bluuebunny/crossref_metadata_2025 huggingface dataset:
223 Chronic pain is frequently under-treated among older people in Ireland: data from TILDA
Authors: Swanton A , Lalor P , Lavan A , Kenny R A , Briggs R
Published: September 2023

Background

Chronic pain can have significant adverse effects on quality-of-life, functional status, and well-being in later life. Concerns exist regarding under-treatment of pain among older people, however. The aim of this study, therefore, is to ascertain the prevalence of chronic pain among older people in Ireland, including prescribed pharmacological treatment.

Methods

Participants ≥70 years at TILDA Wave 1 were asked ‘Are you often troubled with pain?’ and if yes, were then asked ‘How bad is it most of the time? Mild, moderate, or severe?’. Medication lists were examined by anatomical therapeutic chemical code for analgesics (N02), opioids (N02A), and non-opioid analgesics (N02B). Frailty was assessed by Fried Frailty Scale. Data was analysed descriptively. Chi-square tests assessed differences in binary variables; t-tests for continuous variables.

Results

Over 1/3 of participants (n = 2,308; mean 77 years; 53% female) reported chronic pain (839/2,308), with 10% (222/2,308) reporting severe pain. Over 60% of participants with chronic pain (517/839) reported pain made it difficult to complete day-to-day activities. Almost two thirds of participants with moderate–severe pain (407/618) were not prescribed analgesia. Participants with untreated chronic pain were more likely to be female (62% vs 52%, p < 0.001), have functional impairment (22% vs 13%, p < 0.001) and to be frail (14% vs 6%, p < 0.001). Over 98% of participants with untreated pain had contact with healthcare (GP practice or ED) in the preceding 12 months.

Conclusion

In this population-representative analysis, chronic pain affects 1/3 older people in Ireland, with 1/10 reporting severe pain. Chronic pain often limits day-to-day activities yet is frequently under-treated or not treated at all, particularly in frail, older females, despite contact with the healthcare service. It is imperative, therefore, that we empower older people to report chronic pain to a healthcare professional and we facilitate appropriate assessment and treatment of their pain.
47 The knowledge and attitudes of healthcare workers towards sexuality and sexual relationships in older persons
Authors: Shaji A
Published: September 2023

Background

Sexuality is one of the activities of living, and a person’s sexual desire and actions can continue into old age. Even though it is a basic need for a person, organisations can often ignore this activity. Staff in the healthcare sector showed a lack of knowledge and negative attitudes towards sexuality in older persons. Older persons usually keep silent about it due to embarrassment, lack of knowledge and lack of communication. The negative attitude and lack of knowledge regarding sexuality reflects that the staff require education and other interventions to improve their knowledge and attitude towards aged sexuality. The purpose of this literature review is to identify staff knowledge and attitudes towards sexuality in older persons.

Methods

A literature search was conducted in the CINAHL, PubMed, Embase, Science Direct and MEDLINE databases, published from 2007. The number of articles was reduced to 10,123 when the search topic included knowledge and attitudes of staff about sexuality and sexual relationships in older persons. After screening of period, age limited, English language, title and abstract, the result was reduced to 22.

Results

The literature review found very insufficient studies about staff knowledge and attitudes about sexuality in older persons within the last 11 years and could not find any studies conducted in Ireland. The review appears to demonstrate that the knowledge of staff regarding sexuality and sexual relationships in older persons are inadequate. Most of the studies showed that the staff attitude towards aged sexuality remains negative.

Conclusion

It is evident that staff’s positive attitude will resolve one of the leading barriers to expressing sexuality. The studies show that education and training programmes for staff, supported by policies and procedures, are the important interventions that are required. The findings of this review suggest that more research and interventions are needed for health workers towards sexual relations in older persons.
68 The recovery of mobility post hip fracture as measured by the new mobility score and patient perception
Authors: McDaid E , Hewitt J , Walsh M
Published: September 2023

Background

Return to prior mobility after hip fracture is an important patient goal. This study aimed to assess recovery of mobility at 30 and 120 days post fracture using the New Mobility Score (NMS) and patient perception.

Methods

This prospective cohort study included consecutive patients ≥60 years admitted after hip fracture if they could provide informed consent and participate with or without a proxy. Pre fracture mobility was measured using the NMS. Participants were contacted by telephone or in person at both 30 and 120 days to complete the NMS and questions about recovery of mobility. At day-120, EQ-5D-5L was also completed.

Results

Of 82 patients admitted with hip fracture during the study period, 60 were eligible and consented. The mean age of participants was 83.3 years, with 70% (n = 42) being female and all lived at home pre-fracture. All participants (n = 60) completed 30-day follow-up only 83% (n = 50) at 120 days with 3 patients known to have died. The proportion of participants mobile unaided indoors, outdoors and shopping respectively was 78% (n = 47), 63% (n = 38) and 50% (n = 30) pre-fracture; 5% (n = 3), 2% (n = 1), and 0% at day 30; and 42% (n = 23), 20% (n = 10) and 16% (n = 8) at day 120. The mean total NMS score pre-fracture, at 30 days, and 120 days was 7.28 (SD = 2.1), 2.73 (SD = 1.7) and 5.6 (SD = 2.2), respectively. At day-120, moderate to severe problems with mobility (EQ-5D-5L score ≥ 2) were reported by 44% (n = 22). No participant recovered their pre-fracture mobility at day-30. At day-120, of the 28% (n = 14) who recovered mobility (NMS), 64% (n = 9) still reported their mobility as worse than pre fracture.

Conclusion

Most participants did not recover their pre-fracture mobility by 120 days. There was an associated loss in health-related quality of life, primarily in the domain of mobility. This patient group may benefit from access to physiotherapy up to 4 months after hip fracture.
82 Needs of stroke survivors after acute stroke and early supported discharge (ESD), at hospital discharge, and at 3- and 6-months
Authors: O'Callaghan G , Fahy M , O'Meara S , Chawke M , Waldron E , Corry M , Gallagher S , Coyne C , Lynch J , Kennedy E , Walsh T , Cronin H , Hannon N , Fallon C , Williams D , Langorne P , Galvin R , Horgan F
Published: September 2023

Background

There are gaps in our understanding of the needs of Irish stroke survivors as they return home from hospital, and in the first six months following their stroke.

Methods

We conducted a prospective cohort study in stroke survivors, recruited from three hospital sites across Ireland and profiled their self-reported needs in relation to information, recovery and community re-integration at discharge to home after acute hospitalisation, rehabilitation or early supported discharge, and described ongoing needs over a 6-month period.

Results

72 participants, mean age 70 (SD: 13), 61% female, mean NIHSS score 6.3 (SD 6), were recruited at hospital discharge. Needs were gathered on 59 participants (82%) at 7–10 days post discharge, 54 participants (75%) at 3-months, and 45 participants (63%) at 6-months. 40% of respondents reported no unmet needs at discharge, at 3-months 20% reported no unmet needs. The median number of unmet needs was 3 (range, 1–8). Over 50% of respondents reported not having an opportunity to discuss their transition plan before their discharge home. At hospital discharge, people with stroke reported challenges around mobility and falls (>85%), fatigue (73%), emotional issues (66%), and memory (46%); with emotional problems, fatigue, and memory difficulties rating as highest levels of unmet need. Over 40% needed support with housework. In relation to information after stroke, (80%) needed information about their stroke, support around nutrition (51%), return to driving (40%) and financial concerns (32%). These rehabilitation, information and support needs persisted at 3- and 6- months.

Conclusion

Successful community re-integration after stroke is a complex process for the person with stroke and their family. Our findings concur with those of international-based researchers, that the prevalence of unmet needs is high among stroke survivors. Profiling needs of people with stroke is important to shape the development of therapies to reduce unmet need following a stroke.
112 Barriers and facilitators to data collection for the Irish National Audit of Stroke
Authors: Jonsson A , Jeffares I , Mellon L , Williams D , Hickey A
Published: September 2023

Background

Stroke is an important cause of morbidity and mortality in Ireland and worldwide, with over 7,000 new cases in Ireland each year. The audit of stroke facilitates service evaluation and quality improvement initiatives and is becoming increasingly important as acute stroke treatment is rapidly changing. In Ireland, the National Office of Clinical Audit has managed the Irish National Audit of Stroke (INAS) since 2019. This study is part of a wider project titled ‘Maximising the Quality of Stroke Care in Ireland—Development of a National Stroke Audit’ which aims to further develop INAS.

Methods

As part of the overarching project, semi-structured interviews were conducted with Irish health professionals involved in stroke care and data collection for INAS, including nurses, health and social care professionals and administrators. Qualitative data relating to data collection for INAS were extracted and analysed for recurring themes using NVIVO software.

Results

The most frequently identified barriers to data collection were: 1. Lack of time and resources; 2. Infrastructural challenges (access to computers, desk space and IT systems); and 3. Perceived uselessness of the audit. Identified facilitators were: (1) Systems of organisation (electronic and paper-based solutions) that allow shared responsibility of data input and (2) Leadership from managers and the influence of team members that perceive the data collection for INAS as important and beneficial for the local service. Professionals who valued the audit as an important clinical tool were more likely to have a positive view of the work required to input data for INAS.

Conclusion

INAS is a crucial instrument for understanding the demographic characteristics and care received by stroke patients in Ireland. Streamlining the data collection procedures is an important part in developing INAS. There are significant resource and time limitations affecting data collection that need to be taken into consideration for any future audit development.
113 Training Gardaí in dementia awareness
Authors: McNally D , Keating J , McGuinn C , O’Neill D , Kennelly S , McElwaine P
Published: September 2023

Background

There is increasing awareness of the need to inform public-facing services, and in particular police services, on dementia awareness so as to meet the differing needs of those living with dementia. While there have been programmes in Ireland such as the Dementia Elevator course, no specific course to date has been implemented for the Garda Síochána. Our experience in a pioneering Integrated Care Programme for Older People (ICPOP) team indicated a need to develop a course. We report on the feedback of community and probationary Gardaí to a dementia awareness course.

Methods

Questionnaire survey on 26 participants in course based on existing dementia support framework, and feedback from Gardaí at ICPOP steering group.

Results

The results indicated a positive (100%) (strongly agree/agree) response to: (a) application of knowledge learned, (b) content organised and easy to follow, (c) good quality of training, (d) trainers were knowledgeable, (e) adequate time given for questions and discussion and (f) participation and interaction encouraged. Overall rating of the course was 100% excellent. Useful feedback was given on improving the course—more up to date videos, and more cross organisational communication.

Conclusion

Police forces have a particularly important role in encountering people living with dementia, and a limited number of international reports exist on their implementation. The finding of this course development and survey point to a useful role for expanding dementia awareness training across the Gardaí at a national level, and consideration of delivery to all first-responders.
131 A review of the implementation of a specialist older persons 7 day service within an acute setting
Authors: Price O , McGreevy L
Published: September 2023

Background

As part of Winter Planning Initiatives 2021–2023 additional funding was allocated to expand the service being offered to older persons within the acute hospital setting, across the disciplines of Occupational Therapy (OT), Physiotherapy (PT) and Nursing. This is aimed at providing a person centred 7 day service, supporting admission avoidance and promoting patient flow through the hospital by enhancing timely discharges and transfers of care.

Methods

Referrals to the specialist older persons service were primarily received from the Homefirst team (Frailty at the front door). Those who were referred had been admitted onto an acute ward and had been identified as requiring specialist therapy input to enhance the quality of their stay in addition to supporting safe and timely discharges home or transfers of care. A comprehensive OT assessment was carried out with all patients. A reduced 7 day service was commenced in order to gather information to assist future service planning.

Results

2 Occupational Therapists were recruited prior to additional team members therefore, initial referrals accepted were those with identified OT needs. All referrals were accepted with a triaging system being developed as the service became more established. All referrals had a Clinical Frailty Score (CFS) of between 3–7. Patient Outcomes included discharge direct to home or transfer of care including rehab, stepdown, nursing home and hospice facilities. These outcomes were impacted by social support systems, availability of community resources and limited access to ongoing specialist team input.

Conclusion

The introduction of a specialist older persons 7 day service working within an integrated model of care, has wide ranging impacts for patients and the organisation. Access to specialist acute older persons services provides targeted assessment and intervention, supporting early decision making, quality and flow.
179 Assessing the effectiveness of the Integrated Care Team for Older Persons: a patient satisfaction survey
Authors: Burke K , Connolly W , Wade R , Devitt A , Ciuba D , Cooney F , Dore F , Bhroin A U
Published: September 2023

Background

The Integrated Care Team for Older Persons (ICPOP) commenced operations in June 2022 with a goal of providing quality and person centred care. To assess the effectiveness of the service and enhance the patient experience a patient satisfaction survey was conducted. This qualitative study aimed to evaluate and reflect on the collected data for improving the ICPOP service.

Methods

The feedback questionnaire was adapted from the ICPOP, Community Healthcare East. It is a seven item questionnaire with an additional section for feedback and suggestion for service development and improvement. This questionnaire was sent to patients discharged from the ICPOP service during the months October 2022 to March 2023 inclusive (n = 30). Completed questionnaires and feedback forms were received and information collated (n = 18). To increase the respondent rate, telephone calls were made resulting in a response rate of 60%. The feedback and suggestion section were analysed using thematic analysis.

Results

All participants reported a positive experience following ICPOP intervention and would wish to receive input again. 61% rated their overall experience as ‘excellent’, 23% as ‘very good’ and 16% as having had a ‘good’ experience. 94% of respondents agreed that the treatment they received was effective and would recommend to another older person. 78% of respondents also provided written feedback. 12% of the feedback received provided recommendation for communication and integration with home care applications and service development. 66% of the feedback expressed gratitude and appreciation for the Multi-Disciplinary Team (MDT) service.

Conclusion

Older persons who received input from the Integrated Care Team for Older Persons reported a positive experience and expressed their gratitude for the timely service delivery. Receiving feedback on this new service promotes service development and enables the team to understand the impact and experiences of older persons who received ICPOP intervention and support.
182 Pharmacists’ opinions on deprescribing Fall Risk Increasing Drugs in older people
Authors: Kalim R , McMahon N , Ryder S
Published: September 2023

Background

Falls are prevalent in older adults and can be associated with medication use. Pharmacists play a role in deprescribing Fall Risk Increasing Drugs (FRIDs) and fall prevention. The aim of this study was to explore the factors that prevent or influence the process of deprescribing of FRIDs in older adults, from a pharmacist’s point of view.

Methods

Individual online semi-structured interviews, involving clinical pharmacists (CPs) who work with older adults in hospitals, were conducted. The interviews were steered by an interview guide based on the Theoretical Domains Framework (TDF) and interviews continued until saturation. The transcripts were coded using NVivo 12. Challenges and enablers were matched with possible behavioural change techniques, to identify potential future intervention strategies.

Results

Twelve senior CPs participated in the study (11 female and 1 male; years of practice range 5–30 years). Common challenges included: deprescribing FRIDs not being prioritised by medical teams; medication review is time-consuming; written recommendations to doctors not always read/actioned; fear of withdrawal symptoms; and follow up on patients after discharge is difficult. Deprescribing enablers included: building good team relationships, the belief that medication review is a shared responsibility, verbal being the most effective method of communication, medication review being a core part of pharmacists’ workload, and having the opportunity to review medication and monitor during the inpatient stay.

Conclusion

Work environment challenges and concerns about safety after discharge were considered significant barriers to deprescribing FRIDs in hospitals. Involving pharmacists in multidisciplinary teams in hospitals may facilitate deprescribing.
191 Intermittent: an audit of venous thromboembolism prophylaxis on our stroke unit
Authors: Young C , Sori I F B Mohd , James K
Published: September 2023

Background

The National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends immobile stroke patients receive Intermittent Compression Stockings (IPCs) to prevent Venous Thromboembolism (VTE) from days 3 to 30 of admission. We set out to audit IPC usage on the stroke unit in our hospital.

Methods

Data was collected for all 31 stroke unit patients on a single day by two NCHDs. We documented age, gender, length of stay, and mobility status. We recorded completion of the VTE risk section of the medication chart, and if the patient was prescribed single antiplatelet (SAPT), dual antiplatelet (DAPT), direct oral anticoagulant (DOAC) or IPCs. We also noted if the patient’s stroke was ischaemic or haemorrhagic.

Results

16 patients were male (52%). Mean age was 72 years old. Median length of stay was 29 days. 23 patients had ischaemic strokes (74%), 8 had haemorrhagic strokes (26%). 21 patients had their VTE risk section completed (68%). 9 ischaemic stroke patients were on DOAC, 9 on SAPT, 4 on DAPT, and 1 was on no therapy. 19 patients (61%) were immobile (assistance of one or higher dependency). Of these, 9 had been admitted for between 3 and 30 days. None had IPCs prescribed and only 1 (11%) had them in situ. 3 were on DOAC therapy (33%). One other patient (admitted 41 days prior) had IPCs in situ but not prescribed.

Conclusion

89% of appropriate stroke patients did not have IPCs in situ, and 56% had no VTE prophylaxis at all. The VTE risk section of the medication chart was blank in 32% of cases. Based on these results we are conducting a root cause analysis as to why guidelines are not adhered to. This will guide a planned quality improvement initiative.
195 Enhancing the care of the older adult with delirium in the emergency department: the implementation of non pharmacological strategies
Authors: Mitchell M , Riches R , Breslin D , Byrne C , Magner S , Carey S , Binions L , Cashman S , Bowden H , Laguna R , McAteer C , O'Caheny C , McKenzie L
Published: September 2023

Background

Frail older adults presenting to an acute setting are vulnerable to the adverse effects of hospitalisation including the risk of developing in-hospital delirium. Last year in Ireland the average ED waiting time for the >75 adult was over 13.8 hours and a stay 3 times longer than those >65. A stay of ten hours or more within the ED for the older adult will double the risk of developing in-hospital delirium within the following 72 hours. This can potentially result in the further risk of mortality, morbidity, and dependence for long term care. National Clinical Delirium Guidelines state that the management of delirium is primarily non-pharmacological. However, adequate access to these types of interventions is limited with in the ED.

Methods

The Frailty Intervention Team (FIT) completed Comprehensive Geriatric Assessment (CGA) with everyone over the age of 65 years old that attended the Emergency Department within hours of work. The 4 AT (Assessment Test for Delirium and Cognitive Impairment) was used to identify those who were delirious or at high risk of delirium. Once identified non-pharmacological strategies (orientation, early mobilisation, and comfort measures) were used to support the management of delirium. This was achieved by provision of seating, orientation clocks and a comfort trolley.

Results

Over 3-month period 64 patients reviewed by the FIT were highlighted as delirious or at risk of delirium. Once a patient was identified delirium protocol was followed and orientation, early mobilisation and comfort measure was provided by the FIT. 30 patients were facilitated to sit out in the ED through new provision of chairs.

Conclusion

A delirium friendly environment, appropriate seating and access to non-pharmacological therapies promotes quality of care, education and best practice in delirium management within the Emergency Department.
215 Including dementia simulation in caregiver education enhances knowledge, confidence, empathy and caregiving approach
Authors: O'Reilly S , Murphy F , McCabe D , McGlynn B , Clarke C , Kennelly S
Published: September 2023

Background

An estimated 64,000 people currently live with dementia in Ireland, with this number expected to rise to 150,000 by 2045. For every one person with dementia, there are approximately three others providing support and care. Caregivers can often undergo a decline in physical and mental health and experience feelings of isolation and loneliness. Caregiver education and support can help to mitigate these challenges. Lecture based programmes on their own have a limited effect on understanding the lived experience of the person with dementia, whereas including simulation based empathy building elements can lead to better quality outcomes for caregivers and the person with dementia. A multi-component education programme for family caregivers incorporating dementia simulation, was devised and implemented over 7 weeks. Topics included dementia awareness, delirium, communication, non-cognitive symptoms, self-care, and accessing practical community supports.

Methods

A survey measuring Person-reported outcomes (PROMS) and Person-reported experience (PREMS) was conducted with 14 caregivers attending two pilot groups.

Results

100% of participants felt that the group enhanced their knowledge of dementia and increased their confidence in supporting their loved one as dementia progresses and in relation to non- cognitive symptoms. 100% of the participants found that peer support was extremely beneficial. They also felt that the group was welcoming and felt comfortable sharing in the group. All participants indicated that dementia simulation helped increase understanding of what it is like to have dementia, often reframing their relationship with their loved one.

Conclusion

The benefits of peer supports and dementia awareness education for caregivers are well documented and this survey supports these assumptions. However, for caregivers the addition of dementia simulation scenarios and role play enhanced their understanding of the lived experience of people with dementia, building empathy and confidence in their role, decreasing stress and leading to changes in caregiving approach.
244 Delays in DXAs: an audit on the ordering of DXA scans for fragility fractures in a level 3 university hospital
Authors: Carvalho J , McGurk C , McPartland A , Rooney B , Ong J , O’Malley G
Published: September 2023

Background

Osteoporosis is a serious public health problem due to a rapidly ageing population. One in two women and one in five men will break a bone after the age of 50. Fragility fractures are common, costly and lead to significant changes to a person’s QOL. Many of these fragility fractures can be prevented by timely intervention by a Fracture Liaison Service (FLS). The Royal Osteoporosis Society (ROS) has a Summary of Clinical Standards for FLS’s to inform the best practice of managing bone health risk after a fragility fracture. These standards are underpinned by evidence demonstrating that they are clinically and cost-effective. The standards state that patients aged >50 with a new fragility fracture should be offered an assessment including a quality-assured axial DXA, within 12 weeks of fracture diagnosis.

Methods

The data set of the 847 fragility fractures identified by the FLS was analysed between January 2021 and April 2023. Of these confirmed fragility fractures, it was then assessed who had DXA scans booked and by whom.

Results

Of the 847 patients identified by FLS, 598 (70.6%) had been recommended to the GP to order a DXA scan, 8 (0.94%) had a DXA booked by the FLS, 133 (15.70%) already had a DXA performed and 26 (3.07%) were deemed that a DXA was not necessary and 1 (0.12%) had been booked by the clinical team.

Conclusion

According to this audit, most DXA scans are organised by the FLS writing to the GP to organise the DXA scan. We believe this leads to unnecessary delays in DXA scanning and places more pressure on GPs. This audit highlights the need for the ANP in FLS to collaborate with colleagues in other departments and specialities to help maximise the identification and treatment of people at risk of osteoporosis.
247 Assessing the impact of a new integrated care framework for nursing home residents
Authors: Farrelly A , Faherty L , Garcia R , Saric D , Ryan M , Thavarajah K , Martin R , Kennelly S
Published: September 2023

Background

Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals.

Methods

A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records.

Results

174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments.

Conclusion

Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.
253 An audit of the inpatient management of Parkinson’s Disease medication in a level four hospital in 2019
Authors: Reidy C , Farrell T , Naylor C , Pope G , Cooke J , Bambrick P , Mello S , O'Regan N , Mulcahy R
Published: September 2023

Background

Parkinson’s Disease (PD) is a progressive, complex neurodegenerative disease characterised by both motor and non-motor symptoms. PD medications are time sensitive, and their correct prescription and administration are crucial in optimal management strategies. Previous work presented at the Irish Gerontological Society showed a lack of knowledge regarding PD and its medications among healthcare staff in a level four hospital.

Methods

Data were collected from a retrospective chart analysis of PD admissions in 2019. 115 admissions coded PD were identified from HIPE data. Subsequently, 10 patients were randomly selected from medical, surgical, and orthopaedic admissions respectively (39 admissions). Patients were excluded if they were not on PD-specific medications or if their drug Kardex was not available. 28 patient Kardex’s were reviewed. Data was collected using a predetermined spreadsheet and analysed using Microsoft Excel.

Results

100% of patients were on levodopa medication. 86% of patients did not receive their appropriate PD medications in the Emergency department. 21% had errors in medication prescription (omitted drug [n = 4, 14%], incorrect timings [n = 2, 7%]) on admission. 75% missed at least one dose of levodopa. 83 doses of levodopa were missed across the 28 admissions. 40% were because the patient was nil by mouth (NPO), while 21% had no reason documented. 64% of patients had doses of levodopa delayed by more than 1 hour, with over 80% of these in the perioperative period. 5 patients (18%) received antidopaminergic drugs.

Conclusion

This review highlighted multiple shortcomings in PD medication management during acute admissions. We introduced hospital guidelines for the management of patients with PD while NPO. This guideline includes information on alternatives to oral route, advice regarding the perioperative period, and medications to avoid. It has been approved by the Medications and Therapeutics committee and will be introduced with education sessions at the changeover. We will reaudit practices after 6 months.
255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service
Authors: Clancy M , Curran S , Kerins E , Deane U , McCarthy O , Cregg P , Hayes K , Whelan E , Quinn C , Ryan S , Manning M , Griffin A
Published: September 2023

Background

Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes.

Methods

Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed.

Results

In total, 53 participants were included: 70% were aged >65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity.

Conclusion

cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.
307 An audit of dual antiplatelet prescribing after minor ischaemic stroke
Authors: Okpaje B , Reddin C , Walsh T , Waters R
Published: September 2023

Background

The American Heart Association make class 1A recommendation for dual antiplatelet therapy for secondary prevention in patients with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤ 3) or high risk TIA on the basis of evidence from randomised controlled trials, such as POINT and CHANCE, which have demonstrated a lower rate of subsequent stroke compared with single antiplatelet therapy. A number of clinical factors have been shown to influence effectiveness, including time from symptom onset to initiation of dual antiplatelet therapy. We aim to evaluate the rate of dual antiplatelet prescribing in this cohort and whether the rationale not to prescribe was clearly documented.

Methods

We reviewed the electronic records of all stroke patients aged 18 and above, admitted to University Hospital Galway within June 1st to September 29th 2022. Patients who either had a minor ischaemic stroke with a clearly documented NIHSS score of ≤3 were included in the analysis. These records were then assessed for the rate of dual antiplatelet prescribing versus single antiplatelet prescribing and if the rationale was documented.

Results

Of 29 patients admitted with minor ischaemic stroke, 8 were commenced on dual antiplatelet therapy. The mean number of days from symptom onset to presentation was 1.92 for those who were prescribed DAPT and 2.42 for those who were prescribed SAPT. Of those prescribed SAPT, the rationale for not commencing DAPT was documented. Rationale included delay to presentation (>72 hours) and atrial fibrillation.

Conclusion

48.3% (n = 14) DAPT was either prescribed or a documented rationale for SAPT was provided. Our findings are consistent with DAPT prescribing patterns in other studies [1].
315 Financial planning as part of an integrated care comprehensive geriatric assessment
Authors: Lynch A , Murphy D , Loughlin E , Mannion K , Neachtain M Ni , Sheil Edel , Donohue M , McCleane F , Geoghegan J , Canavan M , Murphy R , Costello M
Published: September 2023

Background

Evaluation of a social support network, including the need for support in managing finances independently is an essential component of Comprehensive Geriatric Assessment (CGA). Safeguarding of finances (e.g. third party authorities, enduring power of attorney, will) should be encouraged in all order adults, particularly those with cognitive decline to provide security and protection of their wishes should they lose capacity to manage financial decisions. We sought to evaluate financial competency and preparedness in a population attending our Integrated Care for Older Persons (ICPOP) service.

Methods

Participants included were new patients referred to ICPOP between January and May 2023 with completed CGAs. A retrospective analysis was conducted of patient demographics, ability to independently manage finances, dependency on personal and instrumental activities of daily living.

Results

Of our analytic cohort (n = 85), 56% (n = 48) were female, median age was 81. The most common reason for referral was new change in cognition which accounted for 48% (n = 41/85) of patients. Median Rockwood Clinical Frailty Scale was 5. Median Barthel score was 17. Median Lawton-Brody score was 4/8 with 80% (n = 68) patients scoring 1 in the financial section which indicates their ability to manage their finances partially or completely. 60% (n = 51) of patients collected their own pensions and on specific questioning reported managing their finances independently. No patient had an advanced care directive, 90% (n = 77/85) did not have EPoA and 41% (n = 35/85) did not have a will.

Conclusion

We identified that in those attending our service, very few had EPoA in place with no person having a documented advanced care directive. Over half required some if not total assistance with financial matters. Supported decision making is essential to uphold the right of the older person to make choices on their welfare, property and affairs and CGA provides opportunity for intervention in this remit.
327 A review of patients referred to community rehabilitation (ExWell Medical) from gerontology clinic in a regional hospital
Authors: Conroy K , Sibthorpe L , Goulden E , Donnelly T , McGlynn J
Published: September 2023

Background

ExWell Medical is an established community-based chronic illness rehabilitation programme which was founded in 2006. It is a not-for-profit company with over 2000 in-person patient visits per week, across 22 centres in Ireland. Its referrals stem from hospital consultants, general practitioners and other allied health professionals. The rationale behind ExWell Medical is that a large proportion of the disability that comes with any long-term illness is caused by deconditioning. It is particularly aimed at the ageing population who may find it difficult to engage with local services and have poor motivation. ExWell Medical offers community-based supervised exercise classes, as well as home programmes.

Methods

We performed an audit looking at the number and demographics of patients referred to ExWell Medical from 12/01/2022–22/5/2023 from the Gerontology Frailty Hub in a regional hospital. All patients attending the clinic during this time were included, and data was logged at each appointment. I then performed a retrospective analysis of patients referred to community rehabilitation.

Results

The total number of patients was 656 (322 male (49%), 334 female (51%). Of these, 67 were referred to ExWell Medical, 587 did not warrant referral and 2 were excluded due to lack of data. This correlates with a 10.2% referral rate. We proceeded to assess the demographics of those referred, which showed 67% were female and 33% were male. With regards to age; 4 patients were < 70 (6%), 15 were 70–75 (22.3%), 23 were 76–80 (34.3%), 14 were 81–85 (21%), 10 were 86–90 (15%) and 1 patient was over 95 (1.5%).

Conclusion

The referral rate to ExWell Medical was less than expected, and especially low in men. By highlighting this we hope to increase the number of patients referred in the future, as well as reducing the gender disparity.
341 Auditing the timing of CT-Brain and Angiograms in suspected acute stroke
Authors: O'Loghlin R , O'Malley T
Published: September 2023

Background

Timing of neuroimaging play a key role in the management and ultimate outcomes of patients presenting to hospital with a suspected acute stroke. The NICE Guidelines on the initial management of suspected acute stroke and the NHS National Stroke Service Model set a target of less than 20 minutes between arrival to hospital and having a CT-Brain and CT-Angiogram performed, analysed, and reported. A clinical audit was performed looking at the timing of all CT-Brain studies performed in 2022 at a level three hospital in Ireland where acute stroke was the suspected presentation.

Methods

A total of 206 CT-Brain and CT-Angiogram studies were included in the audit. The time of the patients’ registration in the emergency department was compared to the timestamp on NIMIS of the completion of each CT study and of the time of publication of the radiologist’s report. For patients already admitted on a hospital ward, the time that the CT study was requested was used in lieu of arrival time.

Results

The average time between arrival in the emergency department and the completion of CT-Brain was 82 minutes. The average time between the completion of the CT and the publication of the radiologist’s report was 26 minutes, however many studies had verbal reports delivered to the requesting physician prior to publication of the report. Altogether, the average time for the performance and reporting of a CT-Brain and Angiogram in patients with suspected acute stroke was 108 minutes.

Conclusion

The average of 108 minutes from door to scanner to reported CT-Brain and Angiogram is significantly longer than the 20 minutes recommended by the NICE Guidelines. This hospital serves a large, rural catchment which makes late presentations common, adding to the urgency of neuroimaging for these patients. In future, key areas of in-hospital delay in CT performance and reporting should be identified and given close attention.
345 Integration of care for older adults: an evaluation analysis of the clinical pathways from the emergency department
Authors: O'Neill S , Linehan D , Sankey C , Carville M , Latoza W , Marks M
Published: September 2023

Background

There is an urgency globally to create novel healthcare models for the older adult population considering the ever-growing demographic. Ireland’s Integrated Care Programme for Older People (2016) emphasises the importance of delivering healthcare to older adults in their community with focus on the direct access to services from the Emergency Department (ED). This ‘frailty at the front door’ team sought to evaluate the clinical pathways facilitating direct integration of care into the community following completion of the Comprehensive Older Adult Assessment (COAA) in the ED of a model 3 hospital.

Methods

The team conducted an evaluation analysis of the critical pathways referring patients to the community directly from the ED. The team recorded the quantity of referrals to each community service on discharge over a period of six months from October 2022–March 2023. This included Health Services Executive (HSE) services and voluntary sector services. The results included admission avoidance pathways. The team completed a case study review for individuals readmitting to the ED within 7 days and 30 days.

Results

796 Older Adults were assessed by the team in the ED. 368 Older Adults were discharged directly to the community. From January–March 2023 there were 79 admissions avoided. For those discharged, there were 440 onward referrals made to community-based services. These included 91 referrals to Primary Care Physiotherapy, 83 to Public Health Nurse, 60 to Primary Care OT, 45 to the Community Intervention Team, and 11 referrals to the Dementia Advisor. The 7 day readmission rate ranged from 0–4% per month. The 30 day readmission rate ranged from 5–13%.

Conclusion

There was a high level of integration of care between the ED ‘frailty at the front door’ team and voluntary or HSE community services. The low readmission rate demonstrates the effectiveness of the discharge pathways in enhancing the safety of discharges.
84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis
Authors: O’Donnell D , Radomska A , Shé É Ní , Davies C , O'Shea M , Devaney C , Donnelly S , O'Donoghue G , De Brún A , Whitty H , Harnett P J , Lang D , Harrison R , McAuliffe E , Ahern E
Published: September 2023

Background

Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons.

Methods

Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design.

Results

This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O).

Conclusion

The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.