bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Physiotherapy on Strength, Mobility and Balance in Older Adults Attending an Integrated Care Programme for Older Persons
Authors: Hassett Patricia , Ryan Eileen 
Published: September 2024

Abstract

Background
Physiotherapy has a significant impact on strength, mobility and balance in older adults but does the presence of frailty negate this? This study aimed to determine the benefit of a six-week physiotherapy intervention as part of an Integrated Care Programme for Older Persons (ICPOP) admission in frail older adults.

Methods
This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP between 2022 and 2024. All patients had a Clinical Frailty Score of 4-6. Each patient referred to physiotherapy had strength assessments including Five Times Sit to Stand (5TSTS) & Grip Strength Test, mobility assessment including Timed Up and Go (TUG) and balance assessment using the Mini BESTest. Patients with pre- and post-admission outcome measures were included in the study. Patients were offered individualised interventions of strength, mobility, and balance rehabilitation once per week for six weeks. Data was collected from a hospital clinical system using Microsoft Excel.

Results
82 patients were included in the data for 5TSTS with an average of 22.3 seconds pre physiotherapy intervention and 18.5 seconds post. 163 patients were included in the Grip Strength Test. Initial mean left/right grip strength was 17.0/18.9kg while final left/right grip strength was 18.2/20.2kg. 173 patients were included in TUG testing with an average of 23.1 seconds pre-physiotherapy and 16.9 seconds post. 41 patients were included in the balance data with mean score of 15.7 pre-physiotherapy intervention and 20.0 post.

Conclusion
Lower limb strength, mobility and balance had on average minimally clinical important differences (MCID) post physiotherapy intervention despite the presence of frailty. The MCID was not achieved for grip strength potentially reinforcing the appropriateness of grip strength as part of the frailty phenotype.
Audit Of Clinical Frailty Scale (CFS) Screening In Medical Assessment Unit (MAU) Admitted Patients In A Model-2 Hospital
Authors: Costello Ciara , Woulfe Cliona , Daly Siobhan , Jennings Emma 
Published: September 2024

Abstract

Background
This model-2 hospital serves a demographic where 1-in-3 MAU attendees are over 75-year-old. It has been shown that in those where frailty is identified and managed early, outcomes are better. This study audits the newly established frailty screening pathway to capture frailty data on patients from point of admission, commencing January 2024.

Methods
The Hospital Frailty Committee established a frailty screening pathway for all patients presenting to the MAU. Using the CFS and a bespoke sticker incorporated into the MAU booklets, patients ≥75 years old were routinely screened. In admitted patients, a CFS score of ≥ 6 triggers a referral to the Clinical Nurse Specialist (CNS) of the Older Adult. For discharged patients, a CFS score of ≥ 6 triggers referral to the public health nurse. We compared the completion of the bespoke sticker to number of onward received referrals to the CNS via electronic referral system. We measured i.) proportion of completed bespoke stickers; ii.) quality of sticker completion and iii.) proportion of appropriate triggered referrals (inpatients).

Results
We identified 34% (n=94) of 247 MAU attendees as meeting the criteria for frailty screening (age≥75) for which the MAU booklet was reviewed manually. A total of 81% (n=77) had a bespoke sticker in their documentation, 71% of which were completed (n=55). Of these 55, 72% (n=40) were admitted with a median CFS of 6 (Average 5.5). Of the 40, 57.5% (n=23) were referred and seen by the CNS, 35% (n=14) were not referred (appropriately), 2.5% (n=1) not referred who should have been and 5% (n=2) were referred but not seen.

Conclusion
Establishment of this pathway and subsequent audit highlights the high level of frailty in our patient cohort. In addition, 5% of admissions would have benefitted from CNS input, but didn’t get it, highlighting need to further expand and develop service.
Piloting a Joint Occupational Therapy and Physiotherapy Falls and Balance Group in an Acute Older Persons’ Ward
Authors: Ryan Ciara , O'Neill Alicia 
Published: September 2024

Abstract

Background
Approximately 1 in 5 older adults in Ireland experience recurrent falls. Consequences of falls include functional decline, fear of falling, reduced participation in activities, hospitalisation and mortality (TILDA, 2017). Increased prevalence of frailty and falls related admissions was identified on this acute older persons’ ward. Therapists found it increasingly difficult to provide comprehensive falls intervention given the ward’s quick turnover and increasing caseloads.

Methods
A joint occupational therapy and physiotherapy falls and balance group was piloted. Weekly once off group sessions were provided to patients over a two-month period. Inclusion criteria included patients who had/were at fear/risk of falling, and demonstrated the cognitive capacity to engage/attend to information in a group setting. Clinical indicators included Timed Up and Go (TUG), Clinical Frailty Scale (CFS), and the PRISMA 7. The group consisted of an educational and practical component including elements from the Otago Exercise Programme (OEP). Qualitative participant feedback was gathered post group attendance and qualitative descriptive analysis was used for evaluation.

Results
A total of 35 patients attended this group over the two-month pilot period. Participants’ mean age was 79 years, with 54.3% being female. 80% had a history of falling. 63% were living with mild to moderate frailty (CFS 4-6) with an average TUG time of 19.3 seconds. An open-ended questionnaire highlighted that 31 participants found the group beneficial with 68.6% valuing the peer support element. 94.2% found their knowledge on falls prevention increased, with 77.1% commenting on their increased awareness of the importance of regular physical activity in falls prevention.

Conclusion
This intervention successfully increased the quality of falls intervention provided on this acute older persons’ ward and effectively increased participants’ awareness/knowledge of falls intervention. It was feasible to deliver this group on an acute ward within existing therapy resources.
CARotenoid and Parkinson’s Disease Severity study (CARPS) – Preliminary results from a Pilot Study
Authors: O'Donoghue Alice , O'Gorman Millie , Nugent Michael , Power Tommy , Nolan John , Cooke John , Mulcahy Ríona 
Published: September 2024

Abstract

Background
Carotenoids are naturally occurring anti-oxidants that give fruit and vegetables their bright colour. Skin carotenoid score (SCS) gives total carotenoid-levels in the body and corresponds well to blood carotenoid-levels. Studies have shown blood carotenoid-levels are low in individuals with Alzheimer’s disease compared with controls. CARPS exams the relationship between carotenoids and Idiopathic Parkinson’s Disease (IPD) by measuring carotenoids in the skin and blood of individuals with IPD vs. controls.

Methods
Cross-sectional, case-control study with age-matched controls. Recruitment commenced January 2024. Case-subjects must have IPD and attend the hospital movement-disorder clinic. Control-subjects are spouse/care-partners of IPD-patients. Exclusion criteria: other forms of PD, Dementia, taking anti-oxidant supplements. Data collected: demographic information, medical history, BMI, frailty assessment. IPD severity assessed using UPDRS. Carotenoid-specific food frequency questionnaire (FFQ) to assess dietary intake. Data was inputted to excel and exported to SPSS.

Results
41 IPD-cases (23 Men, 16 Women) and 12 controls (8 Men, 4 Women) have been recruited to-date. 9/12 controls are spouses of an IPD-participant. Mean age of IPD-cases vs control: 76.1 vs. 74.5. Mean UPDRS score for IPD-cases: 28.02. The skin carotenoid score (SCS) was low in both groups, with a score &gt;400 being within normal range. Mean SCS was lower in the IPD-cases compared to controls: 282.61 vs. 320.58. The IPD cohort are slightly frailer compared to the controls, with higher median-CFS: 3 vs. 1. Mean BMI was similar in both groups. Analysis of blood samples and FFQ is due to take place at a later date.

Conclusion
Early results suggest a trend towards lower SCS scores in the IPD cohort, with an interesting trend towards higher SCS scores in spouse-controls vs. their IPD partners, despite similar food intake. CARPS recruitment is ongoing with further analysis of blood-carotenoids and FFQ required to determine if the link between IPD severity and reduced carotenoid-levels is statistically significant.
Does an Inpatient Rehabilitation Admission Via the Community Prevent Hospital Readmissions in Older Adults? An Integrated Care Initiative
Authors: Campbell Claire , Martin Ruth 
Published: September 2024

Abstract

Background
Rehabilitation interventions are essential in supporting frail older adult’s recovery following periods of decompensation and preventing future hospitalizations. Previously patients (age &gt; 65 years) could only access inpatient rehabilitation via an inpatient stay in an acute hospital. Within the ICT (Integrated Care Team) in Dublin North West (DNW) a community rehabilitation pathway to two inpatient rehabilitation units exists. We retrospectively evaluated patients that were admitted to rehabilitation units via this pathway and measured their 90-day readmission rate to their local acute hospital.

Methods
17 referrals were received from three pathways: Primary Care, the Holly Day clinic and the Frailty Intervention Team (FITT). Clinical frailty score’s (CFS), Falls risk (as per the world falls guidelines) and sarcopenia status as per the European Consensus on the definition of sarcopenia (EWGSOP) were recorded prior to admission. Readmissions within 90 days were collected from the hospital electronic database.

Results
CFS scores ranged from 5 to 7. All patients were identified as a high risk of falls and sarcopenic. The 90-day readmission rate was 11%. 5.5% of these were due to falls and the other 5.5% was due to the exacerbation of a pre-existing condition. All had CFS score of &gt;6.

Conclusion
Readmission to acute care is not common in our patient cohort and shows the involvement of the ICT Geriatrician and Physiotherapist in identifying and referring frail older adults for inpatient rehab is successful. Ongoing development of interagency pathways and further referrals is needed to further progress this pathway and measure its efficacy in preventing readmission to an acute hospital. A 90 day and 180 day follow up and falls risk outcome measure pre and post admission would further demonstrate the success of this initiative and help measure the efficacy of this initiative in reducing the risk of preventable hospitalizations in older adults.
Enhancing Care For Nursing Home Residents Through A Specialised Geriatrician-led Acute Care Team
Authors: Noonan Claire , Davey Naomi , Farrelly Angelina , Soh Josephine 
Published: September 2024

Abstract

Background
Nursing home residents (NHRs) represent one of the most vulnerable groups of older adults, requiring complex and comprehensive care due to their multiple comorbidities and intricate healthcare needs. The establishment of a specialised Geriatrician-led Acute Care Team specifically for NHRs can provide better clinical outcomes over traditional care models. These services are designed to address the unique needs of this population, providing appropriate treatment in settings conducive to their well-being and aiming to mitigate adverse consequences associated with unnecessary hospitalizations.

Methods
In 2023, 343 NHRs were admitted to acute care via Emergency Department in a University Teaching Hospital. Of these, 227 (66%) were admitted under the care of this specialized geriatrician-led team, with an average length of stay of 7 days, totalling 376 bed days, and a readmission rate of 15%. In contrast, 112 NHRs admitted under other non-medical services (surgical specialities) had an average length of stay of 9 days, totalling 849 bed days, and a readmission rate of 11%.

Results
The primary advantage of this specialist team lies in the personalized attention and expertise provided by gerontologically attuned practitioners. These professionals have a profound understanding of age-related changes, complex health conditions, and psychosocial aspects affecting older adults. By tailoring care plans to individual needs and preferences, they optimize treatment outcomes and enhance quality of life for NHRs.

Conclusion
In conclusion, the establishment of a specialised acute care team specifically for NHRs represents a significant advancement in addressing the complex needs of this cohort. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centred care approaches, these services offer a holistic and tailored solution to improve outcomes and enhance the quality of life for this vulnerable population. Continued investment in developing and expanding such services is crucial for advancing care standards for older adults and promoting a more age-friendly healthcare system.
An Audit On Minimising Unnecessary Catheter Use In An Older Population Attending The Emergency Department
Authors: Gargan Daire , Jubril-Raji Omotayo , O'Rourke Kevin , McCabe Aileen 
Published: September 2024

Abstract

Background
Catheter-associated urinary tract infections (CAUTI) pose a great risk of morbidity and mortality to our older population. It is estimated that around 20% of patients admitted to hospital receive an indwelling catheter at some point. Each day that a catheter is in situ increases the risk of urinary tract infection by 5 %. Inappropriate placement of catheters in this population poses an unnecessary and significant risk. Many catheters are inserted in the Emergency Department in older patients, and we wanted to find out if these urinary catheters were inserted in accordance with best practice guidelines.

Methods
An audit was conducted to look at indwelling catheter use in a cohort of patients over 75 years of age who presented to the Emergency Department of a tertiary hospital over a two-week period in November 2023. Using the software Symphony patient records and Emergency Department physician notes were accessed to look at the following: age, whether catheter insertion was consistent with current best practice evidence, whether the indication for catheter insertion was documented and whether the catheter was removed while in the emergency department. Patients who had long term catheters were also included.

Results
We included 22 patients in this audit (n=22)- median age was 81 (range 75-90); 11 were male (50%) and 20 had urinary catheterisation consistent with best practice guidelines (91%). 8 patients had clear documentation of indication for the catheter (36%), while no patients had their catheter removed whilst in the emergency department (0%).

Conclusion
The vast majority of patients had an appropriate indication for urinary catheterisation however clear documentation of a physician order for the urinary catheter was lacking in over half of the cases. A guideline was created showing clear indications for urinary catheterisation in this population and an education session with medical and nursing staff is planned prior to re-auditing.
Introduction of Geriatric Medicine Multidisciplinary Service to Emergency Department
Authors: Merron Georgia , Brolly Amanda , Maher Mairin , O'Carroll Susan , Brick Jacqueline , Randles Mary 
Published: September 2024

Abstract

Background
Ireland has an ageing demographic with a significant community dwelling population living with frailty. Identification of frailty at the hospital front door via a Geriatric Emergency Multidisciplinary Service (GEMS) was expanded in October 2023 with the aim to trigger early comprehensive geriatric assessment (CGA) in the Emergency Department (ED)and to ensure that older people with frailty are diverted to the most appropriate services as quickly as possible and, where appropriate, discharged home on the same day.

Methods
Using Plan Do Study Act (PDSA) cycle framework a screening pathway for all over 75-year-olds who present to ED was established. The service provides screening for frailty and delirium (using 4AT) in the ED with high clinical frailty scores (CFS) or requiring specialist input were selected for CGA. Information was collected on all patients on admission and data was also collected on discharge destination and readmission rates.

Results
1308 patients were reviewed since introduction with average age 82.3 years (68-101). 63.6% (832) patients had CGA and 36.4% (476) were screened. Of those who did not have a CGA, 46.1% (185) were not frail with CFS 3 or less. Average CFS was 4.84 and average 4AT score was 2. 46.7% (611) of patients reviewed were discharged from ED with discharge rates increasing from 40.9% (93) in November 2023 to 49.5% (104) in April 2024 and 28-day readmission rates decreasing from 6.87% in April 2023 to 5.98% in March 2024.

Conclusion
This quality improvement project highlights the impact of GEMS in the ED in reducing admission rates and readmissions. Ongoing areas for improvement include expanding the service to review all patients identified with frailty where possible, and in the future establishing pathways for improved access to community services/supports to further reduce readmission rates and to capture the impact on length of stay.
Improving Delirium Care: A Retrospective Audit of Early Detection and Management Practices
Authors: Devlin Kate , McGreal-Bellone Aimee 
Published: September 2024

Abstract

Background
Delirium, an acute change in cognition, consciousness, attention, and perception, is prevalent among older adults in hospitals. Patients with delirium experience longer hospital stays, higher fall risks, increased mortality, and greater care needs upon discharge. However, delirium is under-recognized, with up to 50% of cases missed. With an aging population, the need for improved delirium recognition and management is critical.

Methods
We conducted a retrospective audit on the charts of 47 patients over the age of 65 on two General Medical Wards at an Irish Model 3 hospital. We assessed medical admission proformas and notes to evaluate delirium recognition and management within the first 24 hours. The audit measured compliance with the 4AT cognitive screening tool, documentation of delirium and risk factors, non-pharmacological management, and antipsychotic use against HSE National Guidelines. Data was analysed in Excel.

Results
47 patients with a median age of 80 years, 51% (n=24) male and 49% (n=23) female, were captured. Cognitive screening within 24 hours was performed in 34% (n=16) of patients, with 75% (n=12) showing abnormal results. Delirium was documented in 8.5% (n=4) of patients, and 50% (n=2) of these had a 4AT score recorded. 15% (n=7) were prescribed new antipsychotics within 24 hours, with 57% (n=4) lacking a formal delirium diagnosis.

Conclusion
This audit reveals deficiencies in initial cognitive screening and delirium recognition among high-risk patients. Only 8.5% of the cohort was identified with delirium compared to national statistics that suggest up to 31% of older patients are affected upon admission. Compliance with cognitive screening and diagnostic tool use was poor. Antipsychotic prescribing without a documented delirium diagnosis was prevalent, highlighting the need for improved diagnostic accuracy and non-pharmacological management. We plan to introduce a “Delirium Tool” for 4AT assessments and “PINCH-ME” risk-factors, alongside regular education sessions. A re-audit will measure improvements in care and outcomes.
Identification of the Needs of Patients ≥ 75 Years Admitted to an Acute Hospital
Authors: McCarthy Gemma , DeFoubert Marguerite , Dukelow Tim , Curtin Denis , Daly Bart 
Published: September 2024

Abstract

Background
More than 30% of older people are discharged with new or additional disability following an acute hospital admission.1, 2 Older adults who are frail experience even higher levels of hospital-associated disability.3 For patients who experience hospital-associated disability, fewer than half will recover to their pre-illness level of functioning after 1 year and rates of death and nursing home placement are high.4 The economic consequences of hospital-associated disability are longer hospital length-of stay, increased rates of re-admission after discharge, an increased requirement for home care packages and long-term residential care beds.

Methods
An observational study was undertaken to determine the profile and needs of adults ≥75 years admitted to an acute hospital. Medical records were reviewed by two advanced nurse practitioners on day 1 of admission. From January 8th -22nd 2024, 352 hospital admission episodes were reviewed.

Objectives

Results

Conclusion
In conclusion, the results highlighted a need for
1. An increase in beds available in a Specialist Geriatric ward
2. A greater awareness at ED level of admitting specialty
3. An increase in the number of beds to be made available such as rehabilitation beds to facilitate early discharge from the acute hospital.
Amplifying Influence: Unveiling the Dynamic Role of Speech and Language Therapists within ICPOP Specialist Community Teams across Ireland
Authors: O'Gara Justyne 
Published: September 2024

Abstract

Background
Integrated Care Programme for Older People (ICPOP) provide services for people with complex needs requiring specialist community multidisciplinary assessment and intervention. This national programme aims to shift care from hospitals, toward communities. As of October 2023, 23 of 30 planned ICPOP teams have been established (Butler, 2023). The Irish Association for Speech and Language Therapists, recommend speech and language therapists (SLT) be included on all frailty intervention teams across all service areas, ensuring equal access regardless of geographical area. Currently 10 ICPOP teams have an SLT in post. The contribution of SLT within these teams remains unstudied. Understanding the role of SLTs within ICPOP, exploring similarities and differences, is essential for informing professional clinical guidelines and practice.

Methods
This study utilised an anonymous, non-experimental, cross-sectional survey design. The survey design incorporated the Tailored Research Method to enhance response rates. Survey Monkey (http://www.surveymonkey. com) was used to create and disseminate the open survey. All SLTs working on ICPOP teams were invited to participate.

Results
Findings highlight the diverse roles and responsibilities of SLTs within ICPOP. While some commonalities were observed in services provided by SLTs, such as dysphagia assessment and communication support, variations existed based on team location, setting, and individual professional experience. The majority of SLTs participated in non SLT specific activities such as triaging, conducting assessments and administrative duties. Rural SLTs faced challenges related to resources and coordination of care. Urban SLTs had greater access to specialist instrumental assessments.

Conclusion
This study underscores the importance of recognising and addressing the varied roles of SLTs within ICPOP teams to guide professional guidelines and promote consistency. By understanding the unique challenges and opportunities faced by SLTs in different geographical and organisational contexts, policymakers and healthcare leaders can better support professionals to meet the diverse needs of older individuals across Ireland.