bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Addressing the Silent Need”
Authors: Gallagher Claire , Staunton Ruth , Boyle Nichola 
Published: September 2024

Abstract

Background
Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations.

Methods
This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023.

Results
Preliminary results:

Conclusion
Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.
Retracted: The Geographical Location Of Nursing Homes: How Accessible Is Care In Our Ageing Society
Authors: Martin Niamh , Conry Miriam , Reddin Catriona , McMahon Rachel , Foye Howard , Costello Maria , Small Cliona , Canavan Michelle , Robinson Stephanie 
Published: September 2024

Abstract

Background
With ageing demographics, the demand for residential nursing care is increasing. Some evidence and anecdotal experience suggests that nursing home care is often not available locally, resulting in individuals moving from their homes, communities and psychosocial support systems.

Methods
To evaluate if residential care in Ireland meets demand the number of residential care beds per 1000 adults&gt;65years were estimated from publicly available data. Persons who sought access to the nursing home support scheme over a 6month period were reviewed. Their home location and nursing home location were analysed with respect to locality (city/suburban/town/rural), distance (km), travel time (minutes) and public service networks. Ethically approved.

Results
Nationally, the lowest availability of nursing home beds was Wicklow and highest Longford. Galway has 0.90 nursing home beds per1000 adults &gt;65years. Of 262 consecutive cases presented to one local placement forum between July–December2023, 133 availed of the scheme and were resident in a nursing home at 3month follow-up. Exclusions included remained at home, deceased, or unknown. Nursing home location was city 6%(n=8), suburb 21%(n=28), town 16.5%(n=22) or rural 56%(n=75). All city placements were public. Drving distance from home to nursing home was 15km (IQR7,31) with a car driving time of 18mins (IQR11,35). No public transport service link from home to nursing home for visiting purposes was available to 38%(n=51), and when available incurred more than one bus change in 65.2%. City dweller was residing in a city located nursing home in 13%(n=5). Of the 87%(n=33) relocated out of the city, over half (n=19) were to rural locations (p&lt;0.001).

Conclusion
Nursing home availability is insufficient to meet demands. The location of public and private nursing homes is creating deficits in accessing care close to home and community. Current public transport services to nursing home locations is poor.
A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform
Authors: McCallion Charlotte , Bowman Mark 
Published: September 2024

Abstract

Background
Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management.

Methods
An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform.

Results
A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform.

Conclusion
Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.
Community Specialist Team for Older Adults - Who Do You Think We Are? Co-Design Of A Patient Information Leaflet
Authors: Walsh Loretta , Rogan Mary , McCleane Fiona , Fitzmaurice Clíodhna , Munnelly Patricia , Campbell Judith , Clancy Alanna , Abed Aisling , Brehony Alma , NíNeachtain Máire , Costello Maria 
Published: September 2024

Abstract

Background
Navigating care pathways can be challenging and confusing for patients and caregivers. With the emergence of several new clinical specialist teams, we identified the need for accurate, clear and relevant information, provided as a printed leaflet and available at referral stage for both older adults and referring practitioners.

Methods
A draft Patient Information Leaflet (PIL) was developed with contributions from all members of the Community Specialist Team for Older Adults (CSTOA) explaining the purpose of the service. A review of referral sources was undertaken to identify those key stakeholders from whom feedback should be sought to ensure content validity. The draft PIL and a feedback questionnaire were distributed to patients and their caregivers who have had intervention from the CSTOA in addition to General Practitioners and Community Health Network colleagues.

Results
There were 27/35 responses to the questionnaire. Data was collated and analysed. All respondents reported that from reading the PIL, they understood clearly what the service provides, and all agreed that the leaflet accurately describes the service. Details such as what to expect from intervention of the team and advice to bring a family member to the initial appointment were mentioned as particularly useful content. Supplementary feedback commended the co-location and accessibility of the service compared to a hospital setting. It was suggested that other services should be included in the CSTOA. Based on survey responses, minor edits were made to the PIL to meet stakeholder satisfaction.

Conclusion
Feedback from this survey helped endorse the provision of a printed PIL to be provided at referral stage. Additional commentary gathered, re-enforces the need for continuous interaction and information sharing with service stakeholders. Next steps include making this PIL available electronically to allow for real time updates and translating to other languages to ensure inclusivity.
“The Past is a Foreign Country”: Time Shelter and exploring dementia and memory impairment representation in literature and the arts
Authors: Roche Adam , Fitzpatrick Neasa , Leroi Iracema 
Published: September 2024

Abstract

Background
Due to ageing populations, the WHO estimates that by 2050 the number of people living with dementia worldwide will more than triple to 152 million. For those working in geriatric medicine and memory services, we regularly interact with and advocate for patients coming to terms with memory impairments. One common theme often encountered during the patient dementia and cognitive impairment diagnosis journey is fear of loss of the sense of “self”, which can be informed by the negative and often inaccurate cultural narrative around dementia.

Methods
Recent promising breakthroughs in the development of disease modifying medications for Alzheimer’s disease, as well as greater emphasis on lifelong brain health and earlier diagnosis, represents a potential source of hope. This presentation will aim to explore the cultural narrative around the “lived experience” of dementia, which is often extremely negative and emphasises hopelessness. We look to some of the most commonly referenced narrative works, which can often form the foundation of many patient's prior knowledge of cognitive impairment and dementia before coming to the memory clinic.

Results
This presentation aims to examine the narrative works familiar to many patients (such as “The Father” and “Still Alice”) as well as some more recent efforts, including this year’s International Booker Prize-winning novel “Time Shelter” by Georgi Gospodinov. This darkly humorous book describes the arrival of a strange new ‘clinic for the past’ offering promising treatment for people with dementia.

Conclusion
Many works of narrative fiction explore dementia and memory impairment. While some are well-informed and researched, many lack empathy or even clinical accuracy. Narrative works can have an enormous impact on the widespread perception and understanding of diseases such as dementia. By exploring the potential for sensitive and accurate representation of dementia in popular culture, we aim to promote equity in this vulnerable and growing population.
Ireland is Above European Average for do-not-Resuscitate Decision Making and Training: A Europe-Wide Survey On Resuscitation Decision Making Practices
Authors: Lochlainn Mary Ni , Trevisan Caterina , Chapelet Guillame , Goluke Nienke , Sanchez Elisabet , Trabert Johannes 
Published: September 2024

Abstract

Background
Resuscitation success rates for older patients are poor. Research has shown that, despite many older people expressing a wish for full resuscitation initially, when the poor prognosis and outcomes are explained, this number drops substantially. One existing study, which did not include Ireland, revealed that a wide gap exists across European countries for rates of resuscitation discussions and the implementation of do-not-resuscitate (DNR) orders. The aim of this survey is to assess differences and barriers between European countries among doctors working in the field of geriatric medicine for DNR decision making.

Methods
An online survey was carried out among doctors working in geriatric medicine in European countries. Besides age, sex, years of experience and country of practice, sixteen questions regarding DNR discussion in terms of the frequency and confidence in doing it, prevalence of DNR discussions and possible barriers to this practice regarding DNR discussions were asked. Data analysis was carried out using R.

Results
In total, 473 respondents from 22 European countries completed the survey. Participants’ mean age was 41.8 years (standard deviation [SD] 9.9) and 64.9% were females. The mean number of years’ experience working as a doctor was 15.39 years (SD 9.62). 45 respondents were based in Ireland (9.5%). 95.5% of those in Ireland responded agree or strongly agree to feeling confident discussing DNR orders, in comparison to 79.7% of the total survey population. 73.4% of respondents in Ireland reported getting training in DNR discussions, versus 61.6% of the pan-European population. 86.7% of respondents in Ireland felt DNR orders are well accepted in their country, compared to 55% of total respondents.

Conclusion
This survey presents intra-European differences regarding practice of discussing DNR orders by doctors working in the field of geriatric medicine. Ireland was above average for discussing DNR orders, training received, and reported higher acceptability to society at large.
Do Early Supported Discharge Teams Increase the Proportion of Stroke Patients Discharged Directly Home from Acute Hospitals in Ireland?
Authors: Harbison Grace , McCormack Joan , Harbison Joseph 
Published: September 2024

Abstract

Background
Early Supported Discharge teams for stroke are associated with improved patient, rehabilitative outcomes, quality of life and potentially reduced mortality. Over the last 5 years the number of ESD teams and the proportion of patients discharge under their care has increased. What is unclear is to what extent has the growth in discharges with ESD support from acute hospitals represent additional discharges or patients who would have been discharged anyway but now receive rehabilitation and support post discharge.

Methods
Data on patients discharged directly home from the Irish National Stroke Audit (INAS) between January 2018 and December 2022 were analysed along with ESD data. This is the five-year period for which comprehensive data on ESD has been collected by INAS. Data used were available on public platforms and ethics approval was not necessary. Chi Square Statistics were performed, using proprietary software to compare proportions.

Results
Data on 23183 inpatient episodes were analysed, 57% of patients were male. INAS cases increased 34% from 3730 in 2018 to 4999 in 2022. Proportion of patients with unknown discharge destination (2.5%-2.9%) and who died (11.0%-10.8%) remained stable across the period. Proportion discharged home increased from 55.6% in 2018 to 59.5% in 2022 (Chi Sq 13.0, p=0.0003), (4.9% absolute, 7.0% relative). Proportion of ESD discharges increased from 3.7% to 9.8% of all patients (Chi Sq 117.3, p&lt;0.0001) and from 6.7% to 16.5% of direct discharges home (Chi Sq 106.6, p&lt;0.0001). However, direct discharges home without ESD support declined from 51.9% to 49.7% of the total population (Chi Sq 4.16, p=0.04). This suggests that, compared to 2018, 64% of ESD discharges in 2022 were additional and contingent on ESD availability.

Conclusion
ESD is an effective way of increasing direct discharges of people with stroke home from hospital. The proportion of patients with access to ESD remains low.
Vitamin D Deficiency Is Associated With An Increased Risk of Diabetes In Older Irish Adults: Results From The TUDA Study
Authors: Moloney Kevin , McSherry Kenneth , Fitzpatrick Donal , Laird Eamon , Ward Mary , Hoey Leane , Hughes Catherine F , Strain JJ , Cunningham Conal , McNulty Helene , Lannon Rosaleen , Molloy Anne M , McCarroll Kevin 
Published: September 2024

Abstract

Background
Several studies have shown that vitamin D deficiency may increase the risk of developing type II diabetes and prediabetes. However, the data are inconsistent. Vitamin D may improve insulin sensitivity and pancreatic beta cell function, which could influence diabetes risk. We aimed to examine the relationship between vitamin D deficiency and type II diabetes in older Irish adults.

Methods
Study participants were from a cross-sectional study of adults aged &gt; 60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Diabetes was defined by self-report, use of diabetic medications or HBA1c ≥ 6.5%. Vitamin D deficiency was defined as 25(OH)D &lt; 30 nmol/l. The relationship between vitamin D deficiency and diabetes was explored in multivariate logistic regression adjusting for age, sex, BMI, waist hip ratio, season, vitamin D supplement use, timed up and go, alcohol intake, current or previous steroid use, smoking, use of statins and socioeconomic status.

Results
There were 5171 participants (67.2% female, mean age 74.0 years) of whom 19.7% were vitamin D deficient and 15.7% had diabetes. Vitamin D deficiency versus non-deficiency was associated with an increased risk of diabetes both before and after multivariate adjustment (OR 1.46, 1.98-1.79, p&lt;0.0002).

Conclusion
Vitamin D deficiency was associated with a 46% increased risk of having type II diabetes. However, the results of longitudinal studies and randomised trials have produced inconsistent results, though many had participants with higher baseline 25(OH)D status. A recent review of 46 trials of vitamin D supplementation found that it may reduce Hba1c in diabetics with vitamin D deficiency. Well designed trials to assess the potential effect of vitamin D supplementation on diabetic risk should be conducted.
Dementia Champions Network in Louth Hospital Group
Authors: Munro Fiona , Carville Michelle , McCabe Blanaid 
Published: September 2024

Abstract

Background
Research indicates that 30% of inpatients within an acute hospital have a dementia diagnosis at any time [1]. A specialist dementia nurse led the vision for transforming dementia care in an acute hospital. Aim: Implementation of a dementia champion’s (champions) network in an acute hospital setting aligning with Irish National Dementia Audit 2 (INAD2)[2].

Methods
Point prevalence revealed 13.9% of all inpatients presented with dementia. One acute older person’s ward revealed 25% of patients had a dementia diagnosis. The authors recruited 12 champions from four wards and E.D. including RGN, HCA and administrative staff to teach the tools to complete a QI project. The champions attended four innovative workshops accumulating in presenting a quality initiative (QI). The pioneering workshops were designed by CNS Dementia and candidate ANP and ADON Dementia QI.

Results
The dementia champions engaged in open discussions at each workshop alongside expert guest speakers from the multidisciplinary team. Discussions lead to identifying gaps within their wards resulting in quality improvements including posters relating to communication, reducing environmental noise and the introduction of the Abbey pain scale. In addition, an increased use of a personal passports and meaningful activities such as completing a knitting project to aid communication and to engage a person with dementia. Another champion enhanced their ward by displaying seasonal decorations which led to reminiscence talks with patients. One champion progressed onto a level 8 module focusing on dementia care.

Conclusion
The champions excelled at becoming dementia leaders within a network for their clinical areas through their QI projects.

References
[1] Begley et al., “Model of Care for Dementia in Ireland.”
[2] Bracken Scally, “Irish National Audit in Dementia (INAD-2).”
“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit
Authors: Fenton Lauren , Moran Leah , Crowley Catherine 
Published: September 2024

Abstract

Background
Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation.

Methods
A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel.

Results
Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p&lt;0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3).

Conclusion
Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.
Preventing Hospitalisation- Providing Specialist Geriatric Services To Nursing Home Patients
Authors: Duran Josep , Malomo Keneilwe , Keating Tracy , Fan Chie Wei 
Published: September 2024

Abstract

Background
Nursing home (NH) residents often require acute hospital care in unexpected deterioration and may have repeated Emergency Department (ED) attendances. Grunier et al (2018) reported 48% of NH residents reattend ED within 1 year. Our aim is to determine if those who require acute hospital admission are more likely to reattend ED or require NH outreach services.

Methods
Nursing home residents who attended Mater ED in March 2023 were identified through Electronic Patient Record. Their age, gender, reattendance of ED within 28 days and 6 months, visit by NH outreach team within 28 days then 6 months and 6-month mortality were recorded. The residents were categorised as admitted or discharged from their sentinel visit in March 2023. Chi-square test was used, and statistical significance was set at p&lt;0.05.

Results
Sixty-three nursing home residents attended within 1-month, median age 85 years (range 67-95), 43 were women. Forty-five (71%) required admission, 6 (9.5%) and 24 (38.1%) reattended ED within 28 days and 6 months respectively. There was no difference in 28-day or 6-month ED reattendance between those who were admitted or discharged in the sentinel visit to ED. Those discharged from ED were more likely to receive NH outreach visit within 28 days (84% vs 6.8%) and 6 months (84% vs 11%) than those who were admitted, p&lt;0.0001. There was no difference in 6 months mortality between the groups.

Conclusion
Our study found that 71% of NH residents who attend ED require admissions showing that the transfer was warranted. More than one-third of NH residents reattend ED within 6 months. Those discharged from ED were more likely to be reviewed by NH outreach team as per service delivery. Working closely with the resident’s General Practitioner, NH and ED staff may help to manage these complex patients to coordinate their treatment and prevent ED reattendance.