bluuebunny/crossref_metadata_2025_split huggingface dataset:
29 Adapting Dementia and Delirium Awareness Training to a Rehabilitation Setting
Authors: O'Brien Emma , Devine Monica , Maxwell Sarah , McDonnell Catherine , Lee Stuart 
Published: September 2019

Abstract

Background
The patient profile in a Dublin rehabilitation hospital has changed in recent years to include older adult rehabilitation alongside orthopaedic rehabilitation. A snapshot audit completed by the occupational therapy department on one day in 2018 demonstrated that 64% of patients had an assessment score indicative of a cognitive impairment.
A subjective gap in knowledge regarding dementia care and a misunderstanding of the ability of people with dementia to engage in rehabilitation was identified. It was imperative that dementia awareness training was provided with a particular focus on modifying rehabilitation techniques to cater for these patients.

Methods
A dementia care committee was established with an Educational Development subgroup responsible for addressing dementia and delirium awareness training. Educational material was received from the field of occupational therapy, nursing, medicine, pharmacy and dietetics. The programme was accredited by the Nursing and Midwifery Board of Ireland.
A focus group was completed pre/post formulation of the presentation with various departmental representatives. Feedback provided was used to inform and finalise the training content.

Results
Sessions are completed once monthly. One hundred and seven participants to date have attended.
Ten-point Likert scales are completed pre and post training.
Data from the Likert scales were analysed revealing on average a 24.4 % increase in knowledge of dementia, a 27.6% increase in awareness of the impact of dementia on function and a 23.3% increase in confidence in caring for a patient with dementia.
Highest contingent of staff members trained were household and catering staff (19%) nursing staff (18%), and health care attendants (13%).

Conclusion
This essential training is ongoing with thirty per cent of staff trained to date. The objective is for all staff to complete this training for enhanced care and rehabilitation for all patients with dementia. It will also aim to review treatment for all patients with cognitive impairment so unique rehabilitation programmes can be tailored.
298 Falls and Syncope in Older People in the Emergency Department: Prevalence, Clinical Characteristics and Outcomes
Authors: Bourke Robbie , Rice Ciara , McMahon Geraldine , Cunningham Conal , Anne Kenny Rose , Briggs Robert 
Published: September 2019

Abstract

Background
Falls, syncope and presyncope comprise a large proportion of emergency department (ED) presentations among older people, however accurate data detailing this is limited.
The aim of this study therefore was to ascertain the percentage of ED presentations in older people due to falls/syncope/presyncope, and examine admission rates, length of stay and likely underlying diagnosis.

Methods
Over 1,300 consecutive presentations of older people (aged ≥60 years) to the ED of a large urban university teaching hospital in March 2018 were examined (electronic and hard-copy notes) to ascertain the prevalence of falls/syncope/presyncope presentations.
Data was collected for each presentation with fall/syncope/presyncope on demographics, and relevant clinical characteristics, including admission outcome and length of stay (LOS).

Results
Falls/syncope/presyncope comprised 19% (250/1,324) of presentations of older people to the ED, with a mean age of 75.3 +/-0.64 years. Almost 60% (158/250) presented during ‘normal’ working hours, i.e. Monday to Friday, 0800-1800.
Almost half (121/250) had a Manchester Triage Score (MTS) of 3, indicating a need for urgent care, while one third (93/250) were categorized as requiring very urgent or immediate assessment (MTS 2 or 1 respectively).
Over one third (97/250) presented with explained/accidental falls, while 26% (66/250) and 35% (87/250) presented with syncope and unexplained falls respectively.
One in two (118/250) older people presenting with falls/syncope/presyncope were admitted to the acute hospital, and this rises to almost two thirds (82/135) of those aged ≥75 years. The median LOS was 15 (9.9 -22.0) days.

Conclusion
Older people frequently present to the ED with falls/syncope/presyncope. The majority present during working hours and admission rates and LOS are relatively high.
Falls/syncope/presyncope therefore represent an appropriate target for structured, multidisciplinary assessment at the ‘front door’ to provide early specialist assessment and management, and reduce complications associated with unnecessary admission to hospital.
299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period
Authors: McFeely Aoife , Small Cliona , Hyland Susie , O'Keeffe Jonathan , Hughes Graham , O'Shea Diarmuid 
Published: September 2019

Abstract

Background
Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances.

Methods
A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13.

Results
Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%.

Conclusion
An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year.
These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services.
We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.
302 Vestibular Assessment and Rehabilitation within a Day Hospital Falls Assessment Service: Is it Necessary and is it Feasible?
Authors: McDonnell Micheal , McGrath Fiona , O'Malley Tom 
Published: September 2019

Abstract

Background
Benign Paroxysmal Positional Vertigo (BPPV) and other vestibular disorders are very common and often missed in older populations and are a significant risk factor and cause of falls. Vestibular rehabilitation is increasingly recognised as an effective intervention for the management of vestibular dysfunction in all age groups. This review aimed to explore the prevalence of vestibular disorders in the cohort attending an integrated day hospital falls assessment service and the feasibility of delivering vestibular rehabilitation interventions as part of this service.

Methods
We retrospectively reviewed the charts of all the patients who attended a new ambulatory day hospital between Nov 2018 and April 2019. Inclusion criteria included a recent history of falls and aged over 75. All patients had received a comprehensive geriatric assessment which included screening for vestibular symptoms and on-site assessment (if indicated) by a physiotherapist with expertise in vestibular rehabilitation.

Results
40 patients (33 women, 7 men) with a mean age of 82 were seen in this period. All had suffered recent falls with 10 having suffered a fracture. 5 patients (12%) tested positive for Benign Paroxysmal Positional Vertigo and 2 others (5%) had evidence of both peripheral and central vestibular impairment. Vestibular rehabilitation interventions, including particle repositioning manoeuvres were delivered within the day hospital setting with review appointments offered to all patients.

Conclusion
This review highlights the high prevalence of vestibular disorders, especially BPPV (12%) in older fallers. It supports the feasibility of delivering vestibular assessments and rehabilitation as a component of the physiotherapy input within a day hospital falls service.
307 A Survey of Nutritional Status of Older Patients Attending Medicine for Older Person Clinics
Authors: Malomo Keneilwe , Soh Josephine , Dolan Eamon , O'Connor Marie 
Published: September 2019

Abstract

Background
Nutritional assessment is an important but frequently overlooked aspect of comprehensive geriatric assessment. Malnutrition is common and associated with clinical complications. Our study aimed to assess older patients’ perceptions of their nutritional status and to investigate clinical factors affecting it.

Methods
All patients attending our clinics over a 2 week period were invited to complete a self-administered questionnaire. Further clinical information including diagnosis and weight collected by review of medical notes.

Results
A total of 43 patients completed the questionnaire; median age 82.5 years (67-102). Of these, 69.8%(n=30) were female and 27.9% (n=12) lived alone. Majority reported good appetite (83.7%, n=36) and eating 3 meals a day (79.1%,n=34). 25.6%(n=11) prepared meals themselves and 34.9%(n=15) had received nutritional advise from healthcare professionals.
17 patients (39.5%) self-reported weight loss over the past year, and of these 76.5% (n=13) had objective weight loss documented. Only 2.3% (n=1) were concerned and seek advice from healthcare professionals. 50% (n=12) of the remaining 24 patients who self-reported no weight loss had objective weight loss in clinic. 26 (60.5%) patients had objective weight loss.
A higher proportion of the weight loss cohort lived alone (30.8% vs 23.5%), had no home care packages(HCP) (65.4% vs 47.1%), did not take nutritional supplement (76.9% vs 58.8%), had no dentures ( 42.5% vs 23.5%) and had no diagnosis of dementia (57.7% vs 47.1%).
Of those who lost weight, 34.6% (n=9) lost significant amount (>5%) of weight, including 4 (15.4%) who lost >10%.

Conclusion
2 out of 3 of our community dwelling, older patients lost weight, with one third having lost significant amount. Awareness is poor with 50% not recognising their weight loss and only one third ever sought nutritional advice. Patients who lost weight were more likely to be living alone with no formal community supports.
308 Association of Diabetes and Frailty with Mortality in Middle-Aged and Older Europeans
Authors: O'Donovan Mark , Sezgin Duygu , Liew Aaron , O'Caoimh Rónán 
Published: September 2019

Abstract

Background
Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years.

Methods
Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant’s first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression).

Results
Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05).

Conclusion
Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals.
311 Older Adults Awareness and Response to Stroke in Ireland.
Authors: O'Connell Liz , McCarthy Geraldine , Hartigan Irene 
Published: September 2019

Abstract

Background
Early recognition of stroke symptoms and immediate response is necessary to ensure timely access to treatment of stroke. However, many individuals fail identify symptoms of stroke or delay in seeking medical attention. The Irish Heart Foundation launched the “Act Fast” campaign which included three waves of broadcasting on national television and radio, throughout 2010 and 2011. Stroke awareness campaigns may have the potential to influence behaviour and response to stroke.

Methods
A non-experimental, descriptive, quantitative, cross-sectional study was conducted. The Stroke Action Test (STAT)1 was used to investigate how participants would respond to specific symptoms of stroke. A convenience sample (n=89) of older adults attending an outpatient clinic in a university teaching hospital completed the questionnaire. The mean age of respondents was 79.6 years (SD =9.3).

Results
Just 4.5% (n=4) of respondents identified what all 4 letters of FAST represent. Overall, 48% (n=43) of respondents recognised all 6 symptoms of stroke and 100% (n=89) recognised at least 2 symptoms of stroke as per STAT. The stroke symptom most frequently recognised was sudden numbness of the face, arm or leg at 99% (n=88). The stroke symptom least frequently recognised was sudden trouble seeing in one or both eyes at 56% (n=50). Despite this 81% (n=64) of respondents would not respond appropriately to 50% of symptoms of stroke described in the STAT. 52% (n=46) of respondents identified irregular heart beat as a risk factor for stroke. Finally, 29% (n=26) of respondents had heard of thrombolysis while just 2% (n=2) had heard of thrombectomy.

Conclusion
Awareness of stroke symptoms does not necessarily influence response to stroke in older adults. Future stroke awareness campaigns should consider FAST2 which speaks to treatment (thrombolysis or thrombectomy) as well as time.
324 Effect of Regular Multidisciplinary Psychotropic Review Meetings on Anti-psychotic Prescribing Practices in a Community Nursing Unit
Authors: Giles Barbara , Gamorak Lesya , Adanza Arlene , Gicale Joy , McCarthy Frances 
Published: September 2019

Abstract

Background
The management of non cognitive symptoms of dementia can be challenging for people living with dementia and their carers. The risks and limited benefit of antipsychotics in this setting is well documented however despite this they still are often prescribed. A previous study at our facility in 2016 highlighted a high prevalence of antipsychotic prescribing at 35% (Bambrick, et al. 2016). As a result of this, multidisciplinary psychotropic review meetings were established and are ongoing.

Methods
Two wards in our community nursing unit were selected. Inclusion criteria included residency > 6 months. The case notes, medication lists (admission and current prescriptions), and psychotropic review meeting notes were reviewed.

Results
43 residents were included in the study. 72% (n=31) were female. The average age was 85 years. 74% (n= 32) of residents had a documented dementia diagnosis.
On admission, 7 residents were taking regular antipsychotics. 5 of these medications were subsequently either reduced or discontinued.
At the time of the study, 16% (n=7) were prescribed regular antipsychotics. There was a definite indication for 3 of these (schizoaffective disorder, psychosis, paranoid depression). 1 resident had a traumatic brain injury with associated distressing symptoms with harm incidents. 3 had a dementia diagnosis with associated distressing symptoms.
A further 14% (n= 6) were prescribed antipsychotics on a PRN basis. 5 had a documented diagnosis of dementia with associated distressing symptoms. None of these residents received these medications in the 4 weeks prior to the study.

Conclusion
Significant improvements are noted since 2016 with the overall prevalence of antipsychotic prescribing decreasing from 35% to 16%, with the majority of these prescriptions having a clear indication. It is reassuring that residents are not receiving prn medications frequently. We await the national clinical guidance on “Appropriate Prescribing of Psychotropic Medication in People with Dementia” to further guide our practice.
331 Implementation of Community Based Comprehensive Geriatric Assessment and Intervention in a Rural Irish Setting
Authors: McLoughlin Petra , Murphy Eleanor , O'Sullivan Fiona , Connellan Ciara 
Published: September 2019

Abstract

Background
The Integrated Care Team for Older People (ICTOP) in Sligo formed in 2018 to provide home based rehabilitation for acutely frail older adults to enable them to continue to live independently.
It serves a predominantly rural catchment area with 14.5% aged >65 years versus the national average of 11%.1
An in-home person-centred multi-disciplinary approach is utilized based on the principles of comprehensive geriatric assessment (CGA).
This observational study aims to describe the typical user of this service, interventions and outcomes to date.

Methods
An Excel database was compiled and analysed from CGA of consecutive referrals from June to December 2018.

Results
Of the 70 referrals studied, 69% resided in rural Sligo, two thirds were female and there was a mean age of 82.3 (range 68-95).
The median Rockwood Clinical Frailty Scale level was 6 and the median Timed Up and Go was 28seconds.
Hospital in-patients accounted for 58% of referrals with functional deterioration (74%), mobility decline (72%) and cognitive decline (28%) the most frequent referral reasons.
Gait imbalance was the most prevalent co-morbidity (77%).
There was an average of 4.5 home visits per person.
Over 80% of referrals received combined physiotherapy and occupational therapy input, with Clinical Nurse Specialist (CNS) in Dementia involvement in 40%, speech and language therapy in 26% and social work in 15%.
CGA identified additional clinical and social needs in 100%, and the team made 217 onward referrals to available community health and social supports.
ICTOP referral decreased length of stay by 2.6days and only one patient required long term care.

Conclusion
The use of a multidisciplinary team providing domiciliary assessments decreased hospital stay, facilitated maintenance of independent living and addressed both identified and un-identified needs in a frail older person’s population. Further evaluation over time is needed to indicate impact on readmission rate.
334 GEMS: Geriatric Emergency Service - Rockwood’s Clinical Frailty Scale and Outcomes
Authors: Reddy Danielle , Gallagher Grainne , O'Callaghan Maureen , Cornally Lorna , Hayes Brennan Megan , Mulholland Ann , Nolan Jane , Normoyle Cathriona , Ahern Emer , Gibbons Ruth 
Published: September 2019

Abstract

Background
Rockwood’s Clinical Frailty Scale (CFS), which uses clinical descriptors and pictographs, was developed to provide clinicians with an easily applicable tool to stratify older adults according to level of vulnerability. The CFS was validated in a sample of 2305 older participants from the Canadian Study of Health and Aging and was shown to be a strong predictor of institutionalisation and mortality (Rockwood K, 2005).

Methods
The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. At the end of CGA all patients have a score 1 to 9 assigned from the Clinical Frailty Scale (CFS).

Results
10,037 patients were triaged in the first two years of the service. 43% screened positive for Frailty. 66% had a CGA. 10% were vulnerable CFS 4, 32% mildly frail CFS 5, 32% moderately frail CFS 6 and 31% severely frail CFS 7. Increasing score on the CFS correlated with increased length of stay, death and institutionalisation.

Conclusion
The CFS correlates with Length of stay (LOS), mortality and institutionalisation in people aged 75 years and older who attend as an emegency and screen positive for Frailty.
36 Use of Biologics in Older Patients with Inflammatory Arthritis
Authors: Donnellan Adam , Hannon Evelyn , Buckley Mary , Murphy Grainne 
Published: September 2019

Abstract

Background
Biologics are a key component of the treatment armamentarium for inflammatory arthritis (IA). Questions remain surrounding the prescription, efficacy and safety of biologics in the older population. This study aims to describe the use of biologics in older patients with IA and compare it to younger patients.

Methods
This was a retrospective cohort study of patients with a diagnosis of IA who were receiving a biologic. Data was collected from medical charts at rheumatology outpatient clinics. Patients were divided into two groups: younger group (age 45 – 65) and older group (age >70).

Results
Each group had 30 patients (total n=60). 58% were female and the mean age overall was 65 years. Rheumatoid arthritis was the most common diagnosis (57%). 8 patients had active disease, and these were mainly older patients (n=6). 8 different biologics featured; the majority of patients received the standard dose of biologic (87% of younger, 80% of older). The incidence of biologic discontinuation due to drug ineffectiveness was the same for both groups (16%). 1 older patient had a biologic discontinued due to a serious adverse event. Infections requiring hospitalisation were not common (total n=5) but were more frequent amongst older patients (n=4). 47% of younger and 60% of older patients received concomitant therapy; most received a disease-modifying antirheumatic drug (DMARD) (72%), and those who received a steroid (n=6) were more likely to be older (n=5).

Conclusion
Biologic prescribing was similar between both groups with regard to the dosage administered, but there were differences in the types of biologics prescribed to each group. Rates of significant infection were low overall, however they were more prevalent amongst the older population. More older patients had active disease, and more were prescribed concomitant steroid therapy, which may represent under-dosing of biologic therapy in this older cohort.