bluuebunny/crossref_metadata_2025 huggingface dataset:
A review: Wireless sensor network location
Authors: Xiao Qing
Published: September 2023

Node localisation is one of the important technologies in wireless sensor networks, and localisation algorithms are the core elements of localisation technology. This paper first lists the evaluation criteria of localization performance, the related terminology used in localization technology, and the classification and analysis of localization algorithms. The paper introduces various node localisation algorithms based on both ranging and non-ranging aspects, and finally presents the shortcomings of the current wireless sensor network localisation technology and provides an outlook on future research prospects.
Navigating the ecosystem flood regulation service flows from subbasin to catchment in the Han River Basin
Authors: Liu Wenping , Li Yan , Chen Shuaipeng
Published: September 2023

With the increasing cross-regional impact of climate change increasing in recent years, the Han River Basin, as a vital water resource supply and densely populated area in China, faces severe cross-regional flood threats and challenges. The systematic consideration of flood regulation throughout the entire upstream and downstream of the basin has become imminent. Our research aims to gain a deeper understanding of the ecosystem flood regulation service flows from upstream to downstream within subbasins and catchments scales of the Han River Basin. The results showed that the overflow path from upstream to downstream of the flood was basically consistent with the trend of the stream and the main tributaries of the Han River. It emerged that subbasins c, e, g, h and k were the key areas for the overall regulation of the upstream and downstream floods at subbasin scale. A total of 11 catchments overflow into their adjacent downstream catchments across the subbasins, a fact which is critical for catchment scale flood regulation. What’s more, there is evident interaction not only between adjacent subbasin and catchment units but also substantial exchange of service flows between non-adjacent units. Notably, catchment c’s flood regulation service flow was primarily contributed by its non-adjacent units. These findings not only contribute to filling the current knowledge gap in cross-watershed flood overflow and flood regulation service flows, but also provide support for the integrated response of upstream and downstream flood disaster risk management at the whole basin scale.
The asymptotic form of the Hagedorn temperature in planar
super Yang-Mills
Authors: Ekhammar Simon , Minahan Joseph A , Thull Charles
Published: September 2023

Using the supergravity dual and the plane-wave limit as a guide, we conjecture the asymptotic large coupling form of the Hagedorn temperature for planar

super Yang-Mills to order

1

/

λ

. This is two orders beyond the presently known behavior. Using the quantum spectral curve procedure of Harmark and Wilhelm, we show that our conjectured form is in excellent agreement with the numerical results.
Orbital expansion variational quantum eigensolver
Authors: Wu Yusen , Huang Zigeng , Sun Jinzhao , Yuan Xiao , Wang Jingbo B , Lv Dingshun
Published: September 2023

Variational quantum eigensolver (VQE) has emerged as a promising method for investigating ground state properties in quantum chemistry, materials science, and condensed matter physics. However, the conventional VQE method generally lacks systematic improvement and convergence guarantees, particularly when dealing with strongly correlated systems. In light of these challenges, we present a novel framework called orbital expansion VQE (OE-VQE) to address these limitations. The key idea is to devise an efficient convergence path by utilizing shallower quantum circuits, starting from a highly compact active space and gradually expanding it until convergence to the ground state is achieved. To validate the effectiveness of the OE-VQE framework, we conducted benchmark simulations on several small yet representative molecules, including the

H

6

chain,

H

10

ring and

N

2

. The simulation results demonstrate that our proposed convergence paths significantly enhance the performance of conventional VQE. Overall, our work sheds valuable insight into the simulation of molecules based on shallow quantum circuits, offering a promising avenue for advancing the efficiency and accuracy of VQE approaches in tackling complex molecular systems.
UAV-based height measurement and height–diameter model integrating taxonomic effects: exploring vertical structure of aboveground biomass and species diversity in a Malaysian tropical forest
Authors: Takeuchi Yayoi , Borjigin Habura , Niiyama Kaoru , Sato Tamotsu , Fukaya Keiichi , Okuda Toshinori , Hayashi Masato , Omar Hamdan , Norizan Azharizan Mohammad
Published: September 2023

The complex stratification of tropical forests is a key feature that directly contributes to high aboveground biomass (AGB) and species diversity. This study aimed to explore the vertical patterns of AGB and tree species diversity in the tropical forest of Pasoh Forest Reserve, Malaysia. To achieve this goal, we used a combination of field surveys and drone technology to gather data on species diversity, tree height (H), and tree diameter at breast height (D). As all trees in the 6 ha plot were tagged and identified, we used the data to classify the taxonomy and calculate species diversity indices. We used unmanned aerial vehicle-based structure-from-motion photogrammetry to develop a Digital Canopy Height Model to accurately estimate H. The collected data and previous datasets were then used to develop Bayesian height–diameter (HD) models that incorporate taxonomic effects into conventional allometric and statistical models. The best models were selected based on their performance in cross-validation and then used to estimate AGB per tree and the total AGB in the plot. Results showed that taxonomic effects at the family and genus level improved the HD models and consequent AGB estimates. The AGB was the highest in the higher layers of the forest, and AGB was largely contributed by larger trees, especially specific families such as Dipterocarpaceae, Euphorbiaceae, and Fabaceae. In contrast, species diversity was the highest in the lower layers, whereas functional diversity was the highest in the middle layers. These contrasting patterns of AGB and species diversity indicate different roles of forest stratification and layer-specific mechanisms in maintaining species diversity. This study highlights the importance of considering taxonomic effects when estimating AGB and species diversity in tropical forests. These findings underscore the need for a more comprehensive understanding of the complex stratification of tropical forests and its impact on the forest ecosystem.
17 The case for more specialist geriatric wards: redesigning health systems to meet the needs of older persons
Authors: Conlon C , Murphy R , Small C
Published: September 2023

Background

The National Clinical Programme for Older Persons outlines that each hospital should have a dedicated Specialist Geriatric Ward (SGW) with appropriate staffing and access to Health and Social Care Professionals. As part of a quality improvement initiative to drive the development of a new SGW, we examined what proportion of older medical admissions had care needs that would be best served in a Specialist Geriatric Ward.

Methods

We completed a retrospective cohort study of unselected medical admissions over a two week period in a level four hospital. We established criteria that would deem a patient suitable for admission to a specialist geriatric ward and examined the journey of patients who were or were not admitted under the care of Geriatric Medicine.

Results

In total over the two week period there were 307 admissions, with 144 over the age of 75 years (47%). Over half of patients had more than one bed moves during their inpatient stay. 78% were frail. 109 (75%) of patients would have been eligible for care on a specialist geriatric ward. 20% of the over 75 year olds were admitted under the care of Geriatrics. 72% of the remaining patients admitted under general medical teams would have met the criteria for care on a specialist geriatric ward. 20% of this cohort had a review by the frailty at the front door team with 23% having an inpatient geriatric medicine consult.

Conclusion

A significant proportion of older adults being admitted have care needs that would benefit from coordinated care on a specialist geriatric ward. Patients receive input from geriatric medicine through a variety of avenues but there is a need for increased access to specialist geriatric inpatient wards. This would improve patient access to the Right Care, in the Right Place at the Right Time.
66 The PROMOTe study: prebiotic supplementation improves cognition versus placebo in healthy older twins
Authors: Lochlainn M Ni , Bowyer R , Whelan K , Steves C J
Published: September 2023

Background

There is a growing body of evidence linking the microbiota in the human gut, to the brain and to physical function. Animal and human studies have shown that inducing changes in the microbiota can alter muscle physiology and cognitive behaviour, indicating causative pathways. The PROMOTe trial aimed to test whether the gut microbiome mediates anabolic resistance to protein in older adults. A secondary objective was to test whether modulation of the gut microbiome using a pre-biotic food supplement, improved cognition versus placebo.

Methods

This placebo-controlled double-blinded randomised controlled trial used twin pairs, recruited from the TwinsUK cohort. Those aged > = 60, with low baseline protein intake, and access to a computer (due to remote trial delivery) were included. One twin received protein supplementation plus placebo and the other received protein supplementation plus a gut microbiome modulator (prebiotic). Intervention period was 12 weeks. Participants were advised to take 1 supplement sachet daily, and to undertake resistance exercises. The primary outcome was muscle strength as measured using chair-rise time. Cognition (CANTAB battery) was a secondary outcome. Linear mixed effects regression models were used to compare intervention groups (arm 1 vs arm 2; blinded). Twin clustering was considered as random effects, both family identifier and zygosity, and treatment group as fixed effect.

Results

Target sample size was 70 individuals. We screened 626 and randomised 72 participants (36 pairs). More adverse events occurred in the prebiotic group (n = 8 versus n = 2 in placebo group; p = 0.041), but compliance remained high in both groups (% adherence >78% in each group; p = 0.37). There was no significant difference between arms for the primary outcome of chair rise time (coefficient 0.184; 95% CI -0.569-0.938; p = 0.631). The prebiotic intervention arm had an improved cognition factor score versus the placebo group (coefficient 0.482; 95% CI 0.823–0.141; p = 0.014).

Conclusion

Prebiotic food supplementation improves cognition versus placebo in a cohort of healthy older twins.
169 Cost-effectiveness analysis of geriatrician-led perioperative services in district general hospitals
Authors: Hall H , Paveley A , Tite M , Clayton A , Godfrey L , Dhesi J , Gupta S , Mandal A
Published: September 2023

Background

Perioperative care for Older People undergoing Surgery (POPS) services using Comprehensive Geriatric Assessment (CGA) and optimisation methodology in the perioperative setting are clinically and cost effective. Originally described within a tertiary centre, the POPS model has been successfully translated to district general hospital (DGH) settings. The aim of this project was to deliver a cost-effective, CGA-based perioperative service for older people at an NHS trust operating across two geographically separate district general hospitals, with support from the newly established POPS Network, an initiative designed to scale up POPS services across the NHS.

Methods

A POPS service had been informally provided by two consultant physicians since 2017, but the service was formalised through the NHS Elect POPS network in 2021. Data were collected from 50 consecutive patients reviewed in POPS outpatient clinic, over a six-week period. Patients with polypharmacy (defined as prescription of five or more drugs) were identified and the number of medications deprescribed was catalogued. The number of specialty referrals or additional outpatient appointments avoided by early CGA was also recorded. Additionally, prospective data on drugs deprescribed on 90 consecutive surgical inpatients were analysed. Economic evaluation was conducted by the trust’s financial and pharmacy departments.

Results

For POPS outpatients, through prevention of onward specialty referral or other outpatient appointments (mean 2.54 per patient), cost saving was calculated at £803 per patient. This generated an extrapolated annual saving of £385,440 at each site. For inpatients, pharmacological optimisation led to an estimated annual cost saving of £239,000, with on average two medications deprescribed per patient. Subsequent benefits realisation analysis at 18 months demonstrated that these results remain consistent.

Conclusion

POPS services within DGHs, when delivered by clinicians who practise holistically, have a significant positive financial impact through pharmacovigilance and by preventing unnecessary specialty referrals and outpatient appointments. These cost savings of over £500,000 have easily funded the substantive service.
239 Predictors of raised bone turnover markers after transitioning to Zoledronic acid from denosumab
Authors: Bradley E , Fitzpatrick D , McLoughlin S , Maher N , Carraher J , O'Carroll C , Steen G , Fallon N , Lannon R , McCarroll K
Published: September 2023

Background

Denosumab is a commonly used to treat osteoporosis though if stopped there is a rebound increase in bone turnover and vertebral fracture risk. Treatment with Zoledronic Acid (ZA) after denosumab discontinuation is recommended to reduce this risk, though in some patients a second ZA infusion may be required six months later to maintain adequate suppression of Bone Turnover Markers (BTM). We aimed to assess the proportion of patients with a sub-therapeutically suppressed BTM after a single dose of ZA post denosumab cessation and explore for predictors of this.

Methods

We identified patients at our bone health clinic who received ZA 6 to 9 months after the last and final denosumab injection. BTM measured was cross linked C-Telopeptide type I collagen (CTX). Sub-therapeutic BTM response was defined as a CTX >0.300 ng/ml. Logistic regression was used to explore for prectiors of CTX >0.300 including age, body mass index (BMI), denosumab duration and lumbar spine bone mineral density (BMD).

Results

There were 88 patients, 93% female with a mean age of 67 years. Median duration of denosumab therapy was 5.0 years and 44% had osteoporosis prior to transitioning to ZA. Mean CTX after ZA (median 127 days post ZA) was 0.252. However, 45% had a CTX >0.300 and in these patients the median value was 0.412. Older age (p = 0.045), longer denosumab duration (p = 0.010) and lower BMD at the spine (p = 0.008) were associated with a CTX >0.30.

Conclusion

A large proportion (45%) had subtherapeutic BTM suppression 3 to 6 months after receiving ZA post stopping denosumab and this was predicted by older age, lower spine BMD and longer denosumab duration. Guidelines suggest a second ZA infusion at 6 months in such patients. If transitioning to ZA, findings highlight the importance of optimising BMD first, especially in older adults with longer denosumab therapy.
248 Influence of self-efficacy on older adults’ perspectives and engagement with technology
Authors: O'Neill M , Walsh K , Poli A , Vogel C
Published: September 2023

Background

Self-efficacy has been demonstrated to influence individuals’ perspectives and preferences in relation to technology use, and informs disparities observed among older adults in terms of their access and use of information communication technology. However, research exploring the effects of technological self-efficacy on the consequent virtual engagement among older adults is scarce. The relationship between self-efficacy and varying levels of technology use and proficiency needs to be considered. These factors not only shape older adults’ perspectives on technology use but also impact their adaptation and engagement in critical areas of daily life: including information access, advocacy, and social participation. This paper investigates the relationship between the adoption of and attitudes towards technology among older people, the role of self-efficacy in informing these attitudes, and the level of use or perceived usefulness of technology.

Methods

The study draws on in-depth interviews with older adult members (n = 40) and stakeholders (n = 30) of a nationally representative membership-based grassroots older adult organisation in Ireland. The semi-structured interviews explored individuals’ experiences of technology use, focusing on daily routines, social connectedness, information access, and civic participation.

Results

Findings reveal that narratives about daily routines involving technology are influenced by perceptions of self-efficacy in relation to technology in general. However, this self-efficacy is also influenced by other factors that influenced interaction with technology in the daily lives of older people. Dependence on social support can paradoxically impair self-efficacy when such support is withdrawn. An ideology of individual responsibility sometimes led participants to view themselves as the problem when struggling with digital engagement, contributing to a lack of confidence and motivation.

Conclusion

While technology development for older people is progressing, there is less consideration of the correlation between technology adoption rates and self-efficacy. This paper proposes interventions to empower individuals, enrich virtual engagement, and reduce technological inequalities. Understanding these dynamics could help shape inclusive technological engagement practices and policies for older adults.
256 How prevalent are markers of blood pressure instability on Ambulatory Blood Pressure Monitoring of older people with falls, faints & dizziness?
Authors: Madden R , Briggs R
Published: September 2023

Background

In older people with BP-related falls, the mechanisms that usually tightly control Blood Pressure (BP) may be less efficient, leading to BP instability. This may manifest as specific markers on Ambulatory Blood Pressure Monitoring (ABPM), including BP variability, BP dipping and absence of nocturnal dipping/reverse dipping. The aim of this study therefore is to ascertain the prevalence of APBM markers of BP Instability among older people with falls/faints/dizziness and examine if there is an age-gradient seen for these markers.

Methods

ABPM data (minimum 25 BP values measured across 24 hours) was collected for 83 consecutive patients aged ≥70 years attending a tertiary-referral Falls & Syncope Unit with falls, fainting or dizziness. Data analysed included BP Variability (standard deviation (SD) of BP values, i.e. measurement of the oscillation of BP measurements); Nocturnal dipping (decrease in average night BP compared to average day BP) and BP dips (number of systolic BP values <100 mm Hg).

Results: Of the analysed ABPMs(n = 83, mean age 78 years, 48% female), mean number of readings per device was 34.6 (33.7–35.5). The average SD for overall systolic BP was 15.9. Over 15% of patients had an average SD ≥20 for systolic BP based on the full ABPM, reflecting high levels of BP variability. There was a significant age gradient seen for nocturnal dipping with mean change −0.30 (−9.3–8.8) in those aged ≥85 years compared to +10.9(7.3–14.6) in the 70–74 years age group. The mean number of systolic BP values<100 mm Hg was 2.9 (1.7–4.0).

Conclusion

Older patients attending with falls/faints/dizziness demonstrate significant BP variability, aberrant nocturnal dipping profiles and frequent systolic BP values dipping below 100 mm Hg. Further work is required to establish if these ABPM aberrancies are reliable predictors of future falls and potentially modifiable targets to reduce falls burden among older people.
259 Understanding carer harm- insights from family carers of people living with dementia and dementia professionals
Authors: Donnelly S , O'Brien M , Dunne N
Published: September 2023

Background

‘Carer harm’ is when carers experience violence or become subject to controlling or coercive behaviour, either on an incidental or systematic basis, resulting in physical, psychological and/or sexual harm. Little is known however about the harm experienced by carers at the hands of the person to whom they provide care. Challenges are often faced by social workers and other professionals when care and violence intersect, and a service user is the alleged perpetrator of abuse against their family carer. This study explores the concept of carer harm from the perspective of family carers of People Living with Dementia (PLwD) and dementia professionals.

Methods

The project deploys an engaged research approach that produced knowledge in collaboration with family carers and professionals. Work Package 1 involved narrative interviews with four family carers of PLwD who self-identified as experiencing carer harm. Work Package 2 involved two focus groups. One with Family Carers Ireland staff and one with dementia professionals. Work Package 3 comprised one World Café Co-Design Workshop with family carers, professionals, and service providers where education and training materials were developed.

Results

Findings indicate high levels of unmet need and psychological distress with family carers of PLwD regularly experiencing verbal and physical aggression. Stigma and shame were identified as barriers for family carers in disclosing their experiences of carer harm. Professionals reflected on their immense feelings of helplessness and frustration about their inability to respond, highlighting the link between carer harm and the absence of appropriate condition-responsive services.

Conclusion

Information booklets for family carers of PLwD were developed to raise awareness of carer harm and to empower family carers to protect themselves and seek help. A practice guide was also developed for professionals and support organisations in order to improve our understanding of and responses to, those experiencing carer harm.
291 Improving the collateral history for older people admitted to hospital: the 6 Cs
Authors: Doyle K , Lavan A , Briggs R
Published: September 2023

Background

Despite its central role in diagnostic formulation in unwell older adults, particularly those with memory problems, little scrutiny has been applied to Collateral History (CH) taking from how/when it should be performed, what information should be gathered and how it should be assimilated.

This quality improvement project aims to address this by improving processes around collateral history taking for older patients.

Methods

The objectives of this project were to: (i) Establish information that should be included in the CH, (ii) Assess if this information is currently being collected and (iii) Use this to inform a proforma to assist with CH taking. Health-Care Professionals (HCPs) involved in the care of older people ranked information from CH in terms of relevance/importance (online survey). An audit was performed on a sample of consecutive patients aged ≥65 years admitted under the geriatric medicine service from 01/02/2023–17/02/2023, to assess compliance with and content of collateral histories against our HCP survey.

Results

41 HCPs (13/41 (32%) medical, 6/41 (15%) nurse specialists, 15/41 (37%) physiotherapists/occupational therapists, 7/41 (17%) medical social workers) were surveyed. They ranked baseline and recent changes in cognition, function and mobility as key features of the CH. CHs were completed in 70% (35/50) of admissions (n = 50, mean 83 years, 42% documented cognitive impairment). Baseline cognition and function were documented in less than half of collateral histories, change in cognition in 18/35 (51%); change in function in 10/35 (29%). Baseline mobility was documented in 20/35 (57%); change in mobility in 9/35 (26%). Findings then informed an electronic patient record (EPR) proforma: ‘The 6 Cs of the Collateral History’ (Consent, Contact, Cognition, Change (Function/Mobility), Communication, Conclusion).

Conclusion

Compliance with, and content of, CHs vary widely. This QI project aims to address this by using an EPR proforma, co-designed by clinicians involved in the care of older people, to prompt/structure CH taking.
8 A prospective audit on outpatient clinical activity in a consultant-led general medical and specialist geriatric clinic
Authors: Jeyaseelan A , Casey A , O'Donnell E , Gillett A , Reardon M
Published: September 2023

Background

It is recognised that there is a significant unprecedented pent-up demand on Irish healthcare services due to the COVID-19 pandemic. This has resulted in lengthy acute hospital scheduled care waitlists. We identified a national protocol that provides guidance in the area of outpatient waiting list management. The aim of this audit was to determine if our practice was consistent with national guidance.

Methods

We conducted a prospective audit on a consultant-led medical and specialist geriatric clinic between January to March 2023 and collected data in relation to referral reason, triage category, waitlist times, clinic attendance, hospital admissions, inter-specialty communication and resolution of clinical problem prior to outpatient clinic attendance.

Results

We included 67 patient appointments in this audit. Median waitlist time was 15.5 weeks. There were 2 urgent referrals, both were not seen within the Clinically Recommended Timeframe (CRT). 94% were seen within the CRT. 11 patients (16.4%) failed to attend their clinic appointment, only 3 of which cancelled beforehand. 5 patients (7.5%) were inpatients during waitlist time and 4 had reason for outpatient referral addressed during their inpatient stay. 8 patients (11.9%) had same referrals sent to a second point of contact, only 5 had correspondence available in medical records at time of audit.

Conclusion

Our findings indicate that the majority of our waitlist times fall within national target recommendations, however more robust pathways need to be developed to ensure urgent referrals are seen promptly. They also indicate inter-specialty and patient communication need to be enhanced to minimise duplicate or unnecessary appointments that add to waitlist burden.
26 Audit of osteoporosis treatment in patients undergoing Orthogeriatric rehabilitation
Authors: O’Donovan C , Young C , Rafferty M , Ahern E
Published: September 2023

Background

There was a perceived under-prescribing of osteoporosis treatment in this population. The transition from acute hospital to rehabilitation unit presented an opportunity to check medications and institute change.

Methods

Retrospective audit of patients’ medication charts. All patients on the rehabilitation ward under the care of an Ortho-geriatrician were included. Data was anonymised and recorded in an excel file. Prescription of calcium and vitamin D (single agent or combination) and targeted osteoporosis medications were recorded. Data collection performed by the specialist registrar on a ward round with the consultant. Interventions included education of Non-Consultant Hospital Doctors (NCHDs) to encourage proactive prescribing and documentation of the bone protection plan on the transfer summary. A re-audit was undertaken at a two month interval using the same methodology.

Results

12 medication charts were examined as part of the initial audit. 10/12 had a neck of femur fracture and 2/12 had fragility fractures of the tibia/fibula requiring surgery. Zero patients were prescribed calcium alone, two vitamin D alone and 9/12 were on combination calcium and vitamin D. No patients were prescribed targeted osteoporosis treatment. 1/12 patients had a documented plan regarding bone protection. Re-audit examined 10 medication charts. 9/10 had a neck of femur fracture, 1/10 had a fracture of both the distal femur and the proximal humerus. Zero patients were prescribed calcium alone, three vitamin D alone and 6/10 were on combination calcium and vitamin D. 2/10 were prescribed oral bisphosphonate, 5/10 denosumab and 1/10 intravenous bisphosphonate. The remaining two patients did not yet have osteoporosis treatment prescribed.

Conclusion

Despite all of the initial patients being >14 days post-operative the majority did not have a plan or prescription for bone protection representing a missed opportunity to prevent further fractures. Re-audit post education demonstrated an 80% improvement in prescription of osteoporosis treatment.
27 An evaluation of suicidality of those over 65 years referred to liaison psychiatry in the acute hospital setting
Authors: Flood J , Butler A
Published: September 2023

Background

The Mental Health Service for Older People (MHSOP) Liaison Service in North Dublin noted an exponential increase in suicide attempts in those over 65 over a period of 3 years (2020–2022). Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged >60). Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men.

Methods

Analysis of referrals to the service from an established clinical database was performed to include those referred post suicide attempt or those referred for suicidal ideation or expressing a Passive Death Wish (PDW). Data was anonymized and recorded using Microsoft excel.

Results

There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n = 1) and 2022 (n = 13), with z = +3.21 p < 0.001. Referrals post suicide attempt in 2021 consisted of 2% (n = 6) of all referrals to the service, and 6% (n = 20) in 2022. In 2021 the mean age of those referred was 75.16, and in 2022 was slightly lower at 72.65, with 60% of those in the 65–72 year age range. Alcohol was involved in 45% of all suicide attempts in 2022. The overall referrals to the service for suicidality (post suicide attempt and PDW) increased from 5% to 16% from 2021 to 2022 of all those referred.

Conclusion

A Suicide prevention working group was established to include members of: MHSOP, Older Persons Services, Public Health and the National Office for Suicide Prevention (NOSP) to explore evidence based suicide and self-harm prevention strategies and guidelines in order to address the multiple precipitative factors for suicidality in older persons by developing improved care pathways and integration of services.
40 Reported hydration intake of older patients in an emergency department
Authors: Patricia D , Sheil O , Roche E
Published: September 2023

Background

Older people are vulnerable to dehydration & inadequate fluid intake is a major contributor to preventable dehydration. Poor oral intake of fluids can be related to the inability to feed independently and having poor availability and access to fluids. This study examined older patient’s ability to access fluids in an Emergency Department (ED) setting.

Methods

A point prevalence study was undertaken in the ED over one working day. Patients in the ED who were aged over sixty five, alert conscious & no upper limb fracture were asked to participate in this survey by completing a task of pouring water from a standard ward water jug weighing 1.5 kg into a cup. In addition patients were asked a series of questions about their water intake and if they had adequate access to water in the ED. 20 patients participated in the study (11 Females 9 Males.)

Results

70% of patients were able to lift the jug and pour water into a cup without assistance. 15% of patients stated they had access to sufficient fluids. All of these patients had brought their own drinks to the ED. 85% of patients stated they did not have access to sufficient fluids. Reported fluid intake ranged from 100 mL to 2litres. 70% of patient’s fluid intake was less than 1 l over 24 hour period. 11 patients had access to a table or overbed tray to place a drink on. The preferred cold drink option was water for 85% of patients.

Conclusion

The majority of older patients in the ED reported they did not have access to sufficient fluids. Fluid intake over a 24 hour period was less than 1 litre. Older adults in the ED are at risk of dehydration. Patients preferred drink choice of water could be made more readily available in the ED setting.
45 New eBook resource: the supportive memory guide—empowering you with practical tips and useful technologies
Authors: O'Brien E , Malone K , McDonnell O , Hanlon K
Published: September 2023

Background

Part of the mPower programme (a Dementia Initiative in CHO 1) was to explore and create digital resources for People Living with Dementia and support community services. One of the projects led by senior Occupational Therapists in collaboration with HSE eHealth was the development of a practical resource eBook with education, practical advice and helpful assistive technologies. The aim was to create a digital resource that provides practical information and advice for People Living with Dementia, empowering them to make positive changes.

Methods

The eBook project commenced in January of 2022, the Occupational Therapists and the digital designer met twice monthly online to collaboratively develop relevant and practical content and advice covering key areas in dementia and daily living. The team provided a focus on assistive technologies and created short explanatory videos. The OTs researched and provided information on relevant apps for smart technology devices that support engagement and brain stimulation. The eBook was reviewed by the National Dementia Office, HSE digital and communications as well as Occupational Therapists and a focus group of People Living with Dementia which provided positive and helpful feedback.

Results

The eBook was completed and launched in February 2023 and covers a wide area of topics with practical advice to help people manage the impact dementia has on their daily engagement in activities and occupations. Assistive technologies, compensatory techniques, modifying activities, downloads and more are provided in the eBook. The topics covered include: Routines & Habits, Scheduling & Planning, Supportive Home Environments, Managing Medication, Simple Home Technologies, Smart Home Technologies, Smart Phones, Keeping Active & Engaged, and Links & Resources.

Conclusion

This eBook will be a valuable resource for People Living with Dementia and their families. It will be an additional tool for healthcare professionals in a time where waiting lists are high and where is some areas specialist services are limited.
48 The collaboration of oncology Clinical Nurse Specialists and Public Health Nurses in comprehensive geriatric assessments in patients undergoing Cancer treatment
Authors: Callaghan C , Chase C
Published: September 2023

Background

Cancer is a widespread health issue, with the number of people >70 diagnosed in 2020, reaching 7.2 million (37% of all cases) worldwide. This is expected to double by 2040. Valid and reliable tools to assess older patients undergoing cancer therapy are necessary to reduce toxicities, decrease delays, and better guide dose modifications. There are performance assessment tools used in oncology, however, they are subjective and have limited use for toxicity risk stratification. Currently, patients do not routinely have a frailty assessment in the oncology setting. Public Health Nurses (PHN) often know these individuals before commencing treatment, they may have a therapeutic relationship with the patient and family, and are in a prime position to perform a frailty assessment which can detect vulnerabilities and age related issues associated with mortality. Moreover, collaboration between Acute services and primary care may enhance CGA’s and improve patient care.

Methods

Two case studies are examined, where collaboration of Acute services and Primary care improved patient outcomes and quality of life.

Results

Case study 1: PHN identified early toxicities of treatment, Rockwood Scale used, Liaised with acute oncology CNS (Clinical Nurse Specialist) and dose of treatment modified, resulting in completion of treatment and avoidance of unnecessary hospital admissions. Case study 2: CNS contacted PHN as concerned about patient on treatment, G8 frailty score: 7 (very vulnerable). PHN supported a Comprehensive Geriatric Assessment (CGA). On discussion with Oncology team, treatment modified, and supports such as OT, Dietician and Physiotherapy were added.

Conclusion

Recommendations for practice include a role for combined Geriatric Oncology services, and also the use of in depth assessment tools in older patients to prevent treatment related toxicity. Collaboration of acute oncology and primary care teams may help identify earlier the need for CGA and enhance integration of care pathways.
69 ‘The model ward’: a stroke and specialist gerontology ward in a level three hospital in Ireland
Authors: Paponette B , Ahmed M , Bilal M , McGurk C , Hickey P
Published: September 2023

Background

A model ward adheres to formal processes and combines input from all members of the Multi-Disciplinary Team (MDT) from admission to discharge ensuring high quality patient care. A stroke and specialist gerontology ward in a level three hospital in Ireland leads this approach with MDT meetings every morning. Research has demonstrated that pre-round MDT meetings decreases length of stay, increases patient safety and enhances patient and staff experience. This audit evaluated the impact of pre-round MDT meetings on a stroke and specialist gerontology ward in a level 3 hospital in Ireland, as per NICE and New South Wales guidelines.

Methods

The audit was conducted between 25/04/2023 and 26/04/2023 via questionnaire consisting of 10 closed and 2 open ended questions. Staff members who attend meetings completed questionnaires and responses were confidential. 20 questionnaires were completed.

Results

100% of members (n = 20) found pre-round MDT meetings useful, aided with better delivery of care, reduced daily stresses and all key disciplines were represented. 85% (n = 17) stated it hastened patient discharge. 90% (n = 18) reported all opinions are brought together openly and patient-centred goals are established. 95% (n = 19) found overall aims, next steps and timeframes are agreed and the meetings make them feel unified. 80% (n = 15) of members previously worked on wards with no pre-round MDT meetings. Of those 15, 87% (n = 13) saw an improvement in patient care compared to other wards. 50% (n = 10) of members recommended no improvements necessary for meetings, 30% (n = 6) recommended earlier meetings, 15% (n = 3) would like more disciplines represented and 5% (n = 1) recommended alteration of seating positions for inclusivity. Currently consultants and registrars sit at the main table.

Conclusion

The results highlight the valuable impact of pre-round MDT meetings in providing continuous patient-centred care. This suggests further exploration by potential implementation of these meetings on other wards in hospitals.
71 NIH-AARP: Association of caregiving with lifestyle cardiovascular disease risk factors
Authors: Costello M , Judge C , Reddin C , McCarthy C , Murphy R , McDermott C , Smyth A , O’Donnell M , Canavan M
Published: September 2023

Background

Adult caregiving has been associated with adverse effects on cardiovascular risk factors and health outcomes, with most research focused on caregivers of individuals with dementia and single risk factors. We sought to explore the association of adult and child caregiving, across a spectrum of intensity, with multiple lifestyle risk factors.

Methods

We evaluated the association of caregiving with behavioural and metabolic cardiovascular risk factors, using unconditional logistic regression analyses in the NIH-AARP Diet and Health Study.

Results

While the overall association of self-reported caregiving with cardiovascular risk factors suggested a mostly positive relationship with healthy lifestyle traits (other than sleep duration), our findings also revealed that higher duration caregiving of adults (≥7 hours per week) was associated with an increased frequency of unhealthy behaviours, including diet, and smoking.

Conclusion

Our findings suggest that the association of caregiving and behavioural cardiovascular risk factors differ by type and intensity of caregiving.
73 A pilot of introducing Comprehensive Geriatric Assessment (CGA) in older patients admitted to an acute hospital to prevent acute re-hospitalisation
Authors: Sohail A A , Cooney E
Published: September 2023

Background

Recurrent hospitalisation is increasingly observed in older adults aged 65 or above and, is associated with increased risk of adverse outcomes including delayed recovery, increased morbidity, and mortality. We introduced Performa-based, Multi-Disciplinary Team (MDT) driven Comprehensive Geriatric Assessment (CGA) as a model of care of older patients admitted to an acute Irish hospital, and to see its impact in preventing acute re-hospitalisation after an acute admission.

Methods

CGA was performed, on inpatients aged 65 or older, admitted to a designated ward which had multidisciplinary team access, via a designed and prescribed Performa, by Advanced Nurse Practitioner and interventions suggested by it, were offered to those patients. The pilot continued for three months. Patients who underwent CGA, were monitored for re-admission at 3 months from the date of their discharge via hospital patient management system. Data was compiled and studied via Microsoft excel spread sheet.

Results

28 patients were admitted to the designated ward who underwent the CGA during the time frame of the pilot. 26 (92.8%) patients did neither present to ED nor were admitted to hospital in the immediate 3 months post discharge from the hospital. CGA resulted in various multidisciplinary interventions/referrals on all patients which were studied as secondary aims. The major interventions were MDT referrals (physiotherapy 100%, occupational therapy 85.7%, Swallow Therapists 46.4% and dietetic referrals 32.1%) and deprescribing (50% of patients).

Conclusion

The pilot showed reduced acute re-hospitalisation rates in older patients undergoing CGA, and an attempt to adopt CGA as model of care in acute hospitals to prevent acute re-hospitalisation in such patients. In the model, CGA also offered multiple interventions including MDT referrals/interventions and deprescribing. Further powered research replicating similar results, is needed to explore and adopt such CGA based models of care in older inpatients in acute hospitals.
128 Foot problems in older persons attending a day hospital
Authors: Carey G , Farrell E , Crowe M
Published: September 2023

Background

Foot problems may contribute to pain and falls in older people. We documented the prevalence of foot problems in older persons attending a Day Hospital for rehabilitation.

Methods

Symptoms of foot pain and prevalence of foot problems and inappropriate footwear were documented by 2 physiotherapists using a ‘foot problem score’ in consecutive referrals by consultant geriatricians to an offsite day hospital with rehabilitation expertise over a 3-month period. Subjects were categorised into 2 groups depending on whether they had none/only one fall or multiple falls in previous 12 months.

Results

Sixty-seven patients, age 72–93 years were included in the study. The most common foot problem was hallux valgus in 62 patients (93%) of whom 41(66%) and 4(6.5%) had moderate or severe deviation respectively. Other findings included corn/callus in 37(55%) patients, toenail abnormality in 30(44.7%) whilst only one patient was found to have an ulcer. Seventeen patients (25.4%) complained of painful feet. Twenty-nine patients (43%) were multiple fallers (2 or more falls in previous 12 months) of whom 13(44.8%) complained of foot pain compared to only 4/38(10.5%) of patients with none or only one fall over previous 12 months complaining of foot pain (p = 0.0014). Footwear was deemed inappropriate in 18.8% of patients whilst 56.3% were attending chiropody.

Conclusion

The higher prevalence of foot problems and foot pain in this survey compared to a similar survey (1) in community dwelling older persons may reflect increased comorbidities in this day hospital population and the adverse effects of foot pain on balance and function. Foot and footwear assessment should be incorporated into comprehensive geriatric assessment.
135 OptiCogs: feasibility of a multicomponent intervention to rehabilitate people with cognitive impairment post-stroke
Authors: O'Donoghue M , Boland P , Taylor S , Hennessy E , Murphy E , Leahy S , McManus J , Lisiecka D , Purtill H , Galvin R , Hayes S
Published: September 2023

Background

Stroke is a leading cause of death and disability worldwide. Despite the prevalence and associated burden of cognitive impairment post-stroke, there is uncertainty regarding optimal cognitive rehabilitation for people post-stroke. This study aimed to assess whether a multicomponent intervention, OptiCogs, is feasible, acceptable and safe for people with cognitive impairment post-stroke. A secondary aim was to explore changes in cognitive function, fatigue, quality of life, physical function and occupational performance.

Methods

A feasibility study was conducted where people post-stroke with cognitive impairment enrolled in a 6-week multicomponent intervention. The primary outcomes recorded included response rate, recruitment rate, retention rate, adherence to the intervention protocol, adverse events and acceptability of the intervention to people post-stroke. Secondary outcomes included (i) change in cognitive functioning, (ii) fatigue, (iii) quality of life (iv) physical function, and (v) patient-reported occupational performance. The Consolidated Standards of Reporting Trials extension reporting guidelines were followed, for pilot and feasibility studies, to standardise the conduct and reporting of this study.

Results

The response rate was 10.9%. Nine eligible participants were enrolled during the 4 month recruitment period, with eight participants completing the entire six-week intervention, as well as the pre and post-intervention outcome measures. There were no reported adverse events. Participants were satisfied with the intervention and found it acceptable overall. Results of the secondary outcomes were promising for cognitive function (Pre: 63.3 ± 23.9 to Post: 69 ± 24.6), fatigue (Pre: 52.5 ± 7.3 to Post: 45.6 ± 7.2), quality of life (Pre: 131.0 ± 26.3 to Post: 169.9 ± 15.3), physical function (Pre: 15.5 ± 6.3 to Post: 15.8 ± 5.3) and occupational performance (Pre: 9.3 ± 2.3 to Post: 22.9 ± 4.2).

Conclusion

Preliminary results suggest low-modest recruitment and high retention rates to the OptiCogs intervention. Changes in cognitive function, fatigue, quality of life and self-reported occupational performance show improvement from pre to post-intervention. These potential benefits require further testing in a definitive trial.