bluuebunny/crossref_metadata_2025 huggingface dataset:
Long Term Care As An Outcome Of Community Integrated Care Team Intervention: A Review
Authors: Bradley Eoin , Kenny Blaithin , Clarke Enda , Hogge Eilish , O'Neill Niamh , Higgins Aislinn , Quinn Aoife , O'Shea Joan , Keating Sharon , Kovalyshyn Volodymyr , Laycock Berneen , O'Toole Ronan , Nee Rory
Published: September 2024

Background

Over 65’s occupy over 55% of inpatient hospital bed days. Assessment of average length of stay for patients awaiting long term care (LTC) in the acute hospital setting was found to be 122 days. My aim is to assess the number of patients transferred to long term care (LTC) from the community post referral to an Integrated Care for Older Persons (ICPOP) service, therefore bypassing inpatient admission.

Methods

Retrospective analysis of patients notes managed by the ICPOP team from January 2023- January 2024. Comprehensive geriatric assessment data as to frailty markers, plus duration of engagement with service and over all discharge destination were assessed. Patients were identified based on unique identifying number but also using date of birth and name to avoid missing cases.

Results

59 patients were discharged to a nursing home from the ICPOP service, mean age 80. Sex differentiation 56% female. On average at least 3 out of 8 possible frailty indicators were identified per patient. Most prevalent -67% polypharmacy, 47% memory impairment and 45% carer stress were identified as key concerns on initial assessment. 96% of cases were initially referred for complex case assessment/admission avoidance. Average length of engagement with service 5 weeks.

Conclusion

The ICPOP service is highly effective at managing complex cases in the community. The multidisciplinary nature of the team facilitates comprehensive assessment and patient centred care which enables a smooth transition through supportive strategies available to the patient and their family. In total 7198 bed days were saved due to direct transfer to nursing home from the community setting. If the patients care needs warrant LTC the ICPOP service is an invaluable tool which could further reduce pressure on hospitals and facilitate appropriate transfers to nursing home care.
“Addressing the Silent Need”
Authors: Gallagher Claire , Staunton Ruth , Boyle Nichola
Published: September 2024

Background

Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations.

Methods

This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023.

Results

Preliminary results:

Conclusion

Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.
Retracted: The Geographical Location Of Nursing Homes: How Accessible Is Care In Our Ageing Society
Authors: Martin Niamh , Conry Miriam , Reddin Catriona , McMahon Rachel , Foye Howard , Costello Maria , Small Cliona , Canavan Michelle , Robinson Stephanie
Published: September 2024

Background

With ageing demographics, the demand for residential nursing care is increasing. Some evidence and anecdotal experience suggests that nursing home care is often not available locally, resulting in individuals moving from their homes, communities and psychosocial support systems.

Methods

To evaluate if residential care in Ireland meets demand the number of residential care beds per 1000 adults>65years were estimated from publicly available data. Persons who sought access to the nursing home support scheme over a 6month period were reviewed. Their home location and nursing home location were analysed with respect to locality (city/suburban/town/rural), distance (km), travel time (minutes) and public service networks. Ethically approved.

Results

Nationally, the lowest availability of nursing home beds was Wicklow and highest Longford. Galway has 0.90 nursing home beds per1000 adults >65years. Of 262 consecutive cases presented to one local placement forum between July–December2023, 133 availed of the scheme and were resident in a nursing home at 3month follow-up. Exclusions included remained at home, deceased, or unknown. Nursing home location was city 6%(n=8), suburb 21%(n=28), town 16.5%(n=22) or rural 56%(n=75). All city placements were public. Drving distance from home to nursing home was 15km (IQR7,31) with a car driving time of 18mins (IQR11,35). No public transport service link from home to nursing home for visiting purposes was available to 38%(n=51), and when available incurred more than one bus change in 65.2%. City dweller was residing in a city located nursing home in 13%(n=5). Of the 87%(n=33) relocated out of the city, over half (n=19) were to rural locations (p<0.001).

Conclusion

Nursing home availability is insufficient to meet demands. The location of public and private nursing homes is creating deficits in accessing care close to home and community. Current public transport services to nursing home locations is poor.
A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform
Authors: McCallion Charlotte , Bowman Mark
Published: September 2024

Background

Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management.

Methods

An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform.

Results

A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform.

Conclusion

Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.
Community Specialist Team for Older Adults - Who Do You Think We Are? Co-Design Of A Patient Information Leaflet
Authors: Walsh Loretta , Rogan Mary , McCleane Fiona , Fitzmaurice Clíodhna , Munnelly Patricia , Campbell Judith , Clancy Alanna , Abed Aisling , Brehony Alma , NíNeachtain Máire , Costello Maria
Published: September 2024

Background

Navigating care pathways can be challenging and confusing for patients and caregivers. With the emergence of several new clinical specialist teams, we identified the need for accurate, clear and relevant information, provided as a printed leaflet and available at referral stage for both older adults and referring practitioners.

Methods

A draft Patient Information Leaflet (PIL) was developed with contributions from all members of the Community Specialist Team for Older Adults (CSTOA) explaining the purpose of the service. A review of referral sources was undertaken to identify those key stakeholders from whom feedback should be sought to ensure content validity. The draft PIL and a feedback questionnaire were distributed to patients and their caregivers who have had intervention from the CSTOA in addition to General Practitioners and Community Health Network colleagues.

Results

There were 27/35 responses to the questionnaire. Data was collated and analysed. All respondents reported that from reading the PIL, they understood clearly what the service provides, and all agreed that the leaflet accurately describes the service. Details such as what to expect from intervention of the team and advice to bring a family member to the initial appointment were mentioned as particularly useful content. Supplementary feedback commended the co-location and accessibility of the service compared to a hospital setting. It was suggested that other services should be included in the CSTOA. Based on survey responses, minor edits were made to the PIL to meet stakeholder satisfaction.

Conclusion

Feedback from this survey helped endorse the provision of a printed PIL to be provided at referral stage. Additional commentary gathered, re-enforces the need for continuous interaction and information sharing with service stakeholders. Next steps include making this PIL available electronically to allow for real time updates and translating to other languages to ensure inclusivity.
“The Past is a Foreign Country”: Time Shelter and exploring dementia and memory impairment representation in literature and the arts
Authors: Roche Adam , Fitzpatrick Neasa , Leroi Iracema
Published: September 2024

Background

Due to ageing populations, the WHO estimates that by 2050 the number of people living with dementia worldwide will more than triple to 152 million. For those working in geriatric medicine and memory services, we regularly interact with and advocate for patients coming to terms with memory impairments. One common theme often encountered during the patient dementia and cognitive impairment diagnosis journey is fear of loss of the sense of “self”, which can be informed by the negative and often inaccurate cultural narrative around dementia.

Methods

Recent promising breakthroughs in the development of disease modifying medications for Alzheimer’s disease, as well as greater emphasis on lifelong brain health and earlier diagnosis, represents a potential source of hope. This presentation will aim to explore the cultural narrative around the “lived experience” of dementia, which is often extremely negative and emphasises hopelessness. We look to some of the most commonly referenced narrative works, which can often form the foundation of many patient's prior knowledge of cognitive impairment and dementia before coming to the memory clinic.

Results

This presentation aims to examine the narrative works familiar to many patients (such as “The Father” and “Still Alice”) as well as some more recent efforts, including this year’s International Booker Prize-winning novel “Time Shelter” by Georgi Gospodinov. This darkly humorous book describes the arrival of a strange new ‘clinic for the past’ offering promising treatment for people with dementia.

Conclusion

Many works of narrative fiction explore dementia and memory impairment. While some are well-informed and researched, many lack empathy or even clinical accuracy. Narrative works can have an enormous impact on the widespread perception and understanding of diseases such as dementia. By exploring the potential for sensitive and accurate representation of dementia in popular culture, we aim to promote equity in this vulnerable and growing population.
Ireland is Above European Average for do-not-Resuscitate Decision Making and Training: A Europe-Wide Survey On Resuscitation Decision Making Practices
Authors: Lochlainn Mary Ni , Trevisan Caterina , Chapelet Guillame , Goluke Nienke , Sanchez Elisabet , Trabert Johannes
Published: September 2024

Background

Resuscitation success rates for older patients are poor. Research has shown that, despite many older people expressing a wish for full resuscitation initially, when the poor prognosis and outcomes are explained, this number drops substantially. One existing study, which did not include Ireland, revealed that a wide gap exists across European countries for rates of resuscitation discussions and the implementation of do-not-resuscitate (DNR) orders. The aim of this survey is to assess differences and barriers between European countries among doctors working in the field of geriatric medicine for DNR decision making.

Methods

An online survey was carried out among doctors working in geriatric medicine in European countries. Besides age, sex, years of experience and country of practice, sixteen questions regarding DNR discussion in terms of the frequency and confidence in doing it, prevalence of DNR discussions and possible barriers to this practice regarding DNR discussions were asked. Data analysis was carried out using R.

Results

In total, 473 respondents from 22 European countries completed the survey. Participants’ mean age was 41.8 years (standard deviation [SD] 9.9) and 64.9% were females. The mean number of years’ experience working as a doctor was 15.39 years (SD 9.62). 45 respondents were based in Ireland (9.5%). 95.5% of those in Ireland responded agree or strongly agree to feeling confident discussing DNR orders, in comparison to 79.7% of the total survey population. 73.4% of respondents in Ireland reported getting training in DNR discussions, versus 61.6% of the pan-European population. 86.7% of respondents in Ireland felt DNR orders are well accepted in their country, compared to 55% of total respondents.

Conclusion

This survey presents intra-European differences regarding practice of discussing DNR orders by doctors working in the field of geriatric medicine. Ireland was above average for discussing DNR orders, training received, and reported higher acceptability to society at large.
Do Early Supported Discharge Teams Increase the Proportion of Stroke Patients Discharged Directly Home from Acute Hospitals in Ireland?
Authors: Harbison Grace , McCormack Joan , Harbison Joseph
Published: September 2024

Background

Early Supported Discharge teams for stroke are associated with improved patient, rehabilitative outcomes, quality of life and potentially reduced mortality. Over the last 5 years the number of ESD teams and the proportion of patients discharge under their care has increased. What is unclear is to what extent has the growth in discharges with ESD support from acute hospitals represent additional discharges or patients who would have been discharged anyway but now receive rehabilitation and support post discharge.

Methods

Data on patients discharged directly home from the Irish National Stroke Audit (INAS) between January 2018 and December 2022 were analysed along with ESD data. This is the five-year period for which comprehensive data on ESD has been collected by INAS. Data used were available on public platforms and ethics approval was not necessary. Chi Square Statistics were performed, using proprietary software to compare proportions.

Results

Data on 23183 inpatient episodes were analysed, 57% of patients were male. INAS cases increased 34% from 3730 in 2018 to 4999 in 2022. Proportion of patients with unknown discharge destination (2.5%-2.9%) and who died (11.0%-10.8%) remained stable across the period. Proportion discharged home increased from 55.6% in 2018 to 59.5% in 2022 (Chi Sq 13.0, p=0.0003), (4.9% absolute, 7.0% relative). Proportion of ESD discharges increased from 3.7% to 9.8% of all patients (Chi Sq 117.3, p<0.0001) and from 6.7% to 16.5% of direct discharges home (Chi Sq 106.6, p<0.0001). However, direct discharges home without ESD support declined from 51.9% to 49.7% of the total population (Chi Sq 4.16, p=0.04). This suggests that, compared to 2018, 64% of ESD discharges in 2022 were additional and contingent on ESD availability.

Conclusion

ESD is an effective way of increasing direct discharges of people with stroke home from hospital. The proportion of patients with access to ESD remains low.
Vitamin D Deficiency Is Associated With An Increased Risk of Diabetes In Older Irish Adults: Results From The TUDA Study
Authors: Moloney Kevin , McSherry Kenneth , Fitzpatrick Donal , Laird Eamon , Ward Mary , Hoey Leane , Hughes Catherine F , Strain JJ , Cunningham Conal , McNulty Helene , Lannon Rosaleen , Molloy Anne M , McCarroll Kevin
Published: September 2024

Background

Several studies have shown that vitamin D deficiency may increase the risk of developing type II diabetes and prediabetes. However, the data are inconsistent. Vitamin D may improve insulin sensitivity and pancreatic beta cell function, which could influence diabetes risk. We aimed to examine the relationship between vitamin D deficiency and type II diabetes in older Irish adults.

Methods

Study participants were from a cross-sectional study of adults aged > 60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Diabetes was defined by self-report, use of diabetic medications or HBA1c ≥ 6.5%. Vitamin D deficiency was defined as 25(OH)D < 30 nmol/l. The relationship between vitamin D deficiency and diabetes was explored in multivariate logistic regression adjusting for age, sex, BMI, waist hip ratio, season, vitamin D supplement use, timed up and go, alcohol intake, current or previous steroid use, smoking, use of statins and socioeconomic status.

Results

There were 5171 participants (67.2% female, mean age 74.0 years) of whom 19.7% were vitamin D deficient and 15.7% had diabetes. Vitamin D deficiency versus non-deficiency was associated with an increased risk of diabetes both before and after multivariate adjustment (OR 1.46, 1.98-1.79, p<0.0002).

Conclusion

Vitamin D deficiency was associated with a 46% increased risk of having type II diabetes. However, the results of longitudinal studies and randomised trials have produced inconsistent results, though many had participants with higher baseline 25(OH)D status. A recent review of 46 trials of vitamin D supplementation found that it may reduce Hba1c in diabetics with vitamin D deficiency. Well designed trials to assess the potential effect of vitamin D supplementation on diabetic risk should be conducted.
Dementia Champions Network in Louth Hospital Group
Authors: Munro Fiona , Carville Michelle , McCabe Blanaid
Published: September 2024

Background

Research indicates that 30% of inpatients within an acute hospital have a dementia diagnosis at any time [1]. A specialist dementia nurse led the vision for transforming dementia care in an acute hospital. Aim: Implementation of a dementia champion’s (champions) network in an acute hospital setting aligning with Irish National Dementia Audit 2 (INAD2)[2].

Methods

Point prevalence revealed 13.9% of all inpatients presented with dementia. One acute older person’s ward revealed 25% of patients had a dementia diagnosis. The authors recruited 12 champions from four wards and E.D. including RGN, HCA and administrative staff to teach the tools to complete a QI project. The champions attended four innovative workshops accumulating in presenting a quality initiative (QI). The pioneering workshops were designed by CNS Dementia and candidate ANP and ADON Dementia QI.

Results

The dementia champions engaged in open discussions at each workshop alongside expert guest speakers from the multidisciplinary team. Discussions lead to identifying gaps within their wards resulting in quality improvements including posters relating to communication, reducing environmental noise and the introduction of the Abbey pain scale. In addition, an increased use of a personal passports and meaningful activities such as completing a knitting project to aid communication and to engage a person with dementia. Another champion enhanced their ward by displaying seasonal decorations which led to reminiscence talks with patients. One champion progressed onto a level 8 module focusing on dementia care.

Conclusion

The champions excelled at becoming dementia leaders within a network for their clinical areas through their QI projects.

References

[1] Begley et al., “Model of Care for Dementia in Ireland.”

[2] Bracken Scally, “Irish National Audit in Dementia (INAD-2).”
“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit
Authors: Fenton Lauren , Moran Leah , Crowley Catherine
Published: September 2024

Background

Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation.

Methods

A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel.

Results

Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p<0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3).

Conclusion

Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.
Preventing Hospitalisation- Providing Specialist Geriatric Services To Nursing Home Patients
Authors: Duran Josep , Malomo Keneilwe , Keating Tracy , Fan Chie Wei
Published: September 2024

Background

Nursing home (NH) residents often require acute hospital care in unexpected deterioration and may have repeated Emergency Department (ED) attendances. Grunier et al (2018) reported 48% of NH residents reattend ED within 1 year. Our aim is to determine if those who require acute hospital admission are more likely to reattend ED or require NH outreach services.

Methods

Nursing home residents who attended Mater ED in March 2023 were identified through Electronic Patient Record. Their age, gender, reattendance of ED within 28 days and 6 months, visit by NH outreach team within 28 days then 6 months and 6-month mortality were recorded. The residents were categorised as admitted or discharged from their sentinel visit in March 2023. Chi-square test was used, and statistical significance was set at p<0.05.

Results

Sixty-three nursing home residents attended within 1-month, median age 85 years (range 67-95), 43 were women. Forty-five (71%) required admission, 6 (9.5%) and 24 (38.1%) reattended ED within 28 days and 6 months respectively. There was no difference in 28-day or 6-month ED reattendance between those who were admitted or discharged in the sentinel visit to ED. Those discharged from ED were more likely to receive NH outreach visit within 28 days (84% vs 6.8%) and 6 months (84% vs 11%) than those who were admitted, p<0.0001. There was no difference in 6 months mortality between the groups.

Conclusion

Our study found that 71% of NH residents who attend ED require admissions showing that the transfer was warranted. More than one-third of NH residents reattend ED within 6 months. Those discharged from ED were more likely to be reviewed by NH outreach team as per service delivery. Working closely with the resident’s General Practitioner, NH and ED staff may help to manage these complex patients to coordinate their treatment and prevent ED reattendance.
The Early Introduction of Geriatric Teaching to Undergraduate Medical Students and its Impact on Behaviour and Attitudes
Authors: Dennehy Karen , Cooke John
Published: September 2024

Background

The World Health Organization (WHO) advocates for investment in high-quality undergraduate education to meet the future needs of the aging global population. Studies conducted by the WHO have found that quality education in geriatric medicine positively influences medical students' attitudes towards older adults and encourages them to consider careers in geriatric care. This investment is especially crucial as the global population continues to age.

Methods

We piloted the introduction of dedicated geriatric medicine teaching into the third year of the undergraduate medical program at University College Cork. Two interactive lectures were developed and integrated into the preplacement lecture block. These sessions focused on commonly occurring conditions, incorporating case studies and fostering discussions. The curriculum was based on the findings from a European undergraduate geriatric medicine program developed through Delphi consensus and published in 2014.

Results

In the third year of the undergraduate program, 203 students attended two one-hour lectures during their lecture block month. An end-of-year survey, completed by 20 students, revealed common adjectives used to describe older adults, such as “frail,” “experienced,” “vulnerable,” “grandparent,” and “wise.” According to the survey, 9 out of 20 students reported a change in their perspective on older adults after the education sessions. Additionally,17 out of 20 students felt more confident interacting with older people during their clinical attachments, and 9 out of 20 expressed interest in a career in geriatric medicine. Students also highlighted the most valuable aspects of the sessions and how they applied their new knowledge in clinical settings.

Conclusion

The program increased students' awareness and comfort with older adults, there were positive signs that students were more likely to consider a career in geriatric medicine. To evaluate the effectiveness more precisely, we plan to collect baseline statistics from students and measure changes post-intervention. Based on student feedback, we will make necessary adjustments and continue the program in the next academic year.
Bridging The Gap: Between an Older Adult Attending The Ambulatory Day Unit and An Acute Hospital Presentation
Authors: McShane Nicola , Monaghan-Tyer Fiona , Toner Rebecca , Lynch Olwyn
Published: September 2024

Background

Older adults attending the ambulatory day units within the hospital group have a comprehensive geriatric assessment (CGA) completed. This identifies the older adult’s functional, physical, social, environmental and psychological baseline, in order to develop and implement a coordinated plan of care and follow up. The CGA is the gold standard in caring for older adults who are frail or at risk of frailty (HSE, 2016). The units are off site from the main hospital, therefore valuable information may not be available to the acute hospital. Valuable information from the CGA can provide the older adult’s functional and cognitive baseline and prevent unnecessary duplication of assessments and increased length of stay.

Methods

Plan-Do- Study-Act (PDSA) cycle was used. A questionnaire was produced to ascertain acute care staff’s understanding of; whether an older adult is attending the ambulatory unit? Would this information and a review by the RANP Gerontology be beneficial? A Registered Advanced Nurse Practitioner (RANP) Gerontology Pathway was developed. Education was provided to nursing, and the wider multidisciplinary team. An alert sheet was introduced and provided to older adult attending the ambulatory day units. The alert was for the older adult to produce, if attending or admitted to the acute hospital. This initiates the RANP pathway. Older adults are then seen by the RANP at source of admission. Clinic letters with baseline is documented in the Healthcare record, including advice plan and follow-up. Post-implementation questionnaire and verbal feedback were obtained.

Results

Positive feedback from older adults, family and staff. Avoidance of unnecessary duplication of assessments, data sharing, optimization of plan of care, treatment and rehabilitation potential. Effective discharge planning, reduction of unnecessary transfer to residential care.

Conclusion

Bridging the gap promotes positive outcomes: Reducing length of stay, positive impact on overall wellbeing, and an organizational cost containment.
Utilising a Co-Design Approach to Strategically Plan Dementia Education for Diverse Populations in Ireland
Authors: Kilgannon AnnMarie , O'Reilly Susan , Noone Paula , Galvin Noreen , McCabe Blanaid , Murphy Stephen , Lang Deirdre
Published: September 2024

Background

In Ireland, the number of people living with dementia is projected to treble by 2050. National dementia education programmes span all care groups and areas of work, and include a 4-hour, a 2-day programme and HSEland modules. However, there is concern that these programmes often adopt a pedagogical approach that does not meet the needs of modern learners. Adopting a coproduction approach in designing dementia education initiatives is essential to ensuring that these programmes effectively impact healthcare professional’s attitudes, beliefs and care practices, meeting the needs of people from diverse populations and cultural backgrounds.

Methods

Methods included three key components: Firstly, a dementia education online survey for facilitators of national programmes to ascertain the benefits, challenges and impact on care practices. Secondly, a national event using World Café methodology to share insights and ideas and co-produce a vision for advancing dementia education in Ireland. Primary stakeholders included individuals living with dementia, their advocates, and delegates from various demographics and cultural backgrounds. Thirdly, a review of literature relating to dementia education in other jurisdictions.

Results

Key themes that emerged include the significance of understanding the lived experience and recognising diversity and cultural differences. Additionally, there is a need to explore various teaching and delivery methods, such as incorporating technology, simulation, and a tiered approach. There was general agreement that co designing a more adaptable, interactive national programme, including the lived experience of people with dementia would be more impactful. Challenges identified include staff turnover, difficulties releasing staff from clinical areas and organisational culture.

Conclusion

Through establishing an inclusive and collaborative platform, we can collectively shape a future where dementia education and care practices are compassionate, rights based and supportive. Crucially, people living with dementia and their supporters are at the heart of planning and decision-making processes in co-designing dementia education initiatives.
Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors
Authors: Paine Wendy , Ntlholang Ontefetse , Browne Joseph
Published: September 2024

Background

Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients.

Methods

Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience.

Results

Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors.

Conclusion

This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.
Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults
Authors: Ashraf Mubashra , Boland Yvonne , Mello Sarah
Published: September 2024

Background

Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’.

Methods

Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded.

Results

Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases.

Conclusion

FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.
Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes
Authors: Clancy Monica , Curran Sarah , Cregg Paula , Hayes Kate , Whelan Elaine , Kerins Elaine , Griffin Anne , Ryan Stephen , Quinn Colin , McGowan Caoimhe Hunter , Manning Molly , Galvin Rose , Deane Una , McCarthy Oonagh
Published: September 2024

Background

Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period.

Methods

A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life.

Results

62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p<0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44).

Conclusion

Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.
Patient Experience in Older Adults Ambulatory Care services in a large Irish teaching hospital
Authors: Byrne Lisa , Baunta Sam , Byrne Tracy , Crosby Lisa , Fallon Nessa , Hade Dymphna , Joseph Lincy , Kelly Deirdre , Maher Niamh , Mullen Anna , Poulose Bindu , Carroll Claire O , Caraher Jennifer , Mathew Sharon , Oakes Katie , Rice Ciara , Reilly Claire , Steen Georgina
Published: September 2024

Background

Ambulatory care pathways aim to reduce hospital overcrowding, provide multidisciplinary, speciality outpatient care, in a timely and cost-effective manner to older people with complex care needs. The delivery of care is centred on the needs of the patient; obtaining and implementing personalized feedback is essential to upholding the highest standards of care.

Methods

All Patients attending ambulatory care services, at a large teaching hospital in 2023–2024 were offered a 30-question survey covering demographics, hospital access, facility usage, and care delivery, with yes/no responses, 5-point Likert scale and free text comments.

Results

This cohort represents 3.5% of overall service users (n=642). Of the group in question, 55% were between 65 and 85, and 10% were over 85, a quarter were under 65. A quarter of people were seen within a month, a further 38% within four months of referral. 63% of respondents travelled by car, 31% took public transportation, 5% walked, and 1% rode a bike. 68% of older adults commuted by car (12% by taxi). Taxi use was due to inability to conveniently access onsite parking. Over three quarters were accompanied to their appointment. A delay was reported by 24% of respondents, two thirds cited a parking issue on campus, with almost 20% identifying a traffic issue. 4% found the distance from the car park to the department challenging. The majority of concerns related to campus traffic and delays getting parking onsite. When asked to rate communication, the environment, and multidisciplinary care delivery, 99%-100% responded positively.

Conclusion

Care delivery was positively represented in this sample. This patient feedback highlights the need for accessible parking in hospital infrastructure planning. Vulnerable older adults requiring supportive care should be protected from the cost implications of hospital attendance, costly taxi use is indicated in this group. There is a need for national action on this.
Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting
Authors: Ruttledge Sarah , Lannon Cian , Minogue Ríana , O'Riordan Julien
Published: September 2024

Background

Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration.

Methods

This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel.

Results

36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital.

Conclusion

Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.
Bridging the Gap: A Competency Framework for Hospital Doctors Caring for Older Adults
Authors: Buckley Emily , Barrett Aileen , O'Tuathaigh Colm , Bennett Deirdre , Cooke John
Published: September 2024

Background

Our ageing population has resulted in an increasing number of older adults requiring healthcare services. This growing demand within a population of varying needs requires that all hospital doctors, regardless of specialty, possess fundamental Geriatric Medicine competencies. However, a consensus on these competencies is lacking with no overarching competency framework available. We aimed to address this gap by synthesising a competency framework for all hospital doctors caring for older adults.

Methods

Our first step involved a comprehensive scoping review of international literature identifying the proposed competencies for hospital doctors caring for older adults. These findings were validated and expanded through a national group concept mapping study inviting multiple stakeholders. An iterative process refined the identified competencies, categorising them into domains, and synthesising a final competency framework using Microsoft Excel.

Results

This study synthesised 110 Geriatric medicine competencies within seventeen competency domains. The scoping review highlighted medication, cognitive, and chronic disease management and the group concept mapping identified interpersonal communication, medicolegal, and delirium management as most critical. The iterative process further refined the framework, emphasising competencies pertaining to cognitive impairment, depression, falls, and acute inpatient management of older adults.

Conclusion

This synthesis highlights the broad range of competencies necessary for effective care of older adults by all hospital doctors. The identified competencies reflect the heterogeneous nature of the older adult population, encompassing both fundamental but also specialised skills. Further research is now essential to determine the optimal educational interventions for ensuring all hospital doctors are equipped with these essential competencies.