bluuebunny/crossref_metadata_2025_split huggingface dataset:
185 Revisiting Comprehensive Geriatric Assessment in the Emergency Department
Authors: Edge Lucinda , O'Rourke Brian , Cunningham Conal , Horgan Frances 
Published: September 2019

Abstract

Background
In a large teaching hospital, a specialist interdisciplinary team identify frailty and begin comprehensive geriatric assessment of older adults in the Emergency Department (ED). This study aimed to determine the clinical utility of a range of measures: grip strength, calf circumference, frailty and functional mobility to evaluate whether they help to estimate the care pathways for patients. Objectives included: (1) To ascertain the prevalence of frailty and (2) To profile this population’s demographics, falls history, calf circumference and grip strength.

Methods
This was a cross-sectional study. Inclusion criteria were persons ≥ 70 who presented to ED weekdays during research hours 9:00 – 16:00, with Manchester triage score ≥ 3. Information on gait aids, social supports and falls in the past 6 months was self-reported. Grip strength was assessed using hydraulic hand-held dynamometry. Sarcopenia was measured using calf circumference as a proxy. Frailty was determined using the Clinical Frailty Scale (CFS). Functional mobility was assessed by an interdisciplinary team member. Onward referrals and admission to hospital were recorded. Data was analysed using SPSS statistics software.

Results
One hundred and one participants were included, 39 male (38.6%) and 62 female (61.4%), mean age 79.3 years. Thirty-five percent (n=36) were considered Frail (a CFS score of ≥5), 35.6% (n=36) lived alone, 52.5% (n=53) used a gait aid. Outcomes included admission to hospital (27.7%, n=28) and discharge with onward referral (25.7%, n=26). The most common referral was community physiotherapy (11.9%, n=12). The population identified as frail were more likely to be female (p = 0.036), to use a gait aid (p = 0.001) and to have fallen within the past 6 months (p = 0.007).

Conclusion
The prevalence of frailty was determined in this population and was not significantly associated with hospital admission, grip strength or calf circumference. A focus on alternative pathways to hospital admission with appropriate access to community services is recommended for individuals with frailty.
187 Capturing the Providers of Services to Older Persons – An Exercise in Integration of Care
Authors: Reilly Patrice , Dockery Frances , O'Leary Una , Grogan Sinead , Walsh Joan , Traynor Lydia 
Published: September 2019

Abstract

Background
There is much focus on the dearth of resources within healthcare systems, with a focus on health services. In 2018, we held a speed networking event for two local areas of a HSE Community Healthcare Organisation. This highlighted the vast array of supports available to assist older people to live well. This, alongside a Listening to Older Person’s Workshop, highlighted the need for a local directory of services.

Methods
In considering potential networking attendees, a social determinants of health approach (Dahlgren and Whitehead, 1991) was adopted to scope all supports available across community, acute, voluntary and statutory health and social care services within the area. This was expanded on further to develop the directory.

Results
The directory provides details of 358 organisations, individuals and groups available to support older persons within a catchment area with a population of 13,833 older persons (CSO Census, 2016). Hospital services comprised 27 of these while community HSE and GP health services made up 130. The remaining 201 were local and national NGOs and community groups ranging in service provision, a sample of which as follows: 39 provided some level of social/education engagement, three befriending, 18 counselling, five housing specific, 11 substance dependency, 12 provided supports to persons impacted by abuse. A further 20 national NGOs provided a local service or helpline with a focus on a particular health diagnosis.

Conclusion
This exercise shows the vast number of services available within just one small region, to support older persons to live well at home. The directory has been approved as a template for other networks in the CHO. It is being adapted into an online version by an interagency group. Using this template nationally has the potential to overcome gaps in health service resources, and support true integration, in line with the ICPOP (2016) 10 step framework.
188 The Use of a Group Based Upper Limb Programme in Improving Outcome in Acute Stroke Rehabilitation
Authors: Donnelly Kerri , Mulcahy Enya , Merrick Catherine , Fitzgerald Orla 
Published: September 2019

Abstract

Background
After a stroke 85% of patients experience altered arm function. Current research demonstrates that increasing upper limb rehabilitation results in improved outcomes (Ward et al., 2019). The Graded Repetitive Arm Supplementary Programme (GRASP) group is an established adjunctive therapy in the stroke service. The group provides additional therapy for suitable patients with upper extremity deficits. The group is run jointly by a physiotherapist and an occupational therapist. Patients attend twice weekly for a one hour period in addition to their regular therapy. The GRASP group consists of 3 levels of varying abilities and patients are categorised by their Fugl-Meyer score.

Methods
A prospective audit was completed in 2019 and data was collected using a word document and excel spread sheet. Standardised outcome measures were completed on admission and discharge to establish upper limb ability. The primary outcome measure was the Fugl-Meyer and the secondary outcome measures were the nine hole peg test and grip strength using the Dynamometer.

Results
12 patients attended the GRASP group over this period. 75% were males. The average age was 76 years with the age range from 48-95 years. 58% of patients experienced upper limb weakness in their non-dominant hand. Post intervention data was not obtained for 5 patients due to unforeseeable discharge from the acute setting. Preliminary data to date shows that our primary outcome measure improved in 86% of patients with increases ranging from 2-11 points on the Fugl-Meyer score (Minimally Clinical Important Difference =5points). Our secondary outcome measures demonstrated patients had no change (28%) or an improvement (72%) in grip strength and 100% of patients improved on the time taken to complete the nine hole peg test.

Conclusion
The GRASP group was found to be effective in improving upper limb outcome measures in an acute stroke inpatient hospital setting.
189 The Fall Champion Toolbox
Authors: Doyle Mary , Coughlan Tara 
Published: September 2019

Abstract

Background
Older adults in residential care setting are three times more likely to fall than those in the community and these falls are associated with a greater risk of injury. More than 400 separate risk factors for falls have been identified with the risk of falling increasing as risk factors accumulate. Multifactorial interventions by an interdisciplinary team to reduce risks have been suggested as the most effective strategy to reduce falls. The aim of this project was to increase fall prevention awareness among staff, reduce fall risk factors and reduce overall fall numbers.

Methods
Fall champions on each unit were identified and equipped with the necessary information in a ‘toolbox’ that was used for short education sessions or ‘toolbox talks’. The toolbox contains 4 fact sheets; each fact sheet designed for a different member of the care team, focusing on their role in reducing fall risks. Fact Sheet 1: Household and Maintenance staff, Fact Sheet 2: Health Care assistants, Fact Sheet 3: Nursing Staff, Fact Sheet 4: Resident information leaflets. A ‘toolbox talk’ takes 10 minutes. The fall champion focuses information at a particular team member by using the fact sheet with specific information targeted to that team member’s role.

Results
An evaluation of the initiative after 3 months demonstrated that the fall champions found the toolbox easy to use (100%). The champions reported that they felt confident that the toolbox had given them the skills to provide each team member with information relevant to their roles (100%).Staff had attended a toolbox talk within 4 weeks of the introduction of the project and reported increased awareness of risks for falls (100%).
Fall numbers for 3 months: Pre introduction =19 Post introduction =10 Reduction of 47%.

Conclusion
The initiative increased staff awareness of fall risks and may have impacted falls rate.
190 Who is ‘Fit to Sit’ in Our Emergency Department?
Authors: Kelly Louise , Ryan Maeve , Whelan Caitriona , Brady Deirdre , Wade Ruth , Boyle Orla , Doherty Orlaith , Mello Sarah , Hayden Derek , McElwaine Paul , Gray James , Murphy Maeve , Malone Brendan , McCabe Aileen 
Published: September 2019

Abstract

Background
Older admitted patients are at risk of deconditioning related to immobility. “Fit to Sit” is a simple change in the Emergency Department (ED) culture and attitude, promoting independence, maximizing well-being and improving health outcomes. We aim to describe the prevalence of patients deemed “Fit to Sit” who were in hospital gowns and lying on trolleys in our ED prior to the commencement of the “Fit to Sit” pilot.

Methods
An observational study was conducted prospectively, over five working days, to determine the proportion of patients present who were dressed and sitting out on a chair, opposed to wearing pyjamas (PJs) and lying on a trolley. Nursing staff familiar with each patient were asked whether or not the patient was fit to sit out in a chair. Statistical analysis was conducted with Microsoft Excel using the chi squared test to calculate differences between the two groups.

Results
Data was collected on 147 patients, median age 66 years (IQR 47-74). 82% were on a trolley and 18% in a chair. 33% were in their clothes, the remaining 67% were in PJs or hospital gowns. 45% of those deemed “Fit to Sit” were on a trolley. Patients 65 and older were more likely to be wearing PJs (p= 0.03), but not more likely to be on a trolley (p= 0.23). Patients in ED for greater than 12 hours were also more likely to be in PJs (p= 0.001) and on a trolley (p= 0.057).

Conclusion
Our study suggests that a significant proportion of ED patients are lying on trolleys despite being deemed to be “Fit to Sit”. Introduction of an ED “Fit to Sit” programme may alleviate deconditioning and promote patient independence.
193 Audit on Inappropriate Prescribing of Proton Pump Inhibitors Amongst Patients over 65 Years in an Acute Rehabilitation Hospital
Authors: O' Reilly Eimear , Gopaul Aquila , Cogan Lisa 
Published: September 2019

Abstract

Background
Proton pump inhibitors (PPIs) are one of the most frequently prescribed drug classes in the older person. Indications for PPI use are outlined in the NICE guidelines, however they are often prescribed without an appropriate indication resulting in increased healthcare costs and increased exposure to potential adverse clinical effects.

Methods
To determine the rate of inappropriate prescribing of PPI’s, an audit was carried out to assess the incidence of inappropriate prescribing in an Acute Rehabilitation facility pre and post Education to Hospital Doctors. An audit was carried out, pre and post intervention, on patients over the age of 65 years admitted to an acute rehabilitation hospital between 2018 and 2019. Patient’s medical charts were reviewed and data was collected on PPI prescribing.

Results
Cycle 1-Pre Education; 83 people included in the audit. Mean age was 80.8 years[SD ±9]. 43% of patients were on a PPI, all of which were prescribed the generic form. 83.4% of patients had no indication for PPI use. Of the 16.6%, indications included GORD, Barrett’s oesophagus, PUD and PPI prophylaxis against NSAID’s including aspirin. 77.7% were on therapeutic dose without any indication. 100% of patients were on PPI for longer than 6 weeks.
Cycle 2, Post education: 86 patients were included in re-audit. Mean age was 81.5[SD ±10]. 60.4% of patients were on PPI. Of those, 55% had no indication for PPI. Of the 44% on PPI, indications were similar to those in Cycle 1. 83% of patients were on PPI longer than 6 weeks. 56.5% were on inappropriate dose of PPI.

Conclusion
This audit highlighted the inappropriate prescribing of PPI’s in the older person. By providing education to Doctors about NICE PPI prescribing guidelines, overall rate of inappropriate prescribing of PPI decreased by 28.4% and accurate dosing of PPI improved by 21.2%.
200 Evaluation of Nutrition Service Provision in a Day Hospital Setting
Authors: Digan Eimear , White Sarah , Fox Emma , Feehan Sinead , Cronin Audrey , Kennelly Sean 
Published: September 2019

Abstract

Background
Malnutrition, frailty and functional impairment adversely impact individuals and should be considered simultaneously in rehabilitation. Individuals in a Day Hospital (DH) setting require a multidisciplinary approach to rehabilitate and nutrition plays a fundamental role in improving patient outcomes. The aim of this study was to establish the nutritional profile of the patients attending the DH and to measure this against current dietetic referral criteria.

Methods
A prospective quality improvement analysis of older adults attending the DH was conducted. Nutritional status, using the mini nutritional assessment short-form, demographic and biochemical information was collected from nursing notes and the software Key. Frailty scores were assigned using Rockwood Clinical Frailty Scale. Nutrition service provision was evaluated in relation to the priority rating system for DH Patients.

Results
Nearly two-thirds of the 57 patients were malnourished (17.5%) or at risk (45.6%), 1 in 4 (26.3%) was obese. Most patients were frail (77.2%). 45.6% of patients were referred to clinical nutrition services. 90% of malnourished patients and 53.8% of those at risk were referred to dietetic services. Patients were seen at 4 ± 2.45 weeks after referral, 19.2% of patients were seen on time. Patients with underweight or obese BMI classifications were at greater risk of malnutrition and frailty. Those referred to the DH for falls review were nutritionally poorer and physically frailer.

Conclusion
This study highlights the need for a focused nutritional service in this environment. Revision of dietetic referral criteria and streamlining strategies are required to provide quality, timely intervention to those who need it most.
21 Prevalence of Potentially Inappropriate Medications (PIMs) in Older Palliative Patients, Defined by STOPPFrail Criteria
Authors: Foo Adeline , O'Brien Tony , O'Mahony Denis 
Published: September 2019

Abstract

Background
Polypharmacy is common in older persons with multi-morbid illness, increasing the risk of adverse drug events. Drug pharmacokinetics and pharmacodynamics are often altered in this group increasing the risk of adverse drug events and many prescribed drugs take considerable time to benefit. STOPPFrail criteria are designed to help prescribers to identify potentially inappropriate medications in older sicker patients with short life expectancy. The aim of this pilot study was to estimate the prevalence of STOPPFrail defined potentially inappropriate medications (PIMs in older patients with terminal illness at the point of admission to specialist hospice care.

Methods
We conducted a prospective analysis of inpatient case records and drug kardexes at a university teaching hospice over a period of one month. We recorded patients’ demographic details, principal symptoms, co-morbidities, medications at admission and at day 3-7. STOPPFrail criteria were applied to patients’ medications lists at both time points.

Results
Of 22 patients studied, 13 were female with a mean (+/- SD) age of 80 years (+/- 6). Eighteen patients were transferred directly from an acute hospital, 4 patients from the community. Common symptoms were pain (72%) and severe lethargy (68%). Twenty out of 22 patients had cancer as the life-limiting condition. There was a significant reduction in the mean (+/- SD) number of medications from admission (11 ± 4.1) to post palliative review (8 ± 4.7; p=0.002). 90% of patients had polypharmacy i.e. ≥ 6 daily medications, 87% had ≥ 1 STOPPFrail PIM on admission. The median number of STOPPFrail PIMs per patient was 1 (1-2, IQR), most commonly high dose proton pump inhibitors, multivitamin supplements, calcium supplements and lipid lowering therapies.

Conclusion
In this small study, STOPPFrail-defined PIMs were highly prevalent in older terminally ill patients. Prescribers should carefully review the medication lists of terminally ill older patients in order to minimize inappropriate polypharmacy.
203 An Evaluation of Polypharmacy and Adverse Drug Events in Older Adults with Rheumatic Disease
Authors: Mooney Niamh , Hannon Evelyn , Buckley Mary , Murphy Grainne 
Published: September 2019

Abstract

Background
Polypharmacy among older adults is a well-documented problem. The practice has been associated with potentially inappropriate medications (PIMs, adverse drug events (ADEs) and hospitalisation. This retrospective cohort study aims to evaluate polypharmacy, ADEs and anticholinergic burden in the ≥65 population with rheumatic disease.

Methods
All patients who were ≥65 and had a diagnosed rheumatic disease were included in this study. Patients' medication lists, specific rheumatic disease, laboratory findings and associated comobidities were obtained from their medical charts at rheumatology outpatient clinics. The data was screened for PIMs using the Screening Tool of Older Persons' Medications (STOPP) criteria and probable ADEs using the WHO-UMC criteria. Anticholinergic burden was determined using the ACB calculator. Polypharmacy in this project was defined as ≥4 regular prescription medications.

Results
70 patients were studied. The prevalence of polypharmacy was 94%. The median (IQR) number of regular prescription medications was 7 (2-16). PIMs were recorded in 43 patients (61%). Increasing numbers of medications was a significant risk factor for PIMS (p=0.0027). ADEs were detected in 18 patients (26%). The ADE detection rate in PIM positive patients was 35% (15/43) and 11% (3/27) in PIM negative patients. A patient who was PIM positive had a statistically significant risk of having an ADE (p=0.047). Of the ADEs detected, 73% were due to a STOPP PIM.
Increasing numbers of medications was a significant risk factor for an increased anticholinergic burden (p=0.017). An anticholinergic burden of ≥3 was a statistically significant risk factor for falls (p=0.025), however it was not a statistically significant risk factor for cognitive decline (p=0.073).

Conclusion
There is a high prevalence of polypharmacy in older adults with rheumatic disease. Increasing numbers of medications is statistically associated with increased number of PIMs, ADEs and increased anticholinergic burden.
204 Clinicoradiological Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation (CAA-ri) - a Non-Invasive Approach to Diagnosis and Management
Authors: McCartan Deirdre , Williams David , Moynihan Barry , Boyle Karl 
Published: September 2019

Abstract

Background
Cerebral Amyloid Angiopathy (CAA) is an age-related disorder characterised by deposition of beta-amyloid protein in the walls of small and medium cortical vessels leading to increased risk of intracranial bleeding. CAA-Related Inflammation (CAA-ri) is an under recognised subtype of CAA potentially responsive to immunosuppression and traditionally diagnosed by invasive brain biopsy. CAA-ri is associated with rapid cognitive decline but shows reversibility for some when treated with immunosuppression. We present the case of an 82 year old lady who presented with first seizure, a history of notable cognitive change and neuroimaging consistent with probable CAA-ri.

Methods
Validated clinicoradiological diagnostic criteria for CAA-ri were applied to MRI T2 FLAIR and SWI sequences. CSF, APOE genotyping, EEG and cognitive testing were performed. Interdisciplinary perspectives were sought from Neurology, Neurosurgery and Infectious Diseases colleagues. Consensus opinion opposed brain biopsy on strength of imaging evidence and pulsed intravenous steroid treatment was initiated. BP, anti-convulsant and bone protection were optimised and anti-thrombotics avoided. Repeat imaging and cognitive testing were repeated after four months.

Results
MRI T2-FLAIR revealed an asymmetric multifocal distribution of cortical and subcortical white matter hyperintensities (WMH) with leptomeningeal enhancement while SWI showed extensive multifocal microhaemorrhages with confluent haemorrhage in the right frontal and temporal regions. EEG demonstrated right frontal theta slowing and absence of epileptiform activity. CSF analysis reported raised protein at 53mg/dl. Normal WCC. Formal cognitive testing with ACEIII revealed a score of 79/100. EPOA was advised.

Conclusion
Clinicoradiological diagnosis of CAA-ri permits early initiation of immunosuppressive therapy and avoids invasive brain biopsy. In the absence of clinical suspicion and blood sensitive imaging sequences CAA-ri may be misdiagnosed as Acute Ischaemic Stroke or TIA where the addition of anti-thrombotic therapy could cause harm while early medical management offers potential reversibility.
206 Deprescribing in Frail Older People Transitioning to Long-term Care: a Randomized Controlled Trial Using STOPPFrail Criteria
Authors: Curtin Denis , Jennings Emma , Daunt Ruth , Randles Mary , Gallagher Paul , O'Mahony Denis 
Published: September 2019

Abstract

Background
Older people with advanced frailty are among the highest consumers of prescription medications. When life expectancy is limited, the use of multiple medications may be unnecessary or burdensome. STOPPFrail criteria were recently developed to assist clinicians with deprescribing decisions in frail older people approaching end-of-life. The aim of this study was to examine whether long-term medications could be safely discontinued in frail older people using STOPPFrail criteria.

Methods
We recruited hospitalized adults aged ≥75 years with polypharmacy (≥5 long-term medications) that were transitioning to nursing home care. Participants were eligible if their Clinical Frailty Scale score was ≥7 and if their attending physician indicated that he/she “would not be surprised if the patient died in the next 12 months”. Patients were randomized to single time point pre-discharge STOPPFrail-guided deprescribing or routine pharmaceutical care. The primary outcome was change in the number of regular medications at 3 months. Secondary outcomes included emergency hospital transfers, incident falls, fractures and mortality.

Results
Results are presented for the first 100 enrolled patients. The mean (±standard deviation [SD]) age of study participants was 85.1 (±5.7) and 61% were female. Intervention (n = 49) and control group (n = 51) participants were prescribed a mean (±SD) of 11.5 (±3.0) and 10.9 (±3.5) regular medications, respectively, at baseline. The mean (±SD) change in the number of regular medications at 3 months was -2.7 (±2.8) in the intervention group and -0.6 (±2.6) in the control group (estimated difference 2.1 ±0.6, 95% confidence interval 0.8 -3.3, p=0.001). Ten intervention participants and 14 control participants died within 3 months of randomization (20.4% vs 27.4%, p=0.49). There was no significant difference between groups for emergency hospital transfers, incident falls or fractures.

Conclusion
STOPPFrail-guided deprescribing significantly reduced medication burden in frail older people without adversely affecting clinical outcomes in the prospective 3 months.