bluuebunny/crossref_metadata_2025_split huggingface dataset:
211 A Novel Integrated Care Approach: Supporting Older Persons to Remain at Home
Authors: Tormey Sarah , Binions Laura , Dunne Aoife , Soh Josephine , O'Connor Marie , Kennelly Siobhan 
Published: September 2019

Abstract

Background
An Integrated Care Team (ICT) was established within our Day Hospital in September 2018 serving a catchment of older persons encompassing 3 Community Healthcare Organisations. The geographical spread of our patients poses challenges to the ICT in establishing an integrated network of services for patients. Provided here is a descriptive analysis of our patient cohort including basic demographics, co-morbidities, interventions and outcomes.

Methods
The team comprises of a Senior Physiotherapist, Occupational Therapist and Medical Social Worker supported by two Geriatricians. Referrals to the ICT are via the Day Hospital with a weekly multi-disciplinary team (MDT) meeting where they are discussed and prioritised. Interventions offered include domiciliary and day hospital based assessments. Following assessment appropriate targeted therapeutic intervention is provided which includes rapid access to enabling equipment, access to community supports and rapid access Geriatrician review. Additionally the ICT communicate with the acute and primary care services to identify existing or previous resource utilisation.

Results
In the inaugural 15 weeks of the service,132 referrals were received. This cohort had a mean age of 81,range (60-102) years; 58% female, 42%male. The Charlson Co-morbidity Index (CCI) score ranged from 2-9 with a mean score of 5. Of these, 50% had a Dementia diagnosis, 33% had a Falls history and 17% had a Stroke diagnosis. The mean Rockwood Clinical Frailty Scale score was 5; range ( 2-7). 62% of referrals were reviewed by both Physiotherapy and Occupational therapy, 58% by Medical Social Work. 34/132 required input from all 3 disciplines.

Conclusion
The ICT service has augmented the existing Day Hospital with timely multi-disciplinary assessment and treatment enabling older persons’ independence within their home in addition to forward planning if dependency levels increase. Additional benefits include reduction of primary care team waiting lists and forging links with our community and local rehab services. Future ambitions include recruitment of specialist nursing and direct referral pathways from our community colleagues.
221 Delirium Detection in the ED Utilizing the 4AT Delirium Screening Tool
Authors: Kelly Louise , Whelan Caitriona , Ryan Maeve , Wade Ruth , Boyle Orla , Brady Deirdre , Doherty Orlaith , Kennelly Sean , Mello Sarah , Gray James , Murphy Maeve , McElwaine Paul , Hayden Derek 
Published: September 2019

Abstract

Background
Delirium is a medical emergency and is associated with increased risk of mortality, in-hospital complications, length of stay and institutionalisation. Delirium screening is recommended for patients at risk on admission. Despite this, delirium screening is frequently not undertaken in the acute setting leading to undiagnosed delirium and sub-optimal clinical care.
We aim to investigate the prevalence of delirium in patients aged ≥75 years attending the Emergency Department (ED) of a tertiary referral centre.

Methods
Patients aged ≥75yrs presenting to the ED between 08.30 and 18.30, Monday- Friday were assessed by an interdisplinary gerontological service using a standardised assessment tool including the 4AT to screen for delirium. Data was collected and analysed via Excel.

Results
Of 163 patients screened over a 4 week period 47.9% (78/163) were male with a mean age of 81.8 years (SD 2.7). Twenty three percent (34/148) scored ≥4 indicating a possible delirium. Patients with delirium were older (85 yrs vs. 80 yrs, P<0.001), were more likely to score ≥4 on Clinical Frailty Scale (97% vs. 56%, P<0.001), and at risk of, or have malnutrition (MNA SF score <12) (86% vs. 40%, P<0.001).

Conclusion
Routine screening of patients in the acute setting detected a high rate of delirium at a level which is consistent with previous studies. Patients with delirium were older, more frequently frail and at risk of malnutrition. Our results support the evidence for routine screening for delirium in the acute setting.
232 The Timing of “Do Not Attempt Resuscitation” Decisions in an Older, Frail Inpatient Population
Authors: McDonough Anna , O'Hanlon Shane 
Published: September 2019

Abstract

Background
Ascertaining and discussing resuscitation status should be a routine part of medical practice. However, it is frequently neglected until a patient is acutely unwell. The National Consent Policy1 recommends that discussion around “Do not attempt cardiopulmonary resuscitation” (DNACPR) orders should occur for patients with “an identifiable risk of cardiorespiratory arrest occurring”. The Clinical Frailty Scale is a useful tool for providing predictive information about the risk of death in older patients2. Along with the presence of comorbidities, it can assist with determining prognosis and identifying patients for whom early discussion about resuscitation status is appropriate.

Methods
A chart review was carried out of all 106 inpatients in a model 3 hospital. Data was extracted on demographic information, frailty score and resuscitation status.

Results
The average age of inpatients was 79.8 years. On admission, the average Clinical Frailty Scale score was 5 (mildly frail), with 15% having a frailty score of 7 or more, and 28% a diagnosis of dementia. 25.5% of inpatients had a DNACPR order in place. It took an average of 32.4 days (range 0-224 days) from admission until this decision was made.

Conclusion
As we are caring for an older population with frailty; care planning, including resuscitation status should be discussed at an earlier stage. Ideally, this should occur on admission for certain patients, particularly those with high levels of frailty and multiple comorbidities. Our current practice, in which DNACPR decisions sometimes take place after a prolonged admission, is suboptimal. A change to the medical admission proforma, adding a prompt for discussion of DNACPR orders will be considered.
236 Socioeconomic and Social Factors among Community-Dwelling Dependent Older People with Cognitive Impairment in Ireland
Authors: Swan Lauren , O'Sullivan Maria , Warters Austin , Irving Kate 
Published: September 2019

Abstract

Background
Dementia, and related cognitive impairment, is prevalent in dependent older adults in receipt of formal home care; importantly, this is a determinant of transition into long-term care (Aspell., 2019). Our study aimed to explore social and socioeconomic factors in community dwelling older people in receipt of formal home care. To our knowledge social deprivation has not been previously investigated in this population in Ireland.

Methods
This study comprised a large cohort (n=1597) of community-dwelling adults aged 65 years or older who were in receipt of formal home care. Demographic, living setting, dependency (Barthel Index) were recorded; cognitive dysfunction (CD) included dementia and related cognitive impairment (Aspell., 2019). Social deprivation was captured by the Pobal HP Deprivation index which categorises affluence or disadvantage by residential area in Ireland.

Results
The study population (n=1597) was of mean age 83.3 ± 7.2, supported by 11.1 ± 7.2 hours of home care per week and 10.8% and 31.7% were categorised as of disadvantaged and affluent deprivation status, respectively. Those who received home support in areas of disadvantage were significantly younger than in affluent areas (79.1 ± 7.3 v 85.6 ± 6.87 years, p< 0.001). Prevalence of CD was 43.3%. CD vs non-documented CD were characterised by a significantly higher proportion of females (66.5% v 61.4%, p <0.05), widowed (47.4% v 41.8%, p <0.05) and very disadvantaged (7.4% vs 5.0%, p <0.05). Furthermore, the CD group had a significantly higher falls risk but lower physical dependency (Barthel), lower requirement for mobility support and higher need for meal assistance. Home care hours were higher (11.6 ± 7.2 v 10.8 ± 7.2 p <0.001) for the CD group, and comprised generic, rather than dementia-specific support.

Conclusion
The findings have implications for developing personalised dementia-specific home support and interventions. Further research is needed into disadvantaged deprivation and the need for home support at a younger age.
237 Systematic Review of Fibrinogen and Risk of Recurrent Stroke and Vascular Events after Ischaemic Stroke or Transient Ischaemic Attack (TIA)
Authors: McCabe John J , O'Reilly Eimear , Coveney Sarah , Collins Ronan , Cronin Simon , Harbison Joe , Cassidy Tim , Dolan Eamon , O'Connor Margaret , Williams David , Pope George , Murphy Sean , J Kelly Peter 
Published: September 2019

Abstract

Background
Inflammation is thought to play an important role in atherosclerotic stroke mechanisms. There is growing interest in the prognostic role of inflammatory biomarkers as risk factors for recurrent vascular events, after ischaemic stroke or transient ischaemic attack (TIA). Elevated fibrinogen levels are independently-associated with the risk of first-ever stroke. However, the prognostic value of fibrinogen, after ischaemic cerebrovascular events is uncertain.

Methods
We searched EMBASE and Ovid Medline, from 1970-January 2019, for any study that measured Fibrinogen after stroke or TIA, and related it to the risk of recurrent stroke or recurrent vascular events. All records were assessed by 2 independent reviewers. Any disagreements between authors regarding eligibility were resolved by consensus.

Results
We identified 2,520 publications, of which, 15 articles from 16 individual studies were eligible (11 observational cohorts, 3 cohort studies within randomized control trials, 2 case-control studies). The sample size for recurrent stroke and recurrent vascular events was 9,963 and 7,381 patients, in 11 and 10 studies, respectively. The time from event to phlebotomy was <7 days in 5, 7-90 days in 6, and >90 days in 5 studies, respectively. There was marked heterogeneity in statistical methodologies employed to examine the relationship between fibrinogen and outcomes, which did not allow valid meta-analysis (above/below specified threshold (n=4), differences in means/medians (n=5), risk per unit increase (n=1), per standard deviation (n=3), per quartile (n=1), per decile (n=1) or not specified (n=1)). 4 studies adjusted for all conventional vascular risk factors (age, smoking, diabetes, hypercholesterolaemia/statin use, and hypertension). 2 of 11 studies found a positive association with recurrent stroke. 5 of 10 studies found a positive association with recurrent vascular events.

Conclusion
The prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.
253 An Overview of the Current Status of Specialist Geriatric Services in Ireland
Authors: Sezgin Duygu , O’Donovan Mark , Whitty Helen , O’Shea Diarmuid , Liew Aaron , O’Caoimh Rónán 
Published: September 2019

Abstract

Background
The Royal College of Physicians of Ireland and the National Clinical Programme for Older People conducted a national survey of Specialist Geriatric Services (SGS) in 2014. The survey was repeated in 2018-2019 period to collect data on the resources available for the care of older people attending hospitals and associated communities in Ireland.

Methods
Participants were geriatrician leads or proxies in each hospital in Ireland. Questions based on the 2014 survey were updated to include frailty and dementia-delirium specific questions. Data were collected between September 2018 and April 2019 using an electronic survey. Comments from open-ended questions were analysed using qualitative analysis methods.

Results
In total, 20 fully complete and 18 incomplete responses were received. Most complete responses were from model 3 or 4 hospitals (n= 14/20). Less than half (47%) reported having a dedicated specialist geriatric ward in their institution. Half (50%) reported currently developing an integrated plan for services for frail older people with complex care needs. Barriers to managing frailty that were identified included limited access to funding and staffing. 82% reported that their group/area/unit/department engaged in case-finding for frailty. The most commonly used frailty-specific screening tools were the CFS (n=9), VIP (n=6), FRAIL scale (n=4), and PRISMA-7 (n=3). A National Frailty Education Programme governance structure was operational in 9/20 sites. Half (50%) reported that their hospital has an integrated pathway for people with dementia and/or delirium, although (82%) stated that their hospital does not formally screen all older people for cognitive impairment in the ED/AMAU, and does not formally screen people at risk for delirium on wards on a daily basis (100%).

Conclusion
Limited staffing and resources were reported for many aspects of SGS in Ireland. Although frailty and dementia-delirium are recognised as priority areas, there is need for standardised assessment and screening approaches.
318 Does a Teleconference-Delivered Educational Programme (ECHO) Provided to Nursing Homes Reduce Emergency Hospital Transfers?
Authors: Dowling MJ , Molloy Una , Payne Cathy , McLean Sarah , McQuillan Regina , Noonan Claire , Ryan DJ 
Published: September 2019

Abstract

Background
Nursing home staff manage increasingly complex patients yet struggle to access education programmes due to geographical logistical barriers. The aim of this study is to measure the impact on emergency hospital transfers a novel teleconference-delivered palliative care education programme (ECHO) has on patient transfers from nursing homes to emergency departments.

Methods
Ten interactive sessions were provided to staff from 20 nursing homes, using teleconferencing technology through the “Project ECHO” model. “Transfer forms” were completed by participating staff 6 months before echo, and 6 months from commencement of echo outlining details of emergency hospital transfers. Participating sites must attend 4 or more of 10 sessions for study inclusion.

Results
Of 20 nursing homes, 15 attended sufficient sessions, and they submitted data regarding 260 emergency transfers over a 12-month period. There was no significant difference in the number of transfers pre vs post ECHO (137 of 260 vs 123 of 260, p=0.62). There was no significant difference in likelihood of hospital admission, length of stay, or number of weekend transfers to hospital (p=0.26, 0.68 and 0.6 respectively). Post-echo, patients were less likely to have pain documented as the primary symptom (11 of 137 vs 1 of 123, p=0.006), and it was more likely that transfer wishes were documented in advance (62 of 137 (45%) vs 82 of 123 (67%), p&lt;0.001). Increase in transfer wishes documentation was explained primarily by an increase in a “for transfer” decision (27 of 62 vs 67 of 82) p=&lt;0.001).

Conclusion
This teleconference, ECHO-delivered palliative education programme did not affect overall rates of emergency hospital transfers from nursing homes. However, it did significantly lower rates of transfers reporting pain as the primary symptom, tentatively suggesting a possible impact on “reversible” hospital transfers. ECHO significantly increased likelihood of transfer status discussion, while most “extra” discussions resulted in a “for transfer” decision.
07 Rehabilitation in Patients with Dementia Following Hip Fracture
Authors: Small Cliona , Lennon Emma , Low Rebecca , Doyle Rachael , O'Hanlon Shane 
Published: September 2019

Abstract

Background
Hip fractures are an increasing phenomenon in the older population. Receiving post-operative rehabilitation is associated with better outcomes and a higher likelihood of returning to preexisting level of functioning. Best rehabilitation practices for people with dementia have not been established.

Methods
All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between March 2016-February 2018 were reviewed. Those with a diagnosis of dementia were extracted from the database. Clinical Frailty Scale (CFS), Zuckermann Functional Recovery Score (FRS) and New Mobility Score (NMS) were documented at baseline and at one year. Outcomes assessed included 1 year mortality, decline FRS/NMS, change in CFS and nursing home (NH) admission rates.

Results
465 patients’ hip fractures were recorded: 175 patients had dementia. 67 patients were dead at 1-year post fracture (38.285% mortality rate). Of the 108 patients with dementia who were living at 1-year; 30.5% (n=33) received offsite rehab. 58.4% (n=63) received routine in-patient rehab. 12 lost to follow-up. Of the 33 patients that received off-site rehab the mean FRS at baseline was 66 and decreased to 45.56 at 1 year (30.9% reduction). The mean CFS at baseline was 5.1, increasing to 6 at 1-year (17% increase). Mean NMS was 5.7 decreasing to 3.7 at 1-year. In those patients with dementia that did not receive off site rehab (n=63); baseline mean FRS was 38 reducing to 30 at 1 year (26.6 % reduction). Mean CFS was 6.25- increasing to 6.47 at 1 year. 41% of patients admitted from home who did not receive off-site rehab were discharged to NH. Of the group discharged to off-site rehab: at 1 year 33% were in a NH and 72% remained at home.

Conclusion
Both groups demonstrated decline in function. Those that received off-site rehab had higher premorbid functioning/mobility and reduced frailty. There was a reduced NH admission rate at 1-year in the group that received off-site rehab.
12 `Risk feeding’ for Older People: a Retrospective Case Series to Review the Decision Making Process
Authors: O'Loughlin Niamh , McCarthy Oonagh 
Published: September 2019

Abstract

Background
`Risk feeding' is a term commonly used when an individual continues to eat and drink despite a perceived risk of choking or aspiration. It is suspected that there is significant variability around how a decision of ‘risk feeding’ is made for older people in the acute hospital setting, particularly whether or not the individual and his/her family are involved. This is of particular interest under the Assisted Decision Making (Capacity) Act 2015.

Aims
To investigate individuals' participation in decision-making regarding `risk feeding' To investigate the duration individuals are kept NPO pending `risk feeding' decisions

Methods
A retrospective case series was completed. 18 medical charts were reviewed for collection of the following data: Average length an individual was NPO pending decision regarding oral intakeDiscussion between individual and medical team regarding oral intakeThe individual's capacity for decision making regarding oral intakeDiscussion of what is in the best interests of the individualDiscussion with family/NOKExplicit plan regarding oral intake

Results
Average length NPO: 1 day (range 0-4 days) Discussion with patient: 17% Patient capacity for decision making: 17% Best interests discussion: 66% Discussion with family/NOK: 77% Explicit plan: 66%

Conclusion
There is significant variability in decision making for `risk feeding' with older adults in the acute hospital setting. Individuals are not consistently involved in their plan to `risk feed'. In some cases there was reliance on family members to decide on `risk feeding', in others the medical team made decision in the best interests of the individual. Individuals are being kept NPO for a period of time to allow decision making, without knowledge of why this is so.
The review highlights the need for individual involvement in decision regarding dysphagia and oral intake. Multidisciplinary education and guidance is recommended to ensure consistent ethical decision making.
15 Not all the Hype is about Hypos: Local Experience of a Multidisciplinary Diabetes Consultation Service for Older Persons
Authors: Costello Maria , Newman Christine , Dennehy Karen , Reddin Caitriona , Abdullah Abdullah , Cunningham Aine , Reddington Lisa , Burke Helen , Bell Marcia , Dinneen Sean , O' Sullivan Esther 
Published: September 2019

Abstract

Background
Diabetes is a prominent health problem with prevalence increasing as the population ages. It is estimated that 11.9% of the Irish population aged 75 years and older are living with type 2 diabetes. This condition puts older people at risk of polypharmacy, incontinence in setting of poor control and neuropathic pain. In addition, they are at risk of premature death and functional impairment arising from associated complications. There is an estimated resource use of 10% of the total healthcare budget including medication costs, hospitalisations and attending non-diabetic specialists for disease associated complications.

Methods
We reviewed all acute hospital diabetes consultations over a two-month period to identify persons aged 75 years and over who had contact with our clinical nurse specialists and consult service.

Results
46 patients aged 75 years and older (median age 79 years) were reviewed on request by the consults service. 6.5% (n=3) had Type 1 Diabetes. 41.3% (n=19) were on insulin and the remainder were on oral medications alone. They had a median HbA1c of 63mmol/mol. 91.3% (n=42) were living at home prior to admission. All patients were reviewed and educated by our clinical nurse specialists. Issues addressed included hypoglycaemic awareness, glucometer use and insulin administration. 17.4% (n=8) had medications discontinued due to hypoglycaemia and/or chronic kidney disease. 32.6% (n=15) had up-titration of insulin and/or addition of new agents. 58.7% (n=27) were subsequently followed up in clinic by telephone.

Conclusion
The 2018 American Diabetes Association guidelines now recommend treatment goals based on functional status rather than age. Our experience locally is reflective of the spectrum of issues that arise in management of diabetes in the older person. This highlights the positive impact of a multidisciplinary diabetes service in minimising complications and promoting individualised person-centred care.
174 Benefits of a Self-Management Program for the Older Couple Living with Parkinson’s Disease: A Pilot Study
Authors: Lyons Karen , Zajack Alex , Greer Melissa , Chaimoy Holly , Dieckmann Nathan , Carter Julie 
Published: September 2019

Abstract

Background
Although community-based self-management workshops have been found to benefit older adults with Parkinson’s disease (PD), it is unclear if there could be added value for the couple if the spouse also participated.

Methods
A quasi-experimental two-wave design (0 and seven week follow-up) was used to explore the effects of a self-management program on the health and relational outcomes of older adults with PD and their spouses in comparison to a wait-list control condition. Thirty nine couples were enrolled and completed the study (19 in the intervention group and 20 in the wait-list control).

Results
Adjusting for baseline outcome values, spouses in the intervention group had significantly greater engagement in mental relaxation techniques (p < .001; d = 1.28) than those in the control condition at seven weeks. Additionally, moderate effect sizes were observed for increases in the mental relaxation (d = 0.44) and aerobic activity (d = 0.44) of older adults with PD and the strength-based activities of spouses (d = 0.33) in the intervention group. Small to moderate effects were observed for declines in the depressive symptoms of spouses (d = 0.29) and older adults with PD (d = 0.14) and care strain of spouses (d = 0.15) in the intervention group. Finally, perceptions of marital quality improved for older adults with PD (d = 0.46) and spouses (d = 0.41) and reports of protective buffering (i.e. hiding concerns) declined for older adults with PD (d = 0.24) and spouses (d = 0.33) in the intervention group compared to the wait-list control condition.

Conclusion
Preliminary data showed promise for self-management programs benefiting couples living with Parkinson’s disease. Although larger samples and randomized controlled trials are needed to establish the full benefit of such programs, greater attention to interventions for the older couple is warranted.