bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evaluation of the Important Aspects of Community Nursing Day Care Services for Older People, a Qualitative Review
Authors: Lynch Olivia , O'Mahonyy Geraldine , Fitzgerald Mari
Published: September 2024

Background

Day Care Services can support healthy ageing and help prevent social isolation and loneliness amongst older people. However, there is little evidence about the aspects of Day Care Services that are most important and how it effects their overall health and wellbeing. This survey was developed to evaluate the benefits of Day Care Services from the perspectives of the service user.

The aim was to:

Methods

The qualitative evaluation asked two questions.

7 Day Care Services participated, the survey was given to over 300 people and there was over 50% response rate. The data was analysed using qualitative content analysis to identify themes and opportunities for improvement.

Results

The participants described every aspect of Day Care Services as very important for them. It supports routine, social activity (“gets me out of the house”) and interaction (“meeting people”), provides meals and appropriate nursing interventions. Staff acted as “familiar faces” that can be approached easily and support their service user’s health and well-being. Overall, the majority of attendees would recommend Day Care Services to other people.

Conclusion

The findings suggest that all aspects of Day Care Services are important for older people to feel part of a community and have healthcare workers to support them on a regular basis. Day Care Services positively affect service users overall health and wellbeing, in particular the social aspect. This would suggest that Day Care Services play an important role in older people's experience of loneliness or social isolation.
Characteristics and Presentation of Orthostatic Hypertension in Community-Dwelling Older Adults
Authors: Solis Sara , Lawlor Brian , Romero-Ortuno Roman
Published: September 2024

Background

Standing poses a hemodynamic challenge for the cardiovascular system, regulated by neurohumoral reflexes. In 2023, an elevated blood pressure response upon standing was officially defined as a minimum 20 mmHg increase in systolic pressure during position changes, distinguishing Orthostatic Hypertension (OHT) as a condition where blood pressure exceeds 140 mmHg when standing. This new definition underscores the importance of understanding the implications of OHT on individuals' health and quality of life.

Methods

Retrospective study of the Technology Research for Independent Living (TRIL) Clinic at St. James’s Hospital, from August 2007 to May 2009. The population included healthy community-dwelling adults aged 60 and older. This study aimed to profile individuals with OHT, understand the predictors of this condition, and explore its association with biopsychosocial variables.

Results

In a study of 442 participants (67.7% female, mean age 72.7), we identified a prevalence rate of 12.9% for an exaggerated orthostatic pressor response and observed OHT in 6.1% of participants at the 120-second mark after standing. Additionally, significant associations were discovered between OHT and conditions such as heart failure, stroke, and the use of certain medications such as SSRI and ACE inhibitors.

Conclusion

The results of this study highlight the potential health consequences of OHT among older adults, particularly in those with pre-existing cardiovascular conditions. Further research is needed to explore this lesser-known but significant orthostatic disorder.
Advance Healthcare Directives: the Irish Implementation Reality from an Interdisciplinary Group Concept Mapping Study
Authors: Dowling Teresa , Kennedy Sara , Foran Sinead
Published: September 2024

Background

Advance Healthcare Directives became legal in Ireland on 26th April 2023. While Advance Healthcare Directives are primarily rooted in patients’ legally binding refusal of treatments or interventions, they also encourage patients to set out their care preferences for the future (Government of Ireland 2015). Despite care of the older adult broadly transitioning from acute hospital to community, and a greater than ever focus on keeping older adults living at home for longer, low awareness of, and professional uncertainty around, Advance Healthcare Directives and how to integrate them into the care of the older adult has been widely expressed by Irish hospital physicians (Crowley and Doran 2022).

Methods

In this implementation study, Group Concept Mapping, using the relatively novel ‘GroupWisdom™’ software, is used to collect and analyse data from multiple healthcare professions to identify contextual issues that affect the implementation of Advance Healthcare Directives. 44 frontline healthcare professionals including Hospital Consultants (n=6), General Practitioners (n=5), Paramedics (n=7), Advance Nurse Practitioners (n=4), Clinical Nurse Specialists (n=4), Public Health Nurses (n=5), Critical Care Nurses (n=3), Nurse Managers (n=2), Healthcare Managers (n=2), Occupational Therapists (n=2) and Social Workers (n=4) participate in this mixed method study. Policymakers and other stakeholders are also involved throughout.

Results

The main implementation issues for Advance Healthcare Directives in order of importance as outlined by Healthcare Professionals are: 1) Public Education; 2) Homecare Services; 3) Timing and Location; 4) Family Members; 5) Lack of Education for the Healthcare Professional; 6) Complications for the Healthcare Professional; 7) Individual and Cultural Beliefs.

Conclusion

This study contributes a valuable understanding of where the implementation issues reside for healthcare professionals and policymakers, and how these can be addressed to ensure successful implementation. This implementation study focuses on practical considerations, offering multiple workable solutions to help to resolve these implementation issues on the ground.
Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App
Authors: Shezard Babar , Bianchi-de-Aguiar Filipa , Paul Nevin
Published: September 2024

Background

Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness.

Methods

We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test.

Results

We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group).

Conclusion

Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.
Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)
Authors: Brolly Amanda , Brick Jacqueline , Maher Mairin , O'Carroll Susan , Carmody Chris , Randles Mary , Donnell Emer Mc , Liston Richard
Published: September 2024

Background

The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time.

Methods

Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period.

Results

27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP.

Conclusion

The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports.

Reference

1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.
The Use of Proton Pump Inhibitors in Patients Aged 65 Years and Above in an Academic Tertiary Referral Hospital
Authors: McCluskey Patrick , Hassabo Mohammed , Zainal Muhammed , Browne Joseph , Ntlholang Ontefetse
Published: September 2024

Background

Proton Pump inhibitors (PPIs) are some of the world's most frequently prescribed medications. While PPIs are generally well tolerated, they do carry with them several associated adverse effects ranging from electrolyte disturbances to altering the absorption and thus the effectiveness of other co-administered medications to more severe concerns such as high frequencies of gastrointestinal infections and possibly even respiratory tract infections. Being so commonly prescribed, often for inappropriate or unknown indications, they become an important and relatively easy target for review.

Methods

A retrospective review of electronic health care records of individuals aged 65 years and older admitted under general medical teams in an academic tertiary referral hospital over the course of a calendar month was undertaken to evaluate typical PPI usage encountered, including frequency of PPI prescriptions at both admission and discharge, recorded indications, and impact of review by clinical pharmacists.

Results

Of the 77 individuals included in this study, 59 (77%) were prescribed a PPI at some point during admission. Of the patients surviving to discharge, 98% (n = 53) remained on a PPI at discharge. One patient (2%) had a PPI stopped before discharge. Indications for a PPI were explicitly stated in 25% (n = 15) of patients prescribed a PPI. A further 27% (n = 16) could have an indication derived from information within the electronic health record. One (2%) patient was prescribed a PPI, and a duration was indicated.

Conclusion

Most PPI prescriptions lack documentation regarding the indication and intended duration and may be inappropriately prescribed. The frequency of usage of PPIs in an older population that is more at risk of the adverse effects of PPIs makes them ideal targets and models for evaluation of prescribing practices and deprescribing efforts.
Evaluating the Documentation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) among Older Adults Inpatients
Authors: Saleeh Nada , O’Connor Kieran , Omar Zeina
Published: September 2024

Background

Cardiopulmonary resuscitation (CPR) can save a person’s life, but rate of success is low especially in older frail cohort. Attempted CPR is not without harm and many patients long for a natural dignified death. DNACPR orders provide a means by which decisions to withhold CPR & set ceilings of appropriate care in hospital can be recorded in advance of a potential cardiac event. Our department aims enhance the overall quality of end-of-life care for our patients. The objectives of this project were to evaluate the documentation around end-of-life care to support the introduction of a new DNACPR policy in September 2023.

Methods

A retrospective review of the deaths in the department for the period between July 2021 to July 2023 was undertaken. Thirty random charts from the deaths were examined, assessing the timing and quality of the DNACPR documentation and communication. A further random 30 charts of patients discharged alive were reviewed to assess any existing care plan for DNACPR.

Results

There were 202 deaths within the study period (mean age was 85, 114 (56%) male). Of the deaths examined, there were 50% male & mean age of 83. The average length of stay (LOS) was14.5 days. This was a dependent group with 56.7% having a clinical frailty score of >/= 6 and 43.4% having known dementia. DNACPR decisions and evidence of communication was documented in 29 patients (96.7%). Ceilings of care were documented in the majority. We also assessed 30 medical notes of community discharged patients (36.7% male, mean age 83, mean LOS 13.86). Pneumonia (33%) was the most common diagnosis. Only 13.3% had DNACPR and ceiling of care documentation.

Conclusion

Recognition of dying seems good in the department with room for improvement in broader advanced care discussions. Further training on end-of-life conversations is planned with regular simulation sessions.
Unusual Presentation of Confusion: Hyperammonaemic Hepatic Encephalopathy Due To Intrahepatic Portosystemic Venous Shunt In An Older Patient
Authors: Yousif Mohand , Cluskey Patrick Mc , Ntlholang Ontefetse , Magee Conor
Published: September 2024

Background

Delirium is an acute, usually reversible neuropsychiatric syndrome and often presents as confusion, especially in the older population. Early detection and management of causes is vital to reduce mortality, morbidity, and long-term cognitive status decline. Intrahepatic portosystemic venous shunts are rare vascular malformations. These malformations can be congenital or acquired and may manifest as heart failure, hepatic encephalopathy, or pulmonary hypertension.

Methods

A 75-year-old man presented to the emergency department with a 5-week history of confusion, daytime somnolence, and fatigue. His physical examination was unremarkable. His symptoms were initially thought to be due to sub-optimally controlled Obstructive Sleep Apnoea. Nevertheless, his confusion progressed further during admission and required admission to the intensive care unit and intubation. Investigations initially showed deranged Liver function tests. Extensive investigations were done, including CT brain, MRI brain, septic screen, Arterial blood gas, and Lumbar puncture, which were all inconclusive. An Electroencephalogram was suggestive of Encephalopathy. His Ammonia level was high (123). Further investigations, Triphasic CT liver, revealed Intrahepatic portosystemic venous shunt and was diagnosed with hyperammonaemic hepatic encephalopathy due to Intrahepatic portosystemic venous shunt.

Results

Management included the commencement of lactulose, rifaximin, and L-ornithine L-aspartate (LOLA). An IR-guided embolisation of the porto-venous shunt was performed. At two-months review, the patient reported no further episodes of confusion.

Conclusion

Intrahepatic portosystemic venous shunts should be considered in the differential diagnosis of patients presenting with confusion or other unexplained neurological symptoms, especially in the presence of liver dysfunction. Early diagnosis and appropriate management are crucial for favourable outcomes.
An Innovative Approach To Increasing Speech And Language Therapy Intensity For Stroke Patients
Authors: Donders-Seoighe Cathelijne
Published: September 2024

Background

Different national guidelines exist for the provision of Speech and Language Therapy (SLT) intensity for stroke patients. The National Institute for Health and Care Excellence (NICE) guidelines on stroke rehabilitation in Adults (2023) advises 3 hours of multidisciplinary therapy a day, five days a week. The National Clinical guideline for Stroke for the UK and Ireland (2023) does not include SLT in this 3-hour provision of motor therapy, but advises 45 minutes of SLT a day, 5 days a week. Poor SLT staffing levels are commonplace, more recently exacerbated by the HSE recruitment embargo, posing significant challenges to rehabilitation provision.

Methods

A Speech and Language Therapist in a stroke service assessed whether the use of Therapy assistants could add to the delivery of the targeted 45 minutes of SLT. Training was provided in the execution of speech, language and swallow rehabilitation exercises, using patient specific exercise packs. A month of data collection started on 8 patients. Intensity was measured in 3 percentage groups:

Results

When rehabilitation was provided by SLT alone, 7 patients received insufficient therapy intensity. One patient scored in the moderate group. With the added input of stroke assistants, 4 patients received sufficient therapy time, 3 patients scored in the moderate group and only one patient received insufficient therapy.

Conclusion

Use of Stroke assistants for the provision of SLT rehabilitation exercises, can be an effective tool in increasing SLT intensity. Training is time intensive, but essential to make assistants knowledgeable and competent in their abilities. All rehabilitation should be under direct supervision of SLT. However, we should not use stroke assistants to mask or minimise the need for adequate SLT resourcing, as specified in international standards.
Impact of Geriatricians on the Outcome of Patients in the Acute Medical Unit at the Largest Acute Academic Teaching Hospital
Authors: Hassan Haswadi , Rowan Aoife , Mazlam Ahmad Zainalabidin , Flynn Ellen , Ntlholang Onte , Zainal Tariq , Browne Joseph
Published: September 2024

Background

The Acute Medical Unit (AMU) forms part of our institution's acute medical pathways. Through the Senior Intervention Flow Triage system in our Emergency Department (ED), medically stable patients likely to complete investigations and treatment within 48 to 72 hours are referred to the AMU for management. Acute medicine geriatricians cover three out of five days in the AMU. This paper aims to study the characteristics and outcomes of patients referred to our AMU.

Methods

Our institution’s innovation and research office approved the study, ref: 8731, on 24/01/2024. Medical notes from patients who attended the AMU from 11 December 2023 to 30 January 2024 were examined. Collected data included demographics, presenting complaints, admissions avoided and converts. Patients were divided into age groups: ≤64, 65-74, and ≥75. Admission avoidance is any intervention by the AMU that results in the patient's discharge. A convert is an on-call team medically admitted patient in the ED who was taken over and successfully discharged by the AMU with appropriate follow-up.

Results

345 patients attended AMU over the six-week period. Of those, 217 (62.9%) were ≤64, 65 (18.8%) were 65-74, and 63 (18.3%) were ≥75 years old. More than 50% of the patients were female in each age group. The ≤ 64 years group had the highest admission avoidance, 72%, followed closely by the ≥ 75 years group, 65% and the 65-74 years group, 57%. The ≥ 75 years group had the highest rate of converts at 11%, followed by the ≤ 64 years group at 10% and the 65-74 years group at 6%. There were similar admission rates across the 3 age groups of 7 to 8%.

Conclusion

This study found that the ≥ 75-year-old group was not inferior to other groups regarding admission rates and avoided hospital admissions.
Work of ART: Profiling the First 100 Patients Discharged Home From an Acute Hospital with the Active Recovery Team (ART)
Authors: McDaid Edel , Ryan Ciara , Daly Eoin
Published: September 2024

Background

The Active Recovery Team (ART) is a new therapy lead rehabilitation team that offers supported discharge and admission avoidance from a large acute hospital. This interdisciplinary team consists of a physiotherapist, occupational therapist, medical social worker and two therapy assistants. ART accepts referrals from all services within the hospital including the emergency department.

Methods

As ART is a new service, a retrospective audit of the first 100 patients who discharged on the pathway was completed. Demographics included age, sex, referring specialty, presenting complaint, frailty (measured by the Clinical Frailty Score) and level of input received. ART use the coding of low, medium and high intensity to describe the intervention provided based on dosage (visits) and complexity.

Results

Most (67%) of the group were female and mean age was 77 years. Only 8% were pre-frail (CFS 0-3), 86% were living with mild to moderate frailty (CFS 4-6) and 6% considered severely frail (CFS 7-9). The type of intervention patients received was 31% low, 33% medium and 36% high intensity. Referrals came from a range of specialties, but the highest percentage of referrals were from emergency medicine (29%), medicine (20%), orthopaedics (18%) and geriatric medicine (16%). Most (53%) initially presented post a fall at home. Most frequent reason for ART referral (78%) was that the patient was discharging home not at their functional baseline but had potential to an achieve a specific goal(s) with further input (most frequently within domains of mobility indoors/outdoors, transfers, stairs and activities of daily living).

Conclusion

This is an effective pathway that improves the transition from hospital to home. ART offer patients an opportunity for further rehabilitation at home with continuity of care from the acute hospital. Future work will examine the impact of ART on length of stay, readmission rate and explore patient satisfaction with this service.
Communicating, Eating And Drinking With Dementia
Authors: Moloney Abbie
Published: September 2024

Background

Problems with eating and drinking can put patients at risk of malnutrition. Hospitalised patients with dementia are at a higher risk for eating/drinking difficulties and inadequate food/fluid intake. Dysphagia in dementia can contribute to malnutrition, dehydration, weight loss, choking episodes, repeat chest infections, pneumonia, and recurrent hospitalisations - all of which can cause strain on relationships between the person with dementia and carers. Where communication (and eating/drinking/swallowing) are impacted, the person with dementia can experience a decrease in quality of life, wellbeing, sense of personhood, and quality of relationships. Direct training and indirect feeding support for care staff results in fewer mealtime difficulties, more time spent assisting at mealtimes, and a positive changes in staff attitudes towards assisting in mealtimes for people with dementia. Using observational instruments to identify eating/drinking difficulties can lead to a positive influence for staff knowledge and skills to support patients/residents.

Methods

Create a Departmental Information Leaflet on “Communicating, Eating and Drnking with Dementia” for staff, visitors, service users, and their families.Select a tool to be used by nursing staff to better inform on behaviours around eating and drinking with dementia (Edinburgh Feeding Evaluation in Dementia Scale (EdFED-Q)).Create a training Powerpoint for Staff on “Communicating, Eating and Drnking with Dementia” and using the EdFED-Q tool.

Results

Departmental Information leaflet created.Selection of the EdFED-Q tool.Training programme for nursing staff developed on Communicating, Eating and Drnking with Dementia and using the EdFED-Q tool.

Conclusion

As outlined in the Irish National Dementia Strategy (2014), all people who provide care or interact with those with dementia should be trained and upskilled in working with and communicating with those with dementia. It is important to continue to develop our services and build on quality initiatives to do this.
Development and Validation of the IDS-TILDA FI; A Novel Frailty Instrument for People with Intellectual Disability
Authors: McFeely Aoife , McCarron Mary , Romero-Ortuno Roman , McCallion Philip , Connolly Eimear , Fitzpatrick Darren , Kennelly Sean
Published: September 2024

Background

Adults with Intellectual Disabilities (ID) are a vulnerable population, experiencing higher rates of multimorbidity, polypharmacy and healthcare inequities. Pre-existing functional disability and dependency complicates frailty measurement in ID. This study aimed to develop an ID-specific Frailty Index (FI), and compare frailty measurements between adults with and without ID.

Methods

This cross-sectional study was conducted using the Intellectual Disability Supplement to The Irish Longitudinal Database of Aging (IDS-TILDA). A 31-item IDS-TILDA FI was developed. Markers of functional dependence were excluded avoid disability bias. The index was applied to 745 adults with ID, with results compared to the general population. Statistical analysis included multivariate regression on frailty controlling for age, sex, level of ID and presence of Down syndrome (DS). Multivariate logistic regression on Mortality controlling for age, Level of ID and DS was also conducted. Predictive validity was tested using receiver operating characteristic (ROC) curves and evaluated the area under the curve (AUC).

Results

FI scores ranged from 0.00 to 0.59; median 0.16 and mean 0.19. These scores are lower than in other studies of frailty in ID, but higher than seen in the general population. Increasing frailty score was associated with older age (p<0.05), female sex (p<0.05) and severe/profound ID (p<0.05). Increasing frailty was associated with mortality, even when controlling for age (p<0.05). This association was lost when ID severity was included in analysis. FI score demonstrated moderate predictive validity for mortality (controlling for age, sex and Level of ID) with an AUC of 0.6101 (p<0.05, 95% CI: 0.564-0.656).

Conclusion

It is possible to measure frailty without measuring functional dependence. Frailty is more prevalent among adults with ID compared to the general population. The IDS-TILDA FI is associated with age and mortality, though the impact of severe ID could not be overcome highlighting the complexity of medical needs for adults with ID.
Developing An Online Course To Increase Staff Awareness And Responses To Unwanted And Illegal Sexual Behaviour Perpetrated Against Older People
Authors: Donnelly Sarah , Ward Marie , Josephine Donlon , Geary Una , Markey Paula , O'Hara Sharon , Healy Una , McGarry Sinead
Published: September 2024

Background

The idea that older people can be victims of unwanted sexual behaviour or sexual assault in health and social care settings is relatively recent. In the Irish context, 165 reports of sexual abuse of older people were made to the HSE National Safeguarding and Protection teams in 2022. The prevalence of sexual abuse against older people in health and social care settings is poorly understood and there is an acknowledgement that hospital staff require additional training to understand and manage incidents.

Methods

In response to the need for training and support for staff, an online awareness-raising course based on a pre-developed course from Australia ‘Preventing unwanted sexual behaviour against older people in health and social care settings’ will be adapted, trialled and tested in a large acute teaching hospital. This course sets out to support acute care staff to identify and manage incidents of sexualised behaviour, to seek expert help and to ensure that older people are protected from unwanted and at times, what may constitute illegal sexual behaviour.

Results

The adapted course ‘Understanding and Responding to Unwanted or Illegal Sexual Behaviour Perpetrated against Older People in Health and Social Care Settings’ utilises a trauma-informed lens and key themes covered include defining unwanted sexual behaviours, understanding older people and sexual behaviour, risk factors for sexual abuse, barriers to recognising and reporting abuse and managing incidents.

Conclusion

The ‘trial and test’ will involve a feedback survey (N=50 respondents) and focus groups with participating healthcare professionals from the hospital site informing further refinement of the course content in preparation for wider rollout and implementation across Ireland's health and social care settings.
Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital
Authors: Woulfe Cliona , Moloney Patricia , Jennings Emma
Published: September 2024

Background

On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023.

Methods

Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy).

Results

Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur.

Conclusion

Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.
Establishment of Registered Advanced Nurse Practitioners (RANP) Gerontology Clinics in Two Ambulatory Day Units
Authors: McShane Nicola , Monaghan-Tyer Fiona , Toner Rebecca
Published: September 2024

Background

Ireland is experiencing substantial growth in the older population. Data from The Irish Longitudinal Study on Ageing (TILDA) suggests that up to 25% of older people in Ireland are living with frailty while a further 45% are at risk of being pre-frail (Roe L et al, 2017). Frailty in older adults can be a predictor to adverse health outcomes including hospitalization, falls, and increased mortality risk. Ambulatory day units proactively identify older adults at risk of frailty living in the community using a comprehensive geriatric assessment (CGA), potentially reducing adverse outcomes.

Methods

Plan-Do- Study-Act (PDSA) cycle was used. Waiting lists were reviewed with Consultant Geriatricians for the ambulatory units. Referral pathways for RANP Gerontology Clinics with inclusion and exclusion criteria were developed. RANP clinics were established in 2023 in the ambulatory day units utilising Slaíntecare’s strategy. Referrals were triaged by Consultants Geriatricians resulting in the RANP clinic caseload.

Results

During 2023, 844 older adults were reviewed in the RANP clinics. This contributed to a reduction in Consultant Geriatricians’ waiting lists and allowed reduced wait times for new Consultant Geriatricians’ referrals. This service also enhanced communication pathways between primary and secondary care settings and became a point of contact for families in crisis, with rapid access review and care planning to avoid unnecessary Emergency Department attendances. Patients attending the RANP clinics, if admitted to hospital, were seen by the RANP during their admission, ensuring continuity of care.

Conclusion

Overall, establishment of RANP Gerontology clinics resulted in a better streamlined service for the older adult. This service ensures continuity of patient care through a working knowledge of patient cohort and rapid access for those known to the service, potentially avoiding an Emergency Department attendance.
Symptomatic Cerebellar Thrombosed Developmental Venous Anomaly: A Case Report
Authors: Feely Owen , Byrne Muireann , Fearon Patricia , Nicholson Patrick
Published: September 2024

Background

With the rising prevalence of advanced neuroradiological imaging, detection of incidental developmental venous anomalies (DVAs) is more commonplace. DVAs are rarely symptomatic (<2%). Typically, symptoms arise due to flow-related complications or mechanical effects. Of particular concern is venous thrombosis, a frequent flow-related complication, which can cause venous ischemia or haemorrhage. Thus, early recognition and intervention is important.

Methods

We describe a case of a 54-year-old male, with background of hypertension, presenting three days after sudden onset headache, ataxia, and diplopia. Initial clinical examination revealed bidirectional horizontal gaze-evoked nystagmus, skew deviation, and decreased temperature sensation of the left face. Ophthalmological examination identified left inferior rectus limitation.

Results

Initial non-contrast CT brain identified hypoattenuation in the right pons, suggestive of sub-acute infarction. Secondary prevention was initiated. Subsequent MRI performed 5 days later revealed hyperattenuation on T2 and FLAIR in the pons, right middle cerebellar peduncle, and right cerebellar hemisphere without restricted diffusion. SWI sequences identified an abnormal venous structure in the right cerebellum, with increased signal within it, suggestive of thrombus. The patient was diagnosed with a thrombosed DVA with associated venous oedema. Symptoms had resolved on dual antiplatelet therapy, without anticoagulation.

Conclusion

This case highlights the potential for DVAs, generally considered a benign entity, to become symptomatic with associated parenchymal damage and a rare, but important, stroke mimic. Moreover, it underscores the pivotal role of MRI imaging; while a CT scan might have led to the assumption of a subacute infarct, MR imaging led to a complete re-evaluation of the diagnosis in this case.
A Multidisciplinary Prospective Audit of Practices of Providing Hydration to Patient in An Acute Care Setting. Stop, Think and Drink
Authors: Kidney Deirdre , Jackson Nicola , Clancy Alice , Harrington Sarah , Hendy Lydia , Joubert Tayla , Murphy Ciara , Dooley Sarah , Murphy Becky , Grygielewicz Kate
Published: September 2024

Background

In the Dementia Friendly Hospital Guidelines 2018, it recommends we support patient safety, health and well-being. This can be facilitated by supporting diet, nutrition and hydration in a calm, accessible and usable space with appropriate lighting, and clearly visible and easily understood furniture and tableware. We have audited our practices across the hospital to ensure we have practices that promote hydration in all our wards. As we are an MDT team we bring a unique broad perspective on the issue of availability, accessibility and assistance.

Methods

We prospectively audited the provision and accessibility of drinks of any kind across our hospital. This was carried out on two separate occasions, once in the morning and once in the afternoon. We developed a unique audit tool. We used the HIQA nutrition and hydration standards to develop this tool. This was carried out on two separate occasions, once in the morning and once in the afternoon.

Results

Total number audited - 131

Availability

Accessibility

Assistance

- 38% required prompting/reminding to drink.

Conclusion

Almost all of our patients in St. Michael’s Hospital had a drink and water jug available, however not all patients were able to access or independently hydrate themselves. Through making improvements, we aim to improve the hydration for our patients. According to the Food, Nutrition and Hydration policy for adults in acute hospital, by improving patient hydration, we are supporting the reduction of malnutrition amongst our patient cohort, in turn reducing their susceptibility to disease and improving their rate of recovery.
Quality Improvements in Dementia Care in an Acute Hospital Setting
Authors: Allen Yvonne , Timmons Suzanne , Galvin Noreen
Published: September 2024

Background

Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital.

Methods

Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward.

Results

The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool.

Conclusion

A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.
A Review of Patient Continence and Related Staff Knowledge on Specialist Geriatric Wards
Authors: Healy Anna , Ryan Siobhan , Brewer Linda
Published: September 2024

Background

Incontinence is a common and troublesome feature of frailty (NCPOP 2012), routinely examined in a comprehensive geriatric assessment (CGA). It can impact on life quality, mobility, falls and overall care needs. Patients often develop incontinence during hospital admission and staff knowledge of continence status (CS) and efforts to drive improvements are often poor. We sought to explore these issues on our wards.

Methods

We conducted a point prevalence study, reviewed medical charts and interviewed ward nurses on three specialist geriatric wards. Patients >65y over a six-week period were included. We developed a proforma and recorded current and pre-admission CS, and use of continence wear. Nursing staff awareness of CS was also explored.

Results

104 patients (57% female, mean age 81y) were included. Overall, 34 (32.7%) had urinary incontinence (UI), of whom 22 (64%) developed new UI since admission. 27 (25.7%) patients had a urinary catheter inserted, most (23; 85%) for short-term use. Almost half (46; 44.2%) had faecal incontinence (FI), of which 74% was new FI since admission. Overall, 19 patients (18%) were doubly incontinent. Continence wear was also reviewed; 57 (54%) were in full wrap-around continence wear, 28 (27%) in pull-ups. 26 (25%) wore continence wear despite being continent. Only 28 (27%) had a call bell within reach. Nursing awareness was examined, 85 nurses (81.7%) were aware of their patient’s CS, and 15 (14.4%) were partially aware. In all cases, nursing handover documents were consulted. For 35 patients, (33%) CS impacted on their discharge plan.

Conclusion

Rates of UI and FI were high in our cohort and further increased during hospital admission. Staff knowledge was satisfactory but suboptimal efforts were made to improve CS. Consequently, an education session was delivered to clinical staff to embed continence assessment into CGA. Additionally, continence advocates have been appointed to each ward.
Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions
Authors: Marks Eleanor , Buckley Sophie , O'Connell Orlaith , O'Brien Claire , Buckley Mary
Published: September 2024

Background

Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation.

Methods

We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer.

Results

We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient.

Conclusion

These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.
Delirium Assessment And Documentation As Part Of An Acute Medical Admission
Authors: Cashen Aoife , Lynch Amy , Cormican Niamh , Chan Kei Yen , Devaney Kathy , Robinson Stephanie , Small Cliona
Published: September 2024

Background

Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients >65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project.

Methods

A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management.

Results

Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously.

Conclusion

There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.
Diagnostic Challenges and Outcomes in Transient Loss of Consciousness: A Retrospective Analysis
Authors: Davey Naomi , Kelly Louise , Kerins Yvonne , Connolly Kieron , Soh Josephine
Published: September 2024

Background

Transient loss of consciousness (T-LOC) is a common presenting complaint, posing significant diagnostic challenges. This study explores outcomes for T-LOC.

Methods

Using the Hospital Inpatient Enquiry System, data on patients with T-LOC were collected at a large academic teaching hospital over six months, including demographics, length of stay (LOS), diagnostic tests, and discharge diagnoses.

Results

A total of 160 T-LOC patient visits were analysed, divided into three age cohorts: under 65 (n=66), 65-74 (n=38), and over 75 (n=56). Of the 94 patients aged over 65 (58.75% of the sample), mean age was 76.07 years; 47% were female. Diagnostics varied by age, with higher rates of computed tomography of the brain (87.23%) and lying-standing blood pressure (37.23%) in those over 65. Conversely, those over 65 were less likely to receive electrocardiograms (86.17% vs. 96.97%), telemetry (51.06% vs. 59.09%), magnetic resonance imaging of the brain (21.28% vs. 25.76%), transthoracic echocardiograms (14.89% vs. 25.76%), and exercise stress tests (3.19% vs. 10.61%) compared to those under 65. Carotid ultrasound and electroencephalography were infrequently performed across all age groups. Patients aged over 75 were most likely to have a diagnosis (78.57% vs 60.53% in 65-74 and 60.61% in under 65). Orthostatic hypotension was the most common diagnosis 8.51% (8/94) of those over 65. 33.13% (53/160) of patients had no diagnosis documented. LOS increased with age: averaging 6 days (range 1-19) for those under 64, 7.45 days (range 1-36) for those 65-74, and 9.09 days (range 1-64) for those over 75. Older adults were less likely to receive cardiology (19.15%) and neurology consultations (11.70%) compared to those under 65 (27.27% and 36.36%, respectively).

Conclusion

A considerable number of patients lacked a diagnosis, highlighting the diagnostic complexities of T-LOC. The development of a specialist syncope assessment pathway is underway to improve diagnostics, potentially reducing unnecessary tests and hospital stays.