bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Integrated Care Team- Detention Order Outcomes And Indications
Authors: Bradley Eoin , Keating Sharon , Quinn Aoife , O'Shea Joan , Hogge Eilish , O'Neill Niamh , Kenny Blaithin , Clarke Enda , Higgins Aislinn , Laycock Berneen , Kovalyshyn Volodymyr , O'Toole Ronan , Nee Rory
Published: September 2024

Background

Detention orders are the inherent jurisdiction of the high court. Only mechanism to support treatment in those lacking capacity and refusing care. Considered a last resort. Integrated care for older persons teams (ICPOP) often engage with complex cases who require this intervention. I aim to review detention orders enacted on ICPOP patients within 1 year.

Methods

Retrospective review of notes on all patients who required a detention order for transfer of care from March 2023- March 2024. Assessing on review patient’s primary diagnosis, expressed wishes, interventions implemented by the ICPOP team to avoid detention and then reasons for detention order and finally patient outcome.

Results

7 patients. 6 female. Every patient expressed a wish to remain in their home. All 7 patients had dementia. Implemented interventions included, Medical social work, home care packages, Memory resource and technology room referrals, meals on wheels plus family support groups, and legal supports, ward of court and decision-making representatives. Interventions where however unsuccessful and reasons for detention ranged from- Night-time wandering x3. Road safety concerns x 3. Family neglect and abuse x 3. Fire safety x1 and Accidental poisoning/malnutrition x1 and Alcohol excess x2. All bar one patient settled without need for medication or specialist unit when transferred to nursing home.

Conclusion

Outcomes were positive in all cases of detention order being implemented. All 7 patients received better care and avoided serious risk to health. The one patient who required significant intervention to maintain transfer was a behavioural fronto-temporal dementia who required a locked unit and psychotropics. In all cases family supported the decision and patient quality of life improved. Where autonomy and liberty remain paramount concerns for all individuals this review confirms that in some cases doctors must act in the best interests of their patients even if this act is against their wishes.
The Ghost Of Hip Arthroplasties Past: It Takes A Geriatrician To Mine For Metal
Authors: Davey Cathy
Published: September 2024

Background

An 84-year-old female presented to Geriatric Medicine out-patient clinic with many years of persistent right hip pain, generalised myalgia; and several months of constipation, weight loss and persistent elevation of C-reactive protein and Erythrocyte Sedimentation Rate. The General Practitioner's concern was occult neoplasm. History of right hip arthroplasty in 2011. 6 years prior, she had wide local excision and adjuvant radiotherapy for a grade 3, “triple negative”, invasive ductal carcinoma of the right breast. Serial imaging identified a right parasternal, internal mammary chain neurofibroma. A Rheumatologist had administered intra-articular steroid to both glenohumeral joints for plain X-ray confirmed osteoarthritis, in the absence of serological vasculitic or autoimmune rheumatological disease. Benefit was transient. Her Oncologist had arranged MRI spine for “sciatica” demonstrating L3/4 and L4/5 stenosis and a large right adnexal cyst. Subsequently, the Gynaecology team assessed and planned interval MRI pelvis as initial MRI suggested a right partial hydrosalpinx, left internal chain lymphadenopathy and nodule adjacent to sacroiliac joint.

Methods

History, examination and imaging results were checked against the Medical Device Alert number 18 from the Medicines and Healthcare products Regulatory Agency (UK) in 2017. Oxford Hip Score Assessment was 29. Lymphatic drainage from medial hip joint is towards right iliac chain.

Results

In the absence of Gadolinium based contrast agents within 96hours, metal testing demonstrated: Serum Cobalt was 232nmol/L or 13.7 ug/L; Serum Chromium was 78.8nmol/L or 4.1ug/L; Chromium Urine: Creatinine Urine Ratio was 24.54nmol/mmol; and Cobalt Urine: Creatinine Urine Ratio73.96nmol/mmol. These elevated blood and urine results confirmed metal-on-metal hip disease.

Conclusion

Consider symptomatic metal-on-metal hip disease with soft-tissue involvement in patients presenting with post-hip arthroplasty joint pain, generalised myalgia and raised inflammatory markers; particularly if there is unexplained ipsilateral internal iliac chain lymphadenopathy and pelvic fluid collections. If confirmed, metalwork explanation is the treatment.
StrokeCog-R: Protocol for a Pilot Randomised Controlled Trial Of A Novel Cognitive Rehabilitation Intervention For Post-Stroke Cognitive Impairment
Authors: Moran Catherine Nora , Oglesby Megan , McGlinchey Jane , Pender Niall , Bennett Kathleen , Horgan Frances , Kelly Peter J , Merriman Niamh , Williams David , Hickey Anne
Published: September 2024

Background

Post-stroke cognitive impairment (PSCI) affects 50% of patients six months post-stroke and is associated with increased disability, reduced quality of life, diminished independence, and a higher risk of long-term care and dementia. Addressing cognitive impairment is crucial to maximise patient recovery, facilitate the return to pre-stroke activities, and optimise secondary prevention efforts. However, cognitive rehabilitation is underrepresented in standard stroke rehabilitation protocols. This pilot randomised controlled trial (RCT) aims to evaluate a novel cognitive rehabilitation intervention, StrokeCog-R, designed to enhance cognitive function in stroke survivors with PSCI. The primary aims are to assess the feasibility of patient recruitment and retention and to determine the statistical power needed for a definitive trial. A secondary aim is to evaluate the efficacy and acceptability of the intervention for individuals with mild-to-moderate PSCI.

Methods

Sixty-four consecutive stroke patients with mild-to-moderate PSCI will be recruited and randomly assigned to either the intervention group (StrokeCog-R) or the control group (usual care). The intervention involves five weeks of group-based cognitive rehabilitation using “Rehearsal-Based” and “Compensatory-Based” strategies, supplemented with tailored home activities. Cognitive function, self-efficacy, and caregiver psychological wellbeing will be assessed pre- and post-intervention (or control) and at a four-month follow-up. Intervention acceptability will be documented through focus groups following each intervention. Recruitment is ongoing, and the first intervention group has concluded.

Results

Recruitment and retention rates, the feasibility of randomisation, patient acceptability, and resource utilisation will be evaluated. Additionally, the effectiveness of various communication techniques for retaining participants between the intervention period and the four-month follow-up will be assessed. These data will inform recruitment strategies and the determination of necessary effect sizes to power a definitive trial.

Conclusion

This study will provide critical insights for a definitive trial, potentially making a substantial contribution to the evidence base for cognitive rehabilitation in stroke patients.
AntiSox-1 Limbic Encephalitis: When A Movement Disorder Evolves Oddly And Delirium Just Does Not Feel Right
Authors: Trolan Ciarán
Published: September 2024

Background

A 74year old male presented to a Movement Disorder service with a 15year history of a parkinsonian syndrome with asymmetric, akinetic rigidity and prominent axial features. Motor features were stable for almost 13years. Neuropsychiatric features rapidly emerged over several months including: multimodality perceptual hallucinosis, upside down and tilt illusion, akinetopsia, intractable insomnia, emotional incontinence and Othello syndrome. A marked motor, mysaesthenic pattern, deterioration occurred in conjunction with hypoactive delirium, dysphagia, pyrexias, raised inflammatory markers and weight loss, necessitating hospitalisation. Computed tomography (CT) of chest, abdomen and pelvis did not demonstrate infective or neoplastic aetiology. CT brain did not demonstrate cerebellar atrophy. Positron emission tomography did not demonstrate a vasculitis. Drg regimen alterations brought about minor improvements, but he remained very severely frail and discharged to hospice care. Unexpectedly, cognition then markedly improved and neuropsychiatric symptoms resolved over months, and he returned home, albeit now severely frail. There was persistence of hemiparkinsonian symptoms, contralateral to which, dystonia had emerged with new bilateral upper limb ataxia and nystagmus. No mysaesthenic features persisted.

Methods

Cerebrospinal fluid analysis and electroencephalography were not undertaken. MRI brain was not undertaken.

Results

Anti Sox-1 positive. Anti Zic-4 and Recoverin were equivocal. Neuronal antibodies were negative.

Conclusion

Limbic encephalitis as a result of AntiSox-1 onconeural antibodies is most commonly associated with small cell cancer of the lung (prevalence of 36.5% of cases). Lambert-Eaton Mysaesthenic Syndrome is a more common presentation than paraneoplastic cerebellar degeneration. Hindsight raises the possibility of non-convulsive status epilepticus as an explanation for abrupt hypoactive delirium presentation on the background of deteriorating neuropsychiatric features. Oncological or immunotherapeutic intervention was not considered appropriate by respiratory or neurology teams respectively; nor did the patient wish for these to be pursued. Case reports indicate that an underlying neoplasm is not always identified. Non-paraneoplastic autoimmune encephalitis can have a better prognosis.
An Audit Of Falls Admissions Documentation To A University Hospital: Cycle 1
Authors: Fernandez Celia , Cronolly Stacey , Boyle Nichola
Published: September 2024

Background

30% of adults aged 65 years and older experience a fall annually which can result in significant disability. The World Falls Guidelines (WFG) 2022 were developed to guide non-specialist clinicians in undertaking a falls assessment for high vs low/medium risk of further fall.

Methods

The medical admission list from July 2023-October 2023 was reviewed and 165 charts were requested for admissions listed as “fall’, ‘syncope’, ‘collapse’ and ‘pre-syncope’. Of 93 charts reviewed, 60 admissions were included in the audit. Of the 26 criteria listed in the WFG 2022, 10 were included in this audit. The index admission document was assessed for documentation of demographics, description of fall, any falls in preceding year, documentation of syncope, documentation of injury, cardiac and neuro examination, walking aids, comment on the cause of fall, medication review and time to mobility assessment. A pre-morbid Rockwood Clinical Frailty Score (CFS) was assigned on chart review.

Results

40% were male and 60% were female. Mean age of patients was 80.25 years (SD=8.4) with a mean CFS of 3.6 (SD=1.89). 91.7% documented some descriptor of the fall, 50% documented asking about syncope, 33.3% documented asking about previous falls. 96.7% had a documented cardiac exam, while only 71.1% documented a neuro exam and 41,7% documenting mobility baseline. 60% had a medication review documented and 41.6% had mobility assessed in under 72 hours. Only 76.7% of admissions had a documented differential for the fall.

Conclusion

Further education is required to adequately risk stratify patients admitted with falls and help guide appropriate investigation and workup as well as promote thorough documentation. An education session was conducted with Medical SHOs on May 14th, 2024, and Cycle 2 of the audit will commence June 2024.
Exploring Stigma in People with Parkinson’s Disease. A Qualitative Approach
Authors: Gaiera Fran , O'Shea Emma , O'Keeffe Gerard , Timmons Suzanne
Published: September 2024

Background

Parkinson’s disease (PD) is a neurodegenerative disorder characterised by motor and non-motor symptoms, which can considerably compromise people with PD’s (PwP) quality of life and psychological well-being in part due to ongoing stigma. Here, we sought to explore the role of stigma in the experience of living with PD in Ireland.

Methods

Twenty-one participants were recruited through convenience and snowball sampling. Data were collected through 30-50 minute semi-structured interviews face-to-face, via videoconference, or telephone. The interview explored PwP’s symptoms, psychosocial experiences, and support needed in the context of stigma. A thematic analysis was performed on interview transcripts.

Results

PwP do not avoid social situations because of their illness and are generally open to sharing their diagnosis with others. Most can avail of a solid social network and found that this supports them during the process of self-acceptance following their diagnosis. However, most do not feel comfortable sharing their feelings with close ones and would avail of an external emotional outlet, were it to be available. Stigma was experienced in social situations where PwP felt pitied and misjudged.

Conclusion

This study provides a snapshot of the social perceptions and experiences of people with PD in the context of stigma, and the consequential effects on their sense of well-being, identity and social connectedness. These findings may help to inform the development of health and social policies and help educate the general public on the lived experience of PwP.
Examining Post Hip Fracture Bone Protection At 30 days After Admission To An Irish Hospital
Authors: Vallely Shanice , Mullen Mary , Walsh Mary , Kiernan Sinead , Salawu Ade
Published: September 2024

Background

The Irish Hip Fracture Database (IHFD) includes a national standard of bone assessment during the acute episode of care. Furthermore, IV Zoledronic Acid (IVZ) is now recommended after hip fracture to provide longer term bone protection. It is not known however, how many patients commence appropriate bone therapy, by 30 days after admission. This audit aimed to examine commencement of bone protection medication for hip fracture patients across one acute hospital and its associated rehabilitation sites.

Methods

A retrospective audit was conducted. Consecutive patients admitted between December 2022 and December 2023, with hip fracture to a single acute hospital were included. Patients that did not meet IHFD inclusion criteria, were excluded. Patients were contacted in-person or by telephone by a physiotherapist to ask about bone-protection medication at 30 days after hip fracture admission, as part of a broader follow-up.

Results

A total of 146 patients were included for follow-up at 30 days after hip fracture admission. Of these patients, n=13 (9%) had died within this time and n=7 were not contactable at 30 days. A further n=8 (5%) did not receive bone-health follow-up. Only n= 3 patients contacted were not started on bone medication because it was contraindicated. While it is known that many patients were given IVZ as inpatients, it was not possible to determine this information accurately from patient report or current information recorded in the IHFD.

Conclusion

Most participants were administered bone protection medication by day 30 post hip fracture admission, however in some cases this was difficult to determine. The process of conducting the audit has improved commencement and recording of specific medication, in particular IVZ. The introduction of long-term outcomes into the IHFD should facilitate our hospital to benchmark our bone protection coverage nationally.
Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service
Authors: Ahmad Mian Shariq Haseeb , McSorley Aileen , Nirodi Pratibha , Canavan Fintan , Graham Marcus , Keelin Ellis , Hutchinson Mark
Published: September 2024

Background

Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality.

Methods

This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality.

Results

The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group.

Conclusion

These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.
DXA In People Living With HIV
Authors: Clarke Aoibhin , Denieffe Stephanie , Dockery Frances , McNally Cora , Coakley Peter , Byrne Maria , Josy Josie
Published: September 2024

Background

As people with HIV now live a near normal life-span, prevention of fractures is increasingly important. Alongside conventional risk factors for fractures, antiretrovirals and chronic inflammation are believed to contribute to their increased fracture risk compared to the general population.

Methods

We audited a 1-year series of consecutive DXA scans conducted on people living with HIV vs the European AIDS Clinical Society guidelines on bone health. These guidelines specify indications for DXA, for repeat DXA and for osteoporosis treatment. We recorded DXA results, any prior DXA, fracture history, fracture risks and drug treatment history. We assessed frequency of scanning and pharmacological management of low bone mass vs. guidelines.

Results

N=90 referred for DXA, of whom 18% did not attend, leaving n=74; 58% female, 42% male, median age 52 years [36-64] and 56 years [49-69] respectively. Of the 18% (n=14) who were aged under 50, 43% had no clear indication (fracture risk factor) for DXA. Of those aged >50 years (n=60), all scans were indicated as the guidelines advises this in those aged >50 years. Bone density was normal in n=32 (43%), osteopenic in 36 (49%) and osteoporotic in 7 (9%). Fifteen percent overall had a fragility fracture history, none of whom were taking osteoporosis treatment though it was indicated in at least 4 based on their DXA result. N=12 (16%) had a DXA in preceding years, and just 2 of the repeat scans were indicated according to guidelines. For the 12 with serial scans, there was no significant change in T score after a median three-year period.

Conclusion

Through an audit of consecutive DXA referrals, rather than consecutive individuals, low bone mass and fragility fractures are prevalent in people living with HIV. With advancing age, fracture incidence may rise sizeable in this group therefore due attention to bone health guidelines in required.
Frailty Screening and Assessment in the Emergency Department: Meeting the Growing Demand with an Expanded Acute Frailty Team
Authors: Dillon Aoife , Edge Lucinda , Bane Emma-Jane , Flynn Sinead , Molamphy Aoife , Byrne Karol , Kenny Elizabeth , Bell Alexandra , Taylor Yvonne , Keane Barry , Brennan Louise , Bentley Kate , Keogan Fiona , Enright Alison
Published: September 2024

Background

Frailty screening and early comprehensive geriatric assessment (CGA) in the emergency department (ED) is recommended to deliver optimal care for older adults with frailty and to reduce associated pressures on hospital systems.1 Interdisciplinary acute frailty teams (AFT) are best placed to lead these specialist assessments and a newly-expanded AFT was launched in February 2024.2 Activity data from the initial months of the AFT’s operations was analysed to understand the patient profile, service demand vs capacity and the impact of the team expansion.

Methods

A newly-expanded interdisciplinary AFT was launched, including Speech and Language Therapy (SLT) for the first time. Aims were to screen all those aged >70 years in ED for frailty using Clinical Frailty Scale (CFS) and commence CGA where appropriate, during core working hours. Additionally, the team expanded their remit from usually seeing patients pre disposition decision to include those referred for admission. Data reports for AFT activity in the first 55 working days and all-ED >70s presentations in the same time period, including weekends (78 days) were generated and analysed using excel.

Results

N = 920 patients were seen in the first 55 working days, n=513(53%) female, mean age 79.2 (6.7 SD, range 70-100), 65.4% living with frailty (CFS ≥4), admitted n=581(63%) vs discharged n=339(36%). The AFT saw 36% of all >70s ED presentations. On weekdays, there is a mean demand of n=35.9 (1.4 SD) >70s, and the AFT met 42% of this demand (mean n=15 (2.1 SD)). Compared to the same period in 2023, n=622 (313%) more patients were assessed or screened. Novel services provided were CGA and interdisciplinary team assessments commencing in ED for admitted patients and a SLT ED service.

Conclusion

An expanded AFT has increased capacity to screen for frailty and commence CGA. Future work will focus on hospital-wide frailty pathways.
Person Centred Dementia Care Made Simple
Authors: Teague Gillian
Published: September 2024

Background

This poster will outline the development and rollout of our person-centred dementia care microlearning course for all patient-facing staff based in St. James's Hospital, Dublin. Person centred care (PCC) appears to make a difference to how well people with dementia manage on hospital wards (Scerri et al., 2020). The term PCC is used widely in healthcare services and the approach is embedded in St James's nursing professional practice model, standards and policies. Yet there are health professionals who find PCC difficult to define and demonstrate in their practice (Byrne et al., 2020). Through our interactions with staff on wards and in nursing homes, Dementia Services Information Development Centre (DSiDC) are aware that healthcare staff can face difficulties in establishing a rapport with a patient with dementia. Therefore, we identified the need to design a course to facilitate the continued development of meaningful interactions between hospital staff and people with dementia. The course was divided into four stand-alone modules using clear, uncomplicated language and demonstrates how staff can use key elements of Kitwood’s PCC approach in their daily practice.

Methods

It is becoming harder for hospital staff to be released for onsite training courses due to increasing demands on their time. With this in mind, the DSiDC team sought innovative time-efficient ways to provide dementia education to hospital staff and so a microlearning educational tool was adopted. Microlearning delivers short pieces of content in easily understandable ways utilising a variety of methods such as: video, short written text and quizzes. Accessed by a QR code, staff can complete the course on their mobile phone at a time and place that suits the individual. A pilot study of the course was conducted among staff in a nursing home and on a key ward in St. James’s Hospital.

Results

73% of participants found the content ‘extremely helpful’. At start of course, 21% of participants rated their knowledge about person centred dementia care as ‘excellent’. On completion of course, this increased to 50%. One outcome of the pilot study identified an improvement of course design to three modules as opposed to four.

Conclusion

As a result of the positive outcomes from pilot study, it was decided as part of the wider dissemination of the course across St. James’s Hospital, to conduct a focus group to further measure the impact of the training.

References

1. Scerri A, Innes A, Scerri C. Person-centered dementia care in acute hospital wards-The influence of staff knowledge and attitudes. Geriatr Nurs. 2020 May-Jun;41(3):215–221. https://doi.org/10.1016/j.gerinurse.2019.09.001. Epub 2019 Oct 17. PMID: 31630871.

2. Byrne AL, Baldwin A, Harvey C. Whose centre is it anyway? Defining person-centred care in nursing: An integrative review. PLoS One. 2020 Mar 10;15(3):e0229923. https://doi.org/10.1371/journal.pone.0229923. PMID: 32155182; PMCID: PMC7064187.
A Five-Year Review of Dietetic Referral Activity in a Long-Term Residential Care Facility for Older Adults in Ireland: 2019–2023
Authors: Hendroff Una , Hogan Florence , Ahern Adrian
Published: September 2024

Background

Long term care (LTC) settings in Ireland have limited access to dietetic services provided by CORU registered dietitians. HSE guidance for community dietetic service provision recommends one whole time equivalent (WTE) dietitian per 100 nursing home beds[i]. National guidance on nutrition screening[ii] recommends malnourished patients and those at risk of malnutrition require referral to a dietitian to improve outcomes associated with malnutrition and disease. This review highlights the changes in dietetic referrals and service demands prior to, during and post the Covid-19 pandemic, and reflects the increasing complexity in the LTC population. [i] Nutritional Care in Health and Disease, HSE 2017, [ii] National Clinical Guideline 22, 2020.

Methods

Data extracted from Excel spreadsheets were utilized to assess activity from 2019 to 2023. New referrals were categorized as either new cases to the service or returning patients who were re-referred due to a change in their medical condition or nutritional status.

Results

In 2019, a lower percentage of residents required dietetic input: 45% (69 out of 152 beds) compared to 92% (69 out of 75 beds) in 2023. Annual referrals saw an increase from 133 in 2020 to 164 in 2022, then a decrease to 146 in 2023. The average caseload returned to pre-COVID rates in 2023, with 69 residents, compared to a higher caseload from 2020 to 2022, ranging from 74 to 82 residents. The dietetic waiting list grew from 5 in 2019 to 21 in 2023.

Conclusion

The data indicates a growing need for nutritional referrals and monitoring for our residents. This reinforces the recommendation of at least one WTE dietitian per 100 nursing home beds. Additionally, it underscores the necessity for more designated care staff with nutritional training to meet the dietary needs of our older persons in residential care.
Balanced: An Evaluation Of A Newly Established Older Adult Exercise Class
Authors: O'Brien Edwina , Conroy Bronagh , Minogue Annemarie , Collins Enda , O'Donnell Marie
Published: September 2024

Background

Falls are common in older adults and one of the leading causes of morbidity and mortality globally. Evidence based falls exercise programme have been proven to reduce the risk of falling in community dwelling older persons. This study aimed to evaluate the impact of a new falls exercise class for community dwelling older adults.

Methods

This class was based on the Falls Management Exercise (FaME) programme model, implemented by a trained Physiotherapist and Exercise Instructor. It consisted of a twenty-six-week programme which included a once weekly supervised group exercise class (1hour) supplemented by a twice weekly home exercise programme. Participants were recruited from primary care services based in the local region. Those who met the inclusion criteria were assessed by a physiotherapist who collected basic demographic data. A range of outcome measures were completed pre and post intervention, assessing motor and behavioural domains. Participant feedback was collected. Data was analysed using SPSS.

Results

Eleven participants completed this programme. The mean age was 78 years old and 73% of participants were female. Participants completed an average of 22 out of 26 classes. The number of falls reported reduced from 0.8 pre intervention to 0.1 post intervention (p 0.03). Timed Up and Go improved from a mean of 11.28 seconds pre intervention to 9.06 seconds post intervention (p 0.02). Mean Health Today Score was 73.2% pre intervention improving to 82.3% post intervention (p 0.05). Participant feedback was positive.

Conclusion

This study demonstrated the significant positive impact of an evidence-based exercise class on our participants functional ability, quality of life and reducing falls. This is a preliminary evaluation and analysis of further data is essential. These classes may assist in reducing demands on acute healthcare services and should continue to run and be further investigated.
Community Connector Pilot – Review Of A Non-Clinical Programme Within An Integrated Care Programme For Older Persons Team
Authors: Hannan Tina , Sieger-Jamison Lisa
Published: September 2024

Background

A Community Connector is a specialist Social Prescriber for older individuals who often present with complex medical needs and are referred directly by an Integrated Care team. The programme is a collaborative model between this team and a respective community host organisation. Integrated Care, as part of the Sláintecare Programme, places a stronger emphasis on social supports and person-centredness as key elements in healthcare (Goodwin, 2013).

Methods

Referrals are received approximately two to three weeks prior to discharge from the Integrated Care team which allows for relevant feedback from the Community Connector to this team. A coaching approach is utilised as a way of exploring each participant’s individual priorities and their expressed interests and goals in order to enhance their awareness of resources and supports in their own community and their subsequent readiness to engage. This process involves co-creating a personalised wellbeing plan with each individual which can act as the basis for a joint learning journey together.

Results

On referrals received to the programme, ongoing data is recorded regarding the number of individuals participating, the activities undertaken and the outcomes affecting the wellbeing of participants. Social isolation is a key reason for referral among this cohort in addition to cognitive stimulation, reengagement in social outlets and carer stress. Programme participants continue to be referred to a range of community activities, programmes and supports. Preliminary findings show an increase in community connectedness in regard to individuals’ increased knowledge and subsequent participation in local activities.

Conclusion

Key qualitative and quantitative data are the basis for initial and ongoing evaluation of the programme. These include recording any reflections and challenges which then act as key learning tools in delivering a unique person-centred programme for older individuals.
Review of Current Early Bed Positioning Practice by Occupational Therapists With Patients Post-Acute Stroke
Authors: Whyte Ella , Sinnott Eimear , Hunt Lauren , O'Sullivan Eve
Published: September 2024

Background

Many patients experience varied degrees of physical impairments post stroke, which can impact their ability to adjust their posture and position independently. National guidelines state that positioning should be assessed promptly and within 4 hours of arrival to hospital (National Clinical Guideline for Stroke for the UK and Ireland, 2023). Therefore, occupational therapists (OTs) working in stroke should prioritise positioning as early as possible within the intervention process. Aim: To highlight current practice and appraise in line with clinical standards to promote the importance of early bed positioning for acute stroke patients.

Methods

A two-month audit on positioning intervention by OTs was completed locally. Data was collated on a secure logbook.

Results

59 patients were admitted with a stroke between January and February of 2024. 15 patients required bed positioning. Only 2 patients received bed positioning on initial assessment. Documented reasons for not completing bed positioning included time constraints, pain, and resources.

Conclusion

OTs are not meeting current standards in relation to bed positioning in SVUH. Time constraints, referral times and staffing were highlighted as contributing factors. A service development opportunity was identified and rolled out during the completion of this audit. Implications for practice: Ward based education and an information resource booklet on bed positioning was provided to the staff on the stroke ward. This has prompted a review of the OT initial assessment form to include bed positioning as part of the assessment, and the development of a positioning guidelines hand-out for the stroke interdisciplinary team to implement upon admission.
Association Between Serum Albumin And Lower Limb Ultrasound Muscle Thickness in Older Patients Admitted with Hip Fracture
Authors: Perez Gomez , Serrano Elodia Teresa Bernabeu , Villalobos Yasling Akintui , Montero Maria Cruz Macias , Ortuno Roman Romero , Tagarro Pilar Del Pozo , Diaz Maria Teresa Guerrero , Gutierrez Elena Ridruejo , Pascual Angelica Munoz , Alegre Pilar Tajada , Robles Victoria Villalta , Gomez Juanjose Diez , Iglesias Pedro
Published: September 2024

Background

Sarcopenia is an important geriatric syndrome that is common in older patients admitted to the hospital with hip fracture. Nutritional status is known to be associated with sarcopenia in the general population, but less is known about this association in hospitalised hip fracture patients, especially when considering biochemical nutritional biomarkers. Our aim was to contribute evidence in this regard.

Methods

We recruited patients over the age of 75 years admitted to a hospital with hip fracture. During admission, we measured muscle thickness (MT) of the rectus femoris (contralateral to the fracture) using ultrasonography (Sonosite M-Turbo). All patients had serum albumin measured on admission, and in a subsample we were able to measure body mass index (BMI). We performed bivariate correlation between serum albumin and MT, and linear regression models were computed to assess how MT was predicted by albumin, controlling for age, sex, and BMI.

Results

69 patients were recruited, mean age 87.8 years (SD 6.3; minimum 76, maximum 103), and 79.7% were women. Mean MT was 1.19 cm (SD 0.36). Serum albumin was available in 68 patients (mean 3.30 g/dl, SD 0.36), and BMI was available in 41 patients (mean 25.4 kg/m2, SD 4.0). The correlation between serum albumin and MT was statistically significant (Pearson’s coefficient = 0.263, p = 0.030). After controlling for age and sex in n = 68, albumin was the only significant predictor of MT (Beta = 0.275, p = 0.036). When adding BMI to the model in n = 41, albumin was the only significant predictor of MT (Beta = 0.364, p = 0.026).

Conclusion

Serum albumin was independently predictive of MT in hospitalised hip fracture patients. Serum albumin may be a useful biochemical nutritional biomarker of risk of sarcopenia in this population, and further research is required to confirm this biologically plausible observation.
Answering an “SOS”: A 12-Month Review of An Urban Pathfinder Service
Authors: Madden Romy , McInerney Emer , Dunleavy Niall , McLoughlin Ruairi , Baldrick Damien , McElwaine Paul
Published: September 2024

Background

The Pathfinder service is a collaboration between the National Ambulance Service (NAS) and acute hospital Physiotherapists (PT) and Occupational Therapists (OT). The service aims to safely treat over-65s who have called 999 with low-acuity problems at home. It offers safe alternative care pathways to traditional Emergency Department (ED) attendance to older adults within our hospital catchment area (Bernard et al. 2021).

Methods

A retrospective review of the service database for 2023 was completed. A patient experience survey was conducted over a 4-week period in Quarter 4 of 2023. The survey consisted of both Likert scale and open-ended questions. Service statistics and Likert data were analysed in Microsoft Excel, while open-ended responses were analysed thematically.

Results

A total of 598 calls were received by our Pathfinder service in 2023: live 999 calls (n=407), and “Special Services” (SS) calls from Dublin Fire Brigade (n=191). 55% of live 999 call referrals attended by Pathfinder were safely kept at home. Of 191 SS referrals, 35% (n=66) had a review by the Pathfinder team. Of the 66 assessed, 94% (n=62) were safely kept at home. A total of 1,392 follow-up interventions (home visits, phone calls, onward referrals) were completed by PT and OT. Service user feedback was overwhelmingly positive, with 100% (n=20) of respondents stating they would be happy to see the Pathfinder team again if calling 999. General feedback highlighted the responsiveness, thorough assessment, and friendliness and professionalism of the team. Areas for development included increasing staffing and increasing to a 7-day service.

Conclusion

The Pathfinder service is effective in an urban setting. Over a 12-month period, 55% of patients assessed by Pathfinder were safely treated at home, with follow-up support from Pathfinder PT and OT. Service users report positive experiences and would be happy to see the team in the future when calling 999.
Implementation of INEWS to Improve Patient Outcomes in a Community Hospital
Authors: Joseph Beena , Salomon Mary Mae
Published: September 2024

Background

It is imperative to identify at risk older patients with clinical deterioration as soon as possible. The Irish National Early Warning System (INEWS)1 is used to detect clinical deterioration at an early stage based on each patient's vital sign records. It can then initiate a communication mechanism between nurses and doctors to enable early patient care. Data on the effectiveness of the INEWS in patients admitted to community rehabilitation wards, the barriers and difficulties encountered during implementation, are still scarce, despite the development and implementation in acute settings. There are not enough standardised tool available to identify patients' deterioration for community hospitals.

Methods

This pilot quality improvement programme was conducted in a community hospital's rehabilitation section. Data were gathered seven weeks after the deployment of INEWS and fourteen weeks before. Issues were studied to determine the underlying cause, created a driver diagram to comprehend the factors that lead to unexpected outcomes, educated and gathered feedback from the clinical care teams involved, measured adherence to the INEWS during the six-week pilot project implementation period, and assessed results by looking back at the deteriorating patient data and INEWS compliance using Plan, Do, Study, Act cycles.

Results

During the pre-INEWS introduction phase (14 weeks), there were 11.9 events per week (7.8 events with infection or septic workups, 9.6 events with onsite management, 1.0 acute care transfers, 0.28 per week unexpected deaths). In the post-INEWS piloting phase (6 weeks), there were 3.6 events per week (2.5 infection or septic workup, 1.8 onsite management and 1.1 acute care transfers per week with no unexpected deaths).

Conclusion

Conclusion Early detection and rapid management through the INEWS can enhance patient care; however, increased stakeholder engagement in escalation response may enhance patient outcome in resource limited community setting.

Reference

https://www2.healthservice.hse.ie/organisation/qps-improvement/deteriorating-patient-improvement-programme-partnership-dpipp/
Risk and Resistance: Ageing in the Charity Retail Sector
Authors: Kelly Siobhán
Published: September 2024

Background

Charity shops have long been found to promote sociability, nurture experiences of belonging and act as spaces for community, caring and well-being. Older people remain likely to participate in this setting and charity shop volunteering is typically associated with events of positive ageing. However, the sector's growing emphasis on professionalism and profit raises questions about the potential impact of organisational change on this group. This research seeks to address this gap by exploring how older volunteers experience their roles within the evolving context of the modern UK charity shop.

Methods

This PhD study employed an ethnographic approach, involving 268 hours of immersive fieldwork across 3 charity shops in Greater Manchester. Ethnographic data was complemented by 17 semi-structured interviews with volunteers and store managers.

Results

Ageist discourses have been embedded into the sector, which work to reconstitute older volunteers as a type of ‘risky subject'. Such discourses manifest in unique ways on the charity shop floor and comprise of a range of practices, both subtle and overt, that are driven by the organisations focus on an intensified form of productivity. This prompts diverse forms of resistance from older volunteers, which are underpinned by the aim to not only counter negative perceptions of ageing but be just ‘visible’ enough in order to get by.

Conclusion

This paper unpacks the multifaceted nature of ageism in the charity retail sector. Whilst it is not as simple as suggesting that charity shops are solely characterised by ageism - especially considering the volunteer experience varies considerably across different contexts and places - age-related tensions are nonetheless more prevalent in the everyday. Older volunteers are not passive in the face of such change and continually work to avoid exclusion and remain integrated in this space in diverse ways.
Chronic Kidney Disease and Frailty: Insights from a Cross-Sectional Study in Older Adults
Authors: Rasheed Mujahid , Sayers Karen , King Lorna , Maher Jennifer , Ryan Siobhan , Donnellan Christina
Published: September 2024

Background

Chronic Kidney Disease (CKD) and frailty are prevalent conditions among older adults, contributing to increased healthcare utilisation and adverse outcomes. The aim of this study was to examine CKD prevalence and associated factors in older adults attending a Community Specialist Team (CST) for older persons for Comprehensive Geriatric Assessment (CGA).

Methods

A cross-sectional study was conducted of all adults aged ≥65 years who had a CGA from October 2023 to March 2024. Variables recorded on an Excel spreadsheet included age, gender, Clinical Frailty Scale (CFS) score, Modified Barthel Index (mBI), presence of probable sarcopenia, Malnutrition Screening Tool (MST) and Dementia Screening Interview (AD8) outcomes. CKD was defined as estimated Glomerular Filtration Rate (eGFR) <60ml/min/1.73m2. The presence of frailty was defined as CFS ≥4. Functional impairment was defined by mBI<15 and MST ≥2 defined malnutrition risk. Regression analysis was used to identify associations.

Results

Ninety-one patients, 59 (64.8%) female and 32 (35.2%) male, with a mean age of 81.83 (SD=7.19) years were included. The prevalence of frailty was 90% (n=82) and of CKD was 53.8% (n=49). Age was a significant predictor of CKD and with each additional year, the odds of having CKD increased by 10% (p=0.004). Twelve (24.5%) of the CKD group had MST ≥2 compared with 17 (40.5%) without CKD (p=0.120). The odds of having probable sarcopenia was non-significantly higher (OR=1.09, p=0.8444) in CKD compared to without CKD. The odds of a positive AD8 was also non-significantly higher (OR=1.24, p=0.605) in CKD compared with no CKD. There was no difference in prevalence of functional impairment between the 2 groups (p=0.466).

Conclusion

CKD is common chronic condition in frail older persons referred to a CST. It is frequently unrecognised. Identification of CKD through CGA should facilitate an integrated interdisciplinary approach to care which may contribute to better overall health and quality of life.
Treatment Escalation Plans: A Snapshot Review on Acute Medical Wards
Authors: Marks Eleanor , Khan Salman , Riaz Filza , Buckley Mary , Rahim Mohamed Faizan
Published: September 2024

Background

In medical care, Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders serve as vital tools in determining whether CPR should be administered to patients, particularly those with progressive life-limiting illnesses or approaching the end of life. Failure to make timely and appropriate CPR-related decisions and treatment escalation plans can lead to the risk of administering futile or inappropriate treatments.

Methods

Admission booklets in our centre prompt clinicians to indicate whether a patient was for CPR or not as part of the admission process, with further instructions to fill out a DNA CPR form if applicable. We conducted a chart review on acute medical wards to assess the frequency and adequacy of DNA CPR decision-making and communication. Data was collected by three investigators on a structured proforma and anonymised. Data analysis was conducted using Excel.

Results

Data was collected on 67 patients, with a mean age of 76.6. Of those 67, only six had CPR status indicated on admission, with five specified for resuscitation and one not for resuscitation. A total of 14 patients went on to have DNA CPR forms filled out during admission, but in only five cases were these decisions discussed with the patients themselves. The main reasons for lack of patient involvement in the discussions included confusion and cognitive impairment. Documentation regarding discussions with next of kin was present in eight cases.

Conclusion

Our snapshot review underscores the importance of early discussions regarding treatment escalation plans and DNA CPR decisions. Our findings reveal that these discussions are not occurring as frequently as advised, and when decisions are made, they are not adequately communicated with patients or those close to them. There is an urgent need for further training on the legal aspects and ethical considerations surrounding DNA CPR decisions to ensure better patient-centered care and decision-making.