bluuebunny/crossref_metadata_2025 huggingface dataset:
84 Does Dual-Task Gait Speed Predict Cognitive Performance in Midlife Type 2 Diabetes? Baseline Results from the ENBIND Study
Authors: Dyer Adam , Killane Isabelle , Bourke Nollaig , Woods Conor , Gibney James , O'Neill Desmond , Reilly Richard , Kennelly Sean
Published: September 2019

Background

Type 2 Diabetes (T2DM) in midlife is associated with a greater risk of dementia in later life. The longitudinal ENBIND Study is examining novel approaches to biomarker discovery in this high-risk group which may help identify those at greatest risk

Methods

Non-demented participants with midlife T2DM (no micro/macrovascular complications) and matched controls were recruited. Following detailed health/diabetes assessment, general cognitive (MoCA) and computerised neuropsychological (CANTAB) assessment were performed. Gait was assessed by stopwatch and accelerometers across several tasks including self-selected and maximal gait speed in addition to a dual-task cognitive paradigm (reciting alternate letters of the alphabet). Bloods were analysed for C-Reactive Protein (CRP) and glycated haemoglobin (HbA1c). Between group differences were analysed using t-tests/non-parametric equivalents and linear regression used for multivariate analysis.

Results

Sixty participants with T2DM (51.9 +/- 8.4 yrs) and 30 matched controls (52.3 +/- 7.9 yrs) were recruited. Controlling for demographic and cardiovascular covariates, T2DM was associated with a lower MoCA score, slower self-selected, maximal and dual-task gait speed (all p<0.05). Maximal gait speed (p =0.006) but not self-selected gait speed (p =0.47) was associated with poorer cognitive function. On multivariate analysis of the dual-task difference, both T2DM and lower MoCA score were associated with a poorer performance, (p<0.001, p= 0.003). Overall, performance in the lowest vs highest quartile on the dual-task gait paradigm was associated with a significantly poorer performance on the MoCA (p<0.001; median 27 vs 29). On multivariate analysis of laboratory parameters, higher CRP levels were associated with slower maximal (p =0.041) and dual-task (p=0.033) gait performance.

Conclusion

Midlife T2DM is associated with poorer cognitive performance. Gait speed, and in particular dual-task gait speed, correlate strongly with general cognitive performance. Future work will tease out the specific domains of gait and cognition which are affected, and assess longitudinally in this high-risk group.
100 The Factors Which Impact Non-Familial Intergenerational Interaction within Public Space: An Integrative Review
Authors: Kennedy Olwen , Boland Pauline
Published: September 2019

Background

Intergenerational interaction is the communication which occurs between people from two or more generations and known benefits include improved psychological wellbeing and decreased social isolation. Intergenerational programs therefore have the potential to decrease risk of loneliness for older people. Public spaces are accessible and open for use to all people, irrespective of age or ability, and are therefore an important environment to consider for intergenerational interaction development. The aim of this review was to identify factors which impact non-familial intergenerational interaction within public spaces.

Methods

An integrative review of qualitative and quantitative peer reviewed literature was completed, from inception through January 2019. Academic Search Complete, Avery Index to Architectural Periodicals, CINAHL, Science Direct, SCOPUS, Social Sciences Citation Index and Web of Science were searched. The search yielded 488 articles, 16 of which were included. Research studies were critically appraised using the Crowe Critical Appraisal Tool and key data were extracted and synthesised to identify the factors which impact non-familial intergenerational interactions in public spaces, through a method of constant comparison analysis.

Results

Three key themes were identified: ‘Comparing naturally occurring non-familial intergenerational interactions with structured intergenerational programs’; ‘Barriers to non-familial intergenerational interactions in public spaces’ and ‘Successful non-familial intergenerational interaction achieved through shared activity’.

Conclusion

The findings highlighted that structured intergenerational programs have a greater chance of facilitating positive intergenerational interaction, as the presence of a group facilitator directly enabled non-familial intergenerational interactions. Successful non-familial intergenerational interactions were achieved through shared experiences of fun and meaningful activities. Barriers to non-familial intergenerational interaction in public space included lack of opportunities, negative attitudes held of different generations, age stereotypes and age segregation. Older people have the potential to benefit most from non-familial intergenerational interaction, due to increased risk of loneliness and high participation rates in non-familial intergenerational interactions in public spaces.
129 To Examine the Factors Affecting the Health and Wellbeing of Centenarians Living in Ireland
Authors: Fagan Alison , Gaffney Lorraine , McDonnell-Naughton Mary
Published: September 2019

Background

The notable increases in life expectancies worldwide combined with advances in contemporary medicine, escalating healthcare costs and increased demands on social services has driven the interest in centenarians as a model for healthy ageing. According to the United Nations, the global number of centenarians is set to continue to climb, expecting to reach more than 25 million people in 2100 (Robine & Cubaynes, 2017). Though the role of genetics in the context of successful ageing is irrefutable, it is important to recognise that the determinants of ageing go beyond genetics alone and equal credence needs to be given to one’s social and economic circumstances, to their physical environment and finally, to one’s own individual characteristics and behaviours.

Methods

The study focused on selecting a subsample of participants who were 100 years or older until the saturation point was reached. This study employed story telling (one to one interviews) in order to give centenarians a voice. Stories help us to answer the “big” questions about the meaning of life in general and of our lives specifically.

Results

A number of key themes emerged from the study denoting the factors that affect the health and wellbeing of Irish centenarians including, social connectedness, resilience & robust personality, continued participation in life throughout the life course and spirituality.

Conclusion

This research demonstrates that the successful attainment of longevity goes beyond the maintenance of physical health and concludes that in order to promote optimum well-being among older people, it is necessary to take note of the experiences, views and values, of the older person themselves.
149 Satisfaction with Food-Related Life Of Irish Adults Older Than 55 Years
Authors: Dermiki Maria , Pope Jennifer
Published: September 2019

Background

Food is an important part of older people’s life contributing to their physiological and mental well-being and to their satisfaction with life. The aim of this study was to investigate the factors that contribute to the satisfaction with food-related life of Irish community-dwelling adults older than 55 years.

Methods

A mixed methods approach was employed. Quantitative data were collected through a survey which tested how socio-demographic characteristics, food habits, mood and self-perceived health were correlated (Spearman correlation) with the 5 items from the satisfaction with food-related life (SWFL) questionnaire. Qualitative data were collected through open-ended questions which investigated the factors determining food satisfaction levels of the 81 adults (54 women) older than 55 years who participated in the study.

Results

The highest score (4.3/5) was given to the item from the SWFL questionnaire: “Food and meals are very important elements in my life”, and was regardless of gender, age and marital status of the participants. In contrast, the lowest score (3.9/5) was given to the item “My life in relation to food and meals is ideal”. Spearman’s correlation revealed that fruit consumption was positively correlated “With regard to food, the conditions of my life are excellent” (rho=0.29, p<0.05). The open-ended questions showed that sensory appeal was the most popular term related to food satisfaction levels.

Conclusion

Meals and food play an important role in older adults’ life; however, participants did not consider their life in relation to meals and food as ideal. Therefore, strategies need to be employed to improve food and meal experience for community-dwelling older adults to keep them healthy for longer. Food industry should focus on developing nutritious and sensory-appealing food for the older consumers. Finally, the finding that consumption of fruit leads to satisfaction with food-related life could be used as a health promotion message to change eating behaviour.
252 Physicians’ Perceptions to Electronic Alerts for Delirium and Dementia Screening - Qualitative Analysis of Bypass Reasons in an Electronic Patient Record
Authors: Rice Darragh , Chapman Lucy , Corbett Mel , Courtney Grainne , Lawlor Brian
Published: September 2019

Background

Delirium and dementia are common cognitive disorders within an inpatient hospital population (Mukadam & Sampson 2010) Efforts were made to improve detection by embedding the 4As Test (4AT) cognitive screening tool within the hospital electronic patient record (EPR). Non consultant hospital doctors (NCHDs) and consultants were prompted to complete the electronic 4AT on all inpatients aged 65 years and over at 24 hours into admission. Doctors could opt to bypass completion of the screening assessment but a reason for bypassing was required.

Methods

Reasons for bypassing the 4AT electronic alert were analysed using mixed methods during a seven week time period between June 28th and August 16th 2018. Free text entries were grouped into 15 qualitative categories. Quantitative methods using descriptive statistics were subsequently applied to qualitative categorisation.

Results

During seven weeks of analysis, hospital doctors bypassed electronic 4AT screening on 2473 occasions equating to a mean of 50.5 bypasses per day. Overall 40% of free text reasons documented were unintelligible. Examples of unintelligible bypass reasons documented in the EPR included “2321” and “dghj”. Amongst the qualitative categories analysed, the most common reasons for bypass observed were “Accessing EPR Remotely from Patient” (33%), “Specific Clinical Reason for Override” (12%) and “Not Patient’s Primary Team” (11%). Twenty-five entries (2%) were deemed to be angry or inappropriate. Examples included “Stop sending me delirium assessment”, “this is irrelevant, restrict this message to intern log-ins” and “I am consultant and I have to prioritise”.

Conclusion

Bypass of cognitive screening alerts within the EPR by doctors is common. Qualitative analysis of reasons for bypassing electronic alerts may provide insights on physicians’ perceptions to computer-generated prompts as well as informing future customisation and optimisation of alerts. Education and awareness amongst physicians regarding the nature and quality of documentation within electronic records is required.
261 Sleep and Frailty: Examining the Effects of Frailty on Sleep Disturbance in Hospitalised Older Adults
Authors: Mannion Helen , O'Caoimh Rónán
Published: September 2019

Background

Sleep disturbance is common in hospital, potentially resulting in poor clinical outcomes. Frailty is similarly prevalent and associated with multiple adverse events. Despite this, little is known about the interaction between frailty and sleep among older hospital inpatients.

Methods

Consecutive, non-critically ill patients aged ≥70, admitted medically through a large university hospital emergency department (ED) during the preceding 24 hours, were evaluated with measures assessing overnight sleep quality (Richards Campbell Sleep Questionnaire/RCSQ), baseline sleep (Pittsburgh Sleep Quality Index/PSQI) and insomnia (Insomnia Severity Index/ISI). Additional variables included medications, frailty (PRISMA-7 scores ≥3 and Clinical Frailty Scale/CFS scores ≥5), functional and cognitive status, and night-time noise levels. Patients were reassessed 48 hours later.

Results

Over four weeks, 152 patients, mean age 80 (±6.8) years were included; 61% were male (n=92). In all, 43% were frail (mean CFS score 4.23±1.6), median PRISMA-7 score 4±4; a further 24% were pre-frail. The median Charlson Comorbidity Index score was 6±2. The majority, 72% (110/152), reported impaired baseline sleep quality (PSQI ≥5) and 13% (20/152) had clinical insomnia (ISI ≥15). The median time spent in ED was 23±13 hours, median duration asleep was only one hour (range 0-8). After adjusting for possible confounders, frailty status was significantly associated with lower PSQI (p<0.001) but not ISI (p=0.07) and RCSQ (p=0.07) scores. Frail patients were twice as likely to report poor baseline sleep OR 2, (95% CI:1.3-3.2). Baseline and overnight sleep disturbance were not associated with prolonged length of stay (LOS) or 30-day readmission rates.

Conclusion

The prevalence of sleep disturbance and clinical insomnia among older adults admitted through ED is high and overnight sleep quality low, although these did not impact on LOS or 30-day re-admission rates. Frail patients reported significantly poorer baseline sleep but did not have higher rates of insomnia or experience worse overnight sleep.
09 #EndPJparalysis
Authors: Noonan Claire
Published: September 2019

Background

Bed rest is a contributor to iatrogenic complications including delirium and muscle atrophy (Lui et al.2017). Getting patients up and moving has been shown to reduce falls and improve patient experiences. Clothes help people maintain their self-esteem and orientation and would also remind their care professionals to recognize them as people (Blackweel, 2014)

Methods

A pre campaign audit on fall and new incidence of delirium was conducted prior to the pilot campaign. To assess what patients were in bed, dressed in pyjamas or up dressed for 2 weeks prior. Education was delivered to both staff and patients with information leaflets on the ward. Informing patients and families the appropriate clothing and foot wear to bring into hospital. Elective patients were notified by post to explain what we were doing and why, whilst asking them to pack their day clothes. At 12:00 every day roaming teams surveyed the amount of patients out of bed and dressed in their day clothes.

Results

37% (n=226) more patients were up, dressed and moving on Medical and Surgical wards.

25% (n=153) less patients were in bed on both the medical and surgical ward.

This pilot project demonstrated a decrease in the number of reported falls from 16 to 4 as well as a decrease in the number of reported new episodes of Delirium from 4 to 0.

Conclusion

Overall, the endpjparalysis initiative resulted in positive outcomes for patient’s small change can impact incidents of falls and acute delirium within our organisation.

Inter-disciplinary approach to roll out this initiative to other wards across the hospital changing our culture of care.

In line with the patients charter empower patients to take control of their care needs thus, promoting their independence.
173 A Qualitative Study Exploring Facilitators and Barriers to Engagement in Physical Activity Among Older Irish and French Adults
Authors: Sheerin Fintan , Lynch Aileen , Kilroy Sean , Epstein Monique , Girault Ariane , Larose Inès , Gillois Pierre , Rolland Carole , McKinney Ciarán , Harkin Mary , McKee Gabrielle
Published: September 2019

Background

The physical and mental health benefits of physical activity (PA) in older adults have been well-documented. However, a large proportion of older adults worldwide fail to meet the internationally recommended guidelines of 150 minutes of moderate intensity PA per week. Factors associated with engagement in PA among older adults are complex, interacting and wide-reaching, involving individual, social, physical and environmental factors. Thus, to develop preventive lifestyle interventions it is necessary to carefully explore these factors.

Methods

This qualitative study (as part of a larger funded study to develop a PA-intervention) sought to identify and explore facilitators and barriers to PA in community dwelling older adults (≥65). Focus groups were conducted in Ireland (one) and France (two) and findings were analysed using thematic analysis.

Results

The main facilitators that emerged from focus group participants (n=33) were: availability of resources; tailored classes facilitated by staff knowledgeable of older adults’ needs; activities that facilitated social support and connectedness; perceived physical and psychological health benefits. Similar factors also influence continued participation in PA, as well as feelings of wellbeing and enjoyment, family support and motivation, although it was noted that it did sometimes require considerable effort. Barriers to engagement in PA included: lack of social support and resources; environmental factors, whether built, social, location or weather-related. Barriers of a more personal nature also emerged and included fear, loss of confidence due to functional changes, and lack of opportunity.

Conclusion

PA guidelines are but the first step. There is a need to develop implementation strategies at all levels: personal; interpersonal; organisational; community; and public policy, specifically for older adults, that will incorporate the above facilitators and address the above barriers to optimize engagement and maintenance in PA among older adults.
183 Risk of Hypoglycaemia in Older Patients in Residential Care on Oral Hypoglycaemic Medication
Authors: Brennan M , Crowe A , Tiernan C , Smith M , Cogan L , Purcell R , Griffin C , Crowe M
Published: September 2019

Background

Diabetes mellitus (DM) is common in older patients in residential care(RC) with prevalence ranging from 11-36%.Guidlines(1) on glucose targets to avoid the risk of hypoglycaemia or hyperglycaemia respectively in older people recommend avoiding a fasting glucose on treatment of 6mmol/L or a random glucose level higher than 11.0mmol/L. An HbA1c of 53to 59mmol/mol(7-7.5%) should be aimed for although this may need adjusting in RC and StoppFrail guidelines suggest a target of HbA1c of <8%(64mmol/mol). We assessed the prevalence, drug treatment and glycaemic control in 107 older patients in residential care at two sites in Dublin.

Methods

Patients with DM were identified from review of medical notes. Hypoglycaemic treatment whether oral hypoglycemic drugs(OHD) or insulin, capillary blood glucose measurements(CBGM) over the previous 28 day period, HbA1c values and weight change over the previous year respectively were tabulated from patient records.

Results

Sixteen patients (15%) aged 66-93 were documented with DM. Eight (50%) were on no hypoglycaemic treatment in whom OHD had been discontinued in 2 patients over the previous 6 months because of risk of hypoglycaemia.. Six patients (38%) were only on OHD, whilst 2 were on insulin. Of the 6 patients on OHD, CABGM were below 6mmol/L in 3 patients (50%) with no values above 11mmol/L. All 3 patients had lost weight ( 2.5-6.8Kg) over the previous year and HbA1c levels were below 53mmol/mol (7%) in all 3 patients.

Conclusion

Although our numbers are small, 50% of our patients in residential care on OHD are at risk of hypoglycemia possibly related to weight loss. Reducing or discontinuing their OHD may be appropriate.
19 Hip Fracture Outcomes in the Frail Older Person
Authors: Small Cliona , Kneafsey Sian , McFeely Aoife , O'Hanlon Shane , Cooney Marie Therese , Doyle Rachael
Published: September 2019

Background

Hip fractures in the older person are associated with significant morbidity and mortality. Screening patients for frailty and assessing baseline mobility and function may help predict poorer outcomes

Methods

All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between February 2016-February 2018 were included. We assessed clinical frailty score(CFS), zuckermann functional recovery score(FRS) and new mobility score(NMS) on admission and at 1 year. Outcomes assessed included mortality rates and nursing home(NH) admission rates

Results

541 patients were included; 533 underwent surgery, 4 died preoperatively and 4 of the periprosthetic fracture cohort were treated conservatively. 33 patients lost to follow-up. Overall mortality was 24.7%(n=134) at one year. In the severely frail cohort (CFS7-9)(n=72); 47.2% mortality rate at 1 year. 20.8%(n=15) came from home, 2 of those were discharged to NH. In the moderately frail cohort (CFS 5-6)(n= 184), mortality rate was 30.4% at 1 year. 77.2%(n=142) were admitted from home and 8%(n=15) of this cohort were discharged to NH. In the non-frail subgroup (CFS 1-4)(n=211), mortality rate was 11.8%(n= 25)at 1 year, 97.1% (n=205) were admitted from home and 7.5%(n=11) of the cohort admitted from home were living in a NH at 1 year. Regarding FRS; compared to those without frailty(FRS>75), those with FRS 30-75 had a two-fold increased risk of one year mortality [OR: 2.16 (95% CI: 1.24 to 3.78)]. This increased to a nearly six-fold increased risk in those with severe frailty (FRS<30); [OR 5.73 (95%CI : 3.16 -10.41)]. This effect was independent of age. A dementia diagnosis independent of age and frailty is associated with 2.5 fold increased risk of NH/mortality at 1 year

Conclusion

All three tools (CFS, NMS, FRS) can accurately predict mortality and NH admission at 1 year. Patients with higher CFS and poor baseline functioning and mobility have poorer outcomes. CFS is a simple tool that can be documented on admission with a hip fracture and help inform discussions with patients and families regarding potential outcomes/prognosis.
205 The Effects of Acquired Hearing Loss in Later Life - A Pilot Study
Authors: Walsh Amy , El Refaie Amr , Kingston Anna , O'Grady Gerrie , Laoide-Kemp Siobhán
Published: September 2019

Background

Acquired hearing loss (AHL) is defined as a hearing loss which is acquired after birth or at any other time in one’s life. In Ireland one in every twelve adults has a permanent hearing loss as a result of ageing or exposure to noise. Statistical findings are consistent with people identified with hearing loss in later life having a corresponding higher risk of cognitive decline. The pilot study aimed to investigate the experience of members of a deaf association who had been diagnosed with AHL in later life. This is the first time this particular group has been surveyed in Ireland.

Methods

A qualitative research design was used. The information was gathered using an open-ended questionnaire which was distributed to 30 participants. Rich data was extracted and analysed using thematic analysis (Braun and Clarke 2006).

Results

12 members of the deaf association responded to the questionnaire. From these responses four themes were identified: emotional well-being, management strategies & rehabilitation, promoting awareness and alienation. This study indicated that AHL can have a detrimental effect on people in later life.

Conclusion

There is irrefutable evidence to suggest that the effect of AHL in later life exceeds the effect on hearing alone and extends to emotional and physical well-being as well as overall quality of life. The pilot study demonstrates the urgent need for a far-reaching study to evaluate the effect of AHL in later life on the Irish population, its impact on quality of life and cognitive decline while highlighting the need for community awareness and understanding.
220 Is Multifactorial Risk Assessment a Team Sport? Disciplinary Differences in Perceived Acceptability and Feasibility of a Community-based Fall Prevention Service
Authors: McHugh Sheena , Cronin Finola , Moriarty Eileen , Turvey Spencer , Barry Patrick , O'Connor Kieran , Timmons Suzanne , M Kearney Patricia
Published: September 2019

Background

Multifactorial falls risk assessment is an evidence-based practice recommended to prevent falls among older people. Previous research has identified cultural, practical and professional challenges to implementing complex fall prevention interventions. Fall prevention interventions are frequently delivered by multidisciplinary teams (MDTs). This requires multiple health professionals, who practice under different professional norms and governance structures, to accommodate new ways of working. Our aim is to explore disciplinary differences in the perceived acceptability, appropriateness and feasibility of community-based multifactorial falls risk assessment clinics during initial implementation.

Methods

A mixed methods study is being conducted with analysis of administrative data on delivery of risk assessments (2016-2018), and semi-structured interviews staff involved in multidisciplinary teams (physiotherapists (PT, n=5), occupational therapists (OT, n=6), and public health nurses (n=4)]. Interviews were conducted prior to implementation and at 6 months (n=30 interviews total). Framework-driven thematic analysis was used to identify factors influencing implementation and explore perceptions of acceptability, appropriateness and feasibility.

Results

Implementation varied across disciplines; 28% of assessments were conducted by nurses (n=83), 36% (n=111) by physiotherapists, and 36% (n=108) by OTs. Preliminary qualitative analysis suggests that OTs welcomed the opportunity to expand their scope of practice. Conducting assessments at set times in static clinics was incompatible with public health nurses’ workflow. Their limited availability and time-sensitive competing priorities were barriers to the feasibility of an MDT-approach. Physiotherapists questioned the relative advantage of a broad assessment, and whether it was an appropriate use of resources given waiting lists for physiotherapy intervention. Data analysis is ongoing.

Conclusion

The study results have already been used to inform service adaptations including the introduction of dedicated intervention sessions. Training and implementation support for multidisciplinary teams may need to be tailored to the needs of different professional groups to enhance adoption and fidelity.
250 Delirium, Common but Forgotten
Authors: Smyth Hannah , Mahmood Maham , Feely Owen , Beirne Joanna , Gallagher Conal , O'Keeffe Hannah , Walsh Michael , Thomas Niju , Rashid Marwah , Khalil Imran , Ansari Ali Al , Shibani Almaqdad Al , Lynch Olwyn , Basit Mian , Bhuachalla Bláithín Ní , O'Brien Helen , Mulroy Martin
Published: September 2019

Background

Delirium is a medical emergency prevalent amongst hospitalised older patients and associated with prolonged hospital stay, functional and cognitive decline, institutionalisation and increased mortality. In Irish hospitals, multiple strategies, e-learning courses, delirium guidelines and prevention programs have aimed to improve delirium care with better diagnosis and prevention. With the increasing awareness campaigns, we aimed to review the prevalence, screening and management of delirium in our cohort of older patients.

Methods

A review of medical notes of all patients admitted under medical teams to an acute geriatric ward was carried out. Data was collected over a 3 week period in an Irish model 3 hospital. The following information was obtained from medical records: 1) Previous diagnosis of delirium/dementia 2) Documentation of a diagnosis of delirium 3) Features of delirium 4) Development of delirium as an inpatient 5) Formal screening for delirium 6) Cause and management of delirium 7) Length of stay.

Results

Of 79 consecutive admissions to an acute geriatric ward (mean age 81.4, 57% female, 30% previous history of delirium or dementia), 25% (n=20) had a diagnosis of delirium documented. 22% (n=18) of patients had confusion and features of delirium highlighted but no formal diagnosis of delirium made during their inpatient stay. A further 20% (n=16) developed delirium on admission. Only 2.5% (n=2) of admissions had formal screening for delirium with the 4AT. 27.5% (n=11) of patients with delirium had a cause and management plan recorded. 70% (n=28) of patients with delirium had a length of stay of over 15 days.

Conclusion

This review showed delirium recognition, screening, prevention and management were overlooked to an alarming extent in our cohort of older patients. The next step is introduction of the 4AT screening tool and regular education sessions to increase the awareness of delirium amongst medical teams looking after older patients and improve care and outcomes.
26 Predictors of In-Hospital Mortality Post Hip Fracture: What Really Matters?
Authors: Ferris Helena , Brent Louise , Martin Jennifer , Crowley Philip , Coughlan Tara
Published: September 2019

Background

The Irish Hip Fracture Database is a national clinical audit developed to improve fracture care and outcomes. Lack of integration with other databases, such as a National Death Register makes determination of longer term outcomes challenging. In hospital mortality is one quality indicator that can be very accurately measured. We sought to determine in-hospital mortality in the Irish Hip Fracture Cohort between 2013 and 2017 and to determine which factors most influenced this outcome with particular reference to the IHFD quality standards.

Methods

A secondary analysis of the 15,603 patients in the IHFD between 2013 and 2017 was conducted. Descriptive and analytical statistics were produced.

Results

In-hospital mortality was 4.5% for the 5 years. Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality of which only 4 (age, gender, pre-fracture mobility, mobilised day of/after surgery) remained significant after multivariate analysis. The most striking finding was that those patients not mobilised on the day of/after surgery were 46% more likely to die in hospital (OR 1.46, p<0.000, 95% CI 1.25-1.70).

Conclusion

Measuring care is challenging and often one standard cannot reflect all aspects. The ability to be mobilised on the day of or day after surgery is a good composite measure of both patient and organisational factors in hip fracture care: timely surgery, adequate pain relief, prevention of delirium, admission to a ward with philosophy, skills and resources to encourage early mobility. While early mobility has always been encouraged this data suggests its adoption as a formal standard to which all units must comply.
265 Awareness of Enduring Power of Attorney in a Frail Older Population Presenting Through the Emergency Department
Authors: Baburaj Binish , Pender Ciara , Cooney Eamonn , Maher Jennifer , Sayers Karen , Ryan Siobhan , Donnellan Christina , Pillay Isweri
Published: September 2019

Background

Enduring Power of attorney (EPA) is a simple legal document. A person can choose a specific individual(s) to take care of both personal and financial affairs in the event of losing mental capacity in the future. The objective of this study is to understand what proportion of frail older patients has either an EPA or an awareness of EPA

Methods

Consecutive emergency department (ED) patients identified as Variable Indicative of Placement (1) positive at triage, were assessed using an interdisciplinary assessment tool (IAT) for 2 months (February 2019 to March 2019). Age, gender, Clinical Frailty Score (CFS) and awareness of EPA were recorded on an Excel database. Simple descriptive statistics were used

Results

150 patients with a mean (SD) age of 83.1(7.4) were assessed by the multidisciplinary team. The female to male ratio was 1.2:1. The mean (SD) CFS was 5.5(1.2). 56 patients were asked about EPA. 96 patients were not asked about EPA. 27% (n=14) patients had an EPA in place and one was in the process of making it. 41 patients neither had an EPA nor awareness of EPA. There was no gender difference between groups

Conclusion

This is the first Irish and international study assessing the awareness of EPA in patients presenting to ED.In this small sample of frail older patients, a quarter of those asked had an EPA. A hospital admission represents an opportunity to discuss future care planning, including EPA. The majority of patients were not asked about EPA by the assessor, as it was felt to be inappropriate at the assessment time. A patient centred approach to introducing these difficult but important discussions needs to be developed.
306 The Changing Face of Stroke in the DOAC Era
Authors: Davern Recie , Hobbs Helena , Murugan Hannah , Cotter Paul
Published: September 2019

Background

Patients prescribed oral anticoagulants (OAC) for atrial fibrillation (AF) can still present with stroke. The mechanism for stroke in these patients can be due to multiple factors including subtherapeutic dosing and non-compliance. With the increasing use of direct-acting OACs (DOACs) in favour of warfarin, it is unclear if the incidence of stroke in those already taking OAC has reduced.

Methods

Data was extracted from our unit’s stroke registry, a prospectively maintained database, for patients who presented with stroke while receiving OAC for AF from 2013 to 2017. Type of OAC, type of stroke, OAC dosing at time of event including non-compliance, stroke management and outcome were recorded.

Results

67 patients were included for analysis, with 55 ischaemic and 12 haemorrhagic strokes. 52 patients were receiving warfarin at the time of their stroke vs. 15 receiving DOACs. 33/55 (60%) of ischaemic strokes occurred in patients taking warfarin with a sub-therapeutic INR. In 3/55 (5%) of ischaemic strokes, the OAC was held for a procedure while in 6/55 cases (11%) the OAC had been stopped for another reasons e.g. bleeding. 5/55 (7%) were due to non-compliance. 1 ischaemic stroke was due to under-dosing of a DOAC (dabigatran). 16 strokes were recorded in 2013 for patients prescribed OAC vs. 3 in 2017. Overall the number of ischaemic strokes due to subtherapeutic OAC decreased from 14 in 2013 to 1 in 2017 (p value 0.06).

Conclusion

The majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
325 Exploring the Complexity of Dementia and Loneliness in Ireland
Authors: Hartigan Irene , Cornally Nicola , Foley Tony , Timmons Suzanne , Park Gyunghee , Jennings Aisling , Müller Nicole
Published: September 2019

Background

Dementia and loneliness are both complex phenomenon’s that impact on both mental and physical health. Research has identified that loneliness can increase a person’s risk of mortality as much as smoking or alcohol consumption. People with dementia are at particular risk of loneliness and social isolation. This can negatively impact on a person with dementia’s health. To effectively address loneliness in dementia, we must first understand how people with dementia experience loneliness.

Methods

Interviews were conducted with people living with dementia. Participants comprised of eight community-dwelling individuals, aged 55 years and older (mean = 63.8; range = 55-77), who were each diagnosed with dementia at least one year prior to interview (range = 1.16 – >5 years). Interviews were conducted in participants’ homes using a semi-structured format and lasted between 37-74 minutes.

Results

Three key themes emerged: the importance of maintaining meaningful relationships, maintaining independence and socio-cultural influences on individual perceptions of loneliness and dementia. The results emphasise the importance of maintaining both a sense of self and meaningful relationships with others post-diagnosis for individuals who identified themselves as “not lonely”. People living with dementia reported that the maintenance of social connection aids in fostering a sense of self-worth and self-management, which in turn mitigates feelings of loneliness.

The majority of participants existing social connections with others was established prior to their diagnosis, although the maintenance of these relationships may have required an adjustment of their premorbid routines and method of social engagement.

Conclusion

Human contact and a meaningful relationship are superior in preventing loneliness. Individual feelings of loneliness or lack thereof are not directly correlated to the coping mechanisms most commonly employed by individuals with dementia. Further exploration is need to understand how people with dementia, who live at home, perceive or experience loneliness.
326 Generic Prescribing: Where are we now? Prescribing Education is not Enough
Authors: Leahy Aoife , Hynes Jason , Saif Kiran , E McCarthy Christine , Mohd Asri Nur Atikah , Roy Amrita , Murphy Elizabeth , Sebaoui Salim , Gabr Ahmed , Zulkifli Muhamad Daniel , Matti Basil , O' Hara Paul , Crotty James , Quinn Colin , Peters Catherine , Lyons Declan , O'Connor Margaret
Published: September 2019

Background

Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now.

Methods

We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant.

Results

285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing.

Conclusion

The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem.
327 The Impact of Implementation of Recommendations from the IFHD 2017 Annual Report in an Irish Model 3 Hospital
Authors: Hearne Siofra , Smyth Hannah , Monahan Pheadra , McGowan Hugh , Timmins Shirley , Hillary Paddy , Mahapatra Anant , Walsh Alan , Conlon Ciaran , Dunill Eithne , Campbell Eleanor , Carolann Danielle , Ahern Tomas , O'Brien Helen
Published: September 2019

Background

Hip fractures in the older person are associated with high mortality rates (NICE, 2011). Up to 40% of patients never regain their pre-fracture mobility, 10-20% never return to live at home. The Irish Hip Fracture Database (IHFD) National Report 2017 recommends appointment of an orthogeriatric consultant in this hospital to achieve IHFD standards 4 to 6.

Methods

We analysed a subset of HIPE data collected for the IHFD in patients over 60 years over a three month period from September – November 2017 and compare it to September – November 2018 after introduction of an orthogeriatric service. We looked at geriatrician review, bone health assessment, falls assessment, discharge destination, 30-day re-admission rate and mortality during admission.

Results

There were 45 hip fracture patients in each group. In the 2017 group, mean age was 79, female 64%; compared to mean age of 80, female 62.2% in 2018. In 2018, after the appointment of an orthogeriatrician, 95.6% of patients were seen by a geriatrician compared to 4.4% in 2017. In 2018, 97.7% received bone health assessment compared to 26.8% in 2017. In 2018 95.3% received specialist falls assessment, compared to 2.4% in 2017. Mean length of stay was 18 days in 2018 versus 13 days in 2017. 2.2% of patients were discharged to convalescence in 2018, 26.7% in 2017. 57.8% of patients were discharged to off-site rehabilitation in 2018 compared to 40% in 2017. 2.2% patients died during admission in 2018, 8.9% in 2017. In 2018, 6.7% of patients were readmitted within 30 days, 8.8% in 2017.

Conclusion

Provision of rapid Comprehensive Geriatric Assessment to all hip fracture patients, reduces falls and fracture risk. There is evidence of improvement in IHFD standards 4-6, mortality rate and 30-day readmission rate. Moreover, the orthogeriatric service has led to increased referral to rehabilitation services ensuring optimal functional recovery.
328 An Integrated Approach to Fear of Falling
Authors: Murphy Eleanor , McLoughlin Petra , O'Sullivan Fiona , Connellan Ciara
Published: September 2019

Background

Fear of falling (FOF) is a known risk factor for falls and subsequent activity restriction which has implications for quality of life and frailty level in older persons.1 The Integrated Care Team for Older Persons in Sligo provides home-based rehabilitation for the acutely frail older adult. We noted that fear of falling was a commonly identified problem in our referral group following comprehensive geriatric assessment (CGA). Our study aims to characterise interventions required.

Methods

Descriptive study from CGA of acutely frail older adults with a FOF in all referrals to ICTOP from June to December 2018.

Results

Of the 52 patients studied, 67% reported a FOF with a higher incidence in females (81% vs 45%).

Increasing age was associated with a greater likelihood of FOF with 0% reported at 70-74years (n=4) and 86% at 90-95 years (n=7).

There was a 1.6 times increased risk of FOF associated with cerebral vascular disease and 1.26 with mental health issues.

The median Rockwood Clinical Frailty score was 6 with a median TUG of 28 seconds.

Of those with a FOF, 100% received falls education, a home exercise program and advice on acquiring a pendant alarm. A mobility aid was provided in 63% and additional functional aids in 71%. Major housing adaption advice was given in 50% and additional equipment signposting and purchasing advice in 66%. Transport advice was provided in 49% of cases and onward referrals to ophthalmology and orthotics were provided in 9% and 11% respectively.

There were only 2 readmissions with a fall within 30 days.

Conclusion

A significant cohort of ICTOP referrals report a fear of falling. Specific physiotherapy and occupational therapy interventions aim to reduce the impact of this and our low rate of readmissions due to falls indicates the success of this program.
333 A Transnational Effectiveness-Implementation Study of the Family Carer Decision Support Intervention to Improve End of Life Care in Long-Term Care
Authors: Hartigan Irene , Brazil Kevin , Kaasalainen Sharon , Sussman Tamara , Van Der Steen Jenny , Loucka Martin , Di Giulio Paola , Cornally Nicola
Published: September 2019

Background

The Family Carer Decision Support (FCDS) intervention has been designed to inform family carers about end of life care options available to a person living with advanced dementia. The FCDS intervention demonstrated a statistically significant impact in reducing family carer decision uncertainty on establishing goals of care at the end of life and, improved family carer satisfaction on quality of care in a study conducted in the United Kingdom.

Methods

The aim of this research is to adapt the application of the FCDS for use in different countries. Funding supported through the EU Joint Programme – Neurodegenerative Disease Research (JPND) project has supported the scaling up of the FCDS transnationally in the United Kingdom; Republic of Ireland; Netherlands; Canada; Czech Republic ; and, Italy. Launched in April 2019, this presentation will report on present activities including: a) description of the FCDS intervention; b) strategy for implementing the FCDS in care homes; c) study design employed for the evaluation of the FCDS; and d) work packages and that will be deployed to achieve intended outcomes

Results

Expected project outcomes of this work will include a) develop guidelines to facilitate transnational use of the FCDS within care homes; (b) staff education material including web learning resources; (c) family carer informational material including web learning resources; (d) measures and tools to evaluate the uptake and outcome of the FCDS intervention; (e) establish a transnational FCDS community of practice across study care homes; (f) estimated costs of providing the FCDS intervention; (g) evidence of enhancing decision making among family members regarding resident care and satisfaction with care.

Conclusion

Recent research revealed that care home structures and staff play an important role in the successful implementation and adoption of innovations such as the FCDS intervention, this is further examined in this transnational study.
335 GEMS: Geriatric Emergency Service Emergency Triage and Older People with Frailty
Authors: O'Callaghan Maureen , Gallagher Grainne , Reddy Danielle , Cornally Lorna , Hayes Brennan Megan , Mulholland Ann , Gibbons Ruth , Nolan Jane , Normoyle Cathriona , Ahern Emer
Published: September 2019

Background

The Manchester Triage System (MTS) is one of the most commonly used triage systems in Europe.

It assigns a clinical priority to patients, based on presenting signs and symptoms. The MTS allocates patients to one out of five urgency categories, which determine the maximum time to first contact with a clinician.

Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) are core elements of our GEMS. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home (Ellis et al 2011).

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 triaged using the Manchester Triage system. Patients are also screened using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team case manage all those who are admitted.

Results

Over 2 years, 10,037 patients were triaged. The median time from arrival to triage and VIP was 15 minutes. 43% (4, 307) screened positive for Frailty. 66% received a CGA. Of those who screened positive for Frailty 1,387 (32%) needed immediate care or very urgent care (Category 1 and 2). A further 43% (1,855) were category 3 requiring urgent care. The most common diagnostic category was Unwell Adult (1560, 36%). The 2nd category was Shortness of Breath (720, 17%) and the third Falls (409, 9%)

Conclusion

75% of older people with frailty who attended hospital required urgent emergency care. The most common diagnostic category was Unwell Adult reflecting the diagnostic and clinical challenge this cohort present. We must build a healthcare system and workforce that is Frailty attuned to be able to deliver optimum outcomes.