bluuebunny/crossref_metadata_2025_split huggingface dataset:
52 Involvement of People with Dementia and Caregivers in Irish Dementia Research: Experiences, Challenges and Opportunities
Authors: Philbin Laura O , Quaid Kevin 
Published: September 2019

Abstract

Background
People with dementia and caregivers of people with dementia have the right to inclusion and involvement in research that pertains to them. They can bring unique insights that add significant value to research. Person/Patient Public Involvement (PPI) occurs when the public/patients work in partnership with researchers in setting priorities, planning and managing research studies, as well as in disseminating findings and putting results into practice. In line with Alzheimer Europe’s position, a dementia charity is working hard to support and build capacity for PPI in Irish dementia research.

Methods
The Dementia Research Advisory Team was established in April 2019 and is supported by the charity. It is a group of Experts by Experience (5 caregivers and 5 people living with dementia) who influence, advise and work with researchers across Ireland in a PPI capacity. Team members collectively developed terms of reference detailing their expectations of researchers, the charity, and their role in all PPI activities. Team members will focus on becoming active stakeholders in Irish dementia research, and the charity will support them to build their capacity to be involved through capacity-building workshops and continuous evaluation.

Results
This joint presentation will discuss the development, capacity building, and experiences of the Dementia Research Advisory Team. A person with dementia, will discuss the progress of the team and report on members’ experiences of being involved in Irish dementia research. They will also discuss the impact of involvement on team members, and on the research they have been involved in. Practical ‘lessons learned’ on what did and did not work well will be presented, in addition to how the Dementia Research Advisory Team has navigated challenges and opportunities for involvement of people living with dementia and caregivers in research.

Conclusion
Members of the Dementia Research Advisory Team represent key stakeholders in Irish dementia research.
85 Linking Diabetes and Dementia Risk: A Role for Aβ-42 Induced Activation of the NLRP3 Inflammasome? Results from the ENBIND Study
Authors: Dyer Adam , Batten Isabella , Killane Isabelle , Woods Conor , Gibney James , O'Neill Desmond , Reilly Richard , Bourke Nollaig , Kennelly Sean 
Published: September 2019

Abstract

Background
Midlife Type 2 Diabetes Mellitus (T2DM) is associated with a greater risk of dementia in later life. The innate immune NLRP3 inflammasome, an innate immune receptor, has been implicated in both T2DM and Alzheimer’s Dementia (AD) and can become activated by Amyloid-β 42 (Aβ-42). We analysed inflammasome-dependent cytokine responses in midlife T2DM and correlated these with cognitive and gait performance

Methods
Peripheral Blood Mononuclear Cells (PBMCs) of otherwise healthy patients with T2DM (n=30; 52 ± 8 yrs) and matched controls (n=15; 52.5 ± 7.86 yrs) were incubated for 18h with the following NLRP3 ligands: (i) Lipopolysaccharide (LPS), (ii) Aβ42 or (ii) LPS & Aβ42. Cell supernatants were analysed for production of the inflammasome-dependent cytokine IL-1β. Cognitive function was assessed using the MoCA and gait speed assessed under self-selected, maximal and cognitive dual-task conditions. Mann-Whitney, Wilcoxon tests and linear regression of log-transformed data were used to analyse results

Results
Incubation of PBMCs from all participants with NLRP3 agonists was associated with significant production of IL-1β (all p<0.001). There were no statistically significant between-group differences in IL-1β production. MoCA score did not predict IL-1β production by PBMCs. However, poorer performance on the cognitive dual-task gait paradigm was associated with significantly greater IL-1β production in response to LPS & Aβ42 in those with T2DM (p=0.015), which persisted after robust control for demographic, cognitive and cardiovascular covariates (p=0.003). The same association was not seen for healthy controls (p=0.58).

Conclusion
Both LPS & Aβ42 induce significant IL-1β production in PBMCs which did not differ between those with midlife T2DM and healthy controls. Poorer performance on the cognitive dual task gait paradigm was associated with significantly greater IL-1β production in response to LPS & Aβ42. Given the value of dual task gait in predicting cognitive decline, longitudinal follow up of this cohort may provide insight into the underlying pathophysiological mechanisms and potential biomarkers of dementia risk in T2DM.
92 Medication Related Quality of Life (MRQoL) in Ambulatory Older Adults with Polypharmacy and Multi-morbidity – a Measurable Outcome?
Authors: Jennings Emma , Jorgensen Katrine , Lewis Natasha , Byrne Stephen , Gallagher Paul , O’Mahony Denis 
Published: September 2019

Abstract

Background
With increasing numbers of older multi-morbid people being exposed to polypharmacy, research needs to focus on medication-related outcomes affecting quality-of-life (QoL). This study examines older-patients’ medication-related QoL (MRQoL), its relationship to medication burden/complexity, frailty, health-related QoL (HRQoL) and potentially inappropriate medications (PIMs.

Methods
A cross-sectional-study was conducted in older-patients attending out-patients and day-hospital services of a tertiary-teaching-hospital. Participants were aged ≥65 years, first-time attendees, taking ≥5 chronic-medications for ≥3 chronic-conditions and mini-mental state examination score ≥26/30. Demographic, medication, comorbidity, frailty status, PIMs(STOPP/STARTv.2 criteria), MRQoL (MRQoL-LS v1.0) HRQoL (Short-form-12; SF-12) and medication burden (Living with Medicines Questionnaire v.2; LMQv2) data were collected. Drg compliance was measured using the Medication Adherence Rating Scale (MARS). Lower MRQoL-LS v1.0 scores indicate better MRQoL (range 0-84). Higher LMQv2 scores indicate higher medication burden (range from 60-300). A negative age-specific mean-difference score in SF-12 physical and mental health composite scale scores (SF12-PCS, SF12-MCS) indicates poorer health.

Results
Over 12 months, 234 patients (attending 78 clinics) were screened, 59 met inclusion criteria and 30 were recruited; 3 patients were subsequently identified as ineligible. Eighteen patients were female (66%), mean age was 79.4 years (SD±6.2), median number of daily medications was 10 (IQR 8-13), median number of comorbidities was 11 (IQR 9-14).
Participants were generally drug-compliant, median MARS score of 9 (IQR 6.5-10). Patients’ median MRQoL score was 14 (IQR 14-22.5); mean LMQ v2 score was 115.64 (SD± 25.18). Mean age specific mean-difference SF12-PCS and SF12-MCS scores were -22.61 (SD±11.7) and -22.1 (SD±17.5) respectively. There was no significant correlation between MRQoL and number of daily medications, number of comorbidities, LMQ, HRQoL, or PIMs(Pearson’s 2-tailed test).

Conclusion
This study demonstrates that MRQoL-LS v.1 is not applicable to most patients attending geriatric ambulatory services. Furthermore, polypharmacy, multimorbidity, presence of PIMs poorer HRQoL do not correlate significantly with MRQoL.
98 Use of Drgs with Anticholinergic Properties in People Living with Alzheimer’s Disease: Data from NILVAD
Authors: Kennelly Sean P , Dyer Adam H , Murphy Claire , Lawlor Brian 
Published: September 2019

Abstract

Background
Prolonged exposure to anticholinergic medication, particularly in midlife, is associated with increased risk of cognitive impairment/dementia. Less well explored is the ongoing use of drugs with anticholinergic properties in patients with Alzheimer’s Disease (AD), where the potential to accelerate cognitive decline may be greatest.

Methods
We analysed medication data from the NILVAD trial, a clinical trial examining the efficacy of Nilvadapine in mild-moderate Alzheimer’s Disease (AD). Drgs were coded based on their Anatomical Therapeutic Chemical (ATC) classification and Anticholinergic Burden Scale (ABS) applied to each participant’s medication list. Logistic and linear regression were used to model predictors of potential anticholinergic medication use/total ABS score.

Results
Of 510 participants with AD (mean age 72.8 +/-8.3 years; 62% female), just over one-quarter (N = 134, 26.27%) were prescribed a drug with potential/definite anticholinergic properties. Half of these had an anticholinergic burden score of 3 or greater (N = 67, 13.4%). The most frequent definite anticholinergics prescribed included quetiapine (N=27) oxybutynin (N = 22), paroxetine (N=14) and amitriptyline (N=8). Usage did not significantly differ by country or study arm. Overall, 88.43% of patients were prescribed a cholinesterase inhibitor. On multivariate analysis of potential/definite anticholinergic usage, age (p=0.044; OR 1.03, 1.01-1.06), total number of medications (p=0.001, OR 1.3, 1.18-1.41) as well as a greater dementia severity rated using the Alzheimer’s Disease Assessment Scale (ADAS-Cog) (p=0.008; 1.04 1.01-1.07) were associated with likelihood of anticholinergic use.

Conclusion
Over one-quarter of community-dwelling older patients with AD are prescribed a drug with potential or definite anticholinergic properties. Use of drugs with potential/definite anticholinergic properties were associated with total medication burden in addition to greater dementia severity at baseline. This is particularly pertinent given the deleterious cognitive effects of anticholinergic medication. Further attention to reducing total anticholinergic burden in patients with dementia is warranted.
109 Impact of Transport Mode on Psychosocial Wellbeing in Community-dwelling Adults Aged ≥50 years: Results from TILDA
Authors: Donoghue Orna , McGarrigle Christine , Anne Kenny Rose 
Published: September 2019

Abstract

Background
Older adults with access to a car report increased social participation, better quality of life and better mental health. Existing research often compares the car to public transport, however we hypothesise that individuals who drive themselves or are driven by spouses have better outcomes compared to those driven by family or friends or taking public transport. This study examined how differences in transport mode affect psychosocial wellbeing in community-dwelling adults aged ≥50 years in Ireland.

Methods
Data were collected from 8092 adults during wave 1 of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study. Participants indicated their most frequent mode of transport: car, car (driven by partner/spouse), car (driven by family/friends/taxi), public transport. Regression analysis was used to examine associations between transport mode with depressive symptoms, quality of life and loneliness.

Results
89.8% of adults travel most frequently by car with 72.2% driving themselves. Driving was independently associated with lower depressive symptoms (beta=-1.9, 95% CI: -2.59, -1.30, p<0.001) and loneliness (beta =-0.45, 95% CI: -0.70, -0.21, p<0.001) and better quality of life OR=4.11, 95% CI: 3.13, 5.08, p<0.001) compared to relying on lifts from family/friends/taxi. Being driven by a spouse/partner or taking public transport were also associated with more positive effects although to a lesser extent. Interaction analysis showed that men who regularly travelled by public transport had higher loneliness scores than women (beta=0.67, 95% CI: 0.16, 1.18, p<0.05).

Conclusion
Most adults aged ≥50 years in Ireland rely on the car for transport. Driving, being driven by a spouse/partner or taking public transport are associated with better psychosocial wellbeing compared to being driven by others, highlighting the importance or independent travel, whether by car or public transport. Opportunities to support this should be considered when planning the future transport needs of ageing populations.
124 Creating Greater Public Understanding of Dementia: Findings on the Impact of a Coalition-led National Awareness Programme
Authors: Foley Fiona , Guiry Roisin 
Published: September 2019

Abstract

Background
Dementia Understand Together is a public support, awareness and stigma reduction campaign aimed at inspiring people from all sections of society to stand together with the 55,000 Irish people living with dementia. Led by the HSE working with The Alzheimer Society of Ireland and Genio it is supported by over 40 partner organisations and 230+ community champions, who are creating communities that actively embrace and include those living with dementia and their families.

Methods
The campaign uses personal testimonial TV commercials, radio advertising, social media and national and local news stories to build understanding among the general public about dementia. At a local level the campaign is growing a movement of people who are taking action to creative inclusive communities across Ireland.
Extensive research using national biennial public surveys (2016 and 2018) (N=1003) and campaign evaluation tools has and continues to inform the development and progression of the campaign.

Results
33% of respondents described themselves as knowing a lot about dementia, up from 24% in January 2016. There was a significant difference in attitudes between those who were aware of the campaign and those who were not.
Dementia risk reduction is a key message of the national campaign and 52% of respondents were aware that there are things they can do to potentially reduce their risk – up from 46% in 2016.
59% who saw the TV campaign said they were impacted in some way as a result of the personal stories featured and stated that they took some action, such as calling into a friend.

Conclusion
The development and implementation of the campaign is a partnership approach between the leading organisations working in the area of dementia. Findings show that the campaign is creating better understanding of dementia among the general public, increasing awareness of the condition and risk reduction, and is inspiring people to take actions.
125 A Quality Improvement Initiative of the Day Hospital Service
Authors: Lambe Avril , Vandenberg Niamh , O'Dwyer Clodagh , Ball Ciara , Cronin Annemarie , Byrne Marina , Jones Joyce , Falvey Diane , Mallin Mary , Fitzgerald Deirdre , Harpur Ann 
Published: September 2019

Abstract

Background
The Day Hospital had the potential to assist the hospital in achieving its target of reducing length of stay and early supported discharge. However the service was not providing a timely, quality service. The Day Hospital was reviewed as part of a week-long Rapid Improvement Event (RIE) to optimise the service.

Methods
Lean methodologies were utilised, including process mapping, gap analysis and A3 thinking. Data collection and analysis was gathered on the initial state prior to the RIE. Patient interviews were conducted and visual management systems were used to clarify the therapy schedules and rapid experiments of clinic flow boards. The key areas for service development were identified and changes were implemented and audited at 90 days and one year.

Results
Results at one year review showed that wait time for patients to attend an appointment was reduced by 75% (average of 270 days to 70 days) from 2017 to 2018. There was a 184% increase in new patient referrals from 2017 to 2018 and 98% of feedback from the patient surveys was positive. Five new clinic pathways were developed and added to the three existing clinics. Slots were also made available at clinics for early supported discharge from the hospital. Communication between staff was greatly improved through monthly meetings and utilizing a visual management system. Patient feedback surveys were checked monthly and streamlining the administration process improved the capacity of the service.

Conclusion
The RIE produced positive outcomes for the hospital, patients and staff. It achieved the key targets of providing a quality and timely service. The data at key time points indicate positive sustainability in these key areas.
127 Modifiable Cardiovascular Risk Profile in People with Mild Cognitive Symptoms Attending a Memory Service - an Opportunity to Promote Brain Health
Authors: Dookhy Joshi , McHale Cathy , Kennelly Sean , Coughlan Tara , Collins Ronan , Ryan Dan , O'Neill Desmond 
Published: September 2019

Abstract

Background
Current evidence strongly implicates the burden of vascular risk factors (VRF) in the development of stroke, cognitive decline and dementia. This effect is mediated through several mechanisms, including amyloidogenesis, chronic neuroinflamation, cerebral perfusion and white-matter changes. Vascular risk profiling is well-embedded in stroke and cardiac services, but less so in memory services.

Methods
A review of established modifiable VRF (hypercholesterolemia, Body Mass Index (BMI), hypertension, HbA1c, smoking and alcohol habits) of people with mild cognitive complaints (mild cognitive impairment and subjective memory decline) in a memory service was performed. Risk factors measured in clinic were classified as: systolic ≥140mmHg / diastolic ≥90mmHg hypertension; LDL cholesterol >3mmol/l; HbA1c >39mmol/mol; weekly alcohol >21units; smoking and BMI >24.9kg/m2. Data was recorded and analysed using Microsoft Excel.

Results
Thirty-seven people, including 16 females (mean age 71.4, range of 49-83 years), were reviewed. 13/37 (35%) were aged ≤69 years. A total of 91 VRFs were identified in the study population. 29/37 (78%) had ≥2 VRF present. 3/37 (8%) had five VRF. 18/37 (49%) had prior history of either stroke, vascular or heart disease.
Five of thirty-seven, (13.5%) and 13/37 (35%) were current and ex-smokers respectively, 2/37 (5%) consumed excess alcohol, 24/37 (65%) had elevated BMI and 11/37 (30%) had elevated LDL cholesterol. 21/37 (57%) had hypertension. Of these, 11/21 were known but poorly-controlled and 10/21 were identified de novo. All of the 32% (12/37) who had hyperglycaemia were de novo.

Conclusion
This study highlights the high prevalence of unidentified or poorly controlled VRF in people with mild cognitive symptoms attending a memory service. Given its importance to brain health and mitigation of future cognitive decline, a structured focus on identifying and managing these VRF in this setting is necessary. Exercise-based lifestyle programs should be embedded in post-diagnostic services for this population.
132 A Survey of Non-consultant Hospital Doctors’ Knowledge and Understanding of the Legal Status of Advance Care Directives in Ireland
Authors: Comber Ruth 
Published: September 2019

Abstract

Background
The legal status of advance care directives (ACDs) in Irish law, as they pertain to current clinical practice, is a relatively new topic to healthcare staff. This project aimed to assess current understanding in non-consultant hospital doctors (NCHDs).

Methods
An online survey was conducted with NCHDs across a range of disciplines to ascertain current knowledge of the legal parameters of ACDs. Descriptive analysis of data was conducted in Excel.

Results
The survey was completed by 183 NCHDs. Of respondents 93.99% (n=172) were familiar with the term advance care directive and 41.53% (n=76) had encountered one in clinical practice. Their current legal status in Ireland was not known to 58.47% (n=107). That to be considered legally binding an ACD must be in writing was understood by 63.39%, but 58.47% (n=107) were unsure if a solicitor is required to draft one. Refusal of medical treatment as an application for ACDs was appreciated by 79.78% (n=146), however 38.89% (n=73) erroneously believed medical intervention could be requested in an ACD, with a further 30.6% (n=56) unsure. Current guidance sets out that only specific situations may be contained within an ACD, however 77.6% (n=142) of respondents believed a general stipulation could be documented, 25.14% (n=46) did not know if cognitive function affected the legality of an ACD, 95.08% (n=174) of respondents would attend formal training on ACDs if provided by their place of work.

Conclusion
Despite being enshrined in current legislation the legal status of advance care directives, their definition and criteria to be considered legally binding are very poorly understood by NCHDs. Guidance and education are crucial to the future protection of both patients and doctors with regards the execution of advanced care directives as prescribed by law.
137 Does the Clinical Frailty Scale Predict Rehabilitation Potential in Older Patients?
Authors: D'Alton Maeve , Larkin Joanne , McKeag Avril , Coakley Grace , Nolan Emma , O'Connor Marie , Dolan Eamon 
Published: September 2019

Abstract

Background
The Clinical Frailty Scale (CFS) is widely used to assess frailty in older adults and reflects functional independence. We examined its use as an outcome measure in an offsite rehabilitation unit for patients over 65 transferred from an acute hospital following medical/surgical admission.

Methods
Patients were given a CFS score by consensus opinion from the multidisciplinary team on admission and on completion of rehabilitation. We included data on diagnosis, length of stay and discharge destination

Results
Thirty patients, with a mean age of 80, completed rehabilitation over a four-month period. The most common diagnosis was fracture of hip or pelvis (53%). Median CFS was 6 on admission and 5 on discharge (range 3-8). Twenty-one (70%) patients saw an improvement in CFS of an average of one point on the scale irrespective of admission score. Of those that improved, 81% were discharged directly home with no need for increased support services, compared with 11% of those who did not improve. Mean length of stay was significantly less in those with mild/moderate frailty (CFS 5-6) at admission versus severe frailty (31 vs 53.8 days, p<0.01).

Conclusion
Frailty score improved in the majority of patients undergoing rehabilitation, regardless of admission score; CFS alone did not predict rehabilitation potential, emphasising the importance of offering rehabilitation to frail older adults – better judged by experienced clinical assessment. CFS is a broad 9-point tool that can miss small improvements in physical function based on other objective scores e.g. FIM+FAM. Severe frailty was associated with longer length of stay in rehabilitation, possibly reflecting more complex discharge planning as well as rehabilitation progress in this group.