bluuebunny/crossref_metadata_2025 huggingface dataset:
101 FACTORS ASSOCIATED WITH FEAR OF FALLING IN OLDER IRISH ADULTS
Authors: Brennan F , Laird E , Hughes C , McNulty H , Ward M , Strain J J , Molloy A M , Cunningham C , McCarroll K
Published: February 2023

Background

Fear of falling is common in older adults and is associated with social isolation, reduced quality of life, depression and increased mortality. We aimed to investigate the factors associated with fear of falling in a cohort of older Irish adults.

Methods

Our study included adults aged ≥60 years attending outpatient services and recruited as part of the TUDA (Trinity, Ulster and Department of Agriculture) study. Physical frailty was measured with the Timed Up and Go (TUG), cognition with the Mini Mental State Examination (MMSE) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with fear of falling were explored in multinomial regression models.

Results

5185 adults were included, 67.3% female and mean age 74.0 ± 8.3 yrs. Fear of falling varied by age: 39.4% (60-70 yrs), 51.2% (70-80 yrs), 70.4% (80 + yrs). Independent positive predictors of fear of falling were age (beta 0.01, P = 0.030), female gender (OR 2.6, CI 2.2–3.2, P < 0.001), fall in the previous year (OR 1.9, CI 1.6–2.3, P < 0.001), depression (CES-D ≥ 16) (OR 1.7, CI 1.3–2.2, P < 0.001), use of osteoporosis medications (OR 1.3, CI 1.1–1.6, P = 0.002), self reported dizziness on standing (OR 1.5, CI 1.3–1.8, P < 0.001), physical frailty (TUG >12 seconds, OR 1.30, CI 1.1–1.6, P = 0.004) and limiting outside activities (OR 16.3, CI 13.8–19.3, P < 0.001).

Conclusion

We identified a high prevalence of fear of falling, though our study sample included frail older adults attending geriatric outpatient services. Those who fell in the last year and who were female were about twice as likely to fear falling. It was also more likely in those who were physically frailer, taking osteoporosis medications and reporting orthostatic symptoms. Notably those with a fear of falling were 70% more likely to be depressed and 16 times more likely to limit outside activities highlighting its negative impact.
103 ORTHOGERIATRIC SERVICES IN THE FACE OF COVID-19
Authors: Davey N , McFeely A , Doyle P , Stankard A , Coveney S , Alsubie N , O'Connor J , Conlon B , Monahan P , Byrne P , Britton D , Halpin T , McShane S , Sohail I , Lynch O , Basit M , NiBhuachalla B , Mulroy M , O'Brien H
Published: February 2023

Background

Nationally agreed standards improve the level of care delivered to all older, frail, multi-morbid patients presenting with hip fractures. Dedicated Orthogeriatric services allow for these standards to be achieved in a multi-disciplinary team (MDT) setting. As the COVID-19 pandemic reached our shores, the model of care set out by the Irish Hip Fracture Standards (IHFS) was under threat. Our dedicated Orthopaedic Trauma ward became an acute COVID ward and the Orthogeriatric service was re-deployed to acute medicine for Quarter 2.

Methods

Using the Irish Hip Fracture Database, local data was analysed and compared with national data from Quarter 1 to 4 (Q1–4) in 2020.

Results

When comparing local IHFS’s with national figures, ongoing challenges and future goals are highlighted.

In 2020, there were 222 hip fracture patients (mean age 81.8 years) in our hospital. Standard 1, time to the ward <4 hours, stands at 71% locally (national average 33%). Standard 2, time to theatre <48 hours, is an ongoing challenge and remains at 66% (national average 75%). Standard 3, pressure ulcer rate, was the same as the national average at 3%. Standards 4, 5 and 6 in our hospital stand at 87% (national averages of 82%, 91% and 85% respectively).

In Q1, 56%, or over 1 in every 2 patients with hip fractures, met all of the Irish Hip Fracture Standards in our hospital. In Q2, only 18% of patients met all of the IHFS’s. Q3 saw improvements with 47% of all hip fracture patients achieving all IHFS’s. Q4 showed maintenance with 45% of all patients achieving all IHFS’s.

Conclusion

These findings highlight the need for a dedicated Orthogeriatric Service and Orthopaedic ward at all times. Going forward with the risk of future waves and the emergence of new variants, every effort should be made to maintain a comprehensive orthogeriatric service to minimise a negative impact on patient care.
104 COMPARING THE OTTAWA 3DY AND 6CIT IN DETECTING COGNITIVE IMPAIRMENT IN OLDER PATIENTS SEEN BY AN EMERGENCY DEPARTMENT THERAPY TEAM
Authors: Daly C , Maher G
Published: February 2023

Background

Recognising cognitive impairment in the Emergency Department (ED) is important in order to optimise outcomes for patients and to carry out a holistic assessment.

Currently the team screen routinely for delirium using the 4AT. Since 2016 the 03DY was used to screen for mild cognitive impairment however it was not being completed frequently in practice.

In a busy ED setting where time and resources are limited, one brief tool is preferable. The purpose of this investigation is to determine the most accurate cognitive screening tool to identify cognitive impairment in older adults in ED.

Methods

A literature review was completed comparing recent articles which examined the O3DY and 6CIT. The search criteria for journal articles were:

● Published within the last 10 years.

● Published in English.

● Full text only.

● Database: CINAHL.

Results

Our investigation identified that the O3DY offered the greatest sensitivity to rule out cognitive impairment.

The O3DY is quick to administer, requires no additional equipment or training, and can be completed at the patient’s bedside (BGS, 2020) which is particularly important within the ED. The 6CIT was shown to have poorer sensitivity for MCI diagnosis (Abdel-Aziz and Larner, 2014) and has a mathematical component which studies noted may not be appropriate for use in a busy clinical setting.

Conclusion

From this literature review, the O3DY has been identified as the most appropriate cognitive screening tool for our team to detect MCI in the ED. It is important to note that many of the articles reviewed highlighted that a single cognitive screen should not be used in isolation for the identification of cognitive impairment. It is unlikely that completing more than one cognitive screen is achievable in the ED however by implementing the most sensitive screening tool we can identify potential MCI and refer onwards.
11 IMPROVING CARE QUALITY IN A NURSING HOME IN JAPAN: ORGANISATIONAL RESILIENCE, ROBOTICS-AIDED CARE AND SYSTEMS APPROACH
Authors: Kodate N , Obayashi K , Masuyama S
Published: February 2023

Background

As one of the most rapidly ageing economies, Japan is currently faced with a shortage of care workers and relatively low intakes of migrant workers. While there is a shortage of health and social care professionals, the retention of professional staff is paradoxically becoming more difficult. The environment in domiciliary care is often associated with heavy and challenging workload. Robotics-aided care has been proposed in Japan to ameliorate the situation. While some positive effects of such a novel care model have been reported, the mechanism by which the technology-driven system improved care and residents’ quality of life remains unclear.

Methods

Using a case study approach, this paper examines one of the nursing homes in Japan where robotics-aided care was introduced. The organisational mechanism was analysed through documents and semi-structured staff interviews from the perspective of safety science. The key attributes of organisational resilience are: anticipating; responding; monitoring and learning. The paper details some of the tools that predated the introduction of the socially assistive robots and monitoring system in the care home. The interviews were conducted with 16 health and social care professionals.

Results

The results of the technological intervention itself demonstrated improved scores for the quality of life among the residents. However, the subsequent interview data highlight the significance of an organisational context in which technologies can be effectively introduced and implemented in nursing homes. The organisation had several well-trained care professionals, including the leaders, who share the mental map of ‘person-centred care’ and the ‘capability approach’. In addition, some tools were used to ‘visualise’ staff practice. Health and social care professionals pointed out some challenges surrounding the human-technology interface.

Conclusion

In order to understand the effectiveness and potential issues of the ICT robotics solution in care for older people, future research should investigate the human-technology interface and the interconnectedness between work system, care processes and outcomes.
126 A QUALITY INITIATIVE TO IMPROVE THE ASSESSMENT AND RECOMMENDATION FOR TOTAL CALCIUM INTAKE
Authors: King L , Pillay I , Sayers K , Maher J , Ryan S , Donnellan C
Published: February 2023

Background

This study assessed factors affecting adherence to calcium supplementation, estimated total calcium intake and potential to increase dietary calcium in the frail older adult.

Methods

Frail Older Adults who completed a comprehensive geriatric assessment (CGA) between January—June 2021 were included. Those taking calcium supplements were telephoned by a Dietitian. Nursing home residents, hospital inpatients and those unable to complete a telephone questionnaire were excluded. A modified version of the Short Calcium Intake List (SCAIL) was used and potential to improve dietary calcium was assessed (1). Data was analysed using descriptive statistics.

Results

N = 50 patients were taking a calcium supplement. N = 15 were excluded. 26 women and 9 men, aged 70 -96 yrs were included. Dietary intake ranged from 250– 1904 mg. 17% (N = 6) achieved >1,000 mg/day dietary calcium requirements from diet. 66% (N = 23) had potential to increase their dietary calcium. 97% (N = 34) were prescribed a Calcium supplement, ranging from 500– 2000 mg/day. Total Calcium Intake including supplementation ranged from 850 mg—2,737 mg. 82% (N = 29) exceeded their daily requirements.40% (N = 14) reported reduced compliance due to swallowing difficulties; 25%(N = 9) gastrointestinal upset; 11% (N = 4,) taste/consistency and 8% forgetting (N = 3).Dietitian recommendations included 31% (N = 11) to stop supplementation, 34% (N = 12) to reduce, 11% (N = 4) advice on managing concerns relating to supplement and 22% (N = 8) dietary education.

Conclusion

Most older adults did not meet their nutritional requirements for dietary calcium. Over two thirds could reduce or stop supplementation following dietary calcium assessment and advice. A dietary calcium estimator for the older adult, with education can be used to correct calcium intake. This modified SCAIL will be integrated into the CGA as part of a quality improvement initiative for the frail older adult.

Reference

1. Rasch L et al. (2017), Content Validity of a Short Calcium Intake List to Estimate Daily Dietary Calcium intake of Patients with Osteoporosis, Calcified Tissue International, 100(3): 271–277.
127 ‘BONE HEALTH AND FRACTURE RISK ASSESSMENT IN COPD EXACERBATIONS DURING HOSPITALISATION- ROOM FOR IMPROVEMENT?’
Authors: McGurk C , Ahheng T , Claffey P , Kiely J
Published: February 2023

Background

COPD increases the risk of osteoporosis and international guidelines recommend that such patients undergo fracture risk assessment, referral for densitometry and appropriate management. We aimed to identify if patients admitted to our hospital with COPD exacerbation underwent assessment and were prescribed bone protection medication.

Methods

All admissions with COPD exacerbation to an Irish level 2 hospital between July 2020 and July 2021 were identified. The discharge summaries were screened for information regarding the presence of fracture risk and bone health assessment. Discharge prescriptions were examined for calcium, vitamin d and anti-osteoporosis medications. Radiology reports were screened for fragility fractures.

Results

Between July 2020–2021, there were 3,840 presentations to the medical assessment unit. Forty-six patients were admitted with a diagnosis of COPD exacerbation, mean age 72 (56% female). Seventy eight percent were classified as having GOLD Stage D disease with 28% receiving long term oxygen therapy. Mean number of hospitalisations per year per patient was 1.91 ± 1.2. Forty-three percent had laboratory evidence of bone health assessment during admission. Only 50% of patients were discharged on vitamin d replacement; 22% on calcium supplementation and 4% on osteoporotic medications. Regarding previous fractures, 9% had evidence of fragility fracture described on radiology reports, this was not mentioned on any hospital discharge letter.

Conclusion

This study suggests that opportunities for bone health assessment and intervention may be under recognised in COPD patients. Ways to improve this may include proformas and visual aids to prompt assessment and documentation of bone health, further education to increase awareness and greater access to densitometry resources in the community. In conclusion, this study highlights that further attention to patients’ bone health assessment and commencement of appropriate treatment is warranted. Admission to hospital or clinic review for such patients provide important opportunities for intervention.
132 GERIATRIC REHABILITATION IN THE COVID-19 ERA: SERVICE INNOVATION AND PATIENT OUTCOMES
Authors: Flood E , Browne L , Kurian S , Lynch C , Doyle M , Jordan A , Varghese R , Mello S
Published: February 2023

Background

The COVID-19 pandemic fundamentally changed the way rehabilitation services are delivered, with focus placed on individual in-room therapy and cessation of group sessions. Sparks Innovation and National Lottery funding was obtained to implement the ‘In-Room Rehabilitation and Well-being Initiative’. This provided patients with individual physiotherapy equipment to use in their room thus maximizing time spent active during periods of isolation. We aim to describe service innovation occurring in a post-acute geriatric rehabilitation hospital during the COVID-19 era, and the resultant patient outcomes.

Methods

Rehabilitation was provided to patients in-line with evidence-based practice and national infection prevention and control guidelines. Patients who were deemed appropriate by the multi-disciplinary team were provided with in-room therapy equipment. Prospective data was collected on service and patient outcomes. Functional outcome measurements were collected on admission and discharge and compared using a paired t-test.

Results

Rehabilitation was provided to 260 patients, average age 80.5 years (range 63–98) with 46.5% male. The majority of patients were admitted with ortho-geriatric diagnoses or general deconditioning following illness (70%). The patients were complex with multiple medical, functional, and psychosocial care needs, as indicated by an average Rehabilitation Complexity Score of 11/20, with 100% of patients requiring daily therapy. Average length of stay (LOS) was 30.7 days (range 3–169), with 85% of patients discharged home. Performance in activities of daily living (Barthel Index: 62 vs 79, p < 0.0001), and mobility (Cumulative Ambulatory Score: 3.8 vs 5.3, p < 0.0001) significantly improved from admission to discharge.

Conclusion

Despite ward closures, disruption to rehabilitation due to COVID-19 illness, and limitations on group therapies, our service achieved positive patient outcomes through innovation and delivery of high-quality evidence-based rehabilitation. Compared to the past eight years, 2020 had the lowest LOS and highest number of patients discharged home.
134 PREVALENCE OF SARCOPENIA AND ASSOCIATED FACTORS IN OLDER ADULTS ATTENDING A DAY HOSPITAL SERVICE IN IRELAND
Authors: Connolly K , Cunningham C , Murphy N , Romero-Ortuno R , Horgan F
Published: February 2023

Background

Sarcopenia is a muscle disease that is linked to the effects of ageing, chronic diseases, physical inactivity, and poor nutrition. In Ireland, there is a lack of readily available information on sarcopenia in older adults. The aim of this study was to describe the prevalence and associated factors of sarcopenia in community dwelling older adults attending a day hospital service in Ireland, using the European Working Group of Sarcopenia in Older People (EWGSOP) 2019 guidelines.

Methods

An observational cross-sectional study was conducted, where a consecutive series of older adults attending a day hospital service were invited to participate. The measure of primary interest was the diagnosis of sarcopenia using the EWGSOP 2019 guidelines. Muscle strength was assessed using both, handheld grip strength and the Five Times Sit to Stand Test. Muscle mass was assessed using appendicular skeletal mass adjusted for height using raw data from Bio Impedance Analysis. Physical performance was measured using the Short Physical Performance Battery and the Timed Up and Go Test. We also collected other Comprehensive Geriatric Assessment measures including cognition, nutrition, frailty and physical activity.

Results

A total of 134 participants took part in the study. The mean age was 81.7 (SD +/− 7.1). Sixty-one percent (N = 82) were female. The prevalence of sarcopenia ranged from 27–37% depending on the assessment tool used to assess muscle strength. Sarcopenia was associated with older age, frailty, reduced nutritional state, poor physical performance and reduced anthropometric measures, irrespective of how muscle strength was measured. Independently associated factors differed depending on muscle strength test, except for older age.

Conclusion

The prevalence of sarcopenia in the day hospital ranged from 27–37%. The assessment tool used to assess muscle strength influenced both the prevalence and associated factors of sarcopenia, suggesting scope for further research.
142 FRAILTY IDENTIFICATION AND INTERDISCIPLINARY ASSESSMENT OF OLDER PEOPLE IN THE EMERGENCY DEPARTMENT
Authors: Edge L , Cunningham C , Murphy N , Dillon A , Flynn S , O'Shaughnessy Í , Davis A , O'Rourke B , Brossier L , Doran C , Hennessy A , Kennedy U , McMahon G , McNamara R , Shields D , Staunton P , Horgan F
Published: February 2023

Background

Older People are attending Emergency Departments (EDs) in increasing numbers but the optimal assessment measures to use have yet to be established. This study examined the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary team (IDT) in the ED and determined any associations with clinical outcomes.

Methods

This observational cross-sectional study recruited adults ≥70 years who were assessed by an IDT on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Ethical approval was obtained and SPSS was used for statistical analysis.

Results

Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IRQ 2.0), range 1–7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. Grip strength predicted frailty even after adjusting for age (p < 0.0001), gender (p < 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p < 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028).

Conclusion

Grip strength in addition to a validated tool such as CFS may assist an experienced IDT in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. Functional assessment in the ED is also important to determine the need for hospital admission.
151 THERAPY OUTCOME MEASURES IN AN OLDER PERSONS REHABILITATION UNIT
Authors: Joyce O , Black C , Armitage D , McDermott J , Healy A , O'Hara C , Flynn B , Costello M , McDonald M
Published: February 2023

Background

The mission of an older person’s sub-acute rehabilitation unit is to improve the individual’s function and quality of life. This is achieved through patient and multidisciplinary team (MDT) collaboration. The MDT collect Therapy Outcome Measure (TOM) (Enderby and John 2015) data to measure the effectiveness of rehabilitation and facilitate analysis of patient and service outcomes. This abstract will present 6 months of data collection with the aim of evaluating the impact of MDT intervention from January 2021.

Methods

The MDT meet weekly to jointly record patient TOM scores on admission and discharge. The TOM scales used are; multifactorial conditions, stroke and neurological disorder. The patient is scored from 0–5 in four domains; impairment, activity, participation and well-being. There are 11 parts to the scale with 0.5 scores permitted (Enderby and John 2015).

Results

Data was analysed on 62 patients. Across an episode of rehabilitation an increase of 0.5 or more on the TOM is a clinically significant (positive) change. 84% of patients had an overall improvement in the total TOM score. There was an average overall increase of 2.6 points on the scale which equates to a 25% overall change. 63% improved in the domain of impairment, 77% in activity, 73% in participation and 66% in wellbeing. 100% of patients post-stroke, 81% with multifactorial conditions and 75% with neurological conditions experienced an overall improvement.

Conclusion

The data objectively shows positive patient outcomes in older persons rehabilitation. Individuals experienced the most positive change in their activity and participation function and high levels of change are also evident in impairment levels and well-being. Overall, TOM is a very useful MDT outcome measure tool. It has been successfully implemented and maintained in the service and facilitates the ongoing analysis of individual and service outcomes to understand the impact of intervention.
184 ‘THROUGH THE LENS OF A CAMERA’—USING PHOTOVOICE TO EXPLORE OLDER ADULTS PERCEPTIONS AND EXPERIENCES OF COMMUNITY AMBULATION
Authors: Conroy B , Murphy N , Cunningham C , Horgan F
Published: February 2023

Background

The ability of an older adult to walk independently outdoors in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. The study qualitatively explored older persons’ perceptions and experiences of the variables associated with their ability to walk outdoors in their community, through the use of photographs and discussion.

Methods

This qualitative study employed Photovoice Methodology (Wang and Burris, 1997). Inclusion criteria were community dwelling older adults over 65 years old, attending a day hospital, able to ambulate at least 10 metres with/without an assistive device and no visual or fine motor limitations that would preclude using a camera. Participants attended an information session and received and practiced with a single use camera. Over one week they took photographs of perceived barriers or facilitators to community ambulation. The developed photographs formed the basis for focus group discussions. Focus groups were recorded; transcribed and thematic analysis was used to identify key themes.

Results

Eight participants, mean age of 78.8 years completed the Photovoice substudy. Five of the participants were female and six lived alone. One participant had experienced a fall in the past six months. Three key themes were identified; personal, environmental and strategic factors, all associated with an older adults’ ability to ambulate in the community. Each of these themes had a number of subthemes highlighting barriers and facilitators to community ambulation in this population.

Conclusion

This novel study design was well received. It provided real life experiences, insights and rich valuable data that may not be captured by other means. The findings demonstrate the multifactorial nature of independent community ambulation, both the personal and environmental factors associated with independent community ambulation in older adults. Physiotherapists should adopt a broader, holistic approach to the assessment and treatment of older adults, to promote the achievement of independent community ambulation.
213 A STRUCTURED CONTENT ANALYSIS OF THE WEBSITES OF NURSING HOMES WITH RESPECT TO LGBT-INCLUSIVITY
Authors: O’Malley K , Waters R
Published: February 2023

Background

The challenges associated with ageing can be amplified for individuals who identify as Lesbian Gay Bisexual or Transgender (LGBT). As a cohort, they are more likely to enter long term care at an earlier age than their non-LGBT counterparts. Many LGBT older adults fear negative bias in their interactions with health and social care services, and perceive nursing homes as potentially unwelcoming and insensitive to their needs. Nursing home websites outline the services and facilities available to residents, and can offer an insight into their culture and values. This research sought to examine the LGBT-inclusivity of nursing homes websites in a single catchment area catering to both an urban and rural population.

Methods

A total of 41 nursing homes and long term care facilities were identified, of which 24 had websites. A structured content analysis of these websites was performed, with respect to; 1) LGBT-inclusive symbols; 2) Messaging directly addressing LGBT individuals; 3) Presence of a diversity/inclusion statement; 4) Explicit reference to LGBT individuals or sexual orientation in a diversity/inclusion statement; 5) Use of heteronormative imagery; and 6) Use of LGBT-inclusive imagery. Data was manually recorded and uploaded to an excel document for analysis.

Results

None of websites featured LGBT-inclusive symbols or directly addressed LGBT individuals. 8% (n = 2) included a statement on diversity and inclusion, however only 4% (n = 1) explicitly referenced sexual orientation. In terms of visual content, 16% (n = 4) of websites included heteronormative photographs with none featuring LGBT-inclusive imagery.

Conclusion

With the exception of one facility, none of the nursing homes acknowledged the sexual identity of residents with respect to inclusivity. None of the facilities examined were suggestive that they would be an inclusive environment for prospective LGBT residents. Greater effort is required to promote inclusivity of sexual minority individuals in the long term care setting.
223 DAY HOSPITAL DISRUPTED: LEARNING FROM THE INNOVATIVE SERVICE DELIVERY DURING COVID-19
Authors: Gilheany A , McDaid E
Published: February 2023

Background

Day Hospital services are a critical part of community based care for older people. In March 2020, in response to COVID-19 Day Hospital (DH) was closed and did not re-open until May 2021. An analysis was completed to review the outcomes of patients who were open cases in the Day Hospital at time of closure as well as a review of the service provided by the Day Hospital during the closure.

Methods

A retrospective service analysis was completed to examine Day Hospital activity during the closure period and multi-disciplinary intervention statistics were also collated and analysed. A second analysis was completed of patient outcomes through review of medical charts and triage documents of patients who were open cases at the time of closure in March 2020.

Results

There were 203 open Day Hospital cases at the time of closure in March 2020. During the 14 month closure period, 179 patients were triaged and supported with telehealth (548 total activities). Home based multi-disciplinary input was provided to 74 patients (176 total activities). By August 2021, 18% (n = 36) of the original Day Hospital patients had died. 65 patients (32%) were still appropriate for/required Day Hospital services and attended when the Day Hospital re-opened. The remaining 50% were discharged as they either no longer wished to, required or were appropriate to attend Day Hospital.

Conclusion

Despite prolonged disruption of normal services, the Day Hospital adapted to provide virtual and domiciliary intervention to open cases offering essential support to community dwelling frail older adults during the pandemic. This experience has enhanced the skillset and reach of the day hospital service and has led to new enhanced models of service delivery.
232 DETECTION OF POST STROKE DEPRESSION IN ACUTE STROKE UNIT AT UNIVERSITY HOSPITAL
Authors: Mohamed A , Wang J , Gabr A , Mustafa W , O'Connor M , Mulroy M
Published: February 2023

Background

Depression is the most common neuropsychiatric manifestation after stroke. It is associated with lower satisfaction and quality of life in stroke survivors and their families. Routine screening for mood disturbance is recommended in stroke patients {Royal College of Physicians, 2016; National Office of Clinical Audit (NOCA) 2019}. The psychological impact of a stroke can present challenges for assessment and diagnosis. We audited the assessment and diagnosis of post stroke depression in a teaching hospital.

Methods

PHQ-9 was prospectively administered to stroke patients (and also to the next of kin with patient consent) within 2 weeks of stroke and repeated at 4–6 weeks after stroke in November 2016. The Patient Health Questionnaire (PHQ—9) is a self-administered, validated screening tool for depression. Chart diagnosis or drug prescribing for depression was retrospectively assessed in the medical and nursing notes.

Results

15 of 34 admitted stroke patients were administered the paper based PHQ-9. 19 patients were excluded due to: severe cognitive impairment; aphasic; death or having been discharged.

No patient had depression diagnosed prior to admission to the hospital. One patient was diagnosed and prescribed an anti-depressant post stroke.

7 patients screened positive for depression on PHQ-9: mild depression n = 4 (27%); moderate n = 2 (13%); and severe depression n = 1 (6%). Repeat questionnaire at 4–6 weeks post stroke revealed an unchanged PHQ-9 score in n = 10 (67%); however n = 2 (11%) had deteriorated and n = 4 (22%) improved.

Conclusion

Depression was a common finding in 47% of patients post stroke and was under-recognized without a formal screening process incorporated in clinical practice. A nuanced screening process, accounting for common co-morbidities such as aphasia and cognitive impairment, was incorporated after this audit. Further guidance is being developed by the National Stroke Programme based on NOCA feedback.
234 THE IMPACT OF OLDER AGE ON CLINICAL OUTCOMES DURING THE FIRST WAVE OF THE COVID-19 PANDEMIC
Authors: Okpaje B , Gabr A , Mohamed A , Teoh T K , Mustafa W , Saleh A , Ali B , Leahy A , Stapelton P , O'Connell N , Power L , O'Connell S , O'Brien A , Shanahan E , Peters C , Galvin R , O'Connor M
Published: February 2023

Background

Severe acute respiratory coronavirus 2 (SARS-CoV-2) was first recorded in Ireland in February 2020. Several studies have explored the association between age and SARS-CoV-2, showing that there were poorer outcomes in older people. Our objective was to evaluate the impact of age on outcomes such as hospital length of stay, mortality, and re-hospitalisation.

Methods

We performed a single-centre, retrospective observational cohort study, using an electronic microbiology database of recorded index admissions of SARS-CoV-2 positive patients aged 65 years and older during SARS-CoV-2 wave one (March 1st to May 31st 2020). PCR testing of nasopharyngeal and/or sputum samples was used to confirm positivity. Our clinical outcomes measured included hospital length of stay, mortality and re-admission rate within 6 months.

Results

153 patients 65 years and above were admitted. The male to female ratio was 1.3 with 90% admitted medically. 79 patients were aged between 65–79 years; 84 patients ≥80 years; and 12 patients ≥90 years. Mortality was 25%, 31% and 42%, respectively. Median length of stay remained 14 days for ages 65–89 rising to 17.5 days for those ≥90 years. Re-hospitalisation rates at 6 months were similar for ages 65–79 and 89–89 years at 42% and 40%, respectively. One patient (14%) over 90 years was re-hospitalised.

Conclusion

SARS-CoV-2 has disproportionately impacted on general medical services treating older hospitalised people. In our centre, mortality for patients ≥65 years was 28.1% which compared favourably with 35.6% internationally as outlined by Victor et al. (2020) based on Spanish data. Treatment of SARS-CoV-2 is not futile in older patients with 58% of nonagenarians and 69% of octogenarians surviving, however re-hospitalisation rates are high at 40%. A targeted approach to discharge support via integrated care may ameliorate this.
253 PREVALENCE OF FRAILTY IN ADULTS OVER 75 ADMITTED UNDER SURGICAL SPECIALTIES IN A TERTIARY HOSPITAL
Authors: Gannon E , Aherne E , Khan I , Nor N , Murphy J , O'Mahony E , Cloney T , Rafferty M , Stoneman S , Murphy D , Crowley P , Creed S , Byrne E , Mensch R , Lewis M , Harnedy N , O'Sullivan P , O'Connor M , O'Mahony D , Curtin D , Healy L , Ducloe T , Daly B
Published: February 2023

Background

The early identification and comprehensive assessment of frailty in older adult hospital inpatients is associated with improved outcomes. The aim of this study was to identify the prevalence of frailty amongst inpatients admitted under surgical services over the age of 75 in a tertiary hospital. A secondary aim was to identify older adult inpatients under surgical specialities who would benefit from Geriatric Medicine input.

Methods

Inpatients over the age of 75 admitted under Surgical specialities were identified by a search of the electronic patient information system iPIMS on 26/08/2021. Patients attending a day service or needing High Dependency or Intensive care Units were excluded. Information was collected using a paper questionnaire from patient records. Frailty was screened by using the Think FRAIL tool. The data was stored on a hospital password protected computer and analysed using Microsoft Excel.

Results

45 were patients admitted under surgical services meeting criteria were identified. The services included Orthopaedics (n = 25), General Surgery (n = 6), Vascular Surgery (n = 2), Cardiothoracic Surgery (n = 8), Neurosurgery (n = 3), and Urology (n = 1). The overall prevalence of frailty indicated by the presence of least one criteria of the Think FRAIL tool reached 75% (n = 34) of patients. A new or worsening functional impairment was present in 66% (n = 30) of patients, altered mental status 29% (n = 13), immobility 71% (n = 32), presence of home supports 60% (n = 27), and residents of long-term care accounted for 9% (n = 4). 51% (n = 23) of patients had a Comprehensive Geriatric Assessment, Orthopaedics (n = 19), Vascular Surgery (n = 1), General Surgery (n = 3). The average time to CGA was 2 days.

Conclusion

Co-management models of care like Orthogeriatrics are associated with better outcomes for patients and better outputs for hospitals. There is increasing interest in Ireland and internationally in perioperative multidisciplinary care of older adults undergoing surgery. This study highlights the need to expand co-management and collaborative models of care.
255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES
Authors: Galvin R , Burton E , Cummins V , O'Sullivan M , Swan L , Doyle F , Sorensen J , Skelton D A , Townley B , Rooney D , Jackson G , Warters A , Horgan N F
Published: February 2023

Background

Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme.

Methods

We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.

Results

Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery.

Conclusion

Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.
27 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC TREATMENT ESCALATION PLAN
Authors: Trolan C
Published: February 2023

Background

The COVID19 pandemic highlighted deficiencies in information exchange around treatment escalation plans (TEP) in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns medical, pharmacy, physiotherapy, occupational therapy and social work teams to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and > 75% return home. Weekly bed turnover is approximately 15%.

TEP documentation is a component of RESTORE2 use, as recommended in the British Geriatric Society Good Practice Guide for Managing COVID19 in Care Homes.

Methods

Semi-structured interviews with nursing leaders and a weighted questionnaire for the whole nursing team were used to determine baseline levels of confidence around aspects of TEP.

An Ishikawa diagram analysed factors contributing to poor documentation and communication. The ‘Chain Of Care’ vision for care home environments incorporated the need for a TEP. Three iterations occurred. A post-implementation weighted questionnaire collated qualitative information on confidence change.

Results

Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence around...: 90%, Cardiopulmonary Resuscitation (CPR) status clarity; 90%, treatment ‘ceiling of care’ e.g. ‘conveyance to the Emergency Department in any situation that the clinical team deem necessary’; 40%, conversations with out-of-hours services/external clinicians around appropriate actions; 30%, conversations with nominated persons around appropriate actions.

Conclusion

The TEP incorporates more than just CPR status and contributed to increased nursing team confidence in responding to the acutely deteriorating adult appropriately in a care home environment. Clear documentation of: capacity assessment; patient prioritisation (using ReSPECT principles); and agreed treatment escalation and limitation, enabled information exchange. Standardisation of language, and cross-fertilisation with Nursing Handover, facilitated conversations with external clinicians and nominated persons.

Tailoring the TEP to the care-home environment and rendering it generalisable to non-intermediate care, non-geriatrician supported care home microsystems was considered in the iterations.
47 DOSING OF DIRECT ORAL ANTICOAGULANTS IN OLDER ADULTS
Authors: O'Riordan F , Murphy J , Egan G , Murphy C , Ahern E
Published: February 2023

Background

Direct oral anticoagulants (DOACs) are approved for a variety of uses including prevention of stroke in non-valvular atrial fibrillation and treatment and prevention of deep vein thrombosis and pulmonary embolism. Adjustment to DOAC dosing may be required for age, weight and renal impairment. Incorrect lower dosing puts patients at risk of thromboembolic events whereas inappropriate higher dosing increases the risk of bleeding. We compared current DOAC dosing for patients admitted to our hospital and compare this against HSE best practice to determine if patients were receiving the correct dose [1].

Methods

A prospective single-centre study. Patients admitted to our hospital following a fracture and reviewed by the Orthogeriatric team between August–October 2020 were eligible for inclusion. We recorded admission DOAC dose, age, weight and renal function. We also obtained data including sex and Clinical Frailty Scale (CFS).

Results

Thirty-one patients were included. Mean age was 86 years [range 66–99] and 21(68%) were female. Apixaban was the most commonly used DOAC; 25(81%). Stroke prevention in non-valvular atrial fibrillation was the most common DOAC indication; 29(93%). Twelve patients (39%) had an inappropriate DOAC dose prescribed. Eight patients (67%) had an inappropriately low dose and 4 patients (33%) had an inappropriately high dose. The mean CFS was 5 [Range 2–7] classifying our cohort as mildly frail.

Conclusion

Our study has shown that over one-third of our patients were on an inappropriate DOAC dose on admission with the majority (67%) due to under-dosing. Many factors may have influenced dosing choices by clinicians but our findings highlight the challenges in dosing, monitoring and the overall management of DOAC therapy in older people. Further studies and research are required to establish the most accurate and effective dosing strategies for DOACs in older adults.

Reference

1. Health Service Executive [Internet]. Ireland ‘Anticoagulation Prescribing Tips’ https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/noac-prescribing-tips-for-noacs.pdf.
52 AUDIT CYCLE EXAMINING QUALITY IMPROVEMENT POST EMERGENCY DEPARTMENT MULTI-DISCIPLINARY SIMULATION BASED MEDICAL EDUCATION TRAINING ON HIP FRACTURE CARE
Authors: Clancy C , Mahony R , Meighan V
Published: February 2023

Background

The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1.

We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of COVID-19, the training was available in person and online via Zoom.

Methods

We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway.

Data was collected from the electronic record database (Symphony). We recorded the following data;

Results

2020 n = 31.

Average time to ward—8 hrs 29 mins.

26% patients reached ward <4 hours. (8/31).

2021 n = 25.

Average time to ward—5 hrs 58 mins (32% reduction vs 2020).

72% patients reached ward <4 hours. (18/25) (46% increase vs 2020).

Conclusion

Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
54 EXWELL: OUTCOMES FROM A SIX-WEEK COMMUNITY EXERCISE REHABILITATION PROGRAM FOR PEOPLE LIVING WITH CHRONIC ILLNESS
Authors: Skelly F , McCaffrey N , Byrne E , Kennelly S
Published: February 2023

Background

Chronic diseases (CD) are long-term conditions, which often require ongoing medical treatment and have the potential to limit the quality of life of the people who live with them. Exercise rehabilitation has been shown to improve physical functioning and health related quality of life (HRQoL) in this cohort.

ExWell is a community-based exercise rehabilitation (CBER) program that offers group exercise rehabilitation classes to individuals with a range of CD. The purpose of this study was to investigate the impact of 6 weeks of participation in the ExWell Medical program on physical functioning and HRQoL in a diverse CD population.

Methods

Participants with a range of CD were referred by healthcare practitioners to the HSE-funded ExWell Medical program based in a community setting. Outcome variables included measurements of body composition, functional capacity and health related quality of life. Assessments were taken at baseline and 6 weeks. Participants were encouraged to attend ExWell Medical classes twice weekly for the duration of the study. Each forty-five minute class included a warm up, aerobic, resistance, core and balance exercises and a cool-down.

Results

Three hundred and ten people (mean age 70.7 ± 7.7 years, 48.3% Female) participated. Statistically and clinically significant improvements were found in cardiorespiratory fitness, lower body strength, balance, co-ordination, body composition and health related quality of life. The greatest improvements were observed in those with the lowest levels of fitness at baseline, and the oldest participants. Improvements in cardiorespiratory fitness and lower body strength matched the recognized clinically meaningful differences in the entire group sample and greatly exceeded them in those in the lowest tertile of fitness at baseline.

Conclusion

The ExWell mixed CD CBER program is an effective approach to rehabilitation delivery in clinical practice. Clinically meaningful improvements can be achieved within 6 weeks of participation, and older and frail participants show greatest improvements overall.