bluuebunny/crossref_metadata_2025 huggingface dataset:
85 QUALITY IMPROVEMENT INITIATIVE TO ASSESS FRAILTY AWARENESS AND USE CLINICAL FRAILTY SCALE AMONGST STAFF IN ACUTE AND PRIMARY CARE SITES
Authors: Sweeney M , Thomas I , OReilly A , Duggan J , Conaty J , Smith B , Enaeney AM , Tackney L , Hopkins C , O'Reilly R
Published: October 2022

Background

Frailty describes a condition characterized by decreased physiological reserve and a decreased resistance to stressors, leading to an increased vulnerability to adverse outcomes. Identification of frailty can generate greater complexity in treatment choices, care planning, and costs of care.

Methods

30 inpatient, Emergency Department and Ambulatory Hub charts were audited to assess the presence of the word Frailty. The use of the Clinical Frailty Scale or alternative frailty scale was also audited. A staff survey was completed across four sites, a total of 115 staff were surveyed.

Results

Awareness of frailty across all services is very good ranging from 92% to 100%. The use and awareness of the Clinical Frailty Scale varied with 41% Emergency department and 12% of acute staff respectively but only 25% Emergency Department and 12% of acute staff feeling competent to complete the scale. Conversely, there was a 73% awareness of the Clinical Frailty Scale amongst primary care staff, 33% feeling competent in it's use. The Ambulatory Hub had 100% awareness of the scale with 54% of staff feeling competent.

The chart audit showed that 20% of charts in the Emergency Department identified frailty, all by the Frailty Intervention Team. 26% of the inpatient charts identified Frailty by the Frailty Intervention Team's notes and from one visiting consultant. Frailty was identified and measured using the Clinical Frailty Scale in all cases of the Ambulatory Hub notes.

Conclusion

By identifying frailty at the first point of contact, targeted specialist interventions and services can be planned for the service user. Frailty identification on the acute site was mainly linked to the Frailty Intervention Team with the Ambulatory Hub leading out on frailty identification and measurement in the community. Future initiatives aim to increase frailty identification and awareness in acute and primary care sites.
86 STAFF EXPERIENCES OF COVID-19 MANAGEMENT IN A LONG-TERM CARE FACILITY FOR OLDER PEOPLE IN IRELAND
Authors: Savolainen K , Ahern A
Published: October 2022

Background

Long term care (LTC) facilities for older people have been challenged by COVID-19 in an unprecedented manner. The impact of COVID-19 on health care professionals working in LTC facilities for older people is emerging as a crucial topic. Healthcare workers in LTC for older people were already pre COVID-19 experiencing high levels of stress and compassionate fatigue. The aim of the study was to capture the experiences of staff working during COVID-19 pandemic in a LTC facility for older people in Ireland.

Methods

Semi-structured interviews were conducted with 28 participants who were staff members, both clinical and non-clinical, in a LTC facility for older people in Ireland. Informed consent was obtained from all participants in accordance with the principles of the Helsinki Declaration. Data were interpreted using thematic analysis which allows for patterns of meaning to emerge by creating themes.

Results

21 clinical and 7 non-clinical staff members participated in interviews conducted between June and September 2021. Through analysis four main themes were identified: ‘Fear of COVID-19’, ‘Coping’, ‘Crisis and communication’ and ‘Teamwork’. Themes were interlinked with each other and mainly highlights the high level of adaption by staff in various roles during a time of uncertainty.

Conclusion

The findings are supported by previous studies into staff experiences of COVID-19 in which the level of uncertainty and stress caused by COVID-19 impacted staff on both professional and personal levels. Although positive examples of strong teamwork and a sense of working together were found, there was also fatigue as the pandemic continues. Future studies into staff stress levels and coping with COVID-19 should include the voices of healthcare professionals in LTC facilities for older people.
88 NATIONAL ANTIMICROBIAL POINT PREVALENCE SURVEY IN HSE OLDER PERSONS RESIDENTIAL CARE FACILITIES (OPS-RCFS)
Authors: Clancy A , Regan M , Armitage S , Shah M , Mannion C , Gallagher O , Foran R , Fagan S , Donnelly M , Love B
Published: October 2022

Background

The HALT study in 2016 found that residents in Irish OPS RCFs were twice as likely to be on systemic antimicrobial compared with European average (10% v 5%). National antibiotic prescribing guidelines are available at www.antibioticprescribing.ie and prescribers are encouraged to choose ‘green’ (preferred) over ‘red’ (reserved) agents. HSE Community Antimicrobial Pharmacists (AMPs) have been employed since 2020. We aimed to establish the quality and quantity of antimicrobial prescribing in OPS-RCFs to inform antimicrobial stewardship activities.

Methods

All residents in HSE OPS-RCFs were surveyed between October 2020 and August 2021. AMPs reviewed all medication charts for systemic antimicrobials prescribed within previous 30 days. Medical notes +/- laboratory results were reviewed for persons on antimicrobials. Adherence to guidelines was assessed and information obtained on practices related to antimicrobial use.

Results

The survey included 4,448 individuals in 121 OPS RCFs. 12% were on systemic antimicrobial at time of survey. 27% received an antimicrobial in the previous 30 days. 50% of antibiotic use on survey day was for prophylaxis (6.3% of all residents). Prophylaxis exceeded 6 months in 66% persons, and 12 months in 57%. There was high usage of green versus red agents (65% vs 30%). Co-amoxiclav (red) was most commonly prescribed antimicrobial to treat infection (19%). 42% of sites reported routine use of dipstick urinalysis to support diagnosis of UTI in asymptomatic residents. 36% of sites did not have onsite electronic laboratory access. 61% of facilities did not record residents’ pneumococcal vaccination status.

Conclusion

Key national recommendations: Review all UTI prophylaxis within 6 months of initiation with view to de-prescribing.Cease routine use of dipstick urinalysis to support diagnosis of UTI for asymptomatic persons.Electronic access to laboratory results on-site required to support timely decision-making.All staff should be aware of the national antimicrobial guidelines.Pneumococcal vaccine status should be determined, and provided as necessary.
91 MONITORING FOR CLINICAL DETERIORATION; NURSES EXPERIENCE USING MODIFIED IRISH NATIONAL EARLY WARNING SYSTEM IN AN OLDER PERSON RESIDENTIAL CARE SERVICE
Authors: Hogan FH , Ahern A , Savolainen K
Published: October 2022

Background

We are a 140-bed Care of the Older Person facility. Approximately 50% of Sepsis cases occur in this demographic. The Irish National Early Warning System (INEWS) is an early warning system to assist staff recognise and respond appropriately to clinical deterioration. Currently there is no INEWS for Older Person Residential Services. Challenges for treatment relating to deterioration in our service are; detecting ‘new confusion’, access to doctors, treatment options available and the necessity to transfer a resident to the Acute Care sector if intravenous antibiotics were required. We used the National Clinical Guideline INEWS Version 2 (2020) to develop a clinical monitoring and escalation protocol. This was rolled out December 2021.

Methods

A Nurses Opinion survey was carried out to determine Nurses experience with using the locally modified Early Warning System.

Results

There was a 63% (n=35) response rate. 100% reported improvement in identifying clinical deterioration in a timely manner and effective monitoring for deteriorating residents. 96% reported improvement in confidence with monitoring unwell residents, confidence with transfer out decisions and referring the resident to the doctor for review. 91% noted improvement in communicating residents’ condition to doctors. 87% improvement in clinical practice when monitoring vital signs. 82% improved communication using the ISBAR. On reviewing clinical documentation for all residents who had deteriorated post implementation there was a significant improvement in monitoring and documentation. 23% stated increased time and staffing levels were required for monitoring of residents. 9% stated doctors didn’t always understand the INEWS.

Conclusion

Implementation of the modified INEWS has resulted in considerably improved clinical monitoring, documentation, & Nurses confidence. Significant challenges remain including ethical issues with decision to transfer out a resident for treatment. Recommendations are upskilling of Health Care Assistants to carry out vital signs monitoring, robust advanced healthcare decision making and implementation of an INEWS for Older Person Services.
102 A REVIEW OF THE REFERRAL PATHWAYS & OUTCOMES TO RAPID ACCESS FRAILTY ASSESSMENT UNIT (RAFAU)IN A REGIONAL HOSPITAL
Authors: O'Keane C , Kemple O , Bocic D , McGlynn J , Donnelly T , Doherty JG , Synott L , Kennedy D
Published: October 2022

Background

The RAFAU is a Multidisciplinary Team including Medical, Physiotherapy and Occupational Therapy, incorporating a fulltime team of OT and PT based in the Emergency Department called RAFT (Rapid Access Frailty Team). It aims to prevent hospital admissions and social crises. There are three main referral pathways, via community (GP, Public Health Nurses, Allied Health Professionals), RAFT-ED, and general medical follow up.

Methods

The data used was from RAFAU attendances between May 2021 and March 2022. Inclusion criteria was age greater than 65 and attendance in person. Exclusion criteria was incomplete data. Data was manually recorded after each attendance using data entry points including age range, methods of and reason for referral, etc. This gave us the raw data to develop information on our cohort. Data analysis was completed using Excel.

Results

A total of 569 patients were seen. The most populous age brackets were 81-85 (28%), 70-75 (25%) and 75-80 (26%) respectively. The vast majority of referrals were from GPs (57%), followed by RAFT-ED (30%). The most common reasons for referral were Medical (34%), Cognitive (27%) and Falls (26%).

Conclusion

A significant number of patients were seen for the first time by the RAFAU MDT. GPs were the major source of referrals which is to be expected as GPs are in more frequent contact with patients and act as gatekeepers to specialist hospital services. The primary referral reasons were also to be expected as these are three issues that are at the core of Gerontology. 173 hospital admissions were prevented in the ED by a combination of the RAFT and Emergency Doctors. There is good rationale for keeping the RAFAU and RAFT-ED team, and where possible expanding their services. This model could easily be expanded to other hospitals.
105 EVALUATION OF A NEW PHYSIOTHERAPY-LED VESTIBULAR SERVICE EMBEDDED IN THE FALLS AND SYNCOPE UNIT
Authors: Bademosi O , Murphy N , Byrne L , Rice C , Briggs R , Lavan A , O’Callaghan S , Kenny RA , Cunningham C , Romero-Ortuno R
Published: October 2022

Background

Clinical presentations in the falls and syncope unit (FASU) are diverse and require a range of skillsets. Vestibular disorders amount to a significant proportion of presentations. In our FASU, we embedded a 0.5 FTE specialist physiotherapist with expertise in vestibular disorders to work alongside medical and nursing staff. We conducted a service evaluation of the activity of this new service.

Methods

Retrospective Service Evaluation Approval was granted by our Research & Innovation Office. Pseudonymised data was collected corresponding to all new FASU physiotherapy service attendances between August 2021 and May 2022. Descriptive statistics were complemented by a binary logistic regression model to establish independent predictors of more than one physiotherapy session being required over the period.

Results

There were 104 episodes recorded by the new service, corresponding to 101 unique patients. Mean age was 67.7 (SD 19.0, range 17-93), and 73.1% were women. 67% were treated and discharged in 1 session. On average, patients had had a mean of 2 falls prior to the consultation (range 0-25). 28.8% were using a walking aid, and 54.8% self-reported fear of falling. 25% of the referrals to the service were due to suspected vestibular disorders, 62% of which were directly treated by the physiotherapy service. The logistic regression model adjusting by age, sex, use of walking aid, number of falls, and fear of falling showed that only referral for vestibular disorder was an independent predictor of patients needing more than 1 physiotherapy treatment (OR 3.91, 95% CI 1.32-11.58, P=0.014).

Conclusion

Vestibular disorders are common in FASU, and a majority can be treated by a specialist physiotherapy service. Repeated vestibular maneuvers are often needed in such patients. A responsive, embedded physiotherapy service in FASU can directly address this need and further evaluation will focus on the impact of this service on avoidance of ED attendances.
109 FRAILTY CARE BUNDLE EAT WALK TALK: MAKING GERIATRIC ATTUNED CARE EVERYONE'S BUSINESS
Authors: Buckley M , Brolly A , Fitzmaurice K
Published: October 2022

Background

Older adults living with frailty are predisposed to functional decline, worsening malnutrition and delirium when admitted to the acute hospital. EAT, WALK and TALK is a comprehensive framework that promotes optimal nutrition and hydration, supports functional recovery and helps prevent delirium [1].

Comprehensive geriatric assessment and interdisciplinary care on an older adult ward can improve outcomes for older adults [2]. However, not all older adults receive care on specialist wards. The frailty care bundle framework could be utilised on general medical wards to apply older adult attuned principles of good care.

Methods

A quality improvement initiative using PDSA was undertaken. Engagement with stakeholders was made through the Quality and Patient Safety Committee. The overall aim was to prevent hospital associated functional decline by increasing mobility, improving nutrition and cognitive engagement on general medical wards. The blue plate initiative, patient mobility and delirium screening was audited.

Results

The audit showed a 13.3% reduction in patients screening positive for delirium and a 100% increase in the use of delirium care plans. Nutritional intake had improved by 50% with the addition of blue crockery. Baseline mobility audit showed gaps in communication between health professionals. Whiteboards were introduced to address this.

Conclusion

The EAT WALK and TALK care bundle prioritises the critical components of good care for the older person living with frailty. The audit data shows improvement in care processes and outcome measurements.

References

1. Mudge AM, et al. Eat Walk Engage: An interdisciplinary Collaborative Model to Improve Care of Hospitalized Elders. American Journal of Medical Quality 2015. Vol. 30(1) 5–13.

2. Ellis G et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane database Syst Rev. 2011(7): CD006211.
122 EVALUATING THE IMPLEMENTATION OF CLINICAL PHARMACIST SERVICES IN A POST DISCHARGE HOSPITAL-BASED REHABILITATION WARD IN IRELAND
Authors: Flanagan R , Quinn O
Published: October 2022

Background

The number of people over 60 years is predicted to double by 2050. Medicines play a significant role in a patient’s recovery and in the management of many acute and long-term conditions. Patients are living with chronic diseases which require management with medication, such as diabetes, stroke, and cancer. Patients over 60 years are more vulnerable to adverse effects of poly-pharmacy due to declining renal and hepatic function, reduced lean body mass and functional capabilities. Medications should be prescribed appropriately with the intention to have a favourable outcome, to improve mortality, morbidity, and the quality of life of the patient. Inappropriate prescribing of medications leads to poly pharmacy, adverse drug reactions, poor adherence, prolonged recovery time and poor participation in rehabilitation programmes.

Methods

Clinical pharmacy services were provided to patients in the rehabilitation ward. Medication reconciliation, clinical medication review of medications, participation in MDT meetings, discharge planning including education on medication regimes with patient and primary care services. All interventions were recorded at each stage.

Results

The average number of medications on admission was eleven. On completion of medicine reconciliation, many changes were intentional. 19% of patients had an unintentional change to their medications. On completion of a clinical review 156 drug related problems were identified. 77% of recommendations were accepted by medical team. 57.5 % of medications were deemed a STOPP medication and 20.8 % were deemed a START medication. On discharge the average number of medications prescribed was six. This represented a 40% reduction in the number of medicines prescribed on discharge.

Conclusion

The inclusion of a clinical pharmacist as a member of the multidisciplinary team on a rehabilitation ward allows for a comprehensive review of patient’s medications. This optimises medications, identifies drug related problems, reduces the pill burden, aids adherence, reduces the possibility of adverse drug reactions and promotes medication safety.
125 STROKE SURVIVOR AND CARER EXPERIENCES OF NAVIGATION OF STROKE SERVICES AND INFORMATION IN IRELAND: AN EXPLORATORY QUALITATIVE INTERVIEW STUDY
Authors: Sexton E , Fowler K , Byrne E , Bennett K
Published: October 2022

Background

Patient navigation of stroke services is challenging, as survivors have diverse and complex needs, and clear care pathways are often lacking, particularly in the post-acute phase. Exploring the views of stroke survivors and main carers is critical to understanding these navigational challenges.

Methods

In-depth semi-structured interviews were conducted online or by phone with stroke survivors (n=16) and main carers (n=13) recruited through voluntary organisations and social media. Participants with communication or cognitive difficulties were included, and provided with accessible information materials. Interviews were audio-recorded and transcribed. Framework analysis was used, involving data familiarisation, coding, development of an analytic framework, charting and interpretation. Ryvicker’s (2018) behavioral-ecological conceptual framework for patient navigation was used to inform the analytic framework.

Results

Barriers to successful patient navigation at the healthcare system level included complex and unclear eligibility criteria for services and entitlements, including arbitrary age limits; geographical variation; and waiting times for services, particularly rehabilitation. Having a skilled or knowledgeable advocate, such as a family member with experience of the healthcare system, was a key enabling factor. Survivors and carers had to be pro-active and “push” or “battle” for needed services and information. Navigation often involved a substantial administrative burden, which survivors and caregivers had to manage in addition to the demands of the stroke itself, the recovery process, and in many cases other co-morbidities. Healthcare provider factors that supported navigation included clear communication with survivors/carers about services and the stroke itself. Staff who specifically supported care co-ordination were helpful, but this tended to be ad-hoc and limited in availability.

Conclusion

Dedicated staff to support patient navigation across the care continuum could make a significant difference to stroke survivor access to services and consequently outcomes. Clearer, standardised and more person-centred referrals pathways, that are widely publicised and understood, would also improve access.
128 TO BLEED OR NOT TO BLEED: THE INTRACEREBRAL HAEMORRHAGE MANAGEMENT QUESTION
Authors: Murphy B , Meagher MK , Noone I , Cassidy T
Published: October 2022

Background

Intracerebral Haemorhage (ICH) accounts for 9-27 per cent of all strokes. There are high rates of early case fatality and poor functional outcome. Clear guidelines and pathways exist around the management of ischaemic stroke. Pathways for the haemorrhagic stroke patient are lacking. Good evidence exists for early Blood Pressure (BP) management, reversal of Oral Anti-Coagulation (OAC) and admission to a Hyper-Acute Stroke Unit (HASU) in terms of improving outcomes.

Methods

A retrospective cohort analysis was performed, looking at all the presentations with ICH over one calendar year. The factors measured included time to CT Brain, BP at presentation, documented target systolic BP of under 140mmHg, time to treatment of hypertension, number on OAC, OAC reversal, time to OAC reversal, admission to HASU. The findings were compared to standards outlined in the European Stroke Organisation and American Heart Association’s ICH management guidance.

Results

76 patients were include (40 female). Mean age was 73, age range 34-93. median age 77. 44 were hypertensive on admission (20 info unavailable [u/a]). Of the 44, 34 had a documented target BP under 140mmHg (12 = n/a, 20 u/a). Time to treatment of hypertension was within 60 minutes for 3 patients. Of those that were hypertensive, 57 per cent were 75 or younger. 16 were on an OAC, of which 11 were appropriately reversed (3 u/a). Of the 11, 2 were reversed within 90 mins (7 u/a). Of those on an OAC, 75 per cent were over 75. 32 were admitted to HASU within 72h (all of these made it within 24h), (10 did not reach HASU, 3 reached HASU bed after 72h, 31 u/a).

Conclusion

Management of ICH is variable and suboptimal. Our goal is to produce a written pathway which will be incorporated into our hyperacute stroke document, with a plan to re-audit.
129 RE-THINKING THE MEMORY CONSENSUS MEETING: A QUALITY IMPROVEMENT INITIATIVE
Authors: Costello M , Munawar N , Bruce I , Crosby L , Burgui D , Finnegan M , McKenna MC , Hutchinson S , Crowe C , Greene E , Leori I , Robinson D
Published: October 2022

Background

As part of our memory clinic service, weekly consensus meetings are held to allow for multidisciplinary diagnostic evaluation of new cases. As part of a local Quality Improvement (QI) initiative, we reviewed how this meeting could be streamlined to maximise efficiency and improve diagnostic accuracy in light of increasing referrals and patient complexity. Here we describe the development and initial implementation of this QI project.

Methods

A structured QI approach was taken to develop SMART (Specific, Measurable, Achievable, Realistic, Timely) goals. All professional stakeholders (from disciplines including geriatric medicine, neurology and psychiatry of later life) who attend the weekly consensus meeting were surveyed anonymously with a response rate of 80% (n=8). Information was gathered on areas that worked well, areas that needed improvement and suggestions for meeting enhancement. In addition, participants were asked at a single meeting to subjectively rate the complexity of eleven cases presented into the following categories: low, medium and high. Data were collated and presented to the memory clinic staff for further refinement.

Results

Four key actions were identified for implementation: formal allocation of a meeting chair, improvement of access to imaging from outside hospitals, revision of current proforma to streamline case discussions, and proposal to discuss patients in order of new assessment, return assessment and review of significant results. During the rating of case complexity, there was substantial variation among respondents.

Conclusion

This initial phase has been used to develop SMART goals to improve the consensus meeting structure. We identified that patient complexity would be an inefficient method to order case discussion. Implementation of action steps are ongoing, with positive feedback from staff to date.
132 STRUCTURED REFLECTION ON POTENTIAL IMPACTS FROM HEALTH INEQUALITIES AND UNCONSCIOUS BIAS ON CLINICAL DECISION MAKING AT A MOVEMENT DISORDER CLINIC
Authors: Trolan C
Published: October 2022

Background

Healthcare inequalities can result in avoidable, unfair and systemic differences in health between different groups of people. Clinicians have unconscious biases that can impact on their decision making. The General Medical Council's Good Medical Practice: Maintaining Trust Domain 4, states that doctors must “treat...patients fairly without discrimination”. The Reflective Practitioner should use a variety of tools to support structured reflection. The movement disorder service in question provides care for a mix of urban and rural communities with a wide range in deprivation indices.

Methods

A single doctor's referral patterns and prescribing decisions for parkinsonian syndromes was retrospectively analysed for 99 consecutive attendees at a mixed face-to-face and telehealth clinic service over six weeks. Harvard Implicit Association Tests were completed to assess for unconscious biases. Patient characteristic data are available for: age, sex, religion, skin colour, sexual orientation, primary language, deprivation index, Trust of residence, weight, hearing loss, visual loss, Rockwood Clinical Frailty Scale, Hoehn and Yahr staging and educational attainment. Clinical decision making data are available for: referral patterns to physiotherapists, occupational therapists, speech and language therapists, continence services, psychiatry services, bone mineral density measurement, specialist nursing service, brain imaging and prescribing decisions made.

Results

The sample had 60 males, 38 females and 1 male-to-female active transition. Deprivation indices ranged from the 64th to 889th least deprived postcodes (of 890). Only one non-white attendee. Two non-heterosexual attendees. Primary language for all was English. Mean age 76.72years. Mean Hoehn and Yahr stage 2.49. 25.25% are living with dementia. 55 attendances were face-to-face. Prescribing changes were more likely to occur through telehealth clinics. Women were more likely to be referred to physiotherapy and psychiatry. Patient religion may have impacted prescribing decisions.

Conclusion

Open and honest reflection can improve patient care by identifying health inequalities and through using a metacognitive approach to clinical decision making.
173 ASSOCIATIONS BETWEEN CARDIOVASCULAR SIGNAL ENTROPY AND FUTURE FALLS, SYNCOPE, AND FEAR OF FALLING
Authors: Knight SP , Davis J , Duggan E , Kenny RA , Romero-Ortuno R
Published: October 2022

Background

Previous studies have reported impaired blood pressure (BP) control during standing to be associated with future falls and syncope. Increased complexity in BP signals has been shown to be associated with poorer cognitive performance, frailty, and increased mortality risk. The aim of this study was to investigate associations between the level of complexity in beat-to-beat BP data during an active stand challenge and future occurrence of falls, syncope, and fear of falling in a cohort of older adults from The Irish Longitudinal Study on Ageing (TILDA).

Methods

Beat-to-beat BP was continuously measured during an active stand protocol at wave 1 of TILDA (2009-2011). Complexity of BP signals was quantified using sample entropy (SampEn) during rest, stand, and recovery sections of data. Self-reported occurrences of falls, syncope, and fear of falling were collected at waves 2 to 6 (2012-2021). Comprehensively controlled modified Poisson modelling was employed to investigate associations.

Results

Complete data were available for 4714 individuals (age: 61.0±8.8 years; 55.3% female). Higher BP SampEn during rest and stand was associated with increased risk of future recurrent falls (IRR=1.34, p=0.003, and IRR=1.22, p=0.044, respectively). Higher BP SampEn during recovery was associated with increased risk of future syncope (IRR=1.84, p=0.041). In a sub-cohort of participants aged 65+, higher BP SampEn was associated with increased risk of future fear of falling (N=1552; IRR=1.25, p=0.037). All reported IRRs are per one unit of SampEn.

Conclusion

This study reports significant associations between higher complexity in BP data during an active stand protocol and increased risk of future falls, syncope, and fear of falling over ten-year follow-up.
176 EXPLORING THE PREVALENCE AND PRESENTATION OF FRAILTY IN AN IRISH EMERGENCY DEPARTMENT – A POINT PREVALENCE STUDY
Authors: O'Neill S , McShane N , Nelson C
Published: October 2022

Background

In Ireland, frailty is routinely identified in the Emergency Department (ED), however its prevalence is not well defined. This contrasts with the prevalence of frailty in the older adult population living in the community setting, where the prevalence of frailty has been defined as 14% in the over 65 population and 33% in the 75 and over (TILDA, 2020). The aim of the study is to explore the prevalence and presentation of frailty in the older adult population attending ED of a model 3 hospital in Ireland.

Methods

In August 2021, a point prevalence study was undertaken in the ED over 14 days, covering a 24-hour period, applying retrospective documentary and observational data analysis. Measures used to identify frailty included: Think Frailty and Clinical Frailty Scale (CFS) version 2.0.

Results

2,582 individuals attended ED over a 2-week period. 22% were aged 65 and over, of which, 37.5% were aged 65 – 74 and 62.5% were aged 75 and over. 60% were admitted and 40% were discharged. Of those identified as living with frailty – 24.8% were identified to be living with severe/very severe frailty (CFS 7 – 8); 19.5% with moderate frailty (CFS 6), and 35.66% with mild/very mild frailty (CFS 4 – 5). The majority of those identified at CFS 1 – 3 were aged 65 – 74. The identified frailty syndromes included, polypharmacy (38.5%), reduced mobility (30.3%), falls (20%), dementia (6%), Delirium (5%), Incontinence (0%).

Conclusion

The results indicated that 80% of the identified cohort were living with frailty (CFS 4 – 8). Frailty status and advancing age were associated with a longer length of stay in ED and a subsequent admission. Dominant frailty syndromes included polypharmacy and reduced mobility; frailty syndromes such as delirium and incontinence appear to be underrepresented, which may be influenced by the absence of routine identification in the ED.
180 DIETITIAN-LED, EARLY IDENTIFICATION OF MALNUTRITION RISK IN THE EMERGENCY DEPARTMENT IMPROVES INTERVENTION RATES
Authors: Cronin L , Pillay I
Published: October 2022

Background

Frailty At The Front Door (FATFD) teams are ideally positioned to facilitate screening for risk of malnutrition in the frail older person. The aim of this quality improvement initiative is to improve malnutrition risk identification and first point of contact intervention, in a frail older Emergency Department (ED) population.

Methods

Dietetic assessment was initially triggered using a non-standardised screen in a Comprehensive Geriatric Assessment (CGA). Referral to dietetics was triggered if there was a ‘yes’ response to - have you lost weight and/or do you have a poor appetite? Patient demographics were prospectively entered onto Excel. A shorter CGA which included a validated MST screen was developed. All patients at risk of malnutrition were referred for dietetic intervention. Patient demographics, MST and Clinical Frailty Score (CFS) score of referred patients were prospectively entered onto Excel. Results were analysed using descriptive statistics.

Results

Pre-standardised screen, an average of 7 patients per week received an intervention. The mean(SD) age was 83.8(6.9) years. The male to female ratio was 1:1.5. No information was available on malnutrition risk or CFS. Post standardised screen, The mean(SD) age was 84(7) years. The male to female ratio was 1:1.2. Mean(SD) CFS was 5 (1.5). An average of 10.3 patients received an intervention per week.

Conclusion

Prioritisation of malnutrition risk screening was successful within a shortened CGA. A 47% increase in dietetic intervention was achieved. This has created an opportunity to further develop specialist pathways for example: Tube Feeding and Oral Nutritional Supplements.
181 UNDERSTANDING OLDER ADULTS’ PERCEPTIONS AND EXPERIENCES OF NOVELTY: A PILOT STUDY
Authors: Tsabary C , Hopper L , Kilcullen S , Gallagher P
Published: October 2022

Background

Our institution is currently developing a technology solution to support adults to live well at home for longer. As the system develops, there is an emerging emphasis on strict structure/routine in older adults’ activities of daily living. In contrast, engagement in novel experiences is widely endorsed as a buffer against cognitive decline. Despite this, there is scant research into the perceptions and experiences of novelty in older adults. Understanding older adults’ views on novelty is necessary to inform the advancement of the current project.

Methods

A multiple-methods, exploratory approach was used. A 90-minute focus group was held with 4 older adults to explore their conceptualisations of novelty, discussing what constitutes a novel experience and gauging the value placed on routine and novelty in daily life. Questionnaires measuring Mental Well-Being (MWB), personality, Novelty-Need Satisfaction (NNS), and preference for routine were subsequently completed by each participant.

Results

Four main themes emerged from the qualitative data. They comprised the contrast between planned and unplanned novel experiences, the influence of context on the enjoyment of novelty, the value of the vicarious experience of novelty and the challenge associated with change at a social/global level. The quantitative data revealed that 91.9% of the variation in MWB is attributed to its relationship with NNS.

Conclusion

The focus group served as a strong foundation; especially into the contextual influence of both internal (psychological/attitude-related) and external (environmental/social) factors upon the enjoyment of novelty; as well as indicating that further research is merited into the contrasting views on planned and unplanned novel experiences. The quantitative data corroborate the importance of maintaining novelty in older age. Understanding how to preserve novelty while supporting routines will allow assistive technology projects such as this, to adopt a holistic approach and encourage consideration for this aspect of life, often neglected in the lives of older adults.
186 FRAILTY IN HOSPITALISED OLDER ADULTS AND THEIR SPOUSES: A CROSS-SECTIONAL STUDY
Authors: Pelow L , French H
Published: October 2022

Background

Hospital admissions are a critical time-point for assessing frailty. Frail older adults have high utilisation of healthcare resources and many require on-going care. Often spouses provide this care, however caregiving can lead to increased frailty in the caregiver. A description of frailty and caregiving within marital dyads has not been explored previously, in relation to hospital admissions.

Methods

Aim: To measure the frequency and describe the characteristics of frailty in hospitalised older adults and their spouse. Objectives were to: (1) Describe frailty, physical and cognitive performance in patients and spouses; (2) Determine frailty correlations between dyads; (3) Establish if patients are more likely to have spouses of the same frailty classification; (4) Describe caregiving within the context of frailty. Participants were recruited from geriatric and stroke services from October 2019-March 2020. Fried Frailty Phenotype (FFP) was used to test frailty. Clinical Frailty Scale, Grip Strength, Montreal Cognitive Assessment, Timed Up and Go, Geriatric Depression Scale and self-reported: mobility status, caregiving status, number of falls and number of hospital admissions were also assessed to describe the population.

Results

Data from 27 dyads that participated and consented were analysed using SPSS. A total of 15 patients (55.5%) and four spouses (14.8%) were classified as frail. Of 15 frail patients, four had frail spouses, five had pre-frail spouses and six had robust spouses. No pre-frail or robust patients had frail spouses. Spearman’s Correlational analysis showed no correlation in FFP between patient and spouse (r=0.24, p=0.23). Participants that provided care (44.4%) accounted for 5 patients (frail n=4) and 19 spouses (frail n=4).

Conclusion

Frailty in dyads is heterogeneous. Caregivers are commonly frail and provide care to frail partners. Older adults admitted to hospital should be assessed for frailty. If the patient has a spouse, especially if the patient is frail, their spouse should be assessed for frailty.
187 ‘OUR LANGUAGE’: AN INITIATIVE TO RAISE STAFF AWARENESS OF THE IMPACT OF OUR CHOICE OF WORDS ON PATIENTS
Authors: Staveley R , Armstrong E , Barry E
Published: October 2022

Background

In a hospital specialising in older persons’ rehabilitation, the Speech & Language Therapy team (SLT) commenced an initiative to raise awareness of the impact of all staff’s language on patients. Our language can either support or undermine patient well-being. Supportive language is easy-to-follow, everyday English and respects each person’s autonomy (‘Would you like help to eat?’). Unnecessary jargon or impersonal words can be undermining (e.g. ‘He needs supervision with feeding’). This is supported by national and international guidance tools such as the online ‘Plain Language Style Guide’ by the Health Service Executive Health Promotion Unit and National Adult Literacy Agency.

Methods

Quality improvement methodology was adopted to facilitate an ongoing, flexible approach. SLT delivered pilot workshops on person-centred language to ward staff. Afterward, staff spent a week self-identifying examples of language that could be improved during their work day. Examples were collated and presented back to teams. Online feedback surveys were conducted. Trolley rounds were then rolled out with quiz-style exercises to raise staff awareness across the hospital. Examples of person-centred language generated by staff were shown on rolling videos in key areas across the hospital.

Results

Staff engaged actively in workshop and trolley activities generating a range of examples of more person-centred language. Surveys revealed a new awareness of the need to adapt our language. Several months later, staff continue to demonstrate increased vigilance with their choice of words and regularly consult SLT for advice on language in clinical sessions, documentation or signage. There is still room for improvement in the language used in other areas such as Care Planning Meetings and clinical documentation.

Conclusion

This initiative has started to increase staff awareness of the importance of our choice of words to patient well-being. With the support of hospital management, this initiative will be continued, reviewed and reported on a rolling basis.
203 TRANSITIONS TO LONG-TERM CARE: EXPERIENCE OF A COHORT OF COMMUNITY-DWELLING OLDER ADULTS RECEIVING INTEGRATED CARE
Authors: Mahon CM , Dunne A , Garcia R , Martin R , Kennelly SM
Published: October 2022

Background

Data from the Nursing Home support scheme 2018 (NHSS) shows the majority of applications to the NHSS come from acute hospitals (44%) followed by referrals from the community (38%). We examined this transition in a cohort of community dwelling older adults to assess how many transition from home to nursing home and, when admission to nursing home from hospital occurred, the indications for same.

Methods

Retrospective examination of Integrated Care Team (ICT) and Acute Hospital data from 2019 in respect of a cohort of older adults. Transitions in care to nursing home including residence at time of admission, last acute hospital presentation prior to nursing home admission and commencement of NHSS application recorded.

Results

319 patients referred to the integrated care service in 2019, average age 81 and 58% female, predominantly from outpatient clinics in the Medicine for the Older Person’s service. 47 patients had moved to nursing home; within this cohort 14 (29.7%) transitioned from home, 28 (59.6%) transitioning after acute hospital admission. Main reasons for presentation to hospital were: Intercurrent acute illness (n=11); Falls (n=6); progression of dementia (n=4). Fair Deal application commenced in community by ICT in 20 of the 47 (42.5%) patients including 8 of 28 patients (28.5%) admitted to hospital prior to moving to nursing home.

Conclusion

This preliminary evaluation highlights the importance of advance care planning in this population when acute hospital admissions can be difficult to predict. Involvement of the ICT can help this transition and lead to shorter hospital stays.
212 FATIGUE EXPERIENCED BY ADULTS WITH LONG-COVID WAS NOT ASSOCIATED WITH AN EMG-DERIVED MUSCLE FATIGUE INDEX
Authors: Xue F , Duggan E , Jennings G , Monaghan A , Romero-Ortuno R
Published: October 2022

Background

One of the most prominent challenges of the COVID-19 pandemic is the emergence of the post-COVID-19 syndrome or ‘long-COVID’ following the acute phase of the viral infection. With a plethora of debilitating symptoms across many physiological systems, the pathophysiology of long-COVID remains elusive and subject of intense research efforts. Adults with long COVID are often affected by prolonged fatigue, which could be linked to neuromuscular function impairment. We hypothesised that there might be a correlation between subjective fatigue and an Electromyograph(EMG)-derived muscle fatigue index in adults with long-COVID.

Methods

As part of a neuro-cardiovascular instability assessment protocol, participants were asked to squeeze the thigh muscles as hard as possible for ten seconds during both supine resting and after active and passive standing (head-up tilt) tests. Surface EMG was used to capture on each leg the physiological activity of the vastus lateralis and rectus femoris during the squeezes, from which the muscle fatigue index was computed based on both the mean and median frequencies of each 10-second maximum prompted muscle contraction. Using two-sided Spearman correlation coefficients, we examined the associations between the muscle fatigue indices and self-reported fatigue measured by the Chalder Fatigue Scale (CFQ).

Results

108 participants were included, 77 female and 31 male, with a mean age of 46 (range 25-78) years, 22% of whom were hospitalised in the acute phase of SARS-CoV-2 infection. Strong intercorrelations were found between the muscle fatigue indices derived from the mean and median frequencies of thigh muscle contractions. However, no significant correlations were detected between the muscle fatigue indices and CFQ scores.

Conclusion

Self-reported fatigue as measured by the CFQ was not associated with an EMG-derived muscle fatigue index in this long-COVID cohort.
215 WHAT VALUE DOES OCCUPATIONAL THERAPY ADD TO THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE?
Authors: Davis AJ , Delaney A , Doyle C , Sweeney A , Nally SM , Namara RM
Published: October 2022

Background

The EDITH team has provided an alternative care pathway for older adults with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods

To assess consistency in OT practice and assessment, an audit was completed of OT logbooks and electronic patient data. Paper count method was used. Data gathered with regards to OT process and assessment.

Results

100% of patients had at least 1 type of OT assessment (e.g functional, home environment, falls prevention, cognitive etc), 80% had at least 2 and 43% had 3 or more types of OT assessments. 100% of patients had Clinical Frailty Scores completed, 100% had their living situation and level of care supports assessed and documented. 43% of patients received onwards referrals to community supports, day hospital, voluntary supports etc.

Conclusion

The OTs complete a thorough and multifactorial assessment of the older adult within the context of their home environment. This holistic assessment approach adds significant value to the overall EDITH assessment and service. It also ensures appropriate and relevant onwards referrals are completed. It is imperative to ensure value for money with regards to health care services. In line with the HSE “Value Improvement Programme” it is timely to review OT services and ensure they are delivering consistent, high quality and high value services for our stakeholders.
219 A SOLITARY AWARENESS - PROFILING TIME TO RECOGNITION OF MEMORY LOSS IN A TERTIARY MEMORY SERVICE
Authors: McHale C , Dookhy J , Dolphin H , Fallon A , O'Toole R , Merron G , Kennelly S
Published: October 2022

Background

Approximately 64,000 people live with dementia in Ireland with expected increases to 150,000 by 2045. Best practice recommends that patients benefit from timely diagnosis. Whilst the presence of cognitive impairment should prompt early referral for diagnostic clarity, patients frequently present with well-established symptoms. In order to understand this phenomenon it is important to understand the way in which symptoms are recognised by the person, companions and casual observers.

Methods

A chart review was carried out on a convenience sample of patients (n=61) diagnosed with dementia where scores were available from Clinical Dementia Rating Scale (CDR) and AD8. Data extracted included global scores and answers to direct questions regarding symptom recognition by patient and companion. Diagnosis was confirmed using the Electronic Patient Record.

Results

Mean age was 75 (range 57-87). Diagnostic breakdown comprised: Alzheimer Dementia (AD) in 67% (n=41), mixed AD/Vascular Dementia (VaD) in 19.6% (n=12); behavioural variant Fronterotemporal Dementia (bvFTD) in 1.6% (n=1), Dementia with Lewey Bodies (DLB) in 1.6% (n=1), Primary Progressive Aphasia (PPA) in 4.9% (n=3), Primary Parkinson’s Dementia (PPD) in 1.6% (n=1) and VaD in 1.6% (n=1). Average CDR Global Scale was 1.0 and average AD8 score 6/8. Family noticed symptoms of dementia an average of 12 months longer than the person themself. The incidence of anosognosia was 19% (n=12) and associated with a diagnosis of AD (91.6 %, n=11). Where anosognosia existed, symptoms of memory loss had been identified by family up to 60 months before diagnosis, with average time to recognition of 24 months. For 75% of this anosognosia group, family reported indiscernible symptoms on casual inspection (n=9).

Conclusion

Where symptoms of memory loss go unrecognised by patients and casual inspection, family may notice changes for up to five years. It is important to educate and empower the public regarding the benefit of a timely dementia diagnosis. Education should focus on supporting family to navigate sensitive conversations in the event of anosognosia and explore ways in which they might encourage timely review.