bluuebunny/crossref_metadata_2025 huggingface dataset:
Using wave signatures for identifying mechanical objects
Authors: Kovalevskyy S , Kovalevska O , Koshevoy A , Tasić I
Published: September 2019

The article provides a rationale for identifying objects based on wave signatures. Wave signatures in the article are limited to the acoustic range of vibration. The results of experimental studies based on modeling the dynamic processes of propagation of complex excitations in samples of various configurations and with the presence of various defects using the signature of acoustic oscillations excited in the objects of study are presented. As such objects are presented parts of engineering production. These studies confirm the possibility of complex diagnostics of objects with their subsequent use in product quality control systems, in particular, to reduce the level of peak values of residual stresses in body parts during multi-frequency vibro-processing.
The technique of designing high-power CNC lathes for enterprises of the heavy engineering industry
Authors: Kovalov V , Vasilchenko Y , Turmanidze R , Dašić P , Sukova T , Shapovalov M
Published: September 2019

Proposed is the method of heavy machine tools constructions’ structural-parametric synthesis based on their components processing parameters statistical study. The process of designing high-power metal cutting equipment that most completely meets the customer’s essential requirements consists in developing its technological structure in the form of a functional-structural model with the main technological parameters (accuracy class, size of working space, necessary power parameters, cutting modes) substantiation.
Contact Problem for Layered Medium Supported by a Wedge
Authors: Yanik Arcan , Bakioglu Mehmet
Published: September 2019

In this paper the plane contact problem for a layered medium supported by an elastic wedge is considered. A compressive load is applied to the top of the layered medium through a frictionless rigid punch. It is assumed that all contact areas are frictionless and only compressive normal tractions can be transmitted through the interfaces. Hence, the length of the contact region along the layers and layer-wedge interface is finite and are also unknown. The problem is formulated in terms of a system of singular integral equations in which the unknown functions are the pressure between layers in layered medium and between layered medium and the wedge. The analytical formulation of layered medium supported by wedge is given. As a numerical example, contact length and stress intensity factor at the tip of rails are calculated and the result are given by diagrams.
The Impact of Participatory Planning Approach on the Quality Urban Design of Former Riverbank Brownfield Sites
Authors: Ladzianska Zuzana , Ondrejička Vladimír , Ondrejičkova Silvia , Husár Milan
Published: September 2019

Processes of brownfield sites redevelopment are very well known and welcome especially by city councils. The new trend of reurbanization with focus on derelict and brownfield sites has reached the Central-East European space, too. City investors are reacting in prompt manner in order to attract new users of the redeveloped sites by good design of public spaces achieved and communicated by public hearings. The topic of participation processes in any development has solid theoretical framework, but the implementation phase often tends to fail. Successful and effective public participation uses properly chosen and appropriately applied tools and methods of participation at the most suitable time of the development process. The aim of the paper is to present how a good participatory planning can have a direct impact on the urban design quality. This participatory approach is explained on case studies of former brownfield sites situated on riverbanks in the cities of Trenčín and Bratislava. In both former riverbank brownfield sites the approach of public participation has been used in different phases and manners. The outcome varies due to the different stages of projects, but nevertheless both can provide a high quality urban design outcome.
The wildlife aspect in the linear transport infrastructure development processes
Authors: Finka Maros , Husar Milan , Ondrejicka Vladimir , Jamecny Lubomir
Published: September 2019

The Carpathian Mountains present some of the most preserved natural habitats for wildlife species in Europe. These natural environments provide a great number of ecosystem services for the whole Europe and their protection is in the interest of all stakeholders in the territory, from the local and regional state authorities, NGOs and private sector actors. Many regulations in form of the various formal and informal documents exist and these are different from country to country which creates one of the key issues when protecting this vast natural area. The unified system of protection recognized in all Carpathian countries is rather missing and for this reason the Framework Convention on the Protection and Sustainable Development of the Carpathians (Carpathian Convention) had been formed with an objective to foster the sustainable development and the protection of the Carpathian region. One of their activities is to support the legal procedures aimed at protecting the Carpathian Mountains and INTERREG-supported TRANSGREEN and CONNECTGREEN project is one of its main activities, of which this paper is one of the main outputs. The objective of this paper is to clarify how and where the wildlife aspects have to be integrated in the general process of the linear transport infrastructure development processes within Carpathian countries.
58 Hospitalisation Rates and Causes for People with Dementia in Northern Ireland
Authors: Zafeiridi Evi , McMichael Alan , McGuinness Bernadette
Published: September 2019

Background

People with dementia are almost 50% more likely to have an acute hospital admission due to a common age-related illnesses, such as urinary tract infection. They also have an 18% higher rate of readmission following discharge and approximately one quarter of hospital beds are occupied by people with dementia. Furthermore, people with dementia have an increased mortality rate in hospital and for six months after discharge compared to age-matched controls. This study assessed the hospitalisation and re-hospitalisation rates for people with dementia in Northern Ireland, as well as exploring whether mortality rates increase during or following these hospitalisations. A secondary aim was to explore the causes of hospitalisations between people with dementia and a representative age-matched control group.

Methods

Data from over 50,000 people with dementia and the control group from national databases in Northern Ireland were retrospectively analysed.

Results

The results showed that dementia does not affect hospitalisations; however, the number of hospitalisations can predict mortality in people with dementia. The most common causes for hospitalisation did not differ between the dementia and the control groups and included pneumonia, urinary tract infection and fractures.

Conclusion

The results will inform health care professionals on whether a reduced number of hospitalisations increases life expectancy and may result in relieving some of the financial strain currently being experienced by the National Health Service.
69 How Useful is an Integrated Assistive Technology System in a Nursing Home? Understanding its Effectiveness on Users and their Perceptions
Authors: Obayashi Kazuko , Kodate Naonori , Kondo Hiromasa , Okamoto Yoshimi , Ishii Yoko , Masuyama Shigeru
Published: September 2019

Background

With the arrival of a super-ageing society, the use of technologies in social care is not only necessary but inevitable. However, there is a dearth of evidence to demonstrate how assistive technologies (AT) can improve standards of care while improving the working conditions of care professionals and care givers. Furthermore, little is known about users’ perceptions of such technologies. The objectives of this paper are: first, to test the effects of an integrated AT system on users (both care recipients and staff) in a residential care home; and second, to understand their perceptions of such technologies.

Methods

We combined an infrared monitoring camera with communicative robots and a sheet-shaped body vibrometer. A 4-week pre/post intervention study was conducted, during which the evaluation was carried out before, during and after the intervention. Twenty care recipients (average age of 89.5) and 15 care professionals participated in the study. In order to measure the effectiveness of the integrated system, the care recipients’ quality of life was examining using the interRAI method. Regarding the impact on professionals, stress levels were examined during night shifts. Perceptions towards use of the system were also explored by the system usability scale (SUS) and semi-structured interviews.

Results

After the system was introduced, the number of unnecessary visits by care professionals during the night was dramatically reduced (by 8.2 times per person on average), and staff’s stress levels were also reduced. The SUS and interview data show mixed results in terms of the perceptions of care recipients and staff towards using the technologies.

Conclusion

Overall, the use of integrated assistive technologies yielded positive results. However, some issues were identified with regard to future implementation of such technologies in a residential care home. This study was financially supported in part by the Japanese Council of Senior Citizens Welfare Services.
95 Accuracy of Off the Shelf Activity Trackers in Ambulatory Settings in Young and Old Adults
Authors: Barton John , Timmons Suzanne , Tedesco Salvatore , Sica Marco , Crowe Colum , O'Flynn Brendan
Published: September 2019

Background

Wrist-worn activity trackers have experienced a tremendous growth lately. Robust studies of the comparative accuracy of currently available, mainstream trackers, in young adults versus older adults are still scarce in literature. This study explores the performance of ten trackers estimating steps, travelled distance, and heart-rate measurements against gold-standards in two cohorts of young and old adults.

Methods

Overall, 38 subjects completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities, including less standardised activities, such as dusting, vacuuming, or playing cards, in order to simulate real-life scenarios. Both wrist-mounted and chest/waist-mounted devices were considered. Gold-standards included treadmill, waist-mounted pedometer, ECG-based chest strap, direct observation or video recording according to the activity and parameter.

Results

Every tracker shows a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. Large mean absolute percentage error (MAPE) was displayed by every monitor at slower walking speeds.

During household activities, the MAPE in young adults climbing up/down-stairs ranged from 3.91-11.41% and 4.34-11.92% (dominant and non-dominant arm), respectively. However, for the same activities older adults displayed a larger MAPE, at 8.38-19.3% and 10.06-19.01%, respectively. Chest-worn or waist-worn devices had more uniform performance. However, unstructured activities (dusting, vacuuming, playing cards), and accuracy in people using a walking aid represent a challenge for all consumer-level trackers as evidenced by large MAPE. Poor performance in travelled distance estimation was also evident during walking at low speeds and household activities for both cohorts.

Conclusion

This study shows a number of limitations to current, mainstream consumer-level wrist-based activity trackers, requiring caution if adopted in healthcare, whether clinical or research. This study demonstrates the particular deficits in commercial devices for use in an aging population, and provides some indications on how to best measure these health parameters in this population.
103 The Characteristics of Frail Older Patients Admitted Through an Emergency Department, who Experience New Disability due to Acute Illness
Authors: Inglis Sara , Ryan Siobhan , Maher Jennifer , Pender Ciara , Sayers Karen , Donnellan Christina , Pillay Isweri
Published: September 2019

Background

No current tool reliably predicts functional decline risk. The modified Barthel Index (mBI) is a validated measure of disability, ideal for use within an interdisciplinary assessment. The aim of this prospective cohort study was to determine the proportion and characteristics of newly admitted frail older patients who experience drops in their Barthel index, requiring intervention.

Methods

Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, were assessed using an interdisciplinary assessment tool (IAT), from February 1st 2019 to March 31st 2019. Data was entered into an excel database on demographics, baseline mBI and inpatient (within 72 hours) mBI, frailty-associated co-morbidities and multi-disciplinary interventions and analysed using Student’s T-test.

Results

150 consecutive patients were assessed with a mean age (mean (+/- SD)) of 83.1(+/- 7.4). mBI scores were recorded for 111(74%) of patients. Mean mBI prior to current illness was 15.4(+/- 4.9). Post-illness mBI was 12.5(+/- 5.3). 65(58.6%) patients experienced an mBI drop. Mean drop was 4.9 (+/- 2.8) points. There was no difference in age or baseline mobility between those who either did or did not experience an mBI drop. Patients with a drop had higher mean pre-illness mBI (16.2 vs. 14.2; p-value 0.017, 4AT score (1.98 vs. 1.11; p-value 0.035) and increased falls history (40 vs. 18 patients; p-value <0.01), compared to patients with no drop. They required more referrals to the multidisciplinary team (3.7 vs. 2.9, p-value 0.002).

Conclusion

Higher proportions of frail patients experienced a drop in function compared with studies where age is used as a cut-off. Within this small frail patient cohort, age was surprisingly not associated with mBI drops. Using frailty as the main determinant for assessment rather than age, results in a different cohort of patients, at risk of functional decline. Future predictive tools should focus on frailty rather than on age.
153 Barriers and Enablers of Assisted Decision-making for Older People in Acute Care Hospitals: A Multi-Stakeholder Inquiry
Authors: Donnelly Sarah , Coimín Diarmuid Ó , O'Donnell Deirdre , Davies Carmel , Shé Éidín Ní , Fattori Francesco , Cooney Marie Therese , O'Shea Diarmuid , Kyne Lorraine , O'Shea Marie , Kroll Thilo
Published: September 2019

Background

Ireland’s Assisted Decision-Making (Capacity) Act 2015 breaks from traditional views of capacity to consider the uniqueness of each decision with relation to topic, time and place for those with impaired or fluctuating capacity. It has yet to be commenced, however codes of practice and educational strategies are in development to support health and social care professionals (HSCPs) to practice in accordance with the Act. This study set out to examine barriers and enablers to the adoption of assisted decision making (ADM) involving older people in acute hospitals from multiple perspectives. It describes a pre-implementation formative evaluation informed by the perspectives of relevant stakeholders in ADM practice.

Methods

In total, 12 key informant interviews and two validation groups were conducted with family carers and older people with and without a diagnosis of dementia in two acute hospitals. In addition, 20 interviews and two validation groups were conducted with HSCPs. Interviews focused on contextual characteristics as well as barriers and enablers of ADM.

Results

Barriers and enablers included supporting capacity through adopting a functional approach, the physical environment where decision-making takes place, meeting information and support needs, methods of communication, upholding will and preferences, relationships and trust. Time and timing were consistently identified as a critical factor. HSCPs also highlighted the need for specialised education and training on ADM practice.

Conclusion

The issues identified around ADM will inform the development of a serious discussion game on acute care scenarios, which will be deployed for awareness raising and educational purposes. Findings will also help focus attention on how those working within complex health systems and organisations can practically implement changes to practice in line with ADM legislation.
293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study
Authors: Bourque Meghan , Foley Tony
Published: September 2019

Background

The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs.

Methods

Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection.

Results

12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care.

Conclusion

GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.
329 An Integrated Care Approach to the Uses of Social Prescribing in an Acutely Frail Older Adult Cohort
Authors: McLoughlin Petra , Murphy Eleanor , O'Sullivan Fiona , Connellan Ciara
Published: September 2019

Background

Community Health Organisation Area 1 has the highest age dependency in Ireland (37.5 vs 34.5) and the highest proportion of its population engaged in unpaid care (4.7%)1. Social prescribing is a novel tool used by the Integrated Care Team for the Older Person in Sligo to address social determinants of health such as social isolation and to minimise the impact of carer burden.

The study aim is to quantify social needs and carer burden in this acutely frail group and describe interventions to address this.

Methods

A descriptive study compiled from Comprehensive Geriatric Assessment of patient care profile and social prescribing from June to December 2018.

Results

50% of patients studied did not have a supportive, able person living with them. 1 in 4 had no local support while 1 in 5 were supported only by neighbours or friends. 53% were not receipt of home help while 24% paid for private care or cleaning services. Carer burden was reported in half of cases with a 2.2 times increased risk with a patient co-morbidity of cognitive decline and a 1.8 times increased risk with a complex medical needs patient. Intervention increased community service usage such as the public health nurse from 70% to 86% and home help applications by 26%. Social prescribing increased day centre use from 18% to 46% and Meals on Wheels usage by 50%. Dementia specific social prescribing was made in 26% of those with cognitive difficulties. 33% received information for carers while 11% were informed of respite options.

Conclusion

In this acutely decompensated and vulnerable group social isolation and carer burden are a significant issue. Our study indicates the potential for the use of a social prescribing model to address this at an earlier point in frailty development at a primary care level.
348 Developing a Frailty Index: Does the Composition of Functional and Disease or Risk Items Influence Frailty Estimates?
Authors: O'Donovan Mark , Sezgin Duygu , Liew Aaron , O'Caoimh Rónán
Published: September 2019

Background

Frailty is a multi-factorial, age-related syndrome, often defined in terms of accumulation of deficits. This approach uses the proportion of a list of age-associated items (signs, symptoms, diseases, impairments, etc.) available to identify frailty. Some frailty indexes (FI) include more functional aspects than others. This study examines whether functional components and diseases or risk factors predict the same phenomena.

Methods

Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) wave seven for participants age ≥50 years. A 52-item FI was constructed from physical health data with 26 functional and 26 non-functional items. Functional items were obtained from activities of daily living questions (ph048 & ph049), and health-related activity limitation (gali question). Non-functional items were obtained from questions on BMI, self-perceived health, disease/risks (ph006), medication use (sleep, anxiety/depression, osteoporosis), and frailty related symptoms (ph048). Participants missing one or more of the 52 items were excluded. Data were analysed at individual and country-level to assess for significant differences.

Results

In total, 73,510 (97.3%) participants had complete frailty data available and were included. The mean score for the FI-52 was 0.12 (95% CI: 0.11-0.12). Mean FI scores for the functional and non-functional components were 0.12 (95% CI:0.12-0.12) and 0.11 (95% CI:0.11-0.11), respectively, representing a significant difference (p<0.001). For a cut-off of 0.25 for frailty this difference was 5.4% (95% CI:3.9%-6.2%). Spearman’s correlation between these components was 0.66 for individual participants and 0.72 for country-level mean scores, indicating moderate to strong correlation. These were similar using a cut-off of 0.25, at 0.45 and 0.71, respectively.

Conclusion

Findings suggest that having more functional items in a frailty index results in significantly higher frailty estimates but this only amounted to an approximately 5% difference. Although moderate-strong correlation was observed, further research is needed to investigate if the proportion of functional components influences risk-prediction at population-level.
05 Profile of a Geriatric Neurosurgical Service
Authors: Malone Kareena , Kinsella Fiona
Published: September 2019

Background

According to the 2016 CSO figures the age category of 65 and older saw the largest increase in the Irish population since 2011, rising by 102,174 to 637,567, a rise of 19.1%. This remains a major concern for a North Dublin teaching hospital as its catchment area has a 20% higher proportion of > 65’s and > 85’s than the national average. This catchment area profile has the potential to impact on the profile of the in-catchment admissions while the National profile will impact on the national specialities including neurosurgery.

Aim

To profile the geriatric neurosurgical population and provide insight that facilitates future service planning and delivery.

Methods

To accurately capture the data, all ward lists for the month of June and July 2017 were reviewed to identify appropriate patients. All patients on any ward within the hospital, under the care of a neurosurgeon, were included in the data collection. Patients in intensive care that did not transfer to the wards were excluded.

Data points including age, sex, consultant, co-morbidities, mobility status and surgical intervention were captured.

Results

120 patients ≥ 65 years were admitted to the neurosurgical service between June and July 2017; 45 (38%) between 60-69, 60 (50%) 70-79, 13(10%) 80-80 and two (2%) ninety years or older. The two most common reasons for admission were non-traumatic cerebral bleeds (N= 40; 34%) and cerebral tumours (N= 38; 32%). Patients had on average four co-morbidities, with cardiac being the most common. 17 patients were admitted post a traumatic event; 13 low impact falls, 3 high impact falls and one assault. The average LOS for these patients was 11.3 days.

Conclusion

This profile highlights the complex needs of this population and the increasing burden on existing neurosurgical resources as the population continues to age.

Future resource allocation and service development, including the National Trauma Strategy, needs to consider the needs of the aging neurosurgical population.
168 Exploring Physical Activity and Sleep in Community-dwelling People with Dementia and their Association with Cognitive Function and Quality of Life
Authors: Mahon Aine , Kirwan Ruairi , Mackey Laura , Guisado-Fernández Estefanía , Caulfield Brian , Curran Fiona , Power Dermot , O'Shea Diarmuid , Doyle Rachael , Blake Catherine
Published: September 2019

Background

The incidence of dementia has reached epidemic levels, both globally and here in Ireland. Many adults with dementia living in the community remain inactive with some also suffering from sleep disturbances. There is evidence to suggest sufficient exercise and sleep can have a positive influence on cognition also. In this study, we explore:

physical activity levels sleep patterns,

of community dwelling people with dementia and explore the association they have on: cognitive functionquality of life.

Methods

Each individual was assigned a Withings-Go wrist-watch to wear over a period of 3 months which measured their: daily steps takentime in deep sleeptime in light sleep.total sleep each night

MMSE and DEM QoL were used to measure cognitive function and quality of life respectively. Assessed at: baseline & after 3 months. This data was coded and analysed using Microsoft Excel and SPSS.

Results

An RHO = 0.617 was detected between the DEMQoL scores and the mean steps taken over the last 5 days of data collection.

An RHO = -0.127 was detected between steps and sleep time which implied that as steps increased, sleep time was reduced with the opposite being applicable also. The average total sleep time for the sample was 08:03:00 (hh:mm:ss) while the average daily steps taken by the group was 3,266 steps.

Conclusion

People with dementia living in the community were found to be physically inactive. This study has displayed that increased levels of physical activity can show signs of an improved self-perceived quality of life. This study was a correlational study and causality was not investigated. The association we have identified may provide support and foundation for future studies that explore causal components.
169 Examining the Associations Between Frailty, Obesity and Allostatic Load in The Irish Longitudinal Study on Ageing (TILDA)
Authors: McCarthy Kevin , McNicholas Triona , Laird Eamon , Ward Mark , Romero-Ortuño Roman , Anne Kenny Rose
Published: September 2019

Background

Fried’s frailty phenotype is defined by five criteria: exhaustion, unexplained weight loss, weakness, slowness and low physical activity. Frailty can also affect obese people. Little is known about how body mass index [BMI] or waist-hip ratio [WHR] are associated with frailty or pre-frailty in the face of confounding factors, including markers of allostatic load which are known to be involved in frailty biology. We cross-sectionally examined these associations in a population-based study.

Methods

A cross-sectional analysis of data collected at Wave 1 (2010) of TILDA was undertaken. Participants aged <50 and those who did not have measurements of their BMI, WHR, chronic disease status, HbA1c, CRP, sex and educational status were excluded. Two multivariate logistic regression models (one with BMI and another one with WHR as measure of obesity) were computed adjusting for these covariates, with frail/pre-frail versus non-frail as the outcome variable.

Results

4,568 participants were included: 3,277 non-frail and 1,291 frail/pre-frail. The frail/pre-frail group had a mean BMI of 29.2 (versus 28.3) kg/m2 and a mean WHR of 0.912 (versus 0.899). In the adjusted regression model, BMI had a significant association with frailty/pre-frailty (OR 1.02, 95% CI: 1.01-1.04, p=0.001). However, in the model using WHR, the latter had a stronger association with frailty (OR 4.52, 95% CI: 1.60-12.72, p=0.004). In both models, age, education, chronic disease status, HbA1c and CRP had the expected associations with frailty/pre-frailty. Female sex was significantly associated with frailty/pre-frailty in the WHR model (OR 1.26, 95% CI 1.06-1.50, p=0.008).

Conclusion

While obesity is associated with frailty, the distribution of body fat may be more important as a marker of frailty. These physical traits should not be overlooked in the over 50 population. The association between frailty, obesity and markers of ‘inflammaging’ could be examined longitudinally to further understand their complex biology.
176 The Impact of Inter-generational Care on the Emotional Well-Being of Older Persons with Dementia Living in Long Term Care Settings
Authors: McGuigan Siobhán , O'Farrell Lisa , O'Dwyer Sarah
Published: September 2019

Background

A significant number of older persons living with dementia highlight feelings of low mood following admission to care settings.

There needs to be ongoing development in addressing the emotional well-being of this group as highlighted by 2013 NICE quality standard: Mental well-being of older persons in care homes.

This exploratory study evaluates the impact of an inter-generational care group with emphasis on the emotional well-being of the older persons. A structured programme of shared experiences between the older persons group and pre-school age children was introduced.

Methods

Approval was sought from the safeguarding committee and insurance board of the care facility. Consent was obtained from residents to participate. Risk assessments were completed for the activities and the participants.

Cognitive screen score and communication ability of each resident was noted in selecting the focus group (n=10). Outcome measures included qualitative interviews completed after each session. A qualitative mood wheel was completed with residents before and after the session had taken place.

Results

Focus group data supported the programme’s impact on emotional well-being. Eighty percent of participants reported mood elevation. Other benefits identified included excitement for the next session and bringing back memories of raising their own children and grandchildren.

A singular negative aspect identified was that on occasion over stimulation impacted mood and participation level of one resident. Ninety percent of participants were female.

The costs incurred were minimal to the organisation. Provision of resources were shared between the care facility and preschool facility.

Conclusion

The findings of this study support the use of inter-generational care groups in long term care facilities for residents with dementia. It confirms the benefits of improving emotional well-being of this cohort.

Adequate supervision measures must be in place to regulate the stimulation level of the environment and facilitate individuals to exit the session.
177 Religious Participation and Health in a Changing Ireland. A Qualitative Exploration of Women Aged 65 and Over
Authors: Orr Joanna , McGarrigle Christine , Anne Kenny Rose , Hogan Linda
Published: September 2019

Background

The previous decades have seen tangible changes in Ireland’s religious landscape. Religion has been investigated as an important factor in wellbeing for many populations, including those aged 65 and over. Women in this age group in particular have higher religiosity while also being more likely to face challenges such as widowhood and demanding caring roles. We explored the ways in which women relate their religious belief, practice and participation to their wellbeing in later life within the Irish context.

Methods

A qualitative research design was employed. In-depth, semi-structured interviews were conducted with women aged 65 and over (n=11), who self-identified as religious. Women were sampled from church congregations in the North Dublin area. Interviews were recorded and transcribed. Thematic analysis was carried out using NVivo. Women were invited to speak on their lifecourse religious trajectories, relationships, and health, using a flexible interview instrument. Both predetermined and emerging themes were explored.

Results

Participants were aged 67 to 89, and were Catholic-affiliated (n=10) and Church of Ireland-affiliated (n=1). The participants described a range of religious identities, and these coloured their strategies for facing the changing role of the church in Irish society. Church abuse scandals were discussed unprompted by the majority of participants. Apprehension regarding the future of the church was common, as was concern for the religious identities and practices of younger generations within their families. Nevertheless, the majority of participants outlined ways in which religious practice, in particular, was conducive to their wellbeing.

Conclusion

Religious feeling, identity and practice was not homogenous in the sample. Feelings of uncertainty around the future were common, and participants employed a range of strategies to cope with these. The study is limited in how generalisation can be made, but provides insight into some of the mechanisms that can link, both positively and negatively, health and religiosity.
194 User Preferences for the Design of Wearable Technology Systems - A Scoping Review
Authors: O'Riordan Clíona , Kenny Lorna , Tedesco Salvatore , Sica Marco , Crowe Colum , Barton John , Timmons Suzanne , O'Flynn Brendan
Published: September 2019

Background

Wearable technology is a fast developing area. Often, the focus of research is on accuracy, while the practicalities of using the device may be overlooked, despite the fact that this greatly influences utility. This scoping review therefore explored the design and usability preferences of people for wearable technology for health monitoring.

Methods

A scoping review was conducted of literature evaluating user preferences for the design of wearable technology systems, for people aged >50 years, with good health, or chronic diseases.

Results

A search of relevant databases yielded 628 potential studies (after duplicates removed). Following title/abstract and then full text screening, 17 papers were included. The most commonly reported theme related to design and user interface (13 studies). Users wanted a small, unobtrusive and light device which doesn’t snag on clothing or affect activities of daily living, but yet has a readable and easy-to-use interface, which may prove challenging for designers! Users were most happy to wear a device on the wrist and/or hip region, being considered the least obtrusive / most discrete. Users were open to the technology aspects of the device, but wanted specific training, or clear and readable instructions. Less commonly reported parameters included issues with privacy and ownership of data (two studies); cost (two studies); reliability and accuracy (three studies), including being accurate overnight and in the shower, etc.; and clinical usefulness, i.e. the data being effectively linked with other healthcare data. Where considered, participants didn’t want to wear a device by night (two studies). Safety of wearable devices was not a theme in any study.

Conclusion

Overall, user needs seem to be rarely considered in the design of wearable technology for health monitoring. However, the limited studies do highlight important user concerns, which should be considered by the technology designers and prescribers.
197 Role of a Dietitian in a Specialist Memory Assessment and Support Service - Improving Brain Health
Authors: Fox Emma , White Sarah , Digan Eimear , Feehan Sinead , McHale Cathy , Dookhy Joshi , Kennelly Sean
Published: September 2019

Background

Dementia cases are rising nationally due to our ageing population and is associated with a multitude of nutritional consequences. Both obesity and malnutrition are strongly implicated in the progression of cognitive decline. From diagnosis onwards, nutritional intervention is important to improve patient outcomes.

Methods

In order to highlight the important role of a dietitian, a retrospective analysis of 142 patients attending the tertiary memory assessment and support service from 2018 to 2019 was performed. Demographic, cognitive, anthropometric, and nutritional data was compiled from the case note review and biochemical laboratory results. This data was analysed using Microsoft Excel (2013) to study prevalence and relationships of variables in this cohort.

Results

A significant proportion of this population were overweight (41.2%) and obese (18.6%). Nearly half the population were at risk of malnutrition (44.1%) or malnourished (3.9%). In this cohort, 18.6% were characterised as frail. Only one individual had a severe clinical dementia rating score (CDR), 19.2% had a moderate and 28.2% had a mild CDR. Half (50.5%) of participants had some level of abnormal eating habits. Higher prevalence of malnutrition, frailty and higher CDR was associated with increased age. Up to 60% of those with normal nutritional status had a CDR of 0 or 0.5. As MNA score worsened, the incidence of robust individuals decreased linearly. Prevalence of frailty increased as CDR score increased. Of those with a mild CDR, 70% were overweight or obese. Those with high Cambridge Behavioural-Inventory (CBI-R) eating habit scores generally had lower CDRs.

Conclusion

Patients attending the memory service are experiencing a multitude of nutritional challenges such as disordered eating habits, overweight and obesity, malnutrition risk and frailty which are associated with cognitive decline and worse health outcomes. Nutritional support and dietetic input as part of the post-diagnostic care-pathway is required to promote brain health and mitigate unnecessary decline.
212 Integrated Care Hubs for Older Persons; RIGHT PERSON, RIGHT TIME
Authors: Phelan Niamh , Bolger Margaret , Grant Emma , Murphy Catherine , Roche Suzanne , Harnett PJ , Pope George , Mulcahy Riona , Cooke John
Published: September 2019

Background

The development of an Integrated Care Hub has resulted in a complete review of the triage system for older people referred to our service. Our aim was to develop a multidisciplinary triage process (MTP) to ensure patients are seen by the right person at the right time for a First Contact Assessment (FCA).

Methods

A quantitative retrospective analysis of referrals and frequency of multidisciplinary team input from January 2018 – June 2018, highlighted the majority of patients were seen for FCA by the staff nurse. This subsequently resulted in onward referrals to Allied Health Professionals within the ‘Hub’, and patients attended for multiple visits. A working group was formed to address these issues. This resulted in the development of the MTP where patients are triaged by the Multidisciplinary team (MDT) and allocated to the most appropriate team member based on the referring information. Following the introduction of this triage process, data analysed from November 2018 - April 2019 highlighted its impact on our service.

Results

In the first reference period the proportion of patients seen for FCA by each discipline was as follows; Staff nurse (SN) 53%, Clinical Nurse Specialist (CNS) 18%, Occupational Therapist (OT) 16% and Physiotherapist 9%. In the second reference period the proportions changed to the following; SN 12%, CNS 31%, OT 33%, Physiotherapist 20% and Dietitian 4%. It has reduced the number of patient visits to the ‘Hub’ and the waiting times to see the right person within the team.

Conclusion

Empowering supported MDT members to triage and the use of this new MTP has resulted in patients having rapid access to the most appropriate team member for FCA. It has resulted in a change in the distribution of the caseload to ensure patients are seen by the right person within the team, and at the right time for early patient centred intervention.
218 Swallowing/Communication Screening in Older Adults Attending the Emergency Department and Association with Clinical Frailty Scale Scores
Authors: Boyle Orla , Kelly Louise , Ryan Maeve , Brady Deirdre , Wade Ruth , Whelan Catriona , Doherty Orlaith , Murphy Maeve , Mello Sarah , McElwaine Paul , Gray James , Kennelly Sean , Hayden Derek
Published: September 2019

Background

Dysphagia, frailty and negative patient outcomes are interlinked1. Changes in communication may result from the ageing process, chronic conditions, and/or neurologic conditions presenting in later years2. However, unlike other cohorts, including stroke, frail older patients are not routinely screened for swallowing/communication difficulties in acute settings. We investigated the proportion of Speech and Language Therapy (SLT) referrals generated for older patients attending our Emergency Department (ED) following use of a swallowing/communication screening tool and their association with Clinical Frailty Scale (CFS) scores.

Methods

A retrospective analysis of data collected over a four week period was completed. Older patients presenting to ED were screened by the interdisciplinary gerontological ED team using a screening tool, including a locally developed swallow/communication screen. Statistical analyses were performed using STATA Version 12.

Results

Of 176 patients screened (mean age 81.8 years, SD 5.9 years), median CFS score was 5 (IQR 3-6). Thirty-seven percent (66/176) of patients were referred for SLT assessment following initial screen. SLT referrals were more commonly required in patients with a CFS score of ≥4 (46.2% vs. 19.3%, P=0.001) and likelihood of requiring SLT referral increased with greater CFS score (P<0.0001).

Conclusion

Results suggest that screening for swallowing and communication difficulties in older patients yields a high level of SLT referrals, with a higher frequency of SLT referrals observed with increasing frailty scores. Further research is required to determine the optimum swallowing/communication screening tool in the acute setting. Future research will focus on evaluating outcomes of SLT assessments completed and determining the prevalence of swallowing and/or communication difficulties in this cohort.
24 Stroke Risk Factors, Aetiology, and Outcomes in a Multi-ethnic Irish Stroke Population
Authors: Finnegan John , Mello Sarah , Greene Suzanne , Cogan Nicola , Ryan Dan , Coughlan Tara , Kennelly Sean , O'Neill Des , Mahon James , Collins Ronan
Published: September 2019

Background

Stroke aetiology, risk factors and outcomes vary among ethnic groups. The profile of patients presenting to hospital with stroke in Ireland is changing as immigration increases. We aim to describe differences that exist between a multi-ethnic immigrant population and native Irish residents.

Methods

Using our hospital's stroke registry we identified all non-Irish (NI) patients admitted to the stroke unit over a two year period through surname recognition (N=44). Country of birth was confirmed by a chart review. The Irish patients admitted over the same time frame were used as a comparison group (N=437). Data was collected on stroke subtype and outcomes, comorbidities, and socioeconomic factors. Patients were grouped based on ethnicity and stroke subtype. Chi squared test was used to analyze the relationship between groups.

Results

NI patients made up 9.1% of all stroke unit admissions. NI patients were younger than Irish patients (average age 57.5 vs 69.6 years, p <0.01) and there was a higher prevalence of ICH in the NI group (34.1% vs 11.7%, p <0.01). Hypertension was the most common vascular risk factor in both groups (72.7% vs 68.2%, p = 0.54). Mortality and morbidity was lower in the NI group, with more patients being discharged to home.

Conclusion

Our study demonstrates that NI stroke patients have a different risk factor and stroke sub-type profile compared to Irish patients. NI patients are more likely to be young, hypertensive, male, and have higher rates of ICH. Cultural and linguistic barriers may adversely influence health seeking behaviour in this group. These findings underscore the need to identify the root causes of these ethnic differences so targeted primary prevention campaigns can be established.
246 A Clinical Audit of Detection and Management of Sarcopenia in Older Persons’ Specialist Rehabilitation Services in an Academic Teaching Hospital
Authors: O'Callaghan Sarah , Quinn Siobhán , Digan Eimear , Fox Emma , Madden Rebecca , Sheridan Carisa , Hogan Patrick , Kennelly Seán
Published: September 2019

Background

Sarcopenia, characterised by progressive loss of muscle mass and strength, is associated with increased morbidity, mortality and poorer quality of life. International and European clinical practice guidelines on diagnosis and management of sarcopenia suggest the algorithm: Find Cases through screening, Assess Strength with validated outcome measures, Confirm Diagnosis with muscle quantity analysis and Determine Severity with validated physical performance measures (PPMs). Treatment recommendations include progressive resistance training (PRT) and a protein-rich diet. This audit aimed to investigate our specialist gerontological services’ adherence to these guidelines.

Methods

Using a custom-designed audit tool, patient medical records (PMRs) were reviewed in two inpatient rehabilitation wards and one Day Hospital (DH). Patients were included if under the care of a geriatrician and reviewed two or more times by a physiotherapist.

Results

Thirty PMRs were reviewed (18 DH, 12 inpatient). 0% of patients were screened for sarcopenia using a validated screening tool. 83.3% (n=15) of DH patients and 33.3% (n=4) of inpatients underwent a validated strength assessment. 0% of patients underwent muscle quantity analysis. 66.6% (n=12) of DH patients and 33.3% (n=4) of inpatients had validated PPMs performed. Probable sarcopenia was identified in 75% of DH and 100% of inpatients who had PPMs conducted. PRT was prescribed in 94% (n=17) and 50% (n=6) of DH patients and inpatients respectively. 16.6% (n=3) of DH patients and 75% (n=9) of inpatients were referred for nutritional assessment. 100% (n=9) of patients assessed by clinical nutrition were prescribed a high-protein/high-calorie diet.

Conclusion

This audit demonstrates limitations in identifying and managing sarcopenia as per the most recent international and European clinical practice guidelines. It is recognised that a multi-disciplinary approach is required to improve adherence to these guidelines. A multi-disciplinary sarcopenia management pathway is being implemented to facilitate this. Re-audit is planned to ensure the effectiveness of this pathway.