bluuebunny/crossref_metadata_2025 huggingface dataset:
99 CHILDHOOD PERSPECTIVES OF PARENTAL YOUNG-ONSET DEMENTIA: A QUALITATIVE DATA SYNTHESIS
Authors: Blake C , Hopper L
Published: October 2022

Background

While it is less common, young onset dementia manifests at a significantly younger age (< 65). Many people with young onset dementia are parents; however, little is known about impact of the condition on children and young adults. A qualitative thematic analysis was conducted to synthesise the literature on the perspectives of children and young adults with a parent living with young onset dementia.

Methods

Electronic databases were searched in order to identify all peer-reviewed literature in relation to the perspectives of children and young adults with a parent living with young onset dementia. A thematic analysis was conducted on the relevant literature.

Results

The electronic database search resulted in 15 full texts articles. Four main themes with related subthemes emerged from the thematic analysis. The four main themes were: changing family dynamics; psychological and physical strain; stigma and coping strategies.

Conclusion

The current synthesis outlines the perspectives of children and young adults with a parent living with young onset dementia. There is a significant lack of research in this area which adds to the stereotypical view of dementia as an older person’s disease. This can lead to children and young adults being impacted by lack of awareness and stigma resulting in significant psychosocial problems. As the number of people living with dementia (including young onset) is set to increase, future research with children and young adults with a parent with young onset dementia is important in order to better support this cohort.
100 MOVING TOWARDS “NET ZERO” HEALTHCARE: THE CARBON FOOTPRINT OF A MIXED FACE-TO-FACE AND TELEHEALTH MOVEMENT DISORDER CLINIC
Authors: Trolan C
Published: October 2022

Background

The climate emergency disproportionately impacts older people. Providing low carbon-emitting care now is important for current and future healthcare. In “For a Greener NHS”, the NHS (National Health Service) set a target to reduce Carbon emissions for which it is directly responsible by 80% by 2028, 100% by 2040; and for emissions over which the NHS has influence by 100% by 2045. A low carbon model of care includes telehealth clinics. 3.5% of all UK road traffic is NHS travel and transport.

Methods

A sample was used to estimate modes of transport to clinics. One calendar year of telehealth clinics were reviewed to estimate distances not travelled by patients. Personal protective equipment (PPE) use was estimated. Carbon Dioxide equivalents emissions were calculated to compare face-to-face attenders with telehealth reviews.

Results

Clinician commute emitted 26.84kgCO2e. A sample of 57 face-to-face attendees indicates 89.48% travel by private vehicle, 7.02% by taxi, 1.75% by ambulance and 1.75% by bus. For the sample, this equates to 246.94kgCO2e if petrol cars used and 238.61kgCO2e if diesel cars used; 1.53kgCOe for taxi transfers; 1.92kgCOe for bus transfer. Reliable data on ambulance transport related CO2e was not found. For telehealth clinics over calendar year 2021, the total distance not travelled by patients was 14,749.8km, mean 25.51km, median 21.6km and range 1-276km. The estimated CO2e savings were: 2.30tonnes CO2e if petrol cars; 2.22tonnes CO2e if diesel cars; 215.65kgCO2e for taxis; 26.4kgCO2e for buses. The PPE related emission-savings were 128.48kgCO2e. Estimating from median travel distance 21.6km for the year: face-to-face attendances resulted in 75.17kgCO2e from taxis; 9.21kgCO2e for bus use; 801.81kgCO2e if petrol private car, 774.78kgCO2e if diesel car. 56kgCO2e in PPE related emissions.

Conclusion

Telehealth clinics can assist in reaching net zero healthcare. Sustainable and active transport needs facilitation. A specific organisational “Green Plan” is required to equitably and effectively deliver sustainable healthcare.
104 SPONTANEOUS ILIOPSOAS TENDON RUPTURE AND PSOAS HAEMATOMA ON ASPIRIN MONOTHERAPY: A CASE REPORT
Authors: Murphy E , Lopez M , Fallon A
Published: October 2022

Background

Spontaneous Iliopsoas Tendon (IPT) rupture is a rare condition, with a prevalence of 0.66%, occurring most commonly in athletes. Risk factors for non-athletic IPT rupture include age, female gender and steroid use. Psoas haematomas are associated with surgery, anticoagulation and coagulopathies. Only a handful of case reports have associated psoas haematoma with single antiplatelet use. We present the case of a patient who developed psoas tendon rupture and psoas haematoma.

Methods

A 77-year-old female presented with a four week history of declining mobility and left hip pain, without history of trauma. Past medical history included chronic lymphoedema and an NSTEMI, for which she was taking aspirin monotherapy. On examination, she had reduced power on left hip flexion and a tender anterior thigh, with normal sensation. CT showed asymmetric thickening of the left iliacus muscle and surrounding fat stranding. MRI demonstrated partial IPT tear with oedema extending into the iliacus muscle.

Results

After several weeks of rehabilitation, her mobility deteriorated again. A second CT was performed, which showed new expansion and fat stranding of the right iliopsoas muscle and tendon compatible with acute haemorrhage. Aspirin was held for four weeks, and she was discharged after completing rehabilitation. Her baseline mobility had disimproved and she required assistance and a frame on discharge.

Conclusion

IPT rupture and psoas haematoma are atypical causes of atraumatic hip pain in older adults. Nevertheless, they can cause significant disability. MRI is recommended as the gold standard for diagnosis. Treatment is commonly conservative, focused on physiotherapy and pain control to maintain mobility. While aspirin is not commonly associated with tendon rupture or haemorrhage, it is widely used in primary prevention of cardiovascular disease and due consideration should be given to stopping it following the occurrence of haemorrhage.
110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC
Authors: Rice C , Byrne L , Ortuno RR , Kenny RA , Cunningham C , Govern MM , Dsouza A , Prabhukeluskar S , Quinlan P
Published: October 2022

Background

Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program.

Methods

A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed.

Results

The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination.

Conclusion

“Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”

The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.
111 THE INFLUENCE OF THE ANDAGO® ON GAIT PARAMETERS AMONG OLDER ADULTS IN THE POST-ACUTE REHABILITATION SETTING: A PILOT STUDY
Authors: Fay A , Synott E , McDaid E , Barrett E
Published: October 2022

Background

Electromechanical devices incorporating body-weight support have been developed to enable a repetitive approach to gait rehabilitation whilst decreasing physical strain on treating therapists. The Andago® gait trainer provides dynamic body weight support for individuals while simultaneously enabling them to walk overground. The purpose of this study was to compare the effect of the Andago® versus conventional overground walking on gait parameters, fear of falling (FOF) and ratings of perceived exertion in a post-acute rehabilitation population.

Methods

Patients undergoing rehabilitation were randomly assigned to the Andago® or conventional walking condition on day one with the alternate testing condition completed on day two. Participants completed a 10-metre walk test where stride length, walking speed and cadence were recorded. Participants then undertook a 20-minute gait re-education session where number of steps, distance walked and number of siting breaks were recorded. Ratings of perceived exertion (BORG) and FOF scores were recorded at minutes 1, 10 and 20.

Results

Twenty-seven participants (mean age 78 (SD 9.2), female 55.6%(n=15)) completed the study. Reasons for rehabilitation included neurological (51.8%; n= 14), orthopaedic (33.3%; n=9) and medical conditions (14.8%; n=4). Forty-four percent of participants (n=12) had a mild cognitive impairment. Body weight support ranged from 10% to 17% (mean 11%, SD 2). No significant differences in the 10-metre walk test were found between conditions. A reduction in the number of sitting breaks (p <0.05) and FOF at minutes 10 (p<0.05) and 20 (p<0.05) was found in favour of the Andago® during the gait re-education session.

Conclusion

Preliminary results suggest the Andago® is a feasible modality for gait re-education in patients undergoing rehabilitation, being at least comparable to conventional overground gait training. A reduction in FOF in patients coupled with decreased physical strain on therapists may provide opportunities for more intensive practice and warrants further investigation.
118 ARE CLIENTS SATISFIED WITH INTEGRATED CARE? CLIENT FEEDBACK ON DISCHARGE FROM A DOMICILIARY-BASED MULTIDISCIPLINARY INTEGRATED CARE SERVICE
Authors: Porter S , Cannon E
Published: October 2022

Background

The Integrated Care Team for Older Persons (ICTOP) team was established in November 2017. The process of client feedback was not developed at this time. Team members received feedback from clients and families in an “ad hoc” basis. There was no formalised method of collecting data. From collating this data in a formal manner, the aim was to evaluate and reflect on the data received to improve on client experience and practice development of the ICTOP Team

Methods

Qualitative study design. The feedback questionnaire was adapted from the Integrated Care Team Older Persons, Community Healthcare East. It is a seven item questionnaire with an additional section for open ended comment and or suggestion for team improvement. A client-feedback form was sent to clients discharged from the ICTOP service during the months January-August 2020 inclusive (n= 97). Completed feedback anonymised forms were received and information collated (n=56). The respondent rate was 57.7%. Thematic analysis was utilised to appraise recurring themes in the open-ended section of the completed forms

Results

All participants agreed that they were satisfied with ICTOP intervention and were involved with decisions regarding their care. 66% of Participants also provided individual comments which were overwhelmingly positive with 7% providing recommendation for service development. All Participants would recommend this team/service to another older person.

Conclusion

Older people accessing integrated care delivered in their home reported a positive experience and appreciated the MDT input. Receiving feedback on the service enables the team to understand the effect and experience of treatment, interventions and interactions with our clients.
119 ENHANCING THE QUALITY OF STROKE CARE IN IRELAND - DEVELOPMENT OF AN IRISH NATIONAL STROKE AUDIT
Authors: Moran CN , Jeffares I , Merriman NA , McCormack J , Harbison J , Sexton E , Williams D , Kelly PJ , Horgan F , Collins R , Bhreacáin M Ní , Byrne E , Thornton J , Tully C , Hickey A
Published: October 2022

Background

Population ageing, stroke treatment advances, changing models of care, and between-hospital heterogeneity in stroke outcomes demonstrate the necessity of continual audit of stroke care to support quality improvement at local and national levels, and to enhance patient recovery and wellbeing. This project aims to identify the core minimum datasets for acute and non-acute stroke care, and Patient-Reported Outcome Measures (PROMs), for integration in to the newly-developed Irish National Audit of Stroke (INAS), in addition to identifying resourcing needs and implementation procedures.

Methods

In Phase 1, a minimum dataset for acute stroke care was identified based on a scoping review of international practice and available guidelines. Phase 2 (ongoing) involves identifying datasets for non-acute rehabilitative and follow-up care based on a scoping review of international practice, iterative cycles of qualitative stakeholder engagement, and systematic review of PROMs. In Phase 3, a review of resourcing and data collection procedures used in stroke audits internationally will be used to produce an implementation strategy for data collection, contextualised to the Irish healthcare system.

Results

Twenty-one eligible international stroke registries were identified from the scoping review. Within Phase 1, core clinical and thrombectomy items in the Irish registry were benchmarked against internationally-collected items to identify common items and to generate an inventory of items that other registries collect that Ireland does not. Based on consensus agreement on the most frequently-occurring international items, as reviewed by key stakeholders, a core minimum dataset for audit of acute stroke care was delivered.

Conclusion

These minimum datasets shall act as the “gold standard” for evaluating stroke care in Ireland, by not only incorporating structure, process, and care quality outcome indicators, but also PROMs. The resultant datasets may inform policy and quality improvement initiatives, and shape health service delivery across the trajectory of stroke care, from hyper-acute care, to rehabilitation, and return to the community.
121 INVESTIGATING THE RELATIONSHIP BETWEEN PROBABLE SARCOPENIA AND ORTHOSTATIC HYPOTENSION: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Duggan E , Murphy CH , Knight SP , Davis JRC , O'Halloran AM , Kenny RA , Romero-Ortuno R
Published: October 2022

Background

Sarcopenia and Orthostatic Hypotension (OH) are emerging age-related health burdens associated with adverse outcomes including falls and functional decline. Despite a possible pathophysiological link, the association between the two disorders is not well established. We sought to further investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA).

Methods

Data from 2,858 participants at wave 3 of TILDA was analysed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised cut-offs: Hand-Grip Strength (HGS) <27kg in men, <16kg in women and/or five-chair stand test (5CST) time >15s. Participants underwent an active stand orthostatic test with non-invasive beat-to-beat blood pressure monitoring. Multivariable logistic regression models adjusting for age, sex, anthropometrics, cardiovascular diseases, medications and fear of falling were used to determine whether probable sarcopenia was a predictor of OH at multiple time-points after standing.

Results

In multivariable analysis, HGS was an independent predictor of OH at 30s, 40s, 60s (P<0.01), 120s and 180s (P<0.05) but not initial OH at 10s or 20s (P=0.531, 0.464) or consensus OH (P=0.064). 5CST time was only associated with OH at 120s (P=0.030). At follow up in wave 5, four years later, those with HGS-defined probable sarcopenia had higher proportions of recurrent falls (10.5% vs 5.7%, P = 0.014), fear of falling with activity limitation (12.4% vs 6.9%, P = 0.011), hospital admission (24.2% vs 12.5%, P < 0.001) and death (4.8% vs 1.9%, P = 0.006) when compared to the non-sarcopenic group.

Conclusion

Probable sarcopenia as measured by HGS, but not 5CST time is an independent predictor of orthostatic hypotension, especially in the blood pressure recovery phase 30-60s after standing. The increased rates of adverse outcomes in this group underline the importance of identification of probable sarcopenia in those at risk of OH and falls.
123 LEVELS OF PHYSICAL PERFORMANCE AND PHYSICAL ACTIVITY IN OLDER ATTENDEES AT A BONE HEALTH CLINIC
Authors: McDonagh L , McCarroll K , Lannon R , Cunningham C , Connolly K , Murphy N , Horgan F
Published: October 2022

Background

Osteoporosis and sarcopenia are two common conditions seen in community-dwelling older adults. Limited information on physical performance and activity exists in older adults at risk of osteo-sarcopenia. The aim of this study was to examine levels of physical performance and physical activity in patients attending a bone health clinic.

Methods

A cross-sectional study was conducted. Community-dwelling older adults attending a bone health clinic in an acute Irish hospital were invited to participate. Primary outcome measures for physical performance and activity were: grip strength, the Short Physical Performance Battery (SPPB), the Timed Up and Go test (TUG) and the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included: Bone Mineral Density T-scores, diagnosis of probable sarcopenia, osteo-sarcopenia, frailty, fractures and falls history.

Results

104 participants took part in the study. Median age was 76 (IQR 12), ranging from 65 to 91 years. Females accounted for the majority (88.5%) of recruited participants. Osteoporosis was present in 63% and osteopenia in 31%. Low physical activity levels were identified in 29%. Probable sarcopenia ranged from 17 to 37%. Osteo-sarcopenia was identified in 9 to 33% depending on four possible definitions. The most common associations with osteo-sarcopenia were frailty (CFS) and low BMI. Using reduced multivariate regression analysis, physical performance (grip strength, SPPB, TUG) and physical activity (IPAQ) were negatively associated with increased age, comorbidities, frailty and falls. Increased age was associated with all four variables analysed. Comorbidities was associated with grip strength (p=0.005), SPPB (p=0.01), TUG (p=0.041). Frailty (CFS) was associated with SPPB (p< .001), TUG (p< .001), and IPAQ (p< .001). Fall(s) history was associated with SPPB (p< .001) and TUG (p=0.028).

Conclusion

A high proportion of participants were classified as having osteoporosis, probable sarcopenia and osteo-sarcopenia. Completing physical performance and activity measures could provide useful information to clinicians about patients and their potential risks/deficits.
131 USE OF FDG-PET BRAIN IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF DEMENTIA IN A UNIVERSITY HOSPITAL
Authors: Marks E , Doyle K , Magennis B , O'Connell M , McGreevy C
Published: October 2022

Background

Neuroimaging is an increasingly important tool dementia work-up. Subtype diagnosis helps predict the course of the disease, aiding prognostication and management. Amyloid-beta peptide is intrinsic to the pathogenesis of Alzheimer’s disease (AD), forming characteristic neuritic plaques which can be imaged in vivo on positron emission tomography (PET) scans. NICE recommendations advise use of PET imaging if dementia sub-type diagnosis is unclear and AD is suspected. We sought to establish the referral patterns for FDG-PET brain scans for patients aged 60 and over in a university hospital and to establish whether this imaging modality contributed to a change in diagnosis or treatment.

Methods

Requests for FDG-PET CT brain from 2019 – 2022 were retrospectively reviewed. Information was obtained from clinical notes and patient information software. Patient demographics, indication for scan, source of referral and whether imaging results led to a change in diagnosis or treatment was recorded.

Results

A total of 32 patients were reviewed, with a mean age of 65 years (13 females; 41%). We further analysed the 25 who were aged over 60; this subgroup had a mean age of 70 (9 females; 36%). All 25 patients were appropriately referred to assess for dementia subtype. A revision in diagnosis based on PET imaging was made in 17 (68%) cases. In 9 (30%) cases, results prompted change in dementia-specific pharmacological treatment, including donepezil and memantine. A further 6 (24%) had pharmacological treatment for non-cognitive symptoms of dementia adjusted, such as anti-depressants or anti-psychotics. The majority of referrals had come from neurologists (n = 15; 60%) rather than geriatricians (n = 10; 40%). The final diagnosis was AD in 12 cases (48%) and fronto-temporal dementia in 3 cases (12%).

Conclusion

PET scans are a useful functional imaging modality which can help to differentiate dementia subtypes and influence management.
133 A CO-ORDINATED EFFORT: THE ADDITION OF A REHABILITATION COORDINATOR TO GERIATRICIAN LED OLDER PERSONS REHABILITATION SERVICES
Authors: McDaid E , Boyle N , Cogan L , O'Shea D
Published: October 2022

Background

It is well recognised that acute illness and hospitalisation can be associated with significant deterioration in mobility and function in older people. Flow to appropriate rehabilitation services has impacts not only on individual recovery but also in efficient utilisation of healthcare resources. This study describes the impact of a therapy trained Rehabilitation Coordinator (RC) on access to off-site inpatient and day hospital specialist rehabilitation services.

Methods

Over 6 months the rehabilitation coordinator collaborated with acute and community services to triage, assess and effectively utilise off-site specialist rehabilitation services with specific reference to role development, feasibility and safety. Key performance indicators measured included assessments completed, time from referral to assessment, time from accepted to transferred, number of admissions and length of stay. This data was compared against a 6-month control.

Results

The rehabilitation coordinator was involved in over 445 assessments (n=258 patients) in the 6 months of the study. Trusted assessment by the RC was assessed as equivalent to assessments completed by Consultant Geriatricians. COVID restrictions resulted in a reduction in available rehabilitation beds between the control and pilot periods. There was a 22% increase in rehabilitation admissions and a 63% reduction in mean length of stay during the pilot period. There was also a reduction in average time from referral to assessment (1.5 working days versus 5.6 workings days); and time to transfer to rehabilitation (2.1 days versus 6.7 days). New pathways of care developed included rapid access to day hospital care from acute inpatient care. Additional benefits were seen in RC-led education, quality improvement and research projects.

Conclusion

The addition of a rehabilitation coordinator enhanced patient access to and progress through inpatient and outpatient older person’s rehabilitation services. The RC provided both oversight and continuity of care throughout the patient journey between hospital and home.
134 ADULT SAFEGUARDING, HUMAN RIGHTS AND PEOPLE LIVING WITH DEMENTIA IN NURSING HOMES: CO-PRODUCING RECOMMENDATIONS FOR BEST PRACTICE
Authors: Donnelly S , Brennan HR , Quinlan K , O'Shea J , Quaid K , Golden F , Keating M , Mackall S , Parfitt R , Paley G
Published: October 2022

Background

People living with dementia (PLwD) in nursing homes have the right to be safe and to live a life free from harm and abuse; all persons are entitled to this right, regardless of their circumstances or where they live. PLwD are at greater risk of abuse and neglect than those without a diagnosis. Such abuse often goes unnoticed, because dementia may affect a person’s ability to recognise abuse or to report it. In 2021, the Alzheimer Society of Ireland’s Irish Dementia Working Group (IDGW) commissioned the development of a briefing paper to outline the key issues relating to upholding the human rights and safeguarding of PLwD in nursing homes including concrete recommendations for policy and practice.

Methods

A scoping review of the existing literature on this topic was carried out. This was supplemented by adopting a snowball strategy to identify additional relevant literature. Three co-design online sessions were convened with members of the IDWG in order to discuss and agree on the general content and members also provided suggestions for additional research or policy papers that should be included. Co-design sessions were also used to brainstorm and reach a consensus as a group on recommendations.

Results

This project identified a number of specific risk factors for PLwD, including organisational abuse, the need to move towards a restraint-free environment, addressing barriers to reporting of abuse and promoting agency and autonomy within safeguarding processes. A number of policy and legislative gaps in our current adult safeguarding framework were identified making it more difficult to adequately protect PLwD in nursing homes.

Conclusion

22 recommendations for best practice were developed by the IDWG for nursing home service providers (public and private), health and social care practitioners, policymakers, the Department of Health, HIQA and political representatives in order to collectively advocate for meaningful change.
135 A FEASIBILITY STUDY TO EXPLORE THE ROLE OF EXERCISE AND PROTEIN SUPPLEMENTATION TO TARGET FRAILTY IN PEOPLE EXPERIENCING HOMELESSNESS
Authors: Kennedy F , Romero-Ortuno R , Cheallaigh C Ní , Doyle S , Broderick J
Published: October 2022

Background

People who are homeless are more likely to experience poor health with acceleration of ageing commonly reported. The concept of frailty is related to age acceleration and research has shown that appropriate exercise and nutritional supplementation strategies can delay or even reverse frailty. This has not been tested in the homeless population. The aim of this study was to explore the feasibility and preliminary efficacy of an exercise intervention with protein supplementation to target physical functioning deficits and frailty in people experiencing homelessness.

Methods

A low-threshold, 'drop-in' exercise programme with protein supplementation was delivered once weekly for 16 weeks. The main recruitment site was a day-service centre for people who are homeless and have addiction issues. A one-day programme was also delivered to a connected female-only centre to offer a more inclusive service. Primary outcome was feasibility, which included recruitment and retention of participants. Secondary outcomes included frailty and nutritional status, physical function and self-reported pain.

Results

Thirty-one participants were recruited, 13 of whom were aged over 50 years. Of these older participants, there was a 100% retention rate to the main recruitment centre, with at least one repeat visit to the exercise intervention. The majority of the older participants presented as frail (6/13) or pre-frail (3/13), with 4/13 non-frail. One of these participants was malnourished, six were at risk of malnourishment and six had normal nutritional status. The possible presence of sarcopenia (eight or less on the Short Physical Performance Battery) was noted in 3/13 of participants. The majority of participants (10/13) reported chronic pain.

Conclusion

This study highlights a high level of frailty and poor physical and nutritional health in older people experiencing homelessness. High retention indicates interest in this intervention. There is a need to establish and roll out targeted interventions to optimise outcomes for this socially excluded group.
136 DIABETES IS ASSOCIATED WITH IMPAIRED PERIPHERAL AND CEREBRAL HAEMODYNAMIC RESPONSES IN OLDER ADULTS
Authors: Hernandez B , Dyer A , Nipoti B , McCrory C , Briggs R , Kennelly S , Finucane C , Romero-Ortuno R , Reilly R , Kenny RA
Published: October 2022

Background

Diabetes is associated with slower gait speed and adverse brain health outcomes in older adults. However, the putative mechanisms underlying these associations remain poorly explored. One such mechanism is via altered cerebral perfusion, which may represent an important intermediate phenotype in the association between diabetes and slower gait. We assessed the impact of diabetes on peripheral and cerebral haemodynamic responses during active stand as part of The Irish Longitudinal Study of Ageing (TILDA).

Methods

We assessed: (i) peripheral haemodynamic responses (heart rate, blood pressure, cardiac output) using finometry and (ii) Tissue Saturation Index (TSI) using Near-Infrared Spectroscopy (NIRS) during active stand in older adults.

Function-on-scalar regressions were used to model the impact of diabetes on the dynamic response to standing. Subsequently, multivariable linear models were used to model usual gait speed.

Results

Of 3,011 older adults (mean age: 64.2; 55.2% female) completing active stand, diabetes (n =193, 6.4%) was associated with significantly higher heart rate (mean 3.2, s.e. 0.02 bpm), higher cardiac output (mean 0.16, s.e. 0.04 L/min) and lower systolic blood pressure (mean –6.9, s.e. 1.8 mmHg) during standing. Additionally, diabetes was associated with significantly lower TSI from 10 seconds post-stand (mean –1.2%, s.e. 0.49%). Associations persisted following robust covariate adjustment. Diabetes was associated with significantly slower gait speed (-5.3 cm/s, CI (-8.4,-2.1)). In analysing the relationship between cerebral perfusion and gait speed, poorer recovery of TSI at 60-120 seconds post standing was associated with slower gait speed (0.53 cm/s slower gait speed per unit increase in TSI, p = 0.007).

Conclusion

Diabetes is associated with impaired peripheral and cerebral haemodynamic responses in addition to slower gait speed in community-dwelling older adults. Neuro-cardiovascular instability and altered cerebral perfusion may represent an important intermediate phenotype between diabetes and adverse health outcomes in older adults.
137 VIRTUAL CONSULTATIONS IN GERIATRIC MEDICINE OUTPATIENT DEPARTMENTS; THE PERSPECTIVE OF GERIATRIC MEDICINE SPECIALIST TRAINEES
Authors: McFeely A , Davey N
Published: October 2022

Background

Covid-19 social distancing measures restricted access to outpatient services. “Virtual Clinics”(VCs) were introduced in Outpatients Departments (OPDs) to continue service provision. OPD experience is vital to geriatric medicine training. The geriatric medicine Higher Specialist Training (HST) curriculum requires annual OPD participation. This study sought to identify the impact of VCs on geriatric medicine training.

Methods

An online mixed-method questionnaire was developed and circulated among geriatric medicine specialist trainees. 20 closed-questions collected demographic information and considered opinion of VCs. 5 open-questions enabled respondents to expand views of VCs. Closed-questions responses underwent quantitative descriptive analysis. Open-question responses underwent qualitative thematic analysis.

Results

Response rate was 61.4%. 86.3% reported VCs were conducted via telephone calls. 58% didn't feel comfortable conducting VCs. 64.7% didn't feel VCs positively contributed to training. 90.2% stated Face-To-Face (FTF) clinics offer greater training opportunities. 74.51% stated they were less likely to discuss VCs with consultants(compared to FTF clinics). 98.04% hadn't received training in conducting VCs. Qualitative analysis revealed four main themes: (1) Patient Selection: certain patient cohorts are unsuitable for VCs. VCs are useful in relaying simple results; not for patients with complex needs; (2) Practical Considerations: there must be access to required technologies for patients and medical staff. Medicolegal concerns were raised by several respondents; (3) Patient Care: the inability to examine patients is a challenge which impacts patient care. The lack of non-verbal cues impeded communication; (4) Training Impact: Respondents felt VCs weren't beneficial to training. There was a sense that training opportunities had been missed.

Conclusion

This study found high rates of dissatisfaction with VCs among geriatric trainees. This may be due to: (1) Inadequate training/preparation; (2) Inappropriate patient selection or (3) Lack of video-conferencing technologies. There is a sense that VCs have negatively impacted geriatric medicine training. Current policy advocates for the continuation of VCs. If VCs continue, additional resources may be needed to address any accompanying training deficit.
138 ORTHOSTATIC CEREBRAL OXYGENATION AND THE RELATIONSHIP WITH SYMPTOMS, SUPINE HYPERTENSION AND ORTHOSTATIC HYPOTENSION
Authors: Newman L , O'Connor JD , Romero-Ortuno R , Reilly RB , Kenny RA
Published: October 2022

Background

Cerebral hypoperfusion is implicated as a cause of orthostatic symptoms such as dizziness and light-headedness. In older adults, Orthostatic Hypotension (OH) may co-exist with Supine Hypertension (SH), with greater cerebral dysfunction being reported in those with SH-OH. It remains unclear whether orthostatic symptoms are indicative of a higher cerebral hypotensive burden in older adults. This study assessed cerebral oxygenation in a cohort of older adults experiencing orthostatic symptoms, via an active stand challenge, as well as the relationship with OH and SH.

Methods

We utilized data from Wave 3 of the Irish Longitudinal Study on Ageing (TILDA). Cerebral oxygenation was continuously measured via near infrared-spectroscopy, and blood pressure via a Finometer. Logistic regression was employed to assess cerebral hemodynamics in the sample (N=2,737, mean age=65 years [range: 54-93 years]). Models were adjusted for covariates such as age, sex, standing speed, medications, and cardiovascular conditions.

Results

In the whole sample, 29% of participants reported symptoms, 13% experienced OH30 and 49% had SH. Those who reported symptoms were less likely to have supine hypertension (OR=0.73, p<0.001), but were more likely to experience OH30 (OR=1.69, p=0.005). They were also more likely to experience a larger initial drop in cerebral oxygenation upon standing (β=-0.07%, p=0.006). However, symptoms were not associated with an impaired recovery in cerebral oxygenation at 30 seconds, or 3 minutes after standing.

Conclusion

Supine hypertension is somewhat protective against symptoms, but there is still a relatively large discord between symptoms, cerebral oxygenation and OH during orthostasis. This implies asymptomatic OH may also be a risk factor for adverse outcome. There is a need for routine screening of OH and SH in older adults.
141 THE INTENSE PROJECT: IMPROVING DEMENTIA CARE THROUGH SIMULATION OF SELF-EXPERIENCE
Authors: Hopper L , Collins R , Forristal K , Riello M , Conotter V , Meyer G , Vugt M
Published: October 2022

Background

The EC is concerned about the growing shortage of experienced health and social care professionals to care for people with dementia. Although specialized dementia education programs have begun to appear in recent years, a lack of consistency and adequate level of knowledge of dementia to anticipate the required treatment remains across Europe. The Improving demeNtia care Through Self-Experience (INTENSE) project supports the creation of skills improvement paths for professionals across Europe that incorporate and promote successful self-experience methodologies and practices to increase knowledge and understanding of the lived experience of dementia (e.g., Virtual Dementia Tours, role plays and practices of theatre workshops).

Methods

A systematic review of self-experience tools, training and interventions was conducted. Participatory stakeholder workshops were then held in Ireland, Italy, Germany and the Netherlands to explore ways in which self-experience could be used to better understand the experience of the person with dementia and how the simulation of self-experience could be incorporated into existing (or new) training programmes. Workshop discussions were transcribed and thematically analysed along with workshop outputs to develop the INTenSE toolkit and supporting platform.

Results

An INTenSE toolkit was developed containing interactive no-tech, low-tech and high-tech approaches to simulating self-experience. Training scenarios, facilitation approaches and sustainability plans were designed and a prototype of the INTenSE Platform (website to house and support use of the toolkit) was developed. Beta versions of each will be presented.

Conclusion

INTenSE has illustrated how participatory research can strengthen cooperation and exchange of experiences between organizations working in the field of dementia care; improve social awareness of the ability of self-experience to improve dementia care; promote the integration of self-experience practices in the training of health and social care professional; and highlight the potential for self-experience simulation to be incorporated into carer training and dementia awareness education, subject to the provision of appropriate supports.
145 ASSESSING MEDICINE LISTS: A QUALITATIVE STUDY WITH MULTIPLE STAKEHOLDERS
Authors: O'Donovan B , Kirke C , Pate M , McHugh S , Bennett K , Cahir C
Published: October 2022

Background

Multimorbidity and polypharmacy often result in numerous interactions with different Healthcare Professionals (HCPs) and many transitions of care. Keeping up-to-date medications list in people taking medicines and/or carers can reduce medication errors at care transitions. The HSE National Quality Improvement team is working on a national medication safety campaign which encourages people to keep lists. However, there is limited information about perceptions of Patient-Held Medication Lists (PHML) in clinical practice. The aim of this study was to examine attitudes to PHML among people taking/managing multiple medicines, HCPs; and how lists are used in practice.

Methods

Purposive sampling was employed and recruitment through relevant organisations, social media and snowballing methods. Semi-structured telephone interviews were conducted with 39 people; HCPs (N=21), patients/caregivers (N=18). Interviews were transcribed and thematically analysed with behavioural frameworks - the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF).

Results

Three core themes were identified: Attitudes to PHML; Function and preferred features of PHML and Barriers and facilitators to future use of PHML. All participants thought keeping medication lists had benefits for both people and HCPs (e.g. empowering, improving adherence). All who were taking medicines used lists and found them useful in particular situations (e.g. emergencies). However, HCPs and patient/caregiver groups expressed concerns about their accuracy. It was felt that some individuals may have difficulties keeping an accurate PHML (e.g. older adults, on multiple/changing medications). The participants also differed on the level of detail that should be included in PHMLs. Most patients favoured simple lists but HCPs reported the lack of detailed information in PHML may be an issue.

Conclusion

Common concerns about the accuracy of PHML and diverging opinions on list content need to be addressed. Health promotion strategies which focus on promotion of lists by key HCPs and provide people with a variety of list options could increase the wider implementation of PHMLs.
146 GOLD STANDARD GOAL-SETTING: ARE WE HITTING THE MARK? IMPLEMENTING AN INTERDISCIPLINARY GOAL-SETTING PATHWAY IN STROKE REHABILITATION
Authors: Delaney S , Armstrong B , Gusha-Zinyemba N , Barry E , Johnson E , Saju B
Published: October 2022

Background

The cornerstone of rehabilitation is effective and realistic interdisciplinary goal-setting with patient and family engagement across the continuum of recovery. The Royal College of Physicians National Clinical Guidelines for Stroke (2016) highlights the importance of encouraging self-management and self-efficacy to support a more person-orientated approach. This quality improvement initiative aimed to introduce a structured interdisciplinary goal-setting pathway on a post-acute 14-bed stroke unit.

Methods

An interdisciplinary working group was established comprising of Physiotherapy, Occupational Therapy, Speech & Language Therapy, Medical Social Work and Nursing. Quality improvement methodology was used to sequentially implement change over a 6-month period. The restructure included the introduction of an initial and review goal-focused family meeting. An interdisciplinary tool was developed based on the East Kent Outcome System (EKOS). A series of workshops was delivered to support implementation.

Results

An interdisciplinary goal-setting pathway is currently being piloted for 6 months on the stroke unit. To date, 22 staff have been trained and 9 patients have progressed through the updated pathway. Analysis has provided useful clinical insights and qualitative feedback has been collated regarding the benefits of the early opportunity to meet the team, establishing patient’s personal goal priorities and clear timeframes.Furthermore, repeat trials followed by reflections have enabled the team to develop consistency and confidence in person-centred, interdisciplinary goal-setting. It is acknowledged that this initiative has been a significant change process for the team and that adjustments are being made, in line with the principles of quality improvement.

Conclusion

This person-orientated interdisciplinary process is evidence-based and in line with national standards and guidelines for stroke rehabilitation. Formal training in EKOS is planned and a clinical audit will follow the pilot phase to systematically evaluate the change in practice.
147 ESTABLISHING A PERI-OPERATIVE MEDICAL SERVICE (POMS) FOR OLDER PEOPLE IN UROLOGY
Authors: O'Donovan C , Samida S , Reynolds S , Miller P , Burrows S
Published: October 2022

Background

Older adults account for approximately 65% of patients undergoing urological procedures therefore as the population ages the demand is anticipated to rise. The benefits of Comprehensive Geriatric Assessment (CGA) have been proven in ortho-geriatrics and a number of surgical specialties but evidence in urology is lacking. The aim of this study was to assess the impact of a Peri-Operative Medical Service for older people (POMS) on patient outcomes in a urology inpatient population.

Methods

This was a single-centre retrospective study of patients ≥50 years with length of stay (LOS) >1 day admitted over two four month periods in 2018 (Pre-intervention) and 2019 (Intervention). Group differences in LOS and complications were examined using univariate regressions and then adjusted for sex, emergency admission, severity of procedure and Charlson Co-morbidity Index which also accounts for age. Secondary outcomes were to record undiagnosed medical conditions identified and the interventions made by the POMS.

Results

There were a total of 218 admissions from 211 patients with equal numbers of admissions in both the pre-intervention and intervention groups. No significant differences were detected for LOS (median 3 vs 4 days, p=0.11) or complications (32(29%) vs 40(37%), p=0.23) between pre-intervention and intervention groups. A new medical diagnosis was made in 13 (12%) of the pre-intervention v 43(39%) of the intervention group (p<0.001). The POMS recommended a change to management in 102 admissions (94%). The most common intervention was medication review: 64(59%) v 19(17%) (p<0.001).

Conclusion

The Peri-Operative Medical Service for older people can improve patient management by identifying and managing medical issues, complications and geriatric syndromes that may otherwise have been missed.
151 A CROSS-SECTIONAL EXPLORATION OF INTERPROFESSIONAL COLLABORATION WITHIN INTEGRATED CARE TEAMS OPERATING UNDER THE NATIONAL INTEGRATED CARE PROGRAMME FOR OLDER PERSONS
Authors: O'Donnell D , Whitty H , Devaney C , Ahern E , Radomska A , Harnett PJ
Published: October 2022

Background

There is an evidence and practice gap in understanding the knowledge, skills, and behaviours required of Health Care Professionals (HCPs) for effective interprofessional collaboration in the context of integrated care for older people. Furthermore, little is known about the outcome factors that may be associated with effective interprofessional collaboration among HCPs working in integrated care teams for older people.

Methods

A cross-sectional representative survey of HCPs employed in the 30 integrated care teams (ICTs) operating under the National Integrated Care Programme for Older Persons was undertaken. The survey measured indicators of competence identified in a previously co-designed framework for core competencies for interprofessional collaboration within ICTs for older people.

Results

The study explores an association between competencies in interprofessional collaboration among HCPs employed in ICTs for older persons and factors associated with higher job satisfaction including psychological safety, trust, and work engagement. Findings elaborate on instances of service innovation which resulted from interprofessional collaboration within the team.

Conclusion

The study findings provide a baseline understanding of competencies for interprofessional collaboration within the ICTs operating in the NICPOP. This will support an implementation evaluation of the co-designed framework that will generate realist evidence regarding how ICTs for older people foster, enhance and sustain their proficiency in interprofessional collaboration. This realist evaluation will identify new models of interprofessional team working and explore the outcomes that are associated with interprofessional collaboration from the perspective of older people, their family carers, and HCPs who are working as part of an interprofessional team.