bluuebunny/crossref_metadata_2025 huggingface dataset:
298 Falls and Syncope in Older People in the Emergency Department: Prevalence, Clinical Characteristics and Outcomes
Authors: Bourke Robbie , Rice Ciara , McMahon Geraldine , Cunningham Conal , Anne Kenny Rose , Briggs Robert
Published: September 2019

Background

Falls, syncope and presyncope comprise a large proportion of emergency department (ED) presentations among older people, however accurate data detailing this is limited.

The aim of this study therefore was to ascertain the percentage of ED presentations in older people due to falls/syncope/presyncope, and examine admission rates, length of stay and likely underlying diagnosis.

Methods

Over 1,300 consecutive presentations of older people (aged ≥60 years) to the ED of a large urban university teaching hospital in March 2018 were examined (electronic and hard-copy notes) to ascertain the prevalence of falls/syncope/presyncope presentations.

Data was collected for each presentation with fall/syncope/presyncope on demographics, and relevant clinical characteristics, including admission outcome and length of stay (LOS).

Results

Falls/syncope/presyncope comprised 19% (250/1,324) of presentations of older people to the ED, with a mean age of 75.3 +/-0.64 years. Almost 60% (158/250) presented during ‘normal’ working hours, i.e. Monday to Friday, 0800-1800.

Almost half (121/250) had a Manchester Triage Score (MTS) of 3, indicating a need for urgent care, while one third (93/250) were categorized as requiring very urgent or immediate assessment (MTS 2 or 1 respectively).

Over one third (97/250) presented with explained/accidental falls, while 26% (66/250) and 35% (87/250) presented with syncope and unexplained falls respectively.

One in two (118/250) older people presenting with falls/syncope/presyncope were admitted to the acute hospital, and this rises to almost two thirds (82/135) of those aged ≥75 years. The median LOS was 15 (9.9 -22.0) days.

Conclusion

Older people frequently present to the ED with falls/syncope/presyncope. The majority present during working hours and admission rates and LOS are relatively high.

Falls/syncope/presyncope therefore represent an appropriate target for structured, multidisciplinary assessment at the ‘front door’ to provide early specialist assessment and management, and reduce complications associated with unnecessary admission to hospital.
299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period
Authors: McFeely Aoife , Small Cliona , Hyland Susie , O'Keeffe Jonathan , Hughes Graham , O'Shea Diarmuid
Published: September 2019

Background

Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances.

Methods

A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13.

Results

Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%.

Conclusion

An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year.

These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services.

We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.
302 Vestibular Assessment and Rehabilitation within a Day Hospital Falls Assessment Service: Is it Necessary and is it Feasible?
Authors: McDonnell Micheal , McGrath Fiona , O'Malley Tom
Published: September 2019

Background

Benign Paroxysmal Positional Vertigo (BPPV) and other vestibular disorders are very common and often missed in older populations and are a significant risk factor and cause of falls. Vestibular rehabilitation is increasingly recognised as an effective intervention for the management of vestibular dysfunction in all age groups. This review aimed to explore the prevalence of vestibular disorders in the cohort attending an integrated day hospital falls assessment service and the feasibility of delivering vestibular rehabilitation interventions as part of this service.

Methods

We retrospectively reviewed the charts of all the patients who attended a new ambulatory day hospital between Nov 2018 and April 2019. Inclusion criteria included a recent history of falls and aged over 75. All patients had received a comprehensive geriatric assessment which included screening for vestibular symptoms and on-site assessment (if indicated) by a physiotherapist with expertise in vestibular rehabilitation.

Results

40 patients (33 women, 7 men) with a mean age of 82 were seen in this period. All had suffered recent falls with 10 having suffered a fracture. 5 patients (12%) tested positive for Benign Paroxysmal Positional Vertigo and 2 others (5%) had evidence of both peripheral and central vestibular impairment. Vestibular rehabilitation interventions, including particle repositioning manoeuvres were delivered within the day hospital setting with review appointments offered to all patients.

Conclusion

This review highlights the high prevalence of vestibular disorders, especially BPPV (12%) in older fallers. It supports the feasibility of delivering vestibular assessments and rehabilitation as a component of the physiotherapy input within a day hospital falls service.
307 A Survey of Nutritional Status of Older Patients Attending Medicine for Older Person Clinics
Authors: Malomo Keneilwe , Soh Josephine , Dolan Eamon , O'Connor Marie
Published: September 2019

Background

Nutritional assessment is an important but frequently overlooked aspect of comprehensive geriatric assessment. Malnutrition is common and associated with clinical complications. Our study aimed to assess older patients’ perceptions of their nutritional status and to investigate clinical factors affecting it.

Methods

All patients attending our clinics over a 2 week period were invited to complete a self-administered questionnaire. Further clinical information including diagnosis and weight collected by review of medical notes.

Results

A total of 43 patients completed the questionnaire; median age 82.5 years (67-102). Of these, 69.8%(n=30) were female and 27.9% (n=12) lived alone. Majority reported good appetite (83.7%, n=36) and eating 3 meals a day (79.1%,n=34). 25.6%(n=11) prepared meals themselves and 34.9%(n=15) had received nutritional advise from healthcare professionals.

17 patients (39.5%) self-reported weight loss over the past year, and of these 76.5% (n=13) had objective weight loss documented. Only 2.3% (n=1) were concerned and seek advice from healthcare professionals. 50% (n=12) of the remaining 24 patients who self-reported no weight loss had objective weight loss in clinic. 26 (60.5%) patients had objective weight loss.

A higher proportion of the weight loss cohort lived alone (30.8% vs 23.5%), had no home care packages(HCP) (65.4% vs 47.1%), did not take nutritional supplement (76.9% vs 58.8%), had no dentures ( 42.5% vs 23.5%) and had no diagnosis of dementia (57.7% vs 47.1%).

Of those who lost weight, 34.6% (n=9) lost significant amount (>5%) of weight, including 4 (15.4%) who lost >10%.

Conclusion

2 out of 3 of our community dwelling, older patients lost weight, with one third having lost significant amount. Awareness is poor with 50% not recognising their weight loss and only one third ever sought nutritional advice. Patients who lost weight were more likely to be living alone with no formal community supports.
308 Association of Diabetes and Frailty with Mortality in Middle-Aged and Older Europeans
Authors: O'Donovan Mark , Sezgin Duygu , Liew Aaron , O'Caoimh Rónán
Published: September 2019

Background

Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years.

Methods

Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant’s first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression).

Results

Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05).

Conclusion

Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals.
311 Older Adults Awareness and Response to Stroke in Ireland.
Authors: O'Connell Liz , McCarthy Geraldine , Hartigan Irene
Published: September 2019

Background

Early recognition of stroke symptoms and immediate response is necessary to ensure timely access to treatment of stroke. However, many individuals fail identify symptoms of stroke or delay in seeking medical attention. The Irish Heart Foundation launched the “Act Fast” campaign which included three waves of broadcasting on national television and radio, throughout 2010 and 2011. Stroke awareness campaigns may have the potential to influence behaviour and response to stroke.

Methods

A non-experimental, descriptive, quantitative, cross-sectional study was conducted. The Stroke Action Test (STAT)1 was used to investigate how participants would respond to specific symptoms of stroke. A convenience sample (n=89) of older adults attending an outpatient clinic in a university teaching hospital completed the questionnaire. The mean age of respondents was 79.6 years (SD =9.3).

Results

Just 4.5% (n=4) of respondents identified what all 4 letters of FAST represent. Overall, 48% (n=43) of respondents recognised all 6 symptoms of stroke and 100% (n=89) recognised at least 2 symptoms of stroke as per STAT. The stroke symptom most frequently recognised was sudden numbness of the face, arm or leg at 99% (n=88). The stroke symptom least frequently recognised was sudden trouble seeing in one or both eyes at 56% (n=50). Despite this 81% (n=64) of respondents would not respond appropriately to 50% of symptoms of stroke described in the STAT. 52% (n=46) of respondents identified irregular heart beat as a risk factor for stroke. Finally, 29% (n=26) of respondents had heard of thrombolysis while just 2% (n=2) had heard of thrombectomy.

Conclusion

Awareness of stroke symptoms does not necessarily influence response to stroke in older adults. Future stroke awareness campaigns should consider FAST2 which speaks to treatment (thrombolysis or thrombectomy) as well as time.
324 Effect of Regular Multidisciplinary Psychotropic Review Meetings on Anti-psychotic Prescribing Practices in a Community Nursing Unit
Authors: Giles Barbara , Gamorak Lesya , Adanza Arlene , Gicale Joy , McCarthy Frances
Published: September 2019

Background

The management of non cognitive symptoms of dementia can be challenging for people living with dementia and their carers. The risks and limited benefit of antipsychotics in this setting is well documented however despite this they still are often prescribed. A previous study at our facility in 2016 highlighted a high prevalence of antipsychotic prescribing at 35% (Bambrick, et al. 2016). As a result of this, multidisciplinary psychotropic review meetings were established and are ongoing.

Methods

Two wards in our community nursing unit were selected. Inclusion criteria included residency > 6 months. The case notes, medication lists (admission and current prescriptions), and psychotropic review meeting notes were reviewed.

Results

43 residents were included in the study. 72% (n=31) were female. The average age was 85 years. 74% (n= 32) of residents had a documented dementia diagnosis.

On admission, 7 residents were taking regular antipsychotics. 5 of these medications were subsequently either reduced or discontinued.

At the time of the study, 16% (n=7) were prescribed regular antipsychotics. There was a definite indication for 3 of these (schizoaffective disorder, psychosis, paranoid depression). 1 resident had a traumatic brain injury with associated distressing symptoms with harm incidents. 3 had a dementia diagnosis with associated distressing symptoms.

A further 14% (n= 6) were prescribed antipsychotics on a PRN basis. 5 had a documented diagnosis of dementia with associated distressing symptoms. None of these residents received these medications in the 4 weeks prior to the study.

Conclusion

Significant improvements are noted since 2016 with the overall prevalence of antipsychotic prescribing decreasing from 35% to 16%, with the majority of these prescriptions having a clear indication. It is reassuring that residents are not receiving prn medications frequently. We await the national clinical guidance on “Appropriate Prescribing of Psychotropic Medication in People with Dementia” to further guide our practice.
331 Implementation of Community Based Comprehensive Geriatric Assessment and Intervention in a Rural Irish Setting
Authors: McLoughlin Petra , Murphy Eleanor , O'Sullivan Fiona , Connellan Ciara
Published: September 2019

Background

The Integrated Care Team for Older People (ICTOP) in Sligo formed in 2018 to provide home based rehabilitation for acutely frail older adults to enable them to continue to live independently.

It serves a predominantly rural catchment area with 14.5% aged >65 years versus the national average of 11%.1

An in-home person-centred multi-disciplinary approach is utilized based on the principles of comprehensive geriatric assessment (CGA).

This observational study aims to describe the typical user of this service, interventions and outcomes to date.

Methods

An Excel database was compiled and analysed from CGA of consecutive referrals from June to December 2018.

Results

Of the 70 referrals studied, 69% resided in rural Sligo, two thirds were female and there was a mean age of 82.3 (range 68-95).

The median Rockwood Clinical Frailty Scale level was 6 and the median Timed Up and Go was 28seconds.

Hospital in-patients accounted for 58% of referrals with functional deterioration (74%), mobility decline (72%) and cognitive decline (28%) the most frequent referral reasons.

Gait imbalance was the most prevalent co-morbidity (77%).

There was an average of 4.5 home visits per person.

Over 80% of referrals received combined physiotherapy and occupational therapy input, with Clinical Nurse Specialist (CNS) in Dementia involvement in 40%, speech and language therapy in 26% and social work in 15%.

CGA identified additional clinical and social needs in 100%, and the team made 217 onward referrals to available community health and social supports.

ICTOP referral decreased length of stay by 2.6days and only one patient required long term care.

Conclusion

The use of a multidisciplinary team providing domiciliary assessments decreased hospital stay, facilitated maintenance of independent living and addressed both identified and un-identified needs in a frail older person’s population. Further evaluation over time is needed to indicate impact on readmission rate.
334 GEMS: Geriatric Emergency Service - Rockwood’s Clinical Frailty Scale and Outcomes
Authors: Reddy Danielle , Gallagher Grainne , O'Callaghan Maureen , Cornally Lorna , Hayes Brennan Megan , Mulholland Ann , Nolan Jane , Normoyle Cathriona , Ahern Emer , Gibbons Ruth
Published: September 2019

Background

Rockwood’s Clinical Frailty Scale (CFS), which uses clinical descriptors and pictographs, was developed to provide clinicians with an easily applicable tool to stratify older adults according to level of vulnerability. The CFS was validated in a sample of 2305 older participants from the Canadian Study of Health and Aging and was shown to be a strong predictor of institutionalisation and mortality (Rockwood K, 2005).

Methods

The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. At the end of CGA all patients have a score 1 to 9 assigned from the Clinical Frailty Scale (CFS).

Results

10,037 patients were triaged in the first two years of the service. 43% screened positive for Frailty. 66% had a CGA. 10% were vulnerable CFS 4, 32% mildly frail CFS 5, 32% moderately frail CFS 6 and 31% severely frail CFS 7. Increasing score on the CFS correlated with increased length of stay, death and institutionalisation.

Conclusion

The CFS correlates with Length of stay (LOS), mortality and institutionalisation in people aged 75 years and older who attend as an emegency and screen positive for Frailty.
36 Use of Biologics in Older Patients with Inflammatory Arthritis
Authors: Donnellan Adam , Hannon Evelyn , Buckley Mary , Murphy Grainne
Published: September 2019

Background

Biologics are a key component of the treatment armamentarium for inflammatory arthritis (IA). Questions remain surrounding the prescription, efficacy and safety of biologics in the older population. This study aims to describe the use of biologics in older patients with IA and compare it to younger patients.

Methods

This was a retrospective cohort study of patients with a diagnosis of IA who were receiving a biologic. Data was collected from medical charts at rheumatology outpatient clinics. Patients were divided into two groups: younger group (age 45 – 65) and older group (age >70).

Results

Each group had 30 patients (total n=60). 58% were female and the mean age overall was 65 years. Rheumatoid arthritis was the most common diagnosis (57%). 8 patients had active disease, and these were mainly older patients (n=6). 8 different biologics featured; the majority of patients received the standard dose of biologic (87% of younger, 80% of older). The incidence of biologic discontinuation due to drug ineffectiveness was the same for both groups (16%). 1 older patient had a biologic discontinued due to a serious adverse event. Infections requiring hospitalisation were not common (total n=5) but were more frequent amongst older patients (n=4). 47% of younger and 60% of older patients received concomitant therapy; most received a disease-modifying antirheumatic drug (DMARD) (72%), and those who received a steroid (n=6) were more likely to be older (n=5).

Conclusion

Biologic prescribing was similar between both groups with regard to the dosage administered, but there were differences in the types of biologics prescribed to each group. Rates of significant infection were low overall, however they were more prevalent amongst the older population. More older patients had active disease, and more were prescribed concomitant steroid therapy, which may represent under-dosing of biologic therapy in this older cohort.
338 Evaluation of a new clinical pharmacy service model in a University Teaching hospital in Dublin, Ireland
Authors: Williamson Claire , Collins Aisling , Carr Bernard , Melanophy Gail , Byrne Stephen
Published: September 2019

Background

Advances in medicines reconciliation, drug monitoring and patient counselling requirements as well as added non-clinical responsibilities at ward level have led to an increased workload on a ward-based pharmacist. There is a need to optimise the service to meet these demands.

The aim of this study was to audit the current clinical pharmacy services and to implement a New Model of Clinical Pharmacy on four wards to aid in the optimisation and prioritisation of patients during the clinical ward service.

Methods

The study was undertaken in Dublin based, University Teaching Hospital between March and June 2018. The study included the following: (1) a comprehensive literature review, (2) focus groups with key decision makers, (3) the collection and analysis of quantitative data on patients screening and interventions performed pre- and post- model implementation, (4) the final stage involved a satisfaction surveys from pharmacists involved in the study. Local ethical approval was obtained for this study.

Results

The new clinical pharmacy model increased the amount of medicines reconciliation completed (pre-model implementation 77.7% (n=192) versus post-model implementation 81.6% (n=236)), decreased time to medication reconciliation completion on Mondays and Fridays, increased discharge information cards completed and did not show statistical inferiority in the amount of interventions picked up by pharmacists (p value= 0.86; two tailed t-test). Pharmacists in the study felt the model impacted their clinical ward visit positively and aided prioritisation but did not improve on their overall job satisfaction level.

Conclusion

The study shows that a new model of clinical pharmacy can impact positively on a pharmacist’s working day by formalising the prioritisation of high-risk patients, setting clear expectations and structure without impacting negatively on other clinical duties. It is believed that the model developed will continue to support the pharmacists’ decision making and workload prioritisation post implementation of electronic prescribing.
40 Using the Variable Indication of Placement Tool to Drive De-prescribing in the Frail Older Person in an Interdisciplinary Integrated Team
Authors: Vince Athanasiyar , Pillay Isweri , O’Reilly Aine , Cooney Eamonn , Maher Jennifer , Pender Ciara , Ryan Siobhan , Sayers Karen , Donnellan Christina
Published: September 2019

Background

The variable indicator of placement (VIP) tool is designed to identify patients at risk of frailty. The risk of harm in a frail older person increases as the number of prescribed drugs increases. Polypharmacy may be either appropriate or inappropriate. Deprescribing, aims to withdraw inappropriate medication under supervision, in order to improve outcomes.

Methods

50 consecutive patients, attending an emergency department, were triaged with the VIP tool, triggering a single interdisciplinary assessment (SIA) by an integrated care team member. The SIA identified polypharmacy. Drugs which may be causing harm, may no longer be of benefit or were potentially interacting with other drugs, were identified. The Anti-cholinergic Burden (ACB) Score was calculated. Appropriate medication changes were made following interdisciplinary and patient/carer discussion. Patients were selected for one to one pharmacy and patient/carer liaison, which was followed through into their community setting e.g. long term benzodiazepine usage.

Results

The drugs which were identified for gradual withdrawal or cessation were benzodiazepines (n=6), opiates (n=4), genitourinary (n=2), digoxin (n=2), hyoscine (n=2), domperidone (n=2) and amitryptilline (n=1). The total ACB score for 50 patients was 95 pre-assessment and 65 post-assessment. This represented a 32% reduction in anti-cholinergic burden alone for this frail older adult cohort.

Conclusion

The VIP tool if used to trigger an SIA, can target those patients at risk of the adverse effects of polypharmacy. The calculated ACB score can trigger meaningful discussion with patients and carers around what matters to them. A system for supervised deprescribing is necessary to ensure successful reduction in ACB.
41 From Ward to Classroom: Service Evaluation of Education to Increase Awareness of Frailty and Resilience and Encourage Greater Physical Activity
Authors: Travers John , Romero-Ortuno Roman , Lyons Declan , Cooney Marie-Therese
Published: September 2019

Background

Our hospital routinely offers a weekly group discussion session for inpatients on aspects of ageing as part of an ‘evergreen programme’ (EP) of health education. Topics are varied and facilitated by a doctor in an informal, open forum. Feedback from nurses, doctors and patients suggested that the EP was lacking in emphasis on the benefits of exercise to improve the levels of physical activity among inpatients. As part of a local quality improvement (QI) initiative, the EP set out to incorporate the provision of patient education on the reported benefits of strength exercises in delaying and reversing frailty. Here we describe the development of this QI initiative and its evaluation.

Methods

New health education content was added to an EP group discussion to address four key aspects of frailty, namely: definition, risks, screening and interventions. The Socratic health education method was used in the next weekly group discussion (e.g., what does frailty mean to you? What are the consequences? How would you measure frailty? What if it could be delayed or reversed?). An exercise leaflet was provided and strength exercises were demonstrated.

Results

18 of 27 over-65-year-old patients attended the group discussion, mean age 75, 11 female (61%). 2 participants were interested in doing strength exercises at the start of the session (11%, 0 female) when asked. Most participants had not been aware that strength exercises can delay and reverse frailty. 14 participants (78%, 8 female) declared interest in doing strength exercises at the end. Interested participants used the exercise leaflet for independent exercise in hospital and brought it home on discharge.

Conclusion

The EP at our hospital has been improved to include greater emphasis on the benefits of strength exercises in delaying and reversing frailty. QI initiatives can allow translation of research evidence into patient education.
55 A Review of Stroke Demographics and Outcomes at a Regional Hospital without a Stroke Unit
Authors: Pillay Lushen , Galav Kushan , Tulsi Deeptish , McGlynn Joanna , Doherty John , Donnelly Teresa
Published: September 2019

Background

According to the 2017 National Stroke Register Report; 75% of strokes occur in patients aged 65 years and older. Within the audit 19 stroke units reported that 70.6% of stroke patients were admitted to a stroke unit and their median length of stay of 9 days. Numerous studies have shown better outcomes in patients admitted to a stroke unit versus a medical unit leading to national stroke networks and bypass protocols for patients. However, stroke patients can still be found in non-stroke unit hospitals such as our own.

Methods

Demographics from HIPE data was collected on all stroke patients admitted to our hospital between January 1st and December 31st 2017. Basic statistical methods were used to analyse the data.

Results

We analyzed 103 patient records. The average age at presentation was 73 years (range: 35-97) and 60.1% were males. The average length of hospital stay was 16.1 days (range 1- 130 days). Ischemic (77%) events were more common than haemorrhagic events (23%). The three most common co-morbidities were hypertension (45%), hyperlipidemia (30%) and atrial fibrillation (19%). Discharge destination was home (66%), nursing home (14%), national rehabilitation (2%) and an 18% mortality rate within 3 months. The mortality rate was higher in the hemorrhagic (42%) compared to ischemic (11%).

Conclusion

The average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.
60 Opening the Narrative on Deprivation of Liberty for the Older Person in Residential Healthcare Facilities: A Legal and Ethical Dilemma
Authors: Hogan Florence , Ahern Adrian
Published: September 2019

Background

While many people enter residential care of their own free will and because it is their preference, the evidence tells us that there are also many who if they had the choice would remain in their own homes. Lack of appropriate community supports may provide some impetus to enter residential care. According to Care Alliance Ireland, an additional four million hours of homecare needs to be provided to cope with the successful ageing demographics, at a cost of €110 million.

There is no statutory or common-law power to detain a patient in a Healthcare Facility outside of the application of the Mental Health Act 2001. This presents legal, ethical and moral dilemmas for Healthcare Providers when caring for a person who lacks capacity wishes to self - discharge. A duty of care obligates healthcare professionals to act in the best interest of the individual. Under the Health Act 2007 the requirement is to provide for a ‘safe discharge’.

Pending advancement of the Assisted Decision Making (Capacity) Act 2015 which provides a statutory framework to assist and support individuals to make legally-binding agreements about their welfare, their property and affairs we are currently acting under the Lunacy Regulations (1871).

Methods

We developed a ‘Deprivation of Liberty’ form which enable comprehensive Interdisciplinary Team discussion and direction of care. Presumption of capacity, respect for the resident’s wishes and consideration of all possible supportive actions up to and including sourcing community support services were considered.

Results

This format has enabled comprehensive discussion and robust adherence to human rights for three residents thus far

Conclusion

The situation remains that there is no legal framework to guide healthcare providers currently. Using a Human Rights based approach is imperative to guide us while awaiting advancement of the ADMA (2015) and Deprivation of Liberty legislation to be included in this act.
74 GPs Knowledge of and Attitudes Towards the Management of Behavioural and Psychological Symptoms of Dementia: a Descriptive Cross Sectional Study
Authors: Jennings Aisling A , Fatimah Dhuny Sheefah Bibi , Foley Tony
Published: September 2019

Background

Evidence suggests that the current management of behavioural and psychological symptoms of dementia (BPSD) in general practice is sub-optimal. Non-pharmacological strategies are recommended first-line but uptake of these strategies is low. Despite their adverse effects and minimal effectiveness antipsychotics are frequently employed to manage BPSD. The aim of this study was to explore general practitioners (GPs) knowledge of and attitudes towards the management of BPSD with a view to informing future interventions.

Methods

A questionnaire was adapted from existing study. Additional questions were included, informed by the findings of a qualitative study previously conducted by the authors. The questionnaire was piloted with 3 GPs and was posted to a census sample of all GPs in county Cork and county Kerry in the south of Ireland. Statistical analysis was performed using SPSS.

Results

Of the 456 questionnaires sent 168 completed questionnaires were returned (36.8% response rate). The sample was representative of GPs nationally in terms of years of practice (p<0.0001). 62.5 % (105/168) of respondents had a nursing home commitment. The majority of GPs (60.7%) agreed that they required more training to improve their management of BPSD. ‘Lack of resources in the primary care team’ was cited as the main barrier to GPs recommending non-pharmacological strategies in the community. Nursing staff were identified as the group of people that most influenced the GPs prescribing of antipsychotic medications in a nursing home setting. The majority of respondents (84/168) did not monitor their prescribing of antipsychotics to people with dementia. 63.1% (106/168) of GPs were concerned that withdrawing these medications would negatively impact on the quality of life of the person with dementia.

Conclusion

This study identified several factors that influenced the management of BPSD in general practice. These findings will be used to guide future interventions in this area.
83 The Feasibility of an Interdisciplinary Led Community Based Functional Training Group for Frail Older Adults in a Post-Acute Orthogeriatric Unit
Authors: McDaid Edel , Johnston Aoife , Ross Elaine , Cogan Lisa
Published: September 2019

Background

Reduced ability to perform instrumental activities of daily living (IADLs) can lead to a difficult transition from hospital to home, increased dependence and diminished quality of life (1). A novel IADL group for frail older adults ‘Ready Steady Home’ was completed to facilitate transition from hospital to home.

Methods

A single centre prospective study was undertaken in a Post-Acute Orthogeriatric Rehabilitation Care unit. A sample of convenience was recruited over a 3 month period. All subjects invited to participate had been referred for Physiotherapy and Occupational Therapy, medically stable, able to give consent, mobile with/without an aid and had a goal of community ambulation and IADLS. The one hour intervention consisted of a car transfer, outdoor mobility on a busy footpath, road crossing, negotiating a busy shop, completing shopping task and financial management. A self-reported modified Client Satisfaction Questionnaire (CSQ-8) was completed by all subjects post intervention. Data was analysed using descriptive statistics.

Results

Twelve participants (female (12); mean age 83.7 years, mean LOS 32.75 days) completed the intervention and were included in the data. All were frail with a Clinical Frailty Scale score ≥ 5, mild (n=4), moderate (n=7) and severe frailty (n=1). Primary diagnosis was femoral fracture (n=7), hip surgery revision (n=2), deconditioning (n=2) and pelvic fracture (n=1). All used a unilateral (n=5) and/or bilateral mobility aid (n=7). The mean CSQ-8 score was 27/32 indicating high satisfaction with the intervention. No adverse events occurred. Common themes reported were improved confidence with community ambulation, preparation for home and re-integration into the community.

Conclusion

This study indicates that an interdisciplinary intervention addressing community based IADLS was feasible, safe and effective in a frail Orthogeriatric inpatient cohort. Further research is required to evaluate the effectiveness of this therapy intervention in improving hospital to home transition and potential reduction in LOS.
104 Exploring the Utility of the VERA Framework to Improve Communication between Nursing Students and People with Dementia in Long-term Care
Authors: Dorey Amber , Jordan Fionnuala , Casey Dympna
Published: September 2019

Background

Developed by Blackhall et al. (2011), the Validation, Emotion, Reassure, Activity (VERA) communication framework seeks to provide student nurses with a guide to provide person-centred care to people living with dementia. The framework aims to enable the caregiver to communicate with the person living with dementia in a respectful manner, and accept that there is both value and meaning to the person’s speech and behaviour. This paper presents the findings from a small pilot control pre-post study which aimed to explore the impact of the VERA framework to promote person-centred communication between student nurses and older people with dementia in long term care.

Methods

A control group of six students, received standard communication training and ten students received additional communication training using the VERA framework. Data was collected using the non-participant observational tool Quality of Interactions Schedule (QUIS) and three self-assessment questionnaires to assess student nurses’ confidence, dementia knowledge and communication skills.

Results

The results of this study found that those students who received the additional VERA communication training were observed to have a significantly (Mann-Whitney U test; p = <0.05) reduced number of negative interactions with people with dementia than those students who had received standard communication training alone. In addition, student nurses trained in the VERA framework showed a significant increase (Mann-Whitney U test; p = <0.05) in their confidence to care for people with dementia than those who had received standard communication skills training.

Conclusion

The study finding need to be interpreted with caution given the small sample size and the pilot nature of the study. Nevertheless, these findings indicate that the VERA framework has the potential to improve (1) person-centred communication between student nurses and older people with dementia and (2) students’ confidence to care for people with dementia.
107 Quality Improvement in Action! The Development of a Delirium Bay
Authors: Loughlin Elaine , Conry Miriam , Gavin Catherine , Sheil Orla , O'Connor Martina , Comer Anne , O'Connell Karen , Kearns Caroline , Mulkerrin Eamon , Canavan Michelle , Robinson Stephanie
Published: September 2019

Background

As illustrated in a cross-sectional study at a Galway hospital, delirium is common with a 29% incidence in hospitalised older adults. This is associated with adverse clinical outcomes. Guidelines support specialised environments in the management of delirium to reduce morbidity and mortality. A delirium bay is a specialised unit with a standardised approach to comprehensive geriatric assessment for older adults with delirium.

Methods

We aimed to improve the care of the delirious older adult within our existing framework by creating a ‘Delirium Bay’ utilising the principles of quality improvement. An interdisciplinary team completed ‘Quality Improvement in Action’ training run by the Royal College of Physicians of Ireland from October 2018-March 2019. This involved defining our problem statement and ‘SMART’ aim (Specific, Measurable, Achievable, Realistic, Timely). Measures for improvement included the rate of adverse events, the duration of episodes, patient/family satisfaction, and the use of one-to-one supervision of patients.

Results

Stakeholder analysis included nursing, catering, multidisciplinary and healthcare assistance staff. We liaised with hospital management regarding restructuring staffing and maintenance regarding environmental changes. An educational programme on delirium was delivered.. We collected baseline data utilising the ‘Plan, Do, Study, Act’ Model and utilised this to guide our changes. A Standard Operating Procedures document was drafted. We opened our four-bedded delirium bay on 11th March 2019. Preliminary data indicates improved management of delirium with preserved continence, reduced risk of falls and high patient and family satisfaction levels. Interventions have been implemented with minimal funding and infrastructural changes. Staffing reconfiguration involved standardised planning replacing a pre-existing ad-hoc system.

Conclusion

Delirium in hospitalised older adults is common and associated with increased morbidity and mortality, yet amenable to interventions. We demonstrate that a delirium bay can be set up with a quality improvement approach. Pilot data suggests improved management of these patients within the framework of existing resources. Further collection of data on clinical outcomes is ongoing.
121 Patients with Prolonged Lengths of Stay. A Point Prevalence Study
Authors: Short Eimear , D'Alton Maeve , Dolan Eamon , Dunne Aoife , Hartigan Denise , Jones Claire , Morrison Laura , O'Connor Marie
Published: September 2019

Background

A hospital's trolley count is often highlighted as a measure of its performance. However there is a more complex reality for each organisation in accessing suitable resources for often frail older patients to improve care and capacity. Coupled with this is the need for pathways that identify these patients early in their admission and access the appropriate specialist care. In 2018, 65% of this hospital's bed days were occupied by those whose hospital stay was greater than 14 days. Nationally this was 57%. We undertook to review processes locally around the care of older acute patients.

Methods

On the 20th November 2018 we conducted a chart audit of 85 in-patients who had been in the acute setting for more than 14 days. A proforma was completed for each patient by a doctor and multi-disciplinary team member.

Results

The length of stay ranged from 15 – 527 days with the median being 41 days. The average age was 76 years. A history of falls/dementia/“acopia” was recorded on admission in 57%. The mean time for referral to MDT was 5 days. Social history was only documented in 47% of cases. Ward transfers was a significant issue with 69% moving wards at least once and 9% moving three times or more. A care planning meeting had not been held in 49% of cases. Over 17% of charts audited were awaiting home care package hours whilst 20% were awaiting long term care. In 62% of cases there was no ongoing medical reason keeping them in hospital and 56% of this cohort could have been cared for elsewhere.

Conclusion

Deficits in clear communication and appropriate timely planning for patients resulted in significant delays in discharge. The findings of our research informed a decision to conduct a root and branch analysis of discharge planning utilising the Lean Six Sigma model.
143 Audio-Visual Training of Perception in Ageing
Authors: O'Brien Jessica , Jason Chan , Setti Annalisa
Published: September 2019

Background

Multisensory perception is the ability to merge information from different sensory modalities. There is a growing interest in identifying ways to improve multisensory perception abilities in older adults, as inefficient multisensory processing has been linked to cognitive and functional impairments. Previous research has shown multisensory perception can be improved in young adults through training their simultaneity judgement. In the present study, we tested whether two different versions of this successful training protocol could train audio-visual abilities in older adults.

Methods

Fifty-eight (32 female) community dwelling and cognitively healthy older adults participated in this study. The age range was 60 – 85 (M=72.47, SD = 6.46). Recruitment was completed through active retired and community-based HSE Falls groups. Participants were randomly assigned to one of two experimental conditions; synchronous or asynchronous training. Each group performed a similar computer-based training protocol, the difference between groups being the instruction given during training. Participants’ multisensory processing was assessed using the Sound-induced Flash Illusion (SiFI) which measures processing efficiency based on susceptibility to an audio-visual illusion.

Results

After 3 days of training, the Analysis of Variance on multisensory thresholds revealed no significant main effect of Training Group [F(1, 42) = .22, p = .64, partial eta squared = .005], Time [F(1, 42) = .007, p = .93, partial eta squared <.001] or SOA [F(5, 210) = 1.19, p = .31, partial eta squared = .028]. Further analyses showed no performance improvement, nor change in susceptibility to the SiFI.

Conclusion

These results provide useful information for future studies exploring ways to train multisensory processing in older adults. We argue the cognitive demands of the computer-based task may account for the lack of an effect in older adults. Our findings highlight the role of task demands and cognitive load as factors to consider in future training studies with older adults.
147 Assessing Assessment: An Audit of Continence Assessment and Documentation in a City Centre Teaching Hospital
Authors: Randles Mary , Hayes Mary , Cotter Susanne , Saramago Ines , McGrath Kieth , O'Caoimh Rónán , O'Connor Kieran , O'Hea Anne , Hannon Evelyn
Published: September 2019

Background

Urinary incontinence (UI) is defined by the International Continence Society as “any involuntary leakage of urine.” UI can negatively impact patients' physical and mental wellbeing and quality of life. Since older adults constitute a growing hospital population, evaluation and improvement of this patient group's quality of care is recognized as a priority in the study hospital. A continence assessment helps to determine what the problem is and what management is required.

This audit aims to determine whether appropriate assessments of continence in older adults presenting to the hospital setting were completed and documented.

Methods

An audit tool was adapted from the Royal College of Physicians National Continence Audit tool and the hospital's own elimination documentation pathway. On a chosen day a general medical ward and a specialist geriatric medicine ward were assessed. Medical charts, nursing notes, emergency department proforma, frailty intervention team proforma and skin integrity proforma were reviewed. Documentation of continence status, symptoms, type, investigations, continence wear, catheterisation and management were assessed. Continence care plans and evidence of communication/discussion with patients were also assessed.

Results

Thirty-one sets of documentation were reviewed. Twenty-four patients were aged over 65. Of these patients 12 were male and 12 were female. Four patients had no continence status documented. Forty-two percent of those reviewed over 65 had documented incontinence and of these only 40% had the elimination section of their nursing proforma fully completed. Six of the patients with documented incontinence had their symptoms/type of incontinence documented. Two Patients had urinary catheters, the indications for these catheters were documented

Conclusion

This audit found that overall the assessment and documentation of continence in older adults was sub-optimal. Based on this audit an assessment tool and education program will be introduced to the specialist geriatric medicine ward with the goal of improving assessment of continence and optimal management.