bluuebunny/crossref_metadata_2025_split huggingface dataset:
The wildlife aspect in the linear transport infrastructure development processes
Authors: Finka Maros , Husar Milan , Ondrejicka Vladimir , Jamecny Lubomir 
Published: September 2019

Abstract
The Carpathian Mountains present some of the most preserved natural habitats for wildlife species in Europe. These natural environments provide a great number of ecosystem services for the whole Europe and their protection is in the interest of all stakeholders in the territory, from the local and regional state authorities, NGOs and private sector actors. Many regulations in form of the various formal and informal documents exist and these are different from country to country which creates one of the key issues when protecting this vast natural area. The unified system of protection recognized in all Carpathian countries is rather missing and for this reason the Framework Convention on the Protection and Sustainable Development of the Carpathians (Carpathian Convention) had been formed with an objective to foster the sustainable development and the protection of the Carpathian region. One of their activities is to support the legal procedures aimed at protecting the Carpathian Mountains and INTERREG-supported TRANSGREEN and CONNECTGREEN project is one of its main activities, of which this paper is one of the main outputs. The objective of this paper is to clarify how and where the wildlife aspects have to be integrated in the general process of the linear transport infrastructure development processes within Carpathian countries.
58 Hospitalisation Rates and Causes for People with Dementia in Northern Ireland
Authors: Zafeiridi Evi , McMichael Alan , McGuinness Bernadette 
Published: September 2019

Abstract

Background
People with dementia are almost 50% more likely to have an acute hospital admission due to a common age-related illnesses, such as urinary tract infection. They also have an 18% higher rate of readmission following discharge and approximately one quarter of hospital beds are occupied by people with dementia. Furthermore, people with dementia have an increased mortality rate in hospital and for six months after discharge compared to age-matched controls. This study assessed the hospitalisation and re-hospitalisation rates for people with dementia in Northern Ireland, as well as exploring whether mortality rates increase during or following these hospitalisations. A secondary aim was to explore the causes of hospitalisations between people with dementia and a representative age-matched control group.

Methods
Data from over 50,000 people with dementia and the control group from national databases in Northern Ireland were retrospectively analysed.

Results
The results showed that dementia does not affect hospitalisations; however, the number of hospitalisations can predict mortality in people with dementia. The most common causes for hospitalisation did not differ between the dementia and the control groups and included pneumonia, urinary tract infection and fractures.

Conclusion
The results will inform health care professionals on whether a reduced number of hospitalisations increases life expectancy and may result in relieving some of the financial strain currently being experienced by the National Health Service.
69 How Useful is an Integrated Assistive Technology System in a Nursing Home? Understanding its Effectiveness on Users and their Perceptions
Authors: Obayashi Kazuko , Kodate Naonori , Kondo Hiromasa , Okamoto Yoshimi , Ishii Yoko , Masuyama Shigeru 
Published: September 2019

Abstract

Background
With the arrival of a super-ageing society, the use of technologies in social care is not only necessary but inevitable. However, there is a dearth of evidence to demonstrate how assistive technologies (AT) can improve standards of care while improving the working conditions of care professionals and care givers. Furthermore, little is known about users’ perceptions of such technologies. The objectives of this paper are: first, to test the effects of an integrated AT system on users (both care recipients and staff) in a residential care home; and second, to understand their perceptions of such technologies.

Methods
We combined an infrared monitoring camera with communicative robots and a sheet-shaped body vibrometer. A 4-week pre/post intervention study was conducted, during which the evaluation was carried out before, during and after the intervention. Twenty care recipients (average age of 89.5) and 15 care professionals participated in the study. In order to measure the effectiveness of the integrated system, the care recipients’ quality of life was examining using the interRAI method. Regarding the impact on professionals, stress levels were examined during night shifts. Perceptions towards use of the system were also explored by the system usability scale (SUS) and semi-structured interviews.

Results
After the system was introduced, the number of unnecessary visits by care professionals during the night was dramatically reduced (by 8.2 times per person on average), and staff’s stress levels were also reduced. The SUS and interview data show mixed results in terms of the perceptions of care recipients and staff towards using the technologies.

Conclusion
Overall, the use of integrated assistive technologies yielded positive results. However, some issues were identified with regard to future implementation of such technologies in a residential care home. This study was financially supported in part by the Japanese Council of Senior Citizens Welfare Services.
95 Accuracy of Off the Shelf Activity Trackers in Ambulatory Settings in Young and Old Adults
Authors: Barton John , Timmons Suzanne , Tedesco Salvatore , Sica Marco , Crowe Colum , O'Flynn Brendan 
Published: September 2019

Abstract

Background
Wrist-worn activity trackers have experienced a tremendous growth lately. Robust studies of the comparative accuracy of currently available, mainstream trackers, in young adults versus older adults are still scarce in literature. This study explores the performance of ten trackers estimating steps, travelled distance, and heart-rate measurements against gold-standards in two cohorts of young and old adults.

Methods
Overall, 38 subjects completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities, including less standardised activities, such as dusting, vacuuming, or playing cards, in order to simulate real-life scenarios. Both wrist-mounted and chest/waist-mounted devices were considered. Gold-standards included treadmill, waist-mounted pedometer, ECG-based chest strap, direct observation or video recording according to the activity and parameter.

Results
Every tracker shows a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. Large mean absolute percentage error (MAPE) was displayed by every monitor at slower walking speeds.
During household activities, the MAPE in young adults climbing up/down-stairs ranged from 3.91-11.41% and 4.34-11.92% (dominant and non-dominant arm), respectively. However, for the same activities older adults displayed a larger MAPE, at 8.38-19.3% and 10.06-19.01%, respectively. Chest-worn or waist-worn devices had more uniform performance. However, unstructured activities (dusting, vacuuming, playing cards), and accuracy in people using a walking aid represent a challenge for all consumer-level trackers as evidenced by large MAPE. Poor performance in travelled distance estimation was also evident during walking at low speeds and household activities for both cohorts.

Conclusion
This study shows a number of limitations to current, mainstream consumer-level wrist-based activity trackers, requiring caution if adopted in healthcare, whether clinical or research. This study demonstrates the particular deficits in commercial devices for use in an aging population, and provides some indications on how to best measure these health parameters in this population.
103 The Characteristics of Frail Older Patients Admitted Through an Emergency Department, who Experience New Disability due to Acute Illness
Authors: Inglis Sara , Ryan Siobhan , Maher Jennifer , Pender Ciara , Sayers Karen , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
No current tool reliably predicts functional decline risk. The modified Barthel Index (mBI) is a validated measure of disability, ideal for use within an interdisciplinary assessment. The aim of this prospective cohort study was to determine the proportion and characteristics of newly admitted frail older patients who experience drops in their Barthel index, requiring intervention.

Methods
Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, were assessed using an interdisciplinary assessment tool (IAT), from February 1st 2019 to March 31st 2019. Data was entered into an excel database on demographics, baseline mBI and inpatient (within 72 hours) mBI, frailty-associated co-morbidities and multi-disciplinary interventions and analysed using Student’s T-test.

Results
150 consecutive patients were assessed with a mean age (mean (+/- SD)) of 83.1(+/- 7.4). mBI scores were recorded for 111(74%) of patients. Mean mBI prior to current illness was 15.4(+/- 4.9). Post-illness mBI was 12.5(+/- 5.3). 65(58.6%) patients experienced an mBI drop. Mean drop was 4.9 (+/- 2.8) points. There was no difference in age or baseline mobility between those who either did or did not experience an mBI drop. Patients with a drop had higher mean pre-illness mBI (16.2 vs. 14.2; p-value 0.017, 4AT score (1.98 vs. 1.11; p-value 0.035) and increased falls history (40 vs. 18 patients; p-value <0.01), compared to patients with no drop. They required more referrals to the multidisciplinary team (3.7 vs. 2.9, p-value 0.002).

Conclusion
Higher proportions of frail patients experienced a drop in function compared with studies where age is used as a cut-off. Within this small frail patient cohort, age was surprisingly not associated with mBI drops. Using frailty as the main determinant for assessment rather than age, results in a different cohort of patients, at risk of functional decline. Future predictive tools should focus on frailty rather than on age.
153 Barriers and Enablers of Assisted Decision-making for Older People in Acute Care Hospitals: A Multi-Stakeholder Inquiry
Authors: Donnelly Sarah , Coimín Diarmuid Ó , O'Donnell Deirdre , Davies Carmel , Shé Éidín Ní , Fattori Francesco , Cooney Marie Therese , O'Shea Diarmuid , Kyne Lorraine , O'Shea Marie , Kroll Thilo 
Published: September 2019

Abstract

Background
Ireland’s Assisted Decision-Making (Capacity) Act 2015 breaks from traditional views of capacity to consider the uniqueness of each decision with relation to topic, time and place for those with impaired or fluctuating capacity. It has yet to be commenced, however codes of practice and educational strategies are in development to support health and social care professionals (HSCPs) to practice in accordance with the Act. This study set out to examine barriers and enablers to the adoption of assisted decision making (ADM) involving older people in acute hospitals from multiple perspectives. It describes a pre-implementation formative evaluation informed by the perspectives of relevant stakeholders in ADM practice.

Methods
In total, 12 key informant interviews and two validation groups were conducted with family carers and older people with and without a diagnosis of dementia in two acute hospitals. In addition, 20 interviews and two validation groups were conducted with HSCPs. Interviews focused on contextual characteristics as well as barriers and enablers of ADM.

Results
Barriers and enablers included supporting capacity through adopting a functional approach, the physical environment where decision-making takes place, meeting information and support needs, methods of communication, upholding will and preferences, relationships and trust. Time and timing were consistently identified as a critical factor. HSCPs also highlighted the need for specialised education and training on ADM practice.

Conclusion
The issues identified around ADM will inform the development of a serious discussion game on acute care scenarios, which will be deployed for awareness raising and educational purposes. Findings will also help focus attention on how those working within complex health systems and organisations can practically implement changes to practice in line with ADM legislation.
293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study
Authors: Bourque Meghan , Foley Tony 
Published: September 2019

Abstract

Background
The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs.

Methods
Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection.

Results
12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care.

Conclusion
GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.
329 An Integrated Care Approach to the Uses of Social Prescribing in an Acutely Frail Older Adult Cohort
Authors: McLoughlin Petra , Murphy Eleanor , O'Sullivan Fiona , Connellan Ciara 
Published: September 2019

Abstract

Background
Community Health Organisation Area 1 has the highest age dependency in Ireland (37.5 vs 34.5) and the highest proportion of its population engaged in unpaid care (4.7%)1. Social prescribing is a novel tool used by the Integrated Care Team for the Older Person in Sligo to address social determinants of health such as social isolation and to minimise the impact of carer burden.
The study aim is to quantify social needs and carer burden in this acutely frail group and describe interventions to address this.

Methods
A descriptive study compiled from Comprehensive Geriatric Assessment of patient care profile and social prescribing from June to December 2018.

Results
50% of patients studied did not have a supportive, able person living with them. 1 in 4 had no local support while 1 in 5 were supported only by neighbours or friends. 53% were not receipt of home help while 24% paid for private care or cleaning services. Carer burden was reported in half of cases with a 2.2 times increased risk with a patient co-morbidity of cognitive decline and a 1.8 times increased risk with a complex medical needs patient. Intervention increased community service usage such as the public health nurse from 70% to 86% and home help applications by 26%. Social prescribing increased day centre use from 18% to 46% and Meals on Wheels usage by 50%. Dementia specific social prescribing was made in 26% of those with cognitive difficulties. 33% received information for carers while 11% were informed of respite options.

Conclusion
In this acutely decompensated and vulnerable group social isolation and carer burden are a significant issue. Our study indicates the potential for the use of a social prescribing model to address this at an earlier point in frailty development at a primary care level.
348 Developing a Frailty Index: Does the Composition of Functional and Disease or Risk Items Influence Frailty Estimates?
Authors: O'Donovan Mark , Sezgin Duygu , Liew Aaron , O'Caoimh Rónán 
Published: September 2019

Abstract

Background
Frailty is a multi-factorial, age-related syndrome, often defined in terms of accumulation of deficits. This approach uses the proportion of a list of age-associated items (signs, symptoms, diseases, impairments, etc.) available to identify frailty. Some frailty indexes (FI) include more functional aspects than others. This study examines whether functional components and diseases or risk factors predict the same phenomena.

Methods
Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) wave seven for participants age ≥50 years. A 52-item FI was constructed from physical health data with 26 functional and 26 non-functional items. Functional items were obtained from activities of daily living questions (ph048 & ph049), and health-related activity limitation (gali question). Non-functional items were obtained from questions on BMI, self-perceived health, disease/risks (ph006), medication use (sleep, anxiety/depression, osteoporosis), and frailty related symptoms (ph048). Participants missing one or more of the 52 items were excluded. Data were analysed at individual and country-level to assess for significant differences.

Results
In total, 73,510 (97.3%) participants had complete frailty data available and were included. The mean score for the FI-52 was 0.12 (95% CI: 0.11-0.12). Mean FI scores for the functional and non-functional components were 0.12 (95% CI:0.12-0.12) and 0.11 (95% CI:0.11-0.11), respectively, representing a significant difference (p<0.001). For a cut-off of 0.25 for frailty this difference was 5.4% (95% CI:3.9%-6.2%). Spearman’s correlation between these components was 0.66 for individual participants and 0.72 for country-level mean scores, indicating moderate to strong correlation. These were similar using a cut-off of 0.25, at 0.45 and 0.71, respectively.

Conclusion
Findings suggest that having more functional items in a frailty index results in significantly higher frailty estimates but this only amounted to an approximately 5% difference. Although moderate-strong correlation was observed, further research is needed to investigate if the proportion of functional components influences risk-prediction at population-level.
05 Profile of a Geriatric Neurosurgical Service
Authors: Malone Kareena , Kinsella Fiona 
Published: September 2019

Abstract

Background
According to the 2016 CSO figures the age category of 65 and older saw the largest increase in the Irish population since 2011, rising by 102,174 to 637,567, a rise of 19.1%. This remains a major concern for a North Dublin teaching hospital as its catchment area has a 20% higher proportion of > 65’s and > 85’s than the national average. This catchment area profile has the potential to impact on the profile of the in-catchment admissions while the National profile will impact on the national specialities including neurosurgery.

Aim
To profile the geriatric neurosurgical population and provide insight that facilitates future service planning and delivery.

Methods
To accurately capture the data, all ward lists for the month of June and July 2017 were reviewed to identify appropriate patients. All patients on any ward within the hospital, under the care of a neurosurgeon, were included in the data collection. Patients in intensive care that did not transfer to the wards were excluded.
Data points including age, sex, consultant, co-morbidities, mobility status and surgical intervention were captured.

Results
120 patients ≥ 65 years were admitted to the neurosurgical service between June and July 2017; 45 (38%) between 60-69, 60 (50%) 70-79, 13(10%) 80-80 and two (2%) ninety years or older. The two most common reasons for admission were non-traumatic cerebral bleeds (N= 40; 34%) and cerebral tumours (N= 38; 32%). Patients had on average four co-morbidities, with cardiac being the most common. 17 patients were admitted post a traumatic event; 13 low impact falls, 3 high impact falls and one assault. The average LOS for these patients was 11.3 days.

Conclusion
This profile highlights the complex needs of this population and the increasing burden on existing neurosurgical resources as the population continues to age.
Future resource allocation and service development, including the National Trauma Strategy, needs to consider the needs of the aging neurosurgical population.
168 Exploring Physical Activity and Sleep in Community-dwelling People with Dementia and their Association with Cognitive Function and Quality of Life
Authors: Mahon Aine , Kirwan Ruairi , Mackey Laura , Guisado-Fernández Estefanía , Caulfield Brian , Curran Fiona , Power Dermot , O'Shea Diarmuid , Doyle Rachael , Blake Catherine 
Published: September 2019

Abstract

Background
The incidence of dementia has reached epidemic levels, both globally and here in Ireland. Many adults with dementia living in the community remain inactive with some also suffering from sleep disturbances. There is evidence to suggest sufficient exercise and sleep can have a positive influence on cognition also. In this study, we explore:
physical activity levels sleep patterns,
of community dwelling people with dementia and explore the association they have on: cognitive functionquality of life.

Methods
Each individual was assigned a Withings-Go wrist-watch to wear over a period of 3 months which measured their: daily steps takentime in deep sleeptime in light sleep.total sleep each night
MMSE and DEM QoL were used to measure cognitive function and quality of life respectively. Assessed at: baseline & after 3 months. This data was coded and analysed using Microsoft Excel and SPSS.

Results
An RHO = 0.617 was detected between the DEMQoL scores and the mean steps taken over the last 5 days of data collection.
An RHO = -0.127 was detected between steps and sleep time which implied that as steps increased, sleep time was reduced with the opposite being applicable also. The average total sleep time for the sample was 08:03:00 (hh:mm:ss) while the average daily steps taken by the group was 3,266 steps.

Conclusion
People with dementia living in the community were found to be physically inactive. This study has displayed that increased levels of physical activity can show signs of an improved self-perceived quality of life. This study was a correlational study and causality was not investigated. The association we have identified may provide support and foundation for future studies that explore causal components.