bluuebunny/crossref_metadata_2025 huggingface dataset:
306 GERIATRICIAN-LED COMPREHENSIVE GERIATRIC ASSESSMENT IN THE EMERGENCY DEPARTMENT: A COST-EFFECTIVE SERVICE APPROVED BY PATIENTS
Authors: Magner S , Carey S , Harrington G , Ward L , Smyth H , Purcell R , Callaly L , O'Caheny C , Pender C , Buckley B , Laguna R , Riches R , Mitchell M , Carrabine N , Ramiah V , Byrne C
Published: October 2022

Background

Many older people are brought to the Emergency Department (ED) who do not require acute hospital admission but there are risks to these patients if this occurs. The Frailty Intervention Team (FIT) are an interdisciplinary team based in the ED including physiotherapy, occupational therapy, speech and language therapy, dietetics, pharmacy, advanced nurse practitioners, and a geriatric registrar and consultant. They assess frail older patients and suggest alternative care pathways to admission. We aimed to investigate the impact of FIT on admission avoidance, bed days saved and to obtain patient feedback on their experience.

Methods

Routinely collected data from May 2021 to April 2022 was reviewed retrospectively. An anonymous patient feedback questionnaire was posted to 40 patients randomised from the FIT worklist between January to May 2022.

Results

2,025 Comprehensive Geriatric Assessments (CGA) were completed between May 2021 and April 2022. 38% percent of patients were discharged home, 45% of this number had follow-up arranged. 104 patients were transferred directly to an offsite bed, mostly rehabilitation. We estimate we avoided 51 admissions to the acute hospital per month, almost half of these were patients admitted to the hospital and, who we discharged to alternative care pathways or home. The average length of stay in April 2022 was 22 days – by avoiding 615 admissions between May 2021 and April 2022 we have saved 13,530 bed days at an estimated cost saving of almost €11 million. 15 completed questionnaires were returned. 73% were very satisfied with their experience. 87% felt the FIT team helped facilitate their discharge from ED. The main themes identified from open ended questions included thorough assessment, patient centred care and satisfaction with early intervention and discharge.

Conclusion

A Frailty Intervention Team is a cost effective and patient centred way of avoiding unnecessary admissions for older people presenting to the ED.
307 THE FEASIBILITY OF USING AN INCLINOMETER TO PROVIDE OLDER HOSPITALISED PATIENTS WITH FEEDBACK ON THEIR ACTIVITY LEVELS
Authors: O'Keeffe E , Landers S , Kehoe B , Davey N , Cooke J
Published: October 2022

Background

Low levels of physical activity in older adults are well documented and have been associated with functional decline, acute sarcopenia, prolonged length of stay and higher readmission rates. Interventions to modify behaviour in hospitalised older adults include providing feedback on performance. Commercially available activity trackers and pedometers which rely on step count, are often unable to detect steps at the walking speeds found in older hospitalised patients. This study investigated the feasibility of using an inclinometer to measure the time spent by older hospitalised adults in lying and sitting versus standing and walking, and to provide feedback to patients on their active versus sedentary levels.

Methods

This was a feasibility study using a cross-sectional single centre design. Twelve inpatients over 70 years of age were fitted with an ActivPAL accelerometer on their thigh, which was worn continuously for 3 days. A graphic display of sedentary versus active time was provided to the participants each morning. Acceptability of wearing the device and receiving feedback was determined using a modified technology acceptance questionnaire.

Results

Twelve hospitalised older adults (7 female, 5 male) were included in the study, median age 74 (66-84). A modified technology questionnaire showed that 83% of participants found the ActivPAL device comfortable to wear, 100% reported that the feedback from the device was clear and understandable and 92% reported that the information enhanced their motivation for physical activity and that they would wear the device again.

Conclusion

This feasibility study shows that the ActivPAL is a device that can be worn in the hospital setting to provide older adults with feedback on their activity levels in order to modify behaviour and increase their levels of physical activity while in hospital.
310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE
Authors: Murphy R , McCarthy C , Reddin C , Canavan M , O’Dwyer C , Mulroy M , O'Donnell M
Published: October 2022

Background

Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).

Methods

In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.

Results

There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.

Conclusion

There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.
311 FROM ONE FRONT DOOR TO ANOTHER: OUTCOMES OF PATIENTS DIRECTLY DISCHARGED FROM THE FRAILTY AT THE FRONT DOOR SERVICE
Authors: Griffith V , Murphy R , Sheil O , Roche E , Devaney T , Geoghegan J , Robinson S , Waters R , O'Donnell M , Canavan M
Published: October 2022

Background

The Frailty at the Front Door service is a novel service that provides comprehensive geriatric assessment in the emergency department for older adults who have an unplanned emergency presentation to hospital. It is important to monitor outcomes of patients discharged by the service to ensure appropriate patient selection.

Methods

Patients over the age of 75 with a Manchester Triage Score of between three and five and a possible frailty syndrome are eligible for review by the service. After initial review patients are either discharged directly or recommended for admission. We reviewed the outcomes of patients who were discharged directly after Emergency Department (ED) assessment by the service.

Results

Discharge disposition was available for review in 413 (95%) of patients since initiation of the service in October 2021. 30% (n= 122) of patients were discharged directly after initial ED review. Elevated 4AT score (p = 0.002) but not frailty (p = 0.80) was associated with decreased chances of direct discharge. Of patients discharged directly from ED 13% were reviewed post discharge by the community integrated care team (GICOP), with 43% of these reviews taking place within 30 days. Overall, 16% of patients discharged directly represented to ED within 30 days. There was a trend towards lower rates of representation to ED among patients who were seen by GICOP after discharge from ED (p = 0.12).

Conclusion

There was a high rate of direct discharge after review by the service, with low rates of representation to hospital. While limited by low numbers there was a trend towards lower representation rates in patients reviewed post-discharge by the integrated care team. Future quality improvement initiatives will aim to improve the integration between the services and highlighting patients who would benefit from more timely reviews.
317 PREVALENCE OF MOTORIC COGNITIVE RISK SYNDROME IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT ATTENDING A MEMORY CLINIC
Authors: Harte G , Kennelly S , Dukelow T
Published: October 2022

Background

Mild Cognitive Impairment (MCI) alone is not predictive of progression to dementia. However, previous research has found that the combination of MCI and slow gait speed, termed Motoric Cognitive Risk syndrome (MCR), is associated with a three-fold increased risk for the development of dementia. This study aimed to identify the prevalence of MCR among patients with MCI attending a memory clinic at a large teaching hospital.

Methods: Participants

Participants were recruited from the memory clinic at the study site. All participants matching the inclusion criteria were invited to participate in the study. Inclusion criteria: Age > 55 years, independently mobile > 50m unaided, diagnosis of MCI. All participants gave informed consent prior to testing.

Procedure

Gait speed (in cm/s) during normal pace walking was measured using a 5-metre computerised walkway with embedded sensors (GaitRite).

Data Analysis

Gait speed data was dichotomised into “normal” or “low” using previously defined gait speed cut-offs derived from age-based norms. Data was analysed using descriptive statistics on Microsoft Excel.

Results

31 participants completed testing (Males: 12; Females: 19). Mean age was 73.65 (range 63-84). Median score on the Montreal Cognitive Assessment (MoCA) was 20 (range 4-28). N = 2 (6.45%) reached criteria for MCR.

Conclusion

Although this study had small numbers, prevalence of MCR was similar to that previously reported among similar populations. This approach to identifying those at high risk for dementia may allow clinicians to target and prioritise further investigations and preventative interventions.
318 CARER STRESS REVIEW IN COMPLEX CASES REQUIRING INTERVENTION BY A COMMUNITY-BASED OLDER PERSONS TEAM
Authors: Bradley E , Byrne A , Ramalingam K , Mills D , Spencer M , Wheelan M , Nee R
Published: October 2022

Background

Complex cases of older adults suffering from multimorbidity are continuing to increase in number. The integrated care team, overseen by a consultant geriatrician, aims to facilitate the management of stable complex cases in the community. Patient care is largely affected by their support system at home; therefore, it is of great importance to ensure that the patient’s primary carer is receiving the support they require to facilitate the older patients’ management in the community. Our aim is to assess carer stress levels before and after Multi-Disciplinary Team (MDT) integrated care intervention.

Methods

Study Population were carers of patients identified as complex cases by the integrated care team. Caregiver stress index was administered during the initial assessment and on the closing of active cases. The maximum score on this index is 13 with high stress classified as >7. Scores were added to a spreadsheet. This spreadsheet was reviewed, and relevant data was collated. One year assessed March 2021- March 2022.

Results

Carer stress information was collected on 62 of 112 identified complex cases (55%). Of these 55 of 96 individual patients were represented (57%). Average age 82 years old. 65% female and 35%, male. Range of carer stress scores observed 0- to 12. Of the 62 cases, 85% (53 cases) had a reduction in carer stress post-intervention(p<0.01). Of these 65% had a reduction below 7 (p<0.01). Mean score improvement 7. No carer stress indices disimproved post-treatment.

Conclusion

Multidisciplinary, patient-centred community care has a clear positive impact on the patient carer. Improvements in carer stress scores could be further evaluated as to the benefits of specific interventions in time. In future, a more large-scale collection and interpretation of data would need to occur for a more conclusive positive impact of the community based integrated care team to be confirmed.
319 CAN INDEX BARTHEL SCORE AT EMERGENCY DEPARTMENT PRESENTATION PREDICT ADVERSE OUTCOMES AMONG OLDER ADULTS AT 30 DAYS AND 6 MONTHS?
Authors: Corey G , Leahy A , Carroll I , Barry L , Galvin R
Published: October 2022

Background

Frailty is acknowledged as a significant syndrome particularly in the older population. Monitoring frailty in late life aetiology and recognising the value of frailty as a marker of risk for adverse health outcomes is vital and ensures the identification of opportunities for intervention with this cohort in clinical practice. The aim of this prospective cohort study is to examine if an index Barthel Score at Emergency Department presentation predicts adverse outcomes among older adults at 30 days and 6 months.

Methods

Six-hundred and fifty older adults (≥65 years) attending a university model 4 hospital ED were recruited. Baseline evaluation included the Barthel Index. Adverse outcomes (hospital readmission or death) were recorded by a research nurse at 30 days and 6 months, blinded to Barthel score. Descriptive statistics were used to profile the population and report the incidence of adverse outcomes.

Results

At 30 days, 61 older adults had either being admitted to hospital (n=28) or died (n=33) and at 180 days a further 72 had been admitted (n=43) or died (n=29). A total of 29% (n=189) of the population had a Barthel score of ≤15 indicating moderate dependency. Of this cohort, 70% had an adverse outcome-readmitted or died within 180 days.

Conclusion

It may be worth looking at introducing the Barthel Index as a routine measure of activity for older adults presenting to the ED. This tool demonstrates an increased risk of adverse outcomes among older adults who present with moderate dependency. Early intervention either in the hospital or community setting with this ‘at risk’ cohort may serve to reduce adverse outcomes among this group.
320 IDENTIFYING OUTCOMES FOR PATIENTS LEAVING REHABILITATION WITHOUT THE MULTI-DISCIPLINARY TEAM (MDT) RECOMMENDED HOME CARE PACKAGE (HCP) HOURS IN PLACE
Authors: Costello R , O'Connor M , McGarvey C
Published: October 2022

Background

Home-Care Packages (HCPs) aim to support older people to remain in their homes. The community care system in Ireland has a small range of services with inconsistent availability. This study aims to identify outcomes for patients leaving rehabilitation without the MDT recommended HCP.

Methods

Demographics of patients discharged from rehab January 2021 to December 2021 were collected. Patients were classified into those with and without recommended HCP at time of discharge. Telephone consultations were held and data collected including; number of falls since discharge and EQ-ED-5L quality of life questionnaires were completed.

Results

Of 30 patients included (aged 66-94), 9 did not have full HCP hours on discharge. The range of Length of Stay (LoS) was 2-120 days in the correct HCP group and 7-59 in the incorrect HCP group. There was 7 readmissions to hospital, 5 from full HCP group. Three patients had a fall since discharge. In the correct HCP group, 42% had a mobility score of 3 or greater and 38% had a self-care score of 3 or greater. This was 11% and 33% respectfully in the incorrect HCP group.

Conclusion

Those who were discharged with full HCP had larger range of LoS. All patients who suffered falls were in the full HCP group. Incorrect HCP group had better scores in mobility and self-care. There were low rates of readmission to hospital in this group of patients discharged following a period of rehabilitation.
321 UNMET NEEDS AFTER STROKE
Authors: Harte G , Keane J , Ryan D , Collins R , Garcia C , Howlin R , Ryan S , Connolly A , Leitch E , Moynan W , Healy S , Keenan M
Published: October 2022

Background

Unmet needs, such as lack of access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services. The UK guidelines on stroke (2016) recommend that all patients should be offered a structured health and social care review at 6 months post-stroke. However, no such clinics exist to date in Ireland. We aimed to explore the extent of unmet needs in the catchment area of a large teaching hospital.

Methods

A random selection of patients 6-months post-stroke were contacted by telephone and unmet needs were assessed using a validated tool, Post-Stroke Checklist. Following analysis of data, the need for a pilot clinic was identified. A separate random selection of patients discharged from acute services 6 months previously were invited to attend a review clinic. Patients were assessed using an adapted version of the Greater Manchester Stroke Assessment Tool. Assessments were conducted jointly by a physiotherapist and a speech and language therapist, and appropriate onward referrals were made.

Results

Telephone clinic: 51 patients completed the checklist. The most prevalent symptoms reported were fatigue (75%), reduced participation in hobbies and activities, decline in cognition (61%) and mobility problems (59%). Review clinic: 21 patients attended. The most prevalent symptoms reported were reduced memory/concentration (71%), low mood (71%), unintentional weight loss/gain (62%), and reduced mobility (43%). Onward referrals were made for in 16/21 (76%) cases; physiotherapy (n=12), occupational therapy (n=7), speech and language therapy (n=7), clinical nutrition (n=5), social work (n=7), psychology (n=5).

Conclusion

Data from this exploratory study supports previous research indicating a high number of stroke survivors with unmet needs. This highlights the importance of establishing post-acute stroke review clinics and pathways in the Irish setting.
325 DISTINCT INTEGRATION OF RAPIDLY PRESENTED AUDIO-VISUAL EVENTS IN OLDER ADULT RECURRENT FALLERS
Authors: O'Dowd AM , Hirst RJ , Setti A , Donoghue OA , Kenny RA , Newell FN
Published: October 2022

Background

The ability to precisely integrate sensory information is critical to everyday functions, including balance/postural control and navigation. Older adults typically integrate sensory information over longer time delays than younger adults, which can reduce the precision of their perceptual judgments. This is particularly evident in older adults with a recent history of falls. However, the extent to which longitudinal patterns of falling or fall risk are associated with the precision of multisensory integration in older adults remains uncertain.

Methods

A sample of 2,321 older adults were grouped into longitudinal trajectories via self-report fall number (decreasing, stable, increasing) and, separately, sensorimotor fall risk via Timed-Up-and-Go (TUG) performance (stable, moderately declining, severely declining). Multisensory integration was measured once with the Sound Induced Flash Illusion, which examines how sound influences vision. A single ‘flash’ and two ‘beeps’ were presented over short (70ms) and longer (150ms and 230ms) temporal delays and older adults were asked to report only the number of ‘flashes’ they perceived. Accuracy on this task was the main outcome measure.

Results

Our results showed that the likelihood of incorrectly perceiving two ‘flashes’ at longer temporal delays increased with age and this was particularly evident for those with an increasing fall number trajectory. Furthermore, the likelihood of incorrectly perceiving two ‘flashes’ at the short temporal delay decreased with age but only for those same recurrent fallers. There was no association between longitudinal TUG trajectories and task performance.

Conclusion

Experiencing increasing incidents of falling over ten years is associated with distinct patterns of audio-visual integration in ageing. In contrast, long-term functional mobility is not. This may reflect links between multisensory integration and perturbed balance function and/or compromised cognitive functions (e.g. inhibitory control). Our findings contribute to our understanding of the mechanisms underpinning brain health in older age.
329 ANTICHOLINERGIC BURDEN IN PEOPLE LIVING WITH DEMENTIA ATTENDING GERIATRIC MEDICINE AND PSYCHIATRY FOR OLDER PERSONS SERVICES
Authors: Burke S , Gibbons O , Ahmed M , Loughlin E , Drumm B , O'Sullivan F , Hickey P , O'Donnell M , Dolan C , McCarthy G , O'Malley G
Published: October 2022

Background

Anticholinergic burden is associated with an increase in cognitive decline, delirium and confusion. We aimed to examine the Anticholinergic Cognitive Burden (ACB) of patients referred to local dementia services, and the prescribing of acetylcholinesterase inhibitors in patients with a significant anticholinergic burden. We also looked at frequency of prescribing of classes of some medications known to increase anticholinergic burden.

Methods

A retrospective chart review was carried out of new referrals attending local Geriatric Medicine and/or Psychiatry For Older Persons outpatient services with a diagnosis of dementia between 2017 and 2018. Medications in use at the time of patient review were obtained. ACB was calculated using ACB score. Results were analysed descriptively.

Results

163 patients over 65 years old were included in this study, 94 (57.6%) were female. 30% (N = 49) had a significant anticholinergic burden (ACB >3). The mean ACB was 1.69 (Range 0 – 8). 38% of all patients (N = 63) were prescribed an acetylcholinesterase inhibitor, and of those, 20% (N = 13) had a significant anticholinergic burden. Polypharmacy (use of 5 medications or more) was evident with 76% (N = 124) patients. Regarding groups of medications known to increase ACB, 35.5% (N = 58) were prescribed antipsychotics and 18.4% (30) were prescribed benzodiazepines.

Conclusion

There is a significant anticholinergic burden among people living with dementia attending the geriatric medicine and psychiatry of later life services. Some patients with a significant anticholinergic burden were being prescribed acetylcholinesterase inhibitors. This suggests acetylcholinesterase inhibitors may be prescribed without also discontinuing inappropriate medications that are contributing to the anticholinergic burden. We should look to further reduce the anticholinergic burden of patients attending the dementia services by avoiding these medications or using alternatives where available.
330 RISK OF MALNUTRITION AND ITS ASSOCIATION WITH FRAILTY-ASSOCIATED FACTORS IN THE OLDER PERSON
Authors: King L , Donnellan C , Pillay I , Sayers K , Ryan S , Maher J
Published: October 2022

Background

The aetiology of malnutrition is multifactorial, with age a facilitating factor. It is associated with poorer physical and mental health and functional ability in frail older persons. Nutritional screening is a key domain in Comprehensive Geriatric Assessment (CGA). This study assessed the relationship between malnutrition risk and other drivers of frailty in the older person by CGA.

Methods

All patients who had a CGA completed by an Integrated Care Team for Older Persons from March 2020 to July 2021 inclusive were studied. Data was entered onto an Excel database by a trained administrator. The variables included were: age, gender, swallow screen, living alone, cognition, loneliness, Clinical Frailty Scale (CFS) score, falls history and risk of malnutrition using the Malnutrition-Screening Tool (MST). Odds ratio (OR), 95% Confidence Intervals (CI) was used to determine if there was an association between malnutrition risk and each variable in the total group.

Results

In total, 567 patients (325 female, 242 male), mean age 82yrs (SD =19), with median CFS of 6 were studied. Sixty-eight percent (n=384) reported a fall, 37.2% (n=211) had a positive swallow screen, 44% (n=251) lived alone, 35% (n=198) had positive cognitive screening, 14% (n=80) reported loneliness and 31.6% (n=179) were identified as at risk of malnutrition. A positive association was identified between risk of malnutrition and cognitive impairment (OR 1.9, 95%CI 1.2-3.1) and a reported fall (OR 2.2, 95%CI 1.4-3.5). In the population who had a fall and risk of malnutrition, the association remained in those aged ≥80yrs (OR 2.6, 95% CI 1.46 – 4.5) and female (OR 3.6, 95%CI 1.7 – 7.4).

Conclusion

The risk of malnutrition is associated with falls risk and cognitive impairment in frail older persons. Frail older persons identified by integrated care team for older persons with falls risk & cognitive impairment will be targeted for specialist dietetic intervention.
338 APPLYING STOPP/START CRITERIA TO A COHORT OF FALL PATIENTS IN THE COMMUNITY
Authors: Feeney L , Drumm B , O'Malley G , O'Sullivan F , Hickey P , Conlon C
Published: October 2022

Background

Integrated Care Teams for Older Persons (ICTOP) aim to transform care away from hospitals towards multidisciplinary community team care. Seventy percent of injuries requiring acute admission are caused by falls, costing €59 million annually, in addition to the overall morbidity and mortality burden. The Screening Tool of Older Person’s Prescriptions / Screening Tool to Alert Doctors to Right Treatment (STOPP/START) identifies inappropriate prescribing and prescribing omissions, which should reduce falls risk and optimise patient outcomes.

Methods

This prospective study randomly included 20 active ICTOP patients all of whom had fallen in the last 6 months. The STOPP/START Criteria were used to screen patient’s prescriptions at time of referral.

Results

The average age was 83 years old, 60% were male. Overall 45% had 1 fall, 15% had 2 falls, 20% had 3 falls and 20% had more than 5 falls. The most common comorbidities were hypertension (55%), heart disease (45%), and cognitive decline (40%). Regarding polypharmacy, 95% were prescribed more than 5 drugs, 55% were prescribed more than 10 drugs. Overall, 30% had a diagnosis of osteoporosis, 40% were on a bisphosphonate, while 65% were taking vitamin D and Calcium supplements. Of the 35% (7 patients) who had a previous fragility fracture, 1 had a DEXA scan and a further 3 were on the waiting list. Four of these patients were taking bisphosphonates and 6 were taking vitamin D and Calcium. Regarding STOPP criteria, 30% were taking opioids, 45% Proton Pump Inhibitors, 30% Calcium Channel Blockers, 30% Beta-blockers and 15% were taking Alpha-blockers.

Conclusion

The study identifies a need for community teams to consider medications that increase falls risk and medications that should be initiated to optimise bone health. Community teams should have access to professional medical and pharmacy support, in addition to timely access to DEXA scans.
342 THE DISCRIMINATORY VALUE OF ANP-LED CGA ON PATIENT REPORTED SYMPTOMS AND IMPACT ON CARERS: A CROSS-SECTIONAL STUDY
Authors: Mannion E , Murphy R , Robinson S , Waters R , Donnell MO , Walsh T , Geoghegan J , Conry M , Canavan M
Published: October 2022

Background

Comprehensive Geriatric Assessment (CGA) is a cornerstone in geriatric care. Objective findings from CGA may differ to patient and carer reported symptoms. This study compared patient reported symptoms with objective metrics collected during CGA and explored the relationship with carer burnout.

Methods

Cross-sectional study of patients attending an Advanced Nurse Practitioner (ANP)-led integrated care clinic. Patient-reported geriatric syndromes included low mood, memory concerns, incontinence, falls or dizziness. CGA metrics collected included Barthel Index, Lawton IADLs, MOCA scores, Geriatric depression scale scores, Rockwood Clinical Frailty Scale (CFS) scores and presence or absence of carer burnout. Descriptive statistics were used to compare the relationship between these variables and logistic regression explored the magnitude of association with carer burnout.

Results

We reviewed 99 CGAs over three months. Median age was 81 (IQR 75–86) with 62% female. Cognitive impairment was present in 96% of patients. Self-reported memory trouble was associated with lower MOCA scores (9 vs 23, p < 0.001) and the presence of dizziness was associated with an increased prevalence of falls (89% vs 24%, < 0.001). The presence of incontinence and functional dependency on IADL were both associated with carer strain and a larger magnitude of association with carer strain was seen with increasing frailty (OR 13.7, 95% CI 3.8-58.8 for moderate to severe frailty) than moderate to severe cognitive impairment (OR 8, 95% CI 3.0–24.1)

Conclusion

Older people reported a wide range of symptoms often subtle, some of which are unmasked during CGA. The resultant frailty syndromes often represent increasing degrees of functional impairment impacting on patient and carer quality of life. Striking the balance between patient reported symptoms and objective measurement is important to allow individualised care pathways to be developed as well as highlighting patients at risk of functional and cognitive decline.
345 HOW PREVALENT ARE UNDETECTED DEPRESSIVE SYMPTOMS AMONGST OLDER HOSPITAL INPATIENTS?
Authors: Chambers H , Ahmed R , Cloonan J , May E , Madden R , Briggs R
Published: October 2022

Background

Depression in later life can have a profound effect on quality of life, functional independence, healthcare use and early mortality. For multiple reasons however, depression in later life may often go undetected. The aim of this study is to ascertain the point prevalence of depressive symptoms on a specialist geriatric medicine unit, examining the rate of detection of clinically significant symptoms.

Methods

The study site is a large urban university teaching hospital with a 150-bed specialist geriatric medicine unit, comprising acute medical, rehabilitation and long-stay wards. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale (CES-D) with a score ≥16 indicating significant symptoms. Medical notes were examined for documentation of screening for/assessment of depression since admission. Patients were included if they were aged ≥70 years, a current inpatient and able to give informed consent.

Results

Almost 62% (47/76) of the study sample (Mean age 83 years, 66% female) met criteria for significant depressive symptoms. Almost-half (23/47, 49%) of patients with significant depressive symptoms were screened for depression (either with a structured screening tool, a documented mood assessment or review by psychiatry) while in hospital. The mean length of stay for patients with depressive symptoms who had not yet been screened for depression was 42.7 (23.2 – 62.2) days and over 70% had been in hospital for at least 10 days, with almost two-thirds (15/24, 65%) currently residing on an acute geriatric medicine ward (rather than a rehabilitation or long stay ward).

Conclusion

Our study demonstrates a high burden of depressive symptoms amongst older inpatients, with almost 2 in 3 meeting criteria for clinically significant symptoms. Less than half of those with clinically significant symptoms were screened for depression however, representing an important missed opportunity to identify, and possibly treat, depression.
347 LONELINESS AMONGST OLDER INPATIENTS IN THE CONTEXT OF COVID-RELATED VISITING RESTRICTIONS
Authors: Madden R , Ahmed R , Cloonan J , May E , Chambers H , Briggs R
Published: October 2022

Background

Loneliness can affect people at all stages of life, but appears to be more closely linked to adverse health outcomes such as quality of life and healthcare use amongst older people. There are concerns that restrictions on hospital visits due to infection control policies related to the COVID-19 pandemic may exacerbate loneliness amongst older inpatients. The aim of this study is to quantify the burden of loneliness amongst older inpatients on a specialist geriatric medicine unit.

Methods

The study site is a large urban university teaching hospital with a 150-bed specialist geriatric medicine unit, comprising acute medical, rehabilitation and long-stay wards. The University of California, Los Angeles (UCLA) Scale was used to measure symptoms of loneliness with scores≥43 indicating high levels of loneliness.

Results

Over 84% of patients were lonely at some time while in hospital, with over one-third (24/76) reporting high levels of loneliness. The mean number of days since last visit from a relative or friend for patients reporting high degrees of loneliness was 11.4 (1.2 – 21.6) days, compared to 5.2 (3.2 – 7.1) days for those with reporting lower levels or no loneliness, though confidence intervals overlapped (p = 0.108). Similarly, patients with higher levels of loneliness had a longer length of stay (68.2 (49.4 – 87.1) compared to 47.9 (33.1 – 62.6) but again findings did not reach significance (p = 0.098). Linear regression models, controlling for competing covariates, found that depressive symptoms, were independently associated with burden of loneliness with a β-Coefficient = 10.69 (5.00 – 16.39).

Conclusion

Loneliness is particularly prevalent amongst older inpatients, with a trend towards higher levels of loneliness in those with less frequent visits. Interventions to help older people stay in touch with family and friends, and maintain social connectedness while in hospital, allowing for COVID-related restrictions, would be welcome, particularly for those with longer lengths of stay.
348 WHAT IS THE OLDER PATIENT’S VIEW ON RECEIVING DETAILED MEDICAL LETTERS?
Authors: Butler E , Walsh JE , Grogan S , Lyons C , Whalley D , Fitzpatrick J , Gallagher L , Dockery F
Published: October 2022

Background

Sending copies of clinic letters to patients involves additional work for medical staff in formatting letters, administrative staff in printing and posting and is an added cost to the healthcare service. Though seen largely as good practice in some specialities, it is not done routinely in Geriatric medical services. We introduced this practice as standard in our service and wished to evaluate whether from the patient perspective, it is worthwhile.

Methods

We sent a questionnaire to n=80 older patients who were evaluated in the home setting (by the Integrated Care Team for Older People – ICTOP) or recently attended CGA (Comprehensive Geriatric Assessment) clinic or FLS (Fracture Liaison Service) clinic. We asked their opinion on the detailed medical letter sent to their General Practitioner (GP), which they received a copy of. The questionnaire could be completed by patient/carer/relative, and returned anonymously.

Results

N=30/80 were returned. Two said they found the letter difficult to understand; 1/30 said the letter caused them to worry but all said they still preferred that they had received it. N= 2 said they would like to have contributed to the letter for accuracy. All said they felt they should receive copies of all their medical correspondence. Free text comments showed overwhelming support for the process, in allowing them to self-manage their health, enhance communication with other healthcare professionals and was a useful document to refer back to when they are trying to process information during short consultations.

Conclusion

Though a small survey and limited by low response rate, older people expressed high levels of satisfaction in receiving copies of medical letters about their health. It supports the ongoing practice and should be adopted widely.
349 THE IMPACT OF INTER-HOSPITAL TRANSFER TO ENDOVASCULAR THROMBECTOMY (EVT) CENTRES ON THE INCIDENCE OF TENOUS THROMBOEMBOLISM (VTE) IN STROKE PATIENTS
Authors: Kinane J , Murtagh N , O'Malley T
Published: October 2022

Background

The risk of VTE is increased following an ischaemic stroke with pulmonary emboli accounting for up to 25% of early deaths after stroke. Patients suitable for EVT have a higher NIHSS (average 16 in Ireland, 2020) and are more likely to have hemiplegia, potentiating the risk of VTE. Many VTE prophylaxis interventions that are provided to in-hospital stroke patients are not provided to those during the journey to thrombectomy centres. Our objective was to assess the incidence of VTE in acute ischaemic stroke patients transferred from a peripheral hospital to an EVT centre and estimate the potential national impact.

Methods

We reviewed the files of patients (n=35) transferred from a peripheral hospital to an EVT centre from January 1st 2019 until December 31st 2021 and included those who had a VTE confirmed on imaging during their admission. We calculated the incidence of VTE in these patients and the potential national figure. The sample size in this review is small, however 458 patents were transported to EVT centres from other hospitals in Ireland in 2020.

Results

VTE was confirmed in 8.57%(n=3/35) ; 1 out of 15, in 2019, 2 out of 10 in 2020, 0 out of 10 in 2021. The potential national rate using figures from 2020 equates to 39 VTEs.

Conclusion

We report a substantial risk of VTE risk in stroke patients during transit to EVT centres. Agreed national thrombectomy guidelines do not address the prevention of VTE in transit. A national audit of VTE in patients transferred from peripheral hospitals is needed with special focus on the role of mechanical preventative devices(pneumatic compression) in this preventable complication of stroke.
351 PRIDE IN AGEING - DEVELOPING LGBTQ+ EDUCATION TO DRIVE INCLUSION IN OLDER PERSONS CARE
Authors: Dillon A , Fitzgerald K
Published: October 2022

Background

Older LGBTQ+ people are more likely to have diminished support networks and increased health risk factors, creating a greater reliance on healthcare. Within the literature concerns are voiced that fear of discrimination leads to mistrust and therefore underutilisation of health and social services among older LGBTQ+ people, leading to a lack of understanding of the specific needs and experiences of this cohort of patients. This mistrust of healthcare professionals and systems can negatively impact upon quality of life as older LGBTQ+ people do not avail of the health and social services they need to age well.

Methods

The author attended an international workshop to hear first-hand the lived experiences of older LGBTQ+ people from five European countries. A systematic literature review was completed to gain greater understanding of the challenges and discrimination faced by older LGBTQ+ people while accessing health and social care services. The author then received training with a leading LGBTQ+ organisation in order to gain insights into the experiences and concerns of older LGBTQ+ people in Ireland. Practical learning was gained on how to foster inclusion, provide education and create change within older persons services. Staff and patient engagement, feedback and evaluation was used to establish requirements for education, training and service development.

Results

LGBTQ+ education and training was developed for all disciplines working across acute, rehabilitation and residential older persons services in a large academic teaching hospital. This education is now delivered monthly to drive inclusion in older persons care. Staff feel more equipped and confident to provide inclusive care. There has been improved staff well-being and pride as the hospital moves towards being an inclusive and safe space for all.

Conclusion

There is a need for sustained education and training to equip staff with the skills and confidence to provide inclusive care to older LGBTQ+ patients accessing health and social care services.
353 FACTORS ASSOCIATED WITH ADVERSE OUTCOMES IN OLDER ADULTS DIRECTLY DISCHARGED FROM THE EMERGENCY DEPARTMENT
Authors: Mohamed A , Leahy A , Gabr A , Mannion M , Cassarino M , Carrol I , Hayes C , Peters C , Shanahan E , O'Connor M , Galvin R
Published: October 2022

Background

Older adults attend the Emergency Department (ED) frequently. Over 40% are directly discharged from the ED. The risk of adverse outcomes is high following discharge including unplanned ED return, institutionalisation, and mortality. The purpose of this study was to highlight factors that predict these adverse outcomes.

Methods

A secondary analysis was completed of SOAED (a prospective cohort study examining screening instruments to predict adverse outcomes for undifferentiated older adults attending the ED) and OPTIMEND (randomised control trial examining the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone). Inclusion criteria were adults aged 65 years and over presenting to ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.

Results

Three-hundred and nine patients were discharged directly from ED (mean age 80 years; 58% female). 96 patients re-attended ED within 6 months. 66 patients were re-hospitalised within 6 months. 16 patients died within six months of discharge. 63% of the discharged patients screened positive for frailty measured by PRISMA-7 (3 or more). Relative risk ratio analysis confirmed that the risk of revisiting a hospital was 1.241 times for patients that scored frail compared to those who scored not frail. The risk of mortality was 1.075 times for patients that scored frail compared to those who scored not frail. The risk of being admitted to a nursing home was 1.146 times for patients that scored frail compared to those who scored not frail.

Conclusion

Older people have a high ED re-attendance rate of 31% after an index visit. Frailty (scored on PRISMA-7) is a significant predictor of adverse outcomes. Focused screening and intervention for frail patients who attend the ED should be a priority.
Comment ça va? The Status of French Laws in Vanuatu
Authors: Corrin Jennifer
Published: October 2022

Prior to Vanuatu’s independence in 1980, in the absence of applicable joint regulations, French law applied to French citizens and English law applied to British citizens. Members of the indigenous population were governed by a different regime. Subjects of other countries were required to “opt” for either the French or the English legal system within one month of arrival. At independence, French and English laws continued in force, unless revoked by the Vanuatu Parliament or incompatible with the independent status of Vanuatu. However, the opting provisions were repealed and it was not made clear when and to whom each system of law was to apply. In practice, French law is rarely applied. Commencing with a brief explanation of the sources of law in Vanuatu, this Article seeks to identify the rules for the application of French law in Vanuatu today through an analysis of relevant case law. It then goes on to explore divergence between English and French law, which might be of significance for parties to civil cases. The Article also discusses the results of empirical work carried out in Vanuatu, which sheds some light on the reasons why French law has been marginalised.
Precision of Soft-Tissue Filler Injections: An Ultrasound-Based Verification Study
Authors: Calomeni Mariana , Bravo Bruna S F , Schelke Leonie W , Velthuis Peter J , Schalet Grant , Frank Konstantin , Guertler Anne , Alfertshofer Michael , Cotofana Sebastian , Moellhoff Nicholas
Published: October 2022

Background

Uncontrolled product spread is an important issue to consider in facial filler injections. Lack of precision can result in reduced effectiveness and surface projection, as well as irregularities and product visibility.

Objectives

The authors sought to assess the precision of soft-tissue filler injections in the face by employing a cannula.

Methods

This single-center observational study investigated soft-tissue filler distribution utilizing real-time non-invasive ultrasound imaging. Outcome parameters included (1) the tissue plane of product distribution, (2) the extent of horizontal as well as vertical product spread at the injection site, and (3) the product surface area taking into account the multifactorial influence of several independent variables. Participants were followed up to 30 days post-injection.

Results

A total 100 facial injections were performed in 8 patients (2 males, 6 females) with a mean age of 37.20 (±6.34) years and a mean BMI of 22.21 (±1.39) kg/m.2. The plane of product distribution remained constant in approximately 90% of cases at day 0 (d0), d14, and d30. Mean horizontal product spread was higher compared with vertical spread, and both significantly decreased over all time points (P < .001). Mean product surface area was 22.51 ± 16.34 mm2 at d0, 15.97 ± 11.28 mm2 at d14, and 12.9 ± 9.15 mm2 at d30. Analysis employing generalized linear models revealed that injection volume and injection depth significantly influenced product surface area.

Conclusions

Injection of soft-tissue filler employing a cannula allows precise application of the product within the intended tissue plane. Precision can be improved by injecting less product into deeper tissue layers.

Level of Evidence: 5
Concept drift detection in toxicology datasets using discriminative subgraph-based drift detector
Authors: Bharti Vandana , Nair Shabari S , Jain Akshat , Kumar Shukla Kaushal , Biswas Bhaskar
Published: October 2022

Due to the increasing importance of graphs and graph streams in data representation in today’s era, concept drift detection in graph streaming scenarios is more important than ever. Contributions to concept drift detection in graph streams are minimal and practically non-existent in the field of toxicology. This paper applied the discriminative subgraph-based drift detector (DSDD) to graph streams generated from real-world toxicology datasets. We used four toxicology datasets, each of which yielded two graph streams – one with abrupt drift points and one with gradual drift points. We used DSDD both with the standard minimum description length (MDL) heuristic and after replacing MDL with a much simpler heuristic SIZE (number of vertices + number of edges), and applied it to all generated graph streams containing abrupt drift points and gradual drift points for varying window sizes. Following that, we compared and analyzed the results. Finally, we applied a long short-term memory based graph stream classification model to all the generated streams and compared the difference in the performances obtained with and without detecting drift using DSDD. We believe that the results and analysis presented in this paper will provide insight into the task of concept drift detection in the toxicology domain and aid in the application of DSDD in a variety of scenarios.