bluuebunny/crossref_metadata_2025_split huggingface dataset:
97 Potentially Inappropriate Medications in Patients with Alzheimer’s Disease: Data from NILVAD
Authors: Murphy Claire , Dyer Adam H , Lawlor Brian , Kennelly Sean P 
Published: September 2019

Abstract

Background
Prescription of Potentially Inappropriate Medications (PIMs) is common in older adults and is associated with adverse drug events, hospitalisation and mortality. Less well described are the patterns and predictors of PIM usage in patients with Alzheimer’s Disease (AD), a patient group who may be particularly vulnerable to polypharmacy and medication associated adverse events.

Methods
Secondary analysis of the NILVAD trial, an international phase three trial of Nilvadipine in mild/moderate AD. The v2 STOPP/START criteria were individually applied by a physician to each participant’s medication list and cross-reference with their medical history to identify PIM usage. Predictors of PIM usage were modelled using binary logistic regression.

Results
Five-hundred and ten patients with AD were included (mean age 72.8 +/-8.3 years; 62% female). The median number of prescribed medications was 5 (IQR 3-7). Over half (55.5%) were prescribed at least one PIM, whilst a minority of patients (14.8%) were prescribed three or more PIMs. The most frequent PIMs were benzodiazepines >4 weeks without indication (n = 55), long-term Proton-Pump Inhibitor (PPI) use without appropriate indication (n = 49), use of non-steroidal analgesics without use of PPI (n=19) and antimuscarinic use in dementia (n= 18). On multivariate analysis, significant predictors of PIM use were higher total number of medications (p=0.001; OR 1.52; 1.36-1.59) in addition to greater AD severity, as rated using the Clinical Dementia Rating Scale Sum-of-Boxes (CDR-sb) (p=0.024; OR 1.18; 1.02-1.35).

Conclusion
The majority of older patients with AD were prescribed at least one PIM. Usage of PIMs was associated with greater number of medications and increased dementia severity. Particularly concerning is the potentially inappropriate use of benzodiazepines and anti-muscarinic agents in this population, given recent evidence for the adverse cognitive profile associated with these medications. De-prescribing and medication review interventions aimed particularly at patients with AD are warranted.
142 Advance Care Planning in Patients with Dementia: An Audit on End of Life Care in Hospital Deaths
Authors: Sullivan Rachel , Power Clodagh , Greene Elaine , Purcell Roisin 
Published: September 2019

Abstract

Background
End of life care (EOLC) planning is a difficult and often neglected area in dementia. Advanced care discussions play an important role in the planning of future care for patients with dementia. The NICE guidelines recommend that patients with dementia should be given every opportunity to discuss their wishes and preferences regarding their future care. The goal of our study was to explore the extent of EOLC planning in patients with dementia who died in hospital.

Methods
Patients with dementia who died in a large tertiary referral hospital in 2017 were identified via the Hospital Inpatient Enquiry (HIPE) database. A retrospective chart review was completed examining the documentation of Advance Care Planning (ACP) and discussions around end of life care. Charleston Comorbidity Index (CCI) was used to predict 1 year mortality.

Results
HIPE identified 49 patients with dementia who died in hospital. The average age was 84 and 53% were female. The commonest cause of death was respiratory (79.5%). Two thirds lived at home and 30% were nursing home residents. The mean CCI was 3.97 indicating 52% 1-year mortality, however only 34% were hospitalized in the last year. Only 14% had an ACP. Only 22% had resuscitation status recorded on admission. The majority had resuscitation status documented 15 days prior to death. In these cases 70% had clearly documented the discussion with family or patient and 84% documented ceilings of care 6 days prior to death. Palliative care were involved in 40% of cases. Two patients did not have resuscitation status documented prior to death and 3 received CPR.

Conclusion
Our study highlights the urgent need to facilitate conversations around end-of-life care with people with dementia. Advance care planning reduces the use of burdensome treatments, ensures dignity and comfort is prioritized enabling patients to live well until they die.
144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning
Authors: Randles Mary , Hickey Sylvia , Cotter Susanne , Walsh Carmel , O'Connor Kieran , O'Sullivan Catherine , McGrath Keith , O'Sullivan Aine , Looney Eileen , Maher Sharon , McGuaran Jane , Higgins Anna , Quirke Anne , Allen Yvonne 
Published: September 2019

Abstract

Background
Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital.

Methods
The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications.

Results
There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days).

Conclusion
Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.
150 Severe Drug Interactions (SDIs) and Potentially Inappropriate Prescriptions (PIPs) in Older Adults with Cancer
Authors: Lavan Amanda , O'Mahony Deirdre , Buckley Mary , O'Mahony Denis , Gallagher Paul 
Published: September 2019

Abstract

Background
The objectives of this study were to identify the prevalence of severe drug interactions (SDIs) and potentially inappropriate prescriptions (PIPs) in older adults with cancer.

Methods
A 12-month prospective observational study of patients ≥65 years admitted to an oncology centre was conducted. SDIs were assessed using Stockley’s interaction checker; PIPs were identified using STOPP/START criteria. Logistic regression was applied to determine the influence of age, gender, co-morbidities and medication number on the likelihood of an SDI and a PIP.

Results
We enrolled 186 participants; mean age 72.5 (SD5.7) years, 46.2% female, mean co-morbidity number 7.5 (SD3.4), median medication number 7 (IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. Systemic anti-cancer therapies (SACTs) were concomitantly prescribed to 60.2%.
SDIs were identified in 50.5% participants; 7.5% ≥1 SACT-SACT SDI, 41.4% ≥1 drug-drug SDI and 10.2% ≥1 drug-SACT SDI. The most common SDIs were beta-blocker/alpha-blocker (n=12), Selective serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (n=11) and SSRI/Aspirin (n=8). A strong correlation between medication and SDI number was identified (r2=0.61, p-value <0.001). For each additional prescription, the odds of an SDI increased by 50.8% (Odds ratio 1.508, 95% CI1.288–1.764, p<0.001).
PIPs were observed in 73.1%; median 2(IQR1-3). The most common PIPs were drugs prescribed beyond the recommended duration (46.8%), high-dose PPIs >8 weeks (34.9%) and regular opioids without laxatives (20.4%). Patients prescribed ≥1 PIP had more co-morbidities (8.4(SD3.4) vs 5.2(SD2.4), p< 0.001), a higher cumulative illness rating score (18(IQR12-20) vs 11(IQR10-14), p<0.001) and more prescribed medications (8(IQR6-10) vs 3(IQR1-4.25), p<0.001). For each additional prescription, the odds of receiving a PIP increased by 79.2% (Odds ratio 1.792, 95% CI1.459–2.02, p<0.001).

Conclusion
SDIs and PIPs are common in older adults with cancer and higher than previously reported. Comprehensive specialist medication evaluation, by a Geriatrician, may benefit patients.
170 Admissions to a Stroke Unit in an Irish Rehabilitation Hospital: A Review from Speech and Language Therapy
Authors: Dhufaigh Niamh Ní , Haughey Marie , Gillen Cliodhna 
Published: September 2019

Abstract

Background
Communication disorders and dysphagia are debilitating sequelae associated with stroke. Speech and Language Therapy (SLT) has a pivotal role in stroke rehabilitation, and in improving outcomes. The research into dysphasia, dysphagia, and dysarthria post-stroke is extensive. In comparison, the research into cognitive-communication difficulties post-stroke is still emerging. Cognitive-communication difficulties (CCDs) are communication impairments resulting from underlying cognitive deficits due to neurological impairments1. The aim of this audit was to review SLT referrals in an Irish Stroke Rehabilitation Unit.

Methods
Single-centre retrospective review of all stroke admissions from January to December 2018. Communication outcomes were assessed using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM)2 a 7-point disability rating scale. Standard Bayesian statistics were employed for analysis.

Results
SLT received referrals for 66% (n=41) of all stroke admissions (n=62). Mean age was 68 years (SD+/-14), compared with 70 years (SD+/-14) for patients not referred. 65% were female and 35% male. Patients requiring SLT had significantly longer length of stay (p=0.0072). 83% of referrals were for communication, 12% dysphagia, and 5% inappropriate. Of communication referrals, primary diagnoses were as follows: 17.5% dysarthria (n=6), 26.5% dysphasia (n=9) and 56% CCD (n=19). Patients with dysphasia showed greater improvement in FIMFAM scores (x̄=1.3) than those with CCD (x̄=0.9) or dysarthria (x̄=0.7). Patients with CCD comprised the largest cohort who required SLT on discharge (68%).

Conclusion
CCDs are highly prevalent and represented the largest subtype of communication disorders in this cohort. FIMFAM scores appear useful in assessing CCDs however they display insufficient sensitivity in capturing change within this population. This audit highlights the need for further interdisciplinary research, education and training into cognitive-communication difficulties with post-stroke populations.
235 Pyjama Paralysis: Time to Make a Move!
Authors: Fitzpatrick Donal , Doyle Kate , Finn Gerard , Gallagher Paul 
Published: September 2019

Abstract

Background
The adverse effects of inpatient falls are well known. The harms of unwarranted bedrest and prolonged immobilisation present insidiously but, arguably, have a greater impact. Deconditioning, itself, is a major contributor to falls in older adults. There is still a troubling assumption that falls can be prevented through restraint and preventing at-risk patients from mobilising.

Methods
We reviewed medical and nursing notes and conducted brief-structured interviews with nurses and brief bedside observations for medical inpatients aged ≥75. We constructed a research template based on the UK National Falls audit 20151 and the Hospital Elder Life Program (HELP) - mobility toolkit2. We included all patients on medical wards over the age of 75, admitted for 3 or more days. We excluded patients who were critically unwell or imminently dying.

Results
We reviewed 100 medical inpatients aged over 75. Patients’ mobility deteriorated significantly from their baseline, with 73% of patients requiring assistance compared to 22% at baseline. PJ paralysis was endemic with only one third of patients wearing day clothes. 75% of patients spent more than half of the day in bed. There were 8 falls during the entire study period. Poorer levels of mobility correlated with delirium and incontinence.

Conclusion
The deleterious effects on older patient of the traditional model of acute hospital care with gratuitous bedrest are universally acknowledged. Falls should be prevented through supervision rather than restraint. Campaigns such as “End PJ Paralysis” and the HELP mobility toolkit can enable a cultural change within hospitals. Such change is impossible without the staffing and leadership to endorse it.
273 Characteristics of Centenarians in the Irish Hip Fracture Database
Authors: Hogan Patrick , Ferris Helena , Brent Louise , McElwaine Paul , Coughlan Tara 
Published: September 2019

Abstract

Background
In 2017 the Central Statistics Office reported that there were 465 people over the age of 100 in Ireland. This number is likely to increase and, as hip fracture increases exponentially with age, we can expect to see more centenarians experiencing hip fracture. In the UK we have comparative data on such a cohort. We sought to define and describe those aged 100 years and over included in the Irish Hip Fracture Database from 2013-2017.

Methods
A secondary analysis of the 15,603 data entries in the IHFD between 2013 and 2017 was conducted. Those patients aged 100 years and over were identified and the cohort described.

Results
57 patients 100 years and over (average 101 range 100-105) were registered in the IHFD over these 5 years. 91% were female. The most common fractures were intertrochanteric (46%) and displaced intracapsular (30%). 55 patients underwent an operative procedure, the most common being bipolar hemiarthroplasty (28%). Over one third were mobilised on the day of or day after surgery. The average length of stay was 22.5 days with only 13 ICU days for the entire cohort. 7 patients died in hospital. Of those surviving to discharge, discharge destination was recorded for 20. 10 patients returned to nursing home, 5 admitted de novo to nursing home, 5 to offsite rehabilitation and one person discharged directly to home.

Conclusion
This data provides the first insight into hip fractures in the oldest old in an Irish context. Rate of operative intervention was reassuringly high with in-hospital mortality outcomes of 12% which is low by international standards. The age of those sustaining hip fractures is increasing with numbers of the oldest old expected to rise. Orthogeriatric input results in improved care for this population and will require increased resourcing for future cohorts of patients.
277 Frailty and Early Supported Discharge (ESD) Post-Stroke: Are Frail Patients Referred to ESD and is Frailty Associated with Rehabilitation Outcomes?
Authors: Condon Marie , O'Regan Louise , Pope Lucy , Barrett Anne 
Published: September 2019

Abstract

Background
Frailty presents in one in four stroke survivors and can be a determinant of recovery post-stroke. Healthcare services provided at home, instead of in hospitals, results in improved outcomes for frail patients. Early supported discharge (ESD) provides multidisciplinary rehabilitation at home post-stroke. It is unknown if frail stroke survivors receive ESD and if they benefit from it. The objectives were to evaluate the prevalence of pre-stroke frailty among ESD patients and examine if frailty is associated with rehabilitation outcomes.

Methods
Consecutive patients in the ESD programme were assessed for pre-stroke frailty using the Clinical Frailty Scale (CFS) from November 2018 to April 2019. Baseline characteristics and programme outcomes were recorded, including admission and discharge scores on the Functional Independence Measure and Functional Assessment Measure (FIM+FAM) and the Stroke Aphasia Quality of Life-39 measure (SAQOL-39). The duration of ESD rehabilitation and number of therapy sessions provided were also recorded. Distributions using Pearson’s Chi Squared test and associations using the Mann–Whitney U test were calculated.

Results
Results from 23 patients were analysed, median age 75±14.8 years, 82.6% male. The prevalence of frailty (CFS >5) was 4.3% (1/23) and pre-frailty (CFS=4) was 26.1% (6/23). Patients who were frail or pre-frail (CFS>4) were less likely to receive speech and language therapy (SLT) (z=-2.201; p=0.03) and have a lower SAQOL-39 on discharge (z=-2.294; p=0.02). No significant differences were noted in the FIM+FAM or the number of physiotherapy and occupational therapy sessions provided.

Conclusion
Frail patients are not routinely referred for ESD post-stroke. Patients who are pre-frail or frail make similar improvements with ESD compared to non-frail patient in functional independence but not quality of life. Comparable levels of physiotherapy and occupational therapy are provided but frail patients require less SLT. Further research is needed to ascertain if frail patients are appropriate for ESD.
03 Examining the Resiliency of Visually Impaired Older Adults with Cognitive Decline Aging in Place
Authors: Fletcher Patricia 
Published: September 2019

Abstract

Background
Visual impairment is a leading chronic condition among older adults and is usually connected with a decline in their performance of instrumental activities of daily living. Understanding the challenges of those with visual impairment is paramount as the population ages over the next four decades. This study examined the hypothesis that older adults who were diagnosed with juvenile macular degeneration as young adults and now have a mild cognitive impairment have better coping mechanisms than older adults who were recently diagnosed with age-related macular degeneration.

Methods
This study utilized a mixed-methods approach to address the complexities in health science research and align with the interdisciplinary field of gerontology.

Results
Participants were 27 older adults aged 65 years of age and older. There was no quantitative difference in resiliency between participants with juvenile macular degeneration (n = 7, M = 77.71, SD = 9.46) and those with age-related macular degeneration (n = 10, M = 72.60, SD = 8.25), t(15) = 1.185, p = .254.

Conclusion
The qualitative results revealed that older adults living with visual impairment develop strategies to improve their quality of life and help them age in place.
198 The Next Steps: The Development of Dementia Post-diagnostic Psychoeducational Support Guidance
Authors: Gibb Matthew , O'Caheny Dearbhla , Craig Cecilia , Begley Emer 
Published: September 2019

Abstract

Background
There is often a `care gap' where people are given a clinical diagnosis of dementia but receive no useful support. (Foley, T. et al., 2019) However, the early stages of dementia are a crucial time for supportive interventions such as advice and strategies to cope with impairments and improve wellbeing and signposting through complex healthcare systems to access key supports and services. In February 2018 the National Dementia Office (NDO) commissioned the Dementia Services Information and Development Centre (DSIDC) to develop a guidance document to support health and social care professionals (HSCPs) establish, organise and facilitate evidence-based post-diagnostic pyschoeducatonal interventions in the community.

Methods
The DSIDC undertook an extensive literature review examining the evidence for multi-component psychoeducational interventions. An experienced group of health and social care professionals provided additional material and expertise resulting in the development of the final guidance document. Members of the Irish Working Group of People with Dementia and the Dementia Carers Campaign Network also reviewed the document.

Results
The literature review found a growing evidence base for dyadic interventions. These interventions, directed at the person with dementia and their care partner, were diverse in their content, outcomes, the measures they used, their frequency and the professional background of the facilitators. They were flexible and cost-effective and drew on the HSCP's own professional knowledge, service resources and experiences of what works and what doesn't.

Conclusion
Dyadic interventions (and psychoeducational programmes in particular) have the potential to benefit both people with dementia and their care partners by decreasing depression and anxiety, increasing knowledge and coping skills and helping improve cognitive function. (Moon and Betts Adams, 2012) The practical guidance document developed from this review provides HSCPs with useful advice and information to facilitate the setting up and running of post-diagnostic psychoeducational support programmes.
207 Acute Incidence of Disease at Elevated Levels of Fine Particulate Matter (PM2.5) in Dublin, Ireland
Authors: Byrne Colm , Bennett Kathleen , Hickey Anne , Kavanagh Paul , Broderick Brian , O'Mahony Margaret , Williams David 
Published: September 2019

Abstract

Background
Fine particulate matter (PM2.5) has been associated with disease incidence worldwide. In Ireland this is mainly produced by residential heating systems, particularly peat, coal and wood. This study aimed to explore the relationship between short-term exposure to PM2.5 and hospital admissions due to stroke, atrial fibrillation, myocardial infarction, atrial fibrillation (AF), heart failure, chronic obstructive pulmonary disease (COPD), asthma, Parkinson’s disease, dementia and hip fracture in Dublin City and County between 2013 and 2017.

Methods
This was an ecological time series design utilising routine hospitalisation data collected from the national Health Service Executive (Hospital In-Patient Enquiry (HIPE)). Incidence of hospitalisation for each disease was identified by county of residence. Mean daily PM2.5 levels for Dublin were calculated using monitoring data from the Environmental Protection Agency’s four monitoring sites. Disease incidence was organised by mean PM2.5 levels into 10μg/m3 categories and analysed using Poisson regression models correcting for minimum daily temperature at a lag of zero to five days.

Results
There was a significant increase in the short-term incidence of acute ischaemic stroke, AF, heart failure, Parkinson’s disease, dementia and COPD when PM2.5 levels were above 50μg/m3 compared to when levels were below 10μg/m3 at one day post exposure when correcting for minimum temperature.

Conclusion
Controls need to be brought in to ensure that PM2.5 does not exceed a 50μg/m3 level due to the increase in disease incidence associated with same. The urban burning of solid fuels should be severely restricted.