bluuebunny/crossref_metadata_2025_split huggingface dataset:
129 To Examine the Factors Affecting the Health and Wellbeing of Centenarians Living in Ireland
Authors: Fagan Alison , Gaffney Lorraine , McDonnell-Naughton Mary 
Published: September 2019

Abstract

Background
The notable increases in life expectancies worldwide combined with advances in contemporary medicine, escalating healthcare costs and increased demands on social services has driven the interest in centenarians as a model for healthy ageing. According to the United Nations, the global number of centenarians is set to continue to climb, expecting to reach more than 25 million people in 2100 (Robine & Cubaynes, 2017). Though the role of genetics in the context of successful ageing is irrefutable, it is important to recognise that the determinants of ageing go beyond genetics alone and equal credence needs to be given to one’s social and economic circumstances, to their physical environment and finally, to one’s own individual characteristics and behaviours.

Methods
The study focused on selecting a subsample of participants who were 100 years or older until the saturation point was reached. This study employed story telling (one to one interviews) in order to give centenarians a voice. Stories help us to answer the “big” questions about the meaning of life in general and of our lives specifically.

Results
A number of key themes emerged from the study denoting the factors that affect the health and wellbeing of Irish centenarians including, social connectedness, resilience & robust personality, continued participation in life throughout the life course and spirituality.

Conclusion
This research demonstrates that the successful attainment of longevity goes beyond the maintenance of physical health and concludes that in order to promote optimum well-being among older people, it is necessary to take note of the experiences, views and values, of the older person themselves.
149 Satisfaction with Food-Related Life Of Irish Adults Older Than 55 Years
Authors: Dermiki Maria , Pope Jennifer 
Published: September 2019

Abstract

Background
Food is an important part of older people’s life contributing to their physiological and mental well-being and to their satisfaction with life. The aim of this study was to investigate the factors that contribute to the satisfaction with food-related life of Irish community-dwelling adults older than 55 years.

Methods
A mixed methods approach was employed. Quantitative data were collected through a survey which tested how socio-demographic characteristics, food habits, mood and self-perceived health were correlated (Spearman correlation) with the 5 items from the satisfaction with food-related life (SWFL) questionnaire. Qualitative data were collected through open-ended questions which investigated the factors determining food satisfaction levels of the 81 adults (54 women) older than 55 years who participated in the study.

Results
The highest score (4.3/5) was given to the item from the SWFL questionnaire: “Food and meals are very important elements in my life”, and was regardless of gender, age and marital status of the participants. In contrast, the lowest score (3.9/5) was given to the item “My life in relation to food and meals is ideal”. Spearman’s correlation revealed that fruit consumption was positively correlated “With regard to food, the conditions of my life are excellent” (rho=0.29, p<0.05). The open-ended questions showed that sensory appeal was the most popular term related to food satisfaction levels.

Conclusion
Meals and food play an important role in older adults’ life; however, participants did not consider their life in relation to meals and food as ideal. Therefore, strategies need to be employed to improve food and meal experience for community-dwelling older adults to keep them healthy for longer. Food industry should focus on developing nutritious and sensory-appealing food for the older consumers. Finally, the finding that consumption of fruit leads to satisfaction with food-related life could be used as a health promotion message to change eating behaviour.
252 Physicians’ Perceptions to Electronic Alerts for Delirium and Dementia Screening - Qualitative Analysis of Bypass Reasons in an Electronic Patient Record
Authors: Rice Darragh , Chapman Lucy , Corbett Mel , Courtney Grainne , Lawlor Brian 
Published: September 2019

Abstract

Background
Delirium and dementia are common cognitive disorders within an inpatient hospital population (Mukadam & Sampson 2010) Efforts were made to improve detection by embedding the 4As Test (4AT) cognitive screening tool within the hospital electronic patient record (EPR). Non consultant hospital doctors (NCHDs) and consultants were prompted to complete the electronic 4AT on all inpatients aged 65 years and over at 24 hours into admission. Doctors could opt to bypass completion of the screening assessment but a reason for bypassing was required.

Methods
Reasons for bypassing the 4AT electronic alert were analysed using mixed methods during a seven week time period between June 28th and August 16th 2018. Free text entries were grouped into 15 qualitative categories. Quantitative methods using descriptive statistics were subsequently applied to qualitative categorisation.

Results
During seven weeks of analysis, hospital doctors bypassed electronic 4AT screening on 2473 occasions equating to a mean of 50.5 bypasses per day. Overall 40% of free text reasons documented were unintelligible. Examples of unintelligible bypass reasons documented in the EPR included “2321” and “dghj”. Amongst the qualitative categories analysed, the most common reasons for bypass observed were “Accessing EPR Remotely from Patient” (33%), “Specific Clinical Reason for Override” (12%) and “Not Patient’s Primary Team” (11%). Twenty-five entries (2%) were deemed to be angry or inappropriate. Examples included “Stop sending me delirium assessment”, “this is irrelevant, restrict this message to intern log-ins” and “I am consultant and I have to prioritise”.

Conclusion
Bypass of cognitive screening alerts within the EPR by doctors is common. Qualitative analysis of reasons for bypassing electronic alerts may provide insights on physicians’ perceptions to computer-generated prompts as well as informing future customisation and optimisation of alerts. Education and awareness amongst physicians regarding the nature and quality of documentation within electronic records is required.
261 Sleep and Frailty: Examining the Effects of Frailty on Sleep Disturbance in Hospitalised Older Adults
Authors: Mannion Helen , O'Caoimh Rónán 
Published: September 2019

Abstract

Background
Sleep disturbance is common in hospital, potentially resulting in poor clinical outcomes. Frailty is similarly prevalent and associated with multiple adverse events. Despite this, little is known about the interaction between frailty and sleep among older hospital inpatients.

Methods
Consecutive, non-critically ill patients aged ≥70, admitted medically through a large university hospital emergency department (ED) during the preceding 24 hours, were evaluated with measures assessing overnight sleep quality (Richards Campbell Sleep Questionnaire/RCSQ), baseline sleep (Pittsburgh Sleep Quality Index/PSQI) and insomnia (Insomnia Severity Index/ISI). Additional variables included medications, frailty (PRISMA-7 scores ≥3 and Clinical Frailty Scale/CFS scores ≥5), functional and cognitive status, and night-time noise levels. Patients were reassessed 48 hours later.

Results
Over four weeks, 152 patients, mean age 80 (±6.8) years were included; 61% were male (n=92). In all, 43% were frail (mean CFS score 4.23±1.6), median PRISMA-7 score 4±4; a further 24% were pre-frail. The median Charlson Comorbidity Index score was 6±2. The majority, 72% (110/152), reported impaired baseline sleep quality (PSQI ≥5) and 13% (20/152) had clinical insomnia (ISI ≥15). The median time spent in ED was 23±13 hours, median duration asleep was only one hour (range 0-8). After adjusting for possible confounders, frailty status was significantly associated with lower PSQI (p<0.001) but not ISI (p=0.07) and RCSQ (p=0.07) scores. Frail patients were twice as likely to report poor baseline sleep OR 2, (95% CI:1.3-3.2). Baseline and overnight sleep disturbance were not associated with prolonged length of stay (LOS) or 30-day readmission rates.

Conclusion
The prevalence of sleep disturbance and clinical insomnia among older adults admitted through ED is high and overnight sleep quality low, although these did not impact on LOS or 30-day re-admission rates. Frail patients reported significantly poorer baseline sleep but did not have higher rates of insomnia or experience worse overnight sleep.
09 #EndPJparalysis
Authors: Noonan Claire 
Published: September 2019

Abstract

Background
Bed rest is a contributor to iatrogenic complications including delirium and muscle atrophy (Lui et al.2017). Getting patients up and moving has been shown to reduce falls and improve patient experiences. Clothes help people maintain their self-esteem and orientation and would also remind their care professionals to recognize them as people (Blackweel, 2014)

Methods
A pre campaign audit on fall and new incidence of delirium was conducted prior to the pilot campaign. To assess what patients were in bed, dressed in pyjamas or up dressed for 2 weeks prior. Education was delivered to both staff and patients with information leaflets on the ward. Informing patients and families the appropriate clothing and foot wear to bring into hospital. Elective patients were notified by post to explain what we were doing and why, whilst asking them to pack their day clothes. At 12:00 every day roaming teams surveyed the amount of patients out of bed and dressed in their day clothes.

Results
37% (n=226) more patients were up, dressed and moving on Medical and Surgical wards.
25% (n=153) less patients were in bed on both the medical and surgical ward.
This pilot project demonstrated a decrease in the number of reported falls from 16 to 4 as well as a decrease in the number of reported new episodes of Delirium from 4 to 0.

Conclusion
Overall, the endpjparalysis initiative resulted in positive outcomes for patient’s small change can impact incidents of falls and acute delirium within our organisation.
Inter-disciplinary approach to roll out this initiative to other wards across the hospital changing our culture of care.
In line with the patients charter empower patients to take control of their care needs thus, promoting their independence.
173 A Qualitative Study Exploring Facilitators and Barriers to Engagement in Physical Activity Among Older Irish and French Adults
Authors: Sheerin Fintan , Lynch Aileen , Kilroy Sean , Epstein Monique , Girault Ariane , Larose Inès , Gillois Pierre , Rolland Carole , McKinney Ciarán , Harkin Mary , McKee Gabrielle 
Published: September 2019

Abstract

Background
The physical and mental health benefits of physical activity (PA) in older adults have been well-documented. However, a large proportion of older adults worldwide fail to meet the internationally recommended guidelines of 150 minutes of moderate intensity PA per week. Factors associated with engagement in PA among older adults are complex, interacting and wide-reaching, involving individual, social, physical and environmental factors. Thus, to develop preventive lifestyle interventions it is necessary to carefully explore these factors.

Methods
This qualitative study (as part of a larger funded study to develop a PA-intervention) sought to identify and explore facilitators and barriers to PA in community dwelling older adults (≥65). Focus groups were conducted in Ireland (one) and France (two) and findings were analysed using thematic analysis.

Results
The main facilitators that emerged from focus group participants (n=33) were: availability of resources; tailored classes facilitated by staff knowledgeable of older adults’ needs; activities that facilitated social support and connectedness; perceived physical and psychological health benefits. Similar factors also influence continued participation in PA, as well as feelings of wellbeing and enjoyment, family support and motivation, although it was noted that it did sometimes require considerable effort. Barriers to engagement in PA included: lack of social support and resources; environmental factors, whether built, social, location or weather-related. Barriers of a more personal nature also emerged and included fear, loss of confidence due to functional changes, and lack of opportunity.

Conclusion
PA guidelines are but the first step. There is a need to develop implementation strategies at all levels: personal; interpersonal; organisational; community; and public policy, specifically for older adults, that will incorporate the above facilitators and address the above barriers to optimize engagement and maintenance in PA among older adults.
183 Risk of Hypoglycaemia in Older Patients in Residential Care on Oral Hypoglycaemic Medication
Authors: Brennan M , Crowe A , Tiernan C , Smith M , Cogan L , Purcell R , Griffin C , Crowe M 
Published: September 2019

Abstract

Background
Diabetes mellitus (DM) is common in older patients in residential care(RC) with prevalence ranging from 11-36%.Guidlines(1) on glucose targets to avoid the risk of hypoglycaemia or hyperglycaemia respectively in older people recommend avoiding a fasting glucose on treatment of 6mmol/L or a random glucose level higher than 11.0mmol/L. An HbA1c of 53to 59mmol/mol(7-7.5%) should be aimed for although this may need adjusting in RC and StoppFrail guidelines suggest a target of HbA1c of <8%(64mmol/mol). We assessed the prevalence, drug treatment and glycaemic control in 107 older patients in residential care at two sites in Dublin.

Methods
Patients with DM were identified from review of medical notes. Hypoglycaemic treatment whether oral hypoglycemic drugs(OHD) or insulin, capillary blood glucose measurements(CBGM) over the previous 28 day period, HbA1c values and weight change over the previous year respectively were tabulated from patient records.

Results
Sixteen patients (15%) aged 66-93 were documented with DM. Eight (50%) were on no hypoglycaemic treatment in whom OHD had been discontinued in 2 patients over the previous 6 months because of risk of hypoglycaemia.. Six patients (38%) were only on OHD, whilst 2 were on insulin. Of the 6 patients on OHD, CABGM were below 6mmol/L in 3 patients (50%) with no values above 11mmol/L. All 3 patients had lost weight ( 2.5-6.8Kg) over the previous year and HbA1c levels were below 53mmol/mol (7%) in all 3 patients.

Conclusion
Although our numbers are small, 50% of our patients in residential care on OHD are at risk of hypoglycemia possibly related to weight loss. Reducing or discontinuing their OHD may be appropriate.
19 Hip Fracture Outcomes in the Frail Older Person
Authors: Small Cliona , Kneafsey Sian , McFeely Aoife , O'Hanlon Shane , Cooney Marie Therese , Doyle Rachael 
Published: September 2019

Abstract

Background
Hip fractures in the older person are associated with significant morbidity and mortality. Screening patients for frailty and assessing baseline mobility and function may help predict poorer outcomes

Methods
All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between February 2016-February 2018 were included. We assessed clinical frailty score(CFS), zuckermann functional recovery score(FRS) and new mobility score(NMS) on admission and at 1 year. Outcomes assessed included mortality rates and nursing home(NH) admission rates

Results
541 patients were included; 533 underwent surgery, 4 died preoperatively and 4 of the periprosthetic fracture cohort were treated conservatively. 33 patients lost to follow-up. Overall mortality was 24.7%(n=134) at one year. In the severely frail cohort (CFS7-9)(n=72); 47.2% mortality rate at 1 year. 20.8%(n=15) came from home, 2 of those were discharged to NH. In the moderately frail cohort (CFS 5-6)(n= 184), mortality rate was 30.4% at 1 year. 77.2%(n=142) were admitted from home and 8%(n=15) of this cohort were discharged to NH. In the non-frail subgroup (CFS 1-4)(n=211), mortality rate was 11.8%(n= 25)at 1 year, 97.1% (n=205) were admitted from home and 7.5%(n=11) of the cohort admitted from home were living in a NH at 1 year. Regarding FRS; compared to those without frailty(FRS>75), those with FRS 30-75 had a two-fold increased risk of one year mortality [OR: 2.16 (95% CI: 1.24 to 3.78)]. This increased to a nearly six-fold increased risk in those with severe frailty (FRS<30); [OR 5.73 (95%CI : 3.16 -10.41)]. This effect was independent of age. A dementia diagnosis independent of age and frailty is associated with 2.5 fold increased risk of NH/mortality at 1 year

Conclusion
All three tools (CFS, NMS, FRS) can accurately predict mortality and NH admission at 1 year. Patients with higher CFS and poor baseline functioning and mobility have poorer outcomes. CFS is a simple tool that can be documented on admission with a hip fracture and help inform discussions with patients and families regarding potential outcomes/prognosis.
205 The Effects of Acquired Hearing Loss in Later Life - A Pilot Study
Authors: Walsh Amy , El Refaie Amr , Kingston Anna , O'Grady Gerrie , Laoide-Kemp Siobhán 
Published: September 2019

Abstract

Background
Acquired hearing loss (AHL) is defined as a hearing loss which is acquired after birth or at any other time in one’s life. In Ireland one in every twelve adults has a permanent hearing loss as a result of ageing or exposure to noise. Statistical findings are consistent with people identified with hearing loss in later life having a corresponding higher risk of cognitive decline. The pilot study aimed to investigate the experience of members of a deaf association who had been diagnosed with AHL in later life. This is the first time this particular group has been surveyed in Ireland.

Methods
A qualitative research design was used. The information was gathered using an open-ended questionnaire which was distributed to 30 participants. Rich data was extracted and analysed using thematic analysis (Braun and Clarke 2006).

Results
12 members of the deaf association responded to the questionnaire. From these responses four themes were identified: emotional well-being, management strategies & rehabilitation, promoting awareness and alienation. This study indicated that AHL can have a detrimental effect on people in later life.

Conclusion
There is irrefutable evidence to suggest that the effect of AHL in later life exceeds the effect on hearing alone and extends to emotional and physical well-being as well as overall quality of life. The pilot study demonstrates the urgent need for a far-reaching study to evaluate the effect of AHL in later life on the Irish population, its impact on quality of life and cognitive decline while highlighting the need for community awareness and understanding.
220 Is Multifactorial Risk Assessment a Team Sport? Disciplinary Differences in Perceived Acceptability and Feasibility of a Community-based Fall Prevention Service
Authors: McHugh Sheena , Cronin Finola , Moriarty Eileen , Turvey Spencer , Barry Patrick , O'Connor Kieran , Timmons Suzanne , M Kearney Patricia 
Published: September 2019

Abstract

Background
Multifactorial falls risk assessment is an evidence-based practice recommended to prevent falls among older people. Previous research has identified cultural, practical and professional challenges to implementing complex fall prevention interventions. Fall prevention interventions are frequently delivered by multidisciplinary teams (MDTs). This requires multiple health professionals, who practice under different professional norms and governance structures, to accommodate new ways of working. Our aim is to explore disciplinary differences in the perceived acceptability, appropriateness and feasibility of community-based multifactorial falls risk assessment clinics during initial implementation.

Methods
A mixed methods study is being conducted with analysis of administrative data on delivery of risk assessments (2016-2018), and semi-structured interviews staff involved in multidisciplinary teams (physiotherapists (PT, n=5), occupational therapists (OT, n=6), and public health nurses (n=4)]. Interviews were conducted prior to implementation and at 6 months (n=30 interviews total). Framework-driven thematic analysis was used to identify factors influencing implementation and explore perceptions of acceptability, appropriateness and feasibility.

Results
Implementation varied across disciplines; 28% of assessments were conducted by nurses (n=83), 36% (n=111) by physiotherapists, and 36% (n=108) by OTs. Preliminary qualitative analysis suggests that OTs welcomed the opportunity to expand their scope of practice. Conducting assessments at set times in static clinics was incompatible with public health nurses’ workflow. Their limited availability and time-sensitive competing priorities were barriers to the feasibility of an MDT-approach. Physiotherapists questioned the relative advantage of a broad assessment, and whether it was an appropriate use of resources given waiting lists for physiotherapy intervention. Data analysis is ongoing.

Conclusion
The study results have already been used to inform service adaptations including the introduction of dedicated intervention sessions. Training and implementation support for multidisciplinary teams may need to be tailored to the needs of different professional groups to enhance adoption and fidelity.
250 Delirium, Common but Forgotten
Authors: Smyth Hannah , Mahmood Maham , Feely Owen , Beirne Joanna , Gallagher Conal , O'Keeffe Hannah , Walsh Michael , Thomas Niju , Rashid Marwah , Khalil Imran , Ansari Ali Al , Shibani Almaqdad Al , Lynch Olwyn , Basit Mian , Bhuachalla Bláithín Ní , O'Brien Helen , Mulroy Martin 
Published: September 2019

Abstract

Background
Delirium is a medical emergency prevalent amongst hospitalised older patients and associated with prolonged hospital stay, functional and cognitive decline, institutionalisation and increased mortality. In Irish hospitals, multiple strategies, e-learning courses, delirium guidelines and prevention programs have aimed to improve delirium care with better diagnosis and prevention. With the increasing awareness campaigns, we aimed to review the prevalence, screening and management of delirium in our cohort of older patients.

Methods
A review of medical notes of all patients admitted under medical teams to an acute geriatric ward was carried out. Data was collected over a 3 week period in an Irish model 3 hospital. The following information was obtained from medical records: 1) Previous diagnosis of delirium/dementia 2) Documentation of a diagnosis of delirium 3) Features of delirium 4) Development of delirium as an inpatient 5) Formal screening for delirium 6) Cause and management of delirium 7) Length of stay.

Results
Of 79 consecutive admissions to an acute geriatric ward (mean age 81.4, 57% female, 30% previous history of delirium or dementia), 25% (n=20) had a diagnosis of delirium documented. 22% (n=18) of patients had confusion and features of delirium highlighted but no formal diagnosis of delirium made during their inpatient stay. A further 20% (n=16) developed delirium on admission. Only 2.5% (n=2) of admissions had formal screening for delirium with the 4AT. 27.5% (n=11) of patients with delirium had a cause and management plan recorded. 70% (n=28) of patients with delirium had a length of stay of over 15 days.

Conclusion
This review showed delirium recognition, screening, prevention and management were overlooked to an alarming extent in our cohort of older patients. The next step is introduction of the 4AT screening tool and regular education sessions to increase the awareness of delirium amongst medical teams looking after older patients and improve care and outcomes.