bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Supported Discharge for Older Adults Admitted to Hospital after Orthopaedic Surgery: A Systematic Review and Meta-Analysis
Authors: Williams Susan , Griffin Anne , O'Riordan Clíona , Morrissey Ann-Marie , Galvin Rose 
Published: September 2024

Abstract

Background
Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints.

Methods
A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used, and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1.

Results
Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%, P &lt; 0.00001). No statistically significant effects favouring ESD interventions were established in secondary outcomes.

Conclusion
In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.
Malnutrition Risk Screening and Dietitian Intervention within an Integrated Care Team for Older Persons
Authors: Knox Sinead 
Published: September 2024

Abstract

Background
Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision.

Methods
Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition.

Results
The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia.

Conclusion
Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.
Retracted: Implementation Of A Specialist Geriatric Ward; Outcomes One Year After Inception
Authors: Conlon Chloe , Robinson Stephanie , Small Cliona 
Published: September 2024

Abstract

Background
Older adults being admitted to an acute hospital setting have care needs that would benefit from coordinated care on a Specialist Geriatric Ward (SGW). Prior to May 2023, older patients admitted to our institution received input from geriatric medicine through a variety of avenues. There was a clear need for dedicated and formal access to specialist geriatric services. It was hypothesised that care delivered on a SGW would improve patient access to the Right Care, in the Right Place at the Right Time. It has long been recognised in the literature that a dedicated SGW with appropriate access to Health and Social Care Professionals is the gold standard of care for older adults admitted to the acute setting.

Methods
An evidence based SGW was designed and implemented in May 2023. This consisted of a 32-bed dementia and delirium friendly ward, staffed with a consultant geriatrician, medical team, frailty and dementia Clinical Nurse Specialists, a multidisciplinary team and a dedicated patient flow lead for older persons. Ingress pathways to the ward included emergency department medical admissions, Frailty at the Front door referrals and patients selected from geriatric medicine consults. Egress pathways availed of included offsite rehabilitation, rehabilitation at home services and integrated care team input. All patients received early discharge planning and a comprehensive geriatric assessment was initiated on admission to the ward. Key performance indicators included length of stay (LoS), reduction in “Safari Rounds” which improves Clinician/Patient contact, daily whiteboard rounds, improved predicted discharge date (PDD) compliance. Data and outcomes were reviewed weekly.

Results
After one year, the SGW demonstrated improvements across all metrics with percentage cohorted patients improving by 24% and both average and median LoS reduce by 19 days. Total number of bed days saved was 1,513.

Conclusion
Multidisciplinary care delivered on a SGW improves patient and service outcomes.
What Are the Perspectives and Experiences of Older Adults of Existing Integrated Care Services in the Mid-West Region of Ireland?
Authors: Condon Brian , Manning Molly , Fitzgerald Christine , Hayes Christina , Griffin Anne , Galvin Rose , Robinson Katie 
Published: September 2024

Abstract

Background
Substantial investment has been provided by the HSE in the form of The Integrated Care Programme for Older People (ICPOP) Community Specialist Teams (CSTs) for older people. These teams aim to provide timely specialist multi-disciplinary assessment and intervention to help maintain older adults’ independence and ability to live well at home. Little is known about older adult’s views or experiences of this service. This study aimed to resolve this research gap by exploring older adults’ experiences of CSTs within the Irish Healthcare context.

Methods
A qualitative descriptive research design was employed to explore this research area and a semi structured topic guide was developed. Purposive non-probability sampling was used to recruit 13 older adults who had completed intervention with the CSTs. Individual semi-structured interviews were completed with each participant and were transcribed verbatim. A reflexive approach to thematic analysis was used to guide analysis of the generated data.

Results
Four themes were identified, older people had limited knowledge of the service and experienced accessibility issues in attending CST within a HUB setting (Theme 1). Older people experienced positive and co-ordinated care by CST (Theme 2). Older people described that they valued the self-management education and support from attending CST that enabled to manage their long-term conditions effectively and maintain their independence (Theme 3). Once discharged from CST older people described positive emotional and physiological impact of CST that enabled them to be more confident to manage daily life at home (Theme 4).

Conclusion
It was evident from the data that CST had a positive impact on supporting older people to remain independent at home and increased their confidence in self- management of their long-term conditions. Further research would be beneficial to address ways to improve the delivery of care for the complex needs older persons within CSTs as they describe accessibility issues in attending the service.
Taking the Piss? Using Lean to Review the Process for Provision & Delivery of Continence Disposable Products
Authors: Doyle Cathy , Shé Éidín Ní 
Published: September 2024

Abstract

Background
Urinary incontinence (UI) is the unintentional passing of urine. Its impact on older people varies from a diminished quality of life, to social isolation and frailty. Pads or diapers are commonly employed tools in the care of older people with incontinence. Incontinence is largely underreported and poorly managed among older people in community care settings (Yan et al., 2022). This work reviews the process map of the provision and delivery of continence disposable products in the community by the Health Service Executive in Ireland.

Methods
Lean is a quality improvement approach that consists of the elimination of waste to improve the flow of people, information or goods. We reviewed the process map baseline assessment; captured steps that added value to the patient and the impact on staff in the community.

Results
The initial assessment tool consists of five pages. There are 28 possible steps presented in the process map. There is a gap in the presentation on connectors to associated processes. Eight people are involved in the ordering, approval and delivery process to the older person. The initial assessment and education add value to the patient. If adverse skin or complaints arise an older person can be referred to a continence advisor or the ADPHN. The patient feedback loop is missing following delivery no check-in for education is provided following initial use. Unclear who is the point of contact for the patient to raise issues. The only noted key performance indicator is the processing of a request to order is inputted in one working day. Objectives are not SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound.)

Conclusion
Further in-depth research is required to review if the right staff are making the approvals. Need to review KPIs throughout to improve process and SMART objectives. Perspectives of older people and GP supports require further investigation.
Advancing Loneliness as a National Health Priority: Results of a Multisectoral Roundtable
Authors: Power Joanna McHugh , O'Reilly Aileen , Homeniuk Robyn 
Published: September 2024

Abstract

Background
Ireland has the highest rates of loneliness of all EU countries. Those in the older old category (aged 80+) are at increased risk of developing loneliness, which is in turn a risk factor for many adverse health outcomes. Ireland has a strong tradition of Irish gerontological loneliness research, and it is critical to now know how best to focus research efforts to mitigate the impact of loneliness on older adults.

Methods
We held a roundtable discussion on priorities in Irish loneliness research at the Loneliness Taskforce Research Network inaugural event on 16th April 2024. 75 attendees were present, including those from non-governmental organisations, health and social care professionals, experts by lived experience, academic experts, researchers, and representatives from the private sector and governmental agencies. Of seven tables discussing loneliness research priorities, two tables were devoted to the discussion of priorities in research on loneliness in older people (with 18 participants in total). The priorities were noted, then amalgamated and organised.

Results
There was considerable heterogeneity in priorities raised, with little overlap across the two roundtable outputs. Of particular note was the need to evaluate the many services being delivered across Ireland to reduce loneliness, which operate without an evidence base. Other priorities included:

Conclusion
Results are informative for those planning future research on loneliness among older adults in Ireland and will form the basis for a report from the Loneliness Taskforce to the Irish Government, who have pledged funding for alleviation of loneliness.
Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention
Authors: Dunne Aoife , Campbell Claire , Quinn Laura , Murphy Carole , John Shalini , Reilly Amy , Digan Eimear , Martin Ruth 
Published: September 2024

Abstract

Background
The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home.

Methods
The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out.

Results
From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate.

Conclusion
Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.
“What Matters To Me?” Responses from Older People in the Acute Setting
Authors: Toole Diane O , Berry Mary , Bracken Marian , Farrelly Alice 
Published: September 2024

Abstract

Background
The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject.

Methods
The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs.

Results
A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7.

Conclusion
“What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.
Stepping Stones to Simulation
Authors: Feeney Sara , Monahan Cathy , Dsouza Archana 
Published: September 2024

Abstract

Background
The authors are part of the education and training (E&T) team in the older person directorate. They noted a large influx of new staff and also wanted to develop the learning needs of current staff. This highlighted a need for staff development.
Simulation:
Aims:

Methods

Results

Conclusion
Day Centre Functional Physiotherapy Classes for Older People; Client Survey
Authors: MacDonagh Eugene , Lordan Ruth , Hogan Florence Horsman 
Published: September 2024

Abstract

Background
Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence.

Methods
This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&gt; 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&gt; 65 years)

Results
70% response rate. 100% reported feeling comfortable asking Physio instructor questions & that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported &gt; 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes.

Conclusion
Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.
Exploring Allied Health Professionals’ Perceptions and Practice Regarding Recommendations for Intensity of Multidisciplinary Therapy for Stroke Patients: A Qualitative Study
Authors: Foley Gemma , Horgan Frances , Galvin Rose 
Published: September 2024

Abstract

Background
Stroke is a leading cause of death and disability in Ireland; approximately 7,500 Irish people have a stroke every year. Rehabilitation is a key aspect of stroke care; greater amounts of therapy are associated with better recovery. Data from the Irish National Office of Clinical Audit shows that stroke survivors often do not receive recommended amounts of therapy. The recently updated UK and Ireland stroke clinical guidelines now recommend larger amounts of therapy time. This qualitative study explored how allied health professionals (AHPs) feel about the recommendation, and what methods they employ in working to achieve recommended amounts of therapy.

Methods
This study used a qualitative research design employing semi-structured interviews to collect data. Participants were AHPs working in stroke care in Dublin, Ireland, and were recruited using a combination of purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using the Braun and Clarke six-step thematic analysis method. An external validator was utilised for code and theme validation. This research was approved by the Royal College of Surgeons in Ireland Research Ethics committee.

Results
Two main themes emerged: ‘Barriers and enablers to achieving guideline recommended therapy time’ and ‘methods of increasing therapeutic time’. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Therapy assistants play an important role in achieving greater amounts of therapy.

Conclusion
AHPs see the new recommendation as challenging but are generally keen to try and achieve it, citing benefits of increased therapy time for patient outcomes. AHPs utilise a wide range of methods to optimise therapeutic time for stroke patients. The role of therapy assistants in supporting delivery of larger amounts of therapy time warrants further evaluation.
An Evaluation Of Social Work Facilitated Peer Support Groupwork With Older Adult Inpatients In Orthopaedic Rehabilitation
Authors: Walsh Mary , Moran Fionnuala , Ward Andrea , O'Connor Marie 
Published: September 2024

Abstract

Background
Social work psychosocial assessments highlighted an elevated prevalence of patients experiencing low mood, isolation, and the impact of their hospital admission. Groupwork is an effective evidenced based social work tool. As psychological factors can impact acute and longer-term recovery, peer support groupwork was piloted to address these issues. This research aims to determine the success of the inclusion of social work facilitated peer support groupwork within the orthopaedic geriatric rehabilitation setting.

Methods
One pilot and three peer support groupwork sessions were held with 4-6 participants per group. Patients were identified with support from multidisciplinary team colleagues. Patients were over 65 years of age, medically stable and were an inpatient on the orthopaedic rehabilitation ward without any contraindications to attendance. A patient led thematic approach informed each session. Structured feedback forms were given to all participants which provided both quantitative and qualitative data.

Results
100% of patients found that peer support groupwork was a beneficial addition to orthopaedic rehabilitation. Patients recognised the benefit of sharing their experiences and emotions with one another. 95% of patients said that they would reattend and many recognised the motivating influence of this forum. 17 out of 19 patients found that the peer support groupwork directly improved their mood. An incidental finding determined a better understanding of the patient and assisted social workers in identifying patients who required more focused holistic support.

Conclusion
Social work facilitated peer support groupwork assists in motivating and improving the mood of older adults engaging with inpatient orthopaedic rehabilitation. It was a resource efficient method which improved the psychological factors experienced by older adults in this setting. The patient led approach and careful consideration and planning generated the groups’ success. This approach has numerous benefits to the overall patient experience and has scope to be utilised within other gerontological settings.