bluuebunny/crossref_metadata_2025_split huggingface dataset:
68 Autonomic Impairment and its Manifestations in Patients with Delirium
Authors: Shanahan Elaine , Ryan Sheila , Costelloe Aine , Sheehy Tina , Peters Catherine , Lyons Declan , O'Connor Margaret 
Published: September 2019

Abstract

Background
Delirium is common among unwell older adults. Despite this the pathophysiology remains poorly understood. We hypothesised that autonomic dysfunction may be associated with the development of delirium.

Methods
35 participants completed a case-control study. Delirium was assessed using DSM-IV and DRS-R98. Autonomic function was assessed with Head-Up Tilt testing (HUT), baroreflex sensitivity (BRS) testing using Baroreflex Effectiveness Index (BEI), 24-hour blood pressure variability (BPV), nocturnal blood pressure dipping status and 24-hour heart rate variability (HRV). A subgroup analysis of those without pre-existing cognitive impairment (CI) was completed.

Results
During tilting the delirium group (DG) had a median decrease of 1mmHg (IQR 38.5) in systolic blood pressure (SBP) compared to a median decrease of 17.5mmHg (IQR 20.75) in the control group (CG) (p=0.04). Increased delirium severity correlated with a reduction in the decrease in SBP (rs= -0.42, p=0.03).
In those without CI, BRS testing during HUT showed that increases in blood pressure were not followed by an appropriate reduction in heart rate with a mean BEI of 36.87% (SD 22.26) in the DG and 56.03% (SD 23.04) in the CG (p=0.05).
Nocturnal dipping differed during subgroup analysis. 58.3% (7) of DG were reverse dippers, 33.3% (4) were non-dippers and 8.3% (1) had a normal dipping pattern. In CG 57.1% (4) were non-dippers, 14.3% (1) had a normal dipping pattern and 28.6% (2) were extreme dippers (p=0.01).
BPV was measured by average real variability (ARV). In those without CI mean ARV was 13.81 (SD 5.98) in the CG and 9.69 (SD 2.75) in the DG (p=0.05).
No difference was detected in HRV.

Conclusion
We identified differences in autonomic function between the DG and CG. This is the first study to look at several components of autonomic function in delirium and thus can provide insights into physiological abnormalities present during, or contributing to delirium.
76 An Incorrectly Set Watch may Suggest Cognitive Impairment in the Older Patient
Authors: Feyzrakhmanova Martina , Killian Owen , Fennelly Evelyn , Toland Samuel , Power Dermot 
Published: September 2019

Abstract

Background
Disorientation to time can be used as a guide to determining the presence and severity of dementia. The inability to maintain one’s wrist watch at the correct time is assessed as a possible marker of dementia.

Methods
Inpatients in a post-acute care unit with a mean age of 76.2 (±12.4 years) were assessed with regard to the time on their wristwatch. The time was recorded as correct or incorrect with a permitted discrepancy of 15 minutes. A current Mini-Mental State Examination (MMSE) score was obtained and patients were divided into two groups: MMSE above/equal to or below 24, with the latter defined as an abnormal result.

Results
The most striking finding of this study was that any patient with an incorrectly set watch had an abnormal MMSE. The majority of patients with an abnormal MMSE had their watch set correctly (n=17, 38%), while only 10 (22%) were found to have an incorrectly set watch. All patients with a normal MMSE had their watch set correctly, n=18 (40%). Acknowledging the fact that conclusions of statistical methods used on a small sample size should be interpreted with caution, we report that the two-tailed Z score for 2 population proportions was 2.9277 (p=0.00338), significant at p<0.05.

Conclusion
This study presents evidence to suggest a relationship between the correctness of the older patient’s watch and their cognitive status. Assessment of time on the patient’s watch could be considered as an instantaneous, approximate “test” for dementia in clinical practice. This test would have a sensitivity of 37% and specificity of 100%.
78 Comparing the Management of Frailty between a Rapid Access Frailty Team and General Medical Teams at a Level Three Hospital
Authors: Tulsi Deeptish , Pillay Lushen , Ogunjembola Ibrahim , Farelly Alice , McGlynn Joanna , Doherty John , Donnelly Teresa 
Published: September 2019

Abstract

Background
Frailty represents a particularly high risk group of geriatric patients whom require specialized care. Dedicated multidisciplinary frailty teams led by Geriatricians have been shown to provide better outcomes. The aim of this study was to compare the inpatient interventions and length of stay (LOS) between patients under the care of a dedicated Rapid Access Frailty Team (RAFT) versus general medical teams.

Methods
Data was collected on a total of 163 patients who were screened as frail positive using a screening tool, over a period of 10 months in 2018. Basic Statistical Analysis was used to analyse data.

Results
Of the 163 patients, 113 were managed by the RAFT and 50 by a medical team. 61.9% were assessed as frail immediately in the Emergency Department, while the remainder where referred to the RAFT from other medical teams.
The main reasons for referral were: cognitive impairment (51.3%), poor mobility and safety awareness (70.8%), polypharmacy (82.3%), poor functioning in ADLs (76.1%) and medical reasons (77.9%). Interventions made by the frailty team included: medication rationalization (82.3%), MDT assessment (91.2%) and discharge planning (87%). 49.5% of patients seen by the RAFT had a MOCA score < 22.
Of patients managed by the RAFT 100% received Physiotherapy and 96.5% were seen by Occupational Therapy, while in the medical group this was 50% and 42% respectively. The mean length of stay was 9 days in the RAFT group, and 12.4 days in general medical group.

Conclusion
Patients managed by the RAFT had an average LOS of 3.4 fewer days. We hypothesize that this is linked to earlier identification by the RAFT, earlier referral and more intensive intervention by allied health services, and specialized Geriatric Medical input. We aim to increase the availability of our frailty service within our hospital to optimize the management of our frail patients.
87 Evolution of Atrial Fibrillation
Authors: Meagher Marykate , Noone Imelda , Davey Naomi , Cassidy Tim 
Published: September 2019

Abstract

Background
Atrial Fibrillation (AF) is a common cardiac arrhythmia and a well-established risk factor for stroke with its prevalence increasing with age. AF related strokes are associated with increased mortality and morbidity however the risk of stroke is reduced by almost 70% by oral anticoagulation (OAC).

Methods
Analysis of data using SPSS allowed us to identify all acute stroke patients admitted in 2018 with AF. We compared data on patients who were admitted with known AF and those who were newly identified with AF and looked at their outcomes.

Results
373 stroke patients admitted,of which 108(29%) patients had AF, mean age 79. 68(63%) had known AF and 40(37%) had a new diagnosis of AF. 52(76.5%) of the known AF were on an OAC (11 on warfarin) and 40(78%) on a Non- Vitamin K antagonist oral anticoagulant (NOAC).
16 patients (23.5%) with known AF were not anticoagulated on admission. (Reasons for no OAC-3 had a history of previous intracerebral haemorrhage (ICH). 2 a history of bleeding and 1 a history excess alcohol). 10 patients were on antiplatelet therapy and were subsequently anticoagulated on discharge.
33(48.5%) of the known AF were discharged home versus 15(37.5%) in the new AF cohort and while mortality was higher in the known AF, there were more patients in the new AF cohort 14(35%) that required long term care compared with 3(4%) in the known AF cohort which not only indicates the severity of their stroke but also suggests that if AF had been detected and treated sooner their outcome may have been very different.

Conclusion
There has been a significant increase in primary prevention practices for AF and this is reflected in the number of stroke patients presenting with known AF on a NOAC, however more needs to be done as there are still patients who have AF that are not being anticoagulated in the community.
88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit
Authors: McDaid Edel , Ross Elaine , Cogan Lisa 
Published: September 2019

Abstract

Background
Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2).
The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination.

Methods
A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel.

Results
Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores.

Conclusion
All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.
90 Demographics and Characteristics of Patients with Recurrent Falls Attending Tertiary Hospital Outpatients Department
Authors: Marion Mohd Ikhwan , Beatty Paula , Zainal Tariq , Riordan Marie-Anne , Daly Toddy , Kyne Lorraine , Duggan Joseph 
Published: September 2019

Abstract

Background
Falls are a common cause of morbidity and mortality in older adults, with most being caused by identifiable risk factors. This study aimed to assess demographics and clinical characteristics of patients who had recurrent falls attending the medicine for the older person (MFTOP) outpatient department at a tertiary centre.

Methods
Retrospective analysis of patients seen at MFTOP OPD between January 2018 and December 2018. Data were obtained from clinical notes. Age, gender, blood pressure, cognitive tests, blood tests, diagnoses and medications that could contribute to falls were recorded.

Results
100 patients were reviewed. 60% were female (60). Mean and median ages were 83. Causes of falls included; gait/balance disorders or weakness 36.0%, environment-related/'accident' 19.0%, alcohol 5.0%, dizziness/vertigo 5.0%, visual disorder 4.0%, confusion 4.0%, others 3.0%, drop attack 1.0%, unknown 5.0%. 18.4% (18/98) had orthostatic hypotension (OH), of which 44.4% (8/18) had low standing systolic BP <120 P=0.0205 compared to the non-OH group. Median HbA1c was 39 (30 - 83) for 80 patients 95% CI 39.5-43.4. 11.9% (11/92) had low serum sodium (<135) (95% CI 137.7-139.3). 29.0% (29/100) had impaired cognition of which 13.4% (4/29) were at risk of vitamin D deficiency P=0.5767. Other medical conditions potentially contributing to falls included; arthritis 16.0%, Parkinson’s disease 7% and incontinence 3.0%. Medications that can contribute to falls included; antihypertensive agents 67 (66.3%), tricyclic antidepressants 19 (18.8%), antianxiety agents 15 (14.9%), opiates 12 (11.9%), hypnotics/ tranquilizers 27(26.7%) and diuretics 28 (27.7%).

Conclusion
There is a high prevalence of co-morbidities and polypharmacy in patients with recurrent falls. Identifying modifiable causes may reduce the risk of falls in the future. Tighter glycaemic control was observed and relaxed glucose control in high-risk older adults are recommended.
91 A Descriptive Analysis of Causative Drgs/Drg Classes of Incident Adverse Drg Reactions in Acutely Hospitalized Older-Adults: SENATOR (Phase I)
Authors: Jennings Emma , Lavan Amanda , Dahly Darren , Eustace Joseph , Flanagan Evelyn , Gallagher Paul , Cullinane Shane , Petrovic Mirko , Perehudoff Katrina , Gudmondsson Adalsteinn , Samuelsson Ólafur , Sverrisdóttir Ástrós , Cherubin Antonio , Dimitri Frederica , Rimland Joe , Cruz-Jentoft Alfonso , Vélez-Díaz-Pallarés Manuel , Lozano Montoya Isabel , L Soiza Roy , Subbarayan Selvarani , O’Mahony Denis 
Published: September 2019

Abstract

Background
Adverse drug reactions (ADRs) are common and have serious repercussions for older-adults. This descriptive-analysis elucidates clinical presentations, severity and responsible drugs of incident ADRs in the SENATOR (Software ENgine for the Assessment & optimization of drug and non-drug Therapy in Older peRsons) phase I feasibility study.

Methods
SENATOR-phase-I was a European multicentre-prospective-observational study. Participants were ≥ 65 years, experiencing acute-hospitalisation and on pharmacological treatment for ≥ 3 conditions.
Adverse events (AEs) were identified by trigger list at recruitment, day-14/discharge and classified as ADRs when association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre ADR causality criteria.

Results
Of 644 participants recruited, 382 (59.1%) experienced 732 AEs, 363 AEs (49.6%) being incident. 139 participants (21.6%) experienced 177 (48.8%) ADRs. Full drug details were recorded in 156 patients (88%). Cardiovascular-system drugs accounted for one-third of ADRs (55, 35.3%).
Five drug classes caused three-quarters of ADRs (135, 76.3%); diuretics 28.2% (furosemide 24.4%), opioid analgesics 16.7%, anti-bacterials for systemic use 14.1%, anti-thrombotic agents 10.3%, and drugs used in diabetes 7%.
68 patients (10.6%) experienced 81 (45.8%) clinically significant moderate-severe ADRs. Significant serum electrolyte disturbance (32, 18.1%), acute kidney injury [AKI] (22, 12.4%), unspecified adverse event (UAE; 21, 11.9%), dyspepsia/nausea/vomiting (20, 11.3%), new-onset major constipation (19, 10.7%) were the most common presentations of ADRs, accounting for 114, (64.4%) of all ADRs. In moderate-severe ADRs; AKI (12, 14.8%), acute bleeding (11, 13.6%), new-onset major constipation (11, 13.6%), UAE (11, 13.6%), significant serum electrolyte disturbance (10, 12.4%) were the most common presentations.

Conclusion
This analysis highlights that;
1-in-5 older adults will experience an incident ADR during acute hospitalisation.
1-in-10 patients experience moderate-severe incident ADRs.
3-of-4 ADRs were caused by 5 drug classes (diuretics, opioids, anti-bacterials, anti-thrombotics and anti-diabetic agents).
This study allows for identification of potentially high risk medications which could be targeted for future ADR prevention.
93 A Multidisciplinary Approach to Restrictive Interventions in Residential Care
Authors: Conway Laura 
Published: September 2019

Abstract

Background
A residential service in Dublin is home to 100 older persons with wide-ranging, complex care requirements. Traditionally restrictive interventions (RI) for residents in the setting were the decision of the Nursing/Medical team. Evidence based best practice stipulates that RI must be supported by a systematic and collaborative assessment between the resident, their family/representative and members of the multi-disciplinary team (MDT). Thus, the MDT identified a need for a change in practice in respect of RI and to facilitate formal MDT discussions regarding the assessment, introduction and review of RI for individual residents.

Methods
A Restrictive Interventions Working Group (RIWG) was set up to facilitate an overall change in practice in respect of RI. The working group developed pathways for planned/emergency RI with particular focus on the development of a Planned RI form to guide MDT discussion. The pathways were implemented across the service. The RIWG drafted a new RI Policy to reflect the changes in practice, followed by education sessions facilitated by Occupational Therapy and Practice Support. Feedback was sought after each education session.

Results
The project was launched on August 1st 2018.
Sixteen Planned RI Forms were presented to MDT from August 2018 to February 2019. Seven of those restrictions were discontinued following MDT discussion.
43% reduction in mechanical RI and a 54% reduction in PRN psychotropic prescription between August and December 2018.
Staff reported the education sessions as being `very informative', `relevant to the setting', `allowed us to think about the key issues we face in our day to day work' and `improved my understanding of RI and the best practice approach'.

Conclusion
An MDT forum for discussing RI provides improved governance over the introduction, review and discontinuation of RI. Further education in respect of RI, management of responsive behaviours and staff competency assessment will further improve practice, with the goal of achieving a RI free home.
99 Safer Mobility: Practice vs Preach
Authors: Carey Sive , Salawu Adefunke , Glynn Marian 
Published: September 2019

Abstract

Background
Activity levels in older people undergoing inpatient rehabilitation are low. Intervention by the rehabilitation team amounts to 2% of a patient’s day. Interdisciplinary working helps to ensure that therapy continues beyond the physiotherapy gym. However, safe handling is required.

Aims
Examine the awareness of ward staff of the mobility status of their patients. Investigate if staff on a general geriatric rehabilitation ward are compliant with physiotherapy mobility recommendations.

Methods
Data collection took place on a general geriatric rehabilitation ward from February to March 2019.
Staff Awareness was assessed by individually asking ward staff (Nurses and Health Care Assistants) to identify the mobility status of their patients. Their responses were recorded and compared with the physiotherapy mobility recommendations as per the MDT (multi-disciplinary) communication whiteboard.
The mobility status of each patient was observed by means of random visual audits. Observations were recorded and subsequently compared to the physiotherapy mobility recommendations as above for compliance.

Results
For the staff awareness audit, 95 responses were obtained from 10 different staff members. 50.5% of responses (n=48) correctly identified patients’ mobility status. 49.5% (n=47) incorrectly identified patients’ mobility status.
From 10 visual audits, a total of 196 patient observations were recorded. In 37.2% (n=73) of observations, patients were not mobilising as per physiotherapy recommendations. 39.3% (n=77) of observations were as recommended. In 23.5% (n=46) of observations, patients were not mobilised at all.

Conclusion
There was limited awareness among ward staff of the mobility status of their patients. Over 1/3 of patients were not mobilised as per physiotherapy recommendations. These findings can compromise both patient and staff safety. The visual audit also highlighted low physical activity levels in some patients.
Implications for clinical practice include the need for education on safer mobility and the promotion of patient physical activity at ward level. Physiotherapy led educational and practical handling sessions for ward staff have proven to be beneficial in this regard.
108 A Prospective Audit and Review of Proton Pump Inhibitors (PPIs) in Older Adults in a Reablement Unit
Authors: Byrne Amy , Hizza Hila Ludin Nor , Byrne Sharon , Purcell Róisín 
Published: September 2019

Abstract

Background
The audit and review was carried out in a 24-bed reablement unit designed to improve independence and mobility in those ≥65 years. PPIs have been identified as a significant source of drug expenditure and evidence has shown that they are often prescribed inappropriately. PPIs are effective for conditions including dyspepsia and gastro-oesophageal reflux disease (GORD) but can also be associated with adverse effects and contribute to polypharmacy. The aim of the audit was to:
Determine the number of patients admitted on PPIs. Determine the appropriateness of PPI prescriptions. Review any inappropriate prescriptions.

Methods
Prospective data collection was carried out for all newly admitted older adults over a 9 week period using a pre-approved data collection tool. Information was collected on PPI prescription details, indications and risk factors. PPI appropriateness regarding indications and dosage was reviewed by the pharmacist using guidelines1 and clinical experience. The pharmacist’s recommendation was then reviewed by the medical team and changes to prescription made where deemed appropriate.

Results
n=40 patients assessed. n=24 (60%) prescribed a PPI. n=19 (79.2%) deemed inappropriate by the pharmacist. Interventions made for n=13 (68.4%) of PPIs deemed inappropriate: n=8 (42.1%) were dose reduced. n=5 (26.3%) were discontinued. n=6 (31.6%) deemed unsuitable for review: n=1 deemed high risk for a gastrointestinal bleed. n=3 with GORD symptoms despite PPI use. n=1 for GP follow-up. n=1 previous unsuccessful dose reduction.

Conclusion
Most patients on a PPI did not have a clear indication. The majority of inappropriate PPIs were deemed suitable for review and were subsequently dose reduced or discontinued. Some patients were unsuitable for PPI review due to multiple risk factors or ongoing symptoms of reflux. The continued need for PPIs should be assessed regularly and a risk-benefit analysis should be carried out.