bluuebunny/crossref_metadata_2025_split huggingface dataset:
169 Examining the Associations Between Frailty, Obesity and Allostatic Load in The Irish Longitudinal Study on Ageing (TILDA)
Authors: McCarthy Kevin , McNicholas Triona , Laird Eamon , Ward Mark , Romero-Ortuño Roman , Anne Kenny Rose 
Published: September 2019

Abstract

Background
Fried’s frailty phenotype is defined by five criteria: exhaustion, unexplained weight loss, weakness, slowness and low physical activity. Frailty can also affect obese people. Little is known about how body mass index [BMI] or waist-hip ratio [WHR] are associated with frailty or pre-frailty in the face of confounding factors, including markers of allostatic load which are known to be involved in frailty biology. We cross-sectionally examined these associations in a population-based study.

Methods
A cross-sectional analysis of data collected at Wave 1 (2010) of TILDA was undertaken. Participants aged <50 and those who did not have measurements of their BMI, WHR, chronic disease status, HbA1c, CRP, sex and educational status were excluded. Two multivariate logistic regression models (one with BMI and another one with WHR as measure of obesity) were computed adjusting for these covariates, with frail/pre-frail versus non-frail as the outcome variable.

Results
4,568 participants were included: 3,277 non-frail and 1,291 frail/pre-frail. The frail/pre-frail group had a mean BMI of 29.2 (versus 28.3) kg/m2 and a mean WHR of 0.912 (versus 0.899). In the adjusted regression model, BMI had a significant association with frailty/pre-frailty (OR 1.02, 95% CI: 1.01-1.04, p=0.001). However, in the model using WHR, the latter had a stronger association with frailty (OR 4.52, 95% CI: 1.60-12.72, p=0.004). In both models, age, education, chronic disease status, HbA1c and CRP had the expected associations with frailty/pre-frailty. Female sex was significantly associated with frailty/pre-frailty in the WHR model (OR 1.26, 95% CI 1.06-1.50, p=0.008).

Conclusion
While obesity is associated with frailty, the distribution of body fat may be more important as a marker of frailty. These physical traits should not be overlooked in the over 50 population. The association between frailty, obesity and markers of ‘inflammaging’ could be examined longitudinally to further understand their complex biology.
176 The Impact of Inter-generational Care on the Emotional Well-Being of Older Persons with Dementia Living in Long Term Care Settings
Authors: McGuigan Siobhán , O'Farrell Lisa , O'Dwyer Sarah 
Published: September 2019

Abstract

Background
A significant number of older persons living with dementia highlight feelings of low mood following admission to care settings.
There needs to be ongoing development in addressing the emotional well-being of this group as highlighted by 2013 NICE quality standard: Mental well-being of older persons in care homes.
This exploratory study evaluates the impact of an inter-generational care group with emphasis on the emotional well-being of the older persons. A structured programme of shared experiences between the older persons group and pre-school age children was introduced.

Methods
Approval was sought from the safeguarding committee and insurance board of the care facility. Consent was obtained from residents to participate. Risk assessments were completed for the activities and the participants.
Cognitive screen score and communication ability of each resident was noted in selecting the focus group (n=10). Outcome measures included qualitative interviews completed after each session. A qualitative mood wheel was completed with residents before and after the session had taken place.

Results
Focus group data supported the programme’s impact on emotional well-being. Eighty percent of participants reported mood elevation. Other benefits identified included excitement for the next session and bringing back memories of raising their own children and grandchildren.
A singular negative aspect identified was that on occasion over stimulation impacted mood and participation level of one resident. Ninety percent of participants were female.
The costs incurred were minimal to the organisation. Provision of resources were shared between the care facility and preschool facility.

Conclusion
The findings of this study support the use of inter-generational care groups in long term care facilities for residents with dementia. It confirms the benefits of improving emotional well-being of this cohort.
Adequate supervision measures must be in place to regulate the stimulation level of the environment and facilitate individuals to exit the session.
177 Religious Participation and Health in a Changing Ireland. A Qualitative Exploration of Women Aged 65 and Over
Authors: Orr Joanna , McGarrigle Christine , Anne Kenny Rose , Hogan Linda 
Published: September 2019

Abstract

Background
The previous decades have seen tangible changes in Ireland’s religious landscape. Religion has been investigated as an important factor in wellbeing for many populations, including those aged 65 and over. Women in this age group in particular have higher religiosity while also being more likely to face challenges such as widowhood and demanding caring roles. We explored the ways in which women relate their religious belief, practice and participation to their wellbeing in later life within the Irish context.

Methods
A qualitative research design was employed. In-depth, semi-structured interviews were conducted with women aged 65 and over (n=11), who self-identified as religious. Women were sampled from church congregations in the North Dublin area. Interviews were recorded and transcribed. Thematic analysis was carried out using NVivo. Women were invited to speak on their lifecourse religious trajectories, relationships, and health, using a flexible interview instrument. Both predetermined and emerging themes were explored.

Results
Participants were aged 67 to 89, and were Catholic-affiliated (n=10) and Church of Ireland-affiliated (n=1). The participants described a range of religious identities, and these coloured their strategies for facing the changing role of the church in Irish society. Church abuse scandals were discussed unprompted by the majority of participants. Apprehension regarding the future of the church was common, as was concern for the religious identities and practices of younger generations within their families. Nevertheless, the majority of participants outlined ways in which religious practice, in particular, was conducive to their wellbeing.

Conclusion
Religious feeling, identity and practice was not homogenous in the sample. Feelings of uncertainty around the future were common, and participants employed a range of strategies to cope with these. The study is limited in how generalisation can be made, but provides insight into some of the mechanisms that can link, both positively and negatively, health and religiosity.
194 User Preferences for the Design of Wearable Technology Systems - A Scoping Review
Authors: O'Riordan Clíona , Kenny Lorna , Tedesco Salvatore , Sica Marco , Crowe Colum , Barton John , Timmons Suzanne , O'Flynn Brendan 
Published: September 2019

Abstract

Background
Wearable technology is a fast developing area. Often, the focus of research is on accuracy, while the practicalities of using the device may be overlooked, despite the fact that this greatly influences utility. This scoping review therefore explored the design and usability preferences of people for wearable technology for health monitoring.

Methods
A scoping review was conducted of literature evaluating user preferences for the design of wearable technology systems, for people aged >50 years, with good health, or chronic diseases.

Results
A search of relevant databases yielded 628 potential studies (after duplicates removed). Following title/abstract and then full text screening, 17 papers were included. The most commonly reported theme related to design and user interface (13 studies). Users wanted a small, unobtrusive and light device which doesn’t snag on clothing or affect activities of daily living, but yet has a readable and easy-to-use interface, which may prove challenging for designers! Users were most happy to wear a device on the wrist and/or hip region, being considered the least obtrusive / most discrete. Users were open to the technology aspects of the device, but wanted specific training, or clear and readable instructions. Less commonly reported parameters included issues with privacy and ownership of data (two studies); cost (two studies); reliability and accuracy (three studies), including being accurate overnight and in the shower, etc.; and clinical usefulness, i.e. the data being effectively linked with other healthcare data. Where considered, participants didn’t want to wear a device by night (two studies). Safety of wearable devices was not a theme in any study.

Conclusion
Overall, user needs seem to be rarely considered in the design of wearable technology for health monitoring. However, the limited studies do highlight important user concerns, which should be considered by the technology designers and prescribers.
197 Role of a Dietitian in a Specialist Memory Assessment and Support Service - Improving Brain Health
Authors: Fox Emma , White Sarah , Digan Eimear , Feehan Sinead , McHale Cathy , Dookhy Joshi , Kennelly Sean 
Published: September 2019

Abstract

Background
Dementia cases are rising nationally due to our ageing population and is associated with a multitude of nutritional consequences. Both obesity and malnutrition are strongly implicated in the progression of cognitive decline. From diagnosis onwards, nutritional intervention is important to improve patient outcomes.

Methods
In order to highlight the important role of a dietitian, a retrospective analysis of 142 patients attending the tertiary memory assessment and support service from 2018 to 2019 was performed. Demographic, cognitive, anthropometric, and nutritional data was compiled from the case note review and biochemical laboratory results. This data was analysed using Microsoft Excel (2013) to study prevalence and relationships of variables in this cohort.

Results
A significant proportion of this population were overweight (41.2%) and obese (18.6%). Nearly half the population were at risk of malnutrition (44.1%) or malnourished (3.9%). In this cohort, 18.6% were characterised as frail. Only one individual had a severe clinical dementia rating score (CDR), 19.2% had a moderate and 28.2% had a mild CDR. Half (50.5%) of participants had some level of abnormal eating habits. Higher prevalence of malnutrition, frailty and higher CDR was associated with increased age. Up to 60% of those with normal nutritional status had a CDR of 0 or 0.5. As MNA score worsened, the incidence of robust individuals decreased linearly. Prevalence of frailty increased as CDR score increased. Of those with a mild CDR, 70% were overweight or obese. Those with high Cambridge Behavioural-Inventory (CBI-R) eating habit scores generally had lower CDRs.

Conclusion
Patients attending the memory service are experiencing a multitude of nutritional challenges such as disordered eating habits, overweight and obesity, malnutrition risk and frailty which are associated with cognitive decline and worse health outcomes. Nutritional support and dietetic input as part of the post-diagnostic care-pathway is required to promote brain health and mitigate unnecessary decline.
212 Integrated Care Hubs for Older Persons; RIGHT PERSON, RIGHT TIME
Authors: Phelan Niamh , Bolger Margaret , Grant Emma , Murphy Catherine , Roche Suzanne , Harnett PJ , Pope George , Mulcahy Riona , Cooke John 
Published: September 2019

Abstract

Background
The development of an Integrated Care Hub has resulted in a complete review of the triage system for older people referred to our service. Our aim was to develop a multidisciplinary triage process (MTP) to ensure patients are seen by the right person at the right time for a First Contact Assessment (FCA).

Methods
A quantitative retrospective analysis of referrals and frequency of multidisciplinary team input from January 2018 – June 2018, highlighted the majority of patients were seen for FCA by the staff nurse. This subsequently resulted in onward referrals to Allied Health Professionals within the ‘Hub’, and patients attended for multiple visits. A working group was formed to address these issues. This resulted in the development of the MTP where patients are triaged by the Multidisciplinary team (MDT) and allocated to the most appropriate team member based on the referring information. Following the introduction of this triage process, data analysed from November 2018 - April 2019 highlighted its impact on our service.

Results
In the first reference period the proportion of patients seen for FCA by each discipline was as follows; Staff nurse (SN) 53%, Clinical Nurse Specialist (CNS) 18%, Occupational Therapist (OT) 16% and Physiotherapist 9%. In the second reference period the proportions changed to the following; SN 12%, CNS 31%, OT 33%, Physiotherapist 20% and Dietitian 4%. It has reduced the number of patient visits to the ‘Hub’ and the waiting times to see the right person within the team.

Conclusion
Empowering supported MDT members to triage and the use of this new MTP has resulted in patients having rapid access to the most appropriate team member for FCA. It has resulted in a change in the distribution of the caseload to ensure patients are seen by the right person within the team, and at the right time for early patient centred intervention.
218 Swallowing/Communication Screening in Older Adults Attending the Emergency Department and Association with Clinical Frailty Scale Scores
Authors: Boyle Orla , Kelly Louise , Ryan Maeve , Brady Deirdre , Wade Ruth , Whelan Catriona , Doherty Orlaith , Murphy Maeve , Mello Sarah , McElwaine Paul , Gray James , Kennelly Sean , Hayden Derek 
Published: September 2019

Abstract

Background
Dysphagia, frailty and negative patient outcomes are interlinked1. Changes in communication may result from the ageing process, chronic conditions, and/or neurologic conditions presenting in later years2. However, unlike other cohorts, including stroke, frail older patients are not routinely screened for swallowing/communication difficulties in acute settings. We investigated the proportion of Speech and Language Therapy (SLT) referrals generated for older patients attending our Emergency Department (ED) following use of a swallowing/communication screening tool and their association with Clinical Frailty Scale (CFS) scores.

Methods
A retrospective analysis of data collected over a four week period was completed. Older patients presenting to ED were screened by the interdisciplinary gerontological ED team using a screening tool, including a locally developed swallow/communication screen. Statistical analyses were performed using STATA Version 12.

Results
Of 176 patients screened (mean age 81.8 years, SD 5.9 years), median CFS score was 5 (IQR 3-6). Thirty-seven percent (66/176) of patients were referred for SLT assessment following initial screen. SLT referrals were more commonly required in patients with a CFS score of ≥4 (46.2% vs. 19.3%, P=0.001) and likelihood of requiring SLT referral increased with greater CFS score (P<0.0001).

Conclusion
Results suggest that screening for swallowing and communication difficulties in older patients yields a high level of SLT referrals, with a higher frequency of SLT referrals observed with increasing frailty scores. Further research is required to determine the optimum swallowing/communication screening tool in the acute setting. Future research will focus on evaluating outcomes of SLT assessments completed and determining the prevalence of swallowing and/or communication difficulties in this cohort.
24 Stroke Risk Factors, Aetiology, and Outcomes in a Multi-ethnic Irish Stroke Population
Authors: Finnegan John , Mello Sarah , Greene Suzanne , Cogan Nicola , Ryan Dan , Coughlan Tara , Kennelly Sean , O'Neill Des , Mahon James , Collins Ronan 
Published: September 2019

Abstract

Background
Stroke aetiology, risk factors and outcomes vary among ethnic groups. The profile of patients presenting to hospital with stroke in Ireland is changing as immigration increases. We aim to describe differences that exist between a multi-ethnic immigrant population and native Irish residents.

Methods
Using our hospital's stroke registry we identified all non-Irish (NI) patients admitted to the stroke unit over a two year period through surname recognition (N=44). Country of birth was confirmed by a chart review. The Irish patients admitted over the same time frame were used as a comparison group (N=437). Data was collected on stroke subtype and outcomes, comorbidities, and socioeconomic factors. Patients were grouped based on ethnicity and stroke subtype. Chi squared test was used to analyze the relationship between groups.

Results
NI patients made up 9.1% of all stroke unit admissions. NI patients were younger than Irish patients (average age 57.5 vs 69.6 years, p <0.01) and there was a higher prevalence of ICH in the NI group (34.1% vs 11.7%, p <0.01). Hypertension was the most common vascular risk factor in both groups (72.7% vs 68.2%, p = 0.54). Mortality and morbidity was lower in the NI group, with more patients being discharged to home.

Conclusion
Our study demonstrates that NI stroke patients have a different risk factor and stroke sub-type profile compared to Irish patients. NI patients are more likely to be young, hypertensive, male, and have higher rates of ICH. Cultural and linguistic barriers may adversely influence health seeking behaviour in this group. These findings underscore the need to identify the root causes of these ethnic differences so targeted primary prevention campaigns can be established.
246 A Clinical Audit of Detection and Management of Sarcopenia in Older Persons’ Specialist Rehabilitation Services in an Academic Teaching Hospital
Authors: O'Callaghan Sarah , Quinn Siobhán , Digan Eimear , Fox Emma , Madden Rebecca , Sheridan Carisa , Hogan Patrick , Kennelly Seán 
Published: September 2019

Abstract

Background
Sarcopenia, characterised by progressive loss of muscle mass and strength, is associated with increased morbidity, mortality and poorer quality of life. International and European clinical practice guidelines on diagnosis and management of sarcopenia suggest the algorithm: Find Cases through screening, Assess Strength with validated outcome measures, Confirm Diagnosis with muscle quantity analysis and Determine Severity with validated physical performance measures (PPMs). Treatment recommendations include progressive resistance training (PRT) and a protein-rich diet. This audit aimed to investigate our specialist gerontological services’ adherence to these guidelines.

Methods
Using a custom-designed audit tool, patient medical records (PMRs) were reviewed in two inpatient rehabilitation wards and one Day Hospital (DH). Patients were included if under the care of a geriatrician and reviewed two or more times by a physiotherapist.

Results
Thirty PMRs were reviewed (18 DH, 12 inpatient). 0% of patients were screened for sarcopenia using a validated screening tool. 83.3% (n=15) of DH patients and 33.3% (n=4) of inpatients underwent a validated strength assessment. 0% of patients underwent muscle quantity analysis. 66.6% (n=12) of DH patients and 33.3% (n=4) of inpatients had validated PPMs performed. Probable sarcopenia was identified in 75% of DH and 100% of inpatients who had PPMs conducted. PRT was prescribed in 94% (n=17) and 50% (n=6) of DH patients and inpatients respectively. 16.6% (n=3) of DH patients and 75% (n=9) of inpatients were referred for nutritional assessment. 100% (n=9) of patients assessed by clinical nutrition were prescribed a high-protein/high-calorie diet.

Conclusion
This audit demonstrates limitations in identifying and managing sarcopenia as per the most recent international and European clinical practice guidelines. It is recognised that a multi-disciplinary approach is required to improve adherence to these guidelines. A multi-disciplinary sarcopenia management pathway is being implemented to facilitate this. Re-audit is planned to ensure the effectiveness of this pathway.
249 Is Our Diabetic Control Too Tight? An Audit of Management of Type II Diabetes in a Long Term Care Setting
Authors: MacMahon Clare , O'Gorman Millie , Martin John , Doyle Marie , O'Donoghue Alice , O'Donnell Desmond , O'Mahoney Anne , Henin Maged , John Cooke , Pope George , Mulcahy Riona 
Published: September 2019

Abstract

Background
Recent guidelines on diabetes management recommend individualisation of management particularly in those with frailty or significant co-morbidities.
The aim of our audit was to assess diabetic control of residents in a long term care setting. Studies have shown that intensive control in an older population increases the risk of hypoglycaemia and does not necessarily improve clinical outcomes. There is also evidence that increased pill burden and hypoglycaemic events negatively affect quality of life among older people.

Methods
176 nursing home residents were assessed. Detailed chart review was carried out on the 47 residents with a diagnosis of type 2 diabetes. Information collated included age, sex, diabetes type, frequency of blood sugar monitoring, weight, BMI, Clinical Frailty Scale, allocation of diabetic diet and treatments including insulin and oral hypoglycaemic agents. Diabetic control was assessed by HbA1c. Evidence of hypoglycaemia in the preceding four weeks was documented.

Results
Of 47 patients (33 female), average age was 79.8 years and median BMI was 25. 41/47 residents had a Clinical Frailty Score of 6 or greater. The median HbA1c overall was 44mmol/l (range was 29-116mmol/l). All patients were on a diabetic diet. 23/47 residents on oral hypoglycaemic agents and the median HbA1c of this group was 51mmol/l. 6/47 were on insulin. Sugars were checked weekly (daily in those on insulin) and HbA1c was checked in the previous 6 months in 36/47.There was 1 recorded hypoglycaemic episode.

Conclusion
Our data showed that long stay residents continue to have tight diabetic control despite low BMI, evidence of frailty, significant co morbidities and dependency. HbA1c can also decrease due to renal disease, weight loss and poor oral intake. In line with recent guidelines our data shows there is scope to rationalise diabetic treatment regimens with reduction in polypharmacy and improvement in quality of life.