bluuebunny/crossref_metadata_2025 huggingface dataset:
137 Harnessing technology to augment comprehensive geriatric assessment for older adults with frailty in CRISP admissions
Authors: Doyle M , Mathew J , Ryan D , McDonagh R
Published: September 2023

Background

The Community Rehabilitation Inpatient Specialist Program (CRISP) is an Advance Nurse Practitioner (RANP) led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient, intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment (CGA). Patients attending the CRISP program are typically frail and have complex, multi-morbid medical backgrounds, many having multiple falls prior to admission. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk. Ambulatory blood pressure monitoring (ABPM) is recognised as especially helpful for identifying hypotension in older adults, where antihypertensive treatment should be individualised. The novel use of 24-hour ABPM in this setting offers these patients early diagnostics and early treatment options.

Methods

For patients, whom the CGA deems ABPM would be beneficial, monitors are fitted by the RANP as they return home for weekend leave mid-program. Results are promptly available to the RANP/Consultant Geriatrician and treatment plans are initiated and monitored throughout the remainder of the inpatient stay.

Results

In April 2023, the first month of use, APBM equipment was used for 80% (n-8) of older adults admitted to CRISP. 24-hour APBM has benefitted patients with a new diagnosis of hypertension, those with poorly controlled hypertension, patients with suspected orthostatic hypotension and those with concurrent hypertension and orthostatic hypotension where alterations to antihypertensive medication are initiated. We anticipate performing ABPM on 64 older adults in 2023 (80% of predicted admissions to CRISP).

Conclusion

The introduction of 24-hour ABPM as a diagnostic tool in this setting offers immediate diagnostic and early treatment options, reducing referrals, waiting lists and costs at over-stretched cardiac departments and increases the value of the Comprehensive Geriatric Assessment for older adults attending CRISP.
144 Personality’s association with the concordance of subjective and objective cholesterol measures: findings from the Irish longitudinal study on ageing (TILDA)
Authors: Coppola D
Published: September 2023

Background

With Cardiovascular Disease (CVD) as a leading cause of death in older adults, examining risk factors for CVD is crucial. High cholesterol, often addressable by lifestyle changes and medication, is a main contributor to CVD. Despite a large portion of Ireland’s (and the world’s) population having high cholesterol, this chronic illness goes undiagnosed or untreated. Personality’s demonstrated associations with overall health, self-reported health, and health behaviours makes it a key facet to examine alongside cholesterol.

Methods

Through secondary analysis of data from Waves 1 and 3 of TILDA, this research explores the intricate relationships between personality, subjective (self-reported cholesterol), and objective (bloods-measured) cholesterol. The 5 domains of personality were first cross-sectionally and longitudinally examined in relation to each manner of cholesterol measure. Overall concordance between subjective and objective results was examined. Finally, personality’s association with levels of concordance was analysed. These analyses were conducted using bivariate analyses and multinomial logistic regression.

Results

Various personality traits were univariately associated with cholesterol, with associations varying by cholesterol measure. Neuroticism was higher in participants with high subjective cholesterol, and extraversion, openness, agreeableness, and conscientiousness were higher in those with high objective cholesterol. Overall agreement between objective and subjective high cholesterol was low and only partially explained by personality traits. While substantial percentage of participants improved their bloods-measured cholesterol over time, openness was the only trait that predicted any change in cholesterol status.

Conclusion

These findings demonstrate univariate effects of personality traits on cholesterol levels. There is also evidence of discordance between subjective and objective cholesterol levels, suggesting a vast amount of the population goes undiagnosed and untreated for high cholesterol. This study’s unique findings have crucial implications for the public health sphere, demonstrating the importance of diversifying healthcare approaches and laying the groundwork for exploring personality’s associations with other cardiometabolic risk factors.
154 Tobacco smoking: impact on medication use, healthcare utilisation and hospitalisation in older adults; TILDA waves 3–4
Authors: Pisharody A , Fitzpatrick P
Published: September 2023

Background

Smoking is a significant cause of preventable mortality, morbidity and healthcare costs. Tobacco Free Ireland aims to reduce smoking prevalence to <5% by 2025. The recently published Department of Health and HSE National Clinical Guidelines for Tobacco Control emphasise the need for healthcare professionals to address smoking cessation during hospital admissions. The aim of this study was to investigate the relationship between smoking and hospitalisation, health service utilisation and prescribed medication use.

Methods

TILDA (The Irish Longitudinal Study on Ageing) wave 3 and wave 4 datasets were used, with 5,564 participants in both wave 3 and 4. Following univariate analysis, logistic regression analysis was performed to determine the health service usage outcomes associated with smoking.

Results

On univariate analysis, primary/no education (p < 0.001) and lower age group (<53 years) were significantly associated with increased smoking. After adjustment for demographic variables, smokers had a reduced likelihood of attending ≥1GP appointments over the past 12 months than non/ex-smokers (adjusted Odds Ratio [OR]: 0.65, 95% Confidence Interval [CI]: 0.42–0.72). Hospitalisations during the same period were found to have no significant association with smoking (p = 0.490). Smoking was also shown to cause a reduced likelihood of having ≥1 regular medications (adjusted OR: 0.69, 95% CI: 0.57–0.85).

Conclusion

Considering the impact of smoking on health, the results appear initially counterintuitive. There are a couple of explanations. Older smokers with more severe smoking-related morbidity may not participate in the TILDA Study. In addition, the results suggest that smokers tend to avoid visiting the GP which may indicate either that smokers are unconcerned about their health or do not wish to discuss smoking. Deferral of care to a later stage may impact prognosis and costs. Further research is required to investigate the dose-effect relationship of smoking with health service utilisation in the Irish setting.
163 Examining the appropriateness of tilt-testing within a community integrated care hub for older persons services
Authors: Ryan S , Ryan S , Lynch P , Mathai V , Ramasia J , Shanahan E
Published: September 2023

Background

Tilt-testing has been widely used in acute hospitals for more than 20 years in Ireland. Its use in community settings has been promoted in recent years with the development of the National Integrated Care Programme for Older Persons (NICPOP). In our integrated care hub our focus lies in the assessment of falls and frailty. We propose to examine if the current rational for performing tilt-testing has showed a diagnostic yield.

Methods

We retrospectively reviewed all tilt reports in the ambulatory care hub from November 2021 to May 2023. We examined the rationale for ordering the test, the number of patients who received a diagnosis of Orthostatic Hypotension (OH) and treatment that was commenced.

Results

59 tilt reports were examined between the 18 month period. The average age of the patients were 83 (range 68–93). The male to female ratio was 1:1.3. All patients had an indicator for testing. The 5 indicators that emerged were falls, syncope, orthostatic intolerance, lying and standing blood pressure drop and dizziness. 11/59 (19%) patients had one indicator, 18/59 (31%) patients had two indicators, 15/59 (25%) patients had three indicators and 15/59 (25%) patients had four indicators for performing a tilt. OH was diagnosed in 36/59 (61%) patients of whom 9/36 (25%) had symptomatic OH during both HUT and AS, 8/36 (22%) had symptoms during HUT alone, 6/36 (17%) had symptoms during AS and 9/36 (25%) were asymptomatic throughout testing. 4/36 (11%) had no documentation regarding their symptoms during tilting. De-prescribing was performed in 16/36 (44%) patients and Midodrine was commenced in 18/36 (50%) patients with fludrocortisone being started on 2/36 (6%) patients.

Conclusion

We demonstrated a high yield from the tilt-test investigations and in combination with Ambulatory BP monitoring had a significant number of medications de-prescribed. The greater preponderance of more than one indicator for tilt-testing was greater than what we perceived.
165 Improving sarcopenia with a physiotherapy-dietetics sarcopenia management pathway in a post-acute rehabilitation unit
Authors: Nolan M , Henry J , Bradley K , O'Callaghan S
Published: September 2023

Background

Sarcopenia is a progressive and generalised skeletal muscle disorder. The prevalence of sarcopenia in Irish studies ranges from 30 to 41%. The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends that management of sarcopenia includes optimal protein intake and resistance training. The objectives of this study were to: (1) Implement a structured physiotherapy-dietetics sarcopenia management pathway for older persons identified as severely sarcopenic in a Post-Acute Rehabilitation Unit, to align with the (EWGSOP2) recommendations and (2) Assess the effect of the combination of protein optimisation and progressive resistance training (PRT) in reducing sarcopenia in those identified as severely sarcopenic.

Methods

Patients admitted to a post-acute rehabilitation unit from January to April 2023 were screened for sarcopenia using Grip strength and the Timed Up & Go test. All patients identified as being severely sarcopenic were referred to dietetics and attended a PRT class three times per week.

Results

There were 38 participants in this study. 73.7% were screened for sarcopenia on admission. From this, 71.4% were classified as having probable sarcopenia and 50% were identified as having severe sarcopenia. On discharge, 28.6% of participants had their sarcopenia completely reversed and 40% had their sarcopenia reduced from ‘severe’ to ‘probable’.

Conclusion

The results demonstrate that implementing a structured sarcopenia pathway for older persons in a post-acute rehabilitation unit has a positive effect on sarcopenia.
175 Navigating the transient ischaemic attack pathway—unveiling the gaps and developing a standard solution
Authors: McDermott C , Murphy D , Hanrahan C , Murphy R , Walsh T
Published: September 2023

Background

Hyperacute management of a Transient Ischemic Attack (TIA) is necessary to decrease subsequent stroke. We examined our current management of TIA patients to inform a quality improvement initiative to bring our practice in line with the 2023 UK and Ireland Clinical Guidelines for Stroke.

Methods

We completed a retrospective cohort study of patients who attended our hospital between December 1st 2022 and February 28th 2023. Patients with a primary diagnosis of TIA were identified though the Hospital In-Patient Enquiry (HIPE). Each diagnosis was verified with electronic records review, with exploration of key investigations and management parameters.

Results

41 patients were coded as TIA from HIPE. 39 were a verified TIA diagnosis, with a mean age of 68.7 years. 10.2% were seen by direct GP referral to the Acute Medical Unit (AMU), with the rest attending ED initially. The median length of Stay (LoS) in hospital was 2.75 days. Most patients were admitted under the AMU (33%) or Stroke service (26%), with a shorter LoS if the patient was admitted under these services. 38 patients underwent neuroimaging; 94.8% CT Brain, 84.6% MRI Brain, and 82.1% both CT and MRI imaging. 1 patient went directly for MRI Brain without CT imaging. 82.1% were reviewed by a stroke specialist. Dual Anti-Platelet Therapy (DAPT) was used in 3 patients, single antiplatelet in 21, and oral anticoagulation in 9. 3 patients were discharged without any anti-thrombotic therapy.

Conclusion

This study highlights areas for improvement in the management of TIA in our facility. Our results have informed the development of a new TIA pathway, which will encourage an ambulatory approach to investigations and management of patients with a TIA. Improved patient-centred outcomes may include improved selection for DAPT, improved neuroimaging efficiency with increased direct to MRI imaging and higher numbers of patients being reviewed by a stroke specialist clinician.
183 Pathfinder emergency response to urgent urinary catheter issues in older adults; a service profile
Authors: Hogan L , Howard W , Corcoran G , Riordan Y O , McGettigan L
Published: September 2023

Background

Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is growing evidence for alternative care pathways at the time of a low acuity Emergency Medical Services (EMS) call. The Pathfinder service is a collaboration between the National Ambulance Service and acute hospital Occupational Therapy and Physiotherapy Departments. The service responds to low acuity 999/112 calls for people aged 365 years within the hospitals catchment area, including low acuity calls for blocked or dislodged indwelling urinary catheters.

Methods

A retrospective analysis of the service’s database was completed (1/1/22–26/5/23). All of the patients seen where the reason for 999 call was recorded as ‘blocked catheter’, ‘dislodged catheter’ or ‘urinary issues’, were identified and analysed.

Results

One hundred patients were identified, with urinary catheter related issues. Of these patients, 70% were male. The average age was 81 years. The average Clinical Frailty Scale score was 7 (severely frail). Ninety One percent of these patients remained at home as a result of the services’ intervention at the time of the 999 call. Of these 91 patients, 54% were classified as ‘treat and discharge’ (no further input or onward referral required), and 37% were ‘treat and refer’ (with onward referral to other services including Hospital Urodynamics Team, Public Health Nursing, GP). Seventy five percent remained at home without representation at 24 hours; 90% at 7 days and 75% at 28 days.

Conclusion

The Pathfinder service is safely and effectively managing urgent indwelling catheter issues, at the time of a 999 call, in older peoples’ homes instead of the ED. This upskilling project was made possible by excellent cross-organisational collaboration with the Hospital Urology and Urodynamics Department. The next phase of upskilling will focus on the management of urgent suprapubic catheter related issues.
185 Outcomes from a nutrition and exercise group targeting sarcopenia in older adults attending an integrated care for older persons hub
Authors: Grant E , Phelan N , Bambrick P
Published: September 2023

Background

Sarcopenia refers to the generalised loss of skeletal muscle mass, strength and function. It is closely related to physical frailty, and is a common contributor to the presentation of older adults to integrated care teams. Research has shown that resistance exercises combined with adequate dietary protein intake can reverse sarcopenia.

Methods

Screening for probable sarcopenia using handgrip strength was introduced as part of the routine comprehensive geriatric assessment. Suitable candidates meeting the inclusion criteria were offered an 8-week program, led by a physiotherapist and a dietitian, incorporating a home-based resistance exercise and nutrition intervention. Measures of strength (using handgrip), muscle mass (using BIA [bioelectrical impedance analysis]) and physical performance (using ‘Timed Up & Go’ [TUG], and gait speed) were taken pre and post intervention.

Results

10 participants (2 female, 8 male) completed the program. Following the 8 week intervention, changes were observed in measures of grip strength (median 1.5 kg, P = 0.04), and in physical performance using gait speed (median − 0.355 seconds, P value = 0.8). This was not seen when using TUG to measure physical performance (median + 0.02 seconds). Issues measuring muscle mass in routine clinical practice using BIA were encountered making analysis non uniform within the group. Frailty scores using the fried frailty scale were taken for 6 out of 10 participants in which the median change was −1 on the Fried scale (p = 0.025).

Conclusion

Participation in this self-directed nutrition and exercise program over an 8 week period was associated with improvements in measures of muscle strength, physical performance (to a lesser extent), and frailty scores. Future work will aim to explore the feasibility of a longer duration of intervention, and to examine whether this results in a greater treatment effect.
194 Weekend warrior: a structured self-directed physiotherapy exercise programme that enhances weekend exercise in older persons inpatient rehabilitation
Authors: Cusack G , McDonnell I , O'Quigley K , Gilheany A
Published: September 2023

Background

Strength and mobility exercise improve functional recovery in older persons rehabilitation. Internal audits and patient feedback show that exercise levels are lower on weekends where no physiotherapy service is available. Weekend physiotherapy intervention reduces length of stay in older persons rehabilitation. Additional interventions may be cost-effective, improve function and quality of life on discharge. This quality improvement project investigates the effect of a structured, self-directed weekend exercise programme on perceived exercise levels and satisfaction with weekend exercise levels. This project also investigates the workload of the programme for ward staff.

Methods

Surveys were completed after patients’ first weekend of admission. Patients self-reported time spent exercising at the weekend and their satisfaction. Weekend Warrior programmes (WWP) were given on week two of admission. Programmes matched manual handling guidelines with a traffic light system (seated = red, standing independently = amber, walking independently = green). Patients completed follow-up surveys after completing 3–4 weeks of WWP. Surveys were given to healthcare assistants to assess WWP workload burden.

Results

Before completing WWP, patients’ (n = 23) self-assessed exercise times were: 0-10mins exercise n = 8;10-20mins n = 7; 20-30mins n = 6 and > 40mins n = 2. N = 9 reported satisfactory exercise levels on weekends. After completing WWP, patients (n = 17) self-assessed exercise times were: 0-10mins n = 1; 10-20mins n = 11 and 20-30mins n = 5. N = 11 reported satisfactory exercise levels on weekends. N = 14 patients enjoyed participating in WWP. All staff (n = 6) reported that WWP did not significantly increase workload burden and supported the programme’s continuation. No adverse events were reported.

Conclusion

Weekend Warrior structured, self-directed exercise programme is safe and feasible in this setting. Patients reported enjoying WWP. This programme did not additional workload burden for ward staff.
210 Screening for frailty in the Acute Medical Admissions Unit and examining referral patterns to physiotherapy
Authors: Nash K , Keogan F , Browne J , Murphy N , Walsh M E
Published: September 2023

Background

Frailty predisposes older people to adverse outcomes following hospitalisation. Physiotherapy can reduce the risk of adverse frailty-related outcomes including functional decline. Research examining frailty and physiotherapy referral in Acute Medical Units is limited. The objective of this study was to estimate the prevalence of frailty in older adults admitted to an Acute Medical Admissions Unit (AMAU), and to explore factors associated with early physiotherapy referral in the frail group.

Methods

A prospective cohort study was conducted in the AMAU of a large acute hospital in Ireland. Participants were those over 65 years who were admitted to the AMAU. All participants underwent frailty screening on admission using both the Clinical Frailty Scale and Program of Research to Integrate Services for the Maintenance of Autonomy-7 questionnaire. They were defined as frail if positive on at least one of the tools. Referral to physiotherapy and time to referral during hospitalisation was recorded. Multivariable logistic regression was used to explore factors associated with early physiotherapy referral (within 24 hours) for frail participants.

Results

210 participants (mean age = 78.3 years, 51.9% female) were included. Frailty prevalence was 71% (n = 149) (95% CI = 64.3–77.0%). Within the frail group, 61.1% (n = 91) experienced early referral to physiotherapy, 15.4% (n = 23) were referred after >24 hours and 23.5% (n = 35) were not referred during hospitalisation. Falls history (Odds Ratio [OR]: 4.08; 95% Confidence Interval [CI]: 1.82–1.94), older age (OR: 1.05; 95%CI: 1.00–1.10) and mobilising with an aid or assistance (OR: 2.42; 95% CI: 1.11–5.27) were associated with early physiotherapy referral in the frail group. Sex and living alone were not.

Conclusion

Frailty screening in AMAU may increase identification of older people at risk of experiencing adverse outcomes. Routine referral to physiotherapy for people who are deemed frail would ensure more equal access to physiotherapy assessment and treatment which could reduce the risk of adverse outcomes including falls, functional decline, and frailty progression.
225 The pattern of ICPOP service use according to the clinical frailty scale
Authors: Mannion K , Shiel E , O'Malley K , Donohue M , Cleary A , Neachtain M Ni , Gavin C , Walsh L , Hanrahan C , Cosgrove J , Sestak K , McDonnell C , Fitzmaurice C , Geoghegan J , McClean F , Costello M , Canavan M
Published: September 2023

Background

We are a specialist integrated team working with older people to co-ordinate and provide enhanced health and social care services through Comprehensive Geriatric Assessment (CGA) and intervention working across a large geographical region.

Methods

New patients who underwent CGA from January–May 2023 were suitable for inclusion in this retrospective study. Key parameters including demographics, cognitive and functional status were recorded and analysed according to the following categories of clinical frailty scale (CFS); 1–3 (non-frail), 4–6 (frail) and ≥ 7 (severely frail).

Results

Of 249 patients who underwent CGA, 64% (n = 159) were female with a mean age of 82, and median MOCA score of 17. Reasons for referral were new or unexpected change in cognition (52%) frailty (40%) and falls (37%). Among this cohort 20% (n = 51) were non-frail, 71% (n = 177) were frail and 8.4% (n = 21) were severely frail. There was no significant difference in mean MOCA score by level of frailty (p = 0.49). Impairment in Instrumental Activities of Daily Living (IADL) was identified in 26% of non-frail, 77% of frail and 100% of severely frail patients. 27% of non-frail, 43% of frail and 33% of severely frail patients were living alone with carer strain reported in 70% of those with severe frailty. Informal care was regularly provided to 35% of non-frail, 60% of frail and 90% of severely frail patients.

Conclusion

Patients attending our service are frail, older and predominantly female. We identified a cohort who are not classified as frail but have cognitive impairment, are dependent for support in IADLs and reliant on informal care to allow them to live independently. In addition, we are supporting a severely frail, heavily dependent cohort and their caregivers. This demonstrates the complex case load within our ICPOP service which requires ongoing evaluation to ensure delivery of high quality person-centred interventions.
231 An evaluation of the dietetic service in a Geriatric Assessment Unit—nutritional status and outcomes
Authors: Mulligan Ú , Stone S , Basit M
Published: September 2023

Background

In 2021 the Geriatric Assessment Unit (GAU) was established, a 0.5 WTE dietitian was appointed to the multidisciplinary team. The Comprehensive Older Age Assessment (COAA) developed by the MDT included two nutritional screening tools—Malnutrition Universal Screening Tool (MUST) and the SARC-F questionnaire for sarcopenia. A MUST score of ≥2 and a SARC-F score of ≥4 were automatic dietetic referrals, referrals were also sent if a clinical concern was identified by the MDT. The aim of this review is to investigate the dietetic referral rates, nutritional status and compile a summary clinical outcomes.

Methods

A review of the dietetic excel database for the GAU, 2021 and 2022 was completed. The review included statistics on: (1) Referral rate, (2) Total number of dietetic interventions and a breakdown of new versus review patients, (3) MUST and SARRC- F score, (4) Body Mass Index (BMI) & weight status and (5) Review of the dietetic outcome following intervention e.g. follow up versus discharge rate and weight status at review appointments.

Results

The data for 2021 and 2022 were combined—77.5% of patients attending the GAU were referred to the dietitian, 80% of patients referred attended a one to one consultation. 55% of all dietetic interventions were for new patients and 45% review patients. Average BMI was 25.5 kg/m2 and 27.7 kg/m2 in 2021 and 2022 respectively. 13% had a MUST score of ≥2. 49.8% had a SCAR –F score ≥ 4. 41% of patients had reported or documented weight loss. 70% required dietetic review. At dietetic review 39.5% had desirable weight gain, 39.5% were weight stable, with only 16% having an undesirable weight loss.

Conclusion

The requirements and benefits of a dietetic service can be seen in the high referral rate, documented concerns of weight loss and percentage of patients with a SARC-F score ≥ 4, leading to patient specific dietetic intervention, with a stable or improved weight status at dietetic review.
232 A scoping review of Interprofessional collaboration for people over 65 with dementia living in the community
Authors: Egan A , Griffin L , Boland P
Published: September 2023

Background

Inter-Professional Collaboration (IPC) has gained prominence for current and future community-based dementia services, as they transition to integrated care. IPC aims to improve patient outcomes by coordinating care across multiple Healthcare Professionals (HCPs) and facilitating informed decision-making. This scoping review examined the nature and extent of evidence on IPC for People with Dementia (PwD) in community settings.

Methods

The methodology process was guided by the PRISMA-ScR checklist, which aligned with the research question. This involved reviewing eligibility criteria and information sources, establishing a search strategy using PICO, removing duplicates using EndNote, and screening articles in Rayann. The selected articles were then charted in a PRISMA flow chart, critically appraised using CCAT, and synthesised into a data extraction table to complete the process. After screening and evaluation, 15 articles were selected for the scoping review from an initial pool of 1,584 articles.

Results

Findings were grouped into two main themes: (1) IPC in Community Dementia Care: significance, team building, challenges and opportunities, the role of interprofessional education (IPE) and (2) Community Care Networks: barriers to implementing IPC and region-specific care models and guidelines.

Conclusion

The scoping review found that IPC in the community can provide high-quality care for PWD, resulting in earlier detection, disease management, and continuity of care. These benefits, however, are contingent upon effective communication, interprofessional coordination and local and national resources. Furthermore, a universal lack of standardised training for HCPs was identified as a key challenge in this. The review also discussed specific roles of IPC teams in dementia care, such as utilising other members of the team to address the shortage of physicians.
267 Survey of knowledge and medications Management of Patients with Parkinson’s Disease among non- consultant hospital doctors
Authors: Ragab I , Doherty R , Abdalla Y E , Brewer L
Published: September 2023

Background

Parkinson’s Disease is a progressive neurodegenerative movement disorder. is the second most common neurodegenerative condition after Alzheimer Disease. The incidence is 1–2:1000 of the general population and 1:100 of the over 80’s, therefore estimating that there are approximately 12,000 people living with Parkinson’s in Ireland. Providing care services and best management for Parkinson’s disease patients needs to be ensured through training staff and continuously auditing the service to meet international standards and patient satisfaction.

Methods

This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties of Non-Consultant Hospital Doctors (NCHD) in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and how commonly NCHD manage patients with Parkinson’s Disease. The second section contained questions to assess general knowledge on medications.

Results

Of the 40 respondents of non-consultant hospital doctors (NCHD) 50% were SHOs, 30% Interns 20% Registrars. 38% reported to lack confidence in managing patients with Parkinson’s and 50% somewhat confident and only 12% were confident. 77% weren’t familiar with medication side effect and 90% weren’t aware about rescue medications. 82% weren’t familiar with conversion methods. 95% felt that they needed more training.

Conclusion

Parkinson’s disease patients are commonly admitted to hospitals under medical and surgical teams, and ensuring every patient gets the best management should be our goal. More training is required among hospital doctors, in addition to other continuous easily accessible supportive materials, such as information leaflets, links to be included into hospital’s mobile phone application, Parkinson’s nurse specialist as a point of contact, and regular education.
269 Profiling frail patients assessed by the rapid access frailty team in the emergency Department of a Level 3 hospital
Authors: Brady A , Benson A M , Donnelly T , McGlynn J , O'Neill A , Moore A
Published: September 2023

Background

The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) currently consists of 2 physiotherapists. The aim of the team is to review frail patients presenting to the ED during core working hours. Key roles of the team include facilitating a safe discharge and providing early intervention to assist patient flow and a safer, more positive patient experience.

Methods

For the purpose of this study, frail patients were defined as those with a score of 4 or greater on the Clinical Frailty Scale (CFS). Data was manually recorded after each episode of care using data entry points including demographic details, interventions, outcome etc. Data was analysed from a 5 month period between January–May 2023.

Results

The RAFT Team reviewed an average of 100 patients per month. (Age range 44-98 yrs). 51% were over 75 years old. Gender distribution was not significantly different. 57% were female versus 43% male. The main presenting complaint of frail patients assessed by RAFT was falls. 69% of those reviewed were discharged. Approximately 36% of this group lived alone. 61% were female (Mean age 81y). 39% were males (Mean age 77y). CFS scores of those living alone ranged from 4–7. 37.5% of those reviewed had formal care in place at home. 10% of carers showed evidence of carer stress. 88% of patients had a falls assessment and equipment was provided to 65%. Physiotherapy (65%), Occupational Therapy (28%) and PHN were the most common community referrals required. 30% were referred to our Rapid Access Frailty Hub.

Conclusion

The number of frail patients presenting to our ED is growing. Increasing numbers of frail under 75yo patients are requiring RAFT input. Many frail patients continue to live at home alone. The RAFT team play a vital role in improving quality of care for this patient group and facilitate rapid, safe discharge home where possible.
283 An online portal to monitor trends of patients clinically deteriorating or requiring transfer from a rehabilitation hospital for older persons
Authors: Prendergast F , Cogan L
Published: September 2023

Background

Due to advances in Healthcare, more medically complex Older Persons are admitted to our Rehabilitation Hospital for Older Persons following an inpatient stay in an Acute Hospital. We created a deteriorating patient working group along with an online portal in July 2022 to ensure hospital wide procedures are in place for the early identification, escalation and management of deteriorating patients. Our online portal monitors patients clinically deteriorating or requiring transfer to an Acute Hospital following admission to our Rehabilitation Hospital for Older Persons.

Methods

Patients clinically deteriorating and patients requiring transfer to an Acute Hospital are captured in separate electronic databases respectively on our secure online portal. We present patient data from August 1st 2022 to June 1st 2023 following the creation of the online portal.

Results

A total of 143 patient episodes at risk of clinical deterioration were entered into the portal from August 1st 2022 to June 1st 2023. A total of 61 patient episodes requiring transfer back to an acute Hospital were entered into the portal from August 1st 2022 to June 1st 2023.

Conclusion

Our Rehabilitation Hospital for Older Persons assesses the suitability of patients for rehabilitation a local acute hospital prior to accepting their care. Most patients who clinically deteriorate can be managed in our hospital but due to our limited access to more advanced treatments and diagnostics, some patients require transfer back to the acute hospital from which they were referred. The creation of a secure online portal has been a very useful means of monitoring trends in our Hospital of both patients who clinically deteriorate and those who require transfer.
294 The value of psycho-educational and peer groups for dementia family carers
Authors: Allen J , Cosgrave S , Flanagan C , Daly C , Dullea G , Spain M
Published: September 2023

Background

Approximately 60,000 informal carers are caring for Persons with Dementia (PwD) in Ireland. The care giving provided by family members often enables PwD to remain living in their own homes for longer, which is associated with more positive outcomes and quality of life for PwD. However, given that dementia is a progressive illness, affecting the whole person and their ability to fulfil their activities of daily living, the task of caring can become incrementally more difficult over time. Family carers have articulated the need for increased information and support to assist them in their caregiving role in numerous studies. Living Well with Dementia monthly family carer evenings, facilitated by experienced cross-service interdisciplinary healthcare professionals aim to provide information and support on a range of relevant issues related to caring for a PwD. The average monthly attendance is forty family carers, predominantly spouses and adult children.

Methods

A self-administered survey was completed at the final carers evening of the Spring/Summer 2023 series. The survey was also circulated to family carers subscribed to the mailing list.

Results

Carers overwhelmingly valued the opportunity to come together in a structured supportive environment. The opportunity to sit with peers and share their experiences of caring for a loved one with dementia was viewed as supportive and deeply valued. The psychoeducational component focusing on dementia and mental health; communication skills; self-care for carers; planning ahead and changes to relationships, was viewed as a means of enhancing coping skills and was greatly appreciated by family carers.

Conclusion

The Carers Evenings provide a structured supportive environment in, which family carers can come together to share experiences, enhance their knowledge of varying aspects of the dementia and caregiving journey, and develop coping strategies.
295 Don’t forget about memory: prevalence of cognitive impairment in older adults attending the integrated day hospital
Authors: Ronayne S , Alexander M , O'Malley T
Published: September 2023

Background

Cognitive impairment and dementia are estimated to affect 1 in 5 adults over 80 years (TILDA 2023) which impacts on participation in complex activities eg. Drving, managing finances, complex decision making. The importance of addressing these issues is to the fore with the enactment of the Assisted Decision Making Act. This review aims to provide local context to design and implementation of assessment and intervention processes for Subjective Cognitive Impairment (SCI), Mild Cognitive Impairment (MCI) and dementia in older adults attending the Integrated Day Hospital (IDH).

Methods

A retrospective analysis of health care records was undertaken on patients attending the IDH from January to May 2023. Inclusion criteria were adults over 70 years, recent history of falls or deterioration in functional or cognitive status. Evidence regarding SCI was gathered via patients’ response to specific question on comprehensive geriatric assessment. Evidence of MCI and dementia was gathered via cognitive screening scores.

Results

Preliminary results indicate a cohort of 150 patients. Preliminary analysis of cognitive screening scores reflect prevalence of MCI at 16% and dementia at 36% of older adults attending the IDH. Family-carer reported impairment is more likely to correlate to an impaired range score on testing, in comparison with self-reported impairment. 50% of older adults report SCI, with 70% of family carers reporting SCI in the same cohort. There is a prevalence of cognitive impairment in older adults presenting for falls and frailty. Final findings will be available for the purpose of this poster presentation.

Conclusion

Cognitive impairment in older adults is evidenced across a range of presentations including falls and frailty. This review highlights the need to explore the holistic needs of older adults to identify presence of SCI, MCI and dementia. Subsequently there is a need to provide person centred, co-ordinated and integrated interventions tailored to the needs of the older adults.
332 Gut reaction: Faecal Microbiota Transplantation in a multimorbid older patient with recurrent Clostridium Difficile Infections
Authors: McManus C , O'Riordan R , Kelly F
Published: September 2023

Background

Clostridium Difficile Infection (CDI) is a leading cause of hospital-acquired morbidity and mortality, especially among older adults. Advancing age and in particular those older adults with End-Stage Kidney Disease (ESKD) are at an increased risk for recurrent CDI due to frequent antibiotic exposure, extended hospitalisations, and compromised immunity. This report presents a unique case of an 85-year-old male with a complex medical history that also includes ESKD on haemodialysis, chronic myelomonocytic leukaemia, hypertension, Barrett’s oesophagus, and secondary hyperparathyroidism. He experienced 7 hospital admissions over a period of 12 months due to recurrent CDI, despite treatment with metronidazole, vancomycin and fidaxomicin, as well as prophylactic fidaxomicin. This amounted to a total hospital stay of 53 days. Interestingly his CDI was not associated with antibiotic use.

Methods

After consultations involving a multidisciplinary team of nephrology, infectious diseases, gastroenterology, geriatrics and haematology specialists, the decision was made to proceed with Faecal Microbiota Transplantation (FMT). Based on the patient’s preference the FMT was performed via a colonoscopy.

Results

The success of FMT in this case was notable. The patient has experienced no further CDI or immediate complications post-FMT, demonstrating the effectiveness and safety of this approach even in a complex clinical scenario.

Conclusion

In an era where recurrent CDI poses significant challenges to older patient health, especially in those with multi-morbidity like our patient, and where standard antibiotic treatments fail, this report underscores the importance of considering FMT as a potential treatment option as well as highlighting its safety in older adults. Hence, this case adds valuable insights to the growing literature advocating FMT use in managing recurrent CDI in complex older adults, potentially directing future clinical decisions and treatment guidelines.
334 Carotenoids and Parkinson’s Disease—what does the literature say?
Authors: Donoghue A O , O'Gorman M , Cooke J , Mulcahy R
Published: September 2023

Background

Carotenoids are brightly coloured pigments found in vegetables and fruits. There are two subgroups; Carotenes (⍺-carotene, β-carotene, lycopene) and Xanthophylls (lutein, zeaxanthin, β-cryptoxanthin). Carotenoids are solely obtained from diet, with approximately 20 present in human blood and tissue. Xanthophylls are predominantly found in the brain. Carotenoids have anti-oxidant and anti-inflammatory properties. Higher intake of carotenoids has been linked with lower risk of cardiovascular diseases, malignacies and eye disorders. Parkinson’s Disease (PD) is characterised by the progressive motor symptoms of bradykinesia, rigidity, tremor and postural instability due to the depletion of dopamine-producing neurons in the midbrain. The mechanism by which PD develops remains unclear however, research-to-date has focused on the role of inflammatory mediators and oxidative stress in its pathophysiology.

Methods

PubMed was searched for relevant papers using the terms ‘Carotenoids’;‘Anti-Oxidants’; ‘Parkinson’s Disease’;‘Neurodegenerative Disorders’. Results from 1992 to 2022 were included.

Results

73 studies were identified. 9 studies (2 case–control, 5 cohort, 2 systematic-reviews) were included in this short-review. β-carotene was most commonly associated with reduced PD risk. One study looked at the link between Carotenoids and PD progression. The majority of studies did not measure serum Carotenoids, only assessing them by dietary questionnaires. There were no Irish studies looking at PD and Carotenoids.

Conclusion

Research around PD and Carotenoids is varied and inconsistent. Majority of studies show no significant associations, most focusing on PD risk rather than progression. Xanthophylls have been poorly studied in relation to PD. Carotenoids could potentially be used in PD as an adjunct given their anti-oxidant/anti-inflammatory properties. Further studies investigating the link between Carotenoids and PD in an Irish population is warranted.
349 From the voice of experience: listening to older adults to co-design: a new frailty service in the emergency department
Authors: O'Neill S , Sankey C , Linehan D , Marks M , Carville M , Latoza W
Published: September 2023

Background

The Patient and Public Involvement (PPI) aspect of healthcare service evaluation is key to service development. Following the 12th month of operation, a ‘frailty at the front door’ team, in a model 3 hospital, sought feedback from the patients using the service with an emphasis on listening to their perspective on using the service and recommendations for improvement. The project aimed to collaborate with the patients to design and implement a service providing high quality care for the older person attending the ED. From this a service improvement initiative commenced.

Methods

The Model for Improvement was employed, which incorporates the plan, do, study, act methodology. A patient survey was issued to all patients who had attended the rapid access clinic on discharge from the ED. Questions included understanding the role of the team within ED, was the intervention received helpful, how was the overall experience and what could be done to improve the service.

Results

Of 12 respondents: 67% reported not understanding the role of the team as a specialised service for older persons in ED. 67% rated their experience in the follow up Rapid Access Clinic to be very good, 25% rated their experience as good and 8% reported they would prefer not to say. 100% reported that they felt the team input was helpful. A suggestion for improvement was to help patients understand the specialised role in ED.

Conclusion

A focus group was held to consult a group of over 65 patients on how to communicate the role of the team and improve visibility. As a result the team created a badge as part of their uniform and also created a patient information leaflet to issue at point of assessment. The survey will be implemented quarterly to measure the success of the new interventions or further improvements.
12 Older workers in low paid employment in Ireland: finance, fit and flexibility
Authors: O’Dare C E , Collins M
Published: September 2023

Background

The demographic shift to an older population has sparked research interest on the working lives of older people. Policy awareness is generally directed towards extending working lives, primarily due to pension related fiscal concerns or evoking an active ageing paradigm. This research focuses on a previously unexplored cohort, older workers in low paid employment in Ireland; bringing together themes of ageing populations, labour market participation, earnings adequacy, and active ageing to answer the question. Why do older workers enter and remain in low paid employment?

Methods

A mixed-methods approach explores the characteristics and experiences of older workers in Ireland. Quantitative analysis of the Survey on Income and Living Conditions (SILC) data provides a profile of the individual, sectoral and household characteristics of low paid older workers. This data informs the qualitative sampling strategy. Semi-structured interviews, online and by phone, were conducted with 20 workers aged 50 and over in Ireland.

Results

The older workers interviewed indicate that financial need is a significant driver into taking up, and remaining in, low paid employment—some beyond official retirement age. Other reasons identified, broadly categorised as ‘fit and flexibility’, encompass skills, location, social drivers, and a gender dimension related to motherhood. Decisions taken earlier in the life course in relation to employment and family reverberate into older age. Findings indicate that while some older workers are ‘stuck’ in low paid employment due to an array of constraints, others choose to be there.

Conclusion

Understanding the reasons why older workers participate in low paid employment has important implications for policies relating to older people in general; not only in relation to labour market participation and extended working lives, but additionally in relation to a living wage income and pension inadequacy, wellbeing and social inclusion. These findings therefore are of interest not only to policy makers, but to older workers, employee representatives and employers.