bluuebunny/crossref_metadata_2025_split huggingface dataset:
37 Impact of Adverse Events on the Older Inpatient Population- A Subgroup Analysis of the Irish National Adverse Events Study (INAES)
Authors: Connolly Warren , Rafter Natasha , Hickey Anne , Conroy Ronan , Condell Sarah , O'Connor Paul , Vaughan David , Walsh Gillian , Williams David 
Published: September 2019

Abstract

Background
Adverse events are any injuries caused by healthcare management, which result in disability, increased length of stay or death. The Irish National Adverse Event Study (INAES)(1) used the Harvard Medical Practice, 2-step methodology of retrospective chart review(2) to determine the adverse event rate in the Irish inpatient cohort.

Methods
We further analysed the INAES data in order to calculate the prevalence and determine the impact of adverse events on the older inpatient population.

Results
INAES captured 1574 randomly selected adult inpatient admissions from 8 hospitals across the Republic of Ireland in 2009. 53% were female and the median age was 55years (IQR 37years to 72years). The prevalence of adverse events was higher in those aged ≥65 compared to those aged < 65 (15.4% versus 9.3% P < 0.001). When an adverse event did occur it was more likely to result in death in the ≥65 years old group (11.4% versus 2.1%, p = 0.01). Furthermore, it was 9 times more likely that an admission would result in a fatal adverse event in those aged ≥65 compared to those aged < 65 years. A further 9% of adverse events in the ≥65 age group resulted in permanent disability and over half were thought to be preventable. Older patients who suffered from an adverse event had an increased length of stay compared to older patients who did not suffer an adverse event (16days versus 6days, p <0.001) at a cost of €9,090 for each adverse-event-associated admission.

Conclusion
Older inpatients are more likely to suffer from an adverse event than their younger counterparts. These adverse events are more likely to contribute to increased morbidity but over half are preventable. The follow-up INAES-2 study, which is currently underway, will determine if an improvement has been made after implementation of the National Clinical Programmes.
138 The Role of Health and Social Care Professional Teams in the Emergency Department: A Qualitative Study of Key Stakeholders’ Views
Authors: Cassarino Marica , Robinson Katie , Quinn Rosie , Boland Fiona , E Ward Marie , McNamara Rosa , McCarthy Gerard , Ryan Damien , O'Connor Margaret , Galvin Rose 
Published: September 2019

Abstract

Background
Introducing Health and Social Care Professional (HSCP) teams to the emergency department (ED) has increasingly demonstrated benefits for ED patient and process outcomes. However, there is a dearth of research exploring the views of key ED stakeholders on the role of HSCP teams in care delivery the ED. This qualitative study investigated the perspectives of a wide range of ED stakeholders about HSCPs teams working in the ED.

Methods
A total of 65 participants including older adults who had recently attended the ED and their carers/relatives, ED doctors and nurses, HSCPs and pre-hospital staff participated in four World Café style focus groups and individual interviews across two Irish hospital sites. Written and audio-recorded data were transcribed and thematically analysed.

Results
Overall, participants expressed positive views on HSCPs working in teams in the ED, with benefits for patients, staff members and the hospital (Theme 1). Having an ED-based HSCP team was described as promoting effective and timely decision-making and a more integrated approach to patient care, particularly for frail older adults with complex needs (Theme 2). Barriers and enablers for effective implementation were identified at multiple levels (Theme 3) including the ED physical environment, (e.g., space and equipment), operational factors (e.g., working hours), and relations (e.g., patient-staff or staff-staff communication); factors at system level included availability of community resources and financial pressures.

Conclusion
Our study indicates overall acceptability of HSCPs working in teams in the ED and positive views on their contribution to enhance the quality care of older adults. However, a number of operational and relational factors need to be considered to ensure feasibility and effectiveness. This information is crucial to inform implementation.
154 Specialised Memory and Attention Rehabilitation Therapy (SMART) Programme
Authors: Griffin Aislinn 
Published: September 2019

Abstract

Background
The population of Ireland is ageing and the number of people with dementia in the coming years will be significant and could be as high as 132,000 people by 2041 (Pierce et al 2014). This estimated prediction highlighted the importance and value of developing and implementing interventions that will meet the needs of individuals with dementia and their carers in the community. We identified the need for a cognitive rehabilitation programme in an acute hospital and developed the “Specialised Memory and Attention Rehabilitation Therapy (SMART) Programme”. The aim of the programme is to improve quality of life, cognitive ability and performance of meaningful occupations for individuals with dementia in the community.

Methods
The SMART programme uses an evidence based approach of education, process training, strategy training and function for delivery to individuals with dementia and their carers. It is a seven week programme with a three month follow up appointment. Weeks one, seven and three month follow up are 1:1 assessments where outcome measures are completed. There is a group intervention programme for five weeks which includes a patient booklet with education sheets, strategy, work and homework sheets as well as functional tasks.

Results
There was statistically significant results pre and post intervention in the Rivermead Behavioural Memory test, Canadian Occupational Performance Measure, Functional Independence Measure and the DEMQoL – Dementia quality of life questionnaire. Overall, the results showed statistically significant improvements in memory function, clinically significant gains in terms of perceived functional performance & satisfaction and objective and significant improvements in functional performance.

Conclusion
The findings have demonstrated potential to significantly improve participants’ cognitive function and have shown functional significant gains as a result both objectively and subjectively. The findings have also demonstrated the feasibility of successfully implementing a cognitive rehabilitation programme on an outpatient basis in an acute hospital setting.
171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation
Authors: Davies Carmel , O'Donnell Deirdre , Ní Shé Éidín , Donnelly Sarah , Fattori Francesco , Coimín Diarmuid Ó , Cooney Marie Therese , O’Brien Michelle , O’Shea Diarmuid , Kyne Lorraine , O'Shea Marie , Kroll Thilo 
Published: September 2019

Abstract

Background
In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context.

Methods
Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018).

Results
The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are:
AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support.

Conclusion
Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.
184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice
Authors: Timmons Suzanne , de Siún Anna , Begley Emer , Manning Mary 
Published: September 2019

Abstract

Background
The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services.

Methods
A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent.

Results
In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists.
The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines.

Conclusion
The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.
223 Prevalence of Depression Among People with Diabetes; Comparative Analysis of Older Adults Across Three Health Systems Using Nationally Representative Data
Authors: McGrath Niamh , McHugh Sheena , Toomey Elaine , Kearney Patricia 
Published: September 2019

Abstract

Background
The co-occurrence of depression and diabetes is an emerging global challenge but any association is influenced by variations in prevalence, study design and measure used. We compared depression prevalence in older adults with and without diabetes across three health systems using a validated measure to examine the causal association between diabetes and depression.

Methods
We used data of adults aged over 49 years, from three nationally representative ageing datasets; The Irish Longitudinal Study on Ageing (TILDA), the English Longitudinal Study on Ageing (ELSA) and the Health and Retirement Study (HRS). Data were collected during 2009–2011 (TILDA), and 2010 (ELSA, HRS). The 8-item CESD scale categorised depression using recommended cut-off scores of < 3 for ELSA and HRS and < 8 for TILDA. Self-reported individual, environmental, behavioural risk, and health system exposure variables were selected a-priori using literature and a directed acyclic graph. Prevalence was presented as a percentage with corresponding 95% confidence intervals. Binomial logistic regression examined the odds of depression by diabetes status. Data were analysed in Stata v15 using the ‘svy’ function.

Results
Diabetes prevalence (Ireland;8%[(95%CI:7.5–8.6), England;11%(95%CI:10.6–12.0) and USA;19%[(95%CI:18.8-20.1);p<0.001]) and depression prevalence (Ireland;10%(95%CI:9.0–10.6), England;16%(95%CI:15.3-16.9), USA;14%[(95%CI:13.5-14.7);p<0.001] varied across countries. Depression was consistently higher among people with versus without diabetes (Ireland;14%(95%CI:10.9-16.6)vs.9%(95%CI:8.7–10.3),p=0.001], England;25%(95%CI:21.7-27.7)vs.15%[(95%CI:14.2-15.9),p≤0.001] and USA;19%(95%CI:16.9-20.0)vs.13%[(95%CI:12.4-13.8);p≤0.001]. The odds of depression were significantly higher in people with versus without diabetes (Ireland;OR=1.5(95%CI:1.2-1.9);p=0.001, England;OR=1.8(95%CI:1.5–2.2);p<0.000, USA;OR=1.5(95%1.3-1.7);p<0.000), but only remained significant in the English sample after adjustment; (Ireland;OR=1.2(0.8-1.6);p=0.356, England;OR=1.3(1.0–1.6);p=0.045, USA;OR=1.0(0.9-1.1);p=0.898).

Conclusion
Among older adults in different health systems, depression was consistently higher among people with versus without diabetes. The findings support incorporation of holistic approaches to diabetes management across health systems.
227 Screening for Frailty in the Emergency Department: Comparison of Tools
Authors: Macdonald Steve , Gray Simone , Kenny Laura , Shé Éidín Ní , Cooney Marie Therese 
Published: September 2019

Abstract

Background
Numerous tools exist to screen for frailty in clinical settings but a single international standard has not yet been adopted. Recent research indicates that more than one tool is often deployed by clinicians to diagnose frailty. This study aimed to compare the use of two screening tools in the emergency department and assess the predictive ability of keywords in triage notes to detect frailty.

Methods
Frailty screening was carried out on 198 individuals (100 female / 98 male) attending the emergency department of a large urban teaching hospital, using the Rockwood Clinical Frailty Scale and the Variable Indicative of Placement Risk (VIP) scale. Average screening time for Rockwood was 43.1 ± 21.7s, whilst average screening time for VIP was 11.8 ± 8.5s. Results were dichotomised to frail, corresponding to Rockwood scores of ≥4 or VIP scores of ≥1, or non-frail (Rockwood=1-3 or VIP=0) for comparisons. Triage notes were reviewed to find keywords associated with frail patients.

Results
Among 198 individuals screened, 149 (75.3%) were frail according to Rockwood, and 143 (72.2%) according to VIP. 25 (12.6%) of the 198 individuals were categorised as frail according to Rockwood but were non-frail according to VIP. Among these, 8 were female (8% of all female patients; 6 were 75+ years of age, and 2 were under 75) and 17 were male (17.3% of all male patients; 11 were 75+ years of age and 6 were under 75). Keywords associated with frailty were identified from triage notes, across the following categories: Falls/ mobility/ balance; Cognition; Living circumstances; Nutrition; Other frailty-associated conditions; and General deterioration.

Conclusion
Comparison of the two scales suggests that frailty could be missed if relying on a single index. This effect may be more frequent in men than women. Screening triage notes to identify frailty-associated keywords may be a helpful adjunct to existing tools.
343 Atrial Fibrillation, Orthostatic Hypotension and Cerebral Perfusion – Data from The Irish Longitudinal Study on Ageing
Authors: McNicholas Triona , Claffey Paul , O'Callaghan Susie , Briggs Robert , Newman Louise , Tobin Katy , Kenny Rose Anne 
Published: September 2019

Abstract

Background
It is thought that cerebral hypoperfusion in Atrial Fibrillation (AF) increases the risk of falls, cognitive impairment, and worse outcome in stroke. This aim of this study is to assess frontal lobe perfusion in response to active stand, and to assess the impact of OH on this association.

Methods
Data from wave 3 of The Irish Longitudinal Study on Ageing were used, a cohort study of community-dwelling adults aged over 50. Frontal lobe perfusion in response to orthostasis was measured using near infra-red spectroscopy (NIRS), reported as tissue saturation index (TSI%). Orthostatic hypotension (OH) was assessed using beat-to-beat blood pressure measurement. Linear regression assessed whether AF was associated with lower baseline TSI. Mixed effects linear regression assessed whether TSI differed across specific time points – 10, 20, 30, 40 60, 90, and 120 seconds. The analysis were repeated including an interaction with OH to assess the impact of OH on this association.

Results
There was no difference in baseline TSI in participants with AF compared to those without. Mixed effects models demonstrated lower TSI at 10 seconds in AF (β -0.52; 95% CI -0.88, -0.16; p-value 0.004), at 40 seconds (β -0.40; 95% CI -0.76, -0.04; p-value 0.031) and at 60 seconds (β -0.40; 95% CI --0.76, -0.04; p-value 0.028). Including an interaction with OH found that in isolated AF, TSI was lower at 10 seconds (β -0.62; 95% CI -1.04, -0.19; p-value 0.005). Those with both AF and OH had lower TSI at 40 (β -0.89; 95% CI -1.55, -0.24; p-value 0.007), 60 (β -0.89; 95% CI -1.54, -0.23; p-value 0.008) and 90 (β -0.68; 95% CI -1.33, -0.03; p-value 0.041) seconds.

Conclusion
There is evidence that frontal lobe perfusion is lower during orthostasis in individuals with AF, and that the presence of OH modifies this association.
344 The Relationship between Late Life Depressive Symptoms and Cerebral White Matter Disease is Modified by Systemic and Orthostatic Blood Pressure
Authors: Briggs Robert , Buckley Anne , Knight Silvin , Meaney Jim , Kennelly Sean , Anne Kenny Rose 
Published: September 2019

Abstract

Background
Cerebral white matter hyperintensity (WMH) burden is a key biological risk factor underpinning late life depression (LLD) and cerebral hypoperfusion has been identified as an important cause of WMH.
The aim of this study therefore is to clarify if orthostatic hypotension (OH) and lower systemic blood pressure (BP), both of which cause reduced cerebral blood flow, modify the relationship between depression and cerebral white matter disease in a cohort of community-dwelling older people aged ≥70 years.

Methods
This study uses data from wave 3 of TILDA. Participants were included if they were aged ≥70 years and had undergone assessment for depressive symptoms, brain MRI and cardiovascular measures.
Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale. Scheltens Score was used by a trained radiologist to calculate overall WMH burden.
Orthostatic BP was measured by active stand. OH was defined as a drop in Systolic BP≥20 mmHg or drop in diastolic BP≥10 mmHg at 30, 60 or 90 seconds post standing.

Results
Participants with depressive symptoms (8%, 16/202) had a significantly higher burden of WMH measured by Scheltens Score (14.6 (95% CI:11.0–18.2) vs. 11.0 (95% CI:10.1–11.8); p=0.0211).
Two-way interaction models demonstrated that the association between depressive symptoms and WMH burden is significant only in those with co-existing OH. Similarly, the two-way interaction between depressive symptoms and systolic BP shows that this association remains statistically significant only in those with both depressive symptoms and lower BP, i.e. <130 mm Hg.

Conclusion
This study demonstrates that depressive symptoms are associated with cerebral WMH in a cohort of community-dwelling people aged ≥70 years but this relationship is modified by co-existing OH or lower BP.
Identifying the processes that lead to WMH accumulation and progression in depression is crucial in order to inform strategies aimed at preventing and ameliorating LLD.
13 Effects of Benzodiazepines on Orthostatic Blood Pressure in Older People
Authors: Rivasi Giulia , Anne Kenny Rose , Ungar Andrea , Romero-Ortuno Roman 
Published: September 2019

Abstract

Background
Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to unfavorable drug-related effects on cognition and psychomotor functioning. BDZs may also have hypotensive effects, but evidence concerning the relationship between BDZs and orthostatic blood pressure (BP) behaviour in older people is scarce. We investigated the effects of BDZs on BP response to an orthostatic active stand test.

Methods
We performed a retrospective analysis of data from an outpatient research clinic in an Irish university hospital, where people aged 60 or older underwent a comprehensive geriatric assessment between August 2007 and May 2009. Non-invasive beat-to-beat orthostatic BP was measured during active stand, with systolic BP assessed at each 10-second interval. Information on regular BDZs use was collected. Factors independently associated with orthostatic systolic BP were investigated using multiple linear regression.

Results
Of 624 community-dwelling people who underwent a clinic assessment, orthostatic active stand data was collected in 541. Information on regular BDZs use was available in 538 people. Of 538 participants, mean age was 72.7±7.2, 67.7% were female and 33 (6.1%) reported regular use of BDZs. History of falls (p=0.027) and fear of falling (p<0.001) were more prevalent in this subgroup. During active stand, participants on BDZs showed a significantly greater systolic BP drop 10 seconds after the posture change (“immediate” BP drop). No significant differences were detected in orthostatic systolic BP in the latter phases of the active stand. After adjusting for possible confounders, BDZs use was independently associated with a mean immediate systolic BP drop of 12 mmHg after standing.

Conclusion
BDZs may confer higher risk of an immediate systolic BP drop after standing in older people, which may contribute to their known falls risk. BDZ should be avoided in older people at risk of falling.