bluuebunny/crossref_metadata_2025 huggingface dataset:
217 Investigating the Delivery of Falls Prevention Interventions to Older People Following Multi-Factorial Risk Assessment: A Cross-sectional Study
Authors: Dennehy Rebecca , Barry Patrick J , O'Connor Kieran A , Cronin Finola , Turvey Spencer , Moriarty Eileen , O'Reilly Éilis J , Browne John P , McHugh Sheena
Published: September 2019

Background

Falls are one of the most common threats to older peoples’ independence. In Ireland, approximately one in three adults aged ≥65 years fall each year. Multifactorial interventions, which include an assessment of an individual's risk of falling followed by customised interventions or referral have been shown to reduce the rate of falls among community-dwelling older people. As part of an Integrated Falls Prevention Pathway initiated in 2016, six multidisciplinary risk assessment clinics were established in Cork city and county. The aim of this study is to examine whether recommended follow-on interventions were received following a falls risk assessment in the community.

Methods

Routinely collected administrative data for clients who attended a falls risk assessment clinic are being collated. Data include client demographics, onward referrals, waiting times and receipt of intervention. A process map of the patient pathway following a falls risk assessment is under development and will be refined based on the study findings.

Results

Preliminary analysis of a two-year implementation period (April 2016-2018) indicates that following assessment, clients received an average of 2.4 onward referrals. Most referrals were made to general practice (29%, n=315), community physiotherapy (25%, n=272), and community occupational therapy (15%, n=165). Other referrals were to public health nurses (n=104, 10%) and falls prevention classes (n=60, 6%). Further analysis will identify the percentage of individuals who receive interventions, the type of interventions received, the percentage of patients who do not attend and the waiting lists.

Conclusion

The Integrated Falls Prevention Service is the sole example of an operational integrated falls pathway in Ireland. This research will identify potential roadblocks for providers and clients along the pathway and will identify opportunities to. The results will also be used to inform service planning and resource allocation to ensure that this model of care is sustainable.
224 Dance Artist and Physiotherapist Collaboration in Stroke Rehabilitation
Authors: Harte Gillian , Claffey Ailish , O’Neill Desmond
Published: September 2019

Background

Many studies have measured the benefits of dance for patients, in particular those with Parkinson's disease, with positive effects demonstrated in functional measures, wellbeing and patient experience. However, neither the value of dance when used as an adjunct to stroke rehabilitation nor the act of collaboration between dance artist and physiotherapist has previously been studied.

Aim: To explore the experience and process of collaboration between the physiotherapist and dance artist when dance is used as an adjunct to conventional physiotherapy post-stroke in a geriatric medicine and stroke service in a university teaching hospital.

Methods

The study used a descriptive qualitative design and a convenience sample of 8 participants were recruited from the stroke rehabilitation ward. The physiotherapist advised the dance artist on specific movement goals for each session. The physiotherapist and dance artist kept individual diaries which included subjective and professional assessment of sessions. Exploratory analysis was used to discover emerging themes.

Results

Themes identified fell into the categories of physiotherapist learning, dance artist learning, collaborative process, language, and the therapeutic relationship.

While benefits such as greater liberation of patients’ movements and higher endurance rates were recorded, what was particularly of note was the communication between the physiotherapist and the dance artist. The language used was key: physiotherapy discourse tends to be more specific to particular movements whereas the dance artist relates more to the overall movement of the individual, identifying movement patterns and habits.

The dance artist uses the lens of choreological studies (the science of movement) when working with patients and this way of working was particularly beneficial. In particular the use of motif writing became an invaluable resource in terms of communication.

Conclusion

Within this study we questioned: what is required to create successful collaboration within a medical context? We hope that describing how this particular collaboration was successful will benefit those interested in similar collaborations.
255 An Exploration of the Feasibility and Acceptability of Wearable Technology in Parkinson’s Disease
Authors: Kenny Lorna , O'Riordan Clíona , Wilkinson Tony , O’Sullivan Mary , Agurjanovs Janis , Tedesco Salvatore , Sica Marco , Crowe Colum , Barton John , Timmons Suzanne
Published: September 2019

Background

Wearable technology is increasingly used to diagnose, monitor and manage neurological disorders such as Parkinson’s Disease (PD). This study aims to gain information about the views and needs of people with Parkinson’s (PwP’s) regarding wearable technology for monitoring the disease and assisting its management.

Methods

The study employed a mixed methods parallel design, wherein focus-groups and questionnaires were concurrently conducted with people with PwP’s in Munster. Questionnaires and topic guides were developed with significant input from PwP’s. The participants for focus-groups were purposively sampled for variation in PD stage, age (all >50 years) and sex. Questionnaire and focus-group results were analysed together, using a pragmatic triangulation protocol.

Results

Thirty-two questionnaires were completed by PwP’s. Four semi-structured focus-groups were held (n=24 participants). Participants were overall positive about wearable technology in PD, and perceived benefits in wearable technology for improved management of symptoms. Wearables should be user-friendly, have an appealing design, and demonstrate clinical usefulness. Comfort and discrete design were emphasised for greater usability.

The value of sharing information between PwP’s and health professionals for improved outcomes was highlighted. PwP’s perceived that increased patient data in the form of reliable information from a wearable device may allow for more accurate management of PD. Participants also felt that a device could help increase physical activity, and potentially track compliance with medication. There was little focus on device safety and privacy/ownership of data. While participants anticipated that there may be challenges for some in wearing a device, they believed overall potential benefits would outweigh these.

Conclusion

Engagement of PwP’s in the design of wearable technology is vital for the development of devices that improve the management of PD. This study will directly inform a multi-country feasibility study of wearable devices for older people, with a particular focus on the needs of PwP’s.
280 Acute Hospital Presentations among Nursing Home Residents: A Retrospective Observational Analysis
Authors: Waters Ruairí , Murphy Robert , Mannion Edel , Gaffney Laura , Donlon Kate , Canavan Michelle , O'Keeffe Shaun T
Published: September 2019

Background

Nursing home residents are prone to acute illness due to their advancing age, underlying illnesses and immobility. The decision to refer a nursing home resident for acute hospital admission is a complex one, and there is no consensus among health care professionals about what constitutes an ‘appropriate admission’ to hospital from a nursing home. We aimed to explore patterns of acute nursing home patient presentations to the emergency department.

Methods

This was a retrospective cohort study of emergency hospital admissions to a tertiary university teaching hospital. Emergency admissions through the emergency department were included. Elective admissions, outpatient admissions, or inter-hospital transfers were excluded. Cases were validated by scrutiny of the patient medical records, and where possible an assessment of the Rockwood clinical frailty scale (CFS) was carried out.

Results

There were 126 nursing home residents who presented to ED over a two month period for emergency assessments. 87.3% (n=115) presented via ambulance. Just over half had a GP referral letter (53.2%). 72.3% of patients who presented to ED were admitted. 25.2% of patients were re-referred to ED within 30 days of hospital discharge. All patients were classified as frail. 21.3% of patients had died at the 90 day follow up mark. 66% of those with a CFS 8 or 9 died, in comparison to 16% of those with a CFS or either 6 or 7.

Conclusion

We noted high numbers of patients from nursing homes attending our emergency department. A very high proportion were admitted, along with a high number of subsequent re-presentations. Death rates were higher in those with more advanced frailty status. We would suggest advanced care planning and strategies to improve the patient experience.

This study highlights the requirement for improved advance care planning in the nursing home setting. This is however a complex issue. Early discussion about end of life preferences with patients and family is required.
294 A Review of a Domiciliary-Based Multidisciplinary Integrated Care Service with Healthcare Assistant Home Support – Is this the Optimum Model?
Authors: Boyle Nichola , McDonnell Sinead , Balasubramanian Subha , Reynolds Niamh , Geary Niamh , Fegan Peter , O'Shea Diarmuid , Hession Eilis
Published: September 2019

Background

The Integrated Care Programme for Older People has supported the development of integrated care services at pioneer sites in Ireland. Key to integrated care is embracing a move away from hospital based assessment and therapy provision, especially for re-ablement and home support care planning, to assessment in the home: “discharge to assess”.

Methods

The Older Persons’ Integrated Care Team (OPICT) provides a targeted, multidisciplinary domiciliary-based re-ablement programme of care to people aged 65 years and older. Using PDSA methodology for service improvement, the addition of home support provided by healthcare assistants (HCAs) was introduced and evaluated. Data was collected prospectively on baseline service user demographics, service activity and outcome measures. HCA delivered home support services were introduced in November 2017. This study contains data for the period November 2017 to March 2019.

Results

Since May 2017, OPICT has provided 266 episodes of domiciliary-based re-ablement to 248 clients, with a further 90 clients assessed but ineligible. The median age of clients was 84 years (8% 65-74 years; 49% 75-84 years; 37% 85-94 years; 6% 95 years and older). The majority of clients were female (58.5%), with low dependency (Barthel score 16 to 19) and classified as vulnerable to moderately frail based on the Clinical Frailty Scale (scores 4 to 6). Of 215 eligible clients, 122 received a total of 1293 hours of healthcare assistant delivered care. Flexibility in the availability of carers to meet demand and willingness of HCAs to embrace a more diverse role were important learning points.

Conclusion

The “discharge to assess” model of integrated care for older people can be achieved in the Irish healthcare setting, with access to flexible HCA delivered home support a key element.
310 Impact of an Integrated Care Hub on Access for the Community to In-patient Rehabilitation: Right Place, Right Time
Authors: O'Gorman Millie , Wall Triona , Naughton Christina , Phelan Niamh , Murphy Catherine , Gantly Thomas , Whyte Caitriona , Bolger Maggie , Brennan Jacinta , Doyle Marie , O'Donoghue Alice , Harnett PJ , Pope George , John Cooke , Mulcahy Riona
Published: September 2019

Background

The Inpatient rehabilitation service serves a population of 116,176 of whom 17,371 are aged 65yrs and over. Access to these units was traditionally via referral from the acute hospital sector with the minority of referrals coming from the community.

Review of the existing rehabilitation pathway was undertaken and highlighted barriers of access to appropriate in-patient rehabilitation. The referral criteria were revised and an updated pathway was devised.

Methods

A quantitative retrospective review of all referrals received in four timeframes, commencing 1st July 2017 to date, was carried out. Each referral was classified into four subgroups: (1) Immediate Crisis (2) Emerging Crisis (3) Stable but Needs Optimisation (4) Stable and No in-patient Intervention required. The origin of the referral was also categorised into four subgroups: (1) Day Hospital (2) GP (3) AHP (4) Other. The Average Length of Stay (AvLoS) was calculated for, acute and community admissions, for each period breakdown.

Results

We compared 1st July 2017 to 31st December 2017 pre-establishment of the new referral pathway and the same six month period in 2018 post-establishment of the pathway. The new streamlined pathway facilitated improved access to in-patient rehabilitation from multiple sources and resulted in an increase in referrals from 25 to 79. Waiting time for admission was reduced from 37 days to 5 days. Community admissions increased from 16 to 48. There was no difference in AvLoS between the two time periods: Acute 22 & Community 17 to Acute 22.25 & Community 18.

Conclusion

This work highlights the effectiveness of an improved co-ordinated referral pathway, within an integrated care hub, from community to in-patient rehabilitation beds with improved accessibility and reduced waiting times. AvLoS figures suggest that appropriate patients were admitted to the rehabilitation units. Also, it confirms the efficiency of a patient centred approach in maximising appropriate services for Right Person, Right Place, Right Time.
322 Major Trauma in the Older Person - Major Challenges Ahead
Authors: Doyle Rachael , Brent Louise , Connolly Aisling , Breslin Tomas , Jones Sophie , Kelly Fionnola , Lawrence Tom , Deasy Conor
Published: September 2019

Background

The mean and median age of major trauma continues to increase for a mean of 36 years in the 1990's to 59 and 61 years respectively in 2016 and 2017. The age planning of major trauma has important implications for healthcare planning.

Methods

The major trauma audit was established by the National Office of Clinical Audit (NOCA) in 2013 and focuses on the most severely injured trauma patients in our healthcare system. The methodological approach is provided by the Trauma Audit and Research Network (TARN). Since 2016 all 26 eligible hospitals have been participating in the audit and the coverage is now 86%.Data has been collected on more than 15000 trauma patients to date.

Results

There were 5061 recorded major trauma cases of which 2233 (44%) were over 65 years in 2017. The most common form of injury (57%) was falls less than two metres (low falls) and this began aged 45 years. 50% of injuries occurred in patient's own home. Only 11% of people were received by a trauma team and this was even lower in the older adult. Older people were very unlikely to be pre-alerted to the Emergency Department prior to arrival. 64% of the mortality from major trauma occurred in the over 65 years. 6%, 7% and 10% of patients aged 65-74, 75-84 and over 85's respectively were discharged directly to nursing home.

Conclusion

There is a marked change in the age profile sustaining major trauma since the late 1990's. Patients today are older with more complex medical needs, have greater lengths of stay and many do not return to independent living. The most common mechanism of injury for older people is a low fall at home. We need to prevent low galls using a multidisciplinary, multi-agency approach.
201 A Re-audit of Lignocaine 5% Medicated Plaster (Versatis®) Prescribing in an Older Adult Inpatient Population Following Changes to Reimbursement Provisions
Authors: McCartan Deirdre , Poff Alison , Lee Stuart , Martin Alan
Published: September 2019

Background

Lignocaine 5% medicated plasters (Versatis®) are licensed only for treatment of postherpetic neuralgia. Our 2017 audit of Versatis® prescribing recorded a potential cost of €28,297/year for just 26 patients, all off-label. We noted however the limited choice of analgesics in older adults due to co-morbid conditions such as CKD and frailty. The 2017 Medicines Management Programme (MMP) directive for label-only Versatis® prescribing aimed to reduce annual exchequer costs of €30 million noting 25,000 people had prescriptions under Community Drugs Schemes (CDS) in 2016.

Methods

We conducted a re-audit of Versatis® prescribing on five core geriatric medical, orthogeriatric and rehabilitation wards across three inpatient sites. Indication for, duration of and patient's personal view of the plaster was recorded. Pharmacy provided medications costings. Cost per day and per length of stay were calculated. All other prescribed analgesics were recorded.

Results

Analgesics prescribed for 127 patients were recorded. Mean age was 81 years, 63% female. 4/127(3%) were prescribed Versatis® compared to 26/129(20%) in 2017, all off-label.Indications included osteoarthritis and spinal stenosis. All four patients were prescribed the plaster prior to admission. Cost per plaster was €3.46 compared to €2.58 in 2017. Cost of Versatis® for these 4 admissions was €346 for their combined 100 bed days. Total cost of co-prescribed paracetamol for these four patients was €45.90. Three patients noted little analgesic benefit, one felt the plaster a psychological support. Seventeen different analgesics were prescribed across 127 kardexes.

Conclusion

No patient was newly prescribed Versatis® during their admission. The MMP directive for the prescribing of Versatis® influenced prescribing practice across our hospital sites. Community practice for prescribing off-label is still evident for chronic pain, reflecting the difficulty of pain control in older adults. The cost of individual plasters increased by 0.88€ since 2017.
208 Life Course Socioeconomic Position and Allostatic Load Burden
Authors: McLoughlin Sinead , McCrory Cathal
Published: September 2019

Background

Allostatic load (AL) is a measure of cumulative physiological dysregulation that is posited to capture the ‘wear and tear’ on the body resulting from exposure to chronic stress. AL has been shown to predict disease, morbidity and mortality. Multiple studies have shown an inverse relationship between AL and SEP, but few have examined the life course social patterning of AL.

Methods

Using baseline data from The Irish Longitudinal Study on Ageing (TILDA), an AL index was calculated by summing the number of biomarkers for which respondents fell within high risk quartiles. 17 biomarkers were examined, representing cardiovascular, immune, metabolic and parasympathetic nervous systems. SEP and life course trajectories were determined using father’s occupation (at age 14) and current occupation, which were aggregated to create four categories of social mobility; stable high, downwardly mobile, upwardly mobile and stable low. Negative binomial regression models were fitted for each of the life course models of critical period, accumulation and social mobility, to examine the associations between SEP and AL (n=3,282).

Results

Higher SEP was associated with lower AL. A significant association between origin SEP and later life remained after controlling for destination SEP. The ‘stable high’ across the life course had the lowest AL burden, the ‘stable low’ had the highest burden, and the mobile groups ranked intermediate.

Conclusion

Findings suggest childhood to be a sensitive period for the embedding of early life disadvantage. The accumulation hypothesis suggests that those who spend more time disadvantaged fair worse in terms of health. This study supports this hypothesis, as those who were stable low / stable high were in the worst / best health respectively.
214 Advance Care Planning: Perspectives of People with Dementia and their Family Members
Authors: Coimín Diarmuid Ó , Ferguson Liz , Beaumont Clíona , Sheridan Sheighle , Kyne Lorraine
Published: September 2019

Background

Clear and effective communication is central to all aspects of healthcare. Discussions centred on advance care planning are vital to ensure the person with dementia receives the support and care they need in the future based on their will and preferences. The aim of this study was to ascertain from those provided with information on advance care planning if it met their needs and assisted their understanding on planning for the future.

Methods

This study centred on eliciting the views of older persons diagnosed with dementia and their carers on the provision of an information booklet titled ‘I have dementia ... How do I plan for the future’. Ethical approval was sought and provided to conduct this study.  Participants presenting to an acute hospital day ward for older persons were identified and recruited through the medicine for older person’s team. 42 people consented to participate with 20 people returning questionnaires, a 48% response rate. Thematic analysis was applied to qualitative comments and descriptive statistical analysis was undertaken with quantitative data.

Results

The overwhelming majority (95%) of respondents found the provision of an information booklet on advance care planning helpful. Nearly two thirds (65%) spoke with someone about advance care planning thereafter. 60% of all respondents reporting that the booklet was either ‘easy’ or ‘very easy’ (40%) to understand. Participants strongly endorsed the provision of information on advance care planning and the benefits that it bestowed to them.

Conclusion

The study has confirmed the importance of communication and the provision of information on advance care planning for people with dementia and their carers in the day ward setting for older persons. Findings strongly endorse the information provided whilst also suggesting minor amendments to the booklet to improve future editions.
219 The Effect of Introducing In-house Radiographers Out of Hours on Door to CT Times for FAST Positive Patients
Authors: Hobson Helen , Cogan Nicola , Greene Suzanne , Ryan Dan
Published: September 2019

Background

Stroke is a leading cause of death and disability in Ireland with up to 7,000 people hospitalised following a stroke annually (IHF/HSE 2016). Every minute in which a large vessel ischaemic stroke is left untreated equates to the average patient losing 1.9 million neurons (Saver, 2006). With the introduction of out of hours in-house radiographers our aim was to look at how this impacted on the service of care to FAST positive patients who present to our Emergency Department. Stroke is a medical emergency where urgent assessment and treatment can lead to improved survival and reduced disability.

Methods

To assess the impact of the introduction of in-house radiographers out of hours we compared door to CT times of FAST positive patients who presented to ED out of hours pre and post the introduction of in-house radiographers. We took the first 30 FAST calls following the introduction of the in-house radiographers and compared those times to the last 30 FAST calls prior to their introduction.

Results

Preliminary results have shown that the introduction of in-house radiographers has reduced the median time spent in the Emergency Department times prior to CT imaging. Current median door to CT times prior to the introduction of in-house radiographers was 27 minutes, the median door to CT time post introduction of in-house radiographers is 21 minutes, however full results are still awaited.

Conclusion

The introduction of in-house radiographers out of hours has led to a quicker transition of patients from the Emergency Department to the CT department thus reducing door to CT times.
230 The Impact of a Palliative Care ECHO Programme on Symptom Severity Scores and Phases Score in a Nursing Home Population
Authors: Murphy Claire , Molloy Una , McLean Sarah , Ryan Daniel
Published: September 2019

Background

In Ireland most deaths occur in acute hospitals however 20% of deaths occur in residential facilities. Less than 30% receive specialist palliative care input. ECHO (extension for community healthcare outcomes) is a palliative care education programme consisting of a 10 part lecture series. Twenty nursing homes and 353 staff participated. A phases score is a 5-point rating scale classifying the status of a palliative care patient ranging from stable to bereaved.

Methods

Data collected by palliative care professionals from September 2017 to December 2018 was analysed. This included demographic features, a phases score and scores for pain, carer stress, spiritual and psychological need. Nursing homes that attended ≤ 3 ECHO sessions were excluded, 15 participating nursing homes were included. Age matched control subjects were selected from non-participating nursing homes on a 2:1 basis. Data was analysed using the paired T Test and Chi squared was analyzed for frequency data.

Results

There were 40 patients in the intervention group and 80 in the control group. Mean ages were 83yrs and 82yrs respectively. Palliative care referral numbers did not change significantly between the two groups (111 and 114). The Phases score was significantly reduced in the ECHO group compared to controls (P=< 0.007). There was no significant reduction in the phases score in the ECHO group pre and post intervention (P=0.29). There was no difference in Pain scores between groups (P=0.98)

Conclusion

The ECHO intervention led to a reduction in the overall phases score in participating nursing homes. This was not the result of increased palliative care referrals. We would infer it is a reflection of better control of symptoms overall. We did not demonstrate a significant reduction in individual symptoms. The phases score is an overall representation of a patient’s status. With the expansion of the ECHO programme on-going analysis will be performed.
233 Potential Deprivation of Patient Liberty: A Qualitative Study of Current Practice Amongst Geriatricians in a Tertiary Setting
Authors: O'Brien Michelle , O'Donnell Deirdre , Clyne Barbara
Published: September 2019

Background

The Assisted Decision Making (ADM) Act 2015 was introduced to support decision making and maximise a person’s capacity to make decisions but has not yet commenced. Within this context, medical professionals such as geriatricians must adjust from a best interest’s outlook to that of patient autonomy in response to the changing legislation. The aim of this study is to explore current geriatrician’s practice. In scrutinizing current practice, it will be evident as to what, if any, adaptations are required in order to practice in accordance with the new legislation.

Methods

Ten semi-structured interviews with individual consultant geriatricians were conducted, each lasting approximately 20 minutes on average in one hospital. Each interview was recorded and transcribed verbatim. The interview involved the geriatrician reading a vignette and answering questions as to how they would manage this situation. Following the vignette, the semi-structured interview proceeded covering topics including; patient decision making in the acute setting, deprivation of patient liberty in the acute setting, thoughts on the ADM (Capacity) Act 2015, and elements learned from experiences in other countries. A thematic analysis was conducted.

Results

Preliminary themes identified from the interviews include; (a) identification, accessibility and availability of medical and legal colleagues in assisting with difficult decision making, (b) need for clear frameworks, guidance and education in relation to laws applying to medical practice, (c) influence of environment, family, perceived risk and delirium on capacity assessment, (d) paternalism versus autonomy. This work is being conducted as part of a master’s in healthcare ethics and law.

Conclusion

Preliminary results highlight the need for collaborative communication between medics and the legal profession in order to achieve a structured and supportive framework to inform practice considering the new legislation.
238 Bridging the Gap: Expanding and Improving the Role of the Integrated Care Team in a Level 4 Hospital
Authors: Fitzpatrick Donal , Heywood Sarah , O'Mahony Catherine , Gallagher Paul
Published: September 2019

Background

The traditional model of acute episodic care for older people is reactive and outdated. The integrated care team (ICT) was introduced in April 2017. It comprises a physiotherapist, occupational therapist, clinical nurse specialist and case manager and provides intensive rehabilitation at home to frail older adults after an acute presentation to hospital, thus bridging acute hospital care and coordinated longitudinal care in the community.

Methods

We evaluated the integrated care team referral database as well as discharge letters from July to November 2018.

Results

Over 5 months, 45 out of approximately 90 referrals were deemed appropriate for the ICT. Almost half of referrals were unsuitable because of medical acuity or specific instructions such as being unable to weight-bear. Over half of referrals came from the emergency department with no referrals from general surgery, orthopaedics or cardiology. During the time of review, the service was operating at <85% capacity. There is no specific registrar assigned to review ICT referrals. The service is expanding with 123 referrals in six months, compared to 54 in the same period the previous year.

Conclusion

The integrated care team helps older adults to avoid hospital admission, return home sooner and regain independence and is a much-appreciated service in the area. We identified shortcomings in the referral process, formal medical oversight and awareness of the service in areas where it could provide the most value. The ICT can expand as a key asset for frail older adults if supported by the necessary resources, staffing, consultant geriatrician leadership, referral criteria and pathways and is promoted and publicized in the clinical settings where it has the greatest potential for benefit.
241 “From SIAD to Happy”: a Case of Effective Use of Tolvaptan for Hyponatremia in an Older Person
Authors: Costello Maria , Newman Christine , Loughlin Elaine , Canavan Michelle , Bell Marcia , Robinson Stephanie
Published: September 2019

Background

Hyponatremia commonly affects the older person, leading to morbidity and mortality. Tolvaptan use is rare in this cohort, but may have benefit in select cases of syndrome of inappropriate antidiuresis (SIAD).

Methods

An 84-year-old gentleman presented with a history of increasing confusion, fatigue and lethargy attributed to symptomatic hyponatremia. He had background of a recent prolonged admission with small bowel obstruction, treated conservatively. That hospital course was complicated by hypovolaemic hyponatremia, sepsis and clostridium difficile colitis. On this admission, he had no clinical symptoms or signs of infection and his septic screen was negative. He had a Rockwood clinical frailty scale score of 7. His biochemical abnormality was a persistent hyponatremia of 129 mmol/L. Clinically, he was euvolaemic. Further biochemical work up revealed serum osmolality of 263 mmol/kg, serum urea of 6.3 umol/L, urine sodium 108 mmol/L and urine osmolality 541 mmol/kg. Thyroid function, cortisol, and HbA1c were normal. CT brain and chest x ray were unremarkable. A diagnosis of SIAD was made. Fluid restriction was ineffective and Tolvaptan (a selective non-peptide arginine vasopressin receptor antagonist) was commenced on consultation with Endocrinology.

Results

With initiation of Tolvaptan there was significant clinical improvement. Sodium normalised to 134 mmol/L. He became alert, less confused and more engaged with the multidisciplinary team. He was discharged home well, and on follow up four months later, his clinical frailty scale score was 4 with significant improvement in his mobility on continued Tolvaptan therapy. An underlying colonic neoplasm is the clinically suspected driver of his SIAD but he is declining further investigation at present.

Conclusion

This case reflects the positive benefits of careful selected use of Tolvaptan in the older population with refractory SIAD, resulting in improved functional status and quality of life.
251 Communicating End of Life Care Decisions in an Acute Hospital
Authors: Morrison Laura , Clarke Rebecca , McAteer Claire , Dolan Eamon , O'Connor Marie
Published: September 2019

Background

Research by the Irish Hospice Foundation reports 43% of Irish deaths occur in hospital. The aim of this study was to review in-hospital deaths in a university teaching hospital to examine whether escalation of care and resuscitation instructions were documented clearly where death was a likely outcome during hospitalisation.

Methods

Medical records from 50 deaths in 2018 were reviewed. A proforma was designed to record detail on: demographics, if death was expected, and if resuscitation status, ceiling of care and discussion of these with the patient or family were clearly documented.

Results

50 patients were included, median age 83.5 years. In 84%, end of life was anticipated by the medical team. 74% of patients were seen by palliative care. The most common cause of death was pneumonia/respiratory sepsis (46%) and median length of stay was 13 days. 3 patients (6%) had cardiac arrest calls.

A clear ceiling of care was recorded in 46% of cases. Goals of care were documented as discussed with the patient in 2% of cases and family in 78%. Resuscitation status was recorded as discussed with family in 62% and the patient in 4%.

Resuscitation status was documented in 96% of cases; 60% by the primary team, 36% by on-call staff. In only 54% of cases the name, position and Medical Council number of the person recording resuscitation status were all clearly written. Resuscitation status was correctly documented on the Early Warning Score chart in 32% of cases.

Conclusion

Clear documentation around treatment escalation plans is needed in patients admitted to an acute hospital. Resuscitation status and ceiling of care, if appropriate, should be decided and documented by the primary team where possible and discussed with the patient/family. This study showed a need to improve documentation and discussion with patients and families approaching end of life.
254 An Audit of the Frequency of Early Swallow Screens Performed in Patients Diagnosed with a Stroke
Authors: Kelly Lisa , Murtagh Niamh , Leonard Rachel , O'Malley Tom
Published: September 2019

Background

The National Stroke Audit 2015 showed that Ireland had made great advances in stroke care but one notable area of deficiency was in access to early swallow screening (within 4 hours). An early swallow screen is recommended by the Royal College of Physicians Stroke Guidelines (2016) to minimise the risk of aspiration pneumonia. The National Guideline for Swallow Screening in Stroke was released in May 2017 and outlines the need to have staff who are trained in swallow screening available 24/7. This audit aimed to evaluate the percentage of stroke patients in our hospital who received a documented swallow screen within 4 hours of admission.

Methods

Data relating to swallow screens/assessments and the time in which they were performed was extracted from our hospital’s HIPE database. The sample size included all confirmed strokes seen by the stroke service in our hospital in the first 6 months of 2018 (1/1/2018- 30/06/2018 inclusive). This amounted to 78 patients.

Results

In our hospital >90% of patients diagnosed with stroke get admitted to our stroke unit. Of the 78 patients, 38 (48.1%) had a documented swallow screen/assessment during admission, 27 did not have a documented swallow screen/assessment (34.2%) and for 14 patients (17.7%) it was unclear whether they had one during admission. Of the 38 patients who had documented swallow screens/assessments during admission 5 (13.2%) of these occurred within 4 hours of admission.

Conclusion

In summary while our hospital is succeeding in getting the vast majority of diagnosed strokes into our stroke unit we are not currently meeting the UK target for early swallow screening. We aim to roll out an education and training programme targeting nurses and doctors in our stroke unit regarding early swallow screening and re-audit this in 6-12 month’s time.
257 Participants’ Experience of a Novel Group Exercise Program: Results from the DEFRAIL (Diet and Exercise for Frailty) Study Pilot
Authors: Bambrick Pádraig , Phelan Niamh , Byrne Thomas , McMahon Clare , Pope George , Harrison Michael , Mulcahy Ríona , Cooke John
Published: September 2019

Background

DEFRAIL (Diet and Exercise for Frailty) is a translational study examining the effect of an eight-week multicomponent group exercise program and protein supplementation on frailty in older adults. As part of the development of this novel intervention, a four-week pilot was carried out to assess participants’ experience of the program, with a view to optimising the final format.

Methods

Inclusion in the DEFRAIL study requires a candidate to be deemed frail as per the Fried criteria. During the initial stages of recruitment for DEFRAIL, any individual who was identified as pre-frail was offered the opportunity to participate in the pilot trial (11 x 1-hour group sessions at a local sporting facility). Following its conclusion, a telephone interview using a standardised questionnaire was conducted on all participants to assess various aspects of their experience.

Results

Of 9 participants recruited for the pilot, 7 completed the four-week program (One participant failed to attend any sessions due to difficulties with transport and one participant withdrew after the first week, reporting excessive fatigue as the main issue). Amongst these 7 individuals, attendance was 90.9%. The only other adverse events recorded were delayed-onset muscle soreness (DOMS) in 4 out of 7 and aggravation of a pre-existing joint injury in one individual (neither of which prevented participation in subsequent classes). All attendees reporting enjoying the program with additional feedback obtained via the questionnaire regarding the timing, duration, frequency and intensity of classes, in addition to identifying potential barriers or enablers to participation.

Conclusion

This pilot of a novel exercise program for older adults was enjoyed and well-tolerated by pre-frail older adults. Participant feedback, both during the pilot and through a standardised questionnaire following completion, has had a meaningful impact on the final version of the exercise program that will be used for frail older adults in the DEFRAIL intervention.
263 An Audit of Patient Medication Lists in the Outpatient Setting
Authors: McAteer Claire , D'Alton Maeve , Farrell Sarah , Dunne Elaine , Soh Josephine , O'Connor Marie , Dolan Eamon , Kennelly Siobhán , Donohoe Orla , McGann Ciara , Colthorpe Anna
Published: September 2019

Background

Medication Reconciliation involves creating the most accurate list of medications that a patient is taking, with the patient/family member/caregiver being the first point of information. The main aim of this audit was to ascertain what proportion of patients attending outpatient appointments, brought an up-to-date list of their medications.

Methods

The audit was conducted using two anonymous, unlinked questionnaires, one completed by patients/caregivers, another completed by Doctors/Candidate Advanced Nurse Practitioners (cANP). Data was collected between 6/11/18 – 9/11/18 and incorporated Memory Clinics, General Geriatric Clinics and Hypertension/Stroke Clinics. 54 patient questionnaires and 53 Doctor/cANP questionnaires were completed.

Results

67% of patients reported having an up-to-date list of medications. 62% of doctors/cANP felt the patient had an up-to-date list. The majority of patients were aged 71-80, on 5-10 medications and felt that their GP had the most up-to-date list of their medications. Only 17% of patients reported that they themselves had the most up-to-date list of their medications. Where patients did not have an up-to-date list, Doctors/cANPs compiled a list by phoning the Pharmacy in 50% of cases and referring to previous clinic letters in 30% of cases. 34% of patients had medications changed at their clinic visit.

Conclusion

This audit shows that roughly one third of patients do not bring up-to-date lists of medications to their outpatient appointments and only a small proportion of patients feel that they themselves have the most up-to-date list of their own medications. Suggested areas for improvement include patient education campaigns, reminder letters/text messages to patients prior to their clinic appointments and the introduction of a Clinical Pharmacist to the outpatient setting.
270 Tackling Chronic Disease Burden and Building Resilience in Frail Community Populations in an Integrated Model- the ExWell Project
Authors: Byrne Emmett , McDermott Laurie , McCaffrey Noel , Kennelly Sean
Published: September 2019

Background

ExWell is a research validated, large scale, community-based chronic illness rehabilitation service. It is a collaborative project between local acute hospital, community organisation, local authority, and exercise medicine specialists. The mission of ExWell is to transform the lives of people with chronic illness through Physical-activity based rehabilitation. Participants are medically prescribed to the ExWell program by hospital physicians or their GP.

Methods

Referred participants have a two-day induction which includes strength and fitness testing that are covered by key metrics - hip/waist ratio, BMI, grip strength (upper body strength), sit to stand time for 10 repetitions (lower body strength), 6 minute time trial and posterior chain flexibility. These metrics are retested in 3 and 6 month intervals to assess progress. Participants are instructed on exercise technique and class fundamentals. These comprise of 4 stations (1) strength/resistance training; (2) Aerobic conditioning; (3) Balance/core strengthening; and (4) Dynamic movement. The regular full class comprises of 10min warmup, 40minute exercise and 10min cooldown.

Results

Since its inception in May 2018, ExWell based in the local leisure centre has grown exponentially with classes having tripled to 6 pw, with a further 3 classes pw starting in May 2019. Over 600 referrals have been received in the first year, 85% of these were from hospital services. Approximately 400/600 of referred participants were inducted into classes. Reasons for non-induction include diminished motivation, transport, work commitments. The average attendance each week is approximately 150 visits with an age range 27-92 years. (Average 68.3 years with 63.5% over the age of 65 and 10.7% over the age of 80).

Conclusion

ExWell demonstrates a scalable integrated partnership model for delivering sustainable exercise based programs to target chronic illness and frailty in community populations. Next steps include consolidating the ExWell program here and in two partner sites, with subsequent expansion to other areas.
274 From Clinical Care Programme to Frailty Pathway; a Multidisciplinary, Interagency Journey
Authors: Casey Amanda , Wei Fan Chie , Duggan Joseph
Published: September 2019

Background

The National Clinical Programme for Older Persons was introduced in the Model 4 Adult teaching hospital in 2012 with the development of a Specialist Geriatric Ward, supported by an existing Day Hospital and access to post acute rehabilitation in the local model 3 hospital. The continuing growth of the population over 70 years in the catchment area and the increasing awareness of the complex needs of this group of patients required a new way of thinking and working.

Methods

Using Lean methodology the group restructured the focus of the care pathway for older persons using evidence based practice and data collection. Workstreams have been identified and iterative project charters established to guide and empower staff to design and evaluate the supports they provide. Key internal and external stakeholders were identified and invited to participate in the ongoing steering group and the voice of the customer was used to underpin targeted improvements.

Results

The hospital now has a structured framework for the delivery and evaluation of care provided to older persons attending our services. Overall governance is provided by a Frailty Steering Group with strong clinical leadership and is informed by agreed quality indicators and realtime data. Despite increases in numbers requiring admission, length of stay has decreased, readmission rates have remained stable and a greater proportion of our patients are accessing both offsite rehabilitation and home supports on discharge.

Conclusion

This is an ongoing project with medium and long term goals identified across all workstreams. The evidence and data gathered will inform service planning and resource allocation. A number of collaborative research proposals are now being considered from across acute hospital and Community Healthcare Organisation.
283 Does a Pen and Paper Assessment of Executive Skills Correlate with Functional Decline Identified Through Specialised Occupational Therapy Assessment?
Authors: Tobin Fiona , McGuinn Caitriona , Pearson Corinne , Dooky Joshi , McHale Cathy , Coughlan Tara , O'Neill Desmond , Ryan Daniel , Collins Ronan , Kennelly Sean
Published: September 2019

Background

Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia.

Methods

Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor & Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen & paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis.

Results

22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman’s Rho correlation (-.2). Results did not identify a strong correlation

Conclusion

Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor & process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia.