland with a checklist and gap analysis
Authors: Hay A , McCabe A
Published: September 2023

Background

The population is ageing rapidly worldwide and in Ireland there has been a significant year on year increase of patients over sixty five presenting to the Emergency Department (ED). With the complexity of older patients, there is a focus on the creation of a department that caters to their needs.

Methods

A scoping literature review was performed to identify a checklist that could be utilised for establishing standards for a Geriatric Emergency Department. It was decided to use the ‘The Geriatric Emergency Department Guidelines’ written by the American College of Physicians et al1 as a model. This was then adapted to the Irish ED. Subsequently we applied this checklist to analyse the components that were in place within our own department.

Results

This study took place in a tertiary university hospital which sees over 50,000 patients per year. Within the ED there is a multi-disciplinary Geriatric Emergency Department Intervention Team (GEDI) in place and an Age Related Assessment Unit (ARAU) has recently been opened. Upon performing the gap analysis the majority of items on the checklist are in place with these resources. Those that are missing include certain members of the multidisciplinary team due to national issues with staffing and environmental constraints secondary to overcrowding within the ED. Despite these universal challenges, areas of improvement that are achievable in both the short and long term were identified.

Conclusion

An Emergency Department that caters to the older population is increasingly important. With the creation of a checklist and gap analysis demonstrating ease of use, essential components of care can be identified and readily implemented to create a department suitable for the older person.
181 The experiences and perceptions of community volunteers in providing nutrition care supporting older adults: a qualitative evidence synthesis
Authors: Griffin A , González B M , Escárcega P S
Published: September 2023

Background

Nutrition care is crucial for the well-being of older adults but can be complex. It involves many healthcare professionals, family, carers and community supports. In numerous situations, volunteers are involved in community and social support initiatives that could have an impact on nutrition care and malnutrition. This study aimed to synthesise and explore the perceptions and experiences among community voluntary service providers of their role in supporting nutrition care among community-dwelling older adults.

Methods

A systematic search of seven databases (Scopus, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and PsycINFO) was conducted with the following 4 key terms, ‘Community voluntary providers’, ‘Nutrition care’, ‘Older adults’ and ‘qualitative’ using Boolean operators. There was no restriction on publication date or language for this search, each database was searched from its origin to the present. Meta-ethnography was used to synthesise data in a descriptive-integrative approach. NVIVO was used to create codes for the selected articles.

Results

The systematic database search resulted in the identification of 275 articles and one more article through reference list filtering. For this qualitative evidence synthesis, two publications were included after applying an exclusion process. Four themes were identified from the first and second-order data: (1) providing social interaction, (2) supporting independent living, (3) benefits for all, and (4) early warnings of health changes. These themes describe the positive experiences for the volunteer and the client, and the impact of volunteering.

Conclusion

The interactions between older adults and volunteers, as well as the connections they form through frequent contact, enable volunteers to identify issues or sudden health changes in individuals. Volunteer meal delivery schemes allow older adults to continue living independently in their own homes. However, there is a need to assess the impact of these interventions on older adults health outcomes and experience.
188 Characteristics and outcomes of long-term care facility residents acutely admitted to hospital
Authors: Power L , Rana W , Coen N , Bambrick P , Mello S
Published: September 2023

Background

Long-term care facility (LTCF) residents represent the frailest members of society and are three times more likely to attend the Emergency Department (ED) than older persons residing in the community. They are also more likely to suffer adverse events when admitted to hospital. This study aims to describe the profile of LTCF residents admitted to hospital in order to inform the implementation of a new nursing home liaison service as part of the Enhanced Community Care program.

Methods

All LTCF residents with acute admission to a model four hospital in 2022 were identified through the Hospital In-patient Enquiry (HIPE) database, and address of residence was verified using the Integrated Patient Management System (IMPS). Demographic and outcome data including International Classification of Diseases (ICD-10) diagnosis, Length-of-Stay (LoS), in-hospital complications, and mortality were analysed retrospectively.

Results

There were 724 ED attendances, resulting in 447 acute admissions by 327 residents. The majority of residents (63%, n = 281) arrived to the ED outside of normal working hours. The average age was 84 (range 46–102), and 60% (n = 194) were female. Most were admitted with infection (50%, n = 225), followed by fall with a fracture (16%, n = 70). The median LOS was 8 days (range 0.5–112), and 11% (n = 37) of residents died in hospital. Complications were common with 27% (n = 120) suffering from delirium, 8% (n = 37) falling, and 7% (n = 33) contracting Covid-19 in hospital.

Conclusion

LTCF residents frequently present with acute unscheduled care episodes. Around 40% of LTCF residents attending ED are not admitted, but those who are have a significant LoS fraught with complications. This study will inform the implementation of the nursing home liaison service with strategies aimed at reduction in potentially avoidable admissions, and alternative provisions of care targeted at common reasons for hospitalisation in this group.
190 Catheterisation and its effects: observations from an acute hospital point prevalence study
Authors: Murphy E , Callaghan N O , Leonard S , Titiloye A , Naqvi S , O’Connor M
Published: September 2023

Background

Catheterisation is associated with negative health outcomes most importantly a 2.8-fold increase in mortality. We examined the duration of and indications for urinary catheterisation insertion in all admission in a Model 3 hospital.

Methods

At a single timepoint data were gathered on all inpatients in the hospital, excluding the Emergency Department and the Intensive Care Unit. Biographical data, admission diagnosis, diagnoses 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 and nursing documentation.

Results

6% of the study population had indwelling catheters prior to admission. On the day of data collection 21% of patients were catheterised. 24% of these newly catheterised patients had a documented trial of void performed. Of the 31 patients who had been catheterised within the last 15 days, only 16% had a trial of void. 30% of the newly catheterised had been so for longer than 15 days, only 55% of whom had ever had a trial of void. Reviewing admission diagnoses, 20% of the newly catheterised had had a hip fracture, and 4% had another reasonable indication for catheterisation. Of the 32 patients that did have a trial of void during their admission, 47% had failed, and remained catheterised, 31% were continent and 22% were newly incontinent. 42% of patients who required assistance of two for mobility were catheterised and 60% of those hoist dependent were catheterised.

Conclusion

There was a high prevalence of catheterisation in our study population. Despite evidence that early removal of a catheter is beneficial for future continence, trials of void were uncommon. Only 1 in 4 newly catheterised patients had a clear and reasonable indication for catheterisation recorded in the medical or nursing notes. Dependent mobility was a predictor of catheter use.
201 Prevalence of osteoporosis based on DXA criteria in large sample of older Irish adults attending GP or outpatient services
Authors: Fitzpatrick D , Lannon R , Laird E , Ward M , Hoey L , Hughes C F , Strain J J , Cunningham C , McNulty H , Molloy A M , McCarroll K
Published: September 2023

Background

Osteoporosis has a markedly increased prevalence in older adults with an associated risk of fragility fractures that can significantly impact on morbidity, quality of life and mortality. Despite this, osteoporosis is both underdiagnosed and undertreated and its true prevalence in older Irish adults is not known. In this study, we evaluate the prevalence of osteoporosis in Irish adults aged ≥60 years and also examine its determinants.

Methods

Participants were from a large cross-sectional study of older Irish adults aged ≥60 years. We excluded those with a known diagnosis of osteoporosis and on pharmacological treatment for same. We also excluded participants with major risk factors for osteoporosis (history of any previous fracture, aromatase inhibitors, androgen deprivation therapy and current or long-term glucocorticoid therapy >3 months). We used logistic regression to assess the relationship between osteoporosis (defined by WHO criteria—DXA T-score < −2.5 at lumbar spine, total hip, or neck of femur) and potential predictor variables.

Results

There were 1,089 participants. Mean age was 70.0 ± 6.2 and 59.8% were female. 15% had osteoporosis and 47% osteopaenia. The only positive independent predictors of osteoporosis were body mass index (p < 0.0001) and 25-hydroxyvitamin D (p = 0.007) while negative predictors were female sex (p < 0.0001), older age (p = 0.037) and glomerular filtration rate (p = 0.028).

Conclusion

Almost one in six older adults with no history of fracture or major risk factors for bone loss had osteoporosis. However, half had osteopaenia and overall, two thirds had low bone density. The major predictors of osteoporosis were consistent with other studies. As the mean age in our sample was 70, the prevalence may be much greater with advancing age. The findings support international guidelines which recommend routine DXA screening for women aged ≥65 years and men ≥70 years or at a younger age if risk factors for low bone mass.
213 A Frailty Intervention Therapy Team (FITT) trialling extended hour’s service within a level 3 Emergency Department
Authors: Bell A , Murphy K
Published: September 2023

Background

Older adults with frailty in the Emergency Department (ED) often present with complex needs requiring a holistic approach to their care. Research has shown the effectiveness of Frailty Intervention Therapy Teams (FITT) in the ED to help reduce hospital admissions as well as improve patient and staff satisfaction. Majority of these teams are working standard working hours with many complex patients presenting outside of these times. The aim of this trial was to assess the benefit of providing this service to older adults that present later in the day.

Methods

Over a one month period an extended hour trial was completed by the 2 Physiotherapists on the FITT which included cover until 6 pm Monday- Friday. The FITT takes a blanket referral system for those ≥75 who present to the ED and all patients reviewed received a routine interdisciplinary assessment.

Results

Over the month 244 patients were screened by FITT with 18%(n = 44) of the patients screened in the extended hour period. This was an increase in patients assessed compared to the previous month (n = 191). Of these patients 80% were deemed frail (Clinical Frailty Score 4–7). We assessed 55%(n = 135) of patients within 2 hours of presenting to ED compared to 50%(n = 95) in the previous month. Of the patients seen in the extended time frame 32% (14) were discharged directly home & 40% (n = 6) were discharged with a new community referral. The admitted patients had an average length of stay(LOS) of 6.5 days compared to the hospital average length of stay of an admitted patient (10 days).

Conclusion

Providing an extended hours service enables a larger proportion of frail older adults to be assessed by the FITT. This facilitates an earlier supported discharge and if admitted improve their outcomes while in hospital.
224 Profiling the first service users of a Community Specialist Team for older persons: a retrospective chart audit
Authors: Wade R , Burke K , Connolly W , Devitt A , Dore F , Ciuba D , Cooney F
Published: September 2023

Background

Community Specialist Teams (CST) are a promising approach to reduce reliance on acute care and improve healthcare delivery for older people. This study aimed to profile the initial cohort of service users to a CST as part of the National Integrated Care Programme for Older Persons (NICPOP), focusing on those who sought assessment through a newly established ambulatory hub or home visits.

Methods

Using a comprehensive retrospective chart audit, data from 70 service users assessed and discharged during the team’s first year were analysed using Microsoft Excel.

Results

The median age of clients was 80, with a range of 66 to 92, and 51% were female. The Clinical Frailty Scale (CFS) scores ranged from 1 to 7, with a median of 5. Notably, 80% of service users were classified as frail, as indicated by a CFS score of 5 or higher (36% CFS 5, 33% CFS 6, and 11% CFS 7). Additionally, 23% of the service users lived alone. The most common reasons for referral included functional decline (77%), post-stroke rehabilitation (9%), non-injurious falls (7%), and injurious falls (7%). Geographically, the two Community Healthcare Networks (CHNs) showed a distribution of 56% and 44% respectively. The average length of stay (LOS) of 10 weeks service exceeded the target duration of six weeks.

Conclusion

Overall, our findings confirm that the CST effectively targets the appropriate cohort in accordance with the NICPOP framework. However, the study highlights an extended LOS, surpassing the intended duration. It is crucial to identify potential contributing factors to this increase, such as challenges in accessing equipment, increased frailty, and the impact of remote addresses. To optimise service delivery, further research should prioritise investigating these factors, enabling the development of targeted interventions. The insights gained from this study lay the groundwork for future initiatives aimed at enhancing the quality of care for older people.
261 Perceptions of and attitudes towards problematic polypharmacy and prescribing cascades in older adults: a stakeholder analysis
Authors: Jennings A , Doherty A , Clyne B , Boland F , Moriarty F , Fahey T , Kennelly S , Wallace E
Published: September 2023

Background

Research to date on appropriate prescribing in older adults has focused on characterising inappropriate prescribing using explicit prescribing indicator tools. Less is known about other causes of problematic polypharmacy such as prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat or to prevent the symptoms of an adverse drug reaction and may be characterised as intentional or unintentional, as well as appropriate or inappropriate. Prescribing cascades, therefore, represent an important and under-researched area of problematic polypharmacy. The aim of this study was to conduct a stakeholder analysis (patients with polypharmacy; carers; General Practitioners [GPs]; hospital doctors; community pharmacists; professional organisation representatives and policymakers) to elicit perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades.

Methods

Qualitative one-to-one semi-structured interviews were conducted. Participants were recruited via a gatekeeper approach. Interview duration ranged from 58 to 80 minutes. Interviews were analysed thematically.

Results

Thirty-one participants (six patients, two carers, seven GPs, eight community pharmacists, four hospital doctors, two professional organisation representatives, and two policy makers) were interviewed. The challenges of communication at the interface of primary and secondary care were outlined, including the lack of clear ownership of drug monitoring. The community pharmacist and, at times, the patient were relied upon to fill in these gaps in communication. Patients discussed the burden of taking multiple medications. GPs described the importance of ‘mindful prescribing’ to avoid, where possible, unintentional prescribing cascades. The need for further education for health care professionals and patients on prescribing cascades was highlighted, as was the importance of improved collaboration between health care professionals.

Conclusion

Understanding the perceptions of different stakeholders towards problematic polypharmacy and prescribing cascades is key to the development of effective tools or resources to improve patient care.
278 Avoiding acute hospital admission through rapid access rehabilitation pathways for frail older patients through cross site integrated working
Authors: Magner S , Glynn M , Whelan M , Daly C , Callaly L , Purcell R , Byrne C
Published: September 2023

Background

Ireland’s population is ageing. Patients over 65 use over half of inpatient hospital beds. Prolonged Length of Stays (LoS) in ED and hospital increase risk of adverse outcomes. Barriers like complicated referral systems, ineffective communication across sites and reduced awareness of services contribute to delays in accessing timely rehabilitation. Aims include: (1) Establish alternative care pathways between ED, rehabilitation and community settings for frail older people; (2) To use a comprehensive geriatric assessment (CGA) as a single referral form.

Methods

Patients were identified in ED as suitable for direct transfer to rehabilitation, or discharge home with Community Specialist Team—Older People (CST-OP). The CGA was accepted as the handover document to all services. Patients in the community deemed to have increased rehabilitation needs could be admitted directly into inpatient rehabilitation. We analysed data from July to December 2022 for the ED, two rehabilitation sites, and the CST-OP.

Results

Patient were aged 66–101. The ED team saw 1,691 patients, 3.5% (n = 56) were transferred to offsite rehabilitation, and 3.7% (n = 63) discharged to the CST-OP. 69 patients were admitted across two rehabilitation units. 33% of patients seen in ED had evidence of a cognitive impairment, compared to 70% in rehabilitation. Approximately 80% of patients in rehabilitation had a Clinical Frailty Scale (CFS) of ≥5, compared to 60% ED patients. 16 patients represented to ED within seven days. On discharge from rehabilitation, 42% of patients required increased formal supports, compared to 3% from ED. Five patients discharged to the CST-OP required admission to inpatient rehabilitation. Average LOS for the rehabilitation units were 46 and 39 days. 9% of patients transitioned into nursing home care.

Conclusion

Shared clinical governance among geriatricians in different services facilitated integrated working of MDTs across sites. The teams have implemented end to end care pathways integrating front door frailty services, CST-OP and existing rehabilitation services.
281 Side-effects associated with IV Zoledronic Acid infusion in patients with osteoporosis
Authors: Maher N , Fallon N , Caraher J , Steen G , O’Carroll C , Fitzgerald D , McCarroll K , Lannon R
Published: September 2023

Background

Osteoporosis is a common condition affecting bone, leading to fragility and fractures. Oral bisphosphonates are the first line treatment for osteoporosis reducing vertebral, hip and non-vertebral fractures. However poor compliance and Gastro-Intestinal (GI) intolerance result in poor persistence. Intravenous Zoledronic Acid (IV ZA) is an effective alternative therapy, improving compliance and tolerability. Side effects have been reported such as fever, flu-like symptoms, myalgia, arthralgia, headache, uveitis, iritis and hypocalcaemia.

Methods

This prospective observational study was carried out in a dedicated Bone Health Service. Patients diagnosed with osteoporosis were assessed by the Bone Health team regarding suitability for IV ZA. Infusions were administered in a nurse-led IV ZA clinic. Pre and 1-week post infusion bloods including Renal, Liver and Bone profile, Parathyroid hormone, Vitamin D and bone markers- Osteocalcin, CTX, PINP were taken. Side effects post infusion were recorded.

Results

N = 189. 161:28 female to male ratio. Age range 32-90 years, median 61 years. All diagnosed with osteoporosis in hip and/or spine. Forty-three percent were bisphosphonate naïve. 51 (27%) attended GP for post infusion bloods while 7 patients received infusion while inpatients. 29% of those returning to clinic for post infusion bloods reported side effects. Treatment naïve and treatment experienced reported similar rate of side effect 21%/20% respectively. Most common side effects include flu-like symptoms (31%) with fatigue/tiredness/generalised aches and pains/GI upset 16% respectively. 10% reported headaches while 5% experienced sore/swollen eyes. Rash, swollen joints and pre-syncope experienced by 3% respectively. Symptoms resolved after 24-48 hrs.

Conclusion

IV ZA is a well-established treatment for osteoporosis particularly for patients intolerant or poorly compliant with oral bisphosphonate therapy and an accepted treatment to close-off Denosumab. According to our study IV ZA is well tolerated with self-limiting side effects. However, pre infusion screening is essential to deem suitability.
330 Evaluating anticoagulant prescribing errors in older adults in a rehabilitation setting
Authors: Merron G , Killeen E , Davey N , Pereppadan B , Fallon A , McDonough A
Published: September 2023

Background

Anticoagulant use is common in older adults for the prevention or treatment of a number of conditions, most commonly Venous Thrombo-Embolism (VTE) or to prevent stroke in atrial fibrillation. Our audit aimed to review anticoagulation prescribing practices, identify errors and areas for improvement.

Methods

The initial retrospective audit of all inpatients in a medical gerontology ward took place from 15/11/2022–30/12/22. Data collected included age, sex, weight, renal profile, anticoagulation type, dose and indication. Information was collected from medication records, clinical notes and online laboratory system. After initial audit, multiple education sessions were conducted with the medical team. Re-audit of all inpatients occurred from 05/04/2023–25/04/2023. The guidelines used were the HSE Prescribing Tips for Anticoagulation and local Hospital Guidelines on VTE prophylaxis.

Results

The initial audit of 73 patients showed 15% (11) rate of prescribing error with 7 subtherapeutic and 4 supratherapeutic doses. Of these 11 errors, 4 doses were corrected recently prior to audit. Average age was 82.6 (64–100) and 55% (40) were female. The re-audit of 51 patients showed the rate of error improved to 7.84%(4) with 4 supratherapeutic doses. 1 dose was corrected on admission and 5.88%(3) required dose adjustment due to fluctuations in weight and renal function throughout admission. Average age was 83.1(66–103) and 69%(35) were female.

Conclusion

The re-audit demonstrated ongoing education sessions reduces prescribing error with a 48% reduction. However ongoing monitoring throughout admission is required to account for fluctuations in weight and renal function. Suggestions for further improvements include ongoing regular education sessions with the medical team. Further sessions are planned with the wider multidisciplinary team members to highlight importance of regularly monitoring weight and renal function and medication dosages. This audit also reinforces the importance of the role of pharmacist in the multidisciplinary team in Rehabilitation Units and would support regular pharmacist input on an regular basis.