bluuebunny/crossref_metadata_2025 huggingface dataset:
197 IMPROVING THE ASSESSMENT OF VISION IN OLDER ADULTS AT RISKS OF FALLS AT A DAY REHABILITATION CLINIC
Authors: McDowell V , Maxwell K , McLoughlin A
Published: October 2022

Background

Assessment of vision is a key component of multifactorial falls prevention programmes. However, the National Audit of Inpatient Falls (2015) found less than half of older adults had a vision assessment when admitted to hospital. We suspected vision assessment could also be improved for patients attending our outpatient Day Rehabilitation Unit who were falling or at risk of falls.

Methods

21 outpatients were audited initially, with determination of baseline characteristics including age and Rockwood frailty score. We assessed whether past ophthalmological history was documented, whether the patient wore glasses and whether they had had a recent eye test in the community. Finally, documentation regarding visual examination was audited; this comprised range of eye movement, visual fields and visual acuity assessments. We adapted the clinic proforma to include a specific section on ophthalmology history and visual assessment; 14 patients were re-audited following intervention.

Results

Our two groups were relatively similar: mean age of 80 in the initial audit and 78 in the subsequent audit. Both groups had an average Rockwood score of 5. Improvements were noted in documentation regarding previous eye testing (33.3% - 86%), testing of eye movements (71.4% - 100%, and testing of visual fields (66.7% - 93%). There remained no testing of visual acuity following intervention.

Conclusion

A dedicated falls proforma targeting specific risk factors for falls improves identification and assessment of those risks. This enables targeted intervention and referral to be made to improve patient outcomes. For further improvement we would recommend educating the multidisciplinary team on how to test for visual acuity in the outpatient setting.
198 A UNIQUE COMMUNITY POST-DIAGNOSTIC DEMENTIA SUPPORT SERVICE DELIVERED BY THE ADVANCED NURSE PRACTITIONER
Authors: Carey E
Published: October 2022

Background

In Ireland, approximately 67,744 people live with dementia and 63% reside in Irish communities with increasing care cost estimated at €58,550 per person, which is set to rise alongside increasing longevity (HSE, 2020; Department of Health, DOH 2014). Across the Republic of Ireland, care provision predominantly focuses on middle or later stages of the journey, leaving the newly diagnosed and their care partner as somewhat the invisible. Service provision for post diagnostic dementia services is disjointed, with resource allocation at a low level of provision relative to need, leading to inequity with subsequent disparity resulting in significant geographical variation in the provision of services.

Methods

Robust interdisciplinary community care pathways developed underpin this ANP Service. The multi-element pathway structure delivers community clinics for Dementia, NCSD and LivDem programmes alongside support networks for family care partners, amongst others. Support and care provision is demonstrated from point of diagnosis and throughout the dementia journey for the patient and family care partners, which is unique in Irish healthcare. ANP service provision through interdisciplinary collaboration has achieved increased QOL outcomes alongside illuminating KPI's and audit outcomes. Capturing dementia services early optimises outcomes for all involved including health service cost reductions, all in one setting.

Results

Patient satisfaction outcomes range from 71 - 100% with service intervention outcomes favourably indicating the direct impact of the service, which are unmeasurable to the older adult living with dementia, and include increases in: (i) Confidence - 90%; (ii) Mood - 50% and (iii) open to talking through difficulties encountered - 87%. This service contributes to innovations in practice in this complex care area and now achieves 60 attendances each month

Conclusion

Advanced practice drives collaboration and integration across services delivering on hospital avoidance, early supportive discharge and timely access to services. Facilitating early post diagnostic dementia services optimises interdisciplinary collaboration, crucial to achieve aging in place with timely access to services for all older adults.
199 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA
Authors: Myint H , Simmons M , Cruz J , Diaz B , Baldonado G , Edwards B , Kiriyadoss D , Drummond K , Mulkerrin E
Published: October 2022

Background

Pressure Injury (PI) management is challenging for dependent patients in Acute Care Wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long-Term Care (LTC) wards and thus may improve outcomes.

Methods

The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD.

After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (60 % female; 19/30). All had stage 2-4 PIs (present in 83% on admission to ACW). On transfer to LTC wards, all had severe physical dependency with mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.

Results

PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.

Conclusion

These results suggest an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation is planned.
202 PATIENTS >65 YEARS ADMITTED WITH AN ACUTE SURGICAL PRESENTATION: REVIEW OF OUTCOME MEASURES FOLLOWING OFF-SITE GERIATRICIAN-LED REHABILITATION
Authors: Treanor C , Smith J , Bhuachalla B Ní , Hoey A , McGreevey S , Faul E
Published: October 2022

Background

The most common causes for surgical admissions in our model 3 hospital are: (1) abdominal pathologies requiring conservative and/or operative management; (2) traumatic injuries leading to rib/sternal fractures; (3) Traumatic Brain Injuries (TBI). With life expectancy increasing, the number of older adults undergoing intra-abdominal surgery and presenting with traumatic injuries is increasing. This cohort often experience high levels of frailty and significant morbidity and mortality due to poor physiological reserves. Further functional decline post-admission causes higher rehabilitation needs with greater risk of requiring long-term care. Care of Older Person Services are under active development in our hospital. An off-site Geriatrician-led specialist rehabilitation unit was initially established for medical patients in 2015. Access was then made available to acute surgical patients in 2021.

Methods

A cross-site review of outcomes achieved by older adults who transferred from the acute surgical ward to specialist inpatient rehab unit was completed.

Results

Twenty-two patients utilised this pathway but unfortunately only data relating to sixteen individuals was available due to the HSE cyber-attack. 56.25% were male (n=9) and 43.75% (n=7) were female. Most common diagnosis included 31.25% (n=5) new TBI; 18.75% (n=3) post-abdominal surgery and 12.5% (n=2) rib fractures. The average Length of Stay (aLOS) in rehabilitation was 27 days. On average, post-operative patients had a lengthier aLOS (48 days) while new TBI had the shortest (18.5 days). Overall, 94% (n=15) returned home with 60% (n=9) requiring home supports. 100% (n=16) demonstrated improvements in both their Barthel scores and ‘Timed Up and Go’ scores. The average Berg score improved from high falls risk on admission to independent with assistive device. There was one instance of acute readmission post discharge home.

Conclusion

Specialist Geriatrician-led rehabilitation for surgical patients has demonstrated low rates of re-admission, improved function and reduced falls risk with 94% (n=15) of patients returning home.
204 DEDICATED NURSING HOME SERVICE IN A TERTIARY HOSPITAL: EFFECT ON ADMISSION NUMBERS AND LENGTH OF STAY
Authors: Mahon CM , Ryan M , Kennelly SM , Martin R
Published: October 2022

Background

In 2019 a dedicated Nursing Home (NH) in-patient service was established in a tertiary hospital, comprising a Consultant Geriatrician, clinical nurse specialist, NCHD and administrative support. All NH residents over 65 with medical diagnoses were admitted by the NH team who also provide a consult service for NH residents under other specialties.

Methods

Data were sourced from the Hospital Inpatient Enquiry system on length of stay of patients identified as admitted from a nursing home compared to those admitted under the NH team and their average lengths of stay over 2019-2021.

Results

In 2019, 749 NH residents were admitted to hospital with an average length of stay (ALOS) of 7.93 days, the NH inpatient service was established in July 2019 and showed a reduction of ALOS from 9.25 to 6.6 days in the 6 months following its establishment (29% difference.) In 2020, 707 NH residents were admitted with 352 admitted under the NH team. The ALOS of NH residents admitted under the NH team was 5.66 days in 2020 compared to 8.65 overall (35% difference.) In 2021, 765 NH residents were admitted with 402 under the NH team. ALOS of NH residents admitted under the NH team was 5.33 days in 2021 compared to 8.28 overall (36% difference.)

Conclusion

Within six months of its commencement the dedicated NH service had decreased length of stay by 29%. The average length of stay across all services has decreased year on year from 6.6 to 5.3 days from 2019 to 2021. The ALOS in the total cohort (including residents admitted surgically and those under 65) was 29-36% higher. Though difficult to accurately compare these cohorts due to different presenting diagnoses and medical backgrounds in those admitted surgically or those under 65, the overall reduction in length of stay over the three years does highlight the benefit from this dedicated service.
206 IMPROVING FALLS ASSESSMENT AND PREVENTION PRACTICES FOR FRAIL OLDER ADULTS IN AN EMERGENCY DEPARTMENT USING BEST PRACTICE GUIDELINES
Authors: Scannell M , Coakley E
Published: October 2022

Background

NICE guidelines are the current gold standard for the management of falls in older persons. The aim was to benchmark the practice of a Frailty At The Front Door (FATFD) team against NICE guidelines.

Methods

All patients referred to and discharged directly by the FATFD team in the emergency department had demographic data entered prospectively by a trained administrator onto excel. Data gathered included age, diagnosis and CFS score. Patient records were accessed to gather assessment and treatment data. Data was analysed using descriptive statistics.

Results

Between January and March 2022, 443 patients were seen of which 48% (n=213) presented due to a fall. 23% (n= 49) were discharged directly from ED. Full clinical information was available for 35% (n=15). The mean(SD) age of those who presented with falls was 84(8) years with a mean(SD) clinical frailty score of 5.6 (0.9). The male to female ratio was 1.5:1. 53% (n=8) patients had a falls assessment in line with NICE guidelines. Fear of falling, perceived unsteadiness and bone health issues were the most commonly-omitted areas. 7% (n=1) patient received falls prevention education or individualised intervention.

Conclusion

The majority of patients received a falls assessment in line with NICE guidelines but 65% of patient data was not available. Data availability is key to service development and a database will be developed for all attendees. A falls education package to address management of visual impairment, home hazard advice, strength and balance training, bone health and individualised patient and family education, including fear of falling, has been developed.
213 EARLY IDENTIFICATION AND NUTRITION INTERVENTION OF FRAIL ADULTS AT RISK OF MALNUTRITION BY AN EMERGENCY DEPARTMENT FRAILTY INTERVENTION TEAM (FIT)
Authors: Pender C , Magner S , Carrabine N , Byrne C , Riches R , Mitchell M , Buckley B , Carey S , Harrington G , Caheny CO , Laguna R
Published: October 2022

Background

Frailty is a nutrition related condition which is potentially reversible if modifiable risk factors including malnutrition are identified at an early stage. National guidance recommends early identification of risk of malnutrition and provision of timely, appropriate oral nutritional support. Over ⅓ of older adults presenting to the Emergency Department (ED) are malnourished/at risk of malnutrition. This study evaluates the early identification and nutrition intervention of frail adults at risk of malnutrition by FIT.

Methods

A retrospective study of frail patients presenting to a level 4 hospital ED over three months was performed. Each patient had a Comprehensive Geriatric Assessment performed. A referral to Dietetics was indicated by: Malnutrition Screening Tool (MST) score ≥2, dysphagia, grade ≥2 pressure ulcer or already prescribed oral nutritional supplements (ONS). Data was collected from a Hospital Clinical System using Excel®. The data recorded included: Clinical Frailty Score (CFS), referral reason, 4AT and admit/discharge location.

Results

117 frail patients were referred to Dietetics by FIT. The median CFS was 5 (mildly/moderately frail) with an IQR of 1. 43%(n=50) had 4AT=0. 75%(n=88) had MST ≥2 identifying risk of malnutrition13.6%(n=16) were already prescribed ONS9.4%(n=11) had dysphagia6.8%(n=8) had a grade ≥2 pressure ulcer

Nutrition support intervention was provided by the Dietitian to 100% (n=117) within 24 hours of referral. 27% (n=32) were discharged from ED and 72% (n=85) were admitted.

Conclusion

FIT have successfully implemented recommendations from the National Clinical Guideline No.22. Early dietetic intervention in ED, for those admitted and discharged, may prevent the onset/progression of malnutrition in frail patients.
216 ENABLING THE DELIRIOUS PATIENT TO REMAIN AT HOME: TWO CASE STUDIES FROM THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Davis AJ , Nally SM , Namara RM
Published: October 2022

Background

The EDITH service brings emergency department care to the older adult thus negating the need for hospital presentation. There is an emerging body of literature regarding optimal treatment for patients with delirium suggesting care takes place in a familiar/ home environment.

Methods

Patient A: an 86 year-old lady with a UTI. She had a CFS:6 and a 4AT:7. She lived with her husband and her daughter who was a nurse lived nearby and provided care. She had a hypoactive delirium presentation. Patient B: an84year old gentleman with a chest infection. He had a CFS:5 and a 4AT:7. He lived with his wife and had a home care package. He had a mixed delirium presentation.

Results

In both cases, the Occupational Therapist (OT) provided education to the family regarding delirium and the recovery process of same. The OT provided advice regarding modifying and optimising the home environment for the delirious patient. The OT provided advice on the therapeutic use of activity and functional engagement. Medical input involved antibiotics and ensuring adequate nutrition and hydration. Safety netting was completed by onwards referrals to community services (PHN, COT, GP etc) and providing additional EDITH in-person reviews and phone-calls during the period of recovery.

Conclusion

Delirium type, level of family support and their understanding of delirium may impact on the success of a delirious patient remaining at home. The OT has a specialised role with regards to the treatment and management of the delirious patient. This is an emerging area of practice that OTs can lead as older adult services evolve and there is a move towards caring for patients with delirium within the familiar home environment.
217 THE USE OF SIILO MESSAGING APP BETWEEN HOSPITAL-BASED FRAILTY INTERVENTION THERAPY TEAM AND COMMUNITY-BASED EMERGENCY DEPARTMENT IN THE HOME TEAM
Authors: Davis AJ , O’Grady S , Donohoe N , Hill R , Langton S , Delaney A , Doyle C , Sweeney A , Van Den Berg N , Nally SM
Published: October 2022

Background

Effective communication is an important component of any healthcare system. There is frequent communication of patient care and information between the EDITH (Emergency Department In The Home) and the FIT (Frailty Intervention Therapy) teams, which are based across two sites. Traditionally handovers between therapists were completed via email/ fax. Siilo is a secure medical messaging app designed to facilitate instant communication of patient information between healthcare professionals in a confidential manner.

Methods

A 3-month pilot of the Siilo app was commenced in August 2021 to improve the flow of information between teams, facilitate timely decision making and improve patient care. A questionnaire to rate speed, efficiency, accuracy, accessibility and confidentiality on a 4point scale was completed by all therapy staff members. Qualitative questions regarding positive and negative aspects, and future suggestions were included.

Results

Pre-pilot the median time from EDITH assessment to receipt of handover was 20 hours. During the pilot, median time to handover was 1 hour. Speed, efficiency and accessibility of communication between teams received a median rating of 2 (“average”) pre-pilot, increasing to 4 (“excellent”) during the pilot. Accuracy and confidentiality received a median rating of 3 (“good”) pre-pilot, improving to a median rating of 4 (“excellent”). 100% of respondents reported Siilo had a positive impact on decision making and on patient care.Qualitative themes included; earlier acute care discharge planning; ease of use and reduction in paperwork. Suggestions to further improve communication between the services were made and will be explored at a later date.

Conclusion

A significant reduction in time from assessment to handover improved the flow of communication between the teams, reduced duplication of assessments and improved patient care for older patients. Confidentiality and accuracy were maintained over this period. The use of the app will be continued and suggestions to further improve the integration between the services will be implemented.
220 RELATIONSHIP BETWEEN HEIGHT AND SYSTOLIC BLOOD PRESSURE IN OLDER ADULTS
Authors: Morrison L , Chen H , Sheehy T , Costelloe A , Griffin M , Quinn C , O'Connor M , Peters C , Lyons D
Published: October 2022

Background

Hypertension is common amongst older adults in Ireland and is a major risk factor for both ischaemic and haemorrhagic stroke. Several studies have investigated the relationship between height and hypertension, however results have been inconsistent. In our Irish tertiary hospital patients undergoing tilt table testing have resting blood pressure measured prior to the test, and height recorded. Our aim was to assess whether there is a relationship between height and resting Systolic Blood Pressure (SBP) in patients aged over 60 years.

Methods

All tilt table test results between 2000 and 2021 in a single centre were reviewed retrospectively, collecting data on age, height and resting SBP. Any incomplete records were excluded, as were those from patients under 60 years old. Linear regression modelling was used to assess relationship between height and resting SBP.

Results

A total of 4,729 complete records were included for patients over 60 years old. 2630 (61.5%) of the patients were female. Mean age was 77 ± 7.8 years. 57.7% patients had either an elevated resting systolic and/or diastolic BP ≥130/80 and 28.4% ≥140/90. The linear regression model established that while height could be used to predict resting systolic blood pressure (beta=-0.166, 95% CI: –0.219 to –0.113, p<0.001), height only accounted for 0.8% of variability in resting SBP (R2 = 0.008).

Conclusion

Our large dataset establishes an association but no meaningful causation between height and resting systolic blood pressure. Current antihypertensive treatment was not recorded, which may have affected the results. Future studies will include further multivariate analysis accounting for antihypertensive use and other factors that may impact hypertension such as age, weight and gender.
221 BEFRIENDING SERVICES ARE ASSOCIATED WITH LESS DECLINE IN HEALTH-RELATED QUALITY OF LIFE, BUT NOT COGNITIVE FUNCTION, OVER TIME
Authors: Power JM , Hannigan C , Scharf T , Moynihan S , Walsh C , Johnson N , Lawlor B , Holton E , Kee F
Published: October 2022

Background

Befriending services are commonly deployed in the support of older people living alone, but lack an established evidence base, particularly in relation to their association with health outcomes.

Methods

To explore the potentially therapeutic impact of befriending on Health-Related Quality-of-Life (HR-QoL) and cognitive function, we used a single case experimental design. Data were collected from 85 new users of ALONE’s befriending service between 2019 and 2021 in an AB multiple baseline design. Generalised additive modelling was then used to assess trajectories of HR-QoL and cognitive function (semantic fluency) over the course of six months, and its association with the onset of the befriending service intervention

Results

The befriending service was associated with less decline over time in HR-QoL, and with a mitigated impact of loneliness on HR-QoL too. No such effects were observed for cognitive function as an outcome, which did not change over time.

Conclusion

Befriending may exert a positive effect on health-related quality of life, and reduce the negative impact that loneliness has on this outcome.
228 LONG TERM OUTCOMES FOR FALLS PATIENTS WHO WERE TREATED BY THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Davis AJ , Kenny L , Delaney A , Doyle C , Sweeney A , Nally SM , Namara RM
Published: October 2022

Background

The EDITH service provides an alternative to an ED attendance for the older adult. Medical treatment and Occupational Therapy (OT) assessment take place within the patient’s home. Patients who experience an explained fall are routinely treated by the EDITH service, these patients receive OT falls prevention and home environment assessment as standard. It is imperative to assess the long-term outcomes for these patients in order to inform future service provision.

Methods

A total of 40 patients, who were referred following an explained fall to the EDITH service and remained at home following assessment, were selected for audit. These patients were seen over a 2-month period in 2021. Data were gathered with regards to ED presentations via healthcare records and mortality rates were captured via RIP.ie

Results

At 3 months, 4 patients had re-presented to ED with a fall and 3 required admission. At 6 months, 6 patients re-presented to ED with a fall with 5 requiring admission. At 9 months, 4 patients re-presented to ED with a fall and 3 required admission. 100% of patients had an OT home environment assessment and received advice regarding falls prevention. The average age of patient was 84 years. At 1 year, the mortality rate for this patient group was 10%.

Conclusion

Patients with explained falls that were treated by the EDITH service appear to have a reasonably low ED re-attendance rate at 3, 6 and 9 months for explained falls. This may be as a result of the tailored falls prevention education/home environment assessment that took place within the patient’s home by the OT. However further audit and a larger population group would be required to suggest a definite correlation between same.
251 PREVALENCE AND CHARACTERISTICS OF SWALLOWING/COMMUNICATION IMPAIRMENTS IN FRAIL OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY
Authors: Boyle O , Kelly L , Whelan C , Murtagh E , O'Dwyer A , Ryan M , Hill F , McCabe A , Hayden D
Published: October 2022

Background

The presentation of frail older adults to the Emergency Department (ED) may be complicated by swallowing and/or communication impairment. Adults with communication impairment may experience difficulty accessing healthcare. Dysphagia is associated with frailty irrespective of age and/or number of chronic diseases [1]. This study aims to determine the prevalence and characteristics of swallowing and/or communication impairments among frail older adults attending the ED.

Methods

A retrospective cohort study of consecutive ED attendees aged ≥ 75 years assessed by an interdisciplinary Gerontological ED team between October 2021 – February 2022 was conducted. A swallow/communication screening tool determined requirement for Speech and Language Therapy (SLT) referral. Data related to demographics and SLT interventions was extracted. Data analysis was completed using STATA Version 12. Ethical approval was obtained.

Results

Among 518 patients, 118 (23%) (mean age 82.4 (+/-6.4) years, 54% male) required SLT assessment. These patients had high rates of frailty (Median CFS= 6 (IQR 5-7), suspected delirium (4AT ≥ 4 in 45%), suspected malnutrition (MNA score 0-11 in 75%), and probable sarcopenia (SARC-F= ≥ 4 in 75%). Therapy Outcome Measurement Scales and the Functional Oral Intake Scale were used in this first episode of SLT care. Oropharyngeal dysphagia was identified for 43% (27% mild, 10% moderate, 3% moderate-severe, 3% severe), with 6% presenting with signs/symptoms of oesophageal dysphagia. Changes in baseline communication was identified for 57%; cognitive communication difficulties (38%), dysarthria (11%), dysphonia (8%). SLT intervention and management approaches were initiated in the ED.

Conclusion

Findings indicate a high prevalence of swallowing/communication impairment in frail older adults attending the ED. Future research should explore SLT outcomes at point of discharge to refine these swallowing/communication presentations.

Reference

1. Bahat G et al. Association between dysphagia and frailty in community-dwelling older adults. The Journal of Nutrition, Health & Ageing. 2019:23, 571–577.
267 WHAT IS THE IMPACT OF ACUTE HEALTHCARE UTILISATION ON FUNCTIONAL DECLINE IN OLDER ADULTS OVER TIME? A POPULATION-BASED COHORT STUDY
Authors: Conneely M , Leahy S , Trépel D , Robinson K , Boland F , Moriarty F , Galvin R
Published: October 2022

Background

Acute healthcare use varies by age, with older adults the highest users of most acute healthcare services. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the impact of acute healthcare utilisation at baseline on subjective and objective measures of function at four-year follow-up in older adults.

Methods

This study represents a secondary analysis of a prospective cohort study where data from Wave 1 (baseline) and Wave 3 (four-year follow up) of TILDA were analysed in conjunction with a public and patient involvement group of older adults. Acute healthcare utilisation was defined as an Emergency Department (ED) visit with or without hospitalisation in the previous 12 months. Function was assessed objectively using Timed-Up-and Go (TUG) and grip strength and subjectively using self-report limitations in activities of daily living and instrumental activities of daily living. Linear regression was used to investigate the relationship between ED use at baseline and grip strength and TUG performance at Wave 3. Logistic regression was used to investigate the relationship between ED use at baseline and whether a participant had a disability in ADL and IADL, or not, at Wave 3.

Results

A total of 1516 participants met the study inclusion criteria. Mean age was 70.9 years (SD=4.6) and 48% were male. At baseline, 1280 participants reported no acute healthcare use. 118 indicated an ED visit but no hospitalisation in the previous twelve months and 118 reported both an ED visit and hospitalisation. Adjusting for all covariates, compared to those with no acute healthcare utilisation, those with an ED visit with no hospital admission had poorer TUG performance at follow up (β= 0.67, 95% CI: 0.34, 1.29, p=0.039).

Conclusion

The results of this study support a relationship between acute healthcare utilisation and functional decline assessed by TUG at follow-up.
270 ENHANCING CAPACITY TO CONSENT IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; USING SPEECH AND LANGUAGE THERAPY TO MAXIMISE COMMUNICATION
Authors: Hogan FH , Ahern A , Byrne MF
Published: October 2022

Background

For consent to be valid the resident must be able understand the information and communicate their choice. People with dementia can have a number of communication deficits; difficulty word finding, tendency to digress and repeat themselves, understanding the spoken word, maintaining a conversation topic without losing track, using semantically empty words (e.g. ‘thing’, ‘stuff’) in place of content words. This can limit their ability to express wishes and preferences. Out of 100 residents in our Older Person Residential Care facility 48% require some supports with communication; 25 diagnosed with dementia, 8 suspected (33%) and 15 with cognitive impairment. As per the HSE National Consent policy 2022 we have a duty to maximise capacity for our residents to consent to treatment and interventions. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited. Speech and Language Therapists (SALT) identify the specific nature of communication deficits for a person with dementia.

Methods

Our SALT reviewed our residents and advised on actions required to reduce the impact of communication deficits. We implemented a Communication care plan for our residents to include all identified communication abilities and disabilities for both speech and language across all modalities (reading, writing, gesture, symbols). To evidence understanding of consent, all staff interacting with residents were requested to undertake the HSELand National Consent policy module. All staff attended training which involved enhancing communication abilities.

Results

In February 2022, 95% of care plans audited had actions to address communication deficits in place. Ad hoc discussion with staff evidenced improved understanding of each resident’s communication deficits and necessity to use SALT reviews to enhance capacity to consent.

Conclusion

We have demonstrated that the use of SALT to enhance ability to communicate has enhanced capacity to consent for our residents. Staff also demonstrated improved communication practices.
278 REAL WORLD VALIDITY OF THE VARIABLE INDICATIVE OF PLACEMENT SCORE
Authors: Ward L , Garvey N , Laguna R , Pender C , Magner S , Binions L , Carrabine N , Ramiah V , Byrne C
Published: October 2022

Background

The Clinical Frailty Scale (CFS) is a widely used frailty measurement that is recommended for use as part of a Comprehensive Geriatric Assessment. The Variable Indicative of Placement (VIP) score was developed to identify at triage in the emergency department patients who require geriatric input. There have only been a limited number of previous studies that have validated the VIP score for use at triage. Current practice in our hospital is to use the VIP score at triage to identify frail older patients and to use the CGA as part of the CGA performed by the Frailty Intervention Team (FIT). We aimed to assess the validity of the VIP tool to identify frail, older patients as identified using the CFS.

Methods

A retrospective analysis was performed using routine data collected for the month of November 2021. Inclusion criteria were patients over the age of 65 who had both a VIP and CFS performed. We used a CFS of 1-4 to define fit patients and 5-9 to define frail patients. Similarly for the VIP score we defined fit as VIP negative and frail as VIP positive. Statistical analysis was performed using Microsoft Excel.

Results

267 patients were identified as meeting the inclusion criteria. 157 patients were found to be positive for frailty using the VIP score and 123 using the CFS. The sensitivity of the VIP score was 75% and the specificity was 55%. The positive predicative value was 59% and negative predictive value was 72%.

Conclusion

The VIP score fails to perform well in the real world as a screening tool for frailty in comparison to the CFS.
288 EARLY SUPPORTED DISCHARGE AFTER STROKE IN THE COVID-19 PANDEMIC: A CONTAGIOUS SERVICE-DELIVERY MODEL
Authors: Breen C , Collins R , Coleman S
Published: October 2022

Background

Early Supported Discharge (ESD) after stroke is an internationally recognised model of best practice for patients with mild to moderate functional deficits after stroke. By end of 2021 there were nine stroke-specific ESD teams in operation in Ireland. This paper outlines the analysis of annual reports submitted by each site to the National Stroke Programme.

Methods

We completed data analysis of the 2020 and 2021 clinical activity of ESD teams, the functional outcomes achieved using the Functional Independence Measure/Functional Assessment Measure (FIM/FAM), and qualitative reporting from patients. Teams were also asked to report on team composition and service developments.

Results

Team composition and size varied, but all had some combination of Occupational Therapy, Physiotherapy, and Speech and Language Therapy. 764 patients received ESD after acute stroke in 2021, representing 24.7% of all patients discharged with stroke in participating sites. Activity increased by 39.9% from 2020 (n = 546), which was in turn an increase of 48% on the 2019 figure (n = 370). Although new sites were added in each year, the increased capacity alone does not account for the growth. All sites reported patient improvement on the extended FIM/FAM. Patient feedback was positive, with many reporting particularly on the benefits of receiving intervention in the home at a time when hospital visiting was restricted. Many sites also reported introducing telehealth to support delivery of ESD.

Conclusion

ESD after stroke continues to grow at pace in Ireland, proving resilient to the pressures of operating in a pandemic. It remains a highly acceptable model to patients, and growth during the pandemic may have been supported by increased capacity, new ways of working, and patients' desire for earlier discharge. Although all teams reported functional improvement among their patients, some sites are achieving greater gains, suggesting that further research into patient selection, treatment intensity and further embedding of telehealth is warranted.
293 PRE-ADMISSION POTENTIALLY INAPPROPRIATE PRESCRIBING PREVALENCE ON A CARE OF THE OLDER ADULT MEDICAL WARD
Authors: Cosgrave N , Stankard A , Walsh J , Walsh S , Mulroy M , Mason C
Published: October 2022

Background

Potentially Inappropriate Prescribing (PIP) is a common but critical issue in care of the older adult. It is estimated that between 50 and 70% of those over 65 years are receiving at least one potentially inappropriate medication. Polypharmacy is a good indicator of PIP as it can indicate over- and inappropriate prescribing through prescribing cascade, exposing patients to risks of drug interactions and Adverse Drug Events (ADEs). 10-20% of hospital admissions of older adults are directly related to ADE of inappropriately prescribed drugs.

Methods

Point prevalence study using the ‘Screening Tool of Older Persons Prescriptions’ (STOPP) to identify PIPs on a geriatric medicine ward. Patients over 65 years of age admitted from home were included in the study. Patients’ pre-admission medications and changes made to these were assessed using STOPP.

Results

Sixteen patients out of 22 met the inclusion criteria. The average age of the patients included in the study was 82.3 years with a range from 70 to 88 years. 75% were female. 94% had polypharmacy prior to admission with an average of 2.25 PIPs (range 0 to 5). 43% (n=7) had all their PIPs addressed by a geriatrician as per STOPP, with a further 18% (n=3) having some of their PIPs altered. 25% (n=4) did not have any alterations to their PIPs.

Conclusion

Despite widely known impacts of PIPs on older adults, PIP remains highly prevalent in those admitted to hospital. PIP and polypharmacy can increase incident frailty two-fold and polypharmacy and frailty can lead to a 6-fold increase in mortality within two and a half years. We must actively educate all those involved in prescribing for this cohort of patients to reduce PIPs and their adverse effects.
295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS
Authors: Davey N , Fitzgerald R , Fauzi MYBM , Khan MA , O'Donnell N , Kumar S , Bambrick P , Pope G , Mulcahy R , Cooke J , O'Regan N
Published: October 2022

Background

Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology.

Methods

The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system.

Results

Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions.

Conclusion

Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.
298 AN AUDIT OF HEALTH PROFESSIONALS’ KNOWLEDGE OF PARKINSON’S DISEASE AND ITS MEDICATION MANAGEMENT FOR HOSPITALISED PATIENTS
Authors: Connolly E , Reidy C , Murphy A , Pope G , Cooke J , Bambrick P , O'Regan N , Mulcahy R
Published: October 2022

Background

Studies have shown that patients with Parkinson’s Disease (PD) have a higher rate of hospitalisation and longer lengths of stay than their age matched controls. Good inpatient management is key to maintaining functional ability and preventing complications, but many PD patients deteriorate while in hospital. Patients with PD are often on multiple time sensitive medications. This study aims to assess healthcare workers knowledge of PD, medications used to treat it and how they should be prescribed and administered.

Methods

A convenience sample survey was distributed to doctors, nurses and other health care professionals over a five-week period. This survey included multiple choice questions and open-ended short answer questions. Results were collated and analysed on Microsoft Excel.

Results

71 surveys were returned - 34 from doctors, 23 from nurses and the 14 others included pharmacists, physios and dieticians. Only 11 (15%) participants correctly identified all PD medications listed in the survey with Sinemet being the most recognised drug (n= 68). Non motor symptoms of PD correctly identified by participants included constipation (n=54, 76%), hallucinations (n=48, 68%) and anosmia (n=18, 25%). 32 participants (45%) were unable to correctly identify when to administer PD medications in relation to mealtimes. 29 participants surveyed (41%) would consider inserting a nasogastric tube for a patient who was fasting and unable to take oral medications. 12 participants (17%) did not know that Sinemet could be given via nasogastric tube.

Conclusion

This survey highlights a gap in knowledge of Parkinson’s Disease and its management. Participants displayed poor knowledge regarding optimum timing of medication administration and management of patients who are fasting. These findings suggest that education sessions and hospital specific guidelines regarding the management and administration of PD medications would assist healthcare professionals with a view to improving patient outcomes and preventing complications.
300 ESTABLISHING THE PREVALENCE OF OSTEOPOROTIC FRACTURES IN IRELAND
Authors: Bhujwalla S , Sorensen J , Carey JJ , Dockery F
Published: October 2022

Background

Fragility/low-trauma fractures are a major burden on health care, yet many could be prevented through Fracture Liaison Services (FLS). An Irish national FLS database (FLSDB) has recently been established and a reliable estimate of fracture numbers per locality is needed to measure FLS efficiency. Currently the Irish FLSDB uses the UK estimate of 1:4 hip vs. non-hip fracture numbers. We wanted to explore its accuracy in an Irish population.

Methods

We looked at all plain x-ray reports from six individual weeks across two years in our hospital. We selected those aged >50yrs with a reported new fracture. We determined the ratio of hip:non-hip fractures and of those admitted vs. discharged. We cross checked these against admitted fracture numbers from NQAIS (National Quality Assurance Information System) for the same 6 weeks. We then looked at all admissions Irish Emergency Departments during 2018-2019 with a new fracture aged >50yrs. We compared hip:non-hip fracture ratio of these vs. our local data.

Results

From 7,654 x-ray reports, 222 new fracture patients were identified. An additional 29 patients sustained fractures during this time period, either CT/MRI diagnoses or managed as fractures despite negative radiology report. NQAIS missed 21 admitted fractures (uncoded). The ratio admitted:discharged fractures in our audit was 2:3. Ratio of patients with hip:non-hip fractures was 1:9.5. Nationally there were 33,627 fracture patients aged >50y admitted to Irish hospitals in 2018-9, and of these, the hip:non-hip fracture ratio was 1:3. Adding estimated numbers of fracture patients not admitted (based on our local data) gives at least a 1:9 hip:non-hip ratio nationally.

Conclusion

Fracture numbers in Ireland are markedly underestimated if extrapolating from UK estimates. This has implications for service planning for Irish FLS, if rising fracture numbers are to be addressed.
301 BENEFITS OF ENVIRONMENTAL MUSIC THERAPY IN AN ACUTE HOSPITAL
Authors: Cassidy M , Hayes R , Nevin R , Griffin A , Herbst J , Mealy B , Walsh K , Donnelly R , Harrison H , Jariol A , Joseph L , Carroll KM
Published: October 2022

Background

Environmental Music Therapy (EMT) uses live music played by a music therapist to enhance the surrounding environment and is increasingly used in clinical settings. Studies show that EMT may reduce anxiety, enhance wellbeing, promote better communication between patients and staff, and reduce patient perception of waiting times in hospital. We aimed to explore the benefit of EMT for older adults in a geriatric outpatient setting and on rehabilitation wards.

Methods

Harp music was played by a music therapist in the vicinity of ambulatory clinics and on rehabilitation wards for 4 hours per week (over a 2-day period) for 20 weeks. Music exposure on any given day was to an estimated 50 outpatients, as well as 50 people passing the vicinity or to about 30 patients on the rehabilitation ward. Music was selected and played in a dynamic process, responding to verbal and non-verbal reactions of patients, family, and staff. Voluntary responses were recorded and collated.

Results

There were 36 recorded responses and all reflected positively on EMT. Patients cited that the music created a welcoming space and stimulated interaction and conversation. Several patients waiting for their clinic appointment noted that it distracted from fearful expectation and was a source of comfort. Some commented that they felt more relaxed and that it reduced stress. On rehabilitation wards, patients found familiar music to be calming with nurses citing that it stimulated social interaction between patients, family and staff. Responses to EMT gave insights that resulted in patient referrals for music therapy.

Conclusion

Environmental music played by a music therapist was found to modify patient hospital experiences. In particular, it appeared to reduce self-perceived stress and stimulate positive social interaction and conversation. This supports the use of EMT to advance the integration of the arts for wellbeing in an acute hospital.
303 SCREENING INSTRUMENTS TO PREDICT ADVERSE OUTCOMES FOR UNDIFFERENTIATED OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: RESULTS OF SOAED PROSPECTIVE COHORT STUDY
Authors: Leahy A , Corey G , Purtill H , O'Neill A , Devlin C , Barry L , Cummins N , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R
Published: October 2022

Background

Frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention in the acute or community setting. We assessed the validity of the ISAR (Identification of Seniors at Risk), Rockwood Clinical Frailty Scale (CFS), PRISMA-7 and InterRAI-ED at predicting adverse outcomes at 30 days and six months among older adults presenting to the ED.

Methods

A prospective cohort study of consecutive older adults (≥65 years) who presented to the ED at a University Hospital was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were performed by an experienced ED research nurse. Blinded follow-up telephone interviews were completed at 30 days and six months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity and specificity of the screening tools were calculated using 2×2 tables.

Results

419 patients were recruited with 49% female and a mean age of 76.9 years (SD 7.15). The prevalence of frailty varied across the screening tools (ISAR, 47% vs InterRAI-ED, 63%). At 30-days, mortality rate was 5.4%, ED re-attendance 16.9%, hospital readmission 13.6%, functional decline 47.1% and nursing home admission 7.3%. Older adults who screened positive for frailty demonstrated an increased risk of all adverse outcomes at 30 days and 6 months, regardless of frailty screening tool administered. All tools had a relatively high sensitivity but low specificity. The ISAR was the only tool which was statistically significant at predicting all outcomes at 30 days.

Conclusion

The ISAR, CFS, PRISMA-7 and InterRAI-ED demonstrated modest validity at predicting adverse outcomes at 30 days and 6 months. We would recommend the implementation of one of these frailty screening tools in Irish EDs to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention in the hospital or community setting.