bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Serum Albumin And Lower Limb Ultrasound Muscle Thickness in Older Patients Admitted with Hip Fracture
Authors: Perez Gomez , Serrano Elodia Teresa Bernabeu , Villalobos Yasling Akintui , Montero Maria Cruz Macias , Ortuno Roman Romero , Tagarro Pilar Del Pozo , Diaz Maria Teresa Guerrero , Gutierrez Elena Ridruejo , Pascual Angelica Munoz , Alegre Pilar Tajada , Robles Victoria Villalta , Gomez Juanjose Diez , Iglesias Pedro 
Published: September 2024

Abstract

Background
Sarcopenia is an important geriatric syndrome that is common in older patients admitted to the hospital with hip fracture. Nutritional status is known to be associated with sarcopenia in the general population, but less is known about this association in hospitalised hip fracture patients, especially when considering biochemical nutritional biomarkers. Our aim was to contribute evidence in this regard.

Methods
We recruited patients over the age of 75 years admitted to a hospital with hip fracture. During admission, we measured muscle thickness (MT) of the rectus femoris (contralateral to the fracture) using ultrasonography (Sonosite M-Turbo). All patients had serum albumin measured on admission, and in a subsample we were able to measure body mass index (BMI). We performed bivariate correlation between serum albumin and MT, and linear regression models were computed to assess how MT was predicted by albumin, controlling for age, sex, and BMI.

Results
69 patients were recruited, mean age 87.8 years (SD 6.3; minimum 76, maximum 103), and 79.7% were women. Mean MT was 1.19 cm (SD 0.36). Serum albumin was available in 68 patients (mean 3.30 g/dl, SD 0.36), and BMI was available in 41 patients (mean 25.4 kg/m2, SD 4.0). The correlation between serum albumin and MT was statistically significant (Pearson’s coefficient = 0.263, p = 0.030). After controlling for age and sex in n = 68, albumin was the only significant predictor of MT (Beta = 0.275, p = 0.036). When adding BMI to the model in n = 41, albumin was the only significant predictor of MT (Beta = 0.364, p = 0.026).

Conclusion
Serum albumin was independently predictive of MT in hospitalised hip fracture patients. Serum albumin may be a useful biochemical nutritional biomarker of risk of sarcopenia in this population, and further research is required to confirm this biologically plausible observation.
Answering an “SOS”: A 12-Month Review of An Urban Pathfinder Service
Authors: Madden Romy , McInerney Emer , Dunleavy Niall , McLoughlin Ruairi , Baldrick Damien , McElwaine Paul 
Published: September 2024

Abstract

Background
The Pathfinder service is a collaboration between the National Ambulance Service (NAS) and acute hospital Physiotherapists (PT) and Occupational Therapists (OT). The service aims to safely treat over-65s who have called 999 with low-acuity problems at home. It offers safe alternative care pathways to traditional Emergency Department (ED) attendance to older adults within our hospital catchment area (Bernard et al. 2021).

Methods
A retrospective review of the service database for 2023 was completed. A patient experience survey was conducted over a 4-week period in Quarter 4 of 2023. The survey consisted of both Likert scale and open-ended questions. Service statistics and Likert data were analysed in Microsoft Excel, while open-ended responses were analysed thematically.

Results
A total of 598 calls were received by our Pathfinder service in 2023: live 999 calls (n=407), and “Special Services” (SS) calls from Dublin Fire Brigade (n=191). 55% of live 999 call referrals attended by Pathfinder were safely kept at home. Of 191 SS referrals, 35% (n=66) had a review by the Pathfinder team. Of the 66 assessed, 94% (n=62) were safely kept at home. A total of 1,392 follow-up interventions (home visits, phone calls, onward referrals) were completed by PT and OT. Service user feedback was overwhelmingly positive, with 100% (n=20) of respondents stating they would be happy to see the Pathfinder team again if calling 999. General feedback highlighted the responsiveness, thorough assessment, and friendliness and professionalism of the team. Areas for development included increasing staffing and increasing to a 7-day service.

Conclusion
The Pathfinder service is effective in an urban setting. Over a 12-month period, 55% of patients assessed by Pathfinder were safely treated at home, with follow-up support from Pathfinder PT and OT. Service users report positive experiences and would be happy to see the team in the future when calling 999.
Implementation of INEWS to Improve Patient Outcomes in a Community Hospital
Authors: Joseph Beena , Salomon Mary Mae 
Published: September 2024

Abstract

Background
It is imperative to identify at risk older patients with clinical deterioration as soon as possible. The Irish National Early Warning System (INEWS)1 is used to detect clinical deterioration at an early stage based on each patient's vital sign records. It can then initiate a communication mechanism between nurses and doctors to enable early patient care. Data on the effectiveness of the INEWS in patients admitted to community rehabilitation wards, the barriers and difficulties encountered during implementation, are still scarce, despite the development and implementation in acute settings. There are not enough standardised tool available to identify patients' deterioration for community hospitals.

Methods
This pilot quality improvement programme was conducted in a community hospital's rehabilitation section. Data were gathered seven weeks after the deployment of INEWS and fourteen weeks before. Issues were studied to determine the underlying cause, created a driver diagram to comprehend the factors that lead to unexpected outcomes, educated and gathered feedback from the clinical care teams involved, measured adherence to the INEWS during the six-week pilot project implementation period, and assessed results by looking back at the deteriorating patient data and INEWS compliance using Plan, Do, Study, Act cycles.

Results
During the pre-INEWS introduction phase (14 weeks), there were 11.9 events per week (7.8 events with infection or septic workups, 9.6 events with onsite management, 1.0 acute care transfers, 0.28 per week unexpected deaths). In the post-INEWS piloting phase (6 weeks), there were 3.6 events per week (2.5 infection or septic workup, 1.8 onsite management and 1.1 acute care transfers per week with no unexpected deaths).

Conclusion
Conclusion Early detection and rapid management through the INEWS can enhance patient care; however, increased stakeholder engagement in escalation response may enhance patient outcome in resource limited community setting.

Reference
https://www2.healthservice.hse.ie/organisation/qps-improvement/deteriorating-patient-improvement-programme-partnership-dpipp/
Risk and Resistance: Ageing in the Charity Retail Sector
Authors: Kelly Siobhán 
Published: September 2024

Abstract

Background
Charity shops have long been found to promote sociability, nurture experiences of belonging and act as spaces for community, caring and well-being. Older people remain likely to participate in this setting and charity shop volunteering is typically associated with events of positive ageing. However, the sector's growing emphasis on professionalism and profit raises questions about the potential impact of organisational change on this group. This research seeks to address this gap by exploring how older volunteers experience their roles within the evolving context of the modern UK charity shop.

Methods
This PhD study employed an ethnographic approach, involving 268 hours of immersive fieldwork across 3 charity shops in Greater Manchester. Ethnographic data was complemented by 17 semi-structured interviews with volunteers and store managers.

Results
Ageist discourses have been embedded into the sector, which work to reconstitute older volunteers as a type of ‘risky subject'. Such discourses manifest in unique ways on the charity shop floor and comprise of a range of practices, both subtle and overt, that are driven by the organisations focus on an intensified form of productivity. This prompts diverse forms of resistance from older volunteers, which are underpinned by the aim to not only counter negative perceptions of ageing but be just ‘visible’ enough in order to get by.

Conclusion
This paper unpacks the multifaceted nature of ageism in the charity retail sector. Whilst it is not as simple as suggesting that charity shops are solely characterised by ageism - especially considering the volunteer experience varies considerably across different contexts and places - age-related tensions are nonetheless more prevalent in the everyday. Older volunteers are not passive in the face of such change and continually work to avoid exclusion and remain integrated in this space in diverse ways.
Chronic Kidney Disease and Frailty: Insights from a Cross-Sectional Study in Older Adults
Authors: Rasheed Mujahid , Sayers Karen , King Lorna , Maher Jennifer , Ryan Siobhan , Donnellan Christina 
Published: September 2024

Abstract

Background
Chronic Kidney Disease (CKD) and frailty are prevalent conditions among older adults, contributing to increased healthcare utilisation and adverse outcomes. The aim of this study was to examine CKD prevalence and associated factors in older adults attending a Community Specialist Team (CST) for older persons for Comprehensive Geriatric Assessment (CGA).

Methods
A cross-sectional study was conducted of all adults aged ≥65 years who had a CGA from October 2023 to March 2024. Variables recorded on an Excel spreadsheet included age, gender, Clinical Frailty Scale (CFS) score, Modified Barthel Index (mBI), presence of probable sarcopenia, Malnutrition Screening Tool (MST) and Dementia Screening Interview (AD8) outcomes. CKD was defined as estimated Glomerular Filtration Rate (eGFR) &lt;60ml/min/1.73m2. The presence of frailty was defined as CFS ≥4. Functional impairment was defined by mBI&lt;15 and MST ≥2 defined malnutrition risk. Regression analysis was used to identify associations.

Results
Ninety-one patients, 59 (64.8%) female and 32 (35.2%) male, with a mean age of 81.83 (SD=7.19) years were included. The prevalence of frailty was 90% (n=82) and of CKD was 53.8% (n=49). Age was a significant predictor of CKD and with each additional year, the odds of having CKD increased by 10% (p=0.004). Twelve (24.5%) of the CKD group had MST ≥2 compared with 17 (40.5%) without CKD (p=0.120). The odds of having probable sarcopenia was non-significantly higher (OR=1.09, p=0.8444) in CKD compared to without CKD. The odds of a positive AD8 was also non-significantly higher (OR=1.24, p=0.605) in CKD compared with no CKD. There was no difference in prevalence of functional impairment between the 2 groups (p=0.466).

Conclusion
CKD is common chronic condition in frail older persons referred to a CST. It is frequently unrecognised. Identification of CKD through CGA should facilitate an integrated interdisciplinary approach to care which may contribute to better overall health and quality of life.
Treatment Escalation Plans: A Snapshot Review on Acute Medical Wards
Authors: Marks Eleanor , Khan Salman , Riaz Filza , Buckley Mary , Rahim Mohamed Faizan 
Published: September 2024

Abstract

Background
In medical care, Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders serve as vital tools in determining whether CPR should be administered to patients, particularly those with progressive life-limiting illnesses or approaching the end of life. Failure to make timely and appropriate CPR-related decisions and treatment escalation plans can lead to the risk of administering futile or inappropriate treatments.

Methods
Admission booklets in our centre prompt clinicians to indicate whether a patient was for CPR or not as part of the admission process, with further instructions to fill out a DNA CPR form if applicable. We conducted a chart review on acute medical wards to assess the frequency and adequacy of DNA CPR decision-making and communication. Data was collected by three investigators on a structured proforma and anonymised. Data analysis was conducted using Excel.

Results
Data was collected on 67 patients, with a mean age of 76.6. Of those 67, only six had CPR status indicated on admission, with five specified for resuscitation and one not for resuscitation. A total of 14 patients went on to have DNA CPR forms filled out during admission, but in only five cases were these decisions discussed with the patients themselves. The main reasons for lack of patient involvement in the discussions included confusion and cognitive impairment. Documentation regarding discussions with next of kin was present in eight cases.

Conclusion
Our snapshot review underscores the importance of early discussions regarding treatment escalation plans and DNA CPR decisions. Our findings reveal that these discussions are not occurring as frequently as advised, and when decisions are made, they are not adequately communicated with patients or those close to them. There is an urgent need for further training on the legal aspects and ethical considerations surrounding DNA CPR decisions to ensure better patient-centered care and decision-making.
The Prevalence of Potentially Inappropriate Medications (PIMs) Among Frail Older Participants of The Irish Longitudinal Study on Ageing (TILDA)
Authors: Ali Ahmed Hassan , McMahon Niamh , Moriarty Frank , Ryder Sheila 
Published: September 2024

Abstract

Background
This study aimed to assess PIMsprevalence among frail older participants of The Irish Longitudinal Study on Ageing (TILDA), using a newly developed OPTI-3S criteria (criteria for OPTImising medicines by Stopping, Stepping down, or Switching to safer alternatives).

Methods
All TILDA participants with polypharmacy (i.e. ≥5 medicines) and frailty based on Clinical Frailty Scale (CFS) ≥4 were included. PIMswere assessed based on the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail v2) [1], Poudel et al. algorithm [1], the Norwegian General Practice--Nursing Home criteria (NORGEP-NH) [1], and OPTI-3S. The prevalence of PIMsidentified by each tool was assessed across all frailty levels (CFS ≥4). Poisson regression assessed associations between PIM prevalence and covariates (e.g. medications).

Results
Most of the study cohort (86.5%, n=504) had at least one PIM identified by any of the four tools. OPTI-3S identified at least one PIM in 62.6% of participants, followed by Poudel’s algorithm (53.9%) and NORGEP-NH (40.5%). OPTI-3S could identify at least one PIM in 97.8% of participants with CFS ≥7, followed by STOPPFrail (88.9%). Overall, 34.8% of prescribed medications were considered to be PIMsThe OPTI-3S list detected more PIMsthan any other tool for all frailty levels (e.g. OPTI-3S, 78.4% vs STOPPFrail, 40.2% in CFS ≥7). Deprescribing all OPTI-3S-defined PIMswould reduce polypharmacy by 20.6% compared to NORGEP-NH (13.3%) and Poudel’s algorithm (12.0%). The most prevalent PIMswere aspirin, benzodiazepines and z-drugs, and antihypertensive medications. The number of medications, anticholinergic burden, and being on specific medications (e.g. aspirin, NSAIDs, benzodiazepines, antidepressants) were significantly associated with increased PIMs.

Conclusion
OPTI-3S is a useful PIM screening tool in community-dwelling frail older adults, pending further testing in the hospital setting.

Reference
1. Anlay, D.Z et al. Br J Clin Pharmacol. 2024;90(1):12-106.
Efficacy of a Nursing Home Liaison Service In Supporting Early Hospital Discharge For Long-Term Care Facility Residents
Authors: Power Leslee , O'Mahoney Niamh , Mello Sarah 
Published: September 2024

Abstract

Background
Long-term care facility residents (LTCR) are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. A new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) commenced recently with the aim of providing early supported discharge for LTCR admitted to hospital. This study aims to describe the efficacy of the NHL service in reducing length of stay (LOS) and readmission rates for LTCR in comparison to data from the year prior to NHL commencement.

Methods
Hospital In-Patient Enquiry (HIPE) data was retrospectively obtained for the pre-service group (PSG), consisting of all medically admitted LTCR in 2022. This included demographic data, International Classification of Diseases diagnosis, LOS, and discharge outcome. The same prospective data was obtained by chart review for the service group (SG), for LTCR following the initialization of NHL between September 2023 and March 2024. Unpaired t-test and Chi-squared test was used to determine significant difference between the two groups.

Results
There were 249 LTCR in the PSG and 171 in the SG. The average age (84 vs 81) and dementia diagnosis rate (60% vs 55%) were similar amongst the two groups. The most common reason for admission in both groups was infection (60% vs 40%). The median LOS was significantly lower for the SG as compared to the PSG (8 vs 6 days, p=0.02). The PSG also had higher seven-day (6.4% vs 4.1% p=0.3) and 30-day (14.5% vs 7.6% p=0.03) readmission rates.

Conclusion
The introduction of a dedicated NHL service for LTCR has resulted in a significant reduction in hospital LOS and readmission rates. By providing enhanced communication through telehealth review and assistance with advanced care planning, the NHL service effectively bridges the gap between acute and community care, resulting in improved patient flow and delivery of person-centred outcomes.
Creating a Guidance Template for NCHDs to Evaluate Cognition in Geriatric Medicine Clinics
Authors: Healy Anna , Brewer Linda , Curran Carmel 
Published: September 2024

Abstract

Background
Non-Consultant hospital doctors (NCHDs), when rotating through geriatric medicine, often take a comprehensive cognitive history for the first time. Graduate clinical exams often overlook this complex assessment, and knowledge of cognitive disorders amongst NCHDs is often limited. We aimed to create a template to guide NCHDs in taking this history, including investigations and management options.

Methods
We developed a 9-question survey, administered to a sample of representative NCHDs and specialist nurses who have rotated through our department, to gauge their confidence in assessing cognition. We examined their understanding of cognitive assessments and if a template would be useful. With consultants, we subsequently drafted an agreed guidance template for use at clinics.

Results
We included 35 respondents who rotated through geriatric medicine clinics this year; 8 registrars, 18 SHOs, 5 interns, 1 ANP. 10(31.25%) felt very confident completing a cognitive history, 17(53.13%) felt just somewhat confident and 5(15.65%) did not feel confident. Regarding investigating a new cognitive impairment (CI) n=10 (31.25%) felt very confident, 12(37.5%) felt somewhat confident and 10(31.25%) did not feel confident. Management of CI - 12(37.5%) felt very confident, 11(34.38%) felt somewhat confident and n=9 (28.13%) did not feel confident. MMSE, MOCA, clock drawing test, Addenbrooks and RUDAS were listed as cognitive assessments. Regarding investigations, CT/MRI Brain were mentioned in all but just n=12 mentioned a PET scan. Services listed included Occupational Therapy (20), Social Work (6), Dublin Alzheimer’s Society (6), psychology (6). Almost all 96.87% (31) felt a guide would be helpful and 100% of participants said that they would use it.

Conclusion
We identified gaps in confidence and knowledge amongst NCHDs regarding assessment of cognition. Consequently, we designed a guidance template to ensure rotating junior staff are more confident and informed during cognitive assessments at clinics in our department.
Challenges and Benefits of Developing Case Management in an ICPOP Hub
Authors: Lewis Natasha , McDonald Patricia , Lee Jennifer , McGrath Keith , McAuliffe Eileen 
Published: September 2024

Abstract

Background
Case management is a collaborative procedure involving assessment, planning, facilitation, care coordination, evaluation, and advocacy. Its aim is to address the comprehensive health needs of individuals and families by utilising communication and existing resources to achieve high-quality and cost-effective results. The Integrated Care Program for Older Persons (ICPOP) aims to improve life for older people by providing access to tailored interventions supporting them to live well in their own homes. (ICPOP, 2017). The goal of nurse-led case management interventions within the ICPOP Hub, is to provide continuous, patient-centred, comprehensive care for older adults with complex care needs.

Methods
The Nursing team, comprising Clinical Nurse Specialists, Candidate Advanced Nurse Practitioner, undertook case management of 40 patients with complex care needs, over a six-month period. Diagnoses included Delirium, Dementia, Parkinson’s disease, frailty syndromes. Particular attention was given to patients who, through case management, were able to be discharged earlier from the acute hospital, aligning with the goals of the Integrated Care Model. Quality Improvement methodologies were used aiming to improve service delivery, efficiency, patient outcomes.

Results
(Required)
Benefits
Challenges

Conclusion
Case management enables older adults to continue living independently at home but requires integration into a broader system prioritising seamless delivery utilising a collaborative, multidisciplinary approach to health and social care.
Exploring the Perceptions of Physiotherapists and Occupational Therapists, Working in the Acute Hospital Setting, of Communication of Older Adults' Rehabilitation
Authors: Smyth Claire 
Published: September 2024

Abstract

Background
As the ageing population continue to rise with this comes an increase in `geriatric syndromes' such as gait, balance or cognitive issues as well as the implications of frailty. Hospitalisation amongst older adults can often see risks such as deconditioning, delirium and losing independence. The role of rehabilitation for older adults becomes key to restoring one’s ability to live independently but can often be impacted by medical or cognitive status, communication and resources within the acute hospital setting. Issues such as uncertainty around goals or abilities as well as lack of resources can mean terms such as `rehabilitation potential' can impact on communication of rehabilitation. Physiotherapists and Occupational therapists frequently communicate with patients, their families and carers as well as the wider multidisciplinary team about older adults’ rehabilitation.

Methods
Focus groups were conducted among physiotherapists and occupational therapists, who worked in acute hospital settings in Ireland, to explore their perceptions of communication of older adults' rehabilitation.

Results
Nineteen therapists were recruited across five focus groups, which identified a number of themes around communication of older adults’ rehabilitation. Participants reported on communication strategies such as building rapport and using meaningful goals with older adults' rehabilitation. Participants discussed the rehabilitative journey through the acute setting and the impact of 'rehabilitation potential', resources as well as cognitive and medical status on communication of rehabilitation. Further training on communication were highlighted by participants as an area for future development.

Conclusion
Communication plays a key role in older adults' rehabilitation and can often be complicated by resources, time and pressures of the acute hospital setting. Multidisciplinary training could play a role in addressing how communication can enhance older adults' rehabilitation.