bluuebunny/crossref_metadata_2025_split huggingface dataset:
26 Predictors of In-Hospital Mortality Post Hip Fracture: What Really Matters?
Authors: Ferris Helena , Brent Louise , Martin Jennifer , Crowley Philip , Coughlan Tara 
Published: September 2019

Abstract

Background
The Irish Hip Fracture Database is a national clinical audit developed to improve fracture care and outcomes. Lack of integration with other databases, such as a National Death Register makes determination of longer term outcomes challenging. In hospital mortality is one quality indicator that can be very accurately measured. We sought to determine in-hospital mortality in the Irish Hip Fracture Cohort between 2013 and 2017 and to determine which factors most influenced this outcome with particular reference to the IHFD quality standards.

Methods
A secondary analysis of the 15,603 patients in the IHFD between 2013 and 2017 was conducted. Descriptive and analytical statistics were produced.

Results
In-hospital mortality was 4.5% for the 5 years. Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality of which only 4 (age, gender, pre-fracture mobility, mobilised day of/after surgery) remained significant after multivariate analysis. The most striking finding was that those patients not mobilised on the day of/after surgery were 46% more likely to die in hospital (OR 1.46, p<0.000, 95% CI 1.25-1.70).

Conclusion
Measuring care is challenging and often one standard cannot reflect all aspects. The ability to be mobilised on the day of or day after surgery is a good composite measure of both patient and organisational factors in hip fracture care: timely surgery, adequate pain relief, prevention of delirium, admission to a ward with philosophy, skills and resources to encourage early mobility. While early mobility has always been encouraged this data suggests its adoption as a formal standard to which all units must comply.
265 Awareness of Enduring Power of Attorney in a Frail Older Population Presenting Through the Emergency Department
Authors: Baburaj Binish , Pender Ciara , Cooney Eamonn , Maher Jennifer , Sayers Karen , Ryan Siobhan , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
Enduring Power of attorney (EPA) is a simple legal document. A person can choose a specific individual(s) to take care of both personal and financial affairs in the event of losing mental capacity in the future. The objective of this study is to understand what proportion of frail older patients has either an EPA or an awareness of EPA

Methods
Consecutive emergency department (ED) patients identified as Variable Indicative of Placement (1) positive at triage, were assessed using an interdisciplinary assessment tool (IAT) for 2 months (February 2019 to March 2019). Age, gender, Clinical Frailty Score (CFS) and awareness of EPA were recorded on an Excel database. Simple descriptive statistics were used

Results
150 patients with a mean (SD) age of 83.1(7.4) were assessed by the multidisciplinary team. The female to male ratio was 1.2:1. The mean (SD) CFS was 5.5(1.2). 56 patients were asked about EPA. 96 patients were not asked about EPA. 27% (n=14) patients had an EPA in place and one was in the process of making it. 41 patients neither had an EPA nor awareness of EPA. There was no gender difference between groups

Conclusion
This is the first Irish and international study assessing the awareness of EPA in patients presenting to ED.In this small sample of frail older patients, a quarter of those asked had an EPA. A hospital admission represents an opportunity to discuss future care planning, including EPA. The majority of patients were not asked about EPA by the assessor, as it was felt to be inappropriate at the assessment time. A patient centred approach to introducing these difficult but important discussions needs to be developed.
306 The Changing Face of Stroke in the DOAC Era
Authors: Davern Recie , Hobbs Helena , Murugan Hannah , Cotter Paul 
Published: September 2019

Abstract

Background
Patients prescribed oral anticoagulants (OAC) for atrial fibrillation (AF) can still present with stroke. The mechanism for stroke in these patients can be due to multiple factors including subtherapeutic dosing and non-compliance. With the increasing use of direct-acting OACs (DOACs) in favour of warfarin, it is unclear if the incidence of stroke in those already taking OAC has reduced.

Methods
Data was extracted from our unit’s stroke registry, a prospectively maintained database, for patients who presented with stroke while receiving OAC for AF from 2013 to 2017. Type of OAC, type of stroke, OAC dosing at time of event including non-compliance, stroke management and outcome were recorded.

Results
67 patients were included for analysis, with 55 ischaemic and 12 haemorrhagic strokes. 52 patients were receiving warfarin at the time of their stroke vs. 15 receiving DOACs. 33/55 (60%) of ischaemic strokes occurred in patients taking warfarin with a sub-therapeutic INR. In 3/55 (5%) of ischaemic strokes, the OAC was held for a procedure while in 6/55 cases (11%) the OAC had been stopped for another reasons e.g. bleeding. 5/55 (7%) were due to non-compliance. 1 ischaemic stroke was due to under-dosing of a DOAC (dabigatran). 16 strokes were recorded in 2013 for patients prescribed OAC vs. 3 in 2017. Overall the number of ischaemic strokes due to subtherapeutic OAC decreased from 14 in 2013 to 1 in 2017 (p value 0.06).

Conclusion
The majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
325 Exploring the Complexity of Dementia and Loneliness in Ireland
Authors: Hartigan Irene , Cornally Nicola , Foley Tony , Timmons Suzanne , Park Gyunghee , Jennings Aisling , Müller Nicole 
Published: September 2019

Abstract

Background
Dementia and loneliness are both complex phenomenon’s that impact on both mental and physical health. Research has identified that loneliness can increase a person’s risk of mortality as much as smoking or alcohol consumption. People with dementia are at particular risk of loneliness and social isolation. This can negatively impact on a person with dementia’s health. To effectively address loneliness in dementia, we must first understand how people with dementia experience loneliness.

Methods
Interviews were conducted with people living with dementia. Participants comprised of eight community-dwelling individuals, aged 55 years and older (mean = 63.8; range = 55-77), who were each diagnosed with dementia at least one year prior to interview (range = 1.16 – >5 years). Interviews were conducted in participants’ homes using a semi-structured format and lasted between 37-74 minutes.

Results
Three key themes emerged: the importance of maintaining meaningful relationships, maintaining independence and socio-cultural influences on individual perceptions of loneliness and dementia. The results emphasise the importance of maintaining both a sense of self and meaningful relationships with others post-diagnosis for individuals who identified themselves as “not lonely”. People living with dementia reported that the maintenance of social connection aids in fostering a sense of self-worth and self-management, which in turn mitigates feelings of loneliness.
The majority of participants existing social connections with others was established prior to their diagnosis, although the maintenance of these relationships may have required an adjustment of their premorbid routines and method of social engagement.

Conclusion
Human contact and a meaningful relationship are superior in preventing loneliness. Individual feelings of loneliness or lack thereof are not directly correlated to the coping mechanisms most commonly employed by individuals with dementia. Further exploration is need to understand how people with dementia, who live at home, perceive or experience loneliness.
326 Generic Prescribing: Where are we now? Prescribing Education is not Enough
Authors: Leahy Aoife , Hynes Jason , Saif Kiran , E McCarthy Christine , Mohd Asri Nur Atikah , Roy Amrita , Murphy Elizabeth , Sebaoui Salim , Gabr Ahmed , Zulkifli Muhamad Daniel , Matti Basil , O' Hara Paul , Crotty James , Quinn Colin , Peters Catherine , Lyons Declan , O'Connor Margaret 
Published: September 2019

Abstract

Background
Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now.

Methods
We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant.

Results
285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing.

Conclusion
The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem.
327 The Impact of Implementation of Recommendations from the IFHD 2017 Annual Report in an Irish Model 3 Hospital
Authors: Hearne Siofra , Smyth Hannah , Monahan Pheadra , McGowan Hugh , Timmins Shirley , Hillary Paddy , Mahapatra Anant , Walsh Alan , Conlon Ciaran , Dunill Eithne , Campbell Eleanor , Carolann Danielle , Ahern Tomas , O'Brien Helen 
Published: September 2019

Abstract

Background
Hip fractures in the older person are associated with high mortality rates (NICE, 2011). Up to 40% of patients never regain their pre-fracture mobility, 10-20% never return to live at home. The Irish Hip Fracture Database (IHFD) National Report 2017 recommends appointment of an orthogeriatric consultant in this hospital to achieve IHFD standards 4 to 6.

Methods
We analysed a subset of HIPE data collected for the IHFD in patients over 60 years over a three month period from September – November 2017 and compare it to September – November 2018 after introduction of an orthogeriatric service. We looked at geriatrician review, bone health assessment, falls assessment, discharge destination, 30-day re-admission rate and mortality during admission.

Results
There were 45 hip fracture patients in each group. In the 2017 group, mean age was 79, female 64%; compared to mean age of 80, female 62.2% in 2018. In 2018, after the appointment of an orthogeriatrician, 95.6% of patients were seen by a geriatrician compared to 4.4% in 2017. In 2018, 97.7% received bone health assessment compared to 26.8% in 2017. In 2018 95.3% received specialist falls assessment, compared to 2.4% in 2017. Mean length of stay was 18 days in 2018 versus 13 days in 2017. 2.2% of patients were discharged to convalescence in 2018, 26.7% in 2017. 57.8% of patients were discharged to off-site rehabilitation in 2018 compared to 40% in 2017. 2.2% patients died during admission in 2018, 8.9% in 2017. In 2018, 6.7% of patients were readmitted within 30 days, 8.8% in 2017.

Conclusion
Provision of rapid Comprehensive Geriatric Assessment to all hip fracture patients, reduces falls and fracture risk. There is evidence of improvement in IHFD standards 4-6, mortality rate and 30-day readmission rate. Moreover, the orthogeriatric service has led to increased referral to rehabilitation services ensuring optimal functional recovery.
328 An Integrated Approach to Fear of Falling
Authors: Murphy Eleanor , McLoughlin Petra , O'Sullivan Fiona , Connellan Ciara 
Published: September 2019

Abstract

Background
Fear of falling (FOF) is a known risk factor for falls and subsequent activity restriction which has implications for quality of life and frailty level in older persons.1 The Integrated Care Team for Older Persons in Sligo provides home-based rehabilitation for the acutely frail older adult. We noted that fear of falling was a commonly identified problem in our referral group following comprehensive geriatric assessment (CGA). Our study aims to characterise interventions required.

Methods
Descriptive study from CGA of acutely frail older adults with a FOF in all referrals to ICTOP from June to December 2018.

Results
Of the 52 patients studied, 67% reported a FOF with a higher incidence in females (81% vs 45%).
Increasing age was associated with a greater likelihood of FOF with 0% reported at 70-74years (n=4) and 86% at 90-95 years (n=7).
There was a 1.6 times increased risk of FOF associated with cerebral vascular disease and 1.26 with mental health issues.
The median Rockwood Clinical Frailty score was 6 with a median TUG of 28 seconds.
Of those with a FOF, 100% received falls education, a home exercise program and advice on acquiring a pendant alarm. A mobility aid was provided in 63% and additional functional aids in 71%. Major housing adaption advice was given in 50% and additional equipment signposting and purchasing advice in 66%. Transport advice was provided in 49% of cases and onward referrals to ophthalmology and orthotics were provided in 9% and 11% respectively.
There were only 2 readmissions with a fall within 30 days.

Conclusion
A significant cohort of ICTOP referrals report a fear of falling. Specific physiotherapy and occupational therapy interventions aim to reduce the impact of this and our low rate of readmissions due to falls indicates the success of this program.
333 A Transnational Effectiveness-Implementation Study of the Family Carer Decision Support Intervention to Improve End of Life Care in Long-Term Care
Authors: Hartigan Irene , Brazil Kevin , Kaasalainen Sharon , Sussman Tamara , Van Der Steen Jenny , Loucka Martin , Di Giulio Paola , Cornally Nicola 
Published: September 2019

Abstract

Background
The Family Carer Decision Support (FCDS) intervention has been designed to inform family carers about end of life care options available to a person living with advanced dementia. The FCDS intervention demonstrated a statistically significant impact in reducing family carer decision uncertainty on establishing goals of care at the end of life and, improved family carer satisfaction on quality of care in a study conducted in the United Kingdom.

Methods
The aim of this research is to adapt the application of the FCDS for use in different countries. Funding supported through the EU Joint Programme – Neurodegenerative Disease Research (JPND) project has supported the scaling up of the FCDS transnationally in the United Kingdom; Republic of Ireland; Netherlands; Canada; Czech Republic ; and, Italy. Launched in April 2019, this presentation will report on present activities including: a) description of the FCDS intervention; b) strategy for implementing the FCDS in care homes; c) study design employed for the evaluation of the FCDS; and d) work packages and that will be deployed to achieve intended outcomes

Results
Expected project outcomes of this work will include a) develop guidelines to facilitate transnational use of the FCDS within care homes; (b) staff education material including web learning resources; (c) family carer informational material including web learning resources; (d) measures and tools to evaluate the uptake and outcome of the FCDS intervention; (e) establish a transnational FCDS community of practice across study care homes; (f) estimated costs of providing the FCDS intervention; (g) evidence of enhancing decision making among family members regarding resident care and satisfaction with care.

Conclusion
Recent research revealed that care home structures and staff play an important role in the successful implementation and adoption of innovations such as the FCDS intervention, this is further examined in this transnational study.
335 GEMS: Geriatric Emergency Service Emergency Triage and Older People with Frailty
Authors: O'Callaghan Maureen , Gallagher Grainne , Reddy Danielle , Cornally Lorna , Hayes Brennan Megan , Mulholland Ann , Gibbons Ruth , Nolan Jane , Normoyle Cathriona , Ahern Emer 
Published: September 2019

Abstract

Background
The Manchester Triage System (MTS) is one of the most commonly used triage systems in Europe.
It assigns a clinical priority to patients, based on presenting signs and symptoms. The MTS allocates patients to one out of five urgency categories, which determine the maximum time to first contact with a clinician.
Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) are core elements of our GEMS. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home (Ellis et al 2011).

Methods
The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are triaged using the Manchester Triage system. Patients are also screened using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team case manage all those who are admitted.

Results
Over 2 years, 10,037 patients were triaged. The median time from arrival to triage and VIP was 15 minutes. 43% (4, 307) screened positive for Frailty. 66% received a CGA. Of those who screened positive for Frailty 1,387 (32%) needed immediate care or very urgent care (Category 1 and 2). A further 43% (1,855) were category 3 requiring urgent care. The most common diagnostic category was Unwell Adult (1560, 36%). The 2nd category was Shortness of Breath (720, 17%) and the third Falls (409, 9%)

Conclusion
75% of older people with frailty who attended hospital required urgent emergency care. The most common diagnostic category was Unwell Adult reflecting the diagnostic and clinical challenge this cohort present. We must build a healthcare system and workforce that is Frailty attuned to be able to deliver optimum outcomes.
346 How Do we Increase Adherence to Home Exercise Programmes? Interviews with Older Adults and Physiotherapists
Authors: Khalijah Siti , Timmons Suzanne 
Published: September 2019

Abstract

Background
Regular exercise and physical activity can maintain function and cardiovascular health, and prevent cognitive decline, in older adults. However, studies show that there is often poor adherence to home exercise programmes (HEP). The purpose of this study was to explore how HEP are perceived by both older adults and physiotherapists.

Methods
A convenience sample of 28 older adults attending outpatient physiotherapy clinics were given an exercise journal to record their adherence to the HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with a purposive sample, and the corresponding prescribing physiotherapists, to achieve maximal variation in terms of HEP adherence, age and sex. The interviews were audio recorded, transcribed, and simple content analysis performed.

Results
Fourteen participants returned their exercise journal. Median age was 80; half were female; median Berg Balance Score and Timed-up-and-Go-Test were 49 and 16 seconds respectively. Participants exercised a median 79.8% of the prescribed dose, or 5.6 days per week. Seven older adults were interviewed; about half had a positive attitude towards exercise. They were also moderately positive about their HEP (comments ranged from “doable” and “nothing bad about it” to “enjoyable”). Barriers included time, mood, boredom, remembering to do the HEP, and variable health status. Enablers included simple instructions and design, family encouragement, and sense of achievement. Physiotherapists (n=5) perceived that many older adults aren’t compliant with HEPs, but there was some therapeutic nihilism (“you can’t force them”). Their HEP instructions varied from verbal to written instructions/diagrams; one physiotherapist used individualised video content. Notably, participants with good adherence understood their HEP well in terms of content and purpose, although this may be cause or effect.

Conclusion
To improve compliance with HEP, healthcare professionals need to take time to motivate the recipient, simplify their instructions, and trouble-shoot potential barriers at the time of prescription.
70 Can a Wholefood Plant-based Diet Affect Healthy Ageing?
Authors: O'Mullan Ailin 
Published: September 2019

Abstract

Background
This study sought to examine existing evidence regards the effects of a wholefood plant-based diet on healthy ageing. As of March 2018 the average life expectancy in Ireland was 81.4 years, ten years above the global average. However approximately 1 million people suffer from chronic disease with 64.8% of people over 65 living with co-morbidity (TILDA 2014). The prevention and treatment of these diseases is central to the healthy ageing of our population.

Methods
This systematic review of the literature explored diet, health, ageing and disease. A scoping search, with relevant key words, was followed by an in-depth search with reference to a pre-ordained search syntax template. Specific eligibility criteria, determined by a PICOSS system were applied to the results. All included studies underwent quality assessment in line with the critical appraisal checklist for cross sectional studies. Extracted data was displayed in table format initially and then explained through narrative synthesis.

Results
A large body of evidence was found to suggest that cardiovascular disease, metabolic disorders and inflammatory conditions improved with a wholefood plant-based diet. Evidence in relation to certain cancers was present but not conclusive. Breast cancer was the exception to this. Evidentiary support, for reductions in BMI and in the need for polypharmacy were also found.

Conclusion
More research is needed into the benefits of a wholefood plant-based Diet. However as this diet is a low cost, low risk intervention it could be applied beneficially in the interim. Ageing was found to be a life-wide, life–long process so the research concluded that this diet could provide benefit to all.
“The side effects of a plant-based diet could be the elimination of the need to take drugs, and further research is needed to find ways to make Plant-Based Diet the new normal” Tuso, et al (2013).