bluuebunny/crossref_metadata_2025_split huggingface dataset:
Location, Location, Location- Impact Of Introducing A Local Clinic On Clients’ Waiting Time, Travel Time And Cost
Authors: Keeffe Orla O , Sadeghi Fatemeh 
Published: September 2024

Abstract

Background
Comprehensive Geriatric Assessment (CGA) is the first, essential step to develop and implement a coordinated and integrated plan for older persons’ care. The National Clinical Programme for Older People recommends that older adults identified as being frail or at risk of frailty should have a timely CGA performed (HSE 2012). This pilot quality improvement project relates to a recently established (June 2023) Integrated Care Programme for Older Persons (ICPOP) team. As our current office lies in a different county to our clients’ homes, all CGAs have been domiciliary to date. This project aims to investigate if running a clinic closer to clients’ homes could result in earlier CGA and reduce travel time and cost.

Methods
Three CGA-pilot clinics occurred over six weeks (29thFebruary-11thApril 2024 inclusive). Clients’ addresses, Clinical frailty Scale (CFS), average waiting time six weeks prior to and during the CGA-clinic period was recorded. Staffing was unchanged during data collection. Distance between office and clients’ homes was calculated using Google Maps. Travel time was calculated on the same weekday at the same time as CGA-clinics ran. As clinicians tend to conduct consecutive visits, unidirectional distances only were populated. National Integrated Staff Records and Pay Programme system was used to calculate mileage cost.

Results
Of twelve clients that confirmed their appointment, eleven clients attended clinic (92% attendance rate). All were frail or at risk of frailty (CFS ≥4). Average waiting time reduced from 28 days to 23 days post introduction of CGA-clinic. Clinicians saved a total of 3 hours 38 minutes, and 44.31 euro was saved on mileage.

Conclusion
Pilot shows the benefits of offering in-clinic CGA closer to home in terms of reducing waiting time, optimising clinician time and reducing cost. Client satisfaction and numbers of clinicians seen will be included in the next steps of this ongoing project.
The Impact Of Assessment And Intervention By The Frailty Intervention Team On Emergency Department Re-attendance Rates Of Older Adults
Authors: Munnelly Orlaith , Desai Dhwani , Jefferies George , McGettigan Michelle , Martin Ruth 
Published: September 2024

Abstract

Background
The mean age of patients presenting to the Emergency Department (ED) is rising significantly each year in line with the ageing population. Older adults with frailty often present with complex medical issues on a background of multiple comorbidities. This poses challenges in the provision of timely assessment, diagnosis and treatment in the emergency environment. Previous research in this area has suggested that older adults attending the ED who receive specialist input from multidisciplinary geriatric teams experience improved outcomes, lower hospital admission and re-attendance rates. Frailty Intervention Team (FIT) services are supported by the Integrated Care Programmes for Older People at local and national levels.

Methods
Our FIT team in ED, composed of 3.5 Whole Time Equivalents (WTE), captured data on all reviewed patients over 75, from January – December 2023. Data was extracted on the cohort who were discharged home from the integrated patient management system (IPIMS). ED re-attendance rates within 30 days were then calculated.

Results
384 patients &gt;75 were seen by FIT and discharged home from January – December 2023. 22 (6%) of these re-attended ED within 30 days.

Conclusion
The results of this review indicate that FIT teams working in the ED contribute towards improving older adults care by reducing rates of admission and re-attendance. Factors contributing to this include improved time to comprehensive geriatric assessment and enhanced pathways with community services supporting discharge. The average length of stay of patients seen by FIT and admitted is 10 days, therefore over 3500 bed days were saved by this small team in 2023. These results provide strong evidence that even frail, older patients can be safely and effectively discharged from ED with minimal risk for re-attendance.
Modelling the Non-linear Associations between Age and Health: Implications for Care
Authors: Monaghan Cormac , de Andrade Moral Rafael , Power Joanna McHugh 
Published: September 2024

Abstract

Background
Ageing is a complex biological process that weakens the body's defences against various health problems and diseases. This decline is not uniform or linear; rather, it varies significantly among individuals. Understanding the non-linear progression of ageing is crucial for identifying critical periods where intervention might be most beneficial. This study aimed to explore nonlinearities in the association between age and health outcomes.

Methods
Using generalised additive models, we analysed data from the 2020 wave of the United States Health and Retirement Study. This modelling approach allows for the detailed examination of nonlinearities in health outcomes across different ages. Our sample consisted of adults aged over 50 (n = 1338; mean = 68; range = 50 – 95). We assessed seven health outcomes (heart conditions, diabetes, cholesterol, blood pressure, fatigue, back pain, and headaches) and seven protective behaviours (prostate exams, mammograms, cholesterol screenings, pap smears, flu vaccinations, dental check-ups, and smoking patterns) reflecting various aspects of health status and behaviour.

Results
The analysis indicated a significant and pronounced non-linear relationship between age and certain health outcomes, namely headaches, blood pressure, diabetes, and heart conditions. Additionally, ageing was non-linearly associated with specific health behaviours, including the uptake of prostate exams, mammograms, flu vaccinations, and smoking prevalence. Notably, distinct patterns emerged concerning health behaviours in relation to age-specific screening policies.

Conclusion
The findings of this study reveal that the probability of developing health problems or engaging in health protective behaviours do not increase/decrease linearly in direct proportion to age. Rather, the probability curve exhibits fluctuations, presenting periods of heightened odds interspersed with phases of relative stability. Such non-linearity may be partially attributed to policy decisions but could also reflect a complex interplay of factors such as weakened immune systems, access to healthcare, personal health beliefs, and the evolving perception of risk as one grows older.
An Evaluation of the Important Aspects of Community Nursing Day Care Services for Older People, a Qualitative Review
Authors: Lynch Olivia , O'Mahonyy Geraldine , Fitzgerald Mari 
Published: September 2024

Abstract

Background
Day Care Services can support healthy ageing and help prevent social isolation and loneliness amongst older people. However, there is little evidence about the aspects of Day Care Services that are most important and how it effects their overall health and wellbeing. This survey was developed to evaluate the benefits of Day Care Services from the perspectives of the service user.
The aim was to:

Methods
The qualitative evaluation asked two questions.
7 Day Care Services participated, the survey was given to over 300 people and there was over 50% response rate. The data was analysed using qualitative content analysis to identify themes and opportunities for improvement.

Results
The participants described every aspect of Day Care Services as very important for them. It supports routine, social activity (“gets me out of the house”) and interaction (“meeting people”), provides meals and appropriate nursing interventions. Staff acted as “familiar faces” that can be approached easily and support their service user’s health and well-being. Overall, the majority of attendees would recommend Day Care Services to other people.

Conclusion
The findings suggest that all aspects of Day Care Services are important for older people to feel part of a community and have healthcare workers to support them on a regular basis. Day Care Services positively affect service users overall health and wellbeing, in particular the social aspect. This would suggest that Day Care Services play an important role in older people's experience of loneliness or social isolation.
Characteristics and Presentation of Orthostatic Hypertension in Community-Dwelling Older Adults
Authors: Solis Sara , Lawlor Brian , Romero-Ortuno Roman 
Published: September 2024

Abstract

Background
Standing poses a hemodynamic challenge for the cardiovascular system, regulated by neurohumoral reflexes. In 2023, an elevated blood pressure response upon standing was officially defined as a minimum 20 mmHg increase in systolic pressure during position changes, distinguishing Orthostatic Hypertension (OHT) as a condition where blood pressure exceeds 140 mmHg when standing. This new definition underscores the importance of understanding the implications of OHT on individuals' health and quality of life.

Methods
Retrospective study of the Technology Research for Independent Living (TRIL) Clinic at St. James’s Hospital, from August 2007 to May 2009. The population included healthy community-dwelling adults aged 60 and older. This study aimed to profile individuals with OHT, understand the predictors of this condition, and explore its association with biopsychosocial variables.

Results
In a study of 442 participants (67.7% female, mean age 72.7), we identified a prevalence rate of 12.9% for an exaggerated orthostatic pressor response and observed OHT in 6.1% of participants at the 120-second mark after standing. Additionally, significant associations were discovered between OHT and conditions such as heart failure, stroke, and the use of certain medications such as SSRI and ACE inhibitors.

Conclusion
The results of this study highlight the potential health consequences of OHT among older adults, particularly in those with pre-existing cardiovascular conditions. Further research is needed to explore this lesser-known but significant orthostatic disorder.
Advance Healthcare Directives: the Irish Implementation Reality from an Interdisciplinary Group Concept Mapping Study
Authors: Dowling Teresa , Kennedy Sara , Foran Sinead 
Published: September 2024

Abstract

Background
Advance Healthcare Directives became legal in Ireland on 26th April 2023. While Advance Healthcare Directives are primarily rooted in patients’ legally binding refusal of treatments or interventions, they also encourage patients to set out their care preferences for the future (Government of Ireland 2015). Despite care of the older adult broadly transitioning from acute hospital to community, and a greater than ever focus on keeping older adults living at home for longer, low awareness of, and professional uncertainty around, Advance Healthcare Directives and how to integrate them into the care of the older adult has been widely expressed by Irish hospital physicians (Crowley and Doran 2022).

Methods
In this implementation study, Group Concept Mapping, using the relatively novel ‘GroupWisdom™’ software, is used to collect and analyse data from multiple healthcare professions to identify contextual issues that affect the implementation of Advance Healthcare Directives. 44 frontline healthcare professionals including Hospital Consultants (n=6), General Practitioners (n=5), Paramedics (n=7), Advance Nurse Practitioners (n=4), Clinical Nurse Specialists (n=4), Public Health Nurses (n=5), Critical Care Nurses (n=3), Nurse Managers (n=2), Healthcare Managers (n=2), Occupational Therapists (n=2) and Social Workers (n=4) participate in this mixed method study. Policymakers and other stakeholders are also involved throughout.

Results
The main implementation issues for Advance Healthcare Directives in order of importance as outlined by Healthcare Professionals are: 1) Public Education; 2) Homecare Services; 3) Timing and Location; 4) Family Members; 5) Lack of Education for the Healthcare Professional; 6) Complications for the Healthcare Professional; 7) Individual and Cultural Beliefs.

Conclusion
This study contributes a valuable understanding of where the implementation issues reside for healthcare professionals and policymakers, and how these can be addressed to ensure successful implementation. This implementation study focuses on practical considerations, offering multiple workable solutions to help to resolve these implementation issues on the ground.
Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App
Authors: Shezard Babar , Bianchi-de-Aguiar Filipa , Paul Nevin 
Published: September 2024

Abstract

Background
Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness.

Methods
We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test.

Results
We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group).

Conclusion
Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.
Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)
Authors: Brolly Amanda , Brick Jacqueline , Maher Mairin , O'Carroll Susan , Carmody Chris , Randles Mary , Donnell Emer Mc , Liston Richard 
Published: September 2024

Abstract

Background
The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time.

Methods
Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period.

Results
27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP.

Conclusion
The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports.

Reference
1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.
The Use of Proton Pump Inhibitors in Patients Aged 65 Years and Above in an Academic Tertiary Referral Hospital
Authors: McCluskey Patrick , Hassabo Mohammed , Zainal Muhammed , Browne Joseph , Ntlholang Ontefetse 
Published: September 2024

Abstract

Background
Proton Pump inhibitors (PPIs) are some of the world's most frequently prescribed medications. While PPIs are generally well tolerated, they do carry with them several associated adverse effects ranging from electrolyte disturbances to altering the absorption and thus the effectiveness of other co-administered medications to more severe concerns such as high frequencies of gastrointestinal infections and possibly even respiratory tract infections. Being so commonly prescribed, often for inappropriate or unknown indications, they become an important and relatively easy target for review.

Methods
A retrospective review of electronic health care records of individuals aged 65 years and older admitted under general medical teams in an academic tertiary referral hospital over the course of a calendar month was undertaken to evaluate typical PPI usage encountered, including frequency of PPI prescriptions at both admission and discharge, recorded indications, and impact of review by clinical pharmacists.

Results
Of the 77 individuals included in this study, 59 (77%) were prescribed a PPI at some point during admission. Of the patients surviving to discharge, 98% (n = 53) remained on a PPI at discharge. One patient (2%) had a PPI stopped before discharge. Indications for a PPI were explicitly stated in 25% (n = 15) of patients prescribed a PPI. A further 27% (n = 16) could have an indication derived from information within the electronic health record. One (2%) patient was prescribed a PPI, and a duration was indicated.

Conclusion
Most PPI prescriptions lack documentation regarding the indication and intended duration and may be inappropriately prescribed. The frequency of usage of PPIs in an older population that is more at risk of the adverse effects of PPIs makes them ideal targets and models for evaluation of prescribing practices and deprescribing efforts.
Evaluating the Documentation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) among Older Adults Inpatients
Authors: Saleeh Nada , O’Connor Kieran , Omar Zeina 
Published: September 2024

Abstract

Background
Cardiopulmonary resuscitation (CPR) can save a person’s life, but rate of success is low especially in older frail cohort. Attempted CPR is not without harm and many patients long for a natural dignified death. DNACPR orders provide a means by which decisions to withhold CPR & set ceilings of appropriate care in hospital can be recorded in advance of a potential cardiac event. Our department aims enhance the overall quality of end-of-life care for our patients. The objectives of this project were to evaluate the documentation around end-of-life care to support the introduction of a new DNACPR policy in September 2023.

Methods
A retrospective review of the deaths in the department for the period between July 2021 to July 2023 was undertaken. Thirty random charts from the deaths were examined, assessing the timing and quality of the DNACPR documentation and communication. A further random 30 charts of patients discharged alive were reviewed to assess any existing care plan for DNACPR.

Results
There were 202 deaths within the study period (mean age was 85, 114 (56%) male). Of the deaths examined, there were 50% male & mean age of 83. The average length of stay (LOS) was14.5 days. This was a dependent group with 56.7% having a clinical frailty score of &gt;/= 6 and 43.4% having known dementia. DNACPR decisions and evidence of communication was documented in 29 patients (96.7%). Ceilings of care were documented in the majority. We also assessed 30 medical notes of community discharged patients (36.7% male, mean age 83, mean LOS 13.86). Pneumonia (33%) was the most common diagnosis. Only 13.3% had DNACPR and ceiling of care documentation.

Conclusion
Recognition of dying seems good in the department with room for improvement in broader advanced care discussions. Further training on end-of-life conversations is planned with regular simulation sessions.
Unusual Presentation of Confusion: Hyperammonaemic Hepatic Encephalopathy Due To Intrahepatic Portosystemic Venous Shunt In An Older Patient
Authors: Yousif Mohand , Cluskey Patrick Mc , Ntlholang Ontefetse , Magee Conor 
Published: September 2024

Abstract

Background
Delirium is an acute, usually reversible neuropsychiatric syndrome and often presents as confusion, especially in the older population. Early detection and management of causes is vital to reduce mortality, morbidity, and long-term cognitive status decline. Intrahepatic portosystemic venous shunts are rare vascular malformations. These malformations can be congenital or acquired and may manifest as heart failure, hepatic encephalopathy, or pulmonary hypertension.

Methods
A 75-year-old man presented to the emergency department with a 5-week history of confusion, daytime somnolence, and fatigue. His physical examination was unremarkable. His symptoms were initially thought to be due to sub-optimally controlled Obstructive Sleep Apnoea. Nevertheless, his confusion progressed further during admission and required admission to the intensive care unit and intubation. Investigations initially showed deranged Liver function tests. Extensive investigations were done, including CT brain, MRI brain, septic screen, Arterial blood gas, and Lumbar puncture, which were all inconclusive. An Electroencephalogram was suggestive of Encephalopathy. His Ammonia level was high (123). Further investigations, Triphasic CT liver, revealed Intrahepatic portosystemic venous shunt and was diagnosed with hyperammonaemic hepatic encephalopathy due to Intrahepatic portosystemic venous shunt.

Results
Management included the commencement of lactulose, rifaximin, and L-ornithine L-aspartate (LOLA). An IR-guided embolisation of the porto-venous shunt was performed. At two-months review, the patient reported no further episodes of confusion.

Conclusion
Intrahepatic portosystemic venous shunts should be considered in the differential diagnosis of patients presenting with confusion or other unexplained neurological symptoms, especially in the presence of liver dysfunction. Early diagnosis and appropriate management are crucial for favourable outcomes.